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August 2018 Volume 10  Issue 8

THE INDEPENDENT VOICE OF PHARMACY

Winners Issue

In this issue: NEWS: Concern over shortage of pharmacy locums Page 4

NEWS: Consultation on ePrescribing launched Page 5

NEWS: Pharmacies advised to recall Valsartan Page 10

TOP 100: Top 100 OTC products Annual Feature Page 16

BREXIT: Casting shadow over future of pharmacies Page 50

CPD: Anxiety Page 55

FEATURE: The Pharmacist’s role in oral health care Page 88

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If it’s out there... we can source it for you

For more information please contact: Free Phone 1800 440 440 I PharmaSource@uniphar.ie I www.uniphar.ie


Contents Page 6: IPU calls for recommendations to tackle pharmacy crime to be taken forward

Page 9: Hickey’s expansion plans revealed

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Page 16: Top 100 OTC products Page 50: Brexit presents risk to future of Irish pharmacies Page 54: Call for pharmacists to be allowed to substitute biological medicines for biosimilars, to help plug overspending at the Department of Health

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Page 105: AIB report on future of pharmacies PUBLISHER IPN Communications Ireland Ltd. Clifton House, Fitzwilliam Street Lower, Dublin 2 00353 (01) 6690562

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COMMERCIAL MANAGER Natalie Millar natalie.millar@ipnirishpharmacynews.ie

EDITOR Jonny McCambridge editorial@ipnirishpharmacynews.ie JOURNALIST Áine Carroll editorial@irishpharmacynews.ie Beau Donelly Editorial@ipn.ie CONTRIBUTORS Jason Bradshaw | Dr Paul Carson, Eamonn Brady | Robert McOwan

Regulars

This month’s edition of Irish Pharmacy News truly is an epic read, packed with latest news, special features and current information. Dominating the August edition is our highly anticipated Top 100 OTC products. The Irish Pharmacy News Top 100 uniquely compares the market performance of the products over the past number of years. It is designed to take some of the strain away from the decision about which popular OTC products to stock, in order to boost profitability. The information is collected through distributor data from wholesalers, direct distribution by manufacturers and parallel importers on their sales into pharmacy, in terms of volume. The information is exclusive to Irish Pharmacy News and has been compiled by IQVIA, formerly IMS Health and Quintiles. IQVIA is the world’s leading information, service and technology company. August’s IPN features many of the big subjects which are causing concern to pharmacists on a daily basis. This includes pharmacy crime with a report on the IPU’s response to the Report on the Cost of Doing Business from the Joint Oireachtas Committee on Business, Enterprise and Innovation, which was recently launched. The IPU has called for the Minister for Justice to go before the Committee to outline how the recommendations on crime will be implemented. This edition also features reports on the anticipated impacts of Brexit on the industry as well as the entry of the retail delivery giant Amazon into the pharmacy business. The article on Amazon by Jason Bradshaw from JPA Brenson Lawlor is required reading for all pharmacists.

MANAGING DIRECTOR Natalie Maginnis n-maginnis@btconnect.com

COMMERCIAL MANAGER Nicola McGarvey nicola@ipnirishpharmacynews.ie

Foreword

Irish Pharmacy IRISH News is circulated PHARMACY to all independent, NEWS multiple and hospital pharmacist, government officials and departments, pharmacy managers, manufacturers and wholesalers. We also distribute to buyers of pharmacy groups and healthcare outlets. Circulation is free to all pharmacists. Subscription rate for Irish Pharmacy News is ¤60 plus vat per year. All rights reserved by Irish Pharmacy News. All material published in Irish Pharmacy News is copyright and no part of this magazine may be reproduced, stored in a retrieval system or transmitted in any form without written permission. IPN Communications Ltd. has taken every care in compiling the magazine to ensure that it is correct at the time of going to press, however the publishers assume no responsibility for any effects from omissions or errors.

The AIB has released its annual Pharmacy Outlook Report which shows an improving outlook for pharmacists, but indicates that pressure remains on the sector. Alan Makim, Head of Retail & Franchising, Retail & Business Banking AIB said: “As the population grows older, the demand for healthcare services will increase and this will present opportunities for pharmacists to grow their business in the future if they evolve with the changing trends in the sector.” As well as all of the above this edition is packed with the usual news, features, tips and CPD articles. We also continue our series telling the stories of the winners at the recent Irish Pharmacy Awards. Do you have a news tip? Is there a community pharmacy topic you would like to see featured in Irish Pharmacy News? Do you know someone in your business going the extra mile to promote best practice in Irish pharmacy? Email editorial@ipn.ie

PROFILE

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CPD

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FEATURE - BACK TO SCHOOL 94

FEATURE - ECZEMA

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FEATURE - IBS

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News Concern that locum shortages are driving news brief up the cost of cover PSI COUNCIL’S HEAD AND DEPUTY TO SERVE ANOTHER TERM The Council of the Pharmaceutical Society of Ireland has re-elected R ory O’Donnell and Nicola Cantwell as president and vice-president respectively. Mr O’Donnell, who owns a pharmacy in Gweedore, Co. Donegal, has served on the council since 2015 and held the role of president for the past year. Ms Cantwell, a clinical governance pharmacist with Caredoc and a lecturer at IT Carlow, was first appointed to the council in 2013. The council is responsible for overseeing the delivery of the functions of the PSI, in the public interest. Both Mr O’Donnell and Ms Cantwell will serve in their positions for one year.

PHARMACIES PLAY CRUCIAL ROLE IN HELPING SMOKERS QUIT Smokers are more likely to seek help from tobacco quitline services when pharmacies run active smoking cessation campaigns, new research shows. The study, published in the Journal of the American Pharmacists Association, looked at the long-term impact of pharmacy intervention in referring patients who wanted to quit smoking. The randomised trial was conducted across 64 community pharmacies in Connecticut and Washington. It found higher numbers of people who called the smoking quitline reported being referred by their local pharmacy after staff were given on-site smoking cessation training. “The percentage of quitline callers who reported having heard about the quitline from a pharmacy increased significantly, from 2.2% during the baseline monitoring period to 3.8% during the 12-month intervention,” the study said. The authors concluded that cessation interventions were feasible in community pharmacies and led to meaningful increases in the number of all patients who called the quitline.

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Sources have told Irish Pharmacy News that a shortage of pharmacy locums is driving up the cost of cover with one pharmacy manager describing it as a “mess.” Longer retails hours, seven day openings and a recently introduced PSI language exam are making it harder to find locum cover, according to sources who would only speak to Irish Pharmacy News on the basis of anonymity. It was also suggested that younger pharmacists are choosing to go into hospital in order to work in a more clinical environment, and that some are going to the North because they have the professional capacity to prescribe, making it a more attractive jurisdiction to work in. Shortages in the number of available locums is driving up costs and leading to severe budgeting problems, and the fact that time off can’t be guaranteed is leaving some pharmacy staff “disgruntled”. Sources said the pattern began around 2014 when it started to become difficult to find Saturday cover. In 2015 it worsened and finding cover on Friday, Sunday

and Monday also became problematic for pharmacists. Rates began to fluctuate and started to increase around this time, especially for Saturday and emergency cover. This continued throughout 2016 and 2017 with the summer months becoming difficult, though the problem at this time was described as ‘manageable’. A ceiling of fifty euros per hour was reached in 2017 for Saturday and last minute/ emergency cover. That figure has now been breached, with some pharmacists being quoted sixty to seventy euro per hour. The highest quote IPN heard was for seventy five euros per hour for Saturday and last minute cover. Around April 2017 the Pharmaceutical Society of Ireland introduced a language exam for locums, following feedback that some had poor levels of English. The exam has a high pass rate and this could be causing gaps in cover that previously did not

exist. Younger pharmacists leaving college are not attracted to long opening hours and weekend working and are more inclined to make it in the ‘gig economy’, a trend that is also being replicated across the UK. Anonymous sources told Irish Pharmacy News that filling locum shifts is becoming a stressful enterprise and is putting a real strain on resources. Before shortages became a problem, locums would book work days in advance, but now the pattern appears to be that locums are waiting longer to book work, and the rate is higher when booked closer to the time. Another source suggested that better planning around annual leave could help pharmacists to address rostering issues before they become a problem, and suggested that pharmacists should strongly resist paying over the top rates to ensure the accepted ceiling rate is not breached further.

New app helps patients beat the queue A new app is providing an all-in-one platform for patient and carer medical management at one of Ireland’s largest pharmacy chains. and help our customers and healthcare professionals manage their medication at ease. “The app will be especially beneficial for parents of young children or those caring for the elderly as they can, subject to valid consent, have the medication history for those they are caring for on their phone. It will also be extremely useful for attending emergency doctors or hospitals whilst away from home such as on their holidays. We believe this app will truly revolutionise medication management.” The all-in-one app provides a direct link to a local Sam McCauley Chemist, allowing patients and carers to upload their prescriptions to the system and order within a few quick clicks. Once the prescription is ready, the app will send a notification directly to the phone and can be collected with the original paper prescription at the customer’s own convenience. This click-and-collect service is ideal for busy parents and carers alike, they can simply pre-order

a prescription and avoid having to wait in the queues for it to be prepared. The app also allows consumers to directly message their pharmacist with queries about their medicines, receive medication reminders, and provides access to their complete medicine history. Launching the app, Geraldine Ramage incoming Group Superintendent Pharmacist for Sam McCauley Chemists, said: “Sam McCauley Chemists is delighted to launch our new app,

Sam McCauley Chemists, which has approx. 200,000 unique patients annually across its 32 stores, will have dedicated App ambassadors available in certain stores throughout the summer, introducing the app and training patients on the app’s features and functionality. Patients will still need their original paper prescription unless they are collecting a repeat prescription. Your local Sam McCauley Chemist will not need the original paper prescription as it will be stored on file. In this instance, customers can simply show a photo of the repeat prescription.


News HIQA launches consultation on the future of community-based ePrescribing The Health Information and Quality Authority (HIQA) has launched a public consultation on information requirements for ePrescribing in a community setting. As part of this six-week consultation, HIQA has published the Draft Standard for consultation: Information requirements for community-based ePrescribing.

“A national ePrescribing service can also benefit pharmacists through the electronic downloading of prescription details, rather than manual entry.

HIQA is developing standards to define the information requirements for the implementation of community-based ePrescribing and dispensing in Ireland.

“This can make the dispensing process more efficient and can reduce errors, thus increasing patient safety. It can also reduce the time the pharmacist spends contacting prescribers to query, clarify or get a correction for a prescription, which improves the quality of prescribing.

Information requirements are a minimum set of data items that are recommended for implementation in information systems that create and transfer information to support the delivery of safe and quality care to patients. The inclusion of data in the minimum set of data is determined by its clinical relevance and the potential for the data to improve patient safety in a collaborative care environment. HIQA’s Standards and Technology Manager, Dr Kevin O’Carroll, said: “A national ePrescribing service can benefit prescribers by enabling the safe electronic sharing of prescription information. “Prescribers can receive notifications when a patient collects a prescription from a pharmacy, enabling the prescriber to ensure follow-up with the patient. There may also be reduced interruptions from pharmacies that have queries about prescriptions or need corrections to a prescription.

Dr O’Carroll added: “HIQA is committed to stakeholder consultation and values all feedback provided to support the development of standards to define the information requirements for the implementation of community-based ePrescribing. “The consultation process will take place over a six-week period. In this way, the public, service users and service providers will have the opportunity to provide feedback and become involved in the future of ePrescribing in Ireland.” The closing date for receipt of comments is 5pm on Friday, 31 August 2018. HIQA’s Director of Health Information and Standards, Rachel Flynn, said: “A national, community-based ePrescribing programme can deliver significant benefits for patients, prescribers

Rachel Flynn, HIQA Director of Health Information and pharmacists. It can improve patient safety considerably by reducing cases of mistaken identity, incorrect dosage, incorrect medication and adverse drug interactions. ePrescribing can also save money and time compared to processing the same prescriptions manually.” ePrescribing is used to describe all aspects of the generation and transfer of prescriptions electronically using a dedicated system, whether in paper or electronic form, rather than faxing or emailing the prescription. Based on the final version of the information requirements, HIQA will develop technical specifications to support the implementation of the information requirements.

Stalled reforms cost State 140 million euros annually according to generics representative body Medicines for Ireland (MFI) marked five years since the introduction of generic medicine substitution with the launch in July of their new policy document, Generics@5. MFI is the representative body for the generics, biosimilar and valueadded industry. Its members are the biggest suppliers of medication to the HSE and are united under a common vision for the reform of Ireland’s national medicines policy. The policy document calls on the government to maintain reform momentum, warning that further savings of around 140 million euros are possible, but are not being achieved. State spend on medicines is set to grow further and “the flow of savings is now at an end” the document reads. “Our population is ageing. Despite living longer, we are now impacted by a greater incidence of chronic

disease. That brings with it an increased need for medicines - but sadly, today, access to them is no longer guaranteed,” said MFI chairperson Owen McKeon. “The challenge for the government now is to maintain affordable access in the years ahead.” MFI has criticised Minister for Health Simon Harris for failing to continue with reform and the Generics@5 document sets out a number of proposals which they say can deliver an extra 140 million is savings for the State. Spending in the High-Tech Scheme has accelerated rapidly in recent years, almost doubling from 337 million euros in 2009 to 662

million euros in 2017. Even though some of these high-tech drugs lost patent protection, lack of generic competition is costing up to 20 million per annum, which would not be the case if government pressed on with reforms. Increased generic competition in the low-value, low-volume end of the market could reap a saving of around 75 million. Ending protection for some branded medicines would require legislation to be passed in the Oireachtas and could achieve savings of around 18 million. Savings of around 25 million euros could be achieved with the immediate publication of a National Biosimilars Strategy.

news brief POLL SHOWS CONCERNS OVER UNDERSTAFFING More than 60% of Irish pharmacists believe their workplace is understaffed, according to a new industry poll. The survey, run by online resource PharmaBuddy, asked pharmacists across the country if they believed there were adequate staffing levels in their dispensaries. About 150 people cast their vote, with 60.5% of pharmacists answering “no.” A further 37% of respondents said staffing levels were adequate, while just under 3% were undecided. In a separate poll, pharmacists were asked if they believed they should have the right to conscientiously object to dispensing medications used to induce abortions. Of more than 150 pharmacists surveyed, 60% answered “yes”, compared to 37% who answered “no.” PharmaBuddy launched in January 2017 and has signed up more than 2,800 registered pharmacists.

JAILED FOR BOOTS RAZOR THEFT A homeless man has been jailed after stealing more than ¤4,000 worth of toothbrushes and razors from a Dublin pharmacy. Mareks Treinovskis pleaded guilty to four counts of theft committed at the Grafton Street branch of Boots between February and September last year. The Dublin Circuit Criminal Court heard the 32-year-old targeted the pharmacy in the mornings, after realising the store’s security guard did not begin work until 11am. Treinovskis stole electric toothbrushes and razors, worth a total of ¤4,323, over multiple crime sprees at the pharmacy. Treinovskis, who has 56 previous convictions, including for theft, stole the goods to feed his heroin addiction, the court heard. Judge Melanie Greally sentenced Treinovskis to 18 months in prison.

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News Committee includes IPU recommendations on pharmacy crime in report The Irish Pharmacy Union (IPU) has welcomed the Report on the Cost of Doing Business from the Joint Oireachtas Committee on Business, Enterprise and Innovation, which was recently launched. Committee’s Report. However, we now need action in these areas. “I raised at today’s launch that the Minister for Justice must be asked to appear before the Committee to outline his strategy for implementing those recommendations related to crime. This must happen as soon as possible, to ensure that budgets allow for these measures, and pharmacists can start seeing a difference within their communities.”

IPU President Daragh Connolly Speaking at the launch, IPU President Daragh Connolly said he was pleased to see the recommendations from the IPU taken on board, and called for the Minister for Justice to go before the Committee to outline how the recommendations on crime will be implemented. Mr Connolly said: “The IPU presented to the Committee in April, and told Committee

members that pharmacies throughout the country have been subjected to criminal activity on an ongoing basis, and the problem continues to get worse. “We made a number of recommendations, including the recording of specific statistics on crimes against businesses, and more visible policing. We are pleased that these recommendations are in the

Mr. Connolly concluded: “We commend and thank the Committee members and staff for their work on the Report, which is quite comprehensive and addresses many of the issues that small business owners, including pharmacists, face on a daily basis. The recommendations on rates and insurance costs, in particular, are very pertinent to family pharmacies, and we look forward to seeing progress in these areas.” The most recent survey by the IPU found four-in-five pharmacies in Ireland have been targeted within the last year. The Irish Pharmacy Union Crime Survey research also shows

that crimes against pharmacies are not isolated incidents, with 81% of victims reporting having experienced two or more incidents during 2017. The IPU has called for tougher sentencing and a more visible garda presence to deter crime against pharmacies. The survey, among a sample of 130 pharmacies nationwide, was undertaken in the week beginning 8 January 2018. Almost one third of cases were described as violent and/or involved the use of a weapon. A knife was used in 77% of robberies or raids where a weapon was present and a gun was present in 8% of these cases. The number of pharmacists who experienced a raid, at 13%, was up considerably on last year (6%). The survey found that 45% of pharmacists who decided not to report a crime did so because they felt the perpetrator would not be charged. It found 23% had no confidence in the garda response, while 97% invested in CCTV to protect their staff and their businesses.

PSI carried out 310 pharmacy inspections, annual report reveals PSI, the pharmacy regulator, has published its annual report, which highlights its key activities and achievements during the year. These included extensive activity in the areas of registration, inspection of pharmacies, investigations, practice development as well as the handling of 46 complaints about registered pharmacists and pharmacies. Over two million visits are made to pharmacies every month by the public, making pharmacists the most accessed healthcare professionals in Ireland. The PSI regulates the professional practice of over 6,000 pharmacists, 362 pharmaceutical assistants and 1,930 pharmacies. During the last year, there was a net increase of 346 registered pharmacists and 25 pharmacies. The PSI carried out 310 pharmacy inspections to assess whether pharmacies are providing safe and appropriate care to people using them. As part of its continued development of how it regulates

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pharmacy businesses, it also rolled out a new pharmacy assessment system, a self-audit tool for ongoing use by pharmacies in assessing the quality of their own services. In support of its adoption in pharmacies, PSI regulatory staff made 1,826 advisory visits to pharmacies during the year. The majority of pharmacists who were implementing the system (79%) were positive about its benefits, saying it had already helped them identify areas for improvement. Niall Byrne, Registrar and Chief Officer of the PSI, said that the summary of activities contained in the report reflects the extensive work undertaken by the regulatory body during the year to meet its commitment to patient safety and to upholding public trust in the quality of pharmacy services.

“The public places significant expectations on pharmacists, who play an important role in public health and patient care. In addition to their widespread availability across the country, the profession is highly trusted. The PSI’s core objective is to play our part in maintaining that trust through a robust and effective regulatory system,” he said. The majority of the 46 formal complaints related to alleged dispensing errors and pharmacy practice issues and came from patients. Over 100 concerns were also received from the public and each was assessed for risk to patient safety. Of these, 14 were later referred into the PSI’s formal complaints process. While the number of matters raised with the PSI about pharmacists or pharmacies was relatively low, Niall Byrne said there cannot be room

for complacency when it comes to the competence of individual pharmacists or the safety and quality of pharmacy services. “The PSI believes in building a collaborative approach to the effective and appropriate delivery of pharmacy services, where all stakeholders play their role. Pharmacists, particularly those with governance responsibilities, and pharmacy owners, have a clear duty of care to their patients and to the wider public. “By working together, the regulator and the profession can continue to build a stronger culture of patient safety and thereby ensure that future patient needs are met through the availability of competent and capable pharmacists working within well-governed and safe pharmacy services.”


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News Hickey’s five year expansion plans revealed Hickey’s Pharmacy has unveiled an ambitious growth strategy, with plans to double the size of the business over the next five years. the end of next year, with a target of 60 stores by 2022. “It’s the first time in 20 years that there are more sellers than buyers, so we’re talking to a number of people,” he told Irish Pharmacy News. “It’s a tipping point for the first time in a long time.” Mr Hickey said the company was “not too caught up on numbers” and was instead focused on sustainably growing the business through a combination of acquisitions and new stores.

Paddy Hickey, founder and MD of Hickey's Pharmacies It follows the opening of three new stores last month, one in Dublin and two in Cork, bringing the total number of Hickey’s Pharmacies to 37. Founder and managing director Paddy Hickey announced the company’s plans to add another eight dispensaries to its stable by

The target areas for expansion would include cities and larger towns, he said. “We’re a very fair acquirer. With over 20 years in the business, I understand what it’s like to be a pharmacist.” Mr Hickey, who opened his first pharmacy in Dubin’s busy Northside shopping centre in 1995, has grown the business into one of Ireland’s most recognised pharmacy brands, operating across Dublin, Cork, Kildare, Louth, Meath and Wexford.

In July, Hickey’s opened pharmacies on Mayfield and Baker’s Road in Cork, bringing to five the number of stores it has in the county. Hickey’s expansion plans will see an increase in the number of staff from 350 to 475 over the next 18 months. “One of the things we’re very good at is onboarding staff into the Hickey’s family,” Mr Hickey said. “People look to join us now because they know we’re serious about investing in their longerterm development. We want to empower everyone in our teams.” Mr Hickey said it was vital that the pharmacy industry continued to adapt and innovate. “We shouldn’t rest on our own laurels,” he said. “There isn’t enough innovation in the sector and we need to think more imaginatively about what pharmacy can, and needs to do, to stay relevant to patients.”

Sam McCauley store chain paid ¤2m dividend last year Pre-tax profits at the Sam McCauley pharmacy group tumbled last year to €1.1m, due to increased costs. New accounts filed show that the expanding pharmacy retail group sustained the 75pc drop in pre-tax profits as revenues rose by 1.6pc, going from ¤78.78m to ¤80m in the 12 months to the end of September last. In May, during the year under review, Carlyle Cardinal Ireland (CCI) acquired a majority stake in the business in a deal understood to be worth ¤50m. The takeover came ahead of nine directors resigning. The accounts show that ¤472,500 was paid out to directors for compensation of loss of office during the year. The accounts confirm that the business paid out a dividend of ¤1.985m during the year. The accounts also disclose that the business is in expansion mode and paid ¤5m for two pharmacy businesses this year. The directors state that, in a post-balance-sheet event, the company acquired Karas Medical Hall Ltd trading in

Bawnogue Dublin 22 in February 2018 and Fermoy Medical Hall Ltd in April of this year. The purchase of the two new chemists brings to 32 the number of shops operating under the Sam McCauley brand. Prior to the Carlyle Cardinal Ireland group acquiring control of the company last year, the firm was in business 60 years. It has a strong presence in counties Carlow, Cavan, Cork, Dublin, Kerry, Kilkenny, Meath, Tipperary, Waterford, Wexford and Wicklow. According to the directors’ report, they “are confident of future revenue growth in existing stores along with store acquisitions and greenfield store developments adding to the growth within the group over the next 12 months”. The directors state that they are satisfied with the performance of the company last year. Staff costs at the Co Wexford group last year increased from

¤16.09m to ¤17.22m. Numbers employed increased from 560 to 592. The compensation paid to directors for loss of office of ¤472,500 contributed to overall directors’ pay last year increasing from ¤713,594 to ¤1.168m. At the end of September last, the group had shareholder funds totalling ¤28.35m that included accumulated profits of ¤17.9m. The firm’s cash pile last year decreased going from ¤4.32m to ¤2.4m. The firm’s cost of sales last year increased from ¤45m to ¤47.6m while administrative expenses increased from ¤28.9m to ¤31.3m. Operating profits at the group decreased by 73pc, going up from ¤5m to ¤1.3m. The firm also received “other operating income” of ¤259,833. The group incurred a ¤494,314 tax bill that gave the group a post tax profit of ¤662,661.

news brief ASTHMA DRUG GETS GREEN LIGHT The HSE has approved a new drug to treat patients suffering from severe asthma. GSK Ireland said Nucala (mepolizumab), an add-on treatment for severe refractory eosinophilic asthma in adult patients, was now available in Ireland. Nucala is a biologic therapy targeting interleukin-5 (IL-5), which plays an important role in regulating the function of eosinophils, an inflammatory cell known to be important in asthma. The drug is administered as a 100mg fixed dose subcutaneous injection every four weeks in addition to the patient’s normal respiratory medication. Professor Anthony O'Regan, consultant respiratory physician at Galway University Hospital, said asthmatic patients with eosinophilic inflammation often struggled to control their symptoms and could suffer from frequent asthma attacks that require hospitalisation. “Newer treatments specifically targeting eosinophils have been shown to improve asthma control by reducing exacerbations and steroid dependence,” he said.

TALKING TO KIDS ABOUT SEX The government has launched a new resource aimed at helping parents talk to their young children about sex and relationships. The HSE Sexual Health and Crisis Pregnancy Programme’s Talking to Your Young Child about Relationships, Sexuality and Growing Up is aimed at parents of four to nine-year-olds. Dr Catherine Conlon, assistant professor at Trinity College’s School of Social Work and Social Policy, said research found parents considered it “difficult or tricky” to raise these topics with their younger children. “Parents overwhelmingly want to be able to have open and honest conversations with their own children,” she said.

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News Pharmacies advised to recall Valsartan Pharmacies across Ireland have been advised to recall all batches of the medication valsartan over fears they contain a chemical which can cause cancer. used in a number of medicines marketed in Europe,” the HPRA said. Valsartan is an important prescription medicine used to treat high blood pressure and heart failure. It is also sometimes prescribed after a heart attack. The regulator advised patients not to stop taking the medicines but to go to their pharmacist or doctor at an early opportunity to discuss their treatment. “Not all valsartan medicines are affected by the recall. There are alternative valsartan-containing medicines and other treatments available to patients,” it said. The impurity N-nitrosodimethylamine (NDMA) that has been found is classified as a probable carcinogen.

Dr Lorraine Nolan, Chief Executive of the HPRA The recall is understood to affect about 50,000 patients in Ireland. The Health Products Regulatory Authority (HPRA) said it was a “precautionary recall” of a number of specific medicines containing the active ingredient valsartan.

“A recall is under way across Europe following recent and emerging information that an impurity has been identified as part of the manufacturing process in a valsartan-active substance manufactured at one facility in China. This active substance is

“At present there is no evidence that this impurity has caused any harm to patients; however, this recall action is being undertaken as a precautionary measure to prevent any further exposure to the impurity in the affected medicines whilst the investigation is ongoing,” the regulator added. HPRA chief executive Dr Lorraine Nolan said this was “an emerging situation being managed in real time by the HPRA working with the European network of medicine

regulators in order to determine the extent of the issue”. “Laboratory testing and risk assessments will provide more information as part of this coordinated European approach to establish the possible impact on patients who have been taking these medicines and to ascertain if other products may be impacted. At this time, a precautionary recall of implicated products is the most appropriate action to protect patient health. We are engaging with healthcare professionals to manage this situation,” Dr Nolan added. The HPRA said that in addition to working closely with the European regulatory network on the investigation, it was informing all stakeholders including the Department of Health, the Pharmaceutical Society of Ireland, the Irish College of General Practitioners and others of the regulatory action. It said it would provide further updates as more information became available. The products include some manufactured by Clonmel Healthcare Ltd, by Rowex Ltd and by Actavis Group PTC. They include some products with names including Vatan, Valtan, Co-Vatan and Valsartan Actavis.

Pharmacists overwhelmed with inquiries after recall Pharmacists have told how they were overwhelmed with inquiries from patients seeking alternative medicines in the wake of the valsartan recall last month. Kerry TD and pharmacist John Brassil said dozens of patients had attended his Ballyheigue pharmacy with concerns over the potential harm their blood pressure or heart failure medicine was causing. Mr Brassil also said the HPRA did not give pharmacists enough warning before announcing the public recall.

Mr Brassil said each patient query took around 20 minutes to deal with and that about 30 patients came to his pharmacy worried that their blood pressure or heart failure medicine was causing them harm.

HPRA has since acknowledged that many emails to pharmacists were automatically marked as spam.

He said pharmacists were hamstrung in providing an alternative because they cannot write prescriptions.

Valsartin products, used to treat blood pressure and heart conditions, are being recalled after revelations they contained an impurity believed to cause cancer.

Mr Brassil said it was also a concern that a pharmacist recall only, and not a patient recall, had been instigated.

The precautionary recall of the

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medicines, which contain the active ingredient valsartan, is understood to affect about 50,000 patients in Ireland.

“In other words, while we stop selling the product and quarantine

it for return to the wholesaler, we don’t have to contact the patient,” he said. “But if they come into me I have to tell them to stop taking it and find an alternative, which I can’t prescribe. They are then going to their GP which is putting a further strain on an already stressed system. And GPs have not been given guidelines as to what to do. “The HPRA should have put a protocol in place before issuing the recall.” The regulator announced the safety measures in July. It comes as a recall was announced across Europe after an impurity was identified as part of the drug's manufacturing process at a facility in China.

Kerry TD and pharmacist John Brassil The impurity N-nitrosodimethylamine (NDMA) that has been found is classified as a probable carcinogen.


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Profile Swords pharmacies meeting the challenge of a rapidly changing industry MacNamara’s Pharmacy is a family run business, and business owner John MacNamara operates four independent pharmacies in North Dublin. Each of the branches is totally unique. Grainne Gibney is the pharmacy manager in MacNamara's pharmacy on Swords Main Street. She explains to IPN how each branch has its own demands. “We have three branches in Swords and a branch in Raheny and each one is completely different in terms of the dispensary. Our customers here on the Main Street would be more traditional Swords customers whereas in the Boroimhe there are a lot of families and young people. With the doctors surgery near our store in Boroimhe it means that although they are busy the dispensing would be quicker with just maybe single items. In our pharmacy here on the Main Steet there would be a higher proportion of older people so most of our prescriptions would be for multiple items. That’s why we are so busy.” The branch on Main Street, Swords is a well-established pharmacy with a great team and a loyal customer base. The staff are trained up to a very high standard and customers enjoy the warm and friendly atmosphere, which is balanced by professional knowledge. MacNamara’s website states that this is a pharmacy that will go to great lengths to research and source difficult to find prescription or OTC products for customers. Independence Irish Pharmacy News met the team in the Sword's branch of MacNamara's Pharmacy. When asked about the challenge of maintaining independent status in a market crowded by franchise and buying groups, pharmacy manager Grainne Gibney says buying is their biggest challenge. “Buying is a challenge so there’s a lot of competition and it’s very hard to compete price-wise so certainly Yvonne Hughes who is the shop floor manager is always looking for something a little bit

12

Amy Caul, Student, Claire Hickey, Pharmacy Technician and Tina Dillon, OTC Adviser

different to stock to give us a bit of an edge. But buying and keeping costs low is a challenge. Particularly now things have changed so much as regards what the HSE will pay for. But we have a loyal customer base and that’s because they know us. They come back for that.” MacNamara’s Pharmacy benefits from passing pedestrian traffic and is located not far from Swords Castle, which has recently been designated by Fingal County Council as a cultural quarter. Tourists are common in the area and MacNamara’s competes with Swords Pavilions, a large shopping centre at the opposite end of the town to the Castle. Swords is the largest town in Dublin and the second largest town in the country. In many

ways it is like a small city, but MacNamara’s has retained a loyal customer base of people who live mainly in the traditional housing estates that surround the Main Street. “Some people like to go to a nice big anonymous pharmacy and just deal on a professional basis but I think our little thing is that we have been here since 1994 and mostly we know everybody and we even recognise their voices on the phone.” Grainne explains that the pharmacy relies heavily on a phone-in type service, and customers know the staff so well that the system works for everyone. “We have an issue with parking as it’s a busy Main Street and that’s why the phoning-in works. We couldn’t cope with people

just arriving in. The wait would be too long.” Dispensary challenges Grainne explains how the dispensary can be impacted by changes to the profession, and while new duties are added to the pharmacists list of chores, the daily dispensing still needs to be taken care of. “The challenge all pharmacies are facing is how rapidly it’s changing. So many issues arise and when you’re trying to do your daily dispensing, which is nearly full time in itself, and then you have all the other things to attend to - paperwork and things like GDPR and we would be very conscious about protecting people’s privacy. Now, you can’t fax scripts to doctors or vice versa. It’s all to go through Healthmail so that’s another


thing you have to remember; and then there are all the standard operating procedures that have to be in place. I can see the need for them and the benefit for them but trying to keep on top of them, well personally I find it a challenge. There’s always information coming in from the HSE or the drug companies. Like we just had the valsartan recall issue so that was challenging because doctors had to be contacted and customers medication had to be changed. We had to source valsartan from somewhere else and in the meantime everybody else has to get their prescriptions.” Valued staff Grainne has worked in MacNamara’s for 20 years. “We feel [John] is very loyal to us and he is very good boss and a very good manager. He is also a very good pharmacist. In fact he is terrific, I find it amazing how he retains it all. Certainly he is a very good employer as far as the staff are concerned. He’s very fair and we are all treated very well if we ever have any issues or challenges. We are not a chain like Boots or Lloyds and it is a family run business. Most of the staff have been here for years and years and years and there is very little staff turnover.” In such a busy pharmacy, it’s not possible to leave the dispensary unattended so pharmacy technician Alison Donnelly held the fort while Irish Pharmacy News caught up with Tina Dillon, OTC advisor with MacNamara’s for 14 years. Pharmacies could not operate without OTC staff and Grainne introduces Tina as a “valued senior member of staff” and “one of the linchpins who keeps things going for us all in the pharmacy.” Tina Dillon is very much the friendly face of MacNamara’s on the Main Street. She is known by customers as someone who is kind and friendly and who always has a smile on her face. When asked how she always stays upbeats Tina says, “I like working here and I just feel like it’s a second home. We are kind of like a family here.” Tina has been around pharmacists for a long time. “Pharmacists are a clever little bunch. They know their stuff so we respect that and only

Alison Donnelly, Pharmacy technician and Grainne Gibney, Pharmacy Manager

for them the shop wouldn’t be open. It’s a very busy dispensary. Some customers come in and think I should be able to just take what they need down from the shelf myself for them so I have to explain there’s a little bit more work to it than that.” In a busy town like Swords, Tina is at the coal-face. “A small minority of customers can be difficult and you just have to try and calm them down because if they are worked up then I’m worked up and you have to keep them calm so these guys can do their job behind the dispensary without feeling stressed.” Not everyone is cut out to be a

pharmacy OTC adviser and Tina proves that this is not the kind of job you just coast through. To be good at this job, you must be prepared to constantly progress. “I always liked shopping in pharmacies, as everybody does, so I got a job in a pharmacy in the city centre - very busy job - I loved it but I just wasn’t learning. Nothing was going in. The girls were too busy to teach me. You can read and read and read but I think you have to thrown in the deep end to learn.” Tina later moved to a pharmacy in Skerries and loved her time working in Adrian Stack’s. She’s been working for John MacNamara for 14 years. Irish

Pharmacy News asked Tina what keeps her here. “Definitely it’s the staff. And John has our best interests at heart and I want to work hard for him. It’s not like coming to work. I don’t wake up in the morning dreading it. I didn’t start off knowing everything but they taught me and it just built up from there.” Swords is a strong and changing community and MacNamara's Pharmacy lies at it's heart. The team work tirelessly to ensure the communities of Swords, both old and new, maintain a good overall level of health. Long may their independent presence on the Main Street last.

The challenge all pharmacies are facing is how rapidly it’s changing. So many issues arise when you’re trying to do your daily dispensing 13


News Codeine misuse a problem, but training for pharmacy staff is lacking: study Almost two-thirds of pharmacists in Ireland view codeine misuse as a public health issue, yet only a fraction say they have received specialist training in substance abuse, a new study has found. The web-based survey analysed the views of more than 700 pharmacists, pharmacy assistants and technicians from Ireland, the UK, and South Africa in a bid to evaluate codeine use and misuse across the three countries. Researchers also wanted to assess the level of pharmacy staff expertise in dealing with codeine dependence, and identify where future training might be helpful. The report said global public health and medicines regulatory concerns were increasingly focused on the intentional or unintentional misuse of pharmaceutical opioids. Codeine, while viewed as a weak opiate, is one of the most widely available and consumed opiates worldwide, particularly in relation to over-the-counter pain and cough relief medication, and as prescription medication. In all three countries, the study found, combination medication

(those containing codeine together with other ingredients such as paracetamol and ibuprofen) were mentioned as being most popular.

countries reported that a low-tomedium amount of codeine sold in their pharmacies was misused.

The majority of Irish participants reported that Solpadeine and Nurofen Plus were the most popular codeine-containing OTC products sold, followed by Maxilief.

But when asked about risk management systems in place to flag customers who may be abusing codeine, Ireland rated significantly lower (39.0%), compared to the UK (51.6%) and South Africa (50.4%).

There was no significant difference across the three countries in the level of codeine misuse reported by pharmacy staff, although codeine use was seen as significantly more of a public health problem in South Africa than in Ireland and the UK.

The majority of participants also said they had not received any kind of specialist training in substance abuse, but again, Ireland lagged behind, with only 15.0% reporting they had received training, compared to 25.2% in South Africa and 24.8% in the UK.

"There were some inter-country differences, but overall the findings seem to suggest that pharmacists across all three countries view codeine misuse as a problem among their customers," the authors wrote.

"Another inter-country difference noted was the proportion of participants who reported that their country had an existing risk management system in place in pharmacies that could be used to limit drug-related harms," the study said.

Respondents across all three

"In this regard, the highest proportion of participants in the UK reported a willingness to participate in such a monitoring system. The use of real-time reporting to monitor medications including opiates exists in various countries including the USA, Canada and Australia and has also been recommended based on the findings of a recent scoping review of codeine. "This review suggested that prescription drug monitoring through an online system for prescriptions, combined with real time systems for both OTC and prescription codeine-containing products should be developed which could be used in pharmacies." Most participants reported a further need for training and education. There were 464 Irish participants, 123 participants from South Africa and 129 participants from the UK.

Teva Pharmaceuticals call for consideration of new nebuliser for people with CF Teva Pharmaceuticals Ireland has called on the Government to support healthcare professionals who wish to prescribe their new tobramycin 300mg/5ml nebuliser solution, for people with Cystic Fibrosis. “We also recognise the need to bring value based medicines to the Irish Market. TYMBRINEB® is a new generic drug that not only meets specific needs of people with CF, but also has the potential to save the HSE and State over ¤680,000. It is incredibly important that we continue to raise the bar and be innovative for people with CF, their families and HCPs, whilst also delivering on value based medicines.”

Jason Dabek, Senior Product Manager at Teva Pharmaceuticals Ireland TYMBRINEB®, which came to the Irish market on 1st July 2018, has the potential to achieve wider benefits in the healthcare system in Ireland, Teva claims. Speaking about the new Nebuliser

14

Solution, Clodagh Kevans, Head of Specialty Medicines at Teva Pharmaceuticals Ireland said: “At Teva Ireland we hope to provide an opportunity for people with CF to live longer, more comfortable and healthier lives.

“The savings made by TYMBRINEB® can free up funding of other CF treatments, such as ‘CFTRs’, and which include Orkambi. I urge all HCPs to help achieve real change for people with CF in terms of freeing up much needed funds in our healthcare system.” TYMBRINEB®, aimed at people with CF of 6 years or older, and taken twice daily will cost 50%

less than comparable nebuliser solutions, Teva stated. Jason Dabek, Senior Product Manager at Teva Pharmaceuticals Ireland stated: “We are delighted to bring TYMBRINEB® to the Irish market. TYMBRINEB® provides the opportunity to maintain existing standards of treatment, as well as making important cost savings to the HSE, and ultimately, the Irish taxpayer. The cost savings can potentially free up funding for other CF treatments. Teva strives to meet the needs of patients, Healthcare Professionals, as well as the healthcare system in Ireland.” HCPs and pharmacists are encouraged to contact their regional Teva representatives for more details.


The Top 100 OTC Products

Pain relievers dominate top spots in Top 100 OTC Products list Pharmacies with a strong front-of-shop game and dependable non-dispensing businesses will withstand any short to medium term challenges that they face. Irish people report that they trust their local pharmacists to always give them the best advice and information and that they enjoy the experience of pharmacy shopping. And while every pharmacy will try to differentiate itself from local competitors by sourcing interesting products, from perfumery to cosmetics to diagnostics, certain lines will ensure a stable revenue stream from month to month. The information below is exclusive to Irish Pharmacy News and has been compiled by IQVIA, formerly IMS Health and Quintiles. IQVIA is the world’s leading information, service and technology company and is dedicated to improving health outcomes by using an evidence and data-based approach to healthcare. Exclusive The Irish Pharmacy News Top 100 uniquely compares the market performance of the Top 100 products over the past number of years. It is designed to take some of the strain away from the decision about which popular OTC products to stock, in order to boost profitability. The information is collected through distributor data from wholesalers, direct distribution by manufacturers and parallel importers on their sales into pharmacy, in terms of volume. Exclusive, first-hand insight into the top performing OTC products can help pharmacy business owners to:

are pain relievers. Perrigo’s Solpadeine continues to dominate the number one position and doesn’t appear to be losing any footing, standing firm as market OTC leader since 2012. Reckitt Benckiser’s Nurofen Plus also holds firm in the second spot, comfortable in this position since 2014. There are twenty seven manufacturers on the list. Johnson & Johnson have the most products and manufacture a total of twenty three of the top 100 products, followed by Reckitt Benckiser with twelve. Reckitt Benckiser hold twelve spots on the table, with an impressive five products featuring in the top ten alone. GSK Consumer Health have eleven products on the list and Panadol Extra is their leading OTC product. Panadol Extra has been climbing steadily, going from fifth position in 2016 to fourth in 2017. Panadol is now the third best performing OTC product. Other climbers include Teva’s Sudocrem, which climbed a whopping seventy two places this year. Rowa’s Brupro climbed an impressive fourty four places and Ovelle’s Elave is doing well at sixty-third position, climbing twenty six places in twelve months. Reckitt Benckiser’s Optrex also does well this year, reaching 72nd spot, up twenty five places on last year.

 Inform purchasing

Fifteen products have entered into Top 100 territory since last year and Ecolab’s Spirigel Complete is the best performing new entrant, breaking in at spot fifty five. Paralief, Clonmel Healthcare’s branded generic is in 7th position and doing well against the branded pain relief products.

 Minimise internal stock shortages

Ask your business some questions

 Enhance category management

There are some key pieces of information that pharmacy owners need to know before planning for the OTC side of their business. This exercise should help pharmacy owners to identify OTC opportunities within their business that they may not have previously identified.

 Optimise product placement  Identify opportunities

 Ensure customers needs are met Trends Analgesic is the largest OTC category by value and nine out of the top ten products

Please note that the six year comparison listed opposite, along with other comparisons with previous years, may include brands and categories whose classification may have changed over the four year period. The IPN top 100 OTC products and the method of its collation evolves with the pharmacy sector and in this context, comparisons with previous years are for indicative purposes only, using the data as printed in the IPN Top 100 in the year in question. As such, all comparative data publishes in this issue is designed to offer readers a broad reference tool rather than a like for like comparison.

16


 How much does OTC revenue contribute to the overall business?  What are the top selling OTC products in your particular store?  How is your store performing relative to local competitors?  Are there products/categories you could focus on to generate opportunities? The information below can be used to compare the market performance of Ireland’s favourite OTC products and demographic issues and customer needs should also be taken into account when deciding which products to stock. Products that sell well should be regularly replenished to avoid missing out on potential sales. Order in bulk if possible to secure a better deal, which makes better business sense in the long term. Regular monitoring OTC sales should be monitored regularly and

20 18

20 17

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seasonal demands can also be taken into account. It is advisable to purchase stock on the most competitive terms, while also taking into account the impact of tying your revenue up in stock as cash flow can have an impact on buying decisions. Excess stock can be a drain on resources so concentrating on the OTC aspect of your business will ensure that the most popular items regularly move off the shelves, helping to keep the revenue stream flowing. Featuring top market performers and giving them the optimum position on the shop floor will have a positive impact on sales. This is when merchandising strategies come in handy and can be adopted to help customers find what they need quickly and without hassle. A neat store that has orderly fixtures ensures that customers have a positive experience. Adopting these strategies will likely ensure that the customer is satisfied, making them most likely to return to your store, in the knowledge that their most reached for products are available all year round.

20 15

20 14

20 13

20 18

20 17

20 16

20 15

20 14

20 13

1 1 1 1 1 1

14 27 26 27 31 25

2 2 2 2 2 3

15 21 28 18 22 26

3 4 5 5 9 10

16 18 18 21 18 19

4 7 7 7 8 11

17 25 25 26 23 21

5 6 6 6 7 6

18 23 22 28 15 14

6 5 4 4 4 4

19 22 23 22 17 16

7 8 13 11 10 8

20 31 41 81 0 0

8 13 10 10 5 5

21 24 24 25 19 18

9 14 14 14 14 13

22 29 33 29 33 28

10 9 8 9 11 9

23 26 35 0 0 0

11 15 15 17 21 0

24 33 30 34 29 31

12 17 17 16 25 59

25 30 27 23 24 22

13 20 20 19 20 20

VING CASH SALES YOUR PHARMACY

amol Brand in Pharmacy*

234,304

16,233

s ab at

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IMS MAT Mar 2012

nmel, Co. Tipperary. t. ys read the label.

2012/ADV/PAR/076

17


TOP 100 OTC PRODUCTS 20 20 20 20 20 20 18 17 16 15 14 13 SUDOCREM

26 98 61 47 52 54

SAVLON

51 66 85 56 32 30

BENYLIN DAY NIGHT

27 35 43 50 68 58

PANADOL ACTIFAST

52 70 64 63 63 52

CALDESENE

28 50 54 41 46 50

RENNIE

53 67 63 61 57 53

ARRET

54 69 66 58 59 56

TYROZETS

29 38 44 57 65 71

CANESTEN

30 19 16 15 16 17

DIFFLAM

31 40 38 38 38 34

SPIRIGEL COMPLETE

55 - - - - -

CYSTOPURIN

56 71 73 70 100 78

BEROCCA

32 39 36 33 27 24

IMODIUM PLUS

57 72 72 75 88 65

GAVISCON

33 10 9 8 6 7

SEVEN SEAS C L O

58 73 78 73 61 49

EASOFEN

34 46 31 35 41 43

CORTOPIN

35 37 52 49 55 61

CODINEX

36 36 39 59 86 68

SINUTAB CORSODYL

38 48 53 45 45 42 39 59 57 62 49 46

VICKS

40 43 47 43 58 86

BONJELA E 45

20 20 20 20 20 20 18 17 16 15 14 13 BENYLIN 4 FLU

76 92 77 76 77 63

BIO KULT

77 - - - - -

PREVALLERGY 78 - - - - PHARMATON

79 84 68 68 70 45

BENYLIN

80 - 100 - - -

ALFLOREX

81 - - - - -

OLBAS

82 - - - - -

TEARS NATURALE 83 -

-

- 94 83

BENYLIN DRY COUGH

84 - - - - 95

B D MICRO FINE

85 -

BENYLIN DRY N/D 59 74 74 72 74 62 -

-

-

-

SILCOCKS BASE PWD

60 96 89 82 71 48

CARNATION CORN 86 - - - - -

BEPANTHEN

61 78 90 85 85 84

ANUSOL

87 99 92 88 82 74

SILCOCKS BASE OVE

62 86 87 94 0 0

MURINE

88 - - - - 99

ELAVE

63 89 83 92 0 0

ANTI HIST ALLERGY

89 - - - - -

CB12

64 76 79 90 66 0

SONA VITAMIN B COM

90 - - - - -

CERUMOL

65 81 81 79 0 0

ZOVIRAX GLX

66 87 82 86 0 0

THERMACARE

67 75 84 96 0 0

PANADOL SOL MAX

92 - - - - -

ACIC

68 85 91 80 79 79

AQUEOUS PWD

93 -

VOLTAROL

69 28 32 36 37 38

KIN GINGIVAL

94 - - - - -

BEPANTISEPTIC

70 82 71 91 0 0

LYCLEAR

95 90 - - - -

COMPEED

71 91 96 84 0 0

ADVIL COLD & FLU

96 - - - - -

OPTREX

72 97 - - - -

BENYLIN CHILDREN

97 - - 100 - -

CYMEX

98 - - 99 81 0

37 45 42 39 42 35

IMODIUM

DIORALYTE

18

20 20 20 20 20 20 18 17 16 15 14 13

41 16 19 20 26 29

CALPOL VAPOUR 91 - - - - -

42 58 58 52 50 47 43 64 56 46 43 36

LISTERINE

44 53 51 48 0 0

PARACETAMOL PZC

45 52 60 60 0 0

SUDAFED NASAL

46 62 62 64 69 66

ACTIFED

47 54 55 44 48 41 BEECHAMS NIGHT NRS

73 - - - - -

-

- 72 51

DEEP HEAT

48 63 65 66 67 57

BRUPRO

49 93 - - - -

PHARMATON KIDDI

74 79 67 71 76 69

CARMEX

99 - - - - -

BROLENE

50 68 69 69 64 73

NIQUITIN

75 77 0 0 35 23

EXCEDRIN

100 - 88 - - -


** O N 1

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T O WO R K *

ONE

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IRELAND’S PHARMACY ONLY PAIN RELIEVER

PA R A C E TA M O

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**IMS MAT volume sales to May 2018. 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: April 2014.


The Top 100 OTC Products 1

SOLPADEINE Perrigo

Solpadeine is Ireland’s number 1* pharmacy only pain relief brand and offers a range of different pain solutions to address different customer needs. Pain management is one of the most vital services provided by pharmacists today. Solpadeine is an effective short-term solutions for acute pain when Paracetamol and Ibuprofen are not enough. With a triple active formulation of paracetamol, caffeine and codeine; Solpadeine provides fast and effective relief from headache, backache and other acute pain. Product name: Solpadeine Soluble Tablets (P), Solpadeine Tablets (P) and Solpadeine Capsules (P). MA Holder: Chefaro Ireland Ltd., First Floor, Block A, The Crescent Building, Northwood Office Park, Dublin 9, Ireland. Further information is available upon request. *Source: IQVIA MAT Volume Sales May 2018

2

NUROFEN PLUS RB Ireland

Maintains its position at number two in this years Top 100. Nurofen Plus has held this position since 2014.

3

PANADOL EXTRA GSK Consumer Healthcare

A top 5 product for the last 4 years, Panadol Extra Soluble tablets contain caffeine, which amplifies the analgesic effect of Paracetamol, giving up to 30% more pain relieving power when compared to standard paracetamol tablets.

4

NUROFEN EXPRESS RB Ireland

Climbs three places this year, to its highest position in the Top 100 over the comparison period.

5

CALPOL Johnson & Johnson (Ireland)

CALPOL® is the number 1 children’s pain relief brand in Ireland*. With over 45 years’ experience, helping parents to treat their child’s pain and fever at all ages and stages. CALPOL® Sugar Free Infant Suspension and Sachets are specifically formulated for babies and infants from as young as 2 months (for babies weighing over 4kg and not premature). CALPOL® starts to work on fever in just 15 minutes but is still gentle on delicate tummies. CALPOL® provides effective relief for pain and fever associated with; teething, earache, sore throat, and colds. CALPOL® infant suspension is gentle enough for post-immunisation fever in babies as young as 2 months. Contact your OTC Territory Manager for more information. MAH: McNeil Healthcare (Ireland) Ltd. Airton Road, Tallaght, Dublin 24, Ireland. Product not subject to medical prescription. Further information available upon request from Johnson & Johnson (Ireland) Ltd. *combined IQVIA & Nielsen data MAT June 2018.

20

6

NUROFEN FOR CHILDREN RB Ireland

The third of five products from RB’s Nurofen range in this year’s Top 100.

7

PARALIEF Clonmel Healthcare

Paracetamol 500mg tablets 24 pack. For the relief of headaches, musculoskeletal disorders, period pain, toothache, colds and flu. Also available in the range is Paralief 500mg Effervecent Tablets in 12 and 24 packs. Available from Clonmel Healthcare.

8

NUROFEN RB Ireland

Climbing 5 places this year and re-entering the Top ten.

9

LEMSIP RB Ireland

Up 5 places from its 2017 position, Lemsip offers relief of the symptoms of colds and influenza, including the relief of aches and pains, sore throat, headache, nasal congestion and lowering of temperature.

10

NICORETTE Johnson & Johnson (Ireland)

NICORETTE® IS Ireland’s No 1 NRT* and Total OTC** brand with the widest range of products to support every smoker. Nicorette® understands that quitters need help with the psychological as well as the physical side of stopping smoking. It offers a unique format to help you quit – Quickmist, clinically proven to relieve cravings in just 30 seconds***. NICORETTE® is launching a new exciting Cool Berry flavor of Quickmist in October and this will be supported with an instore campaign, TV, Out of Home and a digital campaign. MAH: Johnson & Johnson (Ireland) Ltd, Airton Road, Tallaght, Dublin 24, Ireland. Products are not subject to medical prescription. Further information is available upon request (from Johnson & Johnson (Ireland) Ltd. *IMS Data June 2018 MAT Value Sales & Value Share **IMS Data June 2018 MAT Value Sales ***Based on 2x 1 mg dose


ABSOLUTE PURITY

DAILY UV DEFENCE FOR VISIBLY YOUNGER SKIN

Available in pharmacies nationwide. Buy online at elaveskincare.com


The Top 100 OTC Products AVEENO Johnson & Johnson (Ireland)

11

AVEENO® is Ireland’s Number One* Pharmacy skincare brand and once again this year moves up the ranking in the top 100 of all Pharmacy Brands to number 11**. AVEENO® has a wide range of products to suit all skin types; from normal skin to dry, irritated or sensitive skin. All AVEENO® body moisturisers contain colloidal oatmeal or oat extract, derived in nature and activated by science, to provide real skincare benefits. With a continuous focus on innovation to meet the changing needs of consumers, The AVEENO® range now includes the AVEENO® Daily Moisturising After-Shower Mist and the AVEENO® Daily Moisturising Body Yogurts and Yogurt Body Washes. AVEENO® Daily Moisturising Lotion provides healthier looking skin from day 1 and is recommended by 9 out of 10 Irish Women***. For more information please contact your Johnson & Johnson territory representative. * ** *** IMS MAT Volume

Sales (Pharmacy only), Skincare Category from December 2016 to December 2017 IQVIA 'The top 100 Pharmacy Products 2017/2018' based on Volume Sales AVEENO® DML Consumer Product Trial with Beaut.ie August/September 2013 (91 respondents) IRE/AV/18-3275

CETRINE ALLERGY Rowex

12

Cetrine Allergy 10 Tablets (Cetirizine) Cetirizine is indicated for the relief of nasal and ocular symptoms of seasonal and perennial allergic rhinitis. For the relief of symptoms of chronic idiopathic urticaria. Available in packs of 7's and 30's. Marketed by Rowex Ltd, Co. Cork. Always read the leaflet.

SUDAFED Johnson & Johnson (Ireland)

13

SUDAFED is the number one selling decongestant brand in Ireland*. Over the past 30 years SUDAFED® has developed clinically proven, over-the-counter treatments for congestion and associated symptoms. This enables people to treat a vast array of congestion symptoms without the need for a prescription. Sudafed offers relief from nasal congestion and catarrh while Sudaplus provides additional benefit of pressure and pain relief. The Sudafed range now contains SUDAPRO Headcold which target the 3 symptoms of a headcold. Contact Your OTC Territory Manager for more information. *IQVIA/ MAT June ®

15

DUPHALAC Mylan Healthcare

Duphalac climbs 6 places this year, to its highest position in the Top 100 over the comparison period (2012 – 2018). Duphalac contains lactulose. It makes the stool softer and easier to pass, by drawing water into the bowel. It is not absorbed into the body.

16

NUROFEN COLD & FLU RB Ireland

The fifth product from RB’s Nurofen range in this years Top 100 is up two places.

17

SENOKOT RB Ireland

Senokot is a gentle effective constipation relief product. Senokot contains senna, a natural plant extract. The brand has gained 5 places and enters the top 20 this year.

18

MOTILIUM Johnson & Johnson (Ireland)

Motilium is indicated for the relief of the symptoms of nausea and vomiting. A climb of 5 places this year.

19

PANADOL GSK Consumer Healthcare (Ireland)

Panadol this year sees a rise of 3 places, which is in line with the growth of the Panadol Extra range.

2018, MAH: McNeil Healthcare (Ireland) Ltd., Airton Road, Tallaght, Dublin 24. Product not subject to medical prescription. Full Prescribing Information available from Johnson & Johnson (Ireland) Ltd.

14

CALPOL SIX PLUS Johnson & Johnson (Ireland)

As children get older their needs can change in all sorts of ways. CALPOL® SIXPLUS™ Suspension and Fastmelts are specially formulated to provide effective, soothing relief from pain and fever in children aged 6 and over. The CALPOL® SIXPLUS™ range has over two times the strength of infant paracetamol and starts to work on fever in just 15 minutes without being harsh on the tummy. CALPOL® SIXPLUS™ Fastmelts melt in the mouth with no need for water to provide Onthego pain & fever relief for older children. Calpol will be supported this year with TV, Digital, Radio and Pharmacy Point of Sale. Contact Your OTC Territory Manager for more information. MAH: McNeil Healthcare (Ireland) Ltd. Airton Road, Tallaght, Dublin 24, Ireland. Product not subject to medical prescription. Further information available upon request from Johnson & Johnson (Ireland) Ltd.

22

20

NEXIUM CONTROL Pfizer Consumer Healthcare

Nexium Control has been one of the most successful OTC launches in pharmacy in recent years. It is currently the fastest growing brand in the GI category with an annual growth rate of 28%. Since its launch, the product has taken the top spot in the OTC PPI market and is now second in the overall category with 36% value market share year to date June 2018. A high level of continued marketing support has driven the success of the brand together with continued pharmacy support from the Pfizer Consumer Healthcare representative team. Full product details available on medicines.ie For Pharmacy only. 1. IMS MAT and YTD Report Data June 2018. PP-NEX-IRL-0068


Clinically proven to help you quit

Now PCRS Reimburseable

Nicorette Icy White 2mg Medicated Chewing Gum. Composition: Each medicated chewing gum contains 2 mg nicotine as a resin complex. Pharmaceutical Form: Medicated Chewing Gum. A square, coated, white coloured chewing gum. Indications: For the treatment of tobacco dependence by relieving nicotine craving and withdrawal symptoms: thereby facilitating smoking cessation in smokers motivated to quit. - helping smokers temporarily abstain from smoking In certain circumstances, Nicorette 2mg Gum may be used in combination with Nicorette Invisi 10mg and 15mg Transdermal Patch for the treatment of tobacco dependence as part of a stop smoking programme. In smokers currently unable or not ready to stop smoking abruptly, Nicorette gum may also be used as part of a programme to reduce smoking prior to stopping completely. Dosage: Nicorette Gum should be chewed slowly. Smoking cessation: Adults The strength of gum to be used will depend on the smoking habit of the individual. In general, if the patient smokes fewer than 20 cigarettes a day, Nicorette 2mg Gum is indicated. If more than 20 cigarettes per day are smoked Nicorette 4mg Gum will be needed to meet the withdrawal of the high serum nicotine levels from heavy smoking. The patient should be urged to stop smoking completely when initiating therapy with Nicorette Gum. The chewing gum should be used whenever there is an urge to smoke according to the “chew and rest” technique described on the pack. After about 30 minutes of such use, the gum will be exhausted. Not more than 15 pieces of the chewing gum may be used each day. Absorption of nicotine is through the buccal mucosa, any nicotine which is swallowed being destroyed by the liver. Administration of nicotine should be stopped temporarily if any symptoms of nicotine excess occur. Nicotine intake should be decreased by lowering dosing frequency if nicotine excess symptoms persist (see Section 4.9). Nicorette Gum may be used for up to 3 months during which time the habits associated with smoking will be lost. For those using the 4mg Gum, the 2mg will be helpful during withdrawal. If not successful after 12 weeks the patient should be encouraged to make a fresh attempt to stop smoking. This may necessitate full or partial re-treatment with an NRT programme. Temporary Abstinence: During periods of temporary abstinence, the patient should use Nicorette Gum when required to relieve nicotine cravings and withdrawal symptoms. The strength of gum to be used will depend on the smoking habits of the individual. In general, if the patient smokes fewer than 20 cigarettes a day, Nicorette 2mg Gum is indicated. If more than 20 per day are smoked Nicorette 4mg Gum is indicated. Not more than 15 pieces of the gum should be used per day. A minor reduction in total clearance of nicotine has been demonstrated in healthy elderly patients, however, not justifying adjustment of dosage. Smoking reduction: For smokers who are unwilling or unable to quit abruptly. Use the gum whenever there is a strong urge to smoke in order to reduce the number of cigarettes smoked as far as possible and to refrain from smoking as long as possible. The number of pieces of gum is variable and depends on the patients needs. Not more than 15 pieces of the gum should be used per day. If a reduction in number of cigarettes per day has not been achieved after 6 weeks, professional advice should be sought. Reduced tobacco consumption should lead to complete cessation of smoking. A quit attempt should be made as soon as the number of cigarettes has been reduced to a level whereby the smoker feels ready to quit completely, then start as outlined for “smoking cessation” as given above. If the attempt to stop smoking completely has not been started within 6 months after the beginning of treatment, it is recommended to consult a healthcare professional. Combination Therapy: It may sometimes be beneficial to utilize more than one form of NRT concurrently. For example, combination therapy could be used by smokers who have relapsed with NRT monotherapy in the past, who experience breakthrough acute cravings or have difficulty controlling cravings for cigarettes using monotherapy. Hence, if required, the Nicorette Invisi Patch and Nicorette 2mg medicated chewing gum may be combined. Step 1: The Nicorette Invisi 15mg Patch would be applied daily on waking for 16 hours and removed just before bedtime for a total of 8 weeks. The Nicorette 2mg medicated chewing gum would be used ad libitum when the smoker felt an urge to smoke or in situations where he/she feels that breakthrough cravings may occur, up to a maximum of 15 pieces per day. Step 2: After the initial 8 weeks the lower dose Nicorette Invisi 10mg Patch should be used. The Nicorette Invisi 10mg Patch would be applied daily on waking for 16 hours and removed just before bedtime for a total of 4 weeks. The Nicorette 2mg medicated chewing gum would be used ad libitum when the smoker felt an urge to smoke or in situations where he/she feels that breakthrough cravings may occur, up to a maximum of 15 pieces per day. Step 3: Use of the Nicorette Invisi Patch should be stopped after the 12 week treatment program. The Nicorette 2 mg medicated chewing gum can continue to be used for a further 3 months during which time the habits associated with smoking will be lost. Contraindications: Hypersensitivity to the active substance or to any of the excipients Use in non-smokers Special Warnings and Precautions for use: 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, Nicorette Gum may be considered but as data on safety in this patient group are limited, initiation should only be under close medical supervision. 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 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 Phaeochromocytoma and uncontrolled hyperthyroidism. Nicotine, both from NRT and smoking, causes the release of catecholamines from the adrenal medulla. Therefore, Nicorette should be used with caution in patients with uncontrolled hyperthyroidism or pheochromocytoma. - 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 reductions in nicotine-induced catecholamine release can affect carbohydrate metabolism. Patients with diabetes mellitus may require lower doses of insulin as a result of smoking cessation. - Smokers who wear dentures may experience difficulties in chewing Nicorette Gum. The chewing gum may stick to, and may in rare cases damage dentures. Transferred dependence: Nicotine in any dose form is capable of inducing a dependence syndrome after chronic use and is highly toxic after acute use. However, dependence with Nicorette Gum is a rare side-effect and is both less harmful and easier to break than smoking dependence. 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. 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 aphthous ulceration, or nasopharyngitis. In addition, and of clinical significance, nicotine cravings may result in profound urges to smoke. Adverse Drug Reactions (ADRs) Nicorette Gum may cause adverse reactions similar to those associated with nicotine administered by other means and are dose dependent. Most of the undesirable effects reported by the patient occur during the early phase of treatment and are mainly dose dependent. Irritation in the mouth and throat may be experienced, however most patients adapt to this with ongoing use. Adverse reactions observed in patients treated with oral nicotine formulations during clinical trials and post-marketing experience are listed below by system organ class (SOC). Frequencies are defined in accordance with current guidance, as: Very common (>1/10); common (>1/100, <1/10); uncommon (>1/1 000, <1/100); rare (>1/10 000, <1/1 000); very rare (<1/10 000), Not known - cannot be estimated from the available data. Immune System Disorders Hypersensitivity Common Anaphylactic reaction Not known. Psychiatric disorders Abnormal dreams Uncommon. Nervous System Disorders Headache Very Common Burning sensation Dysgeusia Paraesthesia Common Eye Disorders Blurred Vision Lacrimation increased Common Cardiac Disorders Palpitations Tachycardia Not known Vascular Disorders Flushing Hypertension Uncommon Respiratory, Thoracic and Mediastinal Disorders Cough Throat irritation Very common Bronchospasm Dysphonia Dyspnoea Nasal Congestion Sneezing Throat tightness Uncommon Gastrointestinal Disorders Hiccups Nausea Very common Abdominal pain Diarrhoea Dry mouth Dyspepsia Flatulence Salivary hypersecretion Stomatitis Vomiting Common Eructation Glossitis Oral mucosal blistering and exfoliation Paraesthesia oral Uncommon Dysphagia Hypoaesthesia oral Retching Rare Dry throat Gastrointestinal discomfort Lip pain Not known Skin and Subcutaneous Tissue Hyperhidrosis Pruritus Rash Urticaria Disorders Uncommon Erythema Not known Musculoskeletal and Connective Tissue Disorders Pain in jaw Uncommon Muscle tightness Not known General Disorders and Administration Site Conditions Fatigue Common Asthenia Chest discomfort and pain Malaise Uncommon Allergic reactions including angioedema Rare. Marketing Authorisation Holder: Johnson & Johnson (Ireland) Ltd. Airton Road Tallaght Dublin 24 PA numbers: 330/37/8. Products not subject to prescription. Full prescribing information available upon request. Date of revision of text: April 2018

IRE/NI/18-3287


The AVEENO DERMEXA Range ®

Clinically proven to moisturise & cleanse Balance efficacy & gentleness for very dry itchy skin

NEW Introducing NEW DERMEXA FAST & LONG–LASTING BALM Intensely Moisturising Clinically proven to immediately soothe itchy feeling skin

IRE/AV/18-3290


i

The Top 100 OTC Products 21

STREPSILS RB IRELAND

Strepsils, for the symptomatic relief of mouth and throat infections, climbs 3 places this year.

22

MAXILIEF Clonmel Healthcare

Maxilief effervescent tablets contain Paracetamol 500mg, Codeine 8mg & Caffeine 30mg. For the relief of headache, musculoskeletal pain, toothache, backache, common cold, influenza, menstrual pain. Available in 24 & 60 packs. 60 pack is GMS reimbursable. Available from Clonmel Healthcare.

23

BUTTERCUP BRONCHOSTOP Perrigo

Bronchostop is a traditional herbal medicinal product used for the relief of coughs, such as chesty, dry, tickly, irritating coughs and catarrh, exclusively based upon long-standing use.

24

OTRIVINE GSK Consumer Healthcare (Ireland)

Otrivine® Adult Nasal Spray is a nasal decongestant spray that helps to unblock nose in 2 minutes and last for up to 10 hours, containing the active ingredient xylometazoline hydrochloride.

25

DULCOLAX Sanofi Consumer Healthcare

Dulcolax®, the world’s No 1 selling 1 selling laxative range*, laxative range*, nts to suits patients’ offers a choice of treatments to suits ds: patients’ individual 0), the latestconstipation innovation in needs: relief of s for comfortable DulcoSoft mode of action that® can (macrogol 4000), the latest yl) and Dulcolax® PicoinLiquid innovation the (sodium picosulfate) soften the stools for comfortable relief of constipation. With relief fromrange, constipation. a gentle mode of action that can suit all the family**. isacodyl) can provide relief in as little as 10 minutes. Dulcolax® Tablets (bisacodyl) and Dulcolax® Pico Liquid (sodium picosulfate) offer predictable overnight relief from constipation. egnant and breastfeeding women can take DulcoSoft® under advice from a GP. Dulcolax® Suppositories (bisacodyl) can provide relief in as little as www.medicines.ie SAIE.DULC1.18.07.0203 – July 2018 10 minutes. *based on sales data **children from 2-8 years and pregnant and breastfeeding women can take DulcoSoft® under advice from a GP. Full product details available on www.medicines.ie SAIE.DULC1.18.07.0203 – July 2018

26

SUDOCREM Teva

Sudocrem Antiseptic Healing Cream is an iconic Irish brand manufactured in Baldoyle, Dublin. It is indicated in the management of various dermatoses including local skin reactions associated with incontinence (nappy rash, cuts & grazes, eczema, sunburn, minor burns, surface wounds, acne and bed sores). Sudocrem Antiseptic Healing Cream is a licenced medicine and has been used by generations of Irish for its soothing, protecting and healing properties. Further information is available on request from: TEVA PHARMACEUTICALS IRELAND, Freephone: 1800 201 700 E: info@teva.ie www.teva.ie Always read the label carefully. Date of Preparation: July 2017. IE/ OTC/17/0038

27

BENYLIN DAY NIGHT Johnson & Johnson (Ireland)

BENYLIN® Day and Night tablets occupy a unique position in the market being the only day & night tablets for 24 hour cold and flu relief. During the day the white tablet relieves fever and decongests the nose. During the night the blue tablet helps relieve cold symptoms for a better night sleep. The coming winter season will again see heavy investment behind BENYLIN® with two TV copies, digital support as well as eye catching in store POS. Contact your Johnson & Johnson OTC territory manager for more information. MAH: McNeil Healthcare

(Ireland) Ltd. Airton Road, Tallaght, Dublin 24, Ireland. Full prescribing information available upon request. Product not subject to medical prescription.

28

CALDESENE Clonmel Healthcare

Caldesene Medicated Powder (Calcium undecylenate 10% w/w) protects your baby by attacking harmful bacteria and soothing irritation. Its special formulation forms a barrier against wetness and eliminates the need to rub the affected area and irritate further. Caldease medicated ointment (Zinc Oxide 15% w/w) and CaldeSpray for Nappy Rash (Zinc Oxide 10% milk spray) are additional products in the Caldesene range.

29

TYROZETS Johnson & Johnson (Ireland)

Continues to show marked growth year on year up the list, as J&Js throat lozenges move from 38 to 29 on the list.

30

CANESTEN Bayer Limited

Canesten® is Ireland’s No 1 well-known trusted women’s health brand worth ¤2.7m. Canesten® is the go to brand in both the thrush and bacterial vaginosis categories. In terms of thrush, it is important to treat thrush infections both internally and externally. Canesten® Combi offers the complete treatment for thrush as it treats the source of the infection and calms the external itch. The product also offers the convenience of a one-day treatment. If women are unsure which infection they have, Canestest® allows women to identify their intimate health condition in their own home. Canesbalance® is designed to treat bacterial vaginosis and is a clinically proven treatment.

25


Nurofen for Children Strawberry 100mg/5ml Oral Suspension. Contains ibuprofen. Suitable from 3 months and weighing over 5kgs. Always read the label. Date of preparation: Jan 2018. IRL/NfC/0117/0002a(1)

Abbreviated Prescribing Information for Nurofen for Children Orange 100mg/5ml Oral Suspension Nurofen for Children Strawberry 100mg/5ml Oral Suspension Please refer to Summary of Product Characteristics for full information. Active ingredient: Ibuprofen 100 mg/5 ml (equivalent to 2.0% w/v). Pharmaceutical Form: An off-white orange flavoured syrupy oral suspension or an off white strawberry flavoured syrupy oral suspension. Indications: Reduction of fever and relief of mild to moderate pain, such as cold and flu symptoms, teething pain, headache, sprains and strains and to ease the pain of sore throats and earache. Dosage and Administration: For short term use only. The maximum daily dosage is 30mg of ibuprofen/kg bodyweight administered in divided doses, achieved as follows: 3-6 months (weighing 5kg-7.6kg) is 2.5ml, 3 times a day. 6-12 months (weighing 7-7.9kg) is 2.5ml, 3 times a day. 1 to 3 years (10-16kg) is 5ml, 3 times a day. 4 to 6 years (17-20kg) is 7.5ml, 3 times a day. 7 to 9 years (21-30kg) is 10ml (two 5ml spoonfuls) 3 times a day. 10 to 12 years (31-40 kg) is 15ml (three 5ml spoonfuls) 3 times a day. This product should only be given to infants aged 3-6 months who weigh more than 5kg. For infants aged 3-5 months medical advice should be sought if symptoms worsen, or not later than 24 hours if symptoms persist. If in children aged from 6 months and in adolescents this medicinal product is required for more than 3 days, or if symptoms worsen, a doctor should be consulted. Do not dose more frequently than at 6 hourly intervals. The recommended dose should not be exceeded. Not suitable for children under 3 months of age unless advised by a doctor. For oral administration. For patients with sensitive stomachs, the product can be taken during a meal. Contraindications: severe hepatic failure, severe renal failure or severe heart failure. History of GI bleeding or perforation related to previous NSAID therapy. History of, or existing peptic ulceration, or other gastrointestinal disorders. Known hypersensitivity to ibuprofen or any of the ingredients. History of bronchospasm, asthma, rhinitis, angioedema or urticaria associated with aspirin or other non-steroidal anti-inflammatory drugs. During the last trimester of pregnancy. Warnings and Precautions: Undesirable effects may be minimised by using the minimum effective dose for the shortest duration necessary to control symptoms. Concomitant use of NSAIDs including cyclooxygenase-2 selective inhibitors should be avoided. The elderly have increased frequency of adverse reactions to NSAIDs especially GI bleeding and perforation which may be fatal. GI bleeding, ulceration or perforation, which can be fatal, has been reported with all NSAIDs at any time during treatment, with or without any warning symptoms or a previous history of serious GI events. The risk is higher with increasing NSAID doses, in patients with a history of ulcer, particularly if complicated with haemorrhage or perforation and in the elderly. Combination therapy with protective agents should be considered for these patients and also for patients requiring low dose aspirin or other drugs likely to increase GI risk. Caution should be advised in patients receiving concomitant medications such as oral corticosteroids, anticoagulants, selective serotonin reuptake inhibitors or anti-platelet agents. Treatment should be withdrawn if GI bleeding or ulceration occurs. Caution is required in patients with a history of GI diseases, cardiac impairment or a history of hypertension and/or heart failure (see SPC). Use of ibuprofen may be associated with a small increased risk of arterial thrombotic events. Overall, epidemiological studies do not suggest that low dose ibuprofen (e.g. < 1200mg daily) is associated with an increased risk of myocardial infarction. Caution is required in patients with renal or hepatic impairment. Caution is required in patients with idiopathic thrombocytopenic purpura (ITP), intracranial haemorrhage and bleeding diathesis. Patients with rare hereditary problems of fructose intolerance should not take this medicine. Serious skin reactions, some of them fatal, including exfoliative dermatitis, Stevens-Johnson syndrome and toxic epidermal necrolysis, have been reported very rarely in association with the use of NSAIDs. Treatment should be discontinued at the first appearance of skin rash, mucosal lesions, or any other sign of hypersensitivity. It is advisable to avoid use in the case of varicella as NSAIDs can worsen serious cutaneous and soft tissue infectious complications. May impair female fertility by an effect on ovulation, however this is reversible on withdrawal of treatment. Bronchospasm may be precipitated in patients suffering from, or with a history of, bronchial asthma or allergic disease. Caution is advised in patients with systemic lupus erythematosus and connective tissue disease. This medicinal product contains 1.2mmol of sodium per dose. To be taken into consideration by patients on s controlled sodium diet. There is a risk of renal impairment in dehydrated children and adolescents. Interactions with other medicinal products: Please see SPC for full details. Ibuprofen should be avoided in combination with Aspirin and other NSAIDs. Considered unsafe to take NSAIDs in combination with warfarin or heparin unless under direct medical supervision. Care should be taken in combination with anti-hypertensives, Corticosteroids, Anti-coagulants, Anti-platelet agents and selective serotonin reuptake inhibitors (SSRIs), Cardiac glycosides, Lithium Methotrexate, Cyclosporin, Tacrolimus, Aminoglycosides, Probenecid, Oral hypoglycaemic agents, Mifepristone, Zidovudine and Quinolone antibiotics. Fertility, pregnancy and lactation: Not recommended in the first 6 months of pregnancy. Do not use in the last trimester of pregnancy. It is not necessary to interrupt breast-feeding for short-term treatment with the recommended dose for mild to moderate pain and fever. May impair female fertility by an effect on ovulation, however this is reversible on withdrawal of treatment. Ability to Drive and Operate Machinery: No adverse effects known. Side Effects: The list of the following adverse effects relates to those experienced with the product at OTC doses (max 1200mg per day), for short-term use. In the treatment of chronic conditions, under long-term treatment, additional adverse effects may occur. Gastrointestinal Disorders: Uncommon: Abdominal pain, dyspepsia and nausea. Rare: diarrhoea, flatulence, constipation and vomiting. Very rare: Peptic ulcer, GI perforation or haemorrhage, melaena, haematemesis, exacerbation of colitis and Crohnâ&#x20AC;&#x2122;s disease. Mouth ulcers and gastritis. Nervous System Disorders: Uncommon: Headache. Very rare: Aseptic meningitis. Renal and Urinary Disorders: Very rare: Acute kidney failure. Liver Disorders: Very rare: Liver disorders, especially in long-term treatment, cholestatic jaundice, hepatitis, elevation of serum enzymes. Blood and Lymphatic System Disorders: Very rare: Haematopoietic disorders. Skin and Subcutaneous Disorders: Uncommon: Skin rash. Very rare: Severe forms of skin reactions such as erythema multiforme, epidermal necrolysis and Stevens-Johnson syndrome. Immune system Disorders: Uncommon: Hypersensitivity reactions with urticarial and pruritus. Very rare: Severe hypersensitivity reactions including facial, tongue and throat swelling, dyspnoea, tachycardia and hypotension. Cardiac Disorders: Very rare: cardiac failure and oedema. Vascular Disorders: Very rare: Hypertension. Respiratory, Thoracic and Mediastinal disorders: Very rare: Asthma, aggravated asthma, bronchospasm or dyspnoea. Investigations: Very rare: Haemoglobin decrease, urea renal clearance decrease. Infections and infestations: Very rare: Exacerbation of infections related inflammation, severe skin infections. Soft tissue complications may occur during a varicella infection. See SPC for more detail. Name and address of Marketing Authorisation Holder: Reckitt Benckiser Ireland Ltd., 7 Riverwalk, Citywest Business Campus, Dublin 24. PA numbers: PA 979/32/1, 979/32/9. For full prescribing information, please consult the SPC which is available on www.medicines.ie. For product queries, please call (01) 630 5429 or contact the MAH above. Legal Category: Supply through Pharmacy only. Date of preparation: December 2016.


The Top 100 OTC Products 31

DIFFLAM Meda Health Sales

Difflam is up nine places in this year’s Top 100, now in its highest position over the comparison period. For symptomatic relief of painful inflammatory conditions of the throat and mouth. Available as an oral rinse and spray.

36

CODINEX Pinewood

Another strong year for the codeine-based medication, maintaining its place to follow on from 2016's 20 place spike.

37

SINUTAB Johnson & Johnson (Ireland)

A significant climb of 8 places for the popular decongestant containing paracetamol and pseudoephedrine from Johnson and Johnson.

32

BEROCCA Bayer Limited

A specially tailored formula containing high dose vitamin B complex, plus other essential nutrients. The highest placed VMS product in the Top 100.

33

GAVISCON RB Ireland

For the management of gastric reflux, reflux oesophagitis, hiatus hernia, heartburn (including heartburn of pregnancy) and similar gastric distress.

34

EASOFEN Clonmel Healthcare

The full Easofen range comprises of Easofen 200mg film-coated tablets 12, 24 and 48 packs, Easofen Max strength 400mg filmcoated tablets 24 pack and Easofen for Children Strawberry 100mg/5ml and 200mg/5ml Oral Suspension in 100ml and 200ml pack sizes.

35

38

CORSODYL GSK Consumer Healthcare (Ireland)

The GSK brand has maintained a healthy level of consumer activity in the market and has justified it, with significant growth of 10 places this year.

39

IMODIUM Johnson & Johnson (Ireland)

Johnson and Johnson's trusted brand, for the treatment of sudden, acute attacks of diarrhoea in adults and children 4 years and over and chronic diarrhoea in adults has climbed an impressive 20 places this year.

40

VICKS Teva

The VICKS® range of products treat the symptoms of coughs and colds, providing effective relief for cough, nasal congestion, sore throat, runny nose, fever & related symptoms in children and adults. Products include: Vicks® Vaporub, Vicks® Inhaler Nasal Stick, Vicks® Sinex Micromist and Vicks® First Defence. Further information is available on request from: TEVA PHARMACEUTICALS IRELAND, Freephone: 1800 201 700 E: info@teva.ie www.teva.ie Always read the label carefully. Date of Preparation: July 2017. IE/OTC/17/0038

CORTOPIN Pinewood

Pinewood's hydrocortisone cream has made a small gain in position within the Top 100 this year following a significant climb last year.

27


The Top 100 OTC Products 41

DIORALYTE Sanofi Consumer Healthcare

A drop in position this year for Sanofi's oral rehydration therapy containing a balanced combination of electrolytes which include glucose, sodium chloride, potassium chloride and disodium hydrogen citrate.

46

A healthy increase of 16 places for Johnson and Johnson's fast acting treatment for congestion and associated symptoms.

47 42

BONJELA RB Ireland

SUDAFED NASAL Johnson & Johnson (Ireland)

ACTIFED Johnson & Johnson (Ireland)

Johnson and Johnson's ACTIFED, for the symptomatic relief of upper respiratory tract disorders climbs 7 places this year.

A climb of 16 places for RB's popular gel for the relief of pain and discomfort of common mouth ulcers, cold sores, denture sore spots, infant teething and mouth ulcers, and sore spots due to orthodontic devices in children.

48

DEEP HEAT Mentholatum

The trusted brand for muscular aches and pains climbs 15 places, entering top half of the chart this year.

43

E45 RB Ireland

Trusted by many as the go-to brand for the symptomatic relief of dry skin conditions where the use of an emollient is indicated, E45 is up 21 places this year.

44

LISTERINE Johnson & Johnson (Ireland)

A climb of 9 places for the well-known consumer brand, which continues to make a strong showing within pharmacy.

45

PFIZER PARACETAMOL Pfizer Consumer Healthcare

Another strong year for Pfizer's paracetemol brand, which climbs 7 places.

28

49

BRUPRO Rowex

Brupro 200mg Film-coated tablets - Targeted pain relief and easier to swallow. Each tablet contains 200 mg of ibuprofen. For the short-term management of mild to moderate pain such as headache, dental pain, period pain, muscular strain and backache and for the management of feverishness and the symptoms of colds and influenza. Available in the following packs sizes: 200mg x 12, 200mg x 24, 200mg x 48 as well as Brupro Max 400mg Film-coated Tablets x 12 and 24. Marketed by Rowex.

50

BROLENE Sanofi Consumer Healthcare

Sanofi's Brolene, for minor infections of the eye or eyelid has gained good ground this year, with an increase of 18 places.


10mg Film-Coated Tablets (Cetirizine Dihydrochloride).

Cetrine Allergy 10mg Film-Coated Tablets (Cetirizine Dihydrochloride).

IRELAND’S NO. 1 ALLERGY RELIEF1 • NO. 1 IN PHARMACIES1 • RELIEF OF ALLERGIES* • ONE TABLET PER DAY** • AVAILABLE IN A 7 & 30 PACK SIZE * Adults, elderly and children aged 6 years and over. ** Divided dose for 6-12 years (half a tablet twice daily). Medicinal product not subject to medical prescription. Further information is available from: Rowex Ltd., Bantry, Co. Cork. Ireland. Freephone: 1800 304 400. Fax: 027-50417. PA: 711/75/2, Date of preparation (05-18) CCF No: 20693

Always read the leaflet. Ref 1: IMS Data.


The Top 100 OTC Products 51

SAVLON GSK Consumer Healthcare (Ireland)

Another substantial jump up the list this year for Savlon, from number 66 in 2017. Having been a top 30 product in 2013, this cements a return in sales form for a household name.

52

PANADOL ACTIFAST GSK Consumer Healthcare (Ireland)

Panadol's extensive range provides many options in OTC pain therapy, their Actifast brand has climbed a huge 18 places this year and is one of 4 Panadol products within the top 100.

53

CYSTOPURIN Bayer Limited

A climb of 15 places and the highest position in the Top 100 this year for Cystopurin, for the symptomatic relief of mild urinary tract infections.

57

IMODIUM PLUS Johnson & Johnson (Ireland)

Imodium plus is performing well, offering complete relief from diarrhoea, wind, bloating and cramps. Both Imodium products in this year's chart have seen a significant climb.

RENNIE Bayer Limited

With over 85 years of experience, Rennie* provides a range of antacids each developed to bring you quick, lasting relief from your symptoms, so you can get on with your life. Rennie neutralises excess acid simply by turning it in to water and other natural substances. Rennie can be taken day or night for fast relief. Whether your problem is heartburn, indigestion, acid reflux or trapped wind, youâ&#x20AC;&#x2122;ll find a product specifically designed to help you. Rennie is available in a number of flavours and pack sizes each to suit your customerâ&#x20AC;&#x2122;s lifestyle including Rennie Deflatine providing multi symptom relief not only from heartburn/indigestion but also from trapped wind /bloating and fullness after food. Always read the label *Trade Mark L.IE.MKT.07.2018.2190

54

56

ARRET Johnson & Johnson (Ireland)

58

SEVEN SEAS Cod Liver Oil Merck

Seven Seas, a traditionally recognised brand, has seen a more marked growth this year and is up 15 places.

59

BENYLIN DRY Night and Day Johnson & Johnson (Ireland)

Climbs 15 places to its highest position in the Top 100 in recent years.

Johnson and Johnson's diarrhoea management brand climbs 15 places up the list, bringing it back level with its previous form 3 years ago.

55

SPIRIGEL COMPLETE Ecolab

A high new entry this year for Spirigel Complete, a fully Virucidal 85% Alcohol hand sanitiser gel in 500ml bottle with integral pump dispenser bottle ensuring correct dosage and minimal wastage.

30

60

SILCOCKS BASE Pinewood

Pinewood's Silcocks base gains a huge 36 places this year.


The Top 100 OTC Products 61

BEPANTHEN Bayer Limited

Climbs 17 places to its highest position in the Top 100 this year. Available in both 100g and 30g sizes.

62

Ovelle Pharmaceuticals Silcockâ&#x20AC;&#x2122;s Base is the No. 1 emollient of choice for consumers, dermatologists, pharmacists and medical professionals nationwide , moving up 24 places since 2017. Ovelle Pharmaceuticals creating trusted sensitive skincare solutions in Dundalk for over 80 years.

ELAVE Ovelle Pharmaceuticals

Elave sensitive skincare continues its impressive growth moving up 26 places this year. This pharmacy only, multi-award winning brand offers trusted skincare solutions for dry, sensitive, eczema and dermatitis prone skin in all categories including baby, dermatological, junior, dermo-renew, menâ&#x20AC;&#x2122;s and sun. Elave products are clinically proven and are dermatologically and paediatrician approved for sensitive and eczema prone skin. Recommended and used by medical professionals nationwide. Made in Ireland.

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CB12 Meda Health Sales

CB12 neutralizes and prevents the formation of the substances that cause bad breath. CB12 mouthwash is unique and is based on a clinically proven formula. The active ingredients in the mouthwash patented formula, zinc and chlorhexidine, eliminates VSCs from exhaled air. The chlorhexidine in the formula also has the unique ability to adhere to the gums, tongue and teeth, thereby providing a 12 hour effect on the VSCs that cause bad breath. It also includes fluoride, an ingredient proven to strengthen the teeth. The CB12 range includes a toothpaste, spray, gum and in addition the mouthwash is available in White, Mild & Mint. Discover more, visit www.cb12.ie.

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Ear drops solution Arachis oil 57% Chlorobutanol 5% for the loosening and removal of ear wax 11ml. Also available in the range Cerumol Olive Oil Ear Drops 10ml. Available from Clonmel Healthcare.

SILCOCKS BASE Ovelle Pharmaceuticals

In 1934 Ovelle Pharmaceuticals, founded by Joseph Gardiner was the first manufacturing chemist in Ireland to prepare traditional apothecary for sensitive skin conditions and we continue that tradition to this day.

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CERUMOL Clonmel Healthcare

66

ZOVIRAX GSK Consumer Healthcare (Ireland)

The evergreen cold sore brand continues to be popular amongst consumers, with a significant climb of 21 places this year.

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THERMACARE Pfizer Consumer Healthcare

Thermacare continues to grow consistently year on year, up 8 places this year, following its 9 place jump last year.

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ACIC Cold Sore Rowex

Acic Cold Sore 5% w/w Cream is indicated for the treatment of Herpes simplex virus infections of the skin, lips and face (recurrent herpes labialis) Marketed by Rowex Ltd, Co. Cork. Always read the leaflet.

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VOLTAROL GSK Consumer Healthcare (Ireland)

Voltarol Emulgel is a topical gel that provides relief for pain and inflammation of muscles and joints. Voltarol gel creates a reservoir of diclofenac when applied regularly according to instructions, which gives the skin a source of the active ingredient throughout the day for lasting relief of pain and inflammation. Unlike products that work by just heating or cooling the skin, Voltarol Emulgel contains an anti-inflammatory medicine (NSAID) called diclofenac.

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BEPANTISEPTIC Bayer Limited

A significant return to a growth in sales, following the brand's entry into the Top 100 3 years ago.


No.1 Selling Rehydration Treatment*1

Rehydrate right with

STOCK NOW

Are your customers suffering from diarrhoea? If yes, they may be dehydrated. Dehydration can be a serious side effect of acute diarrhoea especially in children and the elderly. can help your customers to rehydrate right and recover faster than with water alone.

Trusted by Pharmacists for over 30 years Meets ESPGHAN2 and NICE3 guidelines for oral rehydration Suitable for children aged 3 months and up** Available to stock in a convenient CDU ** For infants under 12 months, use only under medical advice.

* Based on sales data. References: 1. Data on File March 2018. 2. ESPGAN Working Group. J Pediatr Gastroenterol Nutr 1993;14:113-115. 3. NICE, Diarrhoea and vomiting caused by gastroenteritis in under 5s: diagnosis and management. Clinical guideline [CG84]. Published date: April 2009 (excludes Citrus)

TO PLACE AN ORDER WITH YOUR SANOFI REPRESENTATIVE CALL: Padhraic Speight Tel: 086 0456 817 Munster

Colm Moran Tel: 086 0470 989 Midlands, North West

PRESCRIBING INFORMATION DIORALYTE™ NATURAL, BLACKCURRANT AND CITRUS, POWDER FOR ORAL SOLUTION Presentation: Sachet containing the active ingredients Sodium Chloride 0.47g, Potassium Chloride 0.30g, Glucose 3.56g and Disodium Hydrogen Citrate 0.53g. Indications: Oral correction of fluid and electrolyte loss and the management of watery diarrhoea in infants, children and adults. Dosage and Administration: Each sachet should be reconstituted in 200ml (approximately 7 fluid ounces) of fresh drinking water. For infants where fresh drinking water is unavailable the water should be freshly boiled and cooled. The solution should be made up immediately before use. If refrigerated, the solution may be stored for up to 24 hours, otherwise any solution remaining an hour after reconstitution should be discarded. The solution must not be boiled after reconstitution. Daily intake may be based on a volume of 150ml/kg body weight for infants and 20-40 mg/kg body weight for adults and children. A reasonable approximation is: Infants – One to one and a half times the usual feed volume. For infants under 12 months, use only under medical advice. Children – One sachet after every loose motion. Adults (including elderly) – One or two sachets after every loose motion. More may be required initially to ensure early and full volume repletion. Contraindications: None known. Warnings and Precautions: The solution must not be reconstituted except with water at the volume stated. Solutions of greater concentration may result in hypernatraemia. Those of greater dilution may result in inadequate replacement. If there is no improvement within 24-36 hours, consult the physician. If nausea and vomiting are present with the diarrhoea, small but frequent amounts of dioralyte should be drunk at first. No specific precautions are necessary in the elderly. However, caution is required in cases of severe renal or hepatic impairment or other conditions where the normal electrolyte balance may be disturbed. Pregnancy and Lactation: Dioralyte is not contra-

Laurence O’Carroll Tel: 086 0456 816 East Coast

indicated in pregnancy or lactation. Interactions and Adverse Effects: None stated. Overdose: In the event of significant overdose, serum electrolytes should be evaluated as soon as possible, correct any abnormalities and monitor levels until return to normal, especially in the very young and in cases of severe hepatic or renal failure. Precautions for Storage: Do not store above 25°C. The reconstituted solution should be used immediately but may be stored for up to 24 hours in a refrigerator at 2-8°C. Marketing Authorisation Holder: Sanofi Ireland Ltd., Citywest Business Campus, Dublin 24. Marketing Authorisation No. PA 540/98/1 (Blackcurrant), PA 540/98/2 (Citrus), PA 540/99/1 (Natural) Legal Category: P Further information: Available from Sanofi Ireland Ltd., Citywest Business Campus, Dublin 24 or contact IEmedinfo@sanofi. com. Please refer to Summary of Product Characteristics which can be found on IPHA at http://www.medicines.ie/ before prescribing. Date of Preparation: January 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: medsafety@hpra.ie. Suspected adverse events can also be reported to Sanofi Ireland Ltd. directly by emailing IEPharmacovigilance@Sanofi.com or calling 01 403 5600. Date of Preparation: June 2018 SAIE.DIO.17.01.0010c


Calpol SixPlus Specially formulated for older children ®

8 7 6+

Lets Kids be Kids Calpol® SixPlus contains paracetamol. ALWAYS READ THE LABEL. Calpol Six Plus 250mg/5ml Sugar/colour Free Oral and Calpol Six Plus Fastmelts 250mg Orodispersable Tablets. Calpol Six Plus Sugar / Colour Free Oral Suspension contains Paracetamol 250 mg per 5 ml. Calpol Six Plus Fastmelts 250mg Orodispersable Tablets: Each orodispersable tablet contains 250mg paracetamol PHARMACEUTICAL FORM: Oral Suspension. Orodispersable Tablets Therapeutic indications: Calpol Six Plus Sugar / Colour Free Oral Suspension is indicated for the symptomatic relief of headache, migraine, neuralgia, toothache and teething pains, sore throat, influenza, feverishness and feverish colds. . Calpol Six Plus Fastmelts are indicated for the treatment of mild to moderate pain such as headache, teething pain and sore throat, and as an antipyretic (e.g. fever associated with colds and flu).

IRE/CA/18-3288

Calpol Six Plus 250mg/5ml Sugar/colour Free Oral Suspension Dosage: Child’s Age

How Much

6 – 8 years 8 – 10 years

One 5 ml spoonful (large end) One 5.0 ml spoonful (large end) and one 2.5ml spoonful (small end) Two 5 ml spoonfuls (large end) Two – three 5ml spoonfuls (large end)

4 times 4 times 4 times

Two – four 5ml spoonfuls (large end)

4 times

10 – 12 years 12 – 16 years Adults and children over 16 years

How often (in 24 hours) 4 times

Calpol Six Plus Fastmelts 250mg Orodispersable Tablets Dosage: Child’s Age

How Much

6 – 9 years 9 – 12 years 12 – 16 years Adults and children over 16 years

1 tablet 2 tablets 2 to 3 tablets

How often (in 24 hours) 4 times 4 times 4 times

2 to 4 tablets

4 times

Children under 6 years: Calpol Six Plus Suspension and Calpol Fastmelts are not suitable for administration to children under 6years of age. The Elderly: In the elderly, the rate and extent of paracetamol absorption is normal but plasma half-life is longer and paracetamol clearance is lower than in young adults. Heptatic / renal dysfunction Caution should be exercised when administrating the product to patients with severe hepatic or renal impairment. Contraindications: Hypersensitivity to the active substance or to any of the excipients. Calpol Six Plus Fastmelts are contra-indicated in patients with phenylketonuria Special warnings and precautions for use: CALPOL should be used with caution in moderate to severe renal impairment or severe hepatic impairment. Serious skin reactions such as acute generalized exanthematous pustulosis (AGEP), Stevens - Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN), have been reported very rarely in patients receiving paracetamol. Patients should be informed about the signs of serious skin reactions, and use of the drug should be discontinued

at the first appearance of skin rash or any other sign of Undesirable effects: Paracetamol has been widely used and, when taken at the usual recommended dosage, side effects are mild and infrequent and reports of adverse reactions are rare. Skin rash and other allergic reactions occur rarely. Most reports of adverse reactions to paracetamol relate to overdosage with the drug.Isolated cases of thrombocytic purpura, haemolytic anaemia and agranulocytosis have been reported. Chronic hepatic necrosis has been reported in a patient who took daily therapeutic doses of paracetamol for about a year and liver damage has been reported after daily ingestion of excessive amounts for shorter periods. A review of a group of patients with chronic active hepatitis failed to reveal differences in the abnormalities of liver function in those who were long-term users of paracetamol nor was the control of the disease improved after paracetamol withdrawal. .Low level transaminase elevations may occur in some patients taking labelled doses of paracetamol; these are not accompanied with liver failure and usually resolve with continued therapy or discontinuation of paracetamol. Nephrotoxic effects following therapeutic doses of paracetamol are uncommon. Papillary necrosis has been reported after prolonged administration.

System Organ Classification (SOC)

Frequency category Adverse Event Preferred Term

Blood and lymphatic system disorders Not known Not known Not known Immune system disorders Not known Rare Hepatobilary disorders Not known Not known Skin and subcutaneous tissue disorders Rare Not known Not known Renal and urinary disorders Uncommon Not known Investigations Not known

Thrombocytopenic purpura Haemolytic anaemia Agranulocytosis Anaphylactic reaction Hypersensitivity Hepatic necrosis Liver injury Rash Urticaria Pruritic rash Nephropathy toxi Renal papillary necrosis Transaminases increased

MAH: McNeil Healthcare (Ireland) Ltd Airton Road, Tallaght, Dublin 24, Ireland. PA No. PA 823/10/4, PA 823/10/8 Date of revision: Calpol Six Plus Sugar / Colour Free Suspension: January 2015. Calpol Six Plus Fastmelts July 2015. Product Not subject to medical prescription. Full prescribing information available upon request from Johnson & Johnson (Ireland) Ltd.


The Top 100 OTC Products 71

COMPEED Johnson & Johnson (Ireland)

A strong climb of 20 places, following the brands entry in the Top 100 in 2015.

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BIO KULT Scope Healthcare

Whatâ&#x20AC;&#x2122;s your gut feeling? The Bio-Kult range is an award-winning line of live bacteria supplements for the whole family. These innovative research-based products are of the highest quality, suitable for many digestive conditions. The strains found in BioKult are individually fermented and then freeze-dried to ensure they withstand stomach acidity and storage at normal room temperature. Bio-Kult can be taken continuously for digestive and immune support or for a short period of time when taking antibiotics or whilst travelling. Available in a handy capsule or sachet form.

OPTREX RB Ireland

An impressive climb of 25 places, following the 2017 debut to the Top 100 for the eye care brand.

73

BEECHAMS NIGHT NURSE GSK Consumer Healthcare (Ireland)

A debut into the Top 100 this year, for Night Nurse, for the nighttime relief of the symptoms of colds, chills and influenza, including cough.

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PHARMATON KIDDI Sanofi Consumer Healthcare

A small drop of 5 places this year for the trusted children's VMS brand.

75

78

PREVALIN ALLERGY Perrigo

A new entry into the Top 100 this year, for Perrigo's Prevalin Allergy, which offers fast allergy relief at the onset of symptoms.

79

PHARMATON Sanofi Consumer Healthcare

Pharmaton is the No. 1 brand for multivitamins and minerals in Pharmacy based on IMS value sales. It is a Pharmacy only focused brand hence helping to grow and support your business. To continue driving support for the brand and helping grow your business, Pharmaton will be investing in implementing a strong communications mix of TV, Press, PR including eye catching POS materials over the rest of the year. So stock up now and contact your Pharmaton sales rep for any more details.

NIQUITIN Perrigo

NiQuitin offers a range of products specifically designed to help customers beat both the underlying physical addiction and sudden cravings.

76

BENYLIN 4 FLU Johnson & Johnson (Ireland)

A climb of 16 places this year for 4 Flu, which provides effective relief from flu symptoms including fever, congestion, and aches and pains.

80

BENYLIN Johnson & Johnson (Ireland)

A re-entry at 80 for Benylin, a popular and trusted brand since the early 1970s and is currently the number one selling UK cough brand.

35


The Top 100 OTC Products 81

ALFLOREX Prescision Biotics

A Debut in the Top 100 list this year for Alflorex, winner of the Best Natural Product Award in this year's IPN OTC and Pharmacy Retail Product Awards.

82

ANUSOL Johnson & Johnson (Ireland)

A climb of 12 places this year.

OLBAS Lanes Health

A new entry, Olbas Oil is a blend of pure plant oils for the relief of bronchial and nasal congestion, hayfever and minor infections of the airways by inhalation.

83

87

TEARS NATURALE Novartis Ireland Limited

88

MURINE Prestige

A new entry for Murine, drops to relieve dry and tired eyes. Ideal for dry, tired, gritty eyes caused by environmental factors such as heating, air conditioning, wind, smoke, dust, computer use, driving, overwork, swimming and other causes.

A re-entry this year for Tears Naturale, a lubricant and artificial tear in dry eye and other ocular irritation syndromes associated with deficient tear or mucous secretion.

84

BENYLIN DRY COUGH Johnson & Johnson (Ireland)

A re-entry to the Top 100 for Benylin Dry Coughs; indicated as an antitussive, for the relief of persistent, dry, irritating cough.

85

BD MICRO FINE BD

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ANTI HIST ALLERGY Clonmel Healthcare

Anti-Hist Allergy 10mg cetirizine dihydrochloride Film-coated tablets 30 pack. For the relief of symptoms of hay fever and other allergic conditions, skin rashes or itchy, watery eyes in adults and children aged 6 years and above. Also available in the range 10mg 7 pack and 200ml Oral Solution. Available from Clonmel Healthcare.

Clinically demonstrated Pentapoint Technology to reduce the pain of injection.

86

CARNATION FOOTCARE Ovelle Pharmaceuticals

Carnation Foot-care, leaders in innovative foot-care products with over 90 years expertise have a comprehensive range of solutions to almost any foot problem. This Pharmacy only brand has seen a substantiated growth in the market over the last 3 years. Corns are the most common of all foot problems; Carnation foot-care offers a variety of treatments for corns, medicated removal plasters, cushioning pads and corn shields for the management of pain and discomfort. The trusted brand is a customer favourite renowned for its reliability.

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90

SONA VITAMIN B COMPLEX Sona

B complex is comprised of 11 B vitamins, namely, Thiamin, Riboflavin, Niacin, Pantothenic Acid, Biotin, Folic Acid, Cyanocobalamin (B12), Choline, Inositol, and Para-aminobenzoic Acid (PABA). Because the B vitamins work together, a deficiency in one often indicates a deficiency in another.


®

G N I L L SE 1 1

✓ Fast Treatment Time

✓ Kind to Hair & Skin

✓ Up to 100% Effective In One Go ✓ Scientifically Proven

For more information visit www.lyclear.ie 1 IMS MAT volume sales Jan 2018. Lyclear Spray, Sensitive & Shampoo are medical devices. Use insect repellents safely. Always read the label and product information before use.


The Top 100 OTC Products 91

CALPOL VAPOUR Johnson & Johnson (Ireland)

A debut in the Top 100 this year Calpol Vapour Plug & Nightlight releases soothing lavender and camomile vapours that comfort the child through the night and help with clear and easy breathing.

92

PANADOL SOLUBLE MAX GSK Consumer Healthcare (Ireland)

A re-entry, at the same position as 2012, the last time the product appeared in the Top 100.

93

AQUEOUS Pinewood

A re-entry after a missing out on the Top 100 for the past 3 years.

94

KIN GINGIVAL Pamex

A new entry this year. Formulated with 0.12% Chlorhexidine Digluconate, Kin Gingival Mouthwash is used for intensive care of delicate gums and offers protection against dental plaque.

95

LYCLEAR Perrigo

Lyclear is Ireland’s number 1* selling head lice brand. There are a wide range of Lyclear products available to choose from, either with or without insecticides. The Lyclear range also includes a repellent as well as treatments. Lyclear’s treatment Shampoo, Sensitive & Spray 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 to any ingredients. Lyclear Sensitive, Shampoo & Spray are medical devices. Lyclear Crème Rinse (P). MA Holder: Chefaro Ireland DAC, Treasury Building, Lower Grand Canal Street, Dublin 2, Ireland. Further information available upon request. *Source: IQVIA MAT Volume Sales May 2018

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96

ADVIL COLD & FLU Pfizer Consumer Healthcare

A new entry into the Top 100 this year for Advil Ibuprofen.

97

BENYLIN CHILDREN Johnson & Johnson (Ireland)

Non-drowsy with syrup with a blackcurrant flavour. Soothes dry and tickly coughs for children aged 1 year and over.

98

CYMEX Teva

Cymex Cream’s TRIPLE ACTION FORMULA relieves and promotes the healing of painful and unsightly cold sores and dry cracked lips. It soothes the tingling burning sensation, helps stop lips from drying and cracking and it contains moisturising ingredients which ease discomfort and soften raw skin. It also helps to control infection through antiseptic properties and therefore promotes effective healing. Cymex can be used during pregnancy. Always read the label. Date of preparation July 2017. IE/OTC/17/0040a

99

CARMEX Carma Laboratories

First introduced in the U.S. in 1937, the classic jar of Carmex makes in into Ireland's Top 100 list this year for the first time.

100

EXCEDRIN GSK Consumer Healthcare (Ireland)

A re-entry for Excedrin, for the acute treatment of headache and migraine attacks (symptoms such as headache, nausea, sensitivity to light and sound and functional disability) with or without aura.


Irelandâ&#x20AC;&#x2122;s No.1 choice of multivitamins & minerals

*

Exclusive to Pharmacies * of multivitamins and minerals in Pharmacy based on total Pharmaton unit sales. Pharmaton Capsules is for the relief of fatigue. Legal status: P. Further information is available in the SmPC. MA holder: Sanofi-Aventis Ireland Ltd. T/A SANOFI, Citywest Business Campus, Dublin 24. Ireland. SAIE.PHAR.17.06.0145c, date of preparation: July 2018.

TV and Radio campaign starting this August

STOCK UP NOW


Feature

How pharmacists can help patients manage eczema Atopic eczema is a common skin condition that causes a dry, red, itchy rash. The word eczema originates from the Greek term meaning ‘to boil’ and is used interchangeably with the word dermatitis to describe inflamed or irritated skin. Frequently, eczema strikes in infancy but it can also develop for the first time in adults. Affecting one in five children and one in 12 adults, the complex condition is categorised by a weakened skin barrier, which makes skin more susceptible to bacterial and viral infections. Some people experience small patches of red, itchy skin while others experience more severe symptoms, including cracked, sore and bleeding skin. The number of people being diagnosed with eczema is on the rise. What causes eczema? The Irish Skin Foundation says while the exact cause of eczema is unknown, some factors, such as a genetic predisposition and heightened allergy responses are believed to contribute to its development. It has also been known to occur alongside other atopic conditions, including hay fever and asthma. Often, there is no obvious reason why a person suffers from eczema. The weather, stress, warm indoor environments, some foods, certain types of clothing and hot baths can all play a part. A common misconception is that a food allergy causes eczema. While there is an association between eczema and food allergies, eczema is a skin condition, not an allergy. The HSE recommends that people who suffer from eczema do not make any dietary changes without speaking to their doctor. While foods such as dairy products, wheat, eggs, soya, and nuts may trigger symptoms for some people, they will not be the primary cause of the eczema and it might not be healthy to cut these out completely, especially in children. Is there a cure? No. But there are numerous treatment options available to help patients manage the condition and keep flare-ups under control. Some, but not all people, will grow out of the condition. “Unfortunately,” says Ireland’s Eczema Clinic, “eczema cannot be cured, though certain types will eventually clear up

40

Eczema affects one in five children and one in 12 adults

and others can be resolved by avoiding particular triggers. For many sufferers this is a lifetime condition that has to be carefully managed and monitored.” What are the symptoms? Eczema presents in different ways in different people. People who suffer from eczema often experience flare-ups of red and dry skin, which sometimes weeps, becomes blistered, crusted and thickened. Patients commonly experience an intense itch that is only temporarily relieved by scratching. “Eczema can look different on everybody,” said Dr Theresa Wynne, principal clinical psychologist at Sheffield

Children's Hospital. “It can be found anywhere on the body, including behind the knees, in the bend of the elbows, on hands, feet, arms, legs, the trunk of the body, face, behind ears, on the scalp – anywhere.” Generally, eczema will go through cycles of being severe and then settling down. Eczema is not contagious. Triggers A number of factors can cause eczema to flare-up. Irritants and allergens, including soap, shampoo, bubble bath, detergents, fragrances, wool, house dust and pollen have all been known to trigger an

eczema outbreak. Certain foods can bring on or aggravate eczema for some people. Emotional stress can also lead to an outbreak. Skin that is susceptible to eczema is more vulnerable to infection, and therefore infection will often make a case of eczema more severe. Eczema’s impact The skin condition, aside from being painful and very uncomfortable, can negatively affect a patient’s quality of life. It can disrupt sleep and put significant strain on relationships. Flare-ups can be debilitating and often lead to absenteeism from


Advertorial

Eucerin – Experts in eczema care for over 100 years IPN spoke with Dylan Griffiths, Eucerin Medical Manager, about what he recommends for people with eczema or dry skin conditions. 1. More people than ever are suffering with eczema. How can pharmacists help people who come to them with skin conditions like this? Eczema affects approximately one in five children and one in 12 adults. Most sufferers will have a family history of eczema or another atopic condition such as asthma or hay fever. It’s an individual condition and can be worsened by triggers specific to the sufferer, such as allergies, stress or cosmetic products. There is also an increase in people developing eczema in later life as skin loses more moisture as it ages. To support your customers, I’d advise you discuss their history, common triggers and what treatments have worked best in the past. A treatment diary can also help people highlight which treatments work best for them. 2. What products should healthcare professionals recommend to people with dry skin and what specific conditions do they treat? Emollients should be applied liberally, frequently, and in the right direction of hair growth to avoid inflammation of the hair follicles. Applying emollients immediately after a bath or shower is one way of “locking in” moisture. Both the Eucerin Intensive 10% w/w Urea Treatment Cream and Intensive Lotion 10% w/w Urea Cutaneous Emulsion are emollients developed to moisturise, soothe

Eucerin Intensive Lotion 10% w/w Cutaneous Emulsion

and support patients with Atopic Eczema. They contain Urea and Lactate, natural moisturising factors found in the body and lacking in patients with dry skin. The cream and the lighter textured emulsion are clinically proven to support the skin barrier of patients with eczema. For those who suffer with atopic eczema on their scalp, there is Eucerin DermoCapillaire Urea Shampoo to moisturise the scalp and the DermoCapillaire Calming Scalp Treatment which contains Licorice Extract to reduce itching as well as the moisturising urea. The Scalp treatment was recently awarded best hair and scalp product at the 2018 Irish Pharmacy News awards. 3. How does it work? When urea is applied to the skin it penetrates the stratum corneum, where it readily absorbs and retains water, thus increasing the capacity of the skin to hold moisture and rehydrate. Urea has anti-itch properties and an amazing ability to hold on to water molecules, keeping our skin moist. Not only does it readily absorb water, but it also has a very high-water content, which helps to reduce the amount of water lost through the skin. In many dry skin conditions, natural Urea levels are reduced, leading to further moisture loss. By replenishing this active

Eucerin Intensive 10% w/w Urea Treatment Cream

ingredient it effectively relieves itching and skin dryness. 4. What results can patients expect when they use this product? A study was carried out on 30 subjects with normal skin and 40 subjects with eczema. Looking at water loss from the skin, acceptability of the Eucerin Intensive 10% w/w Urea Treatment Cream and the condition of the skin barrier. After 7 days of application twice a day, water loss from the skin of subjects with eczema was returned to that of normal subjects. After 4 weeks, subjects with eczema agreed there was an improvement in dryness, itching and inflammation. The cream was considered easy to apply, pleasant and quickly absorbed by the skin. Results demonstrated the Eucerin Intensive 10% w/w Urea renewed the barrier function of the skin and increased ceramide levels. 5. Why should pharmacists recommend this product? The Eucerin products are clinically proven to support patients with eczema and include natural skin compound ingredients such as Urea which is well-tolerated by dry and sensitive skin. Eucerin is also a world leading dermocosmetic brand with over 100 years of heritage and is still

Eucerin DermoCapillaire Calming Urea Shampoo

Dylan Griffiths, Eucerin Medical Manager recommended by pharmacists and dermatologists worldwide. 6. What is the background of Eucerin? Since Eucerin launched more than 100 years ago, we’ve been leading innovation in the science of skincare. Eucerin is now one of the world’s most trusted dermo-cosmetic brands, endorsed by dermatologists and pharmacists and recommended to keep skin healthy and beautiful. Our expertise and energy is focussed on giving people the very best skin care products available. Our commitment to research, development and testing delivers innovative and effective products for your face and your body. Eucerin products help to protect your skin and keep it healthy, now and in the future.

Eucerin DermoCapillaire Calming Urea Scalp Treatment


Feature Pharmacists are perfectly placed to offer advice about managing the condition and to demonstrate the most effective use of wet dressings. work and school. Some people need to be hospitalised, and many suffer an emotional toll due to feelings of embarrassment about the appearance of the condition. How can eczema be managed? People who have eczema lose moisture from their skin because its protective barrier is compromised, meaning irritants and allergens pass through more easily. The Irish Skin Foundation recommends daily (and generous) use of emollients to manage the condition. During a flare-up, topical steroids are commonly prescribed. Antihistamines can also be used and, in more severe cases, wet dressings, phototherapy, immunosuppressants, or bleach baths may be recommended. The foundation’s tips for managing the condition are: • Replace soaps and shower gels (which dry out the skin) with emollient wash products • Apply moisturizer to the skin several times a day

42

• Always apply emollient after bathing or showering (ensure skin is only “patted” dry) • Use a pump dispenser as emollients can become contaminated • Continue to apply moisturiser even when skin is clear • Cut down on harsh cleaning products • Avoid synthetic fabrics, wool, and fabrics that don’t let skin breathe • Use thin layers of clothing rather than one thick layer • Use soft cotton sheets and blankets Eczema in children One in five children suffer from eczema and, according to the HSE, most have their first flareup before the age of five. The UK’s National Eczema Society, which has developed a school pack to help teachers and parents, says for most children with eczema, the condition will improve as they get older. “And for some the eczema will clear,

but there is no way of telling in advance whether this will happen,” it says. “As a general rule, children whose eczema is more severe tend to retain the condition into adulthood.” Ireland’s Eczema Clinic says it is essential that parents instill in their children the importance of skin care from a young age in a bid to help them develop a good daily routine. Dermatologists at Melbourne’s Royal Children's Hospital recommend keeping children with eczema cool at all times (Australia has one of the highest rates of eczema in the world). They say heat is the most common trigger for eczema and urge parents to use cotton sheets and blankets, keep their house below 20°C during the day, keep their child’s room at or below 15°C overnight, and ensure teachers know how to dress the child appropriately. What is the pharmacist’s role in managing eczema? It has been estimated that the average out-of-pocket spend for patients with eczema is hundreds of euros per year. In the UK, almost 200 million euros is spent annually on treating the skin condition. Pharmacists

can help people with eczema by advising them about the best treatment protocols and helping select fragrance-free emollients i.e. lotions, creams and ointments (finding the best emollient for the patient is often a matter of trial and error). Pharmacists are also perfectly placed to offer advice about managing the condition, including information about irritants, clothing, temperature, and to demonstrate the most effective use of wet dressings. Allergy UK provides advice to healthcare professionals about managing patients who suffer from eczema. It stresses the importance of a twice-daily skin cream regime to help keep skin healthy and hydrated. “Current medical guidance advises the best way to manage eczema and improve the quality of life for sufferers is to identify and avoid triggers while using the most suitable emollients, even when the skin is in good condition,” it says. “Having a stepwise approach in place, where patients can use other treatments when necessary, provides a good support system to keep the eczema under control.”


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Helping patients to treat hair loss Hair loss, thinning and baldness affects hundreds of thousands of people in Ireland. The search for a cure to hair loss goes back thousands of years, and globally, the hair replacement industry is now worth billions of dollars a year - more than is spent on researching a cure for malaria. According to one study, going bald is a worse fate to suffer than going bankrupt or never finding a partner.

Male pattern baldness affects around half of all men

Types of hair loss Male-pattern baldness is the most common type of hair loss. It can affect both men and women (in the latter it is called female-pattern baldness). The symptoms of male and female-pattern baldness are a receding hairline and thinning of the hair on the crown and temples. According to the HSE, male-pattern baldness affects around half of all men at some point. Female-pattern baldness becomes more common in women over the age of 40, particularly after menopause. Women's hair gradually thins with age, but women generally lose hair from the top of their head only. Alopecia areata is an autoimmune condition affecting 1-2% of the population, which is characterized by patches of baldness about the size of a large coin that may come and go. Occuring at any age, it mostly affects teenagers and young adults, with 60% of people suffering from the

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condition developing their first bald patch before the age of 20. Alopecia areata usually appears on the scalp but can also occur on the beard, eyebrows and eyelashes. In most cases the hair grows back after about a 12 months. Hair loss that occurs as a result of complications from another condition is called scarring alopecia. In these cases the hair follicle is destroyed, meaning the hair will never grow back. Scarring alopecia is commonly caused by scleroderma (which causes the body's connective tissue to become hard and puffy), lichen planus (an itchy rash) or shingles (an infection of a nerve and the area of skin around it). Unlike other forms of hair loss, the skin where the hair has fallen out is likely to be affected in some way. Telogen effluvium is a common type of alopecia that is defined by widespread thinning of the hair, rather than specific bald patches. Hair is shed from the scalp, usually as a reaction to

stress or medication. This type of hair loss, which does not impact other body hair, tends to improve without treatment after a few months. Traction alopecia is caused by forceful brushing, tight braiding or habitual twisting of the scalp hair. This condition usually improves when the patient changes their behaviour. Trichotillomania is a psychological condition where a person has an urge to pull or twist their hair until it comes out. Causes Some medical conditions and treatments can cause hair loss, such as anaemia, stress (including bereavement), fungal infections and chemotherapy. Women who are pregnant or have recently given birth can also suffer hair loss. Male and female-pattern baldness is caused by over sensitive hair follicles. This is linked to the hormone dihydrotestosterone (DHT), which is made from the male hormone testosterone.

Alopecia areata runs in the family in up to 1 in 5 cases, suggesting it could be inherited. The condition is also more common in people with other autoimmune conditions, such as thyroid disease, diabetes and vitiligo. Telogen effluvium can be caused by a reaction to hormonal changes, such as those that take place following illness (for example, severe infection, cancer, liver disease), major dietary changes, and some medications (such as anticoagulants and beta-blockers). Cancer therapies and hair loss Hair loss can be a side effect of some cancer treatment medicines, including chemotherapy and radiotherapy. Treatment damages the hair follicles, causing hair to fall out and preventing new hairs from growing. The Irish Cancer Society says not everyone who undergoes cancer treatment will lose their hair. Usually, the hair loss is temporary and hair will grow back within a few weeks


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Feature • Viviscal Maximum Strength Hair Growth Supplement, which contains Biotin and Zinc, is promoted to help maintain hair growth • Vitabiotics Hairfollic Man hair support programme, a course of micronutrient tablets including biotin, selenium and zinc which contribute to the maintenance of normal hair health • Bioxsine Shampoo, formulated with Biocomplex B11, can be used on sensitive scalps to treat hair loss by promoting natural growth and revitalising hair roots • Nanogen Root Boost Hair Thickening Spray, which adds thickness and volume to hair

Losing hair can have a negative impact on self-confidence and can lead to depression

of finishing the treatment. It is not possible to prevent hair loss entirely if it is a side-effect of treatment, but it might be possible to reduce or delay hair loss by using a cold cap, which reduces the amount of blood and the drug flowing to the scalp. The effects Hair loss and baldness can be difficult for both men and women to cope with because it is tied in with a person’s image of themself. Losing hair can leave some people feeling as though they are losing part of their identity, which can have a negative impact on their selfconfidence and sometimes lead to depression. Patients who are struggling emotionally with hair loss should be referred to a GP and possibly to counselling. What treatment is available? The only medicine in Ireland licensed to treat male and female-pattern baldness, Minoxidil, is a lotion (containing either 5% or 2% minoxidil) that should applied to the scalp every day. Minoxidil, which tends to slow down hair loss rather than stop or reverse it, usually needs to be used for at least four months before any effect is seen. The balding process will often resume if treatment stops. In general, women respond better to minoxidil than men. Most people with alopecia areata can expect their hair to

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grow back within 12 months without any specific treatment. There is no completely effective treatment for alopecia areata. Corticosteroid injections, injected several times into the bald area, work by suppressing the immune system and can be useful in alopecia areata cases. Topical corticosteroids (such as betamethasone, hydrocortisone and mometasone) are widely prescribed for treating alopecia areata for up to three months, but their long-term benefits are not known and there are mixed opinions about their effectiveness. Immunotherapy (diphencyprone) appears to be the most effective form of treatment for extensive or total hair loss, but fewer than half of those who are treated will see worthwhile hair regrowth. A possible side effect of immunotherapy is a severe skin reaction. Dithranol cream, which causes a skin reaction followed by hair regrowth in some cases, can be applied regularly to the scalp before being washed off. Dithranol cream is not as effective as immunotherapy and is not widely used. Ultraviolet light treatment, which is administered in two or three sessions a week in hospital, can take up to a year to produce maximum results. Responses vary, and there is a high relapse rate. Side effects can include

nausea, pigment changes to the skin, and an increased risk of skin cancer. Complementary therapies including aromatherapy, acupuncture and massage are often used for alopecia, but there is not enough evidence to support their use as effective treatments. Other treatment options include hair loss surgery, hair transplants, scalp reduction, artificial hair implantation, and hair cell cloning. OTC medications Community pharmacies stock a wide range of OTC products that are aimed at helping people who suffer from hair loss. They include oral supplements, formulas and vitamins, as well as shampoo, topical lotions, creams and sprays. Popular products sold across Irish pharmacies are: • Regaine Minoxidil Foam (for both men and women), which contains Minoxidil and is clinically proven to reverse hair loss by increasing the blood supply to hair follicles • Nourkrin Hair Growth Supplement, available for women and men, is a food supplement containing Marilex, acerola cherry extract, silica, horsetail extract and D-biotin

• Nanogen Hair Thickening Keratin Fibres, which merge with hair using electrostatic charge to give hair more thickness. Advice for patients Finasteride, which is used in the UK and is not licensed for hair loss treatment in Ireland, works by inhibiting the hormone dihydrotestosterone (DHT), which causes damage to hair follicles. The HSE urges anyone using finasteride for hair loss treatment to inform their GP because it interferes with the PSA test for helping to detect prostate cancer. Some private clinics claim to offer wonder cures and have been known to use aggressive sales techniques. Patients should always check the qualifications of any practitioner or clinic offering to treat or cure hair loss. For hair loss that does not follow typical patterns, patients should be referred to their GP to find out the cause, and, in some cases, the patient should be referred to a dermatologist or to a counselling service. Patients suffering from hair loss may benefit from joining a support group or speaking to other people in the same situation. For support and a list of online forums, visit alopeciaireland.ie.


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News Global research links pharmacist prescribers with better healthcare

news brief

Pharmacist prescribers have been linked to better access to healthcare services and improved patient outcomes, a new study has found. According to a review of 65 studies from around the world, including the UK, Australia, the US and Canada, there is global evidence to support expanding community pharmacists’ role to prescribing.

evidence of the positive views and experiences of diverse stakeholder groups and their perceptions of facilitators and barriers to pharmacist prescribing,” the authors wrote.

The report said doctors who had worked alongside pharmacist prescribers and patients managed by pharmacists were “very supportive of their professionalism and skills.”

The authors of the study, published in the British Journal of Clinical Pharmacology, examined the views and experiences of stakeholders towards pharmacist prescribing. These included pharmacists, patients, doctors, nurses and the public.

The study builds on evidence about the effectiveness and safety of pharmacist prescribing.

The authors concluded that healthcare policies in other countries, such as the UK, support the wider expansion of pharmacist prescribing.

Most reported positive experiences, particularly in relation to ease of patient access to healthcare services, improved patient outcomes, better use of pharmacists' skills and knowledge, improved pharmacist job satisfaction, and reduced doctor workload. “There is an accumulation of global

Any lack of support for pharmacist prescribing largely related to accountability for prescribing, limited pharmacist diagnosis skills, lack of access to patient clinical records, and issues concerning organisational and financial support. Many countries are implementing regulations concerning pharmacist prescribing. Non-medical prescribing is most advanced in Scotland, where there is a push to make all patient-facing pharmacists independent prescribers by 2023.

“The positive findings of this systematic review, together with previous reviews of effectiveness and safety, provide evidence to support such developments,” they said. “Furthermore, such review findings are important in those countries and settings starting to explore and develop models of pharmacist prescribing.”

Boots Ireland in partnership with the Irish Cancer Society launch their annual Night Walk Boots Ireland launched their annual Night Walks for Night Nurses campaign in association with the Irish Cancer Society. As part of the campaign, Boots Ireland is holding two public Night Walks, designed to raise both funds and awareness of the critical care provided by the Irish Cancer Society Night Nurses. Boots is encouraging the public to take part in the Dublin and Cork Boots 5km Night Walks, which will be held on Friday 17th August starting at 7.30pm. To show support for the service, Boots colleagues in 87 stores across the country take part in night walks during August, while the public is invited to take part in the Boots Dublin Night Walk in Marlay Park and in the Cork Night Walk at Páirc Uí Chaoimh, both on Friday 17th August. Alongside the walks, Boots offer Honour Tags for sale in Boots stores nationwide for ¤2. Customers can purchase a tag in honour of someone who has survived or passed away from cancer. One metre will be walked in honour of that person and the tags are brought from each store across Ireland to their local night walk. The front of the tag allows for the name of the individual with space on the back for a personal message. Bernadette Lavery, Managing Director, Boots Ireland says:

Bernadette Lavery, MD Boots Ireland “Boots Ireland are proud to support this invaluable service for those who really need care. The service is funded entirely by donations, so we would invite the public to get involved by joining us in a Night Walk, or purchasing an honour tag in any Boots store nationwide.” Boots Ireland is in their sixth year of partnership with the Irish Cancer Society, with the aim of the partnership to increase awareness,

promote prevention and support people living with cancer across Ireland. To date Boots employees and customers have raised over ¤1.3 million to fund the Night Nursing service, equating to over 3,715 nights of nursing care for families around the country. For further information about the Irish Cancer Society Night Nursing service or to donate to the Irish Cancer Society visit: www.cancer.ie

ONLINE TRENDS TRANSFORM PHARMACY The online doctor company, VideoDoc, has teamed up with McCabes pharmacy, announcing plans to deliver medications at no cost to VideoDoc patients. People will now be able to see an online doctor in their home, get a diagnosis, and have their medication delivered to them. The cost of delivery is included in the cost of the VideoDoc service. Online doctors carry out consultation with patients via the website or via the app, and all are registered with the Irish Medical Council. Patients can choose to have their medication delivered by McCabes, who offer a same day service in Dublin and next day delivery anywhere in Ireland, and there is no extra charge for the delivery. Cormac Loughnane, superintendent pharmacist of McCabes pharmacy, said: “Our delivery service ensures that patients never run out of much needed medication.”

MEDICAL TECH FIRM OPENS CENTRE OF EXCELLENCE Medical technology firm Becton Dickinson has opened a new research facility at Plassey Technological Park in Limerick, adding 85 new jobs. The new global research facility is expected to drive the company’s international growth and has been designated as a centre of excellence. Becton Dickinson, who currently employ 1,300 people throughout Ireland in facilities across Drogheda, Dun Laoghaire and two sites in Limerick, has invested 21 million euros into its new research and development facility. Extensive renovation to a pre-used site has taken place in the Castletroy campus, which is close to the University of Limerick. Becton Dickinson will collaborate with local universities to develop new technical capabilities. The facility will concentrate on product and software development, clinical research instrumentation and prototype development, primarily for its life science business.

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Brexit Brexit and lack of Government funding casting shadow over future of Irish pharmacies The twin threats of Brexit and lack of Government funding continue to cast a shadow over the future of community pharmacies in Ireland, it has been warned. of marketed medicinal products share labels and leaflets with the UK market place. “If there is a disruption in the supply of medicines this potentially could have a serious knock-on effect with the threat of medicine shortages in a worst case scenario. The HPRA is actively planning Brexit contingencies and encourages companies wishing to discuss any aspect of their operations related to the UK’s withdrawal from the EU to contact them.” Future of the business model Research released from JPA Benson Lawlor at the event showed that average pharmacy turnover fell by ¤295,000 during the recession, largely as a result of FEMPI cuts. Jason Bradshaw of JPA Benson Lawlor said “What we have seen is that pharmacies have been forced to diversify and innovate to maintain and grow their businesses. The addition of new services such as weight management, blood pressure measurement, vaccinations and smoking cessation are attempts to offset lost income in other areas of the business, particularly the dispensary.”

Darragh O'Loughlin, Secretary General of the Irish Pharmacy Union

Speaking at the Future of Irish Pharmacy conference, organised by the Irish Pharmacy Union, Darragh O’Loughlin said: “Many pharmacies suffered over the recession, particularly under the FEMPI cuts, which extracted almost ¤1.4bn from Community Pharmacies since 2009. “However, innovative thinking by Government could enable the sector to grow further, while also improving healthcare services available to the Irish public. Ireland currently lags far behind countries such as Canada and the UK, where community pharmacies are providing an increased range of services without the need for a doctor’s prescription. “These services include a pharmacy-based Minor Ailment Scheme, provision of

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oral contraception and a wide range of vaccination services, New Medicine Services, and management of chronic diseases such as hypertension, all of which could easily be introduced here in Ireland.” Threat of Brexit While Brexit looms over the entire economy, the pharmacy sector could be among the worst hit, with medicine shortages a very real concern. Dr Lorraine Nolan, Chief Executive of the Health Products Regulatory Authority (HPRA) addressed the conference outlining these concerns. According to Dr Nolan, “Given our close existing ties with the UK including a shared market place, there are significant implications for Ireland. Up to 60%

being able to prescribe some medications for minor ailments. Nine out of ten would like the pharmacist to be able to offer services such as cholesterol management and weight management.” Concluding, O’Loughlin called on the Government to empower the pharmacy sector to grow. “There is a crisis in the health service and it is steadily getting worse. Government plans to reorient the health service towards primary care are leading to an over-reliance on GP services that GPs themselves have consistently argued is unsustainable. The focus of the healthcare system must be towards the creation of a patient-focused health service delivered at the lowest level of complexity and as close to people’s homes as possible. “Proper resourcing of pharmacy services would offer a sustainable future for primary care.” Meanwhile, Medicines for Ireland, the representative body for the generic medicine industry in Ireland, voiced its concerns that medicines shortages which have been growing in Ireland are likely to increase further once the UK leaves the EU.

He warned that increasing business costs, including rising wages and rents, were a serious threat to the future development of pharmacy businesses throughout the country, and were putting increasing pressure on the bottom line”.

Currently there are over 120 medicines which are out of stock. These medicines cover a wide range of conditions, which impact upon tens of thousands of Irish patients, including asthma, thyroid conditions, oral contraception, angina and schizophrenia.

Consumer Attitudes

Medicines shortages have become a growing feature of the Irish healthcare landscape in recent years, prompting bodies such as the HPRA to now move to develop solutions to the problem.

Irish consumers are overwhelmingly positive towards their pharmacy experience with 88% saying they are accessible and 91% seeing them as good value for money, according to new research from Behaviour & Attitudes. “80% of Irish adults visit their pharmacy at least once a month”, explained Larry Ryan of B&A. “This makes them the most efficient component of the Irish health care system. It is clear that patients value the interaction with the pharmacist and want to see that role expanded. 92% of people would welcome the pharmacist

However, industry groups such as Medicines for Ireland point out that the unsustainably low reimbursement price set by the HSE for many of these medicines is often a major driver for shortages. Many generic medicines are now priced so low as to render them unattractive to global suppliers, who direct these products away from Ireland to higher priced markets.


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Brexit Ireland has now reached a tipping point whereby the price of some generic medicines has fallen to such an extent that often a month’s supply can cost less than a bar of chocolate. This is unsustainable over the longer-term. These lowcost medicines continue to be used by tens of thousands of Irish patients but are also often most vulnerable to shortages”. “This unsustainable pricing has made the Irish market unattractive to global suppliers, who have to factor in development, production, regulatory and staffing costs before supplying the market here”, noted Mr. McKeon. Medicines for Ireland has also pointed out that the continued long-standing practice of medicine ‘batch sharing’ with the UK is now unclear.

Owen McKeon, Chair of Medicines for Ireland and Country Manager for Mylan

According to Owen McKeon, Chair of Medicines for Ireland and Country Manager for Mylan: “While everyone is supportive of

a reduction in medicines prices from the historic high prices paid for branded medicines in the past, balance is still needed.

Under the latter system, because of the small volumes of medicines required for the market here, medicines packed in the UK are often marketed and supplied to the Irish market. However, after the UK leaves the EU its medicine regulatory regime may diverge from the existing European regime and by extension the Irish regime. This could mean that medicines

approved for use in the UK may not be approved for use in the EU and Ireland. “The risk of an end to batch sharing is a concern for the pharmacy sector. It has always worked in favour of Irish patients who can access medicines here marketed for the much larger UK market by availing of a smaller portion of the UK’s supply. If this practice cannot continue post-Brexit continuity of supply is threatened, leaving patients and our health system exposed to shortages. “Medicines for Ireland welcome the HPRA’s lead on this issue. However, we would urge both it and wider decision makers such as the HSE and Department of Health not to explore this issue in isolation from the untenable pricing of some medicines in the Irish market. This, more than anything, is exacerbating medicine shortages here. “Brexit will add to the problem of medicines shortages, so we must develop comprehensive solutions which address all the root causes of shortages in advance of the UK’s departure from the EU”, added Mr. McKeon.

News Children with diabetes raise ¤6,000 for University Hospital Limerick Children living with Type 1 Diabetes in the Mid West have helped raise almost €6,000 through various community fundraisers for the improvement of services at University Hospital Limerick. Members of the Parents Association, as well as the patients themselves, took time out of the school holidays to donate the proceeds to members of the paediatric diabetes multidisciplinary team. There are approximately 200 children and adolescents attending UHL for diabetes services. And while Type 1 diabetes is a lifelong condition requiring careful management, children are encouraged to be active and reminded there is nothing to prevent them pursuing their goals in life. Many of the children, their families and supporters participated in the Bons Secours Hospital Great Limerick Run over the May bank holiday weekend and the kids Fun Run hosted at the University of Limerick on the eve of the race. This year, primary school children

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attending paediatric diabetes services at University Hospital Limerick formed Team Type 1 to take part in the four races on the day. Team Type 1’s participation was co-ordinated by Dr Kerrie Hennigan, an intern at UHL and Maaz Mirza, a third year medical student at UL GEMS. Dr Orla Neylon, consultant paediatric endocrinologist, thanked the patients and the parents' association for their generosity. “You give so much back to improving the service in our hospital and all of it voluntary, giving of your own time and it is all very much appreciated. Your work is also very important in that diabetes Type 1 is more recognised for what it is at community level and in the schools. And in doing all this work in your own community you are challenging some of the misconceptions around Type 1

diabetes which I am sure you meet all too often,” said Dr Neylon. Diabetes in children is almost always Type 1 diabetes mellitus, which means that they require insulin and this can only be given by injection. Type 1 childhood diabetes is quite different from the adult, Type 2 diabetes associated with obesity and lifestyle. Children with diabetes are usually prescribed about four-to-six insulin injections per day with blood sugar monitoring 8 to 12 times per day. Some children and families choose to work towards insulin pump therapy, which means that they wear a small pump. Using this pump, every time they eat, they have to administer extra insulin. Since 2012, UHL has been one of only five designated pump centres for children with diabetes in Ireland, with the others being in Dublin, Cork and Sligo.

Dr Orla Neylon, consultant paediatric endocrinologist

To start and maintain children on insulin pumps and indeed on complex insulin regimes, University Hospital Limerick now has a skilled children's diabetes team, comprising three clinical nurse specialists and a children's diabetes dietitian in addition to two consultants.


News Allowing pharmacists to use biosimilars could ‘plug gap’ in health overspend The Irish Pharmacy Union (IPU) has called on the Government to allow pharmacists to substitute biological medicines for biosimilars, to help plug overspending at the Department of Health. that savings are available if steps are taken to address soaring spending on biological medicines but, despite concrete proposals being submitted in September 2017 by the IPU, no action has been taken.

IPU Secretary General Darragh O’Loughlin

It has emerged recently that health overspending will delay a budget surplus and could eat into the potential for tax cuts. The IPU said that pharmacists have clearly demonstrated

IPU Secretary General Darragh O’Loughlin says failure to implement this proposal is costing ¤2 million in potential savings every week: “If the Government had heeded IPU advice when we submitted the proposal last September, approximately ¤80 million could have been saved to date. The IPU is presenting solutions to budget problems, but Government continues to ignore potential savings.” “Substituting expensive biological medicines with more cost-effective biosimilars would

require a legislative change, but could save the Exchequer up to ¤800 million over 5 years,” said Mr. O’Loughlin, who added “This is the fastest and most effective way to ensure a rapid and meaningful increase in the use of biosimilars”. Mr. O’Loughlin continued: “In the absence of specific steps being taken to improve biologic uptake, HSE spending on biologics is expected to reach ¤900 million by 2020. If this amendment is made, there are potential savings of ¤370 million over the next 3 years, and up to ¤800 million over 5 years. In 2017 the Department of Health held a public consultation on a National Biosimilar Medicines Policy, and the IPU made these proposals in our submission in September 2017.”

In 2013 pharmacists began facilitating Government policy on the use of generic medication. Consequently, the use of generic medicines in Ireland increased fivefold, saving the State over ¤667 million by the end of 2017. As the experience of generic substitution demonstrated, allowing community pharmacists to substitute is the fastest and most effective way to ensure a rapid and meaningful increase in the usage of biosimilars. “The time to act on this is now, and we’re calling on Minister Harris to amend the Health (Pricing and Supply of Medical Goods) Act 2013 and allow pharmacists to substitute biological medicines with more cost-effective biosimilars”, concluded Mr O’Loughlin.

Biosimilars: your questions answered Q: Are biosimilars as effective? A: The European Medicines Agency (EMA) has acknowledged that there are no clinically meaningful differences between a biosimilar and the reference biological medicine and has stated that the evidence acquired over 10 years of clinical experience shows that biosimilars approved through the EMA can be used as safely and effectively in all their approved indications as other biological medicines. Consequently, there should be no concerns about the safety or efficacy of biosimilars and their increased use should be encouraged. Q: What are the potential savings from biosimilars? A: Applied Strategic, a UK consultancy firm with expertise in biosimilar markets, conducted an assessment of the savings opportunity

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presented by biosimilars in the Irish health system. Using published PCRS data, they concluded that, in the absence of specific steps being taken to improve biosimilar uptake, spending on biologics can be expected to reach ¤900 million in 2020. Even though biosimilars can provide more cost effective treatment, thus broadening patient access to treatment for a given budget, uptake has been historically low in Ireland, with biosimilars representing less than 10% market share, which is significantly lower than the EU average. Applied Strategic’s assessment of the Irish biologics and biosimilar market identified a potential saving of ¤370 million over the next 3 years, and up to ¤800 million over 5 years, with optimum biosimilar entry and penetration. ¤62 billion worth of biological medicines are expected to go

off patent by 2020 globally, providing significant savings possibilities, and there is already a potential three year saving of ¤370 million for the Irish health system, none of which will be realised if biosimilar usage in Ireland is not brought to European norms. Q: What legislation governs substituting medicines? A: The Health (Pricing and Supply of Medical Goods) Act 2013 lays out the rules and regulations for generic substitution of medicinal products, identified as interchangeable by the Health Products Regulatory Authority (HPRA). Pharmacists have demonstrated that they have the competence and capability to implement this legislation, resulting in a significant increase in the usage of generic medicines in Ireland, from 11% by volume pre-2013 to 53% by 2016.

An amendment to this primary legislation is required to facilitate substitution by a pharmacist from a biological reference product to a biosimilar. Q How will it work? A: The HPRA does not recommend that patients switch back and forth between a biosimilar and a biological reference medicine. In the IPU’s proposal, a pharmacist, on receiving the initial high tech prescription for a patient, will make the decision to dispense and supply a biosimilar or the biological reference medicine. A note of this will be made in the patient’s medication record (PMR) and, because the patient nominates a single specific pharmacy for their high tech medicine, subsequent supplies will be for the same product and no further switching will occur. (Information from IPU website)


CPD 93: ANXIETY DISORDERS Biography - Since becoming owner of Whelehans Pharmacy, Eamonn Brady MPSI has striven to build and grow his business around his philosophy of placing his customer led, independent pharmacy firmly at the centre of his community and to extend its reach through engagement “outside the front door” with the public and local groups. At the core of Eamonn’s vision of his own role as a community pharmacist, is his belief that prevention is better than cure and to “help people to help themselves” through education and information initiatives delivered in a variety of ways. Welcome to the Continuing Professional Development Module. CPD is a mandatory professional requirement 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 the progress of your development by going to www.pharmacynewsireland.com/cpdtraining where you can register to record your learning.

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?

60 second summary Our natural anxiety response in these perceivably stressful situations helps maximise performance. In general terms, people are natural worriers. Anxiety is experienced by everyone at some time or another. When worrying and feelings of anxiety become uncontrollable and ever present, to the point that they take over and interfere with everyday living, this then is what is known as “Generalised Anxiety Disorder” or GAD. GAD is the most common type of “Anxiety Disorder”. Other anxiety disorders include: • • • • •

Obsessive Compulsive disorder (OCD) Panic Disorder (PD) Post-Traumatic Stress Disorder (PTSD) Social anxiety Disorder (SAD) other phobias

Anxiety Disorders Anxiety is normal. It helps get out of harm’s way and prepare for important events. Anxiety warns of impending danger. In stressful situations, it triggers the “fight or flight” response. It is the body’s way of preparing for danger or a threat. Hormones such as adrenaline are released, resulting in many physiological reactions throughout the body. Given the appropriate situation, the body has its own defences which helps us survive dangerous and potentially lifethreatening situations.

anxiety become an “Anxiety Disorder”? It’s when our normal reactions and responses become excessive, persistent and debilitating. When worrying and feelings of anxiety become uncontrollable and ever present, to the point that they take over and interfere with everyday living, this then is what is known as “Generalised Anxiety Disorder” or GAD.

Elevated levels of anxiety or worry regarding an exam, job interview or a test, (e.g. driving test) would be considered “normal”. Ask a professional stage actor “Do you get nervous before a performance?” and they would say they would be worried if they didn’t!

Other anxiety disorders include: -

Our natural anxiety response in these perceivably stressful situations helps maximise performance. In general terms, people are natural worriers. Anxiety is experienced by everyone at some time or another.

• Social anxiety Disorder (SAD)

So, when does “worrying” or our natural

Panic Disorder (PD) - Daily SSRI/SNRI. Use long-acting anxiolytics because short-acting agents are unlikely to abort panic attacks Obsessive Compulsive disorder (OCD) - Daily SSRI/SNRI. Anxiolytics may be needed as a bridge for severe symptoms until antidepressants provide relief Social Anxiety Disorder (SAD) - Daily SSRI/ SNRI. Propranolol is useful for public speaking Post-Traumatic Stress Disorder (PTSD) Daily SSRI/SNRI. Anxiolytics may be needed as a bridge for symptoms until antidepressants provide relief. Benzodiazepines are not recommended Self help Exercise, relaxation, healthier diet, smoking cessation and alcohol reduction

• Obsessive Compulsive disorder (OCD) • Panic Disorder (PD) • Post-Traumatic Stress Disorder (PTSD)

• other phobias Generalised Anxiety Disorder or GAD The table below highlights the main differences between “normal anxiety” and GAD

Normal Anxiety

GAD

Worry about a specific event such as a work deadline, school exam, job interview

Constant chronic and unsubstantiated worry causing significant stress disrupting social activities and interfering with work, school or family

Difficulty relaxing, sleeping or concentrating when faced with a problem such as an illness, job loss or death of a loved one

Edginess, irritability, insomnia, or difficulty concentrating more days than not for no apparent reason

Muscle aches, tension, tiredness related to an activity or situation such as over exertion at the gym, a stressful day at work, or sitting too long at the computer.

Restlessness, muscle aches and pain, fatigue not related to a specific physical or emotional problem persisting for six months or more

Condition specific medication treatment recommendations Generalised Anxiety Disorder (GAD) - Daily SSRI/SNRI. Anxiolytics may be needed as a bridge for severe symptoms until antidepressants provide relief

GAD is the most common type of “Anxiety Disorder”.

(table content provided AmericanDepression Depressionand and Anxiety Anxiety Association (table content provided byby American Association)

GAD can significantly affect daily life, making it difficult to perform normal everyd THIS CPD MODULE IS SUPPORTED BY tasks. A long-term condition manifesting in chronic anxiety. If left untreated, it can


CPD 93: ANXIETY DISORDERS GAD can significantly affect daily life, making it difficult to perform normal everyday tasks. It is a long-term condition manifesting in chronic anxiety. If left untreated, it can have a significant impact on relationships with family and friends. In Ireland and throughout Europe, Anxiety Disorders are the most common mental health problems along with depression. They account for similar levels of stress and disability within society as do cancer or heart disease. Whilst there are no accurate figures regarding the extent of the condition in Ireland, it is estimated that 11% will suffer a primary anxiety disorder at some point in their life. Only a relatively small number of sufferers will receive appropriate treatment, however, awareness and understanding of anxiety and its treatment continues to grow. GAD is most common in people in their 20’s. It affects approximately 5% of adults, (slightly more women than men). A “primary” Anxiety Disorder is defined as one where anxiety is the primary problem. Symptoms, occurring independently of other mental problems, follow a set pattern over a longer period, perhaps months or years. Whilst they exist, problems can be heightened when coupled with other challenging life situations. Anxiety can be defined also as a “secondary” problem where it is a symptom of another disorder associated with elevated levels of anxiety, (i.e. depression and / or substance or alcohol misuse). In these cases, most benefit comes from treating the underlying problem and not simply the anxiety itself. Anxiety Disorders can occur at any time and can affect the person physically and mentally. Anxiety disorders are also associated with elevated divorce rates, greater unemployment, a diminished sense of well-being, and increased reliance on public assistance. Significantly, suicide risk elevates with acute and chronic anxiety disorders. Patients with anxiety disorders often seek treatment from primary care providers (PCP). They may present with medically unexplained symptoms, making identification of the correct diagnosis a challenge. The patient may be oblivious to recognizing their symptom as anxiety and the correct diagnosis becomes easier to miss. Given that 25% to 50% of primary care clinic patients present with medically unexplained symptoms, it is important for the PCP to screen for psychiatric illnesses, including anxiety. Unfortunately, patient descriptions of their symptoms can mislead even the most astute doctor. Causes As is the case with most mental health conditions the specific cause of GAD and other related Anxiety Disorders is not known. Whilst some understanding relating to individual disorders exists, a person could develop GAD for no apparent reason. Researchers believe the condition is caused by a combination of factors, including: • The body’s (and more specifically, the brain’s) biological processes • Genetic factors • The person’s environment • Life experiences Primary Anxiety disorders are thought to result

from a combination of genetic predisposition and life stress triggering a vicious cycle. Chemical reactions in the brain (imbalance of neurotransmitters, particularly serotonin and noradrenaline) can significantly affect mood. This, along with other factors like distorted thoughts and beliefs about risk and danger combined with changing patterns of behaviour, such as avoidance or safety seeking, all interact to develop and exacerbate the problem.

To establish the correct diagnosis and subsequent best course of treatment, a GP can ask questions regarding fears, emotions, feelings, personal life. They may also present the patient with certain “life” situations or scenarios to gauge the reaction. The person may find it difficult to answer and talk openly about these, but responses are invaluable in giving the GP a full understanding of symptoms and circumstances.

It is estimated that up to 90% of persons with GAD experience one or more comorbid psychiatric diagnoses. An American study by Stein and co found that in patients with posttraumatic stress disorder (PTSD), major depression is seen in 61% of patients, GAD in 39%, social phobia in 17%, PD in 6%, and substance use disorders in 22% of patients. Additionally, the presence of comorbid psychiatric conditions worsens prognosis. Patients with multiple psychiatric diagnoses experience lower remission rates, increased rate of suicide, and higher use of health care.

Generally, there are two main treatment types for GAD

GAD Symptoms Symptoms often develop slowly, so it can be the case that the signs are simply not recognised as small adjustments are made along the way to compensate. Symptoms can vary in both severity and number depending on the individual circumstances. The condition can cause a change in the person’s physical behaviour and in their outlook on things they previously never thought about.

o Psychological Therapy o Medication Treatment may be either of the above or perhaps a combination of both. The most common advice for those diagnosed with GAD is to consider psychological therapy first before going down the medication route. OTHER ANXIETY DISORDERS OCD (Obsessive Compulsive Disorder) OCD is an anxiety disorder in which people experience unwanted and intrusive thoughts (obsessions) and of being compelled to repeatedly perform routines (compulsions) to ease anxiety. It is estimated that 1 in 10 people will experience some form of OCD during their lifetime. Onset can be at any time from preschool age to adulthood; typically, adolescence or early childhood being most likely.

The person may become withdrawn, pulling back from social and family gatherings as a way of avoiding negative feelings. Working life too can become increasingly stressful perhaps resulting in time off due to “illness”. These factors can result in increased remoteness, worry and plummet into a spiral of hopelessness, thereby increasing the severity of the condition.

Obsessions: they come in the form of intrusive, unwanted involuntary thoughts, images or impulses. The key features of obsessions are that they are automatic, frequent, or distressing and difficult to control or get rid of.

Psychological symptoms include: -

o Irrational fears regarding poor hygiene and cleanliness

Restlessness, a sense of dread and foreboding, constant edginess, poor concentration, easily irritated, lack of patience.

Common obsessions include: o Fears of getting sick, especially a terminal illness

o Anxiety that aggressive thoughts/impulses become reality

Physical symptoms can include: -

o Fears of harming a loved one or one self

Dizziness, chronic tiredness, palpitations, aching muscles, dry mouth, excessive sweating, short of breath, stomach ache, nausea, diarrhoea, headache, excessive thirst, difficulty falling asleep, insomnia.

o Excessive preoccupation with the order, arrangement or symmetry of things

Exhibiting any or all the following traits should sound an alarm bell as to if a patient may have GAD and if so, the person should visit their GP o worrying is significantly affecting daily life, including job and social life o worries are extremely stressful and upsetting o worrying about all sorts of things and a tendency to go straight to “thinking the worst” o worrying is uncontrollable o having felt worried nearly every day for at least six months, or at least more days than not A major step in treating GAD is acknowledging a problem and then doing something positive about it. Generally, the first port of call should be a GP.

o Intrusive words or sounds o Fear of losing valuables Compulsions: In most cases compulsions are triggered to manage the anxiety brought on by the “obsession”. Occasionally compulsions appear without the obsession attached. In the same way that a coffee drinkers’ tolerance to the effects of caffeine increases the more they consume, the same is true with compulsions; the more the ritual is performed the less effective it becomes; therefore, frequency is increased to increasingly less effect. Common compulsions include: o Excessive personal hygiene rituals, esp. hand washing o Checking and rechecking objects, information

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CPD 93: ANXIETY DISORDERS o Repetitive actions, e.g. touching, counting o Repeating a name or phrase or tune o Arranging and ordering, e.g. items in a room, furniture, books etc o Hoarding things

 Be submissive when talking with more “powerful” people, i.e. employer, supervisor etc  Avoid using public toilets.  Fear of talking or presenting in front of a group

OCD is an extremely complex disorder. Sufferers are constantly in a “state of alert” regarding potential harm and threats. They often see themselves as solely responsible for protecting people, especially close family, from external harm. Families and those living with sufferers can find this extremely disruptive and attritional over time.

TREATMENT OPTIONS

Panic Disorder

CBT

Panic attacks can be extremely alarming events. Typically, an attack will occur without warning and for no obvious reason. What is happening is the panic reflex is deployed by the body in response to a perceived threat which doesn’t exist. At the onset of an attack, acute severe anxiety/panic ensues and adrenalin is released throughout the body, producing different physical and emotions and reactions. These may include: -

One of the most effective types of treatment for GAD and other Anxiety disorders is CBT (Cognitive Behavioural Therapy). CBT, proven to give full recovery from GAD in up to 50% of cases, is a type of talk therapy that targets the anxiety and associated behaviours in a collaborative way. Attending weekly 1-2-hour sessions, CBT helps the patient learn to identify negative thinking patterns and their triggers and replacing them with positive ones.

 Irregular breathing

Through learning how the cycle of anxiety works and how to challenge unhelpful beliefs and applying the new skills and techniques learned during therapy sessions, patients can regain control of previously lost situations. Learning how to deal with “today” rather than “yesterday” is also a valuable tool when creating a positive enabling environment. The skills and techniques need to be practised between sessions so that they become embedded and remain there for life.

 The need to escape  Feeling of imminent danger or doom  Palpitations, pounding heartbeat  Chest pain  Dizziness, light-headed or faint  Sweating  Trembling or shaking  Ringing in the ears  Hot or cold flushes  Fear of losing control  Fear of dying Commonly linked with agoraphobia, up to 2 in 10 people will experience some form of panic episode at during their lifetime. Social Anxiety Excessive levels of anxiety in social situations or performance situations such as presenting or talking to groups. Those with this disorder become adept at developing and employing subtle strategies that help them avoid or hide from social gatherings. For them, these methods enable avoiding their core fears of being judged too negatively or harshly or appearing foolish. More than 12% of people will be affected by Social Anxiety issues at some point. Whilst onset is most frequent in adolescence, this disorder can occur at any time. Physical symptoms can include blushing, sweating and palpitations. People with social anxiety may:  Be overly self-critical of the smallest error.  Find blushing as painfully embarrassing.  Feel their actions are constantly under scrutiny.

Psychological Therapy Although psychotherapy and pharmacotherapy have been shown to be individually effective, studies consistently demonstrate that combination treatment gives superior results compared with either treatment alone.

Whilst the programme duration itself is relatively short term, typically around 12-16 weeks, the benefits and sense of stake holding in their own outcome the patient derives from participating is very much long term. Psychological therapy is the preferred route initially in most cases. It may be the case however that, dependent on the severity of the case, a combination of therapy and medication offers the best results. Serotonin boosting medication can help ease anxiety, thereby enabling the patient to get more from their therapy sessions. Exposure Therapy A form of CBT and as the name suggests, the patient is “exposed” to a feared situation. This can prove particularly effective with those suffering with specific phobias. This treatment can also be used as a pre-cursor to regular CBT therapy. If the level of anxiety is too high, starting with regular CBT may be ineffective. Exposure therapy can help reduce sensitivity to a situation or event. Applied Relaxation Therapy Applied relaxation is a different type of psychological treatment. Developed initially in the treatment of phobias, it is now more widely used to treat other anxiety disorders including GAD and is as effective as CBT Application focuses on relaxing the muscles when potentially anxious situations occur. The methods used are taught by a trained professional over 3-4 months and they include: -

o learning special techniques to relax muscles o learning how to implement the techniques quickly and in response to a trigger thereby enabling use in situations that cause anxiety Medication The table on the next page outlines the main classes of medications for treatment of anxiety disorders. Anxiolytics Anxiolytic medications are the second set of medication for treatment of acute anxiety with anti-depressants being the first set. These medicines abort current symptoms of anxiety and do little to prevent symptom recurrence. Anxiolytics can be divided into benzodiazepines and nonbenzodiazepines. Benzodiazepines are frequently thought of as the classic anxiolytic. This class of medication provides a wide range of choices in terms of onset of action, half-life, and the presence of an active metabolite. There are no specific recommendations in terms of use of one benzodiazepine over another in the treatment of anxiety disorders. In general terms, benzodiazepines with shorter halflives and more rapid onset of action are more likely to lead to rebound anxiety when effects of the medication wane, leading to a need to take more of the medication. If possible, longer-acting benzodiazepines (i.e., clonazepam) should be used in conjunction with antidepressants, when the prescriber needs to decrease anxiety acutely, to allow for treatment engagement, and/or treat symptoms that are threatening patient safety. If possible, treatment should be limited in duration and stopped once antidepressants lower overall anxiety levels and patients are able to engage in other forms of treatment. Although benzodiazepines are effective, physiologic dependence develops in all users so misuse poses potential problems. Tapering benzodiazepines must be gradual and can be dangerous if completed too abruptly. The withdrawal syndrome that accompanies benzodiazepine cessation closely parallels that of alcohol withdrawal. The mildest form is rebound anxiety that can be seen with reducing or missing doses and is most common with short-acting benzodiazepines (i.e., alprazolam). In rare cases, severe withdrawal symptoms can be seen, which can lead to seizure, coma, and death. Although exact rates of risk are unknown, severe withdrawal is rare and more likely in patients taking higher doses, for prolonged periods, and for whom the medication is discontinued abruptly. Co-occurring substance use disorder is common and in such situations treatment with benzodiazepines is contraindicated. When anxiety needs to be controlled acutely, but benzodiazepines are not indicated, there are other alternatives. The anticholinergic agent hydroxyzine, b-blocker propranolol, gabapentin and pregabalin are effective alternatives as anxiolytics without abuse potential. OTHER MEDICATIONS Anti-histamines: Whilst usually prescribed to treat allergic reactions, some are used to treat anxiety short term as they have a calming effect on the brain, helping to lessen the feeling of anxiety. Hydrazine is the most commonly prescribed anti-histamine for treating anxiety.

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o learning how implement the techniques quickly and in response to a trigger thereby enabling use in situations that cause anxiety

Medication

CPD 93: ANXIETY DISORDERS

The table below outlines the main classes of medications for treatment of anxiety disorders.

Medication

SSRI

(selective serotonin reuptake inhibitor)

Generic Names

How it works

citalopram, escitalopram, fluoxetine, paroxetine,

Relieves symptoms by blocking the reabsorption, or reuptake, of serotonin by certain nerve cells in the brain. This leaves more serotonin available, which enhances neurotransmission—the sending of nerve impulses—and improves mood. SSRIs are “selective”

sertraline

because they affect only serotonin and not other neurotransmitters.

Possible Side effects Nausea, low sex drive, blurred vision, diarrhoea or constipation, dizziness, dry mouth, loss of appetite, sweating, feeling agitated insomnia

No single SSRI has proved consistently more effective than others.

SNRI

(serotoninnorepinephrine reuptake inhibitor)

Venlafaxine*, duloxetine

mirtazapine

NaSSA

(Noradrenergic and specific serotonergic anti-depressant)

Tricyclic antidepressant

Benzodiazepine

amitriptyline, imipramine, nortriptyline

alprazolam, clonazepam, diazepam, lorazepam

An antagonist of certain adrenergic and serotonin receptors. Effective for anxiety disorders either as single agent or combined with SSRIs for augmentation. Can require 4 to 8 weeks to work. Treatment of anxiety disorders typically requires higher doses and longer duration than indicated for unipolar depression. Brief medication trials can give the false perception of failure and treatment resistance. The ability to wait for response is required by the prescriber and patient.

Inhibits the reabsorption of the neurotransmitters serotonin and norepinephrine. (Has been increasingly replaced by SSRIs.)

Promotes relaxation and reducing muscular tension and other physical symptoms of anxiety. Frequently used for short-term management of anxiety, such as for minor medical procedures.

OCD: Exposure and response prevention SAD: Cognitive behavioural therapy Nausea, headache, drowsiness, dizziness, constipation, indigestion, dry mouth, insomnia, sweating

Drowsiness, dizziness, vivid dreams, vision changes, dry mouth, constipation, increased appetite, weight gain

PTSD: Prolonged exposure Cognitive processing therapy SELF HELP Exercise • Taking regular exercise, particularly aerobic exercise such as walking, jogging or swimming, will help combat stress and release tension. Exercise also stimulates the brain to release serotonin to improve mood and maintain a positive outlook. • At least 30 minutes of moderate exercise, at least five days a week. Moderate exercise should make the person feel slightly out of breath and tired. Relaxation

Dry mouth, blurred vision, constipation, urinary retention, drowsiness, increased appetite leading to weight gain, hypotension, increased sweating Confusion loss of balance memory loss drowsiness and lightheadedness, potential dependency issues

Has high blood pressure (hypertension) that is not being treated,

Anxiolytics

Anxiolytic medications are the second set of medication for treatment of acute anxiety with anti-depressants being the first set. These medicines abort current

Buspirone: Can help ease psychological symptoms. Belongs to group of medicines known as anxiolytics. Usually taken for at least two weeks before any improvement noticed. Works in a similar way to benzodiazepines.

Post-Traumatic Stress Disorder (PTSD) Daily SSRI/SNRI. Anxiolytics may be needed as a bridge for severe symptoms until antidepressants provide relief. Benzodiazepines are generally not recommended.

PD: Cognitive behavioural therapy

o high Hasblood recentlypressure had a heart(hypertension) attack, o Has that is not being treated, o recently Is at risk had of having irregular heartbeats (cardiac arrhythmias) o Has a heart attack, o Is at risk of having irregular heartbeats (cardiac arrhythmias)

Pregabalin: May be offered if SSRI or SNRI are not suitable. Although prescribed for epilepsy, has been found to be beneficial in treating anxiety.

Social Anxiety Disorder (SAD) Daily SSRI/SNRI. Propranolol is useful for public speaking.

GAD: Cognitive behavioural therapy

*Note: - Venlafaxine should not be prescribed patient: *Note: - Venlafaxine should not be ifprescribed if patient: o

Obsessive Compulsive disorder (OCD) Daily SSRI/SNRI. Anxiolytics may be needed as a bridge for severe symptoms until antidepressants provide relief.

CONDITION SPECIFIC PSYCHOTHERAPY TREATMENT RECOMMENDATIONS

The choice of SSRIs and SNRIs over tricyclic antidepressants (TCAs) as first-line therapy is due largely to their lack of anticholinergic side effects and toxicity in overdose. Increased tolerability does not translate to increased efficacy Increases the levels of the neurotransmitters serotonin and norepinephrine by inhibiting their reabsorption into cells in the brain.

because short-acting agents are unlikely to abort panic attacks.

CONDITION SPECIFIC MEDICATION TREATMENT RECOMMENDATIONS Generalised Anxiety Disorder (GAD) Daily SSRI/SNRI. Anxiolytics may be needed as a bridge for severe symptoms until antidepressants provide relief.

• Finding a way to relax properly is important. There are many different relaxation therapies to choose from. Many like Yoga or Pilates are particularly focused on mindfulness, breathing correctly. Diet • Diet can influence symptoms. Too much caffeine can increase anxiety as it can disrupt sleep and speed up heartbeat. Tiredness makes it harder to control anxious feelings. • Being overweight or simply eating the “wrong” food can also contribute to feelings of anxiety. A discussion with a professional could help to move the person out of the rut of fad diets and the stress of not being able to change. Smoking and drinking • Smoking and alcohol have been shown to make feelings of anxiety worse. • It is recommended that that men should not drink more than 21 standard drinks per week and women no more than 14 per week. (A standard drink is one glass of beer, a small glass of wine or a pub measure of spirits.) References available upon request

Panic Disorder (PD) Daily SSRI/SNRI. Use long-acting anxiolytics

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News

Amazon is coming – don’t say you weren’t warned

By Jason Bradshaw, Partner, JPA Brenson Lawlor

Amazon, famous for online shopping and drone deliveries, have gone into the pharmacy business. Quite recently they bought the US company Pillpack for $1 billion. However, almost everyone in the pharmacy sector here that I’ve spoken to about it dismisses it as something ‘American’, that ‘it couldn’t/wouldn’t happen here’. I’m afraid I disagree. European pharmacy market, I strongly recommend that, as an owner, that you understand now what your key strengths are, and to play to them. Saying that the pharmacy sector is a regulated sector and therefore Amazon and all will make no inroads into Ireland is first of all ‘doing a Canute’ on it. Secondly it’s forgetting that we are members of the EU, which is forever trying to find ways of creating competition across all businesses. The EU does try to take competition issues very seriously.

Amazon CEO Jess Bezos

How many of you have booked and holidayed on Ryanair using their online booking services only, to complete the transaction? Is this how you booked your holidays 10 years ago? How many of you have used AirBnB or know someone who has? Did any of you hear of AirBnB ten years ago? Finally, how many of you have used online shopping? My guess is that everyone reading this has used one, or possibly all, of the above. Now, if those of you who have watched your own habits being changed by technology (as above) think that Amazon’s move won’t affect you, then please think again. Those of you familiar with the frequently misinterpreted (thank you Wikipedia!) legend of King Canute will know that he tried to stop the tide coming in and failed. Similarly, whether it’s a year or five years away, for pharmacies (and other sectors) the Big Beasts like Amazon are circling. They are not going to go away and now is the time for businesses like yours to act. According to research from US based GlobalData more than

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half of Americans surveyed about Amazon’s move into the pharmacy sector approve of it, with just a quarter saying it is a ‘bad thing’. Just under two thirds say they’d like Amazon to stick with mail order but, and this is where it gets very interesting for us, as a sizeable number would like to see Amazon have a physical presence in pharmacy. Amazon has previously bought an upscale food chain called Whole Foods (think of the original SuperQuinn, though with much higher prices), so Amazon does have some (small) presence on the streets in some US cities. They understand far more than online shopping, and the move into the relatively small Whole Foods is said to be Amazon’s test bed for bigger plans they may have for food shopping. Amazon is run by a man called Jeff Bezos. A glance at the Amazon share price will show that Jeff is a bit of a genius. Amazon’s shares have gone up and up and up again. When Jeff brings Amazon into a new business sector he normally manages to successfully disrupt

it and make a lot of money out of it for Amazon. Tellingly, when he announced the purchase of PillPack the value of quoted pharmacy companies plummeted. That was the market giving its verdict on whether Amazon would triumph. When the Big Bad Wolf comes knocking on your door, doing nothing is not an option. A hungry Wolfie tends not to go away. So now is the time to start thinking of what you, and your colleagues, would do if such a threat comes about. Very recently I spoke at an IPU conference we sponsored, and I laid out some strategies for the future of pharmacies. Also speaking was Larry Ryan of research company, Behaviour and Attitudes. His very detailed presentation drilled right into what the public like and dislike about pharmacies, what they’d like to see more of and there was plenty of meat for the pharmacy owner to chew on, as to what future direction they should take. (Those slides are still available from the IPU – well worth a read). If Amazon (and probably others) decide to make a move into the

In every country across the EU healthcare and healthcare budgets is very close to the No. 1 financial issue affecting EU member government. So, whether directly or indirectly, (as is already happening in Trump’s USA) drugs, drug costs and drug supply will come under future, further, scrutiny. So don’t say Amazon isn’t coming and when they, and others do come, don’t say that it won’t affect you. Most importantly don’t say that you weren’t warned.

When the big bad wolf comes knocking at your door, doing nothing is not an option


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Zirtek Usage and Attitude in the ROI report. Does not cause drowsiness in the majority of people. Zirtek is available in liquid formula for ages 2 and upwards, and in tablets suitable for ages 6 and upwards. Zirtek D is suitable for adults and adolescents from 12 years of age and upwards.

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:

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Legal Category: OTC

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July 2018 UK/18ZI0009(1)


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“My journey with Alopecia began over 10 years ago. Initially it was very scary, upsetting and unknown and it took a long time to come to terms with it once diagnosed. At first the patches of hair loss were small enough to be covered by my own hair but as time went on the patches became larger and it was getting more and more difficult to cover them by myself. With hair loss comes a loss of confidence, selfesteem and social activity. I was unhappy and I began to search for help. Going down the wig route was difficult for me. Being a young woman, I found it hard to get a look I was happy with as well as them being uncomfortable. Around this time I came across Hair Solved. Once I found the courage to visit them I realised that they were the solution to my condition, offering a natural look and one that was easy to maintain.” Joanna Cascade House, 229 Lisburn Road Belfast BT9 7EN 02890 683005 or 0845 676 9756 info@hair-solved.com


News Boots Ireland launches ‘Feel Like You Again’ campaign to support people living with cancer Through its latest “Feel Like You Again” campaign, launched across a variety of TV channels, Boots Ireland demonstrates that while cancer can change how you feel, it can never change who you are. This new film, the first Boots Ireland TV advertising campaign by Ogilvy Dublin, runs through a beautifully simple day of a mum, who’s getting ready to watch her child play in a sports match. Through stolen moments and subtle looks between the two, we begin to realise how important it is for her to get up and out on this day, both for herself and her son. VSupporting the campaign is broadcaster Georgie Crawford, who was diagnosed with breast cancer last year when she was a new mother with a seven month old baby. She has recently finished treatment. The film is told in reverse sequence, each scene plays forwards in time, but the order is backwards. It demonstrates how for one mum and her child, when dealing with an illness like cancer, getting through one day can be a struggle but it’s the small, daily victories that can help you begin to feel like you again. The “Feel Like You Again” campaign aims to raise awareness of the free in-store support services that Boots Ireland offer nationwide for people living with cancer. Boots Ireland is in its sixth year of partnership with the Irish Cancer Society, with the aim of the partnership to increase awareness, promote prevention and support people living with cancer across Ireland. Since the partnership began in 2012, Boots has trained over 100 Boots Irish Cancer Society Beauty

Advisors and over 150 Boots Irish Cancer Society Information Pharmacists to offer practical tips and advice to help manage the effects of cancer The Boots Irish Cancer Society Beauty Advisor offers makeup and skincare advice to help manage the visible side effects of treatment - helping people to feel like themselves again. In addition to the Boots Irish Cancer Society Beauty Advisor role, the Boots Irish Cancer Society Information Pharmacists are in all pharmacy stores nationwide and can help with advice on medication and side effects alongside sign posting to local support services. Commenting on about the launch of the “Feel Like You Again” campaign, Gillian Hennessy, Head of Marketing, Boots Ireland said: “At Boots Ireland we’re extremely proud to be able to offer in-store supports to people living with cancer. Our “Feel Like You Again” film shows a beautiful insight into the life of a mum, trying to feel a bit more like her normal self for both herself and her son. Our message is simple, we’re here to support those with cancer when they need it, whether it’s advice on medicines and local services from our Information Pharmacists or beauty and skincare advice from our Cancer Beauty Advisors.” Ogilvy Dublin is one of the largest marketing communications networks in Ireland, it’s a collective of passionate, innovative thinkers, working collaboratively within

Broadcaster Georgie Crawford was diagnosed with breast cancer last year a wider group of like-minded companies, to bring to light a shared vision of making brands matter. “Feel like you again” was created by award-winning team, Emma Fielding and Marcus Hartung: “We’re proud to work with Boots Ireland to communicate the hugely valuable services that they provide women all over the country who are fighting cancer. Our research for the campaign told us that

one of the most difficult aspects of the disease was the physical impact on one’s appearance, something as tender as losing one’s eyelashes. Such a personal issue required a deeply personal response, which inspired the story in this film between the young mother and her son.” The film is directed by Zak Emerson, who is also known for his direction on award winning commercials.

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Feature New drug free treatment for hay fever sufferers By Dr Paul Carson 2018 – a very long winter with snow into late March. A short spring, possibly less than four weeks followed by a prolonged spell of warm (sometimes even hot) sunny weather. could be re-stocked. Nasal decongestants, steroid nasal sprays, eye lotions, each and every OTC product was tried or offered. Success depended on how soon your customer sought help and whether he/she followed your suggested plan of action. Never underestimate the misery allergy sufferers experience. Don’t say “it’s only a touch of hay fever; it’ll pass when the rain comes.” Nothing annoys patients/customers more than having their discomfort belittled. So what should you do when faced with a sniffing, coughing, sneezing, red-eyed and miserable customer? Suggest self-help tips: • Avoid areas of lush grassland • Keep house and car windows closed during peak pollen hours of late morning and late afternoon • Wear wrap-around sunglasses to reduce pollen grains affecting the eyes • If you can, avoid being outdoors late morning and late afternoon

Allergy management expert Dr Paul Carson

This produced tree and grass pollen bursts with sudden large volumes of pollen grains circulating. For hay fever sufferers (around 24% of the population) it also triggered a summer of misery. So what did these unfortunates suffer? Some or all of the following: • Sneezing • Blocked and runny nose • Sinus congestion with headaches, especially along the forehead • Itchy, red and watery eyes

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• Puffy eyes and lower eyelids • Cough and occasional wheeze, even worsening or first onset of asthma • Ears popping with occasional hearing impairment • Diminished senses of taste and smell (severe hay-fever sufferers) • Feeling of intense lethargy Pharmacists throughout the country would have noticed a sudden spike and then steady queue of hay fever victims looking for relief: antihistamines disappeared faster than shelves

• Don’t smoke and keep away from smokers (passive smoking aggravates all allergies) • Get someone else to mow the lawn or wear a face mask if you have to cut the grass. • Choose seaside breaks for holidays as off shore breezes blow pollen away • Check TV, radio and newspapers for the next day’s pollen count and plan your schedule accordingly • Put a smear of Vaseline inside each nostril to ease the soreness and to capture pollen entering the nasal passages.

• Never sleep with the bedroom window open. • Don’t drive with the window open. • Put used tea bags in the fridge. They make great soothing compresses to relieve swollen or puffy eyes. Assume the customer has an array of self-help products at home so ask: “what have you tried already?” Handing out a variation of what they’ve already used is a recipe for disappointment (and treatment failure). By the time a customer seeks help he/she will have a significant degree of nasal blockage. So first unblock that nose before adding in other OTC products. Suggest a three day course of a nasal decongestant (Otrivine is as good as any but warn about long term use). When your customer feels his/ her nose is unblocked then an OTC steroid spray such as Flixonase could be added in. The combination of a nasal steroid spray and oral antihistamine is the best strategy for the summer. Caution this should be kept up until the pollen season ends, even on rainy days. Push the dose of antihistamine to maximum allowed during high pollen days. Get it right and you have a loyal customer for life. Get it wrong and you’ve lost one customer and maybe more as allergy runs in families. All allergy conditions, but especially hay fever, are on the rise internationally. Experts believe 50% of the global population will have some type of allergy by 2026. New drug-free treatment for allergy A new and exciting drug-free treatment for hay fever (or any nasal/sinus allergy) is now available. Rhinolight® is a medical device that uses U/V


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Feature Rhinolight® does not damage healthy nasal tissue and thus can be safely used as a long term treatment in allergic conditions affecting the nose and sinuses. And, at last, it’s a safe treatment for AR in pregnant/breast feeding women and elite athletes worried about what they can or cannot take during an allergy attack. In the next edition of this journal I’ll explain in more detail how Rhinolight works, success rates etc. based on my own experience of using it for close on 2 years and over 250 patients.

The Rhinolight procedure for allergy treatment

phototherapy to reverse and prevent all allergy driven nasal and sinus conditions. It is in use in over 300 centres worldwide How it works • Blocks histamine release from mast cells. • Induces apoptosis of eosinophils and lymphocytes. • Reduces the number of eosinophil cells.

• Reduces the quantity of ECP and IL-5 in nasal secretions. In plain English this means Rhinolight U/V phototherapy rids the nasal lining of allergy cells (which shouldn’t be there and are not important in usual nasal function). This allows the mucosa recover and gets rid of the usual hay fever symptoms such as sneezing, runny and blocked nose etc.

I’ll also explain how pharmacists could use Rhinolight in their stores. Business opportunity Community pharmacists are now the go-to professional of choice. GPs are so overstretched they cannot handle sudden surges in allergy problems such as happens in the summer with high pollen levels. In the UK the NHS Clinical Commissioners – an independent voice for

clinical commissioning groups in England - advised GPs to refuse to issue prescriptions for hay fever. So never before has an informed and sympathetic pharmacist been more important. Dr Paul Carson has been involved in allergy management for over 30 years. He is the author of five popular health books dealing with allergy problems in children and has written numerous articles on allergy management for medical journals. He is a member of the British Society for Allergy & Clinical Immunology, The European Academy of Allergology and Clinical Immunology and on the board of the Irish Lung Foundation. He is Medical Advisor and co-founder with of Hay Fever Relief, the world’s first 3D interactive app for hay fever sufferers. Dr Carson was the first allergist in UK/Ireland to use Rhinolight phototherapy for nose and sinus allergy.

News National public consultation process by HIQA on extending the HPV vaccination programme to include boys begins Minister for Health Simon Harris has welcomed the commencement of a national public consultation process by the Health Information and Quality Authority on extending the HPV vaccination programme to include boys. The HPV vaccine is currently offered to girls in their first year of secondary school. Minister Harris said, “I requested HIQA to undertake this Health Technology Assessment, which will establish the clinical and cost-effectiveness of providing the vaccine to boys. This public consultation is an important part of the process and I encourage people to take this opportunity to give their views. “This Government is supportive of the extension of the HPV programme to boys and it will be prioritised should the HTA make a positive recommendation. I am encouraged to hear the HIQA assessment has found that vaccinating both boys and girls would have considerable health benefits and that it reiterates that the vaccine is safe and effective at preventing infection with HPV.”

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The Minister added, "Cervical cancer impacts the lives of almost 7,000 women in Ireland every year. Vaccination teams will be returning to schools in September to administer the HPV vaccine to girls in first year and I encourage parents to ensure that their daughters receive this important life-saving vaccine". In total, 539 cases of cancer associated with HPV infection are diagnosed each year in patients in Ireland. HPV infection is also responsible for causing genital warts, with 90% of these caused by HPV types that are included in the vaccine. Nine out of every ten people will be

infected with HPV at some point in their lives. At the request of the Department of Health, HIQA carried out a health technology assessment reviewing both the likely clinical and cost effectiveness of an extension to the vaccination programme to boys. Its draft findings, which are now open for public consultation, found vaccination of both sexes would have considerable health benefits. Austria, Australia, Canada, New Zealand and the US already offer the vaccine to both girls and boys. "From reviewing the evidence, HIQA has found that the HPV vaccine is safe and is effective at

preventing infection with HPV," said Dr Máirín Ryan, HIQA's Director of Health Technology Assessment and Deputy Chief Executive. "Extending the current girls-only HPV immunisation programme to include boys would reduce HPV related disease in males and females in Ireland, improving patient-related outcomes and reducing mortality from HPVrelated cancers." The HSE began offering the vaccine here in 2010 and while uptake climbed to as high as 86.9% in 2014-15, it then dropped to 72.3% in 2015-16 and 51% in the 2016-2017 period.


Awards The Irish Pharmacy

2018

Winners’ Profiles

The United Drug Business Development of the Year Award 2018

Pharmacy award winner shows how to stand out from the crowd United Drug Business Development of the Year 2018 Winner: Kieran’s Avenue Pharmacy Dundalk Every pharmacy is searching for something to make them stand out in a crowded market and the winner of the United Business Development of the Year category displayed how innovation and new technology can drive your business forward. The business that Amy Kieran opened on a greenfield site in Dundalk just three and a half years ago, Kieran’s Avenue Pharmacy, was recognised this year at the Irish Pharmacy Awards in the United Drug Business Development of the Year category. The website they built, avenuehealthandbeauty. ie, has proven to be a great success in terms of attracting new customers to the business and in growing brand awareness. It has also helped to meet the requirements of a changing demographic profile of pharmacy users, a business development idea that greatly impressed the judges. Established in 2014, Kieran’s Avenue quickly saw that the business needed to tap into the young demographic profile of Dundalk in order to reach a wider customer base beyond the immediate community. Kieran’s developed a website that allowed people to shop for the products they wanted from the comfort of their own homes, drawing a new generation of customers to the business. The staff underwent specific marketing and online training and the website balanced the needs of a growing business

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with retaining the feel of a local pharmacy. Kieran’s Avenue also put a lot of effort into their online footprint and used all platforms available to them to help grow their social media following. Kieran’s Avenue looked at their internal systems as well as the external ones, and ensured that online orders were dealt with swiftly, accurately and even personally – with all deliveries accompanied by a note from the pharmacist. This innovation led not only to increased customer loyalty, but also to job creation. The ability to create and innovate were key to the judges’ decision to award this special award to Amy Kieran and the team. Winning Amy Kieran spoke to Irish Pharmacy News about a win that was very important to the whole team. “We’ve been very lucky. I opened up here about four years ago and we’ve won an award nearly every year since and it’s been great for advertising the business. It gives you a real feel good factor too.” This award recognises a pharmacy that has demonstrated an emphasis on advancement and on developing business models that sustainably improved commercial performance and operational effectiveness, by bringing benefit to the business, its customers and other stakeholders. The purpose of

Patrick Watt, Director of Sales and Marketing, McKesson Ireland with Amy Kieran of Kieran’s Avenue Pharmacy


competition did not deter the proprietors, and Kieran is up-front about persuading customers to fill their prescriptions in her store. “The customer is obviously very important and we’ve built up a great community because it was a greenfield site so we didn’t have any customers in our stores initially and now we have so many. People just pop in to say hi and see what's happening in-store. I was at a wedding in Scotland a while back and I met a lady who comes into us and she approached me and said, ‘I’ve moved my full prescription to you now and I love coming into your pharmacy, it’s so uplifting and there’s always something nice going on and it’s cheerful’ and she said she always feels good when she leaves so she’s not going wherever she used to go.”

Amy Kieran at her pharmacy in Dundalk

the award, sponsored by United Drug, is to reward a pharmacy business that has demonstrated an innovative approach to creating new business. Awards can also serve as important marketing tools and winning one of these acclaimed accolades can help a business to stand out from the crowd, to attract talented personnel and to raise your company profile. Being nominated is an achievement that can help to grow brand awareness and can drive footfall towards your pharmacy. The awards are open to pharmacies all over the country and offer a chance for individuals and teams to showcase the quality of their contribution to pharmacy based healthcare. Since 2016 United Drug, the largest pharmaceutical wholesaler in the Republic of Ireland, has been part of McKesson Europe. Pat Watt is the director of sales and marketing at McKesson Ireland and he spoke to IPN about the spirit of camaraderie in Irish pharmacy, saying that he was thrilled to present the award to Kieran’s Avenue Pharmacy. “This is a great example of

innovation and a great example of customer centricity,” he said. “The business results are there to be seen, not just in a commercial sense but also in terms of the impact it has had on customers and patients. Fantastic innovation.” Kieran’s Avenue Irish Pharmacy News went to Dundalk to meet the team responsible for the hard work behind the win. Kieran’s Avenue is uniquely laid out and the store gleams with shining, high end displays, while also having all the essential products that customers would expect. A smart, eye catching summer display is the first thing you notice as you enter. A red swimsuit hangs under a large blue umbrella and bright paper lanterns dot the store. The display is a discreet nod to youth culture and marks Kieran’s as a smart, fresh and forward thinking business. Kieran herself has been qualified for 10 years and has the advantage of being media-savvy.

She gives the impression of someone who is streets ahead of the pack. “We are very big into social media, we’re active on Facebook, Snapchat, Twitter and Instagram and we’ve used it to promote the business from the start. We’ve been doing it since before anyone else was using it. We do live videos, and we post fun things depending on what’s going on. Like if it’s raining and we have an umbrella to sell we might do a video of that, or if we have a travel bag for sale we might do a demonstration.” Kieran explains how she uses the demographic profile of the community to get the most out of the business. “The demographic of the area would be young, healthy people and they like looking after their health so that’s what we’ve gone for in terms of the shop front. It’s young, it’s bright, it’s vibrant. We use colourful displays to attract people in so the windows are important.” There were already 20 pharmacies operating in the area when Kieran’s Avenue first opened but this level of

When asked about how they make this business stand out from all the others, Kieran says, “All along we had our own ideas about what we wanted the business to be and for me it was important that I would be here to meet the customers and they could meet the business owner, so that I could start building the relationship from there. I always felt working for a group that you’re only a number and if customers left there was only so much you could do to try to keep [them] happy. Customer service was how we built it up: being friendly and chatting with people, and by making connections.” Amy Kieran and her team have a firm grasp on the rapid changes that are taking over the pharmacy industry and the dynamism, ingenuity and innovation they display can be a benchmark for other pharmacy teams to measure themselves against. Building a website that met the needs of the business while also serving the changing demands of their customer base wasn’t just a smart move it proved to be an award-winning innovation. Has your pharmacy created something important? Discovered new ways of addressing business needs? Successfully attracted new customers or found ways to improve healthcare? If you think your pharmacy is a contender, be sure to apply for the Irish Pharmacy Awards 2019.

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Awards The Irish Pharmacy

2018

Winners’ Profiles

KRKA Counter Assistant of the Year Award 2018

Long-serving counter assistant who has embraced changes in the pharmacy world KRKA Counter Assistant of the Year 2018 - Winner: Phil Cahill (Adrian Dunne, Trim) The counter assistant is the first point of contact for any visitor to a community pharmacy and winner of the KRKA Counter Assistant of the Year category, Phil Cahill, is making a positive difference to patients’ lives on a daily basis. The standard of entry this year in this category at the Irish Pharmacy Awards was extremely high and the judges’ task of shortening the list of finalists to one winner was a challenge. In the end the prestigious prize was scooped by Cahill from the Adrian Dunne pharmacy group, a business that prides itself on going that “extra mile” for customers. This year the judges were looking for evidence of outstanding achievement by a customer assistant who regularly goes above and beyond their job description to make a real difference in their local community. Having worked in the Trim branch of Adrian Dunne for 14 years, Cahill proved to the judges that her valued contribution to this business deserves special recognition. Adrian Dunne pharmacies have been involved in the Irish Pharmacy Awards for the last number of years and were successfully shortlisted twice. They are now the proud custodians of two Irish Pharmacy Awards. Adrian Dunne describes what

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it meant to the business to get involved in the awards and the benefits it brought to the pharmacy team. “We believe the awards are a great way to recognise the hard work and dedication of staff and to encourage best practice across the industry. The well wishes and congratulatory messages from customers were a testimony to Phil and her hard work and created a great buzz around the pharmacy.” Over the years, businesses that get involved in the nominations and awards process have consistently reported the positive impact it has had on the business and on the wider team too. Recognising the achievements of your team members with a nomination is an opportunity that is open to pharmacies all over the country. Awards also help to drive excellence and provide opportunities for benchmarking that otherwise may not be available. Adrian Dunne continues, “It’s fair to say that winning an award can boost the credibility and professionalism of not only members of staff, but the entire business. It also sets a very high standard for other staff members in the group and among our competitors. We fully intend to participate in the Awards next year.” Sponsors KRKA Pharmaceuticals specialise in the research and development, manufacture, and

Phil Cahill receives her award from sponsor Daniel Byers from KRKA


News that she only gets behind products she truly believes in and that this has been the key to her successful sales figures. “If I don’t really believe in something I can’t sell it. These are people who will come back to me so I don’t want them thinking I sold them something that doesn’t work. I can’t sell something that I don’t believe in and I can’t do this pretend link selling because I know from experiences in the past what it’s like to walk into a shop with only ten euro in my pocket.” Pharmacy Business

Phil Cahill at work at Adrian Dunne Pharmacy, Trim

supply of generic medicines and formulations. The company was founded in 1954 and joined the Irish market in 2011. On the night, general manager Daniel Byers explained why KRKA sponsor this important award and why the company is keen to recognise the hard work that counter assistants do. “We’ve been sponsoring this award for three years now. Counter assistants tend to be a real focal point, a touch point in pharmacies for customers, and we like to recognise that. A huge congratulations to Phil as this award is very much deserved.” The counter assistant is the first point of contact for all customers of the community pharmacy and are often the people who will build up important levels of contact with the public. By awarding the coveted KRKA Pharmacy Counter Assistant of the Year Award to Cahill, the judges were recognising her individual contribution to the business, the positive impact she has on customers, the level of excellence and commitment she brings, and the clear evidence of teamwork and effective communication

she demonstrated between individuals, colleagues and customers. Pride When IPN went to meet the team at the Adrian Dunne branch in Trim, the award was on display and given pride of place on top of the dispensary counter, for everyone to see. The team were already looking forward to next year and to recreating the excitement the awards brought to the store and to the town of Trim. Awards are not only about acknowledging and celebrating achievement - they can also serve as an effective marketing tool and can draw people into the business. Cahill was nominated by her manager Amy Regan. Regan points to a special mattress Cahill had brought in from home for a customer whose husband had recently suffered a motorbike accident. Regan explained to IPN that “this is an example of what Phil does - she always goes above and beyond to make a practical difference to people’s lives.”

A well-trained and confident OTC team are one of the pillars of a healthy, well-functioning and profitable pharmacy business. Counter assistants must be knowledge as their understanding of the issues can help to achieve strong and positive relations with customers. Cahill’s experience reaches far beyond just selling products and she enthusiastically explains the background to one of this year’s most talked about community pharmacy issues. IPN spoke to Cahill last July. “The hayfever is so bad at the moment. We have a pollen bomb going off because nothing pollinated in April and May as it was so damp and then we got this fabulous weather. But the pollen that we should have had in April is really only coming through now. We have the rapeseed pollen and we have the tree pollen, so people are really suffering.” When the nomination was made, the application emphasised Cahill’s performance in OTC, describing how she consistently delivers and even overachieves year on year, in terms of sales. Cahill explains to Irish Pharmacy

Phil is open, friendly and says she loves getting to know the customers she meets every day. She often anticipates what individual customers will require and orders products in advance so as not to disappoint them. When asked what it takes to be the KRKA Pharmacy Counter Assistant of the Year, Phil had the following to say: “You really have to care about people because they come in and tell us all sorts of things. You have to be engaging and you have to really want to listen to them. In the pharmacy business, we aren’t selling cans of beans. It’s not just a two minute sale - you have to be able to remember what the problem was and just really be enthusiastic and interested - you have to want to do it. If you want to do it you will love it and that makes it so much easier. If you just want to work in a shop, find another shop, because pharmacy is different and people can tell if you just don’t care.” Phil’s enthusiasm for the position and the energy and good humour she brings to work with her every day put her at the heart and soul of the Trim branch of Adrian Dunne. The experience she brings, coupled with her confidence in learning new skills and continuing to grow in her position as counter assistant, signal her out as one to watch, not just in 2019, but right into the future too. There is no doubt that Adrian Dunne will continue to have a strong presence at the Irish Pharmacy Awards over the coming years.

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Awards The Irish Pharmacy

2018

Winners’ Profiles

The Pharmaton People’s Pharmacist of the Year Award 2018

People’s award is recognition for pharmacist who went the extra mile The Pharmaton People’s Pharmacist of the Year Winner: Joel Duffy, Markievicz Pharmacy, Sligo When news first emerged that Sligo pharmacist Joel Duffy had been nominated for the Pharmaton People’s Pharmacist of the Year award, it became a rallying call for the whole community.

customers and attract new business. It also drives the pursuit of excellence, boosts staff morale, and can even serve as a highly effective tool within marketing strategies.

Carried along on a wave of goodwill, the Donegal-born pharmacist triumphed at the Irish Pharmacy Awards in the only category which is decided by a popular vote. Once nominated, the decision was up to the wider community and after the final count it was Duffy who triumphed.

Special award

The awards provide opportunities for pharmacists to benchmark and compare themselves to their peers and to identify what exactly they have to offer customers that others don't. The Pharmaton People's Pharmacist Award is particularly special because it is up to the public to decide. Nominations were sought by IPN and the manufacturers of Pharmaton, Sanofi, through a consultation process and local papers helped to inform the public of a drive to identify community pharmacists most deserving of recognition. The nominees were reduced to four and the public then got the chance to vote for their preferred winner via the social media networking site, Facebook. The finalists were encouraged to increase their chance of winning by publicising their nomination, and the story behind it. The level of exposure that can be achieved by being nominated for an Irish Pharmacy Award has proven over the years to send a positive message to existing

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At the Irish Pharmacy Awards ceremony in May this year, pharmacist Joel Duffy was given the honour of being named the Pharmaton People's Pharmacist of the Year 2018. When Irish Pharmacy News went to meet Duffy and the team in the Markievicz Pharmacy in Sligo town, the award was proudly on display in the store for all of their valued customers to see. Duffy tells IPN that the whole process, from nomination to winning on the night, "was really humbling." This was the first time the Markievicz Pharmacy had been involved with the Irish Pharmacy Awards and Joel explains that it didn't just benefit the team in terms of increased morale, it also lifted the whole community, even drawing people inside the business thanks to the buzz it created. “To hear all the nice things people said and to see all those nice words written down was just amazing. I also got a lot of messages of support from other customers as well. When the award was here in the store people were coming in to congratulate me, and some people who maybe saw the story in the paper were popping in to see it. It's been really nice for the team and has given the whole business a real boost. It meant a lot to me, it was special."

Joel Duffy receives his award from Tanya O’Toole, Consumer Healthcare Manager, Sanofi


look at is our standard of service: it has to be spot on. I'm the shortest tenured member of staff here in Markievicz Pharmacy and the team have done great work over the years. Thanks to them we have a very loyal customer base. We also try to be part of the community as much as we can. We try to support the Northside Community Centre next door, we support their summer camp and I ran the Donegal marathon last year to raise funds for them so we really try to get behind the community.” Quietly celebrating

Joel Duffy at work at Markievicz Pharmacy in Sligo

Award sponsor Tanya O'Toole, Sanofi's consumer healthcare manager, said this award was close to the company's heart. “For Sanofi this is a really, really special award,” she said. “This award is the one that lets us understand how important pharmacy is to all of the general public in Ireland. I think it really goes to show that the pharmacist is truly in the heart of the community, and people really are very happy to support their pharmacist and want them to be recognised.” Nomination Duffy was nominated by Anne Marie Frizzell. When Frizzell's ten year old daughter Erica was diagnosed with Burkitt's Lymphoma last year, the Donegal born pharmacist stepped up to help relieve some of the worry and pressure that was heaped on the family during her treatment. By managing Erica's medication from the pharmacy, the team did something that seemed simple to them at the time. In the end though, it turned out that the gesture meant a lot not only to the family, but to the whole community.

Erica McCauley, whose mother Anne Marie nominated Joel Duffy for the award after he managed Erica’s medication when she was diagnosed with Burkitt’s Lymphona

Duffy admits it was a bit of a shock when he found out he had been nominated and is sincere when he says he can't really think of anything he did for Anne Marie and Erica that he wouldn't have done for another customer. "I think I did what anyone would have done. I can't think of anything I did that would be classed as going above and beyond, I just did little things that I knew would make their lives a bit easier. They had a lot of travelling up and down to Dublin, to me it was nothing to just ring up the surgery and get the prescription sorted and ordered in. They were having a difficult enough time. This is just day to day stuff for us but it was really humbling to get the feedback and to hear all the nice messages of support that I got from others customers who learned about our nomination and win.” Markievicz Pharmacy Duffy says he always had his eye on a career in pharmacy. He worked for a number of years in Boots in Edinburgh after his preregistration year under the shadow of Edinburgh Castle. Now he

works under the shadow of Sligo's beautiful Benbulbin and the town has recently been designated city status. It serves a wide area with different demographic features. Joel tells IPN that his philosophy and that of the team is that how you treat people matters. “We do have a mix of different people coming to the pharmacy and it's really just as simple as treat everybody the same. We take each patient as they come and give the same level of respect and service to everyone. We have the best bunch of patients here.” When asked what sets this business apart from all the other pharmacies in Sligo, Duffy puts their success down to the hard work that has gone on behind the scenes, and emphasises community engagement. “Running a business in Sligo is difficult. It's a small town and there are fourteen different pharmacies so it is very competitive. Odds are if you went around to all of them you might get something at a slightly cheaper price elsewhere. We are as competitive as we can be with our prices but the main thing we

Anne Marie Frizzell spoke to Irish Pharmacy News. "Sligo is a small town and we like to see other people doing well. It is the type of place where people celebrate quietly.” Here she describes why she nominated Joel Duffy. “Sometimes it is hard to say thank you it can sound feeble. I wanted to thank Joel and the team for the way they looked after us [during Erica's treatment]. I am generally a very capable and competent woman but the simple things became overwhelming at the time. I found that it was the intangible things that people did for us that mattered most. The staff in Markievicz Pharmacy had never met Erica before but they treated her like family. They recognised straight away, almost innately, exactly what I needed from them and what I needed was practical help, and that's what they gave me by managing Erica's medication. It meant I never had to ask for anything. It wasn't like I went in with a prescription and they just handed me back what I needed they went to another level and that meant I wasn't stressed over all of the changes to Erica's medication. Joel and the team managed it for me and took all the stress away. It's hard to put it into words but the Markievicz Pharmacy is a special place.” The Pharmaton People's Pharmacist of the Year award sets a high standard and serves as a benchmark of excellence that can inspire other healthcare professionals to strive for more in their own service. It is important to recognise and champion excellence because in doing so we can glimpse how easy it is for a pharmacist to become a hero, with even the simplest of gestures.

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Awards The Irish Pharmacy

2018

Winners’ Profiles

McLernon Computers Innovation & Service Development (Independent) Award 2017

Innovative pharmacist uses health promotion to increase awareness McLernon’s Innovation and Service Development (Independent) Award Winner: Joanne O’Brien-Sheridan, Staunton’s Link Pharmacy, Castlebar Pharmacies are at the heart of local communities, and being proactive in teaching the community to improve their own health scooped the McLernon’s Innovation and Service Development Award (Independent) for Staunton’s Link in Castlebar. Joanne O’Brien-Sheridan, supervising pharmacist, applied to the Irish Pharmacy Awards on behalf of the team in order to recognise everything they had achieved together through their monthly health promotion events. The nomination led to Staunton’s Link appearing on the shortlist for the McLernon’s Innovation and Service Development Award (Independent), and at the recent ceremony O’Brien-Sheridan accepted the award on behalf of the whole team, who were “thrilled” to have their hard work recognised. The purpose of this particular award is to identify and champion a community pharmacy whose ideas and initiatives led to measurable improvements in the patient experience, and in all levels of care throughout the community. The judges were impressed by Staunton’s Link pioneering innovation through the delivery of a series of highly successful health promotion campaigns that are delivered to the public on a monthly basis. They decided to reward Staunton’s Link initiative as it encouraged, educated and engaged the community to

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become custodians of their own health outcomes. O’BrienSheridan’s confidence in the team’s delivery of these events inspired the nomination and this one small act of recognition eventually led to the win, an accolade that was shared by the pharmacy team, the business owners and the community. Awards not only recognise excellence - they also lead to opportunities. Winners of past awards have all reported that taking part in the process not only boosted staff morale and sent positive messages to existing customers, but that taking part also attracted new business. When Irish Pharmacy News went to visit the team in Castlebar, Co. Mayo, the award was proudly on the display in the centre of the shop floor. Sponsors McLernons Pharmacy Software are proud sponsors of the Innovation and Service Development award. This family run company are market leaders in providing software systems to Irish pharmacists and they have developed strong links with community pharmacists throughout the country. The company states that they believe that innovation among practitioners is intrinsic to the relationships that the pharmacy sector depends on. Sales director Robin Hannah told Irish Pharmacy News that

Joanne O’Brien-Sheridan receives her award from sponsor Robin Hanna, Sales Director, McLernon’s Pharmacy Software


of working for an independent pharmacy group. “When you are in independent you can go outside the box, so to speak, and you can be more adventurous, more assertive and more proactive about the things you would like to do. People these days are very focused on their health, be it mental or physical, and there is a lot more awareness now about preventing your health from going astray or from going downhill. If someone is on the borderline then our goal is to help to get people back into the normal range. When you work for a large multiple there can be a lot more paperwork, a lot more targets and budgets, and this can take you away from your work as a pharmacist, whereas when you work for an independent there’s more time for things like health promotion - and that’s what we really like to focus on in Staunton’s because it can have a very positive impact on people’s lives. The community can learn a lot from us and this in turn helps them to achieve better health outcomes.”

Joanne O'Brien-Sheridan, Evelyn Maloney, Rachel Duffy and Mark Jordan at Staunton’s Link Pharmacy in Castlebar

Staunton’s Link was a deserving winner. “We think this award is really key because pharmacy is going through such a challenging time,” he said. “It’s a fantastic opportunity to recognise those pharmacists that are taking that extra step to try to make a difference in the community and in their own pharmacy business.” The judges were looking for examples of pioneering new models or systems that improved the pharmacists’ impact on patient safety and care. Central to this award was the ability to show a measurable patient benefit to the initiative, serving as a template for other pharmacy professionals to emulate in their own service. Feedback from the judges indicated that the standard of applicant this year was very high and that this category in particular was competitive. Health promotion Under the guidance of pharmacy business owner Pat Staunton and supervising pharmacist Joanne

O’Brien-Sheridan, the team engaged the local community in a series of health promotion events that proved to be very popular. These included a threeday Diabetes information and awareness campaign as well as separate weight management, heart health, cancer and autism information sessions. The team also organised for the pharmacy to partner with the Irish Osteoporosis Society to host an information session about bone disease. Among other services the pharmacy provides blood pressure monitoring, diabetic and cholesterol screening, emergency contraception and flu vaccinations. Staunton’s Link are thorough in their mission to promote health and healthy habits in the community. O’Brien-Sheridan completed a training course and was able in turn to train the team on the use of the heartsaver AED defibrillator. O’Brien-Sheridan also demonstrated to the team how to use a pre-filled injection device for use when someone experiences a serious allergic

reaction, so that the members of staff could handle an emergency confidently and effectively if one arose. They also focused heavily on the flu vaccination over the winter months and O’Brien-Sheridan is delighted with the fact that they managed to administer over two hundred doses to customers, focusing heavily on the groups who were most at risk. Staunton’s Link pharmacy also opens every Sunday, and O’Brien-Sheridan believes that small things like that can help people access important healthcare, when they need it. She explains why these initiatives are of benefit to communities. “It’s important to mind your own health. It’s like the airplane - put on your own mask first. It’s all about reinforcing behaviours and habits that will lead to positive, healthy outcomes.” Independent Pharmacy Joanne came from a pharmacy background herself and joined the team last year. She explains to Irish Pharmacy News the benefits

O’Brien-Sheridan stresses that team-work has been a key ingredient to their successful health promotion campaigns and to their subsequent win on awards night. “It’s a very friendly pharmacy. There’s a great atmosphere here and there’s a positive energy among the staff which transmits to the customers. The team get on very well and works well together: whether it’s a health promotion event or a cosmetic event, we all support each other.” The staff in Staunton’s Link pharmacy came together as a team and, under the guidance of the business owner Pat Staunton and supervising pharmacist O’Brien-Sheridan, they created a series of successful campaigns that added a measurable benefit to the health of the community. The judge's decided to reward Stauntons because the initiatives they ran empowered the community to take an active role in their own health outcomes, showing exactly what is possible when pharmacies and communities come together.

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Awards The Irish Pharmacy

2018

Winners’ Profiles

Clinigen Group Community Pharmacist of the Year 2018

Community pharmacist turned his fascination into thriving career Clinigen Group Community Pharmacist of the Year 2018 Winner: Mike Walsh, Walsh's Pharmacy Fermoy, Co. Cork Pharmacists are at the heart of their communities. This award recognises a pharmacist who provides excellent service to the public, has succeeded in business, and advanced the profession as a whole. Mike Walsh is the Clinigen Group Community Pharmacist of the Year 2018. In this competitive category, which saw highly skilled applicants nominated from across the country, Walsh stood out for his unrivalled dedication to the profession that extends well beyond the traditional pharmacy walls. The award has promoted Walsh’s to existing patients and new customers alike, boosting brand awareness as well as the pharmacy’s own values of professional customer care, timely and cost-effective service, technical innovation, and personal and professional staff development. From Walsh’s Pharmacy in Fermoy, the picturesque river town in North Cork, Walsh has pioneered numerous health initiatives, sponsored dozens of local causes, and organised a series of public health talks. Over the past 15 years, he has grown the business into a well-

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respected dispensary, acclaimed for excellent customer service and a commitment to patient safety. Walsh is a leader in the field, combining the day-to-day running of a busy pharmacy with cutting edge practice and superior management skills. Global pharmaceutical and services company, Clinigen Group, which sponsored this award, said it was delighted to be involved. Clinigen have sponsored the Irish Pharmacy Awards for the past five years, since the company entered the market. “The work of the community pharmacist has grown so much over the last few years,” Clinigen's country manager Anna Ryan told Irish Pharmacy News. “It’s lovely to see a [pharmacist] from outside of Dublin being recognised for their work.” The application process for entering the awards encourages applicants to stand back and look at their business from a different perspective. Benchmarking is an important tool in all industries, and never more so in the community pharmacy sector as the landscape continues to shift. The judges in this category were looking for evidence of dedication to the community a

Mike Walsh of Walsh’s Pharmacy and Anna Ryan, Country Manager of sponsor Clinigen Group


Staff members at Walsh’s Pharmacy in Fermoy

pharmacist serves. Everything Mike Walsh has done in business is aimed at improving the customer experience. From installing a fully automated ARX Dispensing Robot (officially named “Spencer the Dispenser” after a competition involving local children), to technological innovations including a text-andcollect program and an email prescription service. Innovations such as these have freed up the pharmacists’ time so they can talk to patients. There are many more examples of Walsh’s dedication to long-term service delivery. Earlier this year, the pharmacy encouraged diabetic patients to upgrade their old blood glucose monitors, some of which were giving inconsistent readings. Last year, he organised a baby-and-child first aid training evening at Fermoy’s local community centre. The second annual event attracted 85 people and a waiting list of another 40. The feedback from parents was tremendous and more events are planned. Walsh, who has a personal interest in atrial fibrillation, set up a mini AF screening service

in the pharmacy. Patients are assessed on a device that measures blood pressure and AF. Already, staff have flagged an irregular heartbeat in nine patients. “I genuinely believe this is a huge area that pharmacy should be involved in,” Walsh says of the service. Walsh stands out as a pharmacist who continually goes above and beyond in his community. He has an excellent understanding of the goals of community pharmacy - and he consistently sets the bar higher. On top of the day-to-day running of the pharmacy, Walsh hosts public health talks at HSE sheltered housing centres, secondary schools, a local widows’ group and a Men’s Active Retirement Group. He covers topics including blood pressure, cholesterol, common medication interactions, the benefits of the flu vaccine, and how to make your pharmacist work for you. He is heavily involved with the local GAA Club, where he wears the administrative hat of vice treasurer and volunteers as the first aid officer at matches. Walsh also organised

a first aid course for 12 club coaches, which included vital defibrillator training. Walsh is the only pharmacist in town to offer a prescription delivery service, which has proved very popular with customers, especially those living in rural areas surrounding Fermoy. Walsh is a regular contributor to the local Fermoy newspaper, writing monthly “Healthy Living Articles” on topics ranging from colic and reflux in babies, staying healthy after retirement, head lice, and sports injuries. Then, there’s the philanthropic side to the business. The pharmacy sponsors an average of 40 different causes each year. “Rather than giving any one organisation everything I prefer to spread the sponsorship budget evenly among everyone, each getting something for their organisation each year,” he told Irish Pharmacy News. Walsh says the best part of his job is seeing the meaningful benefit that the pharmacy profession can have on individual patients, and in the wider health landscape. He firmly believes the public appreciate the vital link

community pharmacies play in the health industry. “Patients really respect their pharmacist, having the one to one conversation, and that piece of advice really builds up the relationship over time.” But there are challenges. Namely, time constraints, Walsh says. “Time management is vital in our daily operations,” he told Irish Pharmacy News, adding that he would like to spend more time with his patients. In the future, Walsh would like to see pharmacists providing an even wider range services and for the role of the pharmacy technician to be expanded as well as the pharmacist. On winning the Community Pharmacist of the Year Award 2018, Walsh was quick to thank his dedicated staff. “The most successful organisations have one thing in common; the importance they place in their people,” he says. Walsh credits the commitment of his staff with freeing up his time so he can continue doing what he loves: helping patients.

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Awards The Irish Pharmacy

2018

Winners’ Profiles

The GSK Self Care Award 2018

Lloyds store taking health promotion campaign to new heights GSK Self Care Award 2018 - Winner: LloydsPharmacy, Castletroy, Co. Limerick LloydsPharmacy this year made a commitment to focus on heart health. Across its 88 stores in Ireland, staff received specialised training to support the roll out of bespoke self-care programmes aimed at providing expert advice to their customers. LloydsPharmacy in Castletroy hit the ground running. As always, the store's 21 colleagues took their health promotion campaigns to new heights. This award honours a pharmacy that identified and addressed a need within their local community. It celebrates a store that has shown a consistent dedication to self-care and demonstrated evidence of outstanding achievements that have created a positive impact on the lives of patients. The judges were looking for evidence of long-term programs that can be replicated, serving as a model for the future of pharmacy, and leading to the advancement of the profession.

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suffered from hypertension, with most requiring a referral to their GP for follow-up advice and treatment. Castletroy pharmacy manager Maria McBrearty said she never could have anticipated how successful the program would be. “It was a huge success, an opportunity to build stronger relationships with our customers and to enhance the customer experience,” she told Irish Pharmacy News. Global healthcare company, GlaxoSmithKline, has sponsored the Irish Pharmacy Awards since 2014. Sponsoring this year’s Self Care Award, GSK congratulated LloydsPharmacy on its outstanding achievement. “Self-care is so important to the pharmacy industry,” GSK customer business manager Bryan Dunne said. “It empowers people to make the right choice, based on the best information.”

LloydsPharmacy in Castletroy was the clear winner. With increased GP waiting times, the Castletroy team knew many of their customers were not getting their blood pressure checked on a regular basis. They decided to do take action. The pharmacy ran a series of public awareness campaigns about hypertension in a bid to inform their customers about the benefits of proactively managing their heart health.

A seminar earlier this year showed just how vital self-care is to the pharmacy sector, with evidence that 92% of people liked to be involved in decisions about their own health and mediation. The research, commissioned by the Irish Pharmacy Union and the The Irish Pharmaceutical Healthcare Association, also showed that one in three Irish adults had a significant medical condition, with high blood pressure, arthritis and diabete the most common ailments.

The result? The pharmacy’s free blood pressure measurement campaign identified that a staggering 17% of participants

In selecting the winner of the GSK Self-Care Award, the judges said Lloyds’ demonstrated a significant, measurable and

Rebecca Barry, Supervising Pharmacist and Maria McBrearty, Pharmacy Manager with Bryan Dunne, GSK customer Business Manager


“People tend to come here sometimes before they go to the GP,” says McBrearty. “We have a huge number of people coming in looking for that five minute consultation with the pharmacist. I think that’s the way forward in pharmacy. As everything gets busier, people still need easy access to medical professionals.” Sometimes, it’s just a simple case of making a phone call or a home visit. McBrearty and a colleague recently called into one of their regular patients at home when she didn’t come into the store for her daily medication. Supervising pharmacist Rebecca Barry attended a local school to train teachers about administering diabetes medication to one of their students in the event of an emergency.

Staff at the Lloyds Pharmacy in Castletroy positive impact on the experience of pharmacy patients. Castletroy has made great strides, they said, in implementing health promotion, self-care and community wellbeing initiatives. It was not just the pharmacy’s hypertension campaign that gave them the competitive edge this year. The team was also singled out for growing Lloyds’ innovative Change Your Health Direction programme, which is aimed at making positive lifestyle changes including healthy eating, smoking control and increasing physical activity. The free service offers patients one-onone consultations with specialised health coaches over an eight-week period. Patients set personal goals and monitor their progress in store every week with their dedicated health coach. They are given a diary with health tips and recipes, and educated about the best way to achieve their goals. Patients attend the store for a “weigh in” and health check, and then set about planning for the week ahead. Castletroy surpassed sign up targets and active participants (numbering in the dozens), exceeding all objectives in every performance. “The whole idea behind this service is providing the

expertise, support and care to our customers so they can live more positive lives,” says McBrearty. “We started this because we saw huge interest from our customers who wanted to educate themselves about prevention, as opposed to treatment when they have become ill. It’s such an important program for us. It’s a fundamental service that we offer now."

part of the LloydsPharmacy family that this was also prioritised. The most important thing we can offer is trust, and sales will follow.” McBrearty lists example after example of how the colleagues build lasting relationships with their patients.

LloydsPharmacy Castletroy is based in a buzzing shopping centre in the middle of a large suburb of Limerick City, serving the greater Castletroy, Annacotty and Monaleen areas. The expansive residential store is part of the fabric of the local community, surrounded by schools, doctors surgeries, a university and nursing home.

Whether it’s the pharmacists meeting regularly with a local retirement group to answer their queries about medicines and payment schemes. Or makeup artists linking in with transition year students to volunteer their time educating teenagers about skin care. Or the ‘Look Good, Feel Better’ campaign, run several times a year, where staff offer skincare give advice to women undergoing cancer treatment.

It was previously an independent store, but four and a half years ago became part of LloydsPharmacy. McBrearty says one of her fondest memories was when customers came back into the store after the name over the door changed.

“We pursue these programs when we identify a need in our local community,” says McBrearty, “and LloydsPharmacy is very supportive. There’s no charge for these programs. We cover the staffing costs.”

“That was really nice,” she says, “it’s a real indication that we’re doing something right. We have always operated on trust and I was really pleased when we became

Then there’s the busy consultation room, which, at times, seems more like a little triage room. Patients come in for help dressing wounds and fitting slings.

Rebecca Barry combines the day-to-day running of the pharmacy with drive, determination and passion. She has also built links with patients through her work with retirement groups. Earlier this year, she ran a flu vaccine campaign which saw the team in Castleroy distribute the highest number of vaccinations in the LloydsPharmacy group. She also regularly contributes to LloydsPharmacy health blogs and prepares articles to raise awareness on a range of health topics including Diabetes, Children’s Health, Stress management, just to name a few. The various initiatives Castletroy has implemented have made a measurable and lasting difference to the business: growing the customer base, increasing sales, and boosting staff morale. Receiving recognition and validation from their peers through the awards process has also been an extremely positive experience: the GSK Self Care gold trophy and certificate take pride of place in the dispensary, differentiating the Castletroy store from other pharmacies in the area. For a busy, dynamic pharmacy that has already achieved so much, what is McBrearty’s vision for the future? “We’re going to keep doing what we’re doing,” she says. “It’s all about building trust with patients; you have to have that personal interaction.” It’s that personal touch and accessibility that sets Lloyds Pharmacy in Castletroy apart.

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Awards The Irish Pharmacy

2018

Winners’ Profiles

Cellnutrition Community Pharmacy Team of the Year Award 2018

Teamwork at the heart of success for award winning community pharmacy Cellnutrition Community Pharmacy Team of the Year Award 2018 - Winner: McCartans Allcare Pharmacy Donaghmede, supervising pharmacist manager Kerrie Finnan and feel that the business supported them if they wanted to upskill or move into different positions. “I saw that people were segregated into specific roles and it wasn’t working as well as it could have been,” she told Irish Pharmacy News. “I think teamwork is the best way to run a business: everyone should have their role in the pharmacy but we should also work together. I wanted someone on OTC to be able to come into the dispensary and look for a prescription competently, and staff on dispensary who will happily go and sell perfume and cosmetics.”

The McCartans Pharmacy team with Lorna Howard (far right), National Sales Manager at sponsor Cellnutrition

A community pharmacy's biggest asset is its employees. Good pharmacy teams become great when every staff member uses their individual skills and talents to contribute to the store's overall objective, delivering outstanding patient care. McCartans Allcare Pharmacy in Donaghmede has taken out the coveted Cellnutrition Community Pharmacy Team of the Year Award in recognition

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of its unified approach to healthcare initiatives over the past 12 months. Throughout the year, the 15 team members at the Donaghmede store have encouraged and supported each other. They have shown a dedication to innovation and forward-thinking. They have pioneered projects that demonstrate excellence in quality, innovation, productivity and prevention.

Supervising pharmacist manager, Kerrie Finnan, who moved to the Donaghmede pharmacy three years ago, is responsible for driving the dispensary business, ensuring compliance, mentoring staff, and improving operations. When Ms Finnan started at the pharmacy she made a conscious decision to build a more cohesive team. She wanted her staff to be confident working in any role

Ms Finnan set about rebuilding her team, training staff to work across different departments. The results speak for themselves: the strong bond between staff members at Donaghmede is palpable, and the benefit to patients cannot be measured. Mineral and supplement specialist, Cellnutrition, which joined the Irish Pharmacy Awards sponsorship programme in 2017, this year chose to sponsor the Community Pharmacy


shopping centre, acts as a social hub for residents, with older patients regularly dropping by just for a chat or a cup of coffee. Ms Finnan, who is originally from Donegal, said that in her career, Donaghmede’s loyal customer base stands out.

Tracey Kealy, Bernie Cregan, Leona Kelly, Sarah Hawkshaw, Sinead Delaney, Aoife Behan, Suzanne Rigney and Kerrie Finnan at work at McCartans Allcare Pharmacy in Donaghmede

Team of the Year award. “A special congratulations to McCartans,” said Lorna Howard, Cellnutrition’s national sales manager. “These are really prestigious awards and everyone who was nominated was deserving.” Pharmacy owner, Brian McCartan, said the award was a boon for business and a strong acknowledgement of his team’s unshakeable dedication to their patients. “I am very proud of the hard work and commitment of the whole team in Donaghmede in achieving the wonderful award, which is truly deserved,” he said. The award has not only increased the pharmacy’s exposure in the market, but also helped to build more awareness about the products and services it offers, sending a positive message to existing customers and helping to attract new business.

This award recognised Donaghmede's ability to overcome obstacles by working together, and utilise individual strengths to build a highly skilled team that has placed the store at the heart of its community. The judges were particularly impressed by Donaghmede's unified approach to each and every healthcare initiative it offers patients. The pharmacy's top quality clinical service includes regular medication reviews, patient referrals and clear communication between the dispensary and local GPs to ensure the highest standards of patient care. It also runs various public health initiatives in-store, including a COPD clinic, a Breast Cancer Awareness Day and a growing and highly efficient Flu Vaccination service, which sees OTC staff calling patients to remind them about their appointments.

There have been countless examples when the team has come together to deliver outstanding service to patients. In one recent week, an ambulance was called to the busy dispensary in Dublin’s northern suburbs four times in a single week. The quickthinking staff worked together to provide emergency medical care to one patient who was having a stroke, another who suffered a heart attack, and a customer who had an epileptic fit on the shop floor. “It was a really busy week and the staff were amazing,” said Ms Finnan. Over the past 12 months, the pharmacy has gone from strength to strength. Traditionally a dispensary servicing an older population, Donaghmede’s customer base has been expanding thanks to an influx of families and younger customers moving to the area. The pharmacy, located in a bustling residential

The pharmacy is also extremely active in its local community, running several events including charity fundraisers for the Donaghmede Estate Residents Association. The much-loved community group provides vital support and a social outlet for elderly residents who live by themselves at home or in residential care. Many of its members are also customers of the pharmacy. Among the pharmacy’s most successful fundraisers was a DERA day event, which was held in-store. It included a raffle, cake sales, face painting for kids, and free makeovers for older customers. Radio station Spin 103.8 even presented its show live from the shop. The event raised more than 2000 euro. For Ms Finnan, her biggest professional achievement has been building a strong team, a sentiment that is reflected in the winning of this award. “We've really come together,” she said. “We're improving our service all the time and I’m seeing staff members growing individually.” Of winning the Cellnutrition Community Pharmacy Team of the Year Award, a beaming Ms Finnan said: “It was a massive achievement for us. The staff here are exceptional and the team spirit is second-to-none.”

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Awards The Irish Pharmacy

2018

Winners’ Profiles

MRII Pharmacy Representative of the Year Award 2018

Award winner brings quality affordable healthcare products to pharmacies MRII Pharmacy Business Representative of the Year - Winner: Amanda Quinn A successful pharmacy business rep combines excellent knowledge of products with total commitment to customers – and in MRII Pharmacy Representative of the Year award winner Amanda Quinn, the judges found an individual who excelled across the board. More than ever, pharmacies must be in a position to offer quality, value and ethical service to patients and customers with sales being integral to the growing success of the industry. The first point of contact in order to achieve this goal is often the pharmacy business representative, and close links between pharmacists and suppliers are cultivated through the building of relationships. Pharmacy representatives play a vital role in helping business owners to meet the ever-evolving demands of the public. Quinn recently won the MRII Pharmacy Representative of the Year category at the recent Irish Pharmacy Awards, an accolade that recognises sales representatives who goes above and beyond, and who always excel in their customer service. Judges were looking for pharmacy representatives who demonstrated excellent

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knowledge of their product base and who showed commitment to their profession in terms of future growth and development. The award is also designed to recognise an individual who stood out in their business ethics, and who demonstrated real integrity in their relationships with customers. They were seeking candidates who served their clients with creativity and who presented them with evidence of an inspiring work ethic. They found these qualities in Quinn, who has been a rep for Perrigo for the past three years. Quinn shares with IPN that winning was not something that was on her mind on the night as there were pharmacy representatives in the category with more experience. In the end, Quinn came out on top. “The awards were amazing. I really didn’t expect to win. It’s hard to piece it all together but I was so honoured. I couldn’t believe that I was nominated after only three years in the industry, so when I won it I was in shock. The company were delighted and were fully supportive.” Sponsors MRII (Medical Representatives Institute of Ireland) proudly

Amanda Quinn receives her award from Anthony Carroll, MRII President


they are highly visible and well represented on shelf with the relevant point of sale supporting them. And you also have to hit your targets. No rep likes to be in the red. We don’t just like to hit target: we want to surpass it.”

Amanda Quinn, Pharmacy Business Development Manager with Perrigo

sponsor this award. They are the educational body for Healthcare Sales Professionals in Ireland and work on behalf of their members to provide educational, networking and social opportunities for professionals working in customer facing roles within the Life Sciences Sector. Winner Quinn clearly demonstrated a commitment to excellence within the industry while also maintaining a consistently high sales record. The rep, originally from Offaly, also showed strong leadership skills and has a consistent reputation in ably presenting the features and benefits of the company’s products to pharmacists and their customers. “I am a people person so this job is perfect for me as I love meeting people on a daily basis, presenting innovative

products, educational support and adding value to community pharmacies and their customers.”

really help you tailor your call to ensure you are meeting their needs whilst also achieving your business goals."

Quinn can't speak highly enough of the company, the profession, the day to day job, and colleagues. Every day is as different as the people she meets and she likes the challenge of tailoring her delivery to teams with varying requirements, indicating a level of intelligence that allows her to tacitly mould her sales technique to each unique situation. To date, Quinn has learned that everything she does should have the pharmacy customer and patient firmly in centre focus."It's all about being prepared. It's about sitting down that morning and making sure you are organised before you step inside the pharmacy – taking the time to understand who your customer is and what is important to them can

Quinn’s customers range from small independent pharmacies to large national and multinational chains, buying groups and regional independent groups. Every relationship is as important as the next but what's key is building trust with customers from the outset. The brief is to make them feel confident that what is being presented will meet both their patients and their business’s commercial needs. "We strive to provide our customers with all the information they need in order to ensure they are equipped to credibly recommend our brands. It can be challenging at times because you have a list of things to do when you go into a pharmacy, for example securing distribution for your brands, making sure

Quinn puts a lot of thought and planning into everything she does, even admitting to turning up for her Perrigo interview fourty five minutes early. She is thorough and organised and comes across as someone who meets challenges head on - and who loves what she does. "That's what I enjoy the most - meeting people and building the relationship. I try to be accommodating and supportive and I try to provide a superior service. If my customers are satisfied with our products and service then that will be reflected in my sales performance, meaning my company will be satisfied." Irish Pharmacy News asks what it is about her service that sets her apart from the competition. "I make sure they always have their products on time, that they are never out of stock, and I help provide education to the staff and make sure they are happy to recommend the products. If they can't recommend them then they aren't going to advise people to use them. I try to be that support system that they need. Basically my job is to make sure everyone is happy." Competition is high in the pharmacy sector so differentiation is key providing her customers with a platinum service has never been more important. Quinn may not be in the industry as long as some of her peers, but she has proven to the judges that she has everything it takes - and more - to have longevity and to be a success in this industry.

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Feature Helping to manage muscle pain Muscle and joint pain strikes people of all ages. Broadly defined as suffering from aches, pains, and swelling, it can be a debilitating condition that affects a person’s mobility and sleep. At its worst, it can negatively affect their quality of life. The good news is that community pharmacists offer patients a plethora of oral and topical medications, as well as various supports and aids, to treat the many conditions that cause muscle and joint pain. diclofenac which can reduce inflammation and act as an analgesic. When diclofenac is applied to the skin as a gel, it is absorbed into the skin and then moves deeper into areas of the body where there is inflammation (for example, the muscle). Using a topical product means that the total amount of diclofenac in the body remains low. This in turn means less likelihood of any sideeffect to the medicine. Patients should be advised not to use diclofenac gel more than 4 times in any 24-hour period. What role do dietary supplements have in managing pain?

Pharmacies stock a variety of products for local symptomatic pain relief What is muscle and joint pain? There are many causes for this type of pain, including injuries, poor posture, and disease. It can impact a particular area, or can also present as referred pain. Joint pain and stiffness is commonly caused by fractures, sprains and arthritis (such as rheumatoid or osteoarthritis), while muscle pain often results from impact injuries, overstretching, overuse, and strains. Injuries to the tendons that join muscle to bone are another common source of pain, as are ligament sprains, which normally result from over-stretching or the twisting of a joint. How is this type of pain treated? No two patients will respond in the same way to one, or a combination of muscle and joint pain relief therapies. The Irish Society of Chartered Physiotherapists lists some of the most common therapies for alleviating muscle and joint pain as manual techniques (manipulation, traction or mobilisation), soft tissue techniques (massage, trigger point therapy, and acupressure),

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stretching and strengthening exercises, electrotherapy, hydrotherapy, and posture therapy. According to Arthritis Research UK, prescription analgesics, steroid tablets and steroid injections may be prescribed to some patients. What can pharmacists offer? Patients who suffer from muscle and joint pain - whether it’s chronic or acute - are advised to treat it immediately. Various types of joint pain can be considered for management in the pharmacy setting. Aside from dispensing prescription medications, there are many over-the-counter options available to pharmacy patients. These include: • painkillers, such as paracetamol • non-steroidal anti-inflammatory drugs, such as aspirin or ibuprofen tablets • topical gels, creams, roll-ons, massage balms and patches that can be applied locally to the painful joint • heat pads, heated rice pads or hot-water bottles

• various supports, braces, sleeves and walking aids Hot and cold pain relief products in the form of gels, creams, roll-on lotions and patches, can provide targeted, relief and help to relax stiff and sore muscles and joints by boosting blood flow to the affected area. Heat therapy works by improving circulation and blood flow to a particular area due to increased temperature. Increasing the temperature of the afflicted area even slightly can soothe discomfort and increase muscle flexibility. Heat therapy can relax and soothe muscles and heal damaged tissue. Cold therapy (cryotherapy) works by reducing blood flow to a particular area, which can significantly reduce inflammation and swelling that causes pain, especially around a joint or a tendon. It can temporarily reduce nerve activity, which can also relieve pain. Pharmacies should stock a variety of topical products for local symptomatic pain relief, for example products containing

There is a range of antiinflammatory dietary supplements on the market to treat muscle and joint pain. Flexofytol capsules are promoted as a natural supplement that improves and maintains joint mobility through a bio-optimized extract of turmeric (which is lauded for its anti-inflammatory effects). Vitabiotics Jointace with Omega-3 capsules contain Vitamin C, Vitamin D, Zinc, Copper and Manganese, which contribute to maintaining connective tissue and bone health. Revive Active’s Joint Complex is sold as a cartilage growth-promoting product capable of improving joint mobility. Cod Liver Oil supplements, such as Seven Seas Simply Timeless Cod Liver Oil, contain Omega-3 Fish Oil with Cod Liver Oil and Vitamin D, which are promoted as being beneficial to muscle function. For people with arthritis - where there is an increased risk of developing osteoporosis - Calcium and Vitamin D supplements may be recommended to improve bone health. How can long-term pain relief be managed? Experts recommend that people who suffer from long-term joint and muscle pain may benefit from a combination of physical therapy, exercise and painkillers. Paracetamol is one of the safest painkillers, but patients could also try anti-inflammatory tablets such as ibuprofen. If, after two weeks of taking OTC painkillers, patients are still suffering from pain, they should consult their pharmacist or GP.


News New appointment at IQVIA IQVIA Ireland are pleased to announce the appointment of Gwynne Morley to the position of Commercial Manager. In this role Gwynne will have responsibility for the engagement with pharmacy, commercial pharmaceutical companies and distributors. Gwynne comes with many years’ experience and knowledge across the industry. Prior to joining IQVIA, Gwynne was the Director of the Heart & Vascular, Diabetes & Emergency Department at the Mater Private Hospital. She is the former Managing Director at Uniphar Retail Services.

Previously she worked for United Drug Group (UDG) Healthcare for 13 years. During her tenure with UDG, she held a number of senior roles namely in prewholesale, consumer and quality. Gwynne is a TCD pharmacy graduate and is a welcome addition to the established IQVIA team.

IQVIA works in partnership with pharmacy, through the provision of analytical tools and consulting expertise, to drive business insights and market views which helps pharmacies to understand their performance.

Gwynne Morley, who has taken up the position of Commercial Manager at IQVIA

Probiotics dramatically improves IBS gut symptoms and anxiety in largest ever trial Ishaque SM, Khosruzzaman SM, Ahmed DS, Sah MP. A randomized placebo-controlled clinical trial of a multi-strain probiotic formulation (Bio-Kult®) in the management of diarrhoea-predominant irritable bowel syndrome. BMC Gastroenterol 2018;18(1):71. Probiotic supplements containing 14 strains of “gut-friendly” bacteria have been shown to not only dramatically improve abdominal pain in IBS patients but reduce anxiety too. In the largest-ever doubleblind randomised controlled trial of probiotic supplements in IBS-diarrhoea type patients ever-conducted, dramatic improvements in symptoms have been reported. In the study of 360 patients who had IBS with diarrhoea as their predominant symptom (IBSD); those patients who took the probiotic supplement Bio-Kult® reported a 69% decrease in abdominal pain, compared to 47% in a group who took a placebo. The four-month study conducted by the University of Bangabandhu Sheikh Mujib Medical University in Dhaka, Bangladesh also found the number of patients who rated their symptoms as moderate to severe at the beginning of the study was reduced by 86% in the Bio-Kult® group, compared to only 52% in those who took a placebo. A total of 33.7% in the Bio-Kult® group said all their symptoms had disappeared at the end of the 16 weeks compared to just 12.8% in the placebo group.

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Significantly though, as well as relieving IBS-D symptoms, Bio-Kult® was also shown to markedly improve all aspects of Quality of Life (QoL) evaluated using as 34 point IBS-QoL questionnaire. These included psychological issues such as anxiety about health, depression, lack of enjoyment of life, and feelings of having to avoid stressful situations. Leading experts say the findings are a significant breakthrough in understanding the role bacteria play in not only physical gut symptoms, but also psychological symptoms of IBS too. Dr Philip Burnet, Associate Professor at Oxford University, a leading UK expert on the gut microbiome/ brain axis, says that although several symptoms within the IBS-QoL survey in the study were significantly improved after taking probiotic supplements, the reduction in dysphoria (unease or generalised dissatisfaction), and health worries were particularly noteworthy. 'The influence of gut bacteria on the brain is a topical area of research in neuroscience and the microbiome-gut-brainaxis is considered a potential therapeutic pathway for brain

disorders,' says Dr Burnet.' Using probiotics that influence brain function, or the so called "psychobiotics", may in the future help alleviate conditions such as depression and anxiety. 'Indeed, there is a strong link between depression and IBS, and some researchers have suggested that mood disorders themselves may arise from dysbiosis (a microbial imbalance within the body such as within the gut).' Dr Burnet says another recent study by the University of Cork has demonstrated that a single-strain probiotic, B.Longum, reduced depression scores in 22 IBS patients. 'Importantly, the Bio-Kult® formulation not only contains B.Longum but also several other probiotic strains that have been reported to have psychotropic effects in both mouse models of anxiety and depressed mood, and in preliminary human studies,' says Dr Burnet. 'Therefore, the current trial not only demonstrated the therapeutic effects of Bio-Kult® in IBS, but has also alluded to its possible anxiety-lowering effects by reducing the incidence of health worries, social reactions and body image issues in participants.'

Professor Glenn Gibson, professor of food microbiology at the University of Reading said few effective therapies for IBS exist and it was extremely encouraging to see the positive results of the Bio-Kult® study. 'The mechanism of action is likely to be positive influences of the probiotic on gut microbiology, known to be both positive and negative for health,' he says. The full paper, published in BMC Gastroenterology, can be accessed here: https://rdcu.be/PgyZ Bio-Kult® contains 14 strains of probiotics including: Bacillus subtilis PXN 21, Bifidobacterium spp. (B. bifidum PXN 23, B. breve PXN 25, B. infantis PXN 27,B. longum PXN 30), Lactobacillus spp.(L. acidophilus PXN 35, L. delbrueckii spp. Bulgaricus PXN39, L. casei PXN 37, L. plantarum PXN 47, L. rhamnosus PXN 54 , L.helveticus PXN 45,L. salivarius PXN 57) Lactococcuslactis PXN 63, Streptococcus thermophilus PXN 66]. Scope Healthcare Suite 4/5 Westland House, Westland Park, Willow Road, Dublin 12 Freephone 1800 816 005 Email: info@scopehealthcare.ie Visit: www.scopehealthcare.ie


The Bio-Kult range is a line of live bacteria supplements for the whole family. Make the most of your travels this summer and avoid any unwanted digestive discomfort by supporting your immune systems and digestive health. le ilab r a v A you from cal lo aler les who

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@ScopeGroup1 1 800 816 005 info@scopehealthcare.ie www.scopehealthcare.ie


Feature Oral health – how community pharmacists can help to restore that smile Mouth ulcers Sometimes called aphthous ulcers, mouth ulcers are very common and usually appear on the inside of the lips or cheeks, the floor of the mouth, and under the tongue. There are three main types of mouth ulcer: • minor ulcers (accounting for 80% of all cases) are small, 2 to 8mm in diameter and usually heal naturally, within 10 to 14 days • major ulcers are deeper and larger, usually categorised by a raised or irregular border, and can take several weeks to heal • herpetiform ulcers present as multiple, pinhead-sized sores (ranging from five to 100, and often fuse together). They are very painful and account for 5 to 10% of all mouth ulcers Treatments Antimicrobial mouthwashes kill the bacteria, viruses or fungi that may cause ulcers. The most commonly prescribed mouthwash, Chlorhexidine gluconate, is normally used twice a day. Corticosteroids reduce inflammation in the mouth, making ulcers less painful. Experts recommend using corticosteroid medication, such as Hydrocortisone lozenge, as soon as a mouth ulcer appears. Painkillers, such as benzydamine mouthwash, can be applied directly to the ulcer for very painful conditions. Interdental cleaning No matter how well patients brush their teeth, it is impossible to dislodge all the dental plaque, especially where teeth contact each other. The interdental area - between the teeth - is where most plaque collects. Dentists often recommend OTC interdental cleaning aids, such as dental floss, wood sticks, and brushes to help maintain healthy gums and teeth. They can be particularly useful for patients with extensive dental work (fillings, crowns, bridge), orthodontic patients, and patients with periodontal problems. Interdental cleaning tools are not usually recommended for children.

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Community pharmacists work with dentists to maintain good oral health Bad breath Bad breath is a common and embarrassing problem which is often caused by bacteria in the mouth breaking down food. In other cases it can be a sign of gum disease, result from eating strongly flavoured foods, or be caused by smoking and drinking alcohol. Occasionally, bad breath, also known as halitosis, is the result of an infection or illness. Pharmacists are perfectly placed to treat bad breath by promoting good oral hygiene, such as regular brushing and flossing of the teeth, and regular cleaning of the tongue.

• gently brush teeth and gums at least twice a day for two minutes each time • use a separate toothbrush or tongue scraper to lightly brush the tongue • regularly use dental floss (three times a week) to clean between the teeth • rinse with an antibacterial or anti-odour mouthwash

can be caused by anxiety and cancer treatments. Persistent dry mouth can be a sign of diabetes or Sjögren's syndrome. Pharmacists can advise patients suffering from dry mouth about treatments, gels, sprays, tablets and lozenges that will help keep the mouth moist. If the condition is caused by a blocked nose, pharmacists may suggest decongestants.

• drink lots of water

Patients should be referred to their GP if pharmacy treatments do not work after a few weeks. Other signs that may warrant referral are:

• use breath sprays, gums and/or mouthwash

• difficulty chewing, swallowing or talking

Patients can be advised to:

Dry mouth

• replace their toothbrush every three months

A dry mouth is often not a sign of a serious problem. Usually the condition is caused by dehydration, some medicines, or breathing through the mouth while asleep. In some cases it

• pain, redness or inflammation in the mouth

• use a small or medium-sized toothbrush with soft, synthetic bristles

• sore white patches in the mouth • other symptoms, such as needing to urinate regularly or suffering from dry eyes


Bleeding gums Bleeding gums are caused by plaque not being removed properly, leading to the healthy tissue around the teeth being attacked. When the gums become swollen and irritated, they may bleed when brushing or flossing. Gum disease This is a condition that affects the teeth and gums. Most people will suffer from at least one case of mild gum disease during their lifetime. The disease is usually caused by too much plaque on the teeth and causes red and swollen gums, and bleeding gums when brushing. Good oral hygiene will usually help treat a mild case of gum disease. If gum disease is left untreated it can turn into periodontitis, a more severe form of the condition which also affects the tissue connecting teeth to the socket, and the bone in the jaw. Gum disease can be combated with OTC antiseptic mouthwashes that contain chlorhexidine or hexetidine. The HSE says patients should be advised to brush teeth twice a day with a toothpaste containing fluoride, and to floss regularly. Smoking cessation programs can also be offered to reduce the risk of gum disease. Tooth sensitivity Tooth sensitivity occurs when the enamel protecting the teeth becomes thinner or when the gums recede. It is a condition categorised by a painful sensation in the teeth usually experienced when a person eats or drinks hot, cold, sweet, sour or acidic products. It can come and go over time. The most common causes of sensitive teeth are: • using a hard toothbrush or brushing aggressively • consumption of highly acidic foods and drinks • tooth decay and leaky fillings exposing the dentin of the tooth • gum recession which leaves the root surface exposed • teeth grinding during sleep • dental treatment such as crowns, fillings and tooth bleaching There are a variety of treatments to manage tooth sensitivity. Over-thecounter desensitizing toothpastes, which work by blocking the nerve endings, can help when used on a

regular basis. For persistent tooth sensitivity, patients should be referred to their dentist. Dentures Most modern dentures are made from hard resin. This material breaks down faster than natural teeth, and therefore needs to be taken care of. Daily cleaning of dentures, chemical or mechanical is imperative to combat a build-up of microbial plaque, calculus and food debris. Failure to do so can lead to an inflammatory conditions affecting the mouth. Much like real teeth, poor denture hygiene can also cause bad breath, undesirable tastes and staining.

through the gums. They may experience a higher temperature, facial redness, reddened and swollen gums, excessive drooling, poor appetite, irritability or disturbed sleep. However, there are many way to reduce the symptoms of teething, such as by giving giving the baby something hard to chew on and by using a sugar-free teething gel applied to the gums. Some common OTC treatments used to soothe babies who are teething include: • teething rings or keys, which give the baby something safe to chew on (popular products

include the Sophie the Giraffe So Pure Teething Ring and the Gummee Glove) • painkillers containing a small dose of paracetamol or ibuprofen • teething gels, often containing a mild local anaesthetic to help numb the area, such as Caldebaby Teething Gel or Nelsons Teetha Teething Gel (teething gels should not be used on babies under four months of age) • cold water or cool sugar-free drinks to soothe gums

To keep dentures clean, patients should: • remove false teeth after eating and rinse them under water • brush often with soap, water and a soft-bristled toothbrush • soak dentures in warm water or an immersion cleaner overnight • periodically use liquid cleansers such as sodium hypochlorite, alkaline peroxides or acid cleaners • avoid abrasive cleaning materials (stiff-bristled brushes, strong cleansers, harsh toothpastes and whitening toothpastes) • avoid bleach-containing products and hot or boiling water Teeth whitening Tooth whitening is the increasingly popular practice of removing surface stains in a bid to restore the natural shade of teeth, or to whiten teeth beyond their natural shade. Usually, the process of removing surface stains (i.e. coffee, red wine, tobacco, tartar calculus buildup) is performed by a dental professional and is termed “scaling and polishing”. But various whitening products are sold over the counter, ranging from bleaching strips and gels, to chewing gums, toothpastes and rinses, to laser tooth whitening. Most at-home methods use either carbamide peroxide or hydrogen peroxide. Popular OTC tooth whitening products include Rapid White 1 Week Tooth Whitening System, Laila London Activated Charcoal Tooth Whitening Powder, and Pearl Drops Professional 3 Step Whitening Treatment.

How to spot the warning signs for oral cancer? The incidence of mouth cancer is on the rise, diagnosis is often made late, and survival rates are low. Could you help a patient identify the signs and symptoms of the potentially deadly disease? According to the Irish Cancer Society, more than 300 cases of cancer affecting the oral cavity and pharynx are reported each year. The disease affects mainly older people, but young people are increasingly being diagnosed. Data from Ireland’s National Cancer Registry shows about half of all mouth cancers and even less cancers of the pharynx are diagnosed early. Early detection rates greatly improve survival rates. The chances of developing oral cancer increases with certain lifestyle factors, including smoking, excessive alcohol consumption, poor diet, excessive exposure to sunlight or radiation, and the human papillomavirus infection (which is transmitted via oral sex). A recent survey found 10% of people who were suffering from a mouth ulcer that was not healing were more likely to consult their community pharmacist for advice before asking their doctor or dentist. If a patient presents with any of the following symptoms, pharmacists should immediately refer them to a specialist. Mouth cancer warning signs: • a mouth ulcer with a raised edge (it may not discharge blood or be painful) • a mouth ulcer that has not healed after three weeks • red or white patches inside the mouth that have an irregular texture • unusual lumps or swelling in the mouth, head and neck • mouth and tongue numbness • jaw stiffness • speech problems • pain inside the mouth • swallowing difficulties • dry mouth

Infants and teething

• persistent halitosis

Some babies suffer varying degrees of pain and discomfort when their teeth start to emerge

• weight loss

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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: medinfo@norgine.com 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: medsafety@hpra.ie. 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.


News Sona announces support for ladies’ Gaelic football Sona, provider of vitamins and nutritional supplements, has announced that it is supporting ladies Gaelic football for a second year running through a nationwide competition. They have a prize fund of €15,000 to offer three clubs across the country, one club per province. Sona has partnered with several Gaelic Football legends including Cork footballer Valerie Mulcahy, Mayo player Fiona McHale and Dublin captain Sinead Aherne to support women in Irish sport. With a presence in pharmacies in every county across the Republic of Ireland, Sona has a significant footprint in local communities nationwide. As a long-established Irish company at the heart of communities across the country, Sona understands the vital role that ladies Gaelic football plays in providing women with the opportunity to lead an active, healthy lifestyle. Through supporting clubs with funding Sona continues to actively support optimizing health and fitness in Irish sport. Sona is asking for people to go to their local pharmacy, purchase a Sona product with a unique competition code and log on to the Sona website to nominate their local club to be in with a chance of winning ¤5,000. Along with the competition, Sona is embarking on a nationwide media campaign across the summer which will support the competition and ladies gaelic football. Media partnerships will include Sona advertising spots on several radio stations and a large scale digital partnership over the next three months.

Dublin captain Sinead Aherne, Cork footballer Valerie Mulcahy and Mayo player Fiona McHale and Dublin captain Sinead Aherne are behind the Sona initiative to support women in Irish sport Newly appointed Sona Brand Ambassador and captain of the Dublin team Sinead Aherne joined Sona to officially launch the competition in Croke Park. Sinead and the Dublin ladies team are preparing for a busy season ahead as Dublin defends its winning title. Sinead Aherne, Dublin Ladies Gaelic Football captain, added: “I’m delighted to be at Drury Buildings to announce Sona’s support of ladies Gaelic football. Brands like Sona acknowledging ladies football as a fundamental game in Irish communities really help in promoting the sport. We

urge people across the country to enter the Sona competition in support of their local clubs. The prize will go a long way in helping future generations of players achieve their best in the game.” Speaking about the sponsorship, Ohan Yergainharsian, Sona MD said: “We are very proud to announce that Sona is continuing to support ladies GAA football this year through our nationwide competition. Last year we were delighted to sponsor TG4 coverage of the ladies’ gaelic game and give away thousands to clubs around the country. This year our in-store

competition will deliver further support to clubs and in turn local communities. “At Sona we have over 34 years’ experience in producing vitamins and nutritional supplements here in Ireland and we know the importance of people caring for their health with a more balanced, healthy lifestyle. At Sona, we prioritize optimizing your health, now and for the future.” To hear more about Sona, the competition and the announcement, see www.sona.ie

E-commerce company Amazon breaks into pharmacy market Online retail giant Amazon has confirmed it will buy a venture capital-backed startup that touts itself as “a new kind of pharmacy,” raising important questions about the future of healthcare. of medications directly to patients in all 50 states in the US, and coordinates refills and renewals. It caters for patients who take several medications each day, such as the elderly and those with chronic health conditions, and also sells popular OTC products including creams and inhalers. Jeff Wilke, Amazon CEO Worldwide Counsumer In a move that is likely to disrupt the US pharmacy industry, Amazon.com Inc. is acquiring online pharmacy, PillPack, for a reported sum of almost $1 billion. PillPack delivers pre-sorted doses

The announcement that Amazon was breaking into the lucrative pharmacy market last month triggered a massive drop in the stocks of pharmacy chains and drug distributors. PillPack’s website unashamedly takes aim at the traditional pharmacy business model, labelling it “inconvenient.”

“Forget what you know about pharmacy,” it says. “Driving to the store, waiting in line, chasing refills, today’s pharmacy is a pain. PillPack is a service that saves you time, headache, and hassle.” Jeff Wilke, Amazon CEO Worldwide Consumer, said PillPack’s “visionary team” had a combination of “deep pharmacy experience and a focus on technology.” “PillPack is meaningfully improving its customers’ lives, and we want to help them continue making it easy for people to save time, simplify their lives, and feel healthier. We’re excited to see what we can do together on behalf of customers over time.”

TJ Parker, co-founder and CEO of PillPack, said the company made it easy for customers to take the right medication at the right time. “Together with Amazon, we are eager to continue working with partners across the healthcare industry to help people throughout the US who can benefit from a better pharmacy experience,” he said in a statement. CNBC first reported Amazon’s interest in selling pharmaceutical drugs last year, and it is understood that PillPack was previously in talks with Walmart. The deal with PillPack is expected to close by the end of this year.

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Feature

Helping to treat the symptoms of IBS Research into high-fibre diets and their impact on IBS varies, but what is known is that soluble fibre (rather than insoluble fibre) appears to help ease symptoms in some cases. People who suffer from constipation have been advised to eat more soluble fibre, while those who experience frequent bouts of diarrhoea are recommended to cut down on insoluble fibre. Some people with IBS find certain foods trigger their symptoms. Experts advise patients to eat regular meals at a leisurely pace, dink at least eight cups of water a day, restrict tea, coffee, alcohol and carbonated drinks, limit fresh fruit to three portions a day, limit intake of resistant starch, and avoid artificial sweetener. Patients can also keep a food diary to help pinpoint potential dietary and lifestyle triggers. Probiotics are nutritional supplements that may increase the amount of ‘good’ bacteria in the gut, and help to ease IBS symptoms. Patients are advised to continue with one brand of probiotics for at least a month to monitor how it affects them.

What is Irritable Bowel Syndrome? Irritable Bowel Syndrome is a chronic disorder whereby the function of the gut (the colon or large bowel) is disturbed, but there are no physical or structural abnormalities. IBS affects an estimated one in five people and is a leading cause of visits to the GP. Twice as common in women than men, symptoms usually first appear in teenagers and young adults. The cause of the disorder itself is unknown, but IBS does not lead to permanent damage to the bowel or other serious diseases. People who suffer from IBS can experience symptoms ranging from mild abdominal cramps to severe pain that impacts their quality of life. The condition can also be embarrassing. One recent study that surveyed IBS sufferers in Ireland and the UK found almost a third believed there was a stigma associated with the syndrome, while half said their self-confidence had decreased. Experts say there is no single effective treatment for IBS. Nutritional and lifestyle changes form the basis of managing the condition. Some

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pharmacological treatments - such as antispasmodics, laxatives, antimotility agents - are proven to be effective. What are the symptoms of IBS? • Waves of spasm-like pain and discomfort in different parts of the abdomen (often eased when the patient goes to the toilet) • Bloating and swelling of the abdomen • Bouts of diarrhoea and/or constipation (often accompanied by a feeling of still needing to go to the toilet) • Passing wind more often • Other nonspecific symptoms can include nausea, headache, indigestion, belching, poor appetite, tiredness, backache, muscle pains, heartburn, bladder symptoms, anxiety and depression How is the condition diagnosed? A doctor will typically diagnose Irritable Bowel Syndrome from symptoms, as there is no specific test that confirms the disorder. A blood sample can be taken to rule out other conditions such as ulcers, colitis, coeliac disease and gut infections.

According to the Women’s Health Clinic, GPs sometimes group people with IBS into one of three categories, but patients may not necessarily fall neatly into one group: • People with abdominal pain or discomfort, with the main symptoms being bloating a nd constipation • People with abdominal pain or discomfort, with the main symptoms being urgency to get to the toilet and diarrhoea • People who alternate between constipation and diarrhoea IBS should not be confused with inflammatory bowel disease, which includes Crohn's disease and ulcerative colitis. People who believe they have IBS should see their doctor to rule out signs that may indicate cancer or inflammatory bowel disease. These symptoms include unexplained weight loss, lumps around the rectum, rectal bleeding, anaemia, and a family history of bowel or ovarian cancer. How is IBS treated? Irritable Bowel Syndrome has various treatment options.

Stress and emotional factors are sometimes a trigger for symptoms, so regular exercise should be encouraged to improve overall wellbeing. Antispasmodic medicines help to relax the muscles in the wall of the gut (and can be useful in people who suffer from spasmodic pain and cramping). Commonly used antispasmodics in the treatment of IBS include mebeverine, hyoscine and peppermint oil. Treatment for constipation and/ or diarrhoea is often sought out by people suffering from IBS. Laxatives can be used in cases where increasing fibre intake has not helped to ease constipation, while antidiarrheal medications, such as loperamide, may be beneficial for people who suffer from bouts of diarrhoea. Some antidepressant medicines (tricyclic) can also help ease diarrhoea, but they need to be taken regularly and are only advised for people who have persistent symptoms that have not been remedied with other treatment. Painkillers can also be prescribed to help manage the symptoms of IBS.


Feature Keeping kids healthy for going back to school After the long summer break, it’s time for the kids to head back into the classroom. But what do parents need to know to help give their kids the best start? Community pharmacists are well placed to engage with parents about how to keep their children in optimal health throughout the school year. Here are Irish Pharmacy News’ top tips for pharmacists. Asthma One fifth of Irish children suffer from asthma, and emergency hospital admissions for children with the condition surge every year in September. The Asthma Society of Ireland recommends parents always have their child’s condition reviewed by a GP before going back to school. Pharmacists can make sure children with asthma are using their asthma medicines correctly and help them to improve their inhaler technique. Parents might also need reminding that their child should have their blue inhaler with them at all times. Head lice No one wants head lice coming home with their kids from school. Head lice is spread by headto-head contact - often during playtime, sporting activities and sleepovers. Parents can minimise the risk by doing a visual head check once a week, and stressing the importance of not sharing hats, clothes, combs and pillows. The good news is that head lice can be treated effectively using over-the-counter pharmacy products including lotions and sprays, or by using the wet combing technique.

be offered to students at various ages to protect them against certain diseases. Pharmacists are well placed to talk to parents about the importance of vaccinating their children, and to combat misinformation about vaccines that is spread in the community. As we head into the colder months, it’s a good idea to talk to parents about getting the annual flu vaccine.

Chickenpox

Pain and fever

Chickenpox is most common in children under the age of 10 and spreads easily through coughs and sneezes. Children who are infected generally develop itchy spots and suffer from a fever for a number of days. While there is no specific treatment for the condition, pharmacy products such as paracetamol and calamine lotion can help to ease the symptoms. The HSE advises that children who become seriously ill with chickenpox (if blisters become infected or they have breathing difficulties) should be referred to a doctor. Vaccinations Children need to get booster doses of some vaccines in school, while other vaccines will

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Head lice can be spread by head-to-head contact during playtime

Children commonly experience pain and fever as symptoms of many different illnesses. A recent study found the overwhelming majority of parents surveyed had given their child or children analgesia for pain relief. First-line pharmacological treatments such as paracetamol or ibuprofen are well tolerated and can help reduce a child’s temperature and relieve pain. Nutrition Healthy food gives children the power they need to perform at their best. Studies show children who eat a nutritious breakfast function better, benefit from more energy and have improved concentration. Advice about the importance of preparing

nutritious snacks, drinking plenty of water, and cutting out junk food can have a positive impact on the whole family. Supplements can also be a great way to ensure kids are getting the nourishment they need. First-aid kits First-aid kits are a great overthe-counter product to promote ahead of the new school year. Parents who already have a kit can be encouraged to check if any items need restocking. Having an ever-ready stock of basic first aid supplies goes a long way when they’re needed. Mental health Mental health is just as important as keeping physically well. Pharmacists can help parents develop strategies to talk to their kids about anything that’s troubling them and are well placed to spot warning signs that might require referral to a doctor. Helping children to manage their stress levels and to look out for signs of anxiety and depression, as well as ensuring they have adequate time to play and relax, will boost their overall health.

Sleep It is recommended that children get eight to 10 hours of sleep every night to stay focused during the day. Pharmacists can help reiterate the importance of getting children into good sleeping patterns at the start of the school year. It’s important to educate parents about minimising screen time and creating a calming environment to help their children wind down before bed. With the new academic year just around the corner, setting regular bedtimes during the week and sticking to a routine on the weekends is a great way to give kids the start they need. Experts recommend starting new sleep routines a couple of weeks before the school year starts, to give their bodies time to adjust. It’s also important to ensure kids wake up at regular times on school mornings. Eye testing Vision screening should be done on a regular basis. Often, vision problems will be detected by parents early, but they sometimes go unnoticed and may affect a child’s performance at school. Good vision is vital to


Feature to encourage play, reading or quiet time. Good hygiene

a child’s ability to concentrate. Signs that a child may be struggling to see clearly include headaches or losing pace while reading, sitting too close to the television, squinting when looking at things from a distance, and poor concentration. Special health care needs For children who have special health care needs, such as asthma, allergies, diabetes or seizures, it is imperative that the school knows how to respond in the event of an emergency.

Parents should be encouraged to inform their children’s teachers about the medical condition and, if necessary, develop a health care plan. Screen time It’s important to give kids time away from screens. Pharmacists can help by encouraging parents to set rules about unplugging from phones, computers and other devices at certain times of the day. This will give children valuable time away from stimulation and is a great way

Instilling good hygiene habits in children will set them up for a healthy future. To help them avoid catching bugs at school and bringing germs home, parents should be encouraged to teach children how to wash their hands after going to the toilet and before eating. Hand sanitiser is a great back-to-school product that can easily be put in a backpack and will come in handy when soap isn’t available.

Regular exercise Children have lots of energy to burn off. Why not encourage parents to enrol their kids in a sports program? After-school activities are a great way to keep kids active and social. Exercise stimulates the frontal lobe and produce endorphins, helping to reduce anxiety and depression and improve brain function and focus. Exercise doesn’t have to be in a formal program. Walking to school is another great way to keep kids healthy and sets them up with good habits for life.

Backpack safety

Annual check-up

Get into the swing of the school schedule with the right backpack. Parents can be encouraged to choose a backpack for their children that fits well and doesn’t put strain on their growing bodies. Experts recommend backpacks with wide, padded shoulder straps and a padded back, and urge parents to ensure the bag never weighs more than 20% of their child’s body weight.

It’s important that as children grow, their health is monitored by medical professionals. Suggesting an annual physical exam helps ensure children are healthy before heading back to school and participating in sports. Any tests will depend on the child’s age and medical history.

A Great New Addition to the Medicare Family! Fleming Medical, proud owners of Medicare, Ireland’s number one pharmacy First Aid brand have released a new Medicare Family Value Pack range. Each pack in this new range includes a variety of over 50 plasters and strips - perfect for those little family first aid emergencies. All the plasters are guaranteed to provide long-lasting protection to wounds from dirt and germs, they are also breathable to aid the healing process. They are flexible for comfort and are hypoallergenic, so they are kind to sensitive skin. The range consists of 3 products including Fabric (Red), Waterproof (Blue) & Sensitive (Green). There are savings for customers with the value pack selling at an RRP of ¤4.75, they along with all Medicare products are endorsed by the Irish Red Cross. As part of the endorsement, Fleming Medical is offering Irish pharmacies the opportunity to host an instore Irish Red Cross Parent & Child Workshop free of charge. This initiative is part of Fleming Medical’s mission to teach people both young and old, basic first aid skills in communities through Ireland.

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News New campaign links alcohol and heart health Pharmacists are being made aware of a new campaign from the HSE’s AskAboutAlcohol.ie and the Irish Heart Foundation to raise awareness of the links between alcohol and heart health. common alcohol-related health problems, but many people don’t realise they have it. Dr Angie Brown, Consultant Cardiologist and Medical Director of the Irish Heart Foundation, explains: “It’s so important to have your blood pressure checked regularly, as high blood pressure can be dangerous if left untreated. Three in five adults over the age of 45 have high blood pressure but the good news is that it is one of the most preventable alcoholrelated problems – once detected it can be effectively managed through lifestyle changes such as drinking less and possibly medication. Ask your GP or pharmacist to check your blood pressure or visit the Irish Heart Foundation’s mobile health unit for a free heart health check.”

Dr Angie Brown from the Irish Heart Foundation

Among the range of harms caused by alcohol, it hurts our hearts too. You can look after your heart and reduce your risk of heart disease and stroke by drinking less alcohol and asking your GP or pharmacist to check your blood pressure. Nearly one million people in Ireland

have high blood pressure, a major cause of heart attack or stroke, and last year almost 9,000 people died from cardiovascular disease in Ireland. High blood pressure usually comes with an even bigger problem, a lack of symptoms. High blood pressure is one of the most

Drinking too much alcohol over time raises your blood pressure, which means your heart has to work harder to pump blood around the body. High blood pressure can significantly increase your risk of stroke and heart disease; it can affect how quickly a heart beats (arrhythmias); and can even cause the heart muscles to weaken (alcoholic cardiomyopathy). Often, there can be a gap between people’s perception of what they drink and what they actually drink. The more alcohol you drink the

higher the risk of developing high blood pressure, but even one drink a day can increase your risk. You can use the Drinks Calculator on AskAboutAlcohol.ie to find out if your drinking level might be putting you at risk. Marion Rackard from the HSE Alcohol Programme says it’s important for everyone to be informed: “You don’t need to be dependent on alcohol for it to affect your health. The purpose of AskAboutAlcohol.ie is to improve people’s knowledge about alcohol, how much we're drinking, how it affects our health, and how we can gain more by drinking less. Health care professionals are also encouraged to screen their patients to make sure they are aware of the risks linked to the amount they are drinking" HSE Radio Advertisements will run nationally encouraging people to get their blood pressure checked and to visit askaboutalcohol.ie to find out more about how alcohol affects their heart and health. Reducing the amount you drink to low-risk levels doesn’t just protect your heart - it can help you feel healthier and happier all round. Visit: http://askaboutalcohol.ie/ health/effects-on-the-body/ heart-health/

Mylan launches new self-administered HIV detection kit in Ireland Mylan, a leading global pharmaceutical company in Ireland, has launched a new over-the-counter HIV self-testing kit that can detect the presence of the virus in the blood. Commenting, Owen McKeon, Country Manager, Mylan Ireland, said: “Mylan has a long history in the fight against HIV and AIDS. As one of the largest providers of antiretroviral solutions in the world, Mylan is supporting early testing and prevention in Ireland through the launch of our HIV self-test kit. “In doing so, Ireland becomes our fourth market to launch in, following already successful launches in France, Italy and Spain. Over the coming months, we will be working with HIV patient organisations to increase awareness of the importance of

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early testing, and how tools like our self-testing kit, as well as taking a proactive approach to your health, can help in the fight against the spread of HIV.” The kit, autotest VIH®, is a medical device for home use, allowing those who want to self-test to do so quickly and discreetly. • To use autotest VIH®, the user takes a pinprick sample of their blood with the device. • The device then looks for the presence of HIV antibodies in the blood.

• Accurate results (HIV+ or HIV-) are provided within 15 minutes. Each HIV self-test kit comes with an information leaflet on how to use the test correctly and contact information for GOSHH (Gender, Orientation, Sexual Health and HIV) helpline. In case of an HIV positive result, users are advised to attend a full sexual health screening with their healthcare professional*. Autotest VIH® is a third-generation self-test kit and as such, users are advised to wait three months from the point of potential exposure to HIV and testing. This window

period is the time it takes for the body to produce antibodies that signal the presence of HIV**. Those people living with HIV, but who are not aware of their status, could be unknowingly transmitting it to others, a reality that Mylan hopes to change. HIV diagnoses in Ireland have increased within the last decade, particularly since 2011. There were 508 new diagnoses of HIV in Ireland in 2016, representing a 43.9% increase since 2006.


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Pharmacists offer advice on how to stay safe in the sun The recent good weather has given everyone a bounce and pharmacists have also benefited from the settled conditions and high temperatures. Careplus pharmacy announced a massive 147% increase in sales of sun cream in June and July and pharmacists in all corners of Ireland are reporting a marked increase in sun cream sales.

Sales of sun cream have soared across Ireland this summer

But it’s not all fun and games the good weather comes with its own risks. Hospitals have reported treating not just revellers, but even young children and workers not wearing tops, for serious burns from the sun. The UV Index for Ireland has been marked "high" or "very high" since the heatwave began, meaning protection is required against the sun's dangerous rays. Forecasters say the weather is expected to continue to be warm and sunny for the foreseeable future. Irish Pharmacy News spoke to a number of community pharmacists about the impact

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the recent good weather is having on business and on people’s health. Pharmacist Mark O’Flaherty is the owner of Strand Street Pharmacy in Skerries, a gorgeous little town in North County Dublin that many Dubliners associate with sunny childhood memories. Mark tells IPN about the good weather and what it has meant for business in Skerries. “We can’t keep [sun cream] on the shelf. It’s absolutely flying out. Particularly we are on Strand Street here so we are very close to the sea, it’s 100 metres from us. People know they can get their sun cream

here and we are renowned for being the cheapest on the street so they usually come in and check our prices first before buying somewhere else. There were days when we couldn’t get it. A lot of our suppliers were out of stock. The most popular tends to be the spray ons and we just couldn’t get them for love nor money at one stage. It’s really gone through the roof but we are delighted that people are being cautious and protective.” Tips for staying safe in the sun: • Stay hydrated, especially older people and babies

• Sip liquids regularly • Apply and reapply as even abrasion from sand can remove sun cream • Seek shade at the hottest part of the day • Check yourself regularly • Tan will develop over time but burned skin will go red quickly, within an hour • Remember the SLIP, SLAP, SLOP and WRAP rule: slip on a t-shirt, slap on a hat, slop on some sun cream and wrap on sunglasses


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Feature because one brand is more expensive, this does not always mean it is better quality. Sun creams today should all have a UVA star rating on the packaging, ranging from zero to five stars, where zero indicates no UVA protection at all. Four stars indicates superior UVA protection and five stars indicates ultra UVA protection. Melanoma Ireland recommend using at least SPF30 and the product should come with a four or five star rating. Consumers will find each product’s star rating clearly on the label. They also recommend looking for the words ‘Broad Spectrum’ as this indicates a level of both UVA & UVB protection. The logo UVA, enclosed in a circle, indicates a high percentage UVA protection relative to UVB protection. Consumers should also consider how waterproof or water resistant the product is as short periods of water activity and even sweat can remove sun cream, leaving the wearer under-protected.

Sun exposure can be a contributory factor in skin cancer

Enjoy the Weather Sunny South East Eoin Caulfield is a pharmacist in the Haven Pharmacy (Kenny’s) in Waterford. Ireland’s sunny South East is renowned for its beautiful beaches and revellers flock there in their droves during fine and settled conditions. Eoin shares with Irish Pharmacy News that not as many people were turning up needing sunburn treatment than would normally have been expected. Eoin thinks this is down to the fact that when the weather is predictably hot for a long period of time, people tend to be more prepared and therefore are more inclined to follow good advice around staying safe in the sun. Eoin remarked that most people were at least attempting to use their sun cream correctly, and those who did need treatment typically had not reapplied after swimming. He warns that the danger period occurs when the sun is still shining but the temperatures drop and the winds pick up. People can become complacent and may be more lax about reapplying, having underestimated the conditions. Eoin’s advice to people enjoying the sun is that prevention is key and putting on a high quality sun cream well in advance of going outdoors is the best way to protect yourself from harm. “If you do happen to get sunburnt

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the best advice is to stay indoors and to monitor for signs of infection. Try to not scratch the skin as unclean fingernails and hands can introduce infection which will worsen the effects of sunburn.” Eoin also says that using after-sun lotion can be of benefit, but there is no point in applying it once the damage has been done. For people with skin conditions Eoin advises that after sun or an appropriate moisturiser can help to avoid dryness as the skin will eventually dry out after multiple sessions in the sun. A good moisturiser in the evening can help to keep the skin hydrated. People who suffer from eczema typically also suffer from hayfever and Eoin advises that a small dose of antihistamine during the sunny season can help to take away some of the worst effects of seasonally itchy skin. Public Health Health authorities have put a lot of effort into informing people about the dangers of inappropriate sun exposure and this is paying off in terms of people’s attitudes towards making sure they stay safe. Back in Skerries, Mark O’Flaherty has noted a marked difference in how people behave during good weather. “I’ve had conversations with patients about the way it was back in the 80’s and factor

15 back in those days was considered total sun block. Nowadays you won’t find any pharmacist selling under factor 15. It would probably be seen as unethical - they just won’t stock it. There’s a big difference these days and I’ve noticed a real change in culture.” Skin cancer is the most commonly diagnosed cancer in Ireland. The latest research indicates that young, affluent people living in cities and large towns are being diagnosed with melanoma as they are not taking enough precautions day to day. In most cases melanoma is preventable and the vast majority of cases are attributable to overexposure to UV radiation, mainly from sunlight, although UV radiation from artificial sources (e.g. sunbeds) can also cause skin cancer. Children especially need to be protected because the risk of skin cancer begins at birth. Babies under six months should always be kept in the shade. Consumer Guidelines Melanoma Ireland have guidelines on their website for consumers to consider when making purchasing decisions as not all sun creams offer similar protection: in short, some products are much more effective than others and just

With all of the above in mind, it is not necessary to completely avoid the sun: the good weather provides us with an all-too-rare opportunity to absorb some of that delicious vitamin D, a vital ingredient to maintaining a good overall level of health. Once people are aware of the dangers and regularly update themselves on the latest advice from pharmacists and health professionals, then there is no reason why the fun can’t continue, weather permitting.

Careplus pharmacy announced a massive 147% increase in sales of sun cream


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Financial Feature How effective financial planning can avoid the worst effects of income loss for pharmacists In the third instalment of a six-part series, Robert McOwan continues his exploration of the financial lifecycle of a community pharmacist. Using his experience in both the business and pharmacy sectors, Robert works as a financial advisor offering both business and personal financial planning. This month he discusses failure to protect income Living on the Edge…. There is no polite or easy way to state that failure to protect income is not clever because a sudden loss of it usually brings very significant financial and personal challenges. What happens is probably best understood by someone who has watched their income, which may have been taken for granted, disappear. The next payday is your last is a sobering message. Especially when all existing direct debits and every other financial commitment, entered into wisely or not, must still be met. Pressure Triggers Loss of income can be a trigger for upset, panic, feelings of failure and loss of self-esteem. A real moment of truth occurs when after losing income, there is the need to calculate how long current funds will last until they are exhausted. Awkward conversations with lenders about what payments can be delayed or postponed is a common cause of sleepless nights. With effective financial planning adding financial hardship to emotional upset can be avoided.

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Below are some of the key

financial factors to address when income stops. Financial planning leads to awareness of the financial risks highlighted which can then lead to peace of mind through awareness and having plans in place to confidence in the financial future. Best Advice Usually Equals Some Disturbance Tax free cash lump sums payable from policies on death or serious illness of the policy holder are the foundation stones of financial planning. Unless a person is independently wealthy and only works because they want to, not because they have to, protection of income and lifestyle is always a high priority best advice subject following a needs analysis at a financial planning meeting Cause of Income Loss Examples of how an income may be lost are redundancy, death or unable to work due to illness for a period of time. Loss due to redundancy can be recovered by finding a new job. Loss due to a specified illness is recoverable with a critical illness plan. Somebody dying means the income loss is permanent but in these tragic

circumstances, a tax free lump sum payment from a life insurance policy is designed to fill potential income gaps over a specified period of time. Life Insurance Check Point “It is worth considering that it would take the average household 80 years or more to save ¤100,000 for their family by putting ¤15 on deposit at 4% per year net interest rate, after tax, to help their family financially in the event of death.” Source: Coyne research, January 2013. Saving for Income Protection is Not a Good Option This savings example is only used to help illustrate that saving monthly, even with significant multiples of the ¤15, to protect a family income in the event of death, would not be effective. The unfortunate reality is that nobody ever dies on time and it often happens at the most challenging time financially. The best way to protect against a sudden loss of income caused by death is a life insurance plan for a monthly premium which would pay a tax free cash lump sum.

Robert McOwan

How Much Life Insurance Identifying the level of life insurance required depends on the annual of income that needs to be replaced, alongside any additional expenses that may be incurred. There may not be any need for life insurance, or a need for a lower level of insurance if there are no dependents. The amount of insurance recommended should ensure a

Income Loss Grid & Risk Assessment What happens to current financial commitments if income stops? Income Scenario: Loss of income because of death or serious illness.

Savings: Are they available and ready to use as income?

Assets: Are they flexible, accessible and available as cash?

Social Spending: Change, stop family events and social spending?

Bills/Commitments: What can be stopped or reduced?

Cards /Personal Loans: Can they be repaid or payments negotiated?

Financial Plans: What current financial plans could be postponed or cancelled?

Holidays: Postpone or cancel any planned holidays?

These are some of the key financial factors to address when income stops. Financial planning leads

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over a specified period time can be calculated. One method to calculate the length of time is to subtract the youngest child’s age from 21 as this is the anticipated age for the child to have completed 3rd level education. S/he may now be close to or have achieved financial independence.

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Based on the above, calculation for total income replacement in a life insurance policy is as follows; Youngest Child Age 21 – 4 equals length of time income required = Annual Income Gap Income Replacement Required = €40,000 x 17 = Minus existing life insurance of €280,000 = total income replacement of

family’s standard of living won’t change in the event of a sudden death. The sum insured should provide enough income for the following:

family left behind. Critical illness

4 17 €40,000 €680,000 life insurance €400,000 life insurance

credit card debts, a spouse/partner

• 4 x Annual Salary

The amount also depends on any capital, savings and assets available and what income may be received from other sources, for example, early retirement might be an option, depending on age or how long would a business or an employer be able to or commit to paying an income.

• Personal Loans Repayment

is payment of a taxplanning who review may not work outside the place to make decisions on These are only indicativeInsurance figures. A financial is the best • Repayment of Outstanding free lump sum to the living policy home and two children to Mortgage unique and personal income protection needs, priorities and affordability. holder in the event of a specified think about.

• Replace the lost income. • Clear any loans or mortgage. • Ensure there is money to cover larger costs that may arise in the future, for example, savings for third level education. • Compensation if the surviving partner / spouse has to reduce working hours. • Cover the cost of any additional supports that may be required within the home. Recommendations to bridge the income gap should take into account other potential sources of income or wealth that may become available, for example; • State Widow’s / Widower’s Pension. • Pension from any pension scheme or plan of which the deceased was a member. • Savings in loan repayments, where they were covered by life insurance. • Any potential savings in living expenses. • Assets or Savings available to use as cash. When the annual income gap is known, the amount of life insurance required to provide income over a specified period time can be calculated. One method to calculate the length of time is to subtract the youngest child’s age from 21 as this is the anticipated age for the child to have completed 3rd level education. S/he may now be close to or have achieved financial independence. Based on the above, calculation for total income replacement in a life insurance policy is in the above table. These are only indicative figures. A financial planning review is the best place to make decisions on unique and personal income protection needs, priorities and affordability. Critical Illness Insurance Check Point Life Insurance is used to financially protect a spouse, partner or

106

critical illness being diagnosed. It is available for whatever use is required, for example, replace lost income, reduce or repay any short term loans, support recovery or help fund medical expenses. How Much Critical Illness Insurance

• Payment of any Credit Card Bills • Potential Home Renovation These are only indicative options. A financial planning review is the best place to make decisions on unique and personal needs, priorities and affordability.

Advances in treatment for the vast majority of critical illnesses means A starting point for most Life Insurance & Other Needs many people can look forward to a calculations is to insure 2 years full or partial recovery. A claim on of salary, for example, if income In conclusion, this article has only a critical illness insurance policy is ¤40,000 per annum, critical focused on how life insurance and helps to avoid financial hardship illness equals ¤80,000. The critical illness policies are used to and can help with recovery. On rationale being that from diagnosis protect personal financial needs. diagnosis of a specified critical to recovery and hopefully back Life Insurance is also used for Illness Pointis two years. The tax illness,Critical a tax free cashInsurance lump sum Check to work mortgage protection, business is paid, e.g., sum insured on the free cash lump sum should Life Insurance is used to financially protect a spouse, partner or family protection, left behind.revenue Critical approved illness policy ¤100,000. This amount is replace some or all income and of capital acquisitions is payment of a tax free lump sum to thewith living policy holderpayment in the event of a specified paid inInsurance full. if necessary, help medical tax. In some situations, it helps thatfor may be incurred criticalof illness being diagnosed. Itexpenses is available whatever use is required, for example, replace The amount critical illness to ensure people who maylost be exclusive of hospital care. Insurance required depends dependent after both income, reduce or repay any short term loans, support recovery or helpfinancially fund medical expenses. entirely on the personal situation. A Another option, depending on parents are deceased can look person who is single with no debts affordability, priorities and needs forward to having a lump sum or dependents, is likely to need and often described as the available to fund their future needs. less than someone who is married, optimum level of critical illness has a mortgage, a personal loan, insurance, is calculated as follows:

It Could Be You.

3 9 25

One in 3 people in Ireland will develop cancer during their lifetime. This will move to one in two people in 2020.

Source: Irish Cancer Society Nov. 2017

9 out of 10 prostate cancer patients In Ireland will survive for five years or more.

Source: Irish Cancer Society Nov. 2017

In Ireland, primary care related costs account for 25% of the total direct cost of Heart Failure.

Source: Heartbeat Trust. Cost of Heart Failure Report Nov. 2015.

1 in six people in Ireland will be affected by a stroke.

Source: Irish Heart Foundation. June 2017

32% of those who returned to work in Ireland after suffering a stroke, were working full-time one year later.

Source: Irish Heart Foundation. June 2017

Approximately 45% of people diagnosed with MS in Ireland need treatment but don’t have severe symptoms.

Source: MS Ireland Sept. 2014

1 32 45

How Much Critical Illness Insurance.


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Advancing pharmaceutical care Focuses on new technologies and approaches to achieve individualised therapy, including emerging ethical th dimensions associated with their implementation. Advancements in drug discovery, formulation, compounding, delivery systems and mathematical modelling can be used to translate such innovations into better outcomes in populations and individual patients.

Emphasises leadership developLooks at special interests in the Recognises that pharmacists and ment, including disseminating new different fields of pharmacy and pharmaceutical scientists cannot operate in a vacuum if the goal knowledge through the identifica- pharmaceutical sciences. is to transform patient outcomes tion of key competencies, along SPECIAL SATELLITE SYMPOSIA: and achieve the best possible care with outstanding approaches to for patients. New collaborative effective and ethical communicapractices, research and educatiotion, to enable life-long learning. BIOSIMILARS / 1 September nal models are needed among Transforming patient outcomes IMMUNIZATION TRAINING / traditional health care professio- can only be achieved with a 1 - 2 September PHARMACY TECHNICIANS / pharmacy workforce empowered nals like doctors and nurses, but these also must be expanded to to develop and implement 1 - 2 September ON the I T A R IST EGin R : include FIP pharmacist and phar-Wherever latest advances pharmacy and SCIENCE OFaround DIFFERENTIATED E you practise Wherever Wherever the THE world, you you practise FIP practise wants around you the tothe be world, inspired world, FIPFIP wants towants exten y ADLINaround DE 18 pharmaceutical care sciences. maceutical scientist members. role MEDICINES /a 7 September 20role T S U so that you role so so that that you you play a full part in ensuring play patients play full a full part get part the in in ensuring best ensuring carepatients possible. patients g 1 AUG

78 FIP World Congress of Pharmacy and Pharmaceutical Sciences Pharmacy: Transforming Pharmacy: Pharmacy: outcomes! Transforming Transformingoutcom outco Glasgow, UK New ways for pharmacy New Newways ways to provide for forpharmacy pharmacy better patient totoprovide provide carebet b 2-6 September 2018

Today’s one-size-fits-all approach to pharmacological Today’s Today’s one-size-fi one-size-fi treatment ts-all ts-all approach approach to pharmacological to pharmacological treatment WELCOME WELCOME TO GLASGOWtreatment WELCOM T Glasgow, a former European Capital of Culture Glasgow, Glasgow onceav is failing many patients around the globe. is failing isCome failing many tomany the patients Glasgow patients around around the the globe. globe. Come Come to the to the Glasgow Glasgow Note world’s friendliest city, has expanded hugely from world’s frien its o congress, which will help you develop congress, new congress, ideaswhich about which will how will help you help youyou develop develop newnew ideas ideas about about howhow youyou world’s Most congress sessions are a small salmon-fishing village on the River aClyde, small a small but salm it accredited for continuing can advance pharmaceutical care, usecan new can advance technologies, advance pharmaceutical pharmaceutical work care, care, useuse new new technologies, technologies, work workits world-class compact enough to explore with ease compact compac en m Please find more information: education. Check with your with others and empower yourselveswith towith provide others others and personalised and empower empower yourselves yourselves provide toaward-winning provide personalised personalised galleriesto and visitor attractions. galleries galleries Away an country’s professional body. www.fip.org/glasgow2018 city, stunning scenery abounds in the beautiful city,city, stunnin countr stu medicines therapy – and thereby transform medicines medicines patient therapy outcomes. therapy – and – and thereby thereby transform transform patient patient outcomes. outcomes. CONGRESS STREAMS:

CONGRESS CONGRESS STREAMS: STREAMS:

Pharmacy: Transforming outcomes! New ways for pharmacy to provide better patient care A > From bench to bedside Advancing pharmaceutical care Focuses on new technologies and approaches to achieve individualised therapy, including emerging ethical dimensions associated with their implementation. Advancements in drug discovery, formulation, compounding, delivery systems and mathematical modelling can be used to translate such innovations into better outcomes in populations and individual patients.

A > From A >in From bench bench to bedside to bedside C > Empowered forinhealth D > Targeting C > Empowered C > Empower special in fo B > Partners health B > Partners B > Partners health in health WELCOME TO GLASGOW Emphasises leadership developEmphasises lead Advancing Advancing pharmaceutical pharmaceutical Looks at special intere Recognises that pharmacists andcarecare Recognises Recognises thatthat pharmacists pharmacists and and Emphasises Glasgow, a former European Capital of Culture ment, including disseminating new ment, including includi Focuses Focuses onscientists new on new technologies technologies andpharmaceutical different fiment, elds of phard pharmaceutical cannot and pharmaceutical scientists scientists cannot cannot operate inonce a vacuum iftothe goal knowledge operate operate through in a in vacuum the a vacuum identifi if the ifcathe goalgoal knowledge knowledge throu th approaches approaches to achieve achieve individuaindividuapharmaceutical scienc voted the world’s friendliest city, has is to transform patient outcomes toistransform to transform patient patient outcomes outcomes tiontion tion ofiskey competencies, along of key of key comp co lisedlised therapy, therapy, including including emerging emerging expanded hugely from its origins as a small SPECIAL SATELLITE SYM ethical ethical dimensions dimensions associated associated and achieve the best possible care with outstanding andand achieve achieve the best the best possible possible care carewith approaches to with outstanding outstan village on River Clyde, withsalmon-fishing with their their implementation. implementation. for patients. New collaborative forthe patients. for patients. New New collaborative collaborative effective effective and ethical communicaeffective andand eth practices, research and educatiopractices, practices, research andand educatioeducatioAdvancements Advancements in drug in drug discovery, discovery, tion, to enable life-long learning. tion,tion, to enable enabl lif BIOSIMILARS /to 1 Septe but it remains compact enough toresearch explore formulation, formulation, compounding, compounding, nal models are needed among nal models nal models are galleries needed are needed among among Transforming patient outcomes Transforming Transforming pat IMMUNIZATION TRAIN with ease its world-class museums, traditional delivery delivery health systems systems careand professioand mathemamathemacan only traditional be traditional achieved health health with care acare professioprofessiocan can onlyonly be achie be a 1 - 2 September and award-winning visitor attractions. PHARMACY TECHNICIA tical tical modelling modelling can be used be to pharmacy to nalsnals workforce empowered pharmacy workfo wo nals like doctors and can nurses, butused like like doctors doctors andAway and nurses, nurses, but but pharmacy the city, stunning scenery abounds in to1 -to these translate alsofrom translate mustsuch be expanded such innovations innovations to intointo to develop these these and alsoalso implement must must be expanded bethe expanded to develop to develop andan im 2 September include FIP pharmacist and pharlatest include advances include FIP in pharmacist FIP pharmacy pharmacist and and and pharpharlatest latest advances advanc i better better outcomes outcomes in populations in populations THE SCIENCE OF DIFFE the beautiful countryside. pharmaceutical care sciences. pharmaceutical pharmaceuti maceutical scientist members. maceutical maceutical scientist scientist members. members. andand individual individual patients. patients. MEDICINES / 7 Septem

Are you a community, hospital Today’sTransforming one-size-fits-all approach to Pharmacy: outcomes! pharmacological treatment is failing or industrial pharmacist, or a New waysmany forpatients pharmacy to provide better patient care around the globe. pharmaceutical scientist? Come to the Glasgow congress, which will practise around the world, FIP wants you to be inspired to extend your Wherever you practise, Wherever FIP wantsyou help you develop new ideas about how role so that you play a full part in ensuring patients get the best care possible. you to be inspired to extend your you can advance pharmaceutical care, Note Most congress sessions use new technologies, work with others accredited for continui Please find more information: Please Please findfimore nd more information: information: role so that you play a full part education. Check with y Today’s one-size-fits-all to pharmacological treatment GLASGOW andapproach empower yourselves to provide WELCOME TO www.fi country’s professional b p.org/glasgow2018 www.fi www.fi p.org/glasgow2018 p.org/glasgow2018 Glasgow, a former European Capital of Culture once voted the in ensuring patients getis the failingbest many patients around the globe. Come to the Glasgow personalised medicines therapy – and world’s friendliest city, has expanded hugely from its origins as congress, which will help you develop new ideas about how you www.fip.org/glasgow2018 thereby transform patient outcomes. a small salmon-fi care possible. shing village on the River Clyde, but it remains can advance pharmaceutical care, use new technologies, work compact enough to explore with ease its world-class museums, galleries and award-winning visitor attractions. Away from the city, stunning scenery abounds in the beautiful countryside.

with others and empower yourselves to provide personalised medicines therapy – and thereby transform patient outcomes. CONGRESS STREAMS: A > From bench to bedside Advancing pharmaceutical care Focuses on new technologies and approaches to achieve individualised therapy, including emerging ethical dimensions associated with their implementation. Advancements in drug discovery, formulation, compounding, delivery systems and mathematical modelling can be used to translate such innovations into better outcomes in populations and individual patients.

B > Partners in health Recognises that pharmacists and pharmaceutical scientists cannot operate in a vacuum if the goal is to transform patient outcomes and achieve the best possible care for patients. New collaborative practices, research and educational models are needed among traditional health care professionals like doctors and nurses, but these also must be expanded to include FIP pharmacist and pharmaceutical scientist members.

C > Empowered for health Emphasises leadership development, including disseminating new knowledge through the identification of key competencies, along with outstanding approaches to effective and ethical communication, to enable life-long learning. Transforming patient outcomes can only be achieved with a pharmacy workforce empowered to develop and implement the latest advances in pharmacy and pharmaceutical care sciences.

Please find more information: www.fip.org/glasgow2018

D > Targeting special interests

at special interests in the MoreLooks Simplicity. different fields of pharmacy and pharmaceutical sciences. More Functionality. SPECIAL SATELLITE SYMPOSIA: More Fun. BIOSIMILARS / 1 September Holos is luxurious plantIMMUNIZATION TRAINING / 1 - 2 September based aromatherapy PHARMACY TECHNICIANS / - 2 September skincare1THE that maintains SCIENCE OF DIFFERENTIATED MEDICINES / 7 September skin health and helps PREVENT the signs of Note Most congress sessions are premature ageing. accredited for continuing

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Clinical Profiles 

MSD’S KEYTRUDA® (PEMBROLIZUMAB ) PLUS PEMETREXED (ALIMTA®) AND PLATINUM CHEMOTHERAPY REDUCED THE RISK OF DEATH BY HALF COMPARED WITH CHEMOTHERAPY ALONE AS FIRSTLINE TREATMENT FOR ADVANCED NONSQUAMOUS NSCLC IN PHASE 3 KEYNOTE-189 STUDY MSD (NYSE: MRK), known as Merck in the United States and Canada, announced results at the 2018 AACR Annual Meeting from KEYNOTE-189, a pivotal Phase 3 trial evaluating KEYTRUDA®, MSD’s anti-PD-1 therapy, in combination with pemetrexed (ALIMTA®) and cisplatin or carboplatin for the first-line treatment of metastatic nonsquamous non-small cell lung cancer (NSCLC). Findings showed that the KEYTRUDA-pemetrexed-platinum chemotherapy combination significantly improved overall survival (OS), reducing the risk of death by half compared with chemotherapy alone (HR=0.49 [95% CI, 0.38-0.64]; p<0.001). In pre-specified exploratory analyses, an OS benefit was observed regardless of PD-L1 expression in the three PD-L1 categories that were evaluated, including: patients whose tumours were negative for PD-L1 (HR=0.59 [95% CI, 0.380.92]); patients whose tumours had PD-L1 tumour proportion scores (TPS) of 1-49 percent (HR=0.55 [95% CI, 0.34-0.90]); and patients who had a TPS of greater than or equal to 50 percent (HR=0.42 [95% CI, 0.26-0.68]). The addition of KEYTRUDA to pemetrexed plus platinum chemotherapy also achieved a significant improvement in progression-free survival (PFS), with a reduction in the risk of progression or death of nearly half for patients in the KEYTRUDA combination arm, compared with chemotherapy alone (HR=0.52 [95% CI, 0.43-0.64]; p<0.001). A PFS improvement in the KEYTRUDA combination group was observed in patients whose tumours were negative for PD-L1 (HR=0.75 [95% CI, 0.53-1.05]); patients with a TPS of 1-49 percent (HR=0.55 [95% CI, 0.37-0.81]); and patients with a TPS greater than or equal to 50 percent (HR=0.36 [95% CI, 0.250.52]). The results were presented during the plenary session at the American Association for Cancer Research (AACR) Annual Meeting 2018 (Abstract #CT075), with simultaneous publication in The New England Journal of Medicine. “In this trial, KEYTRUDA in combination with pemetrexed

110

and platinum chemotherapy, compared with chemotherapy alone, prolonged overall survival and progression-free survival in patients with advanced nonsquamous non-small cell lung cancer regardless of PDL1 expression,” said Dr. Leena Gandhi, director of thoracic medical oncology at NYU Langone’s Perlmutter Cancer Center and lead author of The New England Journal of Medicine paper. “There is good scientific rationale for combining KEYTRUDA with pemetrexed and platinum chemotherapy, and these clinical data now suggest this combination as a new standard of care for the first-line treatment of these nonsquamous non-small cell lung cancer patients.” “Our goal is to extend the lives of patients with lung cancer, and the unambiguous survival findings from KEYNOTE-189 showing the risk of death was reduced by half in the KEYTRUDA arm are important not only for patients but also for the medical community,” said Dr. Roger M. Perlmutter, president, Merck Research Laboratories. “The results of this trial have the potential to change the treatment paradigm for patients with nonsquamous non-small cell lung cancer in the first-line setting, including patients whose tumors are either PD-L1 negative or are untested.”

VIIV HEALTHCARE REPORTS LANDMARK PHASE III STUDIES FOR DOLUTEGRAVIR AND LAMIVUDINE, DEMONSTRATING THE ABILITY TO CONTROL HIV WITH A TWO-DRUG REGIMEN IN TREATMENT NAÏVE PATIENTS

ViiV Healthcare has announced positive headline results from its phase III GEMINI study programme. The studies (GEMINI-1 and GEMINI-2) are designed to evaluate the safety and efficacy of a two-drug regimen (2DR) of dolutegravir and lamivudine compared to a three-drug regimen of dolutegravir and two nucleoside reverse transcriptase inhibitors, tenofovir disoproxil fumarate/emtricitabine (TDF/FTC), in treatment naïve HIV1 infected adults with baseline viral loads less than 500,000 copies per ml. The studies met their primary endpoint for non-inferiority based on plasma HIV-1 RNA <50 copies per millilitre (c/mL), a standard measure of HIV control, at Week 48. The safety results for the 2DR of dolutegravir and lamivudine were consistent with the product labelling for the medicines. No patient who experienced virologic

failure in either treatment arm developed treatment-emergent resistance. Full results from the studies will be presented at an upcoming scientific meeting. John C. Pottage, Jr., MD, Chief Scientific and Medical Officer of ViiV Healthcare, said: “People with HIV are living longer and more productive lives. However, under current standard of care, many patients still take three or more medicines every day. The GEMINI studies demonstrate the potency, safety and tolerability of the dolutegravir plus lamivudine combination. They affirm our two-drug regimen strategy, and reinforce our belief that many patients can control their disease with two drugs instead of three or more. Importantly, the studies show that this two-drug regimen could be an option for treatment naïve patients and can support a broad range of patients living with HIV around the world.” The GEMINI studies are part of ViiV Healthcare’s innovative clinical trial programme for two-drug regimens that seeks to address long-term toxicity concerns of people living with HIV by reducing the number of medicines used in their treatment. The studies together include approximately 1,400 men and women living with HIV and are being conducted at research centres in Europe, Central and South America, North America, South Africa and Asia Pacific. ViiV Healthcare will now plan for regulatory submissions for the two-drug regimen of dolutegravir and lamivudine later this year.

NUCALA (MEPOLIZUMAB) LAUNCHED IN IRELAND AS AN ADD-ON TREATMENT FOR SEVERE REFRACTORY EOSINOPHILIC ASTHMA IN ADULT PATIENTS GSK Ireland Ltd is delighted to announce that Nucala (mepolizumab) is now available in Ireland. Nucala is indicated as an add-on treatment† for severe refractory eosinophilic asthma in adult patients and is administered as a fixed dose 100mg SC independent of weight. Nucala has been approved by the HSE for a sub-population of severe refractory eosinophilic adult asthma patients. To identify which of your patients fall into this sub-population ensure they meet the following criteria: blood eosinophil count ≥ 300 cells/μL anytime in the previous year and ≥4 exacerbations in the previous year or on maintenance OCS. Nucala is a biologic therapy that targets interleukin-5 (IL-5), which plays an important role in regulating the function of

eosinophils, an inflammatory cell known to be important in asthma. It is administered as a 100mg fixed dose subcutaneous injection every four weeks in addition to the patient’s normal respiratory medication, which often comprises high-dose inhaled corticosteroids plus additional maintenance treatment(s), with or without oral corticosteroids. Eosinophils are a type of white blood cell that, in some individuals with asthma, can cause inflammation in the lungs, making breathing difficult and increasing the risk of an asthma attack or ‘exacerbation’. An exacerbation is characterised by an increase in shortness of breath, coughing, wheezing, chest tightness and a decrease in lung function beyond the patient’s usual status, which is sufficient to require a change in treatment. An exacerbation may be severe and require a patient to receive treatment with oral corticosteroids. A severe exacerbation may also require hospitalisation or an emergency room visit. Eimear Caslin, General Manager, GSK (Ireland) Ltd said: “Following the launch of Nucala, GSK can now offer as part of our overall respiratory portfolio, a biologic treatment for a specific subset of severe asthma patients whose condition is driven by eosinophilic inflammation. These are difficult-to-treat patients who up until now have had limited treatment options. By allowing healthcare professionals to target severe asthma patients who are most likely to respond, Nucala represents an advance in personalised medicine.” Professor Anthony O'Regan, Consultant Respiratory Physician, Galway University Hospital said: "Research has shown that not all asthma is the same. Severe asthma can have a number of underlying causes, including eosinophilic inflammation. Asthmatic patients with eosinophilic inflammation often struggle to control their symptoms and may experience frequent asthma attacks that require hospitalisation. While inhaled corticosteroids usually provide good asthma control, some patients continue to experience severe symptoms despite high doses of inhaled steroid and many rely on oral corticosteroids. Systemic steroids have significant side-effects. Newer treatments specifically targeting eosinophils have been shown to improve asthma control by reducing exacerbations and steroid dependence. To have a treatment available that specifically targets the underlying pathophysiology of their disease is an important option for these patients."


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Difflam contains Benzydamine Hydrochloride. Always read the Patient Information Leaflet in the pack. Should symptoms persist, consult your doctor. If you have details of an Adverse Event or Pharmacovigilance Relevant Information to report please email UK Pharmacovigilance TODAY at ukpharmacovigilance@mylan.com or phone +44 (0)800 1218267

Meda Health Sales Ireland, 34/35 Block A, Dunboyne Business Park, Dunboyne, Co Meath. T: 01 802 6624 www.meda.ie CODE: DIFF-2017-0006 Date of Prep: Dec 2017

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