April 2018 Volume 10 Issue 4
THE INDEPENDENT VOICE OF PHARMACY
In this issue: NEWS: Viagra Connect still not available OTC in Ireland Page 6
PROFILE: Foley’s Pharmacy, still going strong after more than a century Page 12
EDUCATION: The benefits of proper footcare for patient and pharmacist Page 24
FEATURE: The benefits of point of care testing Page 28
CPD: Understanding pain and its management Page 43
AWARDS: The OTC Awards 2018 – winners revealed Page 48
Awards The Irish Pharmacy
The Irish Pharmacy Awards 2018 are now open The seventh annual Irish Pharmacy Awards are expected to be the best yet, with the glittering ceremony to take place on May 12th, 2018 at the Clayton Hotel in Dublin. The closing date for applications is April 20th. This is the most prestigious event of Ireland’s pharmacy calendar and consistently attracts the big-hitters of the pharmacy world, from CEOs to government ministers to pharmacy groups and even students. More than 650 professionals from every aspect of the pharmacy industry are expected to attend. These awards are the benchmark of pharmaceutical excellence in all aspects of the wider pharmacy community today. Previous winners have routinely reflected innovation and dedication to their community pharmacy roles and have enhanced their professional status within the wider healthcare circle. As pharmacies continue to be on the frontline of community healthcare, so too does patient demand grow across the country. Winners at the Irish Pharmacy Awards have, both in
the past and recently, reflected the industry’s determination and dedication to enhancing the profession’s status in the wider healthcare circle. A strong relationship between pharmacist and patient provides the care and expertise a community needs from its pharmacy. By going above and beyond the pharmacist can help people live well and stay well. An entry into these awards allows you to examine your business, its practises, and its place within the community. Not only will a win enhance your business’ profile, but the ceremony itself is the perfect networking opportunity for anyone involved in the pharmacy industry. With more than 1,500 pharmacies across Ireland today, these prestigious awards are certainly an acclaim to be proud of. But this night is not just about winners and losers – everyone who enters the awards this year deserves commendation. This year the Irish Pharmacy Awards are showcasing a new design of the award itself. Winners of the prestigious
awards will receive a specially commissioned trophy, a fitting recognition for clinical excellence. The gold figure pays special tribute to Raphael, the patron saint of healing. He clutches a medical staff and is adorned with wings, a traditional symbol of healing. The figure is entwined with snakes with pills at its feet – both symbols of chemists and the medical profession. This year there are 16 award categories including Community Pharmacists of the Year, Community Pharmacy Team of the Year and Community Pharmacy Technician of the Year. Each award will be judged by an independent panel of industry experts. There will also be the People’s Pharmacist of the Year Award which is now open to public nomination and will be decided by a social media vote. More information on this award can be found on page 26. All applications for the Irish Pharmacy Awards can be found at www.irishpharmacyawards.ie The closing date for entries is April 20th.
Applications for all of these awards are available at www.irishpharmacyawards.ie Clinigen Group Community Pharmacist of the Year 2018 GSK Self Care Award 2018 McLernons Innovation and Service Development (Independent) of the Year Award 2018 Innovation and Service Development (Multiple) of the Year Awards 2018 The Fixxa Category Development of the Year Award 2018 Cellnutrition Community Pharmacy Team of the Year Award 2018 The Nurofen for Children Baby Health Pharmacy of the Year Award 2018 JPA Brenson Lawlor Young Community Pharmacist of the Year Award 2018 KRKA Counter Assistant of the Year Award 2018 OTC Retailer of the Year Award 2018 United Drug Business Development (Independent) of the Year Award 2018 Clonmel Business Development (Multiple) of the Year Award 2018 Community Pharmacy Technician of the Year Award 2018 Irish Pharmacy Representative of the Year Award 2018 The Life Pharmacy Student of the Year Award 2018 Teva Superintendent Pharmacist of the Year Award 2018 Pharmaton Peopleâ€™s Pharmacist of the Year Award 2018 (see more on page 26)
Book your table at the Awards now The Irish Pharmacy Awards will take place on May 12, 2018 at the Clayton Hotel, Burlington Road, Dublin. These awards will honour both individuals and teams for outstanding achievements and innovation in the pharmacy sector. With more than 650 guests expected to be in attendance, tables are in great demand and selling fast. Early booking is recommended to avoid disappointment. For more information or to book a table please visit www.irishpharmacyawards.ie or contact Natalie Maginnis on 00353 1 669 0562 or email firstname.lastname@example.org
Are sore joints holding you back? Flexible is possible with ZinCuFlex! Whether you are a professional athlete, a fitness enthusiast or just venturing to complete your first 5km, the muscle soreness and joint pain in the 12- to 48hour time frame after a vigorous workout can serve as a major frustration. ZinCuflex is a new health food supplement with proven benefits for joint health. Combining the power of Ginger, Curcumin and vitamin C, ZinCuflex® may help to protect joints and help maintain joint mobility. ®
to the group given a placebo. Altman et al (2001) found that among 247 patients with osteoarthritis (OA) of the knee with moderate to-severe pain, those taking ginger extract for six weeks experienced significant reduction in knee pain on standing, compared with those taking a placebo. The Power of Curcumin Curcumin is the active component of the yellow spice turmeric, with numerous health benefits. Curcumin helps to
BACK RUNNING AND FEELING GREAT “I’ve been using ZinCuFlex for the last 2 years. Being an avid runner, I was disappointed when I was told to stop running in order to mind my joints. A friend recommended that I try ZinCuFlex. I was so impressed. It works… you can feel the difference quickly. I’m back running again and I feel great. I would happily recommend ZinCuFlex to anyone with joint problems, knee issues or sports injuries.” Alison Murphy, Dublin
Ginger – a Spice renowned for its Joint Benefits Ginger and curcumin (the active part of turmeric) are well known for their benefits for joint health. Ginger is an extract which helps to maintain joint mobility and avoid morning stiffness. The Mozaffari et al. (2016) study on 120 patients with osteoarthritis, demonstrated that use of 500mg ginger a day for three months caused a decrease in inflammatory markers compared
control inflammatory responses in the body. Curcumin contributes to joint health as curcumin helps to protect joints and helps to maintain joint flexibility. While curcumin offers great benefits, absorption has always been an issue. ZinCuflex® uses a patented process “NPT501TM” that combines curcumin with liquefied ginger to achieve 65x better absorption compared to ordinary curcumin, making it
more bioavailable and therefore more effective. Positive Feedback: We regularly get feedback that people are back enjoying their hobbies again, due to the joint benefits they feel while taking ZinCuFlex. Galway native Carol Fahy had a great experience.. “Having spent weeks with bad joint swelling and at times unable to open my hands, I tried ZinCuFlex. Within a couple of weeks, the stiffness had reduced. joint mobility had improved and I was able to get back living again, enjoying my hobbies - gardening and knitting.” The positive feedback we have been receiving from customers is backed up by research as a study of 200 ZinCuFlex users in Denmark found that 90% reported a significant
improvement in joint mobility, with many feeling the difference within 14 days. Whatever your Passion… Get Moving with ZinCuFlex!
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Product Features A unique combination of Ginger, Curcumin and Vitamin C Curcumin is the active component of Turmeric, with numerous health benefits. Curcumin and ginger may help protect joints and maintain joint mobility. Ginger may help reduce joint stiffness and inflammation. Highly bioavailable so that greater levels of active curcumin can be released to support joint, brain and immune health. 30 Capsules - RRP €19.95
Contents Page 4: We take a look at a new medicine management system
Page 18: Our nominated charity Hugh’s House
Page 24: Pharmacists and the importance of footcare Page 33: Allergic rhinitis and its triggers Page 48: Celebrating the winners of the OTC Awards
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Profile: Foley’s Pharmacy
Foreword In this issue we are proud to showcase the winners of the 2018 OTC and Pharmacy Retail Product Awards which took place in Dublin’s Radisson Blu last month. Both the judges and the editorial team were delighted by the extremely high standard set by all of our finalists this year. The winners were both big and small on the day with big brand names and smaller, newer to the market products all taking home awards. You can see who scooped what from page 50. As May draws closer, so too do the 2018 Irish Pharmacy Awards, the most important event in the pharmaceutical calendar. Our 16 award categories have been launched and are now open for entry, you can find out how to submit an application and how to purchase a table. This is one of the biggest networking opportunities of the year and tables are selling fast, it’s the perfect event for any pharmacy team to attend. More information can be found on pages 2 and 3. Also launched this month is the nationwide search for the People’s Pharmacist of the Year 2018. This is the chance of both the general public and the pharmacy profession to nominate the person they feel goes above and beyond the call of duty in their role as a community pharmacist. Anyone can nominate any pharmacist for this role and the four finalist will then face the public vote on social media. Find out more on page 26. Foley’s Pharmacy, profiled on pages 12 and 13, have shown how a pharmacy business can be affected by a myriad of different external factors. A family pharmacy going back over 100 years, we speak to Michael and Eoin, the third and fourth generation pharmacists now running the business about the rise of the multi-cultural community and public transport. This year the chosen charity of the Irish Pharmacy Awards is Hugh’s House. A home away from home for the families of sick children that was founded by Ade and Marty when their son was ill. Now more than 200 families have found comfort in Hugh’s House and the hope is that many more will continue to in the future. The future of the pharmacy technician is discussed on page 22 by Elaine Lorigan McSweeney, President of the Association of Community Pharmacy Technicians. She addresses fears that, because of the lack of unionisation and regulation, the pharmacy industry is losing many qualified technicians to different fields. And, as the hope of some warmer weather always springs eternal, we focus on allergic rhinitis and how prevention is as good as a cure. Pharmacist Eamon Brady investigates the causes and treatment of conditions such as hay fever as the new season rolls in. Last, but not least, due to popular demand the deadline for entries into the 2018 Irish Pharmacy Awards has been extended to April 20. For more information and application forms visit www.irishpharmacyawards.
Feature: Allergic rhinitis CPD – Understanding and managing pain:
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News New study shows improvement in clearance of scalp psoriasis with Cosentyx Novartis has presented new Cosentyx® (secukinumab) data from the prospective Phase III SCALP study which showed significant improvement in skin clearance with Cosentyx in patients with scalp psoriasis. Due to the presence of hair, scalp psoriasis is particularly difficult to treat with common topical and phototherapy options. These study results were presented at the 2018 American Academy of Dermatology (AAD) Annual Meeting in San Diego, California.
"The data presented at AAD is encouraging for both physicians and patients, who can have greater trust in Cosentyx as a complete treatment option for patients with plaque psoriasis who want to avoid scalp and other manifestations of psoriasis."
"Scalp psoriasis can be painful and, in some cases,, can lead to temporary hair loss and cause the involved area to crack and bleed," said Kristian Reich, M.D., Ph.D., Georg-August-University Göttingen and Dermatologikum Hamburg, Germany.
Approximately 60 million people worldwide are impacted by scalp psoriasis, a form of the disease which can have a substantial impact on quality of life due its highly visible nature. Additional stress may be added as many psoriasis patients will not achieve
an adequate response from standard treatments. "As a science driven company, we are committed to investigating the full potential of Cosentyx. It is our ambition to offer the best evidence to doctors, and to deliver the best treatment to patients," said Eric Hughes, Global Development Unit Head, Immunology & Dermatology. "Cosentyx is backed by a large study program including more than 10,000 patients in over 60 studies since our first Cosentyx study initiation 10 years ago. We believe that study data on specific
manifestations such as scalp help doctors reach the right decisions with their patients." Cosentyx is a fully human interleukin-17A (IL-17A) inhibitor which has demonstrated rapid and sustained long term efficacy in the treatment of moderate-to-severe psoriasis, psoriatic arthritis and ankylosing spondilytis, as well as a consistently favourable safety profile including injection site pain at rates similar to placebo-. To date, Cosentyx has been prescribed to more than 140,000 patients worldwide across all indications since launch.
No sign yet of OTC Viagra in Ireland The reclassification of Viagra to a P medicine now means that Viagra Connect can be purchased as an over the counter medicine in pharmacies across the UK. drug to be made over the counter are very different between the UK and Ireland anyway. The various bodies that deal with the various legal aspects of that will have a lot more to say in Ireland than they do in the UK as I understand it.” It’s understood that the move is to make the drug more available to men who might not have felt comfortable asking for a prescription for it but is also a bid to prevent the sales of counterfeit versions online which can be harmful. In the UK it is estimated up to one in five men suffer from some form of erectile dysfunction which equates to around 4.3 million people. Peter said: “A pharmacist would be well able to manage the sale of such a drug, provided the correct protocols are in place.” Until April 11, Viagra Connect can only be purchased in store or online from Boots pharmacies thanks to a special deal with pharmaceutical giant Pfizer, but the drug will become available from all Pharmacies in the UK after that date. As yet there are no apparent plans for Viagra Connect to be reclassified and sold over the counter in Ireland. Pharmacist and MD of McElwee’s pharmacies and former member
of the Irish Pharmacy Union Executive Committee, Peter McElwee said: “It can be frustrating when products are available over the counter in the UK but not here. But I don’t always blame the manufacturers themselves. They will attempt to enter into larger markets first and Ireland is a smaller market. “I would love if there was the blanket treatment across both sides but the credentials for a
He continued: “erectile dysfunction can be a sensitive area for men and pharmacists are well placed to manage that sensitivity. I’m a midlands pharmacist so men with this problem would ring me asking if I could do anything for them – they’re all patients and clients of mine that I have a relationship with and they don’t want to be standing in a doctor’s surgery waiting for it.” Viagra Connect will be the first pharmacy medicine for erectile
dysfunction to be made available without a prescription, according to manufacturer Pfizer. The familiar blue pill will be priced at £19.99 for four, with a packet of eight retailing for £34.99. Before purchase customers must answer some questions about their general health in consultation with their pharmacist, either online or in person. The drug is only available for those aged 18 and above. Some patients with pre-existing conditions such as liver or kidney failure, severe heart problems or those already taking interacting medications will still need to be prescribed the drug under care of a doctor. As for the likelihood of the medicine becoming available in Ireland, Peter McElwee believes it might be some time yet. “I would certainly hope that Viagra Connect will be available over the counter at some point in Ireland, but I would say it’s probably a long way off,” he explained. “There are a number of medications that hope to be made available over the counter before that will happen and the focus now is on bigger markets, Ireland is only a small one with 4 million customers, unlike the UK’s 70 million.”
News Ireland lags behind in clinical use of biosimilars, study reveals The absence of a national policy on the use of biosimilar medicines is leading to perceived uncertainty over their use in Ireland, new research has suggested. Ireland has had an “exceptionally low” uptake of biosimilar medicines in clinical settings compared to other countries because prescribing is not mandated here, the newly published review has stated, The paper ‘Biosimilar infliximab introduction into the gastroenterology care pathway in a large acute Irish teaching hospital: a story behind the evidence’ describes how a hospital in Ireland introduced biosimilar infliximab for the treatment of inflammatory bowel disease (IBD). The authors note: “In the absence of a national Irish biosimilar medicines policy and with perceived uncertainty surrounding biosimilar medicines, this descriptive review adds to the literature by illustrating the independent systematic evidence base behind the decision-making process to introduce biosimilar infliximab CT-P13 into secondary care treatment of IBD.” A biosimilar is a biologic medicine that is approved based on showing that it is highly similar to an existing approved innovative biological product In June 2013 infliximab was licensed by the European Medicines Agency (EMA). The agency’s Committee for Medicinal Products for Human Use (CHMP) recommended the granting of marketing authorizations for the first two monoclonal antibody biosimilars, Remsima® and
Inflectra®, both of which contain the same known active substance infliximab CT-P13. But the European Crohn’s and Colitis Organisation (ECCO) recommended that most biosimilars in patients with IBD should require testing in the particular patient population with comparison to the appropriate innovator product (Remicade®) before approval. Despite this the chief pharmacist and consultant gastroenterologist of a large acute Irish teaching hospital decided to introduce biosimilar infliximab CT-P13 for use in new patients in September 2014. The report authors said that the pharmacist and gastroenterologist “believed there was enough accumulated evidence from various sources to support their decision” and added that ‘hospital budget coordinators were pleased given that the biosimilar product was cheaper than the originator brand’. . The authors say that, as patients were given reassurance on the safety and efficacy of the biosimilar, physicians did not face resistance to the prescribed agent. In 2015, the National Institute for Health and Care Excellence (NICE) voiced support for prescribing the biosimilar, and Ireland’s Health Products Regulatory Authority released a guide to biosimilars for healthcare providers and patients. In 2016, NICE and the British Society of Gastroenterology (BSG)
updated their guidance to indicate that clinicians—in consultation with patients—should be the final authority on switching, and products should not automatically be substituted at the pharmacy level. Following these changes, the chief pharmacist and consultant gastroenterologist of the hospital elected to switch all patients who were stable on the originator infliximab to the biosimilar. However, despite the fact that this hospital moved more quickly than any other in Ireland, the decision to switch patients “could have been regarded as over-cautious, delayed and conservative given that EMA had already licensed the biosimilar medicine  years earlier,” the authors state. They continue: “One wonders why prescribers had not switched patients sooner,” and add that “a -year time lag for the next biosimilar medicine, from market authorisation to the patient switching process, should not occur.” References O’Brien, GL, Carrol D, Mulcahy M, Walshe V, Courtney G, Byrne S. Biosimilar infliximab introduction into the gastroenterology care pathway in a large acute Irish teaching hospital: a story behind the evidence [published online February 27, 2018]. GaBI J. gabi-journal.net/ biosimilar-infliximab-introduction-intothe-gastroenterology-care-pathwayin-a-large-acute-irish-teaching-hospitala-story-behind-the-evidence.html.
Long-term prescribing of Benzodiazepine still rife in Ireland There has been little progress in reducing the long-term use of benzodiazepine in Ireland a new study has found. Benzodiazepine and Z-drug prescribing in Ireland: An analysis of national prescribing trends from 2005-2015 has found that a third of medical card patients received benzo prescriptions for more than three months.
Lead author of the report, Dr Cathal Cadogan, a lecturer in pharmacy practice at the Royal College of Surgeons in Ireland, said the committee’s guidelines had little effect on the rate of benzo prescribing in Ireland.
The announcement comes after updated prescribing guidance was issued in February, stating such drugs should be prescribed for no more than two to four weeks.
In fact, over an 11-year period there was more than a 25% decrease in the prescribing of Benzodiazepine, however in the same period there was a 14.4% increase in the rates of prescriptions of Z-drugs, which include diazepam, alprazolam, temazepam, zopiclone, and zolpidem.
A Benzodiazepine committee was established in 2000 to address the potential for tolerance and dependence through long-term prescribing, but it seems to have had little influence on long-term prescription rates in this country.
aged over 65 and that long-term use of benzo and Z-drugs could lead to dependency, tolerance and often falls. The report concluded that the risk of long-term use could persist in Ireland for generations to come, when it was published in the British Journal of Pharmacology. It warned: “new and existing prescribing practice needs to be carefully monitored, as inappropriate use of these medications and dependence has been identified among all age cohorts.”
news brief UP TO 300 RURAL PHARMACIES IN IRELAND COULD BE AT RISK ACCORDING TO NEW RESEARCH A report by economic consultancy DKM and commissioned by the Irish Pharmacy Union revealed that of the 1,900 pharmacies analysed, almost 300 faced threat of closure as they were not meeting costs. Irish Pharmacy Union President, Daragh Connolly, has himself seen the numbers of his own pharmacies in Dungarvan drop from nine to seven in just 18 months. Mr Connolly said: “We are so reliant on the payments we receive from the Government for the services we provide to people who need health services - through the GMS, the medical card.” He continued: "So what you might find is, that there are pharmacies now honeypotting. Which is to say, like any business, you go to where the cash customer is because that's where the best chance of your business surviving is." The report blamed lack of footfall and an over-reliance on over-the-counter sales for the decline. With pharmacists ever more reliant on funds from medical card holders, services such as blood-pressure monitoring and cholestoral screening were falling by the wayside. These possible closures could put the medical care of those living in rural areas at risk, with little or no access to vital medicines as pharmacies shut down. IPU CEO Darragh O’Loughlin said that pharmacies in Donegal, Monaghan, Cavan and Leitrim were most at risk, with many pharmacists saying keeping their pharmacy businesses afloat was increasingly difficult.
The report found that prescriptions rates were highest among women
News Irish invention could change the face of diabetes managment A chance meeting at a London university could lead to one of the most innovative pieces of technology seen by the pharmacy industry in recent years. Di@dem is a device designed to continuously monitor diabetes and its associated medicines in real time, 24 hours a day and even allows for connectivity with healthcare professionals. The device will also include an early warning system to alert patients in danger of a hypo or hyperglycaemic attack. Kyriakos Hatzaras
Cork pharmacist Garvan Lynch met systems engineer Kyriakos Hatzaras at Imperial College in London as he studied for an MBA. Garvan put together a thesis examining the effects of medicine adherence by patients given information on their medication – Kyriakos was his thesis supervisor. The study was clearly a success with results reporting a 70% increase of medication adherence by patients. After such a positive collaboration, Garvan and Kyriakos decided to continue to work together. They aimed to combine
Garvan’s hands-on experience in dealing with patients with Kyriakos’ extensive experience in developing medical devices. The duo turned their attention to diabetes. one of the most prevalent health concerns of recent years and one that pharmacist Garvan still witnesses his patients struggle with every day Their goal was to create a device that would enable patients to manage their diabetes with continuous monitoring. Pending approval, they appear to have reached it.
The system is being built by Granite Digital in Dublin with the Health Innovation Hub in Cork project managing the proof of concept study. Garvan Lynch said: “This has been a fascinating project to develop over the last few years. Kyriakos Hatzaras and I started this three years ago but now we’ve been joined by professionals with all sorts of expertise from across the European Union, from software developers to senior academics.” He continued: “it’s been an extraordinary journey, both educational and very enjoyable. We’ve managed to develop something that existed only in our heads all the way through to becoming a real medical device. To date, there is nothing like this on the market anywhere in the world. “A huge boost to us has been that we’re the only health-based
project in Ireland to have received funds from the EU Horizon 2020 Health Innovation fund. As well as recognition from Europe this has opened up new channels of expertise to us.” Understandably, Garvn is a little cryptic about the exact nature of Di@dem as it’s currently undergoing classification through the Health Products Regulatory Authority with the results expected in a few weeks. This process has been delayed as there is no-one on the island of Ireland with the right level of expertise to test the software – the device has had to be sent abroad to be properly assessed. Unusually, thanks to Di@dem’s system of managing and securing data, Garvan has been invited to this year’s Blockchain in Healthcare Congress in London. “Patient data is obviously very sensitive and needs to be protected,” explained Garvan. “We developed our own system of managing and securing data and this has similarities with blockchain technology. It’s a huge honour to have been invited to speak at such a conference.”
HSE approves 1,300% Zarontin price hike Pharmacists can expect to see a 1,300% rise in the cost of epilepsy drug Zarontin in 2018. The US-based manufacturer Essential Pharma wrote to the Health Service Executive in February last year claiming that to “ensure the continued supply” of the drug this significant price hike was necessary. The HSE accepted the rise in a move that will cost the state €284,600 a year. This will see the price of Zarontin, an anti-convulsant, rise from ¤3.56 a pack to ¤50. Although this is a steep rise the HSE deemed it essential for the continued care of those suffering from seizures.
increase in the current climate, strategically from a financial and clinical perspective it would seem that the best course of action for the HSE would be to grant this price increase.”
Kate Mulvenna, Chief Pharmacist for the HSE said:
As well as Zarontin, Essential Pharma also requested a rise of 2,207.65% on another epilepsy drug Carbamazepine and a rise of 2,997.64 on Slow-K, used by patients suffering from potassium deficiency hypokalemia. Both of these were denied by the HSE.
“While it is likely that the HSE will be exposed to greater costs if the product is no longer marketed in Ireland, the more important consideration is the risk of upsetting seizure control for a vulnerable group of patients.” She continued: “While we are frustrated by the request for a price
Prices rises such as these occur when the patent of a particular drug expires and the license is sold
to another company. Epilepsy is classed as a long-term illness, so some patients can be prescribed drugs such as Zarontin and Carbamazepine for years. “When you’re changing somebody’s anti-epileptic medication it’s a very, very delicate balancing act,” said pharmacist and Fine Gael TD Kate O’Connell. “It’s very difficult to do because if someone has a seizure while you’re doing that it can cause brain damage and death. It’s not something that a neurologist would want to do because it’s risky,” she said.
The Chief Executive of Epilepsy Ireland, Peter Murphy, agreed saying: “Switching between epilepsy drugs can lead to breakthrough seizures and worsening of seizure control. These are old drugs that cannot be substituted.” In 2017 Health Minister Simon Harris described Ireland’s taxpayers as being held to ransom by pharmaceutical companies who gave discounts to larger markets. He said the Irish Health Service was forced to pay over the odds for medicines discounted in larger markets.
My patient called to say it’s still working Now that I’ve seen Sarah achieve sustained results*1 with Cosentyx 300mg I know I don’t have to wait to use it.
achieved clear or almost clear skin at week 161
Sustained efficacy up to
ABBREVIATED PRESCRIBING INFORMATION. t COSENTYX 150 mg solution for injection in pre-filled pen. 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. See section 4.8 of the SmPC for how to report adverse reactions. Please refer to the Summary of Product Characteristics (SmPC) before prescribing. Presentation: COSENTYX 150 mg solution for injection in pre-filled pen. Therapeutic Indications: The treatment of moderate to severe plaque psoriasis in adults who are candidates for systemic therapy; the treatment of active ankylosing spondylitis in adults who have responded inadequately to conventional therapy; the treatment, alone or in combination with methotrexate (MTX), of active psoriatic arthritis in adult patients when the response to previous disease modifying anti rheumatic drug (DMARD) therapy has been inadequate. Dosage & Method of Administration: Plaque Psoriasis: Recommended dose in adults is 300 mg given as two subcutaneous injections of 150 mg. Dosing at Weeks 0, 1, 2 3 and 4, followed by monthly maintenance dosing. Ankylosing Spondylitis: The recommended dose is 150 mg by subcutaneous injection with initial dosing at Weeks 0, 1, 2 3 and 4, followed by monthly maintenance dosing. Psoriatic Arthritis: For patients with concomitant moderate to severe plaque psoriasis or who are anti-TNFa inadequate responders, the recommended dose is 300 mg by subcutaneous injection with initial dosing at Weeks 0, 1, 2 3 and 4, followed by monthly maintenance dosing. Each 300 mg dose is given as two subcutaneous injections of 150 mg. For all other patients, the recommended dose is 150 mg by subcutaneous injection with initial dosing at Weeks 0, 1, 2, 3 and 4, followed by monthly maintenance dosing. For all of the above indications, available data suggest that a clinical response is usually achieved within 16 weeks of treatment. Consideration should be given to discontinuing treatment in patients who have shown no response up to 16 weeks of treatment. Some patients with initially partial response may subsequently improve with continued treatment beyond 16 weeks. The safety and efficacy in children below the age of 18 years have not yet been established. Contraindications: Severe hypersensitivity reactions to the active substance or to any of the excipients. Clinically important, active infection (e.g. active tuberculosis). Warnings/ Precautions: Infections: Cosentyx has the potential to increase the risk of infections. Infections observed in clinical studies are mainly mild or moderate upper respiratory tract infections such as nasopharyngitis not requiring treatment discontinuation. Non serious mucocutaneous candida infections more frequently reported for secukinumab than placebo in psoriasis clinical studies. Caution in patients with a chronic infection or a history of recurrent infection. Instruct patients to seek medical advice if signs or symptoms suggestive of an infection occur. If a patient develops a serious infection, close monitoring and discontinue treatment until the infection resolves. Should not be given to patients with active tuberculosis. Anti tuberculosis therapy should be considered prior to initiation in patients with latent tuberculosis. Crohn’s disease: Caution should be exercised when prescribing to patients with Crohn’s disease as exacerbations of Crohn’s disease, in some cases serious, were observed in clinical studies. Close monitoring of patients with Crohn’s disease treated with Cosentyx. Hypersensitivity reactions: In clinical studies, rare cases of anaphylactic reactions have been observed in patients receiving Cosentyx. If an anaphylactic or other serious allergic reactions occur, administration should be discontinued immediately and appropriate therapy initiated. Latex-sensitive individuals: The removable cap of the Cosentyx pre filled pen contains a derivative of natural rubber latex. Vaccinations: Live vaccines should not be given concurrently with Cosentyx. Patients may receive concurrent inactivated or non live vaccinations. Concomitant immunosuppressive therapy: Use in combination with immunosuppressants, including biologics, or phototherapy have not been evaluated. Interactions: Live vaccines should not be given concurrently with Cosentyx. In a study in subjects with plaque psoriasis, no interaction was observed between secukinumab and midazolam (CYP 3A4 substrate. No interaction seen when administered concomitantly with methotrexate (MTX) and/or corticosteroids. Fertility, Pregnancy and Lactation: Women of childbearing potential should use an effective method of contraception during treatment and for at least 20 weeks after treatment. It is preferable to avoid the use of Cosentyx in pregnancy as there are no adequate data from the use of secukinumab in pregnant women. It is not known whether secukinumab is excreted in human milk. A decision on whether to discontinue breast feeding during treatment and up to 20 weeks after treatment or to discontinue therapy with Cosentyx must be made taking into account the benefit of breast feeding to the child and the benefit of Cosentyx therapy to the woman. The effect of secukinumab on human fertility has not been evaluated. Undesirable Effects: Very common (≥1/10); Upper respiratory tract infections. Common (≥1/100 to <1/10); Oral herpes, rhinorrhoea, diarrhoea, urticaria. Uncommon (≥1/1,000 to <1/100); Oral candidiasis, tinea pedis, otitis externa, neutropenia, conjunctivitis. Rare (≥1/10,000 to <1/1,000); Anaphylactic reactions. Please see Summary of Product Characteristics for further information on undesirable effects. Legal Category: POM. Marketing Authorisation Holder: Novartis Europharm Ltd, Frimley Business Park, Camberley, GU167SR, United Kingdom. Marketing Authorisation Numbers: EU/1/14/980/004-005. Date of Revision of Abbreviated Prescribing Information: August 2017. Full prescribing information is available upon request from: Novartis Ireland Limited, Vista Building, Elm Park Business Park, Elm Park, Dublin 4. Tel: 01-2204100 or at www.medicines.ie Detailed information on this product is also available on the website of the European Medicines Agency http://www.ema.europa.eu Quotes are based on verbatim text from dermatologists’ experiences with individual patients and are not representative of the entire patient population. References: 1. Bissonnette R et al. Br J Dermatol June 2017. 2. Thaçi D et al. J Am Acad Dermatol 2015; 73(3): 400-409. 3. Bissonnette R et al. Presented as P2223 at EADV 2017. Date of Preparation: October 2017. IE02/COS17-CNF041b
Perrigo Seminars around the Country Pharmacists receive expert guidance on pain, cough and NRT Perrigo took its award-winning seminar programme back out on the road in March, making stops in Enniscorthy, Athlone, Donegal, Tralee and Dublin, where training consultants, Sarah Whitehead and Jennifer Valentine guided over 200 pharmacists through best practice on pain management, cough and NRT in pharmacy. According to Jesse Mu, Senior Brand Manager, Perrigo: “We are committed to supporting pharmacists and the pharmacy team in their management of the often-challenging areas of over-the-counter medicine including pain management, cough and NRT. Our workshops are designed to educate the pharmacy team in the latest best thinking and practice as well as to equip them with
the latest knowledge so that they can provide excellent advice, in line with the latest clinical evidence and guidelines, which is an important part of the pharmacist’s role.” Key modules explored during the workshop included understanding the psychology of pain and how people perceive pain, pain thresholds and the pain pathway; understanding cough, how
it develops, how to treat and simplify the journey for the customer; and understanding nicotine addiction, dual therapy and how to recommend. For more information on best practice in pain management, cough and NRT in Pharmacy or Perrigo’s seminar programme, please contact your Perrigo Business Manager.
Michelle Naughton, Susan Fleming and Marguerite West, Naylors Pharmacy, Pierse St. Athlone
Margaret Conroy and Sarah Fitzmaurice, Walshs Pharmacy, Ferbane, Co Offaly
Jennifer Valentine and Paul Hatton, Perrigo, Katie Butler, McGorisks, Athlone
Maggie Shine and Kittie Kerrigan, Cooney's, Athlone
Nicole Reeves and Emma Hanniffy, Banagher Total Health Pharmacy
Rachel Kenny, Marrian Dolan Brien and Donna Devine Healy, Dolans Pharmacy, Moate
Geraldine McGlynn, Patricia Gallagher and Denise Langan, Raphoe pharmacy
Susan McMonagle, Gemma McGinley, Anne McConigley, McAddens pharmacy, Letterkenny
Philomena Gallagher, Catherine Rooney and Mary Ramsay, Healthwise, Ballybofey
Bernardine Connolly, Eoghan Maguire, Martina Kerrigan and Nadine Kennedy, Toners pharmacy Ballyshannon
Alison Ferry, Shauna Heena and Donna Patterson, McElwee pharmacy, Dungloe
Ollie Higgins, Perrigo with Bernice Jordan, Conor Keown and Michelle Gallagher, Eske pharmacy, Donegal
Eithne Tennyson and Laura Lawlor, Kissanes pharmacy, Thomastown
Jacinta O’Connor, Ann-Marie O’Neill and Catherine Pettit, David Garahy pharmacy, Enniscorthy
Deborah Kavanagh and Aileen Pardue, Fortune's pharmacy, Wexford town
Kate Szymaczewska and Susan Kinch, Ferns pharmacy
Terje Tali and Marian Saunders, Stacks pharmacy, Gorey
Paul Hatton, Perrigo with Clare Cowman, Alison Bennett and Theresa Crowe, McCauley’s, New Ross
Brendan O’Keeffe, Perrigo with Yvonne Hunt and Noreen Dunlea, McGuires pharmacy, Listowel
Catherine Forde and Helena Rusk, Haven pharmacy, Tralee
Kayrena O'Dowd and Shaleen O'Riordan, O'Donoghues pharmacy Tralee
Mary Lyne, Martina O'Keeffe and Heather O'Rourke, CH pharmacy Tralee
Una Moynihan and Sheila O'Sullivan, O'Donoghues pharmacy Milltown
Maureen O'Neill and Catherine Dowd, Grogans pharmacy, Dingle
New Luas line boosts sales for Foley’s Pharmacy
By Kathleen O’Callaghan
The new Luas Cross City is bringing increased business to Dublin’s north inner city and to Foley’s Pharmacy in particular. The 109-year-old chemist on Parnell Street is experiencing an upsurge in turnover with the extended Luas line just a short hop from its shop front.
Pictured left to right Mildred Roberos, Ray Foley, Eoin Foley, Michael Foley, Liam Kirwan copy
Eoin Foley, (39) is the fourth generation pharmacist to take on Foleys iconic pharmacy with its ruby red awning and original black and gold facade. “We’re experiencing a positive upturn in the market,” he says at his premises. “The street is now busy day and night with ethnic restaurants, 24-hour supermarkets and a huge residential development for students.” Other factors like the rise of a multi-cultural community; the Polish Medical Centre; the thriving Chinese, African and Asian community along with the Dublin city regeneration plan are paying off too. “Turnover is approximately running at ¤2million per annum and with the increased business and going on-line we’re expecting increased sales this year,” says Eoin at the busy retail counter.
Going Digital Michael Foley (68), Eoin’s father is also very pleased with the chemist’s new e-commerce website that Eoin launched recently. It’s this new age approach keeps the business competitive and ready to meet the multi-national challenges. “Putting the business on-line with a strong product-led element is a big step forward,” says Eoin who upskilled in IT training and social media. “Dublin City Council issues grants to companies for building websites and so I applied for the grant and received 50% of the website costs which was ¤4,000 and they offered me a day’s free training as well.” “I personally logged each of the 1000 products up on the Foley site myself and every item is optimised for search engine browsing as well as tagging, pricing and legally
It’s great to wake up in the morning and hear my phone beeping announcing that we’ve sold a number of products overnight labelling them. They all have to be individually weighed as well so it’s time consuming.”
superintendent pharmacist. “The business is running while we’re asleep.”
Although labour intensive and requiring continual updating to ensure stock is available - the effort has paid off.
Eoin is surprised at the website’s global reach.
“It’s great to wake up in the morning and hear my phone beeping announcing that we’ve sold a number of products overnight,” says Eoin, the
“We are selling Regaine hair growth to Kuwait; drug testing kits to the US; urine tests, vitamins, skincare and make-up palettes are checking out on-line,” he says thanks to An Post and a reliable courier service.
Michael Foley, Eoin’s dad is the supervising pharmacist at Foleys. “Eoin completed his B.Comm before he went to the RCSI to do his pharmacy degree and the combination of a business background and IT knowledge is an added bonus.” Another on-line sales incentive is free delivery for products over ¤50. For Michael Foley whose father Cornelius lived over the shop, the need to reinvent and adapt is critical in this market. Like all pharmacies he has seen his profit margins decreasing within the drug dispensing section due to the HSE cuts and the increased administrative workloads. “The main profit margins are now made in the front of shop,” says Michael. This is where the bulk of sales are taking place from the make-up ranges, organic formulae, to the creams and the baby products. We have to make a decent margin here as the profits decline in the drugs dispensary.” Security Measures Foley's is part and parcel of the community DNA and with 60 addicts in the methadone clinic for the past 15 years they’re an essential support in the locality. “Security is always an issue but fortunately there have been no incidents lately,” says Michael. “We have four male members of staff as well two women which probably
acts as a deterrent as well.” The use of CCTV cameras, a private waiting area, and a well-laid out shop assists visibility and reduces shoplifting opportunities. Language Issues The multi-cultural population brings its own language issues but fortunately Aga, their Polish employee is excellent with dealing with Polish Customers. “We may well be looking for a Chinese sales assistant soon to help us with the Mandarin,” says Eoin. “We have a Romanian doctor next door too but fortunately they have good English.” Eoin sometimes takes out his Google Translate to assist customers looking for the right words. Ageing Community The older community makes up a large part of business and Michael knows them all by name. “We are lucky to have so many longstanding locals still with us and we keep a close eye on them. We spend a lot of time making up their weekly blister pill packs too for carers.” Like all pharmacists the preparation of pills and unit dose dispensing is time consuming with about 60 blister packs to do weekly and Eoin says he has just completed 125 phased applications.
Michael Foley Snr & son Eoin With four pharmacists, two technicians, and two female front of shop sales staff they are prepared to taken on the 500 student apartments nearing completion in Gardiner Street and Summerhill.
Chemist in a Capsule: Foley's, 136 Parnell Street 01-8746972 www.foleyschemist.ie
“Make up brands like Flormar and the tanning products are big sellers with the younger market,” say Eoin who found a lot of leftover waste with other brands.
• Annual turnover approximately ¤2million
Foley's have a reputation for exclusive skin products and conditions. Grandfather Cornelius made up a lot of his own formulae for eczema and psoriasis but they can’t make up the old potions anymore due to manufacturing licences, although they have their own brand creams. Eoin is currently working on Foley’s Facebook page. “I think it’s a good strong form of social media but it has to be managed and updated regularly. We may hire a social media manager to look after that side of the marketing so I can concentrate on the core business. In the midst of all this CPD goes on and Michael, although 68, regularly attends his CPD lectures. “There is no end to the upskilling in this business!” he muses thinking of the hundreds of modules he has studied and digested over the years. “I’m still learning all the time.” Foley's has changed dramatically from the days when the family lived over the shop and the messenger boy came to the door – but dramatic changes made now are boosting their profits and plans for the future.
• Family owned and established in 1909
• Invested in new website with aid of Dublin City Council grant for on-line sales • Multi-cultural community of Chinese, Polish and African boosts business • New Luas line injects new lease of life into North City • Global reach of website sending parcels as far as Mauritius and Kuwait • Foleys have run a methadone clinic for 15 years with 60 patients • Security is tight but a good rapport in the community means lots of local support • Specialising areas: skin consultations; own brand lotions; flu vaccines; book on-line prescriptions; • Products range from Greenlight CBD oil to Dermaplump skin care Keeping Tradition Michael Foley, his son Eoin and his young nephew Ray are carrying on the tradition of community care and represent the third and fourth generation to run the family business. They are still renowned for excellent traditional skin potions and treatments. The old façade is still outside but inside the pharmacy is full of innovation.
The current trends in the community pharmacy merger and acquisition market Stuart Fitzgerald, director of Fitzgerald Power, writes about how it is likely that the community pharmacy sector in Ireland will continue to be a target for investment from existing pharmacy operators and investors seeking to deploy capital throughout 2018. • Sentiment: the outlook of vendors and investors remains very strong both domestically and internationally. This positive sentiment makes it an attractive time to raise investment or sell a business. • Valuations: robust valuations, driven in part by investor sentiment, are enticing vendors to sell.
Stuart Fitzgerald, Director of Fitzgerald Power
The global market It is expected that global merger and acquisition activity will breach $3 trillion this year. We are in the middle of a low interest rate/cheap cash cycle which creates the perfect conditions for deal making.
• Demographics: a generation of potential vendors felt they lost their opportunity to exit during the recession. These individuals are now bringing their businesses to the market and they are joined by younger entrepreneurs who are also looking to sell. There is now a demand to exit across a broader than normal age range. • Return profile: in this current low yield cycle investors are looking for a home for their capital and a return on their investments. • Disruption: historically mergers and acquisitions were driven by a desire to either accelerate a business or consolidate a market position. Recently disruption became the third factor. Consider the impact on traditional healthcare providers from Amazon, Berkshire Hathaway and JP Morgan combining to provide cheaper healthcare for more than 1 million of their employees. Almost as a pre-emptive strike the US pharmacy chain CVS acquired Aetna, a healthcare insurer, in a bid to tackle soaring health spending by providing
Pic of author to come
lower-cost medical services in pharmacies. M&A in Ireland It is predicted that M&A activity in Ireland will soar in 2018 due to our business-friendly environment. Ireland currently ranks as the seventh most attractive location for investment, ahead of countries like the UK and Germany according to a report by US law firm Baker McKenzie. The factors that are driving international deal making apply equally to Ireland where we have seen some big recent exits which include Mercury Engineering, Merlyn Showering and Lilly O’Brien’s. We have also seen a glut of combinations across several sectors including BWG’s deal with 4 Aces, Davy’s proposed takeover of IFG’s Saunderson House and Boyle Sports acquisition of JP McGuinness. Private equity is driving much of the activity in Ireland and we are starting to see the purchase of healthy, growth-oriented businesses by private equity firms such as Renatus, Broadlake, Carlyle Cardinal Ireland and MML. There is also regular interest from UK based private equity firms and while historically there was a lack of familiarity with private equity in Ireland, that is quickly changing.
with Carlyle Cardinal’s acquisition of Sam McCauley Chemists. It is likely that the pharmacy sector will continue to be a target for investment from existing pharmacy operators and investors seeking to deploy capital. It is a sector that is somewhat unusual. Ownership remains fragmented with 74% of pharmacies in Ireland in holdings of less than six outlets as at 31st December 2017. Deregulation has reduced barriers to entry but has equally diminished the value of incumbent businesses. These dynamics make pharmacy an interesting sector for investment but also make it a challenging market in which to build scale (as scale is slowly built in ones and twos) and defend profit positions (as no pharmacy in Ireland can be fully insulated from a new business opening in direct competition). Increased transaction activity From an analysis of the PCRS Payments to Pharmacies list we estimate there were approximately 29 pharmacy acquisitions in Ireland in 2015 and a further 27 in 2016. We believe there were in excess of 35 deals in 2017 and we expect increased volumes again in 2018.
Second pic caption: Ian Daly from Cardinal Capital Group, Sam McCauley and
Aside from the availability of cheap capital there are six factors driving activity:
Jonathan Cosgrave, from Carlyle. The Carlyle acquisition of Sam McCauley By extrapolating fee payments Chemists was the first notable private equity deal in the pharmacyto sector Ireland pharmaciesin to derive an
• Funding options: there has never been more favourable time to raise capital. Banks, specialist debt funds, private equity firms, venture capitalists, family offices and high-networth individuals are all vying for investment opportunities.
Less than €750K €750K to €1.25M €1.25M to €1.75M Greater than €1.75M Total 14
The Irish pharmacy market That is particularly true of the Irish community pharmacy market and 2017 saw the first notable private equity deal in the pharmacy sector
2015 6 5 11 7 29
estimated turnover base for every contractor on the PCRS Payments to Pharmacies list we have calculated deal volumes by turnover bracket which are set out in the following table:
2016 4 6 9 8 27
Acquisition activity has focused on large volume pharmacies with 62.5% of transactions in 2015 and
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It still all begins with a valuation and as ever the valuation methodology is adjusted, mainta earnings times an earnings multiple plus working capital on completion (assuming the busin being sold net of debt, surplus cash, investments etc.). The following table sets out a simple example:
Adjusted maintainable earnings Earnings multiple Goodwill valuation
€200,000 5.5 €1,100,000
Completion working capital Enterprise valuation
• Remove unnecessary costs • Consider the maintainability of earnings • Consider internal business succession. This is a significant consideration as a purcahser will want to ensure the business will survive when you leave • Ensure legal documents are fit for purpose On the other side of the fence purchasers are looking for is a business proposition that can be managed relatively easily and an earnings base that can be defended and grown.
As previously mentioned earnings multiples purchaser tended tocashfluctuate • Local factors such as from reserves or in 2017. We have visibility competition and GP succession from an alternative source. New than 50% of the pharmacies bought and soldentrants in Ireland each year and in our experience the such as private equity • The availability of funding firms and venture debt funds are Stuart Fitzgerald is a director multiple range in the market is 4.5 to 6 times earnings, however, with thatPower. said in Fitzgerald He we can have see bridging the equity gap but they • Competition in the bidding be contacted by email are hunting return on investment, process isolated instances of multiples as low as 3 times earnings and as high as 6.5 times. These ar firstname.lastname@example.org often over a five year time horizon, and are often asked how high Stuart and the Fitzgerald Power exceptions rather thanWe the rule. are therefore unwilling to invest valuation multiples can go and team will be in attendance at the
Acquisition activity has focused on large volume pharmacies with 62.5% of transactions in 2015 and 2016 involving pharmacies with annual turnover of ¤1.25m or greater. While there are a host of practical commercial reasons for this focus it has helped to create a slightly erratic market where value can still be found if operators feel they have a solid plan to grow the trade of a smaller pharmacy through improved service, expanded product range etc.
in many ways this is a difficult question to answer as it driven by a number of intertwined considerations. What we can say is that the availability of funding would have to fundamentally change for valuation multiples to increase significantly.
in projects that don’t make financial sense.
United Drug Pharmacy Show on 15th and 16th April in Room 419 at the Aviva Stadium and would be delighted to answer any questions that arise from this article.
We have also seen numerous cases in recent times of very similar pharmacies achieving ver Buying or selling a pharmacy? different prices and some of the factors that affect valuation multiples include:
Stay calm and adjust the earnings
• Location It still all begins with a valuation There is a very simple reason and as • ever the valuation Turnover bracket for this. Banks will lend at three methodology is adjusted, and a half to four times adjusted, maintainable earnings times an • The defendability of the trade maintainable earnings so anything earnings multiple plus working capital on completion (assuming the business is being sold net of debt, surplus cash, investments etc.). The table at the top of the page sets out a simple example.
above this has to be funded by the
If you are considering bringing your pharmacy to the market the focus should be on packaging the business for sale. Some of the factors to consider include:
Fitzgerald Power’s corporate finance team have been shortlisted for the Advisory Team of the Year Award at this year’s Irish Accountancy Awards.
• Drive turnover and items • Maximise procurement margins
As previously mentioned earnings multiples tended to fluctuate in 2017. We have visibility of more than 50% of the pharmacies bought and sold in Ireland each year and in our experience the typical multiple range in the market is 4.5 to 6 times earnings, however, with that said we have seen isolated instances of multiples as low as 3 times earnings and as high as 6.5 times. These are the exceptions rather than the rule. We have also seen numerous cases in recent times of very similar pharmacies achieving very different prices and some of the factors that affect valuation multiples include: • Location • Turnover bracket • The defendability of the trade • The growth opportunity
Ian Daly from Cardinal Capital Group, Sam McCauley and Jonathan Cosgrave, from Carlyle. The Carlyle acquisition of Sam McCauley Chemists was the first notable private equity deal in the pharmacy sector in Ireland
QUICKMIST STARTS TO RELIEVE CRAVINGS IN 30 SECONDS *based on 2 x 1mg dose
Abbreviated Prescribing Information. Please consult the summary of product characteristics for full prescribing information. Nicorette Quickmist 1mg/spray, oromucosal spray, solution. Composition: One spray delivers 1 mg nicotine in 0.07 ml solution. 1 ml solution contains 13.6 mg nicotine. Pharmaceutical Form: Oromucosal spray, solution. Indications: Nicorette QuickMist is to be used for the treatment of tobacco dependence in adults by relief of nicotine withdrawal symptoms, including cravings, during a quit attempt. Permanent cessation of tobacco use is the eventual objective. Nicorette QuickMist should preferably be used in conjunction with a behavioral support program. Dosage: Subjects should stop smoking completely during the course of treatment with Nicorette QuickMist. Adults and Elderly The following chart lists the recommended usage schedule for the oromucosal spray during full treatment (Step I) and during tapering (Step II and Step III). Up to 4 sprays per hour may be used. Do not exceed 2 sprays per dosing episode and do not exceed 64 sprays (4 sprays per hour, over 16 hours) in any 24-hour period. Step I: Weeks 1-6: Use 1 or 2 sprays when cigarettes normally would have been smoked or if cravings emerge. If after a single spray cravings are not controlled within a few minutes, a second spray should be used. If 2 sprays are required, future doses may be delivered as 2 consecutive sprays. Most smokers will require 1-2 sprays every 30 minutes to 1 hour. Step II: Weeks 7-9: Start reducing the number of sprays per day. By the end of week 9 subjects should be using HALF the average number of sprays per day that was used in Step I. Step III: Weeks 10-12: Continue reducing the number of sprays per day so that subjects are not using more than 4 sprays per day during week 12. When subjects have reduced to 2-4 sprays per day, oromucosal spray use should be discontinued. To help stay smoke free after Step III, subjects may continue to use the oromucosal spray in situations when they are strongly tempted to smoke. One spray may be used in situations where there is an urge to smoke, with a second spray if one spray does not help within a few minutes. No more than four sprays per day should be used during this period. Regular use of the oromucosal spray beyond 6 months is generally not recommended. Some ex-smokers may need treatment with the oromucosal spray longer to avoid returning to smoking. Any remaining oromucosal spray should be retained to be used in the event of sudden cravings. Paediatric population: Do not administer Nicorette QuickMist to persons under 18 years of age. There is no experience of treating adolescents under the age of 18 with Nicorette QuickMist. Method of administration: After priming, point the spray nozzle as close to the open mouth as possible. Press firmly the top of the dispenser and release one spray into the mouth, avoiding the lips. Subjects should not inhale while spraying to avoid getting spray into the respiratory tract. For best results, do not swallow for a few seconds after spraying. Subjects should not eat or drink when administering the oromucosal spray. Behavioural therapy advice and support will normally improve the success rate. Contraindications: Hypersensitivity to nicotine or to any of the excipients. Children under the age of 18 years. Those who have never smoked. Special warnings and precautions for use: Nicorette QuickMist should not be used by non-smokers. The
benefits of quitting smoking outweigh any risks associated with correctly administered nicotine replacement therapy (NRT). A risk-benefit assessment should be made by an appropriate healthcare professional for patients with the following conditions: Cardiovascular disease: Dependent smokers with a recent myocardial infarction, unstable or worsening angina including Prinzmetal’s angina, severe cardiac arrhythmias, recent cerebrovascular accident and/or who suffer with uncontrolled hypertension should be encouraged to stop smoking with non-pharmacological interventions (such as counselling). If this fails, the oromucosal spray may be considered but as data on safety in this patient group are limited, initiation should only be under close medical supervision. Diabetes Mellitus. Patients with diabetes mellitus should be advised to monitor their blood sugar levels more closely than usual when smoking is stopped and NRT is initiated as reduction in nicotine induced catecholamine release can affect carbohydrate metabolism. Allergic reactions: Susceptibility to angioedema and urticaria. Renal and hepatic impairment: Use with caution in patients with moderate to severe hepatic impairment and/or severe renal impairment as the clearance of nicotine or its metabolites may be decreased with the potential for increased adverse effects. Phaeochromocytoma and uncontrolled hyperthyroidism: Use with caution in patients with uncontrolled hyperthyroidism or phaeochromocytoma as nicotine causes release of catecholamines. Gastrointestinal Disease: Nicotine may exacerbate symptoms in patients suffering from oesophagitis, gastric or peptic ulcers and NRT preparations should be used with caution in these conditions. Paediatric population: Danger in children: Doses of nicotine tolerated by smokers can produce severe toxicity in children that may be fatal. Products containing nicotine should not be left where they may be handled or ingested by children. Transferred dependence: Transferred dependence can occur but is both less harmful and easier to break than smoking dependence. Stopping smoking: Polycyclic aromatic hydrocarbons in tobacco smoke induce the metabolism of drugs metabolised by CYP 1A2 (and possibly by CYP 1A1). When a smoker stops smoking, this may result in slower metabolism and a consequent rise in blood levels of such drugs. This is of potential clinical importance for products with a narrow therapeutic window, e.g. theophylline, tacrine, clozapine and ropinirole. The plasma concentration of other medicinal products metabolised in part by CYP1A2 e.g. imipramine, olanzapine, clomipramine and fluvoxamine may also increase on cessation of smoking, although data to support this are lacking and the possible clinical significance of this effect for these drugs is unknown. Limited data indicate that the metabolism of flecainide and pentazocine may also be induced by smoking. Excipients: The oromucosal spray contains small amounts of ethanol (alcohol), less than 100 mg per spray. Care should be taken not to spray the eyes whilst administering the oromucosal spray. Undesirable effects: Effects of smoking cessation: Regardless of the means used, a variety of symptoms are known to be associated with quitting habitual tobacco use. These include emotional or cognitive effects such as dysphoria or
depressed mood; insomnia; irritability, frustration or anger; anxiety; difficulty concentrating, and restlessness or impatience. There may also be physical effects such as decreased heart rate; increased appetite or weight gain, dizziness or presyncopal symptoms, cough, constipation, gingival bleeding or apthous ulceration, or nasopharyngitis. In addition, and of clinical significance, nicotine cravings may result in profound urges to smoke. Nicorette QuickMist may cause adverse reactions similar to those associated with nicotine given by other means and these are mainly dosedependent. Allergic reactions such as angioedema, urticaria or anaphylaxis may occur in susceptible individuals. Local adverse effects of administration are similar to those seen with other orally delivered forms. During the first few days of treatment irritation in the mouth and throat may be experienced, and hiccups are particularly common. Tolerance is normal with continued use. Daily collection of data from trial subjects demonstrated that very commonly occurring adverse events were reported with onset in the first 2-3 weeks of use of the oromucosal spray, and declined thereafter. Adverse reactions with oromucosal nicotine formulations identified from clinical trials and during post-marketing experience are presented below. The frequency category has been estimated from clinical trials for the adverse reactions identified during post-marketing experience. Very common (≥1/10); common (≥1/100 to <1/10); uncommon (≥1/1 000 to <1/100); rare (≥1/10 000 to <1/1 000); very rare (<1/10 000); not known (cannot be estimated from the available data). Immune system disorders Common Hypersensitivity Not known Allergic reactions including angioedema and anaphylaxis Psychiatric disorders Uncommon Abnormal dream Nervous system disorders Very common Headache Common Dysgeusia, paraesthesia Eye disorders Not known Blurred vision, lacrimation increased Cardiac disorders Uncommon Palpitations, tachycardia, Atrial fibrillation Vascular disorders Uncommon Flushing, hypertension Respiratory, thoracic and mediastinal disorders Very common Hiccups, throat irritation Uncommon Bronchospasm, Rhinorrea, dysphonia, dyspnoea, nasal congestion, oropharyngeal pain, sneezing, throat tightness Gastrointestinal disorders Very common Nausea Common Abdominal pain, dry mouth, diarrhoea, dyspepsia, flatulence, salivary hypersecretion, stomatitis, vomiting Uncommon Eructation, gingival bleeding, glossitis, oral mucosal blistering and exfoliation, paraesthesia oral Rare Dysphagia, hypoaesthesia oral, retching Not known Dry throat, gastrointestinal discomfort, lip pain Skin and subcutaneous tissue disorders Uncommon Hyperhidrosis, pruritus, rash, urticaria Not known Erythema General disorders and administration site conditions Common Burning sensation, fatigue Uncommon Asthenia, chest discomfort and pain, malaise. MA Holder: McNeil Healthcare (Ireland) Limited, Airton Road, Tallaght, Dublin 24 Ireland. MA Number: PA 823/49/29. Revision of text: January 2016. Legal Category: Not subject to medical prescription.If you require full prescribing information or wish to report an adverse event please contact Johnson & Johnson (Ireland) Ltd., Airton Road, Tallaght, Dublin 24, Ireland. Telephone: 1800 22 00 44 Date of Preparation: August 2017
News Hugh’s House – the Irish Pharmacy Awards 2018 Charity of the Year Ade and Marty’s son Hugh was born seriously ill and spent all of his short life in hospital. As Ade and Marty cared for their infant son they saw parents around them struggle to do the same for their children. Sadly, the cause of Hugh’s illness was never diagnosed as Ade and Marty faced the challenges of family life while looking after their seriously ill son. Of course, Ade and Marty weren’t the only parents experiencing this ordeal. The couple saw families divided at the worst possible time as one parent travelled to Dublin to care for a sick child while the other remained at home to look after the rest of the family. Accommodation was scarce forcing some parents to sleep in their cars, some families were even unable to visit their children in hospital because of steep travel and accommodation costs. When Hugh passed away, his parents decided to put the money they would have spent on him during his lifetime to good use and established Hugh’s House, a home away from home for the parents and families of sick children in hospital. The seven-bedroomed house opened in 2015 and is fully equipped with family bedrooms, bathrooms, kitchen, laundry and even computers and printers. There is also a fully wheelchair accessible garden where, if possible, families can spend time together outside of the hospital. Every possible service is provided at Hugh’s House; meals are cooked, laundry done and cleaning
Gwen and premature son Shea
taken care of. There is an on-site house mother to lend a hand or simply lend a friendly ear. “There are a lot of parents of sick babies from the Rotunda Hospital and parents of older children in Holles Street and the Coombe Hospital who just need somewhere they can go,” explained Monica Macken. Monica was Hugh’s godmother and had been involved with the charity since its inception. “You could have a new mum, who is herself recovering from a C-section, and she can go to Hugh’s House for a shower and sleep, to pump breast milk and have somewhere to store it. “We have a mother who is staying in the house with her five-month old baby at the moment. She has a two-year-old staying with her mother-in-law and an 11-year-old in the hospital. At the weekend her husband, mother-in-law and children can all stay in the house together as a family. That really makes a difference to people.” More than 200 families have taken advantage of the facilities of Hugh’s House since doors opened and the charity are hoping many more will be able to follow. The neighbouring house has now been acquired providing overflow accommodation and it’s hoped that treatment rooms and rooms for counselling services will soon be available.
As Hugh’s House is a charitable organisation it’s unsurprising that donations are always needed and cash is always welcome, but there are many different ways to give to these struggling families. “it doesn’t cost anything to stay in the house and we ensure that everything is provided for the residents,” said Monica. “Someone coming in to do some ironing for an hour, someone who could make a meal for the residents or someone who’s a bit handy and could put up some shelves. Of course cash donations are greatly appreciated and they keep the house running but every little bit helps.” More than 200 families have now been through the doors of Hugh’s House. Gwen Curley is one such mother who credits the organisation as being a real lifeline. “I was in a car accident in June last year and after that my son Shea was born in 13 weeks premature in Mullingar Hospital by caesarean section,” she explained. “Shea was immediately transferred to Hollis Street because he was so sick. He was so small when he was born we didn’t even have anything ready for him. “We couldn’t afford to stay in Dublin every night while Shea
Gwen and Shea, the early days
was in hospital. I was expressing milk and couldn’t drive after the C-section, so I wasn’t able to go up and down each day. “Hugh’s house was the best thing that happened during a very bad situation. It wasn’t long before I was sitting in the kitchen with everyone else and I did that every day after I came back from the hospital. No matter how bad a day you had, there was always someone there who knew what you were going through and knew what to say. “I don’t think I would have gotten through the whole thing as well as I did without Hugh’s House. It’s so much more than a bed and a shower and somewhere to stay. You can’t pay for the kind of support you get there.” As for Shea, the tiny baby who was born at just 27 weeks, Gwen can’t help but laugh. “He’s a raging lunatic now! He’s absolutely great.” Irish Pharmacy News are proud to support Hugh’s House as the nominated charity for 2018. IPN will be fundraising for the charity at the 2018 Irish Pharmacy Awards on May 12th at the Clayton Hotel, Dublin.
Gwen and Shea today
N E iﬀ & W er en t! D
Added Extra Added Conﬁdence Adex Gel
Adex Gel oﬀers a new, simple and diﬀerent approach to the treatment and management of mild to moderate eczema. Adex Gel emollient can help reduce inﬂammation and redness because Adex Gel provides Added Extra anti-inﬂammatory action.
Recommend Adex Gel and see the results occur with emollients when applied to damaged skin. Such symptoms usually subside after a few days of treatment, however, if they are troublesome or persist, stop using and seek medical advice. Rarely skin irritation (mild rashes) or allergic skin reactions can occur on extremely sensitive skin, these tend to occur during or soon after the first few uses and if this occurs stop treatment. As safety trials have not been conducted during pregnancy and breast-feeding, seek medical advice before using this product. Care should be taken as emollients which soak into clothing, pyjamas, bedlinen etc. can increase the flammability of these items. Patients should avoid these materials coming into contact with naked flames or lit cigarettes etc. As a precaution, dressings and clothing, etc., should be changed frequently and laundered thoroughly. Ingredients: Carbomer, glycerol, isopropyl myristate, liquid paraffin, nicotinamide, phenoxyethanol, sorbitan laurate, trolamine, purified water.
Pack sizes: 100g tube and 500g pump pack. Legal category: Class III medical device with an ancillary medicinal substance. Further information is available from the manufacturer: Dermal Laboratories, Tatmore Place, Gosmore, Hitchin, Herts, SG4 7QR, UK. Date of preparation: August 2017. ‘Adex’ is a trademark. Adverse events should be reported to Dermal. ADX PR009/I/DEC16
Adex™ Gel Presentation: White opaque gel. Uses: Highly moisturising and protective emollient with an ancillary anti-inflammatory medicinal substance for the treatment and routine management of dry and/or inflamed skin conditions such as mild to moderate atopic dermatitis, various forms of eczema, contact dermatitis and psoriasis. Directions: Adults, the elderly and children from 1 year of age. For generalised all-over application to the skin. Apply three times daily or as often as needed. Adex Gel can be used for as long as necessary either occasionally, such as during flares, or continuously if the added anti-inflammatory action is beneficial. Seek medical advice if there is no improvement within 2-4 weeks. Contra-indications, warnings, side effects etc: Do not use if sensitive to any of the ingredients. Keep away from the eyes, inside the nostrils and mouth. Temporary tingling, itching or stinging may
News news brief INFLUENZA COMPOSITION RECOMMENDATIONS RELEASED FOR 2018/2019 The EU recommendations for the 2018/2019 seasonal flu vaccine composition have now been released by the European Medicines Agency. Based on international surveillance by the World Health Organisation and recommendations by experts of influenza of the member states, trivalent vaccines should contain the following: • an A/Michigan/45/2015 (H1N1) pdm09-like virus; • an A/Singapore/ INFIMH-16-0019/2016 (H3N2)like virus; • a B/Colorado/06/2017-like virus (B/Victoria/2/87 lineage). For quadrivalent vaccines with two influenza B viruses, a B/ Phuket/3073/2013-like virus in addition to the strains mentioned above is considered appropriate. These recommendations also apply to the manufacture of live attenuated influenza vaccines. The EU recommendations for the composition of seasonal influenza vaccines are issued each year in response to the rapidly changing influenza virus. The compositions are based on the recommendations of the WHO and are endorsed by the Committee for Medicinal Products for Human Use at their March meeting. The EMA recommends that those holding marketing authorization submit applications to change the composition of the centrally authorized flu vaccines by June 18,2018. Influenza vaccines are on the WHO’s List of Essential Medicines. It is recommended that children, the elderly and those suffering from persistent respiratory conditions receive a vaccine each year. If those immunized do contract influenza, they find that symptoms are less severe and don’t last as long. The flu vaccine should not be given if an individual has had an allergic reaction to a previous flu vaccine or if they have an allergy to eggs. The vaccine is recommended for pregnant women and children aged six months or older. For those aged 18 or over in Ireland, the vaccine is available from the pharmacist, GP or Occupational Health department.
Meaghers hit the gold standard Irish pharmacy chain Meaghers have been awarded Gold Standard by Deloitte in the Best Managed Companies Awards of 2018.
Left to right: Meaghers Pharmacy team Emer Mc Laughlin, Elaine Illis, Oonagh O’ Hagan, Ian Clarke, Debbie Coughlan and James Murphy
The awards, now in their 10th year, took into consideration the complete scope of the business and examined areas such as operational excellence, strategy and human resources. To achieve the Gold Standard, companies must successfully go through the two-stage process four years in a row. Owner and MD of Meaghers Pharmacy Group Oonagh O’Hagan said: “Being recognised as a Gold Standard Deloitte Best Managed Company was an incredibly special moment for me and all our team at Meaghers Pharmacy. The process recognises indigenous Irish companies across the island of Ireland which are operating at the highest level of business performance, so to feature with some of the most progressive and innovative companies in Ireland makes us all really proud.” She continued: “In order to achieve this award the company
must undergo a process which reviews your business on the key pillars of strategy, capability and commitment and those companies who successfully demonstrate excellence under each criteria, get recognised. I feel that the award is unique in that it recognises the efforts of the entire organisation and not such one person, so it is a much more holistic view of the company.” The first Meaghers Pharmacy opened Dublin’s Baggot Street in 1921. The chain was run by the Meagher family until 2001 when pharmacist Oonagh O’Hagan purchased the business. As a qualified pharmacist herself, Oonagh had served her Pre Regyear at Meagher’s and for her, keeping the original name for the business was imperative. Oonagh and her team have opened seven more pharmacies over the years – with the original site in Baggot Street still in operation. She is quick to point out that the success of the chain is a collective effort.
“I always say that the success of Meaghers is quite simply down to our people; great people make great companies. Our teams engage with our customers with a positive, can do attitude every day, and they are empowered to make decisions that ultimately have a lasting impact on how our customers are feeling. It is our team that this Gold Standard award is recognising and without their efforts Meaghers simply would never be a Deloitte Best Managed Company for the last four consecutive years in a row.” The Deloitte Best Managed Company programme is the only awards scheme on the island of Ireland that considers a business’ performance from every perspective. Entrants to the programme must compete for this designation in a rigorous and independent process that evaluates the calibre of their management abilities and practices.
Let the community pharmacy technicians’ voices be heard Elaine Lorigan McSweeney is president of the Irish Association of Community Pharmacy Technicians. Here she writes about the difficulties faced by pharmacy technicians The Irish Association of Community Pharmacy Technicians, a voluntary association, was set up seven years ago to encourage acknowledgement of the importance of pharmacy technicians in community pharmacy. In almost all conversations with pharmacists, pharmacy owners, locums etc., the technicians are heralded as the backbone of the dispensary, similarly to the way nurses are lauded as being the backbone to our hospital services. It is therefore incredibly disappointing to know that; • There is no registration of community pharmacy technicians in Ireland. • We have no figures of how many qualified technicians there are in our own country. • There is no standardised test or exam to ensure that all technicians are of the same dispensing calibre or capability. • There is very little CPE aimed at ongoing learning for technicians, and if there is, there is a charge and they are generally run in the evening, after the person has been on their feet all day and quite often, do not get time in lieu for attending. • There is no pay scale; it is at the discretion of the employer.
• There is no union. Pharmacists are actively encouraged to attend CPD, and with the IIOP it is compulsory in some cases. OTC and beauty staff get courses from various companies, from vitamins to skincare products to encourage sales. Technicians, in a lot of cases, do not receive any courses, or are not encouraged to develop their own skills to progress. In the past few years we have seen a great rise in the number of technicians diversifying into different fields, such as medical representatives, into corporate buying structures and even starting their own consultancy companies, as I have. We hope to encourage this rise as, in the past, there has been very little career progression for technicians, it was thought that they were there to stay in the dispensary, ‘putting labels on boxes’, and no more. This is a voluntary association and we have three committee members. I am the president. I run my own company, have two teenage daughters and drive about 5,000 km per month on top of a working week. Noelle Liston is vice president and
Elaine Lorigan McSweeney, president of the Irish Association of Community Pharmacy Technicians
treasurer. Noelle works full time and has a little boy. Noeleen Boyce is secretary. Noeleen works full time and is preparing for her wedding. It is tough going to maintain a positive spin on the future of the technicians in Ireland. We are constantly bombarded with bureaucracy from the relevant governing and unionised parties. We cannot afford to take days off to attend meetings; we all work in the private sector. It is not all down to others though. In the case of some of the free
CPD events run by the association and even the AGM, the turnout of pharmacy technicians was poor. Technicians must do it for themselves, they must show up, show their support, let their voices be heard. There is no white knight to come and save the day. The only way we can make our voices heard, is by standing together and supporting the association that many people over the years have given their own free time, willingly, and with great enthusiasm.
Profile Elaine Lorigan McSweeney was born and raised in Cork and first entered the pharmacy sector at 19. No stranger to the medical sector, she gained great knowledge and exposure from her father Dr Patrick Lorigan, her mother Maona, who was a nurse and her extended family of healthcare professionals. Her first full-time job was in Macroom Co. Cork, in Kerins Pharmacy which formed the foundations for her career. After two years she moved to Dublin. Her career continued in Dublin with a five year period in Tracey's Pharmacy on Eden Quay. After giving birth to two daughters in 2000 and 2001 she began working with Shane Ryan in Rathangan. She spent 10 years in Ryan’s Pharmacy, where she became a qualified pharmacy technician. In 2013 Elaine joined the committee of the Irish Association of Community Pharmacy Technicians (IACPT) and was later nominated to take the role of President of the association. In 2013 she changed her career focus, joining the Allcare management team as Claims Coordinator in October. During that time she learned new skills including Microsoft Office, analysis of big data, accounting, training and compliance, and also got exposure to new sides of the business. In April 2017, and with a desire for yet another new challenge Elaine took the plunge and became her own boss and is currently MD of Pharmacy Wizard.
Help sufferers escape the misery of hayfever Nasacort’s unique formula provides 24 hour relief 1* of
Nasal congestion Sneezing Runny Nose
Itchy Nose Even works on eye symptoms
Key advantages: Once-a-day 2 Starts working from day one3,4 Stays where it’s sprayed3,5 The treatment of choice in patients with moderate to severe hayfever 2.
TO STOCK UP CALL
YOUR SANOFI PHARMACY REPRESENTATIVE NASACORT ALLERGY 55 MICROGRAMS/DOSE NASAL SPRAY SUSPENSION (TRIAMCINOLONE ACETONIDE) PRODUCT INFORMATION Presentation: 20 ml bottle, providing 30 actuations containing 55mcg triamcinolone acetonide per metered dose. Indications: Treatment of the symptoms of seasonal allergic rhinitis. Dosage and Administration: Patients aged 18 years and over: The recommended dose is 220 micrograms as 2 sprays in each nostril once daily. Once symptoms are controlled patients can be maintained on 110 micrograms (1 spray in each nostril once daily). If symptoms are not relieved within 14 days, a physician must be consulted. Not recommended in children and adolescents under 18 years of age. Contraindications: Hypersensitivity to the active substance or excipients. Precautions and Warnings: If adrenal function may be impaired, take care when transferring patients from systemic steroids. Localised infections of the nose and pharynx with Candida albicans has rarely occurred which may require local treatment and temporary discontinuation of Nasacort Allergy. Should be used with caution in recent nasal septal ulcers, nasal surgery or trauma, until healing has occurred. Systemic effects may occur, particularly at high doses prescribed for prolonged periods. Potential systemic effects may include Cushing’s syndrome, Cushingoid features, adrenal suppression, growth retardation in children and adolescents, cataract, glaucoma and more rarely, a range of behavioural effects including psychomotor hyperactivity, sleep disorders, anxiety, depression or aggression. Treatment with higher than recommended doses may result in clinically significant adrenal suppression which may require additional systemic corticosteroid cover during periods of stress or elective surgery. Close monitoring in patients with a change in vision or with a history of increased intraocular pressure, glaucoma and/or cataracts. Contains benzalkonium chloride, an irritant, which may cause skin reactions. Interactions: No interaction studies have Date of preparation: March 2018 SAIE.SA.18.03.0073
*Once established on the product References: 1. Nasacort 24 hours data on file, 16th March 2016 2. Treatment of seasonal allergic rhinitis: 1998, MeReC Bulletin, 9(3), 9-12 3. Nasacort SPC 4. Gross G. et al. Annual of Allergy Asthma & Immunology 1996 5. Berridge MS. et al. The Journal of Nuclear Medicine 1998 been performed. Pregnancy and Lactation: should not be administered during pregnancy or lactation unless therapeutic benefits outweigh the potential risk to the foetus/baby. Adverse Reactions: commonly reported adverse reactions: flu syndrome, pharyngitis, rhinitis, headache, bronchitis, epistaxis, cough, dyspepsia & tooth disorder. Rare reactions: nasal septum perforations. Frequency not known: hypersensitivity (including rash, urticaria, pruritus and facial oedema), insomnia, dizziness, alterations of taste and smell, cataract, glaucoma, increased ocular pressure, nasal irritation, dry mucous membrane, nasal congestion, sneezing, dyspnoea, nausea, fatigue, decreased blood cortisol. Legal Category: P. Marketing Authorisation Number: PA 540/11/2. Further information is available from the Marketing Authorisation Holder: Medical Information Department, Sanofi-aventis Ireland Limited T/A SANOFI, 18 Riverwalk, Dublin 24, IEemail@example.com. Tel. 0845 372 7101. Please refer to Summary of Product Characteristics which can be found on IPHA at http://www.medicines.ie/ before prescribing. Date of preparation of PI: December 2016 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 via HPRA Pharmacovigilance, Earlsfort Terrace, IRL - Dublin 2; Tel: +353 1 6764971; Fax: +353 1 6762517. Website: www.hpra.ie; E-mail: firstname.lastname@example.org. Suspected adverse events can also be reported to Sanofi Ireland Ltd. directly by emailing IEPharmacovigilance@Sanofi.com or calling 01 403 5600.
Pharmacists need to educate patients on the importance of footcare The average person walks the equivalent of four times around the earth in their lifetime. The feet take the majority of this impact. More specifically; the 33 joints, 26 bones, 19 muscles and 107 ligaments of the foot are exposed to this constant pressure and shearing force. It is not surprising therefore that any problems with the foot can have a huge impact on an individual’s mobility and overall wellbeing. Pharmacists are often the first point of contact for people experiencing problems, according to Deirde Duignan of Whelehans Pharmacy, Clonmore, County Westmeath. “A lot of people won’t necessarily go to their doctor for foot problems so the pharmacist is the most accessible option for information”. Deirdre ranks problems such as athlete’s foot and fungal nail infections among the most common she encounters in the pharmacy. Athlete’s foot usually develops because of excess sweat or moisture between the toes and it is most prevalent in teenagers and young adults. Fungal nail infections can also require a course of treatment lasting several weeks. Deirdre believes that pharmacists need to educate the patient on the importance of foot care and regular inspection. She said: “It would ultimately save a lot of problems down the line if these measures were in place.” Deirdre said that foot problems are more common in older adults and therefore this group requires special input. As well as fungal infections, they experience problems such as corns, calluses, bunions and sprains from falls. When advising on treatment, Deirdre also examines footwear as often this is the root source of many problems. “The pharmacist has a role to play here too, in terms of making the patient aware”. Whelehans Pharmacy places huge emphasis on the importance of good foot care. They have a dedicated foot clinic with podiatrists on site to treat various ailments. Deirdre who is a
The pharmacist is often the first port of call for footcare patients
pharmacist there, states that the relationship she and other staff have with the foot clinic is paramount to providing successful outcomes. David Watterson who manages the podiatry clinic in Merlin Park Hospital, Galway believes that a multidisciplinary relationship is still lacking. “We don’t work with the pharmacist as much as we should. It is something we should look at. We certainly rely on pharmacists to support our clients in the community more than we realise”. He echoes Deirdre’s belief that better footcare starts with better communication. “As with all MDT systems, communication is critical. I think a start would be to reach out to our local pharmacists and ask them to come and meet with us and see how we can work together more closely to improve the outcomes for our clients”. David primarily treats patients who have manifestations of often avoidable problems “The majority of podiatry services in the HSE are ‘needs led’. This
means that the clients who need the service the most get access as a priority. So as a result we see a lot of Diabetic foot wounds, end stage rheumatology clients with massive foot deformity and pain.” Diabetes Ireland believe that the HSE should adopt a more preventative approach to foot care. They enforce the belief of pharmacists and podiatrists by calling for more education and health promotion surrounding foot care. They state that at risk groups should be the focus of such campaigns and they call for a nationwide foot-screening programme as one such measure. The number of amputations of lower limbs continues to rise annually and this figure could be drastically reduced with the introduction of this programme. Diabetes Ireland states: “Lower limb amputation is one of the preventable potential complications of long term poorly controlled diabetes. However, due to continued under-resourcing of podiatry services, there is inadequate specialised early screening and thus the lack of early intervention for patients who require it”.
As well as improved patient outcome, a screening programme would be a cost effective measure, as it would reduce the financial burden these surgeries and treatments place on the health system. In 2015, an Irish Study showed that the average inpatient hospital treatment of a diabetes related foot ulcer was ¤30,000. In total, the cost to the HSE of treating 451 diabetes related lower limb amputations was over ¤13.5m for that year. When the cost of treating a further 1,948 diabetes patients admitted to hospital for foot ulceration treatment was added to that, the total cost to the HSE was over ¤71m in 2015. In 2016, the estimated in-patient hospital cost to treating 2,820 people with diabetes related foot complications was at least ¤84m. The introduction of a nationwide screening programme would cost considerably less than ¤84m. It would also lead to improved diagnosis, as according to Diabetes Ireland, 25% of people with diabetes are unaware that they have the condition.
Awards The Irish Pharmacy
Saturday 12th May 2018, Clayton Hotel, Burlington Road, Dublin
Nominations are now open for the Pharmaton People’s Pharmacist of the Year 2018 The nationwide search for Ireland’s People’s Pharmacist of the Year 2018 is now under way. One of the most important accolades in the Irish Pharmacy Awards, this award appeals to both industry and community to select the pharmacist they feel brings the most to their community and its patients. This award showcases how pharmacists connect with and build relationships within their local community. This award category recognises the pharmacist’s commitment not only to their role, but also to the training and education they may provide to their pharmacy staff. The knowledge and dedication of a community pharmacist can bridge the gap between suppliers and pharmacy staff on the front line. Establishing a personal relationship between pharmacist and patient can help improve health outcomes by allowing customers to feel comfortable and confident in working with their pharmacist for information This is the sole award in which the finalists are nominated by and then voted for by the general public, ensuring that the local community is involved in the build-up to the awards themselves. Members of the public can nominate their favourite pharmacist, be they working in an independent or multiple store, or if they are working as a locum or superintendent in any pharmacy in Ireland. Most important in this category is the place of the pharmacist within the community and the services provided to patients. In 2017 the People’s Pharmacist of the Year Award went to Kilian McGreal of McGreal’s Pharmacy after an overwhelming response of more than 9,000 votes on social media, proving that he truly was the people’s choice. According to those that nominated him, Kilian is known for going above and beyond the call of duty for his patients and is known throughout his community for the consistently high standard of care he gives. Speaking to IPN about his win and the effect that it has had on both him and his pharmacy team, Kilian said: “it was an absolute honour to win the People’s Pharmacist of the Year Award last year. “It was a great reflection of all the amazing work the team at McGreals have done. We were overwhelmed with the amount of people that popped in to congratulate us after winning the award which could not have been achieved without the unbelievable support from the communities we are in.” To nominate your choice of People’s Pharmacist of the Year 2018 send an email with the name, pharmacy and contact details of your chosen pharmacist along with a supporting statement to email@example.com by midnight on April 22, 2018. The top four pharmacists nominated will be selected by judges and then put to a vote on social media until May 11, 2018. Nominations and social media votes are open to all members of the general public and the pharmacy industry.
Pictured at the Pharmaton People’s Pharmacist launch are Tanya O’Toole, Head of Consumer Health Care, Sanofi, with Awards host Jennifer Zamparelli
Flexible dosing to suit a wide range of patients.1–3
Constipation relief for everyday people. MOVICOL®, MOVICOL® Liquid Orange Flavour and MOVICOL® Paediatric Plain. Prescribing Information REFER TO FULL SUMMARY OF PRODUCT CHARACTERISTICS (SmPC) BEFORE PRESCRIBING Presentation: Movicol Sachet of white powder which dissolves in about 125ml of water to make a lemon/lime flavoured drink. Each sachet contains: 13.1250g macrogol 3350, 0.1785g sodium hydrogen carbonate, 0.3507g sodium chloride and 0.0466g potassium chloride. Movicol Liquid A clear concentrated liquid, which is diluted in water to make an orange flavoured drink. Each 25ml of Movicol Liquid is diluted in 100ml of water before use and contains the following active ingredients: 13.1250g macrogol 3350, 0.1785g sodium hydrogen carbonate, 0.3507g sodium chloride and 0.0466g potassium chloride. Movicol Paediatric Plain Sachet of white powder, which dissolves in about 62.5ml of water. Each sachet contains: 6.5630g macrogol 3350, 0.0893g sodium hydrogen carbonate, 0.1754g sodium chloride and 0.0251g potassium chloride. Does not contain flavourings or sweeteners. Uses: Movicol: Treatment of chronic constipation and faecal impaction in adults, adolescents (aged 12 years or older) and older people. Movicol Liquid: Treatment of chronic constipation in adults, adolescents (aged 12 years or older) and older people. Movicol Paediatric Plain: Treatment of chronic constipation in children aged 2-11 years. For the treatment of faecal impaction in children from the age of 5 years. Dosage and administration: Movicol Chronic Constipation: Adults, adolescents (aged 12 years or older) and older people: 1-3 sachets daily in divided doses, according to individual response. For extended use: adjust dose down to 1 or 2 sachets. Children (below 12 years): not recommended. Alternative Movicol products are available for children. As for all laxatives, prolonged use is not usually recommended. Extended use may be necessary in patients with severe chronic or resistant constipation, secondary to multiple sclerosis or Parkinson’s Disease, or induced by regular constipating medicine, in particular opioids and antimuscarinics. A course of Movicol treatment does not normally exceed 2 weeks, but can be repeated if required. Faecal Impaction: Adults, adolescents (aged 12 years or older) and older people: 8 sachets per day. A course of treatment for faecal impaction does not normally exceed 3 days. The 8 sachets should be taken over 6 hours (2 sachets per hour maximum in cardiovascular impairment). The 8 sachets may be dissolved in 1 litre of water. Children (below 12 years): Not recommended. Alternative Movicol products are available for children. Movicol Liquid Chronic Constipation: Adults, adolescents
(aged 12 years or older) and older people: 25ml diluted in 100ml of water 1-3 times daily in divided doses, according to individual response. For extended use, the dose can be adjusted down to 1 or 2 doses per day, each consisting of 25ml diluted in 100ml of water. As for all laxatives, prolonged use is not usually recommended. Extended use may be necessary in patients with severe chronic or resistant constipation, secondary to multiple sclerosis or Parkinson’s Disease, or induced by regular constipating medicine, in particular opioids and antimuscarinics. A course of Movicol Liquid treatment does not normally exceed 2 weeks, but can be repeated if required. Movicol Liquid is not recommended for faecal impaction Movicol Paediatric Plain Chronic Constipation: The usual starting dose is 1 sachet daily for children aged 2-6 years, and 2 sachets daily for children aged 7-11 years. The dose should be adjusted up or down as required to produce regular soft stools. If the dose needs increasing this is best done every second day. The maximum dose needed does not normally exceed 4 sachets a day. Treatment of children with chronic constipation needs to be for a prolonged period (at least 6-12 months). Faecal Impaction: Escalating dose regimen starting with 4 sachets a day up to 12 sachets a day (at day 7) for children aged 5-11 years. Refer to Summary of Product Characteristics (SmPC) for full dosing recommendations. Not recommended in children with cardiovascular impairment or renal insufficiency. Doses for prevention of re-impaction should be as for patients with chronic constipation. For patients of 12 years and older it is recommended that Movicol is used. Contraindications: Intestinal perforation or obstruction due to structural or functional disorders of the gut wall, ileus and severe inflammatory conditions of the intestinal tract, such as Crohn’s disease, ulcerative colitis and toxic megacolon. Hypersensitivity to macrogol, or any of the excipients. Warnings and precautions for use: The fluid content of the re-constituted solution does not replace regular fluid intake and adequate fluid intake must be maintained. Diagnosis of impaction should be confirmed. If patients develop any symptoms indicating shifts of fluids/electrolytes the product should be stopped immediately. When using paediatric forms of Movicol to treat faecal impaction, use with caution in patients with impaired gag reflex, reflux oesophagitis or diminished levels of consciousness. Movicol Liquid contains benzyl alcohol. Do not exceed the maximum recommended daily dose.
macrogol 3350, sodium hydrogen carbonate, sodium chloride, potassium chloride Interactions: There is a possibility that the absorption of concomitantly administered medication could be transiently reduced. Pregnancy and lactation: Can be used during pregnancy and lactation. Undesirable effects: Reactions related to the gastrointestinal tract are the most common and include: abdominal pain, abdominal distension, nausea, vomiting, dyspepsia, diarrhoea, flatulence, borborygmi and anal discomfort. Allergic reactions, including anaphylactic reactions, dyspnoea and skin reactions (e.g. angioedema, urticarial, pruritus, rash and erythema) can occur. Other effects can include electrolyte disturbances, headache and peripheral oedema. Licensing and legal category: Movicol Legal category: Subject to prescription; MA number: PA 0102/023/002. Movicol Liquid Legal Category: Subject to prescription; MA number: PA 1336/2/4. Movicol Paediatric Plain Legal Category: Subject to prescription; MA number: Number PA 102/23/4. For further information contact: Norgine Pharmaceuticals Limited, Norgine House, Moorhall Road, Harefield, Middlesex, UK UB9 6NS +44 1895 826606 E-mail: firstname.lastname@example.org Date of preparation: Jan 2018 Version number: UK/MOV/0118/0183
Healthcare professionals are asked to report any suspected adverse reactions via HPRA Pharmacovigilance, Earlsfort Terrace, IRL - Dublin 2; Tel: +353 1 6764971; Fax: +353 1 6762517. Website: www.hpra.ie; E-mail: email@example.com. Adverse events should also be reported to Medical Information at Norgine Pharmaceuticals Ltd on +44 1895 826606. References 1. Attar A et al. Gut 1999;44:226–30. 2. Gruss HJ, Ulm G. Eur J Ger 2004;6(3):143–50. 3. Thomson MA et al. Arch Dis Child 2007;92:996–1000. Date of preparation: March 2018. Code: UK/MOV/0118/0186. MOVICOL, NORGINE and the sail logo are registered trademarks of the Norgine group of companies.
Weighing up the benefits of point of care testing for community pharmacists
By Paul Knox
Point of Care Testing (POCT) is defined as laboratory tesing conducted close to the site of patient care.i Since the turn of the decade, there has been advances in diagnosic technology has seen an increase in the demand for and provision of POCT in primary and community care environments, including community pharmacy. This article will chart the advent and evolution of this relatively new aspect of community pharmacy; its incoporation or otherwise into the present field; barriers to its use and what the future may hold for it. Since 2010 all pharmacies have a designated consultation room, ostensibly for private patient consults, but (assuming it adheres to requisite size parameters) it can be employed as a site where supplemental clinical services can be proffered. Ironically, POCT allows healthcare to revert to the paradigm of early western medicine where it was delivered primarily in the patient’s home and what limited testing was available was provided directly at this point of care. As the science and technology developed rapidly in the mid-to late twentieth century, care shifted to hospitals with an emphasis on treating injuries and curing acute disease. As the technology improved further, more pertinently with respect to disease biomarker identification; instrument miniturisation, assay automation, sensors and computing, POCT was born. The health and economic value in absolute terms, however, regarding of these advancements remains to be seen.ii The mere availabilty of a POCT sometimes does not warrant or justify its use either econmically, ethically or prognsotically, notwithstanding any critical information a test may offer about a patient’s health status. However, this is natural function of the increased prevelance of POCT in the community and the marketplace; some POCT kits, such as blood pressure monitors or urinalysis kits can be ordered delivered directly to the patient. It is preferable, surely, to have the patient attend a trained professional to ascertain and interpret results of such testing as opposed to attempting it at home and drawing conclusions about the results, postitively or negatively. In any event, POCT is a sign of the changing times and community pharmacy must move accordingly. To this end, a report was commissioned in 2008 by the PSI, HSE, IMB and various other stakeholders entitled “Guidelines for Safe and Effective Management Use of Point of Care
Testing in Primary and Community Care”. The report listed key recommendations for the safe use and management of POCT in primary care, and these are as follows – • A system for clinical and managerial governance of the service should be established including a person designated as responsible and accountable for the service • The providers should be aware of and cognisant of laboratory services in their locality which can provide expertise if required • POCT should be carried out by appropriately trained competent staff • Standard operating procedures should be developed and implemented for all aspects of the POCT service, including the performance of the POC test, record keeping, interpretation of results, patient referral criteria, quality assurance, patient and staff safety and health.
• Quality assurance is key to assuring the accuracy and reliability of a POCT service and quality control testing should be performed for POC tests in accordance with manufacturer’s instructions. It is further recommended that POCT providers should participate in External Quality Assurance (EQA) schemes, where available. • Patient results should only be interpreted and reviewed by appropriately trained personnel. • All patient and quality control results should be recorded appropriately either via paper or electronic format in accordance with defined procedures and the Data Protection Act. • Appropriate referral criteria should be in place to ensure that confirmatory testing is performed and patients are referred for further medical attention as necessary. • All adverse incidents that occur with POCT devices must be reported to the manufacturer
and/or the Irish Medicines Board (IMB) using the appropriate form located on the IMB website (www.imb.ie) and/or the appropriate professional regulatory body, if necessary. • POCT should be reviewed and monitored on an ongoing basis and a test should be withdrawn or suspended in the event of a safety related issue e.g. a recall. • POCT devices should be CE marked as this is an indication that the device meets the requirements of the relevant legislation. Blood pressure monitors must comply with S.I. No. 252/1994 – European Communities (Medical Devices) Regulations. • It is the responsibility of the service provider to ensure that appropriate occupational health advice is provided to staff performing POCT. • Records should be kept of staff who have been trained in carrying out and/or interpreting test results.
The two key components, according to the report, of a successful POCT are accuracy and reliablity. It specifies that POCT should supplement rather than supercde conventional laboratory testing. POCT comprises three aspects 1. Diagnosis 2. Monitoring 3. Screening In a pharmacy setting, POCT is primarily used for screeing purposes such as blood pressure monitoring or BMI testing. A robust system of patient consent, followup and referral must be devised and implemented and reflected accurately in a corresponding standard operating procedure, as highlighted above. Ultimately, any test results which are employed for diagnosis or critical management decisions, or yield anomalous or unexpected results, should be confirmed by hospital laboratories. Examples of POCT in community pharmacy Blood Glucose testing (including self-tesing devices); Urinalysis; Cholesterol; Anticoagulation therapy monitoring (including selftesting devices); Prostate Speicfic Antigen test; Haemoglobin; Chlamydia trachomatis kits; Faecal occult blood tests; Helicobacter pylori tests; HbA1c; Blood pressure and 24 hour monitoring; Pulse oximiter; Thermometer; BMI; Pregnancy; Spirometry/peak flow; Dexascan. As the above list highlights, the list of POCT is long and not exhaustive. Some tests are non-invasive which require minimal training, time, cost and preparatory work; while some are time consuming, difficult, detailed and expensive. Where appropriate, POCT should be considered if the following conditions are met – • Safety • Quality • Cost effectiveness • Improved Outcome – patient (clinical or satisfaction), health system • Improved effeciency – doctor, patient, health system • Reduced global cost The underlying question is whether it is feasible and economically sensible for pharmacists to take on this extra burden in their practice. The answer is multidimensional and dependent on a number of factors which will be discussed but can be essentially distilled to how the following three key questions are considered – 1. Will POCT benefit my patients? 2. Will POCT benefit my business?
3. Will POCT improve my job satisfaction and expand the role of pharmacist to a useful extent? POCT in community pharmay and the patient It is an unassailable fact that POCT is convenient, expedient and efficient phenomenon that encourages patients to enhance understanding and awareness of the disease. The potential positive patient outcomes are mutltifold – • Reduced number of clinic visits • Reduced length of hospital stay • Earlier discharge from hospital • Fewer unneccessary hospital admissions • Better optimised drug treatment • Less inappropriate use of drugs • Improved quality of lifeiii While the above outcomes may be true in a general primary care setting, it remains to be seen how POCT in community pharmacy, per se, benefits the patient. For example,the simplest and cheapest POCT is measuring blood pressure and it has been shown to be a useful tool for assessing BP in treated hypertensive patients. However, there is still lack of evidence on the ability of this method to identify hypertension. The latter conclusion is the nub of the issue – I would venture that the pharmacist’s role is not to identify a condition, but to identify those whom need to be referred for the possible diagnosis of a condition. A patient who is feeling unwell can present off the street and be strapped to blood pressure monitor within minutes of entering the pharmacy, normally without incurring any cost, and referred where appropriate. This is POCT in community pharmacy working optimally for the patient – blood pressure monitoring does not take very long, doesn’t cost anything and the patient receives expert advice from a trained professional. The same applies to BMI and weight loss programmes. The pharmacist is, in effect, giving their time and expertise free of charge to a patient they may never see again; I am unaware of any other health profession where this is a working, successful business model. Problems may arise for the patient, on the other hand, if they have to pay for POCT. The average cost of a 24-hour blood pressure monitoring service is ¤50. These machines are rented (or bought outright) and furnished to the patient and the findings forwarded to the GP. This seems like a perfect use of primary care resources with the ultimate benefit to the patient, but in many cases the GP will insist on redoing the test at further cost to the patient rendering the first test superfluous, at best. Some
pharmacies navigate this problem by inviting the practitioner to attend to the patients themselves e.g. opticians, audiologists, radiographers, dieticians, and cancer prevention specialists.v This service has the added benefit of freeing the pharmacist to attend to the primary function of the pharmacy while reinforcing the idea that the pharmacy is a bona fide health resource Also, it may be beneficial for the patient to demonstrate POCT on themselves under the pharmacist’s supervision and assess their technique – it may be more prudent to watch a diabetic test their own blood rather than performing the test on them – teach a man to fish etc.. Ultimately, POCT has benefited the patient, but in community pharmacy it should be cheap, efficient and have the full cooperation of the local GPs and practitioners. There is no point in the pharmacist wasting resources if any results are ignored or circumvented down the line. The test should, in my opinion, be used to refer, not to diagnose. POCT and the pharmacist There does seem to be an increasing appetite for an exapnsion of the pharmacist role, clinically and otherwise. A 2011 report commissioned by the PSI on community pharmacy practice in Ireland described the attitude to providing POCT as ‘mixed’. This ambivalence stemmed from the lack of remuneration for providing such services, and the cost of training in the first place. Practicality will trump idealism in most instances, and pharmacists don’t have the time to attend to POCT unless they have a second pharmacist in the dispensary, and that second pharmacist will have to be paid. Fear of disrupting the sometimes fragile relationship with local GPs and the lack of specific, validated training was also touted as a potential barrier. In the interim, however, pharmacists have demonstrated an increased capacity to perfrom similar clinical functions as is borne out by the increasing number of flu vaccinations being delivered year on year - with 9125 in the inaugral season of 2011/12 to 78935 in the 2016/2017 and that is expected to rise again by the close of the 2018 season. This eightfold increase highlights the successful introduction of an analagous clinical POCT type service. The barriers espoused in the 2011 report have been addressed with quality training and HSE pro rata remuneration being delivered. Patients touted convenience, less waiting time and less cost as the
key benefits of this service, and these are in line with what was discussed above about the virtues of POCT. The vaccination service is a viable, accredited alternative to going to the GP. However, the law of diminishing returns applies to flu vaccines as it would to POCT. To ensure the service is econmically viable, ancecdotally at least 60-100 vaccines will have to be administered. Most of these vaccines will be administerered in a two month window in October and November. If the demand and uptake grows and the time per vaccine per patient is 15 minutes, the pharmacist administering the vaccine literally won’t have time for any other POCT during these months – the more the pharmacist does of one the less he/she can do of the other. This time contraint will correspondingly bring up the thorny issue of the pharmacist’s workload and the necessity of a second pharmacist which is an impossibility in most independent pharmacies. While some pharmacist see POCT as a positive exapansion of our role, enhancing or job satisfaction and our place in the public consciousness, other pharmacists tend to see POCT as a red herring: it is optically impressive but econmically neutral, if not negative, depending on the test performed.vi Perhaps it may be more prudent to focus our intrinsic skills already in situ, where there is an absoluteness about the service being provided. The minor ailment scheme, Medication Usage Reviews, the New Medicine Service for chronic diseases may be a better use of the pharmacist’s time and can be more easily funded. Conclusion The uptake in vaccination services highlights a turning point in the public’s perception of the profession from drug centred to a profession providing a broader range of health-care services and management. POCT has the capacity to enhance this perception further. Ideally, POCT provides an oppurtunity for phamacists to become more directly engaged with patients in terms of monitoring their care. Successful POC testing services in community pharmacy rely on utilising resources, cooperatoin and partnering with local practitioners, providing meaningful tests for people (the degregulation of food tolerance testing in pharmacies in January did not help credibilty in this regard) within the financial parameters of the pharmacy, worklow and marketing to provide indivdualised and patient focused care. References on request
Irish pharmacists call for more collaboration with HSE Pharmacists have called on the HSE to do more to raise the profile of pharmacy services on a national level, stating that it could help save the health service millions of euro a year. Keith Brennan, chairman of Indepharm Co-Op and Haven Pharmacy, told Irish Pharmacy News that pharmacists are in "an ideal position" to deal with many minor ailments, thus reducing the need for some patients to visit GP surgeries and help GPs keep more patients out of A&E. “If you have been unlucky enough to visit A&E recently, you will have seen the pressure that service is under,” said Brennan. “We're the easiest point of contact for any member of the public looking for help or information, so it's crucial that we continue to promote this to the public. I think community pharmacists are working hard to promote our services locally, but more can be done to raise the profile on a national level,” he added. Brennan stated that the Irish Pharmacy Union's (IPU) longrunning campaign, 'Ask your Pharmacist First', has helped promote pharmacies as a first port of call for the public, however he believes that the HSE should be working in a more collaborative way with pharmacists. “Together we could develop a range of services which would help reduce the burden on GP surgeries and A&E departments, for which pharmacists could be fairly reimbursed. The community pharmacy network is a resource the HSE has not fully utilised.” Brennan revealed that flu vaccinations continue to grow year on year for pharmacists, while health screening is widely available, particularly for blood pressure, diabetes and cholesterol. “I think the public awareness of these services is mixed, as services provided from pharmacy to pharmacy are mixed. The blocker for the roll out of additional services is
simply financial. Pharmacists can deliver excellent services and be an invaluable asset in the primary care system, if they can find a way to be consistently and fairly paid for their time and expertise,” he said. Victor Murphy, supervising pharmacist at Conways Pharmacy in Ashbourne, Co. Meath, has echoed Brennan's sentiments, agreeing that pharmacists can “definitely help take pressure off the country's exceedingly stretched GPs and A&E units.” “I don't feel the public are fully aware of the services we provide and I feel we need the HSE to help promote pharmacists on a national scale,” Murphy told Irish Pharmacy News. “Pharmacists have great knowledge and experience in dealing with overthe-counter treatable aliments, and as a result can reduce the queues in GP surgeries.” Murphy also believes that community pharmacies need more support from the HSE and that offering additional serves is putting them under increased pressure. “We need the HSE to promote the benefits of attending your pharmacy first and to help fund pharmacies by introducing a Minor Aliment Scheme. “We are under a lot of pressure from Primary Care Reimbursement Service with regards to approvals for phase dispensing, new drug approvals and mountains of paperwork. We need to be funded for the excellent work we do with our communities.” In recent months, the IPU has argued that pharmacies should be allowed to reduce pressure on GP services by prescribing drugs for minor ailments themselves, stating that nearly one million prescriptions a year were filled for medical card holders needing over-the-
Darragh O’Loughlin, general secretary of the IPU
counter treatments, adding that if those patients could access the drugs free of charge through their pharmacies it would free up hours of valuable GP time. Darragh O’Loughlin, general secretary of the IPU, said change was vital as both doctor’s offices and hospitals were overcrowded. “Community pharmacists can play a greater role in patient care, particularly at times such as now when the rest of the healthcare system is under extreme pressure. A Minor Ailment Scheme could divert patients away from busy GP surgeries when their ailment is one that can be treated by a pharmacist, allowing GPs more time for treating patients with more complex illnesses.”
He added that similar schemes already operate very successfully in other jurisdictions, including the UK. The scheme was piloted in Ireland in 2016 but it has not been implemented yet. “It is ironic that the HSE is now actively encouraging patients to visit their local pharmacy and avoid overcrowded GP surgeries while, at the same time, little effort has been made to introduce an initiative that the public overwhelmingly wants and which would offer immediate benefits to the public and to the whole healthcare system,” said O’Loughlin.
Marketing News MAJOR MARKETING DRIVE FOR CAREPLUS PHARMACY AS BRAND GROWS CarePlus Pharmacy, Ireland’s fastest growing brand for independent pharmacists, has engaged in significant marketing activity as it rapidly grows its network across the country. The brand has appeared prominently on television in recent weeks, spreading the message about the importance and value of community pharmacy to a wide audience. The marketing drive coincides with the opening of eight new CarePlus Pharmacies around Ireland, and is focused on the group’s core message to consumers - “Let Us Look After You”. As part of the sponsorship deal, carefully crafted videos shot on site at a recently refurbished CarePlus Pharmacy will feature prominently during the programme and on-line. The sponsorship agreement with TV3 and Virgin Media Solutions also sees the rollout of a catchy new jingle, incorporating the key message “Let Us Look After You”, which will be used in future advertising and sponsorships. TV3 have described the CarePlus Pharmacy brand as a “perfect fit” for the third series of Paramedics.
Paramedics, sponsored by CarePlus Pharmacy, is on TV3 every Thursday in April
In late March, CarePlus Pharmacy was confirmed as the sponsor of fly-on-the-wall documentary Paramedics on TV3, which follows the work of frontline paramedics around Ireland. The series - which airs in the primetime slot of 9pm on Thursdays - has an expected audience reach across its six episodes of 1 million people. Paramedics has gained exclusive access behind the ambulance doors, on the road and in the air with Ireland’s frontline HSE paramedics in communities across the country. With unprecedented access to 999 call takers, viewers will witness first-hand what ambulance crews face from car crashes to cardiac arrests, and the pivotal role they play in all of our lives. “Ireland’s paramedics provide an amazing service to the same communities that our pharmacists serve”, said CarePlus Pharmacy Commercial Director, Niamh Lynch, “We are delighted to be able to sponsor this programme, as it shows us all the importance of our first responders, who are always there when we need them. TV3 Ireland has a proven track record of producing quality programming, and we are happy to partner with them on this project.”
CarePlus Pharmacy has also sponsored appearances by its brand ambassador Lucy Wolfe on the ever popular RTE Today with Maura and Daithi. Both appearances by the hugely popular “Baby Whisperer” drew a big response from the viewing audience both to the studio directly and online. Lucy’s appearance on RTE One complimented a series of free CarePlus Pharmacy sponsored Baby Events in communities across Ireland. These events in Cork, Limerick, Wicklow, Galway and Kinnegad - were organised by local CarePlus pharmacies and were free of charge to CarePlus customers. Attendees at each roadshow heard how dedicated in-store “Baby Advisors” were recently appointed in-store, to help parents during those important first few months of baby’s life. Each of the advisors underwent comprehensive training ensuring they can provide the highest level of care to parents in the comfort of their local pharmacy. A “CarePlus Loves Baby” event took place in all Pharmacies in March, which not only drove category sales up by 50% but also introduced many new parents to the CarePlus Pharmacy brand. CarePlus has also launched its “Babyclub”. Every member receives a new “Baby Welcome Kit” complete with first aid box, samples and gifts from their local CarePlus Pharmacy. Members of the “Babyclub” will also receive monthly updates on all key
Janet O'Reilly (left), Pharmacist; and Sile Kierans (right), Manager, CarePlus Little Island; pictured with CarePlus Brand Ambassador, Lucy Wolfe during Lucy's visit to CarePlus Pharmacy in Little Island, Co Cork. Lucy is Ireland's leading paediatric sleep expert, and has been announced as Brand Ambassador. Picture: Michael O'Sullivan/OSM Photo
promotions and events as well as expert advice.
Ireland, with an expansion to 12 in Dublin alone since 2015.
Sources at CarePlus Pharmacy have also told Irish Pharmacy News that an announcement is expected shortly on another major sponsorship deal that will bring the brand closer to communities around Ireland.
Amongst the recent new additions to the network are pharmacies in Swords, Killarney, Roscrea, Coachford, Ballymakeera, Mitchelstown, Westport and Rathdowney. Further announcements are expected in the coming weeks, as CarePlus Pharmacy continues its drive to become the biggest brand for independent community pharmacies in Ireland.
CarePlus Pharmacy was the proud sponsor of the Family Carers Ireland’s “Carer of the Year Awards” in 2017. Each of the 250 attendees at a recent Family Carers Ireland respite weekend in County Wexford received a CarePlus Pharmacy goodie bag, as a small token of appreciation for their hard work on behalf of their community. CarePlus Pharmacy is looking at ways of further engaging with carers around Ireland in recognition of the work they do every day to help family and friends, and is working closely with Family Carers Ireland in that regard. CarePlus Pharmacy has enjoyed substantial network growth in the past twelve months, attracting independent pharmacists around the country to join the brand. Last November, CarePlus Pharmacy announced plans to create 70 new jobs through the addition of 12 new pharmacies to the franchise. The announcement brought to 51 the number of outlets across
CarePlus Pharmacy is committed to supporting independent pharmacists serving their local community, and securing the future of up to 500 jobs in the pharmacy sector across Ireland. “As independent pharmacies around Ireland face increasing challenges, joining CarePlus Pharmacy makes sense”, said CarePlus Pharmacy commercial director Niamh Lynch, “Being part of a group provides strength through unity, and our marketing drive shows how serious we are about spreading the CarePlus Pharmacy message to communities across Ireland. We are proud to welcome our newest members, and look forward to making many more announcements in the weeks and months ahead”.
Hay Fever - Key Market Trends Key market trends in the Child and Babycare Category identified and discussed by Anne-Sophie Martin, Brand manager for GP number 1 recommended, 100% natural sea water nasal spray brand STÉRIMARTM. driven by decongestants, although hay fever is also a strong subcategory .
According to Mintel reports, not only do a quarter of parents in the UK who have children between the ages of 0 to 2 like to use natural alternatives to personal care products on their children, but one fifth are worried their children are sensitive or allergic to certain ingredients in personal care products. This means that many parents now not only want to know that products are effective, and ‘more natural’ but also they are becoming much more aware of what the different ingredients are in the products they are using, investigating that their full ingredient list is completely safe before believing brand and packaging claims. This is a trend that is predicted to grow throughout the healthcare market in general, as shoppers become more conscious about what they are putting in their own and especially their children’s bodies, opting for products that they perceive to be the ‘healthier alternative’ with minimal or no risk of potential side effects. It is not enough for brands to just state their natural qualities anymore, they need to be able to prove it with ‘nothing to hide’ ingredients and straightforward claims clearly stated on pack. But while they are becoming more savvy, research conducted on behalf of STÉRIMARTM towards the end of 2016 showed that while parents are open to trying new products if they think they will work and are recommended by peers, they are still looking to GP’s as a first port of call for advice on treatment. This is mainly due to the
fact that they think the childcare category can be confusing and hard to navigate themselves, with many products lacking clear benefits and reasons to believe. This is a great opportunity for Pharmacies to bridge the gap between GP advice and peer recommendation, helping parents to navigate through the array of products available. By ensuring that staff are knowledgeable about which products are not only effective, but also the ones that are most often recommended by GPs and which are completely natural, will help position them as a trusted and convenient destination for parents to get advice and treatment recommendation for their children. This can be coupled with ensuring that the childcare products are well categorized at shelf to make it easy for parents to navigate at point of sale. If possible, products could be grouped by ailment and put in age suitable order. Opportunities for pharmacy businesses with the Stérimar™ children’s range According to Kantar Worldpanel and Nielsen Scantratck data 28.01.2017, the Nasal Spray category is a growing area within healthcare. In 2016 the Nasal Spray market grew by 10.3%, attracting 91k more shoppers than the previous year, with the average price rising by £0.25 . New launches and higher price points play a key role in contributing to the growth in this area, mainly
STÉRIMAR™ range of natural sea water based nasal sprays is one of the brands that has helped drive the growth of the Nasal Spray category. Last year, Stérimar grew by 18.3% and attracted an impressive 77k more shoppers. Stérimar is now standing as the 7th largest brand in the whole nasal treatment market with the second largest percentage value growth. The brand is also thriving across the sub-categories becoming the 6th biggest brand in the decongestant sector, the 4th biggest brand in the children’s sector and the 3rd biggest brand in the overall hayfever sector. This is supported by the fact that it is the UK’s GP number 1 recommended brand as well as the fact that the products in the children’s range contain only natural sea water and purified water with some additional copper salts for Stérimar Kids. These gentle yet effective products tick several of the key boxes for parents who are seeking healthier alternatives. How does StérimarTM brand intend to support the pharmacist this year? Stérimar sees pharmacies as key partners. In 2017 Stérimar are planning a campaign to help educate and inform pharmacists on the best treatments inspired by nature that can effectively meet customer’s specific needs. They will do this by rolling out three bursts of activities – with a focus on winter ailments in Q1 and Q4 and hayfever in Q2 and Q3. Activities will involve the development of highly valued and accredited educational tools. This will include CPD and educational guides to support HCP’s professional development and provide them with the confidence needed to recommend effective solutions to their patients. We anticipate this will result in a sustainable growth for our partnered pharmacies.
How to Make the Most of the Hay fever Sub-category? Anne-Sophie Martin says, “Pharmacies should present themselves as the convenient destination for informative advice and products that will address symptoms quickly and effectively. It also presents an opportunity to not only drive sales on treatments but also support this as upsell of products with preventative properties, or natural products that can complement their existing treatment choice for more efficient management of symptoms Stérimar hay fever products have a base of 100% natural purified sea water and can be used alongside a nasal congestion medication and antihistamines based on medical advice. This means that pharmacists are able to up sell and widely recommend Stérimar in the knowledge that it is safe to use and will not cause any rebound congestion. Customers should also be educated on the relevance of preventative solutions when tackling hay fever symptoms. As the first line of defence against pollen, it is essential to keep your nose as healthy as possible to help protect from the symptoms of hay fever. Washing your nose daily with an isotonic solution will simply wash away contaminants and debris trapped in the nose while helping prevent the onset of allergic reactions, and ensuring the nasal lining is kept moistened. Advise your customers to start using Stérimar nasal sprays well in advance and a couple of weeks before they usually start experiencing symptoms and to keep using it regularly throughout the season to keep symptoms at bay.
For more information, samples and pricing please contact your Intrapharma Representative on 01463 2300
Listen out for the Pollen Count brought to you by Sterimar April to June
Allergic rhinitis â€“ how to reduce exposure to triggers
By Eamonn Brady MPSI
Allergic rhinitis is inflammation of the nasal passages caused by an allergen, such as pollen, dust, mould or skin flakes from certain animals. Hay fever is a type of allergic rhinitis caused by pollen or spores. Allergic reaction Allergic Rhinitis is an autoimmune condition so symptoms occur when the immune system overreacts to a normally harmless substance (e.g.) pollen. When the body encounters an allergen, cells in the lining of the nose, mouth and eyes releases histamine triggering symptoms of an allergic reaction. Prognosis Hay fever cannot be cured completely. Data suggests children sometimes improve with age, although many have persistent and worsening symptoms. In adults, the condition is usually persistent with some improvement in older age. Hay fever can cause serious symptoms if left untreated. Total nasal obstruction may cause sleep apnoea, frequent sinus infections, interference with daytime breathing and ear infections.
Hay fever affects the nose, sinuses, throat and eyes. Hay fever usually occurs during the spring and summer months. Exactly when it occurs depends on which pollens the person is allergic to. From May to July grass and flowers are in pollen, so this is the most common time for hay fever. For this article I will refer mainly to hay fever as it is the most common type of allergic rhinitis. Trees, grass and plants release pollen as part of their reproductive process. Mould and fungi also release tiny reproductive particles, called
spores which also cause allergies. People with hay fever can experience symptoms at various times of the year, depending on which pollens or spores they are allergic to. Grass is the commonest allergen implicated with symptoms of hay fever. Hay fever is a common condition that affects around 20% of the population. Hay fever is more likely if there is a family history of allergies, particularly asthma or eczema. It is estimated that up to 50% of asthmatics and up to 30% of eczema sufferers also have allergic rhinitis. Hay fever
usually begins in the early teens and peaks when a person is in their twenties. Symptoms Symptoms of hay fever include sneezing, running nose, watery eyes, nasal congestion, itching in the throat, eyes and ears and swelling around the eyes. Patients with asthma often find that asthma symptoms, such as wheezing and breathlessness, get worse when they have hay fever as well. Sometimes, asthma symptoms only occur during the hay fever season.
Seasonal vs perennial hay feverIf allergen exposure is seasonal, the most likely culprits are tree, flower and grass pollen and the symptoms are predictable and reproducible. Seasonal allergic rhinitis may therefore be diagnosed by the history alone. By comparison, classic perennial allergic rhinitis is associated with nasal symptoms, which occur for more than two hours per day and for more than nine months of the year.3 Perennial allergic rhinitis usually reflects allergy to indoor allergens like dust mites and animal fur. In perennial allergic rhinitis, nasal congestion is common while itchy and streaming eyes is less frequent.6 Pollen Count Hay fever symptoms are likely to be worse if the pollen count
Feature are useful in patients with troublesome symptoms at multiple sites e.g. itching of roof of the mouth, throat or eyes. However, antihistamines may have side effects and drug interactions. There are two main groups of antihistamines: First generation and Second generation. First Generation Antihistamines ("Sedative") Sedation is the most common side effect of these drugs and may affect the patient’s ability to drive and operate machinery and concentrate. They should not be used in patients with prostatic hypertrophy or narrow angle glaucoma. Tolerance to their side effects may develop. Chlorpheniramine (Piriton®) is available over the counter in pharmacies. Piriton® can cause mild drowsiness. is high. This is not determined simply by how many flowers there are, but also by the weather. The amount of sunshine, rain or wind affects how much pollen plants release. Hay fever symptoms tend to begin when the pollen count is over 50. The pollen count is highest in the early evening, so hay fever sufferers are advised to avoid going outdoors at this time. On humid and windy days, pollen spreads easily. On rainy days, pollen may be cleared from the air causing levels to fall. Diagnosis To determine if a patient has allergic rhinitis, the doctor will ask questions to determine cause and type of allergy including the time of day and year the rhinitis occurs (to distinguish seasonal and perennial rhinitis), family history of allergies, medical history, information about medication used including decongestants which can cause a rebound effect and information on pets. The doctor will examine the inside of the nose with an instrument called a speculum. The eyes, ears, and chest may also be examined. Skin tests may be performed. Patients are usually tested for a panel of common allergens. Skin tests are rarely needed to
diagnose mild seasonal allergic rhinitis, since the cause is usually obvious. The skin test is not appropriate for children younger than age 3. Patients should not take anti-histamines for 12 to 72 hours prior to the skin test otherwise the allergy will not show up. Tiny amounts of suspected allergens are applied to the skin with a needle prick or scratch. The patient is tested with selected diagnostic vaccines of tree, grass, or weed pollen, mould, house dust mite, and/or animal allergens. A hive will develop at skin test site within 20 minutes if there is an allergy. Skin allergy tests are popular because they are convenient and inexpensive. They are not 100% accurate. The doctor may take a nasal smear. The nasal secretion is examined microscopically for factors that might indicate a cause, such as increased numbers of white blood cells, indicating infection, or high eosinophil count. High eosinophil counts indicate an allergic condition. Blood tests for IgE immunoglobulin production may also be performed. One test is called the radioallergosorbent Test (RAST), used to detect increased levels of allergen-specific IgE in response to particular allergens. Further
tests may involve a CT scan or a nasal endoscope. Treatment People suffering from hayfever need to try to reduce explosive to triggers such as pollen and dust. I will deal with tips on how to reduce exposure to triggers later in this article. As total avoidance of triggers is impossible, medication is often needed to control symptoms. Treatment in advance of first symptoms is an important aspect of management of hayfever. For example, starting treatment in April; prior to the normal summer increase in pollen count. There are many treatments available to relieve the symptoms. These include antihistamine tablets, nasal sprays and eye drops. Some can only be prescribed by a GP, but many are available over-thecounter (OTC) in pharmacies. Antihistamines Antihistamines are the most frequently used oral medicines for the treatment of hay fever. Many are available without prescription and are a reasonable first line choice for many patients. They are effective in relieving eye symptoms, running nose, sneezing and nasal irritation but have negligible effect on nasal congestion. Antihistamines
Second Generation Antihistamines ("Non- Sedative") Examples include desloratadine (Neoclarityn®), fexofenadine (Telfast®), levocetirizine (Xyzal®), loratadine (Clarityn®) and cetirizine (Zirtek®, Cetrine®). They only require once daily dosage and are non-drowsy. Loratadine and cetirizine are available over the counter without prescription. The non-sedating antihistamines are fast acting, have no reported cardiac side effects, and are not affected by the presence of food in the stomach. However, loratidine is best avoided in elderly patients and patients with liver problems. Decongestants Decongestants have a limited role in hay fever and should be reserved for periods of severe nasal congestion. Nasal decongestants sprays and drops such as Otrivine® should not be used for longer than three to five days because of the possibility of rebound congestion which makes the problem worse. Corticosteroids Nasal drops and sprays reduce inflammation and swelling of the nasal mucosa and in normal dosage side effects are minimal. It is best to start treatment a few weeks before the season begins. All corticosteroids nasal
Enjoy non-drowsy relief from hayfever and other allergies
Medicinal product not subject to medical prescription. Further information available from Rowex Ltd., Bantry, Co. Cork, Ireland Tel No: 027-50077 Fax: 027-50417. PA: 711/088/001, Date of preparation (02-18) CCF No: 20397. Also available in packs of 7.
Always read the leaflet.
Feature sprays appear to have similar efficacy. Fluticasone (Flixonase®), beclomethasone (Beconase®) and Mometasone (Nasonex®) are the most regularly used. There are generic equivalents of all these topical steroids. People find the once daily dosage regimen of Flixonase® and Nasonex® convenient. Side effects are mild and transient and consist of nasal irritation and stinging, dryness, sneezing, sore throat, nose bleeds and fungal overgrowth. They should be avoided during nasal infections. Flixonase® and Beconase® are available to buy over the counter in pharmacies. Oral steroids (e.g.) prednisolone or depot injections (e.g.) triamcinolone (Kenalog®) are only prescribed for certain groups of patients such as those doing exams or those with severe continuous symptoms despite adequate standard therapies. Others Ipratropium bromide nasal spray (Rinatec®) may be prescribed where running nose is the predominant symptom. It does not relieve itching, sneezing or nasal blockage. Azelastine (Rhinolast®) is a prescription only nasal antihistamine spray with a rapid onset of action. It may provide an effective and safe alternative to oral medications. Otrivine Antistin® eye drops are fast acting antihistamine eye drops available over the counter. Hay fever and Pregnancy Topical corticosteroids (sprays and drops) should be used in preference to antihistamine tablets if drug treatment is needed. Topical corticosteroids can be used but high doses of oral corticosteroids should be avoided. Sodium cromoglycate
Immunotherapy Immunotherapy is the use of allergen vaccines containing house dust mite, animal fur or extracts of grass or tree pollen. By gradually increasing the patient’s exposure to the allergen that causes the allergy, the patient becomes tolerant to it. Immunotherapy is only used in patients with severe symptoms and must be done by a specialist. However, long term relief can be achieved. Grazex® is a grass pollen extract available in tablet form which is now available on prescription for patients who have failed to respond to other hayfever treatments. Grazex® must be started at least 4 months before pollen season and should be continued for up to 3 years. Prevention The pollen count is often given with TV, radio, internet, or newspaper weather forecasts. If it is humid or windy, the pollen count is likely to be higher. Generally, the pollen count is highest in the early evening, so try to avoid going outside around this time. Keep windows and doors shut in the house if it gets too warm, try drawing the curtains to keep out the sun and keep the temperature down. Avoid cutting grass, playing, walking or camping in grassy areas. Change clothes and take a shower after being outdoors to remove the pollen from the body. Wear wrap-around sunglasses to stop pollen getting in the eyes when outdoors. Keep car windows closed, and consider buying a pollen filter for the
Reduce your exposure to pollen Hay fever sufferers can limit the effects of plant pollen in the home by showering and changing clothes as soon as they get inside.
can also reduce exposure to pollen. There are cleaning products available that will safely remove lingering pollen, some of which are non-toxic and free from perfumes and irritating additives. Likewise, wash clothes with anti-allergen laundry detergents to effectively and gently remove pollen.
Clean regularly Cleaning regularly and effectively
Wear sunglasses Sunglasses act as a physical
Hay fever – tips for sufferers
is safe to use. The sedating antihistamines, chlorpheniramine (Piriton®) and promethazine (Phenergan®) may be prescribed in severe cases and only if topical treatment is ineffective.
air vents in the car. Keep fresh flowers out of the house, and vacuum (ideally using a machine with a HEPA filter) and damp dust regularly. Do not smoke and stop other people from smoking in your house. Smoke irritates the lining of the nose, eyes, throat and airways which can make symptoms worse. Keep pets out of the house during the hay fever season; if pets normally come indoors, wash regularly to remove any pollen. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines The ARIA guidelines were developed during a World Health Organization (WHO) workshop in 1999 by a panel of experts. They were updated in 2008. The ARIA guidelines have changed the terms that were traditionally used to describe allergic rhinitis. Allergic rhinitis is no longer described as seasonal when it occurs during the summer months and perennial when it occurs all year round. Instead, allergic rhinitis can either be: • intermittent: symptoms are present for up to four days a week, or for up to four weeks in a row, or • persistent: symptoms are present for more than four days a week, or for more than four weeks in a row. These terms have been changed to better reflect the reality of people’s symptoms. Previously, seasonal used to mean an allergic reaction at a particular time of the year, usually caused by outdoor allergens, such as pollen. Perennial meant that the allergic reaction symptoms lasted all year, and were usually caused by indoor allergens, such barrier, preventing pollen from getting into, and directly irritating, your eyes. If you find your eyes stream – a very common symptom of hay fever – sunglasses will help provide some comfort in bright sunlight too. Close windows Warm air lifts pollen high into the atmosphere during the day. When air cools as dusk falls, pollen starts to descend. You
as dust mites. In reality, pollens can be present and cause allergic reaction symptoms throughout the year, and those with allergies to all year allergens, such as dust mites, may not have their symptoms all year round. References 1) DeShazo R, Kemp S. Update. Clinical manifestations and epidemiology of allergic rhinitis (rhinosinusitis) 2010; p4 2) Linna, O, Kokkonen, J, Lukin, M. A 10-year prognosis for childhood allergic rhinitis. Acta Paediatr 1992; 81:100. 3) Dykewicz, MS, Fineman, S, Skoner, DP, et al. Diagnosis and management of rhinitis: Complete guidelines of the Joint Task Force on Practice Paramaters in Allergy, Asthma and Immunology. Ann Allergy Asthma Immunol 1998; 81:478. 4) Dottorini, ML, Bruni, B, Peccini, F, et al. Skin prick-test reactivity to aeroallergens and allergic symptoms in an urban population of central Italy: a longitudinal study. Clin Exp Allergy 2007; 37:188. 5) South Med J 1996;89:11301139 6) St James Hospital Dublin. GPs, Healthcare Professional Newsletters, NMICBulletins, 1997/VOL3-2. Hayfever 7) Ann Allergy Asthma Immunol 1996; 77:225-259 8) N Eng J Med. 1991; 325:860869 9) Drugs 1993; 45:518-527 10) Mod Med Aus; 1994;3 7:74-86 11) J Allergy Clin Immunol 1996; 98:307-318 12) Pharm J 1996; 256:188-191 13) J Allergy Clin Immunol 1996; 98:307-318
Written by Eamonn Brady (MPharm) who graduated from School of Pharmacy, Robert University, Aberdeen in 2000.
may well be exposed to one of these ‘pollen showers’ in the early hours of the morning if you sleep with a window open. Try barrier balms Natural balms applied to the base of the nose and around the eyes throughout the day can trap some pollen before it enters the body. The stickier the balm, the more pollen it will trap.
Sudafed 0.1% w/v Nasal Spray Solution COMPOSITION The Solution contains 0.1% w/v Xylometazoline Hydrochloride. Each metered spray (0.14 ml) delivers 140 micrograms of xylometazoline hydrocholoride Excipients: The solution contains 0.040% w/v benzalkonium chloride solution. PHARMACEUTICAL FORM Nasal spray solution (Nasal spray) A clear, colourless solution Therapeutic indications SUDAFED Nasal Spray is indicated for the symptomatic relief of nasal congestion associated with the common cold, influenza, sinusitis, allergic and non-allergic rhinitis, and other upper respiratory tract allergies. Posology and Method of Administration Adults and children 12 years and over: Nasal. One spray to be expressed into each nostril 2-3 times daily, as necessary. Maximum daily dose: 3 Sprays per nostril. Use for more than seven consecutive days is not recommended. Children aged 6 to 12 years: Nasal. One spray to be expressed into each nostril 2-3 times daily, as necessary. Maximum daily dose: 3 Sprays per nostril. Use only when simple measures have failed to bring adequate relief. Use for more than five consecutive days is not recommended. [See Undesirable Effects] Children under 6 years: SUDAFED decongestant Nasal Spray is not recommended for children under 6 years of age The Elderly Experience had indicated that normal adult dosage is appropriate. Hepatic/renal dysfunction Normal adult dosage is appropriate. Contraindications Sudafed Nasal Spray is contra-indicated in individuals with known hypersensitivity to the product or any of its constituents. Sudafed Nasal Spray is contraindicated in individuals who are taking or have taken, monoamine oxidase inhibitors within the preceding two weeks. Sudafed Nasal Spray is contraindicated in individuals with hypophysectomy or surgery exposing dura mater. Sudafed Nasal Spray is contraindicated for use in children under the age of 6 years. Special warnings and precautions for use There is minimal systematic absorption with topically applied imidazoline sympathomimetics such as xylometazoline, however, Sudafed Nasal Spray should be used with caution in patients suffering coronary artery disease, hypertension, hyperthyroidism or diabetes mellitus. Prolonged treatment may lead to reactive hyperemia of the nasal mucosa. This rebound effect may lead to nasal congestion or nasal obstruction during continued use or after discontinuation, resulting in repeated or even continuous use of the medicine by the patient (see section 4.8). Benzalkonium Chloride is an irritant which may cause skin reactions and may cause bronchospasms Sorbitol E420 â€“ If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicine Do not exceed the stated does. Children aged 6 to 12 years: Consult a doctor or pharmacist before using this product. Do not use with other cough and cold medicines. Undesirable Effects Xylometazoline nasal preparations are generally well tolerated following short-term use and local side effects are mild and infrequent. Localised burning, stinging, itching, soreness, dryness or irritation and sneezing may occur occasionally. Rebound congestion has been reported occasionally, particularly following longer-term use of xylometazoline. MAH McNeil Healthcare (Ireland) Limited, Airton Road, Tallaght, Dublin 24, Ireland MA NUMBER PA 823/33/1. REVISION OF THE TEXT August 2013. Product not subject to prescription. Full prescribing information available upon request. IRE/SU/17-2436
Contains Xylometazoline Hydrochloride. Ask your pharmacist for advice. ALWAYS READ THE LABEL.
News New cash advance product to help cash-strapped pharmacists A new financial product has been launched, designed specifically for those business who might experience temporary cash flow problems. Ireland’s largest retail representative body Retail Excellence has teamed up with small business finance provider Grid Finance to present Grid Cash Advance. Grid Cash Advance is a short-term facility for those retail businesses who might be dealing with a temporary cashflow problem. Retailers can borrow between ¤10,000 to ¤500,000 for terms of six or nine months. To help ease the stress on the business’ cash flow, repayments are made from a small percentage of the daily sales made through credit and debit card transactions, not from a monthly fixed amount This could be a life line for small businesses such as independent pharmacists whose footfall and profits might have been badly affected by the recent snowstorms
John Greene, Pharmacist
that effectively brought Ireland to a standstill. Retail Excellence has a membership of more than 2,000 businesses around Ireland, including a significant number of independent and group pharmacies. John Greene, pharmacist at Poppintree Pharmacy in Dublin was in full support of such a service’s availability for pharmacists He said: “I am currently planning to purchase a pharmacy business; a cash advance loan would allow me to access part of the required finance by leveraging our existing cashflow. Being able to apply online and to get funded within a few days means I could focus on the business and not spend months dealing with the banks.” Deputy CEO of Retail Excellence Lorraine Higgins said: “Given the recent inclement weather many businesses are out of pocket as a consequence of having to scale back operations for a number of days and this product will be of huge assistance to get retailers through this time. We endeavor to constantly bring new and innovative solutions to our Members and those with a retail focus are of particular interest to us”. Grid Cash Advance will be available to businesses such as tourism, restaurants, clinicians
Lorraine Higgins and Derek Butler and, most importantly, retailers such as pharmacies. In most cases Grid hoped to provide same-day approval for the loans. A financial health check and supporting documents will be required as part of the application process. CEO of Grid Finance, Derek Butler said: “I am proud Grid Finance have partnered with Retail Excellence and are now launching this exciting financial product Grid Cash Advance for their members. The retail industry has unique
characteristics that require finance products that make sense for them. Grid Finance recognize this and have built finance products with retail businesses in mind.” He continued:” We are looking forward to providing up to ¤20m in funding to Retail Excellence’s members in the coming year. This will help to create hundreds of jobs in Ireland and ensure that Retail Excellence’s members continue to be financially fit for growth.”
HPRA welcomes new regulations for Epilim to reduce exposure for pregnant women The Health Products Regulatory Authority has welcomed new measures to strengthen regulation of valproate (Epilim), particularly concerning pregnant women. A European-wide safety review by the Committee for Medicinal Products for Human Use has resulted in new safety measures aimed at reducing the exposure of babies in the womb to the effects of valproate medicines. Such medicines are widely prescribed for the treatment of epilepsy, bipolar disorder and, in some countries, migraines. However, these drugs can result in birth defects or developmental
problems after birth if taken during pregnancy. The new EMA guidelines have put forward a ban on such medicines to treat migraines and bipolar disorder during pregnancy as well as a ban on using them to treat epilepsy during pregnancy, unless no other treatment is available. These medicines must now not be used by anyone able to fall pregnant without a pregnancy prevention scheme in place. The
scheme will include assessment of each patient’s potential to become pregnant, pregnancy testing before a course of treatment commences and counselling about the risks of valproates and the need for contraception throughout treatment. In addition, visible warnings of the risks of the drugs taken during pregnancy will now be placed on packaging and patient cards supplied with the medicine when dispensed.
The new procedures were put in place after a review by the EMA’s Pharmocovigilance Risk Assessment Committee. The risk assessment took place following concerns that previous measures to inform women of the risks of valproate medicines did not always reach the patient. As the CMDh position was adopted by majority vote, it will now be sent to the European Commission, which will take an EU-wide legally binding decision.
News Coeliac Awareness Week heralds calls for closer relationship with pharmacists This May welcomes the celebration of Coeliac Awareness Week 2018 with the Coeliac Society of Ireland planning a wealth of events and information sharing. Coeliac Disease is found when the body cannot break down gluten, a form of protein. Gluten is present in cereals such as wheat, barley and rye and so many coeliacs can’t eat foods such as pasta, breakfast cereals, most breads and cakes. The severity of the symptoms vary from case to case, but most coeliacs suffer from digestive issues such as diarrhoea, abdominal pain and bloating and even malnutrition in the most severe cases. Individuals can experience symptoms at any point in their lifetime. Fergal O’ Sullivan, CEO of the Coeliac Society has stressed the importance of working closely with pharmacists to manage the disease Fergal O’ Sullivan, CEO of the Coeliac Society
“The Coeliac Society of Ireland is the national charity supporting people diagnosed as coeliac or
on a gluten free diet for medical reasons. Many of our members suffered for years before receiving a coeliac diagnosis. Some self-medicated believing that they were suffering from irritable bowel syndrome or had a sensitive stomach. “This year the Coeliac Society are keen to build a stronger relationship with pharmacists, as they are well-placed to help identify symptoms that could potentially be related to coeliac disease. Thousands of people are suffering and putting their long-term health at risk as they wait for a diagnosis. We believe Irish pharmacists are in a unique position in raising awareness of coeliac disease among their patients.” In most instances the cure for coeliac disease is to eliminate
any kind of gluten. Even small amounts of gluten can produce severely unpleasant symptoms for someone who has the disease and continued gluten consumption can lead to a greater risk of cancer in later life. This year’s events will take place between the 14th and 20th of May and the theme centres around family. Around one in 100 people in Ireland suffer from the disease, but if a close family member has it then the odds of it manifesting drop to one in 10. The Coeliac Society will host a number of events as well as sharing recipes, cooking tips and For more information on Coeliac Awareness Week or the disease, symptoms and diagnosis, visit www.coeliac.ie
Irish pharmacy firm faces Japanese takeover bid Irish pharmaceutical company Shire has experienced a roller-coaster ride on the stock market recently as rumours of a take-over from Japanese company Takeda have been circulating. With the news of a potential deal, Shire saw its FTSE share prices jump by almost 20% recently. Although Takeda have not yet approached the Shire board with an official offer, the company has taken the step to confirm interest in such a bid. The jump in Shire share prices has been fuelled by speculation that interest from Takeda could start a bidding ward for the Ireland-based company, as big hitters such as Pfizer, AbbVie and Novartis have also show interest in takeover bids in the past. However, all is not certain as Takeda would add to its already considerable debt with such a takeover. And while Shire might be experiencing a surge in shares thanks to such speculation, Takeda has already experienced fluctuation in the stock market. Thanks to a series of acquisitions Shires annual revenues have risen by £10bn, but so too have its debts to the tune of £19bn. This hefty amount would be added to Takeda’s already laden-account if the takeover were to go through. The prospect reduced the Takeda share price down by 7% in just one day. A statement by Takeda announced that while interested in the takeover had been declared, the company would be taking a “disciplined approach to acquisitions, including in relation to its dividend policy and credit rating, which were well established.” The City’s Takeover Panel has now issued an April 25 deadline for Takeda to make a firm bid for Shire.
Bayer AG releases new safety information for Xofigo The Health Products Regulatory Authority have approved important safety information approved by Bayer AG in relation to Xofigo (radium-223-dichloride). A review of the benefits of radium-223-dichloride is currently being carried out, during which time Xofigo is now contraindicated with abiraterone acetate and prednisone/prednisolone. At this point, the safety and efficacy of Xofigo taken with second generation androgens
receptor antagonists such as enzalutamide have not been established. It is advised that the combination must be stopped and review of the patient’s treatment must be undertaken by healthcare professionals. Interim analysis suggests that patients with chemotherapy naive
asymptomatic/mildly symptomatic metastatic castration resistant prostate cancer show an increased risk of death and fracture in patients receiving the combination. The European Medicine Agency is currently investigating the implications of the interim findings on the effect of this combination.
Xofigo is an approved treatment for men with castration-resistant prostate cancer, symptomatic bone metastases and no known visceral metastatic disease. Bayer AG have released this safety information with the support of both the HPRA and the EMA.
...A KEY FOR CHRONIC PAIN
FOR SEVERE CHRONIC PAIN PALEXIA® SR Tablets are indicated for the management of severe chronic pain in adults, which can be adequately managed only with opioid analgesics1
PALEXIA SR® Prolonged Release Tablets Prescribing Information Refer to the Summary of Product Characteristics (SmPC) before prescribing. Presentation: 50 mg (white), 100 mg (pale yellow), 150 mg (pale pink), 200 mg (pale orange) and 250 mg (brownish red) prolonged-release tablets contain 50 mg, 100 mg, 150 mg, 200 mg and 250 mg of tapentadol (as hydrochloride) respectively. Indication: Palexia SR is indicated for the management of severe chronic pain in adults, which can be adequately managed only with opioid analgesics. Dosage and method of administration: Individualise according to severity of pain, the previous treatment experience and the ability to monitor the patient. Swallowed whole with sufficient liquid, not divided or chewed, with or without food. The tablet shell may not be completely digested and eliminated / seen in the patient’s stool which has no clinical significance as the active substance will have already been absorbed. Initial dose 50 mg twice a day. Switching from other opioids may require higher initial doses. Titrate in increments of 50 mg twice a day every 3 days for adequate pain control. Total daily doses greater than 500 mg not recommended. Discontinuation of treatment: Taper dose gradually to prevent withdrawal symptoms. Renal/hepatic impairment: Not recommended in patients with severe cases. Caution and dose adjustments with moderate hepatic impairment. Elderly: May need dose adjustments. Children below 18 years: Not recommended. Contraindications: Hypersensitivity to ingredients, suspected or having paralytic ileus, acute intoxication with alcohol, hypnotics, centrally acting analgesics or psychotropics. Not for use when mu-opioid receptor agonists are contraindicated (e.g. significant respiratory depression, acute or severe bronchial asthma or hypercapnia). Special warnings and precautions: Abuse and addiction potential of Palexia should be considered where there is increased risk of misuse, abuse, addiction or diversion. All patients should be carefully monitored for signs of abuse and addiction. At high doses or in mu-opioid receptor agonist sensitive patients, dose-related respiratory depression may occur. Caution and monitoring required with impaired respiratory function. Should not use in patients susceptible to intracranial effects of carbon dioxide retention (e.g. increased intracranial pressure, impaired consciousness or coma). Use with caution with head injury, brain tumors, moderate hepatic impairment, biliary tract disease including acute pancreatitis. Not recommended if history of or at risk of seizures or with severe renal or hepatic impairment. Care should be taken when combining with mixed mu-opioid agonists/antagonists (e.g. pentazocine, nalbuphine) or partial mu-opioid agonists (e.g. buprenorphine). Should not use with hereditary problems of galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption. Interactions: Use with benzodiazepines, barbiturates and opioid analgesics, antitussive drugs and substitutive treatments may enhance the risk of respiratory depression. Central nervous system (CNS) depressants (e.g. benzodiazepines, antipsychotics, H1antihistamines, opioids, alcohol) can enhance the sedative effect and impair vigilance. Consider dose reduction with respiratory or CNS depressant agents. In isolated cases, there have been reports of serotonin syndrome in a temporal connection with the therapeutic use of tapentadol in combination with serotoninergic medicinal products (e.g. serotonin re-uptake inhibitors). Use with strong inhibitors of uridine diphosphate transferase isoenzymes (involved in glucuronidation) may increase systemic exposure of Palexia SR. Caution if concomitant administration of strong enzyme inducing drugs (e.g. rifampicin, phenobarbital, St John’s Wort) starts or stops as this may lead to decreased efficacy or risk for adverse events, respectively. Avoid use in patients who have taken monoamine oxidase inhibitors (MAOIs) within the last 14 days, due to cardiovascular events. Pregnancy and lactation: Use in pregnancy only if the potential benefit justifies the potential risk to the foetus. Not recommended during and immediately before labour and delivery. Do not use during breast feeding. Driving and using machines: May have major effect on ability to drive and use machines, especially at the beginning or change in dosage, in connection with alcohol or tranquilisers. Undesirable effects: Very common (≥1/10): dizziness, somnolence, headache, nausea, constipation. Common (≥1/100, <1/10): decreased appetite, anxiety, depressed mood, sleep disorder, nervousness, restlessness, disturbance in attention, tremor, involuntary muscle contractions, flushing, dyspnoea, vomiting, diarrhoea, dyspepsia, pruritus, hyperhidrosis, rash, asthenia, fatigue, feeling of body temperature change, mucosal dryness, oedema. Other important undesirable effects observed in clinical trials and/or postmarketing: drug hypersensitivity, depressed level of consciousness, mental impairment (uncommon ≥1/1000, <1/100), impaired gastric emptying, respiratory depression, convulsion, angioedema, anaphylaxis and anaphylactic shock (rare ≥1/10,000, <1/1000). No evidence of increased risk of suicidal ideation or suicide with Palexia SR. Additional information is available on request. Overdose: Seek specialist treatment (see SmPC). Legal classification: POM, CD (Schedule II). Marketing Authorisation numbers and pack sizes: 50 mg: PA 1189/7/4, 28 and 56 packs; 100 mg: PA 1189/7/5, 56 pack; 150 mg: PA 1189/7/6, 56 pack; 200 mg: PA 1189/7/7, 56 pack and 250 mg: PA 1189/7/8, 56 pack. Marketing Authorisation Holder: Grünenthal Ltd, Regus Lakeside House, 1 Furzeground Way, Stockley Park East, Uxbridge, Middlesex, UB11 1BD, UK. IRE/P18 0001. Date of Preparation: January 2018. Reference: 1. Palexia SR Summary of Product Characteristics. Date of Preparation: January 2018. IRE/P18 0005
CPD 89: UNDERSTANDING AND MANAGING PAIN Biography - Amy Louise Oates. I qualified from the Robert Gordon University Aberdeen with a Master in Phamacy in 2011. I then undertook my pre-registration year with Gordons Chemists in Edinburgh. After registration I moved back home, where I am now working for Johnstons Pharmacy in Longford Town, Lanesborough and Ballygar, Co. Galway. I also recently completed a Cardiology in Clinical Pharmacy Practice module with Trinity College Dublin.
Welcome to the Continuing Professional Development Module. CPD is mandatory professional requirements for pharmacists. Journal based education programmes are an important way of keeping up to date with personal clinical and professional development. This module can be used in your personal learning log and can be completed in the magazine or online by completing the reflection questions at the end of the module. You can also track your progress of you development by going to www.pharmacynewsireland.com/cpdtraining where you can register to record your learning.
Understanding Pain and its management Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain is subjective, with two complementary aspects: the first a localized sensation in a particular body part; the other is an unpleasant quality of varying severity commonly associated with actions directed at relieving the pain experience. Pain is always unpleasant and therefore an emotional experience. There are specific pain receptors present in most body tissues that only respond to damaging or potentially damaging stimuli. These pain receptors are known as nociceptors. Nociceptors are specialised sensory receptors responsible for the detection of noxious (unpleasant) stimuli, transforming the stimuli into electrical signals, which are then conducted to the central nervous system. Nociceptors are the free nerve endings of primary afferent Aδ and C fibres. They are found in most body tissues such as the skin, viscera, muscles, joints, meninges and are stimulated by mechanical, thermal or chemical stimuli. Each of these different fibre types possesses different characteristics that allow the transmission of particular types of sensory information. • Aβ fibres - highly myelinated and of large diameter, therefore allowing rapid signal conduction. They have a low activation threshold and usually respond to light touch and transmit non-noxious stimuli. • Aδ fibres - are lightly myelinated and smaller diameter, and therefore conduct more slowly than Aβ fibres. They respond to mechanical and thermal stimuli. They carry rapid, sharp pain and are responsible for the initial reflex response to acute pain. • C fibres are unmyelinated and are also the smallest type of primary afferent fibre.
Hence they demonstrate the slowest conduction. C fibres are polymodal, responding to chemical, mechanical and thermal stimuli. C fibre activation leads to slow, burning pain. There are four major processes involved in processing pain-related information: transduction, transmission, modulation, and perception. Transduction refers to the processes by which tissuedamaging stimuli activate nerve endings. Transmission refers to the relay functions by which the message is carried from the site of tissue injury to the brain regions underlying perception. Modulation is a neural process that acts specifically to reduce activity in the transmission system. Perception is the subjective awareness produced by sensory signals; it involves the integration of many sensory messages into a coherent and meaningful whole. Perception is a complex function of several processes, including attention, expectation, and interpretation. TRANSDUCTION Transduction of pain begins when the free nerve endings (nociceptors) of C fibres and A-delta fibres of primary afferent neurones respond to noxious stimuli. Nociceptors are exposed to noxious stimuli when tissue damage and inflammation occurs as a result of, for example, trauma, surgery, inflammation, infection, and ischemia. The cause of stimulation may be internal, such as pressure exerted by a tumour or external, for example, a burn. This noxious stimulation causes a release of chemical inflammatory mediators from the damaged cells including: bradykinin, serotonin, prostaglandins, cytokines, and histamine. The inflammatory mediators are released from damaged tissue and can stimulate nociceptors directly. They can
Reflection - Is this area relevant to my practice? What is your existing knowledge of the subject area? Can you identify any knowledge gaps in the topic area? Planning - Will this article satisfy those knowledge gaps or will more reading be required? What resources are available? Action - After reading the article complete the summary questions at www.pharmacynewsireland. com/cpdtraining and record your learning for future use and assessment in your personal log. Evaluation - How will you put your learning into practice? Have I identified further learning needs?
also act to reduce the activation threshold of nociceptors so that the stimulation required to cause activation is less. This process is called Primary sensitisation. A pain impulse is generated by an exchange of sodium and potassium ions occurring at the cell membranes. This results in an action potential and generation of a pain impulse. TRANSMISSION The transmission process occurs in three stages. The pain impulse is transmitted from the site of transduction along the nociceptor fibres to the dorsal horn in the spinal cord; from the spinal cord to the brain stem; and then through connections between the thalamus, cortex and higher levels of the brain. MODULATION The modulation of pain involves changing or inhibiting transmission of pain impulses in the spinal cord. The multiple, complex pathways involved in the modulation of pain are referred to as the descending modulatory pain pathways (DMPP) and these can lead to either an increase in the transmission of pain impulses (excitatory) or a decrease in transmission (inhibition). Descending inhibition involves the release of inhibitory neurotransmitters that block or partially block the transmission of
CPD 89: UNDERSTANDING AND MANAGING PAIN
pain impulses, and therefore produce analgesia. Inhibitory neurotransmitters involved with the modulation of pain include: serotonin; noradrenalin; acetylcholine. PERCEPTION Perception of pain is the end result of the neuronal activity of pain transmission and where pain becomes a conscious multidimensional experience. The multidimensional experience of pain has affective-motivational, sensory-discriminative, emotional and behavioural components. When the painful stimuli are transmitted to the brain stem and thalamus, multiple cortical areas are activated and responses are elicited. TYPES OF PAIN 1) Acute / Nociceptive pain - caused by stimuli that threaten or provoke actual tissue damage. Nociceptive pain is often due to musculoskeletal conditions, inflammation, or mechanical/compressive problems 2) Chronic Pain - Chronic pain can be a major problem for people and can greatly affect their quality of life. It can be caused by alterations in nociception, injury or disease and may result from current or past damage to the peripheral nervous system (PNS), Central Nervous System (CNS) or may have no organic cause.
3) Neuropathic pain - resulting from damage to or pathology within the nervous system, can be central or peripheral. Neuropathic pain is distinctly different from nociceptive pain and is described as: burning; dull; aching; tingling; like an electric shock; shooting .Causes of neuropathic pain are multiple, and include diabetes mellitus, postherpetic neuralgia and stroke.
1) Assessment and planning of care – in order to select the most appropriate treatment for a patient it is essential that a detailed patient history is obtained, a thorough examination is carried out and the correct type of pain and severity is identified. Specialist referral should be considered when non-specialist management is failing, chronic pain is poorly controlled and there is significant distress.
2) Supported Self Management - Self management resources should be considered as an aid to other treatment. Self management programmes are structured programmes which aim to allow people to take an active part in the management of their own chronic pain condition. These programmes are primarily educational and have shown to improve patients’ confidence to manage their own health, improve aerobic exercise and personal well-being
The World Health Organization's (WHO) "analgesic ladder" approach to cancer pain management, which was originally published in the mid-1980s, outlines an approach to pain control that is based upon the severity of pain. The choice of an appropriate initial therapy is dependent on an evaluation of the cause of the pain and the type of chronic pain syndrome. Medication is used in conjunction with non-pharmacologic therapies and approaches to relieve the source of the pain. Chronic pain is a major clinical challenge, with approximately 18% of the population across Europe currently affected by moderate to severe chronic pain. Chronic pain has a considerable impact on the patient’s quality of life, resulting in significant suffering and disability. In a lot of cases finding a cure is unlikely, however the impact on quality of life, mood and function can be significantly reduced by appropriate treatment plans. According to SIGN Guideline 136: Management of Chronic Pain, there are a number of clinical recommendations that should be implemented:
3) Psychologically based interventions - Referral to a pain management programme should be considered for patients with chronic pain. The patient’s perception of pain, and the disability that can arise from it, is inextricably linked to the patient’s emotional, cognitive and social functioning. Living with chronic pain can also significantly affect the patient’s mental health and, consequently, their response to treatment. Pain management programmes aim to address these complexities experienced by patients with chronic pain.
CPD 89: UNDERSTANDING AND MANAGING PAIN 4) Physical Therapy - Exercise and exercise therapies, regardless of their form, are recommended in the management of patients with chronic pain. Advice to stay active should be given in addition to exercise therapy for patients with chronic low back pain to improve disability in the long term. Advice alone is insufficient. 5) Pharmacological Management Patients using analgesics to manage chronic pain should be reviewed at least annually, and more frequently if medication is being changed, or the pain syndrome and/or underlying comorbidities alter. The World Health Organization analgesic ladder was originally developed for the treatment of cancer pain, however it widely used to guide basic treatment of acute and chronic pain. The ladder provides an analgesic strategy for non-specialists. Careful assessment and diagnosis is essential to initiating appropriate therapy. Continuing success requires regular, scheduled re-assessment of pain relief and side effects STEP 1 Non-opioid analgesics include paracetamol, nonselective nonsteroidal anti-inflammatory drugs (NSAIDs), and cyclo-oxygenase 2 (COX-2) inhibitors. It is recommended that Paracetamol at a dose of 1g - 4g/day, should be considered alone or in combination with NSAIDs in the management of pain. According to SIGN Guideline 136, regular treatment with an NSAID has a modest beneficial effect in patients with non-specific low back pain. NSAIDs are primarily indicated for mild to moderate pain and are frequently used for soft tissue injury, strains, sprains, headaches, and arthritis. There are many NSAIDs available to choose from with little literature substantiating improved efficacy of one NSAID over another. In many cases however it can be found that a patient who does not tolerate or respond to one particular NSAID may find another more suitable. NSAID treatment is associated with a high risk of adverse effects including abdominal pain, diarrhoea, oedema, dry mouth, rash, dizziness, headache, and tiredness. COX-2 selective NSAIDs are found to have fewer side effects than traditional NSAIDs. Gastrointestinal (GI) adverse effects are associated with term regular NSAID treatment, as is an increased risk of cardiovascular disease, stroke and heart failure. It is important that cardiovascular and gastrointestinal risks are taken into account when prescribing any NSAID.
Adjuvant therapy can include topical NSAIDS. They are of particular benefit in the treatment of patients with chronic pain from musculoskeletal conditions, especially in patients who cannot tolerate oral NSAIDs. Topical capsaicin cream can be considered in the treatment of patients with peripheral neuropathic pain when first line pharmacological therapies have been ineffective or not tolerated. Topical Lidocaine Patches are also included in adjuvant therapy but are only indicated for the treatment of patients with post herpetic neuralgia if first line pharmacological therapies have been ineffective. STEP 2 Opioids are now being increasingly used in the treatment of chronic pain. Weak opioids include codeine and tramadol with defined upper dose limits. The clinical effectiveness of opioid therapy should be assessed regularly with clearly defined stopping plans in the event of inadequate pain relief or unacceptable side effects. Many opioids, including codeine and tramadol are metabolised mediated by cytochrome P450 enzymes. This can lead to a range of unpredictable side effects in patients. One of the main reasons for non-compliance is the side effect profile
associated with opioids. Commonly reported side effects with long term use of opioids include gastrointestinal effects (constipation, nausea, dyspepsia), headache, fatigue, lethargy, somnolence, and urinary complications (retention hesitancy, disturbance).Some more serious side effects include sedation and respiratory depression. Patients prescribed opioids should be advised of the likelihood of common side effects. Tramadol is associated with few side effects, with less risk of constipation, respiratory depression and addiction potential. STEP 3 Strong opioids include morphine, diamorphine, hydromorphone, oxycodone, fentanyl, buprenorphine and methadone. Strong opioids should be considered as a treatment option for patients with chronic low back pain or osteoarthritis, and only continued if there is ongoing pain relief. Regular review is essential. It is important that all patients prescribed strong opioids should be assessed regularly for changes in pain relief, side effects and quality of life, with consideration given to a gradual reduction to the lowest effective dose. Different opioids can be trialled, as efficacy and side effects can
CPD 89: UNDERSTANDING AND MANAGING PAIN
differ between opioids. When changing between different formulations, and between opioids always convert back to the total dose of morphine first. Referral to a specialist should be considered if there are concerns about rapid-dose escalation with continued unacceptable pain relief, or if >180 mg/day morphine equivalent dose is required. Morphine is the most valuable opioid for treating severe pain, and it is the standard against which other opioids are compared. It can be given regularly at 4 hour intervals, or every 12 or 24 hours with modified release preparations. Buprenorphine has a much longer duration of action compared to morphine, and is available in transdermal and sublingual formulations. When given sublingually, buprenorphine provides analgesia for 6-8 hours. Methadone hydrochloride is less sedating than morphine and has a longer duration of action. It can be an alternative to morphine in patients who experience excitation with morphine therapy. Tapentadol is associated with fewer side effects than most of the other strong opioids. Nausea, vomiting and constipation are less common. Oxycodone is similar to morphine in terms of efficacy and side effect profile, its use its mostly for the control of pain in palliative care. MANAGING NEUROPATHIC PAIN Neuropathic pain is pain initiated or caused by a primary lesion or dysfunction in the nervous system resulting from many factors such as: trauma, chronic postsurgical pain, infection, post-herpetic neuralgia, ischaemia, diabetic neuropathy, cancer, or chemotherapy. Some types of neuropathic pain can develop when the peripheral nervous system has become
damaged. Many different agents can be used in the management of neuropathic pain, including anti-epileptics and anti-depressants. ANTI-EPILEPTICS Anti-epileptics are commonly used for pain management. Three anti-epileptics frequently used in the treatment of neuropathic pain include: gabapentin, pregabalin, and carbamazepine. Treatment with gabapentin with daily doses of at least 1,200 mg is effective for pain relief in patients with post herpetic neuralgia, painful diabetic neuropathy or mixed neuropathic pain. Pregabalin at daily doses of 300 mg, 450 mg, and 600 mg daily is effective in patients with various types of neuropathic pain. It is recommended when treatment with other analgesic agents are ineffective. Both gabapentin and pregabalin have few drug interactions, but can produce dosedependent side effects such dizziness and sedation. These side effects can be reduced by starting with lower doses and titrating cautiously according to response and adverse effects. Carbamazepine can be considered for the treatment of patients with neuropathic pain, however the potential risks of adverse events should be discussed. ANTI-DEPRESSANTS Antidepressants have been proven to provide effective pain relief in neuropathic pain conditions and be considered as a treatment option. Both tricyclic antidepressants (TCAs) and serotonin norepinephrine reuptake inhibitors (SNRIs) possess analgesic qualities while the
evidence for the effectiveness of selective serotonin reuptake inhibitors (SSRIs) is weaker. Amitriptyline at daily doses of 25 - 125 mg/day has been found to be effective in the treatment of patients with fibromyalgia and neuropathic pain. It may be appropriate to try alternative tricyclic antidepressants to reduce the side effect profile. The SNRI Duloxetine at a dose 60 mg daily is effective in treating painful diabetic peripheral neuropathy and can also be considered for the treatment of patients with fibromyalgia or osteoarthritis. Although it has been found that drugs that potentiate noradrenaline and serotonin or predominantly noradrenergic mechanisms ( such as tricyclic antidepressants (TCA) and serotonin norepinephrine reuptake inhibitors (SNRI) , are more effective than selective serotonin reuptake inhibitors (SSRI) for treating neuropathic pain, Fluoxetine at a daily dose 20-80 mg/day can be considered for the treatment of patients with fibromyalgia. PHARMACIST POINTS • Counsel patient on the treatment being given, the reasoning behind the treatment, the potential side effects and periodically review the medicines prescribed. • Look out for signs of abuse and addiction in patients using strong opioids. • NSAID use is associated with many risk factors, look out for use in patients with chronic kidney disease, peptic ulcer disease, hepatic or heart disease.
500mg Effervescent Tablets.
FAST ACTING, EFFECTIVE PAIN RELIEF GENTLE ON STOMACH
NOW AVAILABLE IN TABLET OR SOLUBLE FORM Paralief effervescent tablets are for oral administration. Place the tablet in a full glass of water. Allow it to completely dissolve. Then drink the solution straight away. If complaints persist or worsen, you should seek medical advice. Do not exceed the stated dose. Paracetamol Effervescent tablet may be taken with or without food and drinks. If the pain persists for more than 5 days or the fever lasts for more than 3 days, or gets worse or other symptoms appear, you should stop the treatment and consult a doctor. Additional information is available upon request. Do not give to adolescents below 12 years of age. Always read the label carefully before use. Also available Paralief 500 mg Tablets. Clonmel Healthcare Ltd., Waterford Road, Clonmel, Co. Tipperary. A copy of the summary of product characteristics is available on request. Medicinal product available for retail sale through pharmacy only. 2016/ADV/PAR/099.
& Pharmacy Retail Product Awards
The Best of Pharmacy Retail Celebrated at Dublin Awards Event A snowy start to March meant that the fourth annual OTC Awards arrived in Dublin a week later than scheduled. The delayed started certainly didn’t put a dampener on spirits however, as on the day over 120 pharmacists, brand managers and OTC buyers gathered at the Radisson Blu Hotel to feast on a sit-down lunch while enjoying entertainment from X Factor finalist Mary Byrne. The awards were introduced by RTE star Jennifer Zamparelli with staff from both Irish Pharmacy News and Hospital Pharmacy News in full attendance. As pressure on hospitals and doctors in Ireland grows, so does the emphasis on the pharmacist as the first link in the healthcare chain. Pharmacy services, diagnostic testing and of course over-thecounter medicines and remedies now have a larger role to play that ever before. As the role of the pharmacists
expands, so to does that of the OTC product. Any pharmacy’s OTC offering is a key factor that can distinguish any one pharmacy or group from its competitors. Each year the OTC Awards celebrate the finest over-the-counter products available in every category. The awards act as a showcase for new products, product investment and product innovation. More than 100 newly launched and well-established products from the OTC are carefully evaluated by an independent and expert panel. Every judge gave up their own time to give vital positive and objective feedback on all of the products put forward for the awards. The products were judged on everything from packaging and branding the efficacy of individual medicines.
This year judges paid particular attention to the uniqueness of each product within its own market, the marketing and support teams behind the brand and of course, customer popularity. For the pharmacist, innovation of products and the constant training and updating from brand marketing teams are vital tools for the OTC market.
We would like to thank all those in attendance at the awards for making the event the biggest OTC Awards event yet.
With the OTC market continually expanding, IPN Communications were proud to increase the number of categories for this year’s awards, further showing their support to the pharmacy sector. IPN Communications would like to take this opportunity to everyone who took part in the OTC Awards this year. To be particularly commended are the judging panel who volunteered their own free time to provide impartial judging.
Eoghan Phelan, Visualise and Daniel Byers, KRKA
Johnson & Johnson - Shane Freeley, Alys Worthing, Tara Jackson, Hilda O'Shea and Daniel Keegan
GSK - Niall O’Shea, Bryan Dunne, Maria McClafferty, Karen Kaye and Dave Barrett
Fergal O'Shea - IQVIA, Fiona Dunphy - The PMI and Fergus McCauley-IQVIA
Cormac Tobin and Natalie Millar, IPN Communications
& Pharmacy Retail Product Awards
Pharmacy-only Medicine The benefits of pharmacy-only products ensure the consumer a personal and educated service from a dedicated service provider. With a pharmacy-only product, consumers know they can receive trust and reliable advice when making their selection.
Winner – Solpadeine by Perrigo
Product description Pharmacy-only products are just one of the categories that make pharmacies stand out from other retailers. In a time when the consumer will aim for the pharmacy ahead of the surgery, pharmacy-only products have a real service to provide for customers. Judges’ comments “Solpadeine is always a product a pharmacist can rely on. It has striking packaging and is very popular, even selling out on occasion.” A word from the winners “This was a category to be in because we were up against some very well-known brands, but we’ve won this category for a number of years now, so we’re delighted to still be included. It really works that the OTC Awards are a pharmacist lead brand. We focus purely on pharmacy – it’s the core of everything we do.” Nicola McGarvey, Advertising Manager, IPN, Niall McMorrow, Brand Manager, Perrigo
Nurofen Express Maximum Strength Tablets - by RB Ireland
Otrivine - by GSK Consumer Healthcare
Voltarol Emulgel Extra Strength 2% w/w gel by GSK Consumer Healthcare
Solpadeine Soluble Tablets contain paracetamol, codeine phosphate hemihydrate and caffeine. For the treatment of acute moderate pain which is not relieved by paracetamol or ibuprofen alone, including migraine, headache, backache, menstrual pain, musculoskeletal pain, toothache, common cold, influenza. Adults and children 12 years and over: 2 tablets dissolved in water 3 – 4 times a day. Max 8 tablets in 24 hours. Do not give to children under 12 years. Do not take for more than 3 days without consulting a doctor. Do not take any other paracetamol or codeine containing products concurrently. Can cause addiction. Use for 3 days only. In case of overdose, seek immediate medical advice, even if the patient feels well.Contraindications: Acute asthma, known hypersensitivity to ingredients, lactation, known CYP2D6 ultra-rapid metabolisers, patients 0-18 years who undergo tonsillectomy and/or adenoidectomy for obstructive sleep apnoea syndrome. Precautions: Renal or hepatic impairment, non-cirrhotic alcoholic liver disease, obstructive bowel disorders, previous cholecystectomy, acute abdominal conditions, pregnancy, prostate hypertrophy, the elderly. Pregnancy and lactation: Not recommended during pregnancy and breastfeeding. Side effects: Thrombocytopenia, anaphylaxis, cutaneous hypersensitivity reactions, hepatic dysfunction, GI disturbance, dependency or worsening of headache following prolonged use. PA 1186/11/1. P. MAH:Chefaro Ireland Limited, 1st Floor, Block A, The Crescent Building, Northwood Office Park, Dublin 9. RRP (ex. VAT): 12 €5.40 , 24 €8.50 Date of preparation: March 2018. Solpa-Extra 500mg/65mg Soluble Tablets contain paracetamol and caffeine. For the treatment of mild to moderate pain. Adults and children over 16 years: 1-2 tablets dissolved in water every 4-6 hours. Max 8 tablets a day. Children 12-15 years: 1 tablet dissolved in water every 4-6 hours. Max 4 tablets a day. Not suitable for children under 12 years. Contraindications: Hypersensitivity to the ingredients. Precautions: Particular caution needed under certain circumstances, such as renal or hepatic impairment, chronic alcoholism and malnutrition or dehydration. Precautions needed in asthmatic patients sensitive to acetylsalicylic acid, patients on a controlled sodium diet and with rare hereditary problems of fructose intolerance. Patients should be advised not to take other paracetamol containing products concurrently. Pregnancy and lactation: Not recommended during pregnancy and breastfeeding. Side effects: Rare: allergies. Very rare: thrombocytopenia, anaphylaxis, bronchospasm, hepatic dysfunction, cutaneous hypersensitivity reactions. Unknown: nervousness, dizziness. Further information is available in the SmPC. PA 1186/017/001. P. MAH: Chefaro Ireland DAC, Treasury Building, Lower Grand Canal Street, Dublin 2, Ireland. RRP (ex. VAT): 24 €5.99 Date of preparation: March 2018. Lyclear Shampoo is a medical device. *IMS MAT volume sales Jan 2017.
& Pharmacy Retail Product Awards
Most Innovative Product Innovation is the key component to every aspect of the healthcare industry and to pharmacy most of all. Innovation in OTC ensures products that better cater for customer and patient needs and that foster growth. Innovation creates strong brands which in turn build customer networks. All of this year’s nominees demonstrated creativity, imagination and above all, innovation.
Winner – Gloup by Clonmel Healthcare Product description Gloup is a is a strawberry and banana flavoured gel specifically formulated to help patients swallow tablets more easily. It has no known interactions with other medications and can be taken by anyone over the age of two. Judges’ comments “This product has filled a very recognisable gap in the market. It’s one of a kind and is already a best-seller.” A word from the winners “It’s fantastic to win any award, especially an OTC product award. This is a new and innovative product that helps people swallow their food. It’s something that’s found a real niche in the market. For this particular product there is a huge market – places like nursing homes and hospitals might use a similar product for their issue. It’s inexpensive and can be used from the age of two so anyone can pick some up from the pharmacy. It’s fantastic to win something from IPN. We’re big supporters of the company and work with them a lot so to win such an honour from them is really special.”
Nicola McGarvey, Advertising Manager, IPN Communications, Samantha Doundoulakis, Product Manager, Clonmel Healthcare and Cormac Tobin
Proceive – by Ocean Healthcare
Medicare Non-Contact infrared Thermometer – by Fleming Medical SVR XERIAL 50 – Distributed by Graham Anthony Distribution
NiQuitin Fresh Mint Gum – by Perrigo
& Pharmacy Retail Product Awards
Irish Brand In a world filled with global brands, supporting an Irish brand means supporting the local economy and many consumers value Irish brands. In an increasingly competitive market of big-name brands, smaller, local names must work particularly hard to stand-out among global competition. A strong portfolio supported by both brand and consumer are important for the Irish brand to stand out from the crowd.
Winner – Panadol by GSK Consumer Healthcare Product description You can count on Panadol to deliver powerful, effective relief, it’s also gentle on the stomach. Panadol’s Irish manufacturing roots had been one of GSK’s best kept secrets. GSK Dungarvan’s 700 employees play a vital role in Panadol’s global success story, and indeed in the wider community in Waterford. Judges’ comments Panadol is an innovative, versatile product that offers a something extra to consumers. That it is made and manufactured in Waterford means that product investment is returned to the Irish economy. A word from the winners “Following our investment in the Panadol Made in Ireland campaign. It is fantastic to be recognised by the Pharmacy industry as the best Irish brand. Panadol’s Irish manufacturing roots had been one of GSK’s best kept secrets. Buying Irish is becoming more and more important to Irish consumers, so this campaign is something people are really engaging with and in turn driving purchase decisions. Given this, we will continue to invest in telling Panadol’s Made in Ireland story in 2018.”
Natalie Maginnis, Managing Director, IPN Communications, Maria McClafferty, Marketing Manager, GSK and Jennifer Zamparelli
Finalists Alflorex by Precision Biotics Ltd
Cleanmarine Distributed by Naturalife
& Pharmacy Retail Product Awards
Children’s Medication/ Supplement Any parent’s greatest concern will be finding an effective medication that is safe and trusted for their child. An overload of information available from the internet can mean a confusing choice for the consumer. Any children’s product should be tried and tested with a wealth of reliable information behind it.
Winner – Calpol Infant Suspension by Johnson & Johnson Product description Calpol Infant Suspension is an effective pain and fever medicine that gets to work on a fever in just 15 minutes but is gentle on tummies. The active ingredient in Calpol Infant Suspension is 120mg Paracetamol per 5ml of suspension which is an effective relief of headache, migraine, neuralgia, toothache and teething pains, sore throat, rheumatic aches and pains, influenza, feverishness and feverish colds. Judges’ comments “Time and again Calpol has proven itself to be a brand trusted by both pharmacists and parents. Its sales are consistently high because its efficacy is consistently high.” A word from the winners
Hilda O'Shea, Shane Freeley, Johnson & Johnson and Mary Byrne
Colief Distributed by Ocean Healthcare
“This kind of award shows that the level of the brand speaks for itself and that consumers have tried and tested this product again and again. It’s more than just a family brand – this shows that pharmacists respect it too. We have worked with IPN throughout the years so to win one of their awards has real meaning. We’re not complacent about a win like this at all.”
Yummy Gummy Multivitamins by Rowex
Nurofen for Children Chewable Capsules by RB Ireland
Ireland’s No.1 Pain & Fever Reliever for Children* Irish Pharmacy News
BEST CHILDREN’S MEDICATION AND SUPPLEMENTS PRODUCT CALPOL
Lets Kids be Kids Calpol Infant 120mg/5ml Oral Suspension. MAH: McNeil Healthcare (Ireland) Ltd., Airton Road, Tallaght, Dublin 24, Ireland. Products not subject to medical prescription. Full prescribing information available upon request from Johnson & Johnson (Ireland) Ltd.
*Combined Nielsen & IMS Data, December 2017.
& Pharmacy Retail Product Awards
Beauty Product With ever increasing growth, brands must establish themselves as reliable, effective and innovative. This market is once again experiencing growth with improving sales which are helped by increasing demand for premium products. Stocking the best can drive the dynamic of any pharmacy.
Winner – Beauty Complex by Revive Active Product description Beauty Complex by Revive Active is a unique beauty product containing Peptan Marine Collagen, Phytoceramides and Hyaluronic Acid, plus Vitamins C & E , Selenium and Copper in a convenient sachet. It is the first supplement to combine these comprehensive and effective anti-agers all in one. Judges’ comments “This is a product that tastes great and always sells well, not only that but they’re a great company to deal with. We’re looking forward to seeing more bloggers and ambassadors work with Revive but until then there are always promotions on all Revive comments.” A word from the winners “This is a new product for the market and we’re getting wonderful feedback from it already. IPN is such a prestigious brand for us to have attached to this really helps us with the recognition.
Bernie Denning, Area Sales Manager, Tanya McGuirk, Account Manager, Revive Active and Cormac Tobin
There’s not a lot of competition yet for us in this category we’re slightly out on our own. Getting recognition like this does us the world of good though.”
Sanctuary Spa Body Lotion Distributed by United Drug Consumer
Veet Sensitive Precision by RB Ireland
& Pharmacy Retail Product Awards
Best Women’s Product Women’s products are a market vital for the modern pharmacy. The pharmacy team must provide exactly the right environment for a woman to discuss her health. Women are the core consumer for the pharmacy industry.
Winner – pre-Conceive by Pillar Healthcare Product description In a clinical examination of pre-Conceive and infertile women, pre-Conceive was able to improve the key parameters associated with infertility. This included all women improving their hormonal cycle and showing significant improvements in ovulation. Judges’ comments This product is unique to the market and is independently recommended by one of the most senior embryologists in Ireland. It contains specific nutrients that can contribute to normal fertility. A word from the winners “It is always an honour to win awards viewed and adjudicated on by our peers. The award supports the company in its on-going mission and is valuable in presenting Pillar Healthcare to the wider trade and the public, both at home and abroad. IPN is a trusted name amongst the community. To me, this brings an extra layer of trust to the awards. The award illustrates to the public that the wider community has faith in the product and the brand, and that this can be trusted. This carries weight, especially for new, emerging brands.”
Mark Whitney, Managing Director, Pillar Healthcare
Cleanmarine For Women by Naturalife
Multi-GYN Distributed by Ocean Healthcare MyPro Iro-Sorb by Pharmed
Femfresh Intimate Wash Distributed by United Drug Consumer
& Pharmacy Retail Product Awards
Men’s Product Winner – Durex Intense Condom by RB Ireland
Building awareness of men’s health issues has come more and more to the forefront over the last few years and yet men still fare significantly worse than women. Male-focused pharmacy services have been increasing while malegrooming products are one of the fastest-growing in the marketplace. The modern pharmacy must offer solutions to the issues facing men today such as sexual wellness, nutrition and heart health.
Product description A condom that actually helps to make sex better for both. A transparent & lubricated natural latex condom with a stimulating ribs and dots texture, with Desirex gel for warming, cooling or tingling sensations to increase sensitivity in her intimate area. Judges’ comments “Durex is a strong brand, putting them above the others in a competitive market. This is backed up by solid marketing and education from the company.” A word from the winners “There is a massive step change in what we’re doing. It’s not just about contraception any more but an awareness of STIs. People aren’t using condoms as a contraceptive because of the pill so we need to change focus.
Natalie Millar, Commercial Manager, IPN Communications, Ciaran Woods, Senior National Account Manager.
There were three very different products in the category, so it was almost a surprise that we won as the other two were very good products. The OTC awards are always well recognised, and we’ve been very lucky to win a few in the last few years. The more there are the bigger they get.”
Pre-Conceive by Pillar Healthcare Just for Men Control GX Distributed by Brandshapers
& Pharmacy Retail Product Awards
Best In-store Promotion In-store promotion is vital for any OTC brand, to attract attention and educate the consumer searching for a product but without a particular brand in mind.
Winner – Nurofen for Children Fever Fighters Campaign, Q1 2017 by RB Ireland
In-store promotions can drive impulse purchases and increase profits as well as educating customers on previous un-heard of products for future visits to the pharmacy.
Product description Nurofen for Children Oral Suspension range has been supporting parents for 19 years by providing effective relief for children suffering from pain, fever and cold and influenza. It starts to work in just 15 minutes to reduce fever and lasts for up to 8 hours. Judges’ comments “Nurofen for Children is a great brand that sells well all year-round. But the secret behind its success is the support the brand has from the supplier. Nurofen has an excellent marketing team and a Rep who constantly keeps the pharmacist informed with the newest products.” A word from the winners “We were in with some very well-known brands for this award, so it was particularly competitive. Something like this really brings brand awareness and it means that both parents and kids can be assured of the product. Parents can be unsure in using medicines for their kids, but we have such heritage in this category – we’re a go to brand.”
Fergus McCauley, IQVIA, Ciaran Woods, Senior National Account Manager, RB Ireland and Brian Pagni, Owner, Bradleys Pharmacy Group
NiQuitin - by Perrigo
Benylin Winter Campaign by Johnston & Johnston
& Pharmacy Retail Product Awards
Natural Infant Product More and more mothers are turning to natural and holistic remedies for both themselves and their babies as a greater emphasis is based on natural living. Supporting natural healing process and development is a must-have for any product in this range as it supports one of the fastest growing markets in healthcare.
Multi Mam Distributed by Ocean Healthcare Product description The Multi Mam range offers a complete solution for breast feeding mums – protects and treats sore nipples, prevents against mastitis and provides direct relief. Most importantly, the whole range is safe for babies. Judges’ comments “This is a popular product among consumers and it’s backed-up by real support. The company provide excellent training at all levels and excellent product detail aids.” A word from the winners “It’s fantastic because this is a super product – we even get recommendations from midwives because they’ve used it themselves. There’s nothing like this compress in Ireland and it does give immediate relief. Our whole aim is to keep mums breastfeeding. The award is great for recognition.”
Orla O’Connor, Marketing Manager, Graham Stafford, Marketing Director, Ocean Healthcare
Elave Sensitive Baby Bath - by Ovelle Pharmacueticals
Mustela Vitamin Barrier Cream 123 - Distributed by Graham Anthony
Sterimar Baby Distributed by United Drug Consumer
MyPro Colicare Distributed by Pharmed
Multi-Gyn Treats and prevents vaginal discomforts
FloraPlus - For thrush For Thrush, Candida and Recurring Thrush. For relief from itch, odour, irritation and discharge. FloraPlus can be used with Antimycotics. Provides stimulation of lactobacilli.
Contains the patented 2QR complex which neutralises harmful micro-organisms and supports the natural healing process.
For bacterial vaginosis (bv) Prevents and treats BV.
For vaginal dryness
For intimate hygiene pH balanced soap-free pump.
Available from Ocean Healthcare and all Wholesalers. Ocean Healthcare 01 296 8080 â€˘ www.multi-gyn.ie
& Pharmacy Retail Product Awards
Product Launch Breaking in to the highly competitive OTC market requires a carefully orchestrated strategy with a multifaceted campaign. Any successful product launch must communicate to both consumer and pharmacist exactly what the product does, who it is for and why it is better than its competitors. An effective launch campaign paves the way to success.
Winner – Buscopan by Sanofi Consumer Healthcare Product description Buscopan provides relief from abdominal cramps, pain & discomfort, including Irritable Bowel Syndrome. Previously only available on prescription, this is the number one anti-spasmodic range available in Ireland. Judges’ comments As a product was previously only available on prescription, Buscopan has had a very successful transition to OTC. This must be because Buscopan has a tried and tested reputation as an effective medicine. A word from the winners “We are so excited to have won an OTC Award for Buscopan. Buscopan is one of the few products in Ireland to be switched from prescription only to OTC in recent years and it’s been amazing to bring such a great product to the market to help people get effective relief from abdominal pain, especially IBS sufferers. The IPN awards help to inspire us to continuously raise the standard to bring the best products and services to Irish consumers. There’s always strong competition for the awards categories, especially for New launches. We’re really proud that Buscopan stood out for the Judges this year. This award is a fantastic endorsement of Buscopan and we’ll certainly be making sure we communicate strongly about it!”
Fergus McCauley, IQVIA, Laurence O’Carroll, Ashfield Healthcare, Tanya O’Toole, Head of Sanofi Consumer Healthcare and Brian Pagni, Owner, Bradleys Pharmacy Group
Proceive – by Ocean Healthcare
Solpa-Extra – by Perrigo
Colief Breathe Easy Patch – Distributed by Ocean Healthcare
Worldâ€™s No1 antispasmodic range
Effective relief from the pain and discomfort of abdominal cramps and IBS Targets the source Fast acting relief Gentle on the stomach Well tolerated Pharmacy only Contains hyoscine butylbromide. Always read the label. BuscopanÂŽ 10mg Coated Tablets Product Information Presentation: Tablets containing hyoscine butylbromide 10mg. Indications: Relief of spasm of the gastrointestinal tract and for the symptomatic relief of Irritable Bowel Syndrome. Dosage and administration: For spasm of the gastrointestinal tract: adults and children over 12 years: 2 tablets four times daily. For Irritable Bowel Syndrome: initially 1 tablet three times daily, increasing if necessary to 2 tablets four times a day. Contraindications: hypersensitivity to any component, myasthenia gravis, mechanical stenosis in the gastrointestinal tract, paralytical or obstructive ileus, megacolon, narrow angle glaucoma. Warnings and precautions: In case severe, unexplained abdominal pain persists or worsens, or occurs together with symptoms like fever, nausea, vomiting, changes in bowel movements, abdominal tenderness, decreased blood pressure, fainting or blood in stool, medical advice should be sought immediately. Buscopan should not be taken for extended periods without investigating the cause of abdominal pain. Use with caution in conditions characterised by tachycardia; those susceptible to intestinal or urinary outlet obstruction; pyrexia. Warn patients to seek medical advice if they develop a painful red eye with loss of vision whilst or after taking Buscopan 10mg Coated Tablets. Patients with rare hereditary problems of fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency should not take Buscopan 10mg Coated Tablets since the tablet coat contains sucrose. Advise patients to consult their doctor before taking if: this is the first time they have symptoms of IBS, age over 40 years and some time since the last attack of IBS or the symptoms are different; recent rectal bleeding; severe constipation; nausea or vomiting; loss of appetite or weight; difficulty or pain passing urine; fever; recent travel abroad. Advise patients to consult their doctor if they develop new symptoms, or if symptoms worsen, or if they do not improve after 2 weeks of treatment. Interactions: The anticholinergic effect of drugs, e.g. tri- and tetracyclic antidepressants, antihistamines, quinidine, amantadine, antipsychotics (e.g. butyrophenones, phenothiazines), disopyramide and other anticholinergics (e.g. tiotropium, ipratropium, atropine-like compounds) may be intensified by Buscopan 10mg Coated Tablets. Co-administration with a dopamine antagonist may diminish the effect of both medicines. The tachycardic effects of beta-adrenergic agents may be enhanced by Buscopan 10mg Coated Tablets. Pregnancy and lactation: Use during pregnancy and breastfeeding is not recommended. Side effects: Uncommon: dry mouth, tachycardia, skin reactions (e.g. urticaria, pruritus), dyshidrosis, constipation. Rare: urinary retention. Not known: anaphylactic shock, anaphylactic reactions, dyspnoea, rash, erythema, other hypersensitivity, visual accommodation disturbances. Pack sizes: 20 and 40. Legal category: P. Product authorisation number: PA 540/181/2. Product authorisation holder: sanofi-aventis Ireland Ltd., Citywest Business Campus, Dublin 24, Ireland. Tel 01403 5600, email: IEmedinfo@sanofi.com. For further information please see Summary of Product Characteristics. Date of revision: December 2017. Corresponding SmPC ref: B10a/E/SPC/24 dated December 2017. Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard Adverse events should also be reported to Sanofi drug safety department on 0800 0902314 1: Based on sales data.
SAIE.BUSC.17.11.0234 (1) March 2018
& Pharmacy Retail Product Awards
Eyecare Product Another new category for 2018 but certainly not an unimportant one. The importance on vision can never be underestimated, neither can the education of pharmacists in diagnosing eye conditions. In many cases a simple treatment can be very effective.
Winner – Brolene by Sanofi Consumer Healthcare Product description Brolene range helps treat minor eye infections including bacterial conjunctivitis, blepharitis and minor eye irritations such as sties. Brolene’s action helps stop the bacteria growth causing the eye infection. It allows the body to fight off the infection. Both formats, the drop and the ointment can be used for all the family. Judges’ comments “Many of us could easily describe Brolene as old faithful, but that really doesn’t do the product justice. Brolene has been on the market for a long time and it’s always popular because there isn’t much else out there that can compare to it.” A word from the winners
Laurence O’Carroll, Ashfield Healthcare, Tanya O’Toole, Head of Sanofi Consumer Healthcare
Thealoz Duo Distributed by Pamex
“This is a really special product that’s been available in Ireland for decades. Everyone from mums to grandmothers know and use it and that’s a really important part of our market. There are big-name brands in our category, but we do one thing and we try to do it really well. This year we’ve really focused on how to diagnose eye infections, educating pharmacists so they know when a customer needs Brolene.”
Optrex Night restore Gel Drops by RB Ireland
Macu-Save Distributed by Pharmed
The first self-selection laxative on the Irish Market containing Macrogol 4000, a NEW ingredient in the Dulco range A great option for a wide range of customers, including: • those treating constipation for the first time, • those looking for a gentle laxative with a pronounced stool softening effect, or • pregnant and breastfeeding women and children between 2-8 years when advised by a doctor.
SAIE.DULC1.17.06.0139a January 2018
& Pharmacy Retail Product Awards
Hair and Scalp Product Hair care and hair loss are an increasing concern for the consumer. Hair loss in particular can have a profound effect on the self-esteem of both men and women.
Winner – Eucerin DermoCapillaire Calming Urea Scalp Treatment by Beiersdorf
This is a market that continues to grow, with more innovative products appearing every year to solve any number of hairrelated issues. The market is estimated to be worth ¤166m by 2021.
Product description Eucerin DermoCapillaire Calming Urea Scalp Treatment is specifically designed for people with a dry and itchy scalp. Its non-sticky leave-in formula delivers hours of intensive moisture to the scalp and soothes and reduces itchiness from first use. Judges’ comments “This is a product designed with one aim in mind. Although it might not be as well-known as some other products, it sees consistent repeat purchases.” A word from the winners “An award like this is a great thing because it means that this is a brand recognised by pharmacists in the business. Skincare is important to a lot of pharmacists and their customers so it’s great to help them with any issues they have. The IPN brand speaks for itself as industry recognition. We face competition from established brands as well as a lot of new ones coming in which is great to see.” Samantha Bakir, HR & Operations Manager, Smith's Pharmacy Group, Tara Keating-Cahill, Allegro and Brian Pagni, Owner, Bradleys Pharmacy Group
Finalists Batiste Dry Shampoo Distributed by United Drug Consumer Uriage D.S Lotion Distributed by Graham Anthony
“ I thought I would have to accept being in pain forever, but now, because of Flexiseq, I don’t.”
Thanks to Flexiseq, X-Factor’s Mary Byrne has got her mobility back and lost 4 stone. Mary suffered from osteoarthritis in her knee and found it impossible to exercise and at times, even perform: “Quite simply, Flexiseq has changed my life!” Flexiseq® Osteoarthritis gel’s unique drug free action works precisely where it’s needed to lubricate joints affected by osteoarthritis, for effective, everyday relief from pain and stiffness. And because it’s drug-free, Flexiseq® is safe for long term use. Available in all good pharmacies and online. For enquiries please contact:
firstname.lastname@example.org 1 800 939149 www.flexiseq.ie
& Pharmacy Retail Product Awards
GI Product The GI category is one that has been expanding the new product range in recent years, including pharmaceutical solutions, vitamins and minerals. It can be almost impossible for the sufferers of some GI conditions to go about their daily lives without experiencing severe symptoms. Scientifically researched efficacy should be backed by a well-informed and innovative marketing campaign to present consumers for the best possible solution for their ailments.
Winner – Gaviscon Extra by RB Ireland Product description Gaviscon Extra provides long-lasting relief from the pain and discomfort of heartburn and acid indigestion. It gets to work in two different ways, firstly by neutralizing excess stomach acid to relieve pain and discomfort and secondly by forming a protective barrier to soothe the burning pain in your chest. Gaviscon has a range of products to suit all customer needs and that is why it is Ireland’s No. 1 selling Heartburn & Indigestion brand in pharmacy. Judges’ comments This is an effective and very well supported brand – in the industry it’s known for the extra help and training always made available by the reps. A word from the winners “An award like this really raises the profile for an already established brand such as Gaviscon. There are other products coming on to the market but this proves that such a strong and traditional brand is still relevant in the current market. This award proves that Gaviscon stands over the others. It’s good to see some recognition for all the teamwork that goes into it.”
Nicola McGarvey, IPN Advertising Manager, Ciaran Woods, Senior National Account Manager
Dioralyte - Sanofi Consumer Healthcare
Alflorex - by Precision Biotics Ltd
Colodex - Distributed by Pharmed
& Pharmacy Retail Product Awards
Pain Relief Product With many pain relief brands being available only from pharmacies, this is a product that consumers will regularly turn to their community pharmacist for and is the cornerstone of Irish pharmacy. This continues to be a sector with plenty of potential for growth as so many pain relief brands are still pharmacy only. As consumers turn to their pharmacists for advice, the pharmacists must be prepared to supply additional, specific information covering this vast category that encompasses so many indications and contraindication.
Winner – Voltarol Emulgel Extra Strength 2% w/w Gel by GSK Consumer Healthcare Product description Voltarol Emulgel Extra Strength contains an antiinflammatory drug (NSAID) called diclofenac which targets pain at its source. Diclofenac works by blocking production of some of the body’s chemicals that cause swelling (inflammation), pain and tenderness. The active ingredient in Voltarol Emulgel Extra Strength gel, diclofenac, has been used as a pain reliever for over 30 years in Ireland. Judges’ comments “Voltarol is a multi-active pain product that is supported by an excellent team of reps and marketers. They ensure that pharmacists know all there is to know about recommending and using this product.” A word from the winners “This is fantastic to see Voltarol continue to triumph since its launch in 2016 with year on year growth.
Samantha Bakir, HR & Operations Manager, Smith's Pharmacy Group, Maria McClafferty, Marketing Manager, GSK and Brian Pagni, Owner, Bradleys Pharmacy Group
The OTC Awards are great because they’re awards that are recognised industry-wide. There are quite well-established pain relief brands within this category so the fact that such a new product can win in such an established category is a real plus.”
Finalists Solpadeine - Perrigo
400mg Film-coated tablets
Nurofen Express Maximum Strength - RB Ireland
EASY TO SWALLOW
BruPro Max - Rowex
& Pharmacy Retail Product Awards
Allergy Product With hay fever season around the corner, pharmacists and consumers alike eagerly await new product and innovations for tackling this common ailment. Although established brands remain at the top of this market, innovations in effective nasal sprays are gaining increasing prominence, particularly those featuring both mechanical and pharmaceutical nose clearing spray devices. The top allergy brands remain in favour with most customers, but nasal sprays are coming into increasing prominence with many new brands coming on to the market.
Winner – Zirtek Distributed by United Drug Consumer Product description Zirtek provides an effective antihistamine allergy treatment in a variety of SKU’s including the 30 pack of tablets which combines value with convenience for the customer. The range also features the popular 200ml solution which has proven to be a great success in providing much needed relief to younger allergy sufferers. Judges’ comments “Zirtek was the clear favourite in this category. It sells really well in pharmacies because it is unique to other products on the market.” A word from the winners “This does a lot for the marketing of Zirtek. We’ve won an award that is really well recognised, so we’ll be moving to put it on our branding and marketing materials. We were up against generic brands that were strong, so this helps to lift our brand above the others. It’s a real dream and we’re delighted.”
Nicola McGarvey, Advertising Manager, IPN, Joanna Maycock, Brand Manager, Rachel Charman, Brand Manager, United Drug
Cetriz - Teva Pharmaceuticals Ireland
Cetrine - Rowex
Anti-Hist Allergy - Clonmel Healthcare
Eucerin Allergy Protection After Sun Creme-Gel - Beiersdorf
A GREAT SELLING PRODUCT, right under your nose A popular, trusted brand, offering around the clock relief from hayfever and other allergy symptoms Max strength treatment Zirtek D includes an active decongestant to help to clear blocked noses Available in extra value packs of 30 Awareness and sales driven by high-profile marketing activity, including online advertising and social media Point-of-sale material available for your use
Contact your regional representative today to order Zirtek, your point-of-sale support, or to discuss your requirements. www.zirtek.ie
Please consult the Summary of Product Characteristics before prescribing, information about this product can be found at www.medicines.ie Further information is available on request from UCB Pharma Ireland Ltd, United Drug House, Magna Drive, Citywest Road, Dublin 24 MA Numbers:
Zirtek 1 mg/ml oral solution: PA 891/8/3, Zirtek Plus Decongestant 5/120mg Prolonged Release Tablets PA 891/8/1, Zirtek Tablets PA0891/008/005
Product licence holder:
UCB Pharma Limited Legal Category: OTC
Zirtek tablets & oral solution: Cetirizine dihydrochloride Zirtek Plus Decongestant prolonged release tablets: Cetirizine dihydrochloride, Pseudoephedrine hydrochloride
Adverse events should be reported to the Health Products Authority at www.hpra.ie or via email to email@example.com Adverse events should also be reported to UCB Pharma Ireland Ltd via email UCBCares.IE@ucb.com
February 2017 UK/16ZI0052
& Pharmacy Retail Product Awards
Travel Product When preparing to travel consumers turn to safe, familiar and reliable products for minor issues abroad - not least to avoid an unfamiliar market in another country. Pharmacists can thrive in a category that encompasses sun care, GI products and insect bite prevention, particularly with proven, effective brands that consumers will return to every year.
Winner – Elave Sensitive Sun SPF 30 by Ovelle Pharmaceuticals
Product description Elave Sensitive Sun SPF 30 offers high UVA & UVB Protection. The Allergan free formula is safe for all skin types, particularly the most sensitive – it’s even pediatrician approved for newborns. Enriched with Vitamin B5, Vitamin C and Vitamin E the product has a lightweight oil free formula and is recommended by Melanoma Ireland Judges’ comments “This is a great product. Not only is it specifically formulated for sensitive skin but it is paediatrician approved for use on new-borns and higher, offering good protection from UVA and UVB rays.” A word from the winners
Joanna Gardiner, CEO,Ovelle Pharmacueticals, Nicola McGarvey, Advertising Manager, IPN
P20 Continuous Spray SPF 30 by Riemann - Distributed by Eurosales International Ltd
“An award like this brings great confidence to the team, great confidence to the pharmacist and great confidence to the consumer. It’s always a big vote for us. A brand like the OTC awards from IPN really works for us. We’re not a big multinational so this is a real win for the little guys. It’s certainly the right time of year to win an award as an SPF!”
Eucerin, Allergy Protection After Sun Cream Gel by Beiersdorf
DAILY UV DEFENCE FOR VISIBLY YOUNGER SKIN
Available in pharmacies nationwide. Buy online at elaveskincare.com
& Pharmacy Retail Product Awards
Pharmacy-only Product Pharmacy-only products make pharmacies stand out from other retailers. With larger retails now competing with pharmacies in all other markets, now is the time for pharmacy-only brands to attract customers. With many consumer health products still restricted to the pharmacy-only market, customers still turn to the pharmacy for their healthcare needs as they know the products come with professional advice. Particularly with the promotion of self-care, it has never been more important for pharmacy-only brands to attract consumers.
Winner – Uriage Bariéderm CICA-CRÈME Distributed by Graham Anthony Distribution Product description Uriage Bariderm CICA-Crème is a first-aid product that provides fast healing, immediate relief and prevents scarring from the entire range of cuts. This velvety cream is also suitable for minor surgeries and procedures with quick absorption. Judges’ comments “Uriage Bariederm is an effective and reliable product. There is a lot of support from this well-known brand and we have a product here that delivers what it promises.” A word from the winners “Awards like these are great for us because it’s a real acknowledgement of the hard work that we all do to get the brand recognised.
Natalie Maginnis, Managing Director, IPN Communications, Marie Therese Burke National trainer, Graham Anthony Distribution and Jennifer Zamparelli
First Response Early Results Pregnancy Test - Distributed by United Drug onsumer
It makes a real difference because IPN is really well respected in the pharmacy industry. It’s the one magazine that comes through the door that pharmacists and owners really love to read which makes it really valuable to us. When they see awards like this they get to see the brand and see that we’re putting the effort in and that makes them want to work with us more.”
Acne Out - Biofresh Skincare International
Eucerin UreaRepair PLUS Lotion 10% - by Beiersdorf
Carnation Footcare - Distributed by Ovelle Pharmacueticals
& Pharmacy Retail Product Awards
Best Product Training 2018 Good product training for pharmacists and their staff is essential, it is the key to good communications between pharmacy staff and their customers. It is imperative that brand provide pharmacies and their staff with the right tools to ensure professional and ethical standards are adhered to.
Winner – Perrigo National Training Seminars
A brand’s investment in training enables a pharmacy team to develop a better understanding of the challenges and opportunities they will faces each day.
Product description Perrigo host national seminars twice every year to bring category and product training to pharmacists and the wider pharmacy team in an interactive setting. Pharmacists are offered a range of workshops and all of these are supported by published materials. The aim of all Perrigo training is to Make a Difference to Health. Judges’ comments Perrigo have placed a real emphasis on product training and that is evidenced in every pharmacy in Ireland. The team consistently aim to upgrade and improve their seminars and now include CPD within their training. A word from the winners “These product awards bring a lot to our brand. Rather than us talking about our key claims and benefits they bring something more substantial to the table. We have a more holistic approach to training and always try to include something more for the pharmacist or OTC assistant. We’re delighted to have IPN attached to our brand – for us it means that people actually care about the work that we’re doing in our training seminars – it’s something that will certainly encourage us to roll them out again next year.”
Natalie Maginnis, Managing Director, IPN Communications, Geraldine Arnott, Assistant Brand Manager, Perrigo
& Pharmacy Retail Product Awards
Best Marketing Initiative Marketing is essential for any brand but innovation in marketing can make one product stand out among all the other. Being able to identify the needs of the customer and then meet them in distinctive ways will pay dividends.
Winner – Solpa-Extra by Perrigo Product description Based on the insight that consumers wish to use the same brand product throughout the pain path, Perrigo launched Solpa-Extra – the Step 1 pain relief product. Indicated for the treatment of mild to moderate pain, Solpa-Extra contains 500mg of paracetamol and 65mg of caffeine. Judges’ comments “In terms of effective marketing, the results for the campaign surrounding Solpa-Extra speak for themselves as the brand has already sold out.” A word from the winners “We’re delighted as this is a really good award to win. We only launched Solpa-Extra last year so we’re very proud of the marketing behind it. We’re committed to pharmacy and want to highlight that so an award like this really hits that home. There’s a huge amount of competition for us even in our awards category so a win really means something.”
Natalie Maginnis, Managing Director, IPN Communications, Niall McMorrow, Brand Manager, Perrigo and Jennifer Zamparelli
Durex POME STI’s Campaign RB Ireland
Finalists Nicorette - Johnson & Johnson
Panadol - GSK Consumer Healthcare
Nurofen for Children fever Fighters Campaign, Q1 2017 - RB Ireland
& Pharmacy Retail Product Awards
Children’s Product Winner – Lyclear by Perrigo
The child and baby market is one of the fastest growing in the pharmacy sector. While supermarkets can offer big brands and cut-price discounts, pharmacies must return to the personal services offered to parents. Niche brands and specialised staff are real assets for pharmacies.
Product description Lyclear offers a range of products from protection to treatment of head lice. The medical device treatment products do not use a chemical action but work by suffocating and dehydrating the lice and eggs, therefore head lice are unlikely to become resistant. Lyclear has a full range of products to effectively treat head lice and to suit customers’ needs. Judges’ comments This well-known product has always been a reliable one in the pharmacy industry and for that reason it has the leading market share. The brand has an excellent reputation and excellent representatives – they always keep pharmacists up-to-date on the newest developments. A word from the winners “Winning an IPN award is fantastic – for pharmacists to see the IPN logo on marketing materials certainly gives us that little bit more credibility. To know that we have the best children’s product from an IPN perspective will steer people in our direction. There is plenty of competition for us in this category – there are a few other products but ours holds the main market share but we’re just going to continue to focus on ourselves and keep doing what we’re doing.”
Niall McMorrow, Brand Manager, Perrigo and Mary Byrne
Finalists Licetec V-Comb Distributed by Brandshapers
Mustela Stelatopia Emollient Cream Distributed by Graham Anthony Distribution
& Pharmacy Retail Product Awards
Oral Health Product In an era where dental costs are spiralling, reliable and affordable OTC products are a must. Oral healthcare encompasses both the physical and the cosmetic in an age where appearance is everything. Consumers must be able to rely on OTC oral products that they are both safe and effective.
Winner – Beverly Hills Formula, Professional White Kit Distributed by Brandshapers Product description Brilliant Pearl 2-in-1 combines Hydrogen Peroxide with professional whitening ingredient PhthalimidoPeroxy-Caproic Acid (PAP) to help remove surface and deep stains. Both ingredients break down discolorations on the teeth without affecting the tooth structure. Additionally, PAP supports dental hygiene by eradicating bacteria which can harm teeth. PAP is only active on the tooth surface; no irritation is caused to the gums and mucous membranes in the mouth. Judges’ comments “This product stands out at every level – from the eye-catching packaging to its unique selling point.” A word from the winners
Liam Dooley, Commercial Manager, Brandshapers, Joanna McCarthy, International Business Manager and Aoife O’Donovan, Marketing Manager
“An award like this is a big thing for us, it shows that we’re the best in the Irish market. This product already has the endorsement of professional dentists so now we can add the endorsement of pharmacists to it too. That’s really valuable for our sales team.”
Corsodyl Ultra Clean GSK Consumer Healthcare
Kin Care Gel - Distributed by Pamex
& Pharmacy Retail Product Awards
Natural Product As we turn towards healthier lifestyles the natural and organic market has been complimented by a growth in confidence. Consumers are now concerned as much by a product’s ingredients as they are by what it does – more than half of consumers now admit that a product’s natural or organic status is a key feature in the purchasing decision.
Winner – Alflorex by Precision Biotics Ltd Product description Alflorex® is the leading probiotic for IBS. This probiotic is taken daily to manage and prevent recurrence of all IBS symptoms. The unique 35624 culture in Alflorex is a naturally occurring bacterial strain found in the human gut. This Bifidobacterium longum culture is part of the family of bacteria given by mother to baby at birth. Judges’ comments “Alflorex is a great product and has eye-catching packaging. This is an easy to use product that works for both adults and children. We can see the popularity of this brand simply from the number of customers who ask for it in store. A word from the winners “This award is such a big deal for us because it’s the recognition from the pharmacists who are selling it. Irish pharmacists have been wonderful partners for us and have done a great job in explaining how Alflorex can help them. We know that many people who work in pharmacies can recommend our product because they tell us that they use it themselves.”
Brian Barrett, Managing Director, Sarah Beltoise, Marketing Director, PrecisionBiotics and Gerard Murphy, Sales Manager, Pamex
ZinCuFlex Distributed by PPC Galway
Quinton Isotonic - Cell Nutrition
Eskimo-3 Advanced EPA - Distributed by PPC Galway
Wild Alaskan Full Spectrum Omega - Solgar
& Pharmacy Retail Product Awards
Skincare Product For the community pharmacist skincare encompasses everything from acne to anti-aging to sun care and consumers are demanding products that do more to invest their money in, despite the economic downturn. This category encompasses every day and specialist skincare in a market worth billions each year. This is one which has remained buoyant despite the economy and as it improves so does consumer spending.
Winner – Biofresh 3 Steps For Healthy Glowing Skin by Biofresh Skincare International Product description 3 Steps for Healthy Glowing Skin is an introduction to a newprobiotic skincare regimen. The 3 steps are to cleanse, tone and moisturise. A probiotic Night & Eye cream and a Probiotic Lifting Serum support this range. Probiotics are becoming the latest trend in the beauty industry as recent studies are showing that their health promoting effects include powerful skin health benefits. You can create great skin with a probiotic laced skincare regimen that actually works. Judges’ comments “This is a new product to the market but already one that stands out. As well as a distinctive package design this is a concept that should be very popular with customers.” A word from the winners
John Morgan and Catherine Morgan, Director, Biofresh Skincare International
“We are absolutely thrilled to win this award and have to applaud IPN on organising a fabulous event. All of the products in our category were excellent and deserved to win, fortunately we were the best choice. The credibility and recognition we will get from winning this category is priceless and will add even further to the success of our company and brands.”
E45 Cream - RB Ireland
Skin Republic Face Mask Distributed by Pamex
Eucerin Aquaphor Wound Care Ointment Beiersdorf
Uriage Xémose Emollient Milk - Distributed by Graham Anthony Distribution
& Pharmacy Retail Product Awards
Cold & Flu Product The cold and flu market has had a boost in recent years as consumers are encouraged to consult pharmacists first, before a visit to the GP. In turn this has led to strong costumer awareness in an increasing market. The pharmacy is now the first port of call for the management of the common cold and its accompanying ailments. Well trusted brands with a significant brand loyalty among Irish customers are backed with strong campaigns are the first port of call for customers seeking advice on their cold and flu symptoms.
Winner – Otrivine by GSK Consumer Healthcare Product description Otrivine is a nasal spray that acts directly to the nasal mucosa at the source of cold symptoms. Otrivine provides fast relief from nasal congestions, in as little as two minutes. Its decongestant effect lasts up to 10 hours. It has less systemic exposure than oral decongestant formats with a less risk of sleeping disturbance. Judges’ comments “Otrivine was the clear winner in this category. Nasal sprays sell well and they come with a linked selling opportunity, particularly as this is a pharmacy only product. Otrivine is a great product with great support behind it as it’s very well marketed.” A word from the winners “We’ve had a big focus on Otrivine this year and as a result in the last couple of months we’ve really grown our market in a market that is itself growing.
Bryan Dunne, Sales Manager, GSK, Mary Byrne and Cormac Tobin
In particular, this award will be a huge bonus for us. It’s a great result for us as we have a tough category as we’re up against similar products that are performing really well.”
Lemsip Max Sinus & Flu by RB Ireland
llvico Distributed by Brandshapers Benylin Day & Night Tablets by Johnson & Johnson
A.Vogel Echinaforce Distributed by Wholefoods
& Pharmacy Retail Product Awards
VMS Product As a constantly growing market, the vitamins, minerals and supplements market is one worth billions every year, thanks to an ever-increasing consumer awareness of preventative healthcare. More and more consumers are prepared to buy lifestyles they feel they are unable to achieve through health and balanced food consumption alone. With more disposable income, many are opting for supplements and multivitamins with a strong emphasis on natural ingredients.
Winner – Omnium by Solgar Product description Omnium is a multivitamin and mineral formula, which is rich in phytonutrients, antioxidants and contains chelated minerals. It also contains CoQ-10, alpha-lipoic acid, quercetin and proanthocyanidins which provide broad spectrum antioxidant support. Omnium may offer multiple benefits by supporting energy production and providing antioxidant protection against the increased free-radical production generated by intense exercise. Judges’ comments “Solgar is a premium product which looks well, delivers a good margin and satisfies both the law and high ends of the market. All of that is backed up by an excellent product with excellent support from the distributor.” A word from the winners “We’re so happy to win at the OTC awards as this is our first major win. Something like this shows the willingness and support we have within the category. An added bonus is that these awards are organised by IPN as they are so well-known and reputable in the pharmacy market. Having won in such a competitive category is a huge honour and shows how much trust the Irish pharmacy industry has is Solgar as we continue to grow the brand.”
Paul Chamberlain, Nutrition and Education Director, Solgar
MyPro Forte Distributed by Pharmed
Seven Seas Perfect7 Prime Distributed by Brandshapers
Quinton Hypertonic - by Cell Nutrition
Revive Active Super Food Supplement - by Revive Active
Unlock the power of nature from within For 70 years, Solgar® has been unwavering in its efforts to develop innovative products backed by rigorous scientific evidence based on the latest clinical trials and a purity and potency guarantee. We’re proud to deliver ‘Gold Standard’ products people know and trust with uncompromising quality and integrity.
WINNER Solgar® Omnium® - An Award Winning Multivitamin: Omnium® is Solgar’s most advanced multivitamin and mineral formula that is rich in phytonutrients, antioxidants1, vitamins, amino acids and chelated minerals for optimal absorption.
BEST VMS PRODUCT OMNIUM
Unusual for a multinutrient formula, Omnium® also contains CoQ-10, alpha-lipoic acid and quercetin providing broad spectrum antioxidant1 support. This advanced formula contains vitamins B6 and B12 and iron which contributes to normal energy-yielding metabolism and supports your immune system.2 Just two tablets per day and suitable for vegan diets. Available in 30, 60, 90 and 180 size bottles.
For more information contact your Solgar® Territory Account Manager or call 0044 1442 890 355
solgar.co.uk 1. Vitamin C contributes to the protection of cells from oxidative stress. 2. Vitamin B12 and folic acid contribute to the reduction of tiredness and fatigue and immune system function. Food supplements should not be used instead of a varied balanced diet and a healthy lifestyle. Solgar® is a registered trademark.
News Meaghers Pharmacy doing a little extra to get runners off the couch Dublin based pharmacy chain Meaghers have proved time and again that going the extra mile within the community can pay dividends – and this time the cliché runs true. to more advanced workouts and runs are all available online at no cost. Each week all those taking part would watch videos and read tips online before meeting to put what they’d learned into practice. To keep the group motivated a Whatsapp chat was created to keep everyone up to date. Plunket’s running club after their final 5K
Journalist Mary Jennings recently admitted to a March malaise when it came to getting off the sofa. She blamed a lack of motivation, direction and the weeks-long run of bad weather 2018 has seen on her unwillingness to take part in physical exercise this year. Mary freely admitted the absence of companionship was just one of the factors that have prevented her from leaving the cosiness of her couch this winter to pound the
pavements. To remedy this, she found herself joining with a running group for their final 5K run at the end of an eight-week programme. St Oliver Plunkett Eoghan Ruadh GAA Club started a beginner’s couch to 5K programme earlier this year. The tried and tested programme which helps people of almost any fitness level work towards running a 5K. With exercise for being a by-word for keeping illness and medical
The group’s final victory was celebrated with a goody bag on completion, courtesy of sponsor Meaghers Pharmacy. conditions at bay, studies have shown that exercising as part of a group can significantly improve not just physical, but mental health too. A group can be an organised programme such as that run by Plunkett’s, but it can also be just two or more friends taking the time to work out together. Exercise programmes from the couch to 5K programme, to improvers programmes or even stepping up
This isn’t the first time Meaghers have stepped up to help sport as they are regular sponsors of camogie and GAA clubs in Dublin. In addition, each year staff at the pharmacy chain vote to select a dedicated charity to support for 12 months. Of course, not all 5K programmes will result in a surprise goody bag, but Meaghers surprised their community yet again with their display of generosity.
PMI Annual Business Day 2018 Announced The Pharmaceutical Managers' Institute have launched their 29th Annual Business Day for 2018. The event will take place on Friday, April 13 at the renowned Carlton House in Co Kildare, Dublin and the theme for this year’s business day is Progress in Partners. The PMI was founded in 1989 and aims to encourage the highest standards possible within the management of the Irish pharmaceutical society. The institute has a full calendar of networking events, seminars, workshops and masters classes as well as educational events such as the annual business day. Among the speakers at this year’s
business day will be Roisin Adams, Chief Pharmacist with the HSE, oncologist Dr Paul Cornes and Dr Virginia Acha, Global Policy, MSD R&D Innovation Centre. The three speakers will each be giving their own views on biosimilars. Fiona Dunphy, PMI Commercial Director explained: “A major focus of this year’s business day will be looking at biosimilars from three different angles. We have the financial angle from the HSE’s point of view, but also from an industry angle and we’ll also hear from clinicians.”
The Annual Business Day aims to bring together a range of business leaders from the pharmaceutical and wider business industries. More than 300 senior pharmacy managers are expected to attend this year’s event. The day will be sponsored by companies such as United Drug, Volvo, Irish Medical Times and Ashfield. Returning as chairman this year will be journalist, author and broadcaster Matt Cooper. Fiona Dunphy said: “We’re delighted to have Matt return as chairman this year as he performed the role so well in 2017.”
She continued: “The part I’m looking forward to the most is having a huge number of industry experts in one room. The PMI was set up to educate but also to foster contacts and networking within the industry and this is the best occasion to meet with peers in the industry to learn and socialise.” The PMI Annual Business Day will take place from 9am to 5pm on Friday, April 13 and will be followed by a networking supper. For more information or to book your ticket visit www.thepmi.com.
The trade mark Actavis is used under licence by Teva Pharmaceuticals Europe B.V.
GDPR Just one month until GDPR legislation passes is your pharmacy ready? By Richard Kelly One of the biggest issues facing Irish business and indeed business throughout the EU will be the passing into EU statute of the General Data Protection Regulations legislation on May 25th. Whilst the legislation itself was adopted in April 2016, the end of the two-year post adoption grace period is fast approaching and with each day that passes, the chatter surrounding the impending changes gets louder.
Profile Richard Kelly, Director at Profit Pharm, is a qualified and experienced business coach who has been running his own business since 2003, having spent 20 years in various sales, marketing and senior management roles. Working initially within a variety of business sectors, for the last 10 years Richard has focused particularly on the community pharmacy sector, where he had fantastic results. Profit Pharm is a new business launching this Spring. Its primary mission is “to support the independence of independents” through helping independent pharmacy build long term, sustainable growth and profit into their business. Richard says “it’s not just about money, it’s about looking at every area within the business. Working with a preferred partner model, we are all about using proven and innovative strategies and ideas to produce a return on all spend within the pharmacy business, whether this is marketing, sales, staff, compliance, digital or IT. “We will help each business become the best it can be. Profit Pharm brings all our experience into one place enabling us to deliver real benefit to the bottom line of each business.” Richard can be contacted on 085 1455 425 or email firstname.lastname@example.org for a no obligation discussion. Richard Kelly, Director, Profit Pharm
For some, the early adopters, they have embraced the process, are implementing change in their business and are well on their way to being compliant. It would appear that for most businesses however, this is not the case, with many now playing catch up now that the compliance date is looming. Why the Change? One of the first questions people ask is “Why change?” In many ways, much of the intrinsic content of the existing Data Protection Legislation remains, however, the fundamental change is to give all EU citizens (each a data subject) full control over the collecting, use and storage of any personal data
held by any organisation that relates to them. The EU constitute personal data as “Any information related to a natural person or ‘Data Subject’, that can be used to directly or indirectly identify the person. It can be anything from a name, a photo, an email address, bank details, posts on social networking websites, medical information, or a computer IP address.” Another key difference is that GDPR is a legal regulation, fully enforceable from May 25th, rather than an EU directive as was previously the case. Each country took the directive into law within their own jurisdiction whereas now, with GDPR, there
is no requirement for the State bring into law, although there is an Irish bill currently on the way. This legal change will harmonise Data Protection Legislation throughout the EU, making the management and control of data much easier. Key Changes – What’s different? Registration To date, the only actual relationship with the Data Protection Commissioner for most businesses was a simple registration process and the payment of a fee. In return, a certificate was issued and you were compliant. It is a PSI requirement to hold an in-date certificate.
With GDPR, there will no longer be any requirement to register with the Commissioner. From May 25th, it is expected that those businesses that need to be compliant, will be. Indeed, the Data Protection Commissioner Helen Dixon has warned Irish companies “that there will be no leeway or second chances for noncompliance of the new rules”. If an Inspector is standing at your door on May 26th, you are expected to be compliant. Accountability As I mentioned earlier, Accountability is the cornerstone of GDPR and under Article 24 it states “ The legal requirement for Data Controllers (legal entity who determines how data is
collected, processed and used within an organisation) and Data Processors (person that processes data on behalf of the Data Controller) to demonstrate that all appropriate measures have been put in place to meet GDPR compliance guidelines”. What does this mean in reality? From a compliance standpoint, you will need to review all the personal data you hold (for patients /customers and also your staff). Frame the review with questions such as: Why am I storing this information? How did I obtain it? Do I require or have the appropriate consent? How long do I need to keep it? Is it stored securely? Who needs access to it or more importantly….who doesn’t Have I completed due diligence on and have written contracts for third party organisations with which I share information. ( McLernons / Clanwilliam / Touchstore?) How often do I audit / review these processes? To be compliant, you will need to demonstrate, generally through written policies and procedures, that you have measures in place to manage these questions. In addition, with GDPR, liability for breaches of Data Protection now extend to Data Processors as well as Data Controllers, so both Pharmacists, Technicians and Admins have a responsibility to maintain and observe GDPR protocols.
a very clear and unambiguous statement as to what your CCTV system is used for. Consent With the new legislation, the bar has been raised considerably in regard to obtaining consent to process personal data:All requests for consent should be in clear and unambiguous language with the purpose for data processing clearly stated. The Data subject should also be advised that they can withdraw consent at any time. If the consent relates to permission to market electronically, then each mail sent should always include an “opt out” or unsubscribe option. It should be as easy to withdraw consent as it was to give it. The default position in now “opt in” so, for example where previously a registration form for a loyalty card may have said “tick the box if you do not want to receive etc.”, playing on peoples general aversion to ticking boxes meant that no tick meant they were “in”…going forward, the box should only indicate a request to receive info etc. Care should be taken initially to fully determine the amount of information required for each activity, as consent as the only legal basis to proceed is a weak defence should it’s need be challenged. Personal Privacy Rights The personal privacy rights of the individual are now greatly enhanced with GDPR Brief overview of each below:• Right of Access
o Confirmation that their data is being processed
Legal Basis for collection of Data
o Access to their personal data
A description of your legal basis for collection of data should be included in your Privacy Statement. This should detail Lawfulness, Transparency and Fairness aspects of your processing activities. Detail pertaining to Purpose Limitation, Data Minimisation, Storage Limitation should also be included
CCTV information is an area that can give rise to various legal interpretations. You should have
There are a number of scenarios in which access to data can be restricted or refused. These are outlined fully in the regulations, however in the main they centre around the protection of health and wellbeing of the individual. Any general conditions that warrant refusal of an access request should be outlined in your Privacy Statement. Your documented processes should include a section on Managing and Fulfilling Access requests. • Right to rectification
The GDPR gives individuals the right to have personal data rectified.
o Personal data can be rectified if it is inaccurate or incomplete.
• Right to Erasure (Right to be forgotten)
o The right to erasure is also known as ‘the right to be forgotten’.
The broad principle underpinning this right is to enable an individual to request the deletion or removal of personal data where there is no compelling reason for its continued processing.
• Right to restriction of processing Individuals have the right to limit the extent to which their data is used. For example, you might get consent regarding marketing on a particular subject or product. Use of data could be restricted to just this and not other generalised marketing. • Right to Object Individuals have the right to object to:
Other supplementary information – (this should be contained in your privacy statement
Individuals have a right to request a copy of any personal data relating to them whether held electronically or hard copy. Ideally, the request should be made in writing and identity verified before proceeding. The information must be supplied (free of charge) within one month of request (previously 40 days).
Processing based on legitimate interests or the performance of a task in the public interest/exercise of official authority (including profiling)
o Direct marketing (including profiling)
o Processing for purposes of scientific/historical research and statistics.
With the exception of Direct Marketing, there may be circumstances regarding the two
remaining criteria that can refuse to comply with the objection • Right to Data portability An individual has the right to request that their information is transferred to another pharmacy, there are no grounds for noncompliance with the request. All requests must be expedited within one month. Data Breach With such a strong focus on the rights of the individual being paramount, it follows therefore that any data breach should be treated with the same level of importance. From May 25th, all data breaches must be reported to the Data Protection Commissioner within 72 hours. The report should detail the nature of the breach, the likely scale of impact on those whose information has been compromised. In cases where identity or financial / health details could be compromised, the Data Controller must inform the individuals concerned. By default, you should have a Data Breach log and a detailed Data Breach response procedure. Fines and other penalties Worth pointing out at this stage the actions / sanctions that the Commissioner can take in the event of non-compliance or a data breach A written warning in the case of a first-time non-intentional non-compliance. Tier 1 – a fine of up to ¤10m or 2% of gross annual turnover (whichever is the greater) for the full preceding trading year Tier 2 – a fine of up to ¤20m or 4% of gross annual turnover (whichever is the greater) for the full preceding trading year In addition to financial penalties, the Commissioner has the right to seize equipment, ie computers etc and /or order all data collection activities within a business to cease immediately. Data Protection Officer There are a number of public and private sector areas where the appointment of a Data Protection Officer is mandatory.
GDPR List the Individuals rights as outlined above Once completed this should be made available on request and/ or displayed within the pharmacy Online and Web
Ireland's Data Protection Commissioner Helen Dixon
The jury is out however as to at what level you don’t need one. Given the scope of the changes involved and the potential to fall foul of the regulations especially in the early stages, it might be worth considering appointing a staff member as a Data Protection or Privacy lead in your business, or using an external provider on a retained basis. It is important now that GDPR will be law to ensure that Data Protection is at the core of what you do. The Data Controller cannot be this person as there is an obvious conflict of interest. The role is an advisory and compliance ready one: informing and advising on legal obligations relation to data processing; monitor continued compliance with legislation through audit and review;
build awareness through training and also as a liaison and conduit of information with the Supervisory Authority. Privacy Statement Your pharmacy should produce a Privacy Statement which outlines the following as a minimum:Identity of Data Controller and Processors Category of Data that is collected Purpose for collection Collected from where? Is the data shared and if so, who with How long is it kept for?
If you operate a website and especially an online shop, participate in Social Media marketing, ie Facebook, Instagram, Snapchat etc, you need to review all of the above in the context of the information you gather through the site. You need to produce a separate online privacy statement that covers collection methods, cookies etc. This need to be published on your website with access via a visible tab or button called Data Protection Yes, I get it, but where do I start? As the old saying goes... “Start with the end in mind”. By the 25th May, you need to be able to demonstrate you are compliant, so it makes sense to work out exactly where you are today? As there is no certification process, in reality, it’s a bit like an NCT for your car, at that time, on that day, your car was deemed roadworthy. Complying with GDPR is a continuous process, with 25th May being more of a beginning than an end. That said however, a great way to show intent is to audit all the areas discussed
in this article…if you’ve ever carried out a risk analysis for HACCP or Health and Safety, adopt a similar approach. Establish in each area where you are today against what’s required, this give you your initial gaps. Prioritise which tasks need doing first, who will do them, by when etc. Once each one is completed, you can move to the next and so on. The benefit of this approach is that will be able to demonstrate measurable progress to a fully compliant position. All the processes and corrective action you take should be documented and form part of your Data Protection operational folder. In terms of your mindset, use the same methodology and processes that currently exist in your pharmacy. I imagine you adopt an “inspection ready” state as your pharmacy default. You never know when a PSI Inspector will arrive going forward, this is the mindset you should adopt for Data Protection Urgent, but not too late – just get started Hopefully this article has given you a flavour and some insight into what is required from you to make your pharmacy business compliant with the new GDPR legislation. Here are some useful resources www.profitpharm.ie www.gdprandyou.ie www.eugdpr.org
Is your pharmacy business compliant with GDPR legislation? Grab a pen Score your business (1 “not compliant” to 5 “fully compliant”) across the following areas to help start your gap analysis 1. I have documented what personal data I hold, where it came from, who I share it with and what I do with it. 2. I have identified my lawful bases for processing and documented them 3. I reviewed how we ask for and record consent 4. I have systems to record and manage ongoing consent
5. I have provided privacy notices to individuals 6. I have a process to recognise and respond to individuals' requests to access their personal data 7. I have processes to ensure that the personal data I hold remains accurate and up to date.
8. I have an appropriate data protection policy 9. I provide data protection awareness training for all staff 10. I have a written contract with any data processors I use 11. I have an information security policy supported by appropriate security measures.
12. I have effective processes to identify, report, manage and resolve any personal data breaches. Obviously the closer to 60 you are the better……… however, what important is to get started, use your lowest scoring areas to help prioritise your corrective action plan.
Clinical Profiles TREATMENT WITH NOVARTIS' ULTIBRO® BREEZHALER® IMPROVED CARDIAC FUNCTION IN COPD PATIENTS WITH LUNG HYPERINFLATION Novartis has announced the publication of the CLAIM* study in the Lancet Respiratory Medicine, which demonstrated that treatment once-daily Ultibro® Breezhaler® (indacaterol/glycopyrronium 110/50 mcg) significantly improved lung and cardiac function, when compared to placebo, in chronic obstructive pulmonary disease (COPD) patients with lung hyperinflation. Many people living with COPD are at increased risk of death and disability due to comorbid cardiovascular disease. Lung hyperinflation is common in people with COPD, and has been linked to impaired cardiac function and a worsening of COPD symptoms, especially breathlessness. CLAIM is the first study to investigate the effects of dual bronchodilation on cardiac function and lung hyperinflation. The CLAIM study met its primary endpoint demonstrating that treatment with Ultibro Breezhaler led to decreased lung hyperinflation and improvements in cardiac function** after 14 days of treatment. This translated into clinically relevant patient benefits of improved health status and breathlessness (dyspnea), studied as exploratory endpoints. "Lung hyperinflation is often associated with impaired cardiac function in patients with COPD," said Shreeram Aradhye, Chief Medical Officer and Global Head of Medical Affairs for Novartis Pharmaceuticals. "The publication of the CLAIM study is important for any COPD patient with signs of lung hyperinflation. For the first time, we demonstrated that treatment with Ultibro Breezhaler can reduce lung hyperinflation and improve cardiac function, breathlessness and health status." In the CLAIM study Ultibro Breezhaler was well tolerated and its safety profile was comparable with placebo.
The CLAIM study was a randomised, double-blinded, placebo-controlled, singlecenter, two period cross-over study comparing the effects of 14-day Ultibro® Breezhaler® therapy with placebo on cardiac and lung function in hyperinflated COPD patients. It involved a total of 62 patients, of whom 57 completed both treatment periods. All patients had moderate-to-very severe COPD and confirmed lung hyperinflation (residual volume >135% predicted). The primary endpoint of the study was to demonstrate the effect of 14-day once-daily Ultibro Breezhaler treatment on left ventricular enddiastolic volume (LV-EDV) as measured by MRI. Secondary endpoints included effects on lung function parameters as measured by residual volume (RVol), forced expiratory volume in one second (FEV1) and forced vital capacity (FVC). Cardiac assessments included right ventricular end-diastolic volume (RV-EDV), left and right ventricular stroke volume (LVSV and RV-SV), left and right ventricular end-systolic volumes (LV-ESV and RV-ESV) and cardiac index (CI).
HSE APPROVES KYNTHEUM® (BRODALUMAB) FOR REIMBURSEMENT IN IRELAND LEO Pharma welcomes the news that the Health Service Executive (HSE) has approved Kyntheum® (brodalumab) 210mg for reimbursement in Ireland via the High-Tech Scheme following consideration by the Products Committee. The pre-filled syringe containing 210 mg brodalumab in 1.5 ml solution, where 1ml solution contains 140 mg brodalumab, is now available in Ireland for the treatment of adults with moderate-to-severe plaque psoriasis who are candidates for systemic therapy. "I am delighted that patients in Ireland with moderate-to-severe plaque psoriasis will now have access to brodalumab," said Dr Caitriona Ryan, Consultant Dermatologist at the Blackrock Clinic and St Vincent's Hospital, Dublin. "Brodalumab is an important and welcome addition to our treatment
options because it works in a different way to other biologic therapies and has demonstrated high levels of skin clearance sustained over the long term." Psoriasis affects approximately 73,000 people in Ireland. Of these, more than 9,000 are estimated to have a severe form of the disease. "Psoriasis is much more than a skin condition, and has a profound effect on the emotional and psychological wellbeing of those affected, as well as on their physical health," commented David McMahon, CEO of the Irish Skin Foundation. "We are pleased that people with moderate-tosevere forms of the disease in Ireland now have access to another treatment option." Geraldine Murphy, Vice President Europe North, Australia and New Zealand at LEO Pharma, added, "As experts in the field of dermatology, we are determined to tackle the significant unmet needs facing people living with psoriasis. We are very proud today to be able to bring Kyntheum® to Irish patients as a new biologic option."
NEW DATA FOR AFLIBERCEPT SHOW PROLONGED INJECTION INTERVALS Bayer submitted new data to the European Medicines Agency (EMA) to update the current EYLEA® (aflibercept injection into the eye) product information. The new data recommends extending the dosing interval during the first year of treatment. If approved, this alternative treatment option would give clinicians the opportunity to extend injection intervals with EYLEA to 12 weeks and beyond, based on a patient’s individual needs during the first year of treatment. Currently the EYLEA product information recommends a dosing regimen at two monthly intervals in year one, following three consecutive monthly doses in patients with visual impairment due to wet AMD (Age-related macular degeneration). The proposed label change is based on data from the recently
presented ALTAIR trial, where at the end of the first year approximately 60% of patients on EYLEA had their next scheduled appointment at an interval of 12 weeks or more. "Based on the original pivotal studies with anti-VEGF therapy, patients with wet AMD would have required 12 visits to the clinic for either injections or monitoring in the first year of treatment,” said Dr. Michael Devoy, Head of Medical Affairs & Pharmacovigilance of Bayer AG’s Pharmaceuticals Division and Bayer Chief Medical Officer. “Having the additional opportunity to extend the injection intervals of EYLEA to 12 weeks and beyond in the first year of treatment in a responsible and controlled manner could potentially result in as little as three to four visits to the clinic in the second year for some patients, whilst maintaining excellent visual outcomes and the ability to see.” The recently presented data from the ALTAIR T&E (Treat-andExtend) Phase IV study adds further weight to the growing body of real world evidence data supporting the benefits of an early proactive regimen with EYLEA. EYLEA has been approved in the majority of countries for five indications to treat patients with visual impairment due to: wet age-related macular degeneration (wet AMD), retinal vein occlusion (RVO; branch RVO or central RVO), and diabetic macular edema (DME). EYLEA has also been approved for the treatment of myopic choroidal neovascularization. EYLEA is the global market leader of anti-VEGF treatment, with over 16 million treatments administered worldwide. Bayer and Regeneron Pharmaceuticals, Inc. are collaborating on the global development of EYLEA. Regeneron maintains exclusive rights to EYLEA in the United States. Bayer has licensed the exclusive marketing rights outside the United States, where the companies share equally the profits from sales of EYLEA, except for Japan where Regeneron receives a percentage of net sales.
ACCORD HEALTHCARE LAUNCH IVABRADINE 7 AND 7.5 MG FILM COATED TABLETS Accord Healthcare is delighted to announce the launch of Ivabradine 5 mg & 7.5 mg in pack sizes of 56 film-coated tablets. Ivabradine 5 mg & 7.5 mg filmcoated tablets are indicated for the following; Symptomatic treatment of chronic stable angina pectoris and the Treatment of chronic heart failure. Please refer to the Summary of Product Characteristics (SPC) available at www.accord-healthcare. ie or www.hpra.ie for further information. Ivabradine Accord is now available from Uniphar and United Drug. For further information please contact your Accord representative, call Accord in Cork on 021-461 9040 or visit www.accord-healthcare.ie Your Accord Representatives: Richard Doherty, 087 667 1725, Cavan, Clare, Donegal, Galway, Leitrim, Longford, Louth, Mayo, Meath, Monaghan, Offaly, Roscommon, Sligo and Westmeath. John MacHale, 086 884 1114, Cork, Kerry, Limerick, Kilkenny, Tipperary, Waterford and Wexford. Louise Mooney, 086 044 3956, Carlow, Kildare, Dublin, Laois and Wicklow.
ENTYVIO SHOWS HIGH RATES OF MUCOSAL HEALING Takeda Pharmaceutical Company Limited announced new real-world data evaluating the comparative effectiveness of Entyvio® (vedolizumab) and tumour necrosis factor-alpha (TNFα)-antagonist therapy in patients with moderately to severely active ulcerative colitis (UC) or Crohn’s disease (CD). These data were presented as oral presentations at the 13th Congress of the European Crohn’s and Colitis Organization (ECCO) from February 14 to 17, 2018 in Vienna, Austria. These analyses observed that patients with UC treated with Entyvio compared to TNFα-antagonist therapy had statistically significant higher 12-month cumulative rates of mucosal healing (50% vs 42%,
hazard ratio [HR] 1.73, 95% confidence interval [CI] 1.10 2.73) and clinical remission (54% vs 37%; HR 1.54, 95% CI 1.08 2.18), and numerically higher steroidfree clinical remission rates (49% vs 38%; HR 1.43, 95% CI 0.79 2.60). In CD, results reported statistically significant higher 12-month cumulative rates of mucosal healing (50% vs 41%; HR 1.67, 95% CI 1.13 2.47), and numerically higher rates of clinical remission (38% vs 34%; HR 1.27, 95% CI 0.91 1.78) and steroidfree clinical remission (26% vs 18%; HR 1.75, 95% CI 0.90 3.43) compared to TNFα-antagonist therapy. These analyses were conducted by the VICTORY (Vedolizumab Health OuTComes in InflammatORY Bowel Diseases) Consortium.1,2 “These data from the VICTORY Consortium highlight the effectiveness of Entyvio in achieving mucosal healing and clinical remission in the realworld, and support the use of Entyvio as a first-line biologic therapy,” said Professor William Sandborn, M.D., Chief, Division of Gastroenterology, University of California San Diego.
NEW STUDY SHOWS IMPROVEMENT IN CLEARANCE OF SCALP PSORIASIS WITH COSENTYX Novartis has presented new Cosentyx® (secukinumab) data from the prospective Phase III SCALP study which showed significant improvement in skin clearance with Cosentyx in patients with scalp psoriasis. Due to the presence of hair, scalp psoriasis is particularly difficult to treat with common topical and phototherapy options. These study results were presented at the 2018 American Academy of Dermatology (AAD) Annual Meeting in San Diego, California. "Scalp psoriasis can be painful and in some cases, can lead to temporary hair loss and cause the involved area to crack and bleed," said Kristian Reich, M.D., Ph.D., Georg-August-University Göttingen and Dermatologikum Hamburg, Germany. "The data presented at AAD is encouraging for both physicians and patients, who can have greater trust in Cosentyx as a complete treatment option for patients with plaque psoriasis
who want to avoid scalp and other manifestations of psoriasis." Approximately 60 million people worldwide are impacted by scalp psoriasis, a form of the disease which can have a substantial impact on quality of life due its highly visible nature. Additional stress may be added as many psoriasis patients will not achieve an adequate response from standard treatments. "As a science driven company, we are committed to investigating the full potential of Cosentyx. It is our ambition to offer the best evidence to doctors, and to deliver the best treatment to patients," said Eric Hughes, Global Development Unit Head, Immunology & Dermatology. "Cosentyx is backed by a large study program including more than 10,000 patients in over 60 studies since our first Cosentyx study initiation 10 years ago. We believe that study data on specific manifestations such as scalp help doctors reach the right decisions with their patients." Cosentyx is a fully human interleukin-17A (IL-17A) inhibitor which has demonstrated rapid and sustained long term efficacy in the treatment of moderate-tosevere psoriasis, psoriatic arthritis and ankylosing spondilytis, as well as a consistently favorable safety profile including injection site pain at rates similar to placebo-. To date, Cosentyx has been prescribed to more than 140,000 patients worldwide across all indications since launch.
AGE-RELATED MACULAR DEGENERATION MARKET WILL ROCKET TO $11.5BN BY 2026, SAYS GLOBALDATA Pharmaceutical sales within the age-related macular degeneration (AMD) markets were estimated to be $4.9bn across the seven major markets (7MM*) in 2016. This is expected to reach $11.5bn in 2026, at an impressive Compound Annual Growth Rate (CAGR) of 8.9%, according to GlobalData, a leading data and analytics company. The company’s report: ‘PharmaPoint: Age-Related Macular Degeneration’ states that this growth will be driven by new therapies entering the market and a global aging society, which will lead to increasing numbers of elderly people developing AMD.
GlobalData predicts the launches of three drugs for the treatment of geographic atrophy (GA), the late stage of dry age-related macular degeneration (dAMD), and three late-stage pipeline drugs for wet AMD (wAMD). In particular, the launch of drugs into the AMD market to treat dAMD will be a large driver of growth, as there are currently no prescription medications available for these patients. Edit Kovalcsik, PhD, Healthcare Analyst at GlobalData, comments: “We expect that with the launch of brolucizumab in the wAMD market, Novartis will offset the losses to Eylea and regain dominance in the AMD market. Once more efficacy and safety data accumulates and physicians become more accustomed to the use of brolucizumab, its advantage of less frequent dosing will allow it to claim an increasing share and become a first-line therapy if reimbursed.” Key opinion leaders interviewed by GlobalData emphasized that pricing will also play a key role in the uptake of brolucizumab. Novartis’ brolucizumab is expected to reach blockbuster status by 2021, and will be the highest selling drug by 2026 among all drugs launching to the AMD market, with $4.1bn in global sales. New drugs entering the dAMD market will include two anticomplement agents: Apellis’ APL-2 and Ophthotech’s Zimura, and one neuroprotective agent, Allergan’s Brimo DDS, which together will drive an increase of the treated AMD cases, expanding the AMD market. Kovalcsik adds: “Following the failure of both Phase III trials of lampalizumab for the treatment of GA, Apellis’ APL-2 emerged as the most promising GA drug after its positive Phase IIa results were announced. Provided that the planned Phase III trial of APL-2 for GA will confirm these results, we forecast that Apellis’ drug will reach blockbuster status within a few years of its launch, by 2025.” Information based on GlobalData’s report: PharmaPoint: Age-Related Macular Degeneration – Global Drug Forecast and Market Analysis to 2026.
News Boots Ireland are celebrating a successful partnership with the Irish Cancer Society for the fifth year running Since the partnership formed, the Irish Cancer Society has trained more than 140 Boots Irish Cancer Society Information Pharmacists as well as 130 Boots Cancer Beauty Advisors. Jean McAleenan is just one of the many Boots Irish Cancer Society Information Pharmacists. She said: “We are pharmacists who have been given specific training on how to advise those going through cancer.
of information. We feel very comfortable talking about cancer and there is someone here all the time.”
“There are any number of things a cancer patient might want to talk, so we offer a one-on-one consultation with a pharmacist. The consultation could be as simple as going through a cancer treatment plan and explaining the different stages of it. We can advise on managing medication and advising on side-effects. We can also advise on various lifestyle steps that can help to deal with the side effects of cancer treatment.”
“The cancer journey from diagnosis to treatment to recovery can be a long one. There will always be repeat visits to the pharmacy so we can expect to see these patients again and again in the pharmacy,“ she explained.
Pharmacists are able to advise cancer patients on certain sideeffects from their treatment and offer over-the-counter remedies for conditions such as nausea sleeplessness or skin abrasions. They can also signpost their patients to other services such as helplines offered by the Irish Cancer Society.
As well as the specially trained pharmacists, Boots are also serving their customers well with their Boots Cancer Beauty Advisors, recognising that recovering from cancer isn’t just about medication.
As well as specialised training and information, pharmacists in the community currently have one thing that is in very short supply in Irish hospitals at this moment in time. Jean explained: “The pharmacist has more time than a doctor at the minute. We’re very accessible because we’re already out in the community. In fact, many people already have a relationship with their community pharmacist. “You need to travel for other health services but a community pharmacist such as the Boots Irish Cancer Society Information Pharmacist are nearby and plenty
Jean is very aware of the importance of building a good relationship with cancer patients.
“Having a familiar face for people at this difficult time really helps, patients will return to the same pharmacy for support time and again.”
The beauty advisors are trained to offer tips on skincare and make-up to cancer patients to help them disguise the visible side-effects of cancer treatment. “it’s one thing to feel sick, but to look sick all the time is a real challenge in terms of keeping your spirits up,” said DJ Louse McSharry, herself a cancer survivor and now ambassador for the Irish Cancer Society. “The beauty advisors at Boots provide an invaluable service at a time when women really need support. These services help people feel like themselves again.” Jean is keen to stress that the service is open to anyone, not just those currently being treated for cancer.
Jean McAleenan, Boots Irish Cancer Society Information Pharmacist “We can offer tips on prevention through lifestyle choices too.” She continued: “there is an emotional component there too. A patient can come in fresh from a diagnosis and be really worried. The amount of information you’re given when you’re first diagnosed with cancer can be overwhelming. It does help them to talk it over with someone they already have a relationship with.”
More than 140 Boots Irish Cancer Society Information Pharmacists are spread throughout the 86 Boots stores nationwide and no appointment in necessary for a consultation. A recent survey has shown that less that 38% of cancer patients seek help or support regarding the physical changes they go through on their cancer journey.
Evaluating Orphan Drugs report sparks calls for reform Hopes have been raised across the irish pharmacy sector that the speed of access to new drugs in Ireland could soon be brought in line with the rest of Europe. An Irish government committee’s report titled Evaluating Orphan Drugs has included recommendations that the system for the assessment of orphan drugs in Ireland should be amended and that both clinician and patient input should be included in the process. The report has been welcomed by the Irish Pharmaceutical Healthcare Association, which represents 47 research-based pharmaceutical companies in Ireland. IPHA Chief Executive Oliver O’Connor said: “IPHA has been highlighting for some time that patients in Ireland are not getting access to new drugs, including orphan drugs as fast as in other European countries. “The report recognises this and the importance of making new orphan drugs available to patients as quickly as possible.” Mr O’Connor emphasised the IPHA commitment to ensuring the best and most innovation medicines are accessed by Irish patients as quickly as they are in other countries. The IPHA now plans to engage with Oireachtas and other stakeholders mentioned in the report too.
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Bioderma launches ABCDerm – the new dermo-paediatric range The leading French dermo-cosmetic brand has used its dermatological expertise to benefit paediatrics by offering an extra safe and extra gentle range for babies This unique collection of cleanse, treat and care products respect the delicate skin of babies and young children. All products in the ABCDerm range are specifically formulated in accordance with the ABCDerm Dermatological Safety Commitment: SAFETY: minimising the risk of allergies thanks to carefully selected ingredients, excluding those which are not known to be 100% safe. Allergen-free fragrance used EFFICACY: selection of the purest active ingredients at optimal doses for dermatologically proven efficacy and total respect for the skin. TOLERANCE: limited number of selected ingredients to guarantee safety and comfort. TRACEABILITY: all our products are monitored through every step of the process, from production to the sales outlet, for usage in absolute safety.
CANESTEN ANNOUNCEMENT Canesten Soft Vaginal Capsule Combi PA1410/39/14: Due to supply issues with the pessary and with agreement from HPRA, Bayer will temporarily supply the Irish market with equivalent Canesten Thrush Combi Soft Gel Pessary and External Cream PL00010/0635 from the United Kingdom. This product contains a soft gel vaginal capsule/pessary as opposed to a traditional pessary, but will treat the infection in the same way. There are additional warnings on the Irish approved PIL that are missing from this UK PIL. This product contains traces of soy lecithin. Please ensure that this information is brought to your customers’ attention. A PIU letter has been posted to all pharmacies. Please refer to this letter for further information or email firstname.lastname@example.org.
Recommend Uriage for skin problems that need a barrier, protective and healing care – a must buy product for every runner First Aid on the Go - Uriage Bariéderm Repairing CICA-cream is a velvety cream that is easy to massage in for a quick absorption. It is a first aid product that provides fast healing and immediate relief and prevents scarring for the entire range of cuts. This cream will soothe irritations, Lips chaps, dry patches, Skin fold irritations, small blisters and skin problems. In clinical studies, the Bariéderm Repairing CICA-cream was found to decrease redness by 85% in 21 days, immediately relive pain and improve healing. It is the perfect repairing cream for everyday minor skin ailments for any runners as well as the whole family. RRP ¤10
Mustela Very High Protection Sun Lotion The Mustela very High Sun Protection is a face and body sun lotion for babies and children from birth on. The Mustela Very High Protection Sun Lotion provides children with a very high protection against the suns harmful rays with its SPF50+ UVB UVA. This lotion is water resistant, reinforces the skin barrier and preserves the cellular richness of babies’ and children's skin from UV rays thanks to Avocado Perseose®a patented ingredient. Guaranteed safety from birth on: • Sun sensitive and intolerant skin including atopic prone skin • Tested under dermatological and paediatric control • High tolerance • Hypoallergenic - Formulated to minimize the risk of allergic reactions • 0% fragrance, alcohol
Appointments Sarah O’Connor has been appointed as new CEO of the Asthma Society of Ireland. She arrives in the role from Drury Porter Novelli where she spent three years as a communications consultant advising clients on strategic communications, public affairs and media relations. Before her move to the private sector she had worked as Fine Gael’s National Youth Officer before becoming the party’s Dublin Regional Advisor. Previously she had worked in publishing. Sarah has a BA (Hons) in English and History from University College Cork. She was the Fr. William J. Harvey Fellow in Boston College, has a diploma in PR and is a member of the Public Relations Institute of Ireland.
Kieran O’Brien, head of sales and marketing at Compu b, has been appointed as Chairperson of the Retail Excellence eCommerce Committee. The committee leads the way in eCommerce training, standards and strategic planning for retailers. They also maintain a number of partnerships with Google, Facebook, Twitter and eCommerce Europe. Retail Excellence is an organisation owned and run by its members and represents almost 2,000 leading retail companies in Ireland.
Professor Martin Curley has been appointed as Chief Information Officer of the Health Service Executive. Professor Curley has extensive experience in the digital sector having spent a number of years as Director of Intel Labs Europe. His proven track record includes overseeing the start up of Mastercard Advisors Digital Capability. He also established a global network of 15 Intel IT Innovation centres.
News in brief Thick & Easy Clear Launch Thick & Easy Clear is a gum based thickener used to modify the consistency of drinks as an aid for those with dysphagia to swallow. This clear product now means that people can enjoy water and other clear liquids without changing the consistency of the drink, therefore making them more enjoyable to consume. As with other products within the Thick & Easy Clear range, this product does not alter the natural taste or appearance of the liquid, making it more appealing to the customer. To celebrate this new product Fresenius Kabi recently hosted a launch event at the Royal Hospital Kilmainham with speakers Dr Ben Hanson, Senior Lecturer, Department of Mechanical Engineering, University College London and Dr Julie Regan, Assistant Professor, Clinical Speech & Language Studies, Trinity College Dublin.
Dr Ben Hanson, Senior Lecturer, Department of Mechanical Engineering, University College London and Dr Julie Regan, Assistant Professor, Clinical Speech & Language Studies, Trinity College Dublin.
Perrigo fuels TCD-backed research project Trinity College Dublin’s School of Pharmacy and Pharmaceutical Sciences has revealed that pharmacy supplier Perrigo will be the sponsor of this year’s Summer Research Placement Programme. Thanks to this generous sponsorship, Rachel-Jane McGuinness will spend the summer at the University of Hiroshima, Japan with Dr Mikihisa Takano. The potential research that Ms McGuinness will be undertaking in Japan will involve investigating the expression levels of microRNA and the effect of different factors on this or the effects of cigarette smoke on alveolar epithelial cells. Some previous research undertaken by Dr Takano has suggested that cigarette smoke can inhibit the P-glycoprotein ATP Cassette Binding Transporter leading to altered xenobiotic clearance in squamous type I alveolar epithelial cells and some other cell lines. John Sheehy, Perrigo Country Manager (Ireland), Rachel-Jane McGuinness, Junior Sophister student of the Pharmacy Integrated Programme and Paul Hatton, Perrigo National Field Sales Controller
Ms McGuinness is just one of the senior sophister students benefitting from this sponsorship.