Irish Pharmacist September 2026 by GreenX Publishing

VOL 27 ISSUE 9 : SEPTEMBER 2026

WHO C ARES FOR THE C ARE RS? Pharmacies should be a comfortable environment not just for patients, but for all kinds of pharmacists too, writes Áine Mac Grory

CPD MODULE Earn 2 CPD points by completing our module on Men's Health

CLINICAL CONTENT

Diabetes

Women's Health

Obesity

AN E VOLVING PROFESSION A Europe-wide study of community pharmacy before and after the Covid-19 pandemic sheds light on the development of services within the profession

E C I L D A E H KILLS

Y L L A R U NAT

 100% Natural  Clinically proven  Hypoallergenic  Mild for sensitive skin

For external use only. Observe normal safety precautions and always keep hair away from naked flames. Always read the label. 2025/ADV/HED/038H

For your postmenopausal patients with osteoporosis at increased risk of fractures1

DISPENSE PROLIA® BY BRAND NAME2,3 Prolia® is a biologic1 – by Irish law and HPRA guidance, biologics should not be automatically substituted at the pharmacy level2,3

HIGH RISK FOR FRACTURE

Reliable. Committed. Proven.1,4–8 The only denosumab with long-term efficacy and safety for up to 10 years9 Manufactured by Amgen Ireland’s dedicated Dún Laoghaire site, committed to a consistent and reliable supply 4,10 HPRA: Health Products Regulatory Authority. References: 1. Prolia® (denosumab) Summary of Product Characteristics. Amgen. Last accessed November 2025. 2. HSE. HSE Guidance for Biological and Biosimilar Medicines Use in Acute Hospitals. Available at: https://www.hse. ie/eng/about/who/acute-hospitals-division/drugs-management-programme/protocols/guidance-for-biological-medicines-in-acute-hospitals.pdf. Published May 2024. Accessed November 2025. 3. HPRA. Guide to Biosimilars for Healthcare Professionals. Available at: https://assets.hpra.ie/data/docs/default-source/external-guidance-document/aut_g0141-guide-to-biosimilars-for-healthcare-professionals-v4.pdf?sfvrsn=688c384d_10. Published September 2025. Accessed November 2025. 4. Amgen. Reliability. Available at: https://www.amgen.com/science/manufacturing/reliability/. Accessed November 2025. 5. Curtis JR, et al. J Bone Miner Res. 2024;39:826–34. 6. Amgen. Therapeutic areas. Available at: https://www.amgen.eu/therapeutic-areas/. Accessed November 2025. 7. Amgen. Data on file. REF-110752. 8. Amgen. Data on file. REF-110731. 9. Bone HG, et al. Lancet Diabetes Endocrinol. 2017;5:513–23. 10. Amgen. About Amgen. Available at: https://www.amgen.ie/about-amgen/. Accessed November 2025. PROLIA® (denosumab) Brief Prescribing Information. Please refer to the Summary of Product Characteristics (SmPC) before prescribing Prolia. Pharmaceutical Form: Pre-filled syringe with automatic needle guard containing 60 mg of denosumab in 1 ml solution for injection for single use only. Contains sorbitol (E420). Indication: Treatment of osteoporosis in postmenopausal women at increased risk of fractures. Dosage and Administration: 60 mg Prolia administered as a subcutaneous injection once every 6 months. Patients must be supplemented with calcium and vitamin D. No dosage adjustment required in patients with renal impairment. Prolia should not be used in children aged < 18 years because of safety concerns of serious hypercalcaemia. Give Prolia patients the package leaflet and patient reminder card. Re-evaluate the need for continued treatment periodically based on the benefits and potential risks of denosumab on an individual patient basis, particularly after 5 or more years of use. Contraindications: Hypocalcaemia or hypersensitivity to the active substance or to any of the product excipients. Special Warnings and Precautions: Traceability: Clearly record the name and batch number of administered product to improve traceability of biological products. Hypocalcaemia: Identify patients at risk for hypocalcaemia. Hypocalcaemia must be corrected by adequate intake of calcium and vitamin D before initiation of therapy. Clinical monitoring of calcium levels is recommended before each dose and, in patients predisposed to hypocalcaemia, within 2 weeks after the initial dose. Measure calcium levels if suspected symptoms of hypocalcaemia occur. Renal Impairment: Patients with severe renal impairment (creatinine clearance < 30 ml/min) or receiving dialysis are at greater risk of developing hypocalcaemia. Skin infections: Patients receiving Prolia may develop skin infections (predominantly cellulitis) requiring hospitalisation and if symptoms develop then they should contact a health care professional immediately. Osteonecrosis of the jaw (ONJ): ONJ has been reported rarely with Prolia 60 mg every 6 months. Delay treatment in patients with unhealed open soft tissue lesions in the mouth. A dental examination with preventative dentistry and an individual benefit:risk assessment is recommended prior to treatment with Prolia in patients with concomitant risk factors. Refer to the SmPC for risk factors for ONJ. Patients should be encouraged to maintain good oral hygiene, receive routine dental check-ups and immediately report oral symptoms during treatment with Prolia. While on treatment, invasive dental procedures should be performed only after careful consideration and avoided in close proximity to Prolia administration. The management plan of patients who develop ONJ should be set up in close collaboration between the treating physician and a dentist or oral surgeon with expertise in ONJ. Osteonecrosis of the external auditory canal: Osteonecrosis of the external auditory canal has been reported with Prolia. Refer to the SmPC for risk factors. Atypical femoral fracture (AFF): AFF has been reported in patients receiving Prolia. Discontinuation of Prolia therapy in patients suspected to have AFF should be considered pending evaluation of the patient based on an individual benefit risk assessment. Long-term antiresorptive treatment: Long-term antiresorptive treatment may contribute to an increased risk for adverse outcomes such as ONJ and AFF due to significant suppression of bone remodelling. Treatment discontinuation: Following denosumab discontinuation, decrease in bone mineral density (BMD) is expected (see section 5.1 of Intended for healthcare professionals in the Republic of Ireland only. © 2025 Amgen Inc. All rights reserved. Amgen Ireland Ltd. 21 Northwood Court, Santry, Dublin 9, D09 TX31. Date of preparation: November 2025. IRL-162-25-80014

the SmPC), leading to an increased risk for fractures. Thus, monitoring of BMD is recommended, and alternative treatment should be considered according to clinical guidelines. Concomitant medication: Patients being treated with Prolia should not be treated concomitantly with other denosumab containing medicinal products. Warnings for Excipients: This medicine contains 47 mg sorbitol in each ml of solution. The additive effect of concomitantly administered products containing sorbitol (or fructose) and dietary intake of sorbitol (or fructose) should be taken into account. Interactions: Prolia did not affect the pharmacokinetics of midazolam, which is metabolized by cytochrome P450 3A4 (CYP3A4). There are no clinical data on the co-administration of denosumab and hormone replacement therapy (HRT), however the potential for pharmacodynamic interactions would be considered low. Pharmacokinetics and pharmacodynamics of Prolia were not altered by previous alendronate therapy. Fertility, pregnancy and lactation: There are no adequate data on the use of Prolia in pregnant women and it is not recommended for use in these patients. It is unknown whether denosumab is excreted in human milk. A risk/benefit decision should be made in patients who are breast feeding. Animal studies have indicated that the absence of RANKL during pregnancy may interfere with maturation of the mammary gland leading to impaired lactation postpartum. No data are available on the effect of Prolia on human fertility. Undesirable Effects: The following adverse reactions have been reported: Very common (≥ 1/10) pain in extremity, musculoskeletal pain (including severe cases). Common (≥ 1/100 to < 1/10) urinary tract infection, upper respiratory tract infection, sciatica, constipation, abdominal discomfort, rash, alopecia and eczema. Uncommon (≥ 1/1000 to < 1/100): Cellulitis, ear infection and lichenoid drug eruptions. Rare (≥ 1/10,000 to < 1/1,000): Osteonecrosis of the jaw, hypocalcaemia (including severe symptomatic hypocalcaemia and fatal cases), atypical femoral fractures, and hypersensitivity (including rash, urticaria, facial swelling, erythema and anaphylactic reactions). Very rare (< 1/10,000): Hypersensitivity vasculitis. Please consult the Summary of Product Characteristics for a full description of undesirable effects. Pharmaceutical Precautions: Prolia must not be mixed with other medicinal products. Store at 2°C to 8°C (in a refrigerator). Prolia may be exposed to room temperature (up to 25°C) for a maximum single period of up to 30 days in its original container. Once removed from the refrigerator Prolia must be used within this 30 day period. Do not freeze. Keep in outer carton to protect from light. Legal Category: POM. Presentation and Marketing Authorisation Number: Prolia 60 mg: Pack of 1 prefilled syringe with automatic needle guard; EU/1/10/618/003. Price in Republic of Ireland is available on request. Marketing Authorisation Holder: Amgen Europe B.V., Minervum 7061, NL-4817 ZK Breda, The Netherlands. Further information is available from Amgen Ireland Limited, 21 Northwood Court, Santry, Dublin D09 TX31, Ireland. Prolia is a registered trademark of Amgen Inc. Date of PI preparation: July 2025 (Ref: IRL-162-0725-80008) Adverse reactions/events should be reported to the Health Products Regulatory Authority (HPRA) using the available methods via www.hpra.ie. Adverse reactions/events should also be reported to Amgen Limited on +44 (0)1223 436441 or Freephone 1800 535 160.

EDITORIAL

Perspectives from the real world in pharmacy

elcome to your September issue, which is packed with content that will inform and stimulate thought. Your outstanding line-up of columnists bring their A-game, as usual. Dr Des Corrigan casts a forensic eye over the potential for herbal treatments for animals. As always, Des looks closely at the research offered to back-up any claims that may be made. However, along with humans, today's pets and other animals enjoy a longer lifespan than their ancestors. As Des so astutely points out, this is an area where pharmacists could create a positive revenue stream in both rural and urban settings. Of course, the bugbear of scrawled prescriptions is nothing new, and clearly the problem isn't going away. However, Fintan Moore offers a practical solution that just might be a game-changer for you. Rather than pre-empt Fintan's advice, I'll let you read the

column yourself, which would be far more enjoyable anyway. Áine Mac Grory writes a fascinating piece about making the pharmacy a more welcoming place, not just for customers and patients, but also for pharmacists themselves. She asks an important question: Has the profession unknowingly recruited people with exceptional abilities, while simultaneously creating environments that make those abilities harder to sustain? Terry Maguire provides the view from 'Up North', and asks whether the 'skinny pen' has the potential to treat addiction. As always, Terry makes a number of fascinating points and delves into the overwhelming power of addiction, and how the attitude to addicts in the pharmacy has changed over the years. Naturally, we also offer clinical content written by pharmacists, for pharmacists. A lot of research goes into preparing our clinical content, so we hope you will find it useful as an add-on to your regular

diet of clinical reading. As usual, you can earn 2 CPD points by completing our excellent module on Men's Health. In other clinical content, we provide some well-crafted articles on the complexities of obesity, as well as a brief overview of helpful weight-loss apps, and the pharmacist's perspective on obesity treatment. We also offer an In Focus article on Diabetes, which touches on the increasingly important role of the pharmacist in treatment and monitoring. Our clinical section is completed with an excellent article on Women's Health, emphasising how pharmacists are ideally placed to deliver proactive and holistic care for women. Enjoy your September issue, and as always, feel free to get in touch with thoughts or comments. We are always happy to hear your ideas for stories, clinical topics and features, or a letter to the Editor.

Pat Kelly, pat@greenx.ie

Breaking news Earn CPD points by completing our modules on www.medilearning.ie Sharpen your knowledge with our clinical content Enjoy archives of your favourite columnists www.irishpharmacist.ie

CONTENTS

News

04: News

and how it should be treated as multifactorial

National and international news in pharmacy and healthcare

48: Diabetes

14: Evolving pharmacy

Diagnosis, treatment and management of diabetes and related complications

A Europe-wide look at pharmacy services development before and after Covid-19

53: Women's Health The need for a more proactive and holistic approach to woman's health

16: Head space A new study sheds light on prescribing habits in neurodegenerative diseases

Life

57: Fragments of the past

17: A new pathway A new referral pathway strengthens integrated asthma care via Healthlink

19: Jab satisfaction The importance of targeting the right vaccines to the right patients as winter closes in

Comment

22: Fintan Moore The inability of many doctors to write a clear drug prescription is still a bugbear

Editor Pat Kelly, pat@greenx.ie Subeditor Elaine Walsh elaine@greenx.ie Creative Director Laura Kenny laura@greenx.ie Administration Manager Daiva Maciunaite, daiva@greenx.ie Managing Director Graham Cooke, graham@greenx.ie

Prof Brendan Kelly reviews a haunting look back at Ireland's 'mental hospitals'

24: Dr Des Corrigan Casting a forensic eye over herbal remedies for pets and other animals

26: Terry Maguire Evidence has pointed to GLP-1 receptors as a possible target for addiction treatments

28: Áine Mac Grory The cognitive cost of pharmacy work for neurodivergent people

GreenCross Publishing was established in 2007. Publisher and Managing Director: Graham Cooke, graham@greenx.ie © Copyright GreenCross Publishing Ltd 2026. Cover design: Laura Kenny. Imagery used: iStock.com

31: CPD Module Men's Health Earn 2 CPD points with our module

In Focus 42: Obesity

The complexities of obesity

The contents of Irish Pharmacist are protected by copyright. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form by any means – electronic, mechanical or photocopy recording or otherwise – whole or in part, in any form whatsoever for advertising or promotional purposes without the prior written permission of the editor or publishers.

58: Another gem Shane O'Donoghue reviews the latest in a long line of beautiful cars by Aston Martin

Products

60: Product News A round-up of product and industry news

Disclaimer The views expressed in Irish Pharmacist are not necessarily those of the publishers, editor or editorial advisory board. While the publishers, editor and editorial advisory board have taken every care with regard to accuracy of editorial and advertisement contributions, they cannot be held responsible for any errors or omissions contained.

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NEWS

National Poisons Information Centre marks 60 years of service and over 500,000 enquiries The National Poisons Information Centre (NPIC) at Beaumont Hospital recently marked 60 years of service, having grown from its beginnings at Jervis Street Hospital in 1966 to become a vital national resource providing specialist advice on poisoning to healthcare professionals and members of the public across Ireland. Based at Beaumont Hospital, the NPIC responds to more than 11,000 enquiries each year involving medicines, drugs, chemicals, household and agricultural products, plants and other potentially harmful substances. The Centre provides a 24-hour telephone service to healthcare professionals, 365 days a year, and operates a Public Poisons Information Line from 8am to 10pm daily. The Centre’s specialist, evidencebased advice enables approximately 80 per cent of cases to be managed safely at home or in the community, while around one-in-five requires assessment in an emergency department. Last year, more than 55 per cent of calls were from members of the public, with approximately 40 per cent from healthcare professionals. Around 60 per cent of cases involved children under the age of 15. More than 60 per cent involved accidental poisoning, while one-in-five related to a medication error. Established in 1966 by the Department

of Health and the Irish Medical Association, the NPIC provides specialist advice to healthcare professionals treating acute poisoning throughout Ireland, as well as advice to members of the public following suspected accidental poisoning. The Centre also analyses poisoning data to identify emerging trends, support clinical treatment and inform wider public health responses. The 60-year milestone was marked at an anniversary event at Beaumont Hospital, bringing together current and former colleagues, healthcare leaders and national partner organisations to celebrate the Centre’s history and its continuing contribution to patient care and public health across Ireland. The anniversary programme included contributions from Dr Joe Tracey, former Clinical Director of the NPIC, reflecting on the history and development of the Centre; Dr Kieran Connolly, volunteer expert mycologist with the NPIC, discussing poisonous mushrooms found in Ireland; and Dr Saja Alhawal, Research Fellow, Children’s Health Ireland, addressing poisoning risks affecting children. Dr Edel Duggan, Clinical Director of the National Poisons Information Centre, said: “For six decades, the National Poisons Information Centre has provided clear, evidence-based guidance for over 500,000 poisoning enquiries to healthcare

professionals and members of the public when poisoning occurs. “Our advice helps ensure that people receive the appropriate care following a suspected poisoning, whether they can be safely monitored at home or require urgent medical assessment. The medicines, chemicals and other products people encounter continue to change, making access to specialist poisons advice as important today as it was when the Centre was first established. “This anniversary is also an opportunity to recognise the generations of staff and specialist advisers who have shaped the service, alongside the healthcare professionals and partner organisations that continue to support our work.” Anne Coyle, CEO of Beaumont Hospital, said: “Beaumont Hospital is proud to be home to the National Poisons Information Centre and to mark 60 years of this important national service. From its base at Beaumont, the Centre’s expertise reaches into homes, hospitals and healthcare settings across Ireland, supporting patients, families and healthcare professionals every day. “This milestone is an opportunity to recognise the generations of staff whose expertise and dedication have built and sustained a service that continues to make an important contribution to patient care and public health across Ireland.”

Research shows steroids reduce inflammation in chronic mycobacterial lung infections without limiting antimicrobial defence Researchers from Trinity College Dublin and St James’s Hospital have shown that dexamethasone, a commonly-prescribed anti-inflammatory steroid, can reduce harmful inflammation triggered by Mycobacterium avium without weakening the ability of human immune cells to

control the infection. The findings suggest dexamethasone may thus offer a new adjuvant approach for better managing nontuberculous mycobacterial (NTM) disease. NTM infections present a growing global health challenge, particularly among people with chronic lung disease. Treatment often

requires prolonged courses of multiple antibiotics, yet many patients continue to experience symptoms driven by persistent inflammation. Steroids are not routinely used in NTM disease because clinicians have traditionally been cautious about suppressing T cell immune responses

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NEWS

during infection. “Our study suggests that it may be possible to fine-tune this response by reducing damaging inflammation while still preserving the immune defences that help control infection,” said Trinity's Dr Donal Cox, senior author of the research, which has been published in the Journal of Infectious Diseases. Dr Cox and the research team, based in the Trinity Translational Medicine Institute, investigated how human macrophages, specialised immune cells that act as a first line of defence against infection, respond to Mycobacterium avium. They found that treatment with dexamethasone significantly reduced infection-driven macrophage metabolic activity while also lowering the production of inflammatory signals. Importantly, the steroid reduced the inflammatory response but did not increase bacterial growth within these key immune cells.

Advances in immunometabolism research have shown that immune cell metabolism plays an important role in determining how macrophages respond to infection. While this has been well studied in infectious diseases such as tuberculosis, very little is known about how metabolism influences immune responses to NTM. The Trinity research group has previously demonstrated that dexamethasone alters the metabolism of macrophages infected with Mycobacterium tuberculosis. They therefore wanted to determine whether similar pathways could be targeted during Mycobacterium avium infection and whether inflammation could be reduced without compromising the body's natural ability to control infection. NTM infections are increasing worldwide and Mycobacterium avium complex is among the most common causes of NTM lung disease. Patients require lengthy multidrug antibiotic therapy and chronic

inflammation can contribute substantially to symptoms and reduced quality of life for patients, even while on effective antimicrobial treatment. As a result, new treatment options are badly needed. “Current treatment strategies for NTM disease focus primarily on killing the bacteria,” said Dr Cox. “However, inflammation itself can contribute significantly to symptoms and tissue damage in patients, so finding ways to control inflammation without impairing antimicrobial innate immunity offers a potential gateway to much more effective therapies. “This study provides evidence that dexamethasone may be able to do this. And although further studies are needed, our findings are exciting because they provide a strong rationale for investigating steroids as potential host-directed therapies in addition to existing antimicrobial treatments.”

Research highlights impact of eczema on child growth New research from Trinity College Dublin has documented the significant impact of severe eczema on a child’s height, and has also shown, for the first time in a controlled study, that the right treatment can help improve growth. The study investigating the effect of a drug commonly used to treat eczema, also known as atopic dermatitis (AD), has been published in the peer-reviewed Journal of the American Academy of Dermatology. The study of 123 children focused on growth and bone biomarkers in six-to-11 year-olds with severe eczema. It found that children who have severe AD and growth restriction and received a targeted biologic drug, dupilumab, grew more than those with similar AD and growth restriction who did not receive the treatment. The findings imply that early and effective treatment of children with severe eczema could have life-long implications for a child’s growth. The research was undertaken by Prof

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Alan Irvine, Professor of Dermatology in Trinity’s School of Medicine, in collaboration with researchers from Regeneron and Sanofi, companies that had conducted clinical trials of dupilumab for eczema. This drug is now approved and widely used in clinic settings worldwide for the treatment of eczema.Analysing data from the original clinical trial the team found that children who had severe eczema were, on average, shorter than population norms. When their growth was tracked through the clinical trials, it was clear that those who were most growth-restricted benefited greatly from dupilumab treatment, with significant increases in height over the first 16 weeks of the trial. After 16 weeks, the group who had been given placebo were switched to dupilumab and they too rapidly caught up growth. Blood markers that measure new bone growth also reflected normal growth. “Eczema is the commonest skin disorder in children worldwide. It is

typically an itchy and painful rash that interferes with sleep and has a very significant impact on quality of life in affected children,” explains Prof Irvine. “Children who live with severe eczema often have delayed growth that is poorly understood but is thought to be due to a combination of factors, including the energy needed to maintain inflammation, sleep disruption and possibly the effects of steroid treatments for the condition. “These findings are good news for children living with eczema. Effective treatment of eczema not only improves the skin, but it may also help children grow at a more normal rate and support healthy bone development. “We don’t yet know what is behind this improved growth rate. It may be that reducing chronic inflammation helps the body grow, or it may be because better sleep, thanks to improved itch, supports growth. Further research is needed to understand the mechanisms at play.”

NEWS

One-in-three hide weight management treatments from family and friends One-in-three (32 per cent) weightmanagement patients in Ireland admit to hiding their treatments from family and friends, with a quarter (25 per cent) lying about how they have lost weight. That’s according to new research commissioned by Lloyds Online Doctor, which sheds light on the extent to which stigma and shame are shaping patient behaviour around this new generation of medication. Three-in-four (77 per cent) people who are using, considering or previously used weight-management treatments, believe there is a greater stigma attached to them compared with traditional methods such as diet and exercise. To conceal their use of treatments, one-in-four (23 per cent) weightmanagement patients in Ireland have said they avoid collecting medication from local pharmacies, while 19 per cent have arranged for it to be delivered to a different address. The findings reflect a broader issue for people living with obesity in Ireland. Obesity-related stigma remains deeply entrenched, with patients waiting on average eight years from first being concerned about their weight to discussing it with a healthcare

professional. Furthermore, 70 per cent of people living with obesity report stigma when engaging with healthcare services in Ireland. Dr Kieran Seyan, Chief Medical Officer at Lloyds Online Doctor, says: “These findings suggest that many people who use, or are considering using, weight-management medication still feel concerned about how others may perceive their treatment decisions. “Obesity is a chronic health condition, and for some patients, clinically prescribed medicines can form an important part of evidence-based weight management alongside lifestyle changes. “In my clinical experience, some patients feel uncomfortable discussing their use of weight-management medication with friends, family or colleagues, despite being open about treatments they take for other long-term health conditions. When people feel judged for seeking help, it can create unnecessary barriers to accessing care. “Ireland faces a significant challenge from obesity and its related health consequences. If we want to improve health outcomes, it is important that people feel able to access appropriate medical support without fear of embarrassment or judgement. These

findings suggest there is still work to do to normalise evidence-based obesity management and encourage more people to seek help when they need it.” The research also suggests that social perceptions are only one part of the challenge, with respondents identifying affordability and availability as important barriers to treatment access. Cost is one of the biggest obstacles preventing people from accessing treatment. Four-in-five (78 per cent) patients said financial pressures have impacted how they use, or have used, their weight-management medication. A further one-in-three (31 per cent) respondents considering treatment say affordability is the reason they haven’t sought help. The findings also highlight the lengths some patients are willing to go for treatment. One-in-four (27 per cent) who source their medication from unlicensed providers do so due to cost, while one-infive (20 per cent) said limited availability of weight-management medicines through Irish State-funded schemes had led them to do so. Some are looking beyond the Republic altogether, with one-in-four (25 per cent) travelling to Northern Ireland for a prescription.

Minister for Health announces free in-pharmacy service for the safe disposal of unused and expired medicines The Minister for Health, Jennifer Carroll MacNeill TD, recently announced the roll-out of a national medicine disposal service, MediBack, in community pharmacies around Ireland. This free service will allow members of the public to bring their unused and outof-date medicines to pharmacies around

the country for safe disposal. Safe medicines disposal is important for several reasons. It helps prevent antimicrobial resistance, reduces the risk of falsified or diverted medicines entering the black market, lowers the risk of accidental poisoning, and supports suicide prevention and self-

harm reduction by limiting access to unused medicines. The scheme supports Ireland’s One Health objectives by ensuring unused medicines are disposed of safely, helping to protect people, animals and the environment from the risks associated with inappropriate storage or disposal of medicines.

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READY FOR HAYFEVER SEASON? FAST RELIEF OF ALLERGIES 24hr CONTROL Always read the leaﬂet. Abbreviated prescribing information

WƌŽĚƵĐƚ EĂŵĞ͗ ĞƚƌŝŶĞ ůůĞƌŐǇ ϭϬŵŐ &ŝůŵͲĐŽĂƚĞĚ dĂďůĞƚƐ͘ ŽŵƉŽƐŝƚŝŽŶ͗ ĂĐŚ ƚĂďůĞƚ ĐŽŶƚĂŝŶƐ ϭϬŵŐ ĐĞƚŝƌŝǌŝŶĞ ĚŝŚǇĚƌŽĐŚůŽƌŝĚĞ͘ ĞƐĐƌŝƉƚŝŽŶ͗ tŚŝƚĞ͕ ŽďůŽŶŐ ĨŝůŵͲĐŽĂƚĞĚ ƚĂďůĞƚƐ͕ ƐĐŽƌĞĚ ŽŶ ŽŶĞ ƐŝĚĞ͘ ĂŶ ďĞ ĚŝǀŝĚĞĚ ŝŶƚŽ ĞƋƵĂů ŚĂůǀĞƐ͘ /ŶĚŝĐĂƚŝŽŶ;ƐͿ͗ ĚƵůƚƐ ĂŶĚ ƉĂĞĚŝĂƚƌŝĐ ƉĂƚŝĞŶƚƐ ϲ ǇĞĂƌƐ ĂŶĚ ĂďŽǀĞ͗ ZĞůŝĞĨ ŽĨ ŶĂƐĂů ĂŶĚ ŽĐƵůĂƌ ƐǇŵƉƚŽŵƐ ŽĨ ƐĞĂƐŽŶĂů ĂŶĚ ƉĞƌĞŶŶŝĂů ĂůůĞƌŐŝĐ ƌŚŝŶŝƚŝƐ ;ŚĂǇ ĨĞǀĞƌͿ͖ ƌĞůŝĞĨ ŽĨ ƐǇŵƉƚŽŵƐ ŽĨ ĐŚƌŽŶŝĐ ŝĚŝŽƉĂƚŚŝĐ ƵƌƚŝĐĂƌŝĂ͘ ŽƐĂŐĞ͗ ĚƵůƚƐ͕ ĞůĚĞƌůǇ ĂŶĚ ĐŚŝůĚƌĞŶ ĂŐĞĚ ϭϮ ǇĞĂƌƐ ĂŶĚ ŽǀĞƌ͗ ϭϬŵŐ ŽŶĐĞ ĚĂŝůǇ͘ ŚŝůĚƌĞŶ ĨƌŽŵ ϲ ǇĞĂƌƐ ƚŽ ϭϮ ǇĞĂƌƐ͗ ϱŵŐ ;ŚĂůĨ Ă ƚĂďůĞƚͿ ƚǁŝĐĞ ĚĂŝůǇ͘ DŽĚĞƌĂƚĞ ƌĞŶĂů ŝŶƐƵĨĨŝĐŝĞŶĐǇ ;ĐƌĞĂƚŝŶŝŶĞ ĐůĞĂƌĂŶĐĞ ƌ ů ϯϬͲϰϵŵůͬŵŝŶͿ͗ ϱŵŐ ŽŶĐĞ ĚĂŝůǇ͘ ^ĞǀĞƌĞ ƌĞŶĂů ŝŶƐƵĨĨŝĐŝĞŶĐǇ ;ĐƌĞĂƚŝŶŝŶĞ ĐůĞĂƌĂŶĐĞ фϯϬŵůͬŵŝŶͿ͗ ϱŵŐ ŽŶĐĞ ĞǀĞƌǇ Ϯ ĚĂǇƐ͘ ŚŝůĚƌĞŶ ƵŶĚĞƌ ϲ ǇĞĂƌƐ͗ EŽƚ ƌĞĐŽŵŵĞŶĚĞĚ͘ ŽŶƚƌĂŝŶĚŝĐĂƚŝŽŶƐ͗ ,ŝƐƚŽƌǇ ŽĨ ŚǇƉĞƌƐĞŶƐŝƚŝǀŝƚǇ ƚŽ ƚŚĞ ĂĐƚŝǀĞ ƐƵďƐƚĂŶĐĞ͕ ƚŽ ĂŶǇ ŽĨ ƚŚĞ ĞǆĐŝƉŝĞŶƚƐ ŝŶ ƚŚĞ ƚĂďůĞƚ͕ ƉŝƉĞƌĂǌŝŶĞ ĚĞƌŝǀĂƚŝǀĞƐ Žƌ ŚǇĚƌŽǆǇǌŝŶĞ͘ ŶĚ ƐƚĂŐĞ ƌĞŶĂů ŝŵƉĂŝƌŵĞŶƚ ǁŝƚŚ ƐƚŝŵĂƚĞĚ 'ůŽŵĞƌƵůĂƌ &ŝůƚƌĂƚŝŽŶ ZĂƚĞ ф ϭϬŵůͬŵŝŶ͘ tĂƌŶŝŶŐƐ ĂŶĚ WƌĞĐĂƵƚŝŽŶƐ ĨŽƌ hƐĞ͗ ZĞĚƵĐĞ ĚŽƐĂŐĞ ŝŶ ƉĂƚŝĞŶƚƐ ǁŝƚŚ ƐŝŐŶŝĨŝĐĂŶƚ ƌĞŶĂů ŝŵƉĂŝƌŵĞŶƚ͘ ĞƚŝƌŝǌŝŶĞ ŵĂǇ ŝŶĐƌĞĂƐĞ ƌŝƐŬ ŽĨ ƵƌŝŶĂƌǇ ƌĞƚĞŶƚŝŽŶ͕ ƚŚĞƌĞĨŽƌĞ ĐĂƵƚŝŽŶ ŝŶ ƉĂƚŝĞŶƚƐ ǁŝƚŚ ƉƌĞĚŝƐƉŽƐŝƚŝŽŶ ĨĂĐƚŽƌƐ ŽĨ ƵƌŝŶĂƌǇ ƌĞƚĞŶƚŝŽŶ ;Ğ͘Ő͘ ƐƉŝŶĂů ĐŽƌĚ ůĞƐŝŽŶ͕ ƉƌŽƐƚĂƚŝĐ ŚǇƉĞƌƉůĂƐŝĂͿ͘ ĂƵƚŝŽŶ ŝŶ ĞƉŝůĞƉƚŝĐ ƉĂƚŝĞŶƚƐ ĂŶĚ ƉĂƚŝĞŶƚƐ Ăƚ ƌŝƐŬ ŽĨ ĐŽŶǀƵůƐŝŽŶƐ͘ ŽŶƚĂŝŶƐ ůĂĐƚŽƐĞ͘ ŝƐĐŽŶƚŝŶƵĞ ƵƐĞ ŽĨ ĐĞƚŝƌŝǌŝŶĞ ƚŚƌĞĞ ĚĂǇƐ ďĞĨŽƌĞ ĂůůĞƌŐǇ ƚĞƐƚŝŶŐ͘ WƌƵƌŝƚŝƐ ĂŶĚͬŽƌ ƵƌƚŝĐĂƌŝĂ ŵĂǇ ŽĐĐƵƌ ǁŚĞŶ ĐĞƚŝƌŝǌŝŶĞ ŝƐ ƐƚŽƉƉĞĚ͕ ĞǀĞŶ ŝĨ ƚŚĞ ƐǇŵƉƚŽŵƐ ǁĞƌĞ ŶŽƚ ƉƌĞƐĞŶƚ ďĞĨŽƌĞ ƚƌĞĂƚŵĞŶƚ ŝŶŝƚŝĂƚŝŽŶ͘ ^ǇŵƉƚŽŵƐ ŵĂǇ ďĞ ŝŶƚĞŶƐĞ ĂŶĚ ŵĂǇ ƌĞƋƵŝƌĞ ƚƌĞĂƚŵĞŶƚ ƚŽ ƐƚĂƌƚ ĂŐĂŝŶ ;ƐŚŽƵůĚ ƚŚĞŶ ƌĞƐŽůǀĞͿ͘ ŽŶƚĂŝŶƐ ůĂĐƚŽƐĞ͘ /ŶƚĞƌĂĐƚŝŽŶƐ͗ ĂƵƚŝŽŶ ŝƐ ĂĚǀŝƐĞĚ ǁŚĞŶ ƚĂŬĞŶ ĐŽŶĐŽŵŝƚĂŶƚůǇ ǁŝƚŚ ĂůĐŽŚŽů Žƌ ŽƚŚĞƌ E^ ĚĞƉƌĞƐƐĂŶƚƐ͘ ĞƚŝƌŝǌŝŶĞ ĚŽĞƐ ŶŽƚ ƉŽƚĞŶƚŝĂƚĞ ƚŚĞ ĞĨĨĞĐƚ ŽĨ ĂůĐŽŚŽů ;Ϭ͘ϱŐͬů ďůŽŽĚ ůĞǀĞůƐͿ͘ WƌĞŐŶĂŶĐǇ ĂŶĚ >ĂĐƚĂƚŝŽŶ͗ ĂƵƚŝŽŶ ĚƵƌŝŶŐ ƉƌĞŐŶĂŶĐǇ ĂŶĚ ďƌĞĂƐƚͲĨĞĞĚŝŶŐ͘ ďŝůŝƚǇ ƚŽ ƌŝǀĞ ĂŶĚ hƐĞ DĂĐŚŝŶĞƌǇ͗ hƐƵĂůůǇ ŶŽŶͲƐĞĚĂƚŝǀĞ͕ ƉĂƚŝĞŶƚƐ ƐŚŽƵůĚ ƚĂŬĞ ƚŚĞŝƌ ƌĞƐƉŽŶƐĞ ƚŽ ƚŚĞ ƉƌŽĚƵĐƚ ŝŶƚŽ ĂĐĐŽƵŶƚ͘ hŶĚĞƐŝƌĂďůĞ ĨĨĞĐƚƐ͗ ĞƚŝƌŝǌŝŶĞ Ăƚ ƚŚĞ ƌĞĐŽŵŵĞŶĚĞĚ ĚŽƐĂŐĞ ŚĂƐ ŵŝŶŽƌ ĂĚǀĞƌƐĞ ĞĨĨĞĐƚƐ ŽŶ ƚŚĞ E^͕ ŝŶĐůƵĚŝŶŐ ƐŽŵŶŽůĞŶĐĞ͕ ĨĂƚŝŐƵĞ͕ ĚŝǌǌŝŶĞƐƐ ĂŶĚ ŚĞĂĚĂĐŚĞ͘ /Ŷ ƐŽŵĞ ĐĂƐĞƐ͕ ƉĂƌĂĚŽǆŝĐĂů E^ ƐƚŝŵƵůĂƚŝŽŶ ŚĂƐ ďĞĞŶ ƌĞƉŽƌƚĞĚ͘ /ŶƐƚĂŶĐĞƐ ŽĨ ĂďŶŽƌŵĂů ŚĞƉĂƚŝĐ ĨƵŶĐƚŝŽŶ ǁŝƚŚ ĞůĞǀĂƚĞĚ ŚĞƉĂƚŝĐ ĞŶǌǇŵĞƐ ĂĐĐŽŵƉĂŶŝĞĚ ďǇ ĞůĞǀĂƚĞĚ ďŝůŝƌƵďŝŶ ŚĂǀĞ ďĞĞŶ ƌĞƉŽƌƚĞĚ ǁŚŝĐŚ ƌĞƐŽůǀĞƐ ŽŶ ĚŝƐĐŽŶƚŝŶƵĂƚŝŽŶ ŽĨ ƚŚĞ ĚƌƵŐ͘ hŶĐŽŵŵŽŶ͗ ŐŝƚĂƚŝŽŶ͕ ĚŝĂƌƌŚŽĞĂ͕ ƉƌƵƌŝƚƵƐ͕ ƌĂƐŚ͕ ĂƐƚŚĞŶŝĂ͕ ŵĂůĂŝƐĞ͕ ƉĂƌĂĞƐƚŚĞƐŝĂ͘ ^ĞĞ ^W ĨŽƌ Ăůů ĂĚǀĞƌƐĞ ƌĞĂĐƚŝŽŶƐ͘ DĂƌŬĞƚŝŶŐ ƵƚŚŽƌŝƐĂƚŝŽŶ ,ŽůĚĞƌ͗ ZŽǁĞǆ >ƚĚ͕ ĂŶƚƌǇ͕ Ž͘ ŽƌŬ͘ DĂƌŬĞƚŝŶŐ ƵƚŚŽƌŝƐĂƚŝŽŶ EƵŵďĞƌ͗ W ϬϳϭϭͬϬϳϱͬϬϬϮ͘ &ƵƌƚŚĞƌ ŝŶĨŽƌŵĂƚŝŽŶ ĂŶĚ ^W ĂƌĞ ĂǀĂŝůĂďůĞ ĨƌŽŵ͗ ZŽǁĞǆ >ƚĚ͕ ĂŶƚƌǇ͕ Ž͘ ŽƌŬ͘ &ƌĞĞƉŚŽŶĞ͗ ϭϴϬϬ ϴϯ ϮϬ ϴϯ ͲŵĂŝů͗ ŵŝ͘ŝƌĞůĂŶĚΛƐĂŶĚŽǌ͘ŶĞƚ >ĞŐĂů ĂƚĞŐŽƌǇ͗ EŽƚ ƐƵďũĞĐƚ ƚŽ ŵĞĚŝĐĂů ƉƌĞƐĐƌŝƉƚŝŽŶ͘ ĂƚĞ ŽĨ WƌĞƉĂƌĂƚŝŽŶ͗ DĂƌĐŚ ϮϬϮϲ MLR ID for API: MLR-0129-IE

Date of preparation: (03/2026) MLR ID: MLR-0128-IE

Supply status: Supply through pharmacies only

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Minister Carroll MacNeill said: “The most effective way to prevent problems associated with unused or expired medicines is to reduce the quantities of these medicines in circulation within the community. “Pharmacists are uniquely positioned to accept these medicines as they are highly accessible, experienced in safe disposal and appreciate the risks that unused or expired medicines can pose. “MediBack aligns with the objectives of Sláintecare by promoting patient safety, improving environmental sustainability and generating data to inform evidencebased service improvement. Chief Clinical Officer (CCO) of the HSE Dr Colm Henry said: "The introduction of MediBack is an important step in protecting public health and supporting safe use of medicines… "This service also supports wider public health priorities, including tackling antimicrobial resistance and reducing

the environmental impact of medicines entering our waste and water systems. "I would like to acknowledge the strong collaboration between community pharmacists, the HSE, the Department of Health and the Irish Pharmacy Union in delivering this valuable national service.” Through MediBack, anyone can bring unused or out-of-date medicines to any pharmacy nationwide for safe disposal, free of charge. The medicines do not need to have been bought from the pharmacy where they are returned. Welcoming the announcement, IPU President Caoimhe McAuley said: "Community pharmacists are the most accessible healthcare professionals in Ireland and are uniquely placed to help patients dispose of unused medicines safely while protecting both public health and the environment. "Every day, pharmacists support patients with healthcare advice, medicines optimisation and

pharmaceutical care. They understand the risks associated with unused medicines and have the expertise and infrastructure necessary to ensure medicines are disposed of safely and responsibly. "This initiative is another example of the trusted role community pharmacies play in protecting patients’ health while delivering practical public health services closer to home. "We thank the Department of Health and the HSE for engaging so collaboratively on the roll-out of this initiative and we look forward to providing the MediBack service in communities nationwide." The vast majority of medicines for human use (plus some veterinary medicines for pets) will be accepted. Some restrictions will apply, such as the exclusion of ‘sharps’ and medication for farm animals. For a full list of what types of medicines are and are not accepted through the MediBack service, visit gov.ie/mediback.

New course on digital health innovation for healthcare professionals Queen’s University Belfast has launched a new course dedicated to advancing healthcare professionals' knowledge and practical capability in digital health innovation. The 12-week Digital Health Innovation in Practice course responds to a growing digital health movement and a changing healthcare landscape in which AI, data and digital technologies are reshaping care and professional practice. Developed by the School of Nursing & Midwifery, the microcredential is open to healthcare professionals from all disciplines and career stages, with participants gaining relevant skills to apply within their own roles and workplaces. Delivered online, the short course can be studied alongside professional

commitments, giving participants the opportunity to explore digital health systems, data, artificial intelligence and automation, virtual care, mobile health, wearable technologies, and user-centered design. Dr Mark Dornan, Lecturer in the School of Nursing & Midwifery at Queen’s, and Programme Lead, said: “Artificial intelligence and digital technologies are becoming part of everyday healthcare. Professionals need opportunities to understand what these technologies can and cannot do, and consider how digital innovation can apply within their own practice. “This course provides an accessible, structured introduction to digital health innovation. Participants will examine emerging technologies, consider their benefits and limitations, and explore

the ethical, professional and practical questions surrounding their use. “Our aim is to help healthcare professionals develop the knowledge and confidence to engage meaningfully with digital change and apply their learning to a relevant challenge or opportunity.” The microcredential offers a timely opportunity to understand AIenabled tools, digital platforms and data-informed services and engage thoughtfully with their use in practice. Learners will complete the course with a recognised Queen’s University Belfast qualification, an applied digital health project and increasingly valuable professional skills. Applications for Digital Health Innovation in Practice are now open.

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People in most deprived areas at higher risk of chronic pain and three times more likely to face pain-related depression People living in the most socioeconomically deprived areas are at higher risk of developing chronic pain and are three times more likely to face painrelated issues, such as depression, social functioning, and physical disability. This is according to new research from Queen’s University Belfast and the Belfast Health and Social Care Trust’s Centre for Pain Rehabilitation. The study analysed the data of 491 patients living with chronic pain in Northern Ireland. Researchers found that 42 per cent of those who took part in the study were living in the most deprived areas and reported much higher levels of distress, disability and pain-related burden. Depression and anxiety increased proportionally with deprivation levels. The most deprived group experienced up to three times more pain-related issues with mental health, social functioning, and physical disability, compared to the least deprived. Prof Kevin Vowles from the School of Psychology at Queen’s led the study.

He explains: "Chronic pain costs the UK £10 billion annually in healthcare and lost productivity. This study reveals that deprivation doesn’t just increase the risk of chronic pain. Those living in the most deprived areas are facing double jeopardy as it also increases the risk of pain that is more disabling, distressing, and disruptive. The findings are stark. Those in the most deprived areas face a more pain-related issues and burdens, with the severity increasing in step with deprivation. “This inequality deserves to be addressed urgently. Our research shows that deprivation is not only a risk factor for chronic pain, but also amplifies its impact across every aspect of life. The message is clear — we need a biopsychosocial approach to chronic pain care that tackles the root causes of this disparity." Dr Jason Brooks, Lead Clinician and Consultant Anaesthesiologist at the Belfast Centre for Pain Rehabilitation, adds: "These findings mirror what we see daily in our clinics. Patients from deprived communities often struggle

with a perfect storm of physical pain, psychological distress, and social disadvantage, all of which are exacerbated by limited access to support. The impact of pain ripples through every aspect of their lives, from family and work, to education and mental health. “This study confirms what we’ve long suspected; chronic pain cannot be treated in isolation. We need integrated rehabilitation that addresses the physical, psychological, and social dimensions of pain, particularly for those in the most deprived areas. Our goal isn’t just to reduce pain, it’s to help people reclaim their lives." The researchers urge healthcare systems to prioritise biopsychosocial interventions, such as pain education and rehabilitation, to better support those living with chronic pain. They also call for urgent policy action to address the social determinants of health, including poverty, education, and access to services. This could reduce costs, improve care, and help patients return to work and daily life.

New antimicrobials ‘could help tackle deadly drug-resistant infections’ Scientists at Imperial College London and The University of Manchester have developed a promising new way to create safer and more effective treatments for life-threatening fungal infections. The research, published recently in Nature, describes a new family of antifungal agents, which — when tested in mice — are more potent and less toxic than existing treatments. Fungal diseases are an escalating global health threat, becoming harder to treat as resistance to existing drugs grows and the development of new antifungal medicines lags behind. The urgency

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for new treatments was emphasised by a recent report by the World Health Organisation (WHO). While existing antifungal medicines can be highly effective, many can cause serious side-effects because fungal cells share similarities with human cells, making it difficult to target infections without harming healthy tissue. In the new study, researchers from the Micklefield Lab focused on polyenes — a class of powerful antifungal agents. Using an approach called genome mining, they identified bacterial species capable of producing new, undiscovered antifungals.

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Dr Saadia Nasr Mirza, who worked on the project, said: “The most effective antifungal agent currently available is a polyene molecule called amphotericin produced by soil bacteria. Although amphotericin is very potent, it is highly toxic, so we set out to discover if bacteria can produce different types of polyenes that are safer than amphotericin. We developed a bioinformatics pipeline, which surprisingly showed that many bacterial species have the capability to produce novel polyenes.” Using a technique called nuclear magnetic resonance (NMR), the team determined the structures of the newlydiscovered polyenes, showing that each one had a unique structure that differed from any existing antifungal compounds. The researchers also characterised the enzymes responsible for producing them and generated a library of polyene derivatives for testing. Several of the new compounds showed increased antifungal activity, reduced toxicity and improved solubility compared

with the parent drugs. The findings demonstrate that enzymes can be used to redesign these important medicines in a cleaner, more efficient way, producing new compounds that retain strong antifungal activity while reducing toxicity and harmful side-effects. One compound, known as Nys34, showed particularly promising results. In a mouse model of invasive aspergillosis, a serious fungal infection caused by Aspergillus fumigatus, the compound reduced fungal burden without substantive signs of toxicity. Prof Jason Micklefield, who led the project, said: “We were pleased to find that several of the new polyene derivatives were more potent and less toxic than amphotericin and nystatin, which is another important polyene that is also used in the clinic. “Surprisingly, we found that one of the most effective new polyene derivatives, Nys34, has a different mode of action to the widely used amphotericin. Because

Nys34 kills fungal cells in a different way, it could prove very useful to combat emerging pathogens that have evolved resistance to amphotericin.” Polyene antifungal drugs are highly complex molecules. Previous efforts to improve them have typically relied on lengthy chemical synthesis processes that are expensive, inefficient and can require environmentally harmful reagents. The Micklefield lab, based at Imperial’s Molecular Sciences Research Hub, developed an enzyme-based approach that can produce improved polyenes by cleaner and more efficient biological processes, generating promising new drug candidates without the need for complex multi-step chemical manufacturing. Because the process is potentially scalable and cost-effective, it could help make improved antifungal treatments more widely available, particularly in lower-income regions, where fungal diseases are highest and place a substantial burden on public health.

Barretstown to establish Ireland’s first Psychosocial Clinical Research Hub Barretstown, Ireland’s leading provider of psychosocial care for seriously ill children and young people, has announced its intention to establish Ireland’s first Psychosocial Clinical Research Hub. The announcement comes as the charity welcomed its 175,000th camper and launched its new strategy, which will expand its remit. It also reflects the organisation’s commitment to guaranteeing psychosocial care is a part of every treatment plan for children and young people in Ireland who are living with cancer and other serious illnesses. 'Psychosocial care' is the medical term given to care that addresses the full picture of a young person’s recovery, including their emotional wellbeing, confidence, independence and self-esteem. It is

Minister for Health Jennifer Carroll MacNeill chats with the first Camper (RHS) Ciara Hoolahan, and the most recent, the 175,000th Camper, Hayleigh Price

evidence-based, WHO-recognised and government-endorsed healthcare that has been proven to have a profound impact on restoring the lives of seriously ill children

and their families. While it is included in the National Cancer Strategy, it is not yet a consistent extension of clinical care for every seriously ill young person and their families in Ireland. Ireland’s health landscape for those under 25 faces extraordinary challenges. According to the National Cancer Registry Ireland, an average of just under 370 young people are diagnosed with cancer every year in Ireland, while almost one-infive children have a long-standing illness or health problem. This creates additional pressure on young people and families, who need more support. To provide this support and restore more lives, Barretstown is expanding its work to make psychosocial care the standard across Ireland.

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Pamex Ltd team raise €45,346 for Sunflower Children’s Hospice Pamex Ltd has raised an impressive €45,346 for the Sunflower Children’s Hospice following a major fundraising initiative which saw a number of employees undertake a 245km relay walk from Dublin to Castlebar, Co Mayo, over 36 hours. The ‘Linking Little Lives’ challenge took place in June, with members of the Pamex Ltd team walking continuously from Dublin to the site of the new Sunflower Children’s Hospice in Castlebar. This significant distance was chosen to reflect the long and difficult journey that families in the West of Ireland currently face when travelling to Dublin to access specialist children’s care. The Pamex team was seen off at the beginning of the challenge by special guests, including RTÉ broadcaster Miriam O’Callaghan and Martina Jennings, CEO of Mayo Roscommon Hospice Foundation. The 245km route passed through seven counties including Dublin, Kildare, Meath, Westmeath, Roscommon, Galway and Mayo. The fundraising continued when the team arrived in Castlebar, where Pamex Ltd hosted a Family Fun Day in The Mall, bringing together employees, local schools, families and the wider community to celebrate the achievement and raise further funds for the hospice. The €45,346 raised builds on more than €16,000 previously raised by Pamex Ltd through a series of fundraising initiatives, including a Family Day in Portarlington, a wine and cheese evening, a schools colouring competition across Mayo and Galway, a skydive, and generous contributions from Pamex’s corporate partners. Cormac Kearney, CEO of Pamex Ltd, said: “We are absolutely delighted to have raised €45,346 for Sunflower Children’s Hospice and are incredibly proud of everyone who played a part in making ‘Linking Little Lives’ such a success. “The 245km journey from Dublin to Castlebar was challenging, but it gave real meaning to what we were trying to

achieve. Families in the West of Ireland should not have to travel long distances to access specialist care for their children, and we wanted our challenge to physically represent that journey while helping to bring these vital services closer to home. “We received incredible support from our employees, families, schools, customers, corporate partners and the wider community. There has been a real sense of people coming together for something that will make a lasting difference. We are incredibly proud to support the development of Sunflower Children’s Hospice and the families it will serve on the Western seaboard.” Martina Jennings, CEO of Mayo Roscommon Hospice Foundation, said: “We are hugely grateful to the whole Pamex team and everyone who supported this incredible, creative fundraising initiative. Raising €45,346 is an extraordinary achievement and will make a meaningful contribution to the development of Sunflower Children’s Hospice. “Walking 245km was a particularly powerful way to highlight why this service

is so important. For families caring for a child with a life-limiting illness, having access to specialist palliative and respite care closer to home can make an enormous difference. The Sunflower Children’s Hospice in Castlebar will provide a dedicated, welcoming environment where children and their families can receive the specialist care and support they need.” All of the funds raised will directly support the development of Sunflower Children’s Hospice, a dedicated facility that will provide specialist palliative and respite care for children and young people living with life-limiting illnesses, as well as emotional, practical and bereavement support for families across the West of Ireland. The eight-bed hospice will include family accommodation, hydrotherapy baths, sensory and play therapy rooms, and garden access for each bedroom. An on-site multidisciplinary team will provide round-the-clock specialist care in a warm, family-centered environment. For further information, see https://sunflowerchildrenshospice.ie/.

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pharmacist cpd Free, independent CPD for Irish pharmacists by Irish pharmacists

FEATURED MODULE:

Parkinson’s Disease

Successful completion of this module will earn you 2 CPD points

Scan here or visit www.medilearning.ie/pharmacistcpd

FEATURE | Pharmacy services

The evolution of community pharmacy A new European-wide study of community pharmacy before and after the Covid-19 pandemic sheds light on the development services within the profession. Niamh Cahill reports

he evolution of community pharmacy across Europe is clearly illustrated in a new study published recently in the International Journal of Clinical Pharmacy. Titled: ‘Evolution of Community Pharmacy Services in the European Union and Beyond: A Cross-country Survey of 33 National Pharmacy Organisations’, the study compares information gleaned from surveys in 2025 with pre-pandemic (2020) survey data. The study’s authors — including Martin Henman, Adjunct Associate Professor in the Practice of Pharmacy at the School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin (TCD) — wanted to examine trends in service provision, reimbursement, and regulatory barriers from a health policy perspective. In order to do this, a cross-sectional survey was conducted among national pharmacy associations in all 27 EU Member States and in six neighbouring countries. Data was gathered and mapped on 47 community pharmacy services and information on the reimbursement status for services, and their level of implementation was also collected.

Expansion

The results reveal that between 2020 and 2025, community pharmacy services have expanded across Europe, with the increase in services largely dependent on public remuneration and supportive regulatory frameworks, the authors concluded. Speaking to Irish Pharmacist (IP), Prof Henman stated that there are not many studies of this kind conducted at EU level which provide information about the availability of community pharmacy services in Europe.

on an individual pharmacy-by-pharmacy basis — they have got to be recognised by the health service, and you need some support there because that helps people and patients to see that the pharmacy is a part of the health service."

Vaccinations

Speaking from an Irish perspective, Prof Henman said the study showed how services had grown in Ireland during the five-year period, which was due to a number of factors, including the persistence of the Irish Pharmacy Union (IPU) in seeking greater supports for community pharmacy and producing the Community Pharmacy Agreement 2025, he said. “Persistence is the key thing, because in some respects, and compared to the UK, Ireland had very few services that were supported in any way by the Government. That meant the scope of practice of community pharmacists would have been more limited,” Prof Henman said. “Some other countries began to make significant moves in these areas over the last few years. In some ways Ireland, whilst as individuals, community pharmacists were quite progressive, [but] you can’t sustain those services

“The IPU has been very successful in the last few years because they’ve been persistent, particularly since Covid. And in a sense vaccination services, that began before Covid, were a very good thing because it began to show the health service that people going to pharmacies to be vaccinated were not necessarily always the same people who in previous years would have gone to their GP. That meant you were expanding the number of people who are getting vaccinated.” Prof Henman added that the Covid-19 vaccination scheme in pharmacies “went extremely well” and helped to set the scene for future developments in pharmacy services. Another factor related to the boost in community services in recent years has been the recognition that the number of GPs is not keeping pace with population increases, Prof Henman said. Several European countries have a lot of older GPs who will retire from practice in the next few years, he said, posing challenges for primary care services. “That also, in a sense, has begun to push governments to think about finding other ways, and one of those ways is asking community pharmacists to do more,” Prof Henman outlined. Jorge Batista, Senior Professional Affairs Adviser with the Pharmaceutical Group of the European Union (PGEU), and study author, told IP that studies like this one

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Pharmacy services | FEATURE

support the “professional evolution of community pharmacy by demonstrating that the community pharmacy profession is moving beyond the traditional dispensing towards a broader clinical and public health role. “Furthermore, this study highlights the shift from a more product-based model to a service-based model of care, supporting a case where community pharmacists can expand the scope of their practice where appropriate.” Mr Batista said the most striking finding from the study was that 77 per cent of the mapped services (out of a total of 47) were available in more countries in 2025 than in 2020, with strong growth in vaccination, medication reconciliation, and first-time dispensing interventions.

Maturing service provision

“This shows that the expansion of community pharmacy services is not isolated, but a broader trend. Furthermore, this growth has happened in a relatively short time frame — five years only. In general, we see an increase in the number of countries offering pharmacy services, and also that countries are maturing their service provision. “We see cases of countries that in 2020 were offering the service as a pilot, and in 2025, the service has expanded to national-level implementation. This is also important, as increasing service maturity allows for sustainable implementation. “On the other hand, we found surprising the uneven implementation of community pharmacy services across the countries. Even though the median was 26 services per country, the range was wide, between nine and 43 services. This shows a great potential, but also a lack of harmonisation. “The wide range in the number of services per country suggests that patients’ access to pharmacy-based care still depends heavily on where they live. A clear need for more co-ordinated policy development stands out, which is why these type of studies are important to shed some light into practice development and inspire policy changes. The next policy challenge is not only whether

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pharmacists are allowed to provide services, but whether these services are properly commissioned, remunerated, and integrated into primary care.” The results show that Ireland, in general, provides a broad range of services in community pharmacy. Some services and support provided in other EU countries, however, such as medication reviews and shared electronic patient records, for example, are absent. Mr Batista said the evolution of pharmacy services during and after the Covid-19 pandemic was mainly positive, but more nuanced than it appears at first. “While during the pandemic, many parts of the healthcare system were under pressure, community pharmacists remained highly accessible, despite extremely challenging conditions. Community pharmacies kept their doors open, continuing to provide services to the population,” Mr Batista outlined. “The Covid-19 pandemic created a space where existing trends were able to accelerate and get increased public and political recognition for community pharmacists and other essential healthcare professionals. It showed that community pharmacists were ready to take on these additional services in a safe and responsible manner, when regulations allowed it. It created a momentum for vaccination, prescription renewals, and medicine shortage management, among other services that gained popularity during that time. “Our findings show that regulatory changes occurred around the Covid-19 pandemic period — and whilst the pandemic itself was not positive, it created a policy window in which pharmacists’ accessibility and readiness became more visible.” Prof Henman said in the future, it will be interesting to see to what extent new services were being used by the public and taken up by pharmacists. “The difficulty for community pharmacies, which are independent, is that they are small- to medium-sized enterprises and they can be squeezed. There are a number of economic and

business-related factors at play, so it can be difficult for them to manage that,” Prof Henman said about the factors related to service take-up by pharmacies. Prof Henman mentioned that in Germany, a patient medication review service had been introduced there with government support, but that to date it had proved challenging to get pharmacists there to take up the service. “The case in Germany suggests that even with government support, there is still more work to be done to persuade people that they should be looking for this, to create the demand, and convince pharmacists that they should stick their neck out, in a sense, and attempt to do it.”

Future research

Mr Batista said the study clearly demonstrated that the role of community pharmacists was changing and that, in most countries, service provision was becoming an embedded feature of the profession. He added that future research should aim to evaluate the clinical impact of these services and provide evidence not only of the availability, but also the improved outcomes, especially from a patient perspective. “Bringing a clear view of the economic value, the reduced pressure on the healthcare system, and cost-effectiveness of these community pharmacy services can create a basis for future regulations. Above all, the sustainable implementation of these services will also depend on service reimbursement, recognising the role of community pharmacists in primary care,” Mr Batista stated. “As European health systems are facing growing challenges, such as ageing populations, workforce shortages, medicine shortages, chronic disease burden, and constrained budgets, this research highlights the accessibility of community pharmacists and the current and future potential of community pharmacists in relieving pressure on primary care by supporting prevention, medicines optimisation, screening, and patient counselling.” ●

FEATURE | Prescribing

Working in the head space

A new study sheds light on prescribing habits in neurodegenerative diseases

new pan-European study has identified the key behavioural factors that influence whether healthcare professionals prescribe new, novel, or non-routine treatments for patients with neurodegenerative diseases. The findings provide important insights into how behaviour change frameworks could support the uptake of new and potentially transformative treatments. With incidence and prevalence continuing to rise, neurodegenerative diseases such as Parkinson’s represent a growing global healthcare challenge. As new treatment options become available, understanding the factors that influence prescribing decisions is becoming increasingly important to ensure that patients can access the most appropriate therapies. Published as the third and final paper in a three-part research programme, the large-scale statistical analysis — completed by researchers from Alpharmaxim and Aston University as part of their Knowledge Transfer Partnership (KTP) funded by Innovate UK — surveyed 279 healthcare professionals across Europe and examined the psychological and contextual factors that shape decision-making.

uncertainty about the outcome. The stage of a patient’s disease also influences a healthcare professional’s decision as to whether to prescribe new medication. In the early stages of a disease, a prescriber is more likely to adhere to existing guidelines and routine prescribing. They are more likely to consider prescribing a new or different medication to a patient with more advanced disease. The researchers found four main influences on prescribing — a prescriber’s confidence in their skills, opportunity to prescribe new medication, including guidelines and access, motivation, and their intention (or conscious readiness) to prescribe. Improving uptake of innovative treatments isn’t just about better drugs; it requires targeted behaviour change strategies for clinicians. The researchers found that the strongest lever to change behaviour around prescribing is to shift intention to prescribe. This might include addressing beliefs about outcomes, and providing training, decision support and clear, accessible guidelines about new therapies. System-level support and policy alignment help to improve opportunity.

Behaviour change

The study is the culmination of a wider research programme designed to better understand prescribers’ decision-making in neurodegenerative disease. The systematic review results published in PLoS One identified potential intervention strategies to support change, while the focus group study published in BMJ Open established expert consensus on the factors that influence prescribing behaviour. Together, the findings of these three papers triangulate to validate the identified barriers to behaviour change. This research forms the backbone of Alpharmaxim’s Healthcare Behavioural

The researchers, which include Aston University’s Dr Carl Senior, reader in Psychology, and Dr Jason Thomas, senior lecturer in psychology, found that getting new treatments used in practice is as much a behaviour change problem as it is a medical one. They identified several key predictors of prescribing behaviour. Even where the clinical evidence for a new medication is strong, healthcare professionals can be reluctant to prescribe it for several reasons, including past negative experiences with similar new drugs, established habits, and

Intervention strategies

Insights Tool (H-BIT), a diagnostic framework for behavioural barriers that enables stakeholders to design more effective communications strategies. Dr Carl Senior, reader in psychology at Aston University, said: “This study is the final piece of the puzzle. We now have an established method for identifying the factors that may predict the likelihood of a doctor prescribing better therapy. We studied European clinicians caring for patients with Parkinson’s disease, where the dominant therapy has several well-known side-effects. Despite the availability of alternatives, it is notoriously difficult to encourage doctors to prescribe them. Our findings identified ways to facilitate decision change in this uniquely resistant prescribing context.”

‘Flipping a coin’

Jason Thomas, senior lecturer in psychology at Aston University, said: “On average, the chance of a newly-diagnosed patient receiving a new and potentially better drug is around 50:50. Or put another way, your doctor’s decision of whether to give you the latest treatment could be replaced by ‘flipping a coin’. This is not reassuring. This study shows that we can identify what determines healthcare professionals’ decision-making and help unlock access to the latest, most efficacious treatments.” William Hind, CEO of Alpharmaxim, said: “Data alone rarely changes behaviour. This research demonstrates that prescribing decisions are influenced by a complex interplay of specific and generic predictors. By understanding these factors, we can design more effective approaches to support healthcare professionals in making informed treatment decisions and help ensure patients receive the therapies most appropriate for their needs.” To read the full paper in PLOS One, visit https://doi.org/10.1371/journal. pone.0353479. ●

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Patient referrals | FEATURE

Asthma patients can now be referred through Healthlink

New referral pathway strengthens integrated asthma care by providing expert support between appointments

he Asthma Society of Ireland has announced that healthcare professionals can now refer patients directly to its free Asthma Adviceline through the Healthlink electronic referral system, making it easier than ever for patients to access specialist asthma support between routine appointments. The Asthma Adviceline is a free, nurseled service that complements the care provided by GPs and other healthcare professionals by offering personalised education and self-management support. The service is designed to help people better understand and manage their asthma, improve adherence to treatment plans, and reduce the risk of flare-ups. Healthcare professionals play a vital role in supporting people living with asthma, but asthma is a variable condition that often requires ongoing guidance beyond scheduled consultations. The new Healthlink referral pathway provides a seamless way to connect patients with specialist respiratory support when they need it.

Image: iStock.com/sturti

Experienced specialists

Patients referred to the service receive advice from experienced asthma nurse specialists with expertise across primary, secondary, and tertiary care. Depending on their needs, they may also receive specialist physiotherapy or dietetic support, alongside practical education on inhaler technique, Asthma Action Plans, trigger management, asthma control, lifestyle factors, and seasonal health. The service works alongside existing clinical care by reinforcing the treatment plan agreed with the patient's healthcare professional. It does not diagnose conditions or prescribe medication. Evidence from the Asthma Adviceline

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demonstrates significant benefits for both patients and the wider health service. Among users who completed a follow-up survey:  73 per cent reported fewer GP or out-of-hours visits.  67 per cent avoided attending an Emergency Department.  68 per cent reported fewer hospital admissions.  The proportion requiring no oral steroid courses increased from 11 per cent to 35 per cent. A retrospective review of 288 patients completing the Asthma Control Test through the service also found that 90 per cent improved their asthma control scores, while every respondent said they would recommend the service. The Asthma Society of Ireland is encouraging healthcare professionals to integrate referrals into routine asthma care, helping patients access expert advice and education between consultations while supporting better long-term asthma control.

Ongoing support

Healthcare professionals can make referrals directly within Healthlink by selecting Asthma Society under the referral menu and choosing Asthma Adviceline. "We know that asthma is a condition that requires ongoing support, not just care during scheduled appointments. The new Healthlink referral pathway makes it easier for healthcare professionals to connect patients with our free, nurse-led Asthma Adviceline, giving them access to trusted advice and education between consultations. By working alongside GPs and practice nurses, we can help more people improve their asthma control, build confidence in self-management and ultimately reduce avoidable flareups and hospital visits,” said Ms Mary McDonald, Patient Services Manager, Asthma Society of Ireland. For further information about the Asthma Adviceline and the services available to patients and healthcare professionals, visit www.asthma.ie. ●

PROTECT AGAINST RSV## PROTECT AGAINST RSV

Over 3 RSV seasons, a single dose of AREXVY Over 3 RSV seasons, a single doseagainst of AREXVY demonstrated sustained efficacy RSV1,2 demonstrated sustained efficacy against RSVLRTD in adults aged 18 years and older LRTD in adults aged 18 years and older1,2

SEASON 1 OVERALL EFFICACY IN SEASONPROTECTING 1 OVERALL EFFICACY IN AGAINST RSV-LRTD3** PROTECTING

% 82.6 82.6%

AGAINST RSV-LRTD3**

SEASON 1 EFFICACY IN PROTECTING AGAINST RSV-LRTD FOR PARTICIPANTS WITH AT LEAST SEASON 1 EFFICACY IN PROTECTING AGAINST †3** 1 COMORBIDITY OF INTEREST RSV-LRTD FOR PARTICIPANTS WITH AT LEAST

% 94.6 94.6%

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Primary Endpoint ² 82.6% (96.95% CI*, 57.9, 94.1)

PrimaryAREXVY Endpoint 82.6% CI*,placebo 57.9, 94.1) (7 ²cases out(96.95% of 12,466), (40 cases out of 12,494) AREXVY (7 cases out of 12,466), placebo (40 cases out of 12,494) Secondary Endpoint ² 94.6% (95% CI, 65.9, 99.9) Secondary Endpoint ² 94.6% 65.9, (18 99.9) AREXVY (1 case out of (95% 4937),CI, placebo cases out of 4861) AREXVY (1 case 1out ofwith 4937), (18 cases **Season data 6.7placebo months follow up. out of 4861) 2 **Season 1 data with 6.7not months up. Vaccination may protectfollow all recipients. 2 # Vaccination may not protect all recipients. 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[Respiratory Syncytial Virus (RSV) vaccine (Please refer to SmPC before prescribing). (recombinant, adjuvanted)]. After reconstitution, one dose (0.5 mL) contains: RSVPreF31 antigen2, 3 120 micrograms. (1RSV (Please Composition: refer to SmPC before prescribing). 2 RSVPreF3 produced recombinant glycoprotein F stabilised in themL) pre-fusion conformation 1= RSVPreF3, 2 3 antigenwith , 120 micrograms. (1RSVin Composition: After reconstitution, (0.5 contains: RSVPreF3 3 adjuvanted Chinese Hamster Ovary cellsone by dose recombinant DNA technology), 2 AS01E containing: plant RSVPreF3 producedlipid in recombinant glycoprotein F stabilised in the pre-fusion conformation = RSVPreF3, extract Quillaja saponaria Molina, fraction 21 (QS-21) 25 micrograms, 3-O-desacyl-4’-monophosphoryl 3 adjuvanted with AS01 containing:for plant ChineseA Hamster Ovary cells byminnesota recombinant DNA technology), E (MPL) from Salmonella 25 micrograms. Therapeutic indications: Active immunization the extract prevention Quillaja saponaria fraction (QS-21) 25 by micrograms, 3-O-desacyl-4’-monophosphoryl lipid of lowerMolina, respiratory tract 21 disease caused RSV in adults 18 years of age and older. The use of A (MPL) from Salmonella minnesota 25 micrograms. Therapeutic indications: Active immunization for the this vaccine should be in accordance with official recommendations. Posology and method of administration: prevention of lower respiratory caused bydeltoid RSV inmuscle. adults Administered 18 years of age older. The of For intramuscular injectiontract only,disease preferably in the as aand single dose of use 0.5 ml. this vaccine should beneed in accordance with Contraindications: official recommendations. Posology method of administration: Revaccination: not established. Hypersensitivity to and the active substances or any of For intramuscular injection preferably in the deltoid Administered a single of 0.5 ml. the excipients. Special only, warnings and precautions for use: muscle. The name and the batchasnumber of dose the administered product need shouldnot beestablished. clearly recorded. Appropriate Hypersensitivity medical treatmenttoand should or be any readily Revaccination: Contraindications: the supervision active substances of availableSpecial in casewarnings of an anaphylactic event.for Vaccination shouldand be the postponed in subjects suffering from an the excipients. and precautions use: The name batch number of the administered severe However, the presence of a treatment minor infection, such as a cold, shouldbenot result productacute should be febrile clearlyillness. recorded. Appropriate medical and supervision should readily in in deferral. protective immune response may notshould be elicited in all vaccinees. Anxiety-related available case ofA an anaphylactic event. Vaccination be postponed in subjects suffering reactions, from an including vasovagal reactions (syncope), hyperventilation or stress-related reactions may should occur. Precautions acute severe febrile illness. However, the presence of a minor infection, such as a cold, not result should in place to avoid injury frommay fainting. Never administer or intradermally; no data in deferral. A be protective immune response not be elicited in all intravascularly vaccinees. Anxiety-related reactions, available on subcutaneous administration. Caution in individuals with thrombocytopenia or any coagulation including vasovagal reactions (syncope), hyperventilation or stress-related reactions may occur. Precautions since bleeding mayfrom occur following intramuscular administration. Safety and immunogenicity should disorder be in place to avoid injury fainting. Never administer intravascularly or intradermally; no data data on Arexvy are not available for immunocompromised individuals. Patients with immunodeficiency or available subcutaneous administration. Caution individuals with response thrombocytopenia anydose coagulation onon immunosuppressive treatment may have ainreduced immune to Arexvy. or Each contains disorder0.18 since bleeding may 80 occur intramuscular administration. Safety and mg of polysorbate whichfollowing may cause an allergic reaction. Interactions: Arexvy mayimmunogenicity be administered data onconcomitantly Arexvy are not for immunocompromised individuals. Patientsvaccine, with immunodeficiency or withavailable a COVID-19 mRNA vaccine, a pneumococcal conjugate herpes zoster vaccine on immunosuppressive treatmentormay have a seasonal reduced influenza immune vaccines response(standard to Arexvy. Each dose contains (recombinant, adjuvanted), inactivated dose unadjuvanted, high 0.18 mgdose of polysorbate 80orwhich may dose causeadjuvanted). an allergic If reaction. administered unadjuvanted, standard Arexvy Interactions: is to be givenArexvy at the may samebetime as another concomitantly with a COVID-19 mRNA should vaccine,always a pneumococcal conjugate vaccine, injection herpes zoster injectable vaccine, the vaccines be administered at different sites. vaccine Fertility, (recombinant, adjuvanted), or There inactivated influenza dose unadjuvanted, high pregnancy and lactation: are noseasonal data on the effects vaccines on human(standard fertility. Arexvy is not recommended dose unadjuvanted, or standard dose adjuvanted). If Arexvy is to be given at the same time as another injectable vaccine, the vaccines should always be administered at different injection sites. Fertility, pregnancy and lactation: There are no data on the effects on human fertility. Arexvy is not recommended

during pregnancy or in breast-feeding/lactating women. Effects on ability to drive and use machines:

during in breast-feeding/lactating Effects onUndesirable ability toeffects: drive Very and use machines: Arexvy pregnancy has a minoror influence on the ability to drive women. and use machines. common Arexvy a minormyalgia, influence on the injection ability tosite drive andfatigue. use machines. effects: Very common ( 1/10): has Headache, arthralgia, pain, Common Undesirable ( 1/100 to <1/10): injection (site 1/10): Headache, myalgia, arthralgia, injection pain, fatigue. Common ( 1/100 to <1/10): injection swelling, injection site erythema, fever, chills. site Uncommon ( 1/1000 to <1/100): lymphadenopathy, site swelling, injection site erythema, fever, chills. Uncommon 1/1000 to pain, <1/100): lymphadenopathy, hypersensitivity reactions, nausea, abdominal pain, vomiting, injection( site pruritus, malaise. Very rare: hypersensitivity reactions, nausea, abdominal vomiting, injection siteCategory: pruritus, POM pain, malaise. Very rare: Guillain-Barré syndrome, Frequency unknown: pain, injection site necrosis. Legal A. Marketing Guillain-Barré syndrome, Frequency unknown: injection site necrosis. Legal Category: POM A. Marketing Authorisation Number: EU/1/23/1740/001-002. Marketing Authorisation Holder: GlaxoSmithKline Biologicals Authorisation Number: EU/1/23/1740/001-002. Marketing Authorisation Holder: GlaxoSmithKline Biologicals S.A., Rue de l’institut 89, B-1330 Rixensart, Belgium. Further information is available from GlaxoSmithKline (Ireland) Riverwalk, CitywestRixensart, Business Campus, 24.information Telephone: 01-4955000. Code:GlaxoSmithKline PI-11947. S.A., RueLtd. de 12 l’institut 89, B-1330 Belgium.Dublin Further is available from Date of preparation: July 2026. (Ireland) Ltd. 12 Riverwalk, Citywest Business Campus, Dublin 24. Telephone: 01-4955000. Code: PI-11947. Date of preparation: July 2026. Adverse events should be reported directly to the Health Products Regulatory Authority (HPRA) on their

website: Adverse events should be reported to GlaxoSmithKline 1800 244(HPRA) 255 or on via their Adversewww.hpra.ie. events should be reported directlyalso to the Health Products RegulatoryonAuthority online forum https:/ /gsk.public.reportum.com. website: www.hpra.ie. Adverse events should also be reported to GlaxoSmithKline on 1800 244 255 or via online forum https://gsk.public.reportum.com. ▼This medicinal product is subject to additional monitoring. This will allow quick identification of new safety information. Healthcare professionals are asked to report any suspected adverse reactions.

▼This medicinal product is subject to additional monitoring. This will allow quick identification of new safety information. Healthcare professionals are asked to report any suspected adverse reactions. Please see full Prescribing Information for AREXVY, on Medicines.ie. References: 1. Arexvy SPC, www.medicines.ie (accessed August 2026). 2. Ison MG, Papi A, Athan E, et al. Efficacy, safety, and immunogenicity of the AS01E-

adjuvanted respiratory syncytial virus prefusion F protein (RSVPreF3 OA) in older adults over three respiratory syncytial virus seasons (ARe SViPlease see full Prescribing Information for AREXVY, onvaccine Medicines.ie. 006): a multicentre, randomised, observer-blinded, placebo-controlled, phase 3 trial. The Lancet Resp E, Med. References: 1. Arexvy SPC, www.medicines.ie (accessed August 2026). 2. Ison MG, Papi A, Athan et al.2025;13(6):517–529. Efficacy, safety, andhttps://doi.org/10.1016/ immunogenicity of the AS01ES2213-2600(25)00048-7. 3. Papi A,virus Ison prefusion MG, Langley JM, et al., for the(RSVPreF3 AReSVi-006OA) Study Group.adults Respiratory syncytial virus prefusion F protein vaccine in(ARe SViadjuvanted respiratory syncytial F protein vaccine in older over three respiratory syncytial virus seasons older aadults. N Engl J randomised, Med. 2023;388(7):595-608. doi:10.1056/ NEJMoa2209604. 006): multicentre, observer-blinded, placebo-controlled, phase 3 trial. The Lancet Resp Med. 2025;13(6):517–529. https://doi.org/10.1016/ S2213-2600(25)00048-7. 3. Papi A, Ison MG, Langley JM, et al., for the AReSVi-006 Study Group. Respiratory syncytial virus prefusion F protein vaccine in older adults. N Engl J Med. 2023;388(7):595-608. doi:10.1056/ NEJMoa2209604.

Winter vaccines | FEATURE

Jab satisfaction

Image: iStock.com/FatCamera

Targeting the right patients with the right vaccines is vital for public health and pharmacists are perfectly placed to make a major contribution

ccording to the Irish Pharmacy Union (IPU), community pharmacists continued to provide over 30 per cent of all vaccines administered during the Autumn-Winter Vaccination Programme of 2025/2026. During the same period, pharmacists also administered 56 per cent of the Children’s LAIV (Live Attenuated Influenza Vaccine) Primary Schools Programme. According to figures from the HSE, a total of more than 1.3 million flu vaccinations (IIV, LAIV) were administered across all sites, including community pharmacies, GPs, hospitals, and others in Ireland, in the 2025/2026 influenza season. The list of conditions that are vaccinepreventable is extensive, but includes flu, measles, mumps, rubella, pertussis,

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diphtheria, and more. The Health Protection Surveillance Centre provides an exhaustive list of vaccine-preventable diseases. This article will focus on a small number of these preventable conditions. The HSE advises that the best time to get the flu vaccine is before the flu season begins, and people can get this vaccine where they live if they are housebound or living in a nursing home. Those who are vulnerable due to underlying conditions should be encouraged to get the flu vaccine, and those in regular contact with pigs, poultry or waterfowl should also be signposted towards vaccination.

Shingles

Even if a person has an active lifestyle, there is a one-in-three chance that they

will develop shingles. Also known as herpes zoster, shingles is recognisable by blisters and sharp burning nerve pain in the skin caused by reactivation of the varicella zoster virus. This virus can be reactivated at any time during life, but the risk increases as the immune system naturally get weaker as people grow older. Ninety-five per cent of adults aged 50 years or older already carry the virus that causes shingles. Shingles can be prevented through vaccination, but once they get the vaccine, patients may notice immune system reactions and short-term side effects. These normally disappear on their own in two-to-three days, and over-the-counter analgesics can help alleviate side-effects.

FEATURE | Winter vaccines

RSV

Respiratory syncytial virus (RSV) causes varying degrees of respiratory illnesses in all age groups. The RSV season in Ireland is usually from September to February. Immunisation against RSV is the best way to protect babies, according to the HSE, and during RSV season, one-in-two babies will contract RSV, says the Executive. RSV immunisation not only protects the health of babies, but also takes significant pressure off the hospital system. However, the negative effects of RSV are not limited to children. The RSV Vaccination Service is available to eligible patients who are aged 18 years or older and current national immunisation guidance recommends the RSV vaccination for those who are aged 75 years and older, and people aged over 60 years who have an additional risk factor for RSV disease, for example lung or heart disease, obesity, diabetes or a compromised immune system. RSV vaccination is not recommended routinely for all adults, and patients should discuss their suitability for adult RSV vaccination with a healthcare professional. Similar to children, adult RSV vaccination not only protects the health of the vulnerable, but also reduces the need for hospital bed occupancy. At the moment in Ireland, there is no mechanism for pharmacists to prescribe RSV immunisation. RSV is not considered a ‘typical’ vaccination, but rather is a long-acting monoclonal antibody. It is offered in maternity hospitals as part of routine care from the months of September through to February, and now also as a ‘catch-up’ programme in primary care through a GP practice, for example for infants born after March 2025 who were then entering the winter RSV season.

which was launched in August 2025 to provide protective monoclonal antibody immunisation against RSV to vulnerable infants in Ireland. Uptake in the community was 52 per cent and although as infants get older, RSV presentations are usually less significant, higher uptake would continue to reduce hospitalisations and free-up resources. The Pathfinder 2.0 programme followed-up from the Pathfinder 1 initiative, which led to a significant reduction in the number of reported infant RSV cases in the 2024/25 season, at 398 compared to previous seasons (2023/24 = 1,142; 2022/23 =997; 2021/22 = 801). Extracting data from electronic health records, pharmacists can interpret findings and examine determinants of uptake, for example whether the mother’s ethnicity, age or deprivation status play a role in their choice of whether or not to immunise. This data is then fed back to the HPSC by way of an annual report, allowing the HPSC to put measures in place to help support underrepresented cohorts for the following programme. For example, Irish and Roma Travellers have a poor uptake and there has been some work done with Pavee Point to try to improve outcomes for those communities. Community pharmacies have an important role in promoting the programme and administering RSV vaccines in the pharmacy with a prescription.

Benefits

The benefits of pharmacy-based vaccination are clear and have been outlined above, and pharmacists are also playing an important role in delivering

Signposting

The value and contribution of community pharmacists lies in this programme as a signposting role, to actively promote immunisation to eligible patients. Uptake in Irish hospitals was 88 per cent last year through the Pathfinder 2.0 programme,

Uptake in Irish hospitals was 88 per cent last year through the Pathfinder 2.0 programme

services to schools. There have also been indications that the shingles vaccination will become public at some point, and pharmacists will also play an vital role in that area. Pharmacists are also facilitating a range of new services, including the Common Conditions Service, Mediback, BowelScreen, contraception services, and more CPA25 initiatives are set to be delivered this year. Nationally, policy for increased delivery of healthcare in primary care is being progressed and it is a positive development that pharmacists’ and doctors’ skills are being leveraged for this evolving area of healthcare delivery. Pharmacists’ increasing involvement in delivering vaccinations has enabled GPs to tackle RSV backlogs, and this is in keeping with the concept of healthcare professionals working in teams to deliver the most efficient healthcare in the community.

Pneumonia

Vaccination against pneumonia helps protect patients against the effects of the pneumococcal bacteria. Pneumonia can be a life-threatening condition in older adults, especially those in old age, and other people at increased risk include those with diabetes, chronic heart/lung/liver/kidney disease, people with a missing spleen, or weakened immune systems. It is recommended for all adults aged over 65 years, as well as smokers and people with alcohol dependency. It can be administered at the same time as flu vaccination, with each vaccine administered in a different arm if necessary. The HSE National Immunisation Office (NIO) has published its Toolkit to Support the Administration of Flu Vaccination to Children in Primary Schools or Community Settings by Primary Care to support pharmacists and other healthcare professionals. In addition, the IPU offers several resources to support vaccination practices, and the PSI also updates its guidance when necessary. Check the HSE website for full details of the Autumn/Winter vaccination programme. ●

VOL 27 ISSUE 9 : SEPTEMBER 2026

ABRYSVO®: Powerful. Proven. ABRYSVO®: Powerful. Powerful. Proven. ABRYSVO®: Proven. 1, 2 RSV Protection. 1, 2 RSV Protection. 1, 2 RSV Protection. Abrysvo is indicated for: Abrysvo is indicated for: -Abrysvo Active immunisation lower respiratory indicated against for: - Activeisimmunisation against lower respiratory tract disease caused by respiratory syncytial tractimmunisation disease causedagainst by respiratory syncytial - Active lower respiratory virus (RSV) in infants from birth through virus (RSV) in infantsby from birth through tract disease caused respiratory syncytial 6 months of age following maternal 6 months age following maternal virus (RSV) inofinfants from birth through 1 immunisation during pregnancy. 1 immunisation during pregnancy. 6 months of age following maternal - Active immunisation ofofindividuals 18 years - Active immunisation individuals 1 18 years immunisation during pregnancy. of age and older of age and olderforforthe theprevention prevention of of lower lower - Active immunisation of individuals 18 years respiratory tract respiratory tractdisease diseasecaused causedby by RSV.11 of age and older for the prevention of lower 1 of this vaccine shouldbebeincaused inaccordance accordance with TheThe useuse of this vaccine should official respiratory tract disease bywith RSV. 1

recommendations.1 recommendations. The use of this vaccine should be in accordance with official RSV = respiratory syncytial 1 RSV = respiratory syncytial virus;virus; RSV-LRTD = recommendations. respiratory syncytial virus-associated lower respiratory tract disease RSV-LRTD = respiratory syncytial virus-associated lower respiratory tract disease

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PRESCRIBING INFORMATION RSV = respiratory syncytial virus; PRESCRIBING INFORMATION ▼This medicinal product is subject to additional monitoring. This will allow quick identification of new safety information. Healthcare professionals are asked to report any suspected adverse reactions. Refer to section 4.8 of the SPC for how to report adverse reactions. RSV-LRTD =product respiratory syncytial virus-associated respiratory tract disease Actor portrayal ▼This medicinal is subject to additional monitoring. This willlower allow quick identification of [bivalent, new safety information. Healthcare professionals are asked to report any suspected adverse reactions. Refer to section 4.8 of the SPC for how to report adverse reactions. Abrysvo®▼ powder and solvent for solution for injection (Respiratory syncytial virus vaccine recombinant])

Abrysvo®▼ powder and solvent for solution for injection (Respiratory syncytial virus vaccine [bivalent, recombinant]) Ireland Prescribing Information: Ireland Prescribing Information: Before prescribing Abrysvo please refer to the full Summary of Product Characteristics (SmPC). Presentation: Powder and solvent for solution for injection. The powder is white. The solvent is a clear, colourless liquid. Indications: is indicated for; active(SmPC). immunisation of pregnant individuals to protect infants from birth through to 6 months of age against lower respiratory tract disease caused by respiratory syncytial virus (RSV). Before prescribing Abrysvo please refer to the full SummaryAbrysvo of Product Characteristics Presentation: Powder and solvent for solution for injection. The powder is white. PRESCRIBING INFORMATION SeeisSmPC sections 4.2 and 5.1; and active immunisation individuals years of age and olderoffor the prevention of lower respiratory tractfrom disease caused bytoRSV. The useofofage thisagainst vaccinelower shouldrespiratory be in accordance with official recommendations. Dosage and The solvent a clear, colourless Indications: Abrysvo isofwill indicated for;18active immunisation pregnant individuals to protect infants birth through 6any months tract disease caused syncytial (RSV). ▼This medicinal product is subjectliquid. to additional monitoring. This allow quick identification of new safety information. Healthcare professionals are asked to report suspected adverse reactions. Refer to section 4.8 of the SPCby forrespiratory how to report adversevirus reactions. Administration: individuals: A single dose ofof 0.5individuals mL should be between weeks and 36 of gestation (seerespiratory SmPC sections and 5.1).caused Individuals 18 years age of andthis older: A single dose ofbe0.5inmL should be administered. need for revaccination See SmPC sections 4.2 Pregnant and 5.1;for and active immunisation 18administered years of age and [bivalent, older for 24 the prevention of lower tract4.4disease by RSV. Theofuse vaccine should accordance with official The recommendations. Dosage and Abrysvo®▼ powder and solvent solution for injection (Respiratory syncytial virus vaccine recombinant]) has not been established. Immunocompromised individuals: A single dose of 0.5 mL shouldweeks be administered. need for a(see second dose has not4.4 been (see SmPC section 5.1).and Paediatric safety efficacy of Abrysvo in children birth Administration: Pregnant individuals: A single dose of 0.5 mL should be administered between 24 and 36 The of gestation SmPC sections andestablished 5.1). Individuals 18 years of age older: Apopulation: single doseThe of 0.5 mLand should be administered. The need(from for revaccination Ireland Prescribing to less than Information: 18 years of age) have not yet been established. Limiteddose dataofare in pregnant adolescents andneed theirfor infants (see SmPC section 5.1). Method of administration: Abrysvo forPaediatric intramuscular injection into deltoid of the upper arm. vaccine has notprescribing been established. Immunocompromised single 0.5available mL should be administered. The second dose has not established (see SmPC section is5.1). population: Thethe safety andregion efficacy of Abrysvo in The children (from birth Before Abrysvo please refer to the fullindividuals: Summary ofA Product Characteristics (SmPC). Presentation: Powder andofasolvent for solution forbeen injection. The powder is white. should not be mixed with any other vaccines or medicinal products. For instructions on reconstitution and handling the medicinal product before administration, see SmPC section 6.6. Contraindications: Hypersensitivity to the active substance or to any of to than 18 of colourless age) have not yet been established. Limited data are available inimmunisation pregnant adolescents andindividuals their infants (see SmPC section 5.1).birth Method of administration: is for lower intramuscular injection into the deltoid region of the upper arm. The Theless solvent is years a clear, Indications: indicated for; active ofimprove pregnant infants from through to 6and months ofAbrysvo age against respiratory tractshould disease by respiratory syncytial virusvaccine (RSV). the xcipients listed in SmPCliquid. section 6.1. SpecialAbrysvo Warningsisand Precautions: Traceability: In order to the traceabilitytoof protect biological medicinal products, the name the batch number of the administered product be caused clearly recorded. Hypersensitivity and should not sections be mixed withand any5.1; other vaccines or medicinalofproducts. For18instructions reconstitution and handlingofoflower the medicinal product before administration, 6.6. Contraindications: Hypersensitivity to the active substanceDosage or to anyand of See SmPC and active immunisation individuals years ageonand olderinfor theof prevention tract disease caused by RSV.see TheSmPC use ofsection thisreactions: vaccine should be in accordance with official recommendations. anaphylaxis: 4.2 Appropriate medical treatment and supervision should always beof readily available case an anaphylactic eventrespiratory following the administration of the vaccine. Anxiety-related Anxiety-related reactions, including vasovagal reactions (syncope), the xcipients listed in SmPC section 6.1. Special Warnings and Precautions: Traceability: In order to improve the traceability of biological medicinal products, the name and the batch number of the administered product should be clearly recorded. Hypersensitivity and Administration: Pregnantorindividuals: A single dosemay of 0.5 mL in should be administered between 24 andresponse 36 of gestation (see SmPC sections 4.4 and 5.1). years of age single dose ofConcurrent 0.5 mL should be administered. The need for revaccination hyperventilation stress-related reactions occur association with vaccination as aweeks psychogenic to the needle injection. It is important thatIndividuals procedures18are in place to and avoidolder: injuryAfrom fainting. illness: Vaccination should be postponed anaphylaxis: Appropriate medical treatment and supervision should always be readily available in case of an anaphylactic event following the administration of the vaccine. Anxiety-related reactions: Anxiety-related reactions, including vasovagal reactions (syncope), has not been established. Immunocompromised individuals: A singlethedose of 0.5 of mLa should be administered. fornot a second not been established (see SmPC section Paediatric population: Theshould safetybeand efficacy of Abrysvo in childrenwith (from birth in individuals suffering from an acute febrile illness. However, presence minor infection, such as aThe cold,need should result indose the has deferral of vaccination. Thrombocytopenia and 5.1). coagulation disorders: Abrysvo given with caution to individuals hyperventilation or stress-related reactions may occur in association with vaccination as a psychogenic response to the needle injection. It is important thatofprocedures are inAbrysvo place tois avoid injury from fainting. Concurrent Vaccination should postponed thrombocytopenia any coagulation since bleeding or bruising may occur following an intramuscular to these individuals. Immunocompromised individuals: Safety and have been assessed inillness: immunocompromised individuals, to less than 18 years of age)orhave not yet beendisorder established. Limited data are available in pregnant adolescents andadministration their infants (see SmPC section 5.1). Method administration: forimmunogenicity intramuscular injection into the deltoid region of the upper arm.beThe vaccine in individuals suffering from an acute febrile illness. However, the presence of a minor infection, such as a cold, should not result in the deferral of vaccination. Thrombocytopenia and coagulation disorders: Abrysvo should be given with caution to individuals with including those receiving immunosuppressant therapy see SmPC sections 4.8 and 5.1). The efficacy of Abrysvo may be lower in immunosuppressed individuals. Individuals less than 24 weeks of gestation: Abrysvo has not been studied in pregnant individuals less should not be mixed with any other vaccines or medicinal products. For instructions on reconstitution and handling of the medicinal product before administration, see SmPC section 6.6. Contraindications: Hypersensitivity to the active substance or to any of thrombocytopenia or disorder since bruisingRSV maydepends occur following anofintramuscular these individuals. Immunocompromised individuals: Safety and immunogenicity assessed in immunocompromised individuals, than listed 24 weeks of coagulation gestation. protection ofbleeding the infant against on transfer maternal across of theto placenta, Abrysvo should be administered between weeks 24 and of administered gestation (seehave SmPCbeen sections 4.2 and 5.1).recorded. Limitations of vaccine the xcipients in any SmPC sectionSince 6.1. Special Warnings andorPrecautions: Traceability: In order to improveantibodies theadministration traceability biological medicinal products, the name and the batch number of36the product should be clearly Hypersensitivity and includingeffectiveness: those receiving immunosuppressant see SmPC sections and 5.1). The efficacy may beThis lower infollowing immunosuppressed individuals. Individuals lessmg) than weeks Abrysvo‘sodium has not been in pregnant individuals less As with any vaccine, a protective immune response may 4.8 notreadily be elicited after vaccination. medicinal product less than mmol sodiumAnxiety-related (23 per24dose, thatofisgestation: toAnxiety-related say essentially free’ . Thisstudied medicinal product contains anaphylaxis: Appropriate medical treatment andtherapy supervision should always be available in caseofofAbrysvo anExcipients: anaphylactic event thecontains administration of1the vaccine. reactions: reactions, including vasovagal reactions (syncope), than 24 weeks oforgestation. Since reactions protection ofallergic the infant against RSVwith depends on transfer of maternal antibodies the placenta, Abrysvo should(standard be administered between 24unadjuvanted), and 36 of gestation (see SmPC sections andor5.1). Limitations of vaccine polysorbate 80. Polysorbates may cause reactions. Interactions: Abrysvo can administered concomitantly; seasonal influenza dose adjuvanted or weeks hightodose with COVID 19 mRNA vaccines, with without highbe dose hyperventilation stress-related may occur in association vaccination asbe a psychogenic response toacross thewith needle injection. It isvaccines important that procedures are in place avoid injury from fainting. Concurrent illness:4.2 Vaccination should postponed unadjuvanted administered concomitantly. Amay minimum two weeks is recommended between administration of Abrysvo and a tetanus, diphtheria and that acellular vaccine (Tdap). There were no safetytoproduct concerns effectiveness: As with influenza any a protective immune response not be elicited vaccination. Thisnotmedicinal contains lessadministration than 1Thrombocytopenia mmol of sodium (23 mg) dose, is topertussis say essentially ‘sodium contains in individuals suffering fromvaccine, an vaccine acute febrile illness. However, the presence ofinterval a minorofafter infection, such as aExcipients: cold, should result in product the deferral of vaccination. andper coagulation disorders: Abrysvo should be free’ given. This withmedicinal caution individuals with when was co administered with Tdap in healthy non pregnantAbrysvo women. Immune responses toconcomitantly; RSV A, RSV B, diphtheria and tetanus on covaccines administration weredose non-inferior to thosehigh afterdose separate administration. However,19 themRNA immune responses to or thewithout pertussis polysorbate 80.Abrysvo Polysorbates may cause allergic reactions. Interactions: be administered with seasonal (standard adjuvanted unadjuvanted), with with high dose thrombocytopenia or any coagulation disorder since bleeding or bruising may occurcan following an intramuscular administration to theseinfluenza individuals. Immunocompromised individuals:orSafety and immunogenicity haveCOVID been assessed invaccines, immunocompromised individuals, components were lower onadministered co administration compared toAseparate administration andweeks did notis meet the criteria forbetween non inferiority. The clinicalofrelevance ofand thisadministration finding is unknown. Fertility, pregnancy and lactation: Pregnancy: Data on pregnant women (moreno than 4 000concerns unadjuvanted influenza vaccine concomitantly. minimum interval of two recommended administration Abrysvo of a tetanus, diphtheria and acellular pertussis vaccine (Tdap). There were safety including those receiving immunosuppressant therapy see SmPC sections 4.8 and 5.1). The efficacy of Abrysvo may be lower in immunosuppressed individuals. Individuals less than 24 weeks of gestation: Abrysvo has not been studied in pregnant individuals less exposed outcomes) indicate no malformative nor feto/neonatal toxicity. Results from responses animal studies withA, Abrysvo not indicate direct or indirect effects with respect to reproductive (see SmPC section 5.3). InHowever, a phase 3 study (Study 1), maternal adverse when24 Abrysvo was co administered with Tdap of in healthy nonagainst pregnant women. Immune to RSV RSV B,dodiphtheria and tetanus on coharmful administration were non-inferior toweeks thosetoxicity after separate administration. the immune responses to theofpertussis than weeks of gestation. Since protection the infant transfer of maternal antibodies across placenta, Abrysvo shouldinbe administered between 24incidences and 36 ofofgestation (see SmPC sections 4.2 and after 5.1). Limitations vaccine events reported within 1 month after vaccination were similar RSV inadministration thedepends Abrysvo on group (14%) thethe placebo group (13%). Nothe safety signals were detected infants up tois 24 months of age. Thepregnancy adverse events reported within month birth in infants components were lowerany on co administration compared toresponse separate and did notand meet criteria for non inferiority. The clinical relevance of this finding unknown. Fertility, and lactation: Pregnancy: Data on1pregnant women (more than 4 000 effectiveness: As with vaccine, a protective immune may not be elicited after vaccination. Excipients: This medicinal product contains less than 1 mmol sodium (23 mg) per dose, that is to say essentially ‘sodium free’ . This medicinal product were similarindicate in the Abrysvo group (38%)nor andfeto/neonatal the placebo group (35%). Majorfrom birthanimal outcomes assessed in the Abrysvo group compared to indirect placebo harmful includedeffects premature birth (207to (6%) and 172 (5%), respectively), low birth weight (186 (5%) and3158 (4%), respectively) andcontains exposed outcomes) no malformative toxicity. Results studies with Abrysvo do not indicate direct or with respect reproductive toxicity (see SmPC section 5.3). In a phase study (Study 1), maternal adverse polysorbate 80. Polysorbates may(6%) cause reactions. Interactions: Abrysvo be administered concomitantly; seasonal influenza vaccines (standard dosebeen adjuvanted high dose unadjuvanted), with COVID 19Fertility: mRNA vaccines, high dose congenital anomalies (205 andallergic 245 (7%), respectively). Breast-feeding: It iscan unknown Abrysvo is excretedwith in human No adverse effects of shown inorbreastfed of vaccinated mothers. No humanwith dataor onwithout the effect events reported within 1vaccine month after vaccination were similar in minimum the Abrysvo group andwhether theisplacebo group (13%). No safetymilk. signals were detected inAbrysvo infants have up to 24ofmonths of age. Thenewborns incidences of adverse events reported within 1 month birth concerns in infants unadjuvanted influenza concomitantly. interval of(14%) twoharmful weeks recommended of Abrysvo and administration tetanus, diphtheria and acellular pertussis (Tdap). There wereafter no site safety of Abrysvo on fertility are administered available. Animal studies do notAindicate direct or indirect effects with respectbetween to female administration fertility (see SmPC section 5.3). Undesirable Effects:aThe most frequently reported adverse reactionsvaccine were fatigue (33%), vaccination pain were similar in the Abrysvo group (38%) and the placebo group (35%). Major birth outcomes assessed in the Abrysvo group compared to placebo included premature birth (207 (6%) and 172 (5%), respectively), low birth weight (186 (5%) and 158 (4%), respectively) and when Abrysvo co administered with Tdap healthy non pregnant women. Immunewere responses to RSV A,inRSV B, diphtheria andwithin tetanus coofadministration were non-inferior to those after separate However, the immune responses the pertussis (27%),was headache (24%), myalgia (21%) andinarthralgia (10%). The majority of reactions mild to moderate severity and resolved 1-3on days onset. Immunocompromised individuals 18 years of age andadministration. older: Reactogenicity was consistent with the knowntoprofile congenital anomalies (205 (6%) and 245 (7%),safety respectively). Breast-feeding: It is unknown whether Abrysvo is excreted in human milk. No adverse effects of prescription Abrysvo been shown in breastfed newborns of vaccinated mothers. Fertility: No human data the 4effect components were lower co administration to separate andfordid not meet the criteria for non inferiority. The clinical relevance of to this findinghave is unknown. pregnancy and Package lactation: Pregnancy: on pregnant womenNumbers: (moreonthan 000 of Abrysvo. Thereonwere no unexpected compared findings. Refer toadministration SmPC section 4.8 further information on side effects. Legal Category: Product subject which mayFertility, not be renewed (A): S1A. quantities andData Marketing Authorisation of Abrysvo ondose fertility are available. Animal studies doFor notfurther indicate directResults or indirect harmful effectscontact: withAbrysvo respect to female fertility (see section 5.3). Undesirable Effects: The mostFor frequently reported reactions were fatigue vaccination pain One pack with needle; EU/1/23/1752/001. information on this please Pfizerdo Medical Information onorSmPC 1800 633 363 or ateffects medical.information@pfizer.com. queries(see regarding product please Pfizer exposed outcomes) indicate no malformative nor feto/neonatal toxicity. frommedicine animal studies with not indicate direct indirect harmful with respect to reproductive toxicity SmPCadverse sectionavailability 5.3). In a phase 3contact: study(33%), (Study 1),Healthcare maternalsite adverse (27%), headache (24%), myalgia (21%) and arthralgia (10%). TheRingsend majority of reactions tothe moderate ingroup severity andNo resolved daysdetected of onset. individuals 1817,years of age and older: Reactogenicity was consistent thebirth known profile Ireland Unlimited Company, The Watermarque Building, Road, Dublin 4,(14%) D04mild K7N3 + 353 1 4676500. Marketing Authorisation Holder: Pfizer Europe MA EEIG, de la 1050 Bruxelles, Belgium events reported within 1 month after vaccination were similar in the Abrysvo groupwere and placebo (13%). safetywithin signals1-3 were inImmunocompromised infants up toBoulevard 24 months ofPlaine age. The incidences of adverse events reported within 1 monthwith after in infants of Abrysvo. There were no unexpected safety findings. Refer to SmPC section 4.8 for further information on side effects. Legal Category: Product subject to prescription which may not be renewed (A): S1A. Package quantities and Marketing Authorisation Numbers: Dateinofthe Preparation: 06/2026 were similar Abrysvo group (38%) and the placebo group (35%). Major birth outcomes assessed in the Abrysvo group compared to placebo included premature birth (207 (6%) and 172 (5%), respectively), low birth weight (186 (5%) and 158 (4%), respectively) and One doseRef: pack with EU/1/23/1752/001. For further information on this contact: MedicalinInformation 633 effects 363 or of at Abrysvo medical.information@pfizer.com. For queries regarding productmothers. availability pleaseNocontact: PfizeronHealthcare bAB 9_0needle; congenital anomalies (205 (6%) and 245 (7%), respectively). Breast-feeding: It ismedicine unknownplease whether AbrysvoPfizer is excreted human milk.on No1800 adverse have been shown in breastfed newborns of vaccinated Fertility: human data the effect Ireland Unlimited Company, The Watermarque Building, Road, 4, D04 K7N3effects + 353 1with 4676500. Marketing Holder: Pfizer5.3). Europe MA EEIG,Effects: Boulevard la Plaine 17, 1050 Bruxelles, Belgium of Abrysvo on fertility are 1.available. Animal studies do notRingsend indicate directDublin or indirect harmful respect to femaleAuthorisation fertility (see SmPC section Undesirable Thedemost frequently reported adverse reactions were fatigue (33%), vaccination site pain REFERENCES: Abrysvo Summary of Product Characteristics. Date of Preparation: 06/2026 (27%), headache (24%), (21%) C, andMorrison arthralgiaK,(10%). majority of reactions were mild to impact moderate severity and resolved within days ofinonset. Immunocompromised individuals 18 years of age and older: Reactogenicity was consistent with the known profile Hameed SS,myalgia Robertson et al.The Early evidence of RSV vaccination oninhospitalisation rates of older1-3people Scotland. Lancet. 2025. https://doi.org/10.1016/S1473-3099(25)00064-7. Ref: bAB 2. 9_0 of Abrysvo. There were no unexpected safety findings. Refer to SmPC section 4.8 for further information on side effects. Legal Category: Product subject to prescription which may not be renewed (A): S1A. Package quantities and Marketing Authorisation Numbers:

JUL2026 One dosePP-A1G-IRL-0120 pack with needle; |EU/1/23/1752/001. For further information on this medicine please contact: Pfizer Medical Information on 1800 633 363 or at medical.information@pfizer.com. For queries regarding product availability please contact: Pfizer Healthcare REFERENCES: 1. Abrysvo Summary of Product Characteristics. Ireland Unlimited Company, The Building, Ringsend Road, 4, D04 K7N3impact + 353 1 4676500. Marketing Authorisation Europe MA EEIG, Boulevard de la Plaine 17, 1050 Bruxelles, Belgium 2. Hameed SS, Robertson C,Watermarque Morrison K, et al. Early evidence ofDublin RSV vaccination on hospitalisation rates of olderHolder: peoplePfizer in Scotland. Lancet. 2025. https://doi.org/10.1016/S1473-3099(25)00064-7. Date of Preparation: 06/2026 PP-A1G-IRL-0120 | JUL2026 Ref: bAB 9_0

COMMENT | Opinion

Advocates for change

know that pharmacists are generally a bunch of caring professionals who try to do their best for the patients we are serving. Personally, I try not to get too caught up in the emotive side of looking after people, not because I am unfeeling, but rather because I view emotional wear and tear as a genuine workplace hazard akin to any other kind of mental health stress.

VOL 27 ISSUE 9 : SEPTEMBER 2026

Image: iStock.com/ Dimensions

Fintan Moore offers a practical suggestion for dealing with scrawled and illegible prescriptions

Opinion | COMMENT

For any healthcare worker, it can be a risk to care too much. My approach is to keep an emotional distance from the patient’s situation, and focus my energy on doing everything that I can practically and reasonably do to resolve any issues they might encounter in relation to accessing medication. My idea of what is reasonable might stretch beyond (or fall short) of what other pharmacists think, but I see my role as being a problemsolver rather than a carer. There is one specific hard-to-solve problem that does grind my gears, and likewise that of every community pharmacist in the country, namely the staggering inability of so many hospital doctors to write a clear and legally-valid controlled drug prescription. Yes, I know the doctors are busy in a challenging and under-resourced environment with multiple demands on their time and attention, but it takes about five seconds more to write a legal prescription than it takes to lash out a piece of scrap paper. To spend that extra five seconds does take a degree of care, along with the basic commonsense to realise the knock-on problems that an incorrectly written CD prescription creates down the line for the discharged patient when they present it at a pharmacy. The only legally-valid option the pharmacist has is to refuse to dispense a non-legal prescription with the resultant impact on the blameless patient. The ethical argument can be made that it’s in the best interests of the patient to dispense if the prescriber’s intent is clear, but that is still not a legal action. The really galling thing is that any sloppy doctors can scrawl as many illegal prescriptions as they want with no legal consequences. For what it’s worth, all the major hospitals seem to have a Patient Advocacy Department, dedicated to resolving issues where failures on the part of the hospital have led to adverse consequences for patients. Like the hospitals themselves, these departments seem to vary in quality, but a while back I was very impressed with the people in Tallaght Hospital.

VOL 27 ISSUE 9 : SEPTEMBER 2026

After I had spent two wasted days trying to clarify a CD prescription with the emergency department, I emailed a complaint to Patient Advocacy. Within an hour I had a phone call from one doctor getting more details, followed shortly after by a call from another doctor (getting the same information again), followed about an hour later by a call from the actual prescriber who had previously been uncontactable. So, as a suggestion, every time we end up sorting out the fallout from a dud prescription, we should email Patient Advocacy with the details of how patient care was delayed or otherwise compromise, and let them follow up.

Testing patience (instead of patients)

Another recurring problem where the patient and the pharmacist get chewed in the teeth of the State bureaucracy arises when a pregnant woman gets diagnosed with gestational diabetes and needs extra test strips. Some GPs and their teams are really efficient at sorting out the request for approval of additional strips, but some of them not so much. I currently have one patient who was given a Coombe prescription for extra strips at the end of July, and three weeks later was still waiting on the GP to sort the approval. What seems to happen every time she contacts the GP surgery is that we get a freshly Healthmailed prescription for five boxes of strips, so we Healthmail back to remind them again regarding the lack of approval… and then nothing happens. In fairness to this particular GP practice, they are usually very good at negotiating the PCRS hoops and at responding to queries, so it may be a holiday blip. It is nevertheless both head-wrecking and time-wasting for us and the patient. I have also learned the hard way over the years that the PCRS don’t care if a patient was provably pregnant when she got extra strips — unless she had approval in place

... a while back, I was very impressed with the people in Tallaght Hospital

at the time of dispensing, the strips will not be paid for. It’s obviously not fair or reasonable, but ours is not to reason why.

Stick on satisfaction

One of the cheapest, simplest things you can do to make your pharmacy a happier place is to buy a few sheets of stickers for children. Kids aren’t too choosey, so anything from animals to rainbows to sunshine will work, preferably a choice of all of the above and any others you can find. So, if a kid has been really good at letting you look at their cut hand, or the rash on their tummy, or getting their flu vaccination squirted up their nostrils, then you have an immediate small reward for them. Even if a child has just been quiet and well-behaved while waiting in the pharmacy, a sticker can be a nice way to acknowledge that. It can also be a handy way to defuse a looming battle if a toddler has got their hands on something bright and colourful that they don’t want to relinquish — a brief negotiation involving a proffered set of stickers can resolve the situation amicably and save a grateful parent from a meltdown. To kind of quote Neville Chamberlain, ‘Peace in our time — peace with sticky, shiny paper’. ●

Fintan Moore graduated as a pharmacist in 1990 from TCD and currently runs a pharmacy in Clondalkin. His email address is: greenparkpharmacy @gmail.com.

COMMENT | Opinion

Paws for thought Dr Des Corrigan casts his eye over herbal remedies for pets and other animals

eading a recent Irish Times business section feature on the potential of herbal medicine in veterinary practice made me realise that in all the articles I have written about herbs, I have never mentioned their use in domestic, farm or wild animals up to now. This got me thinking about what natural remedies could be used alongside conventional veterinary medicines. The results of my desktop research, thanks to PubMed, were surprising and intriguing. A 2019 review in the Journal of Ethnopharmacology looked at research studies validating medicinal plants used in Canada for pet diseases and wild animals. Among the key conditions covered in the review and in other papers were sedation and anxiety, digestive issues, and also arthritis and joint pain. When it comes to anxiety in pets, two well-known plants feature prominently, just as they do in human medicine. They are Valerian root and Passiflora (Passion Flower) herb. A specified dry extract of Valerian is recognised by the EMA as having a Well-Established Use as a herbal medicinal product for the relief of mild nervous tension and sleep disorders, based on human clinical trial evidence. Other extracts and the powdered root are recognised as traditional herbal medicinal products for the relief of mild symptoms of mental stress and to aid sleep because the evidence from clinical trials was deemed insufficient, although studies in animals support pharmacological plausibility. A 2017 article in BMC Veterinary Research recommends the use of Valerian to enrich the quality of life of cats, especially if they are bored. The

compound actinidine in Valerian triggers a positive response in 50 per cent of cats due to olfactory stimulation similar to that induced by catnip (Nepeta cataria), which was active in 66 per cent of cats tested. Passiflora is also recognised by the EMA, having the same traditional indication claim as Valerian. It was not given WEU status because the numerous clinical trials were seen as being of low quality, but pre-clinical pharmacological studies in rodents did show sedative and anxiolytic effects. While products containing either plant on its own or in combination would be obvious candidates for recommending to pet owners at Halloween in particular,

the literature highlights other uses for the two herbal remedies. A 2022 paper in Animals looked at the use of the tranquilising effect of Passiflora as a way of preventing damaging tail biting by weanling pigs. Compared to a control group, those piglets given Passiflora had significantly fewer ear lesions, exhibited less-aggressive behaviour, and had lower cortisol levels. Weight gain was similar in both groups, whereas a 2017 study in Applied Animal Behavioural Science found that pigs given a mixture of Valerian and Passiflora showed a significant rise in body weight compared to controls that was attributed to the tranquillising effect

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Opinion | COMMENT

of the plants which reduced aggression, thereby transferring energy to growth rather than negative behaviour. A 2026 paper in Frontiers in Veterinary Science investigated the composition and effect of a proprietary multicomponent natural veterinary medicinal product used to reduce stress in horses, pigs, goats, sheep, dogs and cats. This product consists of a mixture of earlystage homoeopathic dilutions (D2) of extracts of Passiflora, oats, coffee and the zinc salt of isovalerenic acid — a constituent of valerian. Even though they are diluted, they still contained measurable quantities of key chemicals upon analysis. The product was tested in Siberian sled dogs undergoing rigorous race training, resulting in a significant reduction in exercise-induced cortisol and gastrin levels. Passiflora also featured in a 2025 article the same journal that evaluated the efficacy of a nutraceutical supplement also containing both the adaptogen Withania (Ashwagandha) and dandelion on inflammatory markers and oxidative stress in older dogs. These were given the supplement for 40 days, resulting in significant reductions in the levels of CRP and IL-6 and IL-10 cytokines compared to baseline, as well as an increase in total antioxidant activity. The researchers also concluded that quality of life improved in the seven ageing dogs. These findings are particularly significant because the literature suggests that 20 per cent of pet dogs and 93 per cent of cats develop osteoarthritis based on US figures. Thus, there is a lot of interest in alternatives to standard NSAIDs. Extracts from plants such as Devil’s Claw, frankincense (Boswellia) and turmeric that are known to be

Several clinical trials in domestic pets with osteoarthritis have been published

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effective in humans with osteoarthritis are obvious candidates for inclusion in pet remedies. Another natural but non-plant option that has received much research attention is the Green-Lipped Mussel (GLM) from New Zealand. Freeze-dried powdered mussel or an oil extract of it contains a mixture of bioactive lipids such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), known to inhibit both COX and LOX cascades of arachidonic acid metabolism. According to a 2021 systematic review in Inflammopharmacology, based on nine human studies involving 452 participants with radiologically confirmed osteoarthritis of the hip or knee, GLM extracts provided moderate and clinically-significant effects on a VAS pain scale and improved GIT symptoms in patients taking antiinflammatory medicines. Several clinical trials in domestic pets with osteoarthritis have been published. In a 2009 RCT published in the journal ECAM, a GLM product showed significant improvement in veterinarian-assessed mobility and a pain VAS evaluated by owners of 45 dogs with a radiographic diagnosis compared to placebo, but it was not as effective as carprofen. The Canadian Journal of Veterinary Research in 2013 reported on a trial with 23 dogs with osteoarthritis given a control diet for 30 days followed by a GLM-enriched one for 60 days. The gold standard for assessing osteoarthritis in dogs is apparently Peak Vertical Force (PVF), which improved significantly after GLM but showed no change after the control diet. Owner-assessed pain questionnaires and motor activity also significantly improved between day 0 and day 90. Less-favourable results were reported from a 2022 study in Veterinary Medicine and Science, in which 32 dogs and 16 cats were enrolled in a double blind, randomised crossover trial for 10 weeks in cats and 16 weeks in dogs, where they were treated with a supplement containing GLM, curcumin

and blackcurrant leaf extract. Only partially positive effects in both species were reported by both owners and veterinarians. An industryfunded RC T comparing the efficacy of a proprietary product containing GLM plus krill oil extract with meloxicam in 101 dogs appeared in Frontiers in Veterinary Science in 2024. After six weeks, the PVF values as a percentage of body weight were significantly greater than at baseline for both the supplement and the meloxicam compared to placebo. In addition, the lowest orthopaedic assessment scores, signifying reduced impairment, were also in the GLM/krill and meloxicam groups. That same year a study in Veterinary Record suggested that GLM extracts in the diet of aged non-domestic cats kept in captivity (tigers, etc) resulted in them taking significantly more steps per minute. On the basis of the evidence, there is clear potential in this area and it might be worthwhile for both urban and rural pharmacists to take a more detailed look at what might turn out to be a positive revenue stream. ●

Dr Des Corrigan, Best Contribution in Pharmacy Award (winner), GSK Medical Media Awards 2014, is an Adjunct Associate Professor at the School of Pharmacy and Pharmaceutical Sciences at TCD where he was previously Director and won the Lifetime Achievement Award at the 2009 Pharmacist Awards. He was chair of the Government’s National Advisory Committee on Drugs from 2000 to 2011, having previously chaired the Scientific and Risk Assessment Committees at the EU’s Drugs Agency in Lisbon. He chaired the Advisory Subcommittee on Herbal Medicines and was a member of the Advisory Committee on Human Medicines at the HPRA from 2007 to 2024. He has been a National Expert on Committee 13B (Phytochemistry) at the European Pharmacopoeia in Strasbourg and served on the editorial boards of a number of scientific journals on herbal medicine.

COMMENT | Opinion

Could ‘skinny-pens’ treat addiction? Emerging evidence from basic research has pointed to GLP-1 receptors as a possible target for developing new pharmacological treatment options for addiction, writes Terry Maguire

is, a positive molecule. It is responsible for identifying positive options, making plans, setting goals, and motivating the chase towards these goals through rewards that focus our activity. Where dopamine gets over-egged, we get problems.

Ropinirole on the BBC

Addicted to addiction

I remain fascinated by addiction, or Substance Use Disorder (SUD), as it is now known; that less pejorative, not so stigmatising, more caring moniker. The incredible power of a molecule to take control of a person, so absolutely, so completely, is something truly to be feared. Addiction remains poorly understood, which is surprising given the excessive and obscene investment in addiction research over recent years. We still only, it seems, have a general idea, a lot of ideology, plenty of empathy, and some small hope for those caught in this unfortunate snare of the human condition. It’s accepted that addiction is an artifact of brain structures that develops due to a combination of genetic predisposition and environmental stresses. Dopamine, ‘the molecule of more’, is key to the emergence of the brain systems of addiction at the cost of personal wellbeing, family and community. The addict is more selfish than a two-year-old in a toy shop. Dopamine should be, and for most of us

In February this year, the BBC reported on an increasing problem with the use of Ropinirole, the dopamine receptor agonist (DRA) drug used in Parkinson’s disease and in restless leg syndrome. Patients using the drug find they develop impulse control disorders manifesting as addictions to shopping, gambling, food, and sex. BNF warns that all DRA drugs have a similar potential and the impact is very real, with patients losing tens of thousands of pounds, being found guilty of sex offenses, becoming shopaholics, and some losing their jobs. One patient told BBC she felt “there was something controlling me". She was right; it was dopamine.

‘Liking’ becomes ‘wanting’

As an individual becomes more addicted, ‘wanting’ will overshadow ‘liking’ and eventually becomes independent of ‘liking’. ‘The dark side’ theory of addiction says that impulsivity, compulsivity and negativeurgency are derived from stress experienced during withdrawal. The neurocircuitry identified involves several neuropeptides but dopamine is prominent in the immediate reinforcing/ rewarding effects of drugs, giving us ‘the dopamine theory’ of addiction. One way or other, all drugs of addiction increase dopamine activity in specific brain regions. Blocking

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Image: iStock.com/ JDawnInk

e gave his initials sometimes as LV, at other times LB, and his date of birth varied between July ’94 and July ’96. He visited the pharmacy frequently after his release from prison, normally falling through the door; advancing up the shop with a gyrating gait as if arresting a fall down a steep embankment. He swept towards our consultation area beside the dispensary, gesturing with pointed finger to whoever was standing around that he wished access to our needle and syringe exchange scheme. There was a serious intensity pained on his face. He could not stand still, moving backwards and forwards from foot-to-foot. I asked what he wanted and when, following a number of attempts, his wishes remained unclear, I handed him a 0.5ml syringe pack (needles with associated paraphernalia), as acute and excessive cocaine use could be the only explanation for this mental and physical manifestation. Accepting the pack, he ripped it open, removing only items of interest. Had I got a bag, he would ask. I did, but I always insisted he took the Cin-Bin, knowing it would end up in a nearby litter bin. If it was Thursday, he would return to the main shopping area and at the edge of the counter extract from his anorak a large wodge of bank notes, mostly £20s, and studiously sort them into three neat piles. The largest was rolled up and placed into a zipped pocket in an inner jacket. The medium one was rolled and stuffed into a trouser pocket, and the smallest pile was rolled and put into the outer pocket of his anorak. All the while he fidgeted, stepped back and forward, and was oblivious to all around him. He exited as he entered.

Opinion | COMMENT

dopamine might offer a treatment for addiction, but so far that theory has proved too simplistic.

sufficient money so they don’t need to turn to criminal behaviour to feed their habit, as JB or JV demonstrated every Thursday.

Treatment of addiction

Medicines

For centuries, society tried stigmatising addicts, locking them up and generally making their lives a living hell when in fact no-one, other than addicts themselves, seemed to realise that they were already living in a hell and society was only making things worse. When, as a more enlightened generation, we found the putative approach generally unsuccessful, we changed tact. We sought to recognise addiction as a disease so we can treat it like cancer or asthma and we cared for and empathised with the addict without blaming them. In principle, and generally, this is a good and humane thing.

Harm reduction

Pharmacy as a profession, has, over the short period of my career, totally changed its attitude towards the addict. For a profession set up to control access to addictive drugs while retaining professional empathy, before the 1980s we mainly policed access. We retain this role but now we also support addicts with clean needles and other drug-taking paraphernalia, distribute naloxone to revive addicts in overdose, and of course observe substitution medicine taking so they can get some relief from the horrors of withdrawal and hopefully move into recovery. Pharmacy is core to the harm reduction approach. In addition, addicts are provided with

Pharmacy as a profession, has, over the short period of my career, totally changed its attitude towards the addict

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Pharmacological treatments for addiction exist for opioids, tobacco and alcohol. But no medication is approved for treatment of cocaine or other stimulant use disorders. Even when pharmacotherapy is available, success rates are modest to say the least. In the case of opioids and tobacco, it is the drug itself that is used but in a less addictive delivery formulation as the speed of delivery to the brain is key to addiction. Alcohol is much too toxic so currently, approved medications to treat alcohol use disorder — disulfiram, naltrexone and acamprosate — reduce drinking through different mechanisms of action: (i) unpleasant effects when consuming alcohol, (ii) reduced rewarding/ reinforcing effects of alcohol, and (iii) reduced negative state when abstinent.

GLP-1s

Glucagon-like peptide 1 (GLP-1), beyond its spectacular rise to fame in obesity management, is receiving much attention in the treatment of addiction. Observational studies in humans and animals suggest it reduces the compulsion associated with addiction and might be helpful as a treatment tool. GLP-1 increases insulin secretion, inhibits glucagon secretion, slows gastric emptying and reduces appetite. GLP1 is also produced in the brain stem and released as a neurotransmitter in several brain regions, including brain regions believed to be involved in reward and addiction. It reduces the reward associated with an activity and is thought to directly suppress dopamine activity in the brain’s reward centres. It is not acting directly as a dopamine receptor antagonist, but is doing so indirectly. One of the possible mechanisms proposed for GLP-1s to suppress cocaine self-administration involves modulation of stress systems. Studies suggest that activation of stress systems contributes to the addictive effects of various drugs,

in the withdrawal and ‘negative affect’ stages of addiction. Emerging evidence from basic research has pointed to GLP-1 receptors as a possible target for developing new pharmacological treatment options for addiction. Overall, preclinical research has identified potent reductions in substance use and attenuation of drug-seeking behaviour with several different GLP-1 receptor agonists. However, it’s unlikely that the current GLP-1s used for obesity management will be of much clinical use. They are known to cause pancreatic problems and acute weight loss, so not ideal for someone with a poly-drug addiction.

Too late for some

For JB, or is it JV, it’s a bit late anyway. He did come to us some years ago before prison and was doing well on methadone for his opioid addiction. He had a slip on his road to recovery. Prison opened up a myriad of new drug options and on release, cocaine was his problem. When he died at the age of 33, on a Sunday in April this year, cocaine, alcohol and benzodiazepines were identified in his system. Poly-drug deaths, it seems, are now the norm and it's unlikely that we will see a pharmacological breakthrough anytime soon. I do worry we are too focused on harm reduction. For a society wishing to ignore the ‘pests’ on the streets and not have them break into their homes and steal their TV, it might be the convenient policy. For the addict, greater focus on the more difficult and, lets be honest, less palatable and potentially more expensive ‘recovery’ approach would be better if we really want to save lives. ●

Terry Maguire owns two pharmacies in Belfast. He is an honorary senior lecturer at the School of Pharmacy, Queen’s University Belfast. His research interests include the contribution of community pharmacy to improving public health.

COMMENT

| Opinion

Who cares for the carers? e have become much better at recognising neurodiversity in recent years. Conversations that were once confined to schools and specialist services are now taking place in workplaces, universities and healthcare settings. We are slowly learning that there is no single ‘right’ way for a brain to process information, communicate, or interact with the world. As pharmacists, we rightly strive to make our pharmacies more welcoming for neurodivergent patients. We think about sensory overload, communication preferences and creating environments that reduce anxiety rather than increase it. Every patient deserves to feel safe, respected and understood. But there is another conversation that deserves our attention. What if some of the people behind the pharmacy counter are neurodivergent too? The reality is that many adults reach their 30s, 40s or 50s before receiving a diagnosis of autism or ADHD, while many others never seek one at all. They have simply spent years adapting to workplaces that were never designed with their way of thinking in mind. Pharmacy may be one of the professions that naturally attracts these individuals. The attention to detail, love of systems, pattern recognition, deep clinical knowledge, and commitment to getting things exactly right are strengths that many neurodivergent people bring in abundance. Yet modern community pharmacy can also present some of the greatest challenges. It is difficult to think of another healthcare setting where the sheer number of interruptions is considered normal. A pharmacist may be clinically checking prescriptions while simultaneously answering questions from staff, responding to patients at the medicines counter, taking phone calls

from GP practices, managing medicine shortages, supervising vaccinations, and making countless decisions that directly affect patient safety.

Mental effort

Every interruption comes with a cognitive cost. For some pharmacists, switching between these demands is simply part of the job. For others, particularly those who are neurodivergent, that constant shifting of attention requires immense mental effort. It may not be visible to colleagues or patients, because years of experience have taught them how to mask the exhaustion that comes with it. The pharmacist who appears calm and composed may be working extraordinarily hard just to filter out background noise, organise competing priorities, and maintain the level of concentration required to ensure every prescription is safe. Ironically, the very qualities that make someone an excellent pharmacist can also leave them

vulnerable to becoming overwhelmed by the environment in which they work. None of this should be mistaken for an argument that standards should change. Patient safety must always remain our highest priority. But recognising neurodiversity within the profession invites us to ask different questions. Could we design dispensaries that minimise unnecessary interruptions? Could we create quieter spaces for clinically demanding tasks? Could we acknowledge that different communication styles do not equate to different levels of competence? Could managers receive greater awareness of how neurodivergence presents in adults, particularly in highly capable professionals who have spent years developing strategies to cope? These changes would not only benefit neurodivergent pharmacists. They would improve working conditions for everyone. There is also a message for the public. Most patients are kind, patient and appreciative. They understand that healthcare is under pressure and that pharmacists are balancing far more than simply handing over medicines. Occasionally, however, frustration spills over. A prescription takes longer than expected. A pharmacist pauses before answering a question. Someone appears quieter or less conversational than anticipated. We are quick to remind ourselves that the person standing in front of us may have an invisible disability or be carrying burdens we cannot see. It is worth remembering that the same may be true of the person standing behind the counter. Grace should not be reserved solely for patients.

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Image: iStock.com/ DrAfter123

Áine Mac Grory wonders about the cognitive cost of working in a pharmacy for neurodivergent people

Opinion | COMMENT

Inclusion

Healthcare professionals are human beings too. They bring their strengths, challenges, personalities and differences to work every day. Some of those differences may never be formally recognised, yet they shape how individuals experience an increasingly demanding profession. The conversation around neurodiversity has taught us that inclusion is rarely about lowering expectations. It is about removing unnecessary barriers so people can contribute their strengths. Community pharmacy has always been built on compassion, professionalism and trust. Maybe the next step in that journey is recognising that neurodiversity is not only something we support in those we care for. It is something that almost certainly exists within our own profession, quietly contributing to patient care every single day. If we truly believe that every brain has value, then that belief should extend to the pharmacists caring for our communities as much as it does to the communities themselves.

Is community pharmacy designed for neurodivergent minds?

Community pharmacy has always attracted people who care deeply about getting things right. We are trained to notice the details others might miss. We are expected to spot prescribing anomalies, identify drug interactions, recognise patterns, remember obscure clinical guidance and make safe decisions under pressure. Accuracy is not simply desirable in our profession, it is fundamental to patient safety. It makes me wonder whether community pharmacy naturally attracts a particular way of thinking. We do not know how many pharmacists are neurodivergent. Many autistic adults remain undiagnosed until later in life, while others never

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seek a formal diagnosis at all. ADHD is similarly under-recognised, particularly in professionals who have developed highly effective coping strategies. Therefore, we should be cautious about making assumptions regarding prevalence. Yet it is difficult to ignore that many characteristics associated with excellent pharmacists overlap with strengths commonly described in neurodivergent cognition. The capacity to develop deep specialist knowledge or ‘special interests’ in areas such as pharmacology, therapeutics, antimicrobial stewardship or medicines optimisation. These qualities are celebrated within pharmacy because they make us safer clinicians. The irony is that the environment in which pharmacists now work often demands almost the opposite. The pharmacist is expected to remain clinically precise while simultaneously switching between multiple competing demands, maintaining a calm demeanour, communicating effectively with every person who walks through the door, and completing an evergrowing list of administrative tasks. We have become so accustomed to this environment that we rarely stop to ask a simple question: Is this actually the best way to work? Or have we normalised a system that asks too much of every pharmacist, particularly those whose brains naturally favour sustained concentration over constant task-switching?

complex task to another, the brain must disengage, retain information, reorient itself and resume the original activity. For work requiring high levels of accuracy, these repeated context switches are not trivial inconveniences, they consume cognitive resources. For many neurodivergent people, that cognitive cost may be even greater. Autistic people often describe expending significant mental energy filtering sensory information, adapting to changing demands and recovering from unexpected interruptions. None of this is visible from the outside. Patients simply see a calm pharmacist answering questions and checking prescriptions. What they do not see is the invisible workload occurring alongside the visible one. This is where masking becomes important. Masking is often misunderstood as pretending not to be autistic. In reality, it is the continual process of adapting natural behaviours to meet social expectations. It may involve consciously monitoring facial expressions, forcing eye contact, suppressing direct communication styles, rehearsing conversations or hiding signs of sensory overwhelm. Many healthcare professionals perform emotional labour every day. Neurodivergent healthcare professionals may be performing an additional layer of cognitive labour that remains almost entirely invisible. The effort required to appear effortlessly ‘professional’ can itself become exhausting. ‘Different’ does not mean ‘deficient’.

Masking

Has the profession unknowingly recruited people with exceptional abilities, while simultaneously creating environments that make those abilities harder to sustain? This raises another question. Could neurodiversity help explain, at least in part, the extraordinary levels of burnout reported across community pharmacy? Burnout has become almost synonymous with healthcare. We discuss staffing shortages, increasing workloads, expanding responsibilities and administrative burden with

There is a tendency to equate productivity with interruption. A busy pharmacy is often considered an efficient pharmacy. A pharmacist who appears endlessly available is viewed positively. Rapid responses, immediate accessibility and continual multitasking have almost become professional expectations. But cognitive science tells us that every interruption carries a cost. Each time attention shifts from one

Burnout

COMMENT

| Opinion

understandable concern. Yet burnout is often framed solely as a consequence of working too hard. Autistic burnout describes something rather different. It is the profound physical, cognitive and emotional exhaustion that can result from prolonged masking, chronic sensory overload and sustained efforts to adapt to environments that are fundamentally misaligned with how an individual processes the world. It is often accompanied by reduced executive functioning, diminished capacity to cope with everyday demands, and increased sensitivity to sensory input. This is not the same as simply feeling tired after a busy week. It represents a depletion of the resources required simply to function. That does not mean community pharmacy causes autistic burnout, nor does it mean every pharmacist experiencing burnout is neurodivergent. The profession frequently celebrates resilience. Perhaps we should also ask why resilience has become such a necessary attribute. Neuroinclusive workplaces should be about removing unnecessary barriers. Psychological safety for colleagues to disclose neurodivergence without fear of judgement. Leadership that understands the difference between poor performance and cognitive overload. These are not accommodations that benefit only neurodivergent pharmacists. Every pharmacist thinks more clearly with fewer interruptions. Every pharmacist benefits from environments that support concentration. Every patient benefits when the clinician responsible for their medicines has the cognitive space to exercise sound clinical judgement.

Public

There is another group whose role should not be overlooked: The public. The overwhelming majority of patients are patient, appreciative and understanding. They recognise that community pharmacy is under immense pressure and that pharmacists are

balancing multiple responsibilities simultaneously. The person standing behind the counter may also be carrying invisible demands. Ultimately, this conversation is not really about autism or ADHD. It is about recognising that human minds are wonderfully diverse. Healthcare has made enormous progress in understanding the needs of patients who think differently. It would be a missed opportunity if we failed to apply those same principles to the professionals delivering care. We do not yet know how many practising pharmacists are neurodivergent. Indeed, the UK literature acknowledges that reliable prevalence data for neurodivergence among medical professionals remains limited. What is emerging, however, is a growing body of research examining the experiences of neurodivergent healthcare professionals. A study of 225 autistic doctors by Shaw et al (2023), the majority of whom were based in the UK, found that the average age of formal autism diagnosis was 36. Almost a third had not disclosed their autism to anyone at work, while fewer than half had requested workplace adjustments and only around half of those reported that the adjustments had been implemented. More recent UK research has explored the experiences of autistic doctors transitioning into clinical practice, identifying the unpredictable nature of healthcare environments and challenging workplace interactions as particular sources of difficulty (Keenan, Doherty & Shaw, 2026). The picture is echoed by the British Medical Association's 2025 UK-wide survey of disabled and neurodivergent doctors and medical students. Among respondents requiring reasonable adjustments, 73 per cent reported that they had not received all the adjustments they needed. Pharmacy-specific research remains scarce. A UK study by Kamdar and Sabir (2024) examining community

pharmacists' understanding of neurodiversity identified significant gaps in knowledge, training and neuroinclusive practice. While this research focused primarily on supporting neurodivergent patients rather than neurodivergent pharmacists themselves, it highlights how relatively new this conversation remains within pharmacy. Should the absence of prevalence data itself make us curious? We cannot currently say how many pharmacists are autistic, have ADHD or are otherwise neurodivergent. But research from our medical colleagues suggests that some healthcare professionals spend substantial portions of their careers working, adapting and masking before their neurodivergence is recognised. Should resilience compensate for systems that routinely overload attention, fragment concentration and demand continual adaptation? Or should we instead examine whether the systems themselves require redesign? Community pharmacy has rightly become more aware of the needs of neurodivergent patients. We encourage clearer communication. We recognise sensory sensitivities. We appreciate that not every disability is immediately visible. We increasingly understand that equitable care sometimes requires different approaches rather than identical ones. It is time to extend that same thinking to the workforce. ●

Áine is a Superintendent Pharmacist and pharmacy owner with over 18 years of experience working in community pharmacies across Ireland. In 2014, she earned her Master of Pharmacy (MPharm) degree in the UK. Her career journey has encompassed a variety of roles, including locum, support, and supervising, culminating in her recent transition to pharmacy ownership. She is deeply committed to upholding the integrity and vital role of community pharmacy in Ireland, combining her extensive experience with a passion for patient care and professional excellence.

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Men's health | CPD MODULE

The pathophysiology of male pattern hair loss This module discusses the hair growth cycle and male hair pattern loss. On completion of this module, it is expected the reader will have an enhanced understanding of differential diagnosis of hair loss in men, the role of the pharmacist, and potential treatments, including new and emerging therapies. Author: Eamonn Brady MPSI

Part 1: The normal hair growth cycle Understanding the normal hair growth cycle is essential to appreciating why androgenetic alopecia (male pattern hair loss) develops and why currently available treatments require prolonged use before any benefit becomes apparent. Hair is composed primarily of keratin, a fibrous structural protein produced within the hair follicle. The hair follicle is a highly active mini-organ that undergoes continuous cycles of growth, regression, and rest throughout life. Hair growth occurs in three distinct phases. The anagen phase is the active growth phase and normally lasts between two and seven years in scalp hair. Approximately 85-to-90 per cent of scalp hairs are in anagen at any one time. The duration of anagen largely determines maximum hair length. This is followed by the catagen phase, a brief transitional period lasting approximately two-to-three weeks, during which the lower portion of the follicle regresses and hair production ceases. Finally, the follicle enters the telogen phase, a resting stage lasting around two-to-four months. At the end of telogen, the hair shaft is shed (the exogen phase), and a new anagen hair begins to develop from the same follicle. Shedding approximately 50-to-100 hairs daily is therefore considered entirely physiological.

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How male pattern hair loss develops

Male pattern hair loss results not from destruction of hair follicles, but from progressive follicular miniaturisation. In genetically susceptible men, terminal hair follicles gradually become smaller, producing progressively shorter, finer, and less pigmented hairs until many follicles eventually produce only barely visible vellus hairs. Importantly, the follicles remain viable for many years, explaining why pharmacological treatment can restore hair growth in some patients if initiated before irreversible follicular loss occurs.

The role of dihydrotestosterone (DHT)

The principal androgen involved is dihydrotestosterone (DHT). Testosterone is converted to DHT by the enzyme 5-alpha-reductase, particularly the type II isoenzyme located within hair follicles and the prostate. DHT binds androgen receptors in genetically susceptible follicles with considerably greater affinity than testosterone. This interaction shortens the duration of the anagen phase while prolonging the interval before new hair growth begins. With successive hair cycles, follicles become progressively smaller and individual hairs become thinner, leading to the characteristic gradual reduction in hair density.

The importance of genetics

Genetics plays a central role in androgenetic alopecia. Rather than following a simple Mendelian inheritance pattern, susceptibility is polygenic, involving multiple genetic loci, including variants affecting androgen receptor signalling and other pathways regulating follicular biology. A positive family history significantly increases risk, although the condition may occur in men without an obvious familial pattern.

Clinical presentation and progression

Clinically, androgenetic alopecia usually begins with bitemporal recession, thinning at the frontal scalp, or loss of hair density at the vertex. These changes may occur independently or simultaneously before gradually progressing. The HamiltonNorwood classification remains the standard method for describing disease severity and progression in clinical practice and research.

Part 2: How common is male pattern hair loss? Male pattern hair loss, also known as androgenetic alopecia, is the commonest cause of hair loss in men and one of the most frequent conditions encountered in primary care and

CPD MODULE | Men's health

community pharmacy. Although it is not medically serious, it can have a profound impact on selfesteem, body image, and quality of life. Pharmacists are often the first healthcare professionals approached by men seeking advice, making an understanding of its prevalence and clinical significance essential.

Prevalence and age of onset

Androgenetic alopecia affects men of all ethnicities, although prevalence varies between populations. It can begin in late adolescence or early adulthood, with incidence increasing steadily with age. Approximately 30 per cent of men show clinically significant hair loss by 30 years of age, around 50 per cent by the age of 50, and up to 80 per cent by 70 years. The age of onset is strongly influenced by genetic susceptibility, with men who develop hair loss at a younger age more likely to experience progressive disease.

Recognising the typical pattern

The characteristic pattern usually starts with bitemporal recession and thinning over the vertex before gradually progressing. The Hamilton-Norwood classification is widely used to stage disease severity and monitor progression over time. Recognising these patterns helps distinguish androgenetic alopecia from other causes of hair loss, such as alopecia areata, telogen effluvium and scarring alopecias, all of which require different management.

Psychological impact

Although male pattern hair loss has no serious physical consequences, its psychological impact can be considerable. It is associated with reduced self-confidence, anxiety and impaired quality of life, particularly in younger men and those with progressive hair loss.

Part 3: Assessment in the pharmacy Community pharmacists are often the first healthcare professionals consulted by men concerned about hair loss. A structured assessment helps distinguish androgenetic alopecia from other causes, identify patients requiring referral, and ensure evidence-based treatment is initiated appropriately. Early intervention is important because treatments are generally most effective before extensive follicular miniaturisation occurs.

Taking a patient history

A thorough history should establish when hair loss began, whether it developed gradually or suddenly, and whether there has been progression over time. Men with androgenetic alopecia usually describe slowly progressive thinning over months or years, beginning at the temples, frontal scalp, or vertex. Sudden diffuse shedding or patchy hair loss suggests an alternative diagnosis such as telogen effluvium or alopecia areata.

Reviewing medicines and potential causes

The pharmacist should ask about a family history of male pattern hair loss, as this substantially increases the likelihood of androgenetic alopecia. Current and recent medicines should also be reviewed, including retinoids, anticoagulants, beta-blockers, antiepileptics, chemotherapy, and other medicines associated with hair loss. Recent illness, surgery, significant psychological stress, rapid weight loss, or nutritional deficiencies may indicate telogen effluvium rather than androgenetic alopecia.

Scalp examination and red flags

Examination should focus on the distribution of hair loss and the condition of the scalp. Typical male

Androgenetic alopecia affects men of all ethnicities, although prevalence varies between populations pattern hair loss presents with preserved frontal hairline recession and vertex thinning without inflammation or scarring. Red flag findings include scarring, marked scalp inflammation, pustules, scaling suggestive of fungal infection, rapidly progressive hair loss, loss of eyebrows or body hair, or associated systemic symptoms. These require referral to a GP or dermatologist.

Managing patient expectations

Treatment expectations are discussed in detail in Part 6.

When to refer

Referral is appropriate where the diagnosis is uncertain, hair loss is rapid or atypical, scarring alopecia is suspected, there are features of an underlying medical condition, or first-line treatment fails despite good adherence.

Part 4: Differential diagnosis of hair loss in men Androgenetic alopecia is the commonest cause of hair loss in men, but it should not automatically be assumed to be the diagnosis in every patient. A careful history and examination help distinguish male pattern hair loss from other conditions that may require investigation or urgent referral.

Androgenetic alopecia versus alopecia areata

Androgenetic alopecia typically presents with gradual thinning over the

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Men's health | CPD MODULE

frontal scalp, temples and vertex while preserving a characteristic pattern. The scalp appears healthy, with no inflammation, scaling, or scarring. In contrast, alopecia areata presents with sudden, well-defined patches of complete hair loss. ‘Exclamation-mark’ hairs may be visible at the edge of lesions, and some patients have nail pitting or a personal or family history of autoimmune disease.

Telogen effluvium

Telogen effluvium usually causes diffuse shedding rather than patterned thinning. Patients often report excessive hair coming out during washing or brushing approximately two-to-four months after a significant trigger such as major illness, surgery, rapid weight loss, severe psychological stress, or certain medicines. Unlike androgenetic alopecia, the hairline is usually preserved, and the condition is often reversible once the underlying cause is addressed.

Scalp disorders and scarring alopecias

Scalp disorders should also be considered. Tinea capitis may present with scaling, broken hairs, inflammation, and occasionally painful swellings (kerions). Although more common in children, it can occur in adults and requires prompt oral antifungal treatment. Scarring alopecias, including lichen planopilaris and frontal fibrosing alopecia, are less common but represent dermatological emergencies because permanent follicular destruction may occur if treatment is delayed.

Other causes of hair loss

Other important causes include traction alopecia, trichotillomania, endocrine disorders such as thyroid disease, nutritional deficiencies, including iron deficiency, and systemic illnesses such as lupus. Medicines including chemotherapy, retinoids, anticoagulants and some antiepileptics may also contribute to hair loss.

VOL 27 ISSUE 9 : SEPTEMBER 2026

When to refer

Referral should be arranged when hair loss is sudden, rapidly progressive, associated with scalp inflammation or scarring, accompanied by systemic symptoms, or when the diagnosis remains uncertain. Recognising these alternative causes ensures that patients receive appropriate treatment while avoiding delays that could result in irreversible hair loss.

Part 5: Investigations and referral Most men presenting with gradual, typical male pattern hair loss do not require laboratory investigations before treatment. The diagnosis of androgenetic alopecia is usually made clinically from the characteristic pattern of hair loss, medical history, and scalp examination.

When are investigations needed?

Blood tests are not routinely recommended for typical androgenetic alopecia but may be appropriate when hair loss is diffuse, sudden, rapidly progressive or accompanied by symptoms suggesting an underlying medical condition. Depending on the clinical presentation, investigations may include a full blood count, ferritin, thyroid function tests, vitamin B12, folate and vitamin D levels. Additional investigations may be required if autoimmune disease, endocrine disorders, or other systemic illnesses are suspected.

When should patients be referred?

Referral is particularly important when hair loss is associated with scalp inflammation, scaling, pustules, scarring, or pain, as these features may indicate inflammatory or infectious scalp disorders requiring urgent treatment. Patients with patchy hair loss suggestive of

alopecia areata, suspected tinea capitis, scarring alopecias or unexplained eyebrow and body hair loss should also be referred for specialist assessment.

Specialist assessment

Men who develop hair loss following chemotherapy or other specialist medicines should normally be managed by the treating medical team. Likewise, patients with significant psychological distress related to hair loss may benefit from medical assessment, as anxiety, depression and reduced quality of life are common in individuals with androgenetic alopecia. Dermatologists may perform additional assessments where the diagnosis remains uncertain. These include dermoscopy (trichoscopy), hair-pull testing, scalp biopsy in selected cases, and more specialised investigations where uncommon causes of alopecia are suspected. These investigations help differentiate androgenetic alopecia from inflammatory, autoimmune, and scarring conditions.

Part 6: Evidence-based treatment of male pattern hair loss Treatment of androgenetic alopecia aims to slow further hair loss, preserve existing hair and stimulate regrowth where viable hair follicles remain. No currently licensed treatment permanently cures male pattern hair loss, and patients should be counselled that continuous long-term treatment is required to maintain any benefit.

Treatment goals

Early intervention offers the greatest chance of success because advanced follicular miniaturisation is less likely to respond to treatment.

Topical minoxidil

Topical minoxidil remains the only non-prescription medicine licensed

CPD MODULE | Men's health

for male pattern hair loss in Ireland. Although its exact mechanism is not fully understood, minoxidil prolongs the anagen (growth) phase, increases follicular size, and may improve blood flow around hair follicles. The 5% formulation is generally recommended for men and is applied directly to the affected scalp once or twice daily, depending on the product. Patients should be advised that increased shedding may occur during the first few weeks as resting hairs are replaced by new growing hairs. This is usually temporary and should not prompt discontinuation. Meaningful improvement with topical minoxidil is rarely seen before threeto-six months, while maximal benefit often requires 12 months of continuous treatment. If treatment is stopped, newly preserved or regrown hair is gradually lost over several months. Common adverse effects include scalp irritation, itching, dryness, and contact dermatitis, while unwanted facial hair may occasionally occur due to accidental transfer.

Oral finasteride

Oral finasteride 1mg daily is a prescription-only treatment and is considered one of the most effective pharmacological options for men with androgenetic alopecia. Finasteride selectively inhibits type II 5-alphareductase, reducing scalp and serum dihydrotestosterone (DHT) concentrations and slowing follicular miniaturisation. Clinical trials have consistently demonstrated reduced hair loss and increased hair counts in many men, particularly when treatment is started early. Patients prescribed finasteride should be counselled regarding potential adverse effects, including reduced libido, erectile dysfunction, ejaculatory disorders, and breast tenderness, although these occur in a minority of patients. Reports of persistent sexual symptoms and mood changes have received considerable attention in

recent years, and patients should be encouraged to discuss any concerns promptly with their prescriber rather than stopping treatment without advice.

Dutasteride

Dutasteride inhibits both type I and type II 5-alpha-reductase and suppresses DHT more extensively than finasteride. Although not licensed for androgenetic alopecia in Ireland, it may occasionally be prescribed off-label by dermatologists or hair specialists for selected patients who fail to respond adequately to finasteride. Patients should understand that evidence suggests greater efficacy but potentially a higher incidence of adverse effects.

Combination therapy

Combination therapy with topical minoxidil and oral finasteride generally provides greater benefit than either treatment alone because the medicines act through different mechanisms. Good adherence is essential, and pharmacists play an important role in reinforcing realistic expectations, identifying adverse effects, and encouraging continued treatment where appropriate.

Hair transplantation

Hair transplantation may be considered for carefully selected patients with stable disease who have insufficient benefit from medical therapy. Modern follicular unit transplantation techniques can provide excellent cosmetic outcomes but require careful patient selection and should complement rather than replace medical treatment, as ongoing hair loss in untreated follicles may continue after surgery.

Part 7: Emerging and specialist treatments Combination therapy with topical minoxidil and oral finasteride generally provides greater benefit than either treatment alone because the medicines act through different mechanisms. Good adherence and realistic treatment

Growth factors released from platelets are thought to stimulate hair follicles and prolong the anagen phase

expectations are essential to maximise long-term treatment outcomes.

Low-dose oral minoxidil

Low-dose oral minoxidil has gained considerable interest in recent years. Although not licensed for androgenetic alopecia in Ireland, dermatologists increasingly prescribe low doses off-label for selected patients who cannot tolerate or fail to respond adequately to topical therapy. Studies suggest improvements in hair density and thickness, but adverse effects including hypertrichosis (abnormal/ excessive hair growth), ankle oedema, tachycardia, and postural hypotension require careful patient selection and medical supervision.

Platelet-rich plasma (PRP) therapy

Platelet-rich plasma (PRP) therapy involves injecting concentrated platelets prepared from the patient's own blood into the scalp. Growth factors released from platelets are thought to stimulate hair follicles and prolong the anagen phase. Meta-analyses suggest PRP may improve hair density in some patients, particularly when combined with conventional medical therapy, but treatment protocols remain inconsistent and repeated sessions are usually required.

Microneedling

Microneedling has also attracted attention as an adjunctive treatment. Controlled micro-injury to the scalp

VOL 27 ISSUE 9 : SEPTEMBER 2026

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Men’s Health – The pathophysiology of male pattern hair loss

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CPD MODULE | Men's health

may stimulate growth factor release and improve penetration of topical minoxidil. Clinical trials suggest combination therapy may produce greater improvements than minoxidil alone, although larger long-term studies are still needed.

Low-level laser therapy

Low-level laser therapy (LLLT) uses red-light wavelengths to stimulate follicular activity. Several home-use devices are commercially available, and some studies demonstrate modest improvements in hair density. However, treatment requires excellent adherence over many months, devices can be expensive, and the magnitude of benefit varies between individuals.

Hair transplantation

Hair transplantation remains the most effective option for restoring hair in appropriately selected patients with stable androgenetic alopecia. Modern follicular unit extraction (FUE) and follicular unit transplantation (FUT) techniques can achieve highly natural cosmetic results. Patients should be advised that surgery does not halt progression of androgenetic alopecia and ongoing medical treatment is often recommended to preserve existing nontransplanted hair.

Part 8: Supplements and complementary therapies Supplements and complementary products are heavily marketed for hair loss, and men frequently ask pharmacists whether vitamins, minerals or herbal products can reverse thinning hair. While nutritional deficiency can contribute to hair shedding, androgenetic alopecia is primarily driven by genetic susceptibility and androgen-mediated follicular miniaturisation. In most otherwise healthy men, supplements do not address the underlying mechanism of male pattern hair loss.

Biotin

Biotin is one of the most commonly promoted ingredients in hair, skin, and nail supplements. True biotin deficiency is rare and usually occurs in specific circumstances such as inherited metabolic disorders, prolonged parenteral nutrition, significant malabsorption, or chronic use of certain medicines. There is little evidence that biotin improves male pattern hair loss in men who are not deficient. High-dose biotin may also interfere with some laboratory immunoassays, including thyroid and cardiac marker tests, so patients should inform healthcare professionals if they are taking it.

Iron and other nutritional deficiencies

Iron deficiency can cause diffuse hair shedding, particularly telogen effluvium, but routine iron supplementation is not appropriate unless deficiency has been identified. Men with suspected iron deficiency should be referred for medical assessment because unexplained iron deficiency in men may indicate gastrointestinal blood loss or another underlying condition. Similarly, vitamin D, vitamin B12, folate and zinc should generally be replaced only where deficiency is suspected or confirmed.

Zinc

Zinc has been studied in several forms of hair loss, but evidence for benefit in androgenetic alopecia is limited. Excessive zinc intake can cause gastrointestinal upset and, with prolonged high-dose use, copper deficiency, and neurological complications. Pharmacists should advise against long-term high-dose mineral supplementation unless clinically indicated.

Saw palmetto

Saw palmetto is promoted as a natural anti-androgen because it may weakly inhibit 5-alpha-reductase. Small studies suggest possible modest benefit, but

the evidence is far weaker than for licensed treatments such as topical minoxidil or prescribed finasteride. Patients should also be reminded that natural products can still cause adverse effects and drug interactions.

Other complementary therapies

Marine protein supplements, collagen products, caffeine shampoos, essential oils, and other cosmetic preparations are widely advertised for hair growth. Some may improve the feel or appearance of hair, but evidence that they meaningfully reverse androgenetic alopecia is limited. Patients should be wary of products claiming rapid regrowth, permanent cures or results comparable to prescription treatments without robust clinical trial evidence.

Part 9: The pharmacist's role Community pharmacists are frequently the first healthcare professionals consulted by men who notice thinning hair or early signs of hair loss. As one of the most accessible healthcare professionals, pharmacists have a pivotal role in the early recognition of androgenetic alopecia, distinguishing it from other causes of hair loss, providing evidence-based advice, and ensuring timely referral where appropriate. Early intervention is particularly important because currently available treatments are most effective before significant follicular miniaturisation occurs.

Zinc has been studied in several forms of hair loss, but evidence for benefit in androgenetic alopecia is limited

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Men's health | CPD MODULE

Initial assessment

Pharmacists should establish when the hair loss begins, whether it develops gradually or suddenly, and whether it is continuing to progress. Typical androgenetic alopecia develops gradually over months or years, whereas sudden diffuse hair shedding or patchy hair loss may suggest alternative diagnoses such as telogen effluvium or alopecia areata. A medication history should also be undertaken, as several medicines may contribute to hair loss. Recent illness, surgery, significant emotional stress, rapid weight loss, restrictive dieting, and chronic medical conditions should also be explored, as these factors may point towards causes other than male pattern hair loss.

Recognising red flags

While many men presenting to the pharmacy have uncomplicated androgenetic alopecia, pharmacists should remain vigilant for features requiring medical assessment. These include rapid onset hair loss, patchy areas of complete hair loss, scalp inflammation, scaling, pustules, scarring, pain or tenderness, loss of eyebrows or body hair, or symptoms suggestive of an underlying systemic illness. Such findings warrant referral to a GP or dermatologist for further investigation. Pharmacists should also advise referral where the diagnosis is uncertain, hair loss develops at an unusually young age, first-line treatment has failed despite good adherence, or significant psychological distress is evident.

Recommending evidence-based treatment

Community pharmacists play an important role in ensuring patients receive treatments supported by goodquality clinical evidence. For suitable patients, topical minoxidil remains the only non-prescription medicine licensed for male pattern hair loss in Ireland. Pharmacists should explain how to apply the product correctly, emphasise

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True/False Q1. Approximately 85-to-90 per cent of scalp hairs are normally in the anagen (active growth) phase at any one time.

expect meaningful improvement within two-to-four weeks of starting treatment.

pattern hair loss.

True / False

Q8. Combination therapy with topical minoxidil and oral finasteride generally provides greater benefit than either treatment alone.

True / False

Q2. Male pattern hair loss occurs because hair follicles are permanently destroyed early in the disease process. True / False

Q3. Topical minoxidil is the only nonprescription medicine licensed for male pattern hair loss in Ireland.

Q5. Oral finasteride works by inhibiting type II 5-alphareductase, thereby reducing dihydrotestosterone (DHT) levels. True / False

Q6. Sudden patchy hair loss with complete bald patches is the typical presentation of androgenetic alopecia. True / False

True / False

Q4. Patients using topical minoxidil should

Q7. Routine blood tests are recommended for every man presenting with typical male

the importance of applying it only to the affected scalp, and advise patients to wash their hands after application to minimise accidental transfer. Patients should be informed that increased hair shedding may occur during the first few weeks of treatment as hairs cycle into a new growth phase. This temporary shedding should not normally be interpreted as treatment failure.

Managing expectations and improving adherence

One of the commonest reasons for treatment failure is unrealistic expectations. Many patients expect visible improvement within a few

True / False

Q9. High-dose biotin supplementation has been proven to improve androgenetic alopecia in otherwise healthy men without biotin deficiency. True / False

Q10. Patients should be referred if hair loss is associated with scarring, scalp inflammation, or rapid progression.

weeks and discontinue treatment prematurely when this does not occur. Pharmacists should explain that meaningful improvement usually requires at least three-tosix months of continuous treatment, with maximal benefit often taking up to 12 months. Equally important is explaining that neither topical minoxidil nor oral finasteride cures androgenetic alopecia. These treatments slow progression, preserve existing hair and may stimulate regrowth while treatment continues. If treatment is discontinued, any benefit is usually lost gradually over several months.

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In order for Viagra Connect be effective, stimulation is required. required. Dosage Method ofofuse: For oral use. Film-Coated Tablets: Adults: oneone 50 mg takentaken with with waterwater approx. one hour sexual sexual iagra Connect (sildenafil) 50 mg orodispersible films Please refer to Summary of Product stimulation is Dosageand and Method use: For oral use. Film-Coated Tablets: Adults: 50 tablet mg tablet approx. one before hour before activity. Orodispersible 50 taken stomach one hour before sexual activity. Orodispersible filmsfilms can be taken with or without water. water. The The ge and Administration: Indications: Viagrafilms: Connect is indicated in adult men withapprox. erectile dysfunction, activity. Orodispersible films: 50mg mg takenon onan anempty empty stomach approx. one hour before sexual activity. Orodispersible can be taken with or without maximum dosing frequency is once per ofof activity bebe delayed if taken withwith foodfood (see(see SmPC Section 5.2). 5.2). 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If after Orodispersible several attemptsfilms on different dosingwith occasions patients are The still not able to achieve a penile erection sufficient for satisfactory sexual activity, they h approx. one hour before activity. can be taken or without water. should be advised to consult a doctor. Elderly: no dosage adjustments required (≥ 65 years old). Renal Impairment: No dosage adjustments for patients with mild to shouldwith be advised to SmPC consultSection a doctor. Elderly: no dosage adjustments required (≥ 65 years old). Renal Impairment: No dosage adjustments for patients with mild to ity may be delayed if taken food impairment. (see 5.2). Patients shouldfor be those advised theyrenal may moderate renal Dosage adjustments required withthat severe impairment, individuals must be advised to consult their doctor before taking renal impairment. 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Hepatic Impairment: for those asions patients are still not able to achieve a penile erection sufficient for be satisfactory theySection mild-moderate hepatic impairment, individuals must advised tosexual consultactivity, their doctor before taking Viagra Connect, since Dosage a 25 mg adjustments tablet may berequired more suitable for with mild-moderate hepatic impairment, be advised to patients consult before Viagra(see Connect, since a 25 mgPresentation: tablet may beFilm-Coated more suitable for stments required (≥ 65 years(see old). Renal Impairment: Noindividuals dosage adjustments for patients withtheir milddoctor to them SmPC Section 4.4). Viagra Connect is must contraindicated for with severe hepatic taking impairment contraindications). them (see SmPC Section 4.4). Viagra Connect is consult contraindicated patients with severefilms: hepatic impairmentfilm (see contraindications). Presentation: Film-Coated Tablets: each tablet contains sildenafil equivalent to 50 mgdoctor of for sildenafil. Orodispersible orodispersible contains sildenafil citrate equivalent to 50 mg those with severe renal impairment, individuals must be citrate advised to their before taking each tablet contains sildenafil citrate adjustments equivalent to 50 mg of sildenafil. films: orodispersible with film nitric contains sildenafil citrateasequivalent to 50 mg of sildenafil. Hypersensitivity to the active substance or those to anyOrodispersible of the excipients. Co-administration oxide donors (such amyl nitrite), for them (see SmPC Tablets: Section 4.4).Contraindications: Hepatic Impairment: Dosage required for with of sildenafil. Contraindications: Hypersensitivity to the active substance or to any of the excipients. Co-administration with nitric oxide donors (such as amyl nitrates, ritonavir, cyclase stimulators as riociguat) contraindicated. Agents for the treatment of erectile dysfunction, including sildenafil, should notnitrite), ed to consult their doctor before taking guanylate Viagra Connect, since a 25 (such mg tablet may beis more suitable for nitrates, ritonavir, guanylate cyclasesexual stimulators riociguat) is contraindicated. Agents for the treatment erectile dysfunction, including sildenafil, should not be usedhepatic by those men for whom activity(such may as be inadvisable, and these patients should be referred to of their doctor. This includes patients with severe ted for patients with severe impairment (see contraindications). Presentation: Film-Coated be used by those men such for whom sexual activity acute may be inadvisable, and (AMI) theseorpatients should be referred to their doctor. includes patients cardiovascular disorders as a recent (6 months) myocardial infarction stroke, unstable angina or severe cardiac failure.This Sildenafil should not bewith used severe mg of sildenafil. Orodispersible films: orodispersible film contains sildenafil citrate equivalent to 50 mg cardiovascular disorders such asimpairment, a recent (6 months) acute(blood myocardial infarction (AMI) or stroke, unstable angina or severe cardiac failure. Sildenafil should not be used in patients with severe hepatic hypotension pressure < 90/50 mmHg) and known hereditary degenerative retinal disorders such as retinitis substance or to any ofinthe excipients. severe Co-administration with nitric oxide donors (such as amyl<nitrite), patients with impairment, hypotension (blood pressure 90/50 mmHg)Sildenafil and known hereditary degenerative retinal suchin as pigmentosa (a minority ofhepatic these patients have genetic disorders of retinal phosphodiesterases). is contraindicated in patients who havedisorders loss of vision oneretinitis uat) is contraindicated. Agents for(athe treatment of erectile dysfunction, including should not eye because ofminority non-arteritic anterior ischaemic optic neuropathy (NAION), of whether this episodeiswas in connection in orpatients not withwho previous inhibitor pigmentosa of these patients have genetic disorderssildenafil, of retinalregardless phosphodiesterases). Sildenafil contraindicated havePDE5 loss of vision in one dvisable, and these patients should be referred to Viagra theirischaemic doctor. includes patients with severe exposure (see Section 4.4). Connect This should not be used in patients with anatomical deformation of the penis (such as angulation, cavernosal fibrosis eye because ofSmPC non-arteritic anterior optic neuropathy (NAION), regardless of whether this episode was in connection or not with previous PDE5 or inhibitor cardial infarction (AMI)exposure or stroke, unstable angina or severe cardiac failure. Sildenafil should not be used Peyronie's disease). Connect is not indicated for use by women. The product is notanatomical intended for men withoutoferectile dysfunction. product cavernosal is not intended (see SmPCViagra Section 4.4). Viagra Connect should not be used in patients with deformation the penis (such as This angulation, fibrosis or ood pressure < 90/50Peyronie's mmHg) and known hereditary degenerative retinal disorders such asproduct retinitis for men under 18 years ofConnect age. Warnings and precautions: dysfunction canisbe withmen a number contributing conditions, hypertension, disease). Viagra is not indicated for use byErectile women. The notassociated intended for withoutoferectile dysfunction. This e.g. product is not intended diabetes mellitus, or Asof a result, all men with dysfunction beofadvised to consult their doctor 6 s of retinal phosphodiesterases). Sildenafil is contraindicated in cardiovascular patients who disease. haveErectile loss vision in one for men under 18hypercholesterolaemia years of age. Warnings and precautions: dysfunction can beerectile associated with a should number contributing conditions, e.g. within hypertension, months for a clinical review was of potential underlying conditions and risk As factors associated erectile dysfunction (ED). If symptoms of EDtohave not improved after thy (NAION), regardless of whether this hypercholesterolaemia episode in connection or not with previous PDE5 inhibitor diabetes mellitus, or cardiovascular disease. a result, all menwith with erectile dysfunction should be advised consult their doctor within 6 taking Viagra on several consecutive occasions, or if their erectile dysfunction theerectile patient dysfunction should be advised consult their e used in patients withmonths anatomical deformation of penis (such as angulation, cavernosal fibrosis orworsens, for a Connect clinical review ofthe potential underlying conditions and risk factors associated with (ED). Iftosymptoms of doctor. ED haveCardiovascular not improved after risk iswithout a degreeconsecutive of cardiac risk associated sexual the cardiovascular of men should considered prior to initiation of Cardiovascular therapy. women. The product istaking notfactors: intended forthere men erectile dysfunction. This isactivity, notdysfunction intended ViagraSince Connect on several occasions, or with ifproduct their erectile worsens, status the patient should bebe advised to consult their doctor. Agents the treatment including sildenafil, are not recommended to be used bystatus those of men who with light or moderateprior physical activity, such risk factors: Since there degreedysfunction, ofofcardiac risk associated with e.g. sexual activity, the cardiovascular men should be considered to initiation of therapy. Erectile dysfunction can be for associated withisof aaerectile number contributing conditions, hypertension, as walking briskly for 20 minutes or climbing 2 flights of stairs, feel very breathless or experience chest pain. For a list of patients who are considered at low Agents forerectile the treatment of erectile dysfunction, including sildenafil, not recommended to be used by those men who with light or moderate physical activity, such sease. As a result, all men with dysfunction should be advised to consult their are doctor within 6 cardiovascular risk from sexual activity (see SmPC Section 4.4). Patients previously diagnosed with the following must be advised to consult with their doctor before as walking briskly for 20 minutes or climbing 2 flights ofhave stairs, feel very breathless or experience chest pain. For a list of patients who are considered at low and risk factors associated withsexual erectile dysfunction (ED). If hypertension, symptoms of moderate ED not improved after disease, resuming activity: uncontrolled to severe valvular left ventricular dysfunction, hypertrophic obstructive and other cardiovascular from should sexual activity (see SmPC Section 4.4). Patients previously diagnosed with the following must be advised to consult with their doctor before heir erectile dysfunction worsens, therisk patient be advised to consult their doctor. Cardiovascular cardiomyopathies, or significant arrhythmias. Sildenafil has vasodilator properties, resulting in mild and transient decreases in blood pressure. Patients with increased resuming sexual activity: uncontrolled hypertension, moderate to severe valvular disease, leftorventricular dysfunction, hypertrophic and other with sexual activity, the cardiovascular status of men should bewith considered prior to initiation of therapy. susceptibility to vasodilators include those left ventricular outflow obstruction (e.g. aortic stenosis), those with the rare syndrome of multipleobstructive system atrophy cardiomyopathies, or significant Sildenafil has vasodilator properties, resulting in mild andnot transient in blood pressure.a Patients with increased nafil, are not recommended to be as used by those menarrhythmias. who with light or moderate physicalMen activity, manifesting severely impaired autonomic control of blood pressure. with such these conditions must use thedecreases product without consulting doctor. Sildenafil susceptibility to hypotensive vasodilators include with left ventricular outflow obstruction those with the rare syndrome of multiple atrophy airs, feel very breathless or experience chest pain. For athose list of patients who are considered at low(e.g. potentiates the effect of nitrates (see SmPC section 4.3). Priapism: Patients whoaortic have stenosis), conditionsor which may predispose them to priapism (suchsystem as sickle manifesting asmultiple severely impaired control of blood Menusing with agents these conditions must not use thedysfunction, product without consulting a doctor. Sildenafil cell anaemia, myeloma orautonomic leukaemia), should consult a pressure. doctor for the treatment of erectile including sildenafil. Prolonged . Patients previously diagnosed with the following must be advised to consult with their before doctor before potentiates the hypotensive effect of nitrates hypertrophic (see SmPC section 4.3).inPriapism: Patients who haveInconditions which may predispose them to priapism (suchthe as sickle erections and priapism have been occasionally reported with sildenafil post-marketing experience. the event of an erection that persists longer than 4 hours, rate to severe valvular disease, left ventricular dysfunction, obstructive and other cell anaemia, myeloma medical or leukaemia), should consult aisdoctor beforeimmediately, using agentspenile for the treatment of and erectile dysfunction, including Prolonged patient should seektransient immediate assistance. If priapism notwith treated tissue damage permanent loss of potencysildenafil. could result. odilator properties, resulting in mildmultiple and decreases in blood pressure. Patients increased erections anduse priapism havetreatments been occasionally reported withissildenafil in post-marketing experience. In the eventbe ofadvised an erection that than visual 4 hours, the Concomitant withor other erectile dysfunction not recommended. Effects on vision: Patients should that in thepersists event oflonger any sudden outflow obstruction (e.g. aortic stenosis), those with thefor rare syndrome of multiple system atrophy patient should seekstop immediate medical assistance. If priapism is immediately. not treated immediately, penile damage and permanent of potency coulda result. defect, they should taking Viagra Connect and consult a physician Concomitant use withtissue CYP3A4 inhibitors: patients shouldloss be advised to consult pressure. Men with these conditions must not use the product without consulting a doctor. Sildenafil Concomitant withViagra other treatments dysfunction is notsuitable recommended. on vision: Patients should be advised thatisinadvised the event of any sudden doctor beforeuse taking Connect as for a 25erectile mg tablet may be more for them.Effects Concomitant use with alpha-blockers: Caution when sildenafil is visual on 4.3). Priapism: Patients who havetoconditions which may predispose them toapriapism (such as sickleConcomitant administered patients taking an alpha-blocker, as the co-administration may lead to symptomatic hypotension in a fewinhibitors: susceptiblepatients individuals. Thus, defect, they should stop taking Viagra Connect and consult physician immediately. use with CYP3A4 should bepatients advisedtaking to consult a a doctor before usingdoctor agents for the treatment of erectile including sildenafil. Prolonged alpha blockers should be advised to consult their before taking Viagra Connect as a 25Concomitant mg tablet may bewith morealpha-blockers: suitable for them (see SmPC Sectionwhen 4.2 &sildenafil 5.2). before taking Viagra Connect asdysfunction, a 25 mgdoctor tablet may be more suitable for them. use Caution is advised is ildenafil in post-marketing experience. In event erection thataspersists longeroccur, thanand 4 hours, theto Treatment should bethe stopped ifof symptoms of postural hypotension patients should seek advice from their doctor onsusceptible what to do.individuals. Effect on bleeding: the use taking administered to patients taking anan alpha-blocker, the co-administration may lead symptomatic hypotension in a few Thus, patients sm is not treated immediately, penile tissue damage and permanent of of potency could result. of sildenafil is not recommended in patients withloss history bleeding disorders or active peptic ulceration, should only befor administered after consultation alpha blockers should be advised tothose consult their doctor before taking Viagra Connect as a 25 mg tablet may and be more suitable them (see SmPC Section 4.2 & 5.2). is not recommended. Treatment Effects on vision: Patients should be advised that in the event of or any sudden visual with a doctor. Renal Hepatic impairment: with hepatic severe renal impairment clearance < 30doctor mL/min), must to bedo. advised consult theirthe use should beand stopped if symptoms of Patients postural hypotension occur, and patients should(creatinine seek advice from their on what Effecttoon bleeding: doctor before Viagra Connect, 25 mg tablet may be suitable for them SmPC peptic Sectionulceration, 4.2 & 5.2). Use alcohol: excessive after alcohol can hysician immediately. of Concomitant use with CYP3A4 inhibitors: patients should bemore advised to consult a (see sildenafil is taking not recommended in since thosea patients with history of bleeding disorders or active andwith should only Drinking be administered consultation temporarily reduce man's ability to get an erection. Menis should be advised not to drink large amounts of alcohol before sexual activity. Film-Coated Tablets:to Lactose: e more suitable for them. with alpha-blockers: Caution advised when sildenafil isimpairment with aConcomitant doctor. Renalause and Hepatic impairment: Patients with hepatic or severe renal (creatinine clearance < 30 mL/min), must be advised consult their The film coating of the tabletConnect, contains lactose. Viagra Connect should notpatients be administered to(see menSmPC with rare hereditary problems of galactose intolerance, total lactase ministration may lead to symptomatic hypotension in a fewsince susceptible Thus, taking doctor before taking Viagra a 25 mg individuals. tablet may be more suitable for them Section 4.2 & 5.2). Use with alcohol: Drinking excessive alcohol can deficiency orreduce glucose-galactose malabsorption. Sodium: This medicinal product less large than 1amounts mmol sodium (23 mg) per tablet. low sodiumTablets: diets can e taking Viagra Connect as a 25 mg tableta may beability more for themMen (seeshould SmPCbe Section 4.2contains & 5.2). temporarily man's tosuitable get an erection. advised not to drink of alcohol before sexualPatients activity.on Film-Coated Lactose: be informed that this medicinal product is essentially ‘sodium-free’. Interaction with other medicinal products and other forms of interaction: Effects of other sion occur, and patients seek advice from their doctor on what to Connect do. Effectshould on bleeding: the use Theshould film coating of the tablet contains lactose. Viagra not be administered to men with rare hereditary problems of galactose intolerance, total lactase medicinal products on sildenafil In vitro studies Sildenafil metabolism is principally mediated by the cytochrome P450 (CYP) isoforms 3A4 (major route) and 2C9 (minor deficiency glucose-galactose malabsorption. This medicinal contains less than 1 mmol sodium (23 mg) per tablet. Patients on low sodium diets can y of bleeding disorders or activeorpeptic ulceration, and should onlySodium: be administered afterproduct consultation route). Therefore, inhibitors of these isoenzymes may reduce sildenafil clearance and inducers of these isoenzymes may increase sildenafil clearance. In vivo studies be informed (creatinine that this medicinal product is essentially ‘sodium-free’. Interaction with other medicinal products and other forms of interaction: Effects of other patic or severe renal impairment < 30 mL/min), must be advised to consult their Pharmacokinetic analysisclearance of clinical trial data indicated a reduction in sildenafil clearance when co-administered with CYP3A4 inhibitors (such as ritonavir, ketoconazole, medicinal products on sildenafil In vitro studies Sildenafil metabolism is principally mediated byobserved the cytochrome (CYP) isoforms 3A4 (major route) andtaking 2C9 (minor be more suitable for them (see SmPC Section 4.2 cimetidine). & 5.2). Use Although with alcohol: Drinking excessive itraconazole, erythromycin, no increased incidence ofalcohol adversecan events was in these P450 patients, with the exception of individuals route). Therefore, inhibitors of these isoenzymes may reduce sildenafil clearance and these isoenzymes may increase sildenafil clearance. uld be advised not to drink largefor amounts of alcohol before sexual activity. Film-Coated Tablets: Lactose: ritonavir which co-administration with sildenafil is contraindicated, individuals must be inducers advised toofconsult their doctor before taking Viagra Connect, since aIn25vivo mgstudies Pharmacokinetic analysis of clinical trial data indicated a of reduction in sildenafil clearance whenwhich co-administered with CYP3A4 inhibitors (such as ritonavir, ketoconazole, should not be administered men rare hereditary problems of galactose intolerance, total lactase tabletto may be with more suitable for them. Co-administration the HIV protease inhibitor ritonavir, is a highly potent P450 inhibitor, at steady state (500 mg twice itraconazole, erythromycin, Although increased incidence ofdiets adverse observed in these patients, with the exception daily) with sildenafil (100 mg cimetidine). single resulted inno a 300% (4-fold) increase sildenafil andwas a 1,000% (11-fold) increase in sildenafil plasma AUC. Atof24individuals hours, the taking edicinal product contains less than 1 mmol sodium (23 dose) mg) per tablet. Patients on low sodiumin can Cevents max ritonavir which co-administration sildenafil individuals must be advised to consult their doctor before taking Viagra Connect, since a 25 mg -free’. Interaction with otherfor medicinal products and with other forms is ofcontraindicated, interaction: Effects of other tablet may be more suitableP450 for them. of the HIV protease bolism is principally mediated by the cytochrome (CYP)Co-administration isoforms 3A4 (major route) and 2C9 inhibitor (minor ritonavir, which is a highly potent P450 inhibitor, at steady state (500 mg twice daily) with sildenafil (100 mg single dose) resulted in a 300% (4-fold) increase in sildenafil Cmax and a 1,000% (11-fold) increase in sildenafil plasma AUC. At 24 hours, the sildenafil clearance and inducers of these isoenzymes may increase sildenafil clearance. In vivo studies ion in sildenafil clearance when co-administered with CYP3A4 inhibitors (such as ritonavir, ketoconazole, d incidence of adverse events was observed in these patients, with the exception of individuals taking dicated, individuals must be advised to consult their doctor before taking Viagra Connect, since a 25 mg e HIV protease inhibitor ritonavir, which is a highly potent P450 inhibitor, at steady state (500 mg twice fold) increase in sildenafil Cmax and a 1,000% (11-fold) increase in sildenafil plasma AUC. At 24 hours, the

plasma levels of sildenafil were still approximately 200 ng/mL, compared to approximately 5 ng/mL when sildenafil was administered alone. This is consistent with levels of sildenafil were still approximately 200 ng/mL, compared results to approximately ritonavir's marked effects on a broad range of P450 substrates. Sildenafil hadplasma no effect on ritonavir pharmacokinetics. Based on these pharmacokinetic sildenafil 5 ng/mL when silden ritonavir's marked on a broad rangewas of P450 substrates. Sildenafil effect state on ritonavir pharmacokinet plasma not levels sildenafil were with still approximately 200 ng/mL, to approximately 5effects ng/mL when sildenafil administered alone. Thishad is consistent with should be of co-administered ritonavir (see SmPC Sectioncompared 4.3). Co-administration of the HIV protease inhibitor saquinavir, a CYP3A4 inhibitor, atnosteady not beritonavir co-administered with ritonavir (see Section 4.3). Co-administration of the HIV protease inh ritonavir's marked effects on a broad range of P450 Sildenafil effect on pharmacokinetics. Based on SmPC theseinpharmacokinetic results sildenafil (1200 mg three times a day) with sildenafil (100 mgsubstrates. single dose) resultedhad inshould ano 140% increase in sildenafil Cmax and a 210% increase sildenafil AUC. Sildenafil had no plasma levels sildenafil werewith stillritonavir approximately 200Section ng/mL,4.3). compared to approximately 5ang/mL when sildenafil was administered alone. in This is consistent with (1200 mg three times day) with sildenafil (100 mg single dose) a have 140% increase sildenafil Cmax and should not be of co-administered (seeSection SmPC Co-administration ofsuch the HIV protease inhibitor saquinavir, a CYP3A4 inhibitor, at steady state in effect on saquinavir pharmacokinetics (see SmPC 4.2). Stronger CYP3A4 inhibitors as ketoconazole and itraconazole would be resulted expected to greater ritonavir's marked effects onwith a broad range(100 of P450 substrates. Sildenafilinhad noon effect on ritonavir pharmacokinetics. Based onin these pharmacokinetic results sildenafil effect saquinavir pharmacokinetics (see SmPC Section Stronger inhibitors such as ketoconazole (1200 three day) sildenafil mg single dose) resulted a 140% increase in sildenafil Cmax andat a 210% increase sildenafil AUC. Sildenafil had no effects.mg When a times single a100 mg dose of sildenafil was administered with erythromycin, a specific CYP3A4 inhibitor, steady state (500 4.2). mg twice dailyCYP3A4 for 5 days), there should not be co-administered with ritonavir (see SmPC4.2). Section 4.3).CYP3A4 Co-administration of the HIV inhibitor saquinavir, abe CYP3A4 inhibitor, atgreater steady state effects. When a such single mgprotease dose ofand sildenafil administered with erythromycin, a specific CYP3A4 inhibitor, effect saquinavir (seeexposure SmPC Section Stronger inhibitors as100 ketoconazole itraconazole would expected have was a on 182% increasepharmacokinetics in sildenafil systemic (AUC). In normal healthy male volunteers, there was no evidence of anwas effect of azithromycin (500tomg daily for 3 (1200 mgthe three times at day) with (100 mgadministered single dose)with resulted in sildenafil aa 140% in sildenafil sildenafil Cmaxat and a 210% increase sildenafil AUC. Sildenafil had no was 182%a increase increase in systemic exposure (AUC). In in normal healthy volunteers, there was no evid effects. a single mg dosesildenafil of sildenafil was erythromycin, specific CYP3A4 inhibitor, steady state (500 mg twice daily for 5male days), there days) onWhen AUC, Cmax, 100 , elimination rate constant, or subsequent half-life of or its principal circulating metabolite. Cimetidine (800 mg), a cytochrome P450 max days) on the AUC,concentrations Cmax , tmaxas ,was elimination rateand constant, or of subsequent half-life of sildenafil its principal circulating effect saquinavir pharmacokinetics (see SmPC 4.2). Stronger CYP3A4 inhibitors such ketoconazole itraconazole would be expected tohealthy have was a on 182% in sildenafil systemic exposure (AUC). normal healthy male volunteers, there nowhen evidence of an effect azithromycin (500mg) mg daily foror 3greater inhibitor andincrease non-specific CYP3A4 inhibitor, causedSection a 56%In increase in plasma sildenafil co-administered with sildenafil (50 to inhibitor non-specific CYP3A4 inhibitor, caused a levels 56% increase ina cytochrome plasma sildenafil when effects. a single mg sildenafil with erythromycin, specific CYP3A4 inhibitor, atin steady state (500 twice daily for 5 days), there days) onWhen theGrapefruit AUC, Cmax, t100 , elimination rate constant, oradministered subsequent half-life of sildenafil its principal circulating metabolite. Cimetidine (800 mg), P450 volunteers. juice is adose weakofinhibitor ofwas CYP3A4 gut wall metabolism and and mayora give rise to modest increases plasma of mg sildenafil. Single doses of concentrations max volunteers. Grapefruit juice is was a when weak inhibitor of gut wall metabolism and may rise was a 182% in sildenafil exposure Inaffect normal male volunteers, there no evidence ofCYP3A4 an effect of azithromycin mg daily for 3 to modest inc inhibitor andincrease non-specific CYP3A4systemic inhibitor, caused a(AUC). 56% increase in healthy plasma sildenafil concentrations co-administered with sildenafil (50 mg)(500 to healthy antacid (magnesium hydroxide/aluminium hydroxide) did not the bioavailability of sildenafil. Although specific interaction studies were not conducted for allgive antacid (magnesium hydroxide/aluminium hydroxide) did not theinhibitors bioavailability volunteers. Grapefruit is a weakanalysis inhibitor of CYP3A4 gut wall metabolism and may give rise to modest increases inwhen plasma levels ofaffect sildenafil. Single doses of sildenafil. days) on the AUC, Cmax , juice tmax, elimination rate constant, or effect subsequent half-life of sildenafil its principal circulating metabolite. Cimetidine (800 mg), a cytochrome P450 Although sp medicinal products, pharmacokinetic showed no of concomitant treatment onorsildenafil pharmacokinetics grouped as CYP2C9 (such of as medicinal products, pharmacokinetic analysis showed no effect of concomitant treatment on sildenafil pharmaco antacid (magnesium hydroxide/aluminium hydroxide) did notselective affect the bioavailability of inhibitors, sildenafil. Although specific interaction studies were notdiuretics, conducted forand inhibitor andwarfarin, non-specific CYP3A4 inhibitor, caused a 56% increase in plasma sildenafil concentrations when co-administered with sildenafil (50 mg) toallhealthy tolbutamide, phenytoin), CYP2D6 inhibitors (such as serotonin reuptake tricyclic antidepressants), thiazide and related loop tolbutamide, warfarin, phenytoin), CYP2D6 inhibitors (such as as selective serotonin reuptake inhibitors, medicinal products, pharmacokinetic analysis showed no effect concomitant treatment on sildenafil when CYP2C9 inhibitors (such as volunteers. Grapefruit juice angiotensin is a weak inhibitor of enzyme CYP3A4 gutofwall metabolism and blockers, may givebeta-adrenoreceptor rise pharmacokinetics to modest increases ingrouped plasma levels of CYP450 sildenafil. Single doses of tricyclic antid potassium sparing diuretics, converting inhibitors, calcium channel antagonists or inducers of metabolism potassium sparing diuretics, angiotensin converting enzyme inhibitors, calcium channel blockers, tolbutamide, warfarin, phenytoin), In CYP2D6 inhibitors (such asvolunteers, selective reuptake inhibitors, tricyclic antidepressants), thiazide and related diuretics, loop and antacid hydroxide/aluminium hydroxide) did not affectserotonin the bioavailability ofthe sildenafil. Although specific interaction studies not[moderate], conducted for allbeta-adrenorece (such as(magnesium rifampicin, barbiturates). a study of healthy male co-administration of endothelin antagonist, bosentan (an inducer ofwere CYP3A4 (suchchannel astreatment rifampicin, barbiturates). In atimes studya of healthy male co-administration of the potassium sparing diuretics, angiotensin converting enzyme inhibitors, calcium blockers, beta-adrenoreceptor antagonists orgrouped inducers of CYP450 metabolism medicinal products, pharmacokinetic analysis effect of concomitant on sildenafil pharmacokinetics when CYP2C9 inhibitors (such asendothelin anta CYP2C9 and possibly of CYP2C19) at steady stateshowed (125 mgno twice a day) with sildenafil at steady state (80 mg three day) resulted involunteers, 62.6%as and 55.4% decrease in CYP2C9 and possibly ofendothelin CYP2C19) atas steady state (125 mg twice a day) with sildenafil at steady state (80 mg three t (such as rifampicin, InCYP2D6 aTherefore, study inhibitors of healthy male volunteers, co-administration of the antagonist, bosentan (an inducer ofgreater CYP3A4 [moderate], sildenafil AUCwarfarin, and Cbarbiturates). , respectively. concomitant administration of strong CYP3A4 inducers, such rifampin, is expected to cause decreases in tolbutamide, phenytoin), (such as selective serotonin reuptake inhibitors, tricyclic antidepressants), thiazide and related diuretics, loop and max sildenafil AUC and C , respectively. concomitant administration of strong CYP3A4 inducers, such as CYP2C9 concentrations and possibly of of CYP2C19) at Nicorandil steadyconverting state mg twice a day) with sildenafil at steady state mg three times a day) resulteditinhas 62.6% and 55.4% in max (80 plasma sildenafil. is (125 a hybrid of potassium channel activator and nitrate. Due to theTherefore, nitrate component potential todecrease resultmetabolism in a potassium sparing diuretics, angiotensin enzyme inhibitors, calcium channel blockers, beta-adrenoreceptor antagonists or the inducers of CYP450 plasma concentrations of sildenafil. Nicorandil isisaexpected hybrid potassium channel activator sildenafil AUC and C , respectively. of strong CYP3A4 inducers, such rifampin, to cause greater decreases inand nitrate. Due to the serious with of sildenafil on male otheradministration medicinal products In vitro studies Sildenafil is aas weak inhibitor of the of cytochrome P450 isoforms 1A2, max sildenafil. Effects (such asinteraction rifampicin, barbiturates). In Therefore, a study of concomitant healthy volunteers, co-administration of the endothelin antagonist, bosentan (an inducer of CYP3A4 [moderate], serious interaction sildenafil. Effects of sildenafil onsildenafil, other products In vitro Sildenafil is a w plasma concentrations sildenafil. is a (125 hybrid potassium channel activator nitrate. the nitrate component it hasmedicinal the potential result in a studies 2C9, 2C19, 2E1 and 3A4 (IC50 at >Nicorandil 150 μM). Given sildenafil peak plasma of with approximately μM after 100 is unlikely that Viagra CYP2C9 and2D6, possibly ofof CYP2C19) steady state mgoftwice a day) withconcentrations sildenafil at and steady stateDue (80 to mg1 three times a mg day)ofresulted in it62.6% andto55.4% decrease in 2C9, 2C19, 2D6, 2E1 and 3A4 (IC50 150 μM). Givenofsildenafil peak plasma concentrations serious interaction with sildenafil. Effects of sildenafil on other medicinal products In vitro studies Sildenafil is a> weak inhibitor the cytochrome P450inhibitors isoforms such 1A2, of approximately 1 μ Connect will alter the clearance of substrates of these isoenzymes. There are no data on the interaction of sildenafil and non-specific phosphodiesterase of strong CYP3A4 inducers,substrates such as rifampin, is expected There to cause greater decreases in sildenafil AUC and Cmax, respectively. Therefore, concomitant administration Connect alter the clearance ofpathway of100 these are no on the of sildenafi 2C9, 2C19, 2D6, or 2E1 and 3A4 (IC50 150studies μM). Given sildenafil peak plasmaeffects concentrations of approximately 1 μM after mgisoenzymes. of sildenafil, it is unlikely that Viagra as theophylline dipyridamole. In>vivo its known onwill the nitric oxide/cGMP (see SmPC Section 5.1), sildenafil wasdata shown to interaction plasma concentrations of sildenafil. NicorandilConsistent is a hybridwith of potassium channel activator nitrate. Due to the nitrate component the potential tothe result in a theophylline or and dipyridamole. In vivo studies Consistent with ititshas known effects on Connect will alter the clearance of substrates ofand these isoenzymes. Therewith areas no data on the interaction of sildenafil and non-specific phosphodiesterase inhibitors suchnitric oxide/cGMP pathw potentiate the hypotensive effects of nitrates, its co-administration nitric oxide donors or nitrates in any form is therefore contraindicated (see SmPC Section serious interaction with sildenafil. Effects of sildenafil on other medicinalpotentiate productsthe In vitro studies Sildenafil is a weakand inhibitor of the cytochrome P450oxide isoforms 1A2, hypotensive effects of nitrates, its co-administration with was nitric donors or nitrates in any as theophylline or dipyridamole. In vivo systemic studies Consistent with itslowering known effects on the nitric oxide/cGMP (see SmPC Section 5.1), sildenafil shownhas to 4.3). Preclinical studies showed additive bloodsildenafil pressure effect when PDE5 inhibitors werepathway combined riociguat. In studies, riociguat 2C9, 2C19, 2D6, 2E1 and 3A4 (IC50 150 μM). Given peak plasma concentrations of 1systemic μMiswith after 100 mg of clinical sildenafil, it effect isSmPC unlikely that Viagra 4.3). Preclinical studies showed additive blood pressure lowering when PDE5 inhibitors were com potentiate the hypotensive effects of>nitrates, and itsPDE5 co-administration withwas nitric oxide donors or approximately nitratesclinical in any form therefore contraindicated (see Section been shown to augment the hypotensive effects of inhibitors. There no evidence of favourable effect of the combination in the population studied. Connect will alter the clearance of substrates of these isoenzymes. There effect are no data PDE5 on theinhibitors interaction of combined sildenafil and inhibitors such been shown to(see augment hypotensive effects of PDE5 inhibitors. was no evidence favourable clinical 4.3). Preclinical studies showed additive blood pressure lowering when were withnon-specific riociguat. In phosphodiesterase clinical studies, riociguat has of Concomitant use riociguat with PDE5 systemic including sildenafil, is contraindicated SmPC the Section 4.3). Concomitant administration ofThere sildenafil to patients as theophylline orofdipyridamole. In vivoinhibitors, studies of Consistent with itsThere known effects on use theof nitric oxide/cGMP pathway (seecombination SmPC Section 5.1), was shown to Concomitant of riociguat PDE5 inhibitors, including sildenafil, is sildenafil contraindicated been shown to augment the may hypotensive effects PDE5 inhibitors. no evidence favourable clinical effect of the in the population studied. taking alpha-blocker therapy lead to symptomatic hypotension in a fewwas susceptible individuals. This iswith most likely to occur within 4 hours post sildenafil dosing (see(see SmPC Section 4.3). potentiate theuse hypotensive effectsPDE5 of nitrates, andincluding its co-administration with nitric oxide donors or nitrates in Concomitant any form is therefore contraindicated (seepatients SmPC Section This is most lik taking alpha-blocker therapy may lead symptomatic hypotension in a feworsusceptible individuals. Concomitant riociguat inhibitors, sildenafil, is contraindicated (see SmPC Section administration of sildenafil SmPC Sections 4.2ofand 4.4). Inwith three specific drug-drug interaction studies, the alpha-blocker doxazosin (4 mg4.3). and to 8 mg) and sildenafil (25 mg, 50 mg, 100tomg) were 4.3). Preclinical studies showed additive systemic blood pressurein lowering effect when PDE5 inhibitors were combined with riociguat. Instudies, clinical studies, riociguat has Sections 4.2 and specific drug-drug interaction the alpha-blocker (4 mg and taking alpha-blocker therapy may lead to symptomatic a fewSmPC susceptible individuals. ThisIn is three most likely to occur within 4 hours post sildenafil dosing (see doxazosin administered simultaneously to patients with benignhypotension prostatic hyperplasia (BPH) stabilized on 4.4). doxazosin therapy. In these study populations, mean additional been to 4.2 augment the effects of PDE5 inhibitors. There was no evidence of favourable clinical effect of the combination in the population studied. administered with prostatic (BPH) stabilized on doxazosin the SmPCshown Sections and 4.4). Inhypotensive three specific drug-drug interaction the alpha-blocker doxazosin (4 to mgpatients and 8 mg) andbenign sildenafil (25 mg, 50 mg, or 100 mg) were reductions of supine blood pressure of 7/7 mmHg, 9/5 mmHg, andstudies, 8/4 mmHg, and mean simultaneously additional reductions of standing blood pressure ofhyperplasia 6/6 mmHg, 11/4 mmHg, of supine blood pressure 7/7 mmHg, 9/5study mmHg, and 8/4 therapy, mmHg, and mean additional reductions of Concomitant use of riociguatwere with PDE5 inhibitors, including sildenafil, isreductions contraindicated (see SmPC Section Concomitant administration of sildenafil to patients administered simultaneously to patients with benign prostatic hyperplasia (BPH) stabilized on doxazosin therapy. In stabilized these populations, mean additional and 4/5 mmHg, respectively, observed. When sildenafil and doxazosin were administered simultaneously toof4.3). patients on doxazosin there were andsusceptible 4/5 mmHg, respectively, wereisobserved. When sildenafil and doxazosin were administered simultaneously to taking alpha-blocker may lead to symptomatic hypotension ahypotension. few individuals. This most likely toblood occur within 4 of hours post sildenafil dosing reductions of supineoftherapy blood pressure of 7/7 mmHg,symptomatic 9/5 mmHg, and 8/4inmmHg, and mean additional of standing pressure 6/6but mmHg, 11/4 mmHg, infrequent reports patients who experienced postural These reportsreductions included dizziness and light-headedness, not syncope. No (see infrequent of patients who experienced hypotension. These reports included di SmPC Sections 4.2 and were 4.4). In three specific drug-drug interaction studies, the administered alpha-blocker doxazosin (4 or mg and 8 mg) and (25 mg, 50metabolised mg,there or 100 mg) and 4/5 mmHg, respectively, were observed. When sildenafil and were simultaneously to patients stabilized on doxazosin therapy, were significant interactions shown when sildenafil (50 mg) was doxazosin co-administered withreports tolbutamide (250 mg) warfarin (40symptomatic mg),sildenafil both of postural which are by were significant interactions were shown when sildenafil (50 did mg)study was co-administered with additional tolbutamide (250 mg) or infrequent reports of mg) patients who experienced symptomatic postural These reports dizziness and but not No administered simultaneously to patients with benign prostatic hyperplasia (BPH) stabilized onincluded doxazosin therapy. Inlight-headedness, these populations, mean CYP2C9. Sildenafil (50 did not potentiate the increase in bleeding timehypotension. caused by acetyl salicylic acid (150 mg). Sildenafil (50 mg) not potentiate thesyncope. hypotensive CYP2C9. Sildenafil (50 mg)(250 did not potentiate the(40 increase in bleeding time caused by acetyl salicylic acid (150 mg). significant interactions werevolunteers shown when sildenafil (50 was and co-administered with tolbutamide mg) or warfarin both of which metabolised bymmHg, reductions of supine blood pressure of 7/7 mmHg, 9/5mg) mmHg, 8/4 mmHg, mean additional reductions of standing blood pressure ofare 6/6 mmHg, 11/4 effects of alcohol in healthy with mean maximum blood alcohol levels ofand 80 mg/dl. Pooling of the following classes ofmg), antihypertensive medication; diuretics, effects of products alcoholsalicylic in(vasodilator healthy with mean maximum blood alcoholblockers, levels of calcium 80 mg/dl. Pooling of the follow CYP2C9. Sildenafil (50 mg) did were not potentiate the increase in bleeding time medicinal caused by acetyl acidvolunteers (150 mg). Sildenafil (50 mg) did not potentiate thetherapy, hypotensive and 4/5 mmHg, respectively, observed. When sildenafil and doxazosin were administered simultaneously to patients stabilized on doxazosin there were beta-blockers, ACE inhibitors, angiotensin II antagonists, antihypertensive and centrally-acting), adrenergic neurone beta-blockers, ACE inhibitors, angiotensin IIsildenafil antagonists, antihypertensive medicinal products (vasodilator and ce effects ofblockers alcohol in healthy volunteers withblockers, mean maximum alcohol levels 80 mg/dl. Pooling ofpatients the following classes ofand antihypertensive medication; diuretics, infrequent reports of alpha-adrenoceptor patients who experienced symptomatic postural hypotension. These reports included dizziness light-headedness, but not syncope. No channel and showedblood no difference in theofside effect profile in taking compared to placebo treatment. In a channel blockers and alpha-adrenoceptor blockers, showed difference in the metabolised side effect profile beta-blockers, ACE inhibitors, angiotensin II antagonists, antihypertensive medicinal products (vasodilator andmg) centrally-acting), adrenergic neurone blockers, calcium significant interactions were shown when sildenafil mg) was co-administered with (250 or warfarin (40 mg), no both of which are by in patients ta specific interaction study, where sildenafil (100 mg) was(50 co-administered with amlodipine in tolbutamide hypertensive patients, there was an additional reduction on supine systolic specific interaction study, where (100 mg) was with amlodipine channel blockers alpha-adrenoceptor blockers, showed difference incaused the side profile in patients taking sildenafil compared placebo treatment. In in a hypertensive patients CYP2C9. Sildenafil mg) did potentiate the increase inno bleeding time byeffect acetyl salicylic acid7sildenafil (150 mg). Sildenafil (50co-administered mg) didto not potentiate the hypotensive blood pressure ofand 8(50 mmHg. Thenot corresponding additional reduction in supine diastolic blood pressure was mmHg. These additional blood pressure reductions were blood pressure of 8 mmHg. additional reduction innot supine diastolic blood pressure was 7 mmH specific interaction where sildenafil (100 mg) was with amlodipine in hypertensive patients, there was an additional reduction on supine of a similar magnitude to those seen when sildenafil wasco-administered administered alone to healthy volunteers (see The SmPC Section 5.1). Sildenafil mg) did affect thesystolic steady effects of alcohol instudy, healthy volunteers with mean maximum blood alcohol levels of 80 mg/dl. Pooling of corresponding the following classes of (100 antihypertensive medication; diuretics, of adiastolic similar magnitude to those when sildenafil was administered alone to healthy volunteers (see SmPC Sec bloodpharmacokinetics pressureACE of 8inhibitors, mmHg. TheHIV corresponding additional reduction in supine blood pressure was seen 7substrates. mmHg. These additional blood pressure reductions were state of the proteaseIIinhibitors, saquinavir and ritonavir, both of which are(vasodilator CYP3A4 In healthy male volunteers sildenafil at steady beta-blockers, angiotensin antagonists, antihypertensive medicinal products and centrally-acting), adrenergic neurone blockers, calcium state pharmacokinetics of the HIV Section protease inhibitors, saquinavir andnot ritonavir, both of which are CYP3A4 substr of a similar toathose seen when was administered alone to volunteers SmPC 5.1). Sildenafil (100 mg) Addition did affect the steady state (80blockers mgmagnitude threeand times day) resulted in asildenafil 49.8% increase in bosentan AUC and a 42% increase in(see bosentan Cmax (125 mg two times a day). of a single dose channel alpha-adrenoceptor blockers, showed no difference inhealthy the side effect profile in patients taking sildenafil compared to placebo treatment. In a state (80 mg three times a day) resulted in a 49.8% increase in bosentan AUC and a 42% increase state pharmacokinetics of the HIV protease inhibitors, saquinavir ritonavir, both which arewith CYP3A4 substrates.greater In healthy male volunteers sildenafil steady of sildenafil to sacubitril/valsartan at steady state inwas patients withand hypertension wasof associated a significantly blood pressure reduction compared tosystolicin bosentan Cma specific interaction study, where sildenafil (100 mg) co-administered with amlodipine in hypertensive patients, there was an additional reduction onat supine of sildenafil to sacubitril/valsartan at steady state in patients with hypertension was associated with a significa state (80 mg three times a day) resulted in a Therefore, 49.8% increase in bosentan AUC and a 42% increase in bosentan Cmax (125 mg treated two times a day). Addition of a single dose administration alone. caution should in be exercised when sildenafil is initiated inmmHg. patients with sacubitril/valsartan. Fertility, blood pressureof ofsacubitril/valsartan 8 mmHg. The corresponding additional reduction supine diastolic blood pressure was 7 These additional blood pressure reductions were administration of100 sacubitril/valsartan alone. Therefore, should be exercised when of sildenafiland to sacubitril/valsartan at no steady state in patients with hypertension wassingle associated with adoses significantly greater bloodcaution pressure reduction compared to sildenafil is initiated in pregnancy lactation: There was effect on sperm motility or morphology after mg oral of sildenafil in healthy volunteers. Viagra Connect is not of a similar magnitude to those seen when sildenafil was administered alone to healthy volunteers (see SmPC Section 5.1). Sildenafil (100 mg) did not affect the steady pregnancy and sildenafil lactation: wasinno effect on sperm motility or morphology after single 100 mg oral doses of administration of by sacubitril/valsartan alone. Therefore,and caution should be exercised when isThere initiated patients treated with sacubitril/valsartan. Fertility, indicated for use women. are no adequate well-controlled studies inboth pregnant or breast-feeding women. No adverse effects were found in steady state pharmacokinetics of There theThere HIV protease inhibitors, saquinavir and ritonavir, of 100 which are CYP3A4 substrates. Inrelevant healthy male volunteers sildenafil at indicated for use by mg women. There are no adequate andvolunteers. well-controlled studies in<1/10): pregnant or breast-feeding pregnancy and lactation: was no effect on sperm motility or morphology after single oral doses of sildenafil in healthy Viagra Connect is not reproduction studies in rats and rabbits following oral administration of sildenafil. Undesirable effects: Very common (≥1/10): headache. Common (>1/100, state (80 mg three times a day) resulted in adequate a 49.8% increase in bosentanstudies AUC and a 42% increase in and bosentan Cfollowing (125 two times a day). of a single reproduction studies rats rabbits oral administration ofAddition sildenafil. Undesirable max indicated usecolour by women. There are no and in pregnant orinbreast-feeding women. Nomg relevant adverse effects were found in doseeffects: Very co dizziness, for visual distortions, visual disturbance, visonwell-controlled blurred, flushing, hot flush, nasal congestion, nausea, dyspepsia. For details of uncommon, rare and very of sildenafil tostudies sacubitril/valsartan at steady state in administration patients with hypertension was withVery a significantly greater blood pressure reduction compared to dizziness, visualassociated colour distortions, visual disturbance, vison blurred, flushing, hot flush, nasal congestion, nausea reproduction in rats and rabbits following oral of sildenafil. Undesirable common (≥1/10): headache. Common (>1/100, <1/10): rarely reported adverse events and those of unknown frequency, see SmPC. Reporting of effects: adverse reactions: Reporting suspected adverse reactions after administration of sacubitril/valsartan alone. Therefore, caution should be exercised when sildenafil isnausea, initiated in patients treated with sacubitril/valsartan. Fertility, rarely adverse events and those of unknown frequency, seeprofessionals SmPC. Reporting of adverse react dizziness, visual distortions, visual disturbance, flushing, hot reported flush, nasal congestion, dyspepsia. For details of uncommon, rare and very authorisation of colour the medicinal product is important. It vison allowsblurred, continued monitoring of the benefit/risk balance of the medicinal product. Healthcare are pregnancy and lactation: Thereand was those no effect on sperm frequency, motility or morphology after single 100 mg oral dosesisofimportant. sildenafil in healthy volunteers. Viagra Connect is not of the product It allows continued monitoring of the rarely to reported events of unknown see authorisation SmPC. Website: Reporting ofmedicinal adverse reactions: Reporting suspected adverse reactions asked report adverse any suspected adverse reactions via HPRA Pharmacovigilance, www.hpra.ie. Adverse reactions/events should also be reported toafter thebenefit/risk balance of indicated for use bymedicinal women. product There are no adequate and well-controlled studies in pregnant or breast-feeding women. via No relevant adverseprofessionals effects wereare found in asked toof report any suspected adverse HPRA Pharmacovigilance, authorisation of the is important. It allows continued monitoring the benefit/risk balance ofCategory: the reactions medicinal product. marketing autorisation holder at the email address: pv.ireland@viatris.com or phone 0044(0)8001218267. Legal Not subject to Healthcare medical prescription.Website: Supply www.hpra.ie. Advers reproduction studies in rats andadverse rabbits following via oral administration ofmarketing sildenafil. Undesirable effects: common headache. Common (>1/100, autorisation holder at theVery email address:(≥1/10): pv.ireland@viatris.com or phone 0044(0)8001218267. Legal C asked topharmacies report any only. suspected reactions HPRA Pharmacovigilance, Website: www.hpra.ie. Adverse reactions/events should alsoLimited, be reported to the<1/10): through Marketing Authorisation Numbers: PA23355/063/001-002 Marketing Authorisation Holder: Viatris Healthcare Damastown through Marketing Authorisation Numbers: PA23355/063/001-002 Marketing Authorisati dizziness, colour holder distortions, visual disturbance, vison blurred, flushing, hotpharmacies flush, nasalonly. congestion, nausea, dyspepsia. ForEmail details of uncommon, and very marketing autorisation at the15, email address: pv.ireland@viatris.com or phone 0044(0)8001218267. Legal Category: Not subject to medical prescription. rare Supply Industrial visual Park, Mulhuddart, Dublin DUBLIN, Ireland Full prescribing information available on request from: Viatris, Dublin 17. : info.ie@viatris.com Date Industrial Park, Mulhuddart, Dublin 15, DUBLIN, Ireland prescribing information available rarely reported adverse and Authorisation those of unknown see SmPC. Reporting of Authorisation adverse reactions: Reporting suspected adverse reactions afteron request from through pharmacies only. events Marketing Numbers: PA23355/063/001-002 Marketing Holder: ViatrisFull Healthcare Limited, Damastown of Revision of Abbreviated Prescribing Information: 06 Julyfrequency, 2026 Reference Number: IE-AbPI-ViagraConnect-FCT+ODF-v001 of Revisionavailable of the Abbreviated Prescribing Information: 06product. July 2026 Reference professionals Number: authorisation the medicinal product is important. allows continued monitoring benefit/risk balance of the medicinal Healthcare are Industrial Park,ofMulhuddart, Dublin 15, DUBLIN, IrelandItFull prescribing information on request from: Viatris, Dublin 17. Email : info.ie@viatris.com DateIE-AbPI-ViagraConnect-F of Revision of Abbreviated Prescribing 06HPRA July 2026 Reference Number: IE-AbPI-ViagraConnect-FCT+ODF-v001 asked to report any suspected adverseInformation: reactions via Pharmacovigilance, Website: www.hpra.ie. Adverse reactions/events should also be reported to the marketing autorisation holder at the email address: pv.ireland@viatris.com or phone 0044(0)8001218267. Legal Category: Not subject to medical prescription. Supply through pharmacies only. Marketing Authorisation Numbers: PA23355/063/001-002 Marketing Authorisation Holder: Viatris Healthcare Limited, Damastown Industrial Park, Mulhuddart, Dublin 15, DUBLIN, Ireland Full prescribing information available on request from: Viatris, Dublin 17. Email : info.ie@viatris.com Date References: 1. Viagra Connect 50 mg orodispersible films Summary of Product Characteristics Feb 2026 of Revision of Abbreviated Prescribing Information: 06 July 2026 Reference Number: IE-AbPI-ViagraConnect-FCT+ODF-v001 IE-VIAC-2026-00055 July 2026 References: 1. ViagraDOP: Connect 50 mg orodispersible films Summary of Product Characteristics Feb 2026 IE-VIAC-2026-00055 DOP: July 2026

References: 1. Viagra Connect 50 mg orodispersible ﬁlms Summary of Product Characteristics Feb 2026

CPD MODULE | Men's health

Counselling on prescribed therapies

Many patients attending community pharmacies will also be prescribed oral finasteride by their GP or dermatologist. Pharmacists should reinforce appropriate counselling regarding expected benefits, the importance of adherence, and potential adverse effects. Sexual dysfunction, breast tenderness, and mood changes should be discussed in a balanced manner, ensuring patients are aware that these adverse effects occur in a minority of users while encouraging them to seek medical advice if concerns arise. Where patients enquire about dutasteride or low-dose oral minoxidil, pharmacists should explain that these treatments may be prescribed off-label by specialists in selected cases and are not appropriate for routine self-medication.

Advising on supplements and complementary therapies

Hair loss is associated with a substantial commercial market, hence pharmacists are frequently asked about vitamins, minerals, herbal preparations, and cosmetic products. Patients should be advised that while correction of genuine nutritional deficiencies is important, most supplements have little convincing evidence of benefit in otherwise healthy men with androgenetic alopecia. Pharmacists can therefore help patients avoid unnecessary expenditure on products making exaggerated or unsupported claims.

Lifestyle advice

Although lifestyle changes cannot reverse genetically determined androgenetic alopecia, pharmacists should encourage measures that support overall scalp and hair health. These include maintaining a balanced diet with adequate protein and essential micronutrients, avoiding crash-dieting, managing chronic illness effectively, and stopping smoking where appropriate. Good general health may optimise normal hair

MCQs Q1. Which phase of the normal hair growth cycle is the active growth phase? A. Catagen. B. Telogen. C. Anagen. D. Exogen. Q2. Oral finasteride treats androgenetic alopecia primarily by: A. Increasing scalp blood flow. B. Stimulating collagen production. C. Blocking androgen receptors directly. D. Inhibiting type II 5-alpha-reductase and reducing DHT production. Q3. Which of the following is the only non-prescription medicine licensed for male pattern hair loss in Ireland? A. Oral finasteride. B. Dutasteride. C. Topical minoxidil. D. Low-dose oral minoxidil.

growth even though it does not alter the underlying genetic process.

Supporting psychological wellbeing

Hair loss can have a considerable psychological impact, particularly in younger men. Reduced confidence, anxiety, social withdrawal, and impaired quality of life are common and should not be underestimated. Pharmacists should approach consultations sensitively, acknowledge patients' concerns, and provide reassurance that effective evidence-based treatments are available for many individuals.

Part 10: Future directions Research into androgenetic alopecia is advancing rapidly, with several

Q4. Which of the following findings should prompt referral for further medical assessment? A. Gradual bitemporal recession over several years. B. Mild thinning at the vertex. C. Family history of male pattern hair loss. D. Scalp scarring with rapidly progressive hair loss. Q5. Which statement regarding supplements for male pattern hair loss is correct? A. Biotin is effective for most men with androgenetic alopecia. B. Routine iron supplementation is recommended for all men with hair loss. C. Supplements should generally only be recommended when a nutritional deficiency is suspected or confirmed. D. Saw palmetto has stronger evidence than finasteride.

novel therapies under investigation. Although topical minoxidil and oral finasteride remain the cornerstone of treatment, a better understanding of hair follicle biology is leading to new approaches aimed at improving efficacy, reducing adverse effects, and potentially reversing follicular miniaturisation more effectively.

New topical anti-androgen therapies

Selective androgen receptor modulation and newer topical antiandrogen therapies are among the most promising developments. Topical formulations seek to reduce scalp dihydrotestosterone while minimising systemic exposure and associated adverse effects. Several investigational agents have demonstrated encouraging early trial results, although further

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Men's health | CPD MODULE

long-term safety and efficacy data are required before widespread clinical use.

Cell-based and regenerative therapies

Cell-based and regenerative therapies are also attracting considerable interest. Researchers are exploring stem-cellderived treatments, exosomes and other regenerative technologies designed to stimulate dormant follicles and enhance hair growth. While these approaches remain largely experimental, they represent an exciting area of ongoing dermatology research.

Artificial intelligence and digital monitoring

Artificial intelligence and digital imaging

References 1. Almohanna HM, Ahmed, AA, Tsatalis JP, and Tosti A (2019). ‘The role of vitamins and minerals in hair loss: A review’, Dermatology and Therapy, 9(1), pp. 51–70. 2. American Academy of Dermatology Association (2024). Hair loss: Diagnosis and treatment. Available at: https://www.aad. org. 3. Asfour L, and Cranwell W (2023). ‘Platelet-rich plasma for androgenetic alopecia: An updated systematic review’, Journal of Cosmetic Dermatology, 22(5), pp. 1548– 1558. 4. Badri T, and Alikhan A (2024). ‘Androgenetic alopecia’, StatPearls. Treasure Island, FL: StatPearls Publishing. 5. British Association of Dermatologists (2022). Patient Information Leaflet: Male Pattern Hair Loss. London: BAD. 6. Cranwell W, and Sinclair R (2016). ‘Male androgenetic alopecia’, BMJ, 355, i5610. 7. European Academy of Dermatology and Venereology (2024) Guidelines for the management of androgenetic alopecia. Brussels: EADV. 8. Gupta AK, Bamimore MA, and Foley KA (2022). ‘Network meta-analysis of treatments for androgenetic alopecia’, Journal of Dermatological Treatment, 33(7), pp. 3401–3412. 9. Gupta AK, and Charrette A (2015). ‘The

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are increasingly being used to monitor treatment response objectively. Smartphone applications, trichoscopy and image-analysis software may improve follow-up by allowing clinicians to quantify hair density and progression more accurately than visual assessment alone.

in follicular miniaturisation and treatment response. ●

Written by Eamonn Brady (MPSI). Whelehans Pharmacies, 38 Pearse St and Clonmore, Mullingar. Tel 04493 34591 (Pearse St) or 04493 10266 (Clonmore). www.whelehans.ie

Gene-targeted therapies

Gene-targeted therapies may eventually allow treatment to be tailored according to an individual's genetic susceptibility. Although personalised medicine for androgenetic alopecia is not yet part of routine practice, advances in genomics continue to improve understanding of the molecular pathways involved

efficacy and safety of 5-alpha-reductase inhibitors in androgenetic alopecia: A network meta-analysis and benefit-risk assessment’, Journal of Dermatological Treatment, 26(2), pp. 156–161. 10. Gupta AK, Mays RR and Versteeg SG (2018). ‘Efficacy of minoxidil for androgenetic alopecia: A systematic review and meta-analysis’, Journal of Dermatological Treatment, 29(4), pp. 366–379. 11. Hamilton JB (1951). ‘Patterned loss of hair in man: Types and incidence’, Annals of the New York Academy of Sciences, 53(3), pp. 708–728. 12. Ho CH, Sood T, and Zito PM (2024). ‘Telogen effluvium’, StatPearls. Treasure Island, FL: StatPearls Publishing. 13. Messenger AG, and Sinclair RD (2006). ‘Follicular miniaturisation in female pattern hair loss: Clinicopathological correlations’, British Journal of Dermatology, 155(5), pp. 926–930. 14. Messenger AG, and McKillop J (2019). ‘Hair loss’, Medicine, 47(6), pp. 386–395. 15. Mounsey AL, and Reed SW (2009). ‘Diagnosing and treating hair loss’, American Family Physician, 80(4), pp. 356–362. 16. National Institute for Health and Care Excellence (2023). Clinical Knowledge Summaries: Hair loss – male pattern hair loss. London: NICE. 17. Olsen EA, Hordinsky M, Roberts JL et al

COMPLETE THIS MODULE ONLINE You can check your answers to the T/F and MCQ questions on PharmacistCPD.ie. Successful completion of this module will earn you 2 CPD points.

(2005). ‘Female and male pattern hair loss’, Journal of the American Academy of Dermatology, 52(2), pp. 301–311. 18. Rossi A, Cantisani C, Melis M, et al (2012). ‘Minoxidil use in dermatology’, Dermatologic Therapy, 25(2), pp. 130–141. 19. Rossi A, Magri F, and Michelini S (2023). ‘Low-dose oral minoxidil in androgenetic alopecia: Current evidence and future perspectives’, Journal of Cosmetic Dermatology, 22(10), pp. 2850–2858. 20. Sinclair R (2005). ‘Male androgenetic alopecia’, Journal of Men's Health & Gender, 2(3), pp. 319–327. 21. Suchonwanit P, Thammarucha S, and Leerunyakul K (2019). ‘Minoxidil and its use in hair disorders: A review’, Drug Design, Development and Therapy, 13, pp. 2777–2786. 22. Varothai S, and Bergfeld WF (2014). ‘Androgenetic alopecia: An evidence-based treatment update’, American Journal of Clinical Dermatology, 15(3), pp. 217–230. 23. York K, Meah N, Bhoyrul B, and Sinclair R (2020). ‘A review of the treatment of male pattern hair loss’, Expert Opinion on Pharmacotherapy, 21(5), pp. 603–612. 24. Zito PM, and Katta R (2024). ‘Alopecia areata’, StatPearls. Treasure Island, FL: StatPearls Publishing. 25. Zito PM, and Katta R (2024). ‘Tinea capitis’, StatPearls. Treasure Island, FL: StatPearls Publishing.

IN FOCUS | Obesity

The complexities of obesity Eamonn Brady MPSI discusses the causes, consequences, and treatment options for obesity Part 1: The condition Epidemiology

while 73 per cent had a healthy weight. Beyond cardiometabolic disease, obesity increases the risk of several cancers, including breast, colorectal and endometrial cancer. It is also associated with musculoskeletal disease, depression, infertility, pregnancy complications, and reduced quality of life. For pharmacy practice, this often means more complex polypharmacy, adherence challenges, and the need to avoid, where possible, iatrogenic weight gain from medicines such as some antidepressants, antipsychotics, corticosteroids, insulin, and sulfonylureas.

Pathophysiology

Body weight is regulated by a complex neuro-hormonal system linking the gut, adipose tissue, pancreas, and brain. Key signals include leptin, ghrelin, insulin, GLP-1, GIP, peptide YY and cholecystokinin. These signals influence appetite, satiety, reward pathways, gastric emptying, glucose regulation, and energy expenditure. In obesity, the normal regulation of appetite and satiety is disrupted. Leptin resistance may develop, meaning that higher body fat stores do not reliably translate into reduced appetite. Reward

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Image: iStock.com

Obesity is a chronic, relapsing disease and remains one of the most pressing health challenges in Ireland and other Western countries. From the pharmacy counter to hospital clinics, the consequences are seen daily: More prescriptions for antihypertensives and lipid-lowering agents, increased demand for sleep apnoea assessment, and younger patients presenting with type 2 diabetes, fertility problems and metabolic dysfunction-associated steatotic liver disease (MASLD), previously referred to as non-alcoholic fatty liver disease. Obesity is not simply the result of individual choices. It is shaped by genetics, appetite regulation, physiology, the built environment, food marketing, socioeconomic pressures, sleep, stress, and medicines that promote weight gain. Recognising obesity as a disease helps frame the pharmacist’s role in a practical way: Supporting patients with evidencebased advice, structured weight management, medicines optimisation, and signposting to appropriate HSE or specialist services. Irish data continue to show that excess weight is common. The 2025 Irish Health Survey reported that 21.5 per cent of adults were living with obesity, with the highest rates seen in those aged 55-to-64 years. Healthy Ireland and HSE data also show that a majority of Irish adults are either overweight or living with obesity, while childhood rates remain a concern, particularly in areas of socioeconomic disadvantage. The latest COSI data for Ireland reported that 17.7 per cent of primary school children were living with overweight or obesity in 2022–2023,

Obesity | IN FOCUS

circuitry, stress pathways and the hypothalamic-pituitary-adrenal axis can also reinforce cravings and energydense food choices. After weight loss, resting energy expenditure may fall, a process known as adaptive thermogenesis, which partly explains why weight regain is common without ongoing support. This biology is important for pharmacists to understand. Many patients have repeatedly tried to lose weight and feel they have ‘failed’. Explaining obesity as a chronic disease with biological drivers can reduce stigma and improve engagement with lifestyle measures, pharmacotherapy, and longterm follow-up.

How are ‘overweight’ and ‘obesity’ classified?

BMI remains the most widely used measure for classifying weight status in adults. BMI is calculated as weight in kilograms divided by height in metres squared. BMI categories:  Underweight: <18.5kg/m²  Healthy weight: 18.5–24.9kg/m²  Overweight: 25.0–29.9kg/m²  Obesity class I: 30.0–34.9kg/m²  Obesity class II: 35.0–39.9kg/m²  Obesity class III: ≥40.0kg/m² NICE also recommends considering waist-to-height ratio alongside BMI, particularly in adults with a BMI below 35kg/m². A waist measurement less than half a person's height indicates lower cardiometabolic risk.

Weight and obesity rates and trends in Ireland

Recent Irish data confirm that excess weight remains common. The 2025 Irish Health Survey reported that 21.5 per cent of adults were living with obesity. The latest COSI report found that 17.7 per cent of primary school children were living with overweight or obesity in 2022-2023.

Risk factors

 Genetic and epigenetic influences.

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 Early-life exposures.  Environmental and behavioural factors.  Socioeconomic factors.  Medical causes including hypothyroidism, PCOS and Cushing’s syndrome.  Medicines associated with weight gain including corticosteroids, some antipsychotics, tricyclic antidepressants, mirtazapine, sodium valproate, insulin, sulfonylureas, and some beta-blockers.

Health consequences

Obesity increases all-cause mortality and contributes to metabolic, cardiovascular, respiratory, gastrointestinal, hepatic, musculoskeletal, reproductive, oncological and mental health disorders. MASLD and MASH are the updated terms replacing NAFLD and NASH. Even sustained weight loss of 5-to-10 per cent improves blood pressure, glycaemic control, triglycerides, and liver health.

Non-pharmacological approaches

Lifestyle intervention remains the foundation of obesity management and should accompany all pharmacological and surgical treatments. Sustainable changes in eating habits, physical activity, sleep, and behavioural support consistently produce better long-term outcomes than isolated interventions.

Dietary strategies

 Encourage minimally processed foods,

vegetables, fruit, pulses, wholegrains, lean protein, and healthy fats.  Ensure adequate protein intake to help preserve lean muscle during weight loss, particularly in older adults and patients receiving GLP-1 medicines.  Create an individualised calorie deficit using an eating pattern the patient can maintain long-term. Mediterraneanstyle diets have the strongest evidence for overall cardiometabolic health, while lower-carbohydrate or DASH-style diets may suit selected patients.  Limit ultra-processed foods, sugarsweetened drinks, and excess alcohol.  Practical advice such as meal

NICE also recommends considering waist-toheight ratio alongside BMI, particularly in adults with a BMI below 35kg/m²

planning, shopping with a list, batch cooking, portion awareness and keeping healthy snacks visible often has greater long-term impact than restrictive dieting.

Physical activity

Current guidance recommends at least 150 minutes of moderate-intensity activity each week together with musclestrengthening exercise on at least two days weekly. Resistance exercise is particularly important during weight loss to preserve lean muscle mass. Encourage patients to choose enjoyable activities such as brisk walking, cycling, swimming, or gardening, and reassure those with obesity that several short bouts of activity throughout the day provide meaningful health benefits.

Behavioural techniques

Self-monitoring using food diaries or smartphone apps, SMART goals, identifying triggers for overeating and developing coping strategies all improve long-term success. Good sleep (seven-to-nine hours), stress management and social support should form part of every weightmanagement plan. Pharmacists should also signpost suitable patients to HSE Healthy Weight services, Slí na Sláinte walking routes and community dietetic services where available.

Weight-loss apps: A pharmacist's perspective

Digital health tools can improve adherence when used alongside lifestyle advice, rather than replacing

IN FOCUS | Obesity

it. Popular apps available in Ireland include MyFitnessPal, Cronometer, Lose It!, Noom, BetterMe, WalkFit, Lifesum, FatSecret and MyNetDiary. Features vary from calorie and nutrient tracking, to behavioural coaching and structured exercise programmes. Prices change regularly; therefore, pharmacists should encourage patients to compare current subscription costs before purchasing paid versions. For most patients, the free versions provide sufficient functionality. Patients needing detailed nutritional analysis may benefit from Cronometer, those wanting behavioural coaching may prefer Noom, while MyFitnessPal and Lose It! remain good all-round options because of their extensive food databases.

Pharmacist take-home points  Apps should support, not replace,

evidence-based lifestyle interventions.  Match the app to the patient's

goals, confidence with technology and budget.  Encourage realistic expectations and long-term habit formation rather than rapid weight loss.  Patients receiving GLP-1 medicines should prioritise adequate protein intake and resistance exercise to minimise loss of lean muscle.  When lifestyle measures alone are insufficient and appropriate BMI criteria are met, anti-obesity medicines should be viewed as an adjunct to comprehensive lifestyle management rather than a substitute for it.

Part 2: Pharmacological treatment options Drug treatment should always be used alongside lifestyle intervention rather than as a replacement. In Ireland, anti-obesity medicines can be broadly divided into nonincretin therapies and incretinbased therapies (GLP-1 receptor agonists and dual GIP/GLP-1 receptor agonists). The latter now dominate

clinical practice because they produce substantially greater and more sustained weight loss.

Type 1: Non-incretin pharmacological options, ie, medicines other than GLP-1 injections

Orlistat (Xenical) remains the only licensed oral anti-obesity medicine widely available in Ireland. It reduces intestinal fat absorption by approximately 30 per cent and is most effective when combined with a low-fat diet. Gastrointestinal adverse effects including steatorrhoea (fatty stools), flatulence, and faecal urgency remain the principal limitation. Patients should take a multivitamin containing fat-soluble vitamins at bedtime. Xenical is available on private prescription and is not routinely reimbursed under GMS or DPS for obesity. Naltrexone/bupropion (Mysimba) acts centrally to reduce appetite and food cravings. Clinical trials demonstrate average weight loss of approximately 5-to-8 per cent when combined with lifestyle measures. Nausea, insomnia, and headache are common. It is contraindicated in seizure disorders, uncontrolled hypertension, chronic opioid use, and eating disorders. In Ireland, it remains available privately without routine HSE reimbursement. Metformin is not licensed specifically for obesity but is sometimes used in patients with prediabetes, insulin resistance, or polycystic ovary syndrome where modest weight loss may be beneficial. Topiramate is also unlicensed for obesity in Ireland and is generally reserved for specialist practice because of cognitive adverse effects and teratogenicity.

Type 2: GLP-1 receptor agonists and dual GIP/GLP-1 receptor agonists Incretin-based therapies have transformed obesity management.

Drug treatment should always be used alongside lifestyle intervention rather than as a replacement They reduce appetite, enhance satiety and slow gastric emptying, resulting in clinically meaningful and sustained weight loss when combined with lifestyle intervention. Medicines currently relevant to Irish practice include semaglutide (Ozempic and Wegovy), liraglutide (Victoza and Saxenda), dulaglutide (Trulicity), exenatide (Byetta and Bydureon), oral semaglutide (Rybelsus) and tirzepatide (Mounjaro). Most are administered as once-weekly or once-daily subcutaneous injections, while Rybelsus is the only oral GLP-1 receptor agonist.

Licensing in Ireland

 Wegovy (semaglutide), Saxenda (liraglutide) and Mounjaro (tirzepatide) are licensed for chronic weight management in appropriate adults.  Ozempic, Trulicity, Victoza, Byetta, Bydureon and Rybelsus are licensed for type 2 diabetes.  Rybelsus remains licensed for diabetes only and should not be prescribed solely for weight management.  Although Ozempic was widely prescribed off-label for obesity before dedicated weight-loss products became available, current prescribing should preferentially follow licensed indications. Medicine shortages affecting GLP1 medicines have eased considerably compared with 2023–2024, although intermittent supply issues may still occur. Pharmacists should continue to follow HPRA and manufacturer advice where shortages arise.

*Victoza, Byetta, Bydureon are now off the market in Ireland.

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Wegovy® delivers quality weight loss1,2,5 and provides cardiovascular risk reduction1,3ɬ

~21% mean weight loss1,2*Ŧ

~25%

weight loss in 1 in 31,2*¥

Safety and tolerability profile comparable to the GLP-1 RA class in general1

Wegovy® is recommended in the ESC CCS guidelines for cardiovascular risk reduction4

tThis product is subject to additional monitoring. ESC = European Society of Cardiology. CCS = Chronic Coronary Syndrome. GLP-1 RA = Glucagon Like Peptide 1 Receptor Agonist. Wegovy®t(semaglutide). Please refer to the full Summary of Product Characteristics (SmPC) before prescribing. Wegovy® 0.25 mg FlexTouch® solution for injection in pre-filled pen. Wegovy® 0.5 mg FlexTouch® solution for injection in pre-filled pen. Wegovy® 1 mg FlexTouch® solution for injection in pre-filled pen. Wegovy® 1.7 mg FlexTouch® solution for injection in pre-filled pen. Wegovy® 2.4 mg FlexTouch® solution for injection in pre-filled pen. Indication(s): Adults: Wegovy® is indicated as an adjunct to a reduced-calorie diet and increased physical activity for weight management, including weight loss and weight maintenance, in adults with an initial Body Mass Index (BMI) of ≥30 kg/m2 (Obesity) or ≥27 kg/m2 to <30 kg/m2 (overweight) in the presence of at least one weight-related comorbidity e.g. dysglycaemia (prediabetes or type 2 diabetes mellitus), hypertension, dyslipidaemia, obstructive sleep apnoea or cardiovascular disease. For trial results with respect to cardiovascular risk reduction, obesity-related heart failure, and populations studied, see section 5.1. of the Wegovy® SmPC. Adolescents: Wegovy® is indicated as an adjunct to a reduced-calorie diet and increased physical activity for weight management in adolescents ages 12 years and above with obesity* and body weight above 60 kg. Treatment with Wegovy® should be discontinued and re-evaluated if adolescent patients have not reduced their BMI by at least 5% after 12 weeks on the 2.4 mg or maximum tolerated dose. *See table 1 in the Wegovy® SmPC for BMI cut-off points for obesity by sex and age. Posology and administration: Administered once weekly at any time of the day, with or without meals. Injected subcutaneously in the abdomen, in the thigh or in the upper arm. The injection site can be changed. It should not be administered intravenously or intramuscularly. For the 7.2 mg dose, inject three doses of 2.4 mg one after each other. The injections can be administered in the same body area but should be at least 5 cm apart. Injection sites should always be rotated to reduce the risk of injection site amyloid deposits. The day of weekly administration can be changed if necessary, as long as the time between doses is at least 3 days (>72 hours). After selecting a new dosing day, once-weekly dosing should be continued. Adults: The maintenance dose of semaglutide 2.4 mg once-weekly is reached by starting with a dose of 0.25 mg. To reduce the likelihood of gastrointestinal symptoms, the dose should be escalated over a 16-week period to the maintenance dose. If needed, the dose can be increased to 7.2 mg once weekly after a minimum of 4 weeks on the 2.4 mg dose in adults with BMI ≥ 30 kg/m2 at treatment initiation. If no additional clinical improvement in body weight is observed with 7.2 mg, lower the dose to 2.4 mg once weekly. In case of significant gastrointestinal symptoms, consider delaying dose escalation or lowering to the previous dose until symptoms have improved. Adolescents: For adolescents ages 12 years and above, the same dose escalation schedule as for adults should be applied. The dose should be increased until 2.4 mg (maintenance dose) or maximum tolerated dose has been reached. Weekly doses higher than 2.4 mg are not recommended in the adolescent population. Patients with type 2 diabetes: When initiating Wegovy®, consider reducing the dose of concomitantly administered insulin or insulin secretagogues (such as sulfonylureas) to reduce the risk of hypoglycaemia. Missed dose: If a dose is missed, it should be administered as soon as possible and within 5 days after the missed dose. If more than 5 days have passed, the missed dose should be skipped, and the next dose should be administered on the regularly scheduled day. If more doses are missed, reducing the starting dose for re-initiation should be considered. Elderly: No dose adjustment is required based on age. Renal impairment: No dose adjustment is required for patients with mild or moderate renal impairment. Experience in patients with severe renal impairment is limited. Semaglutide is not recommended for use in patients with severe renal impairment (eGFR <30 mL/min/1.73m2) including patients with endstage renal disease. Hepatic impairment: No dose adjustment is required for patients with mild or moderate hepatic impairment. Experience in patients with severe hepatic impairment is limited. Semaglutide is not recommended for use in patients with severe hepatic impairment and should be used cautiously in patients with mild or moderate hepatic impairment. Paediatrics: The safety and efficacy of semaglutide in children below 12 years of age have not been established. Contraindications: Hypersensitivity to the active substance or to any of the excipients. Special warnings and precautions for use: Cases of pulmonary aspiration have been reported in patients receiving GLP-1 receptor agonists undergoing general anaesthesia or deep sedation. Therefore, the increased risk of residual gastric content due to delayed gastric emptying should be considered prior to performing procedures with general anaesthesia or deep sedation. Use of GLP-1 receptor agonists may be associated with gastrointestinal adverse reactions. This should be considered when treating patients with impaired renal function, as nausea, vomiting, and diarrhoea may cause dehydration, which in rare cases can lead to a deterioration of renal function. Patients treated with semaglutide should be advised of the potential risk of dehydration in relation to gastrointestinal side effects and take precautions to avoid fluid depletion. Acute pancreatitis has been observed with the use of GLP-1 receptor agonists. Patients should be informed of the characteristic symptoms of acute pancreatitis. If

pancreatitis is suspected, Wegovy® should be discontinued; if confirmed, Wegovy® should not be restarted. Caution should be exercised in patients with a history of pancreatitis. In the absence of other signs and symptoms of acute pancreatitis, elevations in pancreatic enzymes alone are not predictive of acute pancreatitis. Data from epidemiological studies indicates an increased risk for non-arteritic anterior ischaemic optic neuropathy (NAION) during treatment with semaglutide. There is no identified time interval for when NAION may develop following treatment start. A sudden loss of vision should lead to ophthalmological examination and treatment with semaglutide should be discontinued if NAION is confirmed. Wegovy® should not be used as a substitute for insulin in patients with type 2 diabetes. Wegovy® should not be used in combination with other GLP-1 receptor agonist products. Patients treated with Wegovy® in combination with a sulfonylurea or insulin may have an increased risk of hypoglycaemia. The risk of hypoglycaemia can be lowered by reducing the dose of sulfonylurea or insulin when initiating treatment with a GLP-1 receptor agonist. In patients with diabetic retinopathy treated with semaglutide, an increased risk of developing diabetic retinopathy complications has been observed. Patients with diabetic retinopathy using semaglutide should be monitored closely and treated according to clinical guidelines. There is no experience with Wegovy® in patients with type 2 diabetes with uncontrolled or potentially unstable diabetic retinopathy. In these patients, treatment with Wegovy® is not recommended. Semaglutide treated patients with gastroparesis may experience more serious or severe gastrointestinal adverse events. Semaglutide should be used with caution in these patients, and semaglutide is not recommended if gastroparesis is severe. The safety and efficacy of Wegovy® has not been investigated in patients treated with other products for weight management, with type 1 diabetes, with severe renal or hepatic impairment or with congestive heart failure New York Heart Association (NYHA) class IV. Use in these patients is not recommended. There is limited experience with Wegovy® in patients aged 85 years or more, with mild or moderate hepatic impairment, with inflammatory bowel disease. Use with caution in these patients. If semaglutide is used in combination with a sulfonylurea or insulin, patients should be advised to take precautions to avoid hypoglycaemia while driving and using machines. Fertility, pregnancy and lactation: Women of childbearing potential are recommended to use contraception when treated with semaglutide. There are limited data from the use of semaglutide in pregnant women. Therefore, semaglutide should not be used during pregnancy. If a patient wishes to become pregnant, or pregnancy occurs, semaglutide should be discontinued. Semaglutide should be discontinued at least 2 months before a planned pregnancy due to the long half-life. In lactating rats, semaglutide was excreted in milk. A risk to a breast-fed child cannot be excluded. Semaglutide should not be used during breast-feeding. Effect on fertility unknown. Undesirable effects: Very common (≥1/10): Headache, vomiting, diarrhoea, constipation, nausea, abdominal pain, fatigue. Common (≥1/100 to <1/10): Hypoglycaemia in patients with type 2 diabetes, dizziness, dysgeusia, dysaesthesia, diabetic retinopathy in patients with type 2 diabetes, gastritis, gastrooesophageal reflux disease, dyspepsia, eructation, flatulence, abdominal distension, cholelithiasis, hair loss, injection site reactions. Uncommon (≥1/1,000 to <1/100): Hypotension, orthostatic hypotension, increased heart rate, acute pancreatitis, delayed gastric emptying, increased amylase, increased lipase. Rare (≥1/10,000 to <1/1,000): Anaphylactic reaction, angioedema. Very rare (<1/10 000): Non-arteritic anterior ischaemic optic neuropathy (NAION). Not known (cannot be estimated from the available data): Intestinal obstruction. The SmPC should be consulted for a full list of side effects. MA number(s): Wegovy® 0.25 mg FlexTouch® EU/1/21/1608/006. Wegovy® 0.5 mg FlexTouch® (1.5 ml cartridge) EU/1/21/1608/007. Wegovy® 0.5 mg FlexTouch® (3 ml cartridge) EU/1/21/1608/012. Wegovy® 1 mg FlexTouch® EU/1/21/1608/008. Wegovy® 1.7 mg FlexTouch® EU/1/21/1608/009. Wegovy® 2.4 mg FlexTouch® EU/1/21/1608/010. Legal category: Product subject to prescription which may not be renewed. For complete prescribing information please refer to the SmPC which is available on www.medicines.ie or by email from infoireland@novonordisk.com or from the Clinical, Medical and Regulatory Department, Novo Nordisk Limited, 1st Floor, Block A, The Crescent Building, Northwood Business Park, Santry, Dublin 9, Ireland. Date last revised: February 2026. IE26SEMO00055. tThis medicinal product is subject to additional monitoring. This will allow quick identification of new safety information. Adverse events should be reported to the Health Products Regulatory Authority. Information about adverse event reporting is available at www.hpra.ie. Adverse events should also be reported to Novo Nordisk on Tel: 01 8629700 or complaintireland@novonordisk.com.

*From baseline to week 72. Data presented here from the STEP UP trial are based on the trial product estimand, which describes the treatment effect if all people adhered to treatment, whereas the primary treatment policy estimand describes the treatment effect regardless of treatment adherence. When applying the treatment policy estimand, people treated with Wegovy® 7.2 mg achieved a superior weight loss of 18.7% vs placebo of 3.9%. The proportion of patients with a body weight reduction of ≥25% was greater with Wegovy® 7.2 mg (31.2%), vs placebo (0%).1 ɬ People living with overweight or obesity and established cardiovascular disease without diabetes. Ŧ The co-primary endpoints were percentage change in body weight and the proportion of patients with a body weight reduction of 5% or greater for Wegovy® 7.2 mg vs placebo.1 Applying the trial product estimand, the proportion of patients with a body weight reduction of ≥5% was greater with Wegovy® 7.2 mg (93.2%), vs placebo (35.7%).1 ¥Confirmatory secondary endpoint. References: 1. Wegovy® Summary of Product Characteristics www.medicines.ie 2. Wharton S, Freitas P, Hjelmesæth J, et al. Once-weekly semaglutide 7.2 mg in adults with obesity (STEP UP): a randomised, controlled, phase 3b trial. Lancet Diabetes Endocrinol. 2025; S2213-8587(25)00226-8. 3. Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and cardiovascular outcomes in obesity without diabetes. N Engl J Med. 2023;389(24):2221-2232 4. Vrints C, Andreotti F, Koskinas KC, et al. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J. 2024;45(36):3415-3537. 5. Hjelmesæth J, Bhat S, Garvey WT, et al. strength: the STEP UP trial. Presented at: The 61st European Association for the Study of Diabetes (EASD) Annual Meeting; September 15-19, 2025; Vienna, Austria. Wegovy® and FlexTouch® are registered trademarks of Novo Nordisk A/S. Live LighterTM is a trademark owned by Novo Nordisk A/S. March 2026; IE26SEMO00057. Novo Nordisk Limited, First Floor, Block A, The Crescent Building, Northwood Business Park, Santry, Dublin 9. D09 X8W3, Ireland. Tel: 01 8629 700, infoireland@novonordisk.com www.novonordisk.ie

IN FOCUS | Obesity

Pharmacist practice points  Confirm the medicine is being

prescribed for an appropriate licensed indication.  Counsel patients regarding gradual dose escalation and expected gastrointestinal adverse effects.  Reinforce adequate protein intake and resistance exercise to reduce lean muscle loss during rapid weight loss.  Advise patients that pharmacotherapy is an adjunct to comprehensive lifestyle management and long-term follow-up.

GLP-1 medicines: Key products used in Irish practice Semaglutide (Ozempic) Ozempic is licensed for type 2 diabetes and not for obesity. It became widely known as the 'skinny jab' because of its weight-loss effects before dedicated obesity medicines became available. Common adverse effects include nausea, vomiting, diarrhoea, and constipation, which can usually be minimised by gradual dose escalation. Patients with diabetes may receive Ozempic through the Long-Term Illness Scheme when prescribed for its licensed indication.

Off-label use for obesity Prescribing medicines outside their licence is legally permitted in appropriate circumstances but should be clinically justified. Since Wegovy and Mounjaro are now licensed specifically for chronic weight management, these products should generally be preferred where antiobesity pharmacotherapy is indicated. Pharmacists should ensure patients understand the indication for which their medicine has been prescribed. Semaglutide (Wegovy) Wegovy is licensed for chronic weight management and is administered once weekly by subcutaneous injection. Treatment begins at 0.25mg weekly and is increased every four weeks to a maintenance dose of 2.4mg weekly as tolerated. The STEP clinical programme demonstrated mean weight loss

approaching 15 per cent at 68 weeks, while the SELECT cardiovascular outcomes trial showed a significant reduction in major adverse cardiovascular events in adults with overweight or obesity and established cardiovascular disease, even without diabetes. In Ireland, Wegovy remains available primarily on private prescription and reimbursement remains limited. Liraglutide (Saxenda) Saxenda is administered once daily and remains an effective option, although weekly agents are generally preferred because of greater efficacy and convenience. The SCALE programme demonstrated average weight loss of approximately 8 per cent after 56 weeks. Eligible patients may access treatment through the HSE Managed Access Protocol where current criteria are met; otherwise, treatment is generally private. Tirzepatide (Mounjaro) Mounjaro is the first dual GIP/GLP-1 receptor agonist licensed for chronic weight management. Treatment starts at 2.5mg once weekly and is titrated every four weeks to a maximum maintenance dose of 15mg weekly. The SURMOUNT-1 trial demonstrated mean weight reductions of approximately 15 per cent, 19.5 per cent and 20.9 per cent with the 5mg, 10mg, and 15mg doses respectively over 72 weeks, representing the greatest weight loss reported with currently licensed pharmacotherapy. Although availability has improved substantially since its launch, pharmacists should remain alert to occasional supply constraints and counsel patients not to interrupt treatment without consulting their prescriber.

General GLP-1 counselling

Patients should eat slowly, stop eating when comfortably full, and prioritise adequate protein intake to help preserve lean muscle mass during weight loss. Resistance exercise should be encouraged alongside treatment. Nausea

usually improves with gradual dose escalation, smaller meals, and avoidance of high-fat meals. Counsel patients regarding the symptoms of gallstones and pancreatitis, ensure they remain well hydrated, and review medicines whose absorption may be affected by delayed gastric emptying. Patients using insulin or sulfonylureas may require dose adjustment to reduce hypoglycaemia risk.

Will anti-obesity medicines become available on State schemes?

The National Centre for Pharmacoeconomics (NCPE) continues to evaluate the clinical and costeffectiveness of anti-obesity medicines before reimbursement decisions are made. As obesity affects a large proportion of the population, funding decisions must balance clinical benefit with affordability for the Irish healthcare system. Although access has expanded internationally, widespread reimbursement in Ireland remains limited. Patients should therefore be advised that eligibility criteria and reimbursement arrangements may change as additional health-economic evidence and national guidance become available.

Key message for pharmacists

GLP-1 receptor agonists and dual GIP/ GLP-1 receptor agonists have transformed obesity treatment, but medicines alone are not sufficient. Long-term success depends on sustained dietary change, regular physical activity, behavioural support, and ongoing follow-up. Pharmacists remain central to counselling patients, improving adherence, identifying adverse effects, and ensuring medicines are used appropriately within their licensed indications.

General GLP-1 counselling

Advise patients to eat slowly, stop when comfortably full, prioritise protein intake and undertake regular resistance exercise to minimise loss of lean muscle mass. Smaller meals and slower dose escalation can reduce gastrointestinal

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Obesity | IN FOCUS

adverse effects. Counsel patients regarding symptoms of pancreatitis and gallstones, maintain adequate hydration and review medicines whose absorption may be altered by delayed gastric emptying. GLP-1-based therapies should generally be avoided in patients with a personal or family history of medullary thyroid carcinoma or MEN2.

Will Mounjaro and Wegovy become available on State schemes?

The National Centre for Pharmacoeconomics (NCPE) assesses the clinical and cost-effectiveness of medicines before advising the HSE on reimbursement. As obesity medicines have the potential to benefit large numbers of patients, reimbursement decisions require careful assessment of both clinical value and affordability. Reimbursement arrangements continue to evolve. Pharmacists should refer to the latest HSE, PCRS and NCPE guidance rather than relying on anticipated timelines, as eligibility criteria and funded indications may change.

Comparative overview

The comparative tables should be retained but updated before publication to reflect the latest Irish reimbursement status, availability, and product licence information, particularly for Wegovy, Mounjaro, and Saxenda.

Pharmacists' role in obesity management

Community pharmacists remain central to obesity care by:  Identifying patients who may benefit from intervention using BMI, waist measurements, and cardiovascular risk assessment.  Reviewing medicines that may contribute to weight gain and discussing suitable alternatives with prescribers where appropriate.  Counselling on dose titration, expected weight-loss trajectories, adverse effects, and adherence.  Monitoring for gastrointestinal

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adverse effects, dehydration, gallstones, and hypoglycaemia when GLP-1 medicines are combined with insulin or sulfonylureas.  Explaining current HSE reimbursement arrangements.  Providing long-term encouragement, relapse prevention, and realistic expectations, recognising obesity as a chronic relapsing disease rather than a failure of willpower.

Part 3: Longer-term non-pharmaceutical impact of widespread anti-obesity medicines The increasing use of GLP-1 receptor agonists and dual GIP/GLP-1 receptor agonists such as semaglutide, liraglutide and tirzepatide has the potential to influence far more than individual patient health. If these medicines become more affordable and accessible over the coming decade, they could reshape healthcare demand, consumer behaviour, and several sectors of the wider economy. While many of these changes remain speculative, early evidence suggests that obesity pharmacotherapy may have effects well beyond clinical practice.

Healthcare

Effective obesity treatment could reduce the long-term burden of type 2 diabetes, cardiovascular disease, obstructive sleep apnoea, osteoarthritis, and metabolic liver disease. Although expenditure on medicines may increase initially, reductions in obesity-related complications could offset some healthcare costs over time.

Food and beverage industry

Food manufacturers are already adapting to changing consumer preferences. Increased demand for protein-rich foods, smaller portion sizes and healthier convenience meals has been reported, while some companies are reassessing product ranges in response to reduced

appetite and changing purchasing habits among GLP-1 users.

Fitness and lifestyle

Weight loss often improves mobility, allowing greater participation in physical activity. Demand for resistance training, exercise programmes and body composition monitoring may increase as greater emphasis is placed on preserving muscle mass during treatment.

Employment and productivity Improved physical health may reduce sickness absence and improve workplace productivity. Any economic benefit is likely to emerge gradually as reductions in obesity-related complications become apparent.

Social considerations

Although wider access to effective obesity treatment may reduce some of the stigma associated with obesity, it also raises important ethical issues relating to equitable access, affordability, and unrealistic public expectations. Medicines should be viewed as one component of comprehensive obesity management rather than a cosmetic intervention.

Overall

For pharmacists, these developments reinforce the importance of providing balanced, evidence-based advice. Antiobesity medicines are likely to remain an increasingly important part of practice, but long-term success will continue to depend on sustainable lifestyle change, ongoing behavioural support, and appropriate clinical follow-up. ● References on request

Written by Eamonn Brady (MPSI). Whelehans Pharmacies, 38 Pearse St and Clonmore, Mullingar. Tel 04493 34591 (Pearse St) or 04493 10266 (Clonmore). www.whelehans.ie

IN FOCUS | Diabetes

Diabetes: Diagnosis and treatment Damien O’Brien MPSI provides an overview of diabetes, including diagnosis, treatment options, and monitoring strategies

ntroduction

Diabetes mellitus is a common chronic metabolic disorder characterised by persistent hyperglycaemia. In Ireland, it is estimated that over 300,000 people have diabetes, with its prevalence continuing to rise due to an ageing population, rising obesity rates and increasingly sedentary lifestyles. Diabetes is associated with significant morbidity and mortality, contributing to cardiovascular disease, chronic kidney disease, visual impairment and lower limb complications. In recent years, advances in diabetes management have transformed patient care. Alongside established therapies, newer drug classes have improved glycaemic control while also demonstrating significant cardiovascular and renal benefits. Furthermore, developments in diabetes technology such as continuous glucose monitoring systems and insulin pump therapy have enabled more personalised and effective diabetes management. Pharmacists, as some of the most accessible healthcare professionals, play an important role in supporting patients with diabetes through medicines optimisation, patient education, lifestyle counselling and early recognition of complications. This article provides an overview of diabetes, including its pathophysiology, diagnosis, lifestyle management, pharmacological treatment options, monitoring, and the expanding role of the pharmacist in delivering patientcentred care.

Background on diabetes

Diabetes is a group of chronic metabolic disorders characterised by elevated blood glucose levels resulting from impaired insulin secretion, impaired insulin action, or both. Persistent hyperglycaemia is associated with progressive damage to multiple organ systems. Macrovascular complications affect the large blood vessels and include coronary artery disease, peripheral arterial disease and cerebrovascular disease, increasing the risk of myocardial infarction, stroke and lower limb amputation. Microvascular

complications affect the small blood vessels and typically include retinopathy, nephropathy and neuropathy. The two most common types of diabetes are type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). T1DM is an autoimmune condition characterised by the immunemediated destruction of pancreatic beta cells, resulting in insulin deficiency. It commonly presents in childhood or early adulthood, although it can occur at any age. A combination of genetic predisposition and environmental factors

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Diabetes | IN FOCUS

may trigger autoimmunity. T2DM is characterised primarily by insulin resistance, whereby peripheral tissues become less responsive to insulin. Progressive pancreatic beta cell dysfunction leads to inadequate insulin production, resulting in persistent hyperglycaemia. T2DM accounts for approximately 90-to-95 per cent of all diabetes cases. It typically presents in adults over 45 years of age, but it is increasingly observed in younger populations due to rising obesity rates and physical inactivity. The development of T2DM involves a complex interplay between genetic susceptibility and lifestyle factors, including poor diet, obesity and a lack of physical activity. T2DM often has a gradual onset, with many patients remaining asymptomatic for years. Symptoms of T1DM include polyuria, polydipsia, polyphagia, fatigue, unexplained weight loss, and blurred vision. These symptoms typically develop rapidly and, if left untreated, may progress to diabetic ketoacidosis (DKA), a lifethreatening medical emergency. The symptoms of T2DM are often similar and may also include recurrent infections and slow-healing wounds. However, many patients with T2DM remain asymptomatic for several years, highlighting the importance of screening high-risk patients and establishing an early diagnosis to reduce the risk of long-term complications. Gestational diabetes mellitus (GDM) develops during pregnancy and is associated with an increased risk of maternal and foetal complications, as well as an increased lifetime risk of developing T2DM. Less common forms of diabetes include maturity-onset diabetes of the young (MODY) and diabetes secondary to pancreatic disease or certain medications.

Diagnosis

Early diagnosis and initiation of treatment are essential to reduce the risk of diabetes-related complications. The diagnosis of diabetes is based on characteristic symptoms and confirmed

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using plasma glucose measurements or glycated haemoglobin (HbA1c). A diagnosis of diabetes can be made if any of the following criteria are met:  Fasting plasma glucose level ≥7.0 mmol/L following fasting for at least eight hours.  Oral glucose tolerance test (OGTT): A plasma glucose level ≥11.1 mmol/L two hours after a 75g oral glucose load.  Glycated haemoglobin (HbA1c) level ≥ 48 mmol/mol (6.5%): HbA1c reflects the average plasma glucose concentration over the preceding two-to-three months and is used in both the diagnosis and monitoring of diabetes.  Random plasma glucose level ≥11.1mmol/L along with symptoms of hyperglycaemia.

Treatment

Following diagnosis, management of diabetes should be individualised for each patient. Treatment is often complex and requires several interventions, with both lifestyle management and pharmacological treatment often required for successful long-term disease management. Patient education and engagement are vital for effective disease management. Lifelong treatment is often necessary to reduce diabetesrelated complications. HbA1c is the cornerstone for assessing long-term glycaemic control, with a target of <53mmol/mol often appropriate for many patients, although less stringent targets may be suitable in some cases. However, aggressive management may increase the risk of hypoglycaemia. In addition to glycaemic control, optimisation of blood pressure,

Early diagnosis and initiation of treatment are essential to reduce the risk of diabetesrelated complications

lipid levels and other cardiovascular risk factors forms an integral part of diabetes management.

Non-pharmacological treatment

Lifestyle modification is the cornerstone of diabetes management for all patients. Although pharmacological treatment is essential in T1DM, lifestyle interventions also play an important role in optimising glycaemic control, reducing cardiovascular risk and improving overall health outcomes. In T2DM, lifestyle changes may delay disease progression, improve insulin sensitivity and achieve diabetes remission in some cases. An individualised nutritional plan reflecting the patient's preferences, lifestyle and treatment goals is recommended. Patients should be encouraged to consume a balanced diet rich in vegetables, fruit, wholegrains, legumes and lean protein sources, while limiting refined carbohydrates, saturated fats and foods high in free sugars. Patients with T1DM may benefit from consultation with a dietitian to support carbohydrate estimation and to optimise mealtime insulin dosing. Regular physical activity is also an important consideration, with adults encouraged to undertake at least 150 minutes of moderateintensity aerobic exercise each week. In overweight or obese patients with T2DM, sustained weight loss can improve insulin sensitivity, glycaemic control and overall cardiovascular health. Smoking cessation should be strongly encouraged in both T1DM and T2DM, as smoking further increases cardiovascular risk. Alcohol intake should be moderated, with patients advised that alcohol may increase the risk of hypoglycaemia.

Pharmacological treatment

Pharmacological management is essential in T1DM and is often required in T2DM when lifestyle interventions alone are insufficient to achieve glycaemic targets. Treatment should

IN FOCUS | Diabetes

be individualised, with medication choices guided by glycaemic control, comorbidities, cardiovascular risk, renal risk, body weight, risk of hypoglycaemia and patient preferences.

Type 1 diabetes mellitus

Lifelong insulin replacement therapy is required for T1DM. The objective of treatment is to mimic physiological insulin secretion through the administration of basal and prandial insulin. This can be achieved using either a multiple daily injection regimen (basal-bolus therapy) or continuous subcutaneous insulin infusion. A multiple daily injection regimen typically involves administering a longacting basal insulin once or twice daily, with a rapid-acting insulin before meals. Insulin doses should be individually titrated to achieve optimal glycaemic control while minimising the risk of both hypoglycaemia and hyperglycaemia. Long-acting basal insulin analogues, including insulin glargine, insulin degludec and insulin detemir, provide background insulin coverage throughout the day. Rapid-acting insulin analogues, such as insulin lispro, insulin aspart and insulin glulisine, are administered before meals to control postprandial glucose levels. Continuous subcutaneous insulin infusion, commonly referred to as insulin pump therapy, is increasingly used in the management of T1DM. This delivers a continuous infusion of rapid-acting insulin to provide basal insulin requirements, with patient-activated bolus doses administered before meals for prandial coverage. This therapy offers greater flexibility and may improve glycaemic control in appropriate patients.

Type 2 diabetes mellitus

Pharmacological management of T2DM is often progressive and highly individualised. Pharmacological management is indicated if glycaemic targets cannot be achieved through diet and exercise. The objective of treatment is to achieve optimal glycaemic control, to reduce the risk of cardiovascular and renal complications, and improve quality of life.

Metformin is considered first-line treatment for many patients with T2DM. It is a biguanide that lowers blood glucose by decreasing hepatic glucose production, reducing intestinal glucose absorption, and improving insulin sensitivity. Metformin may be used as monotherapy or in combination with other glucose-lowering therapies. It has the benefits of a low risk of hypoglycaemia and having a wellestablished safety profile. Common adverse effects include nausea, vomiting, diarrhoea and abdominal pain, which may be minimised through gradual dose titration, administration with food or the use of modified-release formulations. Sulfonylureas are an effective glucoselowering treatment option in T2DM, with gliclazide an example. They stimulate pancreatic beta cells to increase insulin secretion. They can be used as monotherapy or in combination with other antidiabetic drugs, except the meglitinides, as they have a similar mechanism of action. Treatment should be initiated at a low dose and titrated according to glycaemic response. Sulfonylureas are associated with weight gain and an increased risk of hypoglycaemia, particularly in older adults, after missing meals or with high doses. Although they continue to have an important role in selected patients, their use has declined with the availability of newer therapies that offer additional cardiovascular and renal benefits with a lower risk of hypoglycaemia. Dipeptidyl peptidase-4 (DPP4) inhibitors, including sitagliptin, linagliptin and saxagliptin, provide another treatment option for T2DM. They inhibit degradation of endogenous incretin hormones, increasing glucosedependent insulin secretion while reducing glucagon secretion. They can be used as monotherapy or as an add-on treatment option with other antidiabetic medications. They are typically well-tolerated with a low risk of hypoglycaemia.

Continuous subcutaneous insulin infusion, commonly referred to as insulin pump therapy, is increasingly used in the management of T1DM

Sodium-glucose co-transporter-2 (SGLT2) inhibitors work by inhibiting glucose reabsorption in the proximal renal tubules, thereby promoting urinary glucose excretion. Dapagliflozin, empagliflozin and canagliflozin are commonly prescribed examples. In addition to lowering blood glucose levels, SGLT2 inhibitors have demonstrated significant cardiovascular and renal benefits, making them particularly beneficial in patients with heart failure or chronic kidney disease. They may also promote modest weight loss and have a relatively low risk of hypoglycaemia. Patients should be counselled on the importance of maintaining adequate hydration and the need to temporarily withhold treatment during acute illness in accordance with sick day rules, due to the rare risk of diabetic ketoacidosis. The most common adverse effects include genital mycotic infections, increased urination and volume depletion, while urinary tract infections may also occur. Glucagon-like peptide-1 (GLP-1) receptor agonists activate the GLP-1 receptor, which enhances glucose-dependent insulin secretion, suppresses glucagon release and delays gastric emptying. Dulaglutide, semaglutide and liraglutide are examples of GLP-1 receptor agonists used to treat T2DM. They can be used as monotherapy or in combination with other glucose-lowering therapies. In addition to improving glycaemic control, these agents promote significant weight loss and have demonstrated cardiovascular and renal benefits, making them particularly valuable in patients with obesity or

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IN FOCUS | Diabetes

established cardiovascular disease. Most GLP-1 receptor agonists are administered by subcutaneous injection. An oral formulation of semaglutide is available in other countries, although not yet in Ireland. Gastrointestinal adverse effects, including nausea, vomiting and diarrhoea, are the most common and may be minimised through gradual dose escalation, while there is a relatively low risk of hypoglycaemia. Their use has increased substantially in recent years and pharmacists have an important role in counselling patients on administration, dose titration, adherence, and management of adverse effects. Thiazolidinediones, such as pioglitazone, may be appropriate for selected patients but are not considered first-line treatment because of their adverse effect profile. They work by acting on intracellular metabolic pathways to improve insulin action and increase insulin sensitivity. Potential adverse effects include weight gain, fluid retention, increased risk of fractures, worsening heart failure, and possible increased risk of bladder cancer with prolonged use. However, they may be useful in selected cases as they are not contraindicated in patients with renal disease. Meglitinides work by binding to receptors on beta cells in the pancreas, stimulating insulin secretion. Repaglinide is an example of an agent in this class. The most clinically significant adverse effects are hypoglycaemia and weight gain. However, they are now rarely used in clinical practice following the introduction of newer glucose-lowering therapies. As T2DM progresses, many patients will require insulin therapy due to declining pancreatic beta cell function. Insulin may also be required temporarily during acute illness, surgery, or at the time of diagnosis in patients presenting with marked hyperglycaemia. Insulin remains the most effective glucoselowering therapy but is associated with an increased risk of hypoglycaemia and weight gain. Pharmacists play a role in

supporting patients on insulin therapy by providing education on injection technique, storage requirements, dosing, blood glucose monitoring and management of hypoglycaemia. The expanding range of pharmacological treatment now allows treatment to be tailored to the individual patient. Modern diabetes management extends beyond glycaemic control, with increasing emphasis on reducing cardiovascular and renal complications while improving quality of life through a personalised, patient-centered approach.

Monitoring

Effective diabetes management requires regular monitoring to assess treatment efficacy, identify complications and support timely intervention when required. Routine assessment should include measurement of HbA1c, blood pressure, lipid profile and renal function. Patients should also be encouraged to undergo regular diabetic retinal screening and foot assessments to enable the early detection and management of complications. Patients should be counselled on the importance of recognising and managing hypoglycaemia. Furthermore, they should be up to date with recommended vaccinations, including influenza, Covid-19 and pneumococcal vaccines where appropriate, due to their increased susceptibility to infection and associated complications. Community pharmacists are ideally placed to reinforce these measures. Self-monitoring of blood glucose levels is an important component of diabetes care, particularly for patients receiving insulin therapy. Blood glucose testing helps patients understand the effects of diet, exercise and medication on glycaemic control, while also allowing for the recognition and management of hypoglycaemia and hyperglycaemia. Recent advances in diabetes technology have transformed patient care. Continuous glucose monitoring systems measure glucose levels throughout the day and provide

real-time glucose readings and alerts for both hypoglycaemia and hyperglycaemia. These technologies improve glycaemic control when compared with traditional testing. Many continuous glucose monitoring systems are now integrated with insulin pumps to create systems that can automatically adjust insulin delivery in response to glucose readings, representing a significant advancement in the management of T1DM.

The role of the pharmacist

Pharmacists have an important role in the management of diabetes beyond the traditional dispensing of medication. Pharmacists are one of the most accessible healthcare professionals and are frequently in contact with patients, allowing them to support patients at various points of their journey. Medication adherence is often an issue in T2DM due to its asymptomatic nature and adverse effects of certain medications. Pharmacists can address this challenge through thorough patient counselling, medicines optimisation and regular medication reviews. They also play an important role in educating patients about the safe and effective use of diabetes therapies, including demonstrating injection technique, advising on storage of medication, reinforcing sick day rules and counselling on the use of continuous glucose monitoring systems and insulin pumps. In addition to pharmacological management, pharmacists can support lifestyle interventions through smoking cessation services, weight management advice, and the promotion of physical activity. Optimal diabetes management requires a collaborative multidisciplinary approach involving many healthcare specialists. Pharmacists, through accessible and patient-centred care, can make a significant contribution to improving health outcomes for patients with diabetes. ● References available upon request

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Women's health | IN FOCUS

The need for greater emphasis on women’s health

Collage: Laura Kenny / Images used: iStock.com

Eamonn Brady MPSI writes about the pharmacist’s important role in delivering proactive and holistic care for women

ntroduction

Women’s health encompasses the comprehensive care of a woman’s physical, mental and social wellbeing throughout her entire life. While women and men share many common health conditions, the way these conditions manifest, progress and respond to treatment can differ. Furthermore, women face a spectrum of conditions intrinsically linked to female reproductive biology and hormonal function, many of which remain underdiagnosed or undertreated in traditional healthcare settings. Clinical research and healthcare have disproportionately focused on male physiology and pathophysiology for many years, resulting in significant gender-

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based disparities in healthcare delivery. In this evolving landscape, pharmacists are ideally positioned to support women at every stage of their health journey. This article explores key areas of women’s health, from reproductive and menstrual health, to healthcare equity. The objective is to highlight the challenges and opportunities, focusing on the pharmacist’s role in delivering a more proactive and holistic model of care.

Reproductive and sexual health Reproductive and sexual health is a cornerstone of women’s overall wellbeing, encompassing menstrual health, contraception, fertility, pregnancy, sexually-transmitted infections and

conditions such as dysmenorrhea, menorrhagia, endometriosis and polycystic ovary syndrome (PCOS). While traditionally associated with childbearing, modern reproductive health extends beyond this to include autonomy, informed choice and dignified care. In recent years, reproductive health services have undergone major reforms, with broadened access to abortion services and the introduction of the free contraception scheme for women aged 17-to-35. Despite this progress, many challenges remain. Barriers such as access to care, cultural stigma and lack of education can lead to diagnostic delays and inadequate treatment. Timely and individualised reproductive healthcare

IN FOCUS | Women's health

can support early intervention and improve long-term outcomes for women.

Menstrual health

Menstrual health is a critical and often overlooked component of women’s health. Menstruation is a biological process experienced by approximately 50 per cent of the population at some point in their lives, yet it continues to be surrounded by stigma and misinformation. Conditions including dysmenorrhoea, menorrhagia, endometriosis and PCOS can significantly impact quality of life. Menstrual health requires a multifaceted approach involving early recognition, timely referral, education and empowerment. Pharmacists play an important role — not only by supporting symptom relief, but also by promoting awareness and timely intervention.

Dysmenorrhoea

Among the most common menstrual concerns encountered in pharmacy practice is dysmenorrhoea. It is characterised by pain during menstruation, usually located in the lower abdomen but which may radiate to the thighs and back. It can affect up to 90 per cent of women of reproductive age at some point in their lives and can significantly impact quality of life, yet it is often undertreated. Dysmenorrhoea may be primary, occurring without pelvic pathology, or secondary, caused by conditions such as endometriosis, fibroids or pelvic inflammatory disease. The National Institute for Health and Care Excellence (NICE) provides a clinical knowledge summary with treatment guidelines for dysmenorrhoea. They recommend non-steroidal antiinflammatory drugs (NSAIDs), such as ibuprofen and mefenamic acid, as first-line treatment due to their inhibition of prostaglandin synthesis, which plays a central role in menstrual pain. NSAIDs should be taken at the onset of menstruation and continued for one-to-three days. Hormonal contraception, including the combined oral contraceptive pill (COCP), the

progestogen-only pill and depot injections, may be used if NSAIDs are not effective or contraindicated. Referral is advised if there is no response after three-to-six months, if symptoms suggest a secondary cause or if endometriosis or fibroids are suspected.

Menorrhagia

Menorrhagia, also known as heavy menstrual bleeding, is defined as excessive menstrual blood loss. It interferes with a woman’s physical, emotional and social quality of life, affecting 20-to-30 per cent of women of reproductive age. The most common cause of menorrhagia is hormone imbalance, but it may also result from fibroids, polyps, bleeding disorders, anticoagulation therapy, intrauterine contraceptives, endometriosis, or pelvic inflammatory disease. Patients should be assessed for anaemia and treated with iron supplementation if appropriate. Treatment is guided by patient preference, comorbidities, the underlying cause and response to treatment. A levonorgestrel-releasing intrauterine system (LNG-IUS) is recommended by NICE guidelines as first-line treatment. If unsuitable, hormonal options such as the combined oral contraceptive pill or cyclic oral progestogens may be used. Non-hormonal options, such as NSAIDs and tranexamic acid, may also be considered and are particularly useful for women who are trying to conceive or are unsuitable for hormonal therapy. Tranexamic acid, an antifibrinolytic, can reduce blood loss and is typically taken orally three times daily for five days.

Polycystic ovary syndrome (PCOS)

PCOS is a common endocrine disorder affecting women of reproductive age, with an estimated prevalence of 10to-20 per cent in Ireland. It is a chronic condition with reproductive, metabolic and psychological features that require a long-term, multifaceted approach to management. Symptoms often begin in adolescence and can vary widely, including irregular or absent menstruation, infertility, hirsutism (excess hair growth), acne, alopecia, weight gain and mood disorders. PCOS is also associated with increased risk of long-term complications such as type 2 diabetes, dyslipidaemia, hypertension, and cardiovascular disease. Management should be tailored to the individual. Lifestyle modifications is the first-line intervention, particularly for overweight or obese women. Modest weight loss can restore ovulation and improve metabolic markers, and referral to a dietitian may be considered in line with NICE guidance. The combined oral contraceptive pill is first-line treatment for menstrual regulation, with cyclic progestogens an alternative. Combined oral contraceptive pills containing anti-androgenic progestins such as cyproterone acetate or drospirenone may be used to treat hirsutism and alopecia. Topical eflornithine can help slow the growth of facial hair, while spironolactone or finasteride may be considered under specialist supervision. Letrozole is recommended as the first-line ovulation induction agent. Metformin may be considered in women with insulin resistance. Regular screening for type 2 diabetes, lipid profiles and blood pressure is advised.

Endometriosis

Among the most common menstrual concerns encountered in pharmacy practice is dysmenorrhoea

Endometriosis is a chronic inflammatory condition in which tissue similar to the endometrium grows outside the uterine cavity, often on the ovaries, Fallopian tubes, uterosacral ligaments, and the gastrointestinal tract. This ectopic tissue responds to hormonal changes during the menstrual cycle, leading to inflammation

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Women's health | IN FOCUS

and scarring that can severely impact quality of life. Endometriosis is estimated to affect approximately 10-to-15 per cent of women of reproductive age. Symptoms can range from mild to severely debilitating and may include dysmenorrhea, chronic pelvic pain, dyspareunia (pain during intercourse), dysuria, heavy or irregular menstrual bleeding and infertility. Diagnostic delays are common and often reflect a minimisation of menstrual pain, limited awareness among healthcare professionals, and reduced access to specialist services. NICE guidelines recommend that diagnosis should be based on clinical symptoms and not solely reliant on laparoscopic confirmation. Treatment should not be delayed if symptoms are strongly suggestive of endometriosis. Living with endometriosis can have a significant psychosocial impact, contributing to depression, anxiety, fatigue and social withdrawal. NICE guidance also emphasises the importance of psychological support. The management of endometriosis is individualised, depending on symptom severity, fertility goals and response to previous treatments. Paracetamol or an NSAID can be used alone or in combination as first-line treatment for endometriosis-related pain. If this is not sufficient, other pain management options and referral for further assessment should be considered. Neuromodulators used for neuropathic pain, including amitriptyline, duloxetine, gabapentin and pregabalin, may be considered. Hormonal therapies aim to suppress menstruation and reduce pain, while not negatively affecting future fertility. NICE advises that the combined oral contraceptive pill can be taken either cyclically or continuously. Progestogens, such as norethisterone or medroxyprogesterone acetate, may also be considered. The LNG-IUS causes endometrial atrophy, which can reduce menstrual bleeding or induce amenorrhoea. Gonadotropin-releasing hormone (GnRH) analogues, such as goserelin, may

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be used in the short-term (typically up to six months) to relieve pain. Surgical intervention may be considered for moderate-to-severe cases that do not respond to medical therapy, which may improve fertility outcomes and relieve pain, although recurrence is common.

Contraception

Contraception refers to the prevention of pregnancy through various methods that interrupt ovulation, fertilisation or implantation. The range of contraceptive options for females can be broadly categorised into permanent methods, barrier methods, hormonal methods, and long-acting reversible contraception. Each method has different efficacy rates, adverse effect profiles and noncontraceptive benefits. Tubal ligation is a permanent method that is highly effective but may not be reversible. Female condoms and diaphragms are examples of barrier methods; however, they have higher failure rates than some other options and may cause irritation or discomfort. Hormonal contraceptive methods include combined oral contraceptives, progestogen-only pills, transdermal patches, vaginal rings, implants, and hormonal intrauterine systems. LNG-IUS and the copper intrauterine device (IUD) are examples of long-acting reversible contraception options. NICE provides guidelines that support contraceptive use and informed decisionmaking. They emphasise that women should be offered full information about all available contraceptive options, including non-contraceptive benefits and potential adverse effects. The guidance highlights the importance of timely access to contraception and shared decisionmaking. NICE advocates for the use of long-acting reversible contraception due to its higher efficacy compared to userdependent methods. In Ireland, access to contraception has been expanding. Free contraception was initially offered to women aged 17-to-25 and has since been extended to include those aged 17-to-35. This

scheme, funded through the Health Service Executive (HSE), covers the cost of doctor consultations, prescriptions, and dispensing of various contraceptive methods. These measures have reduced financial barriers, improved access, and supported reproductive autonomy. However, barriers such as social stigma, misinformation, and concerns about adverse effects still exist. Pharmacists are the primary providers of emergency hormonal contraception, often offering immediate access without prescription, which has significantly improved timely access. Two treatment options are available: Levonorgestrel, effective for up to 72 hours after unprotected intercourse, and ulipristal acetate, effective for up to 120 hours. Pharmacists conduct a structured consultation to assess clinical appropriateness, discuss timing, identify potential drug interactions, and provide advice on ongoing contraception. While not available in pharmacy, the copper IUD remains the most effective form of emergency contraception and must be fitted by a clinician.

Menopause

Menopause marks the permanent end of menstrual cycles due to the cessation of reproductive hormone production by the ovaries for at least 12 consecutive months. It typically occurs between ages 45-to-55, with the average age in Ireland being 51, though this can vary. Menopause is a natural life transition, but it is often under-recognised and under-supported. The diagnosis is typically made retrospectively. In women over 45, menopause can be diagnosed clinically — without hormone testing — if there has been 12 months of amenorrhoea. It is characterised by fluctuating hormone levels, particularly a decline in oestrogen, which can cause a wide variety of symptoms: Vasomotor (hot flushes, night sweats, migraines, palpitations), urogenital (vaginal dryness, burning or irritation), psychological (low mood, insomnia, irritability, anxiety), cognitive (brain fog), sexual (reduced

IN FOCUS | Women's health

libido, pain with intercourse), and musculoskeletal (joint aches). Management of menopause focuses on alleviating symptoms that may significantly impact quality of life. Treatment should be individualised and guided by patient preference, symptom severity, and risk factors. Hormone replacement therapy (HRT) is the most effective treatment for vasomotor and urogenital symptoms, and is recommended by NICE guidelines as firstline therapy for many women, provided there are no contraindications. In women with an intact uterus, HRT typically includes both oestrogen and a progestogen to prevent endometrial hyperplasia. HRT is available in a variety of formulations to suit individual needs and preferences, including oral tablets, transdermal patches, gels, sprays, vaginal creams, pessaries, and vaginal rings. Transdermal options are particularly suitable for women with an increased risk of venous thromboembolism or those with liver dysfunction, as they bypass first-pass metabolism. Vaginal oestrogen therapies are preferred for women experiencing vaginal atrophy and usually do not require additional progestogen. NICE also highlights the importance of HRT in maintaining bone density and reducing the risk of osteoporotic fractures in postmenopausal women. However, HRT is not without risk. Potential adverse effects of HRT include breast tenderness, headaches, nausea and irregular bleeding. Long-term use — particularly of combined HRT — is associated with a slightly increased risk of breast cancer. The risk of venous thromboembolism and stroke is primarily linked to oral oestrogens, not transdermal formulations. An individualised assessment should always be undertaken when selecting therapy. Pharmacists can play a key role in counselling women about these risks, dispelling concerns and supporting adherence. Non-hormonal options may be considered in certain cases,

An individualised assessment should always be undertaken when selecting therapy

particularly if HRT is not tolerated, appropriate or effective. Selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and clonidine may help alleviate vasomotor symptoms, though they are not considered first-line treatments. Fezolinetant, a neurokinin-3 receptor antagonist, is a novel non-hormonal treatment for hot flushes in moderate-to-severe cases. It has recently been approved but is not yet included in the NICE guidelines. Potential adverse effects of fezolinetant include hepatic toxicity, abdominal discomfort, and insomnia. NICE also recommends considering testosterone supplementation in women with low libido if HRT alone is not sufficient. Lifestyle modifications such as regular exercise, smoking cessation, weight management, nutritional support and reducing alcohol intake can also contribute to symptom relief and improved long-term health outcomes. Cooling strategies, moisturisers and lubricants are safe and potentially effective alternatives. Herbal remedies show limited evidence of efficacy and may pose a risk of interactions with other medications. In Ireland, growing awareness in recent years has improved access to treatment for many women. However, significant barriers to menopause support still exist. Many women do not receive adequate education and continue to face stigma and misinformation. From June 2025, the health service has offered free HRT to women in Ireland, aiming to reduce financial barriers. However, ongoing stock shortages have led to delays or interruptions in treatment for several women.

Access to healthcare and the role of the pharmacist

Despite notable progress in women’s health in recent years, significant barriers to equitable healthcare remain in Ireland. Women may face long waiting times, limited services, cultural stigma, lack of information, and financial constraints. Even where services are available, misinformation or low health literacy can prevent women from accessing appropriate care. Persistent stigma surrounding menopause, contraception and menstrual disorders continues to undermine open dialogue and early intervention. In addition, ongoing shortages of HRT and contraceptive products have added to the frustration experienced by both patients and healthcare providers. Nonetheless, there is a growing opportunity to address these challenges. The rollout of free contraception and HRT schemes has marked a shift towards more inclusive and accessible healthcare. Public awareness campaigns are helping to increase the visibility of conditions such as endometriosis and menopause, reducing stigma and encouraging earlier engagement with healthcare services. Irish pharmacists are well-positioned to be at the forefront of this effort by expanding access, supporting adherence and facilitating informed conversations around women’s health. They play a vital role in medication counselling, emergency contraception provision and health promotion. Pharmacists are also trusted sources of information who can help counter misinformation through evidence-based guidance. Future initiatives may allow for direct access to the combined oral contraceptive pill without a prescription, representing a significant step towards enhanced reproductive autonomy. As their clinical role continues to expand in Ireland, pharmacists must be recognised as proactive partners in advancing women’s health equity nationwide. ● References available on request

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Book review | LIFE

Dreamlike fragments of the past

or much of modern Irish history, the psychiatric asylum stood at the centre of society’s response to mental illness, distress, poverty, and social disruption. By the middle of the 20th Century, Ireland had one of the highest rates of psychiatric institutionalisation in the world. Vast district asylums, originally established during the 19th Century, became woven deeply into the fabric of Irish life. These ‘mental hospitals’ were often imposing buildings on the edges of towns and cities. Their histories are complicated and uncomfortable. In public memory, Irish asylums are often seen exclusively through the lens of neglect and confinement and there were grave failures within the system. Overcrowding became endemic. Many patients spent years, even decades, institutionalised with little prospect of discharge. People could find themselves admitted for reasons that reflected social judgement as much as psychiatric illness: Bereavement, trauma, poverty, ‘moral’ concerns, family conflict, or behaviour that challenged prevailing expectations. At the same time, history resists simple narratives. Before modern medications, welfare systems, housing supports, or community mental health teams, psychiatric hospitals sometimes represented the only available refuge for people in severe distress or profound social vulnerability. Many staff worked with dedication in under-resourced environments. The asylums were institutions of care as well as control, compassion as well as confinement. It is into this world that Doireann Ní Ghríofa’s Said the Dead quietly and hauntingly enters. Rather than offering a straightforward historical account of Irish psychiatric institutions, Ní Ghríofa approaches asylum history through fragments, voices, archival traces, and acts of imaginative reconstruction. The result is less a conventional novel than a meditation on memory, silence, and the people whose lives disappeared into institutional systems.

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and deeply literary. Ní Ghríofa writes with extraordinary sensitivity to rhythm, silence, and absence. The prose frequently feels dreamlike, even ghostly, as voices from different eras seem to overlap and echo across time. The power of the book lies in accumulation: Image upon image, fragment upon fragment. The result of this technique is a persistent sense of haunting.

Layered

Ní Ghríofa has already established herself as one of Ireland’s most distinctive literary voices. Her earlier work, especially A Ghost in the Throat, demonstrated an unusual ability to blend memoir, history, scholarship, and lyrical reflection. In Said the Dead, she applies a similarly layered approach to the history of Irish psychiatry and institutional life. The book draws inspiration from historical asylum records, particularly those connected to Cork’s old asylum. Ní Ghríofa becomes fascinated by the fragments left behind in institutional archives: Brief descriptions, clinical observations, partial testimonies, and small traces of individuality preserved in ledgers and casebooks. These remnants become the starting point for a broader reflection on who is remembered, who is forgotten, and how institutional systems can reduce human lives to administrative entries.

Ambiguity

Importantly, Said the Dead avoids simplistic condemnation. There is no sense here of easy moral certainty imposed retrospectively upon the past. Instead, Ní Ghríofa allows ambiguity to remain. The institutions she evokes are undeniably oppressive, especially for women whose suffering was poorly understood or socially inconvenient. Yet the book also conveys the loneliness, desperation, and social hardship that shaped the world beyond the asylum walls. The boundaries between care and control often appear blurred. Stylistically, the book is atmospheric

Compassion

What emerges most strongly is Ní Ghríofa’s compassion for those who passed through these institutions. Many psychiatric patients of earlier generations vanished not only from society, but from family memory itself. Their stories were rarely told. Their suffering often remained hidden behind institutional walls. Said the Dead attempts, carefully and respectfully, to restore some measure of voice and presence to those lives. For contemporary readers, especially in Ireland, the book resonates beyond literary interest alone. Mental healthcare has changed considerably since the era of the district asylum. Institutional care has largely given way to community-based approaches, and attitudes towards mental illness have evolved substantially. Yet the broader questions raised by Ní Ghríofa remain highly relevant: How societies respond to vulnerability, how systems can unintentionally silence individuals, and how easily certain lives become marginalised or forgotten. In the end, Said the Dead is not primarily a historical novel about psychiatry. It is a humane reflection on memory, dignity, and the fragile traces people leave behind. Ní Ghríofa handles this difficult material with intelligence, restraint, and considerable grace. The result is a thoughtful and quietly powerful work that lingers long after reading. ● Prof Brendan Kelly is Professor of Psychiatry at Trinity College Dublin and author of Asylum: Inside Grangegorman (Royal Irish Academy).

LIFE | Motoring

Aston Martin’s DB12 S raises the bar Shane O’Donoghue reviews the latest in a long line of gorgeous cars from Aston Martin

he Aston Martin DB12 is the latest in a long line of gorgeous GT cars from the British brand. It was first launched in 2023 in two-door coupe form and the opentopped Volante model joined the range a year later. Now, well-timed to give buyers of the original car something new and shiny to think about, is the DB12 S, offered in both body styles. Aston Martin’s S models all have increased driver focus at their core, with more performance, lower weight, and an enhanced driving experience, accompanied by suitably sporting updates to the cabin and exterior. That is the DB12 S in a nutshell.

Exterior design and image

Aston’s designers took the lithe, graceful form of the original DB12 and sharpened it up a bit, adding a little technicality to the appearance. It’s hardly a dramatic makeover and, depending on specification, it can be relatively subtle. Not only that, but most of the aesthetic changes have been made in the name of function, not just form. For instance, there’s a new protruding chin spoiler up front, which aids aerodynamic balance and cooling flow to the brakes while differentiating the S. New vents on the long bonnet, meanwhile, help extract hot air from the engine bay

underneath. Less obvious are the new side sills, but from the back you’ll know for sure that you’re looking at the S model thanks to its distinctive ‘stacked’ exhaust outlets – four of them in total. Those tailpipes poke out of a new, aerodynamically optimised diffuser, while the previous automatically deploying rear spoiler has been replaced by a lighter, fixed item. All this is topped off by a set of enamelled S badges made by a jeweller.

Interior and practicality

Inside, red accenting is used to mark out the S model, found on the stunning leather upholstery and stitching, and picked up

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Motoring | LIFE

in the red-anodised drive mode selector in the middle of the car. At its centre is the engine-start button and it’s all very solid and tactile. The same goes for the switchgear surrounding this on the centre console and dashboard, where lovely, knurled metal is found in place of plastic. And what’s more, this layout means the driver doesn’t have to use the central touchscreen too often. If you do, you’ll discover this features full connectivity as you would hope and even Apple CarPlay Ultra for more integration with the car than comes with the standard Apple CarPlay system. However, we prefer Aston Martin’s proprietary software, especially when it comes to the customisable digital instruments in front of the driver. On the subject of personalisation, no two DB12 S cabins are likely to be alike thanks to Aston Martin’s seemingly endless list of colour, trim, and material options, and buyers with particularly deep pockets can effectively have a bespoke specification. Not that such a thing is needed for this car to feel special. In practical terms, the DB12 is ostensibly a ‘2+2’ car with two small seats in the back, but we don’t recommend asking an adult you want

to remain friends with to sit back there. Best to think of it as additional luggage space – perfect for holding a large handbag or briefcase perhaps. The boot itself is smaller than that of most family hatchbacks, but it’s still large enough for golf clubs or luggage for two for a week away. Nobody buys a car such as this expecting estate-like cargocarrying capacity.

On the road

The sense of occasion promised by the exterior design and interior tactility ramps up a notch when you put your foot on the brake pedal and press the engine-start button. The big V8 under the bonnet roars into life through the S’s upgraded sports exhaust and settles down to an always-audible rumble. It’s a twin-turbocharged 4.0-litre engine sourced from Mercedes-AMG, but with lots of development by Aston Martin’s

However, it’s worth reiterating that the DB12 S feels special at any speed

own engineers. For the S, it has been tuned to produce a nice round 700hp and 800Nm of torque. But while that delivers a suitably sports-car-like performance, the DB12 S is about much more than just straightline speed. The engine note and the sound it makes at all times is a real highlight. It’s a constant presence when you’re ambling about or cruising on the motorway, if never loud and intrusive. Then, when you have a chance to push the accelerator further, it really comes alive, accompanied by an incredibly rapid automatic gearbox. Buyers can opt for a louder titanium system if they’re not worried about disturbing their neighbours. Meanwhile, keen drivers will soon reach for the ‘manual’ button and choose when to change gears for themselves using the fabulous metal paddles behind the steering wheel. Additionally, advanced adaptive suspension allows the driver to optimise the chassis for comfort or control over various driving modes. At its most extreme, you would need a racetrack to maximise its ability. However, it’s worth reiterating that the DB12 S feels special at any speed. It’s just that it has the ability to really engage driving enthusiasts, too. That comes down to the steering weighting and directness and the confidence-inspiring brakes as much as it does the car’s ability to change direction at its driver’s whim. It seemingly does it all and while it’s never luxury-car soft, neither is it too uncomfortable to consider for a long journey with your favourite person in the passenger seat.

Pricing

The only Aston Martin showroom on the island of Ireland is in Belfast, so there’s no official pricing for the country. But it would be around €450,000 imported, which may be a huge amount of money, but it’s not – relatively speaking – a crazy amount more than the non-S DB12 before it. A very worthy upgrade indeed. ●

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PRODUCTS

Clonmel Healthcare’s Uzpruvo▼ (Ustekinumab) is recommended as a Best Value Biologic Effective from 1st June 2026 Uzpruvo® is recommended as a Best Value Biologic for Ustekinumab on the High Tech Arrangement.1 Reimbursement of Ustekinumab on the High Tech arrangement for treatment naïve individuals is only supported for BVB medicines, such as Uzpruvo®1. Uzpruvo® has been recommended as a Best Value Biologic for Ustekinumab on the High Tech Arrangement, effective from 1st June.1 Reimbursement of Ustekinumab on the High Tech arrangement for treatment naïve individuals is only supported for BVB medicines, such as Uzpruvo®1. Uzpruvo®; the first approved Ustekinumab biosimilar in Ireland, and the first to launch on the Irish market in July 2024 offers flexibility with 3 strength options; 45mg and 90mg solution for injection in pre-filled syringe and 130mg concentrate for solution for infusion. Uzpruvo® is indicated for the treatment of Plaque Psoriasis, Paediatric Plaque Psoriasis, Psoriatic Arthritis and Crohn’s Disease and paediatric Crohn's Disease (patients ≥40 kg) 2. Uzpruvo® is currently not approved for the treatment of ulcerative colitis indication (since the originator still has exclusivity for this indication). Uzpruvo® offers patients a wide variety of benefits: • Equivalent efficacy, safety and immunogenicity to the reference product**3 • Patient-friendly PFS: Easy handling, thinner needle+, latex-free++2,4 • Cost-effective option enabling improved access to ustekinumab treatment • European manufacturing2 and supply chain* Donagh O’Leary, General Manager said “With over 55 years of experience serving the Irish healthcare community, Clonmel Healthcare continues to grow and strengthen its portfolio of biosimilar medicines, now spanning several therapeutic areas including rheumatology, gastroenterology, dermatology, and

oncology. Our commitment as a trusted partner is to bring a comprehensive range of biosimilar medicines to the market, increasing access for patients, physicians, and pharmacists to affordable treatments. We are proud to support patients and the healthcare system, contributing to ongoing savings and improved care outcomes across Ireland.” Clonmel Healthcare is also a proud member of Guaranteed Irish, supporting and creating Irish jobs, and contributing to the local community.

*Supply chain is constantly being optimised and manufacturing location is subject to change. **Stelara ®. + 29 v 27-gauge needle of the reference product, Stelara®. ++ Plunger stopper made of bromobutyl rubber. 1 https://healthservice.hse.ie/staff/ information-healthcare-workers/medicinesmanagement-programme-mmp/best-valuemedicines/ 2 Uzpruvo® SmPC. 3 Feldman SR et al. Expert Opin Biol Ther. 2023;23(3);253-60. DOI: 10. 1080/14712598.2023.2235263; 4 Stelara® PI . Date prepared: June 2026. 2605/ ADV/UZP/506H Uzpruvo® ▼ 45 mg & 90 mg Solution for Injection in Pre-filled Syringe. Uzpruvo® ▼ 130 mg Concentrate for Solution for Infusion. ▼ This medicinal product is subject to additional monitoring. This will allow quick identification of new safety information. Healthcare professionals are asked to report any suspected adverse reactions. Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions to HPRA Pharmacovigilance via www.hpra.ie. Composition: Uzpruvo 45 mg: Each prefilled syringe contains 45 mg ustekinumab in 0.5 mL. Uzpruvo 90 mg: Each pre-filled syringe contains 90 mg ustekinumab in 1 mL. Uzpruvo 130 mg: Each vial contains 130 mg ustekinumab in 26 mL (5 mg/mL). Excipients include histidine, polysorbate 80, sucrose, and water for injections. The

pre-filled syringe components are latex free. Pharmaceutical Form: 45 mg and 90 mg: Subcutaneous injection (pre-filled glass syringe). 130 mg: Intravenous infusion (glass vial). Mechanism of Action: Ustekinumab is a fully human IgG1κ monoclonal antibody that targets the p40 subunit shared by interleukin (IL) 12 and IL-23. Indications: Uzpruvo 45 and 90 mg is indicated for the treatment of plaque psoriasis, paediatric plaque psoriasis, psoriatic arthritis (PsA) adult Crohn's Disease and paediatric Crohn's Disease (patients ≥40 kg). Uzpruvo 130 mg is indicated for the treatment of adult Crohn's Disease and paediatric Crohn's Disease (patients ≥40 kg). Dosage: Uzpruvo is intended for use under the guidance and supervision of physicians experienced in the diagnosis and treatment of conditions for which Uzpruvo is indicated. Refer to Summary of Product Characteristics for information on dosing and administration. Method of administration: 45 and 90 mg: Subcutaneous injection;130 mg: Intravenous use. Contraindications: Hypersensitivity to the active substance or any excipients. Clinically important, active infections (e.g., active TB). Warnings and Precautions: Record product name and batch number of the administered product for traceability. Ustekinumab may increase the risk of infections and reactivate latent infections. Patients must be monitored for signs of infection before and during treatment. Tuberculosis screening required prior to treatment. Delay initiation in patients with active infection. Patients should be instructed to seek medical advice if signs or symptoms suggestive of an infection occur. Uzpruvo may increase the risk of malignancy. All patients, particularly those >60 years of age, or with a history of prolonged immunosuppressant therapy or PUVA, should be monitored for skin cancer. Caution when transitioning from or co-administering with other immunosuppressants. Serious hypersensitivity reactions (including anaphylaxis, allergic alveolitis, eosinophilic pneumonia) have been reported. Regularly assess cardiovascular risk factors. Avoid live vaccines during and up to 15 weeks after treatment (e.g. BCG). In infants exposed in utero, defer live vaccines for 12 months after birth or until ustekinumab infant serum levels are undetectable. It is not known whether ustekinumab may affect allergy immunotherapy. In patients with psoriasis, exfoliative dermatitis has been

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PRODUCTS

reported following ustekinumab treatment. Monitor patients with psoriasis for symptoms of erythrodermic psoriasis or exfoliative dermatitis. Discontinue Uzpruvo if a drug reaction is suspected. Cases of lupus-related conditions have been reported in patients treated with Ustekinumab. Use caution in the elderly due to higher baseline infection risk. Uzpruvo contains polysorbates that may cause allergic reactions. Interactions: Live vaccines should not be given concurrently with Uzpruvo. The pharmacokinetics of ustekinumab was not impacted by concomitant use of MTX, NSAIDs, 6-mercaptopurine, azathioprine and oral corticosteroids in patients with PsA, Crohn’s disease or ulcerative colitis, or prior exposure to anti-TNFα agents, in patients with PsA or Crohn’s disease or by prior exposure to biologics in patients with ulcerative colitis. In psoriasis studies, the safety and efficacy of ustekinumab in combination with immunosuppressants, including biologics, or phototherapy have not been evaluated. In psoriatic arthritis studies,

concomitant MTX use did not appear to influence the safety or efficacy of ustekinumab. In Crohn’s disease and ulcerative colitis studies, concomitant use of immunosuppressants or corticosteroids did not appear to influence the safety or efficacy of Ustekinumab. Fertility, Pregnancy, and Lactation: Women of childbearing potential should use effective contraception during treatment and for at least 15 weeks after the last dose. Data from >450 pregnancies indicate no increased risk of congenital malformations. Ustekinumab crosses the placenta and has been detected in infant serum. Infants may be at increased risk of infection. Live vaccines should be avoided for 12 months post-birth unless ustekinumab levels are undetectable. Ustekinumab is present in breast milk in low concentrations. Risk to breastfed infants is low, but breastfeeding decisions should balance risks and benefits. Effects on fertility have not been evaluated in humans. Driving and Machinery Use: Uzpruvo has no or negligible influence on the ability to

drive and use machines. Undesirable Effects: Upper respiratory infections, nasopharyngitis, sinusitis, dizziness, headache, oropharyngeal pain, diarrhoea, nausea, vomiting, pruritus, back pain, myalgia, arthralgia, fatigue, injection site erythema and pain. Refer to SmPC for full adverse reaction list. Adverse Event Reporting: Adverse reactions should be reported via HPRA Pharmacovigilance, website: www.hpra.ie. Pack Sizes: 45 mg and 90 mg: 1 pre-filled syringe. 130 mg: 1 vial. A copy of the Summary of Product Characteristics is available upon request or go to www. clonmelhealthcare.ie. MA Holder: STADA Arzneimittel AG, Stadastrasse 2-18, 61118 Bad Vilbel, Germany. EU/1/23/1784/001, 004, 005. Distributed in Ireland by: Clonmel Healthcare Ltd., Waterford Road, Clonmel, Co. Tipperary. Medicinal product subject to restricted medical prescription. Date of Last Revision: April 2026. Date prepared: April 2026.

Allcare, Hickey’s and McCauley Pharmacies raise over €85,000 for the Irish Heart Foundation Allcare, Hickey’s and McCauley Pharmacies, part of the Uniphar Group, are proud to announce that its nationwide ‘Move Every Day in May’ campaign raised a staggering €85,884.75 for the Irish Heart Foundation. The campaign brought pharmacy teams, customers, and local communities together in May to raise vital funds for heart, stroke and thrombosis support services, while encouraging people of all ages and abilities to build more movement into their daily lives. With over 9,500 people dying from cardiovascular disease each year in Ireland and more than 600,000 people living with a cardiovascular condition, the campaign helped to shine a light on the importance of awareness, prevention and practical communitybased support. As part of the campaign, participants

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were encouraged to move every day throughout May, taking part in activities ranging from walking and cycling to dancing, gardening and other everyday movement that supports cardiovascular health. Throughout May, Allcare, Hickey’s and McCauley Pharmacies became community heart-health hubs, hosting weekly ‘Love Your Heart Days’, while the Irish Heart Foundation’s Mobile Health Unit visited selected pharmacies nationwide, providing free hearthealth checks and expert advice to help people take positive steps for their cardiovascular health. Joe Scallan, Retail Director, Uniphar, said: “Our pharmacy teams are at the heart of the communities we serve so it has been incredibly meaningful to see them come together with customers and communities nationwide for this

campaign. We are proud to have raised more than €85,000 for the Irish Heart Foundation, while helping people take positive steps for their heart health.” Emma Balmaine, CEO, Irish Heart Foundation, said: “We are hugely grateful to Uniphar, Allcare, Hickey’s and McCauley Pharmacies, and to everyone who supported ‘Move Every Day in May’. The funds raised will help support our work to prevent cardiovascular disease and provide vital services in communities across Ireland. Small daily habits can make a big difference to heart health, and this campaign has shown the power of communities coming together to make a real impact.” The funds raised through the campaign will support the Irish Heart Foundation’s vital work in communities across Ireland, including heart health awareness, prevention, and support services.

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Athena Pharmaceuticals and partners to convene healthcare leaders for National Clinical AI Congress in Dublin Healthcare and industry professionals from across Ireland are being invited to attend the inaugural All-Ireland Clinical AI Congress & AI Tech Expo, a new national meeting dedicated to the consideration and application of artificial intelligence in healthcare. Hosted and developed by Athena Pharmaceuticals, in partnership with University College Dublin (UCD), knowledge partner Cloud21 and industry supporters, the free-of-charge one-day Congress will take place on Saturday, 12 September 2026, from 08:30–16:00 at O'Reilly Hall, University College Dublin. Supporting registered healthcare professionals across Ireland, as well as all disciplines supporting healthcare delivery, the Congress will bring together clinicians, healthcare leaders, academics, policymakers, industry, and technology innovators to explore how artificial intelligence is transforming patient care while addressing the governance, regulatory, and ethical considerations surrounding its adoption. CME/CPD accreditation is pending confirmation. Unlike many AI events focused on future possibilities, the All-Ireland Clinical AI Congress will place a strong emphasis on practical implementation, showcasing how AI is already being deployed in hospitals, primary care, and pharmacy settings, as well as the implications for patient care and communications in Ireland and internationally. The programme features presentations from senior leaders within the HSE, leading Irish hospitals, international experts, and healthcare technology organisations, alongside an interactive AI Tech Expo showcasing clinically deployed solutions across radiology, prescribing, diagnostics, workflow optimisation, patient management, and clinical decision support. Delegates will hear real-world implementation case studies from clinicians at major Hospitals, including the Queen Elizabeth University Hospital,

Glasgow, Beaumont Hospital, Mater Misericordiae University Hospital, and other leading healthcare organisations. Attendees will gain practical insights and understanding from the Tech Expo into how AI is being deployed in clinical practice and the adaptations that AI brings to ways of working and patient engagement. Conference sessions will also examine the implications of the EU AI Act, governance frameworks, digital transformation, clinical decision support systems, and the future integration of trusted AI workflows across healthcare. Speaking ahead of the Congress, Dave Shanahan, CEO of Athena Pharmaceuticals, said: "Artificial intelligence will significantly impact healthcare and its delivery. How it is adopted, used and directed has profound implications for patients and healthcare workers. Our ambition for the All-Ireland Clinical AI Congress is to educate and stimulate a wider readiness within Irish healthcare to anticipate and engage with AI. We need to accelerate governance and design the right frameworks to leverage AI’s potential, to improve productivity, improve patient outcomes and lower healthcare costs." Professor Peter Doran, Director of the UCD Clinical Research Centre and Professor of Clinical Trials at the UCD School of Medicine, added: "Artificial intelligence presents enormous opportunities to transform patient outcomes and clinical workflows, but its true value will only be realised when innovation is anchored in robust clinical evidence, sound trial methodology, and multi-disciplinary governance. This Congress provides an essential national platform for clinicians and researchers to actively engage with deployed technologies and shape the safe, evidence-based adoption of AI across Ireland’s health system."

Highlights of the inaugural Congress include: • Global and national perspectives on AI strategy in healthcare. • The HSE AI for Care 2026–2030 Strategy. • Real-world AI implementation case studies from Irish hospitals. • Primary and secondary care perspectives on AI adoption. • Practical guidance on AI governance, ethics and regulatory compliance. • An interactive AI Tech Expo featuring leading healthcare technology providers. • Local Poster Competition and Exhibition on AI-related projects in health. • Networking opportunities with clinicians, pharmacists, GPs, nurses, healthcare executives, academics and digital health innovators from across the island of Ireland. Athena Pharmaceuticals is inviting healthcare professionals to showcase innovative AI projects. Abstract submissions are now open, with successful entries selected for display at the Congress as part of a dedicated poster exhibition and showcase. Up to 12 abstracts will be shortlisted, with a total of €2,250 in bursaries awarded, including recognition for the most outstanding innovation. The poster competition is open exclusively to healthcare professionals, including those currently in training or education. The deadline for abstract submissions is now 4 September 2026. The organisers expect the Congress to become one of Ireland's leading educational forums focused on the safe, practical and clinically meaningful adoption of artificial intelligence across healthcare. Attendance is free of charge; however, advance registration is essential. For further information and registration, visit www.aiclinicalcongress.com.

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Lift expands its glucose range in Ireland with the launch of new fast-acting Glucose Gels Pamex Limited is pleased to announce the launch of Lift Glucose Gels in Ireland, the latest addition to the trusted Lift glucose range. Joining the popular Lift Glucose Shots and Chewable Tablets, the new gels provide another convenient option for people who need fast-acting glucose, whether managing diabetes or fuelling performance during sport and exercise. For people living with diabetes, carrying a reliable source of fast-acting glucose is an essential part of everyday life. Equally, active individuals and endurance athletes often require a quick and convenient source of carbohydrate during training or competition. Lift Glucose Gels have been developed to meet both needs, delivering a measured 15g dose of fast-acting glucose in a compact, easy-to-use sachet. Designed with convenience in mind,

the lightweight sachets feature a simple tear-and-go design for quick access whenever glucose is needed. Pocketfriendly and easy to carry, they fit neatly

into a pocket, handbag, school bag, gym bag or running belt, ensuring fast-acting glucose is always close at hand. The smooth gel is easy to consume on the move and is available in two popular flavours – Orange and Strawberry. Trusted by users, 98% recommend Lift*, reflecting the confidence people place in the brand and its glucose products. The addition of Lift Glucose Gels builds on this reputation, providing healthcare professionals, patients and consumers with greater choice when selecting a fast-acting glucose product. The Lift Glucose range is available in pharmacies nationwide and through the Long-Term Illness (LTI) Scheme in Ireland, improving access for eligible patients and supporting effective hypoglycaemia management in the community. *Based on 378 reviews, Mar 2026

Exdensur (depemokimab) approved by the European Commission for severe asthma with type 2 inflammation and chronic rhinosinusitis with nasal polyps • Exdensur (depemokimab) is the first and only ultra-long-acting biologic in the EU to treat severe asthma and chronic rhinosinusitis with nasal polyps (CRSwNP). • Approval based on four phase III trials with statistically significant and clinically meaningful primary data across severe asthma and CRSwNP. • An estimated 450,000 people in Ireland currently have asthma, with approximately 900,000 individuals expected to develop the condition over their lifetime. Severe asthma is estimated to affect 3-10% of the asthma population, and many patients with CRSwNP face

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inadequately controlled symptoms. GSK Ireland has announced that the European Commission has approved Exdensur (depemokimab) in two indications: • As add-on maintenance treatment for severe asthma with type 2 inflammation characterised by blood eosinophil count in adults and adolescents 12 years and older who are inadequately controlled despite high dose inhaled corticosteroids (ICS) plus another asthma controller; • As an add-on therapy with intranasal corticosteroids for the treatment of adult patients with severe CRSwNP for whom

therapy with systemic corticosteroids and/or surgery do not provide adequate disease control. The approval is based on data from the SWIFT and ANCHOR phase III trials, which showed sustained efficacy with a twice-yearly dosing regimen for depemokimab. Each of the four trials met their primary or co-primary endpoints with statistically significant and clinically meaningful results, comparing the addition of depemokimab to standard of care versus standard of care alone. GSK Ireland confirms that in August

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2026 an application was submitted to the Corporate Pharmaceutical Unit (CPU) and the National Centre for Pharmacoeconomics (NCPE) in Ireland for reimbursement consideration for Exdensur as an add on treatment for severe asthma with type 2 inflammation and chronic rhinosinusitis with nasal polyps. Professor Richard Costello, Consultant Respiratory Physician, Beaumont Hospital, said: “This is a new era in innovation in asthma care. Exdensur (depemokimab) promises to be a highly effective solution for patients with severe asthma by reducing the burden of medication use and providing meaningful

clinical outcomes.” Eilís Ní Chaithnía, CEO, Asthma Society of Ireland, said: "From a patient perspective, timely access to licensed treatment options is an important part of improving quality of life and long-term health outcomes. While this medicine is already authorised for use, eligible Irish patients will eventually benefit from it, following the NCPE appraisal and when reimbursement arrangements are in place. We welcome ongoing progress between all stakeholders to ensure equitable and sustainable access for the people who need it.” Kaivan Khavandi, SVP, Global

Head, Respiratory, Immunology & Inflammation R&D, GSK, said: “The approval of Exdensur (depemokimab) in the EU means there is now an innovative ultra-long-acting option that offers sustained efficacy over six months to protect patients from severe asthma exacerbations and the debilitating symptoms associated with CRSwNP. Exdensur (depemokimab) may help redefine care for the millions of patients living with these persistent and burdensome conditions, supporting them in achieving their treatment goals with just two doses a year.”

New continuous glucose monitor which predicts overnight hypoglycaemia named on HSE preferred sensor list A in Republic of Ireland A new continuous glucose monitor (CGM) that can predict overnight hypoglycaemia for adults with diabetes has been named on the HSE preferred sensor list A for HCPs in the Republic of Ireland. The device is available to people with type 1 diabetes who do not use insulin pumps. Roche Diagnostics’ Accu-Chek SmartGuide is designed to help adults with diabetes predict dangerous blood glucose levels, forecasting glucose levels up to 30 minutes and two hours ahead, as well as overnight for up to seven hours. A water-resistant sensor worn on the back of the upper arm sends readings to a smartphone app every five minutes, helping people stay informed and take action before hypoglycaemia or hyperglycaemia occurs. The addition of Accu-Chek SmartGuide CGM to the HSE preferred sensors list signifies that the device has been deemed among the best value options for both HCPs and patients. Dr Tomás Griffin, Consultant in

Diabetes, Endocrinology and General Internal Medicine at Galway University Hospitals, said: "It is encouraging to see continued innovation and greater choice in continuous glucose monitoring for people living with diabetes. Diabetes management requires daily attention, and CGM can reduce some of that burden by providing timely information on glucose levels, trends, and, in some systems, predictions of where glucose levels may be headed. “No single device will suit everyone. People differ in their clinical needs, lifestyles, preferences, digital confidence and the features they value most. Having access to a wider range of CGM options allows people, together with their healthcare professionals, to choose the system that best meets their individual needs. Greater choice can support more personalised diabetes care, improve confidence in day-today decision-making and help people manage their glucose levels while maintaining their quality of life."

Accu-Chek SmartGuide was made available under reimbursement for people living with type 1 diabetes in the Republic of Ireland in February this year. Peter Hampson, Head of Medical Affairs at Roche Diagnostics UK & Ireland, said: “For many people living with diabetes, the fear of blood sugar dropping overnight is a constant worry. This technology helps remove some of that uncertainty by predicting potential lows before they happen, giving people greater confidence and peace of mind in their day-to-day lives. Roche Diagnostics is incredibly proud to be helping people feel safer and more in control of their diabetes." The news follows Roche Diagnostics’ integration of the Accu-Chek SmartGuide and Accu-Chek SmartGuide Predict apps into the mySugr app, which now has more than seven million registered accounts worldwide. The integration brings users’ glucose data, predictive insights and diabetes management tools together in one platform, making it easier to access and manage this information in one place.

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AVAIL ABLE IN PRINT AND DIGITAL

WWW.IRISHPHARMACIST.IE

E45 knows how to support skin E45 cream is used for treating dry skin conditions such as dry/flaky skin, eczema, dry psoriasis, dermatitis and sunburn. Suitable for the whole family. Apply 2-3 times daily for best results*.

E45 Cream is a medicinal product not subject to medical prescription, containing White Soft Paraffin 14.5% w/w, Light Liquid Paraffin 12.6% w/w and Anhydrous Lanolin 1.0% w/w. Suitable for use from 1 month of age. Always read the leaflet before use. Marketing Authorisation Number: PA 22650/007/001. Distributed in Ireland by Ocean Healthcare Ltd. Date of preparation: May 2025. *E45 SPC. Available at: https://www.medicines.ie/medicines/e45-cream-31954/spc.

Tel: 01 2968080 orders@oceanhealthcare.ie www.oceanhealthcare.ie