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February 2018 Volume 10  Issue 2

THE INDEPENDENT VOICE OF PHARMACY

NEW

DURANCE

UP TO 24 HOUR RELIEF FROM MUSCLE AND JOINT PAIN IN ONE PATCH

STRETCHABLE Date of prep: Jan 2018. IRL/N/1117/0042d

FLEXIBLE

Abbreviated Prescribing Information for Nurofen Durance 200mg Medicated plasters Please refer to Summary of Product Characteristics for full information. Active ingredient: Ibuprofen Pharmaceutical form: Medicated plaster Indications: For the short-term symptomatic treatment of local pain in acute muscular strains, or sprains in benign traumas close to the joint of the upper or lower limb in adults or adolescents aged 16 years and older. Dosage and Administration: Adults or adolescents aged 16 years and over: One dose is equal to one medicated plaster. The maximum dose for a single 24hour period is one medicated plaster. The plaster can be applied at any time during the day or night, but should be removed and a new plaster re-applied at the same time on the following day. The medicated plaster should be used for the shortest duration necessary to control symptoms. The treatment duration should not exceed 5 days. If there is no improvement, during the recommended duration of treatment or a worsening of symptoms, a healthcare professional should be consulted. The medicated plaster should be used whole and not be cut. The medicated plaster should not be used together with an occlusive dressing. It is recommended to carefully wash and dry the area to be treated before applying the medicated plaster. Apply to intact skin only. Tear or cut the sachet along the dotted line to remove a medicated plaster. First remove the central portion of the release liner used to protect the adhesive surface and apply this surface to the painful area, once securely in place remove the remaining release liner at the edges of the plaster. Avoid getting the medicated plaster wet. Contraindications: Hypersensitivity to the active substance or to any of the excipients listed in section 6.1. In patients who have previously shown hypersensitivity reactions (e.g. asthma, bronchospasm, rhinitis, angioedema or urticaria) in response to ibuprofen, acetylsalicylic acid or other non-steriodal anti-inflammatory drugs (NSAIDs). Application on broken or damaged skin. Third trimester of pregnancy. Use on the eyes, lips or the mucous membranes. Warnings and Precautions: If symptoms persist for longer than 5 days or worsen, a healthcare professional should be consulted. Undesirable effects can be reduced by reducing the duration of treatment. Bronchospasm can occur in patients using ibuprofen who suffer or have previously suffered from bronchial asthma or allergies. The treatment should be discontinued immediately if a skin rash develops after applying the medicated plaster. Patients should be warned against exposure of the treated area to strong sources of natural and/or artificial light (e.g. tanning lamps) during treatment and for one day after removal of the medicated plaster, in order to reduce the risk of photosensitivity. Although the systemic availability of topically applied ibuprofen is significantly less than for oral dosage forms, complications may occur in rare cases. For these reasons, patients with: an impaired renal, cardiac or hepatic function; active or a history of peptic ulcer, intestinal inflammation or haemorrhagic diathesis should seek medical advice before using this medicinal product. Non-steroidal anti-inflammatory drugs should be used with caution in elderly patients, as they are more likely to experience undesirable effects. Interaction with other medicinal products: Non-steroidal anti-inflammatory drugs may interact with antihypertensives, and may possibly enhance the effects of anticoagulants, however if the medicated plaster is used correctly, the rate of systemic transfer is low, so that the interactions reported in association with oral ibuprofen are unlikely to occur. Concurrent acetylsalicylic acid or other NSAIDs may result in an increased incidence of adverse reactions. Pregnancy, breast-feeding and Fertility: The systemic concentration of ibuprofen is lower after topical administration, compared to oral formulations. With reference to experience from treatment with systemically applied NSAIDs, the following is recommended: Inhibition of prostaglandin synthesis may adversely affect the pregnancy and/or the embryo/foetal development. During the first and second trimester of pregnancy, Nurofen Durance 200 mg medicated plaster should not be given unless clearly necessary. If Nurofen Durance 200 mg medicated plaster is used during the first and second trimester of pregnancy, the dose should be kept as low and duration of treatment as short as possible. Nurofen Durance 200mg medicated plaster is contraindicated during the third trimester of pregnancy. After systemic application, only small amounts of ibuprofen and its metabolites pass into the breast milk. As no harmful effects to infants are known to date, it is not usually necessary to interrupt breast-feeding during short-term treatment with this medicated plaster at the recommended dose. However, as a precautionary measure, this medicated plaster should not be applied directly onto the breast area of women who are breast-feeding. Ability to Drive and Operate Machinery: None known. Side Effects: Systemic availability of topical ibuprofen is very low compared to orally administered NSAIDs. Adverse events, particularly those affecting the gastrointestinal tract, are less common with the use of topical ibuprofen. Immune System Disorders: Hypersensitivity [Hypersensitivity reactions have been reported following treatment with oral ibuprofen. These may consist of (a) non-specific allergic reaction and anaphylaxis, (b) respiratory tract reactions comprising asthma, aggravated asthma, bronchospasm or dyspnoea, or (c) skin reactions, including rashes of various types, urticaria, purpura, angioedema and, more rarely, exfoliative and bullous dermatoses (including toxic epidermal necrolysis, Stevens-Johnson Syndrome and erythema multiforme), and pruritus.] Frequency: unknown. Gastrointestinal Disorders: abdominal pain and Dypepsia. Frequency: not known. Renal and Urinary Disorders: Renal impairment (Renal impairment may occur following the use of topical ibuprofen, particularly in those with pre-existing renal dysfunction.). Frequency: not known. General Disorders and Administration site conditions: Application site reaction (The most common undesirable effects are application site reactions.) Frequency: not known. Name and Address of Marketing Authorisation Holder: Reckitt Benckiser Ireland Ltd. 7 Riverwalk Citywest Business Campus, Dublin 24. PA Number(s): PA 979/32/18 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: Pharmacy only. Date of Preparation: 21st December 2017

In this issue: NEWS: Pharmacy Chain Staff raise staffing concerns Page 5

NEWS: IPHA Encourage Prioritizing Patients in Brexit Talks Page 6

NEWS: Myth-busting at virtual conference on unlicensed medicines Page 12

NEWS: Nation’s Self Care Success lies in Community Pharmacy Page 18

CPD: Integrative Medicine; Concepts of Healthy Aging Page 25

EVENT: The OTC and Pharmacy Retail Product Awards 2018 Page 29


Same great Supply..... just a new name!

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To your chosen Wholesaler

To You Growing Together

The trade mark Actavis is used under licence by Teva Pharmaceuticals Europe B.V.

Further information is available on request from Actavis Ireland Ltd, a subsidiary of Accord Healthcare Ltd Euro House I Euro Business Park I Little Island I Cork I T45 K857 I Ireland 021-461 9040 Date of Preparation: August 2017 Reg Code NA-131-03


Contents Page 10: Pharmacist Appointed to Ecommerce Committee Page 10: HSE launch new online service to apply for medical card

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Page 14: Retail Excellence announce New Chairman Page 21: Antimicrobial Resistance Page 60: Pregnancy – Pharmacy Pathways of care

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PUBLISHER IPN Communications Ireland Ltd. Clifton House, Lower Fitzwilliam Street Dublin 2 00353 (01) 6690562

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COMMERCIAL MANAGER Barry Maguire Barry@ipnirishpharmacynews.ie ADVERTISING MANAGER Nicola McGarvey nicola@ipnirishpharmacynews.ie EDITORIAL CO-ORDINATOR Laura Greenhill Editorial@ipnirishpharmacynews.ie PHOTOGRAPHY DESIGNER Matt Wright Matt@ipnirishpharmacynews.ie CONTRIBUTORS Paul Mullholland Madeleine Grant Eamon Brady febIPN_AD_Final.pdf

Regulars

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26/01/2018

In this issue we are thrilled to announce our finalists in The OTC & Pharmacy Retail Product Awards. OTC medicines account for 16% of the total pharmaceutical market and the sector is a key source for business expansion and competitive edge. With recent statistics stating that the total sales value of OTC drugs amounted to ¤3.11 billion, these awards showcase the best in product innovation, marketing and value in retail pharmacy. Turn to Page 29 to see the products that have been shortlisted for this years awards. In other news the IPHA have called for patients to be prioritised in the ever changing Brexit Talks. Oliver O’Connor, IPHA CEO, has said public health and patients concerns have to be taken on board during the negotiation process “It is essential that the concerns of such a wide ranging group on the risks of Brexit on patients and public health across Europe be sufficiently taken on board.” Turn to page 6 for the full story. Elsewhere the IPU and IPHA have launched a new report which promotes increased levels of self care in Ireland and which would lead to a more efficient and effective system of healthcare. Entitled ‘Self Care - Taking Charge of your Health’, the report sets out a range of proposals for a more focused approach to self care which could lead to better patient outcomes and considerable savings for the state. The main focus of the report looks at how the key to the successful development of Self Care and its evolution lies in Community Pharmacy. We have full coverage from the launch of the report on Page 18. In other news, Retail Excellence have a number of additions to their roster, with JP Kennedy announced as their new Chairman for the next two years and Inish Pharmacy’s Paul O’Hea lending his expertise to the retail body’s eCommerce committee, with his new appointment. Full story Page 10 & 14.

MANAGING DIRECTOR Natalie Maginnis n-maginnis@btconnect.com

ACCOUNTS Jon Dickinson accounts@ipncommunication.com

Foreword

18 Irish Pharmacy IRISH News is circulated PHARMACY to all independent, NEWS multiple and hospital pharmacist, government officials and departments, pharmacy managers, manufactures and wholesalers. Buyers of pharmacy groups and healthcare outlets. Circulation is free to all pharmacists subscription rate for Irish Pharmacy News ¤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 of transmitted in any form without written permission. IPN Communications Ltd. have 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.

On page 12 we look at the vast and complex world of Unlicensed Medicines. With pharmaceutical and biotech companies under more pressure than ever to maximise the potential of their asset throughout the entire medicine lifecycle and provide patient access to medicines outside the clinical and commercial environments, one company has taken to dispelling some often thought myths about the lifecycle. Finally, its been an exciting time for a number of pharmacies who have been making some great achievements. Meagher’s Pharmacy are well on their way to exceeding a phenomenal amount of ¤70,000 with their recent charity efforts. Mellerick’s Pharmacy in Waterford are opening their doors to talk about their recent award winning successes as Pharmacy of the Year, by hosting a case study visit in which they will tell the story of the pharmacies humble beginnings and their success. Lastly, West Cork Pharmacist, Diarmuid O’Donovan has received a lifetime achievement award for his dedication and hard work to the pharmacy profession. Receiving the coveted Liz Herbert Memorial Lifetime Achievement Award, Diarmuid joins an elite few whose efforts and dedication to the profession over their lifetime are adjudged to have been the most remarkable. Page 16.

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CPD: Healthy Aging Feature: Pain and Fever in Children

Grow Revenue in Front of Shop

Upsell OTC products to patients based on their diagnosed conditions

Email us pharmacy@realworldanalytics.com Call us 01 693 1433 Visit us realworldanalytics.com

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Feature: Chronic VS Acute Pain 52

Feature: Sexual Health

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48

Feature: A look at Stoma in Ireland 58

Clinical Profils

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News Pharmacy compelled to pay dismissed news brief pharmacist for annual leave and holidays SAVE THE DATE! The Irish Pharmacy Awards are coming! 12th May will see a celebration of the extraordinary hard work and talent of pharmacists across the country. Entering their 7th year the awards will be held at the Clayton Hotel Burlington, Dublin, and the ceremony will see over 650 of the industry’s most influential professionals, gather to celebrate the success of the top performing individuals and teams within the sector. Irish Pharmacy Award winners reflect the industry’s determination and dedication to enhancing the profession’s status in the wider healthcare circle. Unique in their combined measurement of professional success in innovation, dedication and achievement, the awards are a fantastic way to help your pharmacy business stand out from the crowd and attract new business whilst sending a positive message to existing ones. Launching in our March issue some of the categories included this year are: • Innovation & Service Development (Chain) • Innovation & Service Development (Independent) • Irish Pharmacy Representative of the Year • Respiratory Team of the Year • Community Pharmacy Technician of the Year • Counter Assistant of the Year • Excellence in Diabetes Management • Business Development (Independent) of the Year • Business Development (Chain) of the Year • Baby Health Pharmacy of the Year • Superintendent Pharmacist of the Year • Self Care Award • OTC Retailer Award • Young Community Pharmacist of the Year • Community Pharmacist of the Year • Community Pharmacy Team of the Year

For more information on the Irish Pharmacy Awards and how to get involved this year contact Laura Greenhill laura@ ipnirishpharmacynews.ie or visit www.irishpharmacywards.ie

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The Labour Court has found in favour of a supervising pharmacist who said the pharmacy where she was employed failed to pay her for annual leave and holidays due after she was dismissed from the post. The claimant was employed as a Supervising Pharmacist with the pharmacy from 26 September 2016 to the 7 January 2017 The pharmacist was given notice of termination of her employment on the 7 Dec 2016 owing to a decline in sales. She said the pharmacy was in breach of the Payment of Wages Act 1991 for failing to pay her outstanding wages in respect of days worked on the 28 Dec 2016 and the 2 to 5 Jan 2017. Also, the pharmacist said the pharmacy was in breach of the Organisation of Working Act 2017 for failing to pay any holiday pay. It was estimated that the claimant was due 51 hours in outstanding holidays amounting to ¤1,479. It was submitted that the pharmacy was also in breach of the Act for failing to pay the claimant for public holidays arising during the Christmas and New Year period. The pharmacist clarified that subsequent to the making of the complaint, the pharmacy paid outstanding wages and accordingly this element of the complaint was settled. “On the basis of the uncontested evidence of the claimant I find the complaint with respect to annual leave and public holidays to be

well founded and require the respondent to pay the claimant ¤1,479 for monetary loss for outstanding annual leave and I find that she is owed for three public holidays and I require the respondent to pay the claimant ¤739.50 for the monetary loss arising from same,” according to the Workplace Relations adjudication officer Ms Emer O'Shea.

“I require the respondent to pay the claimant ¤500 compensation for the breach of the claimant’s statutory annual leave entitlements and ¤250 for the breach with respect to public holidays. I require the respondent to pay the specified amounts within 42 days of the date of this decision.”

McCabes cuts the cost of Flu Vaccines McCabe’s Pharmacy, is offering the flu vaccination at the reduced price of €10, lowered from €19, in the hope of assisting with the prevention of spreading influenza and helping people protect themselves from catching the now deadly H3N2 strain. According to the HSE the number of cases of ‘Aussie Flu’, across the country, are on the rise. A "small number" of people have died recently after contracting the type A H3N2 strain. There has also been an increase in the number of patient hospitalisations with influenza, both type A and B. Dr Kevin Kelleher, from the Health Protection department spoke about the deaths stating, "There have been a few deaths already... under 10 people have died so far this year."

With Pharmacists considered part of the frontline of defence against dangerous viral outbreaks, notonly helping patients to treat symptoms but also to protect against getting the viruses, cutting the cost of the vaccine is a move McCabes hopes will have a positive affect on the community. Superintendent Pharmacist, at McCabes Cormac Loughnane commenting saying “We believe we can make a positive impact on take up of the vaccine by offering it to patients at this reduced rate of ¤10, down

from the standard price of ¤19. The service is also available free of charge to anyone in the at-risk groups who also holds a medical card.” “The flu vaccine is the best way to reduce your risk of getting the flu and spreading it to others. We would encourage patients, especially those in the at-risk group, who include elderly people, pregnant women and those with chronic illnesses, to visit their local Pharmacy to get the flu vaccine now.”


News PCRS pharmacy fees for October over ¤34 million A total of €34.251 million was paid in Primary Care Reimbursement Service (PCRS) monthly pharmacy fees in October 2017, according to the latest data from the HSE. The figure brings the total PCRS payments to pharmacies in the first ten months of 2017 to ¤344.112 million. During this period, the largest payment occurred in March (¤35.461 million) while the lowest figure was in February (¤32.717). In terms of the October figures, ¤6.807 million was paid in GMS phased fees, and ¤397,186 was paid in GMS Non-Dispensing Fees. A total of ¤1.420 million was paid in high-tech dispensing fees, while hi-tech non-dispensing fees amounted to ¤292,922. Other high payments during the month were for the Drugs Payment Scheme (¤2.56 million) and the Long Term Illness Scheme (¤3.066 million). Also, the data show that ¤817,319 was paid in methadone fees.

According to the HSE performance report for July to September, the Primary Care Division (PCD) spent ¤2,858 million versus a budget of ¤2,846 million leading to an overall deficit of ¤11.4 million or 0.4 per cent. Core operational services within Primary Care, Social Inclusion and Palliative Care delivered a surplus of (¤6.3m) or (0.8 per cent) year to date with the PCRS showing a deficit position of ¤11 million and Demand Led Schemes having a deficit of ¤6.7 million. The year to date variance showed a once- off benefit relating to time-related savings where anticipated expenditure has not yet manifested. This relates mainly to chronic disease clinical posts, primary care leases and palliative care beds not coming on stream as anticipated. The timing benefit is also masking

cost pressures in core primary care services particularly within medical and surgical supplies, GP training and paediatric home care packages to facilitate complex discharges. Meanwhile, the report also showed that returns of needle exchange packs was 38.7 per cent, which was above target and a 12 per cent improvement on last year. “This may in part be due to a specific Returns Action Plan initiated by the PNEX team in Q1 which included targeted PNEX pharmacy returns training, encouragement of pharmacy to client education on safe sharps disposal/return, distribution of PNEX Returns Bulletins to specific pharmacies outlining how to improve returns and face-to-face outreach work with clients regarding safe disposal and drug related litter,” according to the HSE.

Pharmacists seeking to treat minor ailments without GP Prescription A proposal has been put forward by Community Pharmacists urging the government to introduce a minor-ailment scheme which would allow patients with medical cards to be treated for common illnesses in pharmacies without the need for a doctors prescription. The move would apply to conditions such as dry eye, dry skin, scabies, threadworm infection and vaginal thrush. Similar schemes already operate successfully in other jurisdictions, including the UK according to IPU secretary general Darragh O’Loughlin, would help reduce pressure on the rest of the healthcare system. “the scheme would alleviate pressure on overworked GP’s, who could then see more seriously ill patients who may otherwise find themselves in hospital emergency departments.” The IPU has stated that nearly one million prescriptions a year were filled for medical card holders needing over-the-counter treatments. Currently there are 1.7 million medical card holders in Ireland who need a prescription from their GP to get over-thecounter drugs for free.

A pharmacy based minor ailment scheme was first piloted in 2016 and a report completed at the time showed that 90% of patients and pharmacists deemed the scheme successful. However, the feedback from GP’s was mixed, with some stating it created “fragmentation of care” and others fearing pharmacists may misdiagnose serious illnesses. Mr O’Loughlin commented on the feedback stating “This is a red herring in our opinion, because in the vast majority of cases, minor ailments are not signs of cancer or chronic disease. Also it is incorrect to cite fragmentation of care because it assumes that GP’s will not be at the centre of treatment under the scheme, however they will always be notified by pharmacists.” “Little effort has been made to

Darragh O'Laughlin, IPU introduce an initiative that the public clearly, overwhelmingly want and which would offer immediate benefits. While patients are getting sicker and GP surgeries are getting busier it makes no sense to delay it further.”

news brief PHARMACY CHAIN STAFF RAISE STAFFING CONCERNS Boots Pharmacy staff have raised concerns over staffing levels at the chain. More than a quarter of pharmacists working at the pharmacy chain rate staffing levels so low they deem it dangerous. The findings come after the BBC broadcast a programme containing the results of an investigation conducted by the General Pharmaceutical Council (GPhC) into staffing levels at the multiple in 2016. The programme, looked at the concerns that pharmacists at the multiple had about their enduring workload pressures and how they felt this was endangering patient safety. The Pharmacists’ Defence Association Union (PDAU) previously conducted a poll in which more than 60% of Boots pharmacists said “commercial incentives or targets have compromised the health, safety or wellbeing of patients and the public, or the professional judgment of staff” half the time or more. The issues raised in the show were thought to be relevant to pharmacists wherever they are employed as it also looked at whether regulations should allow pharmacy owners to decide staffing levels. The Pharmacists’ Defence Association Union (PDAU), commented on the programme saying “The documentary makers are focusing on Boots in this programme, though any concerns about the effectiveness of the regulators or government priorities for community pharmacy that are addressed as a result of the broadcast may have positive implications wherever you are employed” Encouraging people to watch the programme before making judgement the PDAU continued “Given experience of previous occasions when the mainstream media has focused on community pharmacy, we recommend you watch the programme for yourself so that you are directly aware of the content. Those who have the power to improve safety and working conditions in pharmacy will have a choice on how to respond to the issues raised in the programme.

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News IPHA Encourage Prioritizing Patients in Brexit Talks The Irish Pharmaceutical Healthcare Association (IPHA) has welcomed a call from a group of organisations representing patients, healthcare professionals and the health care industry to the EU and UK to prioritise patients in the Brexit negotiations. expertise and views on the specific issues the healthcare sector may face on ‘day 1’ of Brexit with policy makers on both sides of the Channel. We urge negotiators on both sides to move to the second phase as quickly as possible and agree on an adequate transition period and future cooperation after March 2019. If not addressed in an appropriate and timely manner, the integrated nature of supply chains for medicines and medical technologies across Europe, and the shared regulatory framework, mean that Brexit will affect the supply, regulatory system and the monitoring of medicines and medical technologies for patients across the EU.”

Oliver O’Connor, CEO, IPHA

Hubertus Cranz, Director General of AESGP: With one week to go to the crunch European Council meeting on Article 50, negotiators on both sides are being urged to progress the process. Natalie Moll, Director General of EFPIA, said that “due to the integrated nature of supply chains for medicines and medical technologies across Europe, and the shared regulatory framework, Brexit will affect the supply, regulatory system and the monitoring of medicines and medical technologies for patients across the EU.” Oliver O’ Connor, IPHA CEO, said: “that it is essential that the concerns of such a wide ranging group on the risks of Brexit on patients and public health across Europe be sufficiently taken on board”. Now a group of organisations representing patients, healthcare professionals and the health care industry have called on the EU and UK to prioritise patients in the Brexit negotiations. To coincide with the EPSCO Council of EU Health Ministers in Brussels, this policy statement comes just one week ahead of

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the crunch European Council meeting where negotiators will decide if the Article 50 negotiations can move beyond ‘phase 1’. It is important to move to the second phase of the negotiations as quickly as possible and agree on an adequate transition period and future cooperation after March 2019. The document outlines five priorities, which the group says will ‘determine the risk in Brexit’s impact on patients and public health across Europe’. These priorities are: • Bring close cooperation between the EU and UK on the regulation of medicines and medical technologies, to ensure that UK and EU patients will continue to have access to life-saving medicines and medical technologies. • Establish a common framework for collaboration in research and information sharing between the EU27 and the UK.

• Ensure that there are continued reciprocal healthcare arrangements between the EU and UK. • Develop strong coordination between the EU and UK on public health, including in pandemic preparation and disease prevention programmes. • Ensure EU and UK health professionals continue to benefit from mutually beneficial training and education opportunities, with automatic recognition of qualifications. Nathalie Moll, Director General of the European Federation of Pharmaceutical Industries and Associations (EFPIA) added:

“The life sciences sector in the EU and UK are completely aligned in seeking future cooperation on the regulation and supply of medicines and medical technologies in the Brexit negotiations. We’ve been working since the day following the UK’s decision to leave the EU to share our

“Self-care products are often the first choice when European citizens face a health issue. Brexit negotiations should make sure that their availability in the UK and the EU are not hampered and that the UK authorities stay in the EU regulatory system as much as possible.” Alexander Natz, Secretary General of EUCOPE said:

“Small and mid-sized pharmaceutical companies provide innovative products to millions of patients in Europe. To ensure that European patients, and especially the most vulnerable among them such as those suffering from rare conditions, continue to benefit from medical innovations, it is imperative that uncertainty is minimised throughout the Brexit negotiations and as much continuity as possible in the regulatory process between EU-27 and the UK is ensured.”


Get your “Sunshine vitamin” (even in Ireland!)

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Did you know that: • Sunlight is our primary source of vitamin D and its very difficult to get an adequate amount from our food alone. • We fail to get sufficient vitamin D because the sun is too weak seven months a year. • An SPF 8 or higher blocks the production of vitamin D. • Vitamin D is important for healthy skin, bones and teeth. • Vitamin D supports the immune system. • Vitamin D helps maintain muscle function. D-Pearls: • Are dissolved in cold-pressed olive oil for optimal absorption. • Come in small, easy-to-swallow “pearls” which are also chewable. • Available in 38ug(1520iu) and 75ug(3000iu). • Made from lanolin – the best organic vitamin D source. Please contact us if you would like more information on D-Pearls Pharma Nord®

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Advertorial Haven Pharmacy recognises excellence at Awards Night 2017 Haven Pharmacy celebrated their 4th annual awards night on Saturday 2nd December in the luxurious Mount Wolseley Estate in Co. Carlow. The Oscars themed night welcomed over 300 guests from both new and longstanding Haven Pharmacies across Ireland as well as many of Haven’s Commercial Partners. This special night reflected the appreciation and recognition for the hard work, dedication, customer service, professional excellence and care demonstrated by all 54 independent Haven pharmacies throughout the Group. A total of nine awards were presented on the night: Haven Digital Media Leader, Haven in the Community, Haven Rising Star, Haven Community Pharmacist, Haven Professional Services, Haven Ambassador of the Year, Haven Customer Service Team of the Year, Haven Pharmacy of the Year and a Special Recognition Award.

Foundation and the Beaumont Hospital Foundation in 2017. Mr. Brennan concluded by extending thanks to all the sponsors for the event: Accord Healthcare, Clonmel Healthcare, GSK Ireland, HMR Ireland, Meda, Naturalife,

Fleming Medical, Parle & Hickey, PCO Manufacturing, Perrigo, PKF O'Connor, Leddy & Holmes Limited, Premium Retail Systems & Design, Reckitt Benckiser, Sam McLernons, Teva Pharmaceuticals, Tonic Consultancy, Uniphar, United Drug and Visualise.

The entertainment on the Awards night was run by Dynamic Events and hosted by DJ Bob Conway. Some of the fun and festivities of the night were captured and posted on Twitter and Instagram under the hashtag #HavenAwards2017.

Haven Pharmacy Award Winners 2017:

Indepharm Co-Op and Haven Pharmacy Chairman Keith Brennan remarked: ‘This event has become the highlight of our year and affords us a chance to celebrate another successful year for Haven Pharmacy. It is also a great opportunity to catch up with old friends, make some new ones and welcome our new members into the Haven family.’ He also thanked all Haven Pharmacy staff for their ‘unwavering dedication to meeting the high standards of care set out by Haven Pharmacy’ and noted the significant increase in fundraising efforts throughout the group for various charities throughout the year. Haven Pharmacy raised over ¤35,000 for local community fundraisers and national charities including the Irish Cancer Society, the Irish Hospice

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Haven Pharmacy of the Year sponsored by Clonmel Healthcare and presented by Tom Farrell: Haven Pharmacy Loobys, Palmerstown, Dublin 20


Haven in the Community sponsored by Perrigo and presented by Niall Faul: Haven Pharmacy Butlers, Birr, Co. Offaly

Haven Ambassador of the Year Award sponsored by Uniphar and presented by Brian Mangan: Janet Davis, Haven Pharmacy Gildeas, Kinnegad, Co. Westmeath

Haven Digital Media Award sponsored by GSK Ireland and presented by Stuart Keegan: Haven Pharmacy Moloneys, Ballyfermot, Dublin 10

Haven Professional Services Award sponsored by Reckitt Benckiser and presented by Zara Crofton: Haven Pharmacy Duleek, Duleek, Co.Meath

Haven Rising Star Award sponsored by Accord Healthcare and presented by Gregg Farrell: Tala Hanke, Haven Pharmacy Hollys, Liosban, Co. Galway

Customer Service Team of the Year Award sponsored by United Drug and presented by Veronica Carragher: Haven Pharmacy Kennellys, Tralee, Co. Kerry

Haven Community Pharmacist of the Year Award, sponsored by Teva Pharmaceuticals and presented by Paul Moran: Suzanne Goggin, Haven Pharmacy Scannells, Bandon, Co. Cork. Suzanne was unable to attend the event and the award was collected by her friends from Haven Scannells

Special Recognition Award: Rowena Kelly, Haven Pharmacy Murrays, Killiney, Co. Dublin

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News news brief PHARMACIST APPOINTED TO ECOMMERCE COMMITTEE

HSE launch new online service to apply for medical card The new service allows people to apply for a medical card online for the first time. Using a step by step guide, people will be able to check their eligibility and scan and upload documents and other information, meaning a GP no longer needs to stamp paper forms.

Pharmacist Paul O’Hea from Inish Pharmacy in Co. Donegal, has been appointed as the new member of Retail Excellence’s eCommerce committee. Delighted by his appointment Paul spoke about his excitement saying “I'm delighted to join the Retail Excellence eCommerce committee this year. At Inish Pharmacy we always strive to be progressive and have embraced developments in the world of online retail. The committee includes some of Ireland's leading online retailers and I am looking forward to learning from and contributing to the group over the coming months." Retail Excellence’s Deputy CEO, Lorraine Higgins, also spoke about her happiness and the value she believes Paul will bring to the committee “I am delighted to welcome such a quality addition to the Committee. Paul will bring key insights from the pharmacy sector which added to his individual skillset, wealth of ability and experience will perfectly complement our existing members”. “I have no doubt Paul will make a valuable contribution in shaping and developing future plans, direction and policies in tandem with existing members of the Committee”. Lorraine also went on to talk about the work the committee will be doing in the next year saying “We have much planned for the remainder of this year and in the longer term to try and resolve the huge issues facing retail. It is testament to the strength of our organisation that we can call on the quality and advice of our eCommerce members to come up with solutions to the challenges facing with us. With the rapid development of online shopping, it is an exciting time to be working with the committee.”

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Along with the launch the HSE released the 6 benefits of the new online service: 1. The online system guides you through each step of the application process. 2. Applicants can submit all supporting documentation digitally, including photographs of relevant material.

Anne Marie Hoey, Assistant National Director, HSE Primary Care Reimbursement and Eligibility

440,000 applications were received by the National Medical Card unit in 2017. It is believed the new streamlined will bring a welcome array of benefits in terms of turnaround times as well as security. Anne Marie Hoey, Assistant National Director, HSE Primary Care Reimbursement and Eligibility spoke of her delight at the announcement and explained the service will be able to be used via any smartphone, tablet or computer “I am delighted to

announce that people aged 16 and older will be able to apply or renew their medical card eligibility using our new online service using their computer, tablet or mobile phone. The launch of the National Medical Card Online Service makes it as easy as possible for people to apply for Medical eligibility. This great new development brings considerable benefits for people in terms of turnaround times, convenience and security. Applications that are fully completed will be processed within 15 working days.”

3. Your GP will be able to accept you onto their panel via the online system. 4. If needed to be contacted about their application, the online system will email the applicant instead of writing to them. 5. When the applicant submits their financial details as part of the online application, the system will tell the applicant straight away if they qualify for a medical card. Complete applications will be processed in 15 working days.

Paracetamol suggested for relieving sore throats instead of antibiotics Healthcare professionals in England are being told that they should be encouraging patients to use paracetamol for a sore throat rather than antibiotics. Evidence found from the National Institute for Health and Care Excellence (NICE) suggests that most sore throats are triggered by a viral infection and most people will get better without antibiotics. NICE says healthcare professionals should help people to manage their symptoms with pain relief, such as paracetamol or ibuprofen. Some adults may wish to try medicated lozenges containing either a local anaesthetic, a nonsteroidal anti-inflammatory drug (NSAID) or an antiseptic. However, they should be told these may only help to reduce pain by a small amount.

Dr Tessa Lewis, GP and chair of the managing common infections guidance committee, said: “A sore throat can be very painful, making you feel tired and unwell for about a week. But in most cases antibiotics will not make much difference. Instead, we should drink plenty of fluids and rest. “Paracetamol can help to relieve pain and control temperature. Medicated lozenges might not reduce the pain by much, but some people may choose to use them.” Professor Gillian Leng, deputy chief executive at NICE, added: “The evidence shows antibiotics

are not an effective treatment for the majority of sore throats. People who need them should be given them, and our advice will support those decisions. But it is clear that routine prescribing in all cases isn’t appropriate. “We are living in a world where bacteria are becoming resistant to antibiotics. It is vital these medicines are protected, and only used when they are effective The recommendations come after the ‘Sore Throat guideline was published as part of the NICE ‘Managing Common Infections antimicrobial prescribing guideline series.


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News

Myth-busting at virtual conference on unlicensed medicines Pharmaceutical and biotech companies under more pressure than ever to maximise the potential of their asset throughout the entire medicine lifecycle and provide patient access to medicines outside the clinical and commercial environments.

INDUSTRY CHALLENGES

Rising costs of R&D

These demands raise multiple challenges at each point of access, spanning the lifecycle from early access to market exit. With this in mind Clinigen has hosted a virtual conference; Unlicensed Medicines: Addressing Access Challenges Across the Lifecycle. A number of industry peers heard expert speakers share their experiences and give real world insights from pharmaceutical and biotech companies who have provided access to their medicines at various points in the lifecycle. The conference covered a wide range of themes including Early Access Strategy, Providing Early Access to a Promising New Therapy, Providing Access to Post Trial Patients and Enabling Global Access in Late-to-Launch and Non-Launch Markets. Rob Fox, head of Business Development – Managed Access at Clinigen, shared the following blog ‘Busting 5 common myths around access to unlicensed medicines’. Rob Fox, Head of Business Development – Managed Access There are some common misconceptions or myths regarding providing access to unlicensed

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Need to demonstrate value

Launch success

medicines that I hear on a regular basis in my global business development role at Clinigen. Here are a few I most frequently hear and thought it would be worth sharing. Myth #1: “Access to an unlicensed medicine only occurs during the early stages of a medicine’s life” Reality: Access to an unlicensed medicine can actually happen at any time during the medicine’s lifecycle. Initial demand is driven at the early stages of a medicine’s life, prior to first global approval or alongside early commercial roll-out, with Health Care Professionals (HCPs) trying to gain access in countries where it is not yet licensed. However, the medicine may remain unavailable or unlicensed for many years in some countries where there are significant launch delays or indeed no commercial activities planned at all. In a number of cases we see medicines that were first launched 10-15 years ago still being accessed as an unlicensed medicine in various parts of the world providing a vital lifeline to patients. It is therefore important that controlled and compliant ways to address this need are in place throughout a medicine’s lifecycle.

Maximising access

Myth #2: “Unlicensed medicines are only made available for life threatening or fast progressing diseases” Reality: Of course the history of unlicensed medicines is closely linked to fast progressing life threatening diseases, however, we also see HCPs wanting to gain access to unlicensed medicines for many other disease areas. For example, a large amount of unlicensed medicines are for the treatment of slow progressing chronic inflammatory or neurological conditions where there might be a ‘treatment window of opportunity’ that can be addressed by an unlicensed medicine. The overriding factor here is not the disease type, but whether the treating physician feels an unlicensed medicine is more appropriate to treat their patient than licensed alternatives, whether the treatment is life saving, life extending or life enhancing. Myth #3: “Pharma companies need to review and approve every patient that gains access to their unlicensed medicine” Reality: Sure – if the medicine is very ‘early’ in its lifecycle then the pharma company are going to want to have control over the type of patient being treated with

their medicine via a set of specific eligibility criteria and may want to approve some patients on a case-by-case basis – typically those who do not meet all the criteria. However this is the pharma company’s decision, not a mandate. As the medicine moves through the life cycle and starts to become commercially available in some markets, these eligibility criteria tend to be relaxed to the point where eventually, they are removed entirely, and it is purely the treating physician that deems whether the medicine is appropriate for their patient. Myth #4: “You cannot collect real world data when providing access to an unlicensed medicine” Reality: You can collect data when providing access to an unlicensed medicine and in fact there is a view that if you are providing access to an unlicensed medicine then you should be capturing some data. Moreover, the type of data that can be collected can be more than top-level access data and actually fall into the ‘real world’ bracket including clinical data that help identify how the medicine is working in the real world. Once again the earlier the medicine is in the life cycle the more data that is typically collected which could form the missing piece of the jigsaw when trying to demonstrate the value of a medicine to payors and HCPs. Myth #5: “We can’t tell HCPs that you are making an unlicensed medicines available” Reality: It is important that if HCPs are proactively seeking information about access to an unlicensed medicine that this information is both easy to find and helpful. There is no benefit to having a compliant and controlled route to supply an unlicensed medicine if this information cannot be easily accessed and there are many, compliant ways to ensure communication does not become a barrier to access. In fact the 21st Century Cures Act actually mandates industry to provide information about their stance on providing access to unlicensed medicines in a publically available place such as their website.


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News Cara Pharmacy Charity Challenge to take place for 8th year The annual Cara Bundoran Challenge, brainchild of Canice Nicholas, Joint Director of Cara Pharmacy, will take place in the picturesque town of Bundoran, Co. Donegal. The event which takes place over the weekend of the 9th – 11th of March 2018, attracts participants from all over the country and further afield as it is one of the first major running events of the calendar year. The route featuring some of the nations breathtaking scenery, takes place on the Saturday morning with the 10K and 10 mile runs.

and are expecting this year to be as popular as ever. As a result of its popularity we have made the decision to cap the amount of participants at 2,500 to ensure the comfort and safety of everyone. Each year is a learning experience and we have taken the lessons learned from this year’s event and implemented them into next year’s plan.

Speaking about the success of the Cara Run, Cara Pharmacy joint director Canice Nicholas said “We can’t believe it’s year 8 already and that the event has come round again so quick. We are delighted to be organising it once again

The Cara Challenge will also continue its tradition of benefiting charities both local and national. Canice adds ‘Last year over ¤20,000 was given to 4 charities as a result of proceeds from the event and we’re confident that

this year the same amount can be reached if not surpassed. The Charities chosen for this year is The Alzheimers Society Ireland, The Irish Hopsice Foundation and Local Charity St. Agnes Day Centre located in neighbouring Donegal Town.

Registration is now open on the website www.carabundoranrun. com with a significant increase in numbers on last year to date.. All registration will be done online for the event with no registration on the day of the event.

Retail Excellence Announce New Chairperson Retail Excellence, recently confirmed the appointment of JP Kennedy, Managing Director of TileStyle, to the position of Chairman which will run for a two-year term. Kennedy’s appointment. He said: he “would bring a vast array of skills, experience and knowledge of the Irish retail industry to the role. He has diligently served on the board of Retail Excellence for a number of years and I look forward to continuing to work with him during a really exciting year in the organisation’s history.”

JP Kennedy, Managing Director, Tilestyle Mr Kennedy’s Appointment follows the expiration of Colm Carroll of Carroll’s Irish Gifts term.

CEO of Retail Excellence, David Fitzsimons thanked the outgoing Chairperson and welcomed JP

Speaking about his appointment JP Kennedy said “It is an honour and a privilege to be Chairman of Retail Excellence and I look forward to supporting all the Retail Excellence team, in particular David Fitzsimons and our Deputy CEO Lorraine

Higgins. We have some really significant events and projects planned this year, including the coveted Retail Excellence retreat and expo in May of this year which is a must attend event.” Mr Kennedy has already celebrated great success with Retail Excellence after his business beat some tough competition to retain the title of “Home Interiors Store of the Year” for the second consecutive year, at the 2018 Retail Excellence awards.”

Government launch Health Ireland 2018 Campaign The government are encouraging people to make healthy changes in 2018 and have launched the Healthy Ireland campaign. The campaign which seeks to encourage people to make positive choices to improve their physical and mental health, provides are resource to support and offer information to help people make healthier choices. The three positive steps which the campaign are focused on includes three key areas: • Eating more healthily • Being more active

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• Minding our wellbeing Speaking at the launch of the campaign Taoiseach Leo Varadkar said “The message of the Government’s Healthy Ireland 2018 campaign is simple; Small steps can make a big difference to your health, you just need to start. And while this may not always be easy, when you do make the healthy choice, it's always the right one. I'm encouraging everyone to get involved, by making the small

changes needed to improve your health and your family’s health. That could mean including a walk in your daily routine, making healthier choice at meal times or taking a break from your phone to give your mental health a boost. These positive and sustainable changes can help us all build a healthy Ireland.” Minister for Health promotion Catherine Byrne added “This campaign has huge potential to

get into homes in every community and help individuals and families make those changes that people want to make, but which everyday struggles make harder to do. By tapping into existing partner initiatives and supports, we can work together to deliver clear, consistent messages and resources which will have an impact on the health of families and communities for the rest of their lives.


News news brief MELLERICK’S PHARMACY TO SHOWCASE RETAIL EXCELLENCE SUCCESS Retail Excellence Pharamcy Group are hosting a case study visit to Mellerick’s Pharmacy, Fermoy, County Cork. The Pharmacy which again took the title won Pharmacy of the Year 2018, will be opening its doors for an in-depth visit to the store which will tell the story of the businesses success and feature a number of presentations. At the time of winning the award store owner Orla Mellerick spoke about how the awards were ‘very prestigious’ and that the nomination was ‘great for staff morale’. She added: “We thank all our loyal customers from over the years plus all the new customers that this beautiful new shop has brought through its doors.” Starting at 10.30 on 27th February, the event will feature a presentation from the pharmacies directors Seamus McEvoy and Mike McCarthy, who will unfold the story of the pharmacies success. The event will also feature a presentation from Sam McCauley Chemists CEO Tony McEntee who will discuss “The view of the Irish Pharmacy Sector now and into the future” and Lorraine Higgins, Deputy CEO, Retail Excellence who will discuss “Delivering for the retail industry in 2018”. Promising to be an interesting insight into how the success of the pharmacy business has taken shape, the event is open to all Retail Excellence Pharmacy Members and costs ¤60, which includes access to all aspect of the visit and lunch. For those members who wish to travel, an agreed rate has been agreed with the near by Montenotte Hotel, Middle Glanmire Road, Montenotte, Cork.

Meagher’s charity campaign set to exceed ¤70,000 Meagher’s Pharmacy is set to smash through the €70,000 mark in its most successful ever charity campaign. So far the pharmacy chain has raised a whopping ¤68,031.62 for their charity partner the Peter McVerry Trust. The 97-year-old company exceeded its target of ¤50,000 set at the end of November as part of the #WrapUpHomelessness campaign. The feat was accomplished through the organisation of a number of different events including Beauty for Breakfast in the Gibson Hotel with Tara O’Farrell, Aimee Connolly & Mark Rogers; a Christmas Market run in association with TV3’s XPOSE; and an official sponsored ‘Sleepout’ on Baggot Street in December. Raffles, auctions, bake sales and carol singing were just some of the events organised locally raising large amounts of money that contributed to the overall donation. With some events still upcoming, such as a ‘Shave or Save’ sponsored beard shearing, the expected total will exceed ¤70,000. Many Irish celebrities joined forces with Meagher's to help raise awareness through their social media platforms or through attending events. A very successful auction was held at the Beauty For Breakfast event with pieces donated by some of Ireland’s top celebrities such as Pippa O’Connor Ormond, Ellen

Kavanagh Jones, IMAGE.ie editor Melanie Morris, as well as venues such as The Marker Hotel, The Shelbourne Hotel, The Dylan Hotel and Carton House. Snapchat celebrities such as James ‘Patrice’ Butler, Tara O’Farrell and Mark Rogers raised money through their Snapchat through a variety of sponsored dance-offs and through promoting the text line.

There was an increase of 20% in the number of homeless people in Ireland in 2017. The figures showed that 8,347 people were registered as homeless in September of last year. The campaign’s aim was to raise enough money to give someone the gift of a home.

Lifetime achievement award for Cork Pharmacist Diarmuid O’Donovan, a pharmacist from Skibbereen, West Cork has been awarded a lifetime achievement award for his contribution to the pharmacy profession. Awarded the coveted Liz Herbert Memorial Lifetime Achievement Award, which is presented to those whose efforts and dedication to the profession over their lifetime are adjudged to have been the most remarkable, Mr O’Donovan has been a registered pharmacist since 1977. Noted as a key part of the community, Mr O’Donovan has built a reputation for himself as a dedicated and generous healthcare

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Oonagh O'Hagan, Owner and MD of Meaghers Pharmacy and Glenda Gibson, Model and Television Presenter, TV3 Xpose

professional, often going the extra mile to help his patients. His strong commitment to community pharmacy led Mr O’Donovan to become involved with the IPU and culminated with his election as president of the union in 1996. Still a trustee of the IPU, he oversaw the rollout of a new GMS contract and the formal state funded CPD for pharmacists. Described as a man of utter integrity, honourable, fair, patient,

thoughtful and considerate, Mr O’Donovan has always aimed for the highest professional standards in his pharmacy and has fostered an environment of life long learning for his staff. Whilst the main running of the pharmacy is done by Mr O’Donovan’s son Derry, Mr O’Donovan still steps in to help out from time to time.


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News

Nation’s Self Care Success lies in Community Pharmacy A new report published by the IPU and the IPHA, is promoting increased levels of self care in Ireland which would lead to a more efficient and effective system of healthcare. The report which sets out a range of proposals for a more focused approach to self care could lead to better patient outcomes and considerable savings for the state. Statistics from the report show that 92% of people like to be involved in decisions about their own health and medication and 80% of people view pharmacists as a key partner in maintaining their health. “Embracing a philosophy of self care can lead to real, measurable savings in healthcare expenses and better outcomes for patients. Pharmacists can play a critical, expanded role in this area, utilising our accessibility and professional capabilities to benefit patients in partnership with our healthcare colleagues and the pharmaceutical industry.” Said Darragh Connolly, President of the Irish Pharmacy Union. The campaign supporting the report promotes self care as a “healthcare philosophy in which the role of community pharmacists is pivotal to the successful development of.” Dave Barrett, Chairman of the IPHA Consumer Healthcare Division, commented saying “As well as the obvious benefits for individuals in taking a greater role in maintaining healthy lives, adoption of self-care principles could also help the State manage the financial challenges of an ageing population and strained healthcare budgets. The Government is clearly committed to encouraging people to take more control of their own health, as set out in the Healthy Ireland strategy. Our industry is committed to working with healthcare professionals, especially pharmacists who are often the first port of call for health information and advice, to support consumers to identify

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Darragh O'Loughlin, IPU, Dave Barrett, GSK & Chairman, IPHA Consumer Healthcare Division, Daragh Connolly, IPU and Oliver O’Connor, IPHA

the most appropriate channel within the healthcare system.” The IPHA Consumer Healthcare Division Strategy Board of which Mr Barrett is Chair of represents the consumer healthcare manufacturers and suppliers of OTC medicines in Ireland and is made up of a number of retail pharmacy industry professionals from companies including, Bayer Consumer Healthcare, Johnson & Johnson, Pfizer Consumer Healthcare, Perrigo and A Menerini GSK and RB. “In coming together I believe we really can make a difference in helping consumers to take a greater role in maintaining healthy lives and in the event of illness seeking advice from the most appropriate channel within the healthcare system, which in many cases will mean pharmacists who are often the first port of call for health information and advice”

Recommendations

Minor Ailment Scheme

A number of recommendations made within the ‘Self Care Taking Charge of your Health’ report include:

Amongst the recommendations in the report the development of a minor ailment scheme was highlighted. Such a scheme would enable medical card patients to receive treatment for common illnesses free of charge.

• Expanding the role of the pharmacist including the free treatment of common illnesses to medical card patients through the establishment of a pharmacy-based Minor Ailment Scheme. • The range of medicines made available to patients should be expanded through switching. • Patients should have access to good-quality, trustworthy information so that they can seek care at the appropriate level and, thus, enhance their independence within the healthcare system. • Patients should know that self care means access to high-quality, safe and effective products.

Research done by the IPU revealed that an overwhelming 96% of people would be in favour of pharmacists being able to prescribe some medicines for minor ailments. Pharmacists are in the ideal position to treat routine ailments. A minor ailment scheme would facilitate prompt treatments of ailments, improving quality of life for patients, alleviating pressures on GP surgeries and also preventing unnecessary use of accident & emergency and out-of-hours GP services. Although no economic studies have been carried out as yet in


Ireland, other studies have been carried out in the UK to measure the aggregate cost savings of using OTC medicines for the most common self-treatable conditions and their results are relevant to Ireland. It is estimated that up

to 18% of general practice workload relates to minor ailments at a cost of ÂŁ2 billion annually. Media Interest The campaign is also attracting interest from other areas of the

media as well, such as FM104 radio station who interviewed Darragh Connolly (IPU) at the launch. The radio station has a listenership of 335k per week and the extra publicity will be sure to help the campaign reach people and encourage them to

take charge of their healthcare and let them know that Community Pharmacy is the key to the successful development of Self Care and its evolution.

Dave Barrett, GSK & Chairman, IPHA Consumer Healthcare Division

John Sheehy, Perrigo, Dave Barrett, GSK, Johnny Murphy, A Menarini Ireland and Brendan McLoughlin Johnson & Johnson

Aidan Walsh, Allcare Pharmacy and Catriona Bradley, IIOP

Aoife Grimes, Will O'Brien, and Caroline Connaughton, RB Ireland

Rory O'Donnell Pharmaceutical Society of Ireland, Nial Byrne Pharmaceutical Society of Ireland and Avril Ryan Pharmaceutical Society of Ireland IPU

Marese Damery, Irish Heart Foundation and Pamela Logan Irish Pharmacy Union IPU

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News Pharmacy First Aid Company donates AEDs to Irish Red Cross Fleming Medical, owners of Medicare, producer of a pharmacy confined First Aid brand has recently donated 10 Cardiac Science Powerheart G5 AEDs (Automatic External Defibrillators) to the Irish Red Cross as part of their 3-year partnership agreement. Cardiac Science’s Powerheart G5 AED is the only AED in Ireland that combines variable escalating energy for customised patient therapy, it also has faster shock times and real time CPR feedback which is key in emergency situations. The 3-year agreement is in its 2nd year and includes a range of Medicare & Irish Red Cross branded First Aid Kits plus a cobranded range of Plasters & Dressings. Danny Curran, Head of Fund Raising & Commercial Services for the Irish Red Cross said ‘We are delighted with this sizeable donation of AEDs as they are a crucial piece of equipment that we carry in our mobile units in case of cardiac arrest throughout the Irish Red Cross branch network in Ireland’. Fleming Medical’s Managing Director Mark Fleming added “Our Medicare partnership with the Irish Red Cross has delivered over 65 Family First Aid Workshops to over 1,200 family members in pharmacies nationwide in 2017. We would like to thank the Irish Red Cross for their good work by donating 10 of our market leading Powerheart G5 AEDs which we hope will save many lives in emergency situations in the future’.

Danny Curran, Head of Fund Raising & Commercial Services for the Irish Red Cross & Mark Fleming, Managing Diector, Fleming Medical

Pharmacist Resource celebrates its first year anniversary Pharmabuddy.ie is celebrating its first year anniversary with over 2,200 Irish pharmacists registered using the service. The company’s mission was to create a pharmacist friendly resource online that helps pharmacists at all stages of their career. An online resource full of useful information for pharmacists, the core services Pharmabuddy offers are: • Private discussion forums where pharmacists can share problems or concerns • An education section with video tutorials on a range of different

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topics which helps pharmacists keep up to date on a number of topics and with their CPD requirements. • A communications section which keeps pharmacists up to date on any communications that they should be aware of from the pharmaceutical industry and the PCRS. Commenting on its anniversary, company founder Dr Paul Ryan said: “We have come a long way in

our first year and really appreciate the support of our colleagues. We are in a very privileged position to have a team of 15 experienced pharmacists with us to help solve everyday queries of pharmacists. We are very much looking forward to bringing new features to our members in 2018.” Being a pharmacist, GP, IPU academy tutor and peer support pharmacist at the IIOP, Paul uses his depth of knowledge and

experience previously working in both primary and secondary care to develop Pharmabuddy’s CPD material. PharmaBuddy.ie is only open to pharmacists and pharmacy interns and is not open to the general public. For more information contact Dr Paul Ryan at support@pharmabuddy.ie.


News Mobilising the Microbiome against the Coming Plague of Anti-Microbial Resistance Resistance to antibiotics (antimicrobial resistance; AMR) is a global health threat and poses serious challenges for Irish and other national health systems. However, solutions are emerging. APC Microbiome Ireland, a world leading Science Foundation Ireland Research Institute, based at University College Cork and Teagasc, is at the forefront of research using bacteria and viruses found in our gut (the microbiome) to treat serious infections. International researchers gathered in Cork recently to discuss the latest developments, particularly those focusing on mobilising the microbiome. Each year more than 700,000 people across the world die from infections that are resistant to current antibiotics, and by 2050 drug-resistant infections will take an estimated 10 million lives per year. The economic cost of lost global production caused by antimicrobial resistance will amount to approximately $100 trillion between now and 2050 if it is not tackled. Ireland has a relatively high rate of antimicrobial resistance in human health compared to most European countries, and ranks above the EU average for consumption of antibiotics in the community. “There is about one new case of carbapenemase-producing enterobacteriaceae (CPE) found in Ireland everyday” said Martin Cormican, National Clinical Lead for Health Care Acquired Infections and Anti-Microbial Resistance and keynote speaker at the conference. “Antibiotic resistant bacteria, sometimes called superbugs, are already causing serious illness, shortening lives and increasing health care costs. If we do not manage these better than we have in the past, antibiotic resistant bacteria mayundermine the sustainability of the entire healthcare system. “CPE was declared a public health emergency in Ireland on 25th of October 2017 but so far, about 3 months into this emergency, we are not making progress as quickly as we need to if we are to control this.” The increasing number of bacterial species resistant to antibiotics is both inevitable and predictable, so with increasing amounts of data we can and must start to plan for

the future and to develop new strategies to prevent the spread of AMR, and alternative therapeutics to treat antimicrobial resistant infections. “Broad spectrum antibiotics, which target a broad range of bacterial species, cause collateral damage to the gut microbiome, which is so important to health, and also generate resistance in non-target species with implications for human health” said Colin Hill, APC Microbiome Ireland, UCC. “We are at the forefront of research mining the human microbiome to develop new narrow spectrum antimicrobials that only kill the target species. These will limit resistance in non-target species and the resulting damage to human health. We are also developing live therapeutic bacteria, bacteriophages (viruses which kill bacteria) and faecal microbiota transplants as alternative therapeutics to antibiotics.” “The use of antibiotics in Ireland during the period 2012 to 2016 continued to rise and Ireland, along with Belgium and France, is a higher consumer of antimicrobials relative to other EU countries” said Stephen Byrne, Head of School of Pharmacy, UCC. “Irish studies have reported the overuse of antimicrobials in primary care, even when clinicians deem their use to be unnecessary, and have reported that clinicians feel pressurised by patients to prescribe antimicrobials.” • Broad spectrum antibiotics damage the bacteria in our gut and can generate resistance in non-target species with significant implications for human health. • Bacteria and viruses in the human gut are a source of new narrow spectrum antimicrobials. • APC Microbiome Ireland is at the forefront in developing new treatments to replace broad spectrum antibiotics. These include narrow spectrum antimicrobials derived from bacteria and viruses in the gut, as well live bacteria, bacteriophages (viruses which kill bacteria), fungi and faecal microbiota transplants.

Stephen Byrne, Head of School of Pharmacy, UCC

Graham Rook, University College London, pointed out the importance of hygiene as an effective anti-microbial strategy and contrary to the so-called ‘hygiene hypothesis’ he showed that ancestral microbes or ‘old friends’ are necessary for training and development of the human immune system. “The public health message on antibiotics needs to be refined. In addition to minimising unnecessary and inappropriate use, the public needs to know that broad spectrum antibiotics damage beneficial as well as harmful bacteria. “Moreover, mobilising the microbiome will have a central role in future strategies against infections” said Fergus Shanahan, Director of APC Microbiome Ireland, and Chief Clinical Director of the HSE South/Southwest Hospital Group. APC Microbiome Ireland (APC; http://apc.ucc.ie) is a world leading research institute which was formed in 2003 with funding from Science Foundation Ireland

and in conjunction with key industry partners. It represents a seamless collaboration between University College Cork and Teagasc (the Irish Agriculture and Food Development Authority). It is widely recognised that the gut microbiota plays an important role in human health and has become one of the most dynamic, complex and exciting areas of research in both food and pharmaceutical arenas. Over the last decade the APC has established itself as one of the leading global centres in gut microbiota research. The APC has made several landmark discoveries and has published over 1,700 research articles in peer-reviewed journals, generating many journal covers and associated editorials. The APC comprises over 300 individuals, from the scientific PI’s (the APC Faculty) funded by the partner Institutions, the management team, and a dedicated group of research scientists, research assistants and postgraduate students.

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News HSE will fund painless blood sugar testing More Irish children and adolescents with diabetes will be able to monitor their glucose levels using an innovative needle-free technology after the government agreed to fund it. The Abbott Freestyle Libre system uses a sensor to monitor sugar levels instead of a traditional finger prick. Simon Harris, the health minister, announced that the cost of the product, which starts at ¤169.90, would be reimbursed by the HSE. It will be available to children between the ages of four and 17 only. Blood glucose levels are measured by a small patch that is worn on the upper arm for two weeks. The monitor is held against the patch and records the most recent blood sugar reading. It is pain free and takes less than a second. The system holds data on glucose readings for 90 days, and is able to chart whether levels are increasing or decreasing. It is available for children with type 1 and type 2 diabetes. Minister for Health Simon Harris welcomed the HSE’s decision to reimburse Freestyle Libre for children and young adults Minister Harris said “Almost 190,000 people in Ireland have diabetes. This is a chronic disease that takes a lot of management, but we have made huge strides in treating and managing diabetes here and I’m very happy today to welcome the HSE’s decision to reimburse Freestyle Libre for children and young adults.” “This innovative device will allow blood glucose levels to be monitored without invasive finger prick testing, which will be very welcome news for both parents and children. I know that some patients have to test their glucose levels up to ten times a day and I hope that inconvenience and discomfort can be minimised for as many children and young adults as possible.”

“This is another very positive step in the management of diabetes, along with the Diabetes Cycle of Care, which is a great example of how joined-up primary care and expanding the scope of general practice can be so effective in reducing hospital visits and admissions. The Cycle of Care allows adult patients with Type 2 Diabetes, who hold a medical card or GP visit card, to be managed in the community, by their own GP and practice nurse, rather than in a hospital clinic.” “We know from the National Healthcare Quality Reporting System (NHQRS) that hospitalisation rates that have decreased substantially for diabetes, and I want to see that downward trend continue. My Department is progressing more work in the area – the National Clinical Effectiveness Committee (NCEC) prioritised the

development of a Diabetes Type 1 clinical guideline for adults during 2017. The HSE’s National Clinical Programme for Diabetes plan to complete this guideline and submit to the NCEC for quality assurance early this year, and I hope to see it published soon after.” “The HSE will now make arrangements for the reimbursement of Freestyle Libre on an individual basis where specific criteria are satisfied in line with the recommendations of the Health Technology Assessment Group and I look forward to its being available for patients in the coming months.” An Expert Group, under the auspices of the HSE’s Health Technology Assessment Group, has considered the Free Style Libre application by Abbott for addition to the Reimbursement List in line with the Health (Pricing and Supply of Medical Goods) Act 2013.

The Health Technology Assessment Group recommended that reimbursement for the device should be considered, subject to certain conditions (see here for further information). The HSE has accepted its recommendations in principle and will be developing an application suite for hospital clinicians to use when proposing suitable patients for consideration of individual reimbursement support. This will be confined to children and young adults who require multiple dose injections of insulin in the first instance, with a review after twelve months. The HSE has indicated that it will take some months to build the application suite for reimbursement support which will be endocrinologist / Hospital Clinic initiated.

Pricing Agreement between Government and IPHA comes under criticism The Framework Agreement on the Supply and Pricing of Medicines introduced in July 2016, is said to have a” serious negative impact on profit margins” according to pharmaceutical company Roche. The agreement between the Department of Health and the Irish Pharmaceutical Healthcare Association (IPHA) promised the Government more than 750 million in savings over the four years of the deal. However, there has been criticism of the accord, with the Healthcare Enterprise Alliance claiming that it fails to deliver the best value.

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Statistics from Roche’s company accounts show that the deal would hurt products when the full impact of the agreement would be felt. A representative from Roche commented These measures have a serious negative impact on profit margins as these losses to the top line flow straight to the bottom line,”

The company also added that other drug firms were “continuing to experience significant delays in the reimbursement of products,” adding that this had caused the launch of new products to be delayed with a knock-on effect for both the company and patients. Roche’s other main Irish subsidiary, Roche Ireland Limited,

reported a ¤78.5 million pre-tax loss last year after booking a ¤130 million writedown on its Clarecastle manufacturing plant in Co Clare in 2015. The company is currently trying to find a buyer for the facility and has said to be intending to proceed with plans to close the plant by 2019.


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OBESITY –

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modern,

mismanaged

&

misunderstood malady – By Dr. Heli Goode, MD, Naturopath

CPD 87: INTEGRATIVE MEDICINE; CONCEPTS OF HEALTHY AGING As published in Positive Health Online – Issue 232, August 2016 a growing and serious health concern that has, by Biography - Dr. Heli Goode,Obesity ARH, isSOH, TCM, specialised in Ear, Nose & now, reached epidemic proportions, mostly in the Westernised Throat surgery in her native Estonia before starting her complementary practice world. Increased consumption of unhealthy food coupled with in England nearly 20 years ago. She integrates naturopathy, homoeopathy, decreased physical activity, in part, has led to rising obesity acupuncture, hypnotherapy rates and over traditional Chinese Medicine. She is available for the past three decades. The WHO (World Health consultations from her clinics in Leicester and Harley Street, London. Dr. Goode Organisation) reports that since 1980, worldwide obesity ratesis a lecturer for holistic medicinal practices. have increased by almost 200%. By the end of 2015 nearly 2.3

billion adults were reportedly overweight and 700 million of these obese. Obesity has been linked to certain cancers, diabetes and may shorten the human lifespan bybased eight to ten years.1 Welcome to the Continuing Professional Development Module. CPDcardiovascular is mandatorydiseases, professional requirements for pharmacists. Journal A grim prediction by theand government suggests that obesityThis will module continue can to rise up toin50% education programmes are an important way of keeping up to date with personal clinical professional development. be -used your personal learning log and can be completed in the magazine orofonline byand completing thewill reflection questions at the end Youwill canhave women 60% of men be overweight by 2050 and up of to the 25%module. of children 2 also track your progress of you development by going to www.pharmacynewsireland.com/cpdtraining where you can register to record your learning. weight issues by that indicated timeframe.

Who is classed as overweight or obese?

INTEGRATIVE MEDICINE; CONCEPTS OF HEALTHY AGING In our Western climate, more people than ever before are living into their advanced golden years, hoping to enjoy fulfilment and active retirement. Improved lifestyle, a stronger constitution in pregnancy, good healthcare and education during both childhood and adult life is leading to a more vitalised and happier older generation. Increased life expectancy with a better quality of life is a result of significant advances in technology and medical progress. According to the UK’s Department of Health, the number of people aged over 65 has more than doubled since the 1930s. An average man in the early 1950s was expected to live to the age of 77; today we can expect it to rise to 86. By 2050, the average life span is expected to reach 91. However, despite so many of us living longer, healthier lives, we are still exposed to some worryingly growing problems with age-related challenges, social issues, toxicity and medical conditions. It is reported there are 15,000 people aged 100 or over in the UK needing social acceptance, more attention and improved healthcare.1 Those of us who are lucky enough to live well into our eighties or nineties, or even receive a birthday card from the Head of State, will inevitably develop some sort of age-related wear and tear problems, which, due to their characteristics, generate specific categories of social responsibilities and duties for the next generations. LONELINESS One of those issues is loneliness. The Nobel Prize winner Mother Teresa, who herself lived to the respectable age of 87, said that: “Loneliness and the feeling of being unwanted is the most terrible poverty”. It is defined as “an individual’s personal, subjective sense of lacking

Reflection - Is this area relevant to my In the 17th Century, a Belgian mathematician and astronomer, Lambert-Adolphe-Jacques practice? What is your existing knowledge Quetelet, became fascinated in possible of numerical links area? between different human any body parts. the subject Can you identify knowledge in the topicinarea? After some calculations he concluded that by taking agaps person‟s weight kilograms (kg) and dividing it by the height in meters (m2),Planning it would -give specific numerical figure which is Willathis article satisfy those unique to every individual. He termed knowledge it the Body Mass to gaps Index or will(BMI) more which, readingaccording be some experts, expresses the correlation required? between the bodyresources weight, coronary insufficiencies, What are available? cholesterol level and expected lifespan. Even though the BMI does not take into account the Action - After reading differences in people‟s ethnic background, ethnic characteristics and the way some the article complete the summary desired affection, closeness, and social individuals store fat, in clinical practice it is still a widely used method for assessing questions at www.pharmacynewsireland. interaction with others…loneliness is more weight/health-related issues. A greater BMI leads to aand greater riskyour of learning developing cocom/cpdtraining record dependent on the quality than the number for future usefigure and assessment morbidities such as type 2 diabetes. Anyone‟s BMI of more thanin25your indicates “the 2 of relationships”. Older people are personal log. and is classified as overweight.3 In level at which there is a significant increase in mortality” especially vulnerable to this characteristic. our healthcare system it is a key factor in deciding whowill qualifies surgical weight Evaluation - How you putforyour learning into practice? reduction procedures.4,5

It is estimated that more than half of I identifiedMeasure further learning British people over age of 75 live on Manythe clinicians prefer the Waist Have Circumference to BMIneeds? - a simpler their own and even though living alone anthropometrical measure which is “also a criterion for the metabolic syndrome”. A waist does not necessarily meanofloneliness, measurement more than 35 inches (88cm) for women and 40 inches (102cm) for men overall cognition. Being lonelyit,fuels according to Age UK, over a million people indicates a significant health risk.3 Still, however we weigh or measure obesity and its general insecurity, anxiety, low moods, over 65 feel lonely. The Department related conditions are costing the healthcare system nearly £6 billion annually. It is estimated 6 andyear. in many cases, that cost will have risen tohopelessness £50 billion per single of Health finds it tobybe2050 as the damaging depression with further decline of mental as smoking 15 cigarettes per day and 1 health. People with a high degree of more dangerous than being overweight loneliness are twice as likely to develop or obese.2 Loneliness, with its multiple Alzheimer’ disease suggests key statistics emotional and physical aspects, is a more from the charity’s review.2 complex issue than may be perceived and fully understood by healthy, younger MALNUTRITION and vibrant generations. For anybody living their life to its full extent, it is almost This very common problem may develop impossible to imagine themselves one as a result of oral or dental issues – caries, day as old, fragile, needy, ill, and, in a periodontal diseases, tooth loss, mouth worst-case scenario, forgotten by their ulcers or oral cancer. Amongst our elderly families and friends. society, diminished nutrition may also be caused by restricted access to food, poor Elderly people who previously lived an active family and social life, with additional meal choices, a lack of knowledge about healthy eating, socio-economic situations, roles of building up a successful career, poverty, physical limitations and mental often feel left out, useless and without a health issues. Individuals, especially those specific purpose in life once they retire or who are housebound or those who eat the family departs the nest. Some find it difficult to admit that they feel isolated and poorly, are prone to inferior nutritional cut off, especially if they experience issues states. An estimated 9% of elderly people feel trapped in their own homes and about advancing age and declining health can 6% of those questioned leave their homes bring. Age UK reports that 41% of people once a week or even less.2 aged 65 and over feel out of touch with the pace of modern life and 12% say they feel cut off from society.2 One of the consequences of a lack of regular outdoor activities and sunshine, combined with an already poor diet, is Persistent loneliness can cause a loss vitamin D deficiency. This lack of vitamin of motivation, physical and emotional resource in the elderly community is a confidence, low self-esteem and selfworrying health problem, with signs of neglect, which typically involves poor depression, tiredness, memory lapses, diet, hygiene and ill health. It cruelly muscle weakness, bone pains, frequent affects mental capacities including infections, hypertension, cardiovascular, language skills, verbal expressions and


CPD 87: INTEGRATIVE MEDICINE; CONCEPTS OF HEALTHY AGING respiratory and kidney problems presenting as possible symptoms. These common indicators also mask other potential health concerns, misleading medics and delaying correct diagnoses. In the UK, approximately 11.8 million of people aged 65 or over are deficient in vitamin D. The principle source of this vitamin is produced when the skin is exposed to sunlight, with additional sources coming from food such as fatty fish, beef liver, egg yolks or shiitake mushrooms. In the elderly, there is a general naturally-decreased ability to synthesise vitamin D from the sun. Combined with reduced hours spent outside and a lower absorption rate from the digestive tract and/or poor food sources, this can lead to above mentioned health issues. However, sufficient amount of vitamin D helps to preserve muscle strength, bone health, mobility and retain independence as long as possible. Inactive and bedridden patients can rapidly lose muscle mass, power and mobility. They also experience slower recovery time.3,4 Reduced levels of vitamin D can also contribute to cognitive impairment in the elderly. Dr Dale Bredesen, an expert in the mechanisms of neurodegenerative diseases such as Alzheimer’s disease, believes malnutrition is a significant and neglected health concern.5 ALCOHOL According to Susan Davidson and Phil Rossall ofAge UK, the three top concerns of older people are body pain, loneliness and memory loss. As a result, some people from this category may turn to alcohol consumption as a solution to deal with these concerns.2 Findings suggest that an estimated 1.4 million people aged 65 and over are currently exceeding recommended drinking limits. Loneliness and consequent social isolation seem to be both cause and symptom of problematic drinking. The vicious circle suggests, due to the devastating effects of alcohol, more older people are now estranged from families, friends and neighbours. In a case of inability or reluctance to leave the house, drinks are delivered directly to the household by off-licence services or in some cases, provided by carers, to make the consumer more manageable.6 It is a common concern that alcohol use and abuse among our older population can be hidden - disguised by sympathetic family members, misdiagnosed or just conveniently ignored by society. Alcohol misuse, as we all know, affects

everyone, irrespective of age or gender, but tends to affect geriatric drinkers more severely due to their overall health, medical conditions and relevant medications. Women drinkers can easily become addicted at lesser consumption than men in general. Alcohol abuse puts seniors under increased risk of physical traumas, including domestic and road accidents, making them regular visitors to an already-stretched A&E service.7 Chronic ill health means a portion of the elderly may rely on medications, which can be sometimes over-prescribed or taken inappropriately. Doctors in general tend to prescribe benzodiazepines for age-related chronic pain, anxiety, insomnia, depression and isolation but the risk of drug dependence increases with age. It is also more pronounced in depression and already-established alcohol dependence. Mixing alcohol with benzodiazepines is especially dangerous, causing depressive effects both on the brain and the nervous system. Overall tolerance to alcohol and benzodiazepines decreases with age, making this group of users vulnerable to issues from both of these highly addictive substances, including deepening mental health concerns, various traumas and general ill health.8 In summary, loneliness and social isolation can make certain groups of elderly people especially vulnerable and prone to alcohol misuse in later years. Geriatric drinkers are more likely to drink at home on their own, often successfully hiding away their habits from family members, friends and healthcare providers. However, the devastating health effects of alcohol, combined with everyone’s individual life story and circumstances, may leave the elderly estranged from their families and support, or become easy targets for drug/alcohol suppliers, adding further concerns to the situation of loneliness and deteriorating health. COGNITIVE IMPAIRMENT AND DEMENTIA Mild cognitive impairment (MCI) affects between 5-20% of individuals aged 65 and over who present with a set of symptoms rather than a specific disease or dementia. A person with MCI may experience mild concerns regarding memory, daily planning, problem resolving, reasoning, attention, language and visual depth perception. However, these people are likely to develop Alzheimer’s disease as, over the time, their cognition, memory and brain capacity tends to deteriorate gradually. It is important to mention that symptoms of impairment may

have specific causes other than purely psychological, such as acute or chronic infections, constant pains, on-going stresses and worries – all of which should be taken into consideration before labelling with MCI. However, findings suggest that about 10-15% of patients with MCI develop Alzheimer’s disease each year. It is estimated that one in four over the age of 85 is affected by dementia.9 Alzheimer’s disease is the most common cause and also thought to be better understood than other forms of dementia.10 Alzheimer’s disease is a neurodegenerative progressive disorder, often called a disease of the twentieth century, caused by amyloid deposits in the brain, and can be particularly evident in the cerebral cortex and hippocampal areas. Clinical signs of Alzheimer’s disease are believed to be caused by several factors, such as cholinergic imbalances due to the reduced activity of choline acetyltransferase and the neural dysfunction of choline.11 People with familial Alzheimer’s disease possess specific genetic predispositions to developing Alzheimer’s, even as early as during the fourth or fifth decade of life, linking it to the body’s ability to metabolise the amyloid precursor protein. Keele University Professor, Christopher Exley, a leading scientist in the research of toxic elements and mental health, discusses the fact that increased absorption of aluminium from the digestive tract with consequent accumulation of it in brain tissue are predisposing the person to genetic mutations in the metabolism of APP, leading to the development of Alzheimer’s. So far, it is understood that there are several potential contributory factors and conditions in the development of dementia. However, this study shows that pathological deposits of aluminium in brain tissue cause genetic mutations with devastating effect on those affected.12 The first signs of onset dementia can be easily misdiagnosed by medics and may relate to many other factors such as lifestyle choices, levels of stress, tendency towards anxiety and depression. This can lead to delays in diagnosis and relevant support for sufferers. Forgetfulness and other memory lapses affect all of us from time to time. However, the main symptoms to look for are problems with short-term memory, following and understanding conversations, finding it difficult to choose the correct word, difficulty with simple mathematical calculations, daily planning, easily getting lost in previously familiar environments, repeating questions and sentences without realising it. Clearly it is a very destructive and devastating disease, cruelly progressing and damaging previously healthy minds and bodies.5


CPD 87: INTEGRATIVE MEDICINE; CONCEPTS OF HEALTHY AGING sense for the elderly to keep rooms heated and food warm, using spices like turmeric, black pepper, ginger and cinnamon in cooking.14

SENSORY IMPAIRMENT Apart from declining mental states in old age, there are also other areas of the body causing concerns and disabilities like hearing and vision loss. Such symptoms greatly contribute to a feeling of being cut out from today’s life. Loss of vision due to diabetes, glaucoma, cataracts or macular degeneration disease causes sensory impairment and social isolation in the same way as loss of hearing. Worldwide, nearly half of people over 65 suffer from some degree of hearing impairment. Approximately 180 million individuals are affected by visual disabilities. 13 HOLISTIC WAYS IN ANCIENT DAYS Human beings have always searched for ways to extend one’s life span. Longevity means living longer but to do that it is necessary to slow down the natural aging process. Aging cannot be avoided, but can be decelerated according to ancient Chinese medicine traditions. Why and how we age is still a hot topic among scientists. However, aging as a part of life is closely connected to the immune system and immune responses of the whole body. As soon as immunity is impaired, the survival of the body is in jeopardy. Immune deficiencies make the body more susceptible to various diseases and therefore accelerate aging. Western medicine’s understanding of immune deficiencies greatly differ from traditional Chinese medicine viewpoints, where immune deficiencies, aging and the length of the whole life are associated with the health and vitality of the kidneys. In TCM (traditional Chinese medicine), philosophy believes a person’s longevity is directly connected to their kidney Qi (energy) which is initially inherited from their parents. It doesn’t focus on the immune system as a separate entity.

Inheritance of a strong kidney essence forms a basic core health foundation, provided the person himself maintains healthy kidney energy. This can be done through wholesome, nutritious food, exercise, a happy and active mind, rest and where appropriate, supportive kidney tonics. The process of aging accelerates when the kidney energy has been wasted carelessly. The best examples of kidney energy robbers are the demands of our modern environment; prolonged mental and physical overexertion, stress, inadequate rest and sleep, nightshift work and poor nutritional choices. The foods which deplete the kidneys are refined, sugary foods, alcohol and cold, fizzy drinks. Historical scripts confirm that many Chinese emperors, great philosophers and scholars took kidney tonics in a form of foods or herbs to live a longer, healthier life. Joerg Kastner, author of ‘Chinese Nutrition Therapy’ explains that chronic illness, independent of the organ network involved, always weakens kidney energy. He recommends venison, lentils, walnuts, black sesame seeds, oats, millets, oysters and lobsters, root vegetables, asparagus, spinach, carrots, leeks, onions, garlic, ginger, black pepper as foods that generally strengthen kidney energy. “Venison is an excellent tonic for the kidney network, which is primarily suitable for the cold season diet”.14 Kidneys are responsible for movement and elimination of water waste. A condition like dehydration, a common problem among elderly patients, combined with another frequent disorder, diabetes, depletes kidney energy, complicating and accelerating overall deterioration of health. In Chinese medicine the kidneys are known as the fire of life. They are also very sensitive to cold weather, cold environment and cold food. As older adults naturally feel cold, it makes perfect

According to TCM principles, the kidney energy is not only related to the urogenital system, but also to bone structure, hearing and the mental capacities. It is noticeable in conventional healthcare that common age-related diagnoses are indicative of weak or dysfunctioning kidney energies. Consider urinary infections, incontinence, prostate issues, impotence, degenerative arthropathies, rheumatoid arthritis, cognitive decline, impaired hearing, tinnitus and mental health concerns such as chronic anxiety disorders and depression; all potential age-induced conditions. Even though many TCM teachings may not be regarded by all healthcare professionals in our present day, it is highly possible that as time goes by, we are becoming more willing to accept certain ideas and prove their validity, especially if that means improved quality of life for the patient. Dr James Pickett, Head of Research at the Alzheimer’s Society, recently suggested a healthy diet rich in essential nutrients, combined with regular exercise and avoiding smoking, can help to reduce the risk of developing dementia.10 Poor detoxification of harmful chemicals is also strongly associated with neurodegenerative processes, including aging, indicating the importance of the liver and its sulphoxidation processes, a function of binding sulphur to a toxin to promote its removal from the body.11 HEALTHY AGING; A PREVENTION CONCEPT Even though aging is commonly associated with multiple social, health and mental problems, some of them, to a certain extent, may be entirely preventable by developing and supporting a Healthy Aging attitude. The World Health Organisation (WHO) is promoting such an initiative, hoping to present a more positive and modern perception of growing old. It would be revolutionary to future healthcare paradigms to encourage integrative measures which foster “the ability of people of all ages to live a healthy, safe and socially inclusive lifestyle”. In an solution-based approach, where programs take a closer look at cellular health and the body’s overall environment, complementary measures such as food supplements, herbs and homeopathy can help contribute to the beneficial impact on an increasingly-sick society.


CPD 87: INTEGRATIVE MEDICINE; CONCEPTS OF HEALTHY AGING Cultivating these ideas in safe and measured environments, such as local health clinics or pharmacies, will undoubtedly promote healthy lifestyle choices and better management of ill health. For those approaching or on the cusp of the senior spectrum; the initiative will help avert chronic illnesses or complications and help prevent agerelated physical or mental restrictions. The concept also emphasises the importance of individual responsibility for one’s own lifestyle, management and possible prevention of diseases through healthconscious behaviour, focusing on staying independent for as long as possible, developing resilience, maintaining good health and finding a role or purpose in later life. Significant well-being improvements also come from physical exercises and outdoor activities, further helping delay the onset of many diseases. Regular activity helps our older population stay independent, build up resilience and maintain happier moods. Benefits of exercise also include the reduced risk of developing diabetes, obesity, heart diseases, certain cancers and bone troubles.3 “Fitter older adults have better cognitive function, with even gentle exercise helping to reduce stress, ease depression and anxiety, and enhance well-being”.13 Later in life, emotional wellness is as much important as physical wellness. Feeling valued, respected and loved is a basic human need, contributing to higher self-esteem and self-worth. It encourages open and honest communication and helps retain contact with the younger generation. The third aspect of healthy aging is mental activity. Learning something new helps to increase or maintain self-esteem, develop skills and encourages social interaction. Mentally challenging activities, such as learning a new language or participating in general knowledge quizzes are all recommended pastimes, as they keep minds active. In Scandinavian countries, music and other art therapies are highly recommended for the older population. Significant improvements in cognitive functions with early stages of dementia have been noticed with daily supplementation of ginkgo biloba extract and acetyl-L-carnitine.11 A healthy nutritious diet is fundamental to good health at any age. Lots of attention is paid to obesity concerns, but malnutrition is a serious risk for older people. Several studies have demonstrated that mental health and cognitive capacities are directly

related to nutritional intake. It is found that patients with dementias of all types are deficient in folic acid, vitamins B6 and B12. High homocysteine levels increase Alzheimer’s risk and these vitamins, especially in combination, help to keep homocysteine levels down.11 In addition to that, evidence shows that oxidative stress and a lack of essential omega-3 fatty acids play important roles in the development of Alzheimer’s. For the older generation, it is recommended to eat at least two servings of fish per week with a general diet rich in vitamin C and E and sufficient high-quality antioxidants. These support mitochondrial function and presenilin despite genetic predisposition.11 The Mediterranean diet has found to be beneficial, however, there are concerns about aluminium toxicity. Sources of such toxicity include antacids, antiperspirants, aluminium cookware, foil food wrap and canned drinks. Aluminium absorption is decreased by magnesium intake. Foods rich in magnesium are root vegetables, whole grains, nuts and seeds.5,11 Aging is inevitable. How we all age is down to us - our knowledge and acceptance of it, attitudes, education, lifestyle choices, activities, nutrition, but also genetics and circumstances beyond healthcare and ourselves. It is vital to take responsibility for our own well-being well before we start to see our bodies slow down. There is a plethora of both learning and teaching opportunities, which could easily cushion the road to old age, and the time to prepare future senior citizens is now. REFERENCES 1. 2010-2015 Government Policy: Older People; www.gov.uk

2. Evidence Review: Loneliness in Later Life; www.ageuk.org.uk 3. Dr Denise Taylor. Physical activity is medicine for older adults. Postgraduate Medical Journal; Volume 90, Issue 1059. 4. Helen M. Barker. Nutrition and Dietetics for Health Care. Churchill Livingstone. 2002. 5. Dr Dale Bredesen. The End of Alzheimer’s. Vermilion, London. 2017. 6. Working with Older Drinkers; alcoholresearchuk.org. 7. Jenny Rogers, Bonnie S. Wiese. Geriatric Drinkers: Evaluation and treatment for alcohol overuse. BCMJ, Vol.53, No.7, September 2011. 8. Olivera J. Bogunovic, Shelly F. Greenfield. Practical Geriatrics; Use of Benzodiazepines Among Elderly Patients. Psychiatric Services 2004 55:3, 233-235. 9. Pamela Holmes. The Case for Healthy Ageing; Why it needs to be made. Help the Aged. 2009. www.ageuk.org,uk. 10. www.alzheimers.org.uk 11. Joseph E. Pizzorno Jr. Michael T. Murray, Herb Joiner-Bey. The Clinician’s Handbook of Natural Medicine. Churchill Livingstone. 2008. 12. Prof. Chris Exley. Aluminium: Alzheimer’s Disease, Time to test the link. www.futsci.com. 13. Healthy Ageing Evidence Review; www.ageuk.org.uk. 14. Joerg Kastner. Chinese Nutrition Therapy; Dietetics in Traditional Chinese Medicine. L.Ac. Thieme. 2004.


Awards The OTC and Pharmacy Retail

Product Awards 2018

The OTC & Pharmacy Retail Product Awards showcase the best in product innovation, marketing and value in retail pharmacy. The Awards recognise the achievements of manufacturers and distributors who bring new products and services to the market, and celebrate the sector in the pharmacy industry which is consistently growing. OTC medicines account for 16% of the total pharmaceutical market and the sector is a key source for business expansion and competitive edge, with recent statistics stating that the total sales value of OTC drugs amounted to ¤3.11 billion for the year 2016/2017. The OTC Product Awards represent those leading the way in innovation in areas such as product function and design. A carefully selected panel of industry expert judges from across the country will draw on their own extensive and varied experience and the material submitted to assess each product. The products entered will each be discussed and evaluated in detail using a unique scoring system, to decide the winning entries. Our industry expert panel of judges represent the most knowledgeable decision makers

in the industry, with independent pharmacy owners and OTC buyers from chains, symbol groups, cooperatives and buying groups included in the panel. The winners of the awards will be announced at the OTC Product Awards annual ceremony and dinner on the 1st March at the Radisson Blu Hotel, Dublin. The winner of each category will be showcased in the April edition of IPN. The products shortlisted over the next 18 pages have been entered into the awards by suppliers who have real belief in their brands and have invested in continuous product development, training, marketing initiatives and promotions, both to consumer and to trade. Ongoing support from suppliers demonstrates the level to which they value community pharmacy and ensures that pharmacy teams have the means to maximise the potential in front of shop sales.

• Hair and Scalp Product

• GI Product

• Eyecare Product

• Beauty Product

• Women’s Product • Product Launch

• Best Product Training Children’s (Medication/Supplements)

• Best Marketing Initiative

• Children’s Product

• Most Innovative Product

• Best Men’s Product

• Best In-Store Promotion

• Travel Product

• Pharmacy Only Medicine

• Allergy Product

• Irish Pharmacy Brand

For more information on the awards, contact Natalie Millar natalie.millar@ ipnirishpharmacynews.ie

• Pain Relief Product • Cold and Flu Product • Oral Health Product

This year’s categories include: • Pharmacy Only Product • Natural Product • Natural Infant Product • Skincare Product • VMS Product

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The OTC & Pharmacy Retail Product Awards Pharmacy Only Product Biofresh Acne Out ACNE OUT was introduced to the Irish market in 2015 by Biofresh Skincare and is now recognised as one of the best treatments available in many pharmacies. The patented formula of the ACNE OUT series provides adequate care for skin prone to acne and oiliness, blackheads and enlarged pores. The active ingredient has powerful antibacterial action which eliminates the main cause of the condition (Propionibacterium acnes) The integrated system of our 3 PROVEN STEPS is designed to work together for maximum effectiveness. Excellent results can be expected in 70% to 90% of cases within the first month. ACNE OUT is proven, tested and designed by leading Dermatologists.

Carnation Footcare Carnation Footcare, leaders in innovative foot-care products with over 90 years expertise have a comprehensive range of solutions, including licensed products, to almost any foot problem. This trusted Pharmacy only brand has seen growth of 14% over the last 3 years and is a customer favourite renowned for its reliability, allowing you to recommend to your customers with confidence. Our feet play an important role, supporting our body weight allowing us maintain balance, walk and run in comfort, on occasion our feet need protection, support & cushioning, so ensure your feet stay healthy with Carnation Footcare.

Eucerin UreaRepair PLUS Lotion 10% Very dry skin can look and feel tight, red, rough, flaky and itchy. When skin is dry, its ability to bind in moisture and prevent moisture loss is impaired. Eucerin UreaRepair PLUS Lotion 10% Urea gives extremely dry, itchy and flaky skin the daily care it needs. The formula contains Urea, Ceramide and other Natural Moisturising Factors(NMFs) which bind moisture in and restore skin as natural protective barrier to prevent further moisture loss. Clinically proven to deliver immediate relief and intense moisturisation, delaying the symptoms of both extremely dry and very dry skin for up to 48 hours. Skin feels smooth and supple. Suitable for those with Xerosis, Diabetes, Psoriasis and Keratosis Pilaris. Also for adjunctive care.

First Response Early Results Pregnancy Test The only brand that can tell you 6 days sooner than your pissed period. Read results in just 3 minutes. Discover your pregnancy with the rapid accuracy of the First Response Pregnancy Test, boasting a 99% accuracy from the day of your expected period, First Response delivers a ‘first to detect’ technology that is able to detect minute amounts of the HCG hormone as early as six days prior to your missed period. Through the deliverance of rapid results, it empowers mothers to be to commence early prenatal care ensuring the optimal health and support for both the mother and the growing baby.

Uriage Bariéderm CICA Cream Uriage Bariéderm CICA Cream UriageBariéderm Repairing CICA-cream a first aid product that provides fast healing and immediate relief and prevents scarring for the entire range of cuts, perfect also for minor surgeries and procedures. This Repairing CICA Cream is a velvety cream that is easy to massage in for a quick absorption. In clinical studies, this cream decreased redness by 85% in 21 days, immediately relived pain and improved healing. It is the perfect repairing cream for everyday minor skin ailments for the whole family. All Uriage products are made with Uriage Thermal Water, which is 52 times richer than any other Thermal Water available.

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Natural Product Alflorex Alflorex contains a unique probiotic, Bifidobacterium longum 35624. It’s native to the human gut and is part of the family of bacteria given by mother to baby at birth. In clinical trials of people with IBS, this natural live culture was shown to reduce all symptoms of IBS and have a safety profile comparable to placebo. It can be taken with anti-spasmodics, anti-diarrheals, laxatives & products containing peppermint oil. It’s produced in a pure formulation, with no added bulk yoghurt or animal cultures. Allergy and gluten free. Suitable for vegetarians and those on a low FODMAP diet.

Cell Nutrition Quinton Isotonic Quinton Isotonic is a 100% natural mineral supplement. It contains 78 minerals and trace elements, created by plankton in unique parts of the earth’s oceans and combined with carefully chosen spring water to match the concentration of elements within your blood and extra-cellular fluid, maintaining the correct pH. 7.2. It helps to rebalance and repair the cells to stimulate the immune system and boost the body’s defences against infections. It provides your cells with the perfect environment to thrive and achieve optimum function. Suitable for everyone of all ages including those who are pregnant or breastfeeding and 100% safe for all as it can be taken alongside medication, and poses no risk of side effects.

Eskimo-3 Advanced EPA New Eskimo-3 Advanced EPA with vitamin D3 provides high levels of Omega-3 fatty acids EPA and DHA, plus 800 i.u of vitamin D3 in a One-a-Day capsule. Omega-3 fatty acids are essential, they cannot be synthesised in the body and must be obtained from food. Omega-3 is vital for maintaining general health, heart health, brain function and vision. Vitamin D3 is essential for strong bones, a healthy immune system and muscular function. Eskimo-3 Advanced EPA with vitamin D3 is ideal for those looking to support focus, performance and recovery. Stay Everyday Healthy with Eskimo-3.

Solgar Wild Alaskan Full Spectrum Omega Wild Alaskan Full Spectrum™ Omega is Solgar’s premium blend of pure, wild Alaskan Sockeye salmon oil, providing the Full Spectrum™ of omega fatty acids (omega-3, 5, 6, 7, 9), plus Vitamin D3, astaxanthin and rosemary extract. Two softgels provide 2400mg of pure, wild Alaskan Sockeye salmon oil (supplying 202mg of EPA and 180mg of DHA) derived from sustainably-caught fish from the pristine, cold waters of Alaska. Our fish oil undergoes a cold filtration purification process to remove impurities such as heavy metals, dioxins, PCBs and pesticides.

ZinCuFlex ZinCuFlex is an innovative food supplement containing Ginger, Curcumin and vitamin C. Ginger and Curcumin (the active part of Turmeric) are well known for their benefits for Joint Health. Ginger is an extract which helps to maintain joint mobility and avoid morning stiffness. Curcumin helps to control inflammatory responses in the body, helps to protect joints and helps to maintain joint flexibility. ZinCuFlex uses a patented complex, to improve absorption by up to 100 times compared to ordinary curcumin, making it more bioavailable and therefore more effective. Whatever your passion… Get Moving with ZinCuFlex!

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The OTC & Pharmacy Retail Product Awards Natural Infant Product MyPro Colicare MyPro Colicare contains a clinically proven probiotic called Lactobacillus rhamnosus GG. This treatment comes in the form of sunflower oil droplets and is administered with the infants first meal. Lactobacillus rhamnosus GG has been shown to reduce daily crying rates significantly as well as having many other beneficial effects in creating a healthy symbiosis and intestinal flora. In today's westernised world with the modern diet and increased commonality of Caesarean section, many infants are deficient in healthy bacterial gut flora causing severe intestinal discomfort and decreased digestive capacities. This is believed to heighten colic symptoms signifying the need & benefits for an intervention like MyPro Colicare.

Elave Sensitive Baby bath Elave sensitive Baby bath 400ml (Ecocert certified) 20% organic and 99% Natural Allergan free formula enriched with Organic Aloe Vera and Organic Camomile. 99% of the total ingredients are from Natural origin, 20% of the total ingredients are from Organic origin. Elave baby bath is a clinically tested extremely gentle cleanser enriched with organic camomile and organic aloe vera to protect and hydrate baby delicate skin. Natural and Organic Cosmetic certified by ECOCERT Greenlife according to ECOCERT standard. Clinically proven to be kind and mild to dry sensitive skin. Dermatologically approved. Opthalmologically tested and proven to be kind to eyes. Paediatrician approved from Newborn.

Multi-Mam The Multi-Mam range includes; Compresses; a natural product to successfully treat and prevent sore and irritated nipples for breastfeeding mums, prevent mastitis and are totally safe for babies and mums. Containing the unique ingredient 2QR-complex which effectively neutralises harmful micro-organisms naturally and supports the healing process. 2QR Complex is from plant derived polysaccharides. Multi Mam Balm protects nipples before, during and after breastfeeding, containing vegetable oil and squalene (essential part of human sebum), winning the National Parenting Product Gold Award for Breastfeeding 2017. New Multi Mam Lanolin contains hypoallergenic, medical grade pure natural wool fat, prevents cracking and keeps skin soft, replacing the natural skin fat which is removed by breastfeeding.

Mustela Vitamin Barrier Cream 1 2 3 The Mustela Vitamin Barrier Cream 1 2 3 has been specially formulated with 98% natural ingredients to prevent, relieve and to repair irritations and redness such as nappy rash, with unequalled effectiveness and a unique combination of patented active natural ingredients. Extensive clinical studies prove this is the ONLY nappy cream effective against all the causes of redness and pain, and has a higher protection action than any competitor. Avocado Perseose, a patented natural ingredient, reinforces the skin barrier and protects stem-cell reserves. Mustela - Skincare Expert and number 1 brand in Europe for Babies, Children and Mothers for over 60 Years.

Stérimar Baby Made from 100% natural sea water, the Stérimar children’s range harnesses nature’s power to clear stuffy tiny little noses, relieve discomfort and allow your little one to breathe naturally, so that they can get on with their busy life. Suitable from birth, Stérimar Baby’s effective solution is gentle enough to use as part of your baby’s daily routine to help unblock tiny little noses, also used to help prevent the onset of colds, this wonder spray can also improve breathing to facilitate sleep and bottle or breastfeeding. And don’t forget; babies cannot blow their noses!

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Skincare Product Biofresh 3 Steps For Healthy Glowing Skin Probiotic technology in skincare is proven to reduce cellular damage and activate cellular renewal, with recent studies showing that their health promoting effects include powerful skin health benefits. Topical application of probiotics also helps strengthen natural skin defences, lower the stress level in the skin and re-balance the skins PH balance. Our yogurt probiotic was synthesized from living bacterial cells of Lactobacillus Bulgaricus and isolated using high-tech processes. The 3 STEP promo kit includes: 1.Probiotic Ultra Delicate Cleansing Milk 2.Toner Rose Water 3.Probiotic Collagen Expert Day Cream. Products can be purchased individually, an eye and night cream is also available in the same range.

E45 Cream See medicines.ie for full product description

Eucerin Aquaphor Wound Care Ointment Eucerin Aquaphor Wound Care Ointment is clinically proven to accelerate skin regeneration to aid the healing of extremely dry, damaged or irritated skin. This water-free, paraffin-based formulation helps the skin to heal faster by creating the ideal wound healing environment. The active ingredients Panthenol and Bisabolol are also both clinically proven to accelerate skin regeneration, with Glycerin to moisturise and strengthen the skin barrier. It is also recommended for skin care use in Xerosis, occupational dry skin, and is gentle enough for use on babies (excellent for soothing nappy rash). Eucerin Aquaphor Wound Care Ointment is well tolerated, gentle, non-acnegenic, non-comedogenic, odorless, and free of fragrances, colorants, alcohol and preservatives that could cause irritation or contact dermatitis.

Skin Republic Face Mask The Skin Republic facemasks are a range of sheet masks for all skin types. Made in South Korea, these spun lace masks are soaked in serum to provide effective and instant results. The range includes a Spots and Blemish mask, a Collagen Infusion mask, a CoQ10 + Caviar mask, Hyaluronic Acid + Collagen, Brightening Vitamin C mask and a Bubble Purifying Charcoal mask.

Uriage XĂŠmose Emollient Milk Uriage XĂŠmose Emollient Milk moisturises, protects and soothes irritations on your face and body, making it the ideal skincare product to have in your bathroom for all the family to use. Contains patented Chronoxine which soothes the skin right away, protects the skin while reducing dryness and the feeling of tightness. Perfect for use any time of the year, with up to 24-hours of moisture and is easy to spread, even on areas covered in hair or on scaly skin. All Uriage products are made with Uriage Thermal Water, which is 52 times richer than any other Thermal Water available.

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The OTC & Pharmacy Retail Product Awards VMS Product MyPro Forté MyPro Forté is a supplement which contains a targeted & diverse range of probiotic species & strains. This product is designed to promote general well being by strengthening immunity, improving GI function and promoting digestive health. It is suitable for the whole family and comes in an easy to take capsule.

Cell Nutrition Quinton Hypertonic Quinton Hypertonic is a 100% natural mineral supplement which contains 78 minerals and trace elements, created by plankton in unique parts of the earth’s oceans, and is already bioavailable meaning your cells can absorb it immediately. This unique, natural formula nourishes your cells for optimum cellular health as it contains all the minerals and trace elements that your cells require in organic, bioavailable form. The ideal support for the body and mind during any type of stress that uses up vital trace elements more quickly than normal. The composition of Quinton Hypertonic provides your body with a more rapid remineralisation that people find very energising as well as enhancing cellular nutrition. It is therefore beneficial to those prone to fatigue, those with a busy or stressful lifestyle.

Solgar Omnium Omnium is Solgar’s most advanced multivitamin and mineral formula that is rich in phytonutrients, antioxidants1 and contains chelated minerals. Unusually for a multinutrient formula, Omnium also contains CoQ-10, antioxidants1, alpha-lipoic acid, quercetin and proanthocyanidins and polyphenols, which provide broad spectrum antioxidant support. Plus niacin, pantothenic acid, Vitamin B6 and Vitamin B12, all contributing to normal energy-yielding metabolism. As well as riboflavin and folate, which contribute to the reduction of tiredness and fatigue 1 Vitamin C contributes to the protection of cells from oxidative stress.

Seven Seas Perfect7 Prime Experts at Seven Seas developed Perfect7 Prime to focus on 7 key needs – energy, bones, vision, collagen formation, hair, skin & nails, brain support and heart - for 50+ men and women to help them live life to the full in their prime years. The formula, unique in the 50+ vitamins market, consists of a comprehensive gender specific multivitamin and Omega-3 capsule boosted with collagen. With a blend of Natural Source Marine Oil with Omega-3 plus essential multivitamins and minerals, the special gender specific formula provides effective absorption of nutrients tailored to a 50+ woman’s body's cells.

Revive Active Revive Active, the Irish super food supplement, is a high-quality blend of 26 active ingredients delivered in one convenient sachet. The unique blend of vitamins, minerals and amino acids provide a multitude of health benefits which include naturally sustained energy, without the use of sugar and caffeine, as well as contributing to a normal immune system. The inclusion of L-Arginine and Coenzyme Q10 further improves Revive Active’s ability to enhance energy, vitality & support a healthy immune system in users. Suitable for vegetarians, vegans and gluten free, Revive Active is the best source for increased natural sustained energy, improved immune system function and heart health.

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Hair and Scalp Product Batiste Dry Shampoo Batiste Dry Shampoo is a dry shampoo formula that refreshes your hair between washes, leaving it feeling gorgeously clean and fresh with added body and texture, no water necessary! Batiste Dry Shampoo is the quick and convenient way to get soft, clean and fresh smelling hair. Batiste offers an instant fix by revitalizing greasy, dull and lifeless hair. Batiste thickens thin fly-away hair and adds texture and body for that easy style solution. Simply spray it on and comb it out.

Uriage D.S. Lotion Uriage D.S. Lotion is a Dermatological treatment product for flaky scalp. The lotion eliminates dandruff and thick scales, while soothing itching and irritation. The D.S. Lotion elimates skin flakes by using Cade Wood essential oil. The lotion also calms itching sensations by targeting scalp irritations with Uriage’s patented TLR2-Regul Technology. The skin and scalp are left purified and cleansed, thanks to deep-cleansing active ingredients and Uriage Thermal Water. All Uriage products are made with Uriage Thermal Water, which is 52 times richer than any other Thermal Water available.

Eucerin DermoCapillaire Eucerin DermoCapillaire CALMING UREA SCALP TREATMENT is specifically designed for people with a dry and itchy scalp. Its non-sticky leave-in formula delivers hours of intensive moisture to your scalp, and soothes and reduces itchiness from your first use. It actively relieves your scalp from the microinflammations that cause dryness and itching to significantly improve its condition and restore its natural moisture balance.

Eyecare Product Brolene The complete Brolene range helps treat minor eye infections including:-Bacterial conjunctivitis, Blepharitis and Minor eye irritations such as styes. The Brolene’s action helps stop the bacteria growth causing the eye infection. The Brolene range offers two formats and both can be used by all the family: -Brolene 0.1% w/v Eye Drops solution with Propamidine Isetionate and Brolene 0.15% w/w Eye Ointment with Dibrompropamidine Isetionate.

MacuSAVE MacuSAVE is a once a day, easy to swallow; food supplement, which provides advanced nutrition for the eyes. Enriching the macular pigment and enhancing its protective qualities with ALL three key macular carotenoids, Lutein Zeaxanthin Meso- Zeaxanthin to improve macular function and limit the debilitating effects of Age Related Macular Degeneration.

Optrex Night Restore Gel Drops Optrex created Optrex Night Restore Gel drops, designed to help restore the eye’s moisture at night time and provide lasting protection from discomfort. The time spent asleep is an opportunity for dry eye treatment to help restore moisture to the ocular surface. Optrex Night Restore Gel drops contains sodium hyaluronate which lubricates and moisturises the eye. The multidose, preservative free bottle is convenient and easy to use, drip free and mess free*. Always read the label. *based on May 2016 survey of 307 consumers. ≥74% of 307 users agree. IRL/O/0118/0002 Date of Preparation 22 Jan 2018.

Thealoz Duo Dry Eye is one of the most common complaints from eye patients. Thealoz Duo is a unique blend of sodium hyaluronate and trehalose to provide ocular surface protection. The Hypotonic formulation provides immediate relief and is suitable for all including contact lens wearers. It is free from preservatives and phosphates. The unique ABAK bottle system makes it economical and easy to use. Each bottle contains 300 drops and is suitable for use up to 3 months. Thealoz Duo is available OTC and on the GMS.

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The OTC & Pharmacy Retail Product Awards Women's Product Cleanmarine For Women Irish brand, Cleanmarine For Women is a clinically researched proprietary blend of Omega 3, Rosemary extract, Soy Isoflavones, B and D Vitamin blend designed specifically to target PMS symptoms. Key ingredients tackle hormone regulation, tiredness and fatigue, energy levels and skin health. Over 80% of customers agree that results and ingredients are why they choose Cleanmarine For Women while 98% would recommend to a friend. Cleanmarine For Women is MSC certified for sustainability, contains no artificial colours, is gluten free and sugar free and every single batch is independently tested by a world class sports anti-doping laboratory, reassuring to know for elite and aspiring athletes.

Femfresh Intimate Wash This bottle of goodness is the perfect partner for a quick spruce in the shower or an indulgent soak. The healthy pH-balanced formula, along with a hint of soothing aloe vera, keeps your intimate skin happy and ensures you stay fresh all day long.

MyPro Iro-Sorb MyPro Iro-Sorb is an Iron supplement that provides a natural & innovative platform to increase Iron absorption through dietary means due to its clinically proven patented strain of probiotic LP299V. MyPro Iro-Sorb also contains added Vitamin C which further increases Iron absorption and a folic acid booster. It is suitable to take before, during and after pregnancy and due to its low Iron content (15% RDA) comes with minimal side effects unlike many traditional high dose iron supplements.

Multi-GYN Multi-GYN promotes vaginal health naturally. Its unique patented 2QR-complex supports the healing process. It restores the natural balance of microbial flora. Multi-GYN neutralises harmful micro-organisms naturally. The range consists of ActiGel for Bacterial Vaginosis (BV) and prevention of recurring BV, Flora Plus is for Thrush and prevention of recurring Thrush, can be used alongside antimycotics and provides prebiotic stimulation of lactobacilli. LiquiGel provides relief from irritation and dryness. All optimise the vaginal pH and provide immediate relief. Each treatment is a 5 day treatment. ActiGel has 25 doses and is the most cost effective product on the market Clinical trials highlight Multi-GYN effectiveness. It is recommended by doctors and gynaecologists.

pre-Conceive pre-Conceive combined with nutritional advice improves the levels of key fertility and nutritional parameters," the lead researcher stated.In this clinical examination of pre-Conceive and infertile women, pre-Conceive was able to improve the key parameters associated with infertility. This included all women improving their hormonal cycle and showing significant improvements in ovulation. "Unless the nutritional requirements of the body are specifically catered for, it is highly unlikely that full health can be expected. pre-Conceive consciously provides those specific nutritional needs for full fertility health to be achieved. It may be that, in most cases, very little else is required.

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Product Launch

Buscopan Buscopan has been helping sufferers manage their abdominal cramps for more than 60 years and is the No1 selling antispasmodic brand worldwide and the No1 pharmacy recommended brand in the UK. Buscopan is now available on the Irish market since April 2017. Formulated with hyoscine butylbromide 10mg, Buscopan tablets helps relieving abdominal cramps, pain & discomfort, including Irritable Bowel Syndrome (IBS). Buscopan 10mg coated tablets: Targets directly on the cause of pain to effectively relieve pain and discomfort, Fast acting – starts to work in 15 minutes, can be taken at the first sign of a flare up as needed.

Colief Breathe Easy Patch This unique blend of natural ingredients offer a soothing solution for easy breathing. When the patch is attached to sleepwear, preferably near the chest body heat releases essential vapours, beneficial effects that last up to 8 hours. Each patch contains natural ingredients, eucalyptus and peppermint. The patch helps the child to have a peaceful night’s sleep. Suitable for children 3+, 6 individually wrapped patches.

Proceive Proceive is the new range of scientifically formulated fertility supplements for men and women trying for a baby. Proceive is designed to support nutritional deficiencies associated with the reproductive system. It provides the most comprehensive formulations including Folic acid, amino acids, vitamins and minerals to support the nutritional needs of the body when trying for a baby. Proceive is the result of five years of research by fertility experts ensuring that every nutrient included in Proceive has robust clinical science supporting its impact on key fertility parameters. Proceive was launched in March 2017 and detailed instore by the Ocean Healthcare representatives, highlighting its unique benefits.

Solpa-Extra Solpa-Extra was a significant piece of news within the pain category in 2017. Based on the insight that consumers wish to use the same brand product throughout the pain path, Perrigo launched Solpa-Extra – the Step 1 pain relief product. Indicated for the treatment of mild to moderate pain, Solpa-Extra contains 500mg of paracetamol and 65mg of caffeine. The pain category is the largest category in pharmacy at ¤61.5m MAT. Since launch Solpa-Extra has added ¤705k to the pain category, gaining an incredible market share of 2.1%* on a quarterly basis. *IMS Value Data December 2017

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The OTC & Pharmacy Retail Product Awards Best Marketing Initiative

Durex Intense ALWAYS READ THE LABEL

Nicorette Nicorette is the leading NRT brand on the Irish Market with 73% market share*. Because no two smokers are the same, Nicorette offers the widest range of options to help those looking to quit to find something suitable for them. The range consists of Nicorette Patch, Nicorette Gum, Nicorette Quickmist, Nicorette Lozenge and Nicorette Inhaler. Nicorette launched its “Do Something Incredible” Campaign in Q4 2017 which has run right through to Quit 2018! The campaign was supported with brand new TVC, OOH, Digital Support with the key consumer message being “What Will You Start When You Quit for Good?” The In-Store Activation saw the biggest ever support in Pharmacies Nationwide with key consumer messaging here leveraging on the new speed claim for Nicorette Quickmist which now “Gets to Work on Cravings in Just 30 seconds!”. (IMS MAT November 2017) MAH: McNeil Healthcare (Ireland) Ltd. Airton Road, Tallaght,

Dublin 24, Ireland. Full prescribing information available upon request. Products not subject to medical prescription.

Nurofen for Children Fever Fighters Campaign (Q1 2017) ALWAYS READ THE LABEL

Panadol Panadol’s Irish roots have been one of GSK’s best kept secrets, until now. The ¤1m campaign celebrates the unique role GSK Dungarvans’ 700 employees play in Panadol’s global success story, and indeed in the wider community in Waterford. We were thrilled to introduce Irish consumers to some of the wonderful team in Dungarvan, and to tell some of the very real and local stories behind the brand’s success. We brought our Made in Ireland story to pharmacists and pharmacy assistants as part of our rep detailing cycle. The detailing introduced them to the Dungarvan site, the people who make Panadol and shows the impact the site has in the town of Dungarvan. We also created a massive OOH, digital and PR campaign to support the trade execution.

Solpa-Extra Solpa-Extra was a significant piece of news within the pain category in 2017. Based on the insight that consumers wish to use the same brand product throughout the pain path, Perrigo launched Solpa-Extra – the Step 1 pain relief product. Indicated for the treatment of mild to moderate pain, Solpa-Extra contains 500mg of paracetamol and 65mg of caffeine. The pain category is the largest category in pharmacy at ¤61.5m MAT. Since launch Solpa-Extra has added ¤705k to the pain category, gaining an incredible market share of 2.1%* on a quarterly basis. *IMS Value Data December 2017

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Most Innovative Product

Proceive Proceive is the new comprehensive range of tailored formulations, developed by fertility experts, to support fertility in both men and women. It is the result of five years market research and developed by fertility experts who found there was no robust pre conception product available for men and women trying for a baby available in pharmacies. It is reported that one in six couples experience difficulties when trying to conceive and nutrients are believed, along with a healthy lifestyle, to play a role when trying for a baby.

Gloup Gloup is a universal gel that aids the swallowing of solid medication. Gloup is a strawberry and banana flavoured gel made from carrageen that allows you to swallow tablets easily. It works by moistening the mucous membranes in the mouth and throat cavity and allowing any medication in solid form to pass smoothly via the oesophagus to the stomach. Gloup can be used by / given to anyone who can swallow autonomously, over the age of 2 and has no known interactions with other medicines. Simply put the tablets/capsules onto a tablespoon, squeeze 5ml of Gloup on top and swallow!

SVR XÉRIAL 50 SVR XÉRIAL 50 Extrême Crème Pieds contains 50% Urea, and is perfect for anyone with hard-skin, corns & callouses on their feet. This product contains a higher concentration of Urea than any competitor. Urea helps to remove dead skin, hydrate and protect the renewed skin. This is a foot care that overcomes corns and calluses in 7 days and removes the horn like a pumice without evidence of rebound. Non-greasy and non-sticky formula that is specifically formulated for the feet, and also works on areas of hands and elbows that have thickened skin. Apply daily and watch the impressive results!

NiQuitin Fresh Mint Gum New NiQuitin Fresh Mint Gum, launched in September, has revolutionised the gum category by offering quitters and reducers a great lasting gum*. NiQuitin Fresh Mini Gum offers convenient, on-the-go craving relief when the urge to smoke strikes. The unique Triple flavour technology our unique formulation of three different mint flavours Levomenthol, Eucamenthol and Opticool™ delivers an instant mint burst, layers of freshness and great flavour*! The gum has a thick coat, high flavour and crunchiness and a high level of nicotine masking*. *216 person sensory study.

Medicare Non-Contact Infrared Thermometer Medicare’s Non-Contact Infrared is Fast and accurate Thermometer with convenient features to help you monitor a patient’s temperature, with ease. It’s unique 3-in-1 function that measures the temperature of Body, Room & Surfaces such as water, milk etc. with the touch of a button. This thermometer allows gentle and fast measurement of body temperature without touching the patient, while also being hygienic, easy and comfortable to use. It has an automatic beep to denote the end of measurement but can be silenced if needed so as not to disturb sleeping patients for measurements at night, it also has a built-in fever alarm with a temperature colour coded large backlit display.

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The OTC & Pharmacy Retail Product Awards Best In-Store Promotion Benylin Day and Night BENYLIN are a range of Cough & Cold products suitable for adults and children aged six years and over. Our hero product of our campaign was BENYLIN Dry Cough Non-Drowsy.

Nurofen for Children Fever Fighters Campaign (Q1 2017) ALWAYS READ THE LABEL

NiQuitin NiQuitin offers a range of products specifically designed to help customers beat both the underlying physical addiction and sudden cravings. NiQuitin Patches, with unique Smart Control TM Technology, provide a rapid initial release of nicotine followed by a controlled and continued delivery of nicotine throughout the day, for 24-hour craving control. Oral formats of NRT help relieve cue-provoked breakthrough cravings – the cravings which are brought on at specific times or situations when someone would usually smoke. NiQuitin Mini Lozenges are our smallest NRT lozenge available; they can relieve cravings in 3 minutes**2. New NiQuitin Fresh Mint Gum offers convenient, on-the-go craving relief when you have the urge to smoke. **NiQuitin Mini 4mg Mint Lozenges 1 NiQuitin 21mg Clear Patch. Summary of Product Characteristics 2 Data on file and Durcan MJ et al. Efficacy of the nicotine lozenge in cue provoked cravings (poster). 66th Annual Meeting of College of Problems of Drug Dependence; San Juan, Puerto Rico, 2004

GI Product

Alflorex Alflorex contains a unique probiotic, Bifidobacterium longum 35624. It’s native to the human gut and is part of the family of bacteria given by mother to baby at birth. In clinical trials of people with IBS, this natural live culture was shown to reduce all symptoms of IBS and have a safety profile comparable to placebo. It can be taken with anti-spasmodics, anti-diarrheals, laxatives & products containing peppermint oil. It’s produced in a pure formulation, with no added bulk yoghurt or animal cultures. Allergy and gluten free. Suitable for vegetarians and those on a low FODMAP diet.

Colodex IBS Colodex IBS is a revolutionary new product that aims to alleviate the symptoms of Irritable Bowel Syndrome. It is based on the patented 2QR-complex which is a natural bio-active compound derived from plants which can selectively neutralise harmful bacteria. This coupled with Colodex IBS’s innovative fibres help stimulate intestinal activity and improve stool consistency. These also act as powerful prebiotics to ‘good’ bacteria promoting colonisation by supporting microbial growth, development and diversity. The formula is a 5 day course which is very discrete, easy to carry and its lemon and lime flavour tastes great.

Gaviscon Extra Ireland’s No. 1* selling Heartburn & Indigestion brand in Pharmacy 2017 Full product details available on medicines.ie *IMS Unit Year/12/2017, Acid Cont & Heartburn Prd

Dioralyte This year, Dioralyte has become the number 1 selling product in Ireland not just for oral rehydration but for anti-diarrhoea as well. Dioralyte is clinically proven to provide fast and effective replacement of water, body salts and glucose. It can be used in the oral correction of fluid and electrolyte loss and in the management of watery diarrhoea. It is available in 3 flavours: Blackcurrant, Citrus and Natural, and two pack sizes: 6 sachets and 20 sachets. This year, Dioralyte has been supported by strong detailing and a targeted trade media plan in key publications such as IPN, IPU, PAI and Irish Pharmacist.

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Irish Pharmacy Brand Alflorex Alflorex contains a unique probiotic, Bifidobacterium longum 35624. It’s native to the human gut and is part of the family of bacteria given by mother to baby at birth. In clinical trials of people with IBS, this natural live culture was shown to reduce all symptoms of IBS and have a safety profile comparable to placebo. It can be taken with anti-spasmodics, anti-diarrheals, laxatives & products containing peppermint oil. It’s produced in a pure formulation, with no added bulk yoghurt or animal cultures. Allergy and gluten free. Suitable for vegetarians and those on a low FODMAP diet.

Cleanmarine Based in Co. Wicklow, Irish brand Cleanmarine was formulated to deliver results naturally. We understand the demands of staying well, active and happy at all of life’s stages, in particular heart health, hormone balance and menopause. Our products offer real solutions, born out of scientific research and are created using ingredients of the highest quality. What’s more, they are MSC certified for sustainability, contain no artificial colours, are gluten free and sugar free. Our range includes Cleanmarine For Women, MenoMin, For Men, For Kids and Krill Oil and launching soon; Cleanmarine Cardio 40+.

Panadol Panadol’s Irish heritage was brought to life in 2017 through an innovative new brand campaign ‘This is what we’re made of’. The campaign, celebrates the brand’s Irish manufacturing ties and what it believes has been its “best-kept secrets”: namely that its manufacturing site, GSK in Dungarvan produces over 6 billion Panadol tablets every year, exporting to over 70 countries worldwide. The ¤1m campaign features employees from the Waterford site, and aims to highlight its strong ties to Ireland and celebrate the Irish team who are such a big part of the brand’s global success story.

Pain Relief Product Brupro Max Marketed by Rowex and Proud sponsors of RTE’s “You should really see a doctor.” Brupro Max 400mg Film-coated tablets is available in all good pharmacies. Each tablet contains 400mg of ibuprofen. It is indicated for the management of muscular pain, backache, dental pain and dysmenorrhoea. Brupro Max 400mg Film-coated tablets has a 5 year shelf life. For targeted pain relief and easy to swallow. If you need effective pain relief take it. If you don't, don't. Available in packs of 12 or 24.

400mg Film-coated tablets

FILM-COATED TABLETS

EASY TO SWALLOW

Nurofen Express Maximum Strength ALWAYS READ THE LABEL

Solpadeine Solpadeine is Ireland’s number 1* pharmacy only pain relief brand, with a value of ¤16.5m. Solpadeine provides pain relief from symptoms of headache, including migraine, toothache, backache, common cold, influenza, menstrual pain, musculoskeletal pain. The range includes a variety of formats to meet differing consumer needs. Solpa-Sinus is for the symptomatic relief of nasal congestion when combined with fever and/or pain such as, sore throat, sinus pain or headache in the common cold or influenza. Solpa-Extra, launched with great success in August 2017, are used for the treatment of mild to moderate pain, for example: headache including migraine, backache, toothache, muscle ache, neuralgia, joint pain, dysmenorrhea, sore throat, and for the relief of fever, aches and pains of colds and influenza. *IMS MAT Value Sales Dec 2017 **Solpadeine SPC / Solpa-Sinus SPC / Solpa-Extra SPC

Voltarol Emulgel Extra Strength 2% w/w Gel Unlike products that work by only cooling or heating the skin, Voltarol Emulgel Extra Strength 2% w/w Gel contains a non-steroidal anti-inflammatory drug (NSAID) called diclofenac which targets pain at its source. It works by blocking production of some of the body’s chemicals that cause inflammation, pain, tenderness and swelling. This product introduced innovation to the market in Jul-16 and continues to improve joint pain sufferers’ lives. With a ¤600k marketing investment in 2017, Voltarol drove the Topical Pain Category in Pharmacy and encouraged consumers to have conversations with pharmacists about managing their joint pain.

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The OTC & Pharmacy Retail Product Awards Cold & Flu Product Benylin Day and Night Benylin Day and Night tablets are the only day & night tablets for 24 hour cold and flu relief. Each blue tablet contains 500mg paracetamol and 25mg diphenhydramine hydrochloride. Each white tablet contains 500mg paracetamol and 60mg pseudoephedrine hydrochloride. 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.

Ilvico Ilvico is professionally recommended for Colds and Flu, Runny Nose, Pain Relief and Congestion. Ilvico is a triple combination of antihistamine, analgesic and stimulant and does not contain Pseudoephedrine, which is contraindicated in patients with diabetes mellitus, cardiovascular disease, severe or uncontrolled hypertension, severe coronary artery disease, prostatic hypertrophy, hyperthyroidism, closed angle glaucoma, and pregnant women. The cold and flu film coated tablets contain 325mg of Paracetemol, 30mg of Caffeine and 3mg of Brompheniramine Maleate.

Lemsip Max Ireland’s No.1 selling Cold & Flu brand in Pharmacy 2017 Full product details available on medicines.ie *IMS Unit Year/12/2017, Cold or Flu remedies

Otrivine Nasal Decongestant Spray Otrivine nasal decongestant sprays help to relieve nasal congestion in as little as 2 minutes! The Otrivine portfolio includes clinically proven nasal sprays, both medicated and non-medicated, that answer the different needs of consumers. Otrivine is Ireland’s #1 Selling* Decongestant nasal spray and it is available over the counter in pharmacies only. *IMS Dec’17 Consumption data.

Echinaforce Echinaforce is a licensed traditional herbal remedy for colds and flu, made from fresh extracts of Echinacea purpurea herb (95%) and root (5%). It helps the body fight the symptoms of these infections by supporting the immune system, helping to maintain the body's resistance. It is available as drops (tincture in 15ml, 50ml & 100ml bottles) and as tablets (42 tablets & 120 tablets). Echinaforce is produced using extracts of freshly harvested, organically grown Echinacea purpurea herb and root, picked fresh and used within 24 hours of harvest. The benefit of using freshly harvested herbs has been demonstrated in research to contain almost 3 times more active substances compared with those obtained from equivalent amounts of dried herb.

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Oral Health Product Beverly Hills Formula Teeth whitening experts Beverly Hills Formula have launched their new ProfessionalWhite range for superior whitening results. Following the success of their whitening toothpastes, their 2in1 whitening kit consists of whitening strips and a whitening pen. Brilliant Pearl 2in1 combines Hydrogen Peroxide with professional whitening ingredient Phthalimido-Peroxy-Caproic Acid (PAP) to help remove surface and deep stains. Both ingredients break down discolorations on the teeth without affecting the tooth structure. Additionally, PAP supports dental hygiene by eradicating bacteria which can harm teeth. PAP is only active on the tooth surface, no irritation is caused to the gums and mucous membranes in the mouth.

Corsodyl Ultra Clean GSK supported the launch of Corsodyl Ultra Clean with heavyweight media investment and a new advertising creative, where consumers were taken on a ‘gum disease journey’, illustrating the symptoms associated with bleeding gums. The new advert highlighted how Corsodyl toothpaste helps to stop these symptoms, ending with the strapline ‘Leave bleeding gums behind’. Corsodyl Ultra Clean Toothpaste is a daily toothpaste that is clinically proven to help stop and prevent bleeding gums. Its formula is different from a regular toothpaste, as it uses refined particles of sodium bicarbonate to break apart the layer of plaque bacteria on your teeth to make it easier to remove, even in hard to reach areas.

Kin Care Gel Kin Care Gel is a bio-adhesive gel which helps protect the delicate oral tissues. It contains 3 key ingredients, Hyaluronic Acid to moisturise and reinforce the delicate mouth tissues, aloe vera for tissue regeneration and Carbomer to form a protective layer in the affected area and enable greater permanence of the main active ingredients. The product is ideal for localised applications.

Pharmacy Only Medicine Nurofen Express Maximum Strength ALWAYS READ THE LABEL

Otrivine Nasal Decongestant Spray Otrivine nasal decongestant spray help to relieve nasal congestion in as little as 2 minutes! The Otrivine portfolio includes clinically proven nasal sprays, both medicated and non-medicated, that answer the different needs of consumers. Otrivine is Ireland’s #1 Selling* Decongestant nasal spray and it is available over the counter in pharmacies only. *IMS Dec’17 Consumption data.

Voltarol Emulgel Extra Strength 2% w/w Gel Unlike products that work by only cooling or heating the skin, Voltarol Emulgel Extra Strength 2% w/w Gel contains a non-steroidal anti-inflammatory drug (NSAID) called diclofenac which targets pain at its source. It works by blocking production of some of the body’s chemicals that cause inflammation, pain, tenderness and swelling. This product introduced innovation to the market in Jul-16 and continues to improve joint pain sufferers’ lives. With a ¤600k marketing investment in 2017, Voltarol drove the Topical Pain Category in Pharmacy and encouraged consumers to have conversations with pharmacists about managing their joint pain.

Solpadeine Solpadeine, Ireland’s number 1* pharmacy only pain relief brand, is a highly respected brand in the OTC oral analgesic market, with extensive heritage in pharmacy. Solpadeine offers a range of different formats to provide fast and effective pain relief to patients for acute moderate pain when paracetamol, aspirin or ibuprofen alone are not enough. * Source: IMS MAT Dec 2016 Volume Sales

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The OTC & Pharmacy Retail Product Awards Beauty Product Revive Active Beauty Complex Beauty Complex is the latest product in the Revive Active range. Launched in May 2017, the super supplement contains the best ingredients in optimum quantities, nourishing the skin from within. It contains a unique blend of Peptan Marine Collagen, Phytoceramides and Hyaluronic Acid. Phytoceramides penetrate the four layers of the skin to boost the natural production of collagen, Hyaluronic Acid works as a natural moisturiser and Peptan Marine Collagen contributes to the skins natural structure. Beauty Complex contains no artificial colours or flavours and uses a natural sweetener, Stevia, making it suitable for diabetics.

Sanctuary Spa Body Lotion Sanctuary Spa Body Lotion envelops your body in lashings of silky light hydrating loveliness. This skin quenching blend of aloe vera & argan oil is quickly absorbed to leave skin feeling replenished, soothed & lusciously moisturised. Some beauty products are created in a laboratory – Sanctuary Spa Body Lotion products were born in a beautiful spa with the aim of helping women make time for themselves by recreating the spa experience at home. Inspired by therapists and formulated by experts, our body and skincare products are developed with cutting-edge formulations and luxurious ingredients, but also from hands-on experience. We know what women’s skin needs and we know what works, because we have seen the results in women’s glowing skin and happy smiles.

Veet Sensitive Precision The most recent addition to Veet’s product range is the Veet Sensitive PrecisionTM Beauty Styler, a ground-breaking device that is specially tailored to gently trim and precisely shape sensitive body parts. A staple beauty regime product, this onestop shop hair removal product is the ultimate companion to make personal grooming hassle-free with silky smooth results. It is easy to handle and removes hair gently without making direct contact with the skin, taking away the fear of those dreaded razor burns and cuts. Not only can it be used on sensitive areas such as the bikini line and underarms, it can also be used to achieve perfectly sculpted brows.

Best Product Training Cellnutrition As soon as a new pharmacy comes on board, National Sales Manager, Lorna is in touch to arrange in store training for all staff (1-2-1 and/or group training sessions). These sessions include an overview of all products, the features/benefits, how to take it and, importantly, how to sell it. Samples are provided to staff to give them the opportunity to try the product themselves and speak with experience when selling it. All pharmacies are provided with POS material and on-call customer support service - if customers/staff need extra advice. 'Tasting days/events' are held to support the pharmacies, advising customers and store staff on the products. We are available to contact at any time for advice and support alongside our social media teams who work to support the generation and drive of customers to that pharmacy. Training for new staff and refreshes for existing staff are just a phone call away and feedback is always resoundingly positive.

Perrigo This year Perrigo held two national training seminars in June and September. The June seminar consisted from 3 workshops, Workshop 1 - Demystifying CPD with Sinead Ryan. The masterclass gave pharmacists the skills and strategy required to feel confident and prepared for ePortfolio Review. Workshop 2 - Pain Management and Workshop 3 - Bladder Weakness. The September seminar focused on Smoking Cessation, NRT and NiQuitin. The seminar was attended by key note speakers, Ms Pauline Kent, Smoking Cessation Coordinator, Healthy Ireland Lead, Sligo Hospital, Una Lehane - COPD Outreach Nurse, The Mercy Hospital, Cork and Ms Noeline White – Smoking Cessation Officer, The Mater Hospital, Dublin. Each of the speakers presented on “The Impact of Smoking Addiction and Challenges in Smoking Cessation”.

Solgar Academy Solgar Academy At Solgar training and education are part of our brand DNA. For over 25 years Solgar has recognised the importance of trade education, providing Face-to-Face Training, Lecture Tours, Live Webinars and Masterclass events. Solgar Academy is an online learning hub providing retailers, pharmacists and practitioners access to the best in Solgar’s training and education resources 24/7. From courses and webinars to training manuals and product information, the Solgar Academy puts Solgar’s Nutrition and Education Department at their fingertips. Whether they want to brush up on their anatomy and physiology or learn about a new product, the Solgar Academy can help them keep up to date and support professional development.

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Children’s (Medication/Supplements) CALPOL Infant Suspension CALPOL Infant Suspension – an effective pain and fever medicine that gets to work on a fever in just 15 minutes but is gentle on tummies. The active ingredient in CALPOL Infant Suspension is 120mg Paracetamol per 5ml of suspension which is an effective relief of headache, migraine, neuralgia, toothache and teething pains, sore throat, rheumatic aches and pains, influenza, feverishness and feverish colds.

Colief The Colief Range includes; Colief Infant Drops- clinically proven to reduce the hours of crying. It contains Lactase Enzyme Drops which are added to infant formula or breast milk to reduce lactose content, Colief Baby Scalp Oil is a soothing nourishing oil made with naturally derived ingredients. It helps soften flaky skin on the scalp. It contains rosehip oil, chamomile and vitamin E. Colief Vitamin D3 Drops help promote normal healthy bones and teeth. NEW Colief Breathe Easy Patch provides the soothing solution for easy breathing with natural ingredients including eucalyptus and peppermint. It is a patch worn on sleepwear from age 3+.

Nurofen ALWAYS READ THE LABEL

Yummy Gummy Bears Marketed by Rowa Pharmaceuticals, our Yummy Gummy Bears are Gluten-free, a Smart choice for parents, Great taste for kids and 100% All Natural Flavours. Vitamins and minerals are essential nutrients that the body needs in order to function properly. They are essentially important in promoting healthy growth and strong immune system in children. Yummy Gummy Bear provides a balanced combination of essential vitamins and minerals to fulfil your children’s daily nutritional requirements. While being supplemented with nutrients that may be missing from their daily diet, the children will also enjoy the great tasting fruit flavours of these gummies.

Children's Product Lyclear Lyclear has a full range of products to effectively treat head lice and to suit customers’ needs. Lyclear Treatment Shampoo is clinically proven1, and treats the whole head in 10 minutes. Lyclear Treatment Spray is clinically proven2 and treats the whole head in 15min. The treatment is easy to apply with no odour and no drips. Lyclear Treatment Sensitive is clinically proven to kill 100% of head lice when used as directed3. It is gentle to hair and skin and dermatologically tested. Lyclear Head lice Repellent is scientifically proven to help protect for up to 24 hours4 1.Ex vivo study 2010. 2. Ex vivo study 2010 / In vivo clinical study 2008. 3. Ex vivo Aug 2006 / In vivo Oct 2010. 4. Omega Pharma Data on file.

Mustela Stelatopia Emollient Cream Leave the skin moisturised, replenished and soothed with the STELATOPIA Emollient Cream The Mustela Stelatopia Emollient Cream will gently moisturise, replenish and soothe sensations of itchy skin. This is an innovation – with a proven efficacy on Mustela’s patented Atopic skin Stelaskin, the baby’s epidermises reconstructed in a laboratory. This cream cleanses and protect syour babies’ skin, whilst also soothing any sensations of irritation or tightness. The skin is left feeling soft, silky and supple. This cream restores the damaged skin barrier of atopic-prone skin, and strengthens skin’s natural defences thanks to Avocado Perseose.

V-Comb A chemical and allergy-free head lice treatment – Licetec V-Comb’s combing unit features adjustable, stainless steel teeth that extract head lice and the capture filter compartment is illuminated by a LED, to easily see what has been removed from the hair. The extracted head lice and eggs are then securely trapped in the capture filter, which is simply detached and sealed with a cap for hygienic disposal. With the V-Comb you can actually see what’s been removed from the hair and can be used to treat more than one child. The V-Comb is used by separating hair in to small sections and the device draws live head lice and eggs into the capture filter for no-mess and hygienic disposal.

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The OTC & Pharmacy Retail Product Awards Best Men's Product Just for Men Control GX A breakthrough innovation from Just for Men, Control GX is an entirely new way to get rid of grey hair. Its air oxidation formula reduces grey by depositing a small amount of colour after each use. Grey hairs have lost all their natural melanin– the natural pigment that creates colour in your hair. The unique technology developed for Control GX mimics the natural look that comes from melanin, reducing the number of grey hairs. The only choice that is required is between a shampoo or a 2in1 shampoo & conditioner. Control GX works on all shades of hair.

Durex Intense Durex Intense Condom - A condom that actually helps to make sex better for both! A transparent & lubricated natural latex condom with a stimulating ribs and dots texture, with Desirex gel for warming, cooling or tingling sensations to increase sensitivity in her intimate area. For many men giving pleasure is more important than receiving it, these men get greater pleasure from seeing her so aroused. This condom is designed to improve the sexual experience for both by helping her reach orgasm and for him the pleasure from seeing her so aroused.

pre-Conceive pre-Conceive has been clinically studied to improve male fertility. In a landmark clinical study undertaken in 2014, the lead researchers conclusion stated: "pre-Conceive combined with nutritional advice improves the levels of key fertility and nutritional parameters." For men, pre-Conceive has been shown to improve sperm count in infertile men. pre-Conceive also improved the quality of those cells, increasing the morphology (shape and form) of the cells, the motility of the cells and reduces damage to the all important DNA package within. pre-Conceive has been nominated for 14 awards in 4 years and has helped thousands of men improve their fertility.

Travel Product Elave Sensitive Sun SPF30 Elave Sensitive Sun SPF30 offers high UVA and UVB protection that is EU compliant and, if used as directed, prevents long term sun damage of the skin. Elave sensitive Sun SPF30 decreases the risk of skin cancer and early skin ageing caused by the sun and absorbs 97% of UVB radiation that causes sunburn. Broad spectrum UVA/UVB sunscreen. Allergan free formula that is safe for skin. Paediatrician approved from Newborn Enriched with vitamins B5, C & E Lightweight oil free formula without compromising the highest protection 250ml. Pharmacy confined. Made in Ireland.

P20 P20 is proven to work for up to 10 hours thanks to a very stable formulation, keeping the time spent applying and re-applying sun protection to a minimum. P20 is proven to remain effective in the water and has been categorised as. Very Water Resistant, the highest classification available and is absorbed rapidly leaving non-greasy skin due to its unique transparent lightweight consistency. With new multi-angle spray technology, P20 Continuous Spray makes applying sun protection to those hard to reach areas much easier. It includes UVA protection at a level that far exceeds EU recommendation and is rated at 5 out of 5 stars. P20 contains no fragrance and colourants, making it suitable for the whole family.

Euerin Allergy Protection After Sun Creme-Gel Euerin Allergy Protection After Sun Creme-Gel is designed specifically to soothe, cool and regenerate sun-stressed and sun allergy-prone skin. This innovative formulation contains an effective ingredient complex by combining two plant derived actives: Powerful anti-oxidants AGR (Alpha-Glucosyl-Rutin) that strengthen the skin's own protection system against one of the major triggers of sun allergy. Thus it reduces the skin’s susceptibility to develop sun-induced skin. Additionally Licochalcone A's skin calming properties, that reduces the redness of the skin. This non-greasy creme-gel formulation is free from irritating ingredients such as emulsifiers, perfumes and preservatives.

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Allergy Product Anti-Hist Allergy Anti-Hist Allergy tablets and Oral Solution relieve symptoms of hay fever (seasonal allergic rhinitis) and nasal allergies such as pet allergies or dust mite allergies that occur throughout the year (perennial allergic rhinitis). Anti-Hist Allergy tablets and oral solution contain the active ingredient cetirizine, which is a type of medicine called a non-sedating antihistamine. Cetirizine works by preventing the actions of histamine. This medicine is suitable for adults and children aged six years and over. Anti-Hist Allergy 10mg Film-coated tablets are available in a 7 pack and 30 pack. Anti-Hist Allergy 1mg/ml Oral Solution is available in 200ml.

Cetrine Allergy Cetrine Allergy by Rowex is Ireland’s favourite non drowsy, antihistamine product providing fast relief from hay fever allergy. The active ingredient is Cetirizine Dihydrochloride and currently available in 10 mg Tablets x 7 and 10 mg Tablets x 30 with one tablet per day providing 24 hour control.

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Cetriz 10mg Film-coated Tablets Relief of nasal and ocular symptoms of seasonal and perennial allergic rhinitis. Relief of chronic idiopathic urticaria. Features: Can be divided into equal halves, Can use from age 6 upwards, film-coated tablet, no expected interactions with other medicines and supplied through pharmacies only. Benefits include: Easy dose adjustment, reduces need for separate formulations, easy to swallow, and can be used with other medications Always ready the leaflet carefully. Contains Lactose

Euerin Allergy Protection After Sun Creme-Gel Euerin Allergy Protection After Sun Creme-Gel is designed specifically to soothe, cool and regenerate sun-stressed and sun allergy-prone skin. This innovative formulation contains an effective ingredient complex by combining two plant derived actives: Powerful anti-oxidants AGR (Alpha-Glucosyl-Rutin) that strengthen the skin's own protection system against - one of the major triggers of sun allergy. Thus it reduces the skin’s susceptibility to develop sun-induced skin. Additionally Licochalcone A's skin calming properties, that reduces the redness of the skin. This non-greasy creme-gel formulation is free from irritating ingredients such as emulsifiers, perfumes and preservatives.

Zirtek Leading brand Zirtek provides an effective antihistamine allergy treatment in a variety of SKU’s including the 30 pack of tablets which combines value with convenience for the customer. The range also features the popular 200ml solution which has proven to be a great success in providing much needed relief to younger allergy sufferers. Zirtek is an established, market leading, second generation antihistamine that features the proven, non-drowsy active ingredient cetirizine dihydrochloride with the tiny easy to take tablets providing effective round the clock relief from the symptoms of hay fever and other allergies in a single treatment.

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Feature

Pain and Fever in Children Pain is defined as a highly unpleasant physical sensation caused by illness or injury. Acute pain is one of the most common adverse stimuli experienced by children, occurring as a result of injury, illness and medical procedures. If a child's pain is not treated quickly and effectively, it can have long-term consequences, which may include anticipatory anxiety during future procedures, a lowering of the pain threshold and sensitization to future pain, reduced effectiveness of analgesics and increased analgesic requirements subsequently. If pain is not treated quickly and effectively in children, it can have long-term physical and psychological implications. Therefore, it is important for all health care providers to understand the importance of effective pain control in children. Pain assessment is challenging in paediatrics, as infants and young children are not able to adequately verbalize pain. As a result, children have been under-treated for pain compared to adults. Recent advances in the research of pain in children have made significant contribution to the understanding of pain perception in children. We now know that the anatomical, physiological and biochemical mechanics needed for pain perception are present early in intrauterine life. In fact, preterm infants can perceive pain in a way comparable to older children. Pain assessment To adequately assess a child's response to treatment, it is necessary to have ongoing assessment of the child's pain. Because pain is a subjective experience, individual selfreporting is the preferred method for assessing pain. However, for children who cannot communicate this information due to age or developmental status, observational and behavioural assessment tools are acceptable alternatives when valid self-report is not available. Depending on the age of the child and his/her ability to communicate the information to the health care provider, there are many reliable, valid and clinically sensitive assessment tools available; for example, the Face, Legs, Activity, Cry and Consolability (FLACC) scale, which incorporates 5 pain behaviours that make up the scale's name: facial expression, leg movement, activity, cry and consolability. Each behaviour is scored from 0 to 2, with the highest possible cumulative score being 10 (most pain). For school-aged children and adolescents (4–12 years of age), several tools can be used to report pain. In younger children, developmental capabilities may hinder the use of purely numeric scales and therefore pictorial based pain scales such as the Faces Pain Scale, where the child

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is asked to select 1 of 6 neutral faces that accurately reflect their pain, which is scored from 0 to 10. Older children (>8 years of age) who are able to understand abstract concepts can use the visual analogue scale (VAS) and 0 to 10 Numeric Rating Scale (NRS). The VAS uses either a vertical or horizontal premeasured line (100 mm) to estimate pain. The ends of the lines represent the 2 extremes of pain (“no pain” to “worst pain”). It may include a numerical representation along the line. The child makes a mark on the line to indicate his/her level of pain. The pain score is calculated by measuring the distance from the left end point of the scale to the child's mark. The NRS does not include any lines, but is administered as a script asking the child to rate his/her pain from 0 to 10, with 0 being no pain and 10 being the worst pain. Fever Fever is a normal physiological response to illness that facilitates and accelerates recovery. Although it is often associated with a self-limiting viral infection in children, it may also be a presenting symptom of more serious conditions requiring urgent medical care. Therefore, it is essential to distinguish between a child with fever who is at high risk of serious illness and who requires specific treatment, hospitalisation or specialist care, and those at low risk who can be managed conservatively at home. It is vital that pharmacists, when assessing children who present with fever, can make appropriate decisions on when to refer, the appropriate use of medication and how to advise parents and caregivers. Fever in children is one of the most common reasons for parents or caregivers to seek medical attention for their child. It is frequently a cause for concern among parents and healthcare providers who fear that it may be associated with increased morbidity, such as seizures, brain damage or death. Furthermore, there is confusion about how and whether to manage fever. Although fevers are often a presenting symptom of a selflimiting viral infection, they are also

associated with serious bacterial infections, such as meningitis and pneumonia, and other noninfective illnesses. Therefore, the underlying illness causing the fever needs to be determined and it is essential to be able to distinguish between a child with fever who is at high risk of serious illness and a child who requires specific treatment, hospitalisation or specialist care, and those at low risk who can be managed conservatively at home. This is not only true for clinicians, but also for pharmacists and pharmacy workers, who may be the first to see the ill child or caregiver. • Fever is defined as a body temperature ≥38°C. • Fever in itself is not detrimental, but rather a normal physiological response to infection or illness. In the absence of a diagnosis, treatment with the sole aim of reducing temperature is inappropriate and some febrile children will recover more quickly if the fever is not treated. • Most fevers are due to a self-limiting viral infection, but bacterial infections and other causes must be excluded. • Serious bacterial infection is more common in young children. • Any fever in a child aged <3 months is significant and should be thoroughly investigated and referred to specialist care if the source of the fever cannot be found. Measurement of body temperature Body temperature should be measured in the ear using an infrared tympanic thermometer, or in the axilla. When taking an Axillary measurement, do not measure temperature directly after bathing. Ensure that the child’s axilla is dry. If using a glass thermometer, before placing it in the axilla, shake the thermometer until the liquid is below the 36oC line. Place the tip of the thermometer in the armpit and lightly press the child’s elbow against the chest to close the tip of the thermometer in the armpit.

Managing pain in children Discomfort during a febrile illness is often due to associated pain; e.g. myalgia, sore throat, headache. Ibuprofen and paracetamol may be considered to improve comfort (with accompanying improvements in feeding activity and irritability), because they may also provide relief from pain and may reduce the risk of dehydration. They should be used to make the child more comfortable and not used routinely with the sole aim of reducing the temperature. The use of antipyretic medication and attention to the fever must not detract from monitoring the child’s activity and level of consciousness (as an indicator of worsening illness) and paying attention to adequate hydration. Both paracetamol and ibuprofen are safe and effective for shortterm use in children. The practices of combining or alternating paracetamol and ibuprofen have limited value and are not recommended. Dose of antipyretic medication in children should be accurately based on body weight and should not merely be estimated. For accurate dosing, liquid medicines should be administered with a syringe. The use of NSAIDs has been associated with an elevated risk of severe skin and soft-tissue infections in patients with varicella zoster virus infection. Therefore, paracetamol is recommended as the antipyretic of choice in children with chicken pox. Medicines containing combinations of NSAID(s), paracetamol, codeine and/or antihistamines should not be used in children. Nonpharmacological measures can be used as an adjunct therapy in the management of pain in both adults and children. Nonpharmacological strategies such as physical and psychological comfort measures are useful in conjunction with pharmacological options to help lower levels of anxiety, distress and pain. Some physical comfort measures include the use of massage or heat and/or cold compresses, applying pressure or vibration and repositioning. Psychological comfort measures include use of imagery, distraction and relaxation techniques.


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.


FIRST AID


INTRODUCING THE OPPORTUNITY FOR PHARMACY: Specialised First Aid is a category which is often undervalued by pharmacies, as products are usually self-selected by customers who have been advised what to buy by a medical professional. We see the significant sales and margin opportunity for our customers with a new stand-out brand, delivering the same quality as competing brands, while also offering better margin. We expect pharmacies to achieve a margin of around 50% on the range. The brand and product range were developed, selected and sourced by the Uniphar Retail Services team. The range reflects the bestselling products for the First Aid category in retail pharmacy.

SUPPORTING YOUR

RANGE

We will be providing customers with: • • • • •

Product training A free merchandising service Planograms Marketing support Free acrylic trays for on-shelf merchandising

Start making the most of First Aid today. Ordering is simple through our Uniphar Representatives, our Telesales team and our eCommerce site www.uniphar.ie.


Feature

Chronic v Acute pain In general terms, most people associate pain with some direct cause. It could be from a sports injury, or toothache, perhaps an accident which has resulted in a broken limb. In cases like these, you have an attributable acute pain which you can then do something about. If it’s toothache, you go to the dentist, the problem gets fixed and the pain is gone. If it’s a broken arm, you go to hospital, the usual procedures, x-rays, plaster etc are carried out and with the right convalescence, it’s back to normal.

stimulation of the skin, such as light touch), hypersensitivity or other sensory changes. • Mixed nociceptive and neuropathic pain: combination of symptoms. • Visceral pain: dull, non-specific, difficult to pinpoint. • Autonomic symptoms: physiological changes (colour, temperature), sweating.

Causes of Chronic Pain The cause of chronic pain is often difficult to determine with often many aspects to consider. It is this indeterminate nature which can present the biggest obstacle to health professionals to establishing proper diagnosis of the condition. The infographic below on Reported Cause of Pain from the PRIME study NUIG 2011 illustrates the problem further:

For many though, pain is something which isn’t acute or for which there is a simple “cause and effect” route to fix the problem. Pain is a constant factor in their lives, something which they manage every day. The reason they have pain may be attributable to one or more different causes, however, it is evident that their pain can have a wholly debilitating effect not just their quality of life but also those around them. This is Chronic Pain. Pain is one of the most common disability types and is the main cause of disability for around half of disabled individuals in Ireland today, with arthritis being the most common cause of injury or illness. It is estimated that 13% of Irish population and are affected by chronic pain. For many the pain will impact on their career, lifestyle and mental health. For some, the pain can be so severe that they have suicidal thoughts. The average duration of chronic pain is around 5 years, although some individuals with chronic pain have experienced it for over 20 years. What is Chronic Pain? Chronic Pain can be defined as pain which has lasted longer than what would be considered as “normal” healing time, perhaps as part of recovery from illness or injury…..generally more than 3 months. Chronic Pain may be attributable to an event such as an accident, developing from acute pain. Opinion differs as to whether previous acute pain is always the root cause of chronic pain or simply appears, sometime without an initial cause. In some cases, especially in relation to sports injury in contact sports, the underlying chronic pain may appear sometime after an event. Pain may also be related to another condition. Surveys show that in Ireland, 35% of reported Chronic Pain was arthritis related. It may site specific, ie Back, Knee, Wrist, however 80% of sufferers in Ireland report that their pain relates to more than one site. Types of Chronic Pain Pain can be classified either by type of pain, or by body region. Classes of pain types include: • Nociceptive pain: aching, boring, worse on movement, anatomically defined, fluctuates in severity. • Neuropathic pain: burning sensation, sharp stabbing type, tingling, transient limb pain (shooting), associated with allodynia (experience of pain from a non-painful

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Chronic pain can be attributed to a wide range of identifiable causes – acute injury, arthritis,

migraine,pain fibromyalgia for example. Chronic can be attributed to a wide range of identifiable causes – acute injury, arthritis, migraine, fibromyalgia for example. A general classification is detailed below.

A general classification is detailed below. Headache and/or Musculoskeletal Migraine Headache and/or

Musculoskeletal

Migraine

Osteoarthritis

Cluster Headaches

Osteoarthritis Rheumatoid arthritis

Cluster Headaches Migraine

Rheumatoid arthritis Osteomyelitis

Migraine Trigeminal neuralgia

Osteomyelitis Osteoporosis

Trigeminal neuralgia Giant cell (temporal) arteritis Giant cell (temporal) arteritis Glaucoma

Osteoporosis Ankylosing spondylitis Ankylosing spondylitis Myofascial diseases Polymyalgia Myofascial diseases rheumatica Polymyalgia Polymyositis rheumatica Fractures Polymyositis Chronic or repetitive Fractures overuse

Chronic or repetitive Carpel Tunnel overuse Syndrome Carpel Tunnel Muscular strains Syndrome Faulty posture Mechanical low back pain.

Other causes

Glaucoma Smoking Alcohol Smoking TemporoAlcohol mandibular joint dysfunction Temporomandibular joint Drugdysfunction or Substance overuse or misuse

Drug or Substance overuse or misuse

Neurological

Neurological

Diabetic sensorimotor Diabetic (up polyneuropathy sensorimotor to 25% of diabetics) polyneuropathy (up toSpinal 25% of diabetics) stenosis

Spinal stenosis Brachial plexus traction injury Brachial plexus tractionoutlet injury Thoracic syndrome Thoracic outlet Post-herpetic syndrome neuralgia Multiple Sclerosis Post-herpetic neuralgia Multiple Alcoholism Sclerosis Thyroid disease Alcoholism Pernicious Thyroid anaemia disease Infections (e.g., HIV) Pernicious anaemia Polyneuropathies

Infections (e.g., HIV) Polyradiculopathies Polyneuropathies Polyradiculopathies

Psychological causes Psychological

causes

Depression,

Depression, Anxiety, Anxiety, Personality disorders Personality disorders Sleep disturbances. Sleep disturbances.


...A KEY FOR CHRONIC PAIN

FOR SEVERE CHRONIC PAIN PALEXIA® SR Tablets are indicated for the management of severe chronic pain in adults, which can be adequately managed only with opioid analgesics1

PALEXIA SR® Prolonged Release Tablets Prescribing Information Refer to the Summary of Product Characteristics (SmPC) before prescribing. Presentation: 50 mg (white), 100 mg (pale yellow), 150 mg (pale pink), 200 mg (pale orange) and 250 mg (brownish red) prolonged-release tablets contain 50 mg, 100 mg, 150 mg, 200 mg and 250 mg of tapentadol (as hydrochloride) respectively. Indication: Palexia SR is indicated for the management of severe chronic pain in adults, which can be adequately managed only with opioid analgesics. Dosage and method of administration: Individualise according to severity of pain, the previous treatment experience and the ability to monitor the patient. Swallowed whole with sufficient liquid, not divided or chewed, with or without food. The tablet shell may not be completely digested and eliminated / seen in the patient’s stool which has no clinical significance as the active substance will have already been absorbed. Initial dose 50 mg twice a day. Switching from other opioids may require higher initial doses. Titrate in increments of 50 mg twice a day every 3 days for adequate pain control. Total daily doses greater than 500 mg not recommended. Discontinuation of treatment: Taper dose gradually to prevent withdrawal symptoms. Renal/hepatic impairment: Not recommended in patients with severe cases. Caution and dose adjustments with moderate hepatic impairment. Elderly: May need dose adjustments. Children below 18 years: Not recommended. Contraindications: Hypersensitivity to ingredients, suspected or having paralytic ileus, acute intoxication with alcohol, hypnotics, centrally acting analgesics or psychotropics. Not for use when mu-opioid receptor agonists are contraindicated (e.g. significant respiratory depression, acute or severe bronchial asthma or hypercapnia). Special warnings and precautions: Abuse and addiction potential of Palexia should be considered where there is increased risk of misuse, abuse, addiction or diversion. All patients should be carefully monitored for signs of abuse and addiction. At high doses or in mu-opioid receptor agonist sensitive patients, dose-related respiratory depression may occur. Caution and monitoring required with impaired respiratory function. Should not use in patients susceptible to intracranial effects of carbon dioxide retention (e.g. increased intracranial pressure, impaired consciousness or coma). Use with caution with head injury, brain tumors, moderate hepatic impairment, biliary tract disease including acute pancreatitis. Not recommended if history of or at risk of seizures or with severe renal or hepatic impairment. Care should be taken when combining with mixed mu-opioid agonists/antagonists (e.g. pentazocine, nalbuphine) or partial mu-opioid agonists (e.g. buprenorphine). Should not use with hereditary problems of galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption. Interactions: Use with benzodiazepines, barbiturates and opioid analgesics, antitussive drugs and substitutive treatments may enhance the risk of respiratory depression. Central nervous system (CNS) depressants (e.g. benzodiazepines, antipsychotics, H1antihistamines, opioids, alcohol) can enhance the sedative effect and impair vigilance. Consider dose reduction with respiratory or CNS depressant agents. In isolated cases, there have been reports of serotonin syndrome in a temporal connection with the therapeutic use of tapentadol in combination with serotoninergic medicinal products (e.g. serotonin re-uptake inhibitors). Use with strong inhibitors of uridine diphosphate transferase isoenzymes (involved in glucuronidation) may increase systemic exposure of Palexia SR. Caution if concomitant administration of strong enzyme inducing drugs (e.g. rifampicin, phenobarbital, St John’s Wort) starts or stops as this may lead to decreased efficacy or risk for adverse events, respectively. Avoid use in patients who have taken monoamine oxidase inhibitors (MAOIs) within the last 14 days, due to cardiovascular events. Pregnancy and lactation: Use in pregnancy only if the potential benefit justifies the potential risk to the foetus. Not recommended during and immediately before labour and delivery. Do not use during breast feeding. Driving and using machines: May have major effect on ability to drive and use machines, especially at the beginning or change in dosage, in connection with alcohol or tranquilisers. Undesirable effects: Very common (≥1/10): dizziness, somnolence, headache, nausea, constipation. Common (≥1/100, <1/10): decreased appetite, anxiety, depressed mood, sleep disorder, nervousness, restlessness, disturbance in attention, tremor, involuntary muscle contractions, flushing, dyspnoea, vomiting, diarrhoea, dyspepsia, pruritus, hyperhidrosis, rash, asthenia, fatigue, feeling of body temperature change, mucosal dryness, oedema. Other important undesirable effects observed in clinical trials and/or postmarketing: drug hypersensitivity, depressed level of consciousness, mental impairment (uncommon ≥1/1000, <1/100), impaired gastric emptying, respiratory depression, convulsion, angioedema, anaphylaxis and anaphylactic shock (rare ≥1/10,000, <1/1000). No evidence of increased risk of suicidal ideation or suicide with Palexia SR. Additional information is available on request. Overdose: Seek specialist treatment (see SmPC). Legal classification: POM, CD (Schedule II). Marketing Authorisation numbers and pack sizes: 50 mg: PA 1189/7/4, 28 and 56 packs; 100 mg: PA 1189/7/5, 56 pack; 150 mg: PA 1189/7/6, 56 pack; 200 mg: PA 1189/7/7, 56 pack and 250 mg: PA 1189/7/8, 56 pack. Marketing Authorisation Holder: Grünenthal Ltd, Regus Lakeside House, 1 Furzeground Way, Stockley Park East, Uxbridge, Middlesex, UB11 1BD, UK. IRE/P18 0001. Date of Preparation: January 2018. Reference: 1. Palexia SR Summary of Product Characteristics. Date of Preparation: January 2018. IRE/P18 0005


Feature Other causes Chronic Pain may arise from anatomical site related general medical conditions. Site specific pain includes:

Medication Paracetamol

Can be used for? To treat pain anywhere in the body. Can be used alone or with other drugs such as NSAIDs or a codeine-like opioid, such as cocodamol and co-dydramol.

What are the benefits? Relieves pain quickly. Has few side effects and is considered generally safe if used within the recommended dose.

Oral non-steroid anti-inflammatories (NSAIDs), for example ibuprofen, diclofenac, etoricoxib, ketorolac, piroxicam, naproxen and celecoxib, in the form of a tablet

Low back pain. Hip or knee osteoarthritis pain (pain that affects your joints). Musculoskeletal pain (pain that affects your muscles, ligaments and tendons and joints).

Relieves pain quickly. Reduces pain caused by inflammation, for example in joints.

Topical non-steroid antiinflammatory drugs (NSAIDs), for example ibuprofen, diclofenac, etoricoxib, ketorolac, piroxicam, naproxen and celecoxib, in the form of gel, cream or patches. Other topical medicines (medication applied to the skin in the form of creams, gels or patches), for example: capsaicin; lidocaine patch; and rubefacients (substance that produces redness of the skin). Opioids, for example codeine, dihydrocodeine, tramadol, oxycodone, hydrocodone, tapentadol, morphine,diamorphine, transdermal fentanyl, buprenorphine and methadone

Should be considered when treating localised musculoskeletal pain, particularly if unable take NSAID tablets.Should be used for a short time.

Works directly on the affected area of the body. Less risk of side effects as the medication does not go through the whole body.

Should be considered for nerve pain or musculoskeletal pain which hasn’t improved with other medication, or if unable to t take other medication.

Works directly on the affected area of the body.Less risk of side effects as medication does not go through your whole body.

Sometimes topical painkillers can cause: • Redness • Itching • Stinging • Burning • Or other skin reactions.

Should be considered for chronic low back pain or osteoarthritis. Should only be continued if there is ongoing pain relief. Some opioids are weak (for example codeine) and some are strong (for example morphine). Because opioids can have serious side effects their long term use should only be considered after a detailed discussion with GP.

These are strong painkillers which reduce the intensity of pain and improve physical symptoms and day-to-day living.

Anticonvulsants, for example gabapentin, pregabalin and carbamazepine

This medication is commonly Can stop nerve impulses used to treat epilepsy but they causing some types of pain. can also help nerve pain. Recent studies indicate they may not be as effective as first thought for pain and increasing evidence of abuse

Antidepressants, for example amitriptyline, duloxetine and fluoxetine

As well as helping people who have depression, this medication can help others with chronic pain. Amitriptyline (or nortriptyline) should be considered for treatment of fibromyalgia (chronic widespread pain) and nerve pain. Duloxetine should be considered for treatment of nerve pain. Fluoxetine should be considered for treatment of fibromyalgia.

Common side effects include: feeling sick; being sick; feeling dizzy; constipation; feeling sleepy; feeling confused; and breathing problems. Side effects associated with longer-term use of opioids include: feeling lethargic; headaches; stomach problems (including constipation); urinary problems; reduced immunity to infections; hormone problems; dry mouth; oversensitivity to pain,or pain getting worse; addiction; mood changes; and sleep disturbances. Side effects may be worse in the first few days, when your body is getting used to new medication. The most common side effects include: dizziness; drowsiness; weight gain; rash; dry mouth; feeling sick; and being sick. Less common side effects include: swollen legs, blurred vision, headaches, diarrhoea and tremors (movement disorders). Different antidepressants have different side effects, and side effects are rare with some of them. When you first start to take amitriptyline or duloxetine you may experience: dry mouth; feeling sick; dizziness; urinary retention; constipation; drowsiness; problems sleeping; anxiety; agitation; and problems with your central nervous system.

• Abdominal (e.g. peptic ulcer, irritable bowel syndrome, pancreatitis, hernias, diverticular disease) • Gynaecological (e.g. endometriosis) • Obstetric (e.g. symphysis pubis dysfunction) • Urological (e.g. interstitial cystitis) • Cardiovascular (e.g. ischaemic heart disease, coronary heart disease, angina, peripheral vascular disease, etc) Chronic Pain may also result from disease conditions includes: • Rheumatological - conditions such as rheumatoid arthritis, osteoarthritis or fibromyalgia • Endocrine - conditions such as Hypothyroidism (joint pain), diabetes. • Infectious - diseases such as hepatitis C, Post-herpetic neuralgia • Malignancy – cancer pain and pain from treatment (e.g. radiation, chemotherapy or surgery) [Source: Warrell et al (2004); BMJ Best Practice (2009)] Treatment Before moving on to treatment, it is worth noting that, according to figures from the Pain in Europe study (Breivik et al 2006), 40% of respondents, when asked to describe their care said it was “inadequate”. Leading on from that, there is substantial evidence based on WHO figures that chronic pain is massively under treated across the globe. This is due to a variety of factors such as access to medicines and specialist help. Another contributing factor comes from sufferers themselves. Individuals with chronic pain often do not seek help with pain This occurs for a variety of reasons including religion, fear, finance, culture and a feeling that health care professionals may feel the individual’s pain is ‘imaginary’. Indeed, the fear of stigma and disbelief, especially with females is the most common reason in Ireland for not seeking help with chronic pain. The most common groups at risk of undertreatment for pain are: • Elderly • Female • Individuals with emotional or cognitive dysfunction

54

Source:- Scottish Intercollegiate Guidelines Network 2013

Work by interfering with the way nerve impulses are transmitted and ease some types of pain.

What are the side effects? Side effects from paracetamol are rare, if taken within safe limits. However, taking more than the amount recommended (more than 8 tablets in a day) is extremely dangerous. Rare side effects can include: • Skin rash • Kidney and liver problems, if higher than the recommended dose is taken. Side effects can include: • Stomach pain • Diarrhoea • Heartburn • high blood pressure • rash • dizziness and headaches. In a small number of people, NSAIDs can cause heart problems. Over-use can be associated with serious bleeding. For this reason, you must not use NSAIDs with aspirin. If you have asthma, there is a risk of it becoming worse when taking NSAIDs. Side effects are rare but some people can get mild skin reactions, for example a rash.


Product Information: Please consult the summary of product characteristics for full product information. Panadol Extra 500mg/65mg Soluble Effervescent Tablets, paracetamol, caffeine. Indications: Relief of mild to moderate pain such as that associated with rheumatism, neuralgia, headache, musculoskeletal disorders, menstrual pain, toothache, fever, symptoms of colds and flu. Dosage: Adults and children 12 years and over: 2 tablets up to 4 times a day. Max 8 tablets in 24 hours. Do not give to children under 12 years. Minimum dosing interval: 4 hours. The lowest dose necessary to achieve efficacy should be used. Contraindications: Hypersensitivity to paracetamol, caffeine or any of the other ingredients. Precautions: Do not use with any other paracetamol-containing products. The concomitant use with other products containing paracetamol may lead to an overdose. Paracetamol overdose may cause liver failure which can lead to liver transplant or death. Patients with depleted glutathione levels / glutathione depleted states. Diagnosed liver or kidney impairment, hereditary sugar intolerance, pregnancy, excessive caffeine intake, low sodium diet. Do not exceed the stated dose. Prolonged use except under medical supervision may be harmful. Side effects: Very rare cases of serious skin reactions have been reported. All very rare: Hypersensitivity reactions including anaphylaxis and skin rash, thrombocytopenia, angiodema, Stevens-Johnson syndrome, bronchospasm, hepatic dysfunction. Frequency unknown: Nervousness. dizziness. Legal Category: Pharmacy Only. MA Number: PA 678/39/10. MA Holder: GlaxoSmithKline Consumer Healthcare (Ireland) Limited, 12 Riverwalk, CityWest Business Campus, Dublin 24. Text prepared: July 2017. Further information available on request. Panadol is a registered trade mark of the GSK group of companies. Contains Paracetamol. Always read the label/leaflet. CHGBI/CHPAN/0090/17


Feature • Individuals who do not speak English as a first language Medication:A successful outcome from GP visits should be a pain management plan. It is highly likely that as part of this some form of pain relieving medication will be prescribed. Ideally, advice on promotion of self help. Self management and other treatments to help improve their condition and add value to the benefit offered by medication. Given the wide and varied nature of Chronic Pain, there can be a myriad of medication options. The effectiveness of medication depends on the nature and severity of the pain. Types of medications, their benefits and potential side effects are shown in the table on page 78: Regarding treatment of Chronic Pain caused by headache (eg. Migraine), in addition to standard paracetamol and NSAID’s, triptans are considered the most effective to combat acute attacks if ordinary analgesics do not work These include:• Almotriptan • Frovatriptan • Sumatriptan • Zolmitriptan • Eletriptan • Naratriptan Currently all are POM, although, following calls from pharmacists

and IPU etc, sumatriptan has been listed to move to OTC (available OTC in UK) by HPRA at some point in the future. Sumatriptan is considered especially effective in the treatment of cluster headaches. SELF HELP Pain Management Programme Pain Management Program (PMP) is a psychologicallybased rehabilitative treatment for people with persistent pain. It is delivered in a group setting by an multidisciplinary team of experienced health care professionals working closely with patients. The main aim is to teach a group of patients with similar problems about pain, how best to cope with it and how to live a more active life. Referral to a Pain Management Programme is usually through the general practitioner to your local pain clinic. There are public pain management programmes in*: • St Vincent’s University Hospital, Dublin • The Adelaide and Meath Hospital (Tallaght), Dublin • The Mater Misericordiae University Hospital, Dublin • Mercy University Hospital, Cork *This list not exhaustive

Pain, especially pain due to musculoskeletal disorders.

thinking or unhelpful beliefs which lead to increased distress.

• Hot or cold (ice) pack treatment,

Generally delivered on a “one to one” basis, the participant is taught techniques and strategies to enable them to challenge their thoughts, change their attitude leading to a change in future behaviour. Through regular attendance, confidence builds, leading to positive goal setting. These goals should relate to achieving resumption of activities previously restricted by pain.

• Ultrasound, • Peripheral nerve stimulation/ transdermal electronic nerve stimulation (TENS) A Chartered Physiotherapist can help with manual therapy which helps to increase tissue extensibility and range of movement, thereby decreasing pain. Manual therapy can also help with alignment and joint mechanics issues which in itself can also help alleviate pain. Therapeutic Exercise – such as hydrotherapy can restore joint movement and flexibility and strengthen and condition muscles to help movement thereby reducing pain. Patient Education – can support physical therapy in a self-help or home-based manner. Reading and learning about their condition can assist in management of their own pain. Exercise – Staying active can be the key to improving chronic pain symptoms……. Any activity that increase mobility can have not only a positive physical benefit but also an affirming mental health benefit also.

Physical Therapy

Cognitive behavioural therapy (CBT)

Physical therapy covers a number of different treatment types, which can be beneficial for Chronic

CBT is a proven “talking therapy”, the primary aim of which is to how to recognise and manage negative

Learning problem solving strategies, stress reductions techniques will help then in a successful outcome. The Pharmacists Role It’s not just about medication, although regular review the continued suitability of all medications used by those with Chronic Pain is vital. For many, the pharmacy is becoming the first port of call when a health problem, especially pain related, arises. Using some of the ideas regarding questions, pain diary etc will really help in enabling people to make better informed decisions about their own next step. Becoming familiar with local resources like physio’s, support groups, condition specific charities and sign posting these will only add value to a positive perception. Written by Eamonn Brady (MPSI), owner of Whelehans Pharmacies in Mullingar

Chronic Pain Ireland Announce Next Event Chronic Pain Ireland (CPI) have announced their next event which look at how patients dealing with Chronic Pain can better communicate their pain. Entitled “Coping with Chronic Pain – Communicating Pain effectively & Reshaping life/identity” the event will focus on learning how to best express what life is like for a person with chronic pain and methods of how they can track and record their thoughts, feelings and pain levels. The event will also focus on how patients with chronic pain cope with change and at ways to move through the process of letting some elements of a patients life go which they may not be able to do anymore due to their pain. A few other points the talk aims to address also includes: • A member’s personal experience of living with Chronic Pain • Forms of Identity, the parts that make you, you • What life can offer you if you cant function the way you used to • Making the most of healthcare appointments • What are you telling yourself about your pain • Self-Care techniques that can optimise the resources available whether under public or private healthcare. • Journalling, Visual diaries. • Web applications and reliable sources of information. Limited places are available at the event and will take place at the Marina Hotel, Canada Street, Waterford. For more information visit http://www.chronicpain.ie/our-services/events-and-meetings

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Feature

A look at Stoma in Ireland A stoma is a surgically created opening on the abdomen that lets faeces or urine pass out of the body. It is a Greek word meaning mouth or opening. A stoma is formed using part of the small or large intestine and will be pink/red in colour and moist – similar to the inside of your cheek. In the UK approximately one in 500 people have a stoma and the figures are similar in Ireland. The three most common types of stoma are: Colostomy - part of the large bowel (Colon) is brought to the surface of the abdomen. It is usually sited on the lower left side of the abdomen and the consistency of the output is similar to what is normally passed per rectum. A transverse colostomy (usually a loop colostomy) is sited above the waist on either side. The output can be softer in consistency depending on its siting. Ileostomy - part of the small bowel (ileum) is brought to the surface of the abdomen to form a stoma. An end ileostomy is generally permanent. A loop ileostomy has two openings (although you cannot always see both), one is connected to the upper gastrointestinal system (GI) and is ‘active’ and the other loop is attached to the lower GI system and is inactive. They can often be more difficult to manage than an end ileostomy. A loop ileostomy is generally reversible but can end up being permanent. An ileostomy is usually sited on the lower right side of the abdomen. As the output does not pass through the large bowel it is more liquid in consistency and it is acidic due to digestive juice content. Urostomy - the bladder is either bypassed or removed and an opening is created in the abdominal wall and part of the small bowel is used to divert urine from the kidneys. An example of some of the problems that can occur  In the first three months, the stoma reduces in size as the post op swelling subsides. Patients use cut to fit bags during this time as the size of the hole in the bag needs to be reduced regularly. A patient’s stoma care nurse will usually make these adjustments. However, at any time, if there is an increase or decrease in body weight particularly around the abdominal area this can affect bag security and it may be necessary to adjust the size or type of bag being used. A patient should be encouraged to contact their stoma nurse at these times.

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 Skin problems – a variety of skin problems can occur. If the bag being used is not the correct fit and as a result output gets onto the peristomal skin this can cause irritation - mild to severe. In the case of an ileostomist skin irritation can occur quickly as the output is acidic and will burn the peristomal area when leakage occurs. Skin irritation can be caused by an allergic reaction to any of the products being used. Creams are not suitable to treat peristomal skin conditions as the bag will not be able to adhere to moist skin. A patient should be referred to their stoma nurse or GP if skin irritation persists to prevent a more serious skin condition from developing.  Ongoing leakage is very distressing both physically and mentally. It can affect a person’s self-esteem and sense of well-being.  Wrong fitting bag – it is imperative that a bag fits securely. With a colostomy the hole can be larger than the stoma itself but with an ileostomy and urostomy the stoma bag needs to fit snugly around the base of the stoma  Dehydration – as an ileostomist has a more liquid output they are more prone to suffering from dehydration and need to be very conscious of their fluid intake. They may need to take products like Dioralyte and Immodium regularly to avoid severe dehydration. If a customer reports the signs and symptoms of dehydration - high output from stoma, lack of urinary output or urine appearing very concentrated, lethargy, weakness, nausea, breathlessness - they should be advised to go to their GP as soon as possible.  Hernias – those with a stoma are more prone to hernias and should seek medical advice if they suspect they have developed one.  Urinary infections – having a urostomy can result in urinary infections. Urostomy bags should be changed daily. These bags have a non-return valve which prevent urine reflux and this helps to avoid infections. Urostomists should be encouraged to drink an adequate quantity of water – 6-8 glasses. This helps to maintain the urine at an acidic PH level. It also reduces

salt formation and helps to prevent bacterial growth. Good nutrition with Vitamin C rich foods is recommended. Some Consultants recommend that Urostomists take Vitamin C tablets daily.  Blockages - if a person with a stoma presents with abdominal pain associated with reduced or no output or if their output has increased and is watery in consistency they should be advised to contact their Stoma Nurse or GP as soon as possible.  A normal healthy diet is important to encourage for everyone with a stoma. They will have received dietary advice from their stoma nurse and dietician while in hospital. There are many products available for those living with a stoma. In my experience I would say that less is best – unless someone is experiencing problems extra products should not be prescribed. Peristomal skin integrity will be enhanced if a person feels comfortable to shower with the bag off. The stoma bag should be changed as soon as any leakage is noted. The type of stoma, the type of stoma bag being used and a person’s lifestyle will determine how often they change their stoma bag. Products that can help when a bag starts to leak regularly Stomahesive paste - acts as a seal by filling in any gaps between the stoma bag and the stoma.

Skin protectors - creates a coating on the skin that acts as a barrier and protects peristomal skin from stoma output. Seals - applied around the base of the stoma to act as an extra seal and give greater security. Belts - attach to hooks on the side of some stoma bags to give extra support and security. Extender seals - attach to the flange (the wafer that adheres to the body) of the stoma bag. They extend the flange and increase the area of adhesion to the skin. If leakage persists it may be necessary to change to a convex bag. A convex bag refers to the outward shape (convexity) of the hole that fits around the stoma. It is designed to provide optimum peristomal seal. Changing to a convex bag should only be done on the advice of a stoma care nurse. Ensure you have details in your pharmacy of the stoma nurses that cover your area. Often patients lose touch with their stoma nurse if a long time has passed since their surgery. They should be encouraged to get their stoma reviewed as its size or the contour of the abdomen may have changed. Do not let people put up with ongoing leaks, there is usually something out there that can help. Madeleine Grant MSc, RGN, Stoma Care Nurse, CPT


Excellence is in the detail You want the best for your patients and living with an ostomy, be it for six weeks or a lifetime, can be scary, but with the right support your patients will feel confident and can live a full, active and independent life. We are Ireland’s leading provider of a full range of ostomy and incontinence related products with a bespoke, state-of-the-art Cutting Service.

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delivered within 24hrs with no minimum order charge.


Feature

Pregnancy – Pharmacy Pathways of care Increasingly a key person at the frontline, Community Pharmacists play an important role in advising expectant mothers, with pregnancy. It is an ideal time for pharmacy teams to develop a long-term relationship with prospective parents, and to get across useful information and advice. There are a number common conditions which a pharmacist may be asked to advise on such as: Heartburn and Indigestion Many women suffer from both heartburn (acid reflux) and indigestion during pregnancy and it tends to become more common as the pregnancy progresses. In fact, by the third trimester nearly three quarters of pregnant women can suffer from heartburn. There are two main reasons why heartburn and, to a lesser extent, indigestion are common at this time: 1. The surge in the hormone progesterone causes muscles to relax. This includes the sphincter (ring of muscle) at the entrance to the stomach. When this relaxes, stomach acids are able to travel back up into the oesophagus (food pipe) causing heartburn. 2. During the latter stages of pregnancy symptoms can also be caused by the baby physically putting pressure on the woman's digestive tract. Although harmless to the baby, heartburn and indigestion can be painful and uncomfortable for expectant mothers and pharmacists can advise patients that eating a healthy diet and sitting and/or sleeping in a more upright position can help ease heartburn and indigestion. Fatigue Fatigue is an early sign of pregnancy which nearly all women experience in the first trimester that can begin weeks after conception and implantation. It typically gets better around the start of the second trimester and returns in the third trimester, though it varies from pregnancy to pregnancy. A huge amount of energy goes into building a life support system for a baby, namely the placenta which is why a pregnant woman may be feeling fatigued. The body’s metabolism has increased significantly, while the blood sugar level and blood pressure tends to be lower.

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A number of tips to give expectant mums include: 1. Get enough rest. Advising a patient to start by going to bed earlier, and take naps during the day when they can. Even a 15-minute catnap can make a difference. 2. Stay hydrated. Cutting back on caffeine, and making sure plenty of water is consumed. If frequent urination is keeping a patient up at night, suggest drinking less water a few hours before bedtime and making up for it during the day. 3. Exercising regularly. Getting at least 20-30 minutes of moderate activity, such as walking can also help a patient feel less fatigued and that they have more energy Morning Sickness Despite its name, can happen any time of day or night. It’s also extremely common affecting over 80% of mums-to-be. Although it’s not known exactly what causes expectant mums to feel nauseous, it’s most likely that the feelings of nausea are all down to hormones, particularly Beta hCG, although it is thought that it can be due to a lack of vitamin B6, too. There are several techniques that although have not been scientifically proved to work, have

been frequently noted as helping subside the nausea symptoms for pregnant women. 1. Eating little and often, 6 meals a day. 2. Avoiding food with lots of sugar or saturated fats – such as sweets, chocolate and red meat. 3. Avoiding “trigger” foods or smells that make a patient feel sick. 4. Trying food or drinks that contain ginger. 5. Wearing acupressure bands throughout the day. Sciatica and Muscular Back Pain As many as 98% women will suffer from muscular back pain at some stage during their pregnancy. The pain is caused by the additional weight and changes in the body during pregnancy; hormonal changes can cause ligaments which support the spine to become loose, which puts more pressure on the lower back. During pregnancy, the hormone relaxin increases, which helps prepare the pelvis for childbirth by relaxing ligaments. As ligaments loosen and the body’s centre of gravity shifts, the sciatic nerve can shift and get pinched, which results in a shooting pain sensation down the buttocks and back of the legs.

While being pregnant doesn’t cause sciatica, a pre-existing back problem may be aggravated by increased pressure through the spine during pregnancy. Natural changes to posture can play a part to. As the baby grows it can cause an increase in the curvature of the spine, which causes more pressure on the surrounding joints. There are a number of suggestions pharmacists can make to alleviate symptoms: 1. Use a warm compress on the area where pain is being experienced. 2. Placing a pillow between the legs to better align the pelvis and take some pressure off the sciatic nerve. 3. Strengthen the core and reduce inflammation with pelvic tilts and kegel exercises. 4. Use a cold compress to provide cooling relief for back pain. Medication taking whilst pregnant All of the common conditions a woman faces when they are pregnant tend to have a number of OTC medicine treatments available, however often the effect of medication use during pregnancy and lactation is a major worry for both women and healthcare practitioners. Community pharmacists are frequently the first healthcare


Feature Folic Acid helps support the effective closure of the neural tube of the spine and brain, which happens very early in pregnancy (at approximately 21 - 28 days after conception). Post Pregnancy Advice It’s important that relevant advice doesn’t stop when the baby is born. While bladder sensitivity is a common problem for as many as one in three adult women in the country, many of them can feel too embarrassed to address the subject. Pregnancy can often lead to weak pelvic floor muscles. Pharmacy teams are in a favourable position to start the conversation on adult incontinence with their customers. professional who are asked to give advice regarding medication use during pregnancy. As 50% of pregnancies are unplanned, a woman often discovers she is pregnant while already taking a medication and visits a pharmacy which is easily accessible, to enquire if she has harmed her baby by this action. Whilst studies show there may be a lack of adequate information regarding use of certain medications during pregnancy, it has been suggested that pharmacists should be able to integrate available information with their medication expertise, to make appropriate individual risk/ benefit decisions. This requires active engagement with pregnant women, rather than automatically referring them to their physician. The trimester of the pregnancy often plays an important part in whether medications can be taken, for example Some medicines can be dangerous to take in the first three months but safe in the second or third, or vice versa.

• 1st Trimester – Usually the first trimester is the period of greatest risk for the baby. This is because during this stage the baby's organs are developing. Medicines taken during this time have the potential to affect this development, which could result in malformations or birth defects. If a defect is very severe this could cause a miscarriage. • 2nd Trimester - During the second trimester medicines can interfere with the development of the baby's nervous system or with the growth of the baby, resulting in a low birth weight. However, generally, experts believe that the second trimester is the safest period to take medicines. • 3rd Trimester - Medicines taken in the final three months of pregnancy can cause complications such as breathing difficulties for the baby after birth. This is because the medicine remains in the baby's body after birth and the newborn baby may not be able to cope with the medicine in its bloodstream the way the mother can.

Folic Acid The World Health Organisation (WHO) recommends that all women who may become pregnant take a daily folic acid supplement of 400 micograms for at least 12 weeks before conception. 400mg a day taken 12 weeks before and during the early stages of a pregnancy can cut the risk of a baby developing Neural Tube Defects by 70%. The new Safefood report found fewer than one third (31%) of women here had started taking folic acid daily 12 weeks prior to pregnancy, with almost half saying they had not taken the supplement before becoming pregnant. Almost all (98%) of women surveyed said they had started taking folic acid by the time of their first antenatal appointment.

They can discreetly find out about the specific nature of the customer’s condition; thanks to the one-on-one consultancy they offer. Many of the women affected don’t use the right product that would offer the best level of protection and discretion to meet their needs. Pharmacy staff are well-place to offer advice to women about following a well-balanced diet and maintaining a healthy lifestyle once the baby is born. Such as • Eating a varied diet containing plenty of fruit and vegetables, lean protein, starches, highfibre/ wholegrain foods and dairy • Consume foods rich in folic acid and vitamin D • Peanuts can be eaten during pregnancy as there is no clear evidence that this affects the likelihood of the unborn baby developing a peanut allergy

The UK and Ireland have a higher rate of Neural Tube Defects, which include conditions such as spina bifida, hydrocephalus and anencephaly, than other European countries.

Save the date - The Cosmetic Association (TCA) 2018 Trade Fair The Cosmetics Association, Ltd, which consists of owner/managers of Irish indigenous distribution companies, once again look ahead to May when they hold the largest single Trade Fair for the Pharmacy, Beauty and Gift sectors under one roof. This year’s Trade Fair will take place in the Main Hall at RDS Ballsbridge Dublin, from 20th to 22nd May: Sunday 20th May – 10am to 6pm Monday 21st May – 9am to 8pm Tuesday 22nd May – 9am to 6pm The Cosmetics Association welcomes all Trade Buyers to attend the event. Registration is in person, and parking is widely available and free. The 2017 Trade Fair for The Cosmetic Association was the most successful trade fair to date - Both exhibitor and visitor numbers were increased with almost 1,500 buyers attending over the course of the event.

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First Response Early Results

When to Test

**Source: Social web conversation (UK, English, October 2016 â&#x20AC;&#x201C; February 2017)


Feature Sexual Healing – The Pharmacist Role in Sexual Health Advice Pharmacies are a vital outlet when it comes to contraception and sexual health. People who may not want to visit their local GP or sexual health clinic, can drop into their pharmacy and talk to a trusted healthcare professional in a confidential space. Accessibility Patients are increasingly likely to present at pharmacies for advice on their sexual health as appointments aren’t necessary, opening hours and weekends are often more convenient and private consultations are an option. Pharmacies are usually more often conveniently located than family planning clinics, which are often based in hospitals. In many rural areas the pharmacy is often the only place accessible in which to obtain sexual health advice. Pharmacists can use visual tools to communicate to customers about the contraception options available. Leaflets or cards could be supplied to patients receiving their regular contraceptive medication or if supplying emergency hormonal contraception. Leaflets about STI prevention methods and sexual health can be positioned at the counter, or information on posters around the pharmacy. Information slips about safe sex could be included in prescription bags, particularly when issuing scripts for contraceptives and STI treatments. It’s important to remember that its best not to assume anything about the patient when they approach the pharmacy for advice on sexual health. A person who is asking for information may not be sexually active and just want to be better informed. A person may not already know all the facts. Being prepared to go back to basics and giving information in stages ensures you give a patient time to ask questions about what you have said and clarify any areas of misunderstanding. It can be hard to reduce a whole conversation about sexual health into a 30-second-over-the-counter chat. It is much more beneficial if consultations can take place in an appropriately confidential space if possible. This helps to build up a trusting relationship with the patient as confidentiality is a priority when accessing sexual health services in any setting. Having the Conversation As the most accessible healthcare professional, pharmacists are an important resource for STI prevention and control. The large

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number of pharmacy outlets, and the trust shared between pharmacists and the public combine to afford a unique opportunity to reach patients and discuss their sexual health. The deregulation of EHC in 2011 demonstrated confidence in the pharmacy profession to make the clinical decision regarding its supply. This also opened up opportunities to discuss contraception and protection methods with patients. It is opportunities like these that pharmacists must utilise to promote sexual health and provide information regarding STIs as well as the provision of EHC. Encouraging use of condoms is of utmost importance and can be promoted by listing their advantages: 1. Many contain lubricant 2. 92-98% effective 3. Prevention of STI’s 4. Only contraception males have control of 5. Females can be prepared and carry them also A survey of more than 600 university students around the country (conducted on behalf of University College Cork) found that two thirds had not been tested for an STI but 10% of those who had, had contracted an STI. 90% students said that they had had unprotected oral sex. In addition, more people gave as a reason for

using contraception the desire to avoid pregnancy as opposed to wishing not to contract an STI. This highlights the need to emphasise the need for use of barrier protection as well as regular long-term contraception. Sensitivity Pharmacists are experienced in discussing personal details with patients and giving them advice in a non-judgemental manner. Pharmacists need to be confident in discussing topics such as sexual health to develop a level of trust with the patient. Sexual health topics need to be dealt with in a sensitive manner: • Greet the patient • Bring the patient into the consultation room • Maintain eye contact • Use appropriate body language • Ask open-ended questions • Reassure them that all information remains confidential, as always These factors are fundamental to ensure patient feels at ease and comfortable in your presence. There are some key opportunities to potentially broach the subject and promote sexual health. One such occasion is when emergency hormonal contraception is required. Advice about long term methods of contraception and information regarding STI’s are standard practice throughout the consultation.

A patient asking about irregular periods, spotting or genital warts is a signal that demonstrates the patient requires more knowledge and is open to any information that can be provided. A patient presenting with their first prescription for a contraceptive is another opportunity to utilise, to counsel on sexual health and how to reduce the risk of contracting STIs. Pharmacists can aid patients in several ways including: • Signposting and referral when necessary • Sale of OTC items (pregnancy tests, condoms, self-care products) • Advice and information on STI’s • Supply of EHC where necessary and appropriate • Information on long term contraception options Ultimately the Pharmacist can play a central role on the promotion of sexual health and knowing when referral is necessary. The key to reducing the incidence of STIs is by encouraging safer sex and using fundamental opportunities that arise in the pharmacy to provide advice. To accomplish these goals, it is imperative that Pharmacists and their staff are at ease discussing sexual health issues and are adequately trained to provide advice.


Feature

Winter Asthma Warning Ireland has the fourth highest prevalence of asthma in the world. One-in-five children in Ireland suffer from asthma and overall there are four deaths a day directly associated with poor air quality across all age groups. There are 1,200 premature deaths in Ireland related to air pollution. The main cause of death is cardiovascular disease when pollutants enter the bloodstream. Outdoor air quality Dangerous air pollution readings were recently measured in New Ross, County Wexford, which has led to concerns about the health of its residents. In 2016 Wexford County Council set up real-time monitoring equipment in Wexford Town and New Ross. The system measures fine particles in the air from smoke and fuel emissions known as PM10 and PM2.5, which can penetrate into the lungs and bloodstream. "On one particular evening in mid-December we were reaching limits of PM10 and PM2.5," Said the council's senior executive scientist, Brendan Cooney. “To put that into perspective, the air quality was so bad that a UCC professor told me that New Ross had worse air quality than Beijing in 2008 -when there were concerns over athletes’ exposure to smog during the Olympics." In Ireland, like many EU countries, residential heating is a significant source of PM2.5 emissions. The main source of air pollution is coal and, particularly in the midlands, peat. Dublin imposed a ban on smoky coal in 1990, Cork followed five years later, and it was extended to 25 other urban areas in 2013. However, it's still a problem for smaller, regional towns. In December, Minister Denis Naughten announced that the Government will impose a ban on the burning of smoky coal nationwide. The ban is expected to come into effect in September this year when coal stocks are depleted. "We've seen the difference a smoky coal ban makes. When Dublin became a designated smokeless zone, we saw a drop in the number of people being admitted to hospitals," said Mr Cooney. Indoor air quality A separate study by the Asthma Society of Ireland, shows that improving indoor air quality may also help people with asthma manage their symptoms. The research suggests air quality

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monitoring and air cleaning could be a vital part of ongoing asthma management. Kevin Kelly, interim CEO of the Asthma Society of Ireland, said “The results of this study highlight the need for a larger, longer-term study to fully illustrate the benefits of air quality monitoring and the use of air purifiers as a way to better inform public health initiatives.” John Sodeau, Professor of Chemistry at UCC, said of the study “The main lesson to be learned from this report is that air filtration systems are a real help in reducing the numbers of airborne particulates present in your house. Every asthma management plan should have one”. The research showed that a significant number of asthma events could be linked to poor air quality within the home and that installing an air purifier led to a dramatic drop in dangerous air pollution, particularly a type linked to more severe asthma symptoms, COPD and even lung cancer. Kelly added “The ability to log asthma symptoms against the current air quality in the home is hugely helpful for people with asthma, as it can make identifying and avoiding asthma triggers much easier.” We spend much of our time indoors (up to 90% for young children and elderly people) which means that the air we breathe impacts our health and well-being. When outdoor air quality is bad, it can be difficult for one person to make changes that lead to big improvements. However, with indoor air quality it is relatively easy and often cost-effective to make small changes that can reap real rewards for health. Danger from spores During the Winter months, many people must dry their clothes indoors. The Society has warned that many asthmatics could be damaging their health by doing so. “Research has shown drying wet clothes indoors can raise moisture levels by up to 30%. Moist environments encourage the

growth of mould spores. These often-invisible spores can trigger breathing problems in people with asthma and other respiratory conditions.” People whose asthma is more likely to be triggered by fungal and mould spores include: Babies and children; Elderly people; People with existing skin problems such as eczema; People with a weakened immune system and those with severe asthma. The Asthma Society issued the following tips to help people protect against mould in their homes: • Where possible dry washing outside, or in a tumble dryer in a well-ventilated indoor space away from bedrooms and living areas. • Try not to dry clothes indoors, store clothes in damp cupboards or pack clothes too tightly in wardrobes and drawers. • Ensure the house is well-ventilated by opening windows regularly. • Use extractor fans or open windows to increase ventilation from showers, appliances and cooking. • Wash mould off hard surfaces using a water, vinegar and soap mix.

• Consider using a purifier with a built-in air quality sensor to remove allergens and pollutants from the air. • Consider using a dehumidifier to remove excess moisture. • Keep air conditioner and heating filters clean and dry. • Fix leaks and moisture problems and keep things dry and clean in places where mould tends to grow such as showers and under sinks. Asthma in the pharmacy days The Asthma Society of Ireland runs several Asthma in the Pharmacy days throughout the country. They provide an asthma nurse specialist for the events to give advice, support, information and patient education on asthma. The nurse can see up to 11 patients over a period of 6 hours. The Asthma in the Pharmacy days are an opportunity to advise patients on a range of topics including: Asthma in children, allergies, Asthma management, Inhaler technique, Peak flow monitoring and Smoking cessation. To see the latest Asthma in the Pharmacy days scheduled, head to https://www.asthma.ie/.


Asthma

Relvar Ellipta is an ICS/LABA for patients (≥12 years) uncontrolled on ICS alone and ‘as needed’ SABA1

24 HOUR EFFICACY

Remind her of what she’s been missing Your choice of treatment could mean your patients don’t have to miss out.

Practical efficacy Relvar Ellipta (fluticasone furoate/ vilanterol [as trifenatate]) Prescribing information (Please consult the full Summary of Product Characteristics (SmPC) before prescribing) Relvar Ellipta (fluticasone furoate/vilanterol [as trifenatate]) inhalation powder. Each single inhalation of fluticasone furoate (FF) 100 micrograms (mcg) and vilanterol (VI) 25mcg provides a delivered dose of 92mcg FF and 22mcg VI. Each single inhalation of FF 200mcg and VI 25mcg provides a delivered dose of 184mcg of FF and 22mcg of VI. Indications: Asthma: Regular treatment of asthma in patients ≥12 years and older not adequately controlled on inhaled corticosteroids and ‘’as needed” short-acting inhaled β2-agonists, where a long-acting β2-agonist and inhaled corticosteroid combination is appropriate. COPD (Relvar 92/22mcg only): Symptomatic treatment of adults with COPD with a FEV1<70% predicted normal (post-bronchodilator) and an exacerbation history despite regular bronchodilator therapy). Dosage and administration: Inhalation only. Asthma: Adults and adolescents ≥12 years: one inhalation once daily of: Relvar 92/22mcg for patients who require a low to mid dose of inhaled corticosteroid in combination with a longacting beta2-agonist. If patients are inadequately controlled then the dose can be increased to one inhalation once daily Relvar 184/22mcg. Relvar 184/22mcg can also be considered for patients who require a higher dose of inhaled corticosteroid in combination with a long-acting beta2-agonist. Regularly review patients and reduce dose to lowest that maintains effective symptom control. COPD: one inhalation once daily of Relvar 92/22mcg. Contraindications: Hypersensitivity to the active substances or to any of the excipients (lactose monohydrate & magnesium stearate). Precautions: Pulmonary tuberculosis, severe Relvar Ellipta was developed cardiovascular disorders, heart rhythm in collaboration with abnormalities, thyrotoxicosis, uncorrected hypokalaemia or patients predisposed to low levels of serum potassium. chronic or untreated

infections, diabetes mellitus. Paradoxical bronchospasm – substitute alternative therapy if necessary. In patients with hepatic with moderate to severe impairment 92/22mcg dose should be used. Acute symptoms: Not for acute symptoms, use shortacting inhaled bronchodilator. Warn patients to seek medical advice if short-acting inhaled bronchodilator use increases. Therapy should not be abruptly stopped without physician supervision due to risk of symptom recurrence. Asthma-related adverse events and exacerbations may occur during treatment. Patients should continue treatment but seek medical advice if asthma symptoms remain uncontrolled or worsen after initiation of Relvar. Systemic effects: Systemic effects of inhaled corticosteroids may occur, particularly at high doses for long periods, but much less likely than with oral corticosteroids. Possible Systemic effects include: Cushing’s syndrome, Cushingoid features, adrenal suppression, decrease in bone mineral density, growth retardation in children and adolescents, cataract, glaucoma. More rarely, a range of psychological or behavioural effects including psychomotor hyperactivity, sleep disorders, anxiety, depression or aggression (particularly in children). Increased incidence of pneumonia, including pneumonia requiring hospitalisation, has been observed in patients with COPD receiving inhaled corticosteroids. If a patient presents with visual disturbance they should be considered for referral to an ophthalmologist for evaluation of possible causes which may include cataract, glaucoma, or rare diseases such as central serous chorioretinopathy. Physicians should remain vigilant for the possible development of pneumonia in patients with COPD as the clinical features of such infections overlap with the symptoms of COPD exacerbations. Risk factors for pneumonia include: current smoking, older age, low body mass index and severe COPD. The incidence of pneumonia in patients with asthma was common at the higher dose of Relvar (184/22mcg). Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take Relvar. Interactions with other medicinal products: Interaction studies have only been

performed in adults. Avoid β-blockers. Caution is advised when co-administering with strong CYP 3A4 inhibitors (e.g. ketoconazole, ritonavir, cobicistat-containing products). Concomitant administration of other sympathomimetic medicinal products may potentiate the adverse reactions of FF/VI. Relvar should not be used in conjunction with other long-acting β2-adrenergic agonists or medicinal products containing longacting β2-adrenergic agonists. Pregnancy and breast-feeding: Experience limited. Balance risks against benefits. Side effects: Very Common (≥1/10): Headache, nasopharyngitis. Common (≥1/100 to <1/10): Candidiasis of the mouth and throat, pneumonia, bronchitis, upper respiratory tract infection, influenza, oropharyngeal pain, sinusitis, pharyngitis, rhinitis, cough, dysphonia, abdominal pain, arthralgia, back pain, muscle spasms, fractures, pyrexia. Uncommon (≥1/1,000 to <1/100): Vision blurred, extrasystoles. Rare (≥1/10,000 to <1/1,000): Hypersensitivity reactions including anaphylaxis, angioedema, rash and urticaria; palpitations, tachycardia, tremor, anxiety, paradoxical bronchospasm. Marketing authorisation (MA) Holder: Glaxo Group Ltd, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK. MA Nrs: 92/22mcg 1x30 doses [EU/1/13/886/002]; 184/22mcg 1x30 doses [EU/1/13/886/005]. Legal category: POM B. Last date of revision: September 2017. Job Ref: IE/FFT/0046/15(6). Further information available on request from GlaxoSmithKline, 12 Riverwalk, Citywest Business Campus, Dublin 24. Tel: 01-4955000. Adverse events should be reported to the Health Products Regulatory Authority (HPRA) using an Adverse Reaction Report Form obtained either from the HPRA or electronically via the website at www.hpra.ie. Adverse reactions can also be reported to the HPRA by calling: (01) 6764971. Adverse events should also be reported to GlaxoSmithKline on 1800 244 255. References: 1. Relvar Ellipta Summary of Product Characteristics. GlaxoSmithKline; 2017. IE/FFT/0015/17a Date of Preparation: Nov 2017 Trademarks are owned by or licensed to the GSK group of companies.


Clinical Profiles ACCORD LAUNCH METHOTREXATE 100 MG/ML CONCENTRATE FOR SOLUTION FOR INFUSION Accord Healthcare is delighted to announce the launch of Methotrexate 100 mg/ml concentrate for solution for infusion in a 1 x 10 ml vial pack size. Methotrexate 100 mg/ml concentrate for solution for infusion is indicated for the treatment of; Acute lymphocytic leukaemia, Non-Hodgkin’s lymphomas, osteogenic sarcoma, adjuvant and in advance disease of breast cancer, metastatic or recurrent head and neck cancer, choriocarcinoma and similar trophoblastic diseases, advanced cancer of urinary bladder. Please refer to the Summary of Product Characteristics (SPC) available at www.accord-healthcare.ie or www.hpra.ie for further information. Methotrexate 100 mg/ml concentrate for solution for infusion is now available from Allphar. For further information please contact your Accord representative, call Accord in Cork on 021-461 9040 or visit www. accord-healthcare.ie Your Accord Representatives are: Tracy Kivlehan 086 838 9829 Ánna Barrett 086 037 5953 Ollie Lawrence 087 949 3918

STELARA Janssen announced in November that STELARA (ustekinumab) has been reimbursed in Ireland for the treatment of adult patients with moderately to severely active Crohn’s disease who have had an inadequate response with, lost response to, or were intolerant to either conventional therapy or a tumour necrosis factor alpha (TNFα) antagonist or have medical contraindications to such therapies.[i]

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Two-year data from the ongoing IM-UNITI long-term extension (LTE) study evaluating the efficacy and safety of subcutaneous (SC) STELARA in patients with moderate to severe Crohn’s disease, maintained clinical response and remission for up to two years, and a long term safety profile consistent with placebo through to two years, with no new safety signals observed.[ii] Ustekinumab received marketing authorisation from the European Medicines Agency in November 2016. It is the first biologic therapy for Crohn’s disease that targets interleukin IL-12 and IL-23 cytokines, known to play a key role in inflammatory and immune responses. The EC approval was based on data from three pivotal Phase 3 trials which included approximately 1,400 patients with moderate to severe Crohn’s disease. Among these patients, the Phase 3 studies showed that treatment with ustekinumab induced clinical response as early as week 3 in both conventional therapy failures and anti TNF failures. It also maintained clinical remission in a significantly greater proportion of adult patients after one year of therapy compared to placebo with the more recent IM-UNITI trial results further supporting long term remission after two years of therapy.2,[iii],[iv],[v] The recommended dosing regimen for ustekinumab in moderate to severe Crohn’s disease patients is an initial induction dose (~6 mg/kg) given via a single intravenous (IV) infusion. The first subcutaneous (SC) administration of 90mg ustekinumab should take place at week 8 after the intravenous dose. After this, dosing every 12 weeks is recommended. Patients who have not shown adequate response at week 8, after the first SC dose may receive a second SC dose at this time. Patients who lose response on dosing every 12 weeks may benefit from an increase in dosing frequency to every 8 weeks. Patients may subsequently be dosed every 8 weeks or every 12 weeks according to clinical judgement.[vi] Important Safety Information[viii] For a full list of side effects and for further information on dosage and administration, contraindications and other precautions when using ustekinumab, please refer to the ustekinumab summary of product characteristics, available on www.medicines.ie [i] http://www.medicines.ie/ medicine/16996/SPC/STELARA+1 30+mg+concentrate+for+solution+ for+infusion/#INDICATIONS. Last accessed 10th May, 2017

[ii] Sandborn W, Rutgeerts P, Gasink C et al. Long term efficacy and safety of ustekinumab for Crohn’s disease: Results from IM-UNITI Long-Term Extension through 2 years. Annual Congress of the European Crohn’s and Colitis Organisation (ECCO 2017); 15 – 18 February, 2017; Barcelona, Spain; Abstract A-1285. [iii] Sandborn W, et al. AIBD 2015: Abstract O-001. [iv] Feagan B, et al. UEGW 2015: Abstract UEG15-LB-5668. [v] Sandborn W, et al. DDW 2016:Abstract 768. [vi] EMA. Product information. http://www.ema.europa.eu/ema/ index.jsp?curl=pages/medicines/ human/medicines/000958/human_ med_001065.jsp&murl=menus/ medicines/medicines. jsp&mid=WC0b01ac058001d124 (last accessed 10 May, 2017) [viii] Summary of Product Characteristics for Stelara in Ireland. Medicines.ie website. (Last accessed 17th August 2015)

DISCONTINUATION OF MEDICINAL PRODUCT ANAFRANIL® (CLOMIPRAMINE HYDROCHLORIDE) 10MG, 25MG AND 50MG CAPSULES(PA13/84/1-3), BY NOVARTIS IRELAND. The supply of Anafranil® SR 75mg Prolonged-release tablets will continue to be available. Anafranil is licensed for the following indication: In the management of endogenous depression including manic depression, periodic and involutional depression, reactive and neurotic depression, obsessional and phobic states and as an adjunctive treatment of cataplexy associated with narcolepsy. The decision was made to cease marketing of Anafranil® 10mg, 25mg and 50mg capsules due to ongoing manufacturing issues specific to Anafranil® capsules. January 2018 IE02/ANA17CNF002b

IRISH BASED COMPANY AWARDED $333,333 AND TITLED FIRST-OF-ITS-KIND 26 January – Three Lakes Partners, a venture philanthropy committed to ending Idiopathic Pulmonary Fibrosis (IPF), named Irish based patientMpower, a provider of digital health solutions, among one of three overall winners of the

$1,000,000 IPF Catalyst Challenge at an event in Chicago. The ambitious healthcare competition invited innovators from around the world to develop real, executable solutions to help change the many quality-of-life issues affecting patients living with IPF. Based in The Digital Hub, patientMpower develops a suite of digital health solutions for Idiopathic Pulmonary Fibrosis (IPF), Kidney Transplant, Prostate Cancer, Hemodialysis and Vasculitis with the aim of transforming the lives of people living with chronic disease. Founded in 2014, patientMpower provides a platform for patients to better manage their condition, get access to their medical data and communicate with their health provider. The award-winning solution proposed by patientMpower is based around the development of a mobile platform that enables IPF patients to track their disease using integrated monitors allowing them to better manage their treatment through new insights and connections with peers and caregivers. Eamonn Costello, CEO, patientMpower commented on the award: “Winning the IPF Catalyst Challenge is a pivotal moment for patientMpower and our mission to empower patients, those PF warriors, to live better with IPF. This funding will also be the catalyst for us to fully realize the potential of our digital biobank — data donated by all the PF warriors which is an amazing resource for IPF research. Through collaborations, we will continue to uncover new insights to map IPF human health. We would like to thank all those behind the IPF Catalyst Challenge for giving us this amazing opportunity to empower patients, to improve outcomes, and to accelerate research.” “We created the IPF Catalyst Challenge on behalf of the countless patients around the world living with this largely ignored, heartbreaking disease. By collaborating with brilliant minds and innovative thinkers across the globe, we knew we could attack IPF from all sides and truly make progress,” said Ken Bahk PhD, managing director, Three Lakes Partners. “We couldn’t be more thankful for the inspiring ideas we saw over the course of this competition, and are honored to help bring our winners’ solutions to life. We’re excited for the promise that lies ahead.”


Medication Adherence Packaging f Solutions to the Pharmaceutical, Healthcare and Medicines industry in Ireland. We are sole agents in Medication Adherence Packaging from Ireland for Omnicell, one of the worlds leading Medication Packaging from MCLERNONS - HELPING IMPROVE PATIENT CARE – WHEREVER IT ISAdherence DELIVERED! manufacturers of medication adherence packaging, Sam Mclernons are the leading Provider o to the Pharmaceutical, Healthca solutions and technology. Our Medication products, in paper PackagingSolutions Medicines industry in Ireland. We are sole Adherence from Ireland for Omnicell, one of the worlds le manufacturers of medication adherence p or plastic, range from simple-to-use adherence solutions and technology. Our products, in or plastic, range from simple-to-use adhe SureMed by Omnicell packs, to storage solutions, SureMed by Omnicell packs, to storage so to De-Blistering solutions. Sam Mclernons are the leading Provider of Packaging to De-Blistering solutions. Solutions to the Pharmaceutical, Healthcare and

Medication Adherence Packaging from

Sam Mclernons are the leading Provider of Packaging Solutions to the Pharmaceutical, Healthcare and Medicines industry in Ireland. We are sole agents in Ireland for Omnicell, one of the worlds leading manufacturers of medication adherence packaging, solutions and technology. Our products, in paper Sam Mclernons are the leading Provider of Packaging or plastic, range from simple-to-use adherence Solutions to the Pharmaceutical, Healthcare and SureMed by Omnicell packs, to storage solutions, Medicines industry in Ireland. We are sole agents in to De-Blistering solutions. Ireland for Omnicell, one of the worlds leading manufacturers of medication adherence packaging, solutions and technology. Our products, in paper or plastic, range from simple-to-use adherence SureMed by Omnicell packs, to storage solutions, to De-Blistering solutions.

Sam Mclernons are the leading Provider of Packaging Solutions to the Pharmaceutical, Healthcare and Medicines industry in Ireland. We are sole agents in Ireland for Omnicell, one of the worlds leading manufacturers of medication adherence packaging, solutions and technology. Our products, in paper or plastic, range from simple-to-use adherence SureMed by Omnicell Sam Mclernons are the leading Provider of Packaging packs, to storage solutions, to De-Blistering solutions.

Medicines industry in Ireland. We are sole agents in Ireland for Omnicell, one of the worlds leading manufacturers of medication adherence packaging, solutions and technology. Our products, in paper or plastic, range from simple-to-use adherence SureMed by Omnicell packs, to storage solutions, to De-Blistering solutions.

Solutions to the Pharmaceutical, Healthcare and Medicines industry in Ireland. We are sole agents in Ireland for Omnicell, one of the worlds leading manufacturers of medication adherence packaging, solutions and technology. Our products, in paper or plastic, range from simple-to-use adherence SureMed by Omnicell packs, to storage solutions, to De-Blistering solutions.

To order please call McLernons on 01-4504121 - sales@samm

To order please call McLernons on 01-4504121 - sales@sammclernon.ie

To order please call McLernons on 01-4504121 - sales@sammclernon.ie

To order please call McLernons on 01-4504121 - sales@sammclernon.ie

Mention ‘IPN’ and receive a 5% reduction on all February Orders. To Order please call McLernons on 01-4504121 – sales@sammclernon.ie

To order please call McLernons on 01-4504121 - sales@sammclernon.ie

The 'Art' of Stoma Healing "The challenge is to establish or re-establish a sense of identity unrelated to the body" (Manderson, 2005) People who have a stoma for longer than six months are invited to participate in one, or a series of six Creative Arts Workshops. In these workshops we will explore the issues that can affect those living with a are experiential in nature. Tostoma. order These pleaseworkshops call McLernons on 01-4504121 - sales@sammclernon.ie Workshop 1: Clay The experience of using clay is known to be a strong sensory one and can help us to explore past and present memories and emotions. Workshop 2: Art Body mapping connects us to our body, emotions and experiences. Workshop 3: Sand Using sand as a means of symbolic expression and communication. Workshop 4: Music Exploring our body rhythms through drumming. Workshop 5: Body Work Give the site of your pain/injury a shape, sound and movement. Workshop 6: Dance Movement Using movement to support the integration of body, mind and spirit. For details of upcoming workshops or to organise one in your area please contact: Madeleine Grant at 0872981642/grant.madeleine@gmail.com Facebook page: https://www.facebook.com/LifeandStomas/ These workshops are funded by St. Vincent's University Hospital and The Stoma Care Advisory Service Admission to the Workshops is Free Facilitated by: Madeleine Grant Stoma Care Nurse, Certified Play Therapist, MSc Bereavement Studies. Deirdre Kavanagh MA Play Therapist, Clinical Supervisor, Integrative Sand and Creative Arts Trainer (Sandy Lane Institute Ltd.)

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URIAGE HYSÉAC Cleansing Gel Has Got Your Bacne this Paddy’s Day Perfect Cleansing Gel for Face, Body and Back Imperfection prone skin is always a concern among men and women and not just on our faces. Back acne or ‘Bacne’ as it is often referred to in the press, can be a major confidence buster. Men can be more prone to getting “Bacne”, however many women also suffer from breakouts in this zone. HYSÉAC Cleansing Gel gently cleanses the skin, eliminating impurities and excess sebum which leaves the skin feeling clean & fresh. Suitable for use on face, chest and back, the flip cap bottle makes this the perfect shower buddy. RRP: ¤25.00

FLEMING MEDICAL SHOWCASE AT ARAB HEALTH 2018 The largest gathering of healthcare and trade professionals in the Middle East region. The event is expected to welcome more than 4,200 exhibiting companies and 103,000 attendees from 150+ countries. This will be Fleming Medical’s 5th year showcasing their Medicare pharmacy confined range of products at Arab Health, the company has signed large contracts in previous years with export partners in Dubai, Oman & Saudi Arabia.

Deep Freeze Pain Relief Cold Patch and Deep Freeze Pain Relief Cold Gel – helping mums ease muscular back pain during pregnancy and beyond More than two-thirds of women are expected to suffer from muscular back pain at some time during pregnancy1, according to a 2015 Cochrane Review. But Deep Freeze, the market-leading range of drug-free cooling products, can help ease back pain during pregnancy and beyond with penetrating cooling therapy in a choice of three formats: The range offers the Deep Freeze Pain Relief Cold Patch, Deep Freeze Pain Relief Cold Gel and Deep Freeze Pain Relief Glide-on Gel. CD001139: Liddle, Sarah D, Pennick,Victoria. Interventions for preventing and treating low-back and pelvic pain during pregnancy. Cochrane Database of Systematic Reviews, 2015.

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Nivea Surpasses High End Moisturisers in BBC Documentary NIVEA Soft Moisturising Cream has been revealed as the most effective moisturiser in comparison with selected expensive brands in a recent trial carried out by the BBC’s The Truth About Looking Good. NIVEA came out on top as it was the most effective at adding moisture to the skin and improving the way it felt. www.nivea.ie

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Nyx Professional Makeup Bright Idea Illuminating Sticks Available in a range of radiating hues, including highlighters, blushes and bronzers each creamy-soft shade goes on smoothly and sets right away for an instant, lit-fromwithin glow. Petite, portable and perfecting for strobing on the go!

RRP ¤11.25

NEW Hydrabio Lait (milk) 250ml Leading French dermo-cosmetic brand, BIODERMA, is proud to announce the launch of the NEW Hydrabio Lait (milk). The new moisturising Hydrabio cleanser and makeup remover is the latest addition to the popular range that includes the renowned Hydrabio H20 micellar water. Specifically formulated for those with dehydrated sensitive skin, Hydrabio Lait is the 1st moisturising cleanser and make-up remover with AquageniumTM patent.

RRP ¤12.50


FULLY AVAILABLE now with LONG SHELF LIFE

Preservative FREE

Order from your wholesaler Please consult the summary of product characteristics for side-effects, precautions and contra-indications, which can be found at:

www.goldeneye.ie

Dibrompropamidine isetionate (P)

Propamidine isetionate (P)

Expiry August 2019

Expiry July 2019

Cambridge Healthcare Supplies Ltd, Wymondham, NR18 9SB, United Kingdom

1GE12/1706

Non-Contact Infrared Thermometer

SRP

€39.95 MD1831

Fast and accurate with a unique 3-in-1 feature that measures Body, Room and Water temperature with ease.

FREEPHONE 1800 307 777 • FREEFAX 1800 313 395 pharmacy@flemingmedical.ie • www.flemingmedical.ie

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Irelandâ&#x20AC;&#x2122;s No.1 Pain & Fever Reliever for Children*

Lets Kids be Kids Calpol Infant 120mg/5ml Oral Suspension. MAH: McNeil Healthcare (Ireland) Ltd., Airton Road, Tallaght, Dublin 24, Ireland. Products not subject to medical prescription. Full prescribing information available upon request from Johnson & Johnson (Ireland) Ltd.

*Combined Nielsen & IMS Data, December 2017.

IRE/CA/18-2988

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IPN 2018 February  

IPN 2018 February