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April 2019 Volume 11  Issue 4 PHARMACYNEWSIRELAND.COM

THE INDEPENDENT VOICE OF PHARMACY

In this issue: NEWS:

HEAL WOUNDS * UP TO 2x FASTER

Ireland facing Codeine addiction epidemic Page 4

PROFILE: A ‘Quirky’ Passive Pharmacy Page 9

REPORT: Hi-Tech Hubs in Action Page 16

FEATURE: When Headache Pain Hits Page 30

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CPD: Management of Wound Care Page 49

AWARDS: OTC Product & Retail Pharmacy Award Winners 2019 Page 54


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Contents Foreword

Page 5: Brendan sets off on his charity voyage

Concern has been expressed over the use of codeine within Ireland. Noted as a ‘highly abused substance’ a local researcher has stated that we are on the verge of an epidemic eruption. Codeine use is relatively un-documented here but there are now calls to bring this public health threat to the forefront of practice. Read more on this story on page 4.

Page 6: Ryan’s Pharmacy best in the business Page 12: Over 600,000 falsified medicines detained

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In other worrying news, an astonishing 75% of pharmacies here were the victims of crime last year. The recent Crime Survey, published by the Irish Pharmacy Union (IPU), shows that community pharmacies are suffering from exceedingly high levels of crime. Three quarters of all pharmacies have been the victim of at least one crime over the past twelve months, with the majority of these (81%) experiencing multiple incidents. The IPU has called for more resources to be made available to tackle crime in the community or warned that these high levels of crime will continue.

Page 20: Pharmacy top 3 in Best Managed Companies Page 36: Action Plan outlined for Sláintecare Page 54: OTC Product & Retail Awards 2019 – The Winners

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On a more positive note, two separate news stories in this issue featured on pages 6 and 24 highlight the ongoing dedication towards excellence in care by community pharmacies and their teams. Ryans Pharmacy in Kildare recently won a National Small Business Award for their services whilst Cara, Meaghers and McCabes Pharmacy Groups are amongst the Deloittes Best Managed Companies. Much was celebrated last month also with the presentation of the OTC Product & Retail pharmacy Awards, held in the Radisson Blu, Dublin. These awards mark the standards of excellence and investment into product marketing that pharmacists use to add value to their customers.

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

Awards were given out in 22 categories, including Best Women’s Product, Best VMS Product, Best Pharmacy Only Product and Best Allergy Product. Turn to page 54 for all the winners on the day.

MANAGING DIRECTOR Natalie Maginnis n-maginnis@btconnect.com

In other news, we continue with our clinical coverage of Diabetes, with an in-depth feature on Type 2 on page 40.

EDITOR Kelly Jo Eastwood: 00353 (87)737 6308 kelly-jo@ipn.ie ADVERTISING DIRECTOR Debbie Graham: 00353 (87) 288 2371 debbie@ipn.ie CONTRIBUTORS Professor Christine Purlow DESIGN DIRECTOR Ian Stoddart Design

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36 Irish Pharmacy IRISH News is PHARMACY circulated to all NEWS independent, multiple Pharmacists and academics in Ireland. All rights reserved by Irish Pharmacy News. All material published in Irish Pharmacy News is copyright and no part of this magazine may be reproduced, stored in a retrieval system or transmitted in any form without written permission. IPN Communications Ltd. has taken every care in compiling the magazine to ensure that it is correct at the time of going to press, however the publishers assume no responsibility for any effects from omissions or errors.

One of the pharmacist's most important roles is the referral of patients to other members of the diabetes care team. Implementing diabetes management services requires a commitment of time, effort, and resources and may necessitate training of staff and changes in work patterns. I hope you joy this bumper issue and would like to wish all our readers a very Happy Easter from all the team at Irish Pharmacy News.

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News

Codeine - An epidemic verging on eruption “Codeine addiction is an epidemic verging on eruption and should be recognised now.” These are the words of Emma McDonnell, of the University of Limerick, writing in the Irish Medical Journal. “Codeine is a highly abused substance in Ireland yet remains relatively under-documented in research studies. From a dual perspective as both a current medical student and practising community pharmacist, I note that codeine is an addiction that is often hidden under the guise of pain management, going unaddressed by both doctor and patient,” says the Ms McDonnell. She writes, ‘In Irish law, codeine is classed as Schedule 5 under the Controlled Drug Regulations meaning that it is available to patients over the counter in pharmacies under supervision of a pharmacist who should make the patient aware of the side effects, especially the sedating nature of codeine and emphasise the addictive potential of the drug. Of course, professional judgement is required and if misuse is suspected, the supply should not be made. Yet despite all of these safeguards, codeine-containing analgesics are some of the biggest

selling products over the counter in Irish pharmacies. ‘Perhaps it is the patient’s ability to navigate codeine restrictions so easily that weakens the legislation. Research on future pharmacy practice in 2016 showed that Ireland had 4 pharmacies per 10,000 population, a figure considerably higher than its comparative counterparts including the USA and the UK. ‘Despite the large number of pharmacies per capita, Ireland has a lower number of pharmacists per pharmacy which could mean they have less time for patient consultations due to a high workload 7. It may be difficult to monitor a particular patient if they are ‘codeine shopping’travelling to different pharmacies to purchase codeine. ‘Furthermore, it may be difficult for a pharmacist to discern unsuitable codeine sales if well-constructed and credible explanations regarding pain are given by the

patient and there are no obvious outward signs of misuse. Without medical supervision, a large proportion of the Irish population is self-medicating with codeine and many have unknowingly developed an addiction.’ “The prevalence of codeine usage in Ireland is high and little progress can be made in the area until the issue is fully acknowledged and necessary research is conducted,” concludes the author. “At present, there is scarce literature available on the topic in Ireland. Codeine addiction is an epidemic verging on eruption and should be recognised now. Hopefully, this discussion will be viewed as a conversation starter among colleagues to bring a very prevalent and grave public health threat to the forefront of medical practice and encourage Irish healthcare professionals nationally to work together to improve the current recognition and management of codeine addiction.”

Pitch your ideas for slice of ¤20m Community pharmacists and health and social care providers have been urged to “pitch their ideas” to get a slice of a €20m Sláintecare Integration Fund. The fund will be used to support the development of existing and new best practice projects capable of being upscaled nationally. People are being urged to look at how best to deal with chronic disease management and ways of shifting care to the community.

Successful projects will offer new approaches to sickness prevention, hospital avoidance, and the delivery of care in the community. The launch of the fund has been welcomed by the Taoiseach Leo Varakdar and the Minister for Health Simon Harris. “We are asking people to pitch their ideas as to how they can help reform the health service,” said Mr Harris, when he visited Inchicore Primary Care Centre.

those providing health and social services in the voluntary sector to apply for this. Give us your best ideas,” he said. Welcoming the announcement, Mr Varadkar said Sláintecare was a ten-year cross-party plan to significantly improve and modernise the health service.

Mr Harris said they also wanted people to devise ways of using technology and digitalisation to deliver health services.

“Through this ¤20m integration fund we can put good ideas into action and share best practice to help care for people closer to home and keep them out of hospital,” he said.

The minister said they were also inviting the community and voluntary organisations to also apply as well as public service bodies as nobody had a monopoly on good ideas.

Mr Harris said the fund was in addition to the existing funding commitments made to support the implementation of Sláintecare in the 2019 estimates process.

He went on to describe the fund as “a tangible sign” of the Government's commitment to health reform and added that all of the funding must be spent this year. “So I would encourage people in the public health service and

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Submitted projects must be in a position to be implemented this year and the deadline for applications is Thursday, April 18. A guide to the application process is available on the Department of Health's website.

Primary Care Reimbursement Service The Healthcare Information and Quality Authority (HIQA) has published a review of information management practices at the Primary Care Reimbursement Service (PCRS). The PCRS, which is part of the Health Service Executive (HSE), is responsible for making payments to healthcare professionals for the free or reduced cost services they provide to the public under various national health schemes, including the General Medical Services (GMS) Scheme. This review was undertaken in order to assess compliance with the Information management standards for national health and social care data collections within the PCRS. The review makes eight recommendations which, if implemented effectively, will drive improvements in information management at the PCRS. Rachel Flynn, HIQA’s Director of Health Information and Standards, said, “The review identified a number of areas of good practice in relation to information management within the PCRS. “However, key areas for improvement were also identified, particularly in relation to the need for a more strategic focus on information management across the entire organisation, and in particular, better use and dissemination of the rich data and information that the PCRS holds. To ensure that the PCRS can fulfill its essential role, it is important that the HSE implements the eight recommendations made by HIQA.” This review found that while there are clear governance arrangements in place at an operational level in relation to information management within the PCRS, there is a less structured approach in place in terms of how information management is strategically discussed, planned and managed across the organisation. Specific roles and responsibilities around aspects of information management lacked clarity, including the implementation of audit recommendations or how data generated by the PCRS is used effectively to improve the service.


News Code of Conduct Following a substantial process of review and consultation on the current Code of Conduct for Pharmacists, the Pharmaceutical Society of Ireland Council approved the revised Code in December 2018. The new Code is expected to be published and launched shortly, following approval by the Minister for Health. The PSI will be engaging with pharmacists across the country as part of the roll out of the Code, and to support pharmacists in applying the Code in everyday practice. Dates for these events will be made available soon.

Drug Strategy Funding The Minister of State with responsibility for Health Promotion and the National Drugs Strategy, Catherine Byrne TD has announced additional funding of ¤1 million for implementation of the National Drugs Strategy; ‘Reducing Harm, Supporting Recovery; a healthled response to drug and alcohol use in Ireland, 2017-2025’. The funding, which will be provided on an annual basis, will address the priorities set down in the Strategy including early harm reduction responses, emerging trends in substance misuse (including polydrug use and crack cocaine), and improving services for at-risk groups.

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The Brendan Voyage Community pharmacist Brendan Quinn, owner of Quinn’s Pharmacy in Galway has set himself a challenge for May 2019 - “The Brendan Voyage” by canoe from Strabane to Manchester, via Portstewart. Brendan Quinn, Quinn’s Pharmacy, Galway

Brendan will kayak from Strabane to Manchester to raise funds for two cancer charities across open seas. It will take him nearly three weeks starting on May 16th, 2019. “Four hundred and ninety six km in 2 weeks “weather, backside and soul permitting” says Brendan. The route is pretty straightforward, but 3 legs are particularly challenging: the Ballycastle to Carnlough round Torr and Fair heads, the crossing to Scotland, and the crossing from Isle of Man to UK in particular will be pushing the limits.

Brendan hopes to meet up with fellow canoeists, boat clubs and fund-raisers along the route. Company will kill the drag, as they say in Irish “giorraíonn beirt bóthar”. His aim is to raise funds for 2 great charities, The Caroline Foundation

in Ireland and Maggies Centres in Manchester. You can support Brendan by donating to his iDonate webpage at www.idonate.ie/ fundraiser/11376505_the-brendanvoyage--500km-for-cancer

Pharmacies under siege Pharmacies across Ireland are under siege, due to the high levels of crime they are subjected to, according to a recent Crime Survey published by the Irish Pharmacy union (IPU). Three quarters of all pharmacies have been the victim of at least one crime over the past twelve months, with the majority of these (81%) experiencing multiple incidents. The IPU has called for more resources to be made available to tackle crime in the community or warned that these high levels of crime will continue. Key findings of the Irish Pharmacy Union (IPU) Crime Survey include:

Minister Byrne said; “I am delighted to have secured this additional funding to tackle drug and alcohol misuse in our communities. It will complement enhancements in drug and alcohol treatment services relating to mental health and homelessness under the 2019 HSE National Service Plan.”

• 75% of pharmacies were the victims of crime last year with 81% of these experiencing multiple incidents;

“I am committed to implementing an integrated public health response to substance misuse, with the twin aims of reducing harm and supporting recovery. Working in partnership with statutory, community and voluntary sectors is central to this response. I will shortly be consulting with our 24 Drug and Alcohol Task Forces and the HSE on how best to target the additional funding being announced today.”

• 17% of pharmacies have had controlled or other prescribed drugs stolen in the last year;

• 93% of pharmacies that were victims of crime experienced shoplifting and 11% a break-in, while the percentage experiencing fraud increased to 19%;

• The number of pharmacists who experienced a raid, at 13%, remains extremely high, having increased from 6% in 2016; • Pharmacists are less likely to report crime to the Gardaí than a year previously. President of the IPU, Daragh Connolly, voiced concern at the

findings of this year’s survey, “Ireland’s pharmacies are at the centre of communities nationwide, it is unacceptable that they are persistently subjected to high levels of crime. This is a threat that cannot be ignored any longer. The Gardaí need to be tasked with tackling this issue and be given the resources required to do so in a meaningful way. “Shoplifting continues to be the most prevalent crime against pharmacies. Fake tan is the single most commonly stolen item (50%) along with other cosmetics and perfume. Meanwhile, almost a quarter of pharmacies (24%) have had cash taken. What is undoubtedly the most sinister and concerning crime example is the high level of thefts of medicines, 17% of pharmacies have had controlled or prescribed drugs stolen in the past year.” The level of violence being experienced by pharmacists is a particular concern according to Mr Connolly with one in four pharmacies who were subject to crime describing the incident or incidence as ‘violent’. “Pharmacists nationwide are being threatened with knives, syringes and even guns (in 21% of cases where a weapon was used). This is a terrifying ordeal for any staff or

patients who have the misfortune to witness a violent raid.” According to Mr Connolly the reporting of crimes against pharmacies to the Gardaí is declining. “Only 68% of pharmacies who were victims of crime last year reported those crimes to the Gardaí, which is a decline of from 73% the previous year. A third of these (32%) said that they had a lack of faith that the criminal would be charged. While 65% of those who did report a crime were pleased with the Garda response, unfortunately 35% were not. This indicates once again the clear need to provide the Gardaí with the resources needed to tackle crime against communities and community businesses.” Mr Connolly concluded by calling for a more visible Garda presence in communities, “96% of pharmacists feel that increasing the visibility would have a very positive impact on reducing crime. This would benefit pharmacies, but of course entire communities as well.” Respondents to the survey identified more visible policing (96%), faster Garda response (89%) and tougher sentencing (86%) as the most effective methods for reducing crime.

PHARMACYNEWSIRELAND.COM


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News

Ryan’s Pharmacy show excellence in services Kildare-based pharmacy, Ryan's Pharmacy has won the Services Category at the SFA National Small Business Awards 2019. Sue O’Neill, chair, SFA, Padraig Sheerin, head of SME, Three, sponsor of the Services Award, Shane Ryan and Clodagh Conlon, Ryan’s Pharmacy and Sven SpollenBehrens, director, SFA

Shane Ryan, who runs five pharmacies in Kildare and Offaly is thrilled with the award. listen to what our customers want. We are extremely appreciative," he said. Announcing Ryan's Pharmacy’s win, Sue O’Neill, SFA Chair and Chair of the Awards Judging Panel, added, “This is not your traditional pharmacy. Ryan’s has

won this award for the way the company has demonstrated how it responds to evolving trends and changing customer requirements. Ryan’s is the only pharmacy in Ireland registered with the Design and Craft Council of Ireland and stocks at least 10 Irish craft and design brands at any one time.”

Proposals to use better value medicines Medicines for Ireland (MFI), the largest suppliers of medicines to the HSE, have welcomed remarks made today by the head of the HSE’s medicines management programme which, if implemented, will save millions in the annual medicines bill. MFI was commenting following proposals from Professor Michael Barry, head of the HSE’s Medicines Management Programme, outlined in a recent Sunday Business Post. Professor Barry outlined plans to announce ‘in the coming weeks’ specific measures to move to better value biosimilar medicines. It is understood that the measures may include compulsory prescribing of better value biosimilar medicines over the more expensive, biologic alternatives. Professor Barry also signalled that consideration is being given to making changes to the State reimbursement system which would require GPs and hospital consultants to justify their prescribing decisions if they choose to prescribe medicines which are more expensive than the better value biosimilar alternative.

The World Health Organisation (WHO) has launched its third global patient safety challenge: Medication Without Harm, which focuses on improving medication safety. The goal of the WHO challenge is to reduce severe, avoidable harm related to medicines by 50% in the next 5 years. The Pharmaceutical Society of Ireland has stated it is committed to supporting this important patient safety initiative and will add more information to their webpage as Ireland and Europe co-ordinate a response to the challenge.

The National Small Business Awards celebrate the achievements of small business in Ireland and recognise the vital contribution of the sector to the Irish economy. The winners were selected from hundreds of applications received for the 2019 programme.

"To receive this recognition on a national scale has been amazing to recognise us, as a small group, and validate the service that we provide for all our customers. This award is for all the staff and for all our customers who have supported us. We will continue to innovate, and go above and beyond their expectations and

Medication without Harm

Professor Barry’s remarks come over two years after the Minister for Health, Simon Harris TD, first announced Government plans to establish a National Biosimilars Policy for Ireland. While a public consultation on biosimilars was completed in September 2017, no specific proposals were ever subsequently brought forward. MFI has been campaigning for savings and reforms, including measures such as compulsory prescribing, over the past three years. Each year the HSE spends over ¤280 million on the more expensive biologic medicines, despite more affordable biosimilars available on the Irish market. Biosimilar medicines represent only 6% of the total share of the market in Ireland, compared to as much as 90% in other EU States (see examples in note for editors).

PHARMACYNEWSIRELAND.COM

Welcoming today’s developments, MFI Chairperson, Owen McKeon said, “Professor Barry’s remarks, as published today, are encouraging. If implemented, it would finally represent changes which we and others have long been calling for. The proposals indicated can transform medicine budgets by delivering immediate savings of significant magnitude, just as changes to generic medicines did in 2013. In doing so, taxpayers get better value, and the ability to fund newer innovative medicines is enhanced. “We look forward to Professor Barry publishing these measures. It is crucial that they are accompanied by a clear timetable to drive their rapid implementation.”

The global challenge aims to encourage and empower patients, their caregivers and health care professionals to take an active role in ensuring safer medication practices and medication use processes including prescription, preparation, dispensing, administration and monitoring. The three priority action areas of the challenge are to: Improve medication safety at transitions of care; Reduce the risk in high-risk; Reduce the level of inappropriate polypharmacy. In order to meet the challenge the WHO has identified four domains of work: 1. Patients and the public 2. Healthcare professionals 3. Medicines 4. Systems and practices of medication The call for action of the global campaign is “KNOW. CHECK. ASK.” Before medication is given to a patient, the pharmacist or other health professional, should: KNOW their medication CHECK that they have the right: • Patient • Medicine • Route • Dose • Time ASK the patient if they understand


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Profile

9

The ‘Quirke’ of a Passive Pharmacy

W

hen Clonmel Pharmacist Ronan Quirke decided to update the family pharmacy, the intention was a refurbishment project. What he ended up with, was Ireland’s only passive pharmacy, which heats itself.

The super low energy project: a three-storey building in Tipperary became Ireland’s first certified passive house pharmacy. Quirke’s Pharmacy in Clonmel is only the third non-residential building in Ireland to be independently certified as having achieved the benchmark passive standard in energy efficiency and it’s proving popular with owners and staff. Since 1927, the Quirke family has been running a pharmacy on the main street in Clonmel, Co Tipperary. The original building on their O’Connell Street site was over 200 years old, but in poor shape. The pharmacy reopened requires nearly zero energy for heating, lighting and cooling. Ronan explains, “It was in a bad, bad state of repair, it was always my intention to do something with it. For a start, the dispensary was too cramped for his staff. “The old space that they were asked to work in for many years was appalling,” he says. The shop also suffered from a low ceiling height, poor layout and lack of insulation. Upstairs in the three-storey terraced building was a residence that hadn’t been occupied for at least 40 years, which was just being used for storage. Ronan then approached architect Paul McNally of The Passivhaus Architecture Company, who had previously designed a low energy extension to Quirke’s Georgian home on Anne Street in the town. They looked at the possibility

of retrofitting, but there were so many structural issues that retaining the old building would have required serious interventions, and would have been expensive. “To make the upper floors usable to modern standards would have taken a huge amount of work,” said the Architect. Meanwhile the shop was “a mess spatially. It was a nightmare really to work in, and it was freezing. Ronan decided to knock the old building, which wasn’t a protected structure, and rebuild from scratch. But he was insistent that whatever building replaced it last a lifetime, he didn’t ever want to have to renovate again. “I only wanted to do this once. I certainly didn’t in 20 years want to be faced with a further patch job,” he says. “I wanted to future proof it,” he adds. Construction costs had bottomed out at the time too, which meant he could get more bang for his buck. Quirke asked the Architect what the highest standard he could build it to was, and it was then that he found out about passive house. But Quirke says: “It also had to be cost-effective. I wasn’t going to keep throwing money at the project just to achieve certification for certification’s sake.” During the planning and research, they found out that the ruins of Ireland's second quaker meeting house formed the walls of the site boundary, so they had an archaeologist on site during all the excavation and demolition works.

Ronan Quirke, Quirke’s Pharmacy, Clonmel

The steel frame was installed on Foamglas Perinsul blocks to avoid thermal bridging between it and the concrete slab. After demolition, work began on the new building. The team looked at various options for constructing the new pharmacy, but concrete block with an insulated, ultra wide cavity proved the most cost-effective. The principle walls of the new building feature two leafs of 100mm blockwork, with a 250mm cavity insulated with bonded polystyrene bead, and Gyproc Airtite plaster internally. Cavities were also created by constructing single leaf blockwork walls 250mm from the party walls, and again insulating with bonded bead. In all cases, Ancon Teplo thermal bridge free walls ties were used to bridge the cavities.

It also had to be cost-effective. I wasn’t going to keep throwing money at the project just to achieve certification for certification’s sake.

PHARMACYNEWSIRELAND.COM


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Profile The building is warm, comfortable, spacious, energy efficient, properly ventilated everything you would expect from a passive house. As Ronan says, “It would have been futile to do this exercise and not get those things.” Quirke’s Pharmacy has been serving the people of Clonmel for over 91 years, and are still family owned and family run. “The newly refurbished premises have been finished to the highest standard and we are very proud to be Ireland’s first passive house certified pharmacy,” adds Ronan. The pharmacy team are also delighted with the new store and are always on hand to provide excellence in services and care to the customers within their local community. Ms Quirke says the new building is a pleasure to work in. “Even on a very busy day, we all remark on how the day has flown by. Our tiredness levels after a busy day are reduced, perhaps due to the airiness of the new pharmacy or the lack of fluorescent lights, or probably both.”

Quirke’s Pharmacy in Clonmel is only the third non-residential building in Ireland to be independently certified as having achieved the benchmark passive standard in energy efficiency and it’s proving popular with owners and staff

This observation is backed up by recent research by the Irish Green Building Council entitled Health, Wellbeing & Productivity in Offices which reports that “productivity improvements of 8 to 11 per cent are not uncommon as a result of better air quality”. The passive house standard addresses ventilation and air-quality, thermal bridges and consequently eliminates the risk of surface condensation and mold. Quirke’s premises does not require air-conditioning and is heated with one radiator when necessary. The rest of the year it achieves optimal air quality and temperature with only the waste heat from low-energy lighting and heat emitted by the occupants. In addition, it uses a fraction of the electricity demand of a commercial building built to the current building regulations. The pharmacy faces south onto O’Connell Street, but the buildings on the far side of the road overshadow the ground floor facade, blocking solar gain. The solution was to raise the shop floor ceiling height to a storey and a half and install full height glazing, so that even on

PHARMACYNEWSIRELAND.COM

the winter solstice, solar gain penetrates the store. Being in a terrace there was little scope for glazing on the east and west gable walls, so roof windows were installed in the single storey projection to the back to bring in more natural light. Ronan was also keen to have automatically opening doors for the pharmacy, so that customers in wheelchairs or with buggies could get in easily. Custom-made triple-glazed automatic doors were specified. The project came in on budget and the pharmacy opened a month ahead of schedule.

The pharmacy offers medicines management, discussing blister packs or alternative options that best suit their customers. As medication plans become more complex and tablet loads increase, the team are on hand to discuss how best people can get the most from their medicines and continue to take them safely. They also offer cholesterol testing, 24-hour blood pressure monitoring and influenza vaccinations, amongst many additional services.


News Pharmacy qualifications The legal basis underpinning the recognition of pharmacy qualifications between Ireland and the UK will change following Brexit. Subject to any transitional arrangements, this will have consequences for people holding a qualification obtained in UK/Northern Ireland who seek recognition of this qualification here. The Pharmaceutical Society of Ireland (PSI) has been engaged in reviewing and putting in place means of handling changes that will apply, mindful of those who will seek access to practice in Ireland. The Council is reviewing the routes of recognition/registration. One part of this, is the review of the third country route of recognition to streamline and reform the process for all applicants applying with qualifications from outside of the EU irrespective of nationality. In addition to that general review, at its March 2019 meeting the Council approved a policy position and technical amendment to the PSI (Registration) Rules so that the PSI will be able to operate an efficient and practical approach to qualification recognition under the third country recognition route in the case of a no-deal Brexit occurring. This will rely on the equivalence of a qualification, including UK and Northern Irish qualifications obtained before or in progress before the UK’s departure date from the EU, provided they are listed in Annex V and are compliant with the requirements of Article 44 (EU Directive (2005/36/EC). The Rule change must be approved by the Minister for Health. The PSI has been engaging with regulatory counterparts in the General Pharmaceutical Council UK, the Pharmaceutical Society of Northern Ireland, and with the Department of Health and national health and social care regulators in relation to these matters, with a view to maintaining efficient and effective recognition and registration procedures post-Brexit.

11

Health Minister urged - Drive The switch to affordable medicines New data provided by the HSE reveal that since 2016 it has spent more than €1.2 billion on reimbursing biologic medicines, but just over €2.2 million on more affordable biosimilar medicines. Deputy, John Brassil TD

Annually, the HSE now reimburses biologics to the value of almost ¤450 million and just over ¤1 million on more affordable biosimilar medicines. This level of reimbursement spend gives biologics a 99% share of this category of medicines under the HSE’s Community Drug Schemes, even though lower priced biosimilars are available and widely used across the EU. Data provided by the HSE on 26 March in response to a parliamentary question by Deputy John Brassil TD, Fianna Fail Junior Spokesperson on Primary Care and Community Health Services (see below) revealed the HSE spent the following amounts on biologic and biosimilar medicines over the last three years:  In 2016, ¤423 million was spent on biologics, with ¤445,000 on biosimilars  In 2017, ¤435 million was spent on biologics, with ¤635,000 on biosimilars  In 2018*, ¤425 million was spent on biologics, with ¤1.2 million on biosimilars. The failure to actively promote the use of biosimilars across the healthcare system has been widely acknowledged by several stakeholders in recent years, with others such as the Health Products Regulatory Authority (HPRA) and the National Centre for Pharmacoeconomics supporting the increased use of biosimilars.

In 2018, the UK’s NHS saved over £300 million on two medications alone by switching from biologics to biosimilars. In 2019, the NHS is projecting a further saving of £200 million through a similar switching process. In many other EU states, the rate of biosimilar usage is as high as 90% for the treatment of conditions such as rheumatoid arthritis. Commenting on the data, Owen McKeon, Chairperson of Medicines for Ireland, the representative body for generics, biosimilars and value-added medicines, said,

In February 2017, Minister for Health Simon Harris announced the development of a National Biosimilar Strategy to drive increased uptake of biosimilars as an alternative to more expensive biologics. To date no strategy has been published.

“The figures speak for themselves. The fact that ¤1.2 billion has been spent on biologics versus ¤2.2 million on biosimilars demonstrates the Irish healthcare system’s near total failure to embrace more affordable biosimilar medicines. It matters hugely because, ultimately, this failure restricts patients’ access to life-enhancing medicines and treatments.

Other EU states that have proactively promoted the use of biosimilars have achieved significant savings and reductions in their medicine spend.

“Biosimilar usage across the EU is now standard practice, so it is difficult to understand the reticence in the Irish healthcare to follow suit.

“There are direct consequences for not embracing change. For example, in recent months, much has been made of the fact that the HSE has already spent all its ‘new medicines’ budget. Yet a more joined-up approach, by increasing our use of biosimilars, could deliver savings to fund such new medicines. “Equally, biosimilar manufacturers, as is already happening, will increasingly not launch their products on the Irish market because of the lack of a viable, competitive market here. “The Minister for Health and his Department must now step up and provide the leadership needed to drive the switch to more affordable medicines, otherwise patients will continue to be the losers.” *Data by HSE for 2018 is based on 11 months to end November 2018. ** The data provided by the HSE captures items dispensed under the HSE’s four community drug schemes and does not capture medicines paid for privately by patients or drugs administered by hospitals.

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News

Full figures of illegal medicines detained The Health Products Regulatory Authority (HPRA) has recently published its full year figures for the detention of illegal medicines during 2018, while reiterating its warning to the public of the dangers of sourcing prescription medicines online or from other illicit sources. Lorraine Nolan, CEO, HPRA

The HPRA’s enforcement section detained some 619,213 dosage units (including tablets, capsules and vials) of falsified and other illegal medicines in 2018, compared to 948,915 in 2017. The illegal products included sedatives (36%), erectile dysfunction medicines (18%) and anabolic steroids (16%). The HPRA confirms that the supply of these products into and within Ireland was illegal and stresses that, while falsified medicines can be presented as legitimate, there are no guarantees around the safety, quality or effectiveness of prescription medicines bought outside of the regulated pharmacy setting or purchased via the internet. The HPRA figures for 2018 show that: • Sedative detentions showed a continued, though small decrease again for 2018 with 220,457 units detained, compared to 222,470 in 2017 and 271,545 in 2016. • Anabolic steroids remain an area of focus for the HPRA, with the number of detentions

being significant with some 98,055 units detained in 2018. This compares to 449,411 in 2017, (when there was one significant enforcement action where a substantial detention was made). 109,006 units were detained in 2016. • Ten prosecution cases were initiated and a further fourteen voluntary formal cautions issued during the year. Commenting on the enforcement figures for 2018, John Lynch, Director of Compliance at the HPRA, cautioned against the suggestion that the year on year decrease represented a significant shift in consumer behaviour. “We remain concerned that members of the public are

continuing to put their health at significant risk by buying medicines from unverified and unregulated sources. Analysis of the figures shows that there is a continuing and worrying trend of consumers in Ireland seeking to source illegal prescription medicines. While we welcome a decrease in the total number of dosage units detained in 2018, over the past five year period more than 4.1 million units of illegal prescription medicines have been detained by the HPRA. Every single one of these tablets, capsules and vials intercepted is important and is one less illegal medicine that could cause harm. Our detentions disrupt the illicit market with the aim of protecting the public from the risks associated with products for which there are no guarantees as to what they contain or under what conditions they have been manufactured. Clearly, exposure to such products could cause significant harm to your health and well-being. We cannot stress how dangerous it is to source prescription medicines from the unregulated market.” To inform members of the public about the dangers associated with buying prescription medicines online, the HPRA has published an advice leaflet which is available freely on its website, www.hpra.ie

Smokers need more support – says IPU Medical Card Patients should have access to Nicotine Replacement Therapy (NRT) direct from pharmacies to encourage more people to quit. This call was made by the Irish Pharmacy Union (IPU), ahead of National No Smoking Day, who say providing this service would reduce an unnecessary barrier to NRT and encourage more people to quit. NRT is designed to reduce the physical symptoms associated with stopping smoking. It involves a consultation with a healthcare profession such as a pharmacist, who will understand the patient’s smoking habits and recommend suitable nicotine replacements for that patient. NRT is available in pharmacies nationwide without prescription for private patients. However, despite the IPU providing a detailed proposal to the Department of Health in 2017, medical card patients are still unable to access this vital treatment direct from their pharmacies; they must still go to their GP to get a prescription.

Tomás Conefrey, Pharmacist at Owner or Conefrey’s Pharmacy and member of the IPU said, “Over one in five (22.7%) people aged 15 years and over smoke in Ireland.1 Smoking prevalence is higher in men (24.3%) than women (21.2%). In addition, 19% of people are daily and 4% are occasional smokers. Thankfully, however, the smoking rate in Ireland has been falling in recent years, but the rate of decline has not been fast enough. At its current rate we would not see it fall below 5% until 2052.2 It is clear we need to think differently about how we support people to quit smoking. “NRT works, and the more accessible it is the more

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likely people will be to avail of treatments. We know that smoking is highest among the lowest socio-economic groups and there is simply no reason why a medical card patient should require a prescription to access NRT and the over-the-counter products that private patients successfully receive from pharmacies. “Over half, 57%3 of current smokers are thinking about quitting. The Government has a responsibility to maximise the availability of supports to all of those with ambitions to quit, not just private patients. This is a scheme that can be easily and quickly be implemented as all it requires is a decision to do so.”

Breakthrough against Sepsis Irish research into a new breakthrough therapy in the fight against sepsis has shown that the drug has potential to stop all sepsis-causing bacteria from triggering organ damage in the early stages of the condition. The study is being presented today at RCSI Research Day 2019 by Dr Sinéad Hurley, a Postdoctoral Fellow at the School of Pharmacy and Irish Centre for Vascular Biology, RCSI. The pre-clinical trial of InnovoSep, carried out by researchers at RCSI, has demonstrated that the drug also has the potential to stop progression of sepsis to multiple organ failure in the later stages. Sepsis, otherwise known as blood poisoning, is a silent killer because it is unpredictable, rapid and can go undiagnosed due to its non-specific signs and symptoms. It is critical that the public are empowered with the knowledge of spotting signs and symptoms of sepsis so that rapid treatment can be initiated. The signs and symptoms of sepsis mimic those of the flu - high temperature, rapid heart rate, rapid breathing, pain, pale or mottled skin, and feeling generally very sick. The main difference between sepsis symptoms and flu is that sepsis will come on very quickly whereas flu comes on over days. Any type of infection can cause sepsis ranging from seemingly minor infections on the skin, urinary tract infections, pneumonia or appendicitis - even a simple cut, scrape, or break in the skin can allow bacteria to enter the body and potentially lead to sepsis. Currently there are almost 15,000 cases of sepsis each year in Ireland with almost 3000 deaths. In Ireland sepsis kills more people than either heart attack, lung cancer, colon cancer or breast cancer. A staggering 60% of all hospital deaths has a sepsis or infection diagnosis.


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14

News

Over two-year wait for medicine reimbursement New figures have worryingly shown that 10 innovative treatments - approved by the HSE for use by patients - spent 890 days awaiting decisions The 10 new innovative medicines recently approved by the Health Service Executive for use by patients spent on average almost two-and-a-half years waiting for a reimbursement decision.

way for patients who are seeking newer and better treatments. The figures were revealed by the Irish Pharmaceutical Healthcare Authority (IPHA), who have welcomed the go-ahead for the reimbursement of the 10 medicines - but said the time they spent awaiting a decision was “unacceptably long”.

The 10 products were approved for reimbursement over the coming months so it will be July before some of them will be available to Irish patients.

Oliver O’Connor, Chief Executive of IPHA, said it is vital that industry and policymakers urgently begin a formal dialogue to agree steps that can eliminate the ongoing delays getting medicines reimbursed for patients with serious illness and conditions, something that was promised to us by the Minister in November 2017.

The products spent, on average, 890 days waiting for a reimbursement decision - almost two-and-a-half years. The time-todecision calculation is made from the point at which the products were licensed by the European Medicines Agency. The lengthy delay contravenes the letter and the spirit of the EU Transparency Directive (add ref) which sets a strict time limit of 180 days for decisions on pricing and reimbursement to ensure that bureaucracy does not get in the

“No one is arguing that every medicine can - or should - be reimbursed. But it is clear that the approvals system for new medicines doesn’t work and funding is neither predictable nor

adequate. It’s up to all of us to build planned innovation into our health services, treating the discovery, development and delivery of new medicines as one integrated loop. “The industry has set a simple goal: to place Ireland in the top quartile in the EU28 for speed of access to new medicines. This is consistent with the Government’s own ambitions for outcomes as part of the National Cancer Strategy. We urgently want to work with politicians and policymakers to realise that goal. If we do not Irish patients will be left waiting,” said Mr. O'Connor. The table below shows the number of products, made by originator companies, that awaited reimbursement and the number of days it took the HSE to reach their decision. The average number of days is 890 days. These numbers are from the most recent HSE Senior Leadership Team meeting on February 12, 2019.

Number of Days Waiting

0-300

301-600

601-900

901-1200

1201-1500

Number of products waiting

0

3

3

1

3

Mammoth acquisition for Meath PC Centre Primary Health Properties (PHP) has announced that it has contracted to acquire a The Meath Primary Healthcare Centre, in Dublin 8, for a total cost of €10.9 million. Meath PCC

The Meath PCC provides a range of local integrated care services including; three GP practices, diagnostic services, dentistry, a specialist health clinic, physiotherapy services and a pharmacy. The property comprises circa

2,770m2 which is fully let. The HSE and GP practices account for 64% of the total rent roll and these leases benefit from CPI-led rent reviews. The combined unexpired lease term is approximately 16 years, but circa 20 years for the leases to the HSE and the GP practices.

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The transaction is being conducted through Primary Health Properties ICAV, an Irish investment vehicle that is wholly owned by PHP. This acquisition, which has a completion date of 19 July 2019, is PHP’s tenth in Ireland and increases PHP’s total portfolio to 317 assets, with a gross value of over £1.5 billion and a contracted rent roll of just under £80 million. The gross value of the Irish portfolio is now approaching ¤120 million. HP’s acquisition will complete in July of this year and increases its total portfolio to 317 assets with a gross value of more than £1.5 billion (¤1.75 billion) and a contracted rent roll of just under £80 million.

Help a Future Pharmacist? The first 5th-year placements of the new integrated pharmacy programme will begin in January 2020. APPEL is now accepting expressions of interest from pharmacists who would like to facilitate an experiential learning placement for a 5th-year pharmacy student. • Placements can be in community or hospital practice settings. • Placements will last 8 months from the 6th of January to the 28th of August. • Trainers must be 3+ years registered with the PSI. • Training and support will be provided to all pharmacists facilitating placements. The first cohort of students on the new integrated pharmacy programme are about to reach their final year. APPEL are excited to support students in one of the last “firsts” of their pharmacy degree, their final experiential learning placement. Students will have previously completed a 2-week placement in 2nd year and a 4-month placement in 4th year and are now looking forward to completing their 8-month 5th-year placement. Pharmacists who have previously taken students in their 2nd and 4th years have found the experience enjoyable and rewarding. In surveys, 90% of pharmacists said they would recommend facilitating a placement to other pharmacists. The advantages of facilitating an APPEL placement include: • Continuing Professional Development – APPEL Trainer Training can contribute to your CPD, as can the experience of facilitating a placement. • Development of your talent pipeline – 5th-year students are close to completing their studies and may soon be looking for their first role as a pharmacist. • Engagement – participating in the APPEL programme provides you with the opportunity to increase awareness of your pharmacy/ organisation. APPEL training and events provide fantastic networking opportunities to meet with your current and future peers. If you are interested in facilitating future pharmacists’ training, please call 01-4025129, email ops@appel.ie or go to www.appel.ie to find out more.


16

Report

High Tech Hub – Help or Hinderance? The Hi Tech hub was introduced to all pharmacists by the HSE in March 2018 in an effort to streamline administration of the scheme for pharmacists and to provide enhanced visibility of stock management and spending on this scheme to the HSE. Previously in Ireland, the High Tech drugs scheme was administered by the HSE through the Primary Care Reimbursement Service (PCRS). The PCRS decided to introduce a fully electronic purchasing and stock control system, called the High Tech Hub (HTH), aimed to be a “one-stop-shop” for pharmacies for all high tech medicine orders. The HTH is implementing a new streamlined process for ordering high-tech drugs whereby patients can collect their treatments from their local pharmacy, rather than from hospitals.

Comptroller and Auditor General, has been established in order to offer a number of benefits for the pharmacy. As part of the initiative to prevent costs continuing to spiral out of control, the decision was taken to invest and develop the High Tech Hub. However, there have been several issues with the implementation of this strategy to date and concerns have been voiced by community pharmacists here as to the roll-out and education surrounding the use of the Hub.

The expenditure for these medicines exceeded ¤600 million for the first time in 2016. The HTH will help monitor patient data, tracking prescriptions and minimise wastage and over-ordering.

Mark Jordan is a community pharmacist in Castlebar. He firmly believes the potential exists for the High Tech Hub to make a difference to community pharmacy and to work efficiently in streamlining in order to reach cost savings.

The implementation of this electronic purchasing and stock control system, which will address a number of key principles and concerns raised by the

However there are issues he believes must be resolved first and that the HSE should take a more examined and structured look at its implementation.

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Mark is part of the Pharmabuddy team, and his belief in the potential of the Hub has caused him to research the issues and work both inside and outside of the team to devise solutions. He has recently narrated, authored and produced an educational video to assist pharmacists in their use of the Hub (see below). He told Irish Pharmacy News, “At the time this was implemented, the Primary Care or Community Care Pharmacist based in each region generally had a good handle on drug management and therefore little was wasted. “Many, if not all of my peers, are conscientious professional people who would have always only ordered what they required and made sure that if a medication was no longer required - for whatever reason, medication cessation or changes to dose usually – the Primary Care or Community Care Pharmacist was notified and they would typically find a new home for that medication.

“Furthermore, the notion of employing a building (or a floor) of people to man phones, answer emails and deliberate on queries in order to ’streamline’ and provide ‘enhanced visibility’ in order to save money didn’t seem like the best strategy they could have devised.” The benefits sold to pharmacists at the time were: 1. One stop shop for pharmacies for all high tech medicine orders; 2. Tracking of an order from request to delivery; 3. Central submission point for patient details and high tech prescriptions; 4. Minimise wastage with ordering only occurring by the nominated pharmacies for patients with a valid prescription; and 5. Automated order verification resulting in reduction in error. According to Mark, these benefits were, and are, limited.


17 the fault of the Hub but rarely happened before the middle man was introduced, incorrect doses erroneously being ordered; user interface is poorly designed very easy for staff to make errors in ordering medication, inability to keep stock on hand, inability to order extra stock in extenuating circumstances, such as the patient going abroad and having to ask for permission to order and supply, nominated pharmacy and the laborious task of changing the nominated pharmacy if the patient moves for example.” “Any time I have spoken about the Hub on the Pharmabuddy forum, or when I ask for feedback, it hasn’t been positive, so we were aware this was an area that needed addressed,” he continues. “I personally feel it has potential to serve the pharmacist and the community well for the reasons it was designed, but as I write this, Orkambi that I ordered last week at a cost of thousands to the tax payer never arrived - and since the Hub sent the communication to the supplier (Vertex), the company were extremely reluctant to replace the medication insisting it arrived and was signed for (albeit to the wrong store which they admit). “The idea of the hub was to streamline ordering, reduce waste and create a ’one stop shop’ for High Tech medications. All it has done to date is slowed my ordering, added more

bureaucratic red tape to my dispensing practices and wasted the time of my most valuable dispensary staff members as only they can call the hub when something goes wrong (which is so frequently I know many of the phone operators by their first name). “Like many, I would like to see the Hub work. If some of the issues commonly seen in daily practice were ironed out in the pilot phase or even now before other medications are added the Hub it would certainly become an asset to pharmacy as a whole.” Accord launch Hi Tech Hub Video After speaking to customers Accord Healthcare also identified that many pharmacists have concerns with using the Hub. Accord therefore approached PharmaBuddy with the idea of creating a demonstration video and answering any queries pharmacists may have in relation to the Hi Tech Hub. Marguerite Tierney, Accord’s PR & Marketing Manager explains, “PharmaBuddy, the online resource for Irish pharmacists, conducted further research with their pharmacist members. They received a number of queries from pharmacists such as ‘how to tell if stock is dispatched’, ‘what happens if the hub generates a warning’ or ‘can the user dispense a medicine from the hub if the prescription was written inside

the EU but out of the state’; from there a short demonstration video which covers all the aforementioned issues and many more was created”. “In Accord we understand that pharmacists are busy people and we aim to be as easy to do business with as possible. We have the widest range of Hi Tech medicines of any generic supplier on the Irish market including the recent launch of the biosimilar Pelgraz. “In 2017 we issued pharmacists with a handy reference folder, which explained more about the Hi Tech scheme and each of the Hi Tech products offered by Accord. This initiative is another way we in Accord are working to be our customers partner of choice and we are delighted to offer this helpful resource to pharmacists across the country,” concludes Ms Tierney. Dr Paul Ryan, pharmacist, GP and founder of PharmaBuddy added, “We are delighted to offer this video tutorial to our 3,400 pharmacist members. This is a novel way to meet the needs of our members and answer practical questions that pharmacists have about the Hi Tech Hub.” The video will sit on the PharmaBuddy website, accessible to all registered pharmacist members and also on the Hi Tech page of the Accord Healthcare website www.accord-healthcare.ie

The hub was initially rolled-out to cater for IVF medications only, firstly as a pilot scheme and later as a nationwide facility. Over the following year, new illnesses were added to the Hub and with them obviously the medications used to treat them. Currently, the High Tech Hub caters for IVF, Cystic Fibrosis and Pulmonary Arterial Hypertension. It is understood that the medications due to be added next are for the treatment of Arthritis. The Issues “There are a number of existing issues with the Hub,” Mark adds. But if these could be addressed he says the benefits would follow. “Ordered medication failing to turn up, this is typically not

Marguerite Tierney, Accord Healthcare and Dr Paul Ryan, Pharmacist, GP & Founder of PharmaBuddy

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Nutrition and Eye Health

19

It’s not all about AREDS Time for a pragmatic approach to nutrition for eye health? Advances in treatment for retinal diseases involving neovascularisation have undoubtedly changed the future of eye care across Ireland for the better, but also created great challenges for service delivery in ophthalmology. Some statistics are starting to look alarmingly familiar: there were 59,337 ophthalmology procedures carried out in 2017, equating to 3.45% of the total number of patient procedures that year.1 The number of people in Ireland living with a diagnosis of eye disease is set to increase in line with an ageing population, and this increase will be seen across all principle causes of sight loss. The prevalence of AMD increases steadily with age. With the number of people in Ireland aged over 65 expected to increase by two-fifths by 2026 and to treble by 2041, it is vital that those at risk are identified and treated or monitored early.2 In 2012, data from the Hospital In-Patient Enquiry (HIPE) scheme indicated that there were almost 12,000 day cases from public hospitals for patients who had undergone cataract surgery.2 Glaucoma affects 2% of the population, with the prevalence rising with each decade in age to over 3% in those over 70 years of age.2 In 2014, a senior figure in the health service described the challenges arising from chronic medical conditions as “the healthcare equivalent to climate change”.3 Self-care or self-management is a concept with increasing popularity amongst those planning healthcare services across both primary and secondary care.4 This leads to the topic of nutritional supplementation for eye health, a sometimes controversial subject amongst eye care professionals. The principle behind this idea is that the retina (in particular the retinal pigment epithelium) is particularly prone to oxidative stress – the imbalance between free radical production and antioxidants, resulting in inflammation. Oxidative stress is considered to be one of the principle mechanisms for AMD.5 Nutrients such as lutein and zeaxanthin, and vitamins B, C, E and D and omega 3 fatty acids possess antioxidant and anti-inflammatory properties, hence the links being made between AMD and dietary intake.

As a clinical academic, I realise the importance to strive for robust ‘level 1’ evidence to drive all improvements in eye care, but I also recognise the challenge of generating such robust evidence in the area of nutrition and dietary interventions. The expense of the traditional gold standard of a large scale randomised controlled trial, with suitable intervention and follow-up period, is prohibitive, and can be prone to bias where health-conscious people tend to respond to recruitment. This can produce insignificant results, and perhaps less useful conclusions for clinical management in the general population. The alternative is the observational or epidemiological study where large samples are plentiful, but mostly rely on food diaries, and may not always match the ethnic and genetic profile of a UK society.

Another ‘obstacle’ to evidence based recommendation arises from the nutritional supplement industry itself: non-prescription dietary or nutritional supplements are classed as ‘foods’, and as such simply have to be proved safe and presented accurately to be sold in the UK; they cannot make therapeutic claims. Often the key ingredients in such products may have some robust evidence behind them but the combined product may or may not, depending on its heritage. Suppliers range from leading ophthalmic pharmaceutical companies who invest in research to demonstrate benefit, to wholesalers and distributors whose primary concern might be margin and consumer promotion. Guidance about allowable claims for any benefits for particular nutrients, like zinc or vitamin A for example, is provided by the European Food Standards Agency (EFSA).

With this in mind, the Age-Related Eye Disease Study (AREDS) results have received the most attention: they are large and noteworthy for their study design and aims, but what is not always recalled accurately is that the positive indications for nutritional supplementation are limited to a particular patient group. The AREDS results provide evidence that risk of progression in moderate, high risk AMD to the severe form of AMD can be reduced by up to 25% when taking a combination of high-dose antioxidants and zinc. The AREDS formula showed no beneficial effect for any other stage of AMD.6 In fact, whilst much criticism has been levelled at supplements on sale that do not match the formula used in AREDS or AREDS2,7 there is simply no evidence to show that an AREDS type formula will benefit

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20

Nutrition and Eye Health

everyone else who may be simply concerned with eye health, or have forms of eye disease. Other, more general criticism has been levelled at AREDS and AREDS2 for the inclusion of mostly highly educated and well-nourished Caucasian individuals.8 The AREDS and AREDS2 formulas also contained particularly high doses of vitamin E and zinc: such high dose formulas are controversial amongst many scientists and healthcare professionals, referring to a ‘U-shaped response curve’ where very low or very high blood levels of a nutrient are thought to be harmful but more moderate levels are beneficial. Indeed, the dose of zinc was shown in the AREDS trial to lead to increased hospital admissions secondary to urinary tract infections. Some evidence suggests that high dose vitamin E may have long-term effects on prostate cancer risk.9 So, where does this leave us with regard to dietary advice and eye health? It is beyond the scope of this article to provide a comprehensive review, but perhaps it’s worth bearing in mind a pragmatic approach that considers certain groups of patients who might be considered at risk of eye disease. Smokers Smoking exposes an individual to free radicals and promotes their production, significantly increasing the risk of many diseases, including AMD. It seems the effects of smoking on AMD risk are far-reaching: stopping smoking certainly reduces the risk, but the risk in those who have not smoked becomes comparable to nonsmokers after 20 years.10 Sensible advice to smokers and recent ex-smokers would be to make sure their intake of anti-oxidants in the form of certain vitamins and minerals is considered carefully in order to combat the likely oxidative stress. However, they should not take supplements containing beta-carotene.11

Preventing AMD

References

To date the strongest evidence here comes from epidemiological studies that suggest eating less red meat12 and more oily fish13 reduces the risk of developing AMD. The difference in risk between eating at least four servings per week compared to three servings per month was 35%.13 Another study has shown that one serving of fish per week is linked to a reduced risk of early AMD10 years later.14 There is increasing interest in vitamin D status and risk of AMD with some results suggesting that the odds of AMD are highest in those with deficient AMD status.15

1. HIPE. Activity in Acute Public Hospitals in Ireland, Annual Report, 2017

Patients with no signs of AMD but a family history Relatives accompanying a patient with AMD in outpatients frequently seek the answer to this scenario. The Rotterdam study16 followed over 2000 patients at high genetic risk for AMD, for a median follow-up of 8.6 years. Higher (but not excessive) dietary intake of nutrients with antioxidant properties (including omega 3 fatty acids) reduced the risk of early AMD. A more recent study17 has expanded this data to show that protection against AMD from greater lutein and zeaxanthin intake is evident in those at genetic risk. In summary, it is undisputed that a healthy balanced diet alongside exercise should always be at the front line of self-care, but processed foods and calorie control can make this difficult in reality. Taking a pragmatic approach on behalf of patients may be more helpful in the longer term until more evidence is forthcoming.18 Whilst much of the current evidence focuses on the progression in AMD, perhaps we should be acting sooner to advise patients about the links between eye health and diet as much as possible before they develop the disease.

2. Clinical Strategy and Programmes Directorate. National Clinical Programme for Ophthalmology: Model of Eye Care, May, 2017 3. NHS could be ‘overwhelmed’ by people with long term medical conditions. The Guardian. http://www.theguardian. com/society/2014/jan/03/ nhsoverwhelmed-long-termmedical-conditions Last accessed March 2016. 4. Self Care Forum. http://www. selfcareforum.org/ Last accessed March 2016. 5. Kauppinen A, Paterno JJ, Blasiak J, et al. Inflammation and its role in age-related macular degeneration. CellMol Life Sci 2016 [Epub ahead of print]. 6. Chew EY, Clemons TE, Agron E, et al. Long-term effects of vitamins C and E, betacarotene and zinc onage-related macular degeneration. AREDS Report no.35. Ophthalmology 2013;120:1604-11. 7. Yong JJ, Scott IU, Greenberg PB. Ocular nutritional supplements: are their ingredients and manufacturers’ claims evidence-based? Ophthalmology2015;122(3):595-9. 8. Andreatta W, El-Sherbiny S. Evidence-based nutritional advice for patients affected by age-related macular degeneration. Ophthalmologica 2014;231:185-90. 9. EA Klein, IM Thompson, CM Tangen, et al. Vitamin E and the risk of prostate cancer: results of the Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA2011;306(14):1549-56. 10. Khan JC, Thurlby DA, Shahid H, et al. Smoking and age-related macular degeneration: the number of pack years of cigarette smoking

Written by Professor Christine Purlow Senior Research Fellow, Cardiff University; Head of Medical Affairs UK & Ireland, Thea Pharmaceuticals Ltd. Correspondence: E: PurslowC1@cardiff.ac.uk Declaration of competing interests: Thea Pharmaceuticals' portfolio includes nutritional supplements for eye heallth

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is a major determinant of risk for both geographic atrophy and choroidalneo vascularisation. Br J Ophthalmol 2006;90(1):75-80. 11. The Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group: The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. N Engl J Med1994;330:1029-35. 12. Chong EW, Robman LD, Simpson JA, et al. Fat consumption and its association with age-related macular degeneration. Arch Ophthalmol 2009;127:674-80. 13. Cho E, Hung S, Willett WC, et al. Prospective study of dietary fat and the risk of age-related macular degeneration. Am J Clin Nutr 2001;73(2):209-18. 14. Tan JS, Wang JJ, Flood V, et al. Dietary fatty acids and the 10-year incidence of age- related macular degeneration: the Blue Mountains Eye Study. ArchOphthalmol 2009;127:656-65. 15. Millen AE, Meyers KJ, Liu Z, et al. Association betweenvitamin D status and age-related macular degenerationby genetic risk. JAMA Ophthalmol 2015;133(10):1171-9. 16. Ho L, van Leeuwen R, Witteman JC, et al. Reducing the risk of age-related macular degeneration with dietary antioxidants, zinc, and omega 3 fatty acids: the Rotterdam Study. Arch Ophthalmol 2011;129(6):758-66. 17. Wang JJ, Bitendijk GH, Rochtchina E, et al. Genetic susceptibility, dietary antioxidants, and long-term incidence of agerelated macular degeneration in two populations. Ophthalmology 2014;121(3):667-75. 18. Souied EH, Aslam T, GarciaLayana A et al. Omega-3Fatty Acids and Age-Related Macular Degeneration. Ophthalmic Res 2015;55(2):62-9.


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22

News

Pharmacy proves they are Best Managed Irish pharmacy businesses have proved there worth amongst the retail industry, with three scooping Deloitte Best Managed accolades across Gold and Platinum categories. Cara Pharmacy retained their Best Managed status within the category of Plantinum Club Requalifier, as they have received the award for the eighth time and/ or above. Meaghers Pharmacy Group were awarded the Best Managed title in the Gold Standard Requalifier sector, meaning they received their award for the fifth or sixth consecutive year, whilst McCabes Pharmacy Group Best Managed title is within the ‘Requalifier’

sector, which means receiving their Award for the second or third consecutive year. The Deloitte Best Managed Companies annual awards gala was held in Dublin last month in association with Bank of Ireland. The companies were awarded this designation following a detailed qualification and judging process that evaluates the entire management team and business strategy in some of Ireland’s top privately owned businesses,

looking beyond financial performance at criteria such as operational excellence, strategic planning, governance and talent strategy. These companies join a network of 136 companies which were awarded the status of Best Managed this year. The Best Managed Companies network this year has total revenues of almost ¤11 billion, export sales of almost ¤3 billion and total employment of approximately 44,000 people.

Meaghers Pharmacy Group with Managing Director Oonagh O’Hagan – 2019 Gold Standard Winners

Stigma associated with morning after pill ellaOne has undertaken research to investigate ‘morning after’ behaviour and young peoples’ conversations on emergency contraception. The research found that 91% of young women, aged 1824, feel empowered to make decisions that affect their body by themselves, however, over three quarters (76%) of those surveyed believe that there is still a stigma associated with taking the morning after pill. When asked how they felt the morning after unprotected sex, where the contraception failed or no contraception was used, 6 in 10 (61%) young women said they were worried that they could be pregnant, while just one third said they felt confident, knowing what steps to take. In response to the findings and the evolving conversation around contraception in Ireland, ellaOne has launched the #MyMorningAfter campaign.

McCabes Pharmacy Group with Managing Director Sharen McCabe

A first of its kind, the campaign aims to get women talking about emergency contraception and to shake the stigma so that, if needed, they have the confidence to visit and speak to their pharmacist about the morning after pill. Research conducted by ellaOne in 2018 found that 6 in 10 Irish 18-24 year olds have had unprotected sex in the past and 38%of those who have previously taken the morning after pill said there were other instances after unprotected sex when they also could have taken it but didn’t.

Cara Pharmacy Group with Managing Director Ramona Nicholls

The #MyMorningAfter ad aims to inspire women to take control of their morning after without fear of judgement. The ad portrays five women from different backgrounds redefining the feelings attached to taking emergency contraception. As well as launching this new ad, ellaOne has partnered with Her. ie to host a series of live events in colleges across Ireland and amplify the campaign on the platform and social media. For more information on ellaOne visit www.ellaonepharmacists.ie

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flutiform® k-haler® (fluticasone propionate/formoterol fumarate) 50 µg/5 µg and 125 µg/5 µg pressurised inhalation suspension Prescribing Information Republic of Ireland Please read the Summary of Product Characteristics (SPC) before prescribing. Presentation Pressurised inhalation suspension, in a breathactuated pressurised aerosol inhaler. Indications Regular treatment of asthma where the use of a combination product (inhaled corticosteroid [ICS] and long-acting β2agonist [LABA]) is appropriate: (i) for patients not adequately controlled with ICS and ‘as required’ inhaled short-acting β2-agonist (SABA) (i) for patients already adequately controlled on both an ICS and a LABA. For adults and adolescents aged 12 years and above. Dosage and administration for inhalation use. Patients should be shown how to use the inhaler correctly by a healthcare professional. Patients should be given the strength of flutiform k-haler containing the appropriate fluticasone propionate dose for their disease severity (note that flutiform k-haler 50 µg/5 µg per actuation is not appropriate in patients with severe asthma). The appropriate strength should be taken as two inhalations, twice daily (normally morning and evening) and used every day, even when asymptomatic. flutiform k-haler is not recommended in children under 12 years. Prescribers should be aware that in asthmatics, fluticasone propionate is as effective as some other inhaled steroids when administered at approximately half the total daily microgram dose. Patients should be assessed regularly and once asthma is controlled, treatment should be reviewed and stepped down to the lowest effective dose, or an ICS alone. ICSs alone are first line treatment for most patients. flutiform k-haler is not intended for initial treatment of mild asthma. For patients with severe asthma the ICS therapy should be established before prescribing a fixed-dose combination product. Patients on flutiform K-haler must not use an additional LABA. An inhaled SABA should be taken for immediate relief of asthma symptoms arising between doses. Patients should be advised to contact their prescriber when flutiform k-haler dose counter is getting near zero. Contra-indications Hypersensitivity to the active substances or to any of the excipients. Precautions and warnings flutiform k-haler should not be used as the first asthma treatment, to treat acute asthma symptoms or for prophylaxis of exercise-induced asthma. It should not be initiated during an exacerbation, during significantly worsening or acutely deteriorating asthma, and should not be stopped abruptly. If a patient experiences serious asthma-related adverse events or exacerbations, they should continue treatment and seek medical advice. Patients should be reviewed as soon as possible if there is any indication of deteriorating asthma control. In case of sudden and progressive deterioration, seek urgent medical assessment. Caution in patients with: pulmonary tuberculosis; quiescent tuberculosis; fungal, viral or other infections of the airway; thyrotoxicosis; phaeochromocytoma; diabetes mellitus (consider additional blood sugar controls); uncorrected hypokalaemia; predisposition to low levels of serum potassium; impaired adrenal function (monitor HPA axis function regularly); hypertrophic obstructive cardiomyopathy; idiopathic subvalvular aortic stenosis; severe hypertension; aneurysm or other severe cardiovascular disorders; unstable or acute severe asthma and other conditions when the likelihood for hypokalaemia adverse effects is increased. There is risk of potentially serious hypokalaemia with high doses of β2-agonists or concomitant treatment with ββ2-agonists and drugs that can induce or potentiate a hypokalaemic effect. Monitoring of serum potassium levels is recommended during these circumstances. Formoterol may induce prolongation of the QTc interval. Caution must be observed when treating patients with existing prolongation of QTc interval. flutiform k-haler should be discontinued immediately if there is evidence of paradoxical bronchospasm. Visual disturbance may be reported with corticosteroid use. Systemic effects with an ICS may occur, particularly at high doses for prolonged periods or when combined with potent CYP3A4 inhibitors, but are less likely than with oral corticosteroids. Possible systemic effects include Cushing’s syndrome, Cushingoid features, adrenal suppression, growth retardation in children and adolescents, decrease in bone mineral density and cataract glaucoma. Children may also experience anxiety, sleep disorders and behavioural changes. Increased exposure can be expected in patients with severe hepatic impairment. Prolonged treatment with high doses of corticosteroids may result in adrenal suppression and acute adrenal crisis, particularly in children and adolescents or potentially as a result of trauma, surgery, infection or rapid dose reduction. flutiform k-haler contains a negligible amount of ethanol that does not pose risk to patients. Interactions Cotreatment with CYP3A inhibitors (e.g. ritonavir, atazanavir, clarithromycin, indinavir, itraconazole, nelfinavir, saquinavir, ketoconazole, telithromycin, cobicistat) should be avoided unless the benefit outweighs the increased risk of systemic side-effects. Caution is advised with concomitant use of non-potassium sparing diuretics (e.g. loop or thiazide), xanthine derivatives, glucocorticosteroids, L-Dopa, L-thyroxine, oxytocin, alcohol or other adrenergic drugs, including anaesthesia with halogenated hydrocarbons and digitalis glycosides, β-adrenergic drugs, known to prolong the QTc interval, such as tricyclic antidepressants or MAOIs (and for two weeks following their discontinuation), antipsychotics (including phenothiazines), quinidine, disopyramide, procainamide, antihistamines, furazolidone and procarbazine. flutiform k-haler should not normally be used with β-blockers including those that are used as eye drops to treat glaucoma. Under certain circumstances, e.g. as prophylaxis after myocardial infarction, cardioselective β blockers could be considered with caution Pregnancy and lactation flutiform k-haler is not recommended during pregnancy unless the benefits to the mother outweigh risks to the foetus. A risk to the breastfeeding infant cannot be excluded. Side-effects Uncommon (<1/100) but potentially serious: hyperglycaemia, agitation, depression, aggression, behavioural changes (predominantly in children), vision blurred, vertigo, palpitations, ventricular extrasystoles, angina pectoris, tachycardia, hypertension, dyspnoea, peripheral oedema. Please consult the SPC a full list of side-effects and those reported for the individual molecules. Legal category POM Package quantities One inhaler (120 actuations) Marketing Authorisation numbers PA 1688/013/005 Marketing Authorisation holder Mundipharma Pharmaceuticals Limited Millbank House Arkle Road Sandyford Dublin 18 Tel: +353 (0)1 2063800. For medical information enquiries, please contact info@mundipharma.ie. ® FLUTIFORM is a registered trademark of Jagotec AG, and is used under licence. ® K-HALER is a registered trade mark of Mundipharma AG. © 2018 Napp Pharmaceuticals Limited. Adverse events should be reported to: HPRA Pharmacovigilance, Earlsfort Terrace, IRL - Dublin 2; Tel: +353 1 6764971; Fax: +353 1 6762517. Website: www. hpra.ie; E-mail: medsafety@hpra.ie. Adverse events should also be reported to Mundipharma Pharmaceuticals Limited on drugsafetyireland@mundipharma.ie or by phone on 01 2063800 (1800 991830 outside office hours) UK/FLUT-K-18036 Date of Preparation September 2018

CMYK - Horizontal

THE K-HALER ASTHMA TREATMENT REDESIGNED

125µg/5µg 2 inhalations, twice daily

CMYK - Vertical


24

News

Pharmacy gets behind Inhaler Technique campaign More than one person dies every week in Ireland from asthma and 90% of these deaths are preventable. Minister for Health, Simon Harris, Sarah O’Connor, CEO, Asthma Society of Ireland and Daragh Connolly, President of the Irish Pharmacy Union

one in adults and one in five children have the disease. Inhalers are one of the most common devices used to treat asthma yet research shows as many as 2 in 3 people may be using their inhaler incorrectly. However, when taught the correct technique, people are able to use their inhalers more effectively with substantial benefits for their asthma control and overall health. People with asthma are advised to have the inhaler technique checked by a healthcare professional at every opportunity.

That was one of the key messages to arise from a new awareness campaign encouraging those with asthma to ensure they are using their inhaler device correctly. The ‘Inhaler Technique’ campaign was launched by the Minister for Health, Simon Harris, the Asthma Society of Ireland and the Irish Pharmacy Union (IPU). Two out of three of Ireland’s 470,000 people with asthma may be unknowingly aggravating their condition simply by not using their inhalers correctly.

The Irish Pharmacy Union is supporting the campaign through their 1,750 member pharmacies across Ireland. Throughout the month of March all IPU pharmacies will be offering free inhaler technique advice to their customers. Daragh Connolly, President of the Irish Pharmacy Union (IPU), said, “Pharmacists, as healthcare professionals, are ideally positioned to provide advice and assistance to people with asthma to help them gain control over their condition. Having the correct

inhaler technique is absolutely essential for those who have asthma to get the most out of their medicines and pharmacists are available to provide the support and advice necessary to ensure that this happens. We would encourage people with asthma to bring their inhalers to their local pharmacy and the pharmacist will be able to provide them with the practical advice they need for using their inhalers properly.” Ireland has the fourth highest incidence of asthma in the world;

Sarah O’Connor, CEO of the Asthma Society of Ireland, says, “Many people with asthma may not be aware that poor inhaler technique could be making their condition worse. We have a range of asthma technique videos available on asthma.ie – covering every device available on the Irish market. We also have videos showing people with asthma how to use their spacer, if their inhaler requires one. We encourage both people with asthma and healthcare professionals to use to ensure these videos to keep their inhaler technique is correct. This can make a huge difference to safely managing asthma and living a full life symptom free.”

Memorandum of Understanding The Health Information and Quality Authority (HIQA) has signed a memorandum of understanding (MoU) between national health technology assessment (HTA) bodies in Scotland, Wales and Ireland. The MoU establishes a collaborative approach to the identification and assessment of new health technologies between HIQA, Health Technology Wales and the Scottish Health Technology Group. These bodies assess and give guidance on health technologies within their national healthcare systems.

Dr Máirín Ryan, HIQA’s Deputy CEO and Director of Health Technology Assessment, said, “The MoU aims to formalise working in partnership with HTA bodies across these three countries, including opportunities to collaborate on and co-produce evidence reviews on health technologies. It will also improve shared understanding of work

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programmes and processes, ensuring the best use of resources for the people of each country and their respective care systems. “HIQA welcomes this opportunity to optimise the use of scarce HTA resources and expertise across the three countries and increase efficiencies through joint work.” HIQA has recently worked

successfully with the Scottish Health Technology Group on each country’s national assessments of mechanical thrombectomy to treat ischaemic stroke. HIQA, along with the other HTA bodies, will be attending the Health Technology Assessment International (HTAi) Annual Meeting in Cologne in June 2019 to present the progress made through this new strategic alliance.


Sterimar effectively relieves symptoms without the compromise of steroids, drugs and preservatives that can be found in other more medicated products Our 100% natural, purified seawater based nasal sprays are completely drug free and preservative free. This means that the Sterimar product range offers nasal solutions for everyone, even babies* and pregnant women or breastfeeding mothers. *STERIMARTM Baby can be used from birth and STERIMARTM Kids can be used from 3 months. STERIMARTM Hayfever & Allergies, Congestion Relief and Stop & Prtoect range can be used from 3 years & up.

Over 40 years of expertise in nasal health Sterimar has a strong heritage in providing natural based remedies for nasal conditions and is the UKâ&#x20AC;&#x2122;s #1 GP recommended brand for nasal conditions. Using the expertise of healthcare professionals and early childhood specialists, Sterimar range of solutions has been developed to effectively prevent or treat nasal conditions associated with allergies, congestion and blocked noses when most needed. The Sterimar range is an effective solution trusted by many leading healthcare professionals in the UK, and used by millions around the world.

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Allergies - Not to be Sniffed at Whether patients are coping with allergies caused by seasonal, non-seasonal, or food allergens, pharmacists can help patients prevent and manage their bothersome symptoms. Like an unwelcome guest, many allergens arrive with little warning. Their most common effects are all too familiar to the millions suffering from allergies: itchy nose, eyes, and roof of the mouth; runny or stuffy nose; watery eyes; sneezing; ear fullness and popping; hives; cough; and sinus headache. Allergies are either seasonal or non-seasonal. Mould, animal dander, dust, and pollen are the most common. The first year of life is crucial when it comes to setting off allergies in those with a genetic predisposition. For example, a child who's been exposed to lots of house dust mite allergen in their first year has a higher chance of developing asthma later in childhood compared to a child who hasn't been exposed to such high levels of the allergen. Recognising the Symptoms This is an area that pharmacists are well placed to identify. Selfreporting of allergy is common, with some patients already having an allergy diagnosis. It is important for pharmacists to consider whether management in

the pharmacy is appropriate, to acknowledge expertise limitations and know when to direct a patient to their GP. Patients who may require specialist management include those without a definitive diagnosis or those from specific patient groups with specialised treatment pathways, for example pregnant women. Patients with a suspected food allergy should always be advised to see the GP for an allergyfocused clinical history. Symptom recognition in food allergy is an important aspect of patient education, so the patient knows when to use an adrenaline auto-injector. This is as important as knowing how to use it. Symptoms depend on which part of the body is affected. For example, hay fever (also known as seasonal allergic rhinitis, because it is mainly triggered by pollen) affects the eyes and nose, causing sneezing, a runny nose, watery, itchy eyes, irritated and itchy throat and, sometimes, a stuffy, blocked nose. Perennial allergic rhinitis (a condition that causes symptoms all year round) often causes a stuffy, blocked nose. Eczema (also called dermatitis) can affect the skin causing itchy, red rashes. Allergic contact dermatitis (a condition which is caused by the skin coming into contact with an allergen, such as nickel) is characterised by red, scaly skin

26 | PHARMACYNEWSIRELAND.COM

that itches where it has made contact with the allergen. Asthma affects the respiratory system causing wheezing (a whistling sound in the chest), breathlessness, chest tightness and a cough. Allergies to some foods, bites or stings can cause urticaria (itchy blisters and red patches on the skin). Available Treatments The choice for treating allergic rhinitis can be confusing. Pharmacists are well placed to recommend a product that is matched to symptoms and their severity. It is beneficial to start treatment before symptoms begin. Eye symptoms are common in allergic rhinitis, with patients reporting red, watery and itchy eyes in addition to nasal symptoms. If this is the case, eye drops may be required. Antihistamines are the first line of defence for many allergic conditions.When helping patients choose an antihistamine, it is important to be aware of the sedative effect of first-generation drugs, as well as the short duration of action. The benefit of secondgeneration antihistamines is the rapid onset, which is good for compliance, as is the daily dosing and the fact that they are nonsedating. On occasion, patients may require high doses of antihistamines to manage allergic or potentially


If your customers feel good, your profit margin will too Playing in the park, enjoying a family picnic, or going on a bike ride – nothing feels as good as being in the great outdoors. Encourage your customers to make the most of it with Zirtek Allergy Relief, which can help ease the symptoms of hayfever and other allergies. 24-hour around the clock relief, max strength treatment Range of products suitable for the whole family1 Non-drowsy in the majority of cases Zirtek Oral Solution is Ireland’s No.1 best-selling allergy solution2 A reputation based on reliability, knowledge and research3,4

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Feel free to place an order with your local rep or customer service team: Call: 01 463 2424 Email: cs.pemberton@united-drug.com

Please consult the Summary of Product Characteristics before prescribing, information about this product can be found at www.medicines.ie. Further information is available on request from UCB Pharma Ireland Ltd, United Drug House, Magna Drive, Citywest Road, Dublin 24. MA Numbers: Zirtek 1 mg/ml oral solution: PA 891/8/3, Zirtek Plus Decongestant 5/120mg Prolonged Release Tablets PA 891/8/1, Zirtek Tablets PA0891/008/005. Product licence holder: UCB Pharma Ireland Ltd. Legal Category: OTC. Classification: Zirtek tablets & oral solution: Cetirizine dihydrochloride. Zirtek Plus Decongestant prolonged release tablets: Cetirizine dihydrochloride, Pseudoephedrine hydrochloride. Adverse events should be reported to the Health Products Regulatory Authority at www.hpra.ie or via email to medsafety@hpra.ie Adverse events should also be reported to UCB Pharma Ireland Ltd via email UCBCares.IE@ucb.com 1 2

Zirtek Allergy Relief is available in liquid formula for ages 2 and upwards, and in tablets suitable for ages 6 and upwards. IMS Data, December 2018 MAT units. 3 Zirtek Usage and Attitude in the ROI Report. 4 Antihistamines - Rossen Boev, MD.

March 2019 UK/IE-P-ZI-ALY-1900029


studies have been performed. Pregnancy and Lactation: should not be NASACORT ALLERGY 55 MICROGRAMS/DOSE NASAL SPRAY SUSPENSION (TRIAMCINOLONE ACETONIDE) administered during pregnancy or lactation unless therapeutic benefits outweigh the potential risk to the foetus/baby. Adverse Reactions: commonly reported adverse PRODUCT INFORMATION reactions: flu syndrome, pharyngitis, rhinitis, headache, bronchitis, epistaxis, cough, Presentation: 20 ml bottle, providing 30 actuations containing 55mcg triamcinolone dyspepsia & tooth disorder. Rare reactions: nasal septum perforations. Frequency acetonide per metered dose. Indications: Treatment of the symptoms of seasonal not known: hypersensitivity (including rash, urticaria, pruritus and facial oedema), allergic rhinitis. Dosage and Administration: Patients aged 18 years and over: The insomnia, dizziness, alterations of taste and smell, cataract, glaucoma, increased recommended dose is 220 micrograms as 2 sprays in each nostril once daily. Once provides 24 hour relief * of ocular pressure, nasal ir itation, dry mucous membrane, nasal congestion, sneezing, symptoms are control ed patients can beNasacort’s maintained on 110 microunique grams (1 sprayformula in Itchy Nose dyspnoea, nausea, fatigue, decreased blood cortisol. Legal Category: P. each nostril once daily). If symptoms are not relNasal ieved within 14 days,congestion a physician must Marketing Autworks horisation Number: be consulted. Not recommended in childreSneezing n and adolescents under 18 years Even on PA 540/11/2. Further information is eye availablesymptoms from the Marketing Authorisation Holder: Medical Information of age. Contraindications: Hypersensitivity tRunny o the active substaNose nce or excipients. Department, Sanofi-aventis Ireland Limited T/A SANOFI, 18 Riverwalk, Dublin 24, Precautions and Warnings: If adrenal function may be impaired, take care when IE-medinfo@sanofi.com. Tel. 0845 372 7101. Please refer to Summary of Product transfer ing patients from systemic steroids. Localised infections of the nose and Characteristics which can be found on IPHA at http:/ www.medicines.ie/ before pharynx with Candida albicans has rarely occurred which may require local treatment prescribing. Date of preparation of PI: December 2016 and temporary discontinuation of Nasacort Allergy. Should be used with caution in Key recent nasal septadvantages: al ulcers, nasal surgery or trauma, until healing has occurred. SysteOnce-a-day mic effects may occur, particularly at high doses prescribed for prolonged Reporting suspected adverse reactions after authorisation of the medicinal Starts working from day one periods.Stays Potential systwhere emic effectsit’smay isprayed nclude Cushing’s syndrome, Cushingoid product is important. It allows continued monitoring of the benefit/risk fThe eatures, adrtreatment enal suppression, growtofh retchoice ardation in childreinn and adolescents, cataract, balance of the medicinal product. Healthcare professionals are asked to patients glaucoma and morwith e rarely, a moderate range of behavioural eftofects including psychomotor report any suspected adverse reactions via HPRA Pharmacovigilance, severe hayfever . hyperactivity, sleep disorders, anxiety, depression or aggression. Treatment with higher Earlsfort Terrace, IRL - Dublin 2; Tel: +353 1 6764971; Fax: +353 1 6762517. tTO han recommended doses may result in clinicUP ally significantCALL adrenal suppression which Website: www.hpra.ie; E-mail: medsafety@hpra.ie. Suspected adverse STOCK YOUR SANOFI PHARMACY REPRESENTATIVE may require additional systemic corticosteroid cover during periods of stress or elective events can also be reported to Sanofi Ireland Ltd. directly by emailing surgery. Close monitoring in patients with a change in vision or with a history of IEPharmacovigilance@Sanofi.com or calling 01 403 5600. increased intraocular pressure, glaucoma and/or cataracts. Contains benzalkonium chloride, an ir itant, which may cause skin reactions. Interactions: No interaction

Help sufferers escape the misery of hayfever

Help sufferers escape the misery of hayfever 1

2

3,4

3,5

*Once established on the product

2

References: 1. Nasacort 24 hours data on file, 16th March 2016 2. Treatment of seasonal allergic rhinitis: 1998, MeReC Bulletin, 9(3), 9-12 3. Nasacort SPC 4. Gross G. et al. Annual of Allergy Asthma & Immunology 1996 5. Berridge MS. et al. The Journal of Nuclear Medicine 1998

NASACORT ALLERGY 55 MICROGRAMS/DOSE NASAL SPRAY SUSPENSION (TRIAMCINOLONE ACETONIDE) PRODUCT INFORMATION Presentation: 20 ml bottle, providing 30 actuations containing 55mcg triamcinolone acetonide per metered dose. Indications: Treatment of the symptoms of seasonal allergic rhinitis. Dosage and Administration: Patients aged 18 years and over: The recommended dose is 220 micrograms as 2 sprays in each nostril once daily. Once symptoms are controlled patients can be maintained on 110 micrograms (1 spray in each nostril once daily). If symptoms are not relieved within 14 days, a physician must be consulted. Not recommended in children and adolescents under 18 years of age. Contraindications: Hypersensitivity to the active substance or excipients. Precautions and Warnings: If adrenal function may be impaired, take care when transferring patients from systemic steroids. Localised infections of the nose and pharynx with Candida albicans has rarely occurred which may require local treatment and temporary discontinuation of Nasacort Allergy. Should be used with caution in recent nasal septal ulcers, nasal surgery or trauma, until healing has occurred. Systemic effects may occur, particularly at high doses prescribed for prolonged periods. Potential systemic effects may include Cushing’s syndrome, Cushingoid features, adrenal suppression, growth retardation in children and adolescents, cataract, glaucoma and more rarely, a range of behavioural effects including psychomotor hyperactivity, sleep disorders, anxiety, depression or aggression. Treatment with higher than recommended doses may result in clinically significant adrenal suppression which may require additional systemic corticosteroid cover during periods of stress or elective surgery. Close monitoring in patients with a change in vision or with a history of increased intraocular pressure, glaucoma and/or cataracts. Contains benzalkonium chloride, an irritant, which may cause skin reactions. Interactions: No interaction

studies have been performed. Pregnancy and Lactation: should not be administered during pregnancy or lactation unless therapeutic benefits outweigh the potential risk to the foetus/baby. Adverse Reactions: commonly reported adverse reactions: flu syndrome, pharyngitis, rhinitis, headache, bronchitis, epistaxis, cough, dyspepsia & tooth disorder. Rare reactions: nasal septum perforations. Frequency not known: hypersensitivity (including rash, urticaria, pruritus and facial oedema), insomnia, dizziness, alterations of taste and smell, cataract, glaucoma, increased ocular pressure, nasal irritation, dry mucous membrane, nasal congestion, sneezing, dyspnoea, nausea, fatigue, decreased blood cortisol. Legal Category: P. Marketing Authorisation Number: PA 540/11/2. Further information is available from the Marketing Authorisation Holder: Medical Information Department, Sanofi-aventis Ireland Limited T/A SANOFI, 18 Riverwalk, Dublin 24, IE-medinfo@sanofi.com. Tel. 0845 372 7101. Please refer to Summary of Product Characteristics which can be found on IPHA at http://www.medicines.ie/ before prescribing. Date of preparation of PI: December 2016

Nasacort’s unique formula provides 24 hour relief * of

Date of preparation: March 2018 SAIE.SA.18.03.0072

Date of preparation: March 2018 SAIE.SA.18.03.0072

1

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via HPRA Pharmacovigilance, Earlsfort Terrace, IRL - Dublin 2; Tel: +353 1 6764971; Fax: +353 1 6762517. Website: www.hpra.ie; E-mail: medsafety@hpra.ie. Suspected adverse events can also be reported to Sanofi Ireland Ltd. directly by emailing IEPharmacovigilance@Sanofi.com or calling 01 403 5600.


non-allergic symptoms – eg in chronic spontaneous urticaria. Although these doses should be prescribed, it is important to provide reassurance that they are safe and within national guidelines.

TIPS FOR SUPPORT & ADVICE Patients often self-treat mild to moderate allergies, asking pharmacists for guidance about which OTC antihistamines, decongestants, combination products, or nasal sprays work best. Effective advice and support must be patient specific; however, there are support tips that apply to all patients, including parents with children experiencing allergies.

Allergies and Asthma People who have allergies often also have asthma. And people with asthma often have allergies. While the two may not seem related, studies show about two-thirds or more of those with asthma also have an allergy. What many people don’t realise is that the same things that triggers their seasonal hay fever symptoms, things like pollen, dust mites, mould and pet dander can also cause asthma symptoms. Allergic asthma, where allergies are triggers for asthma symptoms is the most common type of asthma. Researchers have long known that the frequency of children with allergies who also have asthma can be as high as 80%. Recent research has shown that about 75% of adults aged 20-40 with asthma, and 65% of those with asthma aged 55 years and older, have at least one allergy. Local research has shown that up to 80% of Ireland’s 470,000 asthma sufferers also have hay

Tip 1: Identify the culprit

fever. There are more than 30 types of pollen and 20 types of spores which can trigger hay fever. The majority of sufferers find that the allergy can severely disrupt their lives, with up to 94% of hay fever patients reporting that their symptoms have an impact on their day-to-day work. Allergy expert, Dr Paul Carson, points to predictions by experts that the figure for allergies is set to increase by 50% in the next decade. Allergy is going to be an "enormous" healthcare burden in the coming years, he says, adding that it's believed the increase is driven by pollution in the atmosphere and the amount of chemical additives in our food, which he says are "swamping" our immune systems, particularly in young children.

Although most people are aware of seasonal allergies, many cannot pinpoint the culprit. Keeping a log regarding symptom onset, time of day, and environmental surroundings helps narrow the list. Patients’ symptoms often vary in intensity from day to day, further complicating assessment. Patients with ongoing allergies should see a specialist, even if symptoms are mild. Tip 2: Review things that can worsen symptoms Although patients may attempt to avoid allergens’ triggers, they may be unaware of exacerbating environmental conditions, including aerosol sprays, air pollution, cold temperatures, humidity, irritating fumes (including perfume), tobacco and wood smoke, and poor housekeeping. Tip 3: Educate on the difference between food intolerance and food allergies Many people confuse food allergies with more common food intolerances. Allergies involve an immune reaction; food intolerances stem from the inability to digest certain foods. Symptoms are similar, but milder: gastrointestinal problems, hives, itching, or eczema. Although avoiding specific foods is the recommended strategy, patients should be evaluated by an allergist. Tip 4: Discuss anaphylaxis Those with severe reactions have increased risk for anaphylaxis. Inform patients they need to go to the emergency department if; • acute symptoms occur within minutes or hours involving respiratory compromise, tongue swelling, or hypotension

TABLE 1: COMMON MYTHS ABOUT ALLERGIES Myth

Fact

Those with food allergies are allergic to many foods

Most are allergic to four or fewer foods

Those allergic to eggs should not get the flu vaccine

Flu vaccine is safe for people with egg allergies, even though they may contain very low amounts of egg protein a the virus is often grown in hen's eggs

Those allergic to pets are allergic to their fur

The allergen is a specific protein produced not in the animal's fur, but primarily in its skin and a lesser extent urine and saliva

Flowering plants cause hay fever

Hayfever, is caused by allergy to pollen, rather than hay

Allergies aren’t dangerous

Although rare, allergies can kill. Some people can have such an extreme sensitivity to a particular substance that the allergen can trigger an anaphylactic shock

• skin tone is flushed or pale (almost always present with anaphylaxis) • nausea, vomiting, or diarrohea begins • dizziness or fainting, or a weak or rapid pulse, occur Tip 5: Review cross-reactivity Cross-reactivity - allergic reaction to 1 item in a food group resulting in an allergic reaction to other items in the same food group is common. People allergic to prawns are also prone to be allergic to other shellfish. Cross-reactivity is less common in animal food groups. Tip 6: Address unproven treatments A quick Internet search uncovers a host of unproven diagnostics and treatments for allergies, including hair analysis, acupuncture, and herbal medicine. Most lack adequate studies and some, such as “cytotoxic” food testing (mixing blood with a food extract to determine if the cells swell), make no sense given current knowledge of the immune system. Tip 7: Probe for co-morbidities Many allergies, especially food allergies, tend to co-exist with other conditions, including asthma, atopic dermatitis, and eosinophilic esophagitis. Allergy treatments may improve some of these other symptoms. Pharmacists should routinely query about asthma when offering advice on allergies.

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When Headache Pain Hits

H

eadache is a universal experience; most people will suffer with one at some point in their lives. Community pharmacy is ideally placed to support people with chronic health conditions such as headaches. Most headaches, including migraine which is very distressing, can be correctly diagnosed with appropriate over the counter remedies and/or self-care advice provided in a community pharmacy by the community pharmacist and the wider team.

Community Pharmacists already daily use their clinical knowledge to promote evidence-based and cost effective use of medicines to help relieve a patients’ suffering from headaches, empowering patients to manage their own health with the right diagnosis, advice, treatment and where applicable support them through necessary life style changes. Research has shown that migraine is under-diagnosed and under treated in at least half of patients and that one-third of sufferers can experience significant disability as a result of their migraines at some stage of their lives. The Migraine Association of Ireland recently produced free information packs, including posters and leaflets available to pharmacies. The Association is actively encouraging patients to seek the expert advice of their local pharmacist to better manage headache, migraine and associated pain and symptoms. The Background to Headache With 46% of the adult population suffering from an active headache disorder, pharmacies will be the first port of call for treatment. In 2016, Medical Advisor to the Migraine Association, Dr Eddie O’Sullivan from Cork University Hospital conducted a study which demonstrated the key role pharmacists play in advising them

and supporting those suffering with headache or migraine. Half of the study participants had not consulted with a GP for an official diagnosis and only half had ever sought advice from the pharmacist on medication options. The most frequently used painkillers were paracetamol or ibuprofen, whilst the preferred treatment choices were codeine based products, the overuse of which can lead to medicationoveruse headache. Furthermore, the majority of patients in the study did not have a medical card, which suggested that the cost of accessing a GP was a barrier to getting appropriate diagnosis and treatment. Types of Headache There are many different types and causes of headache, so it is helpful to understand which a patient may have in order to help advise them on how to manage their symptoms effectively and select the best treatment option. The classification system of headaches used by the medical profession is one of the longest in medicine, with many types and causes. Here we will take a look at some of the most common to present within community pharmacy. The International Headache Society has two broad categories for headache disorders:

• The first is based on symptoms (called primary headache disorders) and includes migraine, tension-type headache and cluster headaches. • The second is based on their causes (called secondary headache disorders). This would include headaches associated with a head injury, stroke, substance misuse and/or their withdrawal (including alcohol), infection, disorders of the neck, eyes, nose, sinuses or teeth. How is a headache different from a migraine? There is a difference between a headache and a migraine headache. Headaches are not usually accompanied by other symptoms associated with migraine. However, it is quite likely that those suffering with migraine will also experience other headaches. Headaches can vary greatly in their duration, cause and severity. A hangover headache, for example goes within a few hours and headaches associated with an infectious illness improve when the illness is over. Those who suffer from regular headaches should be referred to their GP. Chronic Daily Headache Chronic Daily headache (CDH) is a descriptive term rather than a specific diagnosis. It can evolve

from any primary headache disorder or can be de novo. Studies in the US and Europe indicate that 4-5% of the general population are affected by CDH. It is becoming more frequent and is a major reason for consultation in Headache/Migraine clinics. Much like migraine, CDH can significantly affect someone’s ability to function within the family, in society and in the workplace. In general, headache occurring more often than fifteen days per month, over at least six months and lasting for four hours a day can be considered CDH. People with chronic tension-type headache (CTTH) usually have a history of episodic tension-type headache but may also have no history of migraine. Many people use excessive amounts of analgesics and they may also have concomitant depression. The overuse of analgesics may convert episodic tension-type headaches into CTTH. These headaches are characterised by a daily low-grade headache that is temporarily controlled by the use of the offending acute medication, only to return as the medication wears off. Over time the offending medication loses effectiveness and escalating medication use occurs. If the medication is abruptly withdrawn, a severe rebound headache results

PHARMACYNEWSIRELAND.COM | 31


days with episodic migraine pain superimposed on the ‘headache’. It is a vicious cycle and even if the medication is stopped, withdrawal symptoms are commonly reported including chronic headache. The need to alleviate these withdrawal symptoms perpetuates further use of painkilling drugs and can result in a cycle of medication overuse. The only way of treating this condition is to stop the medication. The withdrawal process is very individualised, based on the types of drugs being taken. Some people will stop the drugs immediately, others may taper them and others may even need to be hospitalised for detoxification under medical supervision. Treatment of Headache and Pain

Tension-Type Headache Tension-type headache is the most common type of primary headache with a lifetime prevalence of up to 78%. However, episodic tension-type headache requires little intervention from medical professionals as it rarely produces significant disability. It usually presents as a low impact, mild to moderate band-like featureless headache. Patients with frequent episodic tension-type headache (1-15 days of TTH per month) often have co-existing Migraine without aura. Patients should be educated to differentiate between the two disorders and encouraged to use a Headache Diary to record individual episodes so that treatment can be maximised and medication-overuse headache avoided. Tension-type headache (TTH) is usually described as a pain that feels like a tight band round the head or a weight on top of it. The neck or shoulder muscles may also hurt along with the headache. The pain can last from 30 minutes to several days, or may be continuous. Tension-type headache can develop into chronic tension-type headache when it becomes more disabling. Cluster headache This is a rare type of headache that affects about 1 to 2 people in every 1,000. Cluster headache is one of the most painful conditions known to mankind and women suffering

from cluster headache describe the pain as worse than childbirth. The symptoms of cluster headache are characterised by unilateral (one sided) pain, although for some people the side can vary from time to time. The pain is usually centred over one eye, one temple or the forehead. It can spread to a larger area making diagnosis harder. During a bout of cluster headache the pain is often experienced at a similar time each day. The headache often starts at night waking people one to two hours after they have gone to sleep. The pain usually reaches its full intensity within 5 to 10 minutes and lasts at this agonising level for between 30 and 60 minutes. For some people the pain can last for 15 minutes, for others 3 hours has been known. It then stops, usually fairly abruptly. Sufferers may experience the head pain every other day during a bout, or up to 8 times per day during a bad cluster. In about 80% of people with cluster headache the bouts (or “clusters”) of head pain last for 4 to 12 weeks once a year often at the same time and often in the Spring or Autumn. It may then disappear for several months or even years. This is known as episodic cluster headache. The reason for this seasonal timing is not completely known, although it is one of the key aspects of diagnosis and may involve a brain area called the hypothalamus. The remaining 20% of people do not have these pain free intervals and are said to have “chronic cluster headache.”

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People with cluster headache are usually unable to keep still during an attack and often try to relieve the agonising pain by pacing the room or walking outside, sometimes even banging their heads against a wall until the pain subsides. Other symptoms which are characteristic of cluster headache are a blocked or runny nose, and on the same side of the head as the pain, a drooping eyelid and watering and redness of one eye. Many people also experience a flushed or sweating face. Medication-overuse headache People who use acute pain-relief medicine more than two or three times a week or more than 10 days out of the month can set off a cycle called ‘medication-overuse headaches’ (MOH). As each dose of medicine wears off, the pain comes back, leading them to take even more. MOH can occur with both over-thecounter and prescription pain-relief medicines. They can also occur whether taken them for headache or for another type of pain. It is characteristic of migraine that people have episodic attacks of multiple symptoms (pain, nausea, vomiting, sensitivity to light and sound) but they go back to their usual state of health in between attacks. Medication-overuse headache, in contrast, is a dull constant headache which is often worse in the morning. It is present on most days or part of every day. It is possible to have medication headaches most

Painkillers such as paracetamol, NSAIDs (aspirin, ibuprofen and diclofenac) and combined analgesics containing paracetamol can be used as first-line treatment to relieve pain from all headaches. There are also treatments that can be combined with paracetamol, such as buclizine and prochlorperazine to treat the nausea especially associated with migraine headaches. If the patient is nauseous a soluble painkiller may be recommended as these are absorbed quicker from the stomach. Sumatriptan can also be recommended over the counter to migraine suffers if ordinary painkillers are not helping to relieve the migraine. As well as relieving the pain associated with migraine, sumatriptan also relieves nausea and sensitivity to light (see end of article for more information on this.) All over the counter treatments have legal licence specifications which the pharmacy must adhere to. This may sometimes be different from that which applies when the same medication is written on a prescription. With sumatriptan for example pharmacies have to follow a sales protocol which excludes certain patients such as under 18 or over 65 years of age, patients with other medical conditions such as epilepsy, high blood pressure, kidney or liver disease amongst other. Other examples where referral is applicable include all pregnant patients with migraine symptoms, symptoms suggestive of cluster headaches as over the counter medications will not relieve that or any other symptoms that are suggestive of severe head injury, stroke, meningitis, brain tumour or any signs of a more serious problem.


DONâ&#x20AC;&#x2122;T LET PAIN HOLD YOU BACK

ESSENTIAL INFORMATION Solpa-Extra 500mg/65mg Soluble Tablets contain paracetamol and caffeine. For the treatment of mild to moderate pain. Adults and children over 16 years: 1-2 tablets dissolved in water every 4-6 hours. Max 8 tablets a day. Children 12-15 years: 1 tablet disolved in water every 4-6 hours. Max 4 tablets a day. Not suitable for children under 12 years. Contraindications: Hypersensitivity to the ingredients. Precautions: Particular caution needed under certain circumstances, such as renal or hepatic impairment, chronic alcoholism and malnutrition or dehydration. Precautions needed in asthmatic patients sensitive to acetylsalicylic acid, patients on a controlled sodium diet and with rare hereditary problems of fructose intolerance. Patients should be advised not to take other paracetamol containing products concurrently. Pregnancy and lactation: Not recommended during pregnancy and breastfeeding. Side effects: Rare: allergies. Very rare: thrombocytopenia, anaphylaxis, bronchospasm, hepatic dysfunction, cutaneous hypersentitivity reactions. Unknown: nervousness, dizziness. Further information is available in the SmPC. PA 1186/017/001. P. MAH: Chefaro Ireland DAC, Treasury Building, Lower Grand Canal Street, Dublin 2, Ireland. Date of preparation: April 2017.


professionals worldwide. This is particularly the case in Ireland where there are insufficient resources to look after migraine patients. We need more doctors, specialist nurses, other healthcare professionals and headache services to care for this growing patient population. For example, the National Clinical Programme for Neurology recommends that there should be a total of 32 specialist headache nurses in Ireland. There are currently the equivalent of approximately three posts.” Clodagh Kevans, Associate Director at Teva Pharmaceuticals, added, “For people living with migraine, diagnosis and treatments are improving. Increasingly there is a greater understanding of the biology of the condition, and this is driving the development of new and emerging treatments that help prevent migraine.” Managing Migraine OTC

Early Intervention Early intervention will often result in a more rapid reduction of headache pain and return to normal functioning. Treating headache early, when the pain is milder will allow the patient to become pain-free within two hours in 80% of cases versus only 36% when a Triptan is used later in the attack, when the pain is more severe. Early intervention will also lessen the likelihood of headache recurrence and limit the drug’s side effects. Treating a migraine swiftly may also reduce the patient’s risk of developing allodynia, a painful response to a non-painful stimulus. Patients with allodynia may experience peripheral pain in their scalp while combing their hair, or they may feel pain in an extremity as the headache pain intensifies. Although up to 80% of patients will experience pain relief within two hours of taking a Triptan (four hours in the case of Frovatriptan), a second dose is advised if the headache has not improved in this time or if the headache resolves and then recurs within 24 hours. Headache recurrence occurs in about 30% or attacks. In these cases, further doses of the prescribed Triptan should be repeated.

looking at causative factors and what good lifestyle changes can help enhance any medicines used to treat. Lifestyle changes, such as getting regular sleep, eating regularly, reducing stress and staying well hydrated, reducing alcohol intake, regular excercise, excluding carbon monoxide poisoning, ensuring sufficient light when reading or working to prevent straining of the eyes, regular eye tests to ensure corrective lenses worn would be considered when treating headaches. Pharmacists should also explore and refer accordingly if headaches in women are caused by hormones, especially if they notice a link with their periods. For migraine suffers, educate them on how to bring their condition under control by keeping a migraine diary to identify triggers. The Struggle with Migraine “Speaking can be a struggle for some when the attack is at its peak.” These were the words of Maria Bailey TD, as she told Oireachtas colleagues about debilitating migraine attacks last month.

Further Advice and Support

On the second day of National Brain Awareness Week (11-17 March 2019), legislators had the opportunity to hear real-life stories about the debilitating effects that migraine has on the day-to-day life of tens of thousands of people in Ireland.

Pharmacists always approach treatment with a holistic approach,

A special information event for Oireachtas members was hosted

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by Dun Laoghaire TD, Maria Bailey, and supported by the Migraine Association of Ireland and Teva Pharmaceutical Ireland. The event revealed how the cost of migraine to the Irish economy is ¤252 million a year1 and Consultant Neurologist in Beaumont Hospital, Dr Martin Ruttledge stated that ‘significant numbers of patients are going undiagnosed and undertreated.’ There are more than a billion people on the planet with migraine and between 600,000 and 700,000 sufferers in Ireland. On any given day in Ireland over 13,000 people are suffering from migraine, the majority forming part of the workforce. Debilitating Condition Speaking at the event, Deputy Bailey said, “Migraine can be a really debilitating condition, and even doing basic tasks like speaking can be a struggle when an attack is at its peak. Today’s event is about learning more about the condition and improving our knowledge, but also to get the message out that by staying on top of your condition, knowing the triggers and doing the basics right in terms of sleep, diet and exercise, supported by medicines if required, it is possible to better manage your migraine.” Dr Ruttledge says, “Migraine is a very common and often debilitating neurological disorder that is underdiagnosed/undertreated by doctors and healthcare

Migraine sufferers in Ireland are now, for the first time, able to access a sumatriptan product without a prescription thanks to the OTC launch of Rowex’s Sumatran Relief. The first OTC Sumatriptan in Ireland for pharmacies only, Sumatran Relief can be used to relieve acute migraine attacks that happen with or without warning signs (aura), such as sensitivity to light, feeling sick, in patients who have a well established pattern of symptoms and who have previously been diagnosed with migraine. Migraine symptoms may be caused by the temporary widening of blood vessels in the head. Sumatriptan is believed to reduce the widening of these blood vessels. This in turn helps to take away the headache and relieve other symptoms of a migraine attack, such as feeling or being sick (nausea or vomiting) and sensitivity to light and sound. Sumatriptan is licensed for the treatment of adults aged 18 to 65 years, for the acute treatment of migraine attacks with or without aura, where a clear diagnosis of migraine has been previously made by a doctor. And this is where it might appear the product is causing some issues for community pharmacists. Irish Pharmacy News understands that whilst demand for the product is extremely high, especially given the removal in recent years of any OTC migraine relief products, the doctor diagnosis and the need to confirm such a diagnosis required creates a hesitance in the pharmacists ability to advise.


DIFFERENT FROM CLASSICAL OPIOIDS*

PALEXIA® SR Tablets are indicated for the management of severe chronic pain in adults, which can be adequately managed only with opioid analgesics1 PALEXIA® Film Coated Tablets are indicated for the relief of moderate to severe acute pain in adults, which can be adequately managed only with opioid analgesics2

*Palexia has a unique mode of action. Palexia MOR-NRI.3

PALEXIA® and PALEXIA SR® Prescribing Information Refer to the Summary of Product Characteristics (SmPC) before prescribing. Presentation: Palexia: 50 mg (white), 75 mg (pale yellow) and 100 mg (pale pink) film-coated tablets contain 50 mg, 75 mg and 100 mg of tapentadol (as hydrochloride) respectively. Palexia SR: 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 is indicated for the relief of moderate to severe acute pain in adults, which can be adequately managed only with opioid analgesics. 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, with or without food. Palexia SR: should not be divided or chewed. 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. Palexia dosage: Initial dose 50 mg every 4 to 6 hours. On the first day of dosing, an additional dose may be taken 1 hour after the initial dose, if no pain control. The first day’s dose should not exceed 700 mg. Maximum maintenance daily dose of up to 600 mg. Palexia SR dosage: 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. Duration of treatment: Palexia: The possibility of switching to Palexia SR should be considered if longer term treatment is required, and pain relief is achieved with Palexia in the absence of intolerable adverse events. 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, H1-antihistamines, 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/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. Palexia only: vomiting. Palexia SR only: constipation. Common (≥1/100, <1/10): decreased appetite, anxiety, sleep disorder, tremor, flushing, diarrhoea, dyspepsia, pruritus, hyperhidrosis, rash, asthenia, fatigue, feeling of body temperature change. Palexia only: confusional state, hallucination, dry mouth, muscle spasms, constipation, abnormal dreams. Palexia SR only: depressed mood, nervousness, restlessness, disturbance in attention, involuntary muscle contractions, dyspnoea, vomiting, mucosal dryness, oedema. Other important undesirable effects observed in clinical trials and/or postmarketing: convulsion, impaired gastric emptying (rare ≥1/10,000, <1/1000). Palexia only: respiratory depression (uncommon ≥1/1000, <1/100), drug hypersensitivity including angioedema, anaphylaxis and anaphylactic shock, depressed level of consciousness, (rare ≥1/10,000, <1/1000). Palexia SR only: drug hypersensitivity, depressed level of consciousness, mental impairment (uncommon ≥1/1000, <1/100), respiratory depression, angioedema, anaphylaxis and anaphylactic shock (rare ≥1/10,000, <1/1000). No evidence of increased risk of suicidal ideation or suicide with Palexia/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: Palexia: 50 mg: PA 2242/12/1, 28 and 56 packs; 75 mg: PA 2242/12/2, 28 and 56 packs; 100 mg: PA 2242/12/3, 28 packs. Palexia SR: 50 mg: PA 2242/12/4, 28 and 56 packs; 100 mg: PA 2242/12/5, 56 pack; 150 mg: PA 2242/12/6, 56 pack; 200 mg: PA 2242/12/7, 56 pack and 250 mg: PA 2242/12/8, 56 pack. Marketing Authorisation Holder: Grünenthal Pharma Ltd, 4045 Kingswood Road, Citywest Business Park, Citywest, Co. Dublin, Ireland. IRE/P18 0017. Date of Preparation: May 2018. Reference: 1. Palexia SR Summary of Product Characteristics. 2. Palexia Film Coated Tablets Summary of Product Characteristics. 3. Kress, et al. European Journal of Pain, 2010. Date of Preparation: July 2018. IRE/P18 0027


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Sláintecare

Milestones for 2019 outlined in Action Plan Minister for Health Simon Harris TD has published the Sláintecare Action Plan 2019, outlining the project management structures and governance approach for the 10-year implementation of Sláintecare and the actions and milestones for 2019. The Action Plan, developed by the Sláintecare Programme Implementation Office, is a fundamental enabler in the delivery of the Sláintecare vision for reformed health and social care services in Ireland.

Dr Tom Keane, Chair, Sláintecare

• Review the recommendations from the Independent Review examining the removal of private practice from public acute hospitals

Minister Harris said, “Sláintecare will deliver a health and social care service that meets the needs of our population and attracts and retains the very best healthcare professionals, managers and staff. Our core objective is to shift the majority of care from the acute to the community setting to bring care closer to home for service users.

• Progress the Patient Safety Bill Workstream 3 – Teams of the Future:

“As I know from experience, implementation does not happen “To implement this ambitious overnight. However, with the keen reform programme, it is essential focus on structured delivery that that we establish a clear, this Action Plan presents, I am accountable and structured confident that we have identified annual plan for delivery, and and sequenced the first essential the 2019 Action Plan that I am steps needed to create the Action Plan 2019 for an Irish health publishing today is just that. Sláintecare It is foundations a detailed and comprehensive and social care service that, in plan for 2019 which firmly due course, will provide the right establishes a programmatic service, in the right place, at the approach to the delivery of the right time.” Sláintecare Strategy. The key Sláintecare actions to be The publication of the Action Plan delivered in 2019 include follows the second meeting of the following: the Sláintecare Implementation Workstream 1 – Advisory Council (SIAC), chaired Service Re-design and Supporting by Dr Tom Keane, which met on Infrastructure: Wednesday 27th February. Citizen Care Masterplan

• Plan bed and diagnostic capacity to meet the needs of our growing population • Prototype a Citizen Health Portal, continue EHR roll-out and explore scale-up of telehealth solutions Workstream 2 – Safe Care, Co-ordinated Governance and Value for Money: • Define and agree a new organisational and operational structure for the future reconfigured health and social care service, including respective roles of the Department of Health, the HSE and regional and community organisations

• Scale projects to improve the Sláintecare Implementation The ten-year reform programme will result in the creation and implementation of a • Develop a roadmap and policy management of chronic disease Advisory Council Chair, Dr Tom Citizen Care Masterplan. The framework for the implementation of the Citizen Care proposals for how to provide and older people’s services so Keane, said, “This Action Plan is Masterplan is outlined in the image below. The framework steps are supported by a universal services at no or low that care can be provided at or deeply rooted in the original vision continuous and cross-cutting programme delivery approach. cost to the patient/service user close to home set out by the Joint Oireachtas Committee on the Future of Figure 1: Sláintecare Implementation Healthcare, and one which hasFramework been informed by stakeholders from across the health and social care service.

• Engage with the education sector and training bodies to agree new ways of training multidisciplinary teams • Implement the recommendations in the Strategic Review of Medical Training and Career Structures • Identify projects which support staff to work to the full scope of their licence to ensure that patients are seen at the lowest level of complexity possible Workstream 4: Sharing Progress: • Commence the development of an evaluation and reporting framework • Launch the ¤20m Sláintecare Integration Fund for 2019 to test, learn from and support the implementation of new models of integrated care • Roll-out a Citizen and Staff Engagement and Empowerment Programme which will be scaled and sustained throughout the 10-year implementation period

Sláintecare Citizen Care Masterplan Implementation

Citizen and Staff Engagement Clinical and and Empowerment Corporate Goverance

Population Health Planning

Service Redesign

Infrastructure and eHealth

Programme Delivery

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PHARMACYNEWSIRELAND.COM

Public and Private Delivery Partners

Workforce Planning and Capacity Building

Entitlement and Eligibilty

Accountability and Value for Money


News Affordable healthcare changes Taoiseach Leo Varadkar TD, and the Minister for Health, Simon Harris TD, have welcomed a number of significant changes which will enable more people to access affordable health care. These changes were announced as part of Budget 2019 and will provide from April 1st for a: - ¤10 reduction in the monthly Drugs Payment Scheme threshold from ¤134 to ¤124; - 10% increase across all GP Visit Card weekly income thresholds; and a - reduction in prescription charges from ¤2 to ¤1.50 for all medical card holders over the age of 70. Welcoming the changes, An Taoiseach Leo Varadkar said, “A big part of Sláintecare is extending free healthcare to more people and reducing the cost for others. So this is another step forward benefitting people across society; young, old, families, single people, low income and better off. “More working people on modest incomes will qualify for free GP care, while changes to the Drugs Payment Scheme and the prescription charge will help make medicines more affordable. Hundreds of thousands of people could benefit from these three actions taken together.” Minister for Health, Simon Harris TD added “These changes, taking effect from the beginning of April, are about ensuring and supporting care in the community setting, a fundamental goal of Sláintecare. “I hope to see as many people as possible benefit from these measures and urge people to check their eligibility and apply.” Anne Marie Hoey, HSE Assistant National Director - Primary Care Reimbursement and Eligibility said “I welcome the continued Government policy of extending eligibility to those who will most benefit from GP and primary care services and in this case to those who may have been slightly over the threshold for a GP Visit Card and who may now gain eligibility.”

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Prescription drugs implicated in overdose deaths Prescription drugs such as benzodiazepines are implicated in the majority of deaths by overdose, according to data compiled by the Health Research Board. By contrast, just 5% of drugrelated deaths are among people who inject drugs. The figures are contained in the National Drug-Related Deaths Index for 2016, which gathers data on deaths due to overdose as well as deaths among drug users due to causes such as cardiac arrest or hanging. More than two people died each day in Ireland during 2016 as a result of poisoning, trauma or medical causes linked to drug use according to the latest figures. Speaking about the findings, Dr Suzi Lyons, Senior Researcher at the HRB, says,”The number of deaths from alcohol increased in 2016. Alcohol remains the number one drug implicated in deaths, alone or with other drugs, over the reporting period. Alcohol was implicated in 132 poisoning deaths in 2016 which accounts for more than one third of all poisonings'. “For 2016 we continue to see that prescription drugs, and taking a cocktail of drugs contributes significantly to deaths from poisoning. Prescription drugs were implicated in almost seven in every ten poisoning deaths in 2016. Methadone and diazepam are the most common prescription drugs implicated. However, we are seeing some new prescription drugs emerging in recent years among

the deaths figures. Pregabalin, licensed for use in Ireland in the treatment of epilepsy, neuropathic pain or generalised anxiety disorder, was implicated in 14 deaths in 2013, but this has risen to 65 deaths in 2016.” Key findings – all deaths 2016 • There were 736 deaths in 2016, similar to the number reported in 2015 (735). • Many of these deaths were premature – half of all deaths in 2016 were aged 42 years or younger. • 21,300 potential life years were lost** because of drug-related deaths. • Three-in-four (549) of all deaths were male.

• A total of 34 (5%) deaths were among people who were injecting drugs and the majority 22 (65%) died in Dublin City. Prescription drugs were implicated in 258 (73%), or seven in every ten, poisoning deaths. • Benzodiazepines were the most common prescription drug group implicated. • Methadone (an opiate substitute) was the most common single prescription drug, implicated in 103 (29%) of all poisonings. • Pregabalin related deaths (anti-epileptic drug which is also prescribed for chronic pain and some anxiety conditions) increased from 49 deaths in 2015, to 65 in 2016 reflecting a persistent rise since 2013.

New Irish vitamin and supplement brand AYA, a new vitamin and supplement brand from Uniphar, will be launched onto the Irish market in April. The Guaranteed Irish range of products is exclusive to Irish pharmacy and will initially include 19 lines. According to research from Uniphar, wellness is the fastestgrowing category in Irish pharmacy with a 30% increase in retail sales observed in some pharmacies who focused on the area. The company has launched AYA following its successful recent experience with own-brand products such as Kit&Kaboodle and FIXXA First Aid. “The Irish market is turning towards the wellness and supplement bays in Irish pharmacies and we felt there was a clear opportunity for a premium product at an affordable price,” said Padraig Flynn, Uniphar Retail Services. “We’ve gone to

the experts in creating AYA and believe we offer the perfect mix of product, price and support.” Staff in pharmacies that order AYA will be given training to ensure they’re well-informed to help customers. This will be key for pharmacies as Uniphar’s research found that one of the most decisive factors for customers moving from interest to purchase was the knowledge of staff. AYA will also offer planograms, a Counter Display Unit and point of sale material to pharmacies who stock the range. Housed in distinctive blue bottles, each of AYA’s 19 initial lines are glutenfree while many are vegan friendly.

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News

¤30 million to be invested in cancer Thanks to the public’s generosity the Irish Cancer Society is on track to invest €30 million in cancer research in the decade up to 2020, it has announced as it launched its 2019 Research Plan. Dr Emma Allott, lecturer in the Centre for Cancer Research and Cell Biology at Queen’s University Belfast

researchers spoke of the huge impact the Irish Cancer Society’s support has had on their work to stop cancer.

Averil Power, Chief Executive of the Irish Cancer Society, said, “This decade has broken all records for cancer research in Ireland. Thanks to the generosity of the public, the Irish Cancer Society has invested more money in life-saving research than ever before, finding better ways to prevent, detect and treat cancer.

potentially life-saving projects, simply because we don’t have enough funds to support them. Unfortunately, this means we may have had to turn down a potential breakthrough or cure. If we’re going to stop cancer this has to change. That’s why Daffodil Day 2019 needs to be the biggest one yet.”

“In 2019 we intend to invest ¤2.3 million in cancer research, supporting the work of over 100 researchers around the country. This makes us the largest voluntary funder of cancer research in Ireland, but we can still do even more.

Daffodil Day 2019, proudly supported by Boots Ireland, took place on Friday, 22 March. Members of the public were urged to get involved by volunteering as fundraisers and donating what they could on the day.

“Every year we have to turn away researchers who come to us with

At the launch of the 2019 Research Plan, two of the Society’s recently-funded

Dr Emma Allott, lecturer in the Centre for Cancer Research and Cell Biology at Queen’s University Belfast, was awarded prostate cancer research funding in 2016. The Dublin native carried out her research in the University of North Carolina at Chapel Hill and Trinity College Dublin as part of a partnership between the Irish Cancer Society, the Dana-Farber Cancer Institute and Harvard T.H. Chan School of Public Health. “Thanks to the Irish Cancer Society’s support, I’ve been able to find out potential links between cholesterol levels and advanced prostate cancer in men. The more we know about why men get advanced prostate cancer, the more we can do to stop it happening in the first place. Preventing prostate cancer means saving countless men from the often harsh treatment that comes

with this disease. The Irish Cancer Society’s funding has allowed me to work with international experts and gain invaluable expertise. I plan to pass this knowledge on to future cancer researchers so that we can come even closer to stopping prostate cancer.” Dr Aideen Ryan, lecturer in Tumour Immunology in the School of Medicine at NUI Galway, received funding from the Irish Cancer Society for research into bowel cancer in 2013. The Galway woman has worked on finding new ways to treat bowel cancer through immunotherapy, treatments that boost the body's natural defences to fight cancer. “Bowel cancer is the second biggest cause of cancer deaths in Ireland, so I feel privileged that my Irish Cancer Society funding has given me the chance to explore new ways to treat this disease and save lives. Through my Irish Cancer Society fellowship I wanted to give more hope to people going through the most advanced forms of bowel cancer by exploring better treatments. Since then I’ve used this experience to progress my research and continue the fight to stop this disease.”

Irish Pharmacy Awards 2019 – Have you Booked Your Table? The eighth Irish Pharmacy Awards are taking place on Saturday, May 18th 2019 in the Clayton Hotel, Burlington Road Dublin and table bookings are now being accepted. The importance and popularity of the Irish Pharmacy Awards are reflected by the speed with which table bookings are made. Last year’s table booking sold out a month before the event, and for that reason, those wishing to attend are being urged to book fast, as this year’s event promises to be even bigger and better than its predecessors! Join over 650 of Ireland’s leading pharmacy professionals, academics, VIPs and pharmaceutical leaders for a unique opportunity to network, celebrate, share in innovation and education and celebrate with the pharmacy individuals and teams leading the way, judges, finalists and sponsors. The Irish Pharmacy Awards, seek to uncover those individuals and teams putting in the groundwork

to the enhancement of community pharmacy throughout Ireland. They represent a unique and high-profile opportunity to celebrate the excellence and amazing achievements of Ireland’s pharmacy professionals, and reaffirm Irish Pharmacy News’s commitment to the core pursuits of pharmacy: excellence in health and innovation. Individual places ¤250 + VAT (A maximum of 9 indidual places can be booked) Table of 10 price ¤2,400 + VAT Table of 12 price ¤2,600 + VAT All Table Bookings include (per person seated):  Champagne on arrival  Unrivalled networking

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 Awards Book of Excellence – programme and commentary on finalists and the night  5 course dinner  Tea, coffee and petit four  Top entertainment and keynote address  Charity auction featuring incredible and unique prizes and experiences  Discounted accommodation at the Clayton Hotel and other hotels near the ceremony To book your table today, please contact Anna Carr directly on 353 87 337 9258 or via anna@ipn.ie Alternatively you can make a booking through our website by visiting www.pharmacynewsireland.com


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World’s first Global Learning Health System and “Response Team Community” Pharmapod’s CEO Leonora O’Brien discusses the launch of the World’s first Global Learning Health System and “Response Team Community” for medication errors and using Artificial Intelligence and Pharmapod’s Cyber-Human learning loop to driving patient safety. What is the Global Learning Health System (LHS)? A cornerstone of a Learning Health System is infrastructure. This is what we develop at Pharmapod, a cloud based infrastructure for the profession of pharmacy to share data on medication errors and enable continuous improvement – it’s developed for pharmacists so that they can accelerate learning from their peers across their own country as well as from other countries. A Learning Health System can been described as a “sociotechnical system for continuous improvement and innovation” that result in “higher quality, safer, and more efficient care.” What is the Global Response Team? Instead of simply collecting data on medication errors, we need to be acting on what we learn from the data – we need to be effectively ‘responding to the data’. To do this Pharmapod is developing a ‘Response Team’ in every market, the world’s first medication error ‘Response Team Community’. Each team consists of pharmacy professionals and patient safety domain experts who are given access to the local Pharmapod aggregate data for analysis and research. They identify trends, risks to patients

and opportunities to improve patient safety. Their analysis and recommendations will be made available directly to pharmacies with clear calls to action for pharmacies to implement to help prevent errors. How do pharmacists get involved? This week we were delighted to announce the launch of our Canadian Response Team – we embrace their expertise and experiences and their dedication to helping reduce harm to patients. This is a tangible action in response to the World Health Organisation's Global Patient Safety Challenge of reducing medication errors by 50% over the next 5 years. We are currently answering queries and welcoming nominations for the Irish Response Team on GlobalResponse@ Pharmapodhq.com. This is an exciting opportunity for pharmacy leaders in Ireland with a specific focus on Medication Safety and/or data analysis. In terms of learning from Patient Safety Incidents, what is the problem with current approaches? Medication error initiatives internationally have traditionally been focussed on the process of collecting data in databases. In

Canadian Response Team

most cases, National Databases provide no or limited feedback, on errors to the reporter and the value proposition for pharmacists in reporting the error is very low. Lack of feedback is a major barrier to reporting patient safety incidents, resulting in only 14% of incidents being reported(1)(2). A basic premise of Quality Improvement is ‘you can’t improve what you don’t know about’, therefore the status quo does not bode well for change happening rapidly, if at all. In fact, it currently takes an average of 17 years for improvements, identified from previous errors, to come into practice(3)(4).” Research has also identified 5 barriers to the use of patient safety information sources by community pharmacies: - lack of time to access information sources and its contents; too many sources of available information; too much information not relevant to community pharmacy practice; complexity navigating online information sources; and lack of community pharmacy involvement in source design(5).” How is Pharmapod’s approach different? At Pharmapod, the feedback to the pharmacy teams will be fed back through the platform where it is easily accessible. The content is also developed by experienced pharmacists such as members of the Response Teams and it is specific for the pharmacy’s environment community pharmacies will only see community pharmacy content, there is a separate Response Team for hospital pharmacy. In this way, we avoid ‘alert fatigue’. Time is precious, so pharmacy teams need engaging information on errors that have happened and good, instantly digestible ideas on improvements that can be made in their own dispensary. At Pharmapod we also utilise Artificial Intelligence tools such as Machine Learning in 3 stages, the first is ‘description’ (creation of our Global Aggregate database of patient safety incidents), the second stage is ‘prediction’ and responding to the data (our analytics, data warehouse and The Response Team efforts), the 3rd is ‘prescription’ — advising and

decision support. As with most Artificial Intelligence tools, they’re most effective when combined with human intelligence; so the insights from the Response Teams will be a key contributor for improvement, as we’ll have a cyber-human learning loop to maximize impact. https://www.pharmapodhq.com/ Referenced Sources: (1) Journal of Nursing & Care. 2018. Medical Error Reporting Attitudes of Healthcare Personnel, Barriers and Solutions: A Literature Review. [ONLINE] Available at: https://www.omicsonline. org/open-access/medical-error-reportingattitudes-of-healthcarepersonnelbarriers-and-solutions-a-literaturereview-2167-1168-1000377. php?aid=84293. [Accessed 16 July 2018]. (2) Source: Evans SM, Berry JG, Smith BJ, et al. Attitudes and barriers to incident reporting: a collaborative hospital study. Qual Saf Health Care. 2006;15:39-43. (3) Mind the Gap: Putting Evidence into Practice in the Era of Learning Health Systems Jeanne-Marie Guise, MD, MPH1,2, Lucy A. Savitz, PhD, MBA3, and Charles P. Friedman, PhD41Scientific Resource Center for the AHRQ Effective Health Care Program, Portland VA Research Foundation, Portland, OR, USA; 2Department of Obstetrics & Gynaecology, Oregon Health & Science University, Portland, OR, USA; 3Kaiser Permanente Northwest Center for Health Research, Portland, OR, USA; 4Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA. (4) Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. Journal of Royal Society of Medicine 2011;104(12):510–520 (5) Barriers to the use of patient safety information sources by community pharmacies: James R. Barker, Todd C. Boyle, Lisa Taya, Andrea Bishop, Bobbi Morrison, Andrea Murphy, Neil J. MacKinnon, Emma Murray, Certina Ho.

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Pharmacy and Medicines in

T

ype 2 diabetes is a chronic disease occurring in ever increasing numbers worldwide. It contributes significantly to the cost of health globally; however, its management remains in the most part less than optimal.

Patients must be empowered to self-manage their disease, and they do this in partnership with community pharmacists and allied healthcare professionals. Whilst the traditional role of the pharmacist has been centred around the supply of medicines and patient counselling, there is an ever-growing body of evidence that pharmacists, through a range of extended services, may contribute positively to the clinical and humanistic outcomes of those with diabetes. Screening Advice Pharmacists can help identify patients with diabetes through screening and should target patients at high risk, people with a family history of the disease, and women with a history of gestational diabetes or who delivered a baby weighing more than nine pounds. Patient education should be provided immediately after diagnosis, at a second stage at which time a patient assessment can be performed, and at a third stage during which patients can receive continuing education to reinforce concepts and a motivational boost. One of the pharmacist's most important roles is the referral of

patients to other members of the diabetes care team. Although the role of the pharmacist in monitoring diabetes is not well defined, it might include such things as testing to assess long-term glycemic control. Implementing diabetes management services requires a commitment of time, effort, and resources and may necessitate training of staff and changes in work patterns. The pharmacist can play an important role in diabetes care by screening patients at high risk for diabetes, assessing patient health status and adherence to standards of care, educating patients to empower them to care for themselves, referring patients to other health care professionals as appropriate, and monitoring outcomes. Diabetes in Ireland The total number of people living with diabetes in Ireland is estimated to be 225,840. The International Diabetes Federation Diabetes Atlas (2013) estimate that there are 207,490 people with diabetes in Ireland in the 20 – 79 age group (prevalence of 6.5% in the population) which is in line with previous estimates that by 2020 there would be 233,000

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people with the condition, and by 2030 there would be 278,850 people with the condition. According to the Healthy Ireland survey, 854,165 adults over 40 in the Republic of Ireland are at increased risk of developing (or have) Type 2 diabetes. More alarmingly, there are a further 304,382 in the 30 – 39 year age group that are overweight and not taking the weekly 150 minutes recommended physical activity, leaving them at an increased risk of chronic ill-health. This means that there are 1,158,547 adults in Ireland that need to consider making changes to their daily behaviours in terms of eating healthily and being more active. It is estimated that there are over 15,600 people over 80 years of age living with Type 2 diabetes based on the TILDA study which showed a prevalence of 11.9% in the over 75 age group. The International Diabetes Federation’s (2012) estimates that by 2030 there will be 278,850 people with the condition (prevalence of 7.5% in the population). The economic burden of diabetes on the Irish health care system is becoming a major challenge for the government and the HSE.

Professor J. Nolan’s seminal CODEIRE study is still the most accurate estimate of costs. The CODEIRE study was an international accredited study and examined the cost of treating type 2 diabetes in Ireland during Nov-Dec 1999, and suggested that 10% of the national health budget was being consumed treating the condition (49% on hospitalisation for complications and wages; 42% on drug costs; 8-9% on ambulatory care and attending non-diabetes specialists for diabetes related complications). CODEIRE remains the best available Irish source for the cost of type 2 diabetes. Symptoms of Type 2 Many people have Type 2 diabetes for years without knowing it because they may have no symptoms of diabetes. Early diagnosis and treatment can reduce the risk of developing complications later. The main symptoms of diabetes are:  feeling very thirsty  going to the toilet a lot, especially at night  extreme tiredness  weight loss and loss of muscle bulk


INVOKANA® (canagliflozin) 100 mg & 300 mg film-coated tablets. PRESCRIBING INFORMATION. Republic of Ireland. Please refer to Summary of Product Characteristics (SmPC) before prescribing. INDICATIONS: The treatment of adults with insufficiently controlled type 2 diabetes mellitus as an adjunct to diet and exercise as monotherapy when metformin is considered inappropriate due to intolerance or contraindications, or in addition to other medicinal products for the treatment of diabetes. DOSAGE & ADMINISTRATION: Adults: recommended starting dose: 100 mg once daily. In patients tolerating this dose and with eGFR ≥ 60 mL/min/1.73 m2 needing tighter glycaemic control, dose can be increased to 300 mg once daily. For oral use, swallow whole. Caution increasing dose in patients ≥ 75 years old, with known cardiovascular disease or for whom initial canagliflozin-induced diuresis is a risk. Correct volume depletion prior to initiation. When add-on, consider lower dose of insulin or insulin secretagogue to reduce risk of hypoglycaemia. Children: no data available. Elderly: consider renal function and risk of volume depletion. Renal impairment: not to be initiated with eGFR < 60 mL/min/1.73 m2. If eGFR falls below this value during treatment, adjust or maintain dose at 100 mg once daily. Discontinue if eGFR persistently < 45 mL/min/1.73 m2. Not for use in end stage renal disease or patients on dialysis. Hepatic impairment: mild or moderate; no dose adjustment. Severe; not studied, not recommended. CONTRAINDICATIONS: Hypersensitivity to active substance or any excipient. SPECIAL WARNINGS & PRECAUTIONS: Not for use in type 1 diabetes. Renal impairment: eGFR < 60 mL/min/1.73 m2: higher incidence of adverse reactions associated with volume depletion particularly with 300 mg dose; more events of elevated potassium; greater increases in serum creatinine and blood urea nitrogen (BUN); limit dose to 100 mg once daily and discontinue when eGFR < 45 mL/min/1.73 m2. Not studied in severe renal impairment. Monitor renal function prior to initiation and at least annually. Volume depletion: caution in patients for whom a canagliflozin- induced drop in blood pressure is a risk (e.g. known cardiovascular disease, eGFR < 60 mL/min/1.73 m2, anti-hypertensive therapy with history of hypotension, on diuretics or elderly). Not recommended with loop diuretics or in volume depleted patients. Monitor volume status and serum electrolytes. Elevated haematocrit: careful monitoring if already elevated. Genital mycotic infections: risk in male and female patients, particularly in those with a history of GMI. Lower limb amputation: Consider risk factors before initiating. Monitor patients with a higher risk of amputation events. Counsel on routine preventative foot care and adequate hydration. Consider discontinuing Invokana when events preceding amputation occur (e.g. lower-extremity skin ulcer, infection, osteomyelitis or gangrene). Urine laboratory assessment: glucose in urine due to mechanism of action. Lactose intolerance: do not use in patients with galactose intolerance, total lactase deficiency or glucose-galactose malabsorption. Diabetic ketoacidosis (DKA): rare DKA cases reported, including life-threatening and atypical presentation cases. Where DKA is suspected or diagnosed, discontinue Invokana treatment immediately. Interrupt treatment in patients who are undergoing major surgical procedures or have acute serious medical illnesses. Consider risk factors for development of DKA before initiating Invokana treatment. Necrotising fasciitis of the perineum (Fournier’s gangrene): post-marketing cases reported with SGLT2 inhibitors. Rare but serious, patients should seek medical attention if experiencing symptoms including pain, tenderness, erythema, genital/perineal swelling, fever, malaise. If Fournier’s gangrene suspected, Invokana should be discontinued, and prompt treatment instituted. INTERACTIONS: Diuretics: may increase risk of dehydration and hypotension. Insulin and insulin secretagogues: risk of hypoglycaemia; consider lower dose of insulin or insulin secretagogue. Effects of other medicines on Invokana: Enzyme inducers (e.g. St. John’s wort, rifampicin, barbiturates, phenytoin, carbamazepine, ritonavir, efavirenz) may decrease exposure of canagliflozin; monitor glycaemic control. Consider dose increase to 300 mg if administered with UGT enzyme inducer. Cholestyramine may reduce canagliflozin exposure; take canagliflozin at least 1 hour before or 4-6 hours after a bile acid sequestrant. Effects of Invokana on other medicines: Monitor patients on digoxin, other cardiac glycosides, dabigatran. Inhibition of Breast Cancer Resistance Protein cannot be excluded; possible increased exposure of drugs transported by BCRP (e.g. rosuvastatin and some anti-cancer agents). PREGNANCY: No human data. Not recommended LACTATION: Unknown if excreted in human milk. Should not be used during breast-feeding. SIDE EFFECTS: Very common (≥1/10): hypoglycaemia in combination with insulin or sulphonylurea, vulvovaginal candidiasis. Common (≥1/100 to <1/10): constipation, thirst, nausea, polyuria or pollakiuria, urinary tract infection (including pyelonephritis and urosepsis), balanitis or balanoposthitis, dyslipidemia, haematocrit increased. Uncommon (<1/100) but potentially serious: anaphylactic reaction, diabetic ketoacidosis, syncope, hypotension, orthostatic hypotension, urticaria, angioedema, necrotising fasciitis of the perineum (Fournier’s gangrene) (frequency not known), bone fracture, renal failure (mainly in the context of volume depletion), lower limb amputations (mainly of the toe and midfoot, incidence rate of 0.63 per 100 subject-years, vs 0.34 for placebo). Refer to SmPC for details and other side effects. LEGAL CATEGORY: POM. PACK SIZES & MARKETING AUTHORISATION NUMBER(S): Invokana 100 mg film-coated tablets: 30 tablets; EU/1/13/884/002. Invokana 300 mg film-coated tablets: 30 tablets; EU/1/13/884/006. MARKETING AUTHORISATION HOLDER: JanssenCilag International NV, Turnhoutseweg 30, B-2340 Beerse, Belgium. ® INVOKANA is a registered trade mark of Janssen-Cilag International NV and is used under licence. © 2017 Napp Pharmaceuticals Limited. FURTHER INFORMATION IS AVAILABLE FROM: Mundipharma Pharmaceuticals Limited, Millbank House, Arkle Road, Sandyford, Dublin 18. For medical information enquiries, please contact medicalinformation@mundipharma.ie UK/INV-18203(1) Date of Preparation January 2019.

Uncontrolled blood sugar can’t wait

INVOKANA is indicated for the treatment of adults with insufficiently controlled type 2 diabetes mellitus (T2DM) as an adjunct to diet and exercise.1

Lower HbA1c levels In patients with HbA1c higher than 9%, INVOKANA reduces HbA1c by 1.57% and 1.80% with its 100mg and 300mg doses respectively.3

Long-term cardiovascular benefits† 14% reduction in the risk of cardiovascular death, nonfatal myocardial infarction and nonfatal stroke (3-point MACE) HR 0.86 (95% CI 0.75-0.97).4 33% reduction in risk of hospitalisation for heart failure HR 0.67 (95% CI 0.52 - 0.87).4

Improved renal outcomes† 47% relative risk reduction in time to first adjudicated nephropathy event (doubling of serum creatinine, need for renal replacement therapy, and renal death) HR 0.53 (95% CI 0.33 - 0.84).5 27% reduction in the progression of albuminuria in patients with normo- or micro-albuminuria HR 0.73 (95% CI 0.67-0.79).4

Adverse events should be reported to: HPRA Pharmacovigilance, Earlsfort Terrace, IRL - Dublin 2; Tel: +353 1 6764971; Fax: +353 1 6762517. Website: www.hpra.ie; E-mail: medsafety@hpra.ie. Adverse events should also be reported to Mundipharma Pharmaceuticals Limited on drugsafetyireland@mundipharma.ie or by phone on 01 2063800 (1800 991830 outside office hours) References: 1. Invokana SmPC www.medicines.ie 2. Davies MJ et al, Diabetes Care. 2018 Oct: 10.2337/dci18-0033 (http://diabetologia-journal.org/wp-content/ uploads/2018/10/Consensus-Report-ADA-EASD.pdf). 3. Wilding JP et al J Diabetes Complications 2015; 29;438-44. 4. Neal B. et al. N Engl J Med 2017; 377:644-657. 5. Perkovic V. et al Lancet Diabetes Endocrinol. 2018 Sep;6(9):691-704 INVOKANA® is a registered trade mark of JanssenCilag International N.V. and is used under licence. MUNDIPHARMA® and the ‘mundipharma’ logo are registered trade marks of Mundipharma AG. Date of Item: February 2019. IRE/INVK – 18273a Distributed in Ireland by: Mundipharma Pharmaceuticals Limited, Millbank House, Arkle Road, Sandyford, Dublin 18, Ireland. Phone +353-1-2063800 www.mundipharma.ie

The recommended starting dose of INVOKANA is 100mg once-daily. * an SGLT2i for treatment of T2DM patients with ASCVD, HF, CKD and for use in patients where there is a compelling need to minimise hypoglycemia and those with a compelling need to minimise weight gain or promote weight loss † Compared to standard of care

Seize the moment to make years of difference


Other symptoms of diabetes can include:  itchiness around the vagina or penis  recurring thrush as a result of the excess glucose in the urine  blurred vision caused by the lenses of the eyes becoming very dry  cuts and sores taking longer to heal Not everyone will experience these other symptoms, and they are not usually severe in those who do get them. Lifestyle Management and Support Lifestyle modification is the first-line of management for any patient with Type 2 diabetes. A healthier diet and increased activity c an delay the onset, slow progression and reduce the risk of complications. Community pharmacists need to be prepared to provide appropriate advice on these lifestyle changes. The main way of treating Type 2 diabetes is eating a healthy diet with weight reduction (in those who are overweight) and being as physically active as possible. When this alone is unable to control blood sugar (glucose) levels, medications to help insulin work more effectively or to make the pancreas produce more insulin is required. Type 2 diabetes is progressive, sufferers will require more medications the longer they have the condition. Sometimes, people newly diagnosed with Type 2 diabetes can manage to control their blood glucose levels by eating a healthy diet, losing weight if overweight and staying active. Others will need to take medication to lower blood glucose level at diagnosis. The most important factor is to keep glucose levels in target range which for most people will be between 4.0mmol/L – 7.0mmol/L before meals and an A1c in the 50-60 mmol/L range. This prevents/delays the long term complications associated with diabetes.

Metformin is the most commonly used oral medication in Type 2 diabetes and is the first choice for the majority of people. Action: Metformin makes the insulin produced work more efficiently, reduces the amount of glucose taken up from the intestines into the blood stream and controls the release of glucose from the liver. Directions: Metformin should always be taken with or after food, never on an empty stomach as much as three times a day. Sulphonylureas such as Gliclazide (Diamicron®) Sulphonylureas are another type of medications used for people with Type 2 diabetes. Actions: Sulphonylureas work by increasing the amount of insulin produced from the pancreas. Directions: They should be swallowed whole with a meal and taken at the same time each day Post Prandial Regulator there is only one medication in this group: Nateglinide (Starlix®) This Post Prandial Regulator is similar to the sulphonylureas but has a rapid onset of action and much shorter duration of action meaning that it must be taken with a meal. A-glucosidase inhibitors or prandial glucose regulators such as Acarbose (Glucobay®) Actions: A-glucosidase inhibitors reduce the amount of glucose absorbed from the bowel Directions: A-glucosidase inhibitors should be taken with the first bite of a meal. Insulin sensitisers (or thiazolidinediones) such as Pioglitazone (Actos®) Actions: Pioglitazone makes insulin work more effectively by increasing the sensitivity of fat and muscle cells to insulin.

Listed below is a brief description of the different types of medication currently available. All the medications outlined aim to reduce blood glucose levels to achieve good diabetes control but will only work in combination with eating a healthy diet and taking as much physical exercise as possible.

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Directions: Can be taken with or without food. Should be swallowed whole with water.

It is good practice to do this at same time each day to avoid missing a dose.

Glucogon like Peptides 1 Agonists (GLP-1) twice daily Exenatide (Byetta®), once daily Liraglutide (Victoza®) and weekly Exenatide (Bydureon®).

Insulin Injections

GLP-1’s must be given by injection, and are used mainly in people with diabetes who have a high body mass index. The small bowel produces a hormone called Glucagon-Like Peptide –1 (GLP-1) which stimulates insulin production and decreases stomach emptying. However, it only acts for minutes so anything that increases how long it lasts in the body could help blood sugar control. Actions: GLP1’s acts to block the natural breakdown of GLP-1 in the body and therefore aids the digestive process of food in several ways: • Stimulates the pancreas to produce insulin in response to food • Slows down the digestion of food which can make someone feel fuller and reduces their appetite. This may help weight loss • Prevents the liver from releasing glucose when the body doesn’t need it. Directions: Taken as prescribed usually injection as a specified time. DPP4 inhibitors such as Sitagliptin (Januvia®), Saxagliptin (Onglyza™, Komboglyze™), Vildagliptin (Galvus®, Eucreas™) and Linagliptin (Tradjenta™ Jentadueto) DPP 4 is also a hormone in the gut which stops the body’s own GLP-1 from working. Action: DPP4 inhibitors stop the body producing DPP4. Blocking the natural breakdown of GLP1 promotes insulin production and decreases stomach emptying. SGLT2 inhibitors such as canagliflozin (Invokana®), and dapagliflozin (Forxiga®) Glucose is not normally excreted through the kidneys unless the blood glucose level is very high. Action: SGLT2 inhibitors act by blocking the kidneys’ reabsorption of glucose resulting in more glucose released in the urine and therefore a reduction in blood glucose. Directions: Invokana should be swallowed whole once a day, preferably before the first meal of the day. If a dose is missed, it should be taken as soon as remembered; however, a double dose should not be taken on the same day. Forxiga should be swallowed whole once daily at any time of day with or without food.

Insulin may also be needed in people with Type 2 diabetes when the medications listed above are not sufficient to control blood glucose levels or are no longer suitable to use. Treatment for hypoglycaemia (low blood glucose) Those with Type 2 diabetes that is controlled using insulin, may experience episodes of hypoglycaemia. Hypoglycaemia can occur when blood glucose levels become very low. Mild hypoglycaemia (a 'hypo') can make individuals feel shaky, weak and hungry, but it can usually be controlled by eating or drinking something sugary. For those who experience a hypo, they should be advised to initially have a form of carbohydrate that will act quickly, such as a sugary drink or glucose tablets. This should be followed by a longer-acting carbohydrate such as a cereal bar, sandwich or piece of fruit. In most cases, these measures will be enough to raise the blood glucose level to normal, although it may take a few hours. Prevention of Type 2 Diabetes There is great potential to prevent type 2 diabetes in high-risk individuals by lifestyle intervention. There is sufficient evidence based on several clinical trials such as American Diabetes Prevention Programme and The Finish Prevention Study, supporting this. These studies had a strong focus on increased physical activity and dietary modification as well as weight reduction among high risk participants. The Diabetes Prevention Program Outcomes Study showed in their follow-up of participants at 10 years (from the initial randomisation to lifestyle intervention or no action), that Type 2 diabetes incidence in the group with lifestyle changes was reduced by 34% compared with the control group. The Finish Diabetes Study was more intensive with participants offered intensive lifestyle support (dietary intake, physical activity, smoking and alcohol intake) with some participants also getting oral hypoglyceamic agents and showed that addressing all the diabetes risk factors could reduce Type 2 diabetes by 80%. Thus, in order to reduce the risk of developing Type 2 diabetes, it is recommended that all people have a healthy balanced diet, take regular physical activity and attain a weight appropriate to their height.


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Walk This Way

F

eet are often neglected; many people don’t pay their feet and legs much attention until they notice something isn’t quite right. Many people simply don’t know whether they have a wart, a verruca, a corn, or even know the source of the pain at all.

Despite the high prevalence of various foot ailments, because many are unable to distinguish the source of the problem, they may use the wrong products or don’t treat at all. So it is important that pharmacists are able to advise customers on key foot care issues, recommend the correct treatment solution and refer them to a GP or podiatrist if required. Pharmacies should ensure that they signpost the footcare section clearly within store and stock a comprehensive range of well-known products for customers to choose from. With an ageing population, suffering from foot, knee and joint problems is seen as just part of getting older, but although to some extent that’s true, there are still warning signs that good pharmacists should take note of and refer on to a GP

• Activity: Sports players and people who take part in vigorous exercise. Women are at higher risk of stress fractures than men. Common Foot Conditions or podiatrist, along with effective support and treatment for feet and leg conditions. Those at Risk Some people are more likely to experience pain in their feet and lower leg than others. Risk factors include: • Age: Feet flatten and widen with age, the fat padding the sole of the foot wears down and skin becomes drier. Foot pain in older people may be an early sign of age-related illnesses such as diabetes, arthritis and circulation issues. Foot problems may also impair balance.

44 | PHARMACYNEWSIRELAND.COM

• Gender: Women are more likely than men to suffer severe foot pain and this may be due to the type of shoes they wear. • Occupation: Foot problems, including arthritis in the foot and ankle, toe deformities, pinched nerves between the toes, plantar fasciitis, adult-acquired flat foot and tarsal tunnel syndrome, have been attributed to repetitive use at work, for example, in people whose job means they have to walk long distances or stand for many hours at a time.

Corns and Callouses - Corns (which usually appear on the tops or sides of toes) and calluses (found on the soles of feet) are areas of hard, thickened skin that develop when the skin is exposed to excessive pressure or friction. Problems can be prevented by wearing well-fitting shoes and using protective gel pads or strips to reduce pressure. Hardened skin can be gently removed with a pumice stone or foot file. OTC products containing salicylic acid are available to treat established corns or calluses, but severe cases or people with diabetes or circulation problems should be referred to a podiatrist.


Cracked Heels - Cracked heels are often caused by openbacked shoes such as sandals or flip-flops striking the heel. Older people are most at risk of cracked heels, as well as those who stand for prolonged periods. Limiting unsupportive footwear can help to prevent the problem arising, while regularly applying a moisturising foot cream can help keep feet smooth and soft. A pumice stone or foot file can be used to remove hard skin; these are particularly effective when used after a bath or shower. Athletes Foot - Athlete’s foot is contagious via skin to skin contact and indirectly if one uses the same towel as a person with the condition. Athlete’s foot, a common fungal infection that usually develops between the toes, most commonly affects teenagers and young adults. The infection usually clears up within days or weeks with antifungal treatment. Customers can choose between fungicidal products that kill the fungus and fungistatic products, which slow down its growth until it stops. A low-potency steroid cream may be recommended if the skin is very sore. Athlete’s foot is highly infectious, as the fungi multiply quickly in warm and humid environments, such as swimming pools, showers and changing rooms. Good foot hygiene can help to reduce the spread of an infection and involves drying the feet thoroughly, particularly between the toes, wearing clean cotton socks, rotating footwear and avoiding walking barefoot in changing rooms. Symptoms of Athlete’s foot include: • An itchy, red rash, which often starts in between the 4th and 5th toes, before spreading to the other toes.

• Scaling or cracking of the skin may occur. • Blisters can occur. If these burst, they can cause pain & swelling. Verrucas - A verruca is a wart on the sole of the foot caused by infection with the human papilloma virus (HPV), which is picked up from contaminated floors in changing rooms or around swimming pools. The affected skin is usually white and may have a black spot in the centre. Verrucas may clear up naturally, but treatment is advisable to prevent the infection spreading. Several treatment options are available OTC, including salicylic acid gels, creams, plasters and paints, cryotherapy sprays containing dimethyl ether propane and silver nitrate. To make verrucas more susceptible to treatment, the affected area should be soaked in warm water for a few minutes and gently filed with a pumice stone or emery board. Waterproof plasters are available to protect the verruca and prevent the infection from spreading. Tired Legs - Tired, aching legs are a common problem, especially in people who sit or stand for long periods. It could be a sign that leg veins are allowing blood to flow backwards and pool, rather than travel up towards the heart. Insole arch supports may provide extra support for the ankles, which can limit any swelling, while compression hosiery can improve the flow of blood, relieving the tiredness and aching sensation. Diabetic Foot Care Diabetes can cause nerve damage and blood vessel disease in the feet. This may cause skin and tissue

breakdown, which can develop into non-healing wounds (ulcers), which are at risk of infection. This may even result in limb amputation. Structural deformity leaves bony prominences exposed to increased external pressure on the skin, leaving it at risk of being damaged. Identification of patients at risk of diabetic foot disease allows early intervention of preventative measures to be taken, and thus reduces the risk of further complications. As the number of type 2 diabetes (T2D) cases continues to escalate each year, pharmacists are likely to encounter patients inquiring about proper diabetic foot care. Foot problems are very common in patients with T2D, accounting for a significant portion of diabetes- related complications and health care costs. Pharmacists are in a pivotal position to educate patients with a new diagnosis of diabetes about their care. Pharmacists should remind patients about the importance of routine diabetic foot care to prevent or delay complications, such as diabetic foot ulcers and amputations. Patients with diabetes, especially those with poorly controlled disease, are more susceptible to skin-related complications; therefore, patients should be reminded that many dermatologic conditions can be either prevented or effectively treated if identified early. Conducting a daily skin inspection and adhering to daily skin care, especially foot care, is imperative for all patients with diabetes. Pharmacists should seize every opportunity to stress the importance of maintaining tight glycaemic control and remind patients how proper and routine foot care is critical to decreasing the incidence of

foot ulcers and amputations. It is estimated that nearly 85% of amputations are preventable with education and early intervention. The primary goal of diabetic foot care is prevention of diabetesrelated complications, such as changes in the skin (dryness and itching) and foot ulcers, which are often attributed to vascular disease, neuropathy, and relative immunosuppression. Strategies for preventing foot problems include patient education, patient involvement and adherence, maintenance of tight glycaemic control, and daily care and inspections of the skin, feet, and nails. Several OTC dermatologic products are marketed specifically for foot care in patients with diabetes. Prior to recommending any of these products, pharmacists should encourage patients with certain signs or symptoms to seek immediate medical care to avoid further complications. Examples of diabetic foot care products include antimicrobial lotions, skin moisturisers, and antifungal and callus treatments. Category Management Pharmacists should think beyond foot and leg care when it comes to making a sale. If someone picks up corn plasters, combination treatments may be required, and there is an opportunity for a link purchase such as insole supports to take the pressure off the area. Also, what about pain relief? This is precisely where community pharmacy can add value over and above its competitors – it’s an opportunity not to be missed. This category should be displayed next to or near the first aid category. This is where you will find antiseptic creams and plasters, so the link to the category is appropriate.


46

News

Mental Health – Culture change needed Mental Health Reform, the national coalition on mental health in Ireland, last month (March) launched the findings of two national surveys into people's experience of HSE mental health services. Pictured at the launch were Kate Mitchell, senior policy and research officer, Mental Health Reform, John Farrelly, Chief Executive of the Mental Health Commission, Director of Mental Health Reform, Shari McDaid, Jim Ryan, HSE Assistant National Director for Mental Health Operation and Dr. Pádraig Ó Féich, Research officer, Mental Health Reform. Picture Conor McCabe Photography

The My Voice Matters reports, launched by John Farrelly, Chief Executive of the Mental Health Commission, include a report on the experience of 1,188 service users and a report on the experience of 786 family members, friends and carers/supporters. The research was funded by the HSE. Commenting on the reports, Director of Mental Health Reform, Dr Shari McDaid, said, “The My Voice Matters reports show that people using mental health services and their families and other supporters, are not yet routinely experiencing the modern, recovery-oriented mental health services envisaged in the national mental health policy A Vision for Change more than 13 years ago.

The reports on the two surveys provide evidence of the very mixed experience people are having when accessing HSE mental health services across Ireland. It is encouraging people are finding some aspects of the services satisfactory, particularly being referred to talking therapies, having a key worker and the support received from their GP. However, many service users reported that they are not satisfied with the services they access, indicating that they do not feel listened to, nor do they feel treated with dignity and respect. Service users also reported a high focus on medication in their treatment.” Dr McDaid continued, “It is also very concerning that those who support someone with a

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mental health difficulty, including family members and other supporters, reported high levels of dissatisfaction with the information provided to them by mental health services. This group also reported a lack of supports for themselves as individuals providing long-term care for service users, including a lack of individual or family counselling or the provision of a key worker to provide them with supports. “The HSE should develop a time-lined, costed action plan to implement the recommendations in these two reports. It will be vital that the HSE work closely with stakeholders from all perspectives to ensure the culture change needed. Ultimately, the Minister of State for Mental Health must ensure that the quality of mental health services improves in line with the recommendations in the My Voice Matters reports,” concluded Dr McDaid.

Research study into Parkinson’s A new research study aims to deepen the understanding of Parkinson’s so that better treatments can be developed in the future. The project, which will be co-ordinated by RCSI, has been awarded ¤7m by the Innovative Medicines Initiative (IMI) with pharmaceutical industry and patient advocacy partners. The PD-MitoQUANT project aims to increase understanding of how cells in the brain become damaged in Parkinson’s so more effective treatments can be developed for the one million people living with Parkinson’s in Europe today, including 12,000 people in Ireland. The researchers will focus on parts of the cell, known as mitochondria, that malfunction in people with Parkinson’s. Mitochondria contribute to cell death and neurodegeneration and there is growing evidence of their role in Parkinson’s, but no effective treatments have been developed based on this knowledge. The EU public-private partnership funding health research and innovation chose the project as it recognises that new, more effective treatments are urgently needed. The most common drug to treat Parkinson’s used in Ireland is more than 50 years old, and no current treatment can stop, slow or reverse the condition. The PD-MitoQUANT Coordinator is Professor Jochen Prehn, RCSI Chair of Physiology, Director of the RCSI Centre for Systems Medicine and Principal Investigator at FutureNeuro, the SFI Research Centre for Chronic and Rare Neurological Diseases. Professor Prehn said, “This project will join forces with top scientists in academia and industry to bring a fresh look on how we identify and test novel drugs for the treatment of this devastating movement disorder.” The key PD-MitoQUANT Investigators based at RCSI are Dr Niamh Connolly and Dr Orla Watters, Department of Physiology and Medical Physics and Centre for Systems Medicine, who will be focusing their research on Parkinson’s in the coming years.


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Continuing Professional Development

CPD

CPD 101: THE MANAGEMENT OF WOUND CARE IN IRELAND This module is suitable for use by community pharmacists as part of their Continuing Professional Development. After reading this module, in the magazine or online, complete the post-test on our website at www.pharmacynewsireland.com and include in your personal CPD ePorfolio. Authors - Maureen Nolan, Director of Nursing, Project Lead: HSE National Wound Guidelines 2018, Office of the Nursing and Midwifery Services Director HSE Dr Steevens' Hospital Mary Wynne, Nursing and Midwifery Services Director, HSE The Wound Management Association of Ireland – www.wmai.ie

The Management of Wound Care in Ireland 60 SECOND SUMMARY Wounds have a major personal, social, and economic impact. Wounds not only impact on the individual and their quality of life, they also have a significant impact on our health service and our society as a whole. Patients will regularly present to the pharmacy to treat minor wounds rather than attending a GP clinic. Most wounds can be treated cheaply and effectively with over the counter products. Wound care management in the pharmacy could potentially be a service that pharmacists offer in the consultation room. A moist environment is best for treating a wound. Leaving a wound to air dry and scab inhibits the formation of new tissue and healing, with a greater chance of scarring. Proper treatment (using plasters and ointment to provide a moist environment) not only helps heal the wound faster, but reduces chance of scarring. When offering patients advice on wound care it is essential to ask the patient about their lifestyle and general health so the dressing and healing process is appropriate for the patient. The pharmacist should ask the patient about the duration of the wound, if a patient who has had a wound for longer than one week should be referred to their doctor.

Wounds have a major personal, social, and economic impact. Wounds not only impact on the individual and their quality of life, they also have a significant impact on our health service and our society as a whole. Studies in the UK indicate that up to 4% of total health care expenditure is spent on the provision of wound management while in Ireland it is estimated that two thirds of community nursing time is spent on the provision of wound management. It is estimated that 1.5% of the population are affected by a wound at any one point in time. Patients will regularly present to the pharmacy to treat minor wounds rather than attending a GP clinic. Most wounds can be treated cheaply and effectively with over the counter products. Wound care management in the pharmacy could potentially be a service that pharmacists offer in the consultation room.

Chronic wounds are associated with comorbidities such as hypertension, diabetes, cardiovascular and neurological illness (DoHC 2007a; DoHC 2007b). The costs associated with wound care are substantial; four per cent of the United Kingdom’s (UK) health care budget is spent on wound care (Posnett and Franks, 2007).

This is a practice that other jurisdictions offer such as Australia and US and has been successful. In these situations it is utilising the skills of community pharmacists to provide enhanced first aid and wound management services and freeing up other highly skilled health professionals to perform health interventions requiring specialised skills. The Pharmacy Guild of Australia report that the introduction of this service gives greater recognition of the role of community pharmacists as a member of the primary health care team and allows community pharmacy the opportunity to develop a viable business involving service provision as an adjunct to product supply.

Continuing Professional Development (CPD) is essential to ensure optimal delivery of patient care (An Bord Altranais, 2000).

The Irish Pharmacy Union (IPU) have asked for a greater expansion of pharmacy services as part of the HSE Health Ireland initiative.

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Mary Wynne

Reflection - Is this area relevant to my practice? What is your existing knowledge of the subject area? Can you identify any knowledge gaps in the topic area? Planning - Will this article satisfy those knowledge gaps or will more reading be required? What resources are available? Action - After reading the article complete the summary questions at www. pharmacynewsireland.com/cpdtraining and record your learning for future use and assessment in your personal log. Evaluation - How will you put your learning into practice? Have I identified further learning needs? Published by IPN, supported by Elastoplast. Copies can be downloaded from www.irishpharmacytraining.ie Disclaimer: All material published is copyright, no part of this can be used in any other publication without permission of the publishers and author. This module is supported by Elastoplast

Wound care is valued at ¤4.3 million in Ireland. Many pharmacy counter assistants and pharmacists are trained in first aid and are familiar with the appropriate equipment and advise for certain ailments and this can encourage loyal and repeat customers. Skin Wounds are a common health concern, which can vary from abrasions, lacerations, rupture injuries, punctures, to penetrating wounds. Treating pressure sores in bedridden or elderly patients is a large part of wound care. Addressing wounds appropriately and timely with dressings and wound closures will minimise cosmetic scaring and infection while making the patient more comfortable.


CPD 101: THE MANAGEMENT OF WOUND CARE IN IRELAND Furthermore, wound therapeutics are continuously evolving requiring the clinician to keep abreast of the research evidence that will inform and underpin their practice to ensure that patients receive the evidencebased assessment and treatment options at the appropriate time. Wound healing is a dynamic process and normal wound healing occurs in a precise and timely manner. Wound management is also dynamic and is dependent on the clinician’s ability and skill in assessing, planning care and evaluating outcomes. The duration of wounds is directly related to prolonged healing rates (Bosanquet and Harding 2014). Early focused treatment of wounds that fail to respond to standard care may reduce the burden of wounds that become chronic.

When offering patients advice on wound care it is essential to ask the patient about their lifestyle and general health so the dressing and healing process is appropriate for the patient. The pharmacist should ask the patient about the duration of the wound, if a patient who has had a wound for longer than one week should be referred to their doctor. HSE Wound Care Guidelines The development of HSE national guidelines for wound management are designed to support the standardisation of care and encourage best clinical practice. These guidelines constitute a general guide to be followed, subject to the medical practitioners judgement in each individual case. These guidelines are based upon up to date scientific evidence and expert opinion and will serve to support consistency of treatment and contribute to improved patient outcomes. Background It is estimated that 1.5% of the population worldwide develop a wound at any one time (Gottrup, 2004). The growing prevalence and incidence of non-healing wounds (acute and chronic) are a major source of morbidity to patients and a major cost to hospital and community healthcare providers globally (Posnett et al., 2009). Changing population demographics, increased prevalence and incidence of multiple comorbidities are challenging health care providers to provide ever more complex interventions with fewer resources (Moore et al., 2014).

It is estimated that between 25% and 50% of acute hospital beds are occupied by patients with a wound. Of these wounds between 55%-60% are non-healing wounds, infected surgical wounds, pressure ulcers and leg/foot ulcers (Posnett et al., 2009). Additionally, it is estimated that more than 23% of all hospital in-patients have a pressure ulcer, many of which are acquired during hospitalisation for an acute episode of illness or injury and therefore are avoidable (EPUAP, 2002). Ireland in the past decade has experienced an unprecedented rise of 16% in population growth. Evidence indicates that the number of people over 65 years of age is expected to triple in the next 30 years (DoHC, 2010b). Consequently, the prevalence and incidence of wounds is likely to continue to increase due to the ageing population and the ongoing increase in prevalence of obesity, diabetes and lower extremity arterial disease (Chandan et al., 2009; HSE, 2009). Chronic wounds are associated with comorbidities such as hypertension, diabetes, cardiovascular and neurological illness (DoHC 2007a; DoHC 2007b). The costs associated with wound care are substantial; four per cent of the United Kingdom’s (UK) health care budget is spent on wound care (Posnett and Franks, 2007). Chronic wounds of all aetiologies cost the Irish Health Service Executive an estimated at ¤285.5 million per annum (Mc DermottScales et al., 2009). The epidemiology of wounds section discusses these issues in greater depth.

One of the objectives of the HSE Corporate Plan (2008-2011) was to ensure that sufficient healthcare professionals have the appropriate competencies to deliver its objectives in maximising the level and quality of service delivery at an affordable cost. A key focus of The Patient Charter, You and your health service (2014) is committed to ‘supporting quality improvement throughout the health system to improve outcomes and reduce patient harm’. The complexity of wounds requires practitioners who are skilled in wound assessment, diagnosis, treatment and evaluation of outcomes (Harding et al., 2013). Continuing Professional Development (CPD) is essential to ensure optimal delivery of patient care (An Bord Altranais, 2000). Whilst no single healthcare discipline can completely meet the complex needs of those presenting with challenging wounds, it is essential that healthcare professionals from all disciplines are aware of the standards and prevention strategies, knowing when and how to refer the patient with a challenging wound. General Wound Care Acute wounds will generally proceed through an orderly and timely process to produce a healed wound which has anatomic and functional integrity. However, there are physiological factors which may enhance or impede wound healing (Table 1). Chronic wounds are defined as those whose healing is impaired. The inflammatory phase is dysfunctional due to intrinsic and extrinsic factors that impact on the person, the wound or the healing environment (Swanson et al., 2015). Chronic wounds include a variety of aetiologies, yet they share a number of characteristics such as a persistent state of inflammation due to high levels of proinflammatory cytokines and unregulated proteolytic activity as a result of the high

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CPD 101: THE MANAGEMENT OF WOUND CARE IN IRELAND

Table 1: Factors affecting Wound Healing Ability (Adapted from Wounds International [2011])

Table 1: Factors affecting Wound Healing Ability (Adapted from Wounds International [2011])

Area

Factors

Patient

       

Aetiology Co-morbidity e.g. diabetes mellitus, auto-immune disease Nutritional Status Allergy Medication e.g. steroids Psychosocial status Pain Concordance

Wound

      

Duration Size Wound Bed Condition Ischaemia Inflammation/infection Anatomical Site Treatment Response

Care Provision

 

Skill and knowledge Healthcare system

levels of active proteases and defective neutrophils, with an imbalanced expression of tissue inhibitors i.e. metalloproteinases. There is also a denaturing of growth factors (Moore, 2010). It is more recently accepted that biofilm may be responsible for this persistent inflammatory state (Swanson et al., 2016). Wound healing in children generally follows the same process as adults; however, there is an increased production of collagen and elastin. Granulation tissue is created at a faster rate than in adults, resulting in a faster healing process (Byrant and Nix, 2016). There is a paucity of evidence examining the treatment of paediatric wounds, with most evidence being anecdotal, opinion based or extrapolated from adult research (Baharestani, 2007; Byrant and Nix, 2016). Accurate and timely wound assessment within a holistic patient assessment, underpins effective clinical decision-making. It is pivotal to good wound management and should form the basis for wound care practice (Baharestani, 2007). Assessment enables appropriate clinical diagnosis and goal setting for the management of the wound in order to improve patient outcomes and reduce morbidity and costs (Posnett et al., 2009). In the treatment of wounds endeavour to facilitate the following objectives of wound healing: 1. The wound should be allowed to heal in a moist wound environment unless the clinical goal is to maintain a dry wound bed, e.g. ischaemic foot 2. To address the issues observed in the assessment process 3. To promote wound healing Due to the complexity and challenging nature of wound healing, a systematic and standardised approach to the assessment process is desirable to provide baseline information against which progress can be measured. Recording of wound size is a useful baseline indicator. Assessment should include identification of all factors that may delay healing. Other factors to assess include current care and local wound environment (Peate and Glencross, 2015). The principles of wound assessment are central to all wound types, although some aetiologies such as leg ulceration, pressure ulceration, diabetic foot ulceration and malignant fungating wounds require additional considerations.

Practice point: Assess and observe for the following: • Primary/ secondary dressings used in relation to type, wear time, frequency of dressing changes, strikethrough (wet or dry), visible leakage and how saturated the dressing is on removal • Wound moisture (e.g. visibly dry, moist/ glossy; wet; saturated; bathed in fluid). The volume of exudate should be recorded in all wound assessments and at each dressing change • Peri-wound skin • Documentation should include a description of the type, colour and consistency of exudate at each dressing change Trigger factors have been identified (WUWHS, 2008b) to aid the clinician in suspecting infection in the acute wound. These include; inflammation, new or increasing pain, local heat, swelling, advancing redness, increases in serous or purulent discharge, abscess or malodour. Some of these indicators also mimic the markers of inflammation. Therefore it is vital that you are able to determine whether a change in these indicators is predictive of wound infection. Immuno-comprised patients, older adults or patients taking antiinflammatory medication may not present with these classical signs.

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It is important to emphasise that the presence of slough, pus and/or necrotic tissue are not evidence of infection, but these non-viable substances do support bacterial growth (Ennis, 2010; Cutting et al., 2005). When present in conjunction with other outlined indicators, the suspicion index for infection is increased. Early diagnosis of wound infection and early treatment are essential to minimise the risk of more serious complications and systemic illness (Cutting and White, 2004). Diagnosis is made on clinical manifestations, yet infection may produce different signs and symptoms in wounds of different types and aetiologies (WUWHS, 2008a). The WUWHS (2008b) identified additional criteria to assist in identifying wound infection in such patient cohorts. These include: • loss of appetite • general lethargy, malaise • inability to undertake normal activities • a deterioration in glycaemic control in patients with diabetes • there may be other subtle changes in the wound bed; e.g., wound bed colour may appear darker, less vascular and there may be an increase in slough (Jones, 2012a)

11


CPD 101: THE MANAGEMENT OF WOUND CARE IN IRELAND Non-steroidal anti-inflammatory drugs (NSAIDs) work peripherally by inhibiting the enzyme cyclooxygenase (COX). It is this enzyme, which converts arachidonic acid, released from the walls of the damaged cells, into inflammatory prostaglandins. Nonsteroidal anti-inflammatory drugs provide good pain relief, but can lead to gastric ulceration, renal failure and prolonged bleeding time due to impaired coagulation. Dressing Codes Compression hosiery products have been provided with new administrative codes, according to a new circular from the HSE. The Expert Group for Wound Management Products recently carried out a national review of dressings and aids for wound management. The circular sent by the HSE’s Primary Care Reimbursement Service enclosed a list of wound management products considered as “Normal Nursing Needs” that would be expected to be available as stock in residential settings.

Clinical judgment, a detailed patient history and a comprehensive assessment of the wound are the pivotal tools to recognise infection in the wound. The aim of effective management of the patient with a wound infection is to restore balance to the interaction between the patient and the infecting microorganism. A multidisciplinary approach and if necessary, referral to a specialised wound expert should be considered (WUWHS, 2008a). Simultaneous maximising of the host response, treatment of the wound bed and the general wellbeing of the patient all form part of the management of the patient with a wound infection. Treatment of the wound to reduce bacterial load includes; facilitating wound drainage, managing excessive exudate, debridement and removal of devitalised necrotic tissue and prevention of further or super infection by the adoption of relevant infection control principles. The judicious use of topical / antiseptic/antimicrobial agents may also be employed. The general wellbeing of the patient is the most important factor in the effective treatment of wound infection. Elimination of stressors such as pain and sleep deprivation are essential. The education of the patient and the family and the active participation of the patient in their plan of care are also necessary.

Wound Pain Wound pain can be categorised as: • Background pain – continuous or intermittent pain that is felt even at rest • Incident pain – pain that occurs during day-to-day activities such as mobilisation or coughing • Procedural pain – pain that results from routine procedures such as dressing changes or wound cleansing • Operative pain – pain associated with significant wound intervention, e.g. debridement or wound biopsy. Tissue damage often occurs during the dressing change procedure and has been described by patients as the worst part of living with a wound (Mudge and Orsted, 2010). Dressing changes are a major contributor to wound pain. In patients with a wound infection whose nervous system has become sensitised, dressing removal, wound cleansing and dressing application may prove particularly painful. Analgesia may need to be timed for maximum efficacy during dressing changes and the patient may find music or some other form of distraction helpful. Even when a dressing change is managed well and the choice of dressing minimises pain, the patient’s past experience of painful dressing removal may lead to increased anxiety at dressing change (Mudge and Orsted, 2010).

According to the circular, these products will not be approved under Discretionary Hardship Arrangements; however, dressings of a more complex nature can be approved under this arrangement. Pharmacists were reminded that while dressings are not available to patients on GMS prescriptions, certain dressings are provided on the reimbursement list for GP Stock Orders. A more comprehensive list of wound management products available for GP Stock Orders was published on the reimbursement list effective 1 November 2017. Where there are no local arrangements in place to make supplies through the public health nurse at local level, applications can be submitted under Discretionary Hardship Arrangements for approval supported by a GP prescription. “In order to further reduce the administrative burden to Pharmacists, Compression Hosiery products have been provided with administrative codes effective 1st January 2018,” the circular states. “This will mean that where such products are prescribed, they can be dispensed and claimed for electronically. Compression Hosiery will no longer require individual authorisation by the Local Health Office under Discretionary Hardship Arrangements. Reimbursement support is provided for two pairs per calendar year. Claims submitted outside the approved yearly threshold will not be reimbursed. This arrangement applies to medical card holders under the GMS scheme only.”

CPD MODULE SUPPORTED BY ELASTOPLAST For more information on how to treat acute wounds, please visit www.elastoplast.co.uk


NEW Relizemaâ&#x201E;˘ ECZEMA DRY & SENSITIVE SKIN BABY CARE

A unique range of Italian emollients and cleansers, which includes products developed for eczema, dermatitis, baby care, dry and sensitive skin.

All products are dermatologically tested

Distributed by: A.Menarini Pharmaceuticals Ireland Ltd, Castlecourt, Monkstown Farm, Monkstown, Glenageary, Co. Dublin. www.relife.ie IE19019 IR-REL-22-2019 Date of item April 2019


54

OTC Awards

Marking Standards of Excellence The OTC Product & Retail Pharmacy Awards, held last month in Dublin, mark the standards of excellence and investment into product marketing that pharmacists use to add value to their customers. They act as a celebration and showcase of product innovation, marketing and value to the customer; designed to recognise product development and innovation in the pharmacy sector. Awards were given out in 22 categories, including Best Women’s Product, Best VMS Product, Best Pharmacy Only Product and Best Allergy Product. Value of the OTC Market Our own research has shown that the OTC sector within Ireland continues to innovate. With more and more consumers focusing on the buzz word of the moment - that of ‘self care’ - the over-the-counter market is indeed the jewel in the crown of Ireland’s community pharmacy sector. With a greater emphasis being placed on self-care and self-medication, so is the emphasis placed on consumers and patients to ensure they select product that are safe and effective for their needs. These Awards are the only industry awards, specifically recognising and showcasing the leading manufacturers, companies and their products within the OTC market. Not only that, they provide the platform from which product innovation, marketing, training and

education and value to customer is celebrated and highlighted. Recognising Innovation Another buzz word of the moment is that of innovation. It is imperative for many business to differentiate themselves in a packed market whilst addressing customer needs and focussing on what they can do differently. Few markets aren't crowded these days, with competition coming not only from local companies but, thanks to e-commerce, overseas too. In a connected world, services are no longer limited to our local high street. Standing out in a crowded market isn't easy, but innovation can help businesses attract the customers they need to stay ahead of their market competition.

Sharen McCabe, Managing Director, McCabes Pharmacy Group

With outside retailers and the buying power of symbol groups ever on the increase, innovation across the OTC market is crucial. With the rise of the internet as both reference and shopping tool, consumers are now managing more and more ailments without the help of either doctor or pharmacist. However, the pharmacist does still have a key role to play in helping their customers make informed healthcare decisions.

Banu Toroglu, Head of Marketing & Activation, Tara Jackson, Brand Manager and Bridget Barcoe, Marketing, Reckitt Benckiser

In order to judge the OTC Products shortlisted effectively and efficiently, we rely on the expertise of those from within the pharmacy profession. Our esteemed judging panel was comprised of pharmacy senior buyers, marketers and supervising pharmacists, from both the multiple and independent sectors. Patrick McCormack, Business Strategy Consultant, Pharmacy

PHARMACYNEWSIRELAND.COM

The feedback from our judging panel was enlightening and constructive. Quite often, it has been stated, that there is a gap

in the flow of information, from manufacturer to pharmacist, to pharmacy staff. It has often been said that the Medium makes the message. There are many mediums available in today’s market, from streaming to mobile apps and various online platforms. Irish Pharmacy News presents the perfect medium from which you can convey your message directly to those who need to hear it loudest and clearest.


Best Women’s Product Arkopharma Cys-Control® Plus

2019 & Retail Pharmacy Product Awards

Cassandra Fanara, Marketing Executive and Peadar Coyle, Business Development Manager, from Pharmed

 Cys-Control Plus® is unique within the Best Women’s Health Product category because it is formulated to treat and prevent the recurrence of urinary tract infections and cystitis, which are becoming increasingly common for women within Ireland.  The 14 sachet pack is a complete and effective natural treatment, thanks to the complementary action of Cranberry and D-Mannose on E.Coli.  Heather is included in the formulation which contains anti-bacterial properties and promotes the “auto-flush” phenomenon and urinary comfort.  Cys-Control Plus® is suitable for use during pregnancy, as a compliment to antibiotics and as a prevention to recurring episodes. The Irish Pharmacy News OTC & Retail Pharmacy Product Awards are extremely important and an absolute asset to the OTC pharmacy sector. Highlighting the significance and value of OTC products to the industry, pharmacies and consumers alike. Olivia Reilly, Head of Customer Engagement in Pharmed said “The IPN OTC Product & Retail Pharmacy Awards instil confidence and promote awareness of the extensive and exceptional range of products and brands available within Irish pharmacies nationwide. We are delighted with the win, which has strengthened our position in the market place.” Active Iron & B Complex for Women

Vagisil Range

Always Discreet

Bio Oil

Best Women’s Product – The Finalists Product Company Active Iron & B Complex Solvotrin for Women Vagisil Range Brandshapers Always Discreet Proctor & Gamble Bio Oil Ocean Healthcare


2019 & Retail Pharmacy Product Awards

Best Allergy Product Cetrine Allergy by Rowex Ltd

Joe Keane, Marketing Manager and Darran Goggin, Assistant Marketing Manager, Rowex Ltd along with Kelly Jo Eastwood, Editor, Irish Pharmacy News and Laura Dowling, the Fabulous Pharmacist

 Cetrine Allergy is Ireland’s favourite allergy relief product, having been number 1 at pharmacy for the last 5 years (Source: IMS Data, 2014-2018). Cetrine Allergy is available in a 7 and 30 pack, exclusive to pharmacies.  The global allergic rhinitis drugs market is expected to post a CAGR of nearly 4% during the period 2019-2023, according to the latest market research. Speaking at the event, Joe Keane, the Marketing Manager for Rowex Ltd said, “I am overwhelmed and delighted that Cetrine Allergy has won this prestigious award. This is a fantastic achievement for our company and we are thrilled to receive such an honour especially in such a highly competitive category.” After receiving the award, Darran Goggin, assistant Marketing Manager told IPN, “This is incredible and is a testament to all the hard work done by our team in the office and on the road.” For further information you can contact 1800 304 400.

Cetriz

Best Allergy Product – The Finalists Product Company Cetriz Teva Nasacort Sanofi Zirtek United Drug Marimer Nasal Hygiene Marimer

Nasacort

Zirtek

Marimer Nasal Hygiene


1

2

FAST RELIEF OF ALLERGIES

ONE TABLET PER DAY

3

24hr CONTROL

Available in 7 & 30 packs. Ref 1: “Cetrine Allergy 10mg Film-coated Tablets” was awarded “Best Allergy product” by IPN (Irish Pharmacy News) on 07/03/2019 at the OTC 2019 and retail pharmacy product awards. Ref 2: IMS Data. Ref 3: Divided dose for 6-12 years (half a tablet twice daily).

Date of preparation: (03-19) CCF: 21907

ABBREVIATED PRESCRIBING INFORMATION

Product Name: Cetrine Allergy 10mg Film-coated Tablets. Composition: Each tablet contains 10mg Cetirizine Dihydrochloride. Description: White, oblong film-coated tablets, scored on one side. Can be divided into equal halves. Indication(s): Relief of nasal and ocular symptoms of seasonal and perennial allergic rhinitis (hay fever), chronic idiopathic urticaria. Dosage: Adults, elderly and children aged 12 years and over: 10mg once daily. Children from 6 years to 12 years: 5mg (half a tablet) twice daily. Moderate renal insufficiency (creatinine clearance CrCl 30-49ml/min): 5mg once daily. Severe renal insufficiency (creatinine clearance ≤30ml/min): 5mg once every 2 days. Children under 6 years: Not recommended. Contraindications: History of hypersensitivity to any constituent in the tablet, piperazine derivatives or hydroxyzine. Severe renal impairment < 10ml/min creatinine clearance. Warnings and Precautions for Use: Reduce dosage in patients with significant renal impairment. Cetirizine may increase risk of urinary retention, therefore caution in patients with predisposition factors of urinary retention (e.g. spinal cord lesion, prostatic hyperplasia). Caution in epileptic patients and patients at risk of convulsions. Contains lactose. Discontinue use of cetirizine three days before allergy testing. Interactions: Caution is advised when taken concomitantly with alcohol or other CNS depressants. Pregnancy and Lactation: Caution during pregnancy and breast-feeding. Ability to Drive and Use Machinery: Usually non-sedative, patients should take their response to the product into account. Undesirable Effects: Cetirizine at the recommended dosage has minor adverse effects on the CNS, including somnolence, fatigue, dizziness and headache. In some cases, paradoxical CNS stimulation has been reported. Instances of abnormal hepatic function with elevated hepatic enzymes accompanied by elevated bilirubin have been reported which resolves on discontinuation of the drug. Uncommon: Agitation, diarrhoea, pruritus, rash, asthenia, malaise, paraesthesia. Marketing Authorisation Holder: Rowex Ltd, Bantry, Co. Cork. Marketing Authorisation Number: PA 711/75/2. Further information and SPC are available from: Rowex Ltd, Bantry, Co. Cork. Freephone: 1800 304 400 Fax: 027 50417 E-mail: rowex@rowa-pharma.ie Legal Category: Not subject to medical prescription. Date of Preparation: August 2014


Best Eye Product Blephaclean

2019 & Retail Pharmacy Product Awards

Orla Smith, Medical Sales Representative and Barry O’Dwyer, Sales Manager, TheaPamex

Good eye health starts with daily lid care. Blephaclean from TheaPamex won the Best Eye Product for 2019 at the OTC & Retail Pharmacy Product Awards.  Blephaclean is a preservative free medical device scientifically proven to relieve the symptoms of blepharitis which is one of the leading causes of dry eye.  Blephaclean wipes are impregnated with an aqueous Micelle solution to gently absorbs debris and impurities, Sodium Hyaluronate a natural moisturiser, Centella Asiatica a natural restorative agent for the skin and Iris Florentina which helps to regulate the oil production on the eyelids.  Blephaclean is part of a family of eyelid cleansing products which includes; Blephasol (a cleansing lotion) and Blephagel (a cleansing gel).  The range is free from preservatives, perfumes and soaps meaning there is no need to rinse after use and can be used on the most sensitive skin. Blephaclean can be used on babies as young as 3 months. Diarmuid Gavin, Country Manager, TheaPamex comments, “Eyesight is one of our most valuable senses and yet we often take its importance for granted. How often do we take time to care for our eyes? Often the eye care category is overlooked and can be hidden low behind the pharmacy counter. “We here at TheaPamex are delighted that Blephaclean has won the Best Eye Care Product award and would like to congratulate the IPN on another successful OTC and Retail Pharmacy Product Awards this year, it truly is a great opportunity to recognise the leading products within the OTC category.” Hy Opti Eye Care

Best Eye Product – The Finalists Product Company Hy Opti Eye Care Rowa Thealoz Duo TheaPamex Macu-SAVE Pharmed

Thealoz Duo

Macu-SAVE


ID DAILY EYELID G CLEANSING

U

THINK MORE IMPORTANT THAN YOU THINK

0459

0459

clinicallyThe only medical device clinically ptomatic proven to provide symptomatic MGD and relief from Blepharitis, MGD and 1 g. Dr y Eye Ocular Surface Disease e.g. Dry Eye1

TP/19/011 Blephaclean IPN Winner Advert V1 1 Lemp M.A. et al. Cornea 2012; 31(5); 472-8


2019 & Retail Pharmacy Product Awards

Best Beauty Product Hair, Skin & Nails Gummies with Biotin

Sarah Gibson, Manager, Key Accounts and Julie Crest, Manager, National Sales UK/Ireland, The Nature’s Bounty Co

Nature’s Bounty Hair, Skin & Nails Gummies with Biotin won the Best Beauty Product for 2019.  Expertly formulated Gummies using collagen, along with other key beauty nourishing nutrients such as zinc, biotin and vitamin C, to bring consumers a winning combination for luscious hair, glowing skin and healthy nails  Gummies which have been made with clean beauty in mind, free of gluten, as well as no artificial colours or flavours  It’s so important to nourish beauty both inside and out, and these Gummies make this so easy and tasty! Just two tasty gummies a day - chew and go! Julie Crest, Manager, National Sales UK/Ireland, The Nature’s Bounty Co said, “We truly believe that looking and feeling great really does start from within, and that’s why we developed our Nature’s Bounty Hair, Skin and Nails gummies. Our gummies are designed to make taking a supplement fun and easy, and better yet, because they’re so delicious, they’re super easy to remember to take each day (in fact, I look forward to taking them!). “Thanks so much to the OTC Awards for recognising and awarding our product, it’s an honour and pleasure! It is awards like this that help to solidify the value of our product in the minds of both our retailers and consumers.”

Best Beauty Product – The Finalists Product Company Love Your Skin Holos Skincare Anti-Ageing Facial Oil CatwalkHQ Tan Remover CatwalkHQ 3 in 1 Hyaluronic Skin Mist Ella & Jo Nailner Treat & Colour Brandshapers for Fungal Nails

Love Your Skin Anti-Ageing Facial Oil

CatwalkHQ Tan Remover

3 in 1 Hyaluronic Skin Mist

Nailner Treat & Colour for Fungal Nails


Award Winning Beauty Gummies!

For more information contact your Nature’s Bounty® Territory Account Manager or call +44 1442 821 419 naturesbounty.co.uk info@nbty.com Food supplements should not be used instead of a varied balanced diet and a healthy lifestyle. Nature’s Bounty® is a registered trademark.


2019 & Retail Pharmacy Product Awards

Best Children and Baby Product Nurofen for Children

Banu Toroglu, Head of Marketing & Activation, Reckitt Benckiser, Natalie Maginnis, Managing Director, IPN Communications and the Fabulous Pharmacist, Laura Dowling

 Nurofen for Children’s ibuprofen based oral suspension provides relief for children. It starts to work in just 15 minutes and lasts for up to 8 hours for fever.  Nurofen for Children have been supporting parents for over 20 years by providing effective relief for children suffering from pain, fever and cold & influenza.  Nurofen for Children is recommended by 9 out of 10 mums*.

*Survey by Empathy carried out in Ireland on 121 mums who would recommend Nurofen for other parents. (August 2013)

Health and personal care products for children and babies cover a wide range of needs including hygiene, skin and hair care, wound care and oral health. The demand for these products will be market specific and dependent on lifestyle and family issues.

Best Children & Baby Product – The Finalists Product Company Junior Revive Revive Active Mustela Stelatopia GA Market Match Foam Shampoo Wartie Brandshapers Calpol Infant Suspension Johnson & Johnson

Junior Revive

Mustela Stelatopia Foam Shampoo

Wartie

Calpol Infant Suspension


Best Baby Product KidsClin® Cradle Cap Treatment Kit

2019 & Retail Pharmacy Product Awards

Natalie Maginnis, Managing Director, IPN Communications, Cassandra Fanara, Marketing Executive, Pharmed and Laura Dowling, the Fabulous Pharmacist

KidsClin® Cradle Cap Treatment Kit from Pharmed, won the Best Baby Product for 2019.  KidsClin® Cradle Cap Treatment Kit is unique within the Baby category because it offers everything needed for the effective treatment of cradle cap in infants.  Cradle Cap (Infantile Seborrhoeic Dermatitis) is a very common condition and KidsClin® is formulated to remove, treat and prevent Cradle Cap and is child friendly and safe.  Ingredients include Borrego Officinalis Seed Oil, Squaline, Vitamin E (Tocopheryl Acetate) and Rosmarinus Officinalis Leaf Extract.  Cradle Cap has been known to reoccur even after successful treatment and by using KidsClin® 2 to 3 times per week, it has been shown to prevent reoccurrence by keeping the scalp healthy.  KidsClin® is a long-lasting treatment; each bottle contains over 7 weeks of treatment over 220 applications! Olivia Reilly, Head of Customer Engagement in Pharmed said, “The Irish Pharmacy News OTC & Retail Pharmacy Product Awards are extremely important and an absolute asset to the OTC pharmacy sector, representing a platform that Pharmed are pleased to be aligned with. The awards highlight the significance and value of OTC products to the industry, pharmacies and consumers alike.” Marimer Baby Nasal Hygiene Spray 100mls

Mustela Cleansing Gel

Elave Sensitive Sun Paediatric SPF 50+

Water Wipes

Best Baby Product – The Finalists Product Company Marimer Baby Nasal Pamex Hygiene Spray 100mls Mustela Cleansing Gel GA Market Match Elave Sensitive Sun Ovelle Paediatric SPF 50+ Water Wipes Irish Breeze


2019 & Retail Pharmacy Product Awards

Best Digestive Product Alflorex

Gerard Murphy, Sales Manager, Pamex and Colm O’Sullivan, Head of Communciations, Precision Biotics with Natalie Maginnis, Managing Director, IPN Communications and Laura Dowling, the Fabulous Pharmacist

Alimentary Health’s Alflorex won the Best Digestive Product Award for 2019.  Only Alflorex® contains the unique 35624® bacterial culture  Efficacy in IBS patients demonstrated in double blinded placebo controlled clinical trials in Europe, on all of the cardinal symptoms of IBS: • bloating & gas • abdominal pain • unpredictable constipation & diarrhoea  Publication in leading Gastroenterology journals with over 2000 citations to date  Trusted by Irish doctors and consumers for over 5 years This award for Alflorex is a great endorsement by Irish pharmacists. We feel it recognises the difference that Alflorex makes to the daily lives of thousands of Irish people. We are proud that Alflorex was discovered and developed in Ireland and that it is now one of the best selling IBS products. Buscopan

Best Digestive Product – The Finalists Product Company Buscopan Sanofi Bio-Kult Advanced Scope 14 Strains Dulcosoft Sanofi Dulcolax Sanofi

Bio-Kult Advanced 14 Strains

Dulcosoft

Dulcolax


AlflorexÂŽ with the #1 Recommended Culture by Gastroenterologists and Doctors in the US.*

14 Moneen Business Park, Castlebar, Co. Mayo, Ireland. Tel: +353 94 9024000 Fax: +353 94 9022824 Email: info@pamex.ie

www.precisionbiotics.com

*Among gastroenterologists who recommended a brand of probiotic in AlphaImpactRx 2018-2017 survey. Among doctors who recommended a brand of probiotic in AlphaImpactRX 2017 survey.


2019 & Retail Pharmacy Product Awards

Roseanna Gorman, Marketing Key Account & Training Manager and Sinead Cowzer, International Marketing Manager with Debbie Graham, Commercial Manager, Irish Pharmacy News and Laura Dowling, the Fabulous Pharmacist

Best Men’s Product Active Iron & B Complex Plus for Men

Solvotrin Therapeutic’s Active Iron & B Complex Plus for Men won the Award for Best Men’s Product, 2019.  The new product contains Active Iron’s ground-breaking protein formulation and a new specially formulated Active B Complex  Targeted release makes it gentle enough to take on an empty stomach.  Active Iron & B Complex Plus is also available for women. Both products are suitable for vegetarians and free from artificial preservatives, yeast, gluten, and sugar. Find out more at www.activeiron.com  With clinically proven better absorption of iron sulfate* combined with high strength B Vitamins. Active Iron & B Complex Plus for Men supports energy and mental performance* *Wang et al, Acta Haematologica 2017; 138: 223-232 **Iron, vitamins B1, B2, B3, B5, B6, B12 contribute to normal energy yielding metabolism in the body. Vitamin B5 contributes to normal mental performance

International Marketing Manager Sinead Cowzer said, “Getting the right amount of vitamins and minerals is key for maintaining a man’s mental and physical performance, no matter what he’s up against. We were delighted to win this award and be recognised by pharmacists in Ireland. We have received a lot of positive feedback from our customers, pharmacists and sporting professionals since the launch of Active Iron & B Complex Plus for Men.” CEO of Solvotrin Therapeutics, Pat O’Flynn said, “Solvotrin is committed to developing cutting edge science to address unmet needs in the market. “New Active B Complex+ for Men makes sure men get the support they need to live a healthy, full life.” Perspirex for Men Regular

Best Men’s Product – The Finalists Product Company Perspirex for Men Regular Eurosales De Facto Shaving Oil Pamex Proceive Men’s Ocean Healthcare Gillette Skinguard Proctor & Gamble

De Facto Shaving Oil

Proceive Men’s

Gillette Skinguard


back to your best. ACTIVEIRON ® IS KIND & STRONG

x2

CLINICALLY PROVEN BETTER ABSORPTION*

yes!

KIND ON AN EMPTY STOMACH

* Clinically proven twice the absorption * Clinically proven twice the absorption compared to iron sulfate. iron sulfate. Wang al, 223-232. Acta Wangcompared et al, Acta to Haematologica 2017;et 138: Haematologica 2017; 138: 223-232.


2019 & Retail Pharmacy Product Awards

Best Hair and Scalp Product ViviscalTM

Sarah Mayanja, Brand Manager, United Drug, Natalie Maginnis, Managing Director, IPN Communications and Laura Dowling, the Fabulous Pharmacist

United Drug’s ViviscalTM won the Award for Best Hair and Scalp Product 2019.  Viviscal should be taken consistently, twice a day for a full 6 months.  Over this period,the supplement works across the four stages in the hair growth cycle, in line with a natural hair cycle.  Viviscal is supported by 10 published clinical trials, and over 25 years of research and development.  The key ingredient is the marine complex AminoMarTM which is unique to ViviscalTM, there is also Biotin, Horsetail plant extract, Vitamin C, Iron, Zinc and Millet seed extract in the supplements. Eleanor Ashfield, Viviscal Senior Brand Manager,said, “Many Irish people suffer from some sort of hair loss, damage, thinning or shedding. For this reason, we are absolutely delighted thatt he ViviscalTM Maximum Strength Hair Growth Supplement has been recognised as an effective, over the counter, solution for a variety of hair and scalp aliments. Winning ‘Best Hair and Scalp Product’ at the OTC & Product Retail Awards 2019 is testament to the 25 years of research that has been put into creating a product that really helps people overcome their hair health problems.”

Best Hair & Scalp Product – The Finalists Product Company John Frieda 6 Effects United Drug Original Serum Luna by Lisa Jordan LUNA Haircare Elave Shampoo Ovelle Bioskin Haircare Range Bioskin

John Frieda 6 Effects Original Serum

Luna by Lisa Jordan

Elave Shampoo

Bioskin Haircare Range


Our supplements feed the root from within

Available from your local Pharmacy

25 years of research in the science of hair

Supported by 10 clinical trials

For further information please contact your Pemberton representative or call customer services on 01 463 2424


2019 & Retail Pharmacy Product Awards

Best Irish Pharmacy Brand Product Panadol

Kelly Jo Eastwood, Editor, Irish Pharmacy News and Bryan Dunne, Customer Business Manager, GSK

 Panadol’s Irish heritage was brought to life through an innovative new brand campaign focusing on the fact that Panadol is Made in Ireland called ‘This is what we’re made of’  Panadol includes variants Panadol Extra, Panadol Base, Panadol Actifast and Panadol Night  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 In an increasingly borderless world, many consumers are favouring Irish pharmacy brand products. Research has shown that a brand’s country of origin can be as important as other purchasing criteria such as price and quality with many Irish pharmacy shoppers wanting to support local businesses, finding local more trustworthy and more attuned to their needs and wants.

Best Irish Pharmacy Brand Product – The Finalists Product Company Elave Skincare Ovelle Seaweed & Collagen Green Angel Face Cream Alflorex Alimentary Health Sudocrem Teva

Elave Skincare

Seaweed & Collagen Face Cream

Alflorex

Sudocrem New convenient pack format

Always read the label carefully


Best Launch of the Year Holos Skincare This is More Range

2019 & Retail Pharmacy Product Awards

Niamh Hogan, CEO, Holos Skincare with Debbie Graham, Commercial Manager, Irish Pharmacy News and Laura Dowling, the Fabulous Pharmacist

Holos Skincare won the Best Launch of the Year Awad for 2019 with their This is More Range.  The This is More Multi-use Oil made with natural and organic oils can be used as a cleansing oil, makeup remover, facial, body or bath oil, hair or cuticle oil or even as a face masque.  The This is More Facial and Eye Serum is a hyaluronic acid serum with plant extracts that can be used on both face and around the eyes.  The This is More Get Better Butter is a product that every family should have in their cabinet. It can be used as a moisturiser for very dry rough skin on the face, hands or body.  The This is More range was inspired by Holos creator Niamh Hogan after realising that consumers were not getting the most from their skincare and only using products how they were directed to instead of experimenting and finding how products can work specifically for them .  For more information about Holos Skincare, go to www.holos.ie or email sales@holos.ie Niamh Hogan, CEO with Holos Skincare comments, “We are a small team that creates luxurious plant-based products that nurture skin health and help prevent the signs of premature ageing. We do it in an ethical, cruelty free way using no animal byproducts. Everything is made onsite at our facility in Co. Wexford. “To be an Irish brand recognised by professionals in the Pharmacy sector motivates us to continue to innovate with future launches that will bridge the gap between mainstream and natural brands. It is our mission to prove that using plants in our skincare has positive and lasting effects on the skin and the prevention of premature ageing. “Being the only awards in the industry, it is important to us to be visible to the sector we wish to work with.” Perrigo Brand

Lemlift

TePe GOOD Sustainable Toothbrush

Solgar Skin, Nails & Hair

Best Launch of the Year – The Finalists Product Company Perrigo Brand Perrigo Lemlift Reckitt Benckiser TePe GOOD TePe Sustainable Toothbrush Solgar Skin, Nails & Hair Solgar


Best N Best Natural Product Es 2019

2019

Eskimo Brain 3-6-9 & Retail Pharmacy Product Awards

& Retail Pharmacy Product Awards

Eskimo Brain, winner of the Best Natural Product - and Olive Curran Marketing Director of PPC Ltd.

Debbie Graham, Commercial Manager, Irish News announces Brain as Brain 3-6-9 from PPC Galway. Winner of Pharmacy the Best Natural Product forEskimo 2019 was Eskimo winner of the Best Natural Product Award  On the market for 15 years in Ireland and is the go to brand for pharmacists when Winner of the Best Natural Pr recommending a good fish oil/ seed oil combination rich in omega-3,-6 and -9. On the market for 15 years  With high levels of omega-3 DHA along with Seed Oils,nvitamin D, E and CoQ10, Eskimo Brain 3-6-9 is ideal for anyone doing exams or just looking to increase brain power. fish provides the most n Oily  On the market in Sweden for more than 25 years and with over 120 scientific Surprisingly, studies, the Eskimo range represents probably the finest quality fish oil on 89% the of Irish pe so often there market, providing Omega-3 rich oil of legendary purity, freshness & stability is a need to t  Eskimo-3 products are 100% pure, natural and scientifically proven to be effective, n With high levels of omega-3 making it a brand that Irish people trust. www.eskimo3.ie.

Eskimo Brain 369 is ideal fo

Olive Curran, Marketing Director with PPC Galway says, “Winning this Award is a power. testament to the quality and efficacy of the product. As an Irish company, we take great n benefits. pride in our brand and we love to spread the word about all its

“The OTC sector is growing significantly year on year, so any opportunity to gain recognition as a premium brand is welcomed. Thank you to the expert judging panel for Omega-3 market, providing assessing our product and giving it their seal of approval by awarding it with the IPN Best Natural Product Award.” n Alflorex

Best Nautral Product – The Finalists Product Company Alflorex Precision Biotics Zerochol Plant Sterols PPC Galway Eucarbon Herbal Tablets Rowa Pharmaceuticals Solgar Curcumin Solgar Academy

Zerochol Plant Sterols

making it a brand that Irish Solgar

Eucarbon Herbal Tablets

Curcumin

Olive Curran, Marketing Directo

recognition as a premium brand assessing our product and givin Natural Product Award.”


Natural Product skimo Brain 3-6-9

roduct for 2019 was Eskimo Brain 3-6-9 from PPC Galway.

s in Ireland and is the go to brand for pharmacists when

beneficial atty acids for brain health, EPA and DHA. eople are not consuming sufficient oily fish in their diet, take a good quality omega-3 fish oil.

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2019 & Retail Pharmacy Product Awards

Best Skin Product Elave Daily Skin Defence SPF 45

Patrick Gardiner, Research and Quality Director, Ovelle Pharmaceuticals and grandson of Founder Joseph Gardiner with Kelly Jo Eastwood, Editor, Irish Pharmacy News and Laura Dowling, the Fabulous Pharmacist

 Elave daily skin defence SPF 45, is an oil free vitamin enriched moisturiser for face, neck & hands with high zinc based SPF45 to protect against everyday UV light/sun damage linked to facial skin ageing and skin redness. Elave sensitive skincare is all about treating skin right, taking out necessary ingredients, harmful to the skin and replacing them with hydrating, natural ingredients to protect sensitive skin and eczema prone skin.  Today Elave works to protect against skin sensitivity by combining advances in clean skincare with our tradition and history in apothecary.  Made in Ireland. Joanna Gardiner, CEO of Ovelle, said, “In 1934 The Ovelle Family Apothecary was created by my grandfather Joseph Gardiner to prepare traditional apothecary like Ovelle Emulsifying Ointment and Calamine Cream for sensitive skin conditions and we continue that tradition to this day. “Winning the Best Skincare product for Elave Daily Skin Defence SPF 45 is particularly special to me as we developed this formulation to be the ultimate sensitive skin defence moisturiser for face, neck and hands. Thank you for this massive recognition & your continued support.”

Best Skin Product – The Finalists Product Company Love Your Skin Holos Skincare Anti-Ageing Facial Oil Riemann P20 Sun Eurosales Protection Face SPF30 Uriage Barriederm GA Market Match CICA Cream Zeoderm Salcura

Love Your Skin Anti-Ageing Facial Oil

Riemann P20 Sun Protection Face SPF30

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2019 & Retail Pharmacy Product Awards

Best Pain Relief Product Voltarol Emulgel Extra Strength 2% w/w Gel

Bryan Dunne, Customer Business Manager, GSK with Debbie Graham, Commercial Manager, IPN Communications and Laura Dowling, the Fabulous Pharmacist

 Unlike tablets that go through the stomach, Voltarol Emulgel Extra Strength 2% w/w Gel concentrates relief deep in the joint to fight pain and inflammation all day long.  Voltarol Emulgel Extra Strength 2% w/w Gel is available in 2 sizes: 30g and 50g tubes.  The Emulgel technology used in this product helps the gel to penetrate deeply into the skin to enhance delivery of the active ingredient, diclofenac, to the site of pain and swelling.

The pain relief market within Ireland is consistently rising. Pain relief products will continue to be in strong demand, with consumers leading busier and more stressful lifestyles, and seeking analgesics for pain relief, particularly from tension and headaches. More active consumers are also likely to require more pain relief for injuries.

Best Pain Relief Product – The Finalists Product Company Alchemlife FlexiQule Pharmed Easolief DUO Clonmel Healthcare Flexiseq Ascension Healthcare ZinCuFlex PPC Galway

Alchemlife FlexiQule

Easolief DUO

Flexiseq

ZinCuFlex


Best Pharmacy Only Product - Voltarol Emulgel Extra Strength 2% w/w Gel

2019 & Retail Pharmacy Product Awards

Bryan Dunne, Customer Business Manager, GSK with Jonny McCambridge, Editor, Hospital Professional News

Voltarol Emulgel Extra Strength 2% w/w Gel by GSK picked up the award for Best Pharmacy Only Product for 2019, scoring GSK with their second win.  Unlike tablets that go through the stomach, Voltarol Emulgel Extra Strength 2% w/w Gel concentrates relief deep in the joint to fight pain and inflammation all day long.  Voltarol Emulgel Extra Strength 2% w/w Gel is available in 2 sizes: 30g and 50g tubes.  The Emulgel technology helps the gel to penetrate deeply into the skin to get the diclofenac to the site of the pain. It also has a moisturising and cooling effect which eases the painful and red areas of the body. While more is being done to promote awareness regarding the importance of the safety and appropriate use of OTC drugs, pharmacists are still the patients best resource in the proper selection of OTC products.

Carnation Footcare

Sumatran Relief OTC

Uriage Keratosane 30

Best Pharmacy Only Product – The Finalists Product Company Sumatran Relief OTC Rowa Carnation Footcare Ovelle Uriage Keratosane 30 Uriage


2019 & Retail Pharmacy Product Awards

Best Tanning Product TanOrganic Self-Tanning Oil

Aaron Lubrani and Noelle O’Connor, Managing Director’s, TanOrganic, Debbie Graham, Commercial Manager, Irish Pharmacy News and Laura Dowling, the Fabulous Pharmacist

The OTC Product & Retail Awards Best Tanning Product Award for 2019 went to TanOrganic Self-Tanning Oil.  The TanOrganic brand has long been recognised for offering natural, high-quality products that care for the skin while also giving a glowing natural tan.  TanOrganic is the world’s first and only Eco-Certified self-tan brand with full Vegan Society, cruelty-free and a 100% score with the Ethical Association, which only 6 cosmetic companies globally have.  TanOrganic Self Tanning Oil can be applied with the hands, it is streak-free, has no fake smell, and it won’t transfer on to white sheets. “Winning the award of Best Tanning Product at the OTC & Retail Pharmacy Awards is an incredible achievement for TanOrganic as our goal is to deliver amazing tanning results while caring for the skin, and we also are committed to raising awareness on the dangers of overexposure to the sun and how you can achieve a sunless tan,” said Noelle O’Connor, Managing Director, TanOrganic. Rosanna Davison, TanOrganic Brand Ambassador commented on the win, “I've been a big fan of the TanOrganic Self Tan Oil for a number of years and love the healthy golden glow it creates, with minimal fuss and no streaks or nasty smell. Using certified organic, cruelty-free products is important to me and as I aim to eat a diet based on fresh, whole foods and plenty of organic produce, it makes total sense to choose the best-quality tan to use on my skin.” Catwalk HQ Dark

Best Tanning Product – The Finalists Product Company Catwalk HQ Medium Catwalk HQ Mousse Body Blur HD Skin Vita Liberta Catwalk HQ Dark Mousse Catwalk HQ

Body Blur

CatwalkHQ Medium


Best Cough, Cold & Flu Product – BENYLIN® Day & Night

2019 & Retail Pharmacy Product Awards

Paulette Battigan, J&J, Natalie Maginnis, Managing Director, IPN Communications and Laura Dowling, the Fabulous Pharmacist

Johnson & Johnson’s BENYLIN® Day & Night took home the Award for Best Cough, Cold & Flu Product for 2019.  BENYLIN® Day and Night is unique in market, in that, it is the only day and night tablet, for 24 hour cold & flu relief.  The pack contains two different tablets, with different actions; one for the daytime and the other for the night.  The day tablet relieves fever and decongests the nose so that you can keep going about your day while you’re ill. Then later, the night tablet helps relieve your cold symptoms for a better night’s sleep. Commenting on their win, Paulette Battigan, with J& J said, “We at J&J are delighted to take home the award for Best Cough, Cold & Flu product for BENYLIN® Day & Night. “BENYLIN® Day and Night has grown hugely in recent years, more than doubling its value sales since 2014 to become the number 1 cold and flu SKU in the market.* We believe the unique Day and Night formulation really resonates with consumers, which has helped drive the success of the product.” *IMS, COLD OR FLU REMEDIES, FY Value sales 2014 – 2018.

Lemsip

Alchemlife Phytorelief

Perrigo Cold & Flu

Bronchostop

Best Cough, Cold & Flu Product – The Finalists Product Company Lemsip Reckitt Benckiser Alchemlife Phytorelief Pharmed Perrigo Cold & Flu Perrigo Bronchostop Perrigo


2019 & Retail Pharmacy Product Awards

Best Marketing Campaign Nasacort, Sanofi

Laurence O’Carroll, Manager, Sales and Tanya O’Toole, Head of Consumer Healthcare Ireland, Sanofi

Sanofi’s Nasacort won the accolade for Best Marketing Campaign 2019.  Nasacort is an intranasal corticosteroid that offers superior relief in nasal hay fever/allergic rhinitis symptoms compared to intranasal antihistamines and oral antihistamines  To support the new launch and ensure that it is successful, the business has invested significantly to start building the Nasacort brand within a highly competitive market  As the market is highly seasonal, the communication was targeted during the hay fever season when it is most relevant to consumers. Tanya O’Toole, Head of Consumer Healthcare Ireland, Sanofi said, “We are delighted that Nasacort has won the Best Marketing Campaign Award. Nasacort is an intranasal corticosteroid that works on nasal and eye symptoms, is tasteless, odourless and alcohol-Free and provide full 24 hour relief. It was launched in 2018 into the OTC market and we are fully committed to continuing to providing the pharmacy community with the necessary training, tools and support to help consumers make the right choice. The OTC awards provide a great platform for brands to build visibility within the industry.” NiQuitin Quit to Fit Online

Best Marketing Campaign – The Finalists Product Company NiQuitin Quit to Fit Online Perrigo Solgar Brand Solgar Cetrine Allergy Rowex NiQuitin Brand Perrigo

Solgar Brand

Cetrine Allergy

Motivational Support - We enlisted Lifestyle and Addiction Expert, Raul Aparici to support on the psychological impact of quitting smoking. Through a series of motivational content he addressed the range of emotions smokers experience during their quit experience and helped to support our participants and readers to stay on track Advertising:  NRT Support - NiQuitin supported our participants through their journey with information and Perrigo creat ed a new testim education on NRT showing them how to use onial supports successfully to complete their smoking cessation Feb, camp May-June aign. Perrigo , and Aug-Sep-O invested in 3 journey ct. Out of Home, media campaigns search and goog The new TV ad was supp in 2018. From lemented with le ad-words. Jana Video Social Media - Social Media is a key medium to directly reach 25-34 year olds and so in addition to then on Demand camp aign, digital campaign, we closely followed our participants through their quit journey and engaged with our athome audience through social media. This involved sending out the participants’ weekly experiences via Instagram stories and encouraging our core participants to document their own progress on Instagram using the Quit to Fit hashtag. 

Measuring Results - To ensure we had a real and accurate benchmark to track our participants’ progress, V02 fitness tests were conducted on each participant at the beginning and end of the 10-week programme to document any change in their fitness

nom Ja , 18. Fr mpaign s in 20 paign Demand ca ia cam 3 med a Video on ed in ith invest mented w go . Perri pple paign ad was su ial cam TV Beauty is in our nature stimon t. The new sing: . new te Adverti created a Aug-Sep-Oc ad-words le d Perrigo -June, an and goog ay ch M sear Feb, Home, of t Ou Digital campaign -Quit to Fit: 10-week prog ramme cente red around three In Partnership core pillars:  with WeeNiQuitin kly Health and Fitness Challenge challenge each s - We gave our week.given, 5. Please detail below support any. Theseifwere encoin-store designed to impr participants a different healt uraging them to change their ove their healt h and fitness habit with anot h and help to habit s and lifestyle rathe her distract from r than faulter cravings, or indeeand d, repla We developed a Point of Sale (POS) kit to highlight the launch of our new advertising campaign sendce one Skin, Nails and Hair Formula with vitamin C, zinc and silica nourishes your body from within for inner wellbeing that shows.* Find out more at solgar.co.uk or find us on social media at @solgaruk1947 Unlock the power of nature from within

*Zinc contributes to the maintenance of normal hair, skin and nails. Food supplements should not be used instead of a varied balanced diet and a healthy lifestyle. Solgar® is a registered trademark.

SG0150

Facebook “f ” Logo

CMYK / .eps

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CMYK / .eps

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Rounded square Only use blue and/or white.

For more details check out our Brand Guidelines.

NiQuitin Brand


Best Training Initiative 2019 Perrigo Cinemars

2019 & Retail Pharmacy Product Awards

Paul Hatton National Field Sales Controller, Perrigo, Debbie Graham, Commercial Manager, IPN and Laura Dowling, the Fabulous Pharmacist

Perrigo Cinemars won the Best Training Initiative of the Year for 2019. Excellence in training initiatives is a crucial component for many pharmaceutical companies in the promotion of their OITC offering, whether it be for an existing or a new product and/or service.  The Cinemar innovation brings together training and development with the added benefit of having a social event for pharmacy staff  The training focussed on the area of headlice  Perrigo also previewed the launch of the Perrigo brand at the Cinemar, allowing those in attendance a sneak peek of the activation that was coming down the line  73% of attendees took the time to complete the feedback form, allowing the Perrigo team to further develop the concept for 2019

2.

3.

 They have also grown their attendance of training events by 40% this year. Training presents a prime opportunity to expand the knowledge base of your audience, ensuring consumers enjoy a consistent experience and background knowledge. 4.

Fleming Medical Training

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24/7 Access to the Best Training and Education Resources: Webinars, E-Courses, Training Manuals & Nutrition News REGISTER NOW at www.solgaracademy.co.uk to enrol in courses, complete assessments and earn great rewards For more information contact your Solgar® Territory Account Manager or call 01442 890 355 Food supplements should not be used instead of a varied balanced diet and a healthy lifestyle. Solgar® is a registered trademark.

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ess.ie

AMD Booklet

1 2018.indd 1

16/08/2018 14:22:04

New Products - Please detail

below information about the

If this is a brand extension, please

product and launch.

detail below.

is the for Pharmacy staff. Education e of providing product training cy Perrigo have a proud heritag on year, listening to the pharma aim to continually invest year heartland of Perrigo and we onal training. excepti deliver and ments teams to understand their require and ensure that if a team require all pharmacies national wide hand Over Field Sales reps call into have all the necessary tools to are empowered to deliver and training in a certain area, they class. in best is d to ensure that the training delivere

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Best Pharmacy Training Initiative – The Finalists Product Company Fleming Medical Training Fleming Medical Macu-SAVE Pharmed Bio-Kult Multi-Strain Range Scope Solgar & Nature’s Solgar Academy Bounty Training


Best VMS Product Revive Active

2019 & Retail Pharmacy Product Awards

Andra Rooney and Tanya McGuirk, Area Managers, Revive Active, Kelly Jo Eastwood, Editor, Irish Pharmacy News and Laura Dowling, the Fabulous Pharmacist

Revive Active have continued their successful trajectory after winning the category of Best VMS (Vitamin, Minerals and Supplement) Product of the Year for the second time at the OTC & Product Retail Awards 2019.  With 26 active ingredients, including 150mg of CoQ10, 3,000mg D-Ribose, 4,000mg L-arginine and Vitamin B12.  The product is supplied in powdered form in single daily sachets which users can add to water, juice or a smoothie.  Revive Active received many unsolicited reviews from customers via Trustpilot, resulting in a trust score of 9.4 out of 10.  The health supplement business headquartered in Galway formulate, manufacture and market premium super supplements that are sold in over 1,000 pharmacies across Ireland.  Revive Active is available in 30 and 7 day supply. Commenting on the Award win, Founder and Managing Director Dáithi O'Connor says, “We are thrilled with this award win which is a fantastic recognition by our colleagues in the pharmacy industry of Revive Active and an acknowledgment of the benefits to our valued customers.”

Best VMS Product – The Finalists Product Company Solgar Full Spectrum Solgar Curcumin Vivioptal Junior Scope Seven Seas Jointcare Brandshapers Supplex + Turmeric Solgar Skin, Nails & Hair Solgar

Solgar Full Spectrum Curcumin

Vivioptal Junior

Seven Seas Jointcare Supplex + Turmeric

Solgar Skin, Nails & Hair


Most Innovative Product Nurofen Durance 200mg Medicated Plaster

2019 & Retail Pharmacy Product Awards

Bridget Barcoe, Marketing, Reckitt Benckiser, Kelly Jo Eastwood, Editor, Irish Pharmacy News and Laura Dowling, the Fabulous Pharmacist

Nurofen Durance 200mg Medicated Plaster secured Reckitt Benckiser’s second win at the OTC Product & Retail Awards by taking home the title of Most Innovative Product for 2019.  Nurofen Durance is the first ibuprofen medicated plaster in Ireland which offers 24 hours duration.  It is a convenient and effective product for muscle and joint pain with stretchable and flexible design.  Ireland's first ibuprofen medicated plaster was launched in April 2018. It is imperative for many business to differentiate themselves in a packed market whilst addressing customer needs and focussing on what they can do differently. Few markets aren't crowded these days, with competition coming not only from local companies but, thanks to e-commerce, overseas too.

Medicare Effigerm First Aid Spray

Easolief DUO

Nicorette Quickmist Berry

Flexiseq

Most Innovative Product – The Finalists Product Company Medicare Effigerm Fleming Medical First Aid Spray Easolief DUO Clonmel Healthcare Nicorette Quickmist Berry Johnson & Johnson Flexiseq Ascension Healthcare


2019 & Retail Pharmacy Product Awards

Best Oral Health Product TePe GOOD Sustainable Toothbrush

Nicola Jones, Territory Manager, TePe with Debbie Graham, Commercial Manager, Irish Pharmacy News and Laura Dowling, the Fabulous Pharmacist

The TePe GOOD Sustainable Toothbrush, from TePe, won the Best Oral Health Product 2019.  The TePe GOOD toothbrushes are the first in a line of products launched as an attempt to work with customers on the problematic area of plastics.  TePe GOOD is better for you and better for your customers.  The TePe GOOD range uses renewable sources of sugar cane for the shaft of the toothbrush and castor oil for the bristles. This makes a product made of “Bio- Plastic”.  The product is recyclable and now renewable. It feels exactly the same for the patient and one of the great things about using sugar cane is that it absorbs carbon-dioxide as it grows. Tom Bailey, Head Of Sales: Wholesale and Ireland with TePe Oral Hygiene UK Ltd says, “Whilst a toothbrush is not a single use plastic, it can still be an environmental cost. Being a proud Swedish company where all of our products are manufactured we have always had a keen eye on doing things better for the environment and indeed we got our first recognition of this in 2003. “One of the great things about the OTC Product & Retail Awards is its use of independent pharmacists to judge the awards. It’s great that our product appealed to them and also reflects the facts that many more patients and consumers are now much more conscious of being able to buy more products which have a lower environmental impact. Recent legislations have cut the numbers of plastic bags being used dramatically by shoppers and television programmes such as the BBC Blue Planet and the Sky Ocean Rescue campaigns are raising awareness of the need for us all to change our behaviours in this area. “The TePe GOOD toothbrushes are our first products in a line using this new technology and we look forward to launching new products with the pharmacies in Ireland soon. We are also sure that the key in producing long-lasting changes in behaviour is to ensure that the costs of the product do not mean that they price people out of the market. This is the reason we have set the RSP at E3.10 for the adult brush.”

Best Oral Health Product – The Finalists Product Company UltraDEX On the Go Eurosales Mouthwash PapayaGold® Pharmed Paw Paw Balm Kin Gingival Pamex Mouthwash 500mls

UltraDEX On the Go Mouthwash

PapayaGold® Paw Paw Balm

Kin Gingival Mouthwash 500mls


86

OTC Awards Red Carpet

Celebrating Success in the OTC Sector Pharmacy industry professionals gathered at the Radisson Blu Dublin on March 7th to recognise achievements within the over-the-counter (OTC) sector. Over 150 attended the OTC Product & Retail Pharmacy Awards for the fourth consecutive year, representing the leading manufacturers, buyers, suppliers and pharmacists.

& Retail Pharmacy Awards acknowledged winners across 22 categories ranging from Best Beauty and Best Baby Product to Best Marketing Campaign and Best Training Initiative.

Hosted by Laura Dowling, the Fabulous Pharmacist, the OTC Product

Pictured over the following 3 pages are some of those who attended.

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1: Jo Somerville and Kevin Gaul, Managing Directors, both The Cosmetics Association 2: Barbara Smith, National Sales Manager and Rachel Doggett, Account Manager, Ireland, both with Water Wipes 3: Martin Gallagher, Director of Marketing & Business Development and Samantha Doundoulakis, Marketing Manager, both with Clonmel Healthcare 4: Heidi Ashmore, Key Account Manager and Mark Turrell, Sales Director, Ascension Healthcare 5: Members of the Judging Panel; Geraldine Ramage, Group Superintendent Pharmacist, Sam McCauley Chemists, David McLean, CPD Sessions and Karen Ahern, Pharmacist, 4Front Pharmacy Solutions 6: Banu Toroglu, Head of Marketing & Activation, Tara Jackson, Brand Manager and Bridget Barcoe, Marketing, all Reckitt Benckiser


88

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OTC Awards Red Carpet

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1: Rob Faulkner, Strategy & Implementation Manager and Niall McMorrow, Brand Manager, both Perrigo 2: Orla Smith, Medical Sales Representative and Barry O’Dwyer, Sales Manager, TheaPamex 3: Laurene Demeules, Holos Cosmetic Formulator and Niamh Hogan, Creator and CEO of Holos Skincare 4: Simon Bradley, UK Commercial Manager, Tanita Europe BV, Triona Hanley, Cassandra Fanara, Marketing Executives, Pharmed and Peader Coyle, Business Development Manager, Pharmed & Pharmaforce 5: Lauren Fitzgerald, Brand Manager, John Meany O’Brien, Owner & Director and Fiona Cooke, Brand Manager, all Eurosales 6: Paula O’Neill and Kelly Wright, Marketing Executives with Vita Liberta 7: Cormac Leonard, National Account Manager, Consumer Healthcare Ireland and Tanya O’Toole, Head of Consumer Healthcare Ireland, both Sanofi 8: Samantha Bakir and Cormac Tobin


Nu

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Ticket to Travel Health Around two million Irish people will go on a sun holiday this year, according to the Irish Travel Agents Association. Pharmacy has utilised the changes in legislation since 2000 to increase the range and supply function of services such as travel health to travellers. With the number of travellers leaving Ireland and trying new destinations there is an increasing need for more travel health provision. Rates of international travel are increasing annually, with particular growth observed in travel to Southeast Asia and to emerging economies. While all patients traveling across geographic regions are recommended to receive a pre-travel consultation to consider their individual risks, many do not, or receive care and recommendations that are not consistent with current evidencebased guidelines. As experts in medicines, and given the largely preventive nature of most travel health recommendations, pharmacists are well suited to help address this need. Pharmacists possess a high degree of knowledge and confidence with more commonly observed travel health topics in community practice such as travellers’ diarrhoea. Pharmacists providing travel advice are also reminded to consider non-infectious risks of illness and injury abroad and to

advise those presenting in the pharmacy on strategies to minimise these risks in addition to providing drug and vaccine recommendations. International Travel The United Nations World Tourism Organisation has reported a steady rise in international travel. In fact, 2016 marked the seventh consecutive year of above-average international arrivals, reaching 1.2 billion. This is expected to continue to increase at a rate of 3.3% annually through 2030. Survey research suggests that 22–64% of travellers experience some degree of health impairment while traveling. Travellers’ diarrhoea is most common, affecting 30–80% of travelers, depending on the destination, with malaria and vaccine-preventable infections significantly less common. Important information to obtain from those seeking medical travel advice includes the travel destination, reason for travel (such as work, or leisure), duration of travel, itinerary, and any specific health concerns. Pharmacists may also be instrumental in helping patients locate a travel-medicine clinic.

90 | PHARMACYNEWSIRELAND.COM

Common Ailments Diarrhoea is one of the most common symptoms experienced during travel. Travellers’ diarrhoea is defined as passing 3 or more loose/watery bowel motions in 24 hours. It may be accompanied by any of the following symptoms; fever, tummy cramps, urgent need to pass bowel motion, nausea or vomiting. Most cases occur in the first week of travel and are mild; i.e. diarrhoea is the only symptom and it does not disrupt normal activities. On average, symptoms last for 3-5 days and most cases resolve without any specific treatment. When travellers’ diarrhoea is associated with additional symptoms and this leads to an interruption of normal activities, it is classed as moderate to severe. Travellers’ diarrhoea can be caused by many different organisms including bacteria, such as E.coli and Salmonella, parasites such as Giardia, and viruses such as norovirus. All these organisms are spread through eating/drinking contaminated food/water or contact between the mouth and contaminated hands, cups, plates etc.

Loose bowel movements can also result from a change in diet including, for example, spicy or oily foods. The priority in treatment is preventing dehydration, especially in young children. • Clear fluids such as diluted fruit juices or oral rehydration solutions (purchased as packeted oral rehydration salts) should be drunk liberally. • All rehydrating drinks must be prepared with safe water. Antidiarrhoeal Agents can help, particularly with associated colicky pains. If > 6 diarrhoea stools are passed in 24 hours and cause incapacitation, or there is blood or mucous in the stool, or marked vomiting, fever, pain, bleeding, medical attention must be sought. Intravenous fluids may be needed to prevent dehydration. Malaria is a serious disease that can be life-threatening. It can affect anyone who travels to a region where infected mosquitoes are found. The burden of malaria is felt most strongly in sub-Saharan Africa, where numerous initiatives are aiming to improve disease


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She says “The days before departing for a holiday can be very hectic. That is why we have published this handy checklist so nothing important gets left behind.” In terms of offering advice to customers, Ann-Marie suggests the following. “The most important thing to remember is essential medicines. Individuals should bring at least enough for the duration of their trip, and always bring a copy of their prescription in case they need something while away. Be aware of the storage conditions of their medications, some will need to be refrigerated. Offer tips on how best

prevention or treatment. Despite reductions in the number of people affected by malaria each year, progress is threatened by the rapid spread of resistance to insecticides and antimalarial drugs But malaria shouldn’t ruin anyone’s trip abroad. Mosquito bite prevention is an important way to reduce the risk of getting malaria; however, for many destinations, travellers are also advised to take malaria chemoprophylaxis. The initial symptoms of malaria resemble flu symptoms, such as vomiting, fever, headache and shivers/chills. Other symptoms, such as diarrhoea, shivering, general malaise, and body aches can also occur. In some cases, flu-like symptoms can be mild or diarrhoea alone may be present, this can make it difficult to diagnose the disease correctly. Malaria can develop within seven days of being bitten by an infected mosquito. However, P. falciparum malaria can take up to three months to develop, while other types of malaria can lie dormant for up to a year. A patient with malaria may seek over-the-counter cold or flu remedies. If this occurs within one year (but especially in the first three months) of their return from a malaria-endemic country, then malaria should be considered. The risk of serious malaria will also be increased for some individuals, for example those who are very young, elderly, pregnant, or who have had a splenectomy. Each travel consultation by a pharmacist is unique and requires individualised advice. Effective bite prevention is the first line of defence against malaria. Stopping bites before they occur also reduces the traveller’s risk of contracting other diseases transmitted via mosquitoes. Travel thrombosis is now a recognised condition. It can affect all travellers, whether it be by air, sea or road, and seems

to be related to long periods of immobility. There is little evidence to suggest that flying is any more dangerous than taking a long sea voyage or traveling by train, bus or car. A pharmacist can assess the risk of travel thrombosis. These risks clearly relate to increasing age of patients, a past history of deep vein thrombosis of whatever cause, a co-existing medical illness, recent surgery, recent accident and, in particular, immobilisation in a plaster cast. Any traveller with any of these conditions is clearly at increased risk. Pharmacists can identify those patients who are at no additional risk, those with some risk factors and those with considerable risk factors. The pharmacist is then in a position to provide advice. All passengers should be aware that sitting down for long periods of time results in the stagnation of blood flow through the legs, which may precipitate thrombus formation. Clots usually start in the small veins in the leg and progress into the larger veins. The process might start during travel and can then continue, often during the holiday period, with further extension occurring during the return journey. For this reason, travellers are more likely to experience problems on the return journey. Before traveling passengers should be encouraged to exercise (walking). After sitting for long periods further exercise can be taken, which may involve walking or carrying out active exercises while seated. The avoidance of drinking too much alcohol combined with drinking plenty of water is advisable. Offering Travel Advice Ann-Marie Horan is a pharmacist at Fortfield Pharmacy, Dublin and a member of the IPU’s Executive committee. Last year, the IPU published a checklist for use by all community pharmacies in helping to advise those travelling.

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TIPS TO PROVIDE: • Medication: Make sure to bring an adequate supply of prescription medication on holidays. Always carry some medication in hand luggage in case checked-in luggage is delayed or goes missing. • Sun: In warmer climates, stay out of the sun between 11am and 3pm. Protect with a high sun protection factor (SPF) with UVA protection, along with a hat, sunglasses and t-shirt. Apply a complete sun block to children and reapply frequently, especially after swimming.

to transport and store these medications. “Depending on where a person is travelling to, and their own language skills, they may find it challenging to communicate with a pharmacy abroad. That is why we would always recommend bringing a supply of common medicines including antihistamines, pain relievers and treatments for upset stomachs.” Of course it is not all about medicines, you should also ensure your store is properly category managed with the full range of sun creams and insect repellents, as well as travel sized toiletries. If a customer comes into the pharmacy asking for insect repellent, this gives pharmacists, and pharmacy staff, the opportunity to ask where they are travelling to and then you can discuss what other items they may need to purchase, such as anti-diarrhoea or oral rehydration treatments. Depending on their destination, the following items can be useful in a travel health kit: • Sunscreen • After-sun lotion • Oral rehydration sachets

• Sunburn: Those with sunburn should stay out of the sun for a few days until the sunburn dies down. Drink plenty of water. Advise on appropriate creams and painkillers to relieve symptoms and bring down a temperature. Severe cases of sunburn may require special burn cream and burn dressings.

• Anti-diarrhoea tablets

• Mixing Alcohol and the Sun: Be careful when drinking alcohol in hot weather as it can cause dehydration. Those who have taken alcohol should avoid swimming or engaging in sporting activities.

• Motion sickness tablets

• Insect bites: Bring insect repellent to protect from insect bites. Those who get bitten should be advised to wash the area with soap and water, and apply a cool compress or calamine lotion to help cool down the affected area. Finally, apply some antiseptic cream to avoid infection. Business Opportunities Alongside giving the appropriate advice, pharmacies can also capitalise on the business opportunity that the travel health category offers. Staff can help customers assemble a travel health kit that is appropriate for the area they will be visiting.

• Laxatives • Lip balms (with SPF) • Tissues/wet wipes/ alcohol-based hand sanitiser • Contraception • Antihistamines

• Painkillers such as paracetamol or ibuprofen • Insect repellent and bite cream • Remedies for indigestion or over-indulgence. Pharmacists should also suggest that customers take a first aid kit, whether it is pre-prepared or comprises individual items. Again, the recommended contents will depend on the person’s destination. For example, a basic kit containing antiseptic cream, plasters and antiseptic wipes will often suffice when travelling on a European holiday or to developed countries, but if someone is going on a more adventurous trip, such as trekking through the Amazon, they will need a more comprehensive kit containing items such as sterilised syringes, sutures and clean needles.


Topic Team Training – Managing Menopause A community pharmacy environment that fosters teamwork ensured high levels of consumer satisfaction. This series of articles is designed for you to use as guide to assist your team in focusing on meeting ongoing CPD targets and to identify any training needs in order to keep the knowledge and skills of you and your team up to date.  Is there any further training required to assist the team discussing menopause and HRT options with customers? Key Points Check your pharmacy team are aware and understand the following key points:  Customers that should be referred to the pharmacist  Those suffering with severe symptoms should be referred to their GP  Ensure you are providing discreet advice to assist those presenting in the pharmacy  Ensure effective category management with allied condition treatments close to hand for those suffering from vaginal and urinary symptoms such as dryness or itch  HRT is the most effective treatment for vasomotor symptoms of the menopause  Advise on benefits of keeping a hot flush ‘trigger record’ in order to help avoid contributing factors  The value of complementary therapies for menopausal symptoms  Benefits and risks of HRT The below information, considerations and checklist provides support to enable you to run a team training session and identify opportunities for learning within the topic of Menopause. The menopause is sometimes known as the 'change of life' and is marked by the ending of menstruation (when a woman's periods stop). A woman's periods do not usually stop suddenly. They generally become less frequent, the odd period is missed and then they stop altogether. The average age for a woman to reach the menopause is 52. A woman is said to have reached the menopause once she has not had a period for one year. After this point, she can be described as post-menopausal. If the menopause occurs in a woman who is under 45 years of age, it is known as premature menopause. It is estimated that premature menopause affects 1% of women under the age of 40 and 0.1% of women under the age of 30.

It is estimated that 8 out of 10 women experience symptoms leading up to the menopause. Of these, 45% find their symptoms difficult to deal with. In most cases, the first symptom is a change in the usual pattern of their periods. Their period may start every two to three weeks, or they may not have one for months at a time. The amount of menstrual blood lost may also change, and most women find it increases slightly. Without treatment, most menopausal symptoms gradually stop naturally. This usually happens two to five years after the symptoms start, although some women experience symptoms for many more years. Symptoms include hit flushes, sleep disturbance, vaginal symptoms such as vaginal dryness, itching or discomfort, and urinary symptoms, such as urinary tract infections. Pharmacists and their staff have a real opportunity to help those experiencing the menopause,

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providing a patient-centered approach to advising women about the menopause, and provide robust information about the risks and benefits of menopause hormone treatment that will allow patients to make an informed choice about how to relieve their symptoms. Consider  Am I, and my team, aware of the symptoms of menopause?  Does my team have the confidence to deal with women suffering from menopausal symptoms sensitively?  Is the pharmacy team aware of the different lifestyle factors which can alleviate symptoms, such as exercise benefits and staying cool?  Is the pharmacy team confident in informing pharmacy customers on the recommended treatment?  Many women are concerned about the link of breast cancer to HRT, am I and my team educated on the latest guidance?

Actions  Ensure discreet merchandising of products such as pads and disposable pants. Creating a ‘Women’s Zone’ could help with this  Insomnia is a key symptoms of menopause, ensure a good selection of sleep aids are available  Locate products in a quiet area visible from the pharmacy so people can be approached to see if they need help  Train the team to meet all the above considerations Resource  www.cleanmarine.ie/hormones A Free Hormone Guide for women of every age Learning  My Second Spring – offering advice and tips for menopausal customers www.mysecondspring.ie


at Su p & ion po M PR al rt ar A e ch Ca dv d b -A m er y pr pa tis il ig ing 20 n 19

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News

Uniphar’s FIXXA supports Team Ireland Uniphar’s FIXXA, the official first aid partner to Special Olympics Ireland, joined athletes at Dublin Airport recently, to support Team Ireland as the delegation departed for the 2019 World Games in Abu Dhabi. Siobhan Flynn, Marketing Director, Uniphars FIXXA the official first aid partner of Special Olympics Ireland with athletes on their way to the 2019 World Games and Matt English, CEO, Special Olympics Ireland

Taking place between 14-21 March, the showpiece was the largest sporting and humanitarian event held in the world this year. The games are heavily supported by volunteers and donations, leading FIXXA to get involved to ensure the Irish team is taken care of during the competition. “Offering this support is our way to say thank you to the athletes and volunteers who bring so much joy to the Irish nation,” said Siobhan Flynn, Uniphar Retail Services. “Each of them has dedicated four years to reaching this point and

we want to make sure that nothing gets in their way.” A total of 91 athletes will travel to the capital of the United Arab Emirates to participate in 12 sports including athletics, badminton, basketball, bocce, bowling, equestrian, football, golf, gymnastics, kayaking, swimming and table tennis. “Our athletes can’t wait to board the plane so they can start competing in Abu Dhabi,” said Matt English, chief executive officer at Special Olympics Ireland.

“Making sure they’re fit and healthy will be our number one priority and we’re well placed to do that with FIXXA First Aid onboard.” The partnership between FIXXA First Aid and Special Olympics Ireland will begin at the World Games and continue to strengthen once the athletes return home. In association with local community pharmacies, FIXXA has committed to provide each of the 317 Special Olympics clubs across Ireland with a first aid kit, covering 7,985 athletes across 15 disciplines.

Ireland behind in Rare Diseases Just one-third of medicines for rare diseases licensed for patients in Europe are available in Ireland, according to new figures released on Rare Disease Day by the Irish Pharmaceutical Healthcare Association (IPHA). According to the figures, just 29% of all available orphan medicines licensed by the European Medicines Agency for use in patients in 27 European countries were available to patients here. Ireland ranked in the bottom half of the list of European countries, and behind all other western European Union countries, including Denmark, Spain, Sweden, Italy and Austria.

The figures, compiled by IQVIA for the European Federation of Pharmaceutical Industries and Associations which includes IPHA, relate to rare diseases medicines authorised by the European Medicines Agency in the years 2015, 2016 and 2017. The figures released today [Thursday] refer to the rate of availability to patients of those medicines at the end of 2018.

The UK and Germany performed best, according to the figures, scoring 92% and 96% for availability of orphan medicines, respectively.

Rare diseases affect about 300,000 people in Ireland during their lifetime, according to Rare Diseases Ireland. Rare diseases are among the hardest medical

PHARMACYNEWSIRELAND.COM

conditions to treat. Though they affect fewer than one in 2,000 people, three-quarters of rare diseases are found in children and the mortality rate is very high. There are between 7,000 and 8,000 recognised rare diseases. IPHA has established a Rare Diseases Group which though calling for a speedy publication of the second National Rare Disease Plan, is also urging that more progress needs to be made in implementing the recommendations on medicines in the existing plan.

Review on Pressure Ulcers An updated review of research led by RCSI has shown that there may be specific methods of managing pressure ulcers, such as using silicone dressings or particular topical treatments, which can aid in the prevention and treatment of these wounds. Pressure ulcers, commonly known as bedsores, are injuries to the skin and/or the underlying tissue that are caused by prolonged pressure being placed on the more bony areas of the body, such as the hips and shoulder blades. These types of wounds can be painful, take a long time to heal and are expensive to treat. The study analysed 18 different clinical trials involving 3,629 participants who were at risk of developing pressure ulcers, such as those with limited mobility and the elderly. One out of five trials found evidence that skin treatments containing fatty acids reduced the likelihood of pressure ulcers developing. Conversely, one out of four separate trials found that skin treatments using the substance dimethyl sulfoxide (DMSO) may actually increase the risk of pressure ulcers developing. Six trials involving silicone dressings for bedsores suggest they help to reduce the risk of the wounds forming, although the results are not clear as the research methods used were not reliable. The remaining trials revealed no conclusive evidence, except for one trial that indicated padded adhesive dressings can potentially increase the risk of pressure ulcers developing. Commenting on the study, Professor Zena Moore, Director of the Skin, Wounds and Trauma (SWaT) Research Centre and Head of the School of Nursing and Midwifery at RCSI, says, “The high cost to healthcare systems is a major factor in why this research is necessary; if we can find effective methods of treatment, we can reduce this cost and the considerable strain it places on healthcare systems globally.”


Clinical Profiles VEDOLIZUMAB (ENTYVIO®) ACHIEVES SUPERIOR RATES OF CLINICAL REMISSION VS. ADALIMUMAB (HUMIRA®) IN FIRST EVER HEAD-TO-HEAD BIOLOGIC CLINICAL STUDY IN ULCERATIVE COLITIS Takeda Pharmaceutical Company Limited (TSE:4502/NYSE:TAK) (“Takeda”) has announced results from the Phase 3b head-tohead VARSITY study which demonstrated that the gut-selective biologic vedolizumab (Entyvio®) was superior to the anti-tumour necrosis factor-alpha (anti-TNFα) biologic adalimumab (Humira®) in achieving clinical remission* in patients with moderately to severely active ulcerative colitis at week 52. Data showed that 31.3% (n=120/383) of patients receiving vedolizumab intravenous (IV) achieved the primary endpoint of clinical remission compared to 22.5% (n=87/386) of patients treated with adalimumab subcutaneous (SC) at week 52, with the difference being statistically significant (p=0.0061). These results were announced as an oral presentation (OP34) on Saturday March 9, 2019 from 09:40-09:50, at the 14th Congress of the European Crohn’s and Colitis Organisation (ECCO) in Copenhagen, Denmark.1 Furthermore, treatment with vedolizumab was associated with significantly higher rates of mucosal healing** at week 52, with 39.7% of patients receiving vedolizumab achieving mucosal healing compared to 27.7% treated with adalimumab (p=0.0005). A non-statistically significant difference in favor of adalimumab was seen in the percentage of patients using oral corticosteroids at baseline who discontinued corticosteroids and were in clinical remission*** at week 52. While the study was not powered to compare the safety of the two biologics, patients treated with vedolizumab (62.7%) had a lower rate of overall adverse events over 52 weeks than patients treated with adalimumab (69.2%), with a lower rate of infections reported in patients treated with vedolizumab (33.5%) as compared to adalimumab (43.5%). The rate of serious adverse events was also lower in vedolizumab-treated patients than adalimumab (11.0% vs. 13.7% respectively).1 “The VARSITY study addresses critical questions concerning the selection of biologic therapy in ulcerative colitis,” said Dr. Bruce E. Sands, primary investigator of the VARSITY study and Chief of the Dr. Henry D. Janowitz Division of Gastroenterology at Mount Sinai Hospital and the Icahn School of Medicine at Mount Sinai in New York. “The goal of treatment in

ulcerative colitis is to achieve clinical remission and mucosal healing, and these results clearly highlight the benefits seen with vedolizumab versus adalimumab on these important outcomes. The results also showed lower rates of overall and serious adverse events including infections in patients treated with vedolizumab than adalimumab.” “As the first clinical study to directly compare the efficacy and safety of two commonly used biologic therapies in patients with ulcerative colitis, VARSITY provides invaluable knowledge to help inform physicians’ treatment decisions when initiating biologic therapy,” said Jeff Bornstein, M.D., Executive Medical Director, Takeda. “This is also the first time we have seen a direct comparison between two medicines with distinct modes of action in ulcerative colitis, the gut-selective anti-alpha4beta7 integrin vedolizumab and the anti-TNFα adalimumab. This is an exciting time in the landscape of ulcerative colitis treatment, as head-to-head clinical data has not previously been available to guide treatment decisions around biologic therapies.” VARSITY is a phase 3b, randomized, double-blind, double-dummy, multi-center, active-controlled study to evaluate the efficacy and safety of vedolizumab IV compared to adalimumab SC at week 52 in patients with moderately to severely active ulcerative colitis. The study randomized 769 patients (vedolizumab n=383 or adalimumab n=386), all of whom had inadequate response with, loss of response to, or intolerance to corticosteroids, immunomodulators, or one TNFαantagonist other than adalimumab prior to being enrolled. Patients were randomized into one of two treatment groups, vedolizumab IV and placebo SC or adalimumab SC and placebo IV. Patients in the vedolizumab group were administered vedolizumab IV 300 mg at weeks 0, 2, 6 and every 8 weeks thereafter until week 46, along with placebo SC at week 0 and every 2 weeks until week 50. The adalimumab group were administered adalimumab SC 160 mg at week 0, 80 mg at week 2 and 40 mg every 2 weeks until week 50, along with placebo IV at weeks 0, 2, 6 and every 8 weeks thereafter until week 46. Dose escalation was not permitted in either treatment arm during the study.1,2 * Primary endpoint: Clinical remission is defined as a complete Mayo score of ≤2 points and no individual subscore >1 point. ** Secondary endpoint: Mucosal healing is defined as Mayo endoscopic subscore of ≤1 point. Mayo score: instrument

designed to measure disease activity of ulcerative colitis. *** Secondary endpoint: Corticosteroidfree clinical remission is defined as patients using oral corticosteroids at baseline (week 0) who have discontinued oral corticosteroids and are in clinical remission at week 52.

ViiV HEALTHCARE PRESENTS POSITIVE, 48-WEEK DATA FROM TWO PIVOTAL PHASE III STUDIES SHOWING LONG-ACTING, INJECTABLE TWO-DRUG REGIMEN OF CABOTEGRAVIR AND RILPIVIRINE HAS SIMILAR EFFICACY TO DAILY, THREE-DRUG ORAL TREATMENT IN ADULTS LIVING WITH HIV-1 INFECTION Comprehensive data from ATLAS and FLAIR studies presented at the 2019 Conference on Retroviruses and Opportunistic Infections show investigational long-acting injectable to be effective in maintaining viral suppression. ViiV Healthcare presented comprehensive 48-week data from the ATLAS (Antiretroviral Therapy as Long-Acting Suppression) and FLAIR (First Long-Acting Injectable Regimen) pivotal phase III studies of the novel, investigational, longacting regimen of cabotegravir and rilpivirine. These two studies met their primary endpoints, showing that the combination of ViiV Healthcare’s cabotegravir and Janssen’s rilpivirine, injected every four weeks, was non-inferior in maintaining viral suppression in adults infected with human immunodeficiency virus type1 (HIV-1) when compared to a standard of care, daily, oral three-drug regimen. These data were presented today at the 2019 Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle, Washington. John C. Pottage, Jr., M.D., Chief Scientific and Medical Officer of ViiV Healthcare, said:“With FLAIR and ATLAS, we now have positive results from two pivotal phase III studies demonstrating that this long-acting, once-monthly injectable regimen has similar efficacy, safety and tolerability to a daily oral three-drug regimen for the treatment of HIV. We are also encouraged by patient preference data showing that nearly all participants who switched to the long-acting injectable regimen preferred it over their prior oral therapy. If approved, this two-drug regimen would give people living with HIV one month between each dose of antiretroviral therapy, changing HIV treatment from 365 dosing days per year, to just 12. We look forward to submitting applications to regulatory authorities later this year.” ATLAS 48-week efficacy and safety results - The global, pivotal,

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phase III ATLAS study met its primary endpoint, with cabotegravir and rilpivirine demonstrating noninferiority to an oral three-drug regimen of two nucleoside reverse transcriptase inhibitors (NRTIs) plus a third agent, as measured by the proportion of participants with plasma HIV-1 RNA ≥50 copies per millilitre (c/mL) using the FDA Snapshot algorithm at Week 48 (cabotegravir + rilpivirine: 5/308 [1.6%], current antiretroviral therapy [CAR]: 3/308 [1.0%], adjusted difference: 0.6%, 95% confidence interval [CI]: -1.2, 2.5). The study found virologic suppression rates (HIV-1 RNA <50 c/mL) at Week 48 were similar between treatment arms (cabotegravir + rilpivirine: 285/308 [92.5%], CAR: 294/308 [95.5%], adjusted difference: -3%, 95% CI: -6.7, 0.7). Confirmed virologic failure (CVF) was infrequent. Three participants (approximately 1% of the study population) who received longacting cabotegravir plus rilpivirine developed CVF with subsequent identification of resistance mutations to one or both agents. In two of these cases, pre-existing NNRTI resistance was identified. Two of the three individuals were from Russia and all three had HIV-1 A subtypes, which are seen frequently in Russia, Eastern Europe and East Africa; however, they are seen infrequently in other parts of the world. This unexpected pattern warrants further investigation. In the oral CAR arm, there were four participants who developed CVF, three of whom developed drug resistance mutations. Treatment with cabotegravir and rilpivirine was generally welltolerated, with low rates of serious adverse events (SAEs) (13/308 [4.2%]) and adverse event (AE) withdrawals (10/308 [3.2%]). Of the participants who received cabotegravir and rilpivirine injections, 83% (250/303) reported an injection site reaction (ISR) at some point through the 48-week study. A majority of injections did not result in ISRs being reported, as out of a total of 6978 injections administered during the 48-week study, 1460 ISRs were reported. Most ISR events (98.5%) were mild or moderate (mild: 1156/1460, moderate: 283/1460) and lasted an average of three days. Four participants (1.3%) withdrew for injection-related events. Patient treatment satisfaction significantly improved after switching to the long-acting injectable from the previous oral therapy compared to remaining on oral therapy at Week 44 based on the HIV Treatment Satisfaction Questionnaire (HIVTSQs mean difference 5.68; 95% CI [4.37, 6.9]; p<0.001).

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Product News

PACK SIZE CHANGES FOR EPILIM AND EPILIM CHRONO TABLET PRESENTATIONS Sanofi has recently announced that pack sizes for all Epilim Tablet presentations will be changing from 100 tablet packs to 30 tablet packs over the coming months as current 100 tablet packs are exhausted. This will ensure that as many patients as possible receive an original pack when Epilim is dispensed, including safety warnings and patient information leaflets. Sanofi would like to reinforce that all patients being dispensed Epilim should receive their medicine in the original package with an outer warning. Dispensing outside of original packaging should be avoided. In situations where this cannot be avoided, a copy of the package information leaflet should always be provided, as well as a warning label added to the outer packaging. Pharmacists are reminded that each time they dispense Epilim, they should ensure the patient has a Patient Card and Patient Guide; and should also remind the patient of the risks of pregnancy while taking Valproate and therefore the need for highly effective contraception.

PROCEIVE® ADVANCED FERTILITY SUPPLEMENTS Proceive® Advanced Fertility Supplements provide the most comprehensive nutritional formulations including Folic acid, amino acids, vitamins and minerals to support fertility and nutritional deficiencies associated with the reproductive system. The range comprises of capsules for men and women - for those couples who have decided to give themselves the best start to help with their fertility journey. The MAX Men and Women’s products are for older couples and those couples who have been trying for a year or more. The Proceive® team at Ocean Healthcare have successfully introduced the range to leading IVF clinics. Dr Phil Boyle from Neo Fertility Clinic in Dublin commented “As a fertility specialist, I understand how important good quality nutrition is for couples trying to conceive, so even if you have a healthy, balanced diet, I would always recommend taking a supplement with a comprehensive formulation; women should make sure that they take something that includes B vitamins and magnesium as well as folic acid, whilst men should ensure they are boosting the quality of their sperm with selenium and arginine.”

Press Release: Rowalief 500mg Film-coated tablets paracetamol HOD 26/03/19

Press Release: ROWA PHARMACEUTICALS LTD IS Rowalief 500mg Film-coated tablets paracetamol TO ANNOUNCE THE LAUNCH PLEASED Rowa Pharmaceuticals Ltd is pleased to announce the laun HOD 26/03/19 500mg Film-coated tablets in a 300-pack size. OF ROWALIEF 500MG FILM-COATED Rowa Pharmaceuticals Ltd is pleased to announce TABLETS IN A 300-PACK SIZEthe launch of Rowalief 500mg Film-coated tablets in a 300-pack size.

Therapeutic Indications:

Therapeutic Indications:

Rowalief Therapeutic Indications:

500mg Film-coated tablets is indicated for the sym

Rowalief 500mg Film-coated tablets is indicated the treatment of mild to moderate painfor and fever. Rowalief 500mg Film-coated tablets is indicated for the symptomatic symptomatic of mild to fever. moderate pain and fever. treatment of treatment mild to moderate pain and BRAND

BRAND NAME

NAME STRENGTH

Rowalief

500 mg

STRENGTH

PACK SIZE

Rowalief

Packs of 300

LEGAL CATEGORY

500 mg POM

PACK

PA SIZE NUMBER

Packs of 300

LEGAL PA NUMBER CATEGORY BARCODE TRADE

PA0074/065/001

POM

PRICE

PA0074/065/001

5390387377044

€ 4.58

539

For further information or to order contact our Rowex® Telesales Team: Irene, Jeanne Marie or Rita on 1800 304 400 Product subject to medical prescription. Further information and SPC are available from the Marketing Authorisation Holder: Rowa Pharmaceuticals Ltd., Bantry, Co. Cork, P75 V009 Freephone: 1800 304 400 Fax: 027 50417 E-mail: rowex@rowa-pharma.ie For further information or to order contact our Rowex® Telesales Team: Irene, Jeanne Marie or Rita on 1800 304 400

Date of preparation: (03-19) CCF No: 21963

Product subject to medical prescription. Further information and SPC are available from the Marketing Authorisation Holder: Rowa Pharmaceuticals Ltd., Bantry, Co. For Cork,further P75 V009 Freephone: 1800 304 400 Fax: 027 50417 information or to order contact our E-mail: rowex@rowa-pharma.ie Irene, Jeanne Marie or Rita on 1800 304 400

Rowex® Tel

Product subject medical prescription. Further Dateto ofWITH preparation: (03-19) CCF No: 21963 informatio CARING FOR BABIES’ SKIN THE available from the Marketing Authorisation Holder: Rowa P WORLD’S PUREST WIPES

Ltd., Bantry, Co. Cork, P75 V009 Freephone: 1800 304 400 WaterWipes® and new WaterWipes with Soapberry are made with E-mail: rowex@rowa-pharma.ie 99.9% water and a drop of fruit extract, and are carefully designed to be suitable and safe for sensitive skin Date of preparation: (03-1 WaterWipes, creator of the

world’s purest baby wipes, has grown from its humble beginnings in Drogheda, Co. Louth to become the number one brand in its product category.

WaterWipes with Soapberry In late 2018, WaterWipes introduced a new wipe for growing babies who are starting to explore food and the world around them. WaterWipes with Soapberry are made with 99.9% water plus a drop of fruit and Soapberry extract, providing parents with the purity they rely on from WaterWipes, while harnessing the natural cleaning properties of Soapberry. WaterWipes are recommended by 97% of midwives for use on newborn baby’s skin, and as a suitable alternative to cotton wool and water. Both WaterWipes and WaterWipes with Soapberry are accredited by Allergy UK.

About WaterWipes WaterWipes, a global Irish brand, are the world’s purest baby wipes made with 99.9% water and a drop of fruit extract. Two types of wipes are now available from the brand – Newborn and WaterWipes with Soapberry. For more information, please visit https://www.waterwipes.com/

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