OTC Update Winter 2021

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1Clinical test performed on 100 patients with mild to moderate melasma for 90 days for the evaluation of percentage reduction in mMASI (modified Melasma Area Severity Index) score from the baseline to 45 days and 90 days.

EDITOR

Pat Kelly pat@greenx.ie

MANAGING DIRECTOR

Graham Cooke graham@greenx.ie

CREATIVE DIRECTOR

Laura Kenny laura@greenx.ie

ADMIN

Daiva Maciunaite daiva@greenx.ie

CONTENTS

HOT TOPICS

08

DIGESTIVE HEALTH

An overview of the typical digestive problems that you may encounter over the festive season

12

COLD & FLU

GreenCross Publishing Ltd, Top floor 111 Rathmines Road Lower, Dublin 6 Tel: 014410024

OTC UPDATE is produced by GreenCross Publishing Ltd. as a supplement to Irish Pharmacist GreenCross Publishing was established in 2007.

© Copyright GreenCross Publishing Ltd. 2020

The contents of OTC UPDATE 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.

DISCLAIMER

The views expressed in OTC UPDATE 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.

16

Treating coughs, colds and flu during the winter season and how to distinguish them from Covid-19

MIGRAINE

Often dismissed as a ‘bad headache’, migraine is one of the most debilitating conditions worldwide

20 SKIN CARE

Ways to offset the harsh effects of winter and keep skin healthy and moisturised in the months ahead

24 WOUND CARE

A look at wound care, from small cuts and grazes, to more serious wounds that need ongoing treatment

WOMEN WITH LONG COVID-19 MAY NEED TARGETED REHAB — RESEARCH

Women with long Covid experience heart rate irregularities in response to physical exertion, and this has the potential to constrain not only exercise tolerance, but free-living physical activity, according to new research.

In the context of the greater prevalence of age-related physical disability among women compared to men, these findings highlight a need for targeted rehabilitation programmes to manage the consequences of persistent heart and lung problems in women with lingering Covid-19-related symptoms, according to research published recently in the UK Physiological Society’s journal Experimental Physiology

Drs Stephen J Carter and Marissa N Baranauskas, physiologists from Indiana University Bloomington, US, reported significant differences in the heart rate responses to and recovery from a six-minute

walk test in women several months following mild-to-moderate SARS-CoV-2 infection compared to non-infected controls.

The control and experimental groups were matched on age and body mass index, providing greater certainty that the present findings were attributed to long Covid syndrome rather than underlying differences related to ageing or obesity.

Specifically, heart rate was reduced during physical exertion, and recovery was delayed after the exertion among SARS-CoV-2 participants, despite a similar distance travelled and ratings of perceived exertion to controls.

Women reported shortness of breath or joint/muscle aches, and at the time of testing achieved a lower proportion of predicted six-minute walk test distance compared to controls.

Furthermore, more abnormal heart rate responses were associated with a greater number of days experiencing shortness of breath at illness onset, and poorer ability for gas exchange in the lungs.

Although male sex is associated with increased Covid-19 symptom severity and mortality, recent reports suggest women may be more susceptible to certain lungrelated limitations months into recovery.

Prior to this study, hospital admissions data from the Mayo Clinic Proceedings already indicated that women outnumber men 3:1 in seeking treatment for persistent symptoms following a positive Covid-19 diagnosis.

However, the influence of these persistent abnormalities on physical functioning for persons recovering from mild-to-moderate Covid-19 has not yet been studied.

NEW RESEARCH REVEALS THAT 60% OF ADULTS ARE CONCERNED ABOUT CONTRACTING THE FLU SINCE THE ARRIVAL OF COVID

New research has revealed that six-in-10 adults (60 per cent) claim that they are concerned about contracting the flu since the arrival of Covid-19. While levels of concern are quite consistent across age groups, almost three-in-10 (28 per cent) adults claim that they are more concerned now than they were before Covid-19 about contracting the flu.

Meanwhile, two thirds (67 per cent) of adults in the research claim that they are likely to get the flu vaccine this year. Those aged 65 and older are more likely to claim that they are likely to get the flu vaccine this year (84 per cent), with those aged 18-to-44 significantly less likely to claim that they are ‘very likely’ to get the flu vaccine.

Almost six-in-10 (57 per cent) adult

respondents claim that they would be open to receiving both the flu and Covid-19 vaccine at the same time, if needed. This rises to 69 per cent in adults aged 55-to-64.

Commenting at the launch of the service, Ms Caoimhe McCauley, Chief Pharmacist at Boots, said: “The seasonal flu vaccine is considered the best protection against the flu, the complications that can arise from it and further spread of the virus in the community. Annual vaccination is recommended because the virus is constantly changing and it is the best way to reduce your chance of contracting the flu year-to-year.”

The research was conducted on behalf of Boots Ireland.

HUGE MAJORITY BACKS CIGARETTE BAN FOR UNDER-21S

Almost three-quarters of people in Ireland want the legal age for the sale of tobacco to be raised from 18 to 21, new research for the Irish Heart Foundation shows.

The charity says the findings send an overwhelming message to Government that the public wants decisive action to save a new generation from the “health catastrophe” of smoking, which still claims almost 6,000 lives here every year.

Findings from the Ipsos MRBI poll were published to coincide with a major online conference on Tobacco 21 laws in the US, which was attended by international experts recently. It follows research showing that smoking among young people in Ireland has increased for the first time in a quarter of a century.

A total of 73 per cent of 1,029 people aged over 15 surveyed in the phone poll are in favour of raising the age for the sale of cigarettes to 21, with 26 per cent disagreeing and 1 per cent undecided. In the 18-to-24 age group, 71 per cent backed the proposal.

“One in every three young people who start smoking will die of a tobacco-related illness. And for every death, a further 30 will suffer a smoking-related disease, such as stroke, heart disease, cancer and COPD (chronic obstructive pulmonary disease),” said the Foundation’s Director of Advocacy Mr Chris Macey.

“It would be an utter dereliction of our duty of

care not to protect our young people from the death and destruction caused by smoking in every corner of the country on a daily basis — we have got to find an end-game to tobacco addiction. If cigarettes were invented today, they would simply not be legal.”

The charity — which said it also wants the ban extended to e-cigarettes due to evidence of their gateway effect on smoking — insists that data showing an increase in teenage smoking in Ireland strengthens the case for a tobacco ban for people aged under 21.

In 1995, the teen smoking rate in Ireland was 41 per cent, which fell dramatically to 13.1 per cent by 2015 —

but by 2019, had crept back up to 14.4 per cent.

“The evidence strongly suggests that raising the age of sale will turn the tide back in the right direction, disrupting a high rate of smokers moving from casual use to addiction between the ages of 18 and 20,” said Mr Macey.

“In the US, Tobacco 21 laws introduced in various States before it became federal law in 2019 reduced smoking in that age group by up to 33.9 per cent. The US Institute of Medicine says 223,000 lives will be saved among those born between 2000-2019. It has also reduced smoking rates in the 15-to-17 age group.

“In addition, we could be confident similar laws will work in Ireland due to the hugely positive impact of increasing the age of sale here in 2002 from 16 to 18.”

Mr Macey insisted introducing it here would not amount to a breach of people’s rights, arguing that the notion that young people automatically acquire all rights possessed by adults at 18 is not true.

For example, under-21s are already prohibited by law from activities such as adopting children, driving large passenger vehicles, supervising learner drivers, and standing in national and European elections, he pointed out.

MENTAL HEALTH IN THE WORKPLACE CRISIS ‘THREATENS TO DERAIL BUSINESS RECOVERY AND GROWTH’

Urgent attention is needed by employers to address the mental health issues and concerns of employees, as new research shows employees are in vital need of support. Forty-five per cent of 18-to-34 year-olds are planning to change jobs in the coming year and within this same age demographic, one-in-three people are more likely to move to an employer that provides mental health resources to support better mental wellbeing. Forty-six per cent of referrals into occupational health currently are for mental health reasons, demonstrating how serious a problem this has become.

HR leaders have reported that while productivity has increased by 28 per cent during 2021, this has been at the cost of employees’ mental health, morale and motivation. Since the first wave of the research in September 2020, overall mental wellbeing has decreased by 19 per cent, morale at work has declined by 23 per cent, and motivation has reduced by 17 per cent.

Forty-eight per cent of employees have felt lonely and isolated, 46 per cent have struggled to get a good night’s sleep, and 24 per cent have experienced sustained levels of anxiety. This is contributing to the fact that 54 per cent of employees’ mental health has been negatively impacted by the Covid-19 pandemic. These findings come as companies start to invest in the future and grow their workforces, with 59 per cent of employers planning to increase the number of new hires in the coming months, compared to just 29 per cent in January 2021, thus signalling an imminent talent acquisition crisis which has the potential to derail business recovery and growth.

The research also showed that the stigma about mental health has not yet been broken, with 59 per cent of employers and HR leaders stating that there is still a stigma about mental health in the workplace. Forty-one per

cent of employees share this view, yet this is more prevalent in manufacturing industries (59 per cent), with three-in-five employees admitting they haven’t sought help for anxiety or mental health issues.

Prof John Gallagher, Specialist in Occupational Medicine, said: “The picture is stark. With a large proportion of people using occupational health needing to do so for mental health reasons, it is clear that employers need to do more to intervene at the very earliest signs of a mental health issue to offer supports that can help a person to get back on track and reduce further deterioration of their mental health. Companies need to have a mental health strategy that focuses on resources and breaking the stigma of mental health, which remains a barrier for many to seek help.”

The statistics are part of the latest update in Laya Healthcare’s ‘Brave New Era’ series, Ireland’s largest study of mental health in the workplace, which was published recently.

RESEARCH REVEALS WHAT FACTORS IMPACT IRISH WOMEN’S EXPERIENCE OF MENOPAUSE

Research published recently has revealed that almost two-thirds of women (64 per cent) say that menopause caused them to experience physical or psychological symptoms that have significantly affected their day-to-day life.

The research showed that among women who have experience of menopause, half (50 per cent) said that they have experienced a lack of confidence caused by the menopause, with almost four-in-10 (39 per cent) agreeing that women become less visible as they experience menopause.

Almost two-thirds of women say menopause causes them to experience physical or psychological symptoms that have significantly affected their day-to-day life. In addition, hormonal changes during menopause typically bring unpleasant symptoms and indignities. Among those who have experienced menopausal symptoms that have

significantly impacted their day-to-day life, the most common symptoms experienced are hot flushes, sleep problems, or weight gain.

Thirty per cent of those who took part in the research don’t know what perimenopause is. Furthermore, even though all women will experience menopause, four-in-10 (41 per cent) women reported feeling like the subject of perimenopause and menopause is not treated seriously, despite it touching on many important issues, such as gender equality and ageism, and most critically, the health and wellbeing of women.

In addition, half of those surveyed say there is not enough information available generally, with a similar proportion (40 per cent) claiming that there is not enough information available on the options available to treat symptoms.

Founder of Menopause Health Clinic and

menopause specialist and GP, Dr Caoimhe Hartley, said: “By 2025, it’s estimated that there will be over one billion women experiencing menopause in the world, equal to 12 per cent of the entire world population. As such, it is likely that everybody knows someone currently experiencing menopause. It’s disappointing to learn that despite this fact, four-in-10 women feel like the subject of perimenopause and menopause is not treated seriously, with a similar percentage believing that there is not enough information available on the options available to treat symptoms. This research... is hugely helpful in highlighting the impact that menopause has on women, both physically psychologically, and gives us the opportunity to sign-post to where support and advice is available.”

The research was undertaken recently by Empathy on behalf of Boots Ireland.

on Nutrition

Big on Nutrition

Big

Fortini Compact Multi Fibre packs the of a standard paediatric oral nutritional supplement* in 38% less volume

Fortini Compact Multi Fibre packs the nutrition of a standard paediatric oral nutritional supplement* in 38% less volume

7.2

NEW

Contact your Nutricia representative to request recipe cards for your patients

Use your phone to scan the QR code or visit Nutricia.ie

professionals only.

under medical supervision.

This information is intended for healthcare professionals Fortini Compact Multi Fibre is a food for Special Medical disease related malnutrition and growth failure in children under medical supervision.

Purposes for the dietary management of from one year onwards, and must be used available on the market. healthcare professional. evaluation only.

^

* Various 1.5kcal/ml, 200ml paediatric ONS with fibre available on the market. Product can be provided to patients upon the request of a healthcare professional. They are intended for the purposes of professional evaluation only.

Deansgrange, Co. Dublin. Date of publication: 10/2021

Nutricia Ireland, Block 1, Deansgrange Business Park, Deansgrange, Co. Dublin. Date of publication: 10/2021

* Various 1.5kcal/ml, 200ml paediatric ONS with fibre Product can be provided to patients upon the request They are intended for the purposes of professional Nutricia Ireland, Block 1, Deansgrange Business Park,

^

SUPPLEMENTS AND BETTER NUTRITION ADVISED TO FIGHT FRAILTY IN OLDER PEOPLE

South Tipperary Enablement Programme for the Older Person (STEP) and the Older Person Nutrition Interest Group (OPNIG) of the Irish Nutrition and Dietetic Institution (INDI) are calling for greater awareness of the vital role of good nutrition in older adults, following the International Day of Older Persons, which took place on 1 October.

Malnutrition increases the risk of falls, infections and hospital stays in older adults and this over-65 age group is the fastest-growing cohort in Ireland, having increased by 17.9 per cent since 2016. This figure is expected to further increase to 1.6 million older citizens by 2051.

Ms Lorna King, South Tipperary Enablement Programme Clinical Specialist Dietitian for the Older Person, said she believes that there are key benefits to incorporating nutrient-rich foods in the older person’s diet. The STEP team has observed among older persons that nutrition when combined with regular physical activity is vital in successful ageing, both for physical and mental health.

Dr Isweri Pillay, Consultant Geriatrician at Tipperary University Hospital and a member of the STEP Team, said: “What matters to most older people that we care for in hospital is maintaining their independence, their families and living in their own home. People worry about losing independence and becoming

dependent on their families as caregivers or having to leave their home. Between 25-to-30 per cent of older people that we care for in hospital are at risk of malnutrition before coming to hospital. This risk of malnutrition is linked to frailty and poorer health outcomes and loss of independence. A nutritionally-balanced diet is an essential component of self-care at every stage of life, but can be life-changing in later years.”

As people age, their nutritional requirements change. Energy (calorie) needs may go down, yet protein requirements can increase. The ability of the body to absorb and use micronutrients will change and taste, appetite and social circumstances evolve too.

Highlighting the key dietary

areas for the older person to promote both physical and mental wellbeing is important. These include:

 Protein power: Protein is the building block of muscle and helps to keep bones strong. Older adults should eat protein-rich foods spread out at meal and snack times throughout the day. Sources include red meat, chicken and other poultry, fish, eggs, dairy products, and cheese. More plant-based protein sources include soya bean products, beans and peas, bread, cereals, nuts and seeds and meat alternatives.

 Drink more fluids: Getting adequate fluid daily is important, as even mild dehydration can negatively affect an older person’s mental function, can increase

risk of falls, and can lead to constipation. These people should aim for at least eight cups of fluid (1.5 litres) a day.

 Keep an eye on appetite and weight: The older person is at higher risk of developing malnutrition, which can lead to muscle loss.

Signs of weight loss include loose rings/clothes/belts, ill-fitting dentures, fatigue and reduced interest in food.

In these situations:

● Encourage three small meals and three small snacks each day.

● Include high-calorie, nourishing foods, for example, full-fat milk, hot chocolate made with full-fat milk, crackers with butter or cheese, full-fat yogurts, rice puddings and custards.

● Try fortifying foods: For example, the addition of cream into soup or grated cheese on potatoes.

● Monitor weight weekly and discuss with the GP.

 Focus on vitamins and minerals: “As we approach the winter period, all older adults should take a daily vitamin D supplement of 15mcg, as advised by the Department of Health last year, to ensure optimal bone and muscle health,” says Ms Lorna King, Clinical Specialist Dietitian. “It plays a role in immunity and is required for the absorption of calcium, needed for healthy bones and teeth. The ability to absorb and use certain nutrients can change as we age, including vitamin B12, folate, iron, and calcium.”

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igestive complaints are very common in the community at the best of times, but with Christmas approaching, changes in diet and lifestyle mean that you will see more customers at the pharmacy counter looking for advice on how to manage their symptoms.

According to the NHS in the UK, approximately four-in-10 people have a digestive complaint at any given time. Among the most common stomach problems are:

 Stomach ache.

 Indigestion.

 Heartburn.

 Bowel habit changes (normally diarrhoea or constipation).

Most digestive problems can be solved with diet and lifestyle alterations, but certain medications can also cause stomach upsets. These include some medications for arthritis, certain tranquillisers, cough medicines or iron tablets, among others. In cases where

medicines are causing stomach problems, consult with the pharmacist on duty for advice or recommend that the customer talk to their GP about possible alternatives that won’t be too hard on their stomach.

STOMACH ACHE

As stated above, this can simply be a cause of a change in diet or lifestyle, especially during times of indulgence, such as the festive season. Almost everybody gets a stomach ache from time-to-time for various reasons, but rich food and alcohol can also trigger abdominal pain. Stomach pain can be:

 Acute: Lasts a few hours or even a couple of days.

 Chronic: This pain lasts longer and may come and go but can last for weeks or even months.

 Progressive: This type of pain gets worse over time and may be accompanied by other symptoms. The causes of stomach pain are wideranging and can be anything from indigestion, food allergies or gas, to more

serious conditions such as an irritable bowel disease, food allergies, food poisoning, or irritable bowel syndrome, to name but a few. Customers should be advised to consult their GP if the pain is accompanied by fever; dehydration and inability to urinate; pain on urination; inability to keep food down for more than 48 hours; extreme thirst and dark-coloured urine; or if the stomach is tender to the touch. Inability to swallow and unexpected weight loss are also serious warning signs.

INDIGESTION

This will be a particular problem around the Christmas season. Also known as dyspepsia, indigestion is a discomfort of the upper abdomen, accompanied by stomach pain and feeling too full soon after eating. The exact symptoms vary from person-to-person and some people may experience it every day. People with dyspepsia will also feel too full after they have eaten and this feeling will last longer than it normally should.

AS CHRISTMAS AND NEW YEAR APPROACH, THERE WILL BE AN INCREASE IN PRESENTATIONS AT THE PHARMACY COUNTER FOR DIGESTIVE COMPLAINTS

Sometimes indigestion will be accompanied by nausea but the person will also experience discomfort, bloating and/or a burning sensation in the upper abdomen.

HEARTBURN

Heartburn is a common symptom of acid reflux. This occurs when some of the stomach’s contents travel back up into the oesophagus, leading to the typical burning sensation.

Indigestion is also often accompanied by heartburn, an unpleasant ‘burning’ sensation in the centre of the chest that may spread to the lower neck or occasionally, the back.

The causes of heartburn vary from person-to-person but the usual causes include anxiety, eating greasy or fatty foods, over-eating or eating too quickly, smoking, excessive alcohol, caffeine, or too much fizzy drinks or chocolate. As above, if other serious symptoms are present,

consult the pharmacist on duty or suggest that the customer see their GP.

Heartburn is rarely a sign of anything more serious, but it can be an indication of gastro-oesophageal reflux disease (GORD). GORD is often diagnosed if the symptoms occur twice a week or more and if it occurs for a long time, this can cause serious tissue damage and medical advice is recommended in these cases.

Heartburn is common among pregnant women; overweight or obese people; it can be a result of certain medications; or it may be caused by smoking.

DIARRHOEA AND CONSTIPATION

As with the other conditions above, constipation is not usually a sign of something more serious but it can be distressing and uncomfortable and can interfere with quality of life. The symptoms of constipation usually include:

 Less than three bowel movements in a week.

 Difficulty in defecating and needing to push the stool harder than is normally necessary.

 If the stool is larger than usual, is hard or lumpy, or is too dry.

Constipation is also quite common during pregnancy and for six weeks after the baby is born, as the hormones produced during pregnancy can change the way the stool moves through the digestive system. Diarrhoea can have a range of causes and again, it is usually temporary and not a sign of a serious underlying cause. However, diarrhoea and stomach pain are sometimes signs of an irritable bowel disease or syndrome and if the symptoms have been present for a long time, a GP may need to run some tests to rule out undiagnosed disease.

Sometimes diarrhoea is accompanied by vomiting and this may be a sign of viral gastroenteritis. Diarrhoea usually resolves itself but sometimes a customer will require medication to shorten the duration if they need to work or travel, for example.

HEARTBURN IS RARELY A SIGN OF ANYTHING MORE SERIOUS, BUT IT CAN BE AN INDICATION OF GASTRO-OESOPHAGEAL REFLUX DISEASE

LIFESTYLE INTERVENTIONS

Many digestive problems can be resolved by changes in diet and lifestyle. Stress is often linked to digestive problems so if it is possible, the customer can try to lessen the stress in their life; getting a good night’s sleep can also help in this regard.

One simple step they can take is to try to eat more slowly, which helps with digestion and the proper absorption of nutrients from food. While a person may not be enthusiastic about drinking fluids if they are bloated, it is always a good idea to drink plenty of water if there is a digestive problem and this is particularly important if there is diarrhoea, which can leave a person dehydrated. Taking prebiotic or probiotic supplements can also help to improve gut health.

Getting enough exercise and eating less fatty or high-sugar foods can also help to relieve symptoms. Sometimes, there may be undiagnosed food intolerance and a GP is well placed to arrange tests to rule this out. Eating more fruit, vegetables and high-fibre foods can also help and there is some evidence to suggest that eating ginger can help with bloating. Smoking cessation and avoiding binge-drinking can also help to relieve the symptoms of acid reflux.

REMEDIES

There are a wide variety of over-thecounter products that can help your customers with their digestive health problems. As always, these should be tailored to each customer’s requirements and the pharmacist on duty should be consulted if you suspect any of these remedies may interact with other medications they are already taking.

To improve overall gut health, Alflorex contains the unique patented 35624 culture — the only product in Ireland that contains this culture — and has been clinically tested by leading scientists and gastroenterologists. The bacterial culture in Alflorex occurs naturally in the human gut and is part

the bifidobacterium family, one of the first kinds of bacteria passed by mothers to their babies at birth. Thirty capsules can last for one month and Alflorex does not need to be refrigerated.

IMODIUM Plus works quickly to relieve diarrhoea and soothe cramps, as well as helping to relieve wind and bloating. It can be used to treat short bouts of diarrhoea and contains simeticone, which helps to soothe excess gas in the gut and relieve wind pains. It can also stop diarrhoea within one hour of the first dose.

of acid that the stomach produces for at least 24 hours. Customers should be advised not to take more than the recommended dose of one tablet (20mg) a day, even if they do not feel an improvement immediately. Emazole Control tablets can be taken on an empty stomach or with food.

The Gaviscon range of products can also help with symptoms of acid regurgitation, heartburn and indigestion. Gaviscon Advance Aniseed Liquid 600ml provides fast, powerful relief from heartburn and indigestion following meals, during pregnancy, or in patients with symptoms related to reflux oesophagitis. Gaviscon Advance Oral Suspension Aniseed Flavour 500ml is a long-lasting, extra-strength formula that also provides fast, effective relief from heartburn and indigestion. The Gaviscon range includes a number of other products designed to suit customers’ different needs.

Dulcolax 5mg Gastro-Resistant

Tablets provide gentle and affective relief from constipation and help to restore the natural digestive rhythm. Each tablet contains 5mg of bisacodyl, which helps to gently stimulate the bowel muscles and are easy to swallow and gentle on the stomach.

Fybogel Orange is a high-fibre drink that contains the active ingredient Ispaghula Husk. This remedy increases fibre in the diet, which helps the digestive system to work more efficiently and relieve constipation, helping to store and maintain regularity. It should be used in patients who require a high-fibre diet for use in the relief of constipation. It is suitable for adults and children aged six years and over.

Emazole Control is a short-term treatment for reflux symptoms, such as heartburn and acid reflux. This product works by reducing the amount

Nexium Control is a remedy that works by limiting the amount of acid the stomach produces, thus helping to prevent heartburn. It does this without affecting your ability to digest food and drink and provides 24-hour protection from heartburn and acid reflux.

For constipation relief, Lactulose Fresenius 500ml is a very widely used and effective laxative, which uses a form of osmotic effect to help relieve constipation in a gentle, reliable way. Lactulose Fresenius oral solution can be taken undiluted or diluted in some liquid and can be taken once-daily, for example during breakfast, or divided into three doses a day.

DulcoEase 100mg Capsules — 60 Soft Gel Capsules provide relief when bowel movement is painful or difficult. This remedy can be used to relieve constipation, piles or anal fissures and works by helping hard, dry stools soak up natural fluids. It contains the active ingredient docusate sodium and is suitable for adults and children aged over 12 years. ●

TAKING PREBIOTIC OR PROBIOTIC SUPPLEMENTS CAN ALSO HELP TO IMPROVE GUT HEALTH

FOR RECURRING HEARTBURN MORE THAN ONCE A WEEK

RECOMMEND IRELAND’S NO.1 PHARMACY ONLY 24 HOUR HEARTBURN PROTECTION TREATMENT*

*IQVIA category summary by brand April 2021

Product information: Nexium Control 20 mg gastroresistant tablets and hard capsules: Each gastroresistant hard capsule/tablet contains 20 mg esomeprazole (as magnesium trihydrate)

Indications: The shortterm treatment of reflux symptoms (e.g. heartburn and acid regurgitation) in adults. Dosage: The recommended dose is 20 mg esomeprazole (one tablet or capsule) per day. It might be necessary to take the tablets or capsules for 23 consecutive days to achieve improvement of symptoms. The duration of treatment is up to 2 weeks. Once complete relief of symptoms has occurred, treatment should be discontinued. If no symptom relief is obtained within 2 weeks of continuous treatment, the patient should be instructed to consult a doctor. Contraindications: Hypersensitivity to the active substance, substituted benzimidazoles or to any of the excipients. Esomeprazole must not be used concomitantly with nelfinavir. Precautions: Jaundice or severe liver disease Unintentional weight loss, recurrent vomiting, dysphagia, haematemesis or melaena and when gastric ulcer is suspected or present, malignancy should be excluded as treatment with esomeprazole may alleviate symptoms and delay diagnosis. Gastric ulcer or gastrointestinal surgery. Treatment of indigestion or heartburn for 4 or more weeks. Over 55 years old with new or recently changed symptoms. Not suitable for long term use. Treatment with proton pump inhibitors (PPIs) may lead to a slightly increased risk of gastrointestinal infections such as Salmonella and Campylobacter and in hospitalised patients, also possibly Clostridium difficile. Consult doctor prior to have an endoscopy or urea breath test. Coadministration with atazanavir is not recommended. Interactions with medicinal products metabolised through CYP2C19 should be considered. The use of esomeprazole with clopidogrel should be discouraged. Patients should not take another PPI or H2 antagonist concomitantly. PPI are associated with very infrequent cases of SCLE. If lesions occur, especially in sun-exposed areas of the skin, and if accompanied by arthralgia, the patient should seek medical help promptly. Pregnancy and lactation: Avoid use of Nexium Control during pregnancy and breastfeeding. Side effects: Common: headache, abdominal pain, constipation, diarrhoea, flatulence, nausea/ vomiting, fundic gland polyps (benign). Uncommon: peripheral oedema, insomnia, dizziness, paraesthesia, somnolence, vertigo, dry mouth, increased liver enzymes, dermatitis, pruritus, rash urticaria. Rare: leukopenia, thrombocytopenia, hypersensitivity reactions e.g. fever, angioedema and anaphylactic reaction/shock, hyponatraemia, agitation, confusion, depression, taste disturbance, blurred vision, bronchospasm, stomatitis, gastrointestinal candidiasis, hepatitis with or without jaundice, alopecia, photosensitivity, arthralgia, myalgia, malaise, increased sweating. Very rare: agranulocytosis, pancytopenia, aggression, hallucinations, hepatic failure, hepatic encephalopathy in patients with pre-existing liver disease, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis (TEN), muscular weakness, interstitial nephritis, gynaecomastia. Not known: hypomagnesaemia; severe hypomagnesaemia which can correlate with hypocalcaemia; hypomagnesaemia may also result in hypokalaemia, microscopic colitis, subacute cutaneous lupus erythematosus (SCLE). Legal category: Supply through pharmacy only. Product licence number: EU/1/13/860/001; EU/1/13/860/002; EU/1/13/860/003; EU/1/13/860/004 and EU/1/13/860/005 MAH: GlaxoSmithKline Consumer Healthcare (Ireland) Limited, 12 Riverwalk, Citywest Business Campus, Dublin 24, Ireland. Full product information is available in the SPC. Additional information is available upon request. Text prepared: July 2021. Trade marks are owned by or licensed to the GSK group of companies. PM-IE-NEC-21-00024

ue to diligent maskwearing, hand hygiene and severe restrictions because of Covid-19 in the last flu season, there were almost no cases of flu recorded in the winter months of 2020/2021. However, that is expected to change this year and in October, the first cases of flu in 2021 were recorded.

There will also be the problem of cocirculation of Covid and the cold and flu viruses, which will pose a problem in terms of sorting out which is which. In normal times in Ireland, between 200 and 500 people die from flu each winter. Worldwide, flu is responsible for between three and five million cases of severe disease and up to 646,000 deaths.

Whilst Covid is foremost in everybody’s mind, the usual cold viruses will still be circulating and your advice and treatment recommendations at the pharmacy counter will be important to reassure customers and provide them with the best advice and product recommendations.

Covid-19 has complicated the identification of colds and flu, as when people get cold- or flu-like symptoms, it first

must be considered whether it is Covid-19. People should be advised to phone their GP, who will advise them if they should get a Covid-19 test. If getting a test, the person needs to self-isolate until they get a negative result. Even if the Covid-19 result is negative, they should still restrict their movements after the symptoms ease for the amount of time recommended by their GP.

Figure 2 illustrates the differences in symptoms of cold, flu, allergies and Covid-19.

THE COMMON COLD

According to the HSE, approximately one-in-three people with a cold will get a cough and feel unwell and the first symptom is usually a sore throat, followed by sneezing and a blocked, painful or runny nose. As the common cold is caused by a virus, it cannot be treated with antibiotics and it is important to emphasise this with customers.

A cold can leave a person dehydrated due to loss of fluid from sweating or a runny nose, so the customer will need to drink plenty of fluids, eat healthily and get lots of rest. Typically, the person will feel worst in the first two-to-three days but these symptoms will improve and the cold

should be resolved within approximately one week. However for children, whilst the symptoms are the same as in adults, a cold may take a little longer to resolve in a child.

In terms of prevention, the Executive states that the best ways to avoid a cold are as follows:

 Not sharing towels or household items, such as cups, with someone who has a cold.

 Washing hands with warm water and soap, especially before eating.

 Not touching the eyes or nose.

It should also be emphasised to customers that whilst the flu vaccine may prevent them from getting influenza, it does not stop them from catching a cold.

People with a cold should see a GP only if they are having difficulty breathing or have chest pain, or if the symptoms do not improve within tree weeks. Also, if their temperature is very high, if they suddenly get worse, or if they have a long-term medical condition or a compromised immune system.

INFLUENZA

The common flu is also caused by a virus and affects the lungs and upper airways. Most cases of flu resolve themselves and can be treated at home by getting plenty

… AND SO IS THE EXPECTED WAVE OF COLDS AND FLU, BUT THERE ARE WAYS TO HELP THESE CUSTOMERS OUT AT THE PHARMACY COUNTER

of rest and fluids, and the months from October to April are normally the time when most flu cases occur. Again, as with the common cold, antibiotics are of no use and you will find that many people with a cold assume they have the flu.

In contrast to a cold, the symptoms of flu happen rapidly and accompanying headache is very common. A real influenza infection will leave the person feeling very weak, sometimes to the point that they are not able to get out of bed. The symptoms between adults and children are similar, although children may also develop an earache and have less energy than normal.

Symptoms usually include rapid onset of muscle pain, weakness, fatigue, headache and fever. A fever is defined as having a temperature above 380C. However, typical flu symptoms may also include:

 Nausea and vomiting.

 Loss of appetite.

 Difficulty sleeping.

 Diarrhoea or stomach pain.

 A sore throat.

For most people, flu will go through their system and they will feel better within a week or two. However, there are some people for whom the flu can be dangerous, including the elderly (aged 65 and older). Other people at risk of complications from the flu are those on certain medications,

people with long-term medical conditions, and those who are pregnant. People who are at risk of complications should consult their GP, as they may require antiviral medicines. Children aged two-to-12 years may also be at risk of complications, depending on whether they have been on longterm aspirin therapy, if they have Down syndrome, or have a neurodevelopmental disorder, such as cerebral palsy. People can avail of the flu vaccine for free in their community pharmacy if they are aged two-to-17 years; are a healthcare worker; are pregnant; are aged 65 years or older; live in a nursing home or other long-term care facility; or are in regular contact with waterfowl, poultry or pigs. People with certain medical conditions — such as chronic heart or liver disease — can also avail of the flu vaccine free of charge. For a full list of conditions that qualify people for a free vaccine, see the HSE website at www.hse.ie.

THERAPIES

There is a wide range of products you can recommend for the symptoms of cold and flu. For example, paracetamol or ibuprofen will help to relieve fever or pain, whilst throat sprays, cough remedies or lozenges will help with other symptoms, and a nasal spray will help to treat a blocked nose.

IS IT A COLD OR A FLU?

It is important to check whether your customer is also taking ibuprofen or paracetamol tablets along with cold medications, as this may push them above the limit of the recommended dose. For congestion relief and preventative care, Sterimar Hypertonic Congestion Relief - 100ml is a unique sea-water based nasal spray that is recommended by doctors. It naturally helps relieve congestion and also helps prevent the onset of colds and infections. This formulation washes away cold-causing germs before they develop and helps drain fluids from the nasal mucosa, allowing you to breathe naturally. It is 100 per cent natural and preservative- and steroid-free.

Sinutab Non-Drowsy

Paracetamol 500mg

Pseudoephedrine Hydrochloride 30mg 15 tablets can relieve some of the symptoms of colds and flu, including aches, pains, fever, and nasal and sinus congestion. The tablets contain paracetamol, an analgesic and antipyretic to relieve pain and fever, and pseudoephedrine, a decongestant to clear nasal congestion and blocked sinuses. Customers must be aged over 18 to buy this product and it is suitable for people aged over 12 years.

Nurofen for Children 6+ strawberry 200mg/5ml oral suspension 200ml can not only relieve the discomfort of colds and flu, such as sore throat, but can also be used to treat pain caused by earache, toothache, and minor aches and sprains. It contains ibuprofen, which belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs), which work by changing how the body responds to pain and fever.

An extremely popular cough remedy is Exputex Carbocisteine 250mg/5ml Oral Solution. It contains carbocisteine, which is an effective mucolytic ingredient that helps to loosen and thin-out the phlegm associated with chesty coughs. It is sugarfree and non-drowsy and can be used from two years of age to adults. Customers must be aged 18 years old or more and should not be sold more than two bottles at a time.

Figure 1: Distinguishing between cold and flu symptoms.

Another option to clear chesty coughs is Viscolex Syrup 250ml . The syrup in this product contains the active ingredient carbocisteine, which breaks down mucus in conditions such as chronic asthma or bronchitis for easier breathing. It is non-drowsy and glutenfree. Customers must be aged 18 years old or more and should not be sold more than two bottles at a time.

Sometimes, acting fast at the first signs of a cold or flu can help shorten the duration of the illness. Taking Sona Zinc 25mg at the first signs of cold or flu can help your customer to recover from the cold sooner. There is evidence to suggest that zinc also may destroy the virus itself, and it has been shown to block the replication of rhinovirus. Other research indicates that zinc can reduce inflammation in the respiratory tract, which may help reduce the symptoms of cold and flu, such as a runny nose and sore throat.

Vitamin C has long been known to help stave-off colds and flu. Sona Revital

Vitamin C Effervescent Orange

Capsules (20) is a powerful antioxidant that helps boost the immune system, whilst also helping to prevent colds and flu. Vitamin C is also needed for the body to make collagen, the ‘glue’ that strengthens many parts of the body, such as the muscles and blood vessels. Vitamin C also plays important roles in woundhealing and as a natural antihistamine and can fight viruses and detoxify the body from alcohol and other substances. Another trusted product in the NSAID group and containing ibuprofen is Brupro Max 400mg Ibuprofen 24 Tablets. As well as treating the symptoms of colds and flu, this therapy can be used to lower fever and manage general pain, such as headache, back pain, dental pain, and period pain. Customers must be aged over 18 years to purchase this product, with a maximum quantity of 24 tablets per purchase.

For the pain associated with colds and flu, another well-established product is Easolief Duo Paracetamol

500mg & Ibuprofen 150mg Tablets

24 Pack. This is a new combination painkiller combining full-strength paracetamol and ibuprofen. Each filmcoated tablet contains paracetamol 500mg and ibuprofen 150mg and it is suitable for the treatment of mild-to-moderate pain.

Research suggests combination therapy zis 30 per cent more effective for pain relief than paracetamol and ibuprofen taken alone, and is also faster-acting.

Customers must be 18 years old or more to purchase this product and should not be sold more than two bottles at a time. ●

Figure 2: Colds vs Flu vs Allergies vs Covid-19

ALTHOUGH IT IS OFTEN DISMISSED AS ‘JUST A HEADACHE’, MIGRAINE IS A COMPLEX NEUROLOGICAL CONDITION AND IS CLASSIFIED AS ONE OF THE MOST DISABLING CONDITIONS WORLDWIDE

he World Health Organisation lists migraine as the seventhmost disabling condition worldwide for men, and the fourth-most disabling condition for women. Overall, it affects 12-to-15 per cent of people worldwide and is the most common neurological condition on earth. It is three times more common in women than in men and there is often a family history — an attack can typically last between four and 72 hours and the condition depends greatly on the individual, however there are options and advice to offer customers at the pharmacy counter.

Migraine Ireland recommends that regardless of the help and advice a migraine sufferer may receive from

their doctor or pharmacy, it is encouraged that they take control of the management of their own condition by modifying their lifestyle and avoiding triggers. A combination of medications and effective self-help is the best way to manage a migraine.

Helping your customer to understand migraine will give them some comfort and confidence in handling the condition and managing their migraine. The NHS in the UK states that most migraine sufferers get relief from sleeping or lying in a darkened room when they are having a migraine attack. Other people get some relief from eati ng something, or they find that the pain subsides a little after they have vomited.

The following graphic is helpful in determining the type of headache that may present at the pharmacy counter

and distinguishing them from an actual migraine. The graphic indicates where the pain typically occurs in each type of headache or migraine.

During a migraine attack, the sufferer will sometimes experience the following, which can vary from person-to-person:

 Increased sensitivity to light and/or sound.

 Nausea.

 Vomiting.

 Visual disturbances.

 A combination of the above.

The NHS lists the most common triggers for a migraine attack as follows:

 Skipping meals or fasting.

 Hormonal changes and medication in women.

 Food additives, like the sweetener aspartame and the preservative monosodium glutamate (MSG), which is

found in many foods.

 Stress at work or home.

 Foods, such as aged cheeses, salty foods, chocolate, red wine and processed foods.

 Alcohol, especially wine, and highly caffeinated-beverages.

 Sensory stimuli, like bright lights and sun glare, as well as loud sounds and strong smells.

 Missing sleep or getting too much sleep, or jet-lag.

 Intense physical exertion, including sexual activity.

 Medications, such as oral contraceptives and vasodilators.

 A change of weather or barometric pressure.

If your customers keep a ‘migraine diary’, this can help them to identify triggers that may be setting-off their migraine attacks, as well as recording the frequency and patterns of attacks.

Migraine Ireland recommends that the sufferer should bring their migraine diary every time they see their doctor to help devise a treatment plan and emphasise to the doctor how the condition has seriously impacted their lives.

There are different types of migraine, each with their own characteristics. These include: Migraine without aura: This is one of the main types of migraine and is accompanied by an intense throbbing headache, usually on one side of the head, worsened by movement and lasting from four-to-72 hours. There can also be blurred vision and stiffness in the shoulders and neck, as well as sensitivity to light, noise and smells, and nausea, sometimes accompanied by vomiting.

Basilar migraine: This involves loss of balance, double vision, blurred vision, difficulty in speaking and sometimes fainting. This type of migraine is terrifying for the sufferer, as they can sometimes lose consciousness during an attack. This type of migraine normally affects young women, but is also sometimes seen in children.

Vestibular migraine: This type of migraine is accompanied by problems with co-ordination of the sensory information sent to the brain from the eyes, muscles and bones, and the vestibular organs inside the ears. Also known as ‘Migraine Associated Vertigo’, the list of symptoms of this type of migraine is extensive but includes vertigo; extreme dizziness; diminished eye focus; tinnitus; loss of control over bodily movement; neck pain; spasms in the upper spine; confusion; disorientation; and anxiety and/or panic. In addition, people who suffer with vestibular migraine also experience the usual effects of the other migraine types, such as nausea and sensitivity to light or sounds.

which usually last for about 20-to-60 minutes. According to Migraine Ireland, approximately 20 per cent of people with migraine experience aura in addition to some or all of the usual symptoms of migraine without aura.

Hemiplegic migraine: This is a rare form of the condition whereby along with the usual migraine symptoms, the person may also suffer from temporary numbness, weakness or even paralysis on one side of the body, again a very frightening group of symptoms. This can also be mistaken for a stroke but unlike in a stroke, the symptoms of begin slowly and build up as the migraine progresses. Again, if there is any doubt, the sufferer should seek immediate urgent medical evaluation.

Ophthalmoplegic migraine: This is an extremely rare variety of migraine that happens mostly in young people, in which there is weakness of one or more of the muscles that move the eye. Other symptoms include dilated pupils; inability to move the eye upward, downward or across; and drooping of the upper eyelid.

THERAPIES

Migraine aura without headache: According to Migraine Ireland, only about 1 per cent of sufferers get this type of migraine, where they experience aura without a headache. It can present with blind spots or flashing lights, or zig-zag patterns. It is often accompanied by pins and needles on one side; slurred speech; muscle weakness; loss of co-ordination; and confusion. These symptoms can be frightening, as the sufferer may think they are having a stroke and if there is any doubt, medical attention should be sought immediately.

Migraine with aura: This refers to the neurological disturbances that occur before the migraine begins,

There is no cure for migraine, but there are over-the-counter remedies that can help relieve the symptoms and improve the quality of life for your customers. With many painkillers, the recommended dose is higher for migraine than for everyday headache, so your customers should be advised to read the label carefully and to never exceed the recommended dose. There are also some add-on therapies, such as gel sheets, that can be used in combination with oral painkillers for maximum effect. Cold packs and staying hydrated will also help with symptoms.

Sometimes, a customer will need to try different medications before they find the one that is perfect for their needs. It is not advised to wait until the migraine is at its worst before taking reliever medications, as by then it is too late to stem the progress

THESE SYMPTOMS CAN BE FRIGHTENING, AS THE SUFFERER MAY THINK THEY ARE HAVING A STROKE

of the pain. If over-the-counter remedies provide no relief, the customer should be advised to see their GP.

Solpa-Extra Soluble 24 Tablets provide fast, effective pain relief from mild-to-moderate pain such as headache, migraine, dental pain, joint and muscle pain, sore throat and period pain. Contains paracetamol and caffeine and can also be used to reduce fever and the aches and pains of colds and influenza. Suitable for adults and children aged over 12 years old, and is not to be taken with any other medicines containing paracetamol.

Nurofen Rapid Relief Liquid

Capsules 400Mg 20s also contain ibuprofen and are designed to be are quickly absorbed to provide pain relief, reduce inflammation and lower temperature. Suitable for the treatment of muscular pain, backache, cold and flu symptoms, fever, headache, dental pain, period pain, rheumatic pain and neuralgia. Not to be taken with any other ibuprofen products.

Panadol Pain Relief Tablets

Paracetamol 500mg 12s is another trusted brand that is designed for fast and effective relief of headaches, toothache, backache, rheumatic and muscle pains and period pain. It is also suitable for the symptomatic treatment of

sore throat and the feverishness, aches, and pains of colds and flu. Panadol Pain Relief Tablets Paracetamol also help relieve the pain of osteoarthritis.

Easofen 400mg Max Strength Ibuprofen 24 Tablets contain the active ingredient ibuprofen to help relieve pain, inflammation and fever.

100 per cent natural origin ingredients, including eucalyptol from eucalyptus globulus and menthol from mint. The massaging effect of the ball creates a feeling of wellbeing and soothes tensions in the temples, forehead and neck, say the manufacturers. It can be used for up to five times daily.

Paralief Paracetamol 500mg Tablets (24) provide relief for migraine, headaches, musculoskeletal disorders, period pain, toothache, fever and the pain resulting from osteoarthritis. Each tablet contains 500mg paracetamol.

They are suitable for migraine, mildto-moderate pain, including headache, dental pain, fever, period pain, muscular strain, nerve pain, rheumatic pain, back and neck pain, and it can also be used for the symptomatic treatment of osteoarthritis. It is a single-dose tablet, which should lead to greater compliance, and is for short-term use only.

Arkopharma Migrastick 3ml Migrastick is a roll-on combination of

Excedrin Migraine and Headache Tablets 20s are also helpful in the treatment of pain associated with migraine attacks. It contains both paracetamol and aspirin, which ease the pain and fever associated with a migraine. Aspirin also reduces inflammation and the caffeine increases the effects of the pain-relieving medication.

Kool n Soothe Migraine

Soft Gel Sheets are another option for migraine. They provide immediate cooling relief for migraine and severe headache that the manufacturers say is proven to last for up to eight hours. They are safe to use with pain relief medication for maximum comfort, and can be removed easily without leaving any sticky residue. ●

THE MASSAGING EFFECT OF THE BALL CREATES A FEELING OF WELLBEING AND SOOTHES TENSIONS

Figure 1: Headache types. Image courtesy of the American Migraine Foundation

DON’T GET FLATTENED BY Migraine

E XCLUSIVE OTC PRODUCT FOR PHARMACIES ONLY*

*Sumatran Relief is a non-prescription migraine treatment, containing sumatriptan S n Further information and SPC are available from: Rowex Ltd , Bantry, Co Cork, P75 V00

ABBREVIATED PRESCRIBING INFORMATION

Product Name: Sumatran Relief 50 mg Tablets Composition: Each tablet contains 50 mg sumatriptan (as sumatriptan succinate) Description: Pink b convex, oblong tablet with a break-l ne on both sides Indication(s): The acute treatment of migraine attacks with or without aura Only to be used where there is a clear d agnosis of migra ne Dosage: Only in Adults aged 18 to 65 years: Recommended adult dose is a single 50 mg tablet

If a patient responds to the first dose of sumatriptan, but the symptoms recur a second dose may be taken for the same attack but no sooner than 2 hours after the first tablet was taken If a patient does not respond to the first dose, a second dose should not be taken for the same attack (in these cases the attack can be treated with paracetamol, acetylsalicy ic acid, or non-stero da ant -inflammatory drugs) No more than 100 mg (2 tablets) should be taken in 24 hrs The recommended dose should not be exceeded

ation, but women with migraine who are taking the combined ora contraceptive have an increased risk of stroke and should seek advice from their doctor f migraine attacks started recently (within the ast 3 months), migraine symptoms have worsened, or they have migraine with aura Not to be given to patients (especially postmenopausal women and males over 40 years of age) with risk factors for ischaemic heart disease, inc uding those patients who are heavy smokers or users of nicotine subst tution therapies, without prior cardiovascular evaluation R sk factors for heart disease include hypercho estero aemia, regular smoking, marked obesity, diabetes or a fami y history of early heart d sease (father/brother developed heart d sease before the age of 55, mother/sister developed heart disease before the age of 65) The d agnosis of medication overuse headache (MOH) should be suspected in patients who have frequent or daily headaches desp te (or because of) the regular use of headache medications (e.g triptans, opioids, ergotamine or comb nat on of these drugs for 10 days or more per month) Pat ents with headache present on more than or 15 days per month for three months whose headache has developed or markedly worsened dur ng medication overuse should be referred to their doctor for further management Conta ns actose monohydrate Interactions: There have been rare post-marketing reports describing patients with serotonin syndrome (inc uding altered mental status, autonomic instability and neuromuscular abnormalities) fol owing the use of SSRIs and sumatriptan Serotonin syndrome has also been reported fol owing concomitant treatment with triptans and SNRIs and s also a risk with concomitant use with lithium Undesirable effects may be more common during concom tant use with herbal preparations containing St John’s Wort (Hypericum perforatum) Pregnancy and Lactation: Not to be used dur ng pregnancy or breast-feed ng unless on the advice of their doctor Ability to Drive and Use Machinery: Drowsiness, dizziness and weakness may occur as a result of migraine or its treatment with sumatriptan This may influence the ability to drive and to operate machinery Undesirable Effects: Common: Dizziness, drowsiness, sensory disturbance including paraesthesia and hypoaesthesia Transient increases n blood pressure arising soon after treatment, flush ng Dyspnoea Nausea and vom ting occurred in some patients, but it is unclear if this is related to sumatriptan or the under ying condition Sensations of heaviness (usually transient and may be intense and can affect any part of the body inc uding the chest and throat), myalgia Pa n, sensations of heat or cold, pressure or t ghtness (these events are usually transient and may be intense and can affect any part of the body ncluding the chest and throat); feelings of weakness, fatigue (both events are mostly mild to moderate in ntensity and transient) Marketing

Cork

WINTER TAKES ITS TOLL ON OUR APPEARANCE BUT THERE ARE OPTIONS OVER-THE-COUNTER THAT ARE DESIGNED TO HELP

he cold air and biting winds of winter have an effect on our skin and overall appearance. This is compounded by the rapid switch from cold air and rain to warm, dry environments in the home or the workplace that can lead to dry, itchy, uncomfortable skin.

Humidifiers can help, but of course it’s not guaranteed that there will be a humidifier in place everywhere we go, so a skin and hair care regimen can go a long way to making sure our appearance is as healthy and fresh as possible.

A number of studies have identified the importance of cosmetics, not only in enhancing appearance, but also to boost self-esteem and self-worth. In one European study, more than 60 per cent of respondents said cosmetics have a positive impact on their wellbeing, mood, image and self-confidence. In addition, more than 40 per cent identified benefits in terms of their social life, family life, love life, professional life and overall health.

A separate German study on adolescents and young adults showed 73 per cent of respondents believe body and

beauty care are very important in their lives, and 85 per cent said they feel safer when they use cosmetics products, whilst 63 per cent said they feel more attractive when they do so.

HARSH WINTER

A number of skin conditions are prone to flare-ups due to the harsh winter weather. Eczema, for example, is a skin condition that causes red, inflamed skin, which becomes very dry. Eczema is normally diagnosed in children, but it can also manifest for the first time in adults. Also known as atopic dermatitis, eczema is

very prone to flare-ups in winter due to dry air conditions. Aside from the clinical characteristics, eczema can be very distressing to the sufferer and affect their self-confidence and self-esteem.

Eczema causes a dry, scaly, itchy rash on the surface of the skin and can be so troublesome and itchy that the sufferer can have trouble sleeping, because the itching is typically worse at night. Other effects include dry, scaly patches that are red or brown-gray on the skin, and small, raised bumps that may leak fluid and

scab-over if they are scratched. The skin can also become raw and sensitive.

Despite the fact that eczema is more prevalent in children, and many outgrow it in their teenage years, it has been estimated that approximately 50 per cent of children with eczema will continue to have the condition into adulthood.

The winter conditions also take a toll on the hair and scalp and red, dry, flaky or itchy skin on the scalp can be irritating and cause unsightly dandruff flakes. This form of dry skin is also

known as seborrheic dermatitis, with ‘seborrheic’ referring to the sebaceous glands, whilst ‘derm’ refers to ‘skin’. Seborrheic dermatitis can also occur on other parts of the body with the most sebaceous gland activity, for example under the breasts and in the creases of the arms, legs and groin, upper back and chest, behind the ears, belly-button, face or forehead, eyebrows, and the creases at the base of the nose.

People born with naturally oily skin are more prone to seborrheic dermatitis. Whilst it occurs most often in infants under three months old and in people aged 30-to-60 years, it is estimated that at any given time, around 11 per cent of the overall population has the condition. As well as the harsh winter conditions and oily skin, it can also be triggered by stress, a history of other skin conditions, and using alcohol-based cosmetic lotions.

Even if conditions such as eczema or dermatitis are not a factor, the winter winds and cold dry-out our skin as there is not enough moisture in the outer layer of the skin, the epidermis. Using harsh soaps and hand sanitisers — particularly during Covid-19 — also dries-out the skin. In cold, dry weather, some people can also develop cellulitis, a type of bacterial skin infection that can be painful and cause the affected areas to redden and swell. Cellulitis often occurs when the skin cracks and bacteria infiltrate these cracks, which is often the result of excessive dryness.

It is always advisable to recommend that customers drink six-to-eight glasses of water every day, as this not only keeps the skin hydrated and more plumplooking and elastic, but reduces wrinkles and soft lines.

HOT TOPIC SKIN CARE & COSMETICS

CHAPPED LIPS

In the winter months, it’s also a challenge to keep lips moisturised and looking their best due to the lack of humidity. Excessive licking of the lips can also cause moisture to evaporate in the oral area, and certain medications can cause this problem too. These medications include vitamin A, retinoids (Retin-A, Differin), lithium (commonly used to treat bipolar disorder), and chemotherapy drugs. These customers will need lip therapies all-year-round, as high UV radiation levels from the sun in summer can also cause their lips to dryout and crack. People with naturally dry skin are especially susceptible to dry and chapped lips and apart from the cosmetic implications, chapped and cracked lips can cause pain and discomfort and interfere with enjoying food and drinks.

Aside from the cosmetic benefits, using the right make-up foundation during winter can help to keep the skin healthy and hydrated. Thickly-layered make-up on parched areas can highlight dryness rather than conceal it, particularly on facial skin. In these cases, sheer-tomedium coverage options are preferable, and should be applied in liquid and lightweight cream formulas. A waterbased formula is best to keep the skin hydrated as the day goes on.

THERAPIES

You are extremely well placed at the pharmacy counter to advise customers on their winter cosmetics and skin care regimen to help them look their best and keep their skin healthy. Some of the products listed below can help in this regard, as well as building confidence in your relationship with customers and to keep them coming back to your pharmacy.

For winter flare-ups of eczema, RELIFE Relizema Cream 100ml has been specially formulated to help treat the typical itching and redness caused by dermatitis, including atopia, eczema and contact dermatitis. This trusted product is a protective cream that helps maintain and restore the

skin's barrier, whilst also protecting and moisturising the skin with a soothing effect, making sure the benefits are felt both inside and out.

Nizoral Care Scalp Tonic is specially created to protect and care for itchy, irritated scalp. It contains natural extracts from magnolia and cactus plants and is dermatologically tested. It is suitable for all hair types and restores the natural balance of the scalp with a soothing complex of natural extracts, leaving the scalp hydrated and relaxed.

gentle, fragrance-free formula, which features three essential ceramides, amino acids and hyaluronic acid. These work together to help maintain the skin barrier and lock-in moisture.

For dry and damaged skin, one solution for repair is La Roche

Posay Cicaplast Baume B5

Repair Balm - 40ml. This therapy is a rich, nourishing balm that helps to soothe, protect and repair irritated or sensitive skin. Its key ingredients combine for triple action — soothing panthenol 5% and antibacterial agents copper-zinc-managa. It is suitable for adults, children and babies and not only treats chapping, dry patches, and cracked skin, but can also be used for everyday minor injuries, such as grazes and minor burns.

For dry and cracked lips, Eucerin

CeraVe Facial Moisturising Lotion with SPF 52ml was developed with dermatologists and provides UV protection, while helping to restore the protective skin barrier. It is a lightweight, non-greasy lotion that contains three essential ceramides and hyaluronic acid, which provide all-day hydration after just one application. This fragrance-free formula is also suitable for sensitive skin. CeraVe Facial Moisturising Lotion locksin moisture for up to 24-hour hydration for normal to dry skin.

As stated above, it’s best to avoid harsh cleansers during the winter months. Another product in the CeraVe range is CeraVe Hydrating Cream To Foam Cleanser 50ml, which has also been developed with dermatologists and begins as a cream before transforming to a soft foam when you begin to lather it on the skin with water. It effectively removes dirt and make-up without stripping the skin’s natural moisture or leaving it feeling tight and dry. It contains a

Dry Skin Intensive Lip Balm 10ml provides instant intensive lip care for dry and extremely dry lips. It is highly effective at instantly soothing and moisturising dry and cracked lips, as well as the perioral area around the lips. Its active ingredients include liquorice extract to help reduce redness and calm irritation, and evening primrose oil to regenerate the lips' natural protective barrier. Panthenol and glycerol also help to promote healing, and this product intensively moisturises the lips and surrounding area, leaving them feeling soft and smooth.

As winter weather can make some people’s skin sensitive, it is important to recommend a make-up foundation that is kind to facial skin. La Roche Posay Toleriane Teint Foundation Fluide 13

Sand Beige 30ml is specially developed to be safe for daily use on sensitive, intolerant or allergy-prone skin. This corrective foundation is formulated with minimalist purified pigments and SPF 25. It provides flawless coverage and a natural, long-lasting semi-matt 'no-mask' finish, helping to unify the appearance of spots, redness and marks. This product has been tested on even very sensitive skin. ●

References on request

PEOPLE WITH NATURALLY DRY SKIN ARE ESPECIALLY SUSCEPTIBLE TO DRY AND CHAPPED LIPS

ECZEMA,

DRY,

OILY,

A LOOK AT OVER-THE-COUNTER OPTIONS IN WOUND CARE, FROM THE EVERYDAY CUTS AND SCRAPES TO MORE SERIOUS WOUNDS

rom everyday cuts and scrapes to the most serious types of chronic wounds, wounds and their care and management are an important part of everyday life.

While wounds can be distressing, especially for young children, there is a range of over-the-counter products to help.

One such product is the iconic Sudocrem. Trusted by generations of people to provide gentle yet effective relief, Sudocrem Antiseptic Healing Cream can be used to treat a number of skin conditions, including cuts, grazes, minor burns, eczema, nappy rash and even sunburn.

It is applied to the affected area using light, circular movements. The cream helps to reduce the risk of infection and contains a mild local anaesthetic to ease pain. Gentle on skin, it is also unlikely to sting when applied.

It can also be used in the treatment of eczema. Sudocrem's emollient soothes and softens skin, while its zinc oxide helps to reduce the loss of fluid from the skin. Its water-repellent excipient base, which includes paraffin and other waxes, creates a protective seal around the affected area.

Savlon Antiseptic Cream is another trusted product to treat minor wounds and skin reactions. It helps cleanse and protect minor wounds from infection and is a first

aid treatment of superficial burns, scalds, and insect bites. It also helps prevent infection on shaving cuts, blisters and sores and can be used to clean and treat minor skin problems.

Bepantiseptic First Aid Cream can also be sold over-the-counter in community pharmacies. It has an antiseptic action to help prevent infections, plus a soothing local anaesthetic to numb pain.

is also a proven, effective, concentrated antiseptic disinfectant that kills bacteria and provides protection against bacteria that can cause infection and illness. It can be used for gentle antiseptic wound-cleansing and disinfection, and antiseptic skin-cleansing.

CHRONIC WOUNDS

As healthcare professionals and patients know, the importance of chronic wound care cannot be overstated. Ulcers, sores, and surgical wounds can be debilitating, painful and can have a significant impact on a person’s life. They can also lead to unnecessary admissions to hospital, something which is to be particularly avoided during the pandemic.

The HSE has estimated that 1.5 per cent of the population are affected by a wound at any one point in time and wounds can have a major personal, social, and economic impact.

TCP Antiseptic Liquid is another very famous staple of the first aid box. Dualaction TCP soothes pain and fights infection. It can also be used for sore throats, mouth ulcers, cuts, grazes, bites, stings, and spots.

Dettol Liquid Antiseptic Disinfectant

“Studies in the UK indicate that up to 4 per cent of total healthcare expenditure is spent on the provision of wound management, while in Ireland, it is estimated that two-thirds of community nursing time is spent on the provision of wound management,” the HSE's National Guidelines for Wound Management said.

The HSE also indicated that as the population ages, the prevalence of chronic

THE HSE HAS ESTIMATED THAT 1.5 PER CENT OF THE POPULATION ARE AFFECTED BY A WOUND AT ANY ONE POINT IN TIME

wounds is expected to grow.

“Consequently, the prevalence and incidence of wounds is likely to continue to increase due to the ageing population and the ongoing increase in prevalence of obesity, diabetes and lower extremity arterial disease,” the HSE's Guidelines said.

However, there is also a range of wound care products to help manage and treat chronic wounds.

HidraMed Solutions hopes to redefine patient-led wound care and specialises in hidradenitis suppurativa. It produces wound dressings, including for the armpit, which is one of the toughest places to dress and retain a dressing, as well as the groin and thigh areas.

The products are wearable wound management garments specifically designed for people living with hidradenitis suppurativa. They comprise three elements

— a reusable garment, disposable dressing pads, and an external fastener. They are skinfriendly, adhesive-free, and easy to use.

Fleming Medical is another provider of high-quality healthcare devices and consumables. It is also a trusted partner to pharmacy, community health and healthcare professionals and operates successfully in more than 20 countries worldwide.

There is a range of wound care products available from Fleming Medical, including URGO Algoplaque. This is a sterile, highperformance dressing for use in treating pressure sores or leg ulcers.

The dressings in the Algoplaque range are made up of a semi-permeable polyurethane backing, combined with an adhesive mass consisting of carboxymethylcellulose hydrocolloid particles exclusively dispersed in an adhesive elastomer matrix. Due to the dressing’s impermeability to water and

bacteria, it provides superior protection to the wound. The hydrocolloid dressings absorb wound exudate and form a colloid gel, which creates the conditions favourable to the healing process.

Another Fleming Medical product is Medistrip Wound Closure Strips They are flexible, breathable and are used for wound support post-operatively, skin tears, or following early suture or clip removal. The strips stay firmly in place, allowing the skin to breathe and the wound to heal.

The strips provide secure wound closure, while allowing maximum porosity and vapour transmission to encourage rapid healing. The adhesive strips are used to secure, close and support small cuts and wounds.

The wound closure strips will protect the wound from contamination and infection,

whilst allowing it to breathe and heal quickly. The strong adhesive ensures that the wound stays dry and clean while it heals.

For foam dressings, there is the Medifoam Non-Adhesive Foam Dressing from Fleming Medical. A hydrocellular sterile foam dressing, it absorbs and retains exudate whilst maintaining a moist wound environment.

Composed of a thick, soft, absorbent polyurethane foam backed by a dual layer of breathable polyurethane film, it is designed for a wide range of exuding wounds, such as leg ulcers, foot ulcers, pressure ulcers, and skin tears.

Medifoam dressings are a range of hydrocellular sterile foam dressings. They are designed for moderate to highlyexuding wounds such as pressure ulcers, leg ulcers, skin tears and abrasions, skin graft donor sites and under compression bandage systems for venous ulcer treatment. They comprise a thick, soft, absorbent polyurethane foam backed by a dual layer of breathable polyurethane film, which effectively absorbs and retains exudates, whilst maintaining a moist wound environment.

There are also a range of transparent dressings from Fleming, including the Medisite Transparent Thin Film Dressing. It is a sterile, transparent, thin, polyurethane bacteria-proof and waterproof film, coated with hypoallergenic adhesive. Versatile, it can be used as a preventative dressing for securing IVs and cannulae or to secure an absorbent dressing underneath.

It has a waterproof film, so patients can shower with the dressing in place. It is also made of polyurethane film, which allows wounds to breathe and water vapour to escape, protecting the skin against maceration.

Furthermore, it contains a bacterial barrier, helping to protect the site against extrinsic contamination and reducing the risk of infection by bacteria. The transparent film also allows the healing process to be observed without removing the dressing.

Another Fleming Medical product,

Mediflex Bordered Silicone Dressing, is also suitable for use on a wide variety of moderate- to highlyexuding wounds, ulcers, second-degree burns and traumatic wounds. The dressing is air-permeable, making it a comfortable way to keep wounds clean and protected. The absorbent pad with the adhesive border on this dressing ensures that the wound is well protected from any irritants. It is particularly suitable for those with fragile skin.

Medicel Super Absorbent Pad is a super-absorbent dressing for moderate- to highly-exuding wounds, ulcers, seconddegree burns and traumatic wounds. It has outstanding absorption and retention properties. The dressing remains dry and comfortable for the patient.

healing. The literature supports a positive effect of supplementation of vitamin A in acute wounds and healing of fractures, burns and radiationinduced injury.”

A healthcare professional may recommend a supplement to improve your diet. Examples of supplements include vitamin, mineral or oral nutritional supplements. However, the HSE has advised that patients do not take a supplement without first discussing it with their doctor or other healthcare professional.

Fresenius Kabi is a global healthcare company that specialises in clinical nutrition and life-saving medicines. Among its products are oral nutritional supplements. This includes Fresubin , a high-energy, high-protein oral nutritional supplement. It is a protein blend that is low in fibre, high in vitamin D, and lactose- and gluten-free. There is also Calshake , an oral nutritional supplement powder which is reconstituted with milk to provide a high caloric shake. It is easy to mix, fibre- and gluten-free, and comes in five different flavours.

NUTRITION

Good nutrition is vital in the management of wounds, as a body needs increased amounts of energy, protein and specific vitamins and minerals to heal well. The HSE in its wound management guidelines indicated that nutrition plays a pivotal role in the wound healing process.

“Studies have shown that both inadequate dietary intake and poor nutritional status correlates with pressure ulcer severity and protracted healing,” the HSE stated.

“Nutrition in wound healing must provide adequate support for an increased energy demand during the wound healing process... Several vitamins and minerals are known to have an important role in wound-

The company Nutricia also believes in the power of nutrition to make a positive difference to health. Included in its range of products is Complan Shake It is a food for special medical purposes for use under medical supervision. Complan Shake is a high-energy nutritional supplement based on skimmed milk powder, carbohydrate and fat, for the dietary management of diseaserelated malnutrition. It can be used to supplement the diet of patients unable to meet their nutritional requirements from regular dietary intake. Complan Shake can be made up with whole milk or added to foods as a fortifier.

Another trusted product, Nutricia Calogen , is suitable for patients requiring electrolyte restrictions. It can be used to replace milk in proteinrestricted diets and can also be used as an energy enhancer in tube feeds and oral nutritional supplements. ●

SEVERAL VITAMINS AND MINERALS ARE KNOWN TO HAVE AN IMPORTANT ROLE IN WOUND-HEALING

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CLONMEL HEALTHCARE ADD

MEDITHYME

COUGH SYRUP TO THEIR PORTFOLIO OF PRODUCTS FOR COUGH AND COLD

Clonmel Healthcare is delighted to announce the launch of Medithyme Cough Syrup, a traditional herbal medicinal product containing thyme liquid extract, which can be used as an aid to facilitate coughing-up phlegm (expectorant) in a productive cough* associated with cold.

Medithyme is a traditional herbal medicinal product. Medithyme is:

 Sugar-free.

 Suitable for vegans.

 Gluten-free.

The recommended dose is: Children from 12 years and adults: 15ml, 4 times per day.

Shelf life of five years; use within six months of opening. Available in 180ml bottle. A copy of the summary of product characteristics is available upon request. Please contact Clonmel Healthcare on 01-620 4000 if you require any additional information.

*Medithyme Cough Syrup is a traditional herbal medicinal product, for use in case of productive cough associated with cold, exclusively based on long-standing use. For supply through general sale.

TR 126/319/001. TR Holder: Clonmel Healthcare Ltd, Clonmel, Co Tipperary. Date prepared: August 2021. 2021/ADV/MED/083H.

 Solferol Vitamin D

90 Soft Gel Capsules

1,000IU.

 Solferol Vitamin D

90 Soft Gel Capsules 2,000IU.

 Solferol Vitamin D

90 soft Gel Capsules 4,000IU.

 Solferol Vitamin D is a high-quality Vitamin D3, to boost

the immune system and to assist with bone formation, muscles and teeth. Solferol is available from UD and Uniphar from 1 September 2021. For more information, contact us at: info@windzorpharma. com or visit www. windzorpharma.com.

WINDZOR PHARMACEUTICALS ARE PLEASED TO ANNOUNCE THE LAUNCH OF SOLFEROL VITAMIN D