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August 2019 Volume 11  Issue 8 PHARMACYNEWSIRELAND.COM


Top 100 OTC Products Edition

In this issue: NEWS: LloydsPharmacy acquire Health Express Page 4

REPORT: Public attitudes to pharmacy Page 16

TOP 100: IQVIA Top 100 Pharmacy Products Page 20

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CPD: Antiretroviral use in community pharmacy Page 55

AUTOMATION: eHealth solutions in pharmacy Page 70

FEATURE: To the root of hair loss Page 88


Microsoft will stop supporting Windows 7 from 14 January 2020, which is just over five months away!

This means: • No more security updates • Other software companies will stop supporting it too • New hardware may not work We would strongly recommend all our customers still using Windows 7 to speak to us immediately about upgrading their software and moving to a new PC with Window 10. Failure to do so could mean that your dispensing system slows down or fails to work completely From 18th April you will have started to see pop-up notices on Windows 7 machines advising that all support will end in January. Failure to upgrade will mean using a system that is more and more vulnerable to security risks. New technology will improve your efficiency and reduce your risks. We can help you make a decision. Ask any of our McLernons team today.




Page 5: Pharmacists to share in Uniphar listing

It may be the summer months, but the news shows no signs of abating with much happening in Irish pharmacy circles. News reached the Irish Pharmacy News offices of LloydsPharmacy’s planned acquisition of Median Healthcare Service and three Health Express stores (turn to page 4) whilst it has also been revealed that Uniphar have successfully floated on the stock market after raising some ¤135 million in its initial public offering (IPO).

Page 6: New Medicines tool kit launched Page 12: FEMPI once again to the fore


Page 16: Our Report looks at public attitudes to pharmacy

In other news, keeping track of medication can be confusing and as a result, the HSE has launched a campaign and a tool for the public, to help improve the safe use of medicines. Know, Check, Ask is designed to assist those who take medicines and everyone involved in their care to make better decision about their treatment. The tool, My Medicines List, will be available in all pharmacies across Ireland. Turn to page 6 for further details. And of course, this issue features our exclusive, annual IQVIA Top 100 pharmacy products section.

Page 20: IQVIA Top 100 Pharmacy Products 2019

This information offers you, our readers, a unique opportunity in which to benchmark your OTC offering and manage your stock in one setting – which is essential to bottom line profit.

Page 64: CBD Oil - A Pharmacist’s experience

The IPN IQVIA Top 100 Pharmacy Products offers readers the exclusive opportunity to compare the performance of key brands in the Irish OTC market over the past four years. This invaluable data is exclusive to IPN and its objective is to present retail pharmacy with market information about Ireland’s leading OTC products.


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

Turn to page 20 for all the details. The use of cannabis-based CBD products for medicinal reasons is no longer a taboo or unreported subject in Ireland. As Irish Pharmacy News has previously reported, Minister for Health Simon Harris TD has signed legislation which will allow for the operation of the Medical Cannabis Access Programme on a pilot basis for five years.

MANAGING DIRECTOR Natalie Maginnis n-maginnis@btconnect.com EDITOR Kelly Jo Eastwood: 00353 (87)737 6308 kelly-jo@ipn.ie ADVERTISING DIRECTOR Debbie Graham: 00353 (87) 288 2371 debbie@ipn.ie CONTRIBUTORS David Reilly, MPSI DESIGN DIRECTOR Ian Stoddart Design




16 Irish Pharmacy News is IRISH 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.

The Programme will facilitate access to cannabis-based products for medical use in line with legislation. Pharmacists will also be able to dispense cannabis for medical use to patients under the new law. On page 64 of this issue, Superintendent Pharmacist Stephen Dickson discusses what community pharmacists in Ireland need to know.


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Lloyds expresses interest in Median LloydsPharmacy Ireland is set to acquire Median Healthcare Services and three former Health Express chemists which went into examinership this year. It is believed the takeover of the two businesses, owned by pharmacists Paddy Halligan, Martin Bates and Dave O’Farrell, is subject to approval by the Competition and Consumer Protection Commission. The High Court appointed Neil Hughes of Baker Tilly Hughes Blake accountants in Dublin as

an examiner in April to restructure finances at Median Healthcare and four of the group’s six Health Express stores. The three stores set to be acquired by LloydsPharmacy are in Artane, Tallaght and Greystones, which were all placed in examinership. LloydsPharmacy has 94 stores and employs about 1,000 people.

The pharmacy chain is owned by McKesson Europe. The Health Express chain of pharmacies, which has outlets in Dublin, Wicklow and Westmeath, sought the appointment of an examiner to four of its six stores to restructure its finances in April of this year.

Two pharmacies targeted by robbers An organised crime gang has targeted a rural pharmacy in a brazen robbery. In the latest in a long series of attacks on community pharmacies, a gang stole thousands of euro worth of high end perfume in the raid in Cahir, Co Tipperary. The burglary was carried by two masked men at about 3am from a pharmacy in the centre of Cahir on July 3.

A garda spokesman said that investigations were ongoing. He said: “Gardai are investigating a burglary at a pharmacy in Cahir that occurred on 3/7/19 at approximately 3:15am. Two men, with their faces covered, stole a wide variety of goods including designer perfume. Investigations are ongoing.”

They were driving a black car, which could be a Volvo, and broke into the shop using a large sledge hammer.

Meanwhile a pharmacy worker has received hospital treatment for an injury they received during a robbery in Dublin.

They stole thousands of euro worth of perfumes, for men and women, and a large amount of other products also. Media reports suggested the total value of good stolen could be as high as ¤20,000.

The incident happened at the Maple Centre on the Navan Road at lunchtime on the last Sunday in July. A woman entered the chemist shop armed with a small pocket knife and threatened staff.

She tried to open the cash register but failed, and escaped with a quantity of tablets. A female staff member was injured during the robbery. It is believed they were cut by the knife the woman was wielding and received hospital treatment afterwards. Her injuries were not believed to be serious and she was discharged after assessment and treatment. The raider escaped on foot and gardai are investigating. Earlier this year the Irish Pharmacy Union (IPU) warned that a quarter of Irish pharmacies have experienced violent crime in the previous 12 months.

Calls for free contraception in pharmacy The Irish Pharmacy Union (IPU) has reiterated its calls enabling women to access contraception from their local pharmacy without a prescription and without charge. Whilst emergency contraception is currently available and free-of-charge to Medical Card holders, the IPU would now like to see a scheme implemented whereby regular contraception is equally available. Pharmacist and IPU Executive Committee member, Caitriona O'Riordan says,“Pharmacists would undergo appropriate training on the selection and supply of the most appropriate contraception and therefore there is simply no clinical cause for concern.” The IPU points out that both the American Academy of Family Physicians and the American College of Obstetricians and Gynecologists support access to contraception without prescription and this is becoming increasingly

available from community pharmacists across the US and Canada. The opportunity for increased access to contraception was launched to public consultation in June this year by Minister for Health Simon Harris TD. Earlier, Minister Harris established a Working Group to consider the policy, regulatory and legislative issues relating to enhanced access to contraception, following the recommendation of the Joint Committee on the Eighth Amendment. “Removing barriers to contraception in a key priority for me as Minister for Health,” he said. All responses will inform the Working Group's examination of the issues on increasing access to


contraception, and will enable the Working Group make appropriate recommendations to the Minister on policy options. It is expected that the Working Group will report to the Minister by end September 2019. Ms O’Riordan added, “Providing convenient and affordable access to birth control should be a public health priority. Even the World Health Organisation in its recent guidelines said that oral contraceptive pills should be made available without a prescription. “Providing women with this choice will make it easier and more convenient to get contraception safely, meaning more women will use it, which should result in reduced rates of unintended pregnancy.”

Bayer to sell Dr Scholl’s footcare business German chemicals and pharmaceuticals giant Bayer has agreed to sell over-the-counter foot care brand Dr Scholl's to US-based Yellow Wood Partners. The Boston private equity firm will pay ¤521m ($585m) for the business, which generated $234 million in revenues last year, Bayer said in a statement. "We look forward to seeing the brand taken to the next level of success under Yellow Wood's ownership," board member Heiko Schipper said, praising its "exciting pipeline of innovative products". Bayer is selling off chunks of its over-the-counter medicines division, known as Consumer Health, as it struggles with ebbing revenues and profits. The unit includes householdname brands like painkiller Aspirin and indigestion treatment Alka-Seltzer. After taking over US seeds and pesticides giant Monsanto for $63 billion last year, the Leverkusen-based group is reorganising itself around its core businesses and biggest earners in agrichemicals and prescription pharmaceuticals. Meanwhile it is busy battling thousands of US lawsuits over flagship Monsanto herbicides containing chemical glyphosate, which plaintiffs argue caused them to develop cancer after years of use. Last month, a judge slashed damages awarded by a jury to one claimant, Edwin Hardeman, from $75 million to $20 million - while continuing to highlight "reprehensible" conduct by Monsanto. Such wider concerns, with potential costs for the group running into the billions, left the Bayer share price little moved by the announcement. Dr Scholl’s was founded more than 110 years ago, and recorded sales of $234 million last year. According to a Bayer statement, Yellow Wood plans to “create a standalone company in which it plans to invest in all aspects of the business to drive the growth and profitability of the brand.”

News Pharmacy Code of Conduct The Pharmaceutical Society of Ireland (PSI) has announced that the new Code of Conduct will be launched on 25 September this year. A review of the Code of Conduct for Pharmacists commenced in 2017. The current Code is in place since 2009 and the review was undertaken to ensure it continues to reflect the current environment, the evolving role of pharmacists and a changing health service. This review involved a substantial process of research and engagement with pharmacists, stakeholders and the public. In 2017, PSI invited a wide range of feedback on the Code to help them consider any changes that might be needed in a revised Code. Following this consultation, and engagement with relevant experts, the Code was revised and updated, and a public consultation was carried out in August 2018. The revised Code will acknowledge the changes that have taken place in the delivery of healthcare in recent years, the evolving role of pharmacists and the exercise of professional judgement by pharmacists in the fulfilment of their professional responsibilities to patients and the public. The new Code will focus on ensuring that all pharmacists practise in a way that maintains and improves the health, wellbeing, care and safety of patients. The new Code will be launched on 25 September 2019 to coincide with World Pharmacist Day. All pharmacists will receive a copy of the new Code in advance of the launch date, and a series of events on the Code will take place this autumn. PSI will be communicating further details on the dates and locations of the events over the coming weeks. The updated Code of Conduct will be effective from 21 October 2019. The Code applies to all registered pharmacists and is intended to provide support and guidance in their professional practice.


Pharmacists to share in Uniphar windfall A group of pharmacists could be set for a windfall from the sale of shares in the stock market listing of healthcare services group Uniphar. Uniphar Chief Executive, Ger Rabbette Some 1,100 pharmacist customers of Uniphar’s traditional drugs distribution business owned a 65 per cent stake in the company ahead of the initial public offering (IPO). It is understood that the larger shareholders in this group as well as management have committed to not selling any shares for a period after the deal. Uniphar’s shares soared by as much as 8.7 per cent after making its debut on the Dublin and London junior stock markets in late July. The company’s shares floated on the market at ¤1.15 each, but quickly rose to ¤1.25. It raised ¤135 million in its initial public offering (IPO) of shares. A further ¤15 million of shares may also be sold on the market by the managers of the transaction, Davy and RBC Capital Markets, within 30 days of the IPO, bringing total proceeds to ¤150 million. Uniphar, formed in 1994 through the merger of United Pharmacists Co-op and Allied Pharmaceutical Distributors, will use the capital from the placing to pay for

acquisitions, growth and to reduce debt. “We have an ambitious strategy for expansion and growth in the coming years and we are now very well placed to progress to the next exciting development phase,” Ger Rabbette said. The rationale of an IPO is to generate the funds required to grow the business into a panEuropean player. Uniphar already has a presence in Ireland, the UK and the Netherlands. In April of last year, Uniphar announced the acquisition of

family-owned Sisk Healthcare, which at that time, was its biggest such deal in five years. The terms of the transaction were not disclosed but it is understood to involve ¤65 million in cash (some of it deferred as part of a two-year earn-out) plus equity (equivalent to a 15% in Uniphar). The equity piece of the transaction was important as Uniphar was then hatching plans to float on the stock market, most likely in Dublin and London, a move that could provide a windfall over time to the Sisk owners who will soon own a significant slice of Uniphar.

Drug giant merger plan for Pfizer and Mylan A proposed deal between Pfizer and Mylan, pharma giants which between them employ around 4,500 people across Ireland, could see the spin out of blockbuster and profitable drugs Lipitor and Viagra into a separate company. And the transaction may have implications for Ireland in general because much of the investments that have flowed into the country have been US pharmaceutical companies. Pfizer, which employs 3,200 in six Irish locations plans to combine its business that sells older blockbuster medicines such as Lipitor and Viagra with generic drugmaker Mylan, in a deal that will reshape the brand-name and offpatent pharmaceutical industries. Under the terms of the all-shares transaction, Mylan investors would get 43% of the new entity and Pfizer investors the rest. The new publicly traded company will have sales of about ¤18bn in 2020, the drugmakers said. Both Pfizer and Mylan have been trying to reshape themselves

in the face of a rapidly shifting pharmaceutical market.

industry that’s punished its profits and its shares.

The deal will let Pfizer focus its considerable muscle on making new medicines, while Mylan gets a financial lifeline after a rocky stretch.

Mylan investors embraced the deal, sending shares up as much as 19% to the highest level since November. Still, the stock is well below the alltime peak reached in 2015.

Mylan employs around 1,250 at facilities in Dublin and in Connemara in Galway.

Pfizer shares fell 2% at one stage. “I’ve listened very, very carefully to shareholders,” Mylan chairman Robert J. Coury said. “This transaction checks every single box that they have discussed with me.

Pfizer had previously pondered both industry-shaking megadeals and a potential breakup. But it recent years it has been slimming itself into a sleek maker of innovative therapies for cancer and other diseases. At the same time, Mylan, with $11.4bn in sales last year, has been looking for ways to realign its business in an intensively competitive generic-drug

The deal will spin out Pfizer’s Upjohn unit and then combine it with Mylan. The new company will have about $24.5bn in debt and an investmentgrade credit rating, the companies said. The transaction is expected to close in mid-2020. The company will be renamed.




Medicine List Tool available in pharmacy Keeping track of medication can be confusing. As a result, the HSE has launched a campaign and a tool for the public, to help improve the safe use of medicines.

Lloyds completes EPoS update project LloydsPharmacy has completed the roll-out of new electronic point of sale (EPoS) systems across its Ireland estate. The project included the deployment of over 2,200 EPoS systems and P2Pe Chip and PIN devices, as well as more than 1,300 PCs and other pharmacy-specific technology across all of their UK and Ireland stores. The deployment covered LloydsPharmacy’s 1,600-strong retail and pharmacy estate in the UK and Ireland, bringing it all on to the Aures J2 PoS system. Technology support company Vista Retail Support led the comprehensive upgrade, which also involved the upgrade of back office IT systems and the deployment of managed print services, as well as a Cisco Meraki Wi-Fi update.

Justin Looby, Superintendent Pharmacist, Haven Pharmacy, Palmerstown and Gordon Ryan, Patient and user of My Medicines List Know, Check, Ask is designed to assist those who take medicines and everyone involved in their care to make better decision about their treatment. The tool, My Medicines List, will be available in all pharmacies across Ireland. People can create their own list instead or ask their pharmacy or GP practice to print a list of medicines from their records. The campaign encourages people who take regular medicines, and those assisting them, to: • Know your medicines and keep a list, bringing it to appointments and if admitted to hospital • Check that you are using the right medicine the right way • Ask your healthcare professional if you’re unsure According to Muriel Pate, Medication Safety Specialist Pharmacist, HSE, “Sooner or later everyone needs medication and often people can be on a number of medicines for different health conditions. Keeping track of all of these medications can be

confusing and so the HSE has developed a ‘My Medicines List’ which is available to download at www.safermeds.ie and is also available in all pharmacies around the country. “Communication can be a big safety challenge in healthcare. Communication about medicines can be tricky as there can be so many details to remember. The ‘My Medicines List’ will be of huge help, especially when people are admitted to hospital or have an appointment. The new list will help them to communicate with healthcare professionals quickly and easily. We engaged with a lot of different people and groups when we were developing the campaign. They told us that using a medicines list can really help people, families, carers and healthcare professionals understand and communicate better and improve patient safety and health,” she said. Welcoming the campaign, HSE National Director for Quality Improvement Dr Philip Crowley said that everyone has a role to play in medication safety and so before you prescribe, dispense or take medicine you need to make sure you know about it. “That is why the HSE – Know, Check, Ask campaign is an important part of keeping people


well. People need to check that they are using their medication in the right way and if they are unsure they should ask a health professional. In turn, healthcare professionals should ensure that patients understand their medications. We would like to thank the Irish Pharmacy Union and the Irish College of General Practitioners for their help and support with the campaign.” Secretary General of the IPU, Darragh O’Loughlin said, “Nearly half the Irish population lives within one kilometre of their local pharmacy, and pharmacists are the local medicines experts. The better people understand the medicines they are taking, the safer it is for them. Always talk to your local pharmacist about any medicines you’re using and any other questions you might have and, if you’re not sure, ask them for a list of your medication. Pharmacies provide a friendly accessible service at the heart of every community, and we would encourage people to have more conversations with us about their medicines.” The HSE campaign forms part of the World Health Organisation ‘Medication without harm’ initiative which aims to reduce severe avoidable medication related harm by 50% over the next five years.

Vista’s data cabling services were also utilised as LloydsPharmacy focused on boosting its tech infrastructure through re-cabling and patching networks where necessary. Ranjit Gill, CIO of LloydsPharmacy parent company McKesson UK, which was formerly known as Celesio UK, said: “We are very pleased with the way in which Vista have managed our projects; they have the scale, flexibility and experience to manage large scale technology changes within our business – they really are a true partner.” He added that Vista proved its flexibility during the collaboration by ably managing additional project requirements and accelerations. James Pepper, CEO of Vista, commented: “Modern businesses benefit from leveraging the use of the latest technology. “Vista has developed an excellent partnership with Lloyds Pharmacy. The Lloyds Pharmacy and Vista Project teams worked seamlessly together on multiple projects through this year. “LloydsPharmacy are continuing to innovate, and the Vista team are pleased to work with Lloyds to help them achieve this throughout their projects.” The project also involved the upgrade of back office IT systems and the deployment of managed print services.

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Poor blood circulation and

COLD HANDS AND FEET? 35°C 30°C 25°C 20°C 15°C 10°C 5°C

Without Ginkgo-Biloba Pharma Nord: After 10 minutes, the skin temperature increased from 12.6° to approx. 20.0° C.

35°C 30°C 25°C 20°C 15°C 10°C 5°C

With Ginkgo-Biloba Pharma Nord: After 10 minutes, the skin temperature increased from 13.8° to approx. 30.9° C.

The thermal photography shown above depicts the flow of blood through the hands of a person before and after taking Ginkgo-Biloba Pharma Nord. The hands are submerged in 7° C. cold water for two minutes and photographed shortly after. After another 10 minutes, the hands are photographed again.

Many people have a postive experience with using Ginkgo-Biloba Pharma Nord against e.g. cold hands and feet. If the supply of blood to cells and tissues is reduced, it may cause a tendency to have cold fingers and toes. Ginkgo-Biloba Pharma Nord is a traditional herbal medicinal product that can offer help against this and similar conditions.

Traditional herbal medicinal product used to alleviate the symptoms of poor blood flow in conditions such as cold hands and feet, exclusively based upon long-standing use. Always read the leaflet.

Tel: 01 899 1650 • Fax: 01 885 3893 Email: ireland@pharmanord.com • Web: www.pharmanord.ie


Ginkgo-Biloba Pharma Nord has a high content of active compounds: The high content of active compounds makes it possible to obtain the desired effect with 1 tablet twice a day.



Diarmuid O’Donnell Medal Pictured is President of the Irish Pharmacy Union, Daragh Connolly alongside Pharmacist Tony Walsh, who was the recipient of the inaugural Diarmuid O’Donnell medal. The medal was presented to him during the IPU President’s Ball held recently in Galway.

Pharmacists able to dispense CBD in Ireland Community pharmacists are to be able to dispense cannabis for medical use to patients for the first time after Minister for Health Simon Harris TD signed legislation which will allow for the operation of the Medical Cannabis Access Programme on a pilot basis for five years. The Programme will facilitate access to cannabis-based products for medical use in line with legislation. Pharmacists will be able to dispense cannabis for medical use to patients as set out in the legislation, on foot of a valid prescription, once suppliers make the specified controlled drugs available on the Irish market. Pharmacists should also refer to the Clinical Guidelines prepared by the Expert Reference Group, available on the Department of Health website. Minister Harris said the cost will be the same as getting any other prescription in a pharmacy. “You will be assessed on the same basis – if you get the drug payment scheme you will be covered in that, if you have the medical card, you’ll be covered under the prescription charges, if you are on long-term illness, you will be covered under that.” The offences and penalties for unauthorised supply and possession of controlled substances remain unchanged. The Minister added, “For years, families have fought for this programme to be established and for years, we have faced many

challenges, obstacles and hurdles. I am so pleased to advance this Programme and help the lives of many families across the country. “The purpose of this Programme is to facilitate compassionate access to cannabis for medical reasons, where conventional treatment has failed. It follows the clear pathway laid out by the Health Products Regulatory Authority in their expert report ‘Cannabis for Medical Use – A Scientific Review’. “Ultimately it will be the decision of the medical consultant, in consultation with their patient, to prescribe a particular treatment, including a cannabis-based treatment, for a patient under their care. It is important to state that there are no plans to legalise cannabis in this country.” Minister of State for Health Promotion and the National Drugs Strategy Catherine Byrne also welcomed the secondary legislation that will underpin the Medical Cannabis Access Programme. Minister Byrne commented: “This is an important and positive step forward for those individuals who are suffering serious ill health but for whom conventional medicines are not working.”

The signing of the legislation underpinning the Access Programme allows for commencement of the operation of the Access Programme, for first stage of which is for potential suppliers to apply to have their medical cannabis products assessed for suitability for medical use. Currently no medical cannabis products are available in Ireland, however, this legislation now means that commercial operators whose cannabis products meet the specified requirements set out in the legislation and which have been listed in Schedule 1 of the Misuse of Drugs (Prescription and Control of Supply of Cannabis for Medical Use) Regulations will be able to supply these products to the Irish market.

• intractable nausea and vomiting associated with chemotherapy; • severe, refractory (treatment resistant) epilepsy. Work on the establishment of Programme began in March 2017, on foot of the conclusions from the Health Products Regulatory Authority’s (HPRA) expert report Cannabis for Medical Use – A Scientific Review, which was prepared at the request of the Minister for Health.

Once suitable medical cannabis products are made available by suppliers, the Access Programme will make it possible for a medica consultant to prescribe a listed cannabis-based treatment for a patient under his or her care for the following medical conditions, where the patient has failed to respond to standard treatments:

It is important to note that where a cannabis product is a specified controlled drug legally permitted for medical use, in connection with the MCAP, this does not signify any endorsement whatsoever of the safety, quality or efficacy of the specified controlled drug for the indication prescribed and the Minister for Health will have no liability in respect of the use of such products by a person issued with a prescription by their clinician under this Regulation. The use of a cannabis product for the purposes of the MCAP is a matter for the patient and their medical advisor.

• spasticity associated with multiple sclerosis;

• Turn to page 64 for a pharmacy discussion on this topic.


Irish Pharmacy Awards 2019


Ola El-Garawany, Superintendent Pharmacist, Lilly’s Pharmacy & Health Store with Paul Neill, Director, Generics & OTC, Teva Ireland

Winner Ola puts the Super in Superintendent Lilly’s Pharmacy & Health Store’s Ola El-Garawany took the title of Teva Superintendent Pharmacist of the Year Award for 2019. Based in Ratoath, Ola was recognised for her work within the community, managing full responsibility for the pharmacy while also holding service clinics and assisting the rest of the pharmacy team. She is described as not only a professional who excels within her Superintendent

remit, but as an approachable and caring healthcare professional to all her customers and staff.

finished, he wanted to go to the UK and I decided to stay in Ireland,” she explains.

Ola El Garawany owns and runs Lilly’s Pharmacy & Health Store with her daughter Sally El Banna, and has seen their business thrive on their holistic approach to health.

In order to be able to practise as a pharmacist here, she returned to Trinity College and completed a year in the school of pharmacy. She completed a further sixmonth placement in a community pharmacy and after completing her licensing exams, she was qualified to practice in Ireland.

Ola studied pharmacy in Egypt where she grew up. When she came to Ireland in the early 1990s, she did an internship in a community pharmacy. “We came to Ireland as my then husband was studying to be a doctor and he was doing a placement over here. My daughter was three at the time. Our plan was always to return to Egypt but when my husband’s placement

“It took roughly two years to be able to transfer my qualifications to practise here and I have been practicing as a pharmacist in Ireland since 1998,” says Ola. “Career wise, I’m definitely more Irish than Egyptian! I’ve only ever had Irish customers. I didn’t

think twice about being a community pharmacist. I love the interaction with people, I love meeting people and I always did, so there was no doubt in my mind that community pharmacy was where I would practice.” Garawany worked in McCabes Pharmacy and then with Boots. “I worked with Boots for 10 years and I learned so much. I worked my way up to store manager and supervisor pharmacist and I worked in a lot of their stores around Dublin,” explains Garawany. However, when Garawany’s daughter Sally decided to study pharmacy also, she started to think about opening her own business. So how was the transition from

TEVA Superintendent Pharmacist of the Year Ola El Garawany with her Teva Superintendent Pharmacist of the Year award needed further training. “This was 2013 and Sally was working in the pharmacy so we both went and studied nutrition and became qualified and it has changed our business”, Ola explains. Ola and her daughter now employ three staff and offer a number of health screenings in the pharmacy including blood pressure testing, early diabetes detection, cholesterol and obesity testing.

Ola El Garawany and her daughter, Sally El Banna own and run Lilly’s Pharmacy and Health Store in Ratoath, Co Meath working for a company to being self-employed?

stores followed me to my own pharmacy,” she says.

“It can feel very isolating and the first five years were really tough. I started the business with my own money and a silent partner investment. We started as the recession was beginning and there were already four other pharmacies in Ratoath.

It was due to her customer relationships that Ola started to notice a trend in what they were asking her for. “A lot of customers were coming in and asking about supplements and had questions about other aspects of health that I didn’t know about at the time. As pharmacists, we are always continuing our education. We have to as there are always new medications on the market but this was a side of health and nutrition I didn’t know anything about”.

“I had to think outside the box. I had to think of ways to get people through the door so I opened a nail bar in the pharmacy. I also stocked all different products on the floor than any other pharmacy. Those things were really my unique selling points at that time. They were simple strategies but they were effective,” says Ola. Her customer interaction meant that a number of her customers followed her from her previous employment to her new pharmacy. “I always gave people time. No matter what pharmacy I worked in, I made sure I was out on the floor talking to people. When I opened my own pharmacy a lot of customers I had in previous

Garawany started to attend health and nutrition trade shows and she realised, if she was going to incorporate this into her business to meet her customers needs, she

The demand for these tests, as well as for the nutrition advice and dietary plans they offer, means she has had to set up an appointmentbased system at the pharmacy. Over the last twelve months, within her pharmacy Ola has carried out a number of public service initiatives and services. Ola ran a 3 week detox programme after Christmas with the store nutritionist Amy. This was based on The Detox diet created by the Institute for Functional Medicine. She created the 3 weeks Detox-clean eating program partnered with Amy Douglas qualified Nutritionist @Restoring Roots Nutrition. “The Detox Diets can be confusing, misleading and mean a lot of things,” she explains. “Our proposed programme diet is more about clean eating and removing the processed high sugar foods from our diet for 3 weeks. It is based on what I learned in my Functional Medicine course and Amy's Nutrition course and is more about educating what are the benefits of good quality foods. “In general if we eat well, eat right, sleep right, and relax more our body will respond nicely and be more detoxed and cleansed.” Part of the Community Ola is an integral part of the community in Ratoath,

customers are aware of her and come from all areas of the country to meet with her. She has faced many challanges over the last year with the opening of her new clinic and in trying to divide her time between the clinic and her pharmacy. She has overcome this by organising an appointment system and hiring a great team in-store to look after the pharmacy whilst she is in the clinic. “We are the only pharmacy in the area that has a weekly bloods clinic, that has a visiting nurse to the in store,” she adds. “We carry out all bloods, cholesterol, hba1c, bp and food intolerance testing and are the only health store in the area with some amazing brands.



Pharmacy potential to advise on Hep C With many people living with Hepatitis C in Ireland unknowingly, community pharmacists and their teams can play a vital role in urging them to get tested. Over 4,000 people here have been treated and cured of Hep C since 2015. On World Hepatitis Day (28th July) the HSE’s National Hepatitis C Treatment Programme aimed to raise awareness that Hepatitis C is curable and treatment is free in the Republic of Ireland. Pharmacists can advise those who might be concerned about their risk of exposure to Hepatitis C in the past, to now get tested. More information, including where

to get tested, can be found at www.hse.ie/hepc. World Hepatitis Day 2019 came at a critical point in the HSE’s National Hepatitis C Treatment Programme’s journey towards making Hepatitis C a rare disease in Ireland. Under the clinical leadership of Professor Aiden McCormick, the programme aims to provide everyone in Ireland infected with Hepatitis C access to free treatment. Professor Aiden McCormick,

Clinical Lead for the HSE’s National Hepatitis C Treatment Programme says, “Hepatitis C can be successfully treated with tablets, which can clear the virus from the liver in more than 97% of people in as little as 8-12 weeks. We hope this message will encourage more people, who may be in a risk group for infection, to come forward to be tested. As Hep C is seen as a ‘silent disease’ – there are no symptoms – many of these people don’t even know they have Hep C.”

Boots expands innovative Mole Scanning Service Boots Ireland has extended the roll-out of their innovative mole scanning service to 17 Boots stores across Ireland due to ongoing demand. The service recently won the KBC Business Banking Innovation & Service Development Award at the 2019 Irish Pharmacy Awards. Over 11,000 cases of skin cancer are diagnosed each year, with the number of cases projected to double by 2045.[iii]

encourage people to be more proactive about their skin health and help identify changes that might be suspicious.”

Heather Feeney, Boots Pharmacist, said, “Many people in Ireland have fair skin and burn easily, and UV rays can cause skin damage even on overcast days. We have seen growing rates of skin cancer diagnosis in Ireland, but if spotted early, up to 90% of cases are curable.[iv] We hope the Mole Scanning Service will

Developed by ScreenCancer, the Boots Mole Scanning Service uses a specialist device called a SIAscope to scan moles and pigmented lesions.[vi] [v]

The Mole Scanning Service costs ¤39 for one mole scanned, and ¤19 for each additional mole scan, up to a maximum of four moles.

Boots Advantage points are available with the Mole Scanning Service purchase. https://health.gov.ie/blog/pressrelease/ministers-launch-skincancer-policy-and-call-on-people-toprotectyourskin/ About Skin Cancer – Irish Cancer Society https://www.cancer.ie/ reduce-your-risk/sunsmart/skincancer#sthash.7pIsg4Zf.dpbs [iv]

[v] https://screencancer.com [vi] Mole Scanning Service is available to those aged 18 and over only

Deputy John Brassil TD, Fianna Fáil once again raised the issue of FEMPI and cuts for pharmacists when raising the issue in a Dáil Éireann Debate in July.

Deputy Brassil asked the Minister for Health when financial emergency measures in the public interest, FEMPI, cuts for pharmacists will be reversed. Minister Harris replied, “In accordance with the provisions of Part 5 and Part 6 of the Public


Pharmacists have warned that 15,000 people suffering from chronic illnesses may face delays in receiving their medicines due to a new ordering system for special drugs brought about by the HSE. The Irish Pharmacy Union has written to the HSE to outline its concerns, and has issued a leaflet to pharmacists to warn those affected. The leaflet says that the HSE has brought in “new rules” for ordering ‘High Tech’ medicines that must be prescribed by a consultant. It says the changes “mean that you must have a valid in-date High Tech prescription from your consultant before your pharmacist can order the medicine for you”. The IPU said the new HSE rules mean pharmacists can no longer hold the medicines in question in stock in anticipation that they will be required by customers.


FEMPI pharmacy cuts again on agenda

Deputy John Brassil TD

Pharmacists warn new system could lead to delays

Service Pay and Pensions Act 2017, the Government is committed to developing a statutory basis for payments to primary care contractors, to replace FEMPI legislation, which expires at the end of this year. “This new statutory basis will enable the determination of payments to contractors based on a range of considerations, including affordability and value for money. “Preparatory work is underway in my Department on the development of that new statutory basis.”

“This change could cause a delay in you receiving your medicine,” the leaflet warns, adding that the IPU has expressed its concerns to the HSE regarding the potential for delays. However, the HSE has denied the new arrangement amounts to a change of its rules, and said the system “will not pose a delay to patients access to medicines, once the order is placed in a timely manner.” “In 2017, the HSE introduced a High Tech Ordering Monitoring and Management Hub to enable ordering of High Tech medicines by pharmacy, via the HSE to suppliers,” the HSE said in a statement. "The HSE can give assurance that the Hub provides greater visibility and transparency around the ordering of High Cost medicines which will cost the State approximately ¤800m in 2019,” it said. The letter from the IPU to the HSE states that the latest phase of the deployment of the Hub will encompass High Tech medicines used in rheumatology, dermatology and gastroenterology, affecting approximately 15,000 people.

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IE19031 IR-REL-49-2019 Date of item August 2019



Future-proofing profit for pharmacy With pharmacy continuing to face challenges, Uniphar recently hosted a roundtable Q&A with community pharmacists from across Ireland to discuss how to safeguard their business and future-proof their profit. Louise Mooney from Uniphar Group and Eleanor Fitzpatrick from Joyce's Pharmacy in Mallow

Uniphar Charleville - Sarah Kennedy from Thurles and Trish Murray from Cork at the event

The solutions-focused event encourageddiscussions among pharmacists to identify common issues they faced. These were then addressed by Uniphar representatives from key areas including commercial, retail, marketing, dispensary, regulatory and HR who outlined a range of actions that would allow pharmacists to get ahead and thrive.

Uniphar's Trish Biggane with James O'Donoghue from Tralee at the event

Uniphar Charleville - Elaine Kennedy from Killenaule Pharmacy and Orlagh Dunne from Uniphar Group at the event

Based on the level of positive feedback received from attendants, Uniphar plans to host similar events in the autumn.

Pharmacist warns that patient care is being hit by drug shortages A prominent pharmacist has issued a public warning that drug shortages are affecting patients' ability to manage their illness and leaving pharmacists scrambling for essential supplies. Kerry pharmacist Jack Shanahan warned that drug shortages are seriously hampering pharmacies' ability to function as normal. “They are also having noticeable effects on patients where optimal treatments are being degraded by erratic supply," he told the Irish Independent. He revealed he placed a bulk order with a well-known generic drug maker recently and of "the hundred odd lines I ordered, over 20 were in short supply.”

Medicines which are affected include blood-pressure pills and anti-inflammatory drugs to treat conditions like arthritis. Patients who cannot get hold of their prescribed drug may have to be put on a second-choice medicine or told to ration their supply by their doctor. Mr Shanahan said he believed the problems go deeper than hoarding of drugs because of fears they will be low in stock after Brexit.


One of the reasons for fluctuations is the way some pharmaceutical plants now produce one kind of medicine before going on to a batch of another drug.

down by the Falsified Medicines Directive which aims to increase the security of the manufacturing and delivery of medicines in Europe.

If any issue is found the next medicine will not be released but they can run out of "buffer stocks”, creating a gap in delivery of the product.

“Drug rationing is a fact of life for us all, under the guise of 'allocations'. We spend countless hours pleading with various functionaries to release stocks for patients in urgent need of essential medicines.”

Supplies are also being slowed

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Attitudes to Pharmacy –

Loyalty is Climbing


new report has revealed that pharmacy usage is at an all-time high and that pharmacy loyalty has continued to grow. The average adult now visits a pharmacy 41 times a year. This special report examines public attitudes towards the profession and the appetite for further expansion in the role of the pharmacist.

The 2019 publication of the Pharmacy Usage and Attitudes survey commissioned by the IPU confirmed a massive boost for the sector. Consumer confidence in the health advice provided by local pharmacists is matched only by unprecedented growth in the perception of value for money delivered across the spectrum of products and services.

Viability of pharmacies is always a concern and while they are performing well in most areas of product and service, we need to be mindful of evidence of discounter growth in toiletries particularly. The survey shows that most people go into the pharmacy for prescriptions, but they are very open to being sold additional OTC products if staff are trained to proactively present them.

specialist consulting rooms in pharmacies and the uptake is another opportunity for everyone, including government to promote the pharmacist for one to one advice. Sadly, one in five medical card holders say the prescription levy makes them think twice about filling their prescriptions while 9% indicated that they haven’t filled a prescription at some stage as a result of it.

A strong message for the HSC is that Pharmacy use is now at an all-time high and loyalty to individual local pharmacies is a strong contributor to that growth.

The gap between consumer willingness to avail of the

The average adult visits a pharmacy 41 times a year which is an enormous opportunity to drive home the message that the ‘pharmacy first’ campaign needs to be enhanced to ease the pressure on hard pressed GPs.

Pharmacy Snaphot

Indeed 44% of respondents visited their pharmacy weekly or more often, versus 14% the GP. Similarly, the pharmacy receives much better ratings for value, accessibility, and ability to manage a patient’s day-to-day healthcare needs.

Past 3 days

Past week

Past month


The full report is a welcome boost

for the hard work of pharmacists, counter staff and suppliers in a deeply competitive market. Growth in terms of consumer confidence and support is growing and is evidenced in the increase of visits, spend and appreciation of the value for money being delivered. However much still has to be done and the report provided strong and detailed advice on how the sector must continue to act with one voice.

18% 44% 81%

About 41visits per year on average (or 1,500 visits per pharmacy per week)


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Pharmacy Loyalty - Base: All ever visit pharmacy - 1,013/3,684,000

Don't know Nearly always visit different Often vary pharmacy visited Sometimes vary pharmacy

Mainly the same pharmacy

Always the same pharmacy

2015 %

2017 %

2018 %

2019 %

1 3 5

1 5

0 4 6

1 4 6








7 12


• Pharmacies are perceived to eclipse GPs in terms of accessibility, value and suitability to manage a patient’s day-to-day healthcare needs. It is important that these strengths are promoted more widely, so that continually support the role and scope of the pharmacy. • Although prescription levies have been reduced, Medical Card holders admit to not filling a prescription due to the added cost. Lobby on their behalf with Legislators who need to be conscious of the quality of life impact of punitive taxes on those least able to afford them.




• Leverage the success of the “think pharmacist first” campaign by speaking with one voice on the value of meeting a genuine consumer need and impacting on public consciousness.

Pharmacy Usage

Clear Advice to Pharmacies

added value. Not only will this retain existing customers it will enhance your ability to draw in a new customer base.

• Don’t jeopardise high levels of customer satisfaction and service by focusing on rising utilisation. • Proactively direct customer attention to the availability and use of the private consultation area, as interest in it is still far higher than uptake. • Maintain customer loyalty and stop drift to discounters with continuous innovation and

There are around 78 million visits to Irish pharmacies each year, and roughly 1.6 million adults have been in a pharmacy in the last week, accounting for 44% of the population. This jumps to 81% who have visited in the last month. Nearly half of the adult population lives within one kilometre of a pharmacy (47%), and 87% live within five kilometres of a pharmacy.

"There are 78m visits to Irish pharmacies each year"

• Remind customers of the value products on offer and consistently signal ‘hot spots’ and added-value where practicable. • The public want pharmacies to deliver more services directly. Actively lobby for more change and you can rely on consumer support.

Nearly nine in ten (88%) people say the pharmacist is available at a time that suits them, while only half (52%) say the same of GPs. Interestingly there is a growth in numbers claiming to use the same pharmacy on a consistent basis, now standing at 55% of all pharmacy users. Such loyalty to a single pharmacy has been climbing since 2015, although this data had been somewhat more volatile at the time of the economic crisis in 2008/2009.

Reasons for visiting pharmacy on last occasion Base: All entered a pharmacy - 1,013/3,684,000

Main Reason %

I came in to fill a prescription

Other Reason %


I came in to buy an Over-The-Counter, non-prescription remedy or medicine


I was just browsing and came in



I came in to ask for some advice from the pharmacist


I came in to buy toiletries etc.


I came in to buy cosmetics or skincare items


20 13 14 10

I came to ask for some advice from the pharmacy staff 1


I came in to buy a gift for someone 2


I came in to buy an item from the infant and baby range 1 2 I came in for a health screening or test 1 2 Other 2 3 Q.6 Can you think back to the last time you visited the pharmacy. Can you indicate which of these reasons comes closest to your main reason for visiting on that occasion? Q.7 And what else did you do in store?



In the current context, there is evidence of growing loyalty to specific outlets. Nonetheless, about a fifth of pharmacy users claim that they vary the pharmacy that they visit often or quite regularly. These tend to be young and single. A consistent pattern within the data is that older adults, particularly those over 50, are much more loyal to the same pharmacy. 4 in 5 adults over the age of 65 always use the same pharmacy, as do two thirds aged between 50 and 64. Loyalty is also more evident among adults from rural backgrounds and among pharmacy users who frequent an owner-run outlet, or one that is part of a symbol group. Loyalty is less evident among those who tend to visit a chain operated pharmacy. It is also evident that users of chain-run pharmacies are younger and more likely to live in urban areas, says the report.

Larry Ryan, Behaviour and Attitudes

HEADLINES:  Pharmacy use is at an all-time high and indeed individual pharmacy loyalty has also continued to grow. The average adult visits a pharmacy 41 times a year.  Satisfaction with one’s regular pharmacy strongly in evidence with a combination of medical, range and value elements underpinning performance. clear that Irish consumers feel very positive about the service they receive in the pharmacy sector. 98% of us rate the professional service we receive as very good or quite good. Very few industries could boast similar satisfaction levels.” The Irish Pharmacy Union (IPU) has undertaken an annual index of public usage of and sentiment towards pharmacies since 2006. This quantitative public opinion survey is fielded by Behaviour & Attitudes Marketing Research, with fieldwork being undertaken face-to-face and in-home among a nationally representative sample of 1,000 adults aged 16 and over.

"Pharmacy under pressure with children’s medication but performing very well in cosmetics, toiletries and haircare" It adds, ‘We have noted in previous waves of this research that pharmacy choice is often a function of the main supermarket used, and thus a shift from one supermarket to another can result in the decision to switch pharmacy. ‘The grocery sector has been quite volatile in the past 10 years and there has been

significant growth in usage of the German discount grocery supermarkets in particular. This undoubtedly will have led to some opting to use a different pharmacy, rather than the one that they may have typically favoured in the past.’ Speaking about the research, Larry Ryan of B&A says, “It is

The 2019 survey was fielded between 4 – 23 April. The study uses demographic quotas in respect of gender, age, social class, region and area of residence, so that the full adult sample mirrors the national population profile aged 16 and over. The quota controls used are derived from the most recent census of population and from research industry-agreed estimates for social class.

Category Triggers - Base: Buyers of each Recommended in store % Probiotics



20 8


Cough medicine


Analagesics (i.e. pain medicine)


Gift items




OTC Medication


22 31


32 36 37

56 41

38 41

21 19







15 19




Toiletries Perfume



40 60


25 48

 In this survey we see very similar assessments from customers of Symbols and customers of Independents; apparent disaffection that had been seen among symbol customers previously is no longer evident.  Pharmacies performing well in most areas but need to be mindful of discounter growth in toiletries particularly, and their inevitable expansion into more medical and healthcare-related space.  Growth in use of the private consultation area, but still under-utilised and in need of concerted promotion.  Continuing public enthusiasm for expansion of the role and focus of the pharmacist.  Seven out of eight pharmacy visitors interact with staff, with one in five expressly seeking advice. Certain lines – probiotics, vitamins, supplements, analgesics and cough medications – evidently respond strongly to advice and recommendation.  44% visit the pharmacy weekly or more often, versus 14% the GP. The pharmacy receives much better ratings for value, accessibility, widening breadth of focus, and ability to manage a patient’s day-to-day healthcare needs.



Prescription Skincare

Pre-planned purchase %


Allergy medicine


Noticed it browsing %

 Symbol pharmacies have grown strongly since 2018 and in Dublin they are now more numerous than owner-run independents.

 One in five medical card holders say the prescription levy makes them think twice while 9% indicate that they haven’t filled a prescription at some stage as a result of it.

Q.9b Did you buy that because it was recommended in-store, because you noticed it while browsing, because it was a pre-planned purchase or for some other reason?









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Reaching for the Top























































































































































Pharmacies in Ireland have a long-standing history of a successful front-of-shop and good relationships with their customers and those who have strong non-dispensing businesses will undoubtedly be in the best position to withstand changing trends in the industry. Recently it has become more apparent that, while pharmacies have suffered reduced turnover from dispensing, this has been balanced out by over-the-counter and front-of-shop sales which has had a stabilising effect on overall turnover. With this in mind, IPN is proud to present our annual IQVIA Top 100 Pharmacy Products list, offering our readers the exclusive opportunity to compare the performance of key brands in the Irish OTC market over the past six years. IQVIA is the world’s leading information, services and


technology company dedicated to making healthcare perform better. This invaluable data is exclusive to IPN and its objective is to present retail pharmacy with market information about Ireland’s leading OTC products. 657,350





110,098 104,404

74,039 16,233




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a ta Pa r



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A successful retail pharmacy should have the ultimate goal of future-proofing the business against industry changes and evolving the experience and services in-store to accommodate the changing needs of shoppers and drive better health for patients and consumers.

Products in units (000s)



IMS MAT Mar 2012

Paralief 500 mg Tablets. Clonmel Healthcare Ltd., Waterford Road, Clonmel, Co. Tipperary. A copy of the summary of product characteristics is available on request. Medicinal product available for retail sale through pharmacy only. Always read the label.

The list, which includes premium brands to diagnostic products, is collected through distributor data from wholesalers, direct distribution by manufacturers, and parallel importers on their sales into pharmacy, in terms of volume. This information allows pharmacists to determine sales opportunities; to keep their shop vibrant and a step ahead of the competition. The IQVIA Top 100 provides a unique point of reference and information tool in the partnership between pharmacy and product owners. The IQVIA Top 100 provides pharmacists with a snapshot of their marketplace, providing insight into product trends and informing retail strategy. The list provides pharmacy managers with a unique view on what their customers are buying across Ireland, which products are key in their portfolio and what new products have come to market.


Continued on page 22 *Disclaimer: Please note that the six year comparison listed opposite, along with other comparisons with previous years, may include brands and categories whose classification may have changed over that period. The IPN/IQVIA Top 100 OTC products and the method of its collation evolves with the pharmacy sector and in this context, comparisons with previous years are for indicative purposes only. As such, all comparative data published in this issue is designed to offer readers a broad reference tool rather than a like for like comparison.


IQVIA Top 100



















Pharmacy Products MOTILIUM

26 28 22 20 25 12




76 79 83 76 81 74


27 25 27 30 33 31


52 51 48 44 37 33


77 103 316 0


28 27 23 22 22 17


53 54 59 57 51 47


78 76 70 67 69 80


29 30 20 26


54 23 46


79 83 78 75 74 191


30 22 18 15 14 13


55 46 47 51 42 37


80 101 124 147 183 0


31 17 17 17 19 15


56 57 56 56 48 43


81 98 134 185 232 280


32 31 28 31 26 24


57 69


82 75 71 73 67 51


33 29 25 33


58 53 50 46 39 70


83 62 35 37 55 79


34 32 32 28 31 26


59 97 166 276 291 0


84 87 73 78 89 94


35 34 34 41 46 60


60 81 82 79 119 0


85 86 84 77 87 88


36 39 43 48 61 83


61 60 52 49 44 42


86 82 96 94 82 85


37 36 37 42 53 61


62 59 53 53 41 41


87 92 109 118 173 252


38 37 33 32 34 29


63 58 42 45 40 52


88 96 104 126 133 233


39 47 63 81 130 225


64 63 75 128 0


89 89 77 71 63 46


40 44 55 65 140 226


65 61 51 58 56 56


90 85 80 91 106 103


41 52 88 193 0


66 70 65 60 57 48


91 65 36 50 45 57


42 40 39 36 35 32


67 102 86 92 79 75


92 88 79 66 86 99


43 42 38 34 30 21


68 67 68 61 59 54


93 84 76 84 80 77


44 43 93


69 66 66 64 64 49


94 80 308 0


45 48 57 55 58 39


70 71 64 80 52 27


95 94 92 102 120 139


46 45 44 40 36 35

E 45

71 64 62 54 43 38


96 134 153 149 142 162


47 50 49 52 38 40


72 74 69 68 65 65


97 106 130 135 186 0


48 55 60 59 60 62


73 77 67 63 54 53


98 112 115 119 116 123


49 56 61 62 62 58


74 78 74 74 85 59


99 95 105 110 100 90


50 49 41 38 50 272


75 72 72 69 66 66


100 90 81 85 75 72






















IQVIA Top 100 Pharmacy Products Gwynne Morley, General Manager at IQVIA and pharmacist underlines this point telling us, “As a pharmacist myself, I realise the importance of not having just a broad range of OTC medicinal products but the right range. Patients are no longer passive recipients of healthcare. They are taking a more active role in their health and wellbeing, and OTC medicines play an important role in this move towards self-care.” The OTC pharmaceutical sector in Ireland is currently generating ¤250.8 million in annual sales and is predicted to rise 0.5% year on year1. Analgesics prove the most lucrative area with an ¤80.2 million market share in 2019, followed by Cold and Flu remedies at ¤58.2 million1. Other categories of note are Digestive Remedies (¤37 million), Skin Treatments (¤42.7 million) and Vitamins & Supplements (¤42.4 million)1. With an ageing and more healthconscious population, the Irish OTC market has become a crucial part of our healthcare ecosystem. Ride the Marketing Coattails The advertising industry in Ireland is expected to grow by 7%, hitting ¤1.07 billion this year2. Media agencies and marketing departments are becoming more sophisticated taking a multichannel approach to their marketing mix. Pharmacists who keep up to date with current and future brand campaigns can align their retail offering to take advantage of this complimentary spend. The IQVIA Top 100 can offer that insight, to the astute pharmacist who can read between the lines. Representation • Johnson & Johnson (J&J) lead the way in representation with 17 products; • Reckitt Benckiser (RB) who sponsored this years’ OTC Retailer of the Year Award at the Irish Pharmacy Awards (won by Boots) also have a significant share of the overall market with 15; • GSK - Sponsors of the GSK Self-Care Award, listed 10 products, followed closely by Clonmel Healthcare who fielded an impressive 7; • Another Irish success story was Rowex with 4 products in the Top 100. Others of note include Bayer and Sanofi with 6 and 5 respectively and Perrigo with 4. It will be interesting to see how GSK and Pfizer’s creation of a Consumer Health joint venture, approved on the 8th of May of this year, will affect the 2020 listings.


The Leaders • We saw no change at the top with Perrigo’s Solpadeine proving Ireland’s best-selling brand for the fourth year in a row. • Nurofen, by RB, was second, a position held for the last four years also. • Panadol Extra, from GSK, maintained third while J&J’s Calpol stayed at fourth for the second year in a row. • Within the Top 10 Takeda’s Calcichew saw the biggest shift, moving up three spots to fifth. New Entrants • The stand out story of this year’s league table is the entry of Nurofen Rapid Relief at 51, taking a significant chunk of market share as a debut product. RB are heavily invested in the analgesic segment of the marketplace with 5 other Nurofen brands making the elite list. • Sanofi’s Buscopan IBS entered the list at 77. Having been released in 2016, the brand has made steady progress moving from 316 at launch, to 103 in 2018. It may be one to watch for 2020. Movers and Shakers • Significant movers this year included Compeed, a footcare brand from HRA Pharma, who narrowly missed out last year. The brand surged into the list moving up 35 places to 67 from 102. • It was a similar story for Vivioptal from Bausch & Lomb who ticked-up 36 places to make the cut at 96. • Cetrine Allergy is at 13, making it the highest-ranking allergy product, from Irish manufacturer Rowex. Round Up With over 1,800 pharmacies operating throughout the country, contributing ¤624 million to GDP and ¤466 million to Exchequer3, the importance of this key sector cannot be underestimated. In

IQVIA Top 100 Pharmacy Products order for the OTC pharmaceutical market to stay competitive and achieve sales growth, it is crucial that there is a synergy between the activities of brand owners and the pharmacists they rely on to reach the end user.

31 companies make up the Top 100 Johnson & Johnson (Ireland) Ltd


Reckitt Benckiser Ireland Ltd


Core Media Outlook 2019

GSK Consumer Healthcare Ireland


AIB Pharmacy Outlook

Clonmel Healthcare


• Zirtek - distributed by United Drug - has moved up the rankings 12 places

Bayer Ltd




• Nurofen has 6 SKU’s, dominating the analgesic market

Perrigo Co plc






• Johnson & Johnson’s Calpol has 3 SKU’s • Clonmel Healthcare’s Easofen is up 20 places to Number 18 • Sanofi’s DulcoLax is up 4 places • GSK’s Piriton Allergy is up 8 places to Number 25 • Local distributor Scope Healthcare is up there with the global giants at Number 39 - up 8 places with Hyloforte • Rowex’s Brupro is up 9 places to 41 after entering in 2016 at number 193

Rowex Consumer Healthcare 4 Mylan 3 Bausch & Lomb


Janssen Ireland


Ovelle Pharmaceuticals


Pfizer Ireland


Pinewood Healthcare


Scope Healthcare


Teva Pharmaceuticals Ireland 2 3M Healthcare


Alimentary Health Ltd


Allergan 1 Ascensia Diabetes Care


• Distributed by Uniphar, Metholatums Deep Heat is up 7 places to 49

BD 1

• Perrigo’s Solpa-Extra is up 12 positions to 57

Fannin Ltd


HRA Pharma


Lanes Healthcare


• Clonmel Healthcare’s AntiHist Allergy is up an amazing 38 positions to 59 • Local manufacture Ovelle’s Silcocks Base is up 21 positions to number 60 • Moving 26 places to 77 is Sanofi with Buscopan IBS • Johnson & Johnson’s Calpol Vapour entered the Top 100 for the first time at number 80, moving up 21 positions from 2018’s 101st position • Alimentary’s Alflorex, distributed by Pamex Health, is up 17 positions to 81

Merck 1

Lifescan 1 M & A Pharmachem Ltd


P&G Ireland


Mentholatum Company


Takeda Ireland Ltd


UCB Pharma Ltd


Photography courtesy of Jacqueline O'Donnell M.P.S.I. O'Donnell's TotalHealth Pharmacy, Shankill, Co Dublin


IQVIA Top 100

Pharmacy Products Management Checklist for 2019 - Optimising your pharmacy for maximum profitability BY SIMON EAMES, CUSTOMER SUCCESS MANAGER, REAL WORLD ANALYTICS

Your pharmacy has a wealth of data – in the dispensary you have data about dispensing volumes and values, fee structures, patient visits and practice trends, medicine usage; your Epos system has data concerning sales values, units sold, margins, stockholding, discounts and so on. The question is, how well are you able to see this data and to use it effectively? The effective analysis and presentation of data is the pathway to maximising your profitability, saving you time and money by doing away with the need to spend hours creating spreadsheets. Dispensary Financials Knowing the basics of what is happening in your business is a cornerstone to survival, success and growth. Are item dispensings, patient counts, revenues and margins up or down on last year? Which stores are growing, and which are not performing? This is basic data that you need to keep your business plan on track. Claim and Cash Management Managing your claims and keeping a hand on compliance should be a top priority if you are looking to plug the holes through which

profits are leaking out of your business. It is all too easy to miss claiming a High Tech patient care fee or to over-dispense a patient’s allowance of test strips. Typically, we find that the average store could be losing anything up to ¤500 each month on their bottom line across these two areas alone. Dispensary Products and Stockholding Identifying your preferred dispensing lines from all the available options and then tracking and managing compliance by store and active ingredient is a powerful tool to add points to your margin.

Those few pharmacies who are running live stock in the dispensary are seeing the advantages – understanding stock values and weeks cover enables you to reduce overstocks, manage your working capital efficiently and replenish stocks correctly. Dead stock is a dead weight in your business – identifying it is the first step towards solving the problem. Customers who are able to transfer stock in an ethically correct way have reported savings in excess of 50% in write-offs of out-of-date stock, and this can be achieved even without a live stock model.

Dispensary Patients Patients are the lifeblood of your business – it’s good to know not only whether your patient count is up or down, but which of your patients are the most valuable to you and which ones are overdue according to their normal visit cycle. Sure, you need to look after all of your patients but from a patient care point of view and a business perspective it makes sense to be aware of the ones who are most important to you. Retail Financials There is ongoing market recovery, but the retail landscape is very different now, and the dispensary is under more financial pressure than ever before. Your front of shop can help relieve some of those pressures. You need to be tracking sales, margin and stock levels in each of your stores and departments. Retail Stockholding & Product Mix Buying decisions need to be datadriven and based on historical sales and margins as well as market trends, so that you are buying into opportunities and identifying and clearing slowmoving and dead stock. Easy-tounderstand reporting on space planning will help you to allocate your retail space by department so that get the most out of each metre of retail shelf space. While range analysis tools will allow you to see which products are driving sales and margins and which are the ones you can really do without. Sounds overwhelming? Getting there is a process. While it is important in even a small business, it is vital in larger or expanding groups to achieve and maintain central awareness and control of key performance indicators, and the factors that affect them.



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.

IQVIA Top 100 Pharmacy Products 1 SOLPADEINE


Solpadeine is Ireland’s number 1* pharmacy only pain relief brand and offers a range of different pain solutions to address different consumer needs. Pain management is one of the most vital services provided by pharmacists today. Solpadeine is an effective short-term solution for acute moderate pain which is not relieved by paracetamol or ibuprofen alone. With a triple active formulation of paracetamol, caffeine and codeine; Solpadeine provides fast and effective relief from headache, backache and other acute moderate pain. Products name: Solpadeine Soluble Tablets (P), Solpadeine Tablets (P) and Solpadeine Capsules (P), MAH: Chefaro Ireland Ltd., First Floor, Block A, The Crescent Building, Northwood Office Park, Dublin 9, Ireland. Can cause addiction. Use for 3 days only. Further information is available upon request. *Source: IQVIA MAT Volume May 2019.



Maintains its position at number 2 in this year’s Top 100. Nurofen Plus has held this position since 2014. Contains codeine.

3 PANADOL EXTRA SOLUBLE Panadol Extra Soluble tablets contains a second active ingredient, caffeine, that amplifies the analgesic effect of Paracetamol, giving up to 30% more pain relieving power when compared to standard paracetamol tablets. So, when you have a headache Panadol Extra Soluble can deliver powerful, effective relief. And it’s gentle on your stomach, too. Panadol Extra Soluble is also effective in treating backache, rheumatic pains and muscle pains, period pains and toothache.

4 CALPOL CALPOL® is the number 1* children’s pain and fever reliever in Ireland with over 45 years’ experience, helping parents to care for their little ones when they’re feeling unwell. In a recent survey of 635 Irish Mums who use CALPOL®, 100% of respondents said they would recommend CALPOL® to a friend**. CALPOL® Sugar Free Infant Suspension is specifically formulated for babies and infants from as young as 2 months***. It starts to work on fever in just 15 minutes but is gentle on delicate tummies. It provides effective relief for pain and fever associated with: teething, earache, sore throat and colds. The CALPOL® Range includes a specially formulated range for children aged SIXPLUS and a range of congestion relievers, including saline nasal spray and saline nasal drops. CALPOL® will be supported this year with TV, digital, out of home and in store pharmacy point of sale. Contact your Johnson & Johnson territory representative for more information. MAH: Johnson & Johnson (Ireland) Ltd. Airton Road, Tallaght, Dublin 24, Ireland. Product not subject to medical prescription. Further information available upon request from Johnson & Johnson (Ireland) Ltd. *IMS Volume sales Paeds general pain category FY 2018. **CALPOL® consumer survey with Mummypages, May 2019 (635 respondents) *** Weighing over 4kg and not premature.

Carol Keating, Group Commercial Activation Manager, J&J

Q: Congratulations on having no less than 18 products within the 2019 Top 100. What do you see as the core reasons for this success? A: We are extremely proud to have 18 products within the Top 100. In fact, Johnson & Johnson Ireland Ltd, hold number one share positions within the majority of categories in which we operate (IMS value share MAT May 2019). This is primarily driven by our commitment to putting our patients and customers at the heart of everything we do. We continuously strive to deliver insight driven, science based new products that address our patient’s needs. This coupled with a superior integrated approach to marketing has most certainly contributed to the strength of our portfolio of brands. Q: How has J&J worked with pharmacy retailers to ensure your products are front and centre when consumers are making a purchase? A: At Johnson and Johnson, we pride ourselves in building relationships and partnerships with our customers to drive joint value creation. We go beyond purely product-based solutions to offer greater services such as training, category management and bespoke customer solutions based on specific patient needs. In addition, we deliver and activate campaigns grounded in consumer insight and drive in store excellence by leveraging path to purchase.



& ALLERGY RELIEF FROM For further information, please contact our Telesales Team - Eugene, Jeanne Marie or Rita on

1800 304 400

Cetrine Allergy 10mg FCT available in 7 and 30 packs, Lorat 10mg Tablets available in 7 and 28 packs, Rhinex Relief 50 micrograms/actuation Nasal spray, suspension, available as 1 x 60 doses. Medicinal products not subject to medical prescription. Further information and SPCs available from the Marketing Authorisation Holder: Rowex Ltd., Bantry, Co. Cork. Ireland. Freephone: 1800 304 400. Fax: 027-50417. Date of preparation: (05-19) CCF No: 22144

Free your customers from the symptoms of hayfever Zirtek Allergy Relief helps to relieve the symptoms of hayfever and urticaria Zirtek Plus Decongestant delivers all the allergy relief of Zirtek with an added decongestant



Zirtek IE

Feel free to place an order with your local rep or customer service team: Call: Email:

01 463 2424 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 Zirtek Allergy Relief is available as an oral solution for 2 years of age and upwards and in tablets suitable for 6 years of age and upwards. Zirtek Plus Decongestant is suitable for adults and adolescents from 12 years of age and upwards.

Cetirizine dihydrochloride Always read the label For further advice please consult your GP or Pharmacist

June IE-P-ZI-ALY-1900047

IQVIA Top 100 Pharmacy Products Will O’Brien, Country Manager, RB Ireland Q: Congratulations on having no less than 14 products within the 2019 Top 100. What do you see as the core reasons for this success?


A: At RB, our mission is to ensure people live healthier and happier lives. We supply effective and convenient products that make a difference to people. We are delighted to see the continued strength of all our brands which help to serve our purpose.

Maintains its position at number 6 in this year’s Top 100.

Q: How has RB worked with pharmacy retailers to ensure your products are front and centre when consumers are making a purchase? A: We know that pharmacy retailers are genuinely committed to helping improve the health of their local communities. We understand the importance of Self-Care in the current Irish landscape and the role that pharmacies play in empowering people to make informed choices in the management of their own health. As a result, we partner with retailers to ensure best in class execution in store from product training to brand activation and category management. Q: What have been the biggest OTC product challenges for RB this year that may have impacted on some of your rankings? A: The 2018/2019 Cold and Flu season has been relatively mild versus prior years which is great news for public health. However, some of the remedy products for this category have seen declines as a result.



NICORETTE® is Ireland’s number 1 and fastest growing NRT brand with the widest range of products* and formats to help smokers quit. The NICORETTE® range spans from more traditional formats such as Gum, Patch and Lozenge to more unique formats Inhaler and Quickmist. NICORETTE® Inhaler is suitable for those who are likely to miss the hand-to-mouth habit of smoking. Quickmist is the fastest growing format in the NRT category*, clinically proven to relieve craving in just 30 seconds**. Last year NICORETTE® launched a Cool Berry flavour for an alternative flavour for quitting. Contact your Johnson & Johnson territory representative for more information. MAH: Johnson & Johnson (Ireland) Ltd. Airton Road, Tallaght, Dublin 24, Ireland. Product not subject to medical prescription. Further information available upon request from Johnson & Johnson (Ireland) Ltd. *IMS Data June 2019 MAT Value Sales | **Based on 2 x 1mg dose

Q: Any new innovations coming down the line for RB in the next twelve months? A: Life is changing and becoming more demanding. At RB we are constantly investing to evolve our product portfolio to meet the everchanging needs of consumers. We do this by putting the consumer at the centre of our in-depth analysis and research. We pride ourselves by bringing and supporting our latest healthcare treatments and innovations to the market every year. Next year will be no exception to this ongoing journey.

10 GAVISCON Gaviscon is the #1 heartburn and indigestion brand in Ireland*. Gaviscon brings fast, soothing and long-lasting relief from heartburn and indigestion which lasts up to 2x as long as antacids. Suitable for use in pregnancy. Full prescribing information available on www.medicines.ie *Based on IMS Antacids Unit & Value Sales, MAT June 2019

The Bio-kult range is a scientifically developed advanced multi-strain formula for the entire family. Proven to survive the high acidity of the stomach, Bio-kult is gluten free and suitable for vegetarians. It can be swallowed whole, sprinkled over food or mixed in a drink and it doesn’t need to be refrigerated.


Ask your wholesaler for more information

@ScopeGroup1 p 1800 816 005

e info@scopehealthcare.ie w www.scopehealthcare.ie

IQVIA Top 100 Pharmacy Products 11 AVEENO AVEENO® is Irelands number one* pharmacy skincare brand with a wide range of products to suit all skin types; from normal skin to dry, irritated or sensitive skin. AVEENO® is the highest ranked skincare brand in the Top 100 retaining the number 11 position. All AVEENO® body moisturisers contain colloidal oatmeal or oat extract, derived in nature and activated by science to provide real skincare benefits. In 2019 the AVEENO® range has seen a complete packaging refresh, putting skin type at the heart of all messaging, for consumer ease of product selection at shelf. The new look packaging will be supported with a brand new Get Skin Happy campaign message. AVEENO® Daily Moisturising Lotion provides healthier looking skin from day 1 and is recommended by 9 out of 10 Irish women**. For more information please contact your Johnson & Johnson Territory Representative. *IMS MAT volume sales (Pharmacy only), Skincare category FY 2018 **AVEENO® DML Consumer product trial with beaut.ie August/September 2013 (91 respondents)


Fiona Clancy, Senior Brand Manager, Perrigo Company plc

Nurofen relieves pain and reduces inflammation giving effective relief from headaches and general pain. Nurofen hold its position at number 12 from 2018.

Q: It’s a brilliant achievement by any company to have products in the Top 100 let alone the Number One product in this report for the past 6 years - how have you achieved this? A: Perrigo is a leading provider of over the counter self-care solutions. Pharmacy is a key destination for self-care in Ireland, and we are proud to provide appropriate solutions that consumers trust. Q: Have you anything new coming down the pipeline for your brands over the next 12 months? A: Innovation is key at Perrigo and answering the needs of consumers is a top priority for us. Keep your eyes peeled! Q: Does consumer marketing play a large part of your success? A: Consumer marketing strategy is a big play for us, ensuring consumers are aware of the products that are available to them. However, a key part of our strategy is to ensure the pharmacy staff are as up to date on the categories and products we provide.

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

14 LEMSIP Lemsip is the #1 cold and flu brand in Ireland* and its range of effective cold and flu remedies have been tried and trusted for generations. Over the years our product range has extended, and we offer a wide range of formats from capsules, tablets and liquids to the more traditional hot drink sachets, so you can recommend a product that best suits your patient’s combination of cold and flu symptoms - whether they are aches and pains, sore throat, cough, blocked nose etc. Full prescribing information available on www.medicines.ie *Based on IMS Unit Sales, MAT June 2019

IQVIA Top 100 Pharmacy Products 15 NUROFEN EXPRESS Nurofen Express (Ireland’s No.1 ibuprofen tablet*) experienced a temporary drop in places driven by a global out of stock. However, this shortage was offset by the launch of Nurofen Rapid Relief Liquid Capsules, which arrived in market in February 2019, providing over the counter fast and effective pain relief to patients.** With the return of the Express range in June, Nurofen now accounts for 44% of the Mild Pain market.* Full prescribing information available on www.medicines.ie *IMS Data June 2019 **Nurofen Rapid Relief Maximum Strength 400mg Liquid Capsules contain Ibuprofen. For pain relief. Always Read the Label.

17 NEXIUM CONTROL Nexium Control is Ireland’s No.1 pharmacy-only heartburn treatment without prescription* and is one of the fastest growing brands in the GI category. It now accounts for 38% value market share for the year ending May 2019and continues to experience double digit growth of 17%. The brand has continued to innovate introducing the mini capsule in 2018 which is an easy to swallow capsule in a convenient bottle format. A high level of continued marketing support is driving the overall success of the brand together with continued pharmacy support from the Pfizer Consumer Healthcare representative team. Suitable for people experiencing heartburn. Nexium Control 20mg gastro resistant Tablets and Capsules.Contains Esomeprazole, for correct use read the leaflet. Full product details available on medicines.ie | For Pharmacy only. * IMS Data May 2019 MAT Value Sales

19 SUDAFED SUDAFED® is the number one selling decongestant brand in Ireland*. Over the past 30 years SUDAFED® has developed clinically proven, over the counter treatments for congestion and associated symptoms. This enables people to treat a vast array of congestion symptoms without the need for a prescription. SUDAFED® offers relief from nasal congestion and catarrh while SUDAPLUS® provides the additional benefits of pressure and pain relief. The SUDAFED® range also contains SUDAPRO® Headcold which targets the 3 main symptom of a headcold; headache, pressure and blocked nose. Contact your Johnson & Johnson territory representative for more information. MAH: Johnson & Johnson (Ireland) Ltd. Airton Road, Tallaght, Dublin 24, Ireland. Product not subject to medical prescription. Further information available upon request from Johnson & Johnson (Ireland) Ltd. *IMS Volume sales nasal decongestant category FY 2018.

21 PANADOL 20 CALPOL SIX PLUS The CALPOL® Range includes a specially formulated range for children aged SIXPLUS and a range of congestion relievers, including saline nasal spray and saline nasal drops. CALPOL® will be supported this year with TV, digital, out of home and in store pharmacy point of sale. Contact your Johnson & Johnson territory representative for more information. MAH: Johnson & Johnson (Ireland) Ltd. Airton Road, Tallaght, Dublin 24, Ireland. Product not subject to medical prescription. Further information available upon request from Johnson & Johnson (Ireland) Ltd.

Panadol is indicated for headache, colds & influenza, backache, period pain, pain of osteoarthritis, muscle pain, neuralgia, toothache & rheumatic pain. It’s fast effective pain relief whilst being gentle on the stomach. Panadol contains paracetamol & is not suitable for children under 6 years. Always read the label/leaflet and only use as directed.

Find the right craving relief for your customer

Now PCRS Reimburseable

Nicorette QuickMist Cool Berry 1 mg/spray, oromucosal spray, solution. Composition: One spray delivers 1 mg nicotine in 0.07 ml solution. 1 ml solution contains 13.6 mg nicotine. Excipient with known effect: Ethanol (less than 100 mg of ethanol/spray). Propylene glycol. Pharmaceutical form: Oromucosal spray, solution. A clear to weakly opalescent, colourless to yellow solution. Indications: For the treatment of tobacco dependence in adults by relief of nicotine withdrawal symptoms, including cravings, during a quit attempt. Permanent cessation of tobacco use is the eventual objective. Nicorette QuickMist Cool Berry should preferably be used in conjunction with a behavioral support program. Dosage: Subjects should stop smoking completely during the course of treatment with Nicorette QuickMist Cool Berry. Adults and Elderly: The following chart lists the recommended usage schedule for the oromucosal spray during full treatment (Step I) and during tapering (Step II and Step III). Up to 4 sprays per hour may be used. Do not exceed 2 sprays per dosing episode and do not exceed 64 sprays (4 sprays per hour, over 16 hours) in any 24-hour period. Step I: Weeks 1-6: Use 1 or 2 sprays when cigarettes normally would have been smoked or if cravings emerge. If after a single spray cravings are not controlled within a few minutes, a second spray should be used. If 2 sprays are required, future doses may be delivered as 2 consecutive sprays. Most smokers will require 1-2 sprays every 30 minutes to 1 hour. Step II: Weeks 7-9: Start reducing the number of sprays per day. By the end of week 9 subjects should be using HALF the average number of sprays per day that was used in Step I. Step III: Weeks 10-12: Continue reducing the number of sprays per day so that subjects are not using more than 4 sprays per day during week 12. When subjects have reduced to 2-4 sprays per day, oromucosal spray use should be discontinued. To help stay smoke free after Step III, subjects may continue to use the oromucosal spray in situations when they are strongly tempted to smoke. One spray may be used in situations where there is an urge to smoke, with a second spray if one spray does not help within a few minutes. No more than four sprays per day should be used during this period. Regular use of the oromucosal spray beyond 6 months is generally not recommended. Some ex-smokers may need treatment with the oromucosal spray longer to avoid returning to smoking. Any remaining oromucosal spray should be retained to be used in the event of sudden cravings. Paediatric population: Do not administer this medicine to persons under 18 years of age. There is no experience of treating adolescents under the age of 18 with this medicine. Method of administration: After priming, point the spray nozzle as close to the open mouth as possible. Press firmly the top of the dispenser and release one spray into the mouth, avoiding the lips. Subjects should not inhale while spraying to avoid getting spray into the respiratory tract. For best results, do not swallow for a few seconds after spraying. Subjects should not eat or drink when administering the oromucosal spray. Behavioural therapy advice and support will normally improve the success rate. Contraindications: Hypersensitivity to nicotine or to any of the excipients. Children under the age of 18 years. Those who have never smoked. Special warnings and precautions for use: This medicine should not be used by non-smokers. The benefits of quitting smoking outweigh any risks associated with correctly administered nicotine replacement therapy (NRT). A risk-benefit assessment should be made by an appropriate healthcare professional for patients with the following conditions: Cardiovascular disease: Dependent smokers with a recent myocardial infarction, unstable or worsening angina including Prinzmetal’s angina, severe cardiac arrhythmias, recent cerebrovascular accident and/or who suffer with uncontrolled hypertension should be encouraged to stop smoking with non-pharmacological interventions (such as counselling). If this fails, the oromucosal spray may be considered but as data on safety in this patient group are limited, initiation should only be under close medical supervision. Diabetes Mellitus. Patients with diabetes mellitus should be advised to monitor their blood sugar levels more closely than usual when smoking is stopped and NRT is initiated as reduction in nicotine induced catecholamine release can affect carbohydrate metabolism. Allergic reactions: Susceptibility to angioedema and urticaria. Renal and hepatic impairment: Use with caution in patients with moderate to severe hepatic impairment and/or severe renal impairment as the clearance of nicotine or its metabolites may be decreased with the potential for increased adverse effects. Phaeochromocytoma and uncontrolled hyperthyroidism: Use with caution in patients with uncontrolled hyperthyroidism or phaeochromocytoma as nicotine causes release of catecholamines. Gastrointestinal Disease: Nicotine may exacerbate symptoms in patients suffering from oesophagitis, gastric or peptic ulcers and NRT preparations should be used with caution in these conditions. Paediatric population: Danger in children: Doses of nicotine tolerated by smokers can produce severe toxicity in children that may be fatal. Products containing nicotine should not be left where they may be handled or ingested by children. Transferred dependence: Transferred dependence can occur but is both less harmful and easier to break than smoking dependence. Stopping smoking: Polycyclic aromatic hydrocarbons in tobacco smoke induce the metabolism of drugs metabolised by CYP 1A2 (and possibly by CYP 1A1). When a smoker stops smoking, this may result in slower metabolism and a consequent rise in blood levels of such drugs. This is of potential clinical importance for products with a narrow therapeutic window, e.g. theophylline, tacrine, clozapine and ropinirole. The plasma concentration of other medicinal products metabolised in part by CYP1A2 e.g. imipramine, olanzapine, clomipramine and fluvoxamine may also increase on cessation of smoking, although data to support this are lacking and the possible clinical significance of this effect for these drugs is unknown. Limited data indicate that the metabolism of flecainide and pentazocine may also be induced by smoking. Excipients: The oromucosal spray contains small amounts of ethanol (alcohol), less than 100 mg per dose (1 or 2 sprays). This medicinal product contains less than 1 mmol sodium (23 mg) per spray, i.e. essentially ‘sodium- free’. This medicine contains 12 mg propylene glycol in each spray which is equivalent to 150 mg/mL. Due to the presence of butylated hydroxytoluene, Nicorette QuickMist may cause local skin reactions (e.g. contact dermatitis), or irritation to the eyes and mucous membranes. Care should be taken not to spray the eyes whilst administering the oromucosal spray.Undesirable effects: Effects of smoking cessation: Regardless of the means used, a variety of symptoms are known to be associated with quitting habitual tobacco use. These include emotional or cognitive effects such as dysphoria or depressed mood; insomnia; irritability, frustration or anger; anxiety; difficulty concentrating, and restlessness or impatience. There may also be physical effects such as decreased heart rate; increased appetite or weight gain, dizziness or presyncopal symptoms, cough, constipation, gingival bleeding or apthous ulceration, or nasopharyngitis. In addition, and of clinical significance, nicotine cravings may result in profound urges to smoke. This medicine may cause adverse reactions similar to those associated with nicotine given by other means and these are mainly dose-dependent. Allergic reactions such as angioedema, urticaria or anaphylaxis may occur in susceptible individuals. Local adverse effects of administration are similar to those seen with other orally delivered forms. During the first few days of treatment irritation in the mouth and throat may be experienced, and hiccups are particularly common. Tolerance is normal with continued use. Daily collection of data from trial subjects demonstrated that very commonly occurring adverse events were reported with onset in the first 2-3 weeks of use of the oromucosal spray, and declined thereafter. Adverse reactions with oromucosal nicotine formulations identified from clinical trials and during post-marketing experience are presented below. The frequency category has been estimated from clinical trials for the adverse reactions identified during post-marketing experience. Very common (≥1/10); common (≥1/100 to <1/10); uncommon (≥1/1 000 to <1/100); rare (≥1/10 000 to <1/1 000); very rare (<1/10 000); not known (cannot be estimated from the available data). Immune system disorders Common Hypersensitivity Not known Allergic reactions including angioedema and anaphylaxis Psychiatric disorders Uncommon Abnormal dream Nervous system disorders Very common Headache Common Dysgeusia, paraesthesia Eye disorders Not known Blurred vision, lacrimation increased Cardiac disorders Uncommon Palpitations, tachycardia Not known Atrial fibrillation Vascular disorders Uncommon Flushing, hypertension Respiratory, thoracic and mediastinal disorders Very common Hiccups, throat irritation Uncommon Bronchospasm, rhinorrea, dysphonia, dyspnoea, nasal congestion, oropharyngeal pain, sneezing, throat tightness Gastrointestinal disorders Very common Nausea Common Abdominal pain, dry mouth, diarrhoea, dyspepsia, flatulence, salivary hypersecretion, stomatitis, vomiting Uncommon Eructation, gingival bleeding, glossitis, oral mucosal blistering and exfoliation, paraesthesia oral Rare Dysphagia, hypoaesthesia oral, retching Not known Dry throat, gastrointestinal discomfort, lip pain Skin and subcutaneous tissue disorders Uncommon Hyperhidrosis, pruritus, rash, urticaria Not known Erythema General disorders and administration site conditions Common Burning sensation, fatigue Uncommon Asthenia, chest discomfort and pain, malaise. MAH: Johnson & Johnson (Ireland) Limited, Airton Road, Tallaght, Dublin 24, Ireland. PA Number: PA 330/37/16. Date of revision of text: Jan 2019. Product not subject to medical prescription. Full prescribing information available upon request. Nicorette Fruit 4 mg Lozenge. Composition: Each 4mg lozenge contains 4 mg nicotine (as nicotine resinate). For a full list of excipients. Pharmaceutical form: Compressed lozenge (lozenge). Indications: Nicorette Fruit Lozenges are to be used for the treatment of tobacco dependence by relief of nicotine withdrawal symptoms and cravings in smokers 18 years and above. Permanent cessation of tobacco use is the eventual objective. Nicorette Fruit Lozenges should preferably be used in conjunction with a behavioural support programme. Dosage: Nicorette Fruit 4 mg Lozenges are suitable for smokers with high nicotine dependency e.g. those smoking their first cigarette of the day within 30 minutes after waking up or those who smoke 20 cigarettes or more per day. Lozenges should not be used for more than 9 months. If users still feel the need for treatment, a healthcare professional should be consulted. Behavioural therapy advice and support will normally improve the success rate. Abrupt cessation of smoking: The patient should make every effort to stop smoking completely during treatment with Nicorette Fruit Lozenges. The lozenges should be used whenever there is an urge to smoke. Sufficient lozenges should be used each day and most smokers usually require 8 to 12, not to exceed 15 lozenges. The duration of treatment is individual, but up to six weeks treatment is recommended to break the habit of smoking. The nicotine dose should then be gradually reduced, by decreasing the total number of lozenges used per day. The treatment should be stopped, when the daily consumption is down to 1-2 lozenges. Use a lozenge whenever there is an urge to smoke to maintain complete abstinence from smoking. In the event of sudden cravings any spare lozenges should be retained and used whenever there is a craving or an urge to smoke. Gradual cessation through progressive reduction in smoking: For smokers who are unwilling or unable to quit abruptly. Use a lozenge between smoking episodes to manage the urge to smoke, to prolong smoke-free intervals and with the intention to reduce smoking as much possible. The number of lozenges a day is variable and depends on the patients needs. Nonetheless it should not exceed 15 lozenges per day. If a reduction in number of cigarettes per day has not been achieved after 6 weeks, professional advice should be sought. Reduced tobacco consumption should lead to complete cessation of smoking. A quit attempt should be made as soon as the smoker feels ready, but not later than 6 months after start of treatment. When the number of cigarettes has been reduced to a level from which the user feels able to quit completely, then the schedule for “abrupt cessation” as given above should be started. If the attempt to stop smoking completely has not been started within 6 months after the beginning of treatment, it is recommended to consult a healthcare professional. Paediatric population: Nicorette Fruit Lozenges should only be used by adolescents (12-17 years inclusive) with advice from a doctor. Nicorette Fruit Lozenges are not recommended for use in children below the age of 12. The safety and efficacy of Nicorette Fruit Lozenges in children and adolescents has not been investigated. Method of administration: Oromucosal use. One lozenge should be placed in the mouth and allowed to dissolve. Periodically, the lozenge should be moved from one side of the mouth to the other, and repeated, until the lozenge is completely dissolved (approximately 16-19 minutes). The lozenge should not be chewed or swallowed whole. Users should not eat or drink while a lozenge is in the mouth. Contraindications: Hypersensitivity to nicotine or to any of the other excipients. Children under the age of 12 years. Those who have never smoked. Special warnings and precautions for use: The benefits of quitting smoking usually outweigh any risk associated with correctly administered nicotine replacement therapy (NRT). A risk-benefit assessment should be made by an appropriate healthcare professional for patients with the following conditions: Cardiovascular disease: Dependent smokers with a recent myocardial infarction, unstable or worsening angina including Prinzmetal’s angina, severe cardiac arrhythmias, recent cerebrovascular accident and/or who suffer with uncontrolled hypertension should be encouraged to stop smoking with non-pharmacological interventions (such as counselling). If this fails, Nicorette Fruit Lozenge may be considered but as data on safety in this patient group are limited, initiation should only be under close medical supervision. Diabetes Mellitus. Patients with diabetes mellitus should be advised to monitor their blood sugar levels more closely than usual when smoking is stopped and NRT is initiated as reduction in nicotine-induced catecholamine release can affect carbohydrate metabolism. Allergic reactions: Susceptibility to angioedema and urticaria. Renal and hepatic impairment: Use with caution in patients with moderate to severe hepatic impairment and/or severe renal impairment as the clearance of nicotine or its metabolites may be decreased with the potential for increased adverse effects. Phaeochromocytoma and uncontrolled hyperthyroidism: Use with caution in patients with uncontrolled hyperthyroidism or phaeochromocytoma as nicotine causes release of catecholamines. Gastrointestinal Disease: Swallowed nicotine may exacerbate symptoms in patients suffering from oesophagitis, gastric or peptic ulcers and oral NRT preparations should be used with caution in these conditions. Paediatric population: Danger in children: Doses of nicotine tolerated by smokers can produce severe toxicity in children that may be fatal. Products containing nicotine should not be left where they may be handled or ingested by children. Stopping Smoking: Polycyclic aromatic hydrocarbons in tobacco smoke induce the metabolism of drugs metabolized by CYP 1A2 (and possibly by CYP 1A1). When a smoker stops smoking, this may result in a slower metabolism and a consequent rise in blood levels of such drugs. This is of potential clinical importance for products with a narrow therapeutic window, e.g. theophylline, tacrine, clozapine and ropinirole. Transferred dependence: Transferred dependence is unusual and is both less harmful and easier to break than smoking dependence. Undesirable effects: Effects of Smoking Cessation: Regardless of the means used, a variety of symptoms are known to be associated with quitting habitual tobacco use. These include emotional or cognitive effects such as dysphoria or depressed mood; insomnia; irritability, frustration or anger; anxiety; difficulty concentrating, and restlessness or impatience. There may also be physical effects such as decreased heart rate; increased appetite or weight gain, dizziness or presyncopal symptoms, cough, constipation, gingival bleeding or apthous ulceration, or nasopharyngitis. In addition, and of clinical significance, nicotine cravings may result in profound urges to smoke. The Nicorette Fruit Lozenge may cause adverse reactions similar to those associated with nicotine given by other means. Most of the undesirable effects reported by the subjects occur during the early phase of treatment and are mainly dose dependent. Irritation in the mouth and throat may be experienced, however most subjects adapt to this with ongoing use. Allergic reactions (including symptoms of anaphylaxis) occur rarely during use of Nicorette Fruit Lozenge. Immune System Disorders: Common – Hypersensitivity; Not known - Allergic reactions including angioedema and anaphylaxis Psychiatric disorders: Uncommon - Abnormal dreams Nervous system disorders: Very common – Headache; Common - Dysgeusia, paraesthesia Eye disorders: Not known - Blurred vision, lacrimation increased Cardiac Disorders: Uncommon - Palpitations, tachycardia, atrial fibrillation Vascular disorders: Uncommon - Flushing, hypertension Respiratory, thoracic and mediastinal disorders: Very common - Cough, hiccups, throat irritation; Uncommon - Bronchospasm, dysphonia, dyspnoea, nasal congestion, oropharyngeal pain, sneezing, throat tightness Gastrointestinal disorders: Very common - Nausea, mouth/throat and tongue irritation; Common - Abdominal pain, dry mouth, diarrhea, dyspepsia, flatulence, salivary hypersecretion, stomatitis, vomiting, heartburn; Uncommon - Eructation, glossitis, oral mucosal blistering and exfoliation, paresthesia oral; Rare - Dysphagia, hypoaesthesia oral, retching; Not known - Dry throat, gastrointestinal discomfort, lip pain Skin and subcutaneous tissue disorders: Uncommon - Hyperhidrosis, pruritus, rash, urticaria; Not known - Erythema General disorders and administration site conditions: Common - Burning sensation, fatigue; Uncommon - Asthenia, chest discomfort and pain, malaise. MAH: Johnson & Johnson (Ireland) Limited, Airton Road, Tallaght, Dublin 24, Ireland. PA Number: PA 330/37/18. Date of revision of text: May 2018. Product not subject to medical prescription. Full prescribing information available upon request.




Available in pharmacies nationwide. Buy online at elaveskincare.com

IQVIA Top 100 Pharmacy Products Sinead McMahon, Sales Manager, Ireland, Ovelle Q: It’s a brilliant achievement by any Irish company to have products in the Top 100 - how have Ovelle achieved this? A: Ovelle was the first manufacturing chemist on the island of Ireland to prepare apothecary for sensitive dry skin conditions so our long tradition has helped us achieve this. Our expertise in manufacturing traditional Ovelle apothecary products like Silcock’s Base, Aqueous Cream and Emulsifying Ointment allowed us to draw on dermatological advances in skincare to create Elave skincare which helps prevent flare up of sensitive including eczema, dermatitis and rosacea prone skin. Elave sensitive skincare is about daily protection of the skin barrier in a world where 25% of babies develop sensitive baby eczema and 12% of adults have eczema, dermatitis and rosacea-prone skin. That means that many of us are living with uncomfortable skin sensitivity and many of us are searching for a solution. And that is what is really behind the success of our sensitive skincare range. It really works and, importantly, is trusted and recommended by pharmacy for this reason. We are very proud to have our two skincare brands, Ovelle Silcocks Base and Elave in the Top 100 OTC listing against massive multi-national competition. Thank you to all staff in pharmacies for your support. Q: Have you anything new coming down the pipeline for your brands over the next 12 months? A: At Elave sensitive skincare we have a very big focus on Allergen free Sun SPF Protection and have a pipeline of Sun Protection Solutions coming. Q: Does consumer marketing play a large part of your success? A: We put most of our marketing focus on working with medical professionals who give advice to families with eczema and dermatitis from Pharmacists to Dermatolgists to GP’s. We also collaborate with charities like TinyLife Northern Ireland’s Premature Baby Charity and we have proudly achieved ‘approved by’ status for our baby skincare range.

23 ZIRTEK Allergic symptoms are not just a summer nuisance brought on by hay fever they can be an all year-round problem, affecting lives every day. Customers suffering from a constantly stuffy or blocked nose and sneezing, both during the day and night, should try Zirtek Because Zirtek not only offers the opportunity to control allergic rhinitis but also provides symptom relief for skin, dust and pet allergies. Zirtek is a 2nd generation antihistamine, which means it does not cause drowsiness in the majority of people, and offers a range of formats to suit the whole family (from ages 2 and upwards).

25 PIRITON Piriton tablets are indicated for symptomatic control of all allergic conditions responsive to antihistamines, including hay fever, vasomotor rhinitis, urticaria, angioneurotic oedema, food allergy, drug and serum reactions, insect bites. Also indicated for the symptomatic relief of itch associated with chickenpox. Each tablet contains 4 milligrams of chlorphenamine maleate. Not recommended for children under 6 years.

26 MOTILIUM Motilium is an antiemetic and a prokinetic medicine. Motilium is indicated for the relief of the symptoms of nausea and vomiting.

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

29 DUPHALAC Duphalac contains lactulose and is used to treat chronic constipation. It works by making the stool softer and easier to pass by drawing water into the bowel.

Calpol ® SixPlus Specially formulated for older children

8 7 6+

Lets Kids be Kids Paracetamol

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

How Much

How often (in 24 hours)

6 – 8 years

One 5 ml spoonful (large end)

4 times

8 – 10 years

One 5.0 ml spoonful (large end) and one 2.5ml spoonful (small end)

4 times

10 – 12 years

Two 5 ml spoonfuls (large end)

4 times

12 – 16 years

Two – three 5ml spoonfuls (large end)

4 times

Adults and children over 16 years

Two – four 5ml spoonfuls (large end)

4 times

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

How Much

How often (in 24 hours)

6 – 9 years

1 tablet

4 times

9 – 12 years

2 tablets

4 times

12 – 16 years

2 to 3 tablets

4 times

Adults and children over 16 years

2 to 4 tablets

4 times

Adults and children over 16 years

Two – four 5ml spoonfuls (large end)

4 times

Children under 6 years: Calpol Six Plus Suspension and Calpol Fastmelts are not suitable for administration to children under 6years of age. Renal impairment: It is recommended, when giving paracetamol to patients with renal impairment, to reduce the dose and to increase the minimum interval between each administration to at least 6 hours unless directed otherwise by a physician. Patients should be advised to contact their healthcare professional before use. Hepatic impairment: In patients with hepatic impairment or Gilbert’s Syndrome, the dose should be reduced or the dosing interval prolonged. Patients should be advised to contact their healthcare professional before use. The Elderly: Experience has indicated that normal adult dosage is usually appropriate. However, in frail, immobile, elderly subjects or in elderly patients with renal or hepatic impairment, a reduction in the amount or frequency of dosing may be appropriate. For certain patient groups, a reduced maximum daily dose should be considered: Patients who are underweight (for adults, those under 50kg), Chronic alcoholism, Dehydration, Chronic malnutrition. These patients should be advised to contact their healthcare professional before use. Contra-indications: Hypersensitivity to the active substance or to any of the excipients. Calpol Six Plus Fastmelts are contra-indicated in patients with phenylketonuria Special warnings and precautions for use: Paracetamol should be administered with caution under the following circumstances: Hepatic impairment, Chronic alcoholism, Renal impairment (GFR≤50ml/min), Gilbert’s Syndrome (familial non-haemolytic jaundice), Concomitant treatment with medicinal products affecting hepatic function, Glucose-6-phosphate dehydrogenase deficiency, Haemolytic anaemia, Glutathione deficiency, Dehydration, Chronic malnutrition, Patients who are underweight (for adults, those under 50 kg), Elderly. In general, medicinal products containing paracetamol should be taken for only a few days without the advice

of a physician or dentist and not at high doses. If high fever or signs of secondary infection occur or if symptoms persist for longer than 3 days, a physician should be consulted. Prolonged or frequent use is discouraged. Patients should be advised not to take other paracetamol containing products concurrently. Taking multiple daily doses in one administration can severely damage the liver; in such cases medical assistance should be sought immediately. Serious skin reactions such as acute generalized exanthematous pustulosis (AGEP), Stevens - Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN), have been reported very rarely in patients receiving paracetamol. Patients should be informed about the signs of serious skin reactions and use of the drug should be discontinued at the first appearance of skin rash or any other sign of hypersensitivity. Calpol Six Plus: Contains sucrose and sorbitol. Patients with rare hereditary problems of fructose intolerance, glucose-galactose malabsorption or sucrose-isomaltase insufficiency should not take this medicine. Contains sunset yellow (E110) which may cause allergic reactions. Contains methyl parahydroxybenzoate (E218) which may cause allergic reactions (possibly delayed). Calpol Six Plus SF/CF: Contains 2.04g Maltitol and 1.4g Sorbitol per 5ml Patients with rare hereditary problems of fructose intolerance should not take this medicine. May have mild laxative effect. Calorific value 2.3kcal/g maltitol and 2.6 kcal/g sorbitol. Methyl and propyl parahydroxybenzoates may cause allergic reactions (possibly delayed). Undesirable effects: Paracetamol has been widely used and, when taken at the usual recommended dosage, side effects are mild and infrequent and reports of adverse reactions are rare. Skin rash and other allergic reactions occur rarely. Most reports of adverse reactions to paracetamol relate to overdosage with the drug.Isolated cases of thrombocytic purpura, haemolytic anaemia and agranulocytosis have been reported. Chronic hepatic necrosis has been reported in a patient who took daily therapeutic doses of paracetamol for about a year and liver damage has been reported after daily ingestion of excessive amounts for shorter periods. A review of a group of patients with chronic active hepatitis failed to reveal differences in the abnormalities of liver function in those who were long-term users of paracetamol nor was the control of the disease improved after paracetamol withdrawal. .Low level transaminase elevations may occur in some patients taking labelled doses of paracetamol; these are not accompanied with liver failure and usually resolve with continued therapy or discontinuation of paracetamol. Nephrotoxic effects following therapeutic doses of paracetamol are uncommon. Papillary necrosis has been reported after prolonged administration. System Organ Classification (SOC) Blood and lymphatic system disorders

Immune system disorders Hepatobilary disorders Skin and subcutaneous tissue disorders

Renal and urinary disorders Investigations

Frequency category

Adverse Event Preferred Term

Not known

Thrombocytopenic purpura

Not known

Haemolytic anaemia

Not known


Not known

Anaphylactic reaction IRE/CA/18-3235(2)



Not known

Hepatic necrosis

Not known

Liver injury



Not known


Not known

Pruritic rash


Nephropathy toxic

Not known

Renal papillary necrosis

Not known

Transaminases increased

MAH: Johnson & Johnson (Ireland) Ltd Airton Road, Tallaght, Dublin 24, Ireland. PA No. PA 330/17/2, PA 330/17/3, PA 330/17/5 Date of revision of text: March 2019. Product Not subject to medical prescription. Full prescribing information available upon request from Johnson & Johnson (Ireland) Ltd.


IQVIA Top 100 Pharmacy Products 31 NUROFEN COLD & FLU

Joe Keane, Marketing Manager, Rowex Ltd.

Nurofen Cold & Flu performance was impacted by the low incidence in Winter 2018/2019 versus the prior year high incidence season. Despite this Nurofen Cold and Flu remains the number 3 brand on the market and achieved the number 1 status in June 2019*.

Q: It’s a brilliant achievement by any Irish company to have products in the Top 100 - how have Rowex achieved this?

Full prescribing information available on www.medicines.ie

A: For a company based in West Cork, it is incredible to have four products in the Top 100 especially when we see Cetrine Allergy edge closer to the Top 10 and Brupro in Top 50.

*IMS Data June 2019 | IRL/CC/0819/0015 Date of preparation Aug 19

33 BUTTERCUP BRONCHO Buttercup Bronchostop Cough Syrup and Berry Flavour Cough Pastilles are traditional herbal medicinal products for the relief of any cough, such as chesty, dry, tickly, irritating coughs and catarrh, exclusively based upon long-standing use. Buttercup Bronchostop Cough Syrup contains thyme herb extract and marshmallow root extract. Buttercup Bronchostop Berry Flavour Cough Pastilles contains thyme herb extract. TR Holder: Kwizda Pharma GmbH, Effingergasse 21, A-1160 Vienna. Further information is available upon request.

Our OTC division continues to grow, going from strength to strength. In March, at the OTC & Product Retail Awards, we picked up Best Allergy Product of the Year for our product Cetrine Allergy and what makes this year extra special is that our parent company, Rowa Pharmaceuticals Ltd., is celebrating 60 years in Bantry. The Top 100 and the awards is all down to the hardworking staff at Rowa/Rowex.

34 OTRIVINE Otrivine nasal spray is a clear, colourless solution indicated in the treatment of nasal congestion, perennial and allergic rhinitis (including hay fever) and sinusitis. Otrivine helps to open up the nasal passages by reducing the excessive nasal secretions and returning the swollen blood vessels to their normal size. The effects start within minutes and last for up to ten hours. Caution is recommended in patients with hypertension, cardiovascular disease, hyperthyroidism, narrow angle glaucoma or diabetes mellitus.

35 BENYLIN DAY NIGHT BENYLIN® Day & Night tablets are the number one selling cold & flu remedy in Ireland*. BENYLIN® Day & Night tablets are the only day & night tablets in the Irish market and provide 24 hour cold & flu relief. They help reduce temperature, relieve aches and pains, help clear catarrh and so aid restful sleep. During the day the white tablet relieves fever and decongests the nose. During the night the blue tablet helps relieve cold symptoms for a better night sleep. The BENYLIN® Cold & Flu range also contains BENYLIN® 4FLU for effective relief from flu symptoms including fever, congestion, and aches and pains. Contact your Johnson & Johnson territory representative for more information.

Q: Have you anything new coming down the pipeline for your brand over the next 12 months? A: We have some fantastic new products that we can’t wait to share, watch this space. Q: Does consumer marketing play a large part of your success? A: Absolutely, marketing is crucial. OTC is an intense and packed marketplace with hundreds of products trying to capture the consumer. We strongly believe that tactical advertising, brand development and brand awareness have been critical in establishing our products as stand out leading brand names that the pharmacist and consumer can trust.

MAH: Johnson & Johnson (Ireland) Ltd. Airton Road, Tallaght, Dublin 24, Ireland. Product not subject to medical prescription. Further information available upon request from Johnson & Johnson (Ireland) Ltd. | *IMS Volume sales cold or flu remedies category FY 2018.

37 TYROZETS TYROZETS™ LOZENGE is a medicine which is used to relieve minor mouth and throat irritations. TYROZETS™ LOZENGES may also be taken to relieve irritation after mouth and throat surgery. The lozenges contain tyrothricin, which is an antibiotic that helps fight throat infection, and benzocaine, a local anaesthetic that numbs sore throat pain. The lozenges dissolve in the mouth, gradually releasing the active ingredients which reach the painful throat area at the back of the mouth.

IQVIA Top 100 Pharmacy Products 39 HYLO FORTE HYLO Forte® is a preservative-free eye drop containing 0.2% Sodium Hyaluronate which provides a long lasting, intensive, soothing relief for more severe cases of dry eye. Supplied in a unique, multi-dose 7.5ml bottle containing 225 guaranteed equal drops.

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

42 DIFFLAM Difflam Spray allows you to deliver just the right amount of fast acting relief, straight to where it’s needed. It can be used to treat many painful conditions of the mouth and throat including: • mouth ulcers, sore throat or gums • inflammation following dental surgery • inflammation of the throat (pharyngitis) following surgical removal of the tonsils(tonsillectomy)  Sugar free, lactose free and gluten free  Suitable for adults and children over 12 months  Handy 30ml spray dispense

44 SUDOCREM Sudocrem Antiseptic Healing Cream is an iconic Irish brand manufactured in Baldoyle, Dublin. It is indicated in the management of various dermatoses including local skin reactions associated with incontinence (nappy rash, cuts & grazes, eczema, sunburn, minor burns, surface wounds, acne and bed sores). Sudocrem Antiseptic Healing Cream is a licenced medicine and has been used by generations of Irish for its soothing, protecting and healing properties.

45 IMODIUM For the symptomatic treatment of acute diarrhoea in adults and children aged 12 years and over. For the symptomatic treatment of acute episodes of diarrhoea associated with Irritable Bowel Syndrome in adults aged 18 years and over following initial diagnosis by a doctor.

Formulated with

pre-biotic oats*. For


healthier looking, more resilient skin

*in vitro test

IQVIA Top 100 Pharmacy Products 46 SINUTAB

Martin Gallagher, Director of Marketing & Business Development, Clonmel Healthcare

Non-Drowsy Sinutab is indicated for the symptomatic relief of conditions where congestion of the mucous membranes of the upper respiratory tract, especially nasal mucosa and sinuses, is accompanied by mild to moderate pain or pyrexia, e.g: the common cold and influenza, sinusitis, nasopharyngitis, allergic rhinitis and vasomotor rhinitis.

Q: It’s a brilliant achievement by any Irish company to have products in the Top 100 - how have Clonmel Healthcare achieved this?

48 SUDAFED NASAL SUDAFED® is the number one selling decongestant brand in Ireland*. Over the past 30 years SUDAFED® has developed clinically proven, over the counter treatments for congestion and associated symptoms. This enables people to treat a vast array of congestion symptoms without the need for a prescription. SUDAFED® offers relief from nasal congestion and catarrh while SUDAPLUS® provides the additional benefits of pressure and pain relief. The SUDAFED® range also contains SUDAPRO® Headcold which targets the 3 main symptom of a headcold; headache, pressure and blocked nose. Contact your Johnson & Johnson territory representative for more information.




The iconic brand, Deep Heat offers pain relief plus heat therapy. It is available in various formats – heat creams, spray and patches in two sizes. Deep Heat Cream, Deep Heat Spray and Deep Heat Pain Relief Patches are recommended for muscular aches, pains and stiffness, delivering targeted pain relief plus penetrating heat therapy. Senior brand manager, Kaye Mackay, says: “The Deep Heat patch is emerging as favourite with consumers who are looking for long lasting, odourless, drug free pain relief for backs as it can give relief for up to 16 hours and is discreet and convenient to use”. The newest addition to the Deep Heat range is Deep Heat Muscle Massage Roll-On Lotion, which offers massage plus heat therapy. It is designed to be used on the go whenever and wherever needed, providing targeted, warming relief to help ease tight, knotted muscles. Both the patches and the roll-on lotion are non-medicinal. Trade contact: starmedical.ie, Uniphar Group, Tel: 00353 (0) 1 468 8282

A: Clonmel Healthcare has a strong history and heritage in the pharmaceutical and OTC space in Ireland. We have invested a lot of time and innovation to deliver the products to our patients and customers. We recently launched Easolief DUO which is the first combination of paracetamol and Ibuprofen in one tablet in the Irish market. We are delighted to have our products in the Top 100 in pharmacy, with Paralief and Galfer in the Top 10, a further 6 products in the Top 50 and 8 in the Top 100. This has been achieved with the support of our customers and hard work from the team. Q: Have you anything new coming down the pipeline for the brands over the next 12 months? A: We continue to look at different categories and products that we believe will deliver quality and innovation for our customers. We will continue to launch many new products over the next 12 months. Q: Does consumer marketing play a large part of your success? A: We believe that marketing is extremely important to the success of our business and our brands. We continue to build our consumer connections with stand out campaigns that resonate with the consumer, and we are also investing in some major TV campaigns that are coming up soon, which is hugely exciting.

Nurofen Rapid Relief liquid capsules jumped to number 51 in the Top 100 brands. 125 million pain occasions were treated by Irish pharmacy over 12 months and 40 million of these were treated with Nurofen.* Nurofen Rapid Relief Liquid Capsules were launched in February 2019 providing over-the-counter fast and effective pain relief to patients.** With the return of the Express range in June, Nurofen now accounts for 44% of the Mild Pain market.*** Full prescribing information available on www.medicines.ie *IMS Data Aug 2018 | **Nurofen Rapid Relief Maximum Strength 400mg Liquid Capsules contain Ibuprofen. For pain relief. Always Read the Label. | ***IMS Data June 2019

Can you spot the difference?

This new needle will give your full insulin dose

This already-used needle may not give your full insulin dose

These needles may look the same, but they are not. Using a new needle with every injection will ensure you get the insulin dose you planned for. A reused needle increases the risk of blockage, as insulin can crystallize at the tip of the cannula. Ask your HCP today how you inject insulin can improve your outcome and ultimately your diabetes management. Use a new needle with every injection. Less painful injections1 Reduced contamination of the needle1 Reduced damage to your skin1

To learn more about BD diabetes care, visit: bd.com 1. Misnikova I.V. et al. The risks of repeated use of insulin pen needles in patients with diabetes mellitus. Journal of Diabetology 2011; 1:1-5 Based on all pen needle production after January 1st 2016 in Ireland. BD, BD Logo and BD Micro-Fine Ultra are trademarks of Becton, Dickinson and Company. Š 2019 BD and its affiliates. All rights reserved.









61 in



Beconase Hayfever nasal spray 50 micrograms per spray contains beclometasone dipropionate. For the prevention and relief of symptoms of Hayfever and other seasonal allergic conditions. Adults aged 18 and over: 2 sprays into each nostril twice a day. Max 8 applications per day (400 mcg). Seek medical advice if symptoms do not improve after 2 weeks. Do not use continuously for longer than 3 months without consulting a doctor. Do not give to persons under 18 years. Pregnant and breastfeeding mothers should not use without consulting a healthcare professional. Caution: Recent nasal injury or surgery. Side effects: Rare cases of hypersensitivity reactions. Unpleasant taste/smell, dryness/irritation of the nose and throat, raised intra-ocular pressure, nasal septal perforation. PA 1186/8/1. P. MAH: Chefaro Ireland Limited, The Sharp Building, Hogan Place, Dublin 2, Ireland. http://www.medicines.ie/medicine/7169/SPC/Beconase+Hayfever/ SPC: http://www.medicines.ie/medicine/7169/SPC/Beconase+Hayfever/. Further information is available on request to the holder of the authorisation or certificate, or in the summary of product characteristics relating to the product. Becodefence is a medical device.

IQVIA Top 100 Pharmacy Products 54 BUPLEX Buplex 200 & 400 mg film-coated tablets offer relief from mild to moderate pain, such as headache, including migraine headache, dental pain, period pain and fever. The active ingredient is Ibuprofen. Product features include: • Tablet can be divided into equal halves • Can use from age 6 upwards (200mg only) • Film-coated tablet • Lactose free • Available through pharmacy only • Pack size 12, 24 (200 & 400mg) & 50 (200mg only)

55 CORSODYL Corsodyl 0.2% mouthwash is used to inhibit the formation of dental plaque. It is also used as an aid in the treatment and prevention of gingivitis and in the maintenance of oral hygiene, particularly in situations where toothbrushing cannot be adequately employed. It is useful in the management of aphthous ulceration and oral candidal infections (e.g. denture stomatitis and thrush). Children under 12 years of age should not use the product unless recommended by a healthcare professional.

57 SOLPA-EXTRA Pain management is one of the most vital services in pharmacy today. Perrigo offers a range of different pain solutions to address different customer needs. Solpa-Extra 500 mg/65 mg Soluble Tablets contain paracetamol and caffeine and are used for the treatment of mild to moderate pain, for example: headache including migraine (with and without aura), backache, toothache, muscle ache, neuralgia, joint pain, dysmenorrhea, sore throat, and for the relief of fever, aches and pains of colds and influenza. MAH: Chefaro Ireland DAC, Treasury Building, Lower Grand Canal Street, Dublin 2, Ireland. P product. Further information is available upon request.

58 NICOTINELL Nicotinell provides relief from symptoms of nicotine withdrawal syndrome in nicotine dependence as an aid to quit smoking. Nicotinell is a smoking cessation treatment range that includes the patch, gum and lozenge for on-the-go (lozenge & gum) and around-the-clock (patch) relief from cravings. The Nicotinell range is indicated to aid smokers wishing to quit or reduce prior to quitting, to assist smokers who are unwilling or unable to smoke, and as a safer alternative to smoking for smokers and those around them.

Nursing in General Practice-Dulco IRE Trade Advert_297mm x 210 PRINT.pdf




IQVIA Top 100 Pharmacy Products 60 SILCOCKS BASE OVELLE


In 1934 Ovelle Pharmaceuticals, founded by Joseph Gardiner was the first manufacturing chemist in Ireland to prepare traditional apothecary for sensitive skin conditions and we continue that tradition to this day. Ovelle Pharmaceuticals Silcockâ&#x20AC;&#x2122;s Base is the No. 1 emollient of choice for consumers, dermatologists, pharmacists and medical professionals nationwide, moving up 21 places since 2018. Ovelle Silcockâ&#x20AC;&#x2122;s Base is manufactured in Ireland and available in 100g, 250ml and 500g sizes. Ovelle Pharmaceuticals creating trusted sensitive skincare solutions in Dundalk for over 80 years.

62 ACTIFED For the symptomatic relief of upper respiratory tract disorders which are benefited by a combination of a nasal decongestant and histamine H1-receptor antagonist, for example: allergic rhinitis, vasomotor rhinitis, the common cold and influenza. Listerine antiseptic mouthwash available for a variety of needs such as gum disease, cavity prevention, bad breath, tooth sensitivity as well as whitening. New to the range is Listerine Ready! Tabs for a clean mouth feel & fresh breath on-the-go.

63 VICKS 4-in-1 relief against colds: nasal catarrh, sore throat, congestion and cough due to colds.

64 NIQUITIN NiQuitin offers a range of products specifically designed for the relief of nicotine withdrawal symptoms including cravings as an aid to smoking cessation. NiQuitin products contain Nicotine. MAH: Chefaro Ireland DAC, The Sharp Building, Hogan Place, Dublin 2, Ireland. RRP (ex. VAT). GSL products. Further information is available upon request.

IQVIA Top 100 Pharmacy Products 65 PARACETAMOL PZC Paracetamol has analgesic and antipyretic actions similar to those of aspirin and hence is a suitable alternative for patients sensitive to aspirin. For the relief of mild to moderate pain and febrile conditions such as headache, toothache, colds, influenza, rheumatic pain and dysmenorrhoea. Not recommended for children under 10 years of age.

68 PANADOL ACTIFAST Panadol ActiFast is a mild analgesic and antipyretic, and is recommended for the treatment of most painful and febrile conditions, for example, headache including migraine and tension headaches, toothache, backache, rheumatic and muscle pains, dysmenorrhoea, sore throat, and for relieving the fever, aches and pains of colds and flu. Panadol ActiFast is not recommended for children under 12 years of age.

74 CB12 CB12 Sensitive Mouthwash Discover CB12 sensitive which not only eliminates bad breath but also helps to protect sensitive teeth, thanks to arginine, creating a protective shield for teeth against pain triggers such as cold, hot, sweet or air blasts. Itâ&#x20AC;&#x2122;s a fact that minty flavors only mask bad breath for a short while. CB12 is different. Itâ&#x20AC;&#x2122;s patented formula of 2 active ingredients - chlorhexidine and zinc, eliminates and prevents bad breath and is clinically proven to actively neutralise bad breath for 12 hours.

75 BENYLIN DRY N/D Indicated for the relief of irritating, tickling dry coughs and sore throats. Not to be given to children under 1 year.

Contains nicotine

“I quit smoking for her” Fergus O’Shea

Help smokers quit with an


combination* from


*Provides significant improvements in quit rates vs patch alone. Stead LF et al. 2012 Nicotine replacement therapy for smoking cessation, Cochrane Library.




NiQuitin CLEAR 24 hrs transdermal patches are indicated for the relief of nicotine withdrawal symptoms including cravings as an aid to smoking cessation. Indicated in adults and adolescents aged 12 years and over. NiQuitin patches should be applied once a day, at the same time each day and preferably soon after waking and worn continuously for 24 hours. Apply a patch to non-hairy clean dry skin surface, a new skin site should be used every day. Therapy should usually begin with NiQuitin 21 mg/24 hrs and reduced according to the following dosing schedule: Step 1 NiQuitin Clear 21 mg/24 hrs transdermal patches first 6 weeks. Step 2 NiQuitin Clear 14 mg/24 hrs transdermal patches next 2 weeks. Step 3 NiQuitin Clear 7 mg/24 hrs transdermal patches last 2 weeks. Light smokers (e.g. those who smoke less than 10 cigarettes per day) are recommended to start at Step 2 (14 mg) for 6 weeks and decrease the dose to NiQuitin 7 mg/24 hrs for the final 2 weeks. Contraindications: Non-smokers, hypersensitivity, children under 12 years and occasional smokers. Precaution: Supervise use if hospitalised for MI, severe dysrhythmia or CVA, if haemodynamically unstable. Use with caution in patients with active oesophagitis, oral and pharyngeal inflammation, gastritis, peptic ulcers, GI disturbances, susceptible to angioedema, urticaria, renal/hepatic impairment, hyperthyroidism, diabeties, phaeochromocytoma, seizures & epilepsy. Discontinue if severe persistent skin rash. Pregnancy and lactation: Oral formats preferable to patches unless nauseous. Remove patches at bedtime. Side effects: Transient rash, itching, burning, tingling, numbness, swelling, localised pain urticaria, hypersensitivity reactions. headache, dizziness, tremor, sleep disorders, nervousness, palpitations, tachycardia, dyspnoea, pharyngitis, cough, nausea, vomiting dyspepsia, upper abdominal pain, diarrhoea, constipation, dry mouth, sweating, dermatitis, photosensitivity, arthralgia, myalgia, asthenia, malaise, influenza-type illness, fatigue, seizures and anaphylaxis. Legal classification: GSL: PA 1186/18/4, PA 1186/18/5 & PA 1186/18/6. MAH: Chefaro Ireland DAC, The Sharp Building, Hogan Place, Dublin 2, Ireland. http://www.medicines. ie/medicine/12136/SPC/NiQuitin+CLEAR+7+mg+24+hours++transdermal+patch/ http://www.medicines.ie/medicine/12137/SPC/NiQuitin+CLEAR+14+mg+24+hours+transdermal+patch/ http://www. medicines.ie/medicine/12138/SPC/NiQuitin+CLEAR+21+mg+24+hours+transdermal+patch/ NiQuitin Mini 1.5mg/4mg Mint Lozenges are used for the treatment of tobacco dependence by relief of nicotine withdrawal symptoms and cravings. Indicated in adults and adolescents aged 12 years and over. NiQuitin Mini 1.5 mg are suitable for those who smoke who smoke 20 cigarettes or less a day. NiQuitin Mini 4 mg are suitable for smokers who smoke more than 20 cigarettes a day. Place a lozenge in the mouth whenever there is an urge to smoke, allow to dissolve completely. Do not chew or swallow whole. Abrupt cessation: Use a lozenge whenever there is an urge to smoke, maximum of 15 lozenges a day. Continue for up to 6 weeks, then gradually reduce lozenge use. Gradual cessation: Use lozenges whenever there is an urge to smoke in order to reduce the number of cigarettes smoked for up to 6 weeks, followed by abrupt cessation. Adolescents (12-17 years): Only with advice from a healthcare professional. Contraindications: Hypersensitivity to nicotine or any of the excipients, children under the age of 12 years and non-smokers. Precaution: Supervised use in dependent smokers with a recent myocardial infarction, unstable or worsening angina pectoris including Prinzmetal’s angina, severe cardiac arrhythmias, uncontrolled hypertensions or recent cerebrovascular accident. Use with caution in those with; stable cardiovascular diseases, diabetes mellitus, susceptiblity to angioedema & urticaria renal/hepatic impairment, phaeochromocytoma & uncontrolled hyperthyroidism, GI disease & seizures. Side effects: Nausea, mouth/throat and tongue irritation, irritability, anxiety, sleep disorders, dizziness, headaches, cough, sore throat, dyspnoea, vomiting, diarrhoea, GI discomfort, flatulence, hiccups, heartburn, dyspepsia, nervousness, depression, palpitation, rash, angioedema, pruritus, erythema, hyperhidrosis, fatigue, malaise chest pain, anaphylactic reactions, hypersensitivity, tremor, dysgeusia, paresthesia mouth, seizures & epilepsy, dysphagia, eructation, salivary hypersecretion, pharyngitis. http://www.medicines.ie/medicine/14493/SPC/NiQuitin+Mini+1.5mg+mint+lozenges/#PRODUCTINFO http://www.medicines.ie/medicine/14492/SPC/NiQuitin+Mini+4mg+mint+lozenges/ Legal classification: GSL: PA 1186/18/11 & PA 1186/18/12. MAH: Chefaro Ireland DAC, The Sharp Building, Hogan Place, Dublin 2, Ireland.

IQVIA Top 100 Pharmacy Products 78 IMODIUM PLUS Imodium Plus is indicated for the symptomatic treatment of acute diarrhoea in adults and adolescents over 12 years when acute diarrhoea is associated with gas-related abdominal discomfort including bloating, cramping or flatulence.



The Calpol Vapour Plug & Nightlight contains a blend of aromatic oils including lavender, chamomile, menthol, camphor and eucalyptus. These oils help to soothe and comfort the child at night time whilst helping to ease breathing. Non-medicated aromatic vapours provide soothing night time comfort. Suitable for children aged 3+ months.

81 ALFLOREX Alflorex® is the only product in Ireland that contains the unique natural 35624® culture, which has been clinically tested by leading scientists and gastroenterologists. It is the number one recommended culture by U.S. doctors and gastroenterologists. Alflorex® has been recognised by Irish pharmacists and industry experts, who voted it the winner of Best Gastrointestinal Product for 3 years in a row at the Irish Pharmacy News OTC Awards, and voted Best Digestive Product in 2019. The product is made by PrecisionBiotics, who specialise in discovery of single strains, targeted at specific conditions. Their discovery partners are world leading experts in the human microbiome, including the APC Microbiome Institute in Ireland. Inclusion of Alflorex® in the Top 100 products, at 81, shows an increase of over 200 places in five years. Consumer advocacy had been very positive for Alflorex® as shown by classification in IQVIA figures March 2019 -as one of Irelands leading food supplements. Alflorex® is also available in chewable form as an alternative to capsules. PrecisionBiotics has also launched a new product called Zenflore® in 2019 aimed at reducing fatigue and supporting a busy lifestyle. For more information on Alflorex, Zenflore and upcoming products visit www.precisionbiotics.com

82 SEVEN SEAS COD LIVER OIL Seven Seas believe that the simple and natural things in life keep you feeling 'young at heart'. That is why Seven Seas Simply Timeless Cod Liver Oil remains the classic way to help to support good health as you get older. Significant investment in TV advertising over the last two years using the ‘Medifacts’ format, has helped reinforce this message with Irish consumers. Watch out for our next TV campaign from early October 2019!

IQVIA Top 100 Pharmacy Products 84 THERMACARE ThermaCare is a range of heat wraps which uses heat cell technology to deliver therapeutic heat right to the site of pain to provide long lasting pain relief for up to 16 hours1. It is clinically proven to be as effective for treating lower back pain as Ibuprofen or Paracetamol at their maximum OTC dosage1. ThermaCare has grown from strength to strength experiencing double digit value growth of 18% in 2018 for the year ending November2 and it continues to be supported heavily with consumer promotions throughout 2019. 1. Nadler SF, Steiner DJ, Erasala GN, et al. Continuous low-level heat wrap therapy provides more efficacy than ibuprofen and acetaminophen for acute low back pain. Spine. 2002;27(10):1012-1017. | 2. Pfizer Sales Nov 2018.

85 ELAVE Elave sensitive skincare continues its impressive performance retaining its position in this year’s OTC Top 100. This pharmacy only, multi- award winning brand offers trusted skincare solutions for dry, sensitive, eczema and dermatitis prone skin in all categories including baby, dermatological, junior, dermo-renew, men’s and sun. Elave products are clinically proven and are dermatologically and paediatrician approved from new-born for sensitive and eczema prone skin. Recommended and used by medical professionals nationwide. Made in Ireland.

87 BIO KULT Bio-Kult is a range of award-winning, scientifically developed live bacteria supplements for the whole family. The full range of supplements include Bio-Kult Advanced, Bio-Kult Pro-Cyan, Bio-Kult Candéa, Bio-Kult Infantis and the latest product Bio-Kult Migréa, targeting the digestive tract and the head.

88 CAVILON 3M™ Cavilon™ Durable Barrier Cream is a concentrated, fragrance‑free moisturising barrier cream that creates an invisible, breathable barrier to moisturise and protect the skin from the irritating effects of bodily fluids, such as urine and/or faeces. Safe to use on intact and injured skin it resists wash-off, meaning fewer applications.

IQVIA Top 100 Pharmacy Products NEW TOP 100 ENTRY 97 ROWALIEF Rowalief, containing paracetamol, makes it into the Top 100 for the first time.

NEW TOP 100 ENTRY 98 BD MICRO-FINE Insulin pen needles are a convenient way to deliver a precise dose of insulin through an insulin pen device. Patients with Type 1 diabetes, unless on an insulin pump all use insulin pen needles. Those patients with Type 2 diabetes once initiated on insulin are also all using insulin pen needles, providing these patients with the most reliable way to deliver their insulin. BD Micro-Fine™ Pen needles are designed for single use and are available on prescription. It also comes with online education for your patients through BD and Me™ to help show them how to use the correct injection technique (https://bdandme.bd.com). It is important to inject insulin according to the recommendations given by a nurse or doctor.

99 OLBAS The Olbas family of products has something for every blocked nose, little and big. Noses get blocked and bunged up with winter colds and attacked by summer hay fever. Luckily, Olbas products are always on hand to help noses find relief, wherever and whenever they need it. Olbas Oil is a special mixture of pure plant oils, with ingredients including clove oil, eucalyptus, juniper berry and cajuput. It’s the combination of these natural ingredients which releases those famously soothing and relieving natural vapours. It’s the power of nature - for noses. Available from Valeo Healthcare.

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

The 2020

PHARMACY Show Date for your Diary Date: Sunday 19th & Monday 20th April 2020 Venue: Citywest Convention Centre, Dublin 24

For further information, please contact:

Laura Payne

Brand and Trade Marketing Manager, United Drug Email: pharmacyshow@united-drug.com Mobile: 087 383 2297

A McKesson Company

Irish Pharmacy Awards 2019


Padraig Cronin, Head of Strategic Planning and Development, United Drug with Laura Gilmartin, Commons Road Pharmacy

Having Success in Common The pharmacy team at Commons Road, led by Pharmacist Laura Gilmartin, has embraced the opportunity to enhance their service offering to patients in numerous ways over the last twelve months. Whilst benefiting the community they serve, this has also impacted positively on the business as a whole. Laura accepted the award stating, “We are a fairly new business, which only opened its doors three years ago, so to win this award is huge for us. This is a really important category and it is thrilling to know that our hard work has paid off. “We wanted to step out of our comfort zone, to think outside

the box with regards to our service offering and do something different and in doing so we have been able to access all demographics and age groups within our community. “The role of community pharmacist is not just a job to me, it is a passion and a vocation.” Overseeing Challenges Since the pharmacy opened back in 2016, unfortunately the team has been involved in a couple of incidents of armed robbery, one in which a staff member was injured. Laura reflects, “As a pharmacist and the pharmacy manager, it was a difficult time to help the staff recover from the emotional trauma it caused. “Over the last year, I feel that myself and my team are stronger than ever but it was a long and difficult road fuelled with emotion and fear. As a predominately female environment, it is hard

for the staff to continue doing all the good work we do without worrying who will walk through the door. I feel that I helped the staff to move forward with the incident by offering whatever support I could, emotional or otherwise. “I would say that I am a very approachable person which helped when the staff want to talk. Extra security measures are now in place, which has had a massive impact on how the staff has dealt with the incidents.” Another challenge faced over the last 12 months which is similar to any new business, is growing the business and getting the pharmacy name out into the public domain. “As a pharmacist, I have had to think outside the box and come up with new and innovative ways to increase business rather than just wait for people to bring their prescriptions to me,” Laura adds. Examples of this include building

relationships with local nursing home, businesses, local GAA teams, increased social media activity and sourcing new products that would benefit patients and customers. One of the team’s most recent ventures is that they are currently sponsoring the Meath Style Awards, which celebrates business owners across Meath. All of these tasks undertaken in the last year have had a positive impact on business. Staying on Top of Health Promotion Commons Road Pharmacy offers a plethora of health promotion opportunities for their customers. These include: Skin Information Night Laura says, “Skin is a passion of mine and it is something that doesn’t just affect a person physically but mentally also. This information night was to

United Drug Business Development (Independent) Award Larua Gilmartin and the team at Commons Road Pharmacy in Clogherboy, Navan, were the winners of the United Drug Business Development (Independent) Award

Ireland, which helped to raise money for homelessness in Ireland.” All of these challenges and opportunities have enabled the business to grow with success.

give people who suffer from conditions such as psoriasis or eczema the opportunity to understand their condition and offer alternative treatment and advice. Simple advice such as the correct method of applying cream – advice that some of my customers had never been given.” Medicine Review Service “Offering this service has been of great benefit to my patients, as it has given them the time and chance to talk about their tablets, any side effects they may be having and an issues taking them. It also gives me the opportunity to ensure the patients understand what they are taking their tablets for and how to take them properly.” Breast Cancer Awareness “This awareness day was of great benefit to all our female customers. I arranged a lady to come from Breast Cancer Ireland to educate women on how to check their breasts and what warning signs to look out for.”

Start 2019 the right way! “This campaign offered customers the opportunity to help customers boost their immune systems and get the well from the inside for the new year by offering alternative remedies.” Operation Transformation “This was a huge success and we were 1 of only 2 pharmacies in Navan that offered the service. We had 150 people call to the pharmacy to avail of this service and we are now continuing to offer this service in store, free of charge.” Engaging with the Community Engaging with the community is an essential role of any successful

pharmacy team. Laura continues, “Part of my role as pharmacist is giving back to the community. As a new business, we have only been open for almost three years. I believe I have nurtured the relationship with the local community to become an integral part of it. Over the last year we have held 2 large scale events for our customers. “In June of 2018 we held a second birthday party. This was a fun day for the community offering great bargains and entertainment for all. We had food and drinks for our customers and plenty of games and activities for the children. We also raised money on the day for a local charity ‘Meath River Rescue’, who were there on the day to help us celebrate. “Following that, in November we held a customer appreciation day which offered our customers a 20% discount off everything in store. Over the last 12 months, we have also raised money for different charities such as the Irish Cancer society by holding a coffee morning and raffle and One for

Laura continues, “As a fairly new business, I feel that I have been instrumental in the growth of the business over the last couple of years. I have been working alongside a local nursing home offering emergency services 7 days per week. I have been influential in the relationship with the pharmacy and the nursing home and ensure we offer exceptional service. Since we began dealing with the nursing home, 9 families have moved their family member’s medication to us to provide the service. “I have also built up a relationship with the local out of hours’ service and offer rotational stock orders and all controlled drug requests. I have even offered emergency services when other pharmacies couldn’t. “Another relationship that has been nurtured is with Meath Senior GAA team, who we now provide all medication for. The senior team doctor deals with myself on a weekly basis to ensure the team are fully equipped with necessary dressings and medication for training and matches.” “I believe that the role of a pharmacist is evolving and I am evolving with it. My role is always expanding to help my patients in many ways other than traditional methods. I step out from the dispensary as much as possible to interact with my patients and build up life time relationships,” Laura concludes.

Continuing Professional Development


CPD 105: ANTIRETROVIRAL USE IN COMMUNITY PHARMACY 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.

Author: David Reilly, Supervising Pharmacist with McCauley Chemist Navan Shopping Centre. David worked as a community pharmacist in the UK for seven years before returning to practice in Ireland in 2016.

Antiretroviral Use in Community Pharmacy 60 Second Summary It is a fact that antiretroviral drugs have been available on private prescription in community pharmacies in Ireland since 2017. Furthermore, the recent approval of antiretrovirals for a novel treatment approach (pre-exposure prophylaxis (PrEP)) by the HSE may see these medicines more widely prescribed and dispensed in community pharmacies. HIV infection has several effects on the body and can lead to the development of life-threatening conditions such as acquired immunodeficiency syndrome (AIDS). Over 6,000 people are estimated to be living with HIV in Ireland with an estimated 15% of them not knowing they have the infection. Effective treatment of HIV infection not only prolongs the patient’s life but also drastically reduces their risk of passing on the infection. The current treatment approaches target various stages of the above HIV life cycle. Different combinations of drugs are used to inhibit this HIV life cycle and prevent the progression of the disease. Nucleotide and nucleoside reverse transcriptase inhibitors (NRTIs/NRtTIs) nicknamed “Nukes” inhibit reverse transcription as the virus tries to form a double stranded molecule from its single nucleoside protein molecules before integration into the human CD4 cell DNA. Non-nucleoside reverse transcriptase inhibitors (NNRTIs) nicknamed for simplicity “Non-Nukes” also inhibit reverse transcription but are not themselves nucleosides. The main aims of treatment are to prevent mortality and morbidity associated with HIV infection at the lowest drug toxicity levels, minimise the risk of transmission of the infection on an individual and population level, and maximise the patient’s quality of life There are many ways that community pharmacists can contribute to the management of the disease both on an individual basis and from a wider population health promotion point of view.

HIV is a condition exclusively managed in the hospital setting under the supervision of specialist doctors, nurses and pharmacists. Other than recalling university training many community pharmacists could be forgiven for a less than working knowledge of the pharmacological management of HIV infection. However, it is a fact that an antiretroviral combination of tenofovir/emtricitabine has been available for the prevention of HIV infection on private prescription in community pharmacies in Ireland since 2017.1 Furthermore, the recent approval of antiretrovirals for this novel treatment approach (pre-exposure prophylaxis (PrEP)) by the HSE may see this formulation more widely prescribed and dispensed in community pharmacies. There is limited opportunity for generalist pharmacists to gain experience or knowledge of antiretroviral drugs in the community pharmacy setting.2 Given the large number of these drugs available, all with different drug interaction profiles and side effects, it is not surprising that community pharmacists may struggle to recognise their role in the management of HIV patients.

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. 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.

HIV infection in Ireland: HIV is a retrovirus that infects lymphocytes, primarily the CD4 cells, which are crucial for the proper functioning of the human immune system. HIV infection can affect any area of the body and can lead to the development of life-threatening conditions such as acquired immunodeficiency syndrome (AIDS). Over 6,000 people are estimated to be living with HIV in Ireland with an estimated 15% of them unaware they have the infection.3 Between 2003 and 2014 the number of positive tests for HIV remained at a stable level in Ireland at around 300-400 new cases per year. Since 2015 there has been an increase to 400-500 new positive tests each year.3 Approximately half of these new cases are among men who have sex with men (MSM) with the remainder being heterosexual men or women and those who inject drugs.3

Transmission and Risk: HIV is transmitted in the following ways • Unprotected anal or vaginal sex (Oral sex carries a very small risk) • Sharing unsterilised drug injecting equipment • Mother to child transmission during pregnancy or breast feeding • Through blood transfusions or during medical or dental procedures It is important to note that, if a patient is on effective treatment, there is no risk of passing on the infection through any of the means mentioned above. This message has been highlighted recently in the U=U campaign, that signifies Uninfectious = Untransmittable.

perform reverse transcription on the HIV RNA proteins to form a double stranded HIV molecule. An integrase enzyme then allows this double strand to link into the human CD4 cells own human DNA. Protease finally, cuts and assemble new copies of the HIV capsid contents which leads to the release of hundreds of new virions toCPD start the cycleANTIRETROVIRAL again (4). 105: USE IN COMMUNITY PHARMACY

Figure 1: HIV life cycle4

but are not themselves nucleosides. They bind to and directly block the action of the HIV reverse transcriptase enzyme.2 E.g. efavirenz and rilpivirine. Protease inhibitors (PIs) block the action of the protease enzyme that cuts the newly formed HIV DNA into component parts prior to assembly and packing into new virions.2 E.g. Atazanavir and darunavir. Integrase (strand transfer) inhibitors (INIs or INSTIs) block the action of the integrase enzyme that the virus uses to integrate its double stranded DNA molecule into the human CD4 cell DNA.2 E.g. dolutegravir, raltegravir, elvitegravir. CCR5 inhibitors are a type of entry inhibitor which block attachment of the virion to a co-receptor (called CCR5) on the outside of the human CD4 cell.2 E.g. maraviroc. Monoclonal antibodies (mAbs) are also entry inhibitors and block HIV virion entry into the human CD4 cell. These agents are at a developmental stage. Pharmacokinetic Boosters: interfere with the breakdown of certain antivirals via liver enzymes, which allows the drug to remain in the body longer at a higher concentration. E.g. ritonavir, cobicistat. Can also result in drug-drug interactions with concomitant medication. Aims of treatment: Life Cycle of HIV:

Figure 1: HIV life cycle (4)

Before we look at the drugs, we must look at how HIV acts in the human body. Figure 1 above shows the HIV life cycle. The virion (or shell containing the virus) attaches itself to the human CD4 cell wall and passes its capsid (the inner part containing the genetic code of HIV) into the interior of the of the human CD4 cell. The capsid then releases HIV proteins and enzymes into the cell. The enzymes perform reverse transcription on the HIV RNA proteins to form a double stranded HIV molecule. An integrase enzyme then allows this double strand to link into the human CD4 cell’s own human DNA. Protease cuts and assemble new copies of the HIV capsid contents which leads to the release of hundreds of new virions to start the cycle again.4 Antiretroviral Drugs: The current drug treatments target various stages of the above HIV life cycle. Different combinations of drugs are used to inhibit replication of HIV cells and prevent the progression of the disease. It is because HIV is a retrovirus that the drugs are named antiretrovirals and this combination treatment approach is called ART (antiretroviral therapy)

or highly active antiretroviral therapy (HAART).4 Standard practice uses at least three different antiviral drugs to treat HIV. We will now look at the different classes of antiretrovirals. A good grasp of the HIV viral life cycle in Figure 1 above is useful to help understand and remember the various classes of antiretrovirals. This is because the drugs are each classified by the stage in the life cycle where they have their inhibiting effect on HIV replication. Nucleotide and nucleoside reverse transcriptase inhibitors (NRTIs/NRtTIs) nicknamed “Nukes” inhibit reverse transcription as the virus tries to form a double stranded molecule from its single nucleoside protein molecules before integration into the human CD4 cell DNA. They are themselves nucleosides or the building blocks of DNA or RNA and take the place of the HIV nucleosides on the HIV reverse transcriptase enzyme to prevent it working on HIV nucleosides.2 Abacavir, lamivudine, tenofovir and emtricitabine are the most widely used examples. Non-nucleoside reverse transcriptase inhibitors (NNRTIs) nicknamed for simplicity “Non-Nukes” also inhibit reverse transcription

The aims of treatment are to prevent mortality and morbidity associated with HIV infection at the lowest drug toxicity levels, minimise the risk of transmission of the infection on an individual and population level, and maximise the patient’s quality of life.2 We need to understand two concepts that are crucial for guiding and monitoring treatment. The first is viral load and the second is the CD4 cell count. Viral load is a measure of the number of HIV virions in the blood stream. It is important to reduce the viral load in the blood to undetectable levels using a combination of the above drug classes to both maintain the immune strength of the patient and minimise the risk of transmission. A detectable viral load will increase the risk of transmission. CD4 cell count is a measure of the patients’ immune system. The range for HIV negative patients is 400-1600 cells/mm3. A “normal” immune system is considered CD4 above 500 cells/mm3. If a patients CD4 count is <200 cells/ mm3, prophylactic anti-biotics are required. It is important for patients and healthcare professionals to have an understanding of these two factors as they are used by HIV clinicians to make crucial decisions on treatment choice and to identify resistant cases.

CPD 105: ANTIRETROVIRAL USE IN COMMUNITY PHARMACY Previously the HSE only recommended ART for patients whose CD4 cell count had dropped below 350 cells/mm3. Today the HSE recommends that all patients attending HIV services in Ireland are offered ART regardless of their CD4 count. This is based on evidence from two important clinical trials, the START study and the PARTNER study.3 The START study from August 2015 found that infected persons treated with ART before their CD4 cell count drops below 500 have a considerably lower risk of developing AIDS or other serious illnesses.5 This approach of starting treatment immediately can lead to life spans approaching normal uninfected populations. Starting patients on treatment early can also help to prevent further transmission of the virus. The PARTNER study then looked at the risk of transmission from an infected person to their sexual partner when not using a condom. It showed that transmission did not occur in those who were on ART and had an undetectable viral load. This was the case for both unprotected vaginal and anal sex.5 This was a landmark study as it proved that patients that who are virally suppressed patients cannot transmit HIV. HIV testing if exposed to any of the risk factors and prevention through safe sex and safe intravenous drug practices (using clean unused needles) are vital tools to reduce the spread of the disease. Community pharmacists should be aware of how at-risk patients can access HIV testing and therefore receive early treatment. Combinations used in practice: ART has proven an effective treatment for HIV and there are over thirty approved drugs and formulations, but only a few combinations are widely used.4 All the combinations if adhered to will reduce the viral load to undetectable levels. As mentioned above first line treatment for HIV uses three drugs â&#x20AC;&#x201C; many of which are available as single tablet combinations. Single tablets are a preferable, are shown to improve adherence but also help to prevent resistance developing by preventing incomplete regimes being taken by patients. EU, British and US guidelines all recommend the combination of two drugs from the NRTI/NRTtI class and one other drug from a different class.6,7,8 For example, tenofovir and emtricitabine are first line in adults. This combination is available in a single pill and can be used with one of six drugs as the third agent. Abacavir and lamivudine are sometimes used as an alternative in a two-drug combination pill. The choice of ART combination is individualised based on several factors. These may include the presence of resistant mutations, viral load, kidney and liver health, co-morbidities and concomitant medication. Personal choices related to side effect profile, shift work and dietary requirements may affect the decision on agents used.7

Pre-exposure prophylaxis (PrEP): Pre-exposure prophylaxis (PrEP) refers to the use of antiviral therapy taken by HIV negative patients in order to prevent HIV infection. PrEP treatment uses oral tablets that contain two drugs: Tenofovir and emtricitabine. Both drugs have been widely used to treat HIV infection in the past4 and have recently been licensed in both the US (2012) and the EU (2016). PrEP is aimed at people who are at high risk of HIV infection and particularly MSM (men who have sex with men). Truvada and generic versions of the combination have been available on private prescription in Ireland since 2017. It is also widely known by health care professionals and community advocates that at-risk people are sourcing PrEP preparations at a much cheaper cost over the internet and not presenting for monitoring and evaluation whilst taking PrEP.5 This is despite the availability of PrEP via community pharmacies. It is important for community pharmacists to advise patients asking about PrEP on the need for ongoing monitoring and evaluation when using these medicines as well as the importance of safe and legal sourcing of their prescription. The HSE has recently approved the use of PrEP in line with the EU guidance. The government plans to roll out the use of PrEP on the DPS/GMS schemes by the end of 2019. Adverse Effects of ART: It is important to consider the side effect profile of ART. All currently used treatments are generally well tolerated and safe, but it is unlikely that patients will not experience some of the adverse effects due to the length of treatment and the fact that they are taking a combination of three agents. A full list of side effects would be beyond the scope of this article and therefore it is preferable to take the example of the combination tablet emtricitabine and tenofovir, which will give us a good insight into the types of adverse effects that can be expected. It is also the only combination available on prescription through community pharmacy in Ireland and is the only licensed treatment for pre-exposure prophylaxis (PrEP). Adverse reactions of this combination have been found to be generally consistent with the single agents studied alone.9 Gastrointestinal: Both agents have been associated with diarrhoea, nausea and vomiting. These adverse effects are usually self-limiting and tend to lessen or disappear after a few weeks of treatment. Encouraging patients to take their medication with food can help reduce symptoms. Metabolic effects: Weight and levels of blood lipids and glucose may increase during all ART. Such changes may in part be linked to disease

control (the patient is gaining weight due to being less sick) and lifestyle.9 Renal effects: Both agents are primarily excreted by the kidneys through a process of glomerular filtration and active tubular secretion. Elevated creatinine and renal failure have been reported with the use of tenofovir. Prior to initiating the combination for HIV infection treatment or in PrEP use it is therefore recommended that creatinine clearance is measured for all patients. Even without any risk factors for renal disease it is recommended that renal function (creatinine clearance and phosphate levels) is monitored after two to four weeks of use, after three months use and every three to six months thereafter.9 More frequent monitoring of renal function is required in patients with risk factors for kidney disease. Bone effects: There is some evidence of reduced bone mineral density with the use of tenofovir. This is most pronounced over the first six months of treatment and does not appear to be longer term. It is recommended to avoid treatment with tenofovir in patients with osteoporosis at high risk of fractures.9 Management in the community pharmacy: The initiation and monitoring of patients on ART are entirely handled by specialist multidisciplinary teams in the hospital setting. However, HIV patients are increasingly managed for co-morbid conditions by non-HIV specialist healthcare professionals.2 Add to this the recent approval by the HSE of the pre-exposure prophylaxis approach and it is clear community pharmacists should play an increasing role in the fight against this disease in Ireland. There are many ways that community pharmacists can contribute to the management of the disease both on an individual basis and from a wider population health promotion point of view. Adherence: The importance of adherence cannot be overstated when it comes to the efficacy of ART for patients. This is also true for PrEP patients who require good adherence in order to minimise their risk of infection. A near perfect adherence of >95% is required for most ART patients to achieve full and durable viral suppression.2 Community pharmacists are in a good position to re-affirm the importance of adhering to the treatment regimen by discussing side effects and drug-drug interactions with patients they see for co-morbid conditions. And again, in discussing adherence and safe sex with patients they see trying to access PrEP through their pharmacy. ART patients treated in community pharmacies for other health problems should be monitored closely for risk factors of poor adherence such as depression, alcohol or drug abuse. Sexual Health Promotion: Pharmacists in community are often in a good position to


educate patients about good sexual health practices. Opportunities arise daily to discuss sexual health with patients receiving antibiotics for sexually transmitted infections (STIs) or in the consultation room when dispensing the emergency contraceptive pill for example.

Community pharmacists should be supported through training and resources to help deliver a service that at-risk groups want to access. This could lead to an extended role for community pharmacists in the future in helping manage ART patients also.

HIV infection, while not common in Ireland, is on the rise and is currently classed as a global epidemic by the world health organisation (WHO). It is vital that pharmacists in the Irish community find ways to be comfortable raising concerns about HIV infection and other STIs. Making the community pharmacy a place where at risk groups feel comfortable approaching an expert to discuss pre-exposure prophylaxis or HIV testing is vital to fighting the spread of HIV in our communities.

After all, community pharmacies provide easily accessed locations, flexible opening times and have proven successful in managing medication-related needs of patients with other chronic illnesses with improved clinical outcomes and reduced health care expenditure.10 This has taken the form of community pharmacist led supplementary prescribing clinics in Scotland for example.

Pre-exposure Prophylaxis: As outlined above many patients are accessing treatment for PrEP online. This is great risk to both the individuals and public health due to the uncertainty in the supply chain online. It perhaps due to the much higher cost or stigma that patients are not choosing community pharmacies to access this service. However, with the recent approval by the HSE this could and should be changed.

A community pharmacy led sexual health clinic should be something that we could aim for in our pharmacies here in Ireland also. But as with all services it requires support in the form of training and adequate remuneration. References: 1. Practical Guidance for Healthcare Workers in Ireland on HIV Pre Exposure Prophylaxis (PrEP) 2017.

2. National Medicines Information Centre, Newsletter titled Human Immunodeficiency Virus Infection; Volume 18, No. 4, 2012. 3. Antiretroviral therapy for people living with HIV in Irealnd, HSE, (sexualwellbeing.ie) 2018. 4. I-Base website http://i-base.info/art/ 5. Health Protection Surveillance Centre â&#x20AC;&#x201C; HIV treatment and PrEP https://www.hspc.ie/a-z/ hivstis/hivandaids/ 6. European Guidelines on management of HIV, EACS guidelines. 7. British Guidelines on management of HIV, BHIVA guidelines. 8. US Guidelines on management of HIV, AIDSinfo. 9. Summary of Product Characteristics for Truvada. 10. How Community Pharmacists Support Disease Management in Scotland https:// www.pharmaceutical-journal.com/news-andanalysis/how-community-pharmacists-supportdisease-management-in-scotland/10020295. article?firstPass=false

PrEP (Pre-Exposure Prophylaxis) can protect against HIV and makes sex safer for adults at high risk of infection*.

Emtricitabine/Tenofovir disoproxil Teva 200/245mg Film-coated Tablets Further information is available on request, in the SmPC or from your doctor or pharmacist.

Teva Pharmaceuticals Ireland Digital Office Centre Swords, Suite 101 - 103, Balheary Demense, Balheary Road, Swords, Co Dublin, K67E5AO, Ireland. Freephone: 1800 - 201 700 | Email: info@teva.ie | Web: www.teva.ie | www.hpra.ie Contact your local Teva representative for more details. Prescription only medicine *when used in combination with safer sex practice

Date of preparation: June 2019 Job code: IE/GEN/19/0020


he arrival of summer evokes the promise of sun-filled days, allowing us to enjoy the outdoors. Furthermore, with several big sporting events on the calendar, such as Wimbledon and the Open Golf, many are inspired to dust off their trainers.

With this upsurge in activity, comes an increased risk of sports-related injuries, presenting community pharmacists and their teams with an opportunity to treat and help with minor sports injuries. Knowing how to identify common sporting injuries and provide specific advice to patients on their effective management, including the role of over-the-counter treatments, as well as when to refer for specialist assessment and treatment, can help many steer clear of long-term muscular pain and joint damage. A worryingly high percentage of people simply ignore niggling sports injuries or treat them incorrectly, according to research. Research also show that men are three times more likely to injure themselves playing sport than women. The 2017 Irish Sports Monitor found that 43% of the Irish

population participate in sport at least once per week. This falls well short of what is desirable, it is estimated only one third (33%) of the Irish population are now achieving the very modest minimum level of activity set by the National Physical Activity Guidelines.

Some 34% of those attending or about 33,000 people a year suffered cuts, sprain, broken bones or other injuries playing sport. 30% said their injury occurred at home while the remaining 36% of cases involved injuries sustained at work or outside.

The Statistics

More recently, the Advanced Nurse Practitioners working in the Emergency Department at Portiuncula University Hospital carried out an audit of all sports related injuries they treated at the hospital from January to March 2018. The aim was to identify the prevalence of minor sports injuries with a view to identifying further opportunity for health promotion and education.

A survey of patients carried out by the HSE IN 2017, showed that sports injuries accounted for one in three visits to the Health Service Executive’s network of minor injury units in 2016.

Ciara Mooney, Advanced Nurse Practitioner and lead author of the study on sports injuries said of the findings, “The most prevalent sport for injuries was hurling and camogie with 38% of all

Not only is physical inactivity linked to poor cardiovascular fitness and obesity, the World Health Organisation (WHO) estimates it to be the main cause for approximately 21–25% of breast and colon cancers, 27% of diabetes and approximately 30% of ischaemic heart disease burden.


presentations followed by soccer with 32%, rugby with 15%, Gaelic football with 10% and horse-riding with 5%. “In line with other studies, hurling and camogie accounted for a significant percent of finger or hand related injuries - 50% were finger or thumb injuries and a further 23% were hand injuries. The largest proportion of soccer injuries were ankle (37%) and knee (16%) injuries. Rugby presentations were an equal number of lower limb and head injuries.” Acute and Chronic Injuries Sport injuries can be acute or chronic. Acute sports injuries occur as a result of a sudden impact or awkward movement. Examples include a cut to the skin or a sprained ankle. Chronic sports injuries develop over time, often due to continual use of the same joints or muscle groups.

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Mentholatum’s message to active individuals The Mentholatum Company is educating active individuals on how to deal with the aches, pains, sprains, strains and other knocks that are part and parcel of being fit and active with its Before, After and Rehab message. Kaye Mackay, senior brand manager for the Deep Heat and Deep Freeze brands, says: “Before you start moving it’s important to complete a dynamic warm up to prepare your body. Using a heat product like Deep Heat Muscle Massage Roll-on Lotion delivers heat therapy with massage helping to loosen and soften muscles, so they move more easily. “After you suffer an injury, especially a sprain or strain, first use a cooling product such as Deep Freeze Pain Relief Glide-on Gel to cool the area and help limit swelling and inflammation, and keep cooling for up to 72 hours. Never ignore an injury and always use a cooling product immediately. “After the first 72 hours, it is time for Rehab and a switch to heat therapy to help rehabilitate the injured area. This is where Deep Heat Muscle Massage Roll-on Lotion can help again, offering the dual benefit of penetrating warmth and soothing massage as the lotion is applied with the integral rollerball. Heat therapy with massage helps to restore movement, realign muscle fibres and breakdown adhesions and scar tissue.” Chronic sports injuries can occur due to bad technique or occasionally structural abnormalities, such as an inherited bone or muscle problem. These injuries should be further investigated by a medical professional to determine the cause and to prevent the injury getting worse. Some of the most common sports injuries include: • Sprains, • Strains, • Cuts and bruises, • Bone fractures and breaks, • Tendonitis (inflammation of a tendon), • Blisters, and • Head injuries. Whilst the figures regarding sports injury presentation to A&E are of note, community pharmacies will collectively see many more minor sports injuries. Common risk factors for sports injury include inadequate warm up, fatigue, over intensive training, unsuitable equipment and a changed environment (e.g. very hot weather, poor lighting, or physical contact with another person or equipment).

when the foot is moved past its normal range of motion. The sudden excess stress puts a strain on the ligaments. Once the strain goes beyond the yield point, the ligament becomes damaged, or sprained. Blood vessels leak fluid into the joint, starting from the site of the injury. Increased blood flow and inflammatory exudates including white blood cells, macrophages and leukocytes migrate to the area, causing both inflammation and swelling. This results in pain, sensitivity and throbbing as the nerves are further sensitised. As further blood flow increases to the site, the area looks a lot redder, feels a lot warmer, becomes more sensitive and there is a decrease in mobility. Use non-steroidal antiinflammatory drugs (NSAIDs) to treat pain, reduce any localised heat, decrease swelling and improve mobility. Oral pain relief normally starts soon after the first dose and the full analgesic effect occurs within a week.

Injury prevention can be achieved through dynamic stretching before activity.

Topical NSAIDs can be applied directly to the site of the injury. Topically applied NSAIDs penetrate the skin and result in therapeutically significant concentrations in underlying inflamed soft tissues, joints and synovial fluid, probably entering the synovial joint mainly via systemic circulation.

A sprain or a twisted joint can happen in most limbs but most commonly in the ankle. One or more ligaments of the ankle experience excessive stress and become abnormally stretched

In tendinopathies (painful tendons), inflammation plays a lesser role and so NSAIDs have little influence on healing but they can help with short-term analgesia. If used in the first seven days inn sprains, strains


or ligament tears NSAIDs can also be used to limit pain and swelling thus increasing the chances of the patient regaining function and returning to activity sooner.

Remind customers who have diabetes to be particularly vigilant when checking for blisters, as their foot injuries take longer to heal due to poorer blood circulation.

Patients should be advised to take NSAIDs with food. Following that advice, short-term use of NSAIDs is safe but patients should be advised that long-term use increases the risks of systemic side effects (such as gastrointestinal and cardiovascular effects).

Athlete's foot (tinea pedis) is a fungal infection that usually begins between the toes.

Tennis elbow (epicondylitis) is a painful condition that affects the outside of the elbow. It is caused by strenuous overuse of the muscles and tendons of the forearm and around the elbow joint. The symptoms of tennis elbow include: • tenderness around the elbow, and • pain when moving the elbow. Tennis elbow is caused by repetitive movement of the muscles in the lower arm. It can be treated with anti-inflammatory medication, an elbow splint to support the arm or a cortisone injection. Sufferers should be advised to avoid activities that cause pain and, in a sporting setting, obtain advice to correct faulty technique. Tendonitis is inflammation (swelling) of a tendon. Symptoms of tendonitis include: • swelling, redness and pain at the injured area, • restricted movement of the affected area, and sometimes • a change in appearance of the affected area, such as a lump or a visible change in position of a limb. Tendonitis is a fairly common injury that can result from a strain or tear in a tendon. Tendonitis can occur in the tendons around the shoulder, elbow, wrist, finger, thigh, knee or the back of the heel (Achilles tendonitis). Blisters are a common minor injury caused by friction on soft skin. Endurance athletes, such as long-distance runners, sometimes develop blisters on their feet. Rowers are at risk of developing blisters on the palms of their hands. Although painful, most blisters will heal on their own unless they become infected, but they can be easily prevented in the first place by covering tender spots with a friction-resistant dressing or plaster. If they do occur, then specialist blister plasters, which claim to aid rapid healing by absorbing the fluid, protecting skin from bacteria and helping relieve the pain of friction and pressure, can be used.

Symptoms include itching or burning and flaking skin, particularly between the toes, although the whole foot can be affected. The condition can be treated with products containing fungicidal or fungistatic ingredients. Making sure the feet are completely dry after washing; regularly changing footwear and wearing cotton socks can help ensure feet are less fungus-friendly. Role of the Pharmacist Two approaches exist for the immediate treatment of acute injuries, the main one being a simple five-step protocol, PRICE (P rotection, R est, I ce, C ompression, E levation). Rest after injury is usually considered appropriate for the first 48–72 hours. During this time, non-weight bearing is usually recommended and crutches or slings can provide support. After 48 hours, MICE (M ovement, I ce, C ompression, E levation) can be introduced, with gentle movement replacing rest. If pain is experienced on repetition of gentle movement, or if there is constant pain, then rest should continue for another 24 hours before the introduction of movement is tried again. If this is unsuccessful, referral to a GP should be considered. Earlier referral may be advised if pain is particularly severe. Points to consider when taking a history from the patient include: • Was the patient treated immediately or later after the injury? • What treatment was received? • Was the patient able to continue with their activity? • What was the intensity of the activity leading up to sustaining the injury? • Has this or any other injury occurred before? • Is this an acute or chronic injury? Injuries to the head, cervical spine, or the thoracic or abdominal organs should be treated as potentially life-threatening and referred to secondary care urgently. A patient with suspected concussion following a blow to the head, face, neck or where an ‘impulsive’ force may be transmitted to the head, who presents subsequently with changes in behaviour, vomiting, dizziness, headache, doublevision or excessive drowsiness requires urgent medical assessment.



Should you be selling CBD to patients? The use of cannabis-based CBD products for medicinal reasons is no longer a taboo or unreported subject in Ireland. As Irish Pharmacy News has previously reported, Minister for Health Simon Harris TD signed legislation which will allow for the operation of the Medical Cannabis Access Programme on a pilot basis for five years. The Programme will facilitate access to cannabis-based products for medical use in line with legislation. Pharmacists will also be able to dispense cannabis for medical use to patients under the new law. Cannabis products are everywhere - as a health professional, should you be engaging with this market and if so how can you be safe, insured and compliant. -Stephen Dickson, a cannabinoid specialist pharmacist discusses.

Stephen Dickson is Superintendent Pharmacist across 4 pharmacies in Glasgow, Scotland. Always at the forefront of technology, Stephen has a specialist interest in Cannabis products - working in the legal minefield of Cannabis products in NHS & Private Pharmacy for over 10 years. Stephen not only understands how to be compliant with the law, but has active and real- life experience in dispensing and providing these products on prescriptions. CBD is just a food supplement right? I don’t need to worry about that as it’s just like selling vitamin C?

Right? Wrong and wrong! The UK CBD market has exploded in recent months, and as a health professional not only should you be prepared to answer questions about it from patients, but if you are selling or dispensing this - you need to be absolutely certain of the provenance of product. The first thing you need to know is that Manufacturers of CBD are not pharmaceutical companies. The manufacturing process for that beautifully packaged product are absolutely nothing like pharma. In fact, in my investigations the majority of suppliers we have examined had standards way below what you would even expect of a food supplier. The majority of manufacturers are small scale, home grown laboratories, run by (in the majority) non registered professions of a quasi scientific background. They range from companies who take their duties seriously - but maybe don’t understand what they are - to cash-grab, fly by night cowboys taking advantage of the poor and sick in a quite disturbing way. If you are expecting clean rooms, laminar flow cabinets, GMP certification, sterility testing, microbiological controls and standard operating procedures well, I can say it is definitely not the norm. Having tested a great number of samples from various manufactures from Ireland, Scotland, England and further afield - I can say that not only is the quality of the work often inconsistent, products in a majority of the time are not what the package says and even more concerningly - often contain illegal amounts of THC or related compounds, effectively making the products schedule 1 controlled drugs. Furthermore, these products after manufacture are often being treated as a commodity. For a “food product” they are being stored and moved through conditions and processes you wouldn’t be happy with a packet of biscuits.


Stephen Dickson, Superintendent Pharmacist

But they fall into this grey zone where food regulators think they are a vitamin and healthcare thinks it’s a food. I haven’t come across many manufacturers doing anything more than rudimentary stability and safety testing. So - after this manic rant, should we be engaging with this market? I still say yes. Absolutely. After 10 + years of using cannabinoids in patients with everything from MS to cancer, I can’t say that I have not seen remarkable clinical benefit. The results can be remarkable, but you have to know what you are doing. Drug interactions: After working in the private sector in the industry and dispensing thousands of prescriptions for cannabinoids - myself and my colleagues have developed very safe, practical and reasonable treatment protocols and drug interaction awareness. There are a huge number of significant interactions around CYP450/3A4 - and not being aware of these and making the appropriate interventions as a pharmacist would put you into serious professional risk. I’m not going to go into detail here / feel free to do the training - but simple drugs like sertraline and oxycodone can have serious problems with CBD. Do not sell any form of CBD unless you have had appropriate training and understand the basics. This is a bit like St Johns Wort!

a supply chain designed for toothbrushes? Of course not. Many pharmacists are purchasing CBD products from sundry wholesalers or 3rd party transfer orders. Doing this breaches good distribution practice and may make the product not only non compliant but potentially unsafe for consumption. Even if the manufacturer made the product correctly - it’s not likely to be the same thing when it’s been stored in a warehouse, in direct sunlight at 40 degrees C for 3 months. I currently use Ethigen for supply chain, as they are national but capable of high levels of GDP whilst being cost effective. Product Cannabinoids are available for retail sale only through a peculiar loophole in the law. The same products are also licensed medicines in the EU and USA. (Sativex and Epididolex as examples). I tend to think of these products like a P / POM Medicine - and would encourage all pharmacists to think in the same way.  Do you have dosing information?  What about renal failure or liver impairment?  Does the packaging include a PIL? With drug interaction info from a reputable source?

Supply chain

 What about THC content? Can you be sure it is zero?

As a very basic question would you buy atenolol from

What happens if a counter assistant makes a sale of a CBD

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product to a patient on oxycodone or fentanyl and they die from an overdose induced by CYP inhibition. If the product has no information for the patient and the pharmacist was in the toilet when the sale was made. These events are occurring right now but not yet being actively monitored by any regulator. This is changing rapidly. From an insurance and legal standpoint, any pharmacist faces significant peril unless they have conducted a risk assessment and considered the above points. My solution I wouldn’t be writing this article if I hadn’t solved this problem

already. The solution is multi factorial, and involves 5 different health professional groups working together in a synergistic way.

The first think we did was to form a training and support retail group / we called it CBD Wellness and it provides training and support to pharmacists.

My background, as I said earlier is that I have worked with cannabinoids for dispensing purposes for over a decade. I’m a superintendent for a small chain of 6 pharmacies one of which is a specialist MS clinic.

The second thing we did was form a research agency, by publishing and supporting clinical supply events through a UK Cannabis Clinic model.

When pharmacy started getting involved in CBD, I realised that our team of doctors, nurses, pharma specialists and ancillary professions had amassed enough information that we should be able to help other pharmacists make compliant supplies.

The third and final thing we did was to form Canidol Pharmaceutics - a research and collaboration agency (specialists, GPs, prescribers , pharmacists and pharma compliance experts) independently verifying 0% THC in products, providing research training protocols and physical products suitable for retail - and dispensing purposes.

The UK Cannabis Clinic is currently being ported for Irish use but basically allows for a pharmacist to use a PGD type environment, that results in a prescription being printed locally issued by one of our experts. This limits vicarious liability immensely. The basic message I have is this: CBD is a minefield. If you are going to do it, do it properly. At the very least - buy CBD from one of your usual wholesalers as incorrect storage of CBD can actually theoretically convert the CBD to THC.

New appointments at IQVIA

Farewell Eugene

IQVIA Ireland has announced the appointment of Gwynne Morley to the position of General Manager.

Meaghers Pharmacy Group said a fond farewell to well-known Superintendent Pharmacist, Eugene Renehan, last month as he set off on a move to San Francisco.

In this role Gwynne will have responsibility for the engagement with pharmacy, commercial pharmaceutical companies and distributors. Gwynne comes with many years’ experience and knowledge across the industry. Prior to joining IQVIA, she was the Director of the Heart & Vascular, Diabetes & Emergency Department at the Mater Private Hospital. She is the former Managing Director at Uniphar Retail Services. Previously she worked for United Drug Group (UDG) Healthcare for 13 years. During her tenure with UDG, she held a number of senior roles namely in pre-wholesale, consumer and quality. Gwynne is a TCD pharmacy graduate.

Eugene Renehan

Gwynne Morley, new General Manager at IQVIA Ireland

Elaine Lillis joined the Meaghers team back in 2011 as an Intern following her graduation from Trinity College Dublin and graduated with her MPharm Royal College of Surgeons in Ireland in 2012.

With Gwynne’s appointment, Fiona O’Hara has moved into the role of Commercial Director for the group, moving from her previous role as Commercial Lead for Medical Sales within IQVIA. Fiona has over 30 years’ experience in the pharmaceutical industry having worked with Sanofi as Business Unit Director, Amgen as Country Manager, Medmedia Account Director and Novartis as a European Digital Liaison. Fiona’s primary degree is in marketing and more recently a Masters in Digital Marketing from DCU where she also worked with the cloud computing team as a research assistant. IQVIA works in partnership with all stakeholders within the

The Group also announced Elaine Lillis as the new Superintendent Pharmacist. Elaine will take up her new role when Eugene Renehan makes his move early this month (August).

Fiona O'Hara is the new Commercial Director at IQVIA Ireland

pharmaceutical industry, through the provision of analytical tools and consulting expertise, to drive business insights and market views which helps each stakeholder understand their performance.


“Elaine has worked across six of our stores since and has excelled in all of her roles. She is currently our Managing Supervising Pharmacist in our Barrow Street store,” said Oonagh O’Hagan, Managing Director of Meaghers Pharmacy Group.

Elaine Lillis

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United Drug staff volunteer at Hugh’s House Volunteers from United Drug recently donated their time and hard work by volunteering at Hugh’s House in Dublin. Hugh’s House, set up by Ade Stack, founder of Stack’s Pharmacies, provides accommodation round the year for the families of children who are long-term in-patients at Temple Street, Holles Street, the Coombe and Rotunda Hospitals.

Among those who gave up their time was David Keyes from United Drug Distributors. He said: “We spent the afternoon in Hugh’s House. We have been cooking, we have been cleaning, we’ve been ironing and we’ve been gardening. We had a really enjoyable day

and we hope that the small contribution that we made will help the wonderful work that the team from Hugh’s House carry out every single day of the year for some families who need really good assistance” Ade Stack added: “Our service

is built on a community volunteer model. Everyone needs help and everyone can help someone, cooking them a meal, making their home more beautiful, just by visiting. Seven volunteers for a day gives us a week of service. Thanks to United Drug.”

Aoife O’Melia preparing food at Hugh’s House

United Drug staff took part in a volunteering day recently at Hugh’s House in Dublin. Back row: Martin Small, Aisling Mahon, Margaret Collins, Anne McCarthy, Sharon Rice, David Keyes Front row: Lisa Byrne, Maria Brennan, Aoife O’Melia David Keyes sweeping up outside Hugh’s House during the United Drug volunteering day Sharon Rice working in the kitchen at Hugh’s House

Anne McCarthy helping out with the ironing during the United Drug volunteering day at Hugh’s House

Aisling Mahon from United Drug


Lisa Byrne in the kitchen at Hugh’s House



eHealth Solutions in Community Pharmacy Across Europe, governments have realised the potential benefits for increasing the use of ICT within their health systems. They include improving service organisation and delivery, better use of resources, increased productivity of health services, greater patient satisfaction and improved quality of care. The Pharmaceutical Group of the European Union (PGEU) has published a paper which provides an overview of the state of eHealth solutions in European community pharmacies, highlighting their key benefits and the main barriers for pharmacists, patients and health services alike, as well as drawing conclusions and making recommendations on the way forward. Pharmacists have a unique role to play in European health systems as experts in medicines who are located in the heart of the communities they serve. Advice, treatment or referral from a healthcare professional with five years of education and training can be accessed without an appointment, within 30 minutes for 98% of the European population,3 including during extended opening hours and in emergency “on call” hours. The Digital Evolution teleHealth has been practiced since the first healthcare professional engaged with their patients on the telephone. Subsequently, this was complemented with video consultations. Pharmacists have been utilising electronic medication records for almost 20 years, for example Belgium, which introduced them in the late 90’s to provide better patient care following successful computerisation of data for

logistical and reimbursement purposes. Computerisation of pharmacies and the use of the internet have long been essential tools for pharmacists. For example as an information source for medicines and medical devices, ePrescription, invoicing, follow-up services for patients, traceability, authentication services and pharmacy services. As technology has evolved, the concept of eHealth developed and in recent years a new paradigm emerged, that of mHealth. Setting the scene today, 100% of pharmacies in Europe are computerised, 100% have an internet connection (of which 95.8% is broadband) and many utilise electronic dispensing software programs. This represents a multi-billion euro investment by the profession into ICT equipment, systems, maintenance and training. Pharmacies in 17 European countries dispense ePrescriptions and a further seven countries plan to implement ePrescribing in the near future. Between 2013 and 2015 significant increases in the implementation and use of ePrescribing systems have been observed across Europe.5 In Denmark, Greece, Estonia, FYR Macedonia, Spain, Sweden and Turkey more than 90% of prescriptions dispensed in community pharmacies are ePrescriptions, with Slovenia achieving almost 100%.6 Pharmacies in Europe are well equipped to process ePrescriptions as prescribers increase the number of ePrescriptions.

With the rapid development of eHealth innovations in Europe, pharmacists are responding accordingly to ensure patient confidentiality and data protection rules are followed. In Germany, for example, pharmacists adhere to a 10 point Code of Ethics8 concerning eHealth innovations. In this code, issues of confidentiality, data protection, value for money and effectiveness are all cited as important factors concerning the use of eHealth services. Similarly in France, pharmacists adhere to a dedicated code of conduct concerning the storage, processing and use of patient data in ICT systems.9 Key to the successful implementation of eHealth innovations in Europe is obtaining the endorsement, support and commitment of the pharmacy professional associations. This has been and continues to be essential for the development of eHealth services. Pharmaceutical Care Today, many pharmacists use eHealth tools on a daily basis, whether it is dispensing electronic prescriptions, checking for medication interactions when accessing electronic medication records, providing support for adherence via a mobile app or telephone call, or acting as the patient’s entry point into the health system. In several countries (“Mobile Pharmacy App” - Austria, “pharmacie.be / apotheek. be” – Belgium, “Open access e-platform” – Bulgaria, “ékárnu” – Czech Republic, “Farmácias Portuguesas” - Portugal and “FASS” - Sweden), mobile apps developed by national pharmacy / pharmacist associations are available which can ‘geo-locate’ the nearest pharmacy. Some mobile apps (Austria, Portugal and Spain) also provide / store health and medication information and in Sweden, users can even check the local stock of their required product with the app. In the Czech Republic it is possible to identify pharmacies participating in various specific public health campaigns via the app. In Denmark, a 24/7 telephone, online “Chat and Video Consultation” service is operated


by pharmacies allowing patients and the general public access to information on medicines and health from a pharmacist. In the Netherlands, a publically accessible online database of medicines which are in short supply is available. The system, called “Farmanco”, is hosted and governed by KNMP – the Royal Dutch Pharmaceutical Association. The submission system is open to reports from manufacturers, wholesalers, pharmacists, other healthcare professionals and patients. Submissions are usually made by pharmacies and each submission is checked by the respective manufacturer. With this system, patients and professionals are able to check the reason for the shortage and how long it is expected to last, allowing for alternative arrangements to be made to ensure the patient receives continuous care and supply of medication. In Switzerland, family physicians and community pharmacists collaborate to provide care through the pharmacy in the “netCare” telemedicine service. This collaboration is a potential solution in the areas with limited accessibility to other health services and additionally can provide relief to constrained health services. The pharmacy is used as the point of access to the healthcare system. Initial triage takes place in the pharmacy by the pharmacist and the patient either receives treatment by the pharmacist, a video consultation in the pharmacy with a physician, referral to a physician for a face-to-face consultation or referral to acute care. In Italy, the pharmacy is also used as an electronic point of access into the healthcare system in the “platform / CUP” project, which is established in the majority of Italian regions. Patients can go to their nearest pharmacy to book a visit to a National Health Service (NHS) specialist doctor or to book a range of tests in an NHS or accredited laboratory. It has been demonstrated by researchers at the Netherlands Institute for Health Services Research that electronic reminders, (such as text messages, pagers and audio-visual solutions) improve medicines adherence by 14%.25 Electronic reminders are



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Dispensing in Ireland Fed upWith with costly Feedback from someslow, of our PillPacPlus pharmacy providers PillPacPlus expert technology the Fed up Irish with slow, costly pharmacy network can deliver manual MDS production manual MDS production Fed up cost with slow, costly effective care and better support We provide a medication sacheting their patients and their carers. service for patients who would benefit from in your in your pharmacy? manual MDS production Fed uptopharmacy? with slow, costly compliance support and nursing homes seeking

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With PillPacPlus expert technology thePillPacPlus the care homes would suggest the nursing administration round has reduced by as much in some cases which has has a dedicated teamasto75% support Irish pharmacy network can deliver supported significant increase in time for nurses nursing care. in your pharmacy? With PillPacPlus expert technology the to provide additional installation and training. Irish pharmacy network can deliver cost effective care and better support Irish pharmacy network can deliver Marketing support is available to help promote William Wylie, Pharmacy Owner – technology Comber Pharmacy, Co. Down the PillPacPlus service to the local community. to their patients and their carers. cost effective care and better support With PillPacPlus expert the cost effective care and better support We were inundated with requests for medicine compliance aids and the Benefits forsolution patientswas either to hire more staff or invest in Irish pharmacy network can deliver to their patients and their carers. to their patients their carers.to support the new technology. I hadand recruited more technicians provision of compliance aids but this was not the most cost

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technicians on weekly dispensing has halved. The pharmacists find the packs easier were and quicker particularly themuch technicians about to check. I would have no hesitation in recommending the PillPacPlus system to other community pharmacists. I can honestly say that I am very happy the system. with the hardware, software and support from the PillPacPlus team, and three months into the installation, the entire team feels that we could never go back to the old system. Since we installed the robot in our Contact PillPacPlus for further information: AP 405 model~

pharmacy the workflow in the dispensary has changed dramatically. Time spent by our technicians on www.pillpacplus.com weekly dispensing has halved. The The right medication to the right patients Compliance sachets–offer: pharmacists find the packs Contact PillPacPlus for further information: – with the right quantity at the right time. much easier and quicker to The right medication – to the right patients Unit 9, 20 Antrim check. Road,I Ballymena would have no – with the right quantity at the right time. Co. Antrim, Northern Ireland BT42 2BJ. hesitation in recommending T: +44 (0)28 2565 7856 the PillPacPlus system to AP 405 model~ other community pharmacists. E: info@pillpacplus.com www.pillpacplus.com I can honestly say that I am Compliance sachets offer: very happy with the hardware, Contact PillPacPlus for further information: AP 405 model~ software and support from the The9,right medication to the right patients Unit 20 Antrim Road,–Ballymena PillPacPlus team, and three months Co. Antrim, Ireland BT42right 2BJ.time. into the installation, the entire team – with the Northern right quantity at the feels that we could never go back to T: +44 (0)28 2565 7856 the old system.

Unit 9, 20 Antrim Road, Ballymena Co. Antrim, Northern Ireland BT42 2BJ. AP 405 model~ Compliance T: +44 (0)28 2565 7856sachets offer: E: info@pillpacplus.com

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widely used in pharmacy practice across Europe (“Mobile Pharmacy App” - Austria, “Online Prescription Overview App” – Denmark, “Observia” and “DO-Pill” – France). In Spain, the Medicines Review with Follow-up Service can be performed and recorded through “Bot PLUS 2.0 – Module for Pharmaceutical Care Services”. This software enables community pharmacists to manage the complete medication of a patient including the detection of possible medication related problems such as adverse events, interactions, adherence problems, etc., and keep a record of them together with the intervention conducted in order to solve the problem. In the UK, a “New Medicine Service” that can be performed via tele-consultation (a semi structured consultation with a pharmacist for patients prescribed new medications for chronic diseases) has been proven to increase adherence by 10%.26 In Denmark a “Medical Reminder App” is available for patients who wish to receive reminders to take their medications. This user programmable app also allows recording of other health data such as blood glucose, blood pressure, weight and can send information to their email if desired. Patient Safety With the increasing burden of chronic diseases, healthcare

Slow adoption of technology impacting on Pharmacy A new survey has found that 87% of pharmacists believe the profession has been slow in its adoption of new technology when compared to other sectors. The survey, commissioned by Omnicell UK, also revealed an overriding consensus that automation within pharmacy could improve both patient and care home services. 80% of pharmacists believe that automation can improve patient services and 72% of pharmacists believe it can improve services for care homes. In fact, nearly threequarters (73%) of those polled believe that there should be an increased focus on the use of technology and automation on the pharmacy agenda. Underpinning the results is a worrying belief by 93% of those interviewed, that funding cuts are the most significant threat to the

systems are allocating major roles to healthcare professionals such as pharmacists and nurses,32 and it has been cited that communication between healthcare professionals and patients is essential for their effective deployment.33 When shared, eHealth records provide opportunities for pharmacists not only to make informed interventions, but also to significantly improve communication within the healthcare team and healthcare system.34 The use of ICT and eHealth services in primary care will increasingly be part of future healthcare systems, with greater multi-professional collaboration demanding better synergies between services and infrastructures.35

level. Despite recent progress, many ePrescription systems in Europe are not deployed with full coverage, both within and beyond national borders. Interoperability barriers exist between different solutions, professionals, between professionals and authorities and between regions and countries.

Currently however, eHealth solutions are fragmented at the regional, national and European levels. Interoperability barriers exist between different solutions, professionals, between professionals and authorities and between regions and countries.

3. PGEU Annual Report 2015

Challenges Ahead The development and expansion of eHealth is expected to bring significant benefits to patient care and health systems performance36 and the global eHealth market is expected to reach USD 308.0 billion by 2022;37 however, solutions are fragmented at the national and European

immediate future of community pharmacy. This was followed by additional concerns on changing regulations like FMD, Brexit and recruitment issues. The survey results have been released as part of a new campaign by Omnicell UK to raise awareness of the importance on the use of technology to improve patient safety and support pharmacies in a challenging marketplace. The campaign, ‘We are Automation’ demonstrates how technical solutions can help to free up staff time. This reduces administrative and manual tasks enabling staff to spend more time on face to face patient care and new revenue streams. Unsurprisingly, the survey also found that work pressures and stress are key areas of concern for the profession. The vast majority of pharmacists (90%) believe that these are caused by Government funding cuts and over threequarters (76%) believe that the


Whilst European guidelines have been developed on eHealth, they are technically focused, do not involve end-users significantly and do not greatly consider fundamental aspects of healthcare practice. Healthcare institutions and healthcare professionals face a continuous need to update and expand health facilities, technology and equipment, at great expense. References:

5. PGEU Facts and Figures 2014-15: Denmark (+22%), Spain (+27%), Finland (+62%), Italy (+64%), Portugal (+78%), Norway (+80%) and Slovenia (+96.3%) 6. PGEU Facts and Figures 201415 8. http://www.abda.de/uploads/ tx_news/E_Health_Ethische_Grundsaetze_ABDA_2015.pdf 9. http://www.ordre.pharmacien.fr/Communications/ Publications-ordinales/ Respect-de-la-confidentialite-des-donnees-de-patients

25. Vervloet M, Linn AJ, van Weert JCM, de Bakker DH, Bouvy ML and van Dijk L. The effectiveness of interventions using electronic reminders to improve adherence to chronic medication: a systematic review of the literature. 2011. J Am Med Inform Assoc doi:10.1136/amiajnl-2011-000748 26. http://www.nottingham.ac.uk/~pazmjb/nms/ 32. Kennie-Kaulbach N, Farrell B, Ward N, Johnston S, Gubbels A, Eguale T, et al. Pharmacist provision of primary health care: a modified Delphi validation of pharmacists’ competencies. BMC Fam. Pract. 2012. p. 27. 33. Santana S. Tendências na utilização da internet: Para questões de saúde e doença em Portugal 2005-2007. Acta Med. Port. 2009;22:5–14. 35. Kreps GL, Neuhauser L. New directions in eHealth communication: Opportunities and challenges. Patient Educ. Couns. 2010;78:329–36. 36. http://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX%3A52012DC0736 37. https://globenewswire.com/news-release/2015/11/18/788256/0/ en/eHealth-Market-Will-Reach308-0-Billion-By-2022-GrandView-Research-Inc.html

scale of the patient/staff ratios is a key contributing factor with too few staff dealing with an increasingly high volume of patients.

• Stock re-ordering (72%)

With increased pressures and time-constraints on pharmacies, the survey goes on to explore the importance of additional revenue streams for pharmacy businesses. 88% of those interviewed believe that introducing technology to support the business could help pharmacists to explore additional patient services and new revenues – with 66% believing that it would enable them to pursue care home pharmacy contracts.

Paul O’Hanlon, Managing Director of Omnicell UK & Ireland says, “Technology plays a pivotal role in reducing medication errors and improving patient safety. Whilst the sector has been slow when compared to other industries in harnessing new technology solutions and recognising the benefits – it’s heartening to see that looking to the future there could be an increased focus on the issue, helping community pharmacies to survive in an everchallenging market.”

Every year, an estimated third of the 47m medication errors2 within primary care occur in the dispensing process. Pharmacists questioned believe that automation provided them with additional confidence in: • Patient safety (77%) • Providing patients with increased face to face time (75%)

• Managing complex patient medication regimes (57%)

References 1. Results based on survey of pharmacy professionals by Omnicell (April/May 2019) 2. http://www.eepru.org.uk/ wp-content/uploads/2018/02/ eepru-report-medication-error-feb-2018.pdf



Improving the lives of obese people with asthma A researcher at University College Dublin has been awarded 2019’s Asthma Research Bursary to continue to improve the lives of obese people with asthma. Dr David Watchorn, UCD School of Medicine

who are also members of the Irish Thoracic Society. Dr Watchorn’s winning study, entitled ‘Evaluation of inflammatory mediators in an asthmatic population on GLP-1 analogue therapy for weight management’ will be completed in 2019. The hormone glucagon-like peptide 1 (GLP-1) appears to reduce the classic 'allergic' inflammation that causes asthma.

Dr David Watchorn, of the UCD School of Medicine, will use the bursary to fund research investigating whether a particular hormone increases the effectiveness of asthma medication for people living with obesity. “My work aims to find a solution to this problem by looking at the effects of a hormone, already used to treat Type 2 Diabetes, which may potentially hold the key to helping countless people who

have asthma and are obese,” said Dr Watchorn. The Asthma Research Bursary, which aims to improve the lives of people with asthma and their families, is a joint collaboration between the Asthma Society of Ireland, the Irish Thoracic Society and Novartis Ireland and is worth ¤10,000. The yearly prize is open to all medical and allied healthcare professionals based in Ireland

Already used to treat Type 2 Diabetes and morbid obesity, (GLP-1) suppresses appetite and slows the emptying of the stomach, as well as having effects on other hormones that control blood sugar levels. This study aims to research the effects of the hormone on people with asthma who are also obese. Loretto Callaghan, Managing Director, Novartis Ireland Ltd, said, “Novartis are very pleased to be associated with this important bursary for asthma research. We would like to congratulate David and look forward to seeing his completed work.”

Calls to reduce financial strain of cancer The Irish Cancer Society launched its Budget 2020 submission this month, calling on the Government to reduce the huge financial strain on cancer patients and their families. Chief Executive Averil Power said, “Many families suffer a big drop in income when someone gets cancer. At the same time, they have to pay for everything from chemotherapy appointments to anti-nausea medication and hospital parking charges. With extra costs of up to ¤1,200 a month, they find themselves under siege financially while also trying to manage the physical and psychological burden of having cancer.”

“It also found those on medical cards often don’t take all their medication because they can’t afford prescription charges. More than 1 in 2 chose to pay for their child’s medication ahead of their own. Unable to afford essential medicines, such as anti-nausea tablets, patients’ suffer far worse side effects from their cancer treatment than they should. This is incredibly unfair and must be addressed”, she said.

According to Ms Power there is clear public support for such measures. “In a survey recently carried out by Core Research, almost 3 in 4 people supported the removal of inpatient charges while 6 in 10 said the drug payment scheme threshold should be reduced.

In Budget 2020, the Irish Cancer Society is also calling for sufficient funding to implement the Government’s commitments under the National Cancer Strategy. This would ensure better treatment and outcomes for cancer patients and reduce the number of people getting cancer in the future.


In Budget 2020 the Society is calling for: • The removal of inpatient charges, which currently cost ¤80 per visit up to a maximum of ¤800 a year; • A reduction in the Drugs Payment Scheme threshold from ¤124 a month to ¤100 for families and ¤72 for single people; • The removal of the prescription charge for medical card holders (currently ¤2 per item up to a maximum of ¤20); and • Reduced hospital parking charges for frequent visitors

Culture of open disclosure Supporting the further development of a culture of open disclosure in medical practice in Ireland was one of the issues addressed at a major national conference on medical professionalism. The event took place at the Royal College of Physicians Ireland (RCSI). The conference, focusing on disclosure and peer support, heard from speakers including Harvard Professor Jo Shapiro, author of the scoping inquiry into the CervicalCheck Screening Programme Dr Gabrielle Scally, and Bernadette O’Reilly, Chairperson of Patients for Patient Safety Ireland. Open disclosure was addressed at the conference with a keynote presentation from Professor Shapiro on 'Open disclosure, peer support and resilience'. At present, open disclosure is voluntary in Ireland but it will become mandatory for ‘serious patient safety incidents’ under the proposed Patient Safety Bill. According to Professor Slattery, "The vast majority of healthcare professionals understand that open disclosure after something goes wrong is the right thing to do. It means having a frank and honest conversation with a patient or their family, apologising for what has happened, providing them with information, as it becomes available, and putting systems in place to help prevent recurrence of the incident. “This open and honest approach supports the trust and confidence of patients. “Openly admitting to an error is always difficult. For healthcare professionals who are supposed to ‘heal’, making a mistake and harming a patient can lead to persistent feelings of guilt, shame anxiety and sometimes depression. Combined with this is a fear of making a mistake again that may harm a patient, isolation from colleagues, loss of job, loss of confidence, litigation and being referred to the regulator. "They need to be reassured that a fair and just outcome will result after a disclosure,” he added.

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Ironman challenge for Tim McLernons Tim O’Brien will be limbering up to race Ironman Copenhagen this August to raise vital funds for The Kieran O’Connor fund (#FriendsofKieran). Tim and Bernie O’Brien

“Kieran has already had a lower leg amputation and continues to fight the good fight. “Having not been able to work for a prolonged period of time as well as the associated costs he does not need the stress of financial issues for his family as he faces his battle. “We would love a few donations and we would equally love if people could donate vouchers of any description so we can auction them to raise funds.

Tim and his wife Bernie will be competing in the race, which is for the faint-hearted, nor the weak, consisting of a 2.4 mile swim, 112 mile cycle and a marathon to finish the day (and hopefully not Tim) off. Tim told us, “Kieran O’Connor is a 39 year-old husband and father of three kids; a magnificent All Ireland Winning Cork senior footballer who is now battling a rare form of cancer for the third time.

Sleeping with psoriasis Sleep is vital for our everyday functioning and is important for our physical and psychological wellbeing. Last month’s issue of Irish Pharmacy News looked in more detail at some of the most common sleep disorders. Disrupted sleep may be caused by a number of issues ranging from physical, lifestyle and environmental factors (family responsibilities, occupational duties) to psychological issues, e.g. stress and anxiety.

Tips to address the itch

Sleep disruption can have a negative impact on quality of life.

• Moisturise, moisturise, moisturise

A recent study in Denmark found that 25% of patients with psoriasis (179 participants) had difficulty in sleeping and over half of them could be classified as poor sleepers. Similarly, another study in 2017 in the British Journal of Dermatology reported that poor sleep is common in patients with psoriasis, affecting 75% (186 participants).

• Keep fingernails short with no sharp edges.

Itch and sleep One common cause for poor sleep revealed in both of these studies was itch. Not everyone with psoriasis will experience itch however it is a common symptom of psoriasis. The authors of the Danish study suggested that improved control of psoriasis with treatment will decrease itch and improve sleep for some.

• Apply psoriasis treatments as prescribed. • Take shorter showers/baths with lukewarm water and wash with a soap substitute.

• Select cotton sleepwear as cotton is a breathable fabric, and is less irritating on the skin. About Psoriasis Psoriasis is a non-contagious, autoimmune, chronic inflammatory skin condition that affects approximately 73,000 people in Ireland. Patients with psoriasis may have 1 of 5 types, each with unique signs and symptoms. Plaque psoriasis is the most common type of psoriasis. About 80% of individuals who develop psoriasis have plaque psoriasis, which appears as patches of raised, reddish skin covered by silvery-white scales. These patches, or plaques, frequently


form on the elbows, knees, lower back, and scalp. The 5 types of psoriasis are: 1. Plaque: most common form of the disease; appears as patches of raised, reddish skin covered by silvery-white scales. 2. Guttate: appears as small red spots on the skin. 3. Inverse: occurs in armpits, groin, and skin folds. 4. Pustular: white blisters surrounded by red skin. 5. Erythrodermic: intense redness over large areas. Many of the medications used to treat psoriasis are widely available to community pharmacies. Given the wide availability of these products and the large number of psoriasis patients, it would appear to be an ideal market in which community pharmacists could build a specialty practice. It should also be a rewarding practice for pharmacists, as bringing support and relief to these patients has a major positive impact on their quality of life.

“If you have a few quid in your pocket and are in full health with life going well for you, as it is for my beautiful wife and I, then be grateful because unfortunately bad things happen to good people.” The race is taking place on August 18th of this year. Anyone wishing to donate and support Tim and Bernie can visit https://www. gofundme.com/f/ironman-copenhagen-for-kieran-o-connor?pc=em_db_co2876_v1&rcid=398d7fde056b463e9f68976d9fefc6f4

Date for your Diary: The Pharmacy Show is taking place on Sunday the 6th and Monday 7th of October 2019 at the NEC in Birmingham The Pharmacy Show is the only event that is pulling out all the stops to help pharmacists. Join pharmacy experts and key opinion leaders, new and existing suppliers and policy makers to keep up with all latest developments, grow your business, improve patient outcomes and get all the practical training and advice you need. www.thepharmacyshow.co.uk for further information.

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News Transforming management of cancer A study led by researchers at RCSI’s Department of Chemistry has the potential to help surgeons more accurately remove tumours and detect cancer in lymph nodes during surgery. The research is being led by RCSI Professor of Chemistry Donal O’Shea. Bringing together expertise in chemistry and biotechnology, the research team has identified the potential benefit of fluorescence imaging as a way of detecting cancer cells during surgery, developing a probe that lights up when it detects cancer. According to Professor O’Shea, "This is a very significant development which has the potential to transform the surgical management of cancer, improving outcomes for patients. Almost 60% of all cancer patients will undergo surgery as part of their treatment. "A new technology that could improve surgical outcomes by giving the surgical team real-time, informative images during the surgical procedure would have a wide-ranging and sustained impact on the care of cancer patients." Addressing the next steps, Professor O’Shea said, "A clinical trial is our next goal and that would allow the full potential of this discovery to be realised for patients, enhancing detection of life-threatening diseases and improving outcomes of surgical procedures." The team has recently secured funding for a project on colorectal cancer diagnosis and treatment under the Project Ireland 2040 Disruptive Technology Innovation Fund in collaboration with leading cancer surgeon Professor Ronan Cahill in the Mater University Hospital, UCD and Dublin based industry partners IBM-research and Deciphex. The project will look at combining tissues responsive probes, artificial intelligence and machine learning to transform medical care for colorectal cancer patients. This paper, 'RGD Conjugated Cell Uptake Off to On Responsive NIR-AZA Fluorophores: Applications toward Intraoperative Fluorescence Guided Surgery' is published in the current edition of Chemical Science.


Pharmacy group taking ‘Care’ in the sun CarePlus Pharmacy is stepping up efforts to help people in Ireland stay safe in the sun this summer. As the first blast of heat arrived towards the middle of last month, each of the more than 60 CarePlus Pharmacies around the country were displaying up-to-date UV Index information sourced directly from Met Eireann. The updates were visible on-screen in the window of each pharmacy and through the store, and were relevant to the store's location. Staff at CarePlus Pharmacy have also been specially trained to answer questions from customers around sun-care products for both adults and children. Exposure to the sun's harmful rays can increase the risk of skin cancer, which is the most common form of cancer in Ireland. There are over 11,000 new diagnoses in Ireland every year. Extra care needs to be taken in any direct sun that will accompany warm weather across Ireland this week. Dermatology Nurse Specialist Selene Daly will act as Skin Ambassador for the CarePlus Be SkinCare Aware Campaign. Selene says, “This announcement by CarePlus Pharmacy is a welcome industry initiative. As the number of new diagnoses of skin cancer continues to rise, it's important that the public sees both the warnings and the importance of high-factor products. Thankfully, with the right advice, it is easy to protect yourself from damaging sun exposure that can be a real threat, even in Ireland." For customers on the move, the UV index is also available on the CarePlus Pharmacy app and online on www.careplus.ie.

Selene Daly, Dermatology Nurse Specialist and CarePlus Skin Ambassador

Innovating for life The Irish Pharmaceutical Healthcare Association (IPHA) has launched ‘Innovate for Life’, a public campaign aimed at telling a value story about the impact of medicines in society. ‘Innovate for Life’, an industry-first for Ireland, is a digital-led initiative, organised into three distinct pillars - ‘The Places’, ‘The Patients’ and ‘The Pioneers’. ‘The Places’ captures the industry’s economic impact in communities like Cork and Westport, County Mayo. ‘The Patients’ profiles the human impact of medical innovation told through patients’ eyes. ‘The Pioneers’ celebrates the new science behind the latest treatments and cures. The campaign, which has been endorsed by IDA Ireland, is captured in a mini-documentary, with six film ‘cutdowns’ and a selection of captioned still images. Digital channels, primarily Facebook, Twitter and LinkedIn, will deliver the content at intervals from now until the end of the year. The mini-documentary will debut at ‘Innovate For Life’, IPHA’s conference on November 21 in Croke Park, Dublin. The campaign is voiced by the people on the frontline of community, science and industry. Their stories illustrate the depth of the impact of the originator pharmaceutical industry on Ireland’s society and the economy. Under each pillar, the films tell different stories. Such as; The Places • Cork is a thriving biopharmaceutical cluster, with

many of the industry’s largest players working on the discovery and manufacture of the latest treatments. The industry has a major economic impact locally. The Patients • Diabetes patient Eoghan Quinn’s recent attempt to solo-kitesurf from France to Ireland was, in part, enabled by innovation in treatments for the disease. • Psoriasis patient Caroline Irwin is able to lead a normal daily life because medicines are helping her to manage her skin condition. The Pioneers • Pfizer’s Orla Cunningham tells how her drug discovery group is finding new treatments for unmet medical needs. • Takeda’s Jennifer Corbett and Ellen Duggan explain how the cell therapy treatment they manufacture in Grange Castle, Dublin, is helping to fight Crohn’s Disease. Orla Cunningham is among the scientists featured in ‘Innovate for Life’. “The campaign highlights some of the innovative science we are working on towards the development of breakthrough medicines,” said Dr Cunningham, Senior Director of Pfizer Ireland’s BioMedicine Design Group at Grange Castle, Dublin. “At Pfizer Grange Castle, we combine early-stage discovery research,

drug development expertise and scale-up manufacturing under one roof which provides a unique environment to accelerate new therapies to patients. In addition to Pfizer disease research units, we are working across the Irish biomedical research network, in collaboration with Science Foundation Ireland, to explore potential new targets for diseases such as haemophilia, fibrosis, Crohn’s disease and breast cancer. This is an exciting time to work in Irish biopharmaceutical research - and ‘Innovate for Life’ helps to draw attention to the promise of science for better patient care.” All across Ireland, our industry is making a difference. We’re discovering and manufacturing innovative new medicines, improving people’s health and transforming local communities. We’re investing in Ireland’s future. We’re contributing to a healthier, more prosperous society through the medicines we make and the jobs we create. More than 30,000 of them. Our impact is felt deeply in lives, lifestyles and livelihoods. We’re proud of the work we do. ‘Innovate for Life’ tells some of the powerful stories about the impact of our industry in Ireland. This is a campaign voiced by the people on the frontline of illness, communities and science – the Patients, Places and Pioneers. We’re innovating for Ireland. Innovating for the world. Innovating for life.


Irish Pharmacy Awards 2019


Rose Cummins, Meaghers Pharmacy, Castletymon with Charlotte Heckford, UK & Ireland Business Unit Director at Pierre Fabre Dermo-Cosmetique

A Rose within Pharmacy Rose Cummins, pharmacy assistant with Meaghers Pharmacy in Castletymon, was recognised for her contribution to the profession and received the Avene Counter Assistant of the Year Award for 2019. Rose is one of the longest standing team members in Meagher’s Pharmacy Group, dedicating 12 years of her to life to serving the community between two stores, Glenview and Castletymon in Tallaght.

Having grown up in the Tallaght area, Rose has an excellent knowledge of her customers who she greets by name and with a smile on a daily basis. Customers are the centre of everything Rose does in her job and without doubt her most loved part of working in community pharmacy. Inspiring the Team Rose is someone who has been described as an extremely flexible member of the team, leading the front of shop being her primary responsibility. She also has excellent knowledge of the dispensary and is always willing to assist the dispensary team whenever required. Rose has also completed numerous skin care training

courses such as La Roche Posay, attending a refresher training for this in March, and Bioderma making her the ‘go to’ expert on skincare in the pharmacy. Rose truly believes in health and wellbeing and has completed many in-house vitamin training sessions and she also attends vitamin training sessions for specific brands at any chance she gets. Rose has also completed ‘You are the difference training’ a customer service technique used to ensure the best possible customer service is provided at all times. She excelled so much at the training that she was voted into a very special position in the company as one of just three team leaders and experts in this

programme. In this extra role Rose was required to visit different stores in the company to assist them in mastering the technique and coach all the team members to ensure they were confident in using the technique with every customer interaction. Making a Difference ‘You have literally changed my life, I feel like crying with happiness’. This is just one quote from a customer Rose recently met. These powerful words were spoken by a woman Rose helped with skincare. The customer was at a loss of what to do with her uncomfortable skin. She had tried many products and was just finding no improvement. She had heard from a friend at how good Rose was at giving

Avène Counter Assistant of the Year skin care advice and visited her in Castletymon. Rose listened very carefully to what this woman was experiencing. She explained different skincare regimes to her, showed her how to use certain products to help her skin and then gave her some samples to try. A week later the woman came back to the pharmacy to speak to Rose and she was keen to thank her. She was so much more confident and happier! As the first face a customer sees when they enter the pharmacy, all pharmacy counter assistants play a vital role in any initiative’s run by the Pharmacy. Rose is no exception to the rule. She is always eager to get involved in any of these with the most recent one she ran being the operation transformation ‘Know Your Numbers’ Campaign. Every year Rose also plays a vital role in the pharmacy Flu Vaccination Programme. Rose also played a vital role in the Meagher’s Pharmacy Wrap for Homeless campaign in 2018, getting involved in wrapping countless presents in return for donations from customers. She organised so many free gifts from suppliers which she raffled off in store or to raise money and she also attended many of the company events helping out in her own time, all leading to the raising of a huge ¤80,000 for The Peter McVerry Trust. Put simply, Rose is an inspiring young woman. Coming from a very difficult upbringing she was faced with an overwhelming number of challenges from a very young age. Instead of letting this get her down, Rose threw herself into her Over the Counter Assistant role and made sure she upskilled as much as she could

Rose Cummins, winner of Avene Counter Assistant of the Year

from the very start. Rose has developed into such a pivotal role in the community that customers come to the pharmacy specifically to see her and ask her advice. Being such a driven woman, Rose constantly looks for new challenges. If she feels like her work is getting too repetitive, she always approaches management with new ways that she can be motivated. Ideas such as sending her on a make-up course so she can give customers makeovers or going on a mental health first aid course so she is able to deal appropriately with any situation that may arise in the pharmacy are two recent requests. She has also led the team through some very challenging times. In the snow storms in March 2018 the roof of our pharmacy fell through and they had to move all equipment to another store to continue to serve customers. Rose was central to this move, ensuring all of the customers received the same excellent service that they would usually experience. If customers were unable to reach the temporary site Rose was always on hand to deliver the medication to them. She has completed numerous OTC training courses and also specialises in skincare, vitamins and make-up. Rose thrives in a learning environment and is always the first hand up to go to a training day. Her interest and enthusiasm for updated product knowledge and services ensures our store is a hub of information for any query.

Optimising Bone Health in Pharmacy


one is a living tissue that is constantly being removed and replaced. Bones need normal sex hormones, calcium, vitamin D, adequate calories, proteins and appropriate weight bearing/strengthening exercise to keep them healthy. At present it is estimated that 300,000 people in Ireland have osteoporosis, a condition in which a person has porous bones which is associated with increased fracture risk. In fact, one in four men and one in two women over 50 will develop a fracture due to osteoporosis in their lifetime. Community Pharmacists can play an important role in prevention education. This article looks at the bones of the issue and focuses on key educational tips for pharmacists and pharmacy staff. Osteoporosis Osteoporosis means porous bones. It is commonly known as “the silent disease” because there are no signs or symptoms before a person starts to break bones. However, this disease is not silent. The effects of undiagnosed/untreated Osteoporosis are devastating. 20% of people aged 60+ who break their hip will die within 6 to 12 months, due to the secondary complications of breaking a bone. 50% of people aged 60+

who break a hip will lose their independence. They will be unable to wash or dress themselves or walk across a room unaided. These statistics are why it is so important that people take responsibility for their bone health and check to see if they are at risk. Only 15% of people in Ireland are actually diagnosed with bone loss, leaving 280,000 undiagnosed and facing losing their independence. Signs and Symptoms Usually the first sign of Osteoporosis is a fragility (low trauma) fracture, for example, a broken bone due to a trip and fall from a standing position or less. Upper, middle or low back pain, especially if the pain is intermittent Loss of height: It should not be considered normal to lose height as you age Their head protruding forward from their body, shoulders becoming rounded, the development of a hump on the back and / or a change in body shape (waist appears bigger or a pot belly develops).


Most people have no pain till a fracture occurs, but a very small percentage of people have had back or hip pain, prior to a fracture. Adequate Calcium and Vitamin D Recommend that patients try to obtain calcium from the diet and to use supplements to make up for what is lacking. Calcium is essential for bone health and the recommended intake (RDA) is 800 mg/day for children, adults and older people, increasing to 1200 mg for teenagers, pregnant and lactating women . Unfortunately, 16% of women in Ireland are consuming less than the estimated average requirement of calcium. The National Children’s Food Survey also found that 28% boys and 37% girls aged 5-12 years have inadequate calcium intakes. The richest sources of calcium in the diet are milk, cheese and yogurt. Three servings a day will help meet calcium needs of an adult or child; five servings are recommended during adolescence and pregnancy. Smaller amounts of calcium may be obtained from other food sources, such as green

vegetables, bread and sardines. It should be noted however that the bioavailability of calcium from non-dairy sources is lower. Foods fortified with calcium and vitamin D such as milk and yoghurt can also be useful. Vitamin D is primarily produced by the action of UVB light on the skin, with a limited number of foods also providing vitamin D (oily fish, egg yolks, liver and fortified dairy products). Due to Ireland’s northerly latitude (and the use of sunscreens) production from UVB light is compromised. This, together with poor dietary intakes, has contributed to wide-spread sub-optimal vitamin D status. Recent research has confirmed that low vitamin D status (25 hydroxyvitamin D < 50nmol/l) is more prevalent than previously believed, particularly in postmenopausal women. Dietary sources should therefore be encouraged in all ages. Calcium and Vitamin D supplements can help to provide building blocks for healthy bone production. If it is not possible to achieve adequate calcium and vitamin D intake









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1,000 IU Name of product: Caltrate 500 mg / 1000 IU, chewable tablets Active ingredient(s): 500 mg calcium (as calcium carbonate) and 25 µg cholecalciferol (vitamin D3, equivalent to 1000 IU) as cholecalciferol concentrate powder form. PA number: PA822/187/1. Name and address of the marketing authorisation holder: Pfizer Healthcare Ireland, 9 Riverwalk, Citywest, Dublin 24. Supply classification: Pharmacies only, pack size 30. Indications: For the prevention and treatment of vitamin D and calcium deficiency in the elderly or as an adjunct to specific osteoporosis treatment for patients who are at risk of vitamin D and calcium deficiency. Dosage and Method of use: Adults/Elderly: 1 chewable tablet daily. Not to be used during pregnancy or by patients with renal impairment. Method of administration: Oral use. The chewable tablets can be taken at any time, with or without food and should be chewed and swallowed. Side Effects: Hypercalcaemia, nausea, diarrhoea, abdominal pain, constipation, flatulence, abdominal distension, eructation, vomiting, rash, pruritus, urticarial, hypercalciuria, nephrolithiasis, milk-alkali syndrome, hypersensitivity reactions such as angioedema or laryngeal oedema. Reporting of suspected adverse reactions: 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. Contra-indications: Hypersensitivity to any of the ingredients. Hypercalciuria and hypercalcaemia and diseases and/or conditions, which lead to hypercalcaemia and/or hypercalciuria. nephrolithiasis, nephrocalcinosis, hypervitaminosis D, severe renal impairment. Due to its high content of vitamin D the use in children or adolescents is contra-indicated. Warnings and Precautions: In the event of long-term treatment, serum calcium levels and renal function should be monitored. Monitoring is especially important in patients on concomitant treatment with cardiac glycosides or thiazide diuretics and in patients with a high tendency to calculus formation. In case of hypercalcaemia or signs of impaired renal function, the dose should be reduced or the treatment discontinued. Vitamin D should be used with caution in patients with impairment of renal function and the effect on calcium and phosphate levels should be monitored. The risk of soft tissue calcification should be taken into account. In patients with severe renal insufficiency, vitamin D in the form of cholecalciferol is not metabolised normally and other forms of vitamin D should be used. Caltrate 500 mg / 1000 IU, chewable tablets should be prescribed with caution to patients suffering from sarcoidosis, due to the risk of increased metabolism of vitamin D into its active form. These patients should be monitored with regard to the calcium content in serum and urine. Caltrate 500 mg /1000 IU, chewable tablets should be used cautiously in immobilised patients with osteoporosis due to increased risk of hypercalcaemia. The content of vitamin D (1000 IU) in Caltrate 500 mg / 1000 IU, chewable tablets should be considered when prescribing other medicinal products containing vitamin D or other dietary sources with a high vitamin D or calcium content (such as milk). Additional doses of calcium or vitamin D should be taken under close medical supervision. In such cases it is necessary to monitor serum calcium levels and urinary calcium excretion frequently. Co-administration with tetracyclines or quinolones is usually not recommended or must be done with precaution. This medicinal product contains aspartame (E951), a source of phenylalanine which may be harmful for people with phenylketonuria. It also contains sorbitol (E420), isomalt (E953) and sucrose. Patients with rare hereditary problems of fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency should not take this medicine. May be harmful to the teeth. Date: 22nd June 2018 PCRS Code: 28902

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display similar effects of estrogen on bone enhancing bone turnover or increasing bone density without adverse effects on breast and endometrium, but stopping treatment may accelerate BMD loss. They are not used as a first-line treatment.

Healthy bone through diet, supplements may be recommended. A metaanalysis of calcium and vitamin D supplementation found that calcium and vitamin D supplementation reduced bone loss and fracture risk in adults aged 50 years and older. The National Osteoporosis Foundation in the USA recommends 1000mg-1200mg calcium and 800-1000IU of vitamin D for adults (aged 50 years and older). Vitamin D given alone has not been found to reduce risk of fracture but has been shown to reduce falls if vitamin D status was low at baseline. Benefits of Exercise Recommend weight-bearing and muscle strengthening exercises for building and maintaining bone density. Patients should check with their GP regarding which exercises are safe, depending on medical history. Examples of weight bearing exercises include dancing, aerobics, tennis, hiking, stair climbing, running, walking, treadmill, and elliptical training machines. Muscle strengthening exercises include lifting weights and using elastic exercise bands. Pharmacists can play an important role in preventing drug induced osteoporosis. These medications include glucocorticoids, proton pump inhibitors (PPIs), and chemotherapy drugs. Studies have suggested many adverse effects are associated with long-term use of PPIs such as increased fracture risk. De-prescribing PPIs may help to prevent long-term use in certain patients and prevent osteoporosis. Osteoporosis Therapies Antiresorptive which reduces bone resorption through the inhibition of osteoclasts activity and anabolic agents that induce new bone formation through stimulating the function of osteoblasts are the two

Osteoporosis main groups of pharmacological agents used in osteoporosis. Biphosphonates (BPs) including alendronate (Fosamax®), risendronate (Actonel®), ibandronate (Boniva®), zoledronic acid (Reclast®), clodronate (Bonefos®, Clasteon®), minodronate (Onobis®), pamidronate (Aredia®), etidronate (Didronel®), and tiludronate (Skelid®) are the first-line therapy for osteoporosis. They act through inactivation of osteoclastic bone resorption and acceleration of apoptosis of osteoclasts, can increase BMD and decrease fracture risk, and have a different affinity to bone. Denosumab (Prolia®) a human monoclonal RANKL antibody that results in osteoclast inactivation, apoptosis, and decreased differentiation of osteoclasts also reduces bone resorption. It can be used as a first-line choice for certain patients who are intolerant to BPs or have renal failure, and it has shown efficacy among osteoporotic women and older men under androgen-deprivation therapy for prostate cancer. Estrogen replacement therapy (ERT) or estrogen-progestin (hormone) replacement therapy (HRT) alone reduce bone resorption is effective for prevention of osteoporosis in postmenopausal women. Tibolone (Boltin®, Tibocina® or Xyvion®) is an estrogen-progestin combination used for prevention of osteoporosis in post-menopausal women. However, HRT and ERT can increase the risk of venous thromboembolic disorders, breast and endometrial cancer, andstroke. HRT or ERT are not recommended as the first-line preventive treatment of osteoporosis. Selective estrogen receptor modulators (SERMs) raloxifene (Evsita®), tamoxifene (Soltamox®), lasofoxifene (Fablyn®), and bazedoxifene (Viviant®, Conbriza®)


Calcitonin (Fortical®, Miacalcin®, Calcimar®) is considered as a second-line therapy when first-line drugs have failed or patients are intolerant to first-line treatments. Calcitonin inhibits bone resorption through increasing osteoblast activity, with beneficial effects in both sexes. It is recommended as a second-line treatment for women 5 years after menopause. It is used to relieve acute pain secondary to osteoporotic fracture, but not for chronic pain. PTH peptides Teriparatide (recombinant human parathyroid 1-34) (Forteo®) and abaloparatide (BA058®) a synthetic peptide analog of PTHrP have anabolic effects on bone by promoting bone formation increasing BMD and reducing fracture risk. They are not recommended as first-line drug mainly for the elevated cost. Studies have shown that combinations of agents with different mechanism of action, possibly with the exception of the combination of anti-inflammatory agents such as anti-tumor necrosis factor (anti-TNF) with anti-sclerostin antibodies tried in animal models do not add additional advantage, and can on the contrary, reduce the potential benefits of the individual drugs. In men, the most common cause of osteoporosis is hypogonadism, and testosterone replacement therapy can increase BMD in spine. Alendronate or risendronate are the first line therapy BPs recommended for osteoporosis in men. Other options for men include zoledronic acid, denosumab, and PTH therapy. New potential treatments such as cathepsin k inhibitor and strontium ranelate, are generally restricted to patients who are at high risk of fracture or failed to respond to first line treatments options due to their high cost. Growth hormones and the role of genes are also being studied. Cathepsin k a cysteine protease expressed by osteoclasts, can degrade matrix proteins and type I collagen that results in bone resorption. Cathepsin k inhibitors odanacatib balicatib, ONO-5334 can reduce bone resorption and/ or bone formation, although the beneficial effects are reversible after stopping treatment. Strontium ranelate (Protelos®) is an antiresorptive agent recommended for treatment of severe

osteoporosis in postmenopausal women and men at high risk of fractures who cannot tolerate other pharmacological agents. The mechanism of action is based in the inhibition of osteoclasts and promotion of the activity of osteoblasts through calcium sensing receptor (CaSR) by strontium, which results in a slight increase of BMD and decrease of fracture risk. Sclerostin a glycoprotein specifically expressed in osteocytes is a potent inhibitor of bone formation and a key negative regulator of bone metabolism, which may have a catabolic action through promoting osteoclast formation and activity by osteocytes. Anti-sclerostin monoclonal antibodies include romosozumb, blosozumab, and BPS804. Additional therapies for postmenopausal osteoporotic women include vitamin K, folic acid, vitamin B12 supplementations, androgens, and fluoride. RGD sequence and human ß3 integrin, osteoprotegerin (OPG), known as osteoclastogenesis inhibitory factor (OCIF), bone morphogenetic proteins (BMPs) a group of growth factors known as cytokines and as metabologens, and PTH have been reported as the most promising molecules for osteoporosis treatment, but not many new molecules have been studied as possible targets. Matrix metalloproteinases (MMPs), selective androgen receptor modulators (SARMs), cell adhesion molecules (CAMs), L-carnitine and insulin like growth factor-1 (IGF-1) are potential new drugs. The best way to treat osteoporosis is to prevent its occurrence. Modification of risk factors is imperative, and pharmacists can play a large role in this area. Pharmacists can advise patients, especially women, who are at an increased risk for osteoporosis to increase their intake of foods and drinks rich in calcium and vitamin D; offer strategies to quit smoking; encourage 30 minutes of weightbearing and muscle-strengthening exercise at least three times per week; and, most importantly, recommend appropriate calcium and vitamin D supplementation and any required prescription medications for osteoporosis. Pharmacists can determine the best therapeutic option for patients based on efficacy, tolerable adverse effects, contraindications, and medication adherence. Patients require education on proper dosing, administration, and adverse effects to promote the safe use and monitoring of medications for osteoporosis.





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McCauley Pharmacy group plans expansion The McCauley pharmacy group has announced ambitious plans to double the size of their business in coming years. The group is targeting revenues of ¤94m this year, boosted by a store refurbishment programme and rebranding to steer the business further towards health and beauty. The group, previously Sam McCauley Chemists, had turnover of ¤84.6m in the financial year to the end of September, up from ¤80m the previous year. Its earnings before interest, tax, depreciation and amortisation rose by 18% to ¤5.3m, according to new accounts. It has 35 pharmacies and employs about 680. Tony McEntee, chief executive of McCauley, said all of its outlets were profitable, following the closure of two loss-making stores. The group recently completed a relocation of its support office and investment in IT, costing about ¤1.5m. McEntee said McCauley had bolstered its management

team and expanded marketing and buying teams. “We have positioned ourselves to seriously grow the business,” he said. “Our intention is to double the size of the group over the coming years.” McEntee said the expansion plan was likely to involve buying a group of pharmacies, as well as standalone outlets. “It would be very difficult to get to 70 [outlets] one at a time,” he said. The private equity group Carlyle Cardinal Ireland took a stake in McCauley in August 2017, valuing the group at more than ¤50m at the time. Former owner Sam McCauley still has a small stake and McEntee is also a shareholder. The group had ¤67m debt at the end of September. McEntee said drug-dispensing made up about 40% of the

McCauley business, with the balance from sales of health and beauty products. It has online sales of about ¤35,000 a week but expects that to increase significantly. McEntee said the chain had benefited from a rise in popularity of Irish brands, such as Carter Beauty and Cocoa Brown, both brands created by Marissa Carter. “There are these remarkable brands, coming out of nowhere, and doing great business,” he said. He said the group had to manage costs, including wage inflation. “Retail is not without its challenges,” he said. The group bought pharmacies in New Ross in Co Wexford and Athy in Co Kildare since last September. It has also opened new stores at Charlemont Square in Dublin and Enniscorthy in Wexford.

Appointment at totalhealth totalhealth Pharmacy, with over 75 member pharmacies nationwide, has recently appointed Naomi O’Farrell as Marketing & Communications Manager. Naomi first joined the symbol group in July 2018. Naomi O’Farrell has been appointed as Marketing and Communications Manager at totalhealth

Naomi has worked in the retail pharmacy industry for over 18 years, primarily in health promotion and service development roles,

with large and small pharmacy chains. At totalhealth, she will be focusing on internal & external communications, health promotion campaigns & services, and the launch of a new website. Naomi holds a BA in Journalism & Media Communications and worked as a pharmacy technician and pharmacy manager.

Survival proposals for pharmacy firms The High Court has approved survival proposals for three healthcare and pharmacy firms employing 79 people, pending competition clearance. BOFH Holdings, trading as Health Express Pharmacy, Median Healthcare and Brady's Pharmacy were granted court protection due to financial difficulties last March, when Neil Hughes of Baker Tilly was appointed examiner. An independent expert believed the firms had a reasonable prospect of survival if some conditions were satisfied, including securing investment and the introduction of cost-saving measures. Under a modified scheme of arrangement approved by Mr Justice David Barniville, a number of measures are to

be implemented, including a Lloyds Pharmacy investment of ¤972,000 in BOFH and ¤1m in Median. DBDC Eight Ltd will invest ¤150,000 in Brady's. Creditors, including AIB, the Revenue, Everyday Finance and the HSE, were neutral as to the survival proposals. Mr Justice Barniville, noting it meant the firms could continue to trade and ensure the 79 jobs, was satisfied to approve the scheme. He said the only difficulty was that the Competition and Consumer


Protection Commission (CCPC) also has to approve the scheme in relation to BOFH and Median. While it is anticipated this will be forthcoming, the judge agreed with a suggestion from Gary McCarthy SC that the survival scheme would come into effect 21 days from Thursday August 1, or from when the CCPC grants approval, or whichever is sooner. Court protection for these two firms would remain until then, while the survival scheme for Brady's would take effect from 5pm on Thursday, August 1.

Boots Ireland launch their annual Night Walks Boots Ireland have launched their Night Walks for Night Nurses campaign, encouraging people to join fundraising Night Walks in either Phoenix Park, Dublin (16 August) or Blackrock Castle (Carpark), Cork (23 August). Tickets to join the 5km walk cost ¤15 for an adult, and under 16s go free. Walks start at 7.30pm in Dublin & 7.00 pm in Cork. Each adult ticket comes with a free t-shirt. Alongside the walks, Honour Tags are on sale in Boots stores nationwide for ¤2. Customers can purchase a tag in honour of someone who has survived or passed away from cancer. One metre will be walked in honour of that person and the tags are brought to respective walks. The front of the tag allows for the name of the individual with space on the back for a personal message. Funds raised will go towards the Irish Cancer Society Night Nursing service, which provides end of life care for cancer patients in their own home, allowing them to pass away at home surrounded by family and loved ones as well as giving much needed respite for the family caring for them. Boots MD Bernadette Lavery said: “We were thrilled to see over 600 people attend the walks last year, raising more than ¤50,000 for this great service. Since partnering with the Irish Cancer Society back in 2012 we have raised over ¤1.4 million or over 4,000 nights for this much-needed service, and we are incredibly proud of Boots’ ongoing commitment to supporting those living with cancer. We’ve set ourselves a target to raise more than ever before this year, so would love to see more participants at our walks, which are truly inspirational and uplifting events.” Speaking at the launch of the Night Walks campaign, Averil Power, Chief Executive, Irish Cancer Society, said: “The Night Nursing service allows cancer patients to remain in their own home during their last days. The Night Nurses are there through the night, keeping the patient comfortable, while also supporting family members during a very difficult time.”


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air-loss, for both men and women, can be distressing, and is a subject which needs careful and sensitive handling by pharmacists and pharmacy staff. It is important you are educated in the types of hair-loss, what causes it and that you understand which treatments are available. A hair growth cycle consists of three phases. During the anagen phase, hair grows actively. This phase may last for years. During the catagen phase, hair stops growing and separates from its follicle, which is the structure beneath the skin that holds the hair in place. The catagen phase lasts about 10 days. During the telogen phase, the follicle rests for two or three months, and then the hair falls out. The next anagen phase begins as a new hair grows in the same follicle. Most people lose 50 to 100 hairs per day as part of this natural cycle.

depression. Prevalence rate of hairloss is high among working age population. As per International Society of Hair Restoration Surgery, 84.6% of individuals who got hair-loss treatment in 2018 was due to genetic hair loss.

If this cycle is disrupted, or if a hair follicle is damaged, hair may begin to fall out more quickly than it is regenerated, leading to symptoms such as a receding hairline, hair falling out in patches, or overall thinning.

It is of five types, alopecia areata, androgenic alopecia, ciatricial alopecia, traction alopecia, and alopecia totalis. Androgenic alopecia is commonly known as male-pattern baldness and female pattern hair loss.

The Root of the Problem

Androgenetic alopecia is the most common form of hair loss for both men and women. It can be caused by either hormonal or hereditary factors.

Hair-loss is mainly genetical but can be caused by some other factors like sedentary lifestyle, unhealthy diets, ageing and hormonal imbalance and increasing chronic disease like arthritis, cancer, hypertension and

Hair-loss, also known as alopecia or baldness, is a medical condition that refers to loss of hair from head or any part of the body. It causes clumps of hair to fall out which leads to hairless patches on scalp or other areas of the body. Hair-loss occurs in both male and female regardless of their age.

Androgenetic alopecia is an androgendependent hereditary disorder in which


dihydrotestosterone is a significant contributing factor. The condition affects Caucasian men more than men of other ethnicities. It can start at any age, but approximately 30% of men will experience some hair loss by the age of 30 years, 50% by the age of 50 years, and 80% by the age of 70 years. In addition, up to 13% of premenopausal women experience some degree of androgenetic alopecia, and the incidence may increase significantly after menopause. By the age of 70 years, approximately 40% to 50% of women experience hair loss. Male Pattern Hair Loss In men, hair loss can begin any time after puberty and progress over the course of years or decades. It starts above the temples and continues around the perimeter and the top of the head, often leaving a ring of hair along the bottom of the scalp. Many men with male pattern hair loss eventually become bald. Female Pattern Hair Loss In women, hair slowly thins all over the scalp, but the hairline usually

doesnâ&#x20AC;&#x2122;t recede. Many women experience this type of hair loss as a natural part of aging, although hair loss may begin any time after puberty. Female pattern hair loss can cause hair to thin dramatically, but only rarely does it lead to baldness. Telogen Effluvium Telogen effluvium, a type of hair loss, occurs when large numbers of follicles on the scalp enter the resting phase of the hair growth cycle, called telogen, but the next growth phase doesnâ&#x20AC;&#x2122;t begin. This causes hair to fall out all over the scalp without new hair growth. Telogen effluvium does not generally lead to complete baldness, although some may lose 300 to 500 hairs per day, and hair may appear thin, especially at the crown and temples. A medical event or condition, such as a thyroid imbalance, childbirth, surgery, or a fever, typically triggers this type of hair loss. Telogen effluvium may also occur as a result of a vitamin or mineral deficiency, iron deficiency is a common cause of hair loss

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whether the cause of the hair loss has been identified. Patients should always be referred to their GP for further evaluation if the cause of their hair loss is unknown or sudden. It is particularly important for women who experience sudden hair loss to seek advice to identify causes or contributing factors. To ensure that their medication is effective, patients should be offered advice on how to properly apply topical minoxidil according to manufacturer recommendations. Patients should also be made to understand the importance of using the product continuously to maintain regrowth of hair, because discontinuation of treatment can result in a rapid reversion to the pre-treatment balding pattern.

Hair Growth Cycle

in women, or the use of certain medications, such as isotretinoin, prescribed for acne, or warfarin, a blood thinner. Starting or stopping oral contraceptives (birth control pills) may also cause this type of hair loss.

cause of hair loss in children. This condition causes hair to fall out in patches, sometimes circular, leading to bald spots that may get bigger over time.

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Telogen effluvium usually begins three months after a medical event. If the triggering event is temporary, hair may grow back after six months. Telogen effluvium is considered chronic if hair loss lasts longer than six months.

The affected areas often look red or scaly, and the scalp may be itchy. Sores or blisters that ooze pus can also develop on the scalp. A child with the condition may have swollen glands in the back of the neck or a low-grade fever as a result of the immune system fighting the infection.

Anagen Effluvium

Treating the Problem

Anagen effluvium is rapid hair loss resulting from medical treatment, such as chemotherapy. These potent and fast-acting medications kill cancer cells, but they may also shut down hair follicle production in the scalp and other parts of the body. After chemotherapy ends, hair usually grows back on its own.

The key for consumers who have hair issues is to feel understood and that you can tailor a solution for them. That solution may be to conceal their thinning hair and scalp using fibres or to improve the health of their hair over time by taking supplements. Taking the time to ask customers about their lifestyle may help you ascertain if their hair issue is related to stress, poor nutrition or hormonal ageing.

Alopecia Areata Alopecia areata is an autoimmune condition, which means the body’s immune system attacks healthy tissues, including the hair follicles. This causes hair to fall out and prevents new hair from growing. This condition can affect adults and children, and hair loss can begin suddenly and without warning. Hair from the scalp typically falls out in small patches and is not painful. Hair in other parts of the body, including the eyebrows and eyelashes, may also fall out. Over time, this disease may lead to alopecia totalis, or complete hair loss. Tinea Capitis Tinea capitis, also called scalp ringworm, is a fungal infection of the scalp that’s a common

Often, it’s a combination of many factors. There are ranges available from pharmacy that encompass a full system for consumers to use that includes supplements, fibres and densifying shampoo, conditioner and elixir. The haircare products help to ensure the scalp is healthy and nourished, while helping the hair to look thicker and fuller. Minoxidil reinvigorates shrunken hair follicles – they increase in size and re-grow thicker hair over time. Minoxidil works by helping the blood flow to the hair follicles and increasing follicular size and hair shaft diameter, stimulating and prolonging hair growth. Minoxidil increases blood flow which stimulates hair follicles,


• Reverses miniaturisation of follicles

• Stimulates follicle movement from resting to hair growth phase

Pharmacists should also inform patients that the product may not be effective for everyone, that it is a suppressive therapy and not a cure, and that hair growth may not be apparent until 4 months after initiation of therapy. If hair growth does not occur after 4 to 6 months of consistent use, the patient should be advised to discuss other possible treatments with their GP. When to refer: • Those who have sudden hair loss • Those who develop bald patches • Those losing hair in clumps

• Extends each follicle’s growth phase

• Those whose head also itches and burns

Alpecin Shampoo is caffeine based treatment, with additional zinc, vitamin A and niacin. There are several small research papers showing some effectiveness of Alpecin in improving hair strength and increasing activity in hair roots after a few months of regular use.

• Those who are worried about their hair loss

Tinea capitis needs to be treated with oral antifungal medication and a medicated antifungal shampoo to reduce spread of the fungus to other people. The shampoo contains the active antifungal ingredient ketoconazole or selenium sulfide. Medicated shampoo helps prevent the fungus from spreading, but it doesn’t kill ringworm. Offering Advice and Education Because hair-loss may cause emotional distress and affect self esteem, pharmacists and their teams should be supportive and empathetic to those experiencing it. Pharmacists can assist patients experiencing hair-loss by reviewing medication profiles and possibly identifying pharmacologic agents that may be associated with increased risk of hair-loss. Prior to recommending the use of topical minoxidil products, it is important to determine whether self-treatment is appropriate and

Category Management Place medicated hair and scalp care products on the shelf near the more cosmetic shampoos to enable customers to see that there are other options available. You could also consider an instore promotion with a focus on men’s health, special displays and product links encouraging men to ask for help, or to try something new. It’s often women who are in charge of buying the shampoo, so this needs to be taken into account when trying to promote scalp care to men. It is important to acknowledge scalp problems and find the best products to treat them. Sometimes women have to manage their partners’ hair problems in addition to any concerns they have. Men tend to suffer more from dandruff, for example, but women are more often searching for information and treatments. Time spent preparing product displays is an effective way to get men to ask about hair loss products. Product displays are a great way to draw attention to these products and encourage customers to ask for advice.

DRYNOL® (BILASTINE) 10 MG ORODISPERSIBLE TABLETS FORMULATION A.Menarini Pharmaceuticals Ireland Ltd. has announced the launch of a new paediatric formulation of Drynol® (bilastine): Drynol® 10 mg orodispersible tablets. Drynol® 10mg orodispersible tablets are indicated for the symptomatic treatment of allergic rhinoconjunctivitis (seasonal and perennial) and urticaria in children aged 6 to 11 years with a body weight of at least 20 kg. 1 Drynol® 10mg orodispersible tablets are included on the Primary Care Reimbursement Service (PCRS) list since June 2019. Celebrating 20 years in Ireland in October 2019, A. Menarini has grown rapidly. Dedicated to launching products that respond to the genuine medical needs of patients and physicians, the company now markets a portfolio of 18 products in the following therapeutic areas: cardiology, respiratory medicine, rheumatology, neurology, analgesia and anti-allergy and employs approximately 50 staff in sales, medical, marketing, administration & finance. If you would like more information about this topic, please call Jason Davies at 01 2846744 or email jdavies@menarini.ie. For full prescribing information, please refer to the Summary of Product Characteristics on www.medicines.ie. For medical information queries please email medinfo@menarini.ie.

GINKGO BILOBA NEW TO MARKET Ginkgo biloba is a natural plant extract with active compounds that dilate your blood vessels so your blood flows more easily through your veins. There are numerous health advantages. Good circulation is essential for literally all your body functions from head to toe, but not everyone is blessed with an effective flow of blood through their cardiovascular system. So if you have poor circulation, you may find relief in a natural plant extract called ginkgo biloba, which contains some active compounds that dilate the vessels and make blood thinner, so it flows more easily to all your different tissues. Your brain alone accounts for nearly 20% of your body’s entire oxygen consumption, so it is not difficult to imagine how important a well-functioning supply of blood to the head and brain is. All of your cognitive functions rely on a generous supply of blood, oxygen and nutrients to the brain cells. Tinnitus, dizziness, and poor concentration are just some of the problems that are typically caused by poor circulation. But there is more. Walking-induced leg pain can also be a result of having an insufficient flow of blood through the legs. And then there is the problem with cold hands and feet, which many people suffer from. A new preparation has just hit the market. Ginkgo Biloba Pharma Nord is specifically indicated for the prevention and treatment of cold hands and feet and certain other circulatory symptoms, provided a physician has ruled out underlying diseases. The prescription-free drug is available from pharmacies all over Ireland.


Topic Team Training – Head Lice 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.  Can I/my team explain to a parent how to detect head lice? Can we teach the technique of detection combing?  Can I do more to liaise with school nurses, head teachers, local general practices, health visitors and infection control nurses to ensure we are all giving the same information to patients and we can refer to one another as appropriate?  Can I explain the correct use of head lice preparations?  Do I know what to recommend if a customer returns saying the treatment has not worked? Key Points: Check your pharmacy team are aware and understand the following key points: 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 Head Lice. Head lice are grey or brown insects that live close to the scalp on human heads. They are 1mm to 3mm long. They can be white, yellow or brown. The main symptom is itching, but only about 1 in 3 children with head lice have an itch. It is estimated that 1 in 10 children suffer from head lice at any one time, with 80% of head lice infestations occurring in children between the ages of four and 16. According to the Irish Pharmacy Union (IPU) all children should be screened for head lice once a week when they return to school. Caitriona O’ Riordan, Pharmacist and member of the Executive Committee of the Irish Pharmacy Union says, “There is no way to completely eliminate the risks of head lice but identifying an infection early will make treating it far easier. This will also help prevent the spread of infection through the family, or amongst school friends. “If an infection is detected it is important to start treatment as soon as possible, lice are a normal part of life and are nothing to be embarrassed about. There are several treatment options available, and you should seek advice from your pharmacist about which is the most appropriate for your child.

This is particularly important for any child suffering from asthma, allergies or those with a preexisting skin condition, as they are the most likely to suffer a reaction.” According to Ms O’ Riordan, “It is also extremely important to only take treatment if a living, moving louse is found. Using head lice products as a preventative measure is not effective, and unnecessarily exposes children to these products.” Because lice crawl and do not jump, head-to-head contact is the primary route of transmission. Once on the scalp, lice attach eggs to the base of hair shafts a few millimeters from the scalp surface. Once laid, eggs hatch within 9 to 12 days, and the resulting nymph matures into an adult louse over the subsequent 9 to 12 days, for a full reproductive cycle of approximately 3 weeks’ duration. After hatching, lice feed on human blood. Products containing dimeticone or isopropyl myristate kill the lice through physical action. Dimeticone coats the surfaces of head lice and suffocates them, while isopropyl myristate dehydrates head lice by dissolving their external wax coating. Checking Tips The best way to find head lice is to check children's hair every week, combing through their hair with a 'detection comb' 1. Wash the hair with ordinary shampoo


2. Apply lots of conditioner and comb it through with an ordinary comb. This makes lice wet, which keeps them still.

 Misconceptions around head lice – how they spread and how to treat them

3. Put the teeth of the detection comb into the hair at the roots and comb down to the ends.

 How to check for the presence of live head lice; the importance and technique of detection combing

4. Work through the hair, section by section, checking the comb each time. 5. Rinse off the conditioner. 6. Repeat combing while the hair is still wet. When offering advice to parents about head lice, make sure you and your team have the knowledge to debunk any common misconceptions or concerns that the parent/child might have. The treatment options have different directions concerning administration, which should be discussed. It is also very important to instruct parents to vacuum the house and to wash all clothes and bedding in hot water to get rid of any lice that may have travelled away from the scalp. Washing these items should be done no later than 3 days after treatment. Any hair supplies including combs and brushes should also be soaked in hot water for 5-10 minutes before use. Consider:  Can I explain the life cycle of head lice to my pharmacy team and how they can apply this knowledge to treatment?

 Scalp itching is not always caused by head lice; the itch develops if the person is allergic to lice  When to recommend an appropriate treatment and how to use it  The role of preventive products such as repellents Actions:  Include POS with associated condition treatments such as other areas associated with school and going back to school  Ensure efficient sign posting to further help and advice or reputable sources for head lice treatment  Ensure there is a discreet area in which staff can assist with advice and product selection  Keep products merchandised together, along with related products to help build sales  Ensure the team are able to communicate lifestyle advice on treating head lice  Train the team to meet all the above considerations


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A Clear Picture of Dry Eye Disease


n estimated 10% to 30% of the population older than 40 years suffers from some degree of dry eye disease (DED). The condition tends to affect people above 60, and it is more common in women than men.

Around one in 13 people who are in their fifties experience dry eye syndrome, and the condition becomes more common with age. Up to a third of people age 65 or older may have dry eye syndrome. DED, which is also sometimes referred to as dry eye syndrome or keratoconjunctivitis sicca, is considered the most prevalent ophthalmic disorder that affects the anterior eye and is most often associated with the aging process, especially in postmenopausal women. DED is a multifactorial disease of the tears and ocular surface that results in discomfort, tear film instability, and visual disturbance, with potential for damage to the ocular surface. DED can be classified as chronic or temporary. DED can be also attributed to Bell’s palsy, collagen disorders such as rheumatoid arthritis,

corneal or eye lid defects, Sjögren syndrome, and thyroid-related eye disease.

changes caused by pregnancy, the use of birth control pills, or menopause.

Other medical conditions associated with DED include diabetes, lupus, and scleroderma.

• The use of cold or allergy medicines, antidepressants, and drugs for high blood pressure; acne; birth control; and Parkinson’s disease.

What Causes Dry Eyes? Dry eyes can be caused by ordinary things that increase tear evaporation, such as looking at a computer screen too long; being outside in windy, dry conditions; or just being tired. Cigarette smoke may also cause dry eyes. Other common causes of dry eye include: • Aging. Tear production tends to decline with age. Dry eyes are common in individuals older than 50 years. • Gender. A deficiency of tears is more common in women, especially with hormonal


• Wearing contact lenses. • An eye injury or other problem with your eyes or eyelids. • Diabetes. • Thyroid disorders. • Vitamin A deficiency. Symptom Checker The symptoms of dry eye syndrome usually affect both eyes and may include: • feelings of dryness, grittiness or soreness, which get worse throughout the day

• redness of the eyes • watering eyes, particularly when exposed to wind • eyelids that stick together when waking up These symptoms may get worse in smoky or hot environments. When a patient presents with symptoms of a dry eye condition, such as irritation, grittiness, burning, soreness, watery eyes and visual disturbances generally affecting both eyes, a detailed history should be recorded by the pharmacist because it may elicit information about contributing factors. Briefly, this should include details of the signs and symptoms, duration of symptoms and exacerbating factors, such as the environment, changes in humidity or computer use.

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ectropion (respectively, inward or outward turning lids that cannot close properly). Sufferers’ constant discomfort and red, swollen eyes negatively affect their well-being and their ability to carry out daily activities. Ophthalmologists and opticians encourage blepharitis sufferers to establish a systematic, long-term commitment to eyelid hygiene, because management will require lifelong vigilance.

It should also record details of topical and systemic medicines taken by the patient, whether the patient wears contact lenses and if the patient has any dermatological, inflammatory or other systemic diseases. A differential diagnosis for other eye conditions (such as conjunctivitis, allergy and acute red eye) should be established because initial presentation may be similar. A Visual on Treatments Once dry eye syndrome develops, some people have recurring episodes for the rest of their lives. There is no cure for dry eye syndrome, but a range of treatments can control the symptoms. In rare cases, more severe cases of dry eye syndrome may require surgery. The ultimate goal of dry eye treatment focuses on symptomatic relief, usually using tear supplements. Despite this, the underlying mechanism of symptomatic improvement with tear supplementation is still poorly understood. It is thought that increased tear volume, improved tear stabilisation, reduced tear osmolarity or a dilution of inflammatory biomarkers or a combination of these factors play a vital role. Topical ocular lubricants are the mainstay of dry eye treatment, with the choice of tear substitute depending on the severity of the condition. Pharmacological interventions in all forms of dry eye conditions range in formulation, such as drops, sprays, gels and ointments. For occasional or mild dry eye symptoms, OTC eyedrops (artificial tears) used regularly may provide relief. Preservative-free artificial tears are preferred, as they cause less irritation. Wearing glasses or sunglasses that fit close to the face (wraparound shades) or that have side shields can help slow tear evaporation from the eye

surfaces. An indoor air cleaner to filter dust and other particles can help prevent dry eyes, as can a humidifier by adding moisture to the air, avoiding dry conditions, and allowing the eyes to rest when performing activities that require someone to use their eyes for long periods of time. Pharmacologic agents that have anticholinergic properties including antihistamines, decongestants, and antihypertensives such as antidepressants, beta-blockers, and diuretics are common causes of DED. Additionally, DED may be caused or exacerbated by allergens and environmental conditions such as dry climates, failure to blink regularly when staring for long periods at electronic devices, smoke, and wind. Laser eye surgery may also cause temporary dry eye. Pharmacists are in a critical position to identify the pharmacologic agents that can exacerbate or increase the risk of DED and advise patients regarding the most efficacious means of preventing episodes of dry eye. Additionally, pharmacists can be instrumental in aiding patients by educating and recommending the many OTC products to manage and treat mild to moderate DED as well as direct patients with chronic and severe cases of DED to seek further medical care from an ophthalmologist when warranted. Prior to recommending any OTC products for DED, pharmacists should ascertain whether selftreatment is appropriate and refer patients to seek medical care when warranted. Patients experiencing severe episodes of DED, red or painful eyes, or signs of ocular infection should always be encouraged to seek medical care from an ophthalmologist to ensure proper treatment and to lessen the incidence of further ocular damage. Patients electing to use OTC products should be advised to seek care from an


ophthalmologist for suggestions for alternative therapies, including prescription medications if the dry eye symptoms do not improve or worsen after self-treatment with OTC products. Initially, patients can be given appropriate lifestyle advice to try to reduce the symptoms of their condition. This includes: using humidifiers; stopping smoking; taking regular breaks from the computer to encourage blinking; ensuring the top of the computer monitor is at eye level to reduce the aperture width between the eyelids; and increasing dietary omega-3 fatty acid intake or oral supplementation. Blepharitis Most people with dry eye syndrome also have blepharitis, which is a common and usually mild condition that causes inflammation (redness and swelling) of the rims of the eyelids. Patients with blepharitis may present with eyelash changes, watering, crusting and mattering around the lashes and canthus, photophobia, pain, and vision changes. The symptoms are usually worse in the morning, after a night of closed eyes has kept eyelids in contact with the ocular surface. Incidence seems to increase with age, but younger people appear to be more bothered by the symptoms than elders. This may be because they spend more time in front of computers, which provokes dry eye, or because they are more likely to wear contact lenses. Although far from life-threatening, blepharitis’ impact can be significant. Patients’ visual function may decline pursuant to corneal damage and inflammation, scar formation, loss of surface smoothness, and clouded corneas. If severe inflammation develops, corneal perforation can occur. The normal progression may include eyelid damage to the lids with trichiasis, or entropion and

Pharmacists should keep certain tips in mind when helping patients who have blepharitis. First, pharmaceutical preparations like ointments and gels will stay in contact with the lid margin longer than solutions. These are usually preferred for blepharitis, but drops are preferred for corneal disease because they spread evenly. Pharmacists need to repeat one message to patients at every visit: when applying any ointment to lid margins, using a clean application device, such as a cotton swab or a clean fingertip, is critical, as is gentle eyelid handling. Otherwise, patients may infect themselves or tear fragile skin. Patients who avoid using eye makeup until symptoms subside will be more comfortable. When to Refer: Dry eye syndrome can cause complications, such as: • scarring of the cornea • conjunctivitis - inflammation (swelling and redness) of the conjunctiva Such complications can produce more severe symptoms, for example: • extreme sensitivity to light (photophobia) • very red eyes • very painful eyes • a deterioration in vision Anyone presenting with these symptoms should be immediately referred to their GP.

Questions to ask a patient with suspected dry eye disease 1. Is the dryness/burning/ watering in both eyes? 2. How long has it lasted? 3. Do you have mouth dryness? 4. Was it precipitated by an event? 5. Are you in pain? 6. Does your vision clear when you blink? 7. Is there redness or swelling?

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