August 2020 Volume 12 Issue 8 PHARMACYNEWSIRELAND.COM
THE INDEPENDENT VOICE OF PHARMACY
In this issue: NEWS: Pharmacy Contract gets Minister for Health focus Page 4
PROFILE: Raising the Bar in Self-Care with Dave Barrett Page 9
REPORT: IQVIA’s Gwynne Morley gives in-depth analysis of Ireland’s OTC market Page 18
TOP 100: Top 100 OTC Products in Ireland Page 24
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Product Shortages and Finance Focus Page 61
FEATURE: Breastfeeding and Medicines Page 88
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Page 5: Pharmacy must be top of Stimulus agenda
Following on the heels of news last month that one third of unused medicines in Ireland are either ‘flushed’ or thrown in bins - leading to the introduction a national medicines recycling programme, known as a DUMP – we report in our August bumper issue that 97% of community pharmacists here are reporting an increase in medicine shortages.
Page 6: Growing concerns over medicine shortages Page 9: Empowering the concept of Self-Care
It is quite alarming that almost every pharmacist across the country reports experiencing a worsening of medicine shortages. The impact of Covid-19, Brexit and the falling price of medicines have all been identified by pharmacists as possible reasons why, in their opinion, medicine shortages persist.
Page 14: Rebrand on the agenda for United Drug Page 19: In-depth analysis of Ireland’s OTC Market with Gwynne Morley Page 24: IQVIA Top 100 OTC Products annual issue
Turn to page 6 for the full story.
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Irish Pharmacy News has been working with data analysts IQVIA for over 5 years in compiling and bringing this information to our readers, pharmacy professionals of Ireland.
Making it on to the Top 100 list is a fantastic achievement for all the brands and products. Staying within the Top 100 is something else.
MANAGING DIRECTOR Natalie Maginnis firstname.lastname@example.org EDITOR Kelly Jo Eastwood: 00353 (87)737 6308 email@example.com
Covid-19 and its impact on OTC medicines is a large focus of this month’s issue. In this edition we present the annual Top 100 OTC Products, as compiled by data analyst specialists IQVIA.
This annual report has now become synonymous for showcasing Ireland’s leading OTC brands, demonstrating their strength within respective category markets, brand leadership and loyalty.
Page 83: Original Medicines combined with Innovation PUBLISHER: IPN Communications Ireland Ltd. Clifton House, Fitzwilliam Street Lower, Dublin 2 00353 (01) 6690562
During the peak of the COVID-19 emergency, 76% of pharmacists reported that medicine stock-outs increased; 92% of pharmacists believe the problem will get worse in the next year; and 48% believe their patients could suffer adverse outcomes as a result of these shortages.
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On page 18 we lead into this special report by featuring an exclusive in-depth interview with IQVIA’s General Manager Gwynne Morley, who shares insights into the OTC market, spikes in demand, the management of stock levels and shopper behaviour amongst other issues. The Covid-19 pandemic has resulted in unprecedented demand across the Irish community pharmacy landscape, including a record for the highest number of consumer products supplied to retail pharmacy in one week. Over-the-counter consumer demand was relatively stable in the first seven weeks of 2020 and comparable to the same period in 2019. It was the week ending March 1st that we started to see an increase in demand for consumer health products, Gwynne reveals. Turn to page 18 for the first page of this report and the subsequent Top 100 products that follow. I hope you enjoy the issue. Stay safe.
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Minister for Health under Pharmacy Contract spotlight New Minister for Health Stephen Donnelly was under the spotlight with regards to a new pharmacy contract recently, when he was questioned about sight of a new contract for the profession. During a Dáil debate last month, Sinn Féin TD David Cullinane and Fine Gael TD Micheal Ring both asked when talks with pharmacists would commence. In answering both questions together, Mr Donnelly acknowledged the role played by pharmacists both within the healthcare agenda and during the Covid-19 pandemic. “It is recognised that community pharmacists have ensured the continued availability of a professional, accessible service for the public and have successfully managed to alleviate the worries and concerns of the population around continuity of medicine supply in the face of great uncertainty,” he said. The existing GMS pharmacy contract dates from 1996 and it is accepted that it is substantially outdated. It has not kept pace with developments that have taken
place over the course of recent years including the increasing emphasis on maximising the proportion of people’s healthcare needs met in primary care, interdisciplinary collaboration and the skillset that pharmacists have by virtue of their education and training. He went on to add, “This has been a period of unprecedented difficulty for the country and pharmacists have been at the forefront of the response. Accordingly, commitment has been given to commence a strategic review of the role of community pharmacists and to engage with the Irish Pharmaceutical Union to develop revised contractual terms. On 5 December 2019, my predecessor met with the Irish Pharmacy Union and communicated this intention. “The comprehensive review of the pharmacy contract will address the role to be played by community
pharmacy in the context of Sláintecare. It will consider all aspects of pharmacy service provision including delivery of a multi-disciplinary model of service delivery for patients, ensuring clarity of roles and achieving optimum value for money. However, any publicly funded pharmacy service expansion should address unmet public healthcare needs, improve access to existing public health services or provide better value for money or patient outcomes. “There has continued to be regular engagement with the IPU throughout the past number of months and a significant number of contingency measures have been put in place under the Medicinal Products (Prescription and Control of Supply) Amendment Regulations, 2020, intended to relieve the pressures on community pharmacies and General Practitioners during the COVID-19 crisis.”
Keane's Pharmacy shoot for AIB Bravery Campaign Pictured is John Keane of Keane’s CarePlus Pharmacy, which is taking part in the new AIB ‘Backing Brave’ campaign. John was pictured during filming for the campaign which his pharmacy features in. Featuring a series of AIB business customers from a variety of industries, Backing Brave highlights the bravery that these business owners show day in and day out; the risks they take, the challenges they face, as well as their relentless drive to succeed and to keep their business going and growing.
Success for ‘Irish First’ App Figures from the HSE show that there have been one million downloads of the COVID Tracker App less than 48 hours after it went live. The app, which was launched at the start of July by the Department of Health and the HSE, is designed to enhance existing contact tracing measures in Ireland and to help manage the spread of the COVID-19 virus. Commenting on the figures, Paul Reid, CEO, HSE said, “The app comes at an important time as we begin to move about more and will support us in managing future cases. I would encourage those who have not yet downloaded the app to do so, and for the 1 million people who have already downloaded the app, I would ask them to share it with their friends and families. The more people who download the app the greater its impact will be.” The COVID Tracker App is now available to download from the App Store and Google Play and has three specific functions 1. Digital contact tracing of close contacts of confirmed cases of COVID-19 2. Allows users to record if they have symptoms 3. Provide daily information about COVID-19 from a trusted source Minister for Health, Stephen Donnelly TD said, “Throughout this pandemic, the Irish people have shown great solidarity and they’re still showing it. One million downloads in less than two days is a huge achievement, and I want to thank everyone who has downloaded it, and especially the team who have worked so hard to develop it.” Fran Thompson, Interim Chief Information Officer, HSE, added, “The App augments our current testing and tracing effort it has been developed with privacy by design at its core, employing the decentralised model.”
News New Analysis from HIQA The Health Information and Quality Authority (HIQA) has published a report examining the number of excess deaths that occurred during the current COVID-19 epidemic. This analysis has been provided to the National Public Health Emergency Team (NPHET) to inform the national response to COVID-19. The report assesses the number of deaths that occurred in Ireland from 11 March 2020 to 16 June 2020, relative to the expected number of deaths, using data from the death notices website RIP.ie. It also examines whether the reported COVID-19 death figures provides an accurate estimate of excess deaths during the epidemic. HIQA’s Chief Scientist, Dr Conor Teljeur, said, “There is clear evidence of excess deaths occurring since the first reported death due to COVID-19 in Ireland. There were about 1,100 to 1,200 more deaths than we would expect based on historical patterns; a 13% increase between 11 March to 16 June. However, the number of excess deaths is substantially less than the reported 1,709 COVID-19-related deaths over the same period.” HIQA found that the officiallyreported COVID-19 deaths likely overestimates the true burden of excess deaths caused by the virus. This could be due to the inclusion within official figures of people who were infected with SARS-CoV-2 (coronavirus) at the time of death whose cause of death may have been predominantly due to other factors. He continued, “In the last four weeks of the analysis, we have seen a reversal of that trend with fewer deaths than expected. However, it is also possible that the changes to healthcare delivery during the COVID-19 epidemic, such as the suspension of elective activity in public acute hospitals, may have a lasting impact on health outcomes, the effect of which may take years to be seen.”
Pharmacy must be recognised in Stimulus Pharmacies across the country must be supported and protected. The Irish Pharmacy Union (IPU) has called on the Government to ensure the July Stimulus recognises the unique challenges faced by pharmacies. Commenting in advance of the anticipated announcement of the Stimulus Plan, IPU Secretary General Darragh O’Loughlin said, “From the first day of lockdown pharmacies have remained open delivering an essential healthcare service to their communities. At a time when many healthcare services were shutting down and scaling back, pharmacies stepped up and ensured medicine supply in communities across the country continued. But this has been an extremely challenging time with significantly increased costs and significantly reduced turnover. “Pharmacies are recognised as an essential healthcare service, but they are also businesses, and it is unreasonable to expect them to bear the soaring costs of providing services for the State during a pandemic. The costs have included installation of protective screens, PPE and additional staff. All of these are primarily designed to keep the public safe while still providing an essential service. Had pharmacies not stayed open they would not
have incurred these costs. It is hard to shake the feeling that we are being punished for staying open and fulfilling our duties. Mr O’Loughlin continued, “The Government needs to protect pharmacies as has happened in other countries. Pharmacies in Northern Ireland have been far better protected with a £20 million support package, while in this jurisdiction we have received no support from the Department of Health. Even a very modest request to supply pharmacy teams with protective masks has not been granted by the Department.” Measures being called for by the Irish Pharmacy Union in the July Stimulus include: • A full commercial rates waiver for essential healthcare businesses in 2020 with a further reduction in 2021; • A scheme to protect pharmacies and other essential businesses from excessive rent demands, particularly under legacy rent agreements. This should include
a facility for State burdensharing and protection from short-term eviction; • Extension of the Temporary Wage Subsidy Scheme until 2021 and commitment that its removal will be phased gradually; and • Expand the eligibility criteria for state supports beyond crude measures of turnover to recognise the impact of increased costs. Mr O’Loughlin concluded, “The pressures on pharmacies during the initial phase of the pandemic were immense, with extreme logistical, financial and personal challenges. The Department of Health poured resources into sustaining GP services, but pharmacies were ignored. The absence of support from the Department of Health means that, should we have a second surge in infections in the autumn as is forecast, we cannot be confident that pharmacy services will be maintainable.”
Canice’s Store to Store Cycle Challenge Canice Nicholas, Managing Director of the Cara Pharmacy Group isn’t letting the Covid-19 pandemic get in the way of the pharmacy group’s fundraising efforts. Canice at Dun Laoghaire Cara Pharmacy The Pharmacy Group recently celebrated 20 years in business, and in the run up to the 10th Anniversary of the ‘Cara Bundoran Challenge’, the team had two milestone events planned Due to the Covid-19 pandemic, it was impossible to run the Cara Bundoran Challenge event earlier this year and having examined all possibilities to try and reschedule it for later in 2020, deferring it until 2021 was deemed the most viable option. “But that does not mean that we cannot let either go without doing something and giving back to our communities,” they state on their Just Giving page. Canice has instead taken part in a 'Cara store to store cycle challenge' - cycling between all pharmacy stores from Cork to Killybegs. This is a total distance of 700kms. During each leg of the cycle, Canice was supported by
members of staff from each of the locations who cycled alongside him. All donations made will go directly to the beneficiaries of the rescheduled Cara Bundoran Challenge - The Marie Keating Foundation, The Asthma Society
of Ireland and Bluestack Special Needs Foundation. https://www.gofundme.com/f/ cycle-with-cara-pharmacy?utm_ source=customer&utm_ campaign=p_cp+sharesheet&utm_medium=copy_link-tip
Growing concerns over medicines shortages A new survey has given startling statistics, showing that 97% of pharmacists have reported increased shortages over the last 12 months. Irish patients are at risk due to shortages of medicines becoming an increasing problem, the survey shows. This warning was issued by the Irish Pharmacy Union (IPU), following a survey of its members. Speaking about the survey findings, Darragh O’Loughlin, Secretary General of the IPU said, “Almost every pharmacist across the country reports experiencing a worsening of medicine shortages. It’s part of a pharmacist’s role to use their expertise and experience to source appropriate substitute medicines for patients but this is becoming an everincreasing challenge. The most worrying statistic is that almost half of pharmacists (48%) believe shortages are potentially impacting on patients’ health. “The impact of COVID-19, Brexit and the falling price of medicines have all been identified by pharmacists as possible reasons why, in their opinion, medicine shortages persist. As we prepare for the upcoming winter season, with the threat of a second surge of COVID-19 hanging over us, there is a sense of foreboding that these shortages will get even worse in the months ahead. “Our approach to medicine pricing is one of the biggest challenges we face,” according to Mr O’Loughlin. “Over half of
pharmacists (55%) believe that HSE pricing policy is contributing to shortages. In Ireland we take a cost-based approach rather than being focussed on patients, which has resulted in significant reductions in medicine prices. However, too often that means when a global shortage emerges Ireland is at the back of queue, as a small country that is constantly driving down the price of medicines and unwilling to pay market prices. “Since the onset of COVID-19 we have seen how other, larger, countries are competing for medicines, with the USA buying up the global supply of remdesivir during the summer and the UK pre-emptively ordering 100 million doses of a COVID-19 vaccine that is still being trialled. The Department of Health and the HSE need to take a realistic and pragmatic approach to medicine pricing to ensure that Irish patients do not end up going without as a result of a fixation on ever-lower prices. “Then, in addition to everything else, Brexit will take its next steps in January, bringing yet more uncertainty, which is heightening concerns for pharmacists
regarding its potential impact on medicines supplies.” In conclusion Mr O’Loughlin said, “It has been acknowledged that medicine shortages have long been an ongoing problem but with the added concerns over COVID-19 and with Brexit coming down the track it is imperative that all necessary steps are taken by the relevant authorities to ensure that there is a continuous and sufficient supply of medicines available to pharmacies and, in turn, to their patients.” Key findings: • 97% of pharmacists report an increase in medicine shortages over the past 12 months. With 70% describing it as a “significant increase”; • During the peak of the COVID-19 emergency, 76% of pharmacists reported that medicine stock-outs increased; • 92% of pharmacists believe the problem will get worse in the next year; and • 48% believe their patients could suffer adverse outcomes as a result of these shortages.
Need to increase medication for Hayfever and Asthma patients Seven in ten people who have both asthma and hayfever have needed to increase their asthma medication when the pollen count was high. That is according to the results of a new Hayfever survey carried out by the Asthma Society of Ireland. The survey, which was completed by 524 people in June 2020, also suggested that more people with both asthma and hay fever experience more severe hay fever symptoms than those without an asthma diagnosis. People with hayfever and asthma were twice as likely to report their hayfever symptoms as ‘severe’ and ‘debilitating’ than people with hayfever and no asthma diagnosis. Dr Marcus Butler, Medical Director of the Asthma Society of Ireland, said, “The Asthma Society’s survey revealed that, in general, hayfever causes distress to people with asthma. In particular, this year people with asthma and hayfever also had the added concern that they might mistake COVID-19 symptoms as being hayfever. “Although there are some common symptoms in hayfever and COVID-19, there are a few important differences people should look out for. It’s worth emphasising that despite its name, historically linked to the summer haymaking season, hayfever is not in fact a condition that causes fever, whereas fever is the number one most common symptom of COVID-19.”
For pollen levels in your area, see our pollen tracker on asthma.ie
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Electronic Patient Summary The Health Information and Quality Authority (HIQA) has commenced a national public consultation on its Draft Recommendations on the Implementation of a National Electronic Patient Summary. HIQA has found that a national electronic patient summary will improve the safety and quality of care a patient receives when they receive unscheduled care. The implementation of a national electronic summary care record is also listed as a priority in the Sláintecare Implementation Strategy, and is considered to be a crucial element of Ireland’s national eHealth policy. Its implementation would support information sharing, patient empowerment and the development of digital services. Based on an analysis of Ireland’s current model, expert advice and a review of international best practice, HIQA has developed 15 draft recommendations for the Minister for Health on how national electronic patient summaries should be successfully implemented. HIQA is now asking the public for their feedback. Dr Kevin O’Carroll, HIQA’s Technical Standards Manager, says, “Electronic patient summaries have the potential to make healthcare delivery safer and more effective by ensuring healthcare professionals have access to a patient’s information, such as medical history and prescribed medications, at the point of care. This is essential in an emergency or unscheduled health visit when a patient may be unconscious or unable to remember their healthcare information. “Feedback from stakeholders on how to implement a patient summary is vital and important to this programme’s success. We are asking the public for their input on our recommendations, and look forward to hearing from professionals, organisations, and the general public, in particular patients and their carers. The consultation will ask people to consider what governance structures should be in place to provide oversight, and how patient and public representation can be built into that structure among other key issues.”
Genuair -has it ‘clicked’ yet? ®
The ONLY prefilled inhaler with visual and audible feedback for confirmed dose delivery 1-4
Genuair - a simple to use inhaler for patients with COPD 4
LAMA + LABA
LAMA Abbreviated Prescribing Information Eklira® Genuair® 322 micrograms inhalation powder. Please consult the Summary of Product Characteristics (SPC) for the full prescribing information. Presentation: Inhalation powder in a white inhaler with an integral dose indicator and a green dosage button. Each delivered dose contains 375 µg aclidinium bromide equivalent to 322 µg of aclidinium. Also, contains lactose. Use: Maintenance bronchodilator treatment to relieve symptoms in adult patients with chronic obstructive pulmonary disease (COPD). Dosage: For inhalation use. Recommended dose is one inhalation of 322 micrograms aclidinium twice daily. Patients should be instructed on how to administer the product correctly as the Genuair inhaler may work differently from inhalers used previously. It is important to instruct the patients to read the Instructions for Use in the pack. No dose adjustments are required for elderly patients, or those with renal or hepatic impairment. No relevant use in children and adolescents. Contraindications: Hypersensitivity to aclidinium bromide or to any of the excipients. Warnings and Precautions: Stop use if paradoxical bronchospasm occurs and consider other treatments. Do not use for the relief of acute episodes of bronchospasm. Use with caution in patients with myocardial infarction in the previous 6 months, unstable angina, newly diagnosed arrhythmia within the previous 3 months, or hospitalisation within the previous 12 months for heart failure functional classes III and IV. Dry mouth, observed with anticholinergic treatment, may be associated with dental caries in the long term. Use with caution in patients with symptomatic prostatic hyperplasia or bladder-neck obstruction or with narrow-angle glaucoma. Do not use in patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption. Interactions: Do not administer with other anticholinergic-containing medicinal products. No other interactions expected. Please consult the SPC for more details. Fertility, pregnancy and lactation: No data on use in pregnancy. Risk to newborns/infants cannot be excluded. Consider risk-benefit before using during lactation. Unlikely to affect fertility at the recommended dose. Side-effects: Common (1-10%): Sinusitis, nasopharyngitis, headache, cough, diarrhoea, nausea. Uncommon (0.1- 1%): Dizziness, blurred vision, tachycardia, palpitations, dysphonia, dry mouth, stomatitis, rash, pruritus, urinary retention. Rare (0.01-0.1%): hypersensitivity. Not known: angioedema, anaphylactic reaction. Pack sizes: Carton containing 1 inhaler with 60 unit doses. Legal category: POM Marketing Authorisation Number: EU/1/12/778/002 Marketing Authorisation holder: AstraZeneca AB, SE151 85 Södertälje, Sweden. Marketed by: A. Menarini Pharmaceuticals Ireland Ltd., Castlecourt, Monkstown Farm, Monkstown, Glenageary, Co. Dublin A96 T924. Further information is available on request to A. Menarini Pharmaceuticals Ireland Ltd. or may be found in the SPC. Last updated: May 2018
This medicinal product is subject to additional monitoring. This will allow quick identification of new safety information. Healthcare professionals are asked to report any suspected adverse reactions to: HPRA Pharmacovigilance, Earlsfort Terrace, IRL - Dublin 2, Tel: +353 1 6764971, Fax: +353 1 6762517, Website: www.hpra.ie, e-mail: medsafety@ hpra.ie. Adverse events should also be reported to A. Menarini Pharmaceuticals Ireland Ltd. Phone no: 01 284 6744. Date of item: October 2019. IR-BRI-17-2019
1. MIMS Ireland October 2019 2. Eklira Genuair Summary of Product Characteristics, last updated February 2018 3. Brimica Summary of Product Characteristics, last updated August 2019 4. Magnussen, H et al. COPD. 2019 Apr;16(2):196-205
Abbreviated Prescribing Information Brimica® Genuair® 340 micrograms/12 micrograms inhalation powder. Please consult the Summary of Product Characteristics (SPC) for the full prescribing information. Presentation: Inhalation powder in a white inhaler with an integral dose indicator and an orange dosage button. Each delivered dose contains 396 µg aclidinium bromide (equivalent to 340 µg of aclidinium) and 11.8 micrograms of formoterol fumarate dihydrate. Also, contains lactose. Use: Maintenance bronchodilator treatment to relieve symptoms in adult patients with chronic obstructive pulmonary disease (COPD). Dosage: For inhalation use. Recommended dose is one inhalation of 340 µg/12 µg twice daily. Patients should be instructed on how to administer the product correctly as the Genuair inhaler may work differently from inhalers used previously. It is important to instruct the patients to read the Instructions for Use in the pack. No dose adjustments are required for elderly patients, or those with renal or hepatic impairment. No relevant use in children and adolescents. Contraindications: Hypersensitivity to the active substances or to any of the excipients. Warnings and Precautions: Do not use in asthma. Stop use if paradoxical bronchospasm occurs and consider other treatments. Do not use for the relief of acute episodes of bronchospasm. Use with caution in patients with myocardial infarction in the previous 6 months, unstable angina, newly diagnosed arrhythmia within the previous 3 months, or hospitalisation within the previous 12 months for heart failure functional classes III and IV. Discontinue if increases in pulse rate, blood pressure or changes in ECG occur. Use with caution in patients with a history of or known prolongation of the QTc interval or treated with products affecting the QTc interval. Use with caution in patients with severe cardiovascular disorders, convulsive disorders, thyrotoxicosis and phaeochromocytoma. Hypokalaemia may occur, is usually transient and supplementation not needed. In patients with severe COPD, hypokalaemia may be potentiated by hypoxia and concomitant treatment. Use with caution in patients with symptomatic prostatic hyperplasia, urinary retention or with narrow-angle glaucoma. Dry mouth, observed with anticholinergic treatment, may be associated with dental caries in the long term. Do not use in patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption. Interactions: Do not administer with other anticholinergic and/or long-acting β2-adrenergic agonist containing medicinal products. Caution in use with methylxanthine derivatives, steroids, non-potassium-sparing diuretics, β-adrenergic blockers or medicinal products known to prolong the QTc interval. Please consult the SPC for more details. Fertility, pregnancy and lactation: No data on use in pregnancy. Consider risk-benefit before using during lactation. Unlikely to affect fertility at the recommended dose. Sideeffects: Common (1-10%): Nasopharyngitis, urinary tract infection, sinusitis tooth abscess, insomnia, anxiety, headache, dizziness, tremor, cough, diarrhoea, nausea, dry mouth, myalgia, muscle spasms, peripheral oedema, increased blood creatine phosphokinase. Uncommon (0.1- 1%): Hypokalaemia, hyperglycaemia, agitation, dysgeusia, blurred vision, tachycardia, electrocardiogram QTc prolonged, palpitations, angina pectoris, dysphonia, throat irritation, stomatitis, rash, pruritus, urinary retention, increased blood pressure. Rare (0.01-0.1%): Hypersensitivity, bronchospasm, including paradoxical. Not known: anaphylactic reaction, angioedema. Pack sizes: Carton containing 1 inhaler with 60 unit doses. Legal category: POM Marketing Authorisation Number: EU/1/14/963/001 Marketing Authorisation holder: AstraZeneca AB, SE-151 85 Södertälje, Sweden. Marketed by: A. Menarini Pharmaceuticals Ireland Ltd., Castlecourt, Monkstown Farm, Monkstown, Glenageary, Co. Dublin A96 T924. Further information is available on request to A. Menarini Pharmaceuticals Ireland Ltd. or may be found in the SPC. Last updated: October 2019 This medicinal product is subject to additional monitoring. This will allow quick identification of new safety information. Healthcare professionals are asked to report any suspected adverse reactions via HPRA Pharmacovigilance, Earlsfort Terrace, IRL - Dublin 2; Tel: +353 1 6764971; Fax: +353 1 6762517. Website: www.hpra.ie; E-mail: medsafety@ hpra.ie. Adverse events should also be reported to A. Menarini Pharmaceuticals Ireland Ltd. Phone no: 01 284 6744.
PANADOL EXTRA SOLUBLE RELIEVES TOUGH PAIN Dual active formula provides up to 30% more powerful pain relief than standard paracetamol1 Suitable for elderly patients* Gentle on the stomach and non-drowsy* Soluble relief for tough pain, including headaches, period pain and dental pain
RECOMMEND FOR FAST RELIEF OF TOUGH PAIN
*when used as directed/always read the label before use 1. Laska EM et al. JAMA 1984; 251(13): 1711-1718 Product Information: Please consult the summary of product characteristics for full product information. Panadol Extra 500mg/65mg Soluble Effervescent Tablets, paracetamol 500mg, caffeine 65mg. Indications: Relief of mild to moderate pain including rheumatism, neuralgia, musculoskeletal disorders, headache, symptoms of colds and flu, fever, toothache and menstrual pain. Dosage: Adults and children 16 years and over: 2 tablets up to 4 times a day. Do not exceed 8 tablets in 24 hours. You may need a lower dose if you are underweight (<50kg), malnourished, dehydrated or if you have alcohol problems. Children aged 12-15 years: 1 tablet up to 4 times a day. Do not exceed 4 tablets in 24 hours. Do not give to children under 12 years. Minimum dosing interval: 4 hours. Contraindications: Hypersensitivity to paracetamol, caffeine or any ingredients. Precautions: Avoid concurrent use with other paracetamol-containing products. Diagnosed liver of kidney impairment. Patients on concomitant treatment with drugs that induce hepatic enzymes. Patients with depleted glutathione levels or chronic alcoholism or sepsis. Avoid excessive caffeine intake. Caution in those with hereditary sugar intolerance or on a low sodium diet. Should not be used in pregnancy or lactation without medical advice. Do not exceed the stated dose. Prolonged use except under medical supervision may be harmful. If high fever, or signs of secondary infection occur or if symptoms persist for longer than 3 days, consult your doctor. Side effects: See SPC for full details. All very rare: Thrombocytopenia, hypersensitivity reactions including anaphylaxis and skin rash, angioedema, Stevens-Johnson syndrome, Toxic Epidermal Necrolysis, bronchospasm, hepatic dysfunction. Frequency unknown: Nervousness, dizziness. When combined with dietary caffeine intake, higher doses of caffeine may increase potential for caffeine related adverse events such as insomnia, restlessness, anxiety, irritability, headaches, GI disturbances and palpitations. Overdose: Immediate medical advice should be sought in the event of an overdose, even if symptoms of overdose are not present. Legal Category: Supply through pharmacy only. MA Number: PA 678/39/10. MA Holder: GlaxoSmithKline Consumer Healthcare (Ireland) Limited, 12 Riverwalk, Citywest Business Campus, Dublin 24. Additional information is available upon request. Text prepared: June 2020. Contains paracetamol. Always read the label/leaflet. PM-IE-PAN-20-00028.
Empowering the Self-Care Emergence We speak to GSK Ireland Country Manager Dave Barrett about the increased awareness of self-care and the role GSK plays in empowering consumers Dave Barrett, Country Manager, GSK Ireland
The World Health Organisation (WHO) defines self-care as “the ability of individuals, families and communities to promote health, prevent disease, maintain health, and cope with illness and disability with or without the support of a healthcare provider,” and add in subsequent publications that “self-care interventions are among the most promising and exciting new approaches to improve health and well-being, both from a health systems perspective and for people who use these interventions.”
“I am proud of my history with GSK, and was delighted to be asked to return home to manage the divestment of our drinks business and re-establish GSK as a leading consumer healthcare provider,” he says.
There has never been a time of greater awareness as to the importance of effective self-care than now. As Covid-19 moved from outbreak to epidemic and subsequently, pandemic, it has brought with it an immediate need for a health system transformation whereby less dependency on healthcare professionals is key.
Dave is now Country Manager for GSK’s Consumer Healthcare business, overseeing the company’s evolution through multiple changes including joint ventures and many successful new product launches, such as Voltarol 2% Gel and Sensodyne Sensitivity and Gum.
With community pharmacists and allied professionals such as GPs face unprecedented pressure, empowering consumers to selfcare where appropriate is vital. Industry, of course, will have to adapt to this shift. GSK are already steps ahead of the game, synonymous for their work within this area. We recently caught up with Country Manager Dave Barrett to dig a little deeper into how they are supporting pharmacy and consumers within the self-care arena.
“Since back in Ireland, I have had the pleasure of Chairing the IPHA Consumer Healthcare division for almost four years, during which time we worked closely with the Irish Pharmacy Union (IPU) to really amplify the importance of self-care to our consumers and patients.”
He continues, “At GSK, we have a very structured approach to running our business, but despite this, every day genuinely feels different. Our business is commercially focused, and I lead a team of passionate, dedicated professionals, who I let get on with their roles as much as possible.
“From my own perspective, I always prioritise customer and consumer focused actions, with as many customer meetings as possible while continuously reviewing our consumer execution plans.”
Dave Barrett has been a part of the GSK family for just over 30 years, having moved through the sales function from Territory Representative, Business Unit management in Ireland and Sales Director in their UK business for the Pharmacy and Field teams.
Reflecting on the last twelve months, Brexit preparations were on the agenda of all pharmaceutical companies, not just in Ireland but across Europe. Despite the arrival of Covid-19 diverting this focus, the challenges remain.
“At GSK, we recognise the essential role that pharmacists and pharmacy teams play in the healthcare system and we’re committed to supporting them through industry leading category training and innovative product launches" PHARMACYNEWSIRELAND.COM
Overcoming Challenges “Compared to 2020, 2019 feels like a long time ago now,” Dave adds. “As a Pan-Ireland business, the biggest challenge for us last year was preparing for Brexit and ensuring no disruption to supply. While we know the UK has now left the EU, this challenge remains ahead of us. With no extension to the transition period requested by the UK government, we now have less than five months to understand the implications of a potential No Deal exit by our near neighbours. “As a large company, with Headquarters in London, we were uniquely placed to prepare for Brexit. Specialist teams were put in place as soon as the vote took place. Extensive planning with Supply Chain, Quality, Finance and Regulatory as well as with key stakeholders such as the Health Products Regulatory Authority (HPRA) allowed us to ensure that the impact could be kept as low as possible.” Whilst 2020 thus far has played out in a way no-one could ever have predicted, there have been numerous positives for Dave to note. “This year has been full of ups and downs, which included me fulfilling my own selfcare driven dream of getting to Everest base camp (and back) in early March. I am also immensely proud of the achievements of the team in GSK with regards to a number of accomplishments and milestones.” One of these has been the successful integration of the Pfizer Consumer Healthcare business, bringing together two legacy teams as a single operational entity in GSK Consumer Healthcare. “Completed on April 27th, this joint venture brings together an array of fantastic brands including Sensodyne, Voltarol, Panadol, Corsodyl, Centrum and Nexium,” he says. “The combined portfolio means GSK strengthens its positions in pain relief, respiratory, vitamins, minerals and supplements, and therapeutic oral health categories and cements the company’s position as the world’s number one OTC business. “I’m also really proud of our consistent market performance, which has been maintained
despite all the new and unique challenges of managing the integration of two great business during a global pandemic, where our priority has been the safety and wellbeing of our teams. Our performance has been helped in no small part by the successful launches of products like Corsodyl alcohol free mouthwash, Corsodyl Complete Protection and Panadol Actifast Soluble.” Leading the Way As already mentioned, GSK are identifiable by their presence within the self-care market, amongst others, being well placed to help redefine the role of selfcare in people’s lives through responsible education and scientifically-backed brands. Dave continues, “The Covid-19 pandemic has been one of the most significant moments in our recent history. The magnitude of its impact has unsurprisingly caused many people to change and re-evaluate their behaviors across different aspects of their lives. Their health is one of these. “Self-care is not a new concept; people have always taken action to look after their personal health and treat minor illnesses. Although by definition, self-care can take place without the need to visit a healthcare professional, effective and safe self-care is best undertaken with the benefit of professional advice. Pharmacists have the skills and training to ensure that patients have an open source of professional expertise in self-care matters. “Patients are no longer passive recipients of healthcare and advice. Greater health literacy and greater access to information, combined with increased individual interest in personal health and personal choice, is leading to more and more patients actively looking after themselves. In addition, public awareness has increased the importance of certain lifestyle factors, such as avoidance of smoking and a balanced diet, in maintaining health and preventing illness. “In this context, self-care can be seen as the most widely available form of healthcare. As pressure grows on the Irish healthcare system, self-care will come to be seen as a means of controlling and rationalising healthcare and medication costs. If we are to successfully confront the demands on our health system as the population ages, we need
to ensure that we all stay fit and healthy for as long as possible.” Thinking Differently As someone who has been improving his own health, through getting more active and improving diet, Dave firmly believes in the foundations and principles of self-care. “I’m really proud of how the selfcare movement has developed in Ireland over the last few years. “Pharmacists have always played a crucial role in selfcare and through the work of the IPHA, in collaboration with the Irish Pharmacy Union, we have started to get real traction with consumers and patients, encouraging us all to ‘Think Pharmacy First’. “At GSK, we recognise the essential role that pharmacists and pharmacy teams play in the healthcare system and we’re committed to supporting them through industry leading category training and innovative product launches. GSK is committed to self-care, from staying fit and well, right through to ensuring the appropriate category therapeutic solutions are available when consumers become unwell.” The Covid-19 pandemic has clearly taught consumers in Ireland to become more aware about the importance of self-care, prompting them to make positive changes to their day-to-day lives for the benefit of their health. “Covid-19 has forced us all to think and behave differently, not only as consumers but also as a healthcare industry. As self-care has been defined as ‘helping consumers proactively pursue healthy lives, but when unwell, think self-care and selfmedication’ there has never been a more important or relevant time for self-care. “Our priorities through Covid-19 have been focused on maintaining a consistent supply and ensuring the safety of our team and those of our customers. Due to necessary restrictions on access, our HCP Customer teams have had to adapt their approach supporting pharmacy, using Microsoft Teams or Skype or indeed the oldfashioned telephone.” Trusting Brands It has been said, that consumers
are now turning to brands they trust, those that are established with strong heritage and that are grounded in science. How has GSK managed to retain their brand strength, we asked. “I 100% agree with this statement,” Dave notes. “Consumers use brands they trust and believe in. At GSK
11 we’re grounded in science and committed to making the best decisions for our consumers and customers and we support our brands through extensive investment. “Panadol Tablets are manufactured in Dungarvan Co Waterford and we have partnered with RTE to continuously remind
consumers of the science and heritage which are associated with this brand. Voltarol 2% Gel was one of the most successful Rx to OTC switches and is heavily supported via product training and in store presence. “Sensodyne Sensitivity and Gum and Corsodyl Alcohol Free Mouthwash are two of our most
recent therapeutic oral health launches, driven by consumer insight and supported through Dental education.” In looking to the future, Dave notes that ability to adapt is going to be key. “There is no doubt that we’re entering a new world which calls on us all to demonstrate great agility in our approach to managing the needs of our consumers and patients. Challenges like keeping our staff and shoppers safe while achieving the best outcome per visit.
Dave Barrett, Country Manager, GSK Ireland
“We also see how consumers and patients are going online more, both for information and to purchase products. These shifts in consumer behaviour are not limited to consumer goods and we need to be ready for consumers / patients who use the internet as their source of information and also who seek to purchase their self-care products though that channel. “GSK will continue to support pharmacies in providing education and making products available for pharmacists to provide the highest level of care for their patients. Individually and through IPHA, we will continue to support self-care and ensure that consumers and patients continue to think, pharmacy first.”
“Covid-19 has forced us all to think and behave differently, not only as consumers but also as a healthcare industry. As self-care has been defined as ‘helping consumers proactively pursue healthy lives, but when unwell, think self-care and selfmedication’ there has never been a more important or relevant time for self-care"
New Covid-19 Operational Standards for Pharmacies The PSI, the pharmacy regulator, has developed Operational Standards for use across all pharmacies during the COVID-19 pandemic. all staff, including pharmacists, take appropriate work breaks, as well as having systems in place to support staff who may be suffering from anxiety or work-related stress due to the current pressures. Mr Byrne said that pharmacy teams are under additional pressures and anxieties due to the pandemic and changing work practices. “It is important that pharmacy owners, as well as superintendent and supervising pharmacists, provide leadership to all their teams in promoting a supportive and safe work environment. By keeping everyone safe and well, pharmacy leaders play a key role in ensuring continuity of medicine supply and clinical advice to the public.”
This is a further development in how the PSI regulates the pharmacy sector and is intended to provide guidance and support to those in leadership and governance positions in the retail pharmacy sector in continuing to ensure safe services and a safe environment for patients, public and staff. The standards cover a range of areas including infection prevention and control, patient and staff safety, as well as continuity planning to ensure the ongoing provision of pharmacy and medicine services. The standards were developed by the PSI in cooperation with a safety collaborative made up of practising pharmacists, the Irish Pharmacy Union (IPU), the Health Service Executive (HSE), the Department of Health and the Health Protection Surveillance Centre (HPSC), Commenting on the standards, Niall Byrne, Registrar and Chief Officer, PSI said, “The delivery of healthcare services, including pharmacy services, has shifted dramatically since March. Pharmacies have worked extremely hard to support patients and the public in the face of unprecedented challenges. Our standards will help assure the public that pharmacies are committed to providing consistently high quality and safe services as well as supporting pharmacies to respond
to further changes and challenges which may arise during the course of the pandemic.” The Operational Standards are being implemented initially through a “use and learn” period. This will allow pharmacies to assess themselves against the standards and introduce any changes or additional measures that may be necessary. A clear focus on ongoing quality and safety underpins the standards which focus on good governance, as well as the pharmacy team, setting and services. “We have provided indicative indicators for each of the five standards which we expect pharmacies to meet. The indicators will help those in governance and leadership positions in pharmacies to identify gaps that exist and to act to address these. The indicators are not intended to be definitive - we welcome and encourage innovation in how pharmacies meet these standards. What matters ultimately is that pharmacies use robust evidencebased indicators to assess the quality and safety of their own services,” said Mr Byrne. Emergency business continuity planning for potential temporary closures is one of the measures that the PSI would expect in any pharmacy that meets the new COVID-19 operational standards. Other measures include ensuring
The Operational Standards also provide guidance to pharmacists on how they can continue to ensure safe, quality services despite the changing work practices and potential resource challenges brought on by COVID-19. “Prior to the pandemic, members of the public were making an estimated two million visits per month to pharmacies, illustrating the role that pharmacies play in the delivery of healthcare in the community. It is vital to public health patients and members of the public can continue to access pharmacy services safely during the pandemic. This includes vulnerable patients such as those in residential care settings, and patients who need to minimise their daily interactions with others.”
Medicine Shortages The Health Products Regulatory Authority has been notified of a shortage of the following products: • Atecor 50mg Tablet – PA0711/003/002 • Ativan 4mg/ml Solution for Injection – PA0822/090/002 • Centyl K 2.5mg + 573mg Modified Release Tablet – PA22650/002/002 • Creon 25000 Gastro-resistant Capsule – PA2010/008/002 • Erwinase 10,000 Units Powder for Solution for Injection – PA1020/002/001 • Galfer 305mg Tablet – PA0126/314/001 • Isoptin 240mg Prolonged Release Tablet – PA2010/003/005 • Maxibar 98.45% w/w Powder for Oral Solution – PA1826/002/001 • Perdamel 1mg Film Coated Tablet – PA0126/169/003 • Propafenone hydrochloride 150mg Tablet – PA2315/116/001 • Propafenone hydrochloride 300mg Tablet – PA2315/116/002 • Telfast 120mg Film Coated Tablet – PA0540/078/002 • Visudyne 15mg Powder for Solution for Infusion – EU/1/00/140/001
“Some patients may feel anxious about visiting a pharmacy at this time. It is important that everyone feels confident about communicating with their pharmacist about how to take their medicines correctly and safely even when this cannot be done face-to-face. The standards provide guidance on how pharmacists will continue to provide a high standard of patient counselling, in person or remotely, while also ensuring patient confidentiality and privacy, and adherence to infection prevention and control measures.
The following shortage has been resolved and supply has resumed to the Irish market:
The length ‘use and learn’ period will be flexible, according to Mr Byrne. “Over the next two months we will be engaging with the pharmacy sector in a process of mutual learning to better understand how our standards work in practice. This feedback will help us to develop an efficient and effective monitoring programme for implementation later in 2020/2021.”
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Rebrand for United Drug Wholesale As the country continues its long journey to recovery following the onset of Covid-19, United Drug are delighted to announce the rebrand of their wholesale division to “Retail Solutions.” Michael Taylor, Head of Sales and Retail Solutions at United Drug
This rebrand comes as part of their strategic goals to support customers and maximise their opportunities to restore and re-energise their retail business following the impacts of lockdown and ongoing challenges in the healthcare sector. As part of their commitment to providing best in class customer support, Retail Solutions encompasses six tailored services that offer pharmacies a one stop shop for optimising their business with access to buying groups, claims management, retail optimisation and patient care services.
Michael Taylor, Head of Sales and Retail Solutions at United Drug says, “At United Drug we are continuously looking at ways to further build relationships and add value for our customers. We recently made enhancements to our website for online orders. In addition to our vast range of Medicine and front of shop products, our quick and reliable sourcing of unlicensed medicines, and our extensive product range and knowledge for Ostomy and Urology care, we are developing our Knowledge Hub so we can also support our customers with insights and training. We have also
appointed Adrian O’Sullivan as our Business Development Manager for Pharmax and ARC.” A full breakdown of the services can be viewed on page 21 of this issue, many of which are already well established in the market such as Pharma Le Cheile, Elements and Ostomy. However, it is the addition of Pharmax, ARC and the Knowledge Hub that has really enhanced the United Drug service offering to provide a comprehensive set of tools that pharmacists can avail of through their Business Development Managers and their dedicated in-house teams. For more information on any of the services mentioned above, get in touch or to place an order, please visit UDW.ie.
Innovations in Healthcare The Pharmaceutical Manager’s Institute (PMI) newest series will give three industry experts 120 minutes to discuss a particular topic including the opportunity for attendees to pose questions to the panel. The first session takes place on Thursday, September 10th from 8-10am, where speakers will be discussing “How Innovation is Disrupting the Delivery of Healthcare” Speakers include Prof Derek O’Keeffe – Consultant Endocrinologist at University Hospital Galway and Professor of Medical Device Technology at NUI Galway; Prof Martin Curley, Director of the Digital Academy & Open Innovation – HSE, and; Dr Frank O’Donnell, Public Sector Lead – Microsoft. The Voices of Pharma Series is kindly sponsored by United Drug
Pharmacy contribution to Snomed CT The Irish Pharmacy Union (IPU) has made a major contribution to the leading international (database of) healthcare terminology by identifying a series of concepts that are not currently included in SNOMED CT. SNOMED CT is a language for health terminology that is recognised as the most comprehensive set of healthcare terms in the world. It facilitates clinicians and other healthcare professionals to record patient data more accurately and comprehensively, as it provides a standardised set of clinical terms for use across more than 80 countries. After establishing a close working relationship with the Irish SNOMED National Release Centre (NRC), the IPU’s Product File Department identified a series of concepts that are not currently included in SNOMED CT, and these will now be coded and launched as part of SNOMED’s July update. IPU Product File Manager Fiona Hannigan says, “Having common
healthcare terminology allows for the exchange of healthcare information globally in a way that is safe and accurate, which allows healthcare providers and policy makers around the world to make informed decisions that improve health systems. “The need to be able to interrogate health information and make informed decisions based on
the experiences of our partners in other countries, has come to the fore as we have dealt with the COVID-19 outbreak in recent months. The IPU’s Product File Department has been proud to make a contribution to this important global (database of) terminology. We are equally proud of collegial collaboration with the Irish SNOMED NRC.”
Irish researchers lead ¤3m study Researchers at RCSI University of Medicine and Health Sciences are leading a new ¤3 million study to investigate the real-world effects of the newest cystic fibrosis (CF) medications as they become available for people with CF. The research will look at how a new triple combination CF drug, Kaftrio, will affect people in their day to day lives, rather than in controlled clinical trial conditions. Kaftrio (known as TriKafta in the US) is a successor to Orkambi. The project, called RECOVER, has been awarded ¤2.85m from the Cystic Fibrosis Foundation (US), ¤112,000 from the Cystic Fibrosis Trust (UK) and ¤100,000 from Cystic Fibrosis Ireland. In recent years, a number of promising new medications have been developed that treat the underlying genetic defect in CF. Pending final European Medicines Agency approval, expected in the next number of weeks, these new medications will be provided for use in the majority of people with CF in Ireland and the UK as part of an existing agreement between the manufacturer and the respective states. Starting in August 2020, the study will recruit patients and begin to examine clinical outcomes over a two-year period across CF centres in Ireland and the UK. “Our study will allow us to discover in detail how this powerful new treatment affects the health and everyday lives of people with cystic fibrosis, to understand why different people might respond differently to the drug and to gain insight into how this treatment might affect the very significant treatment burden that people with cystic fibrosis currently endure,” said Professor Paul McNally, Associate Professor of Paediatrics at RCSI, Respiratory Consultant in Children’s Health Ireland and lead researcher on the RECOVER study.
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McCabes Pharmacy focus on Digital Health The Covid-19 pandemic has reminded everyone that pharmacies are an integral part of our communities. Marina Timotijevic, Marketing Manager of McCabes Pharmacy group of 27 pharmacies, talks about how the pandemic has accelerated digital healthcare strategies that make customer relationships even stronger. Marina Timotijevic, Marketing Manager of McCabes Pharmacy with McCabes Dundrum Pharmacy team
customers but became much more popular during the height of Covid-19 lockdown. We created a rota system and made additional pharmacists available to answer questions from customers. It’s a great example of how digital can enable close human interaction when face-to-face isn’t possible.
We have always been an innovative pharmacy and very invested in the concept of digital healthcare. As we emerge into the ‘new normal’, initiatives we took during lockdown will evolve into longer term plans, like a digital prescription service and video consultations, all developed in response to customer needs during the height of lockdown. While every retailer has struggled with the consequences of Covid-19, it poses a particular challenge for a pharmacy chain like McCabes Pharmacy. We pride ourselves on being part of our communities and have a unique relationship with our customers. People come into us on a weekly basis, so there is a real and meaningful connection between patients and our pharmacists. If we haven’t seen or heard from someone for a while, we will ring them up to check how they are. As a consequence we made thousands of telephone calls to our patients in the months of March and April. Perhaps because of our elderly customer demographic, the telephone is still a favourite method of communication. During Covid-19, our pharmacists were spending more time on the phone to patients, particularly if they were elderly or immune compromised
and more prone to infection. If they didn’t want to come in to pick up their medication, we’d ask if there was someone who could do it for them, or we’d make sure they knew we could deliver it directly. Because the level of phone calls increased dramatically and our phone system struggled to handle the volume, we are now in the process of rolling out 3Connect across all our outlets. We will use it to redirect calls to mobiles or other fixed phones, and we’ll be much better prepared to handle a second wave if it ever comes. We are clear that the telephone will remain a very important channel for our customer demographic. Other changes, however, are focused on expanding digital channels. More click-and-collect The health profile of many of our customers, often elderly with pre-existing conditions, meant that we were highly compliant with Government guidelines during the height of the pandemic. Pharmacies were classed as an essential service and our outlets stayed open, and were made safe with social distancing rules, protective screens and sanitation points. All pharmacy staff wear face masks and sanitise their hands before and after each customer.
As a direct consequence of Covid-19, our click-and-collect service has been extended to all 27 of our pharmacies across Ireland. At the same time, we made a provision for people who were uncomfortable about entering a store. Reserved parking places were organised where our staff could hand over their prescriptions. Increased online interaction A lasting legacy of the pandemic will be a change in customer expectations and an increased reliance on digital services. We saw first-hand how people took to more online shopping with a spike in our website sales during lockdown. We increased online availability of stock, putting some items on the website for the first time, and allocated extra staff to handle increased demand in our warehouse and for online support. Revenue has dropped off since the town main streets have reopened but online sales are still significantly up on what they were before. eCommerce has more than proved its worth and will be something we continue to invest in going forward. An online pharmacist chat service has always been available to our
What were critical services during the pandemic – click and collect, online shopping and online chats – are now a more important part of our business. Digital innovations across the sector, like GP’s using the HSE’s national Healthmail service to email rather than fax prescriptions to pharmacies, may never go back. And our own plan for introducing a digital prescription service has been stepped up. Learning lessons from Covid-19 One consequence of the pandemic is how it has accelerated our digital healthcare strategy. The worst thing you can do in a crisis is bury your head in the sand and wait for it to go away; the best response is to take action and be proactive. We did not have the luxury of learning from other businesses at the beginning of the pandemic in March and we were very much on the frontline of having to adapt incredibly quickly. By following instincts informed by close customer relationships and accelerating digital strategies that were already in place, we were able to rise to the challenge. My biggest advice to other businesses would be to recognise how customer needs can change and the importance of adapting your business model to follow them. If you don’t, you might not survive. The pandemic has proved that. My message to customers is to please support your local Irish retailer. We have seen how important a sense of community can be and how shops of every kind are a valued part of it.
Analysing Growth and Value of the OTC Sector Irish Pharmacy News has been working with Human Data Science company, IQVIA, for the last six years to comprise this annual report which highlights the Top 100 Over-the-Counter pharmacy brands in Ireland. The information contained over the following pages is widely accepted as the industry standard from which brand performance is measured across the OTC sector. We spoke to General Manager of IQVIA Ireland, Gwynne Morley, to gain further insights into how these statistics are compiled and on the value of this market to pharmacy. IQVIA uses data, technology, advanced analytics, and expertise to help customers across healthcare drive health forward. For many of these customers, having an accurate, timely view of product performance is critical to ensuring they are improving both business and patient outcomes. The Top 100 Over-the-Counter (OTC) Market Report is based on the total value of wholesale sales for OTC products into retail pharmacy, in Ireland, over the course of the previous 12 months to May 2020. It is a rolling annual value which includes the five major OTC categories Cold and Cough Remedies (CCR), Pain, Vitamins and Minerals (VMS), Skin and Digestive Health. Market Value to Pharmacy
Gwynne Morley, General Manager, IQVIA, Ireland
Source: IQVIA OTC Ireland Monthly Database, MAT 2020 Source: IQVIA OTC Ireland Monthly Database, Previous Period Growth May 2020 3 Source: IQVIA OTC Ireland Monthly Database, PPG YTD May 2020 4 Source: IQVIA OTC Ireland Monthly Database, YTD May 2020 5 Source: IQVIA OTC Review Forecasts 2020 1 2
18 | PHARMACYNEWSIRELAND.COM
Gwynne explains, “The total value of the non-prescription market in Ireland based on IQVIA’s data for the 12 months, June 2019 to May 2020, was ¤669million1. This market grew by 6.8% when comparing year-on-year growth2. The year-to-date (YTD) value of this market at the end of May 2020 was ¤283 million with a growth rate of 5.2%3. This is 1.6% lower than the growth experienced in 2019, despite the unprecedented demand experienced in the second week of March, due to the COVID-19 pandemic.
In a ‘Low Impact’ Scenario, it is assumed that the current situation gets under control in short term (by Q4 2020/Q1 2021), as vaccine/medication is developed and there is no second wave of spread of infection. In this case, most of the COVID-19 impact is over by 2021
Top 100 OTC Market
"Over-the-counter consumer demand was relatively stable in the first seven weeks of 2020 and comparable to the same period in 2019. It was the week ending March 1st that we started to see an increase in demand for consumer health products"
Gwynne Morley, General Manager, IQVIA, Ireland
“The value of the Irish OTC market including the 5 major categories (CCR, Pain, VMS, Skin and Digestive Health) based on IQVIA’s data YTD was ¤185 million4. “On February 29th, the first case of COVID-19 on the east coast of the country was confirmed. This catalysed an increase in volume demand in subsequent weeks, resulting in an 86% volume increase in the second week compared to the same week in 2019. The OTC market grew by 7.8% in 2019 compared to 4.9% in 20185. IQVIA Consumer Health is forecasting the Irish OTC market will grow in 2020 by +2.3%; down from a pre-COVID forecast of +4.1%5. This forecast is based on a ‘Low Impact’ scenario6 as a result of COVID-19.” The healthcare industry in Ireland is going through a period of significant change – an increasing and ageing population, growing incidence of chronic diseases, ever increasing public expectations of the Irish health service, and increasing healthcare expenditures. “Pre-pandemic, the Gross Voted Expenditure proposed for Healthcare for 2020 was at its highest ever level - ¤18.3 billion, a 5% increase over 2019,” Gwynne continues. “The revised estimate for health is now ¤20.33 billion, including ¤1,997 million of COVID-19 specific spending7. “Patients are no longer passive recipients of healthcare. In this context, self-care not only empowers people to manage important elements of their own and their loved ones’ lives, self-care will come to be a means of controlling and rationalising healthcare and medication costs. “As the most accessible primary healthcare providers, pharmacists are often the first, and in some cases the only, point of contact that a patient may have with a healthcare professional. Having medicinal products available from the pharmacist without the need for a prescription increases patient access to healthcare, enabling and empowering them to manage their own healthcare needs.” We have reported extensively on the challenges faced by community pharmacists and allied healthcare professionals as COVID-19 appeared on the horizon and as it impacted at the height of the pandemic. Gwynne notes that increased awareness around medical shortages have been one of the outcomes. “Prior and unrelated to COVID-19, there were shortages of medicinal products reported across the US and Europe. As a result of COVID-19, there was increased awareness of the potential for exceptional changes in both demand and supply, with governments across both administrations initiating plans to monitor and address the situation. Managing Stock Levels “Across Europe, governments introduced temporary initiatives to manage stock levels of critical treatments which had implications for
Source: Parliamentary Budget Office; Revised estimates 2020; Health (Vote 38) Source: IQVIA COVID-19 Ireland Market Intelligence – Published June 2nd, 2020
supply chain players, including for some countries, export bans, changes in regulations covering distribution, and auditing of the distribution system. Ireland did not impose any export restrictions and the European Union has urged members to lift restrictions since they may cause further shortages. “According to a HCP survey conducted by IQVIA Ireland in May 2020, only 17% of respondents reported issues with medicinal product availability in Ireland8. We know that these shortages were reported prior to COVID-19 and were un-related. All countries emphasised the requirement for manufacturers to communicate on any anticipated supply disruptions. “The global pharmaceutical industry has become more integrated in terms of Active Pharmaceutical Ingredients (APIs), finished medicines manufacturing, and supply, especially for high volume medicines which have treated many patients over the past decade. The COVID-19 pandemic has therefore unsurprisingly raised concerns about the resilience (and vulnerability) of such a highly interdependent network, as waves of countries are affected by the virus. China is a significant and growing API supplier, and those APIs make their way into generics which supply the European and US markets, among others. In China, pharma is fortunate that API manufacturers tend to be located on the coast, away from the epicentre of the COVID-19 infections, and manufacturing was resilient. Equally, Indian generics manufacturers, often dependent on Chinese APIs, had substantial stockpiles, although India did restrict the export of certain molecules on March 3rd, a restriction the authorities subsequently lifted South Korea, a major centre for biosimilar manufacturing and a country that was affected early by the pandemic, has not, according to our research, experienced factory closures9. “Pre-COVID, there was limited awareness and visibility of the supply chain of medicines. During COVID-19, the supply chain became the ‘invisible pillar’ of medical innovation, with supply chain becoming a strategic asset to all governments. Both wholesalers and pharmacies demonstrated that they provide a critical distribution network and an ability to scale-up the provision of COVID-19 treatment.”
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Top 100 OTC Market
OTC Sales Spikes Growth (March 2019 vs March 2020) Calming, Sleep & Mood Enhancing Products
Vitamins & Minerals
Cough & Cold Products
+127% Testing & Measurement
As COVID-19 progressed, a number of OTC categories witnessed unprecedented demand. “The COVID-19 pandemic has resulted in unprecedented demand across the Irish community pharmacy landscape, including a record for the highest number of consumer products supplied to retail pharmacy in one week. Over-the-counter consumer demand was relatively stable in the first seven weeks of 2020 and comparable to the same period in 2019. It was the week ending March 1st that we started to see an increase in demand for consumer health products. This coincided with the first media report of COVID-19 touching Irish shores on 28th February10. “Products used to treat pain (+127%), cough and cold remedies (+77%), and vitamins and minerals (+30%) were amongst those subject to the largest increase in absolute sales volume for the month of March 2020 compared to March 201911. Online and media mentions of symptoms of COVID-19 relating to high temperatures and coughs drove this demand for supply of pain treatments and cough and cold remedies. Similarly, references to the efficacy of dietary vitamin supplements, to help boost the immune system, to fight off COVID-19 have driven the recent growth experienced in the vitamin and minerals category. On 7th May, the HSE issued a media release entitled ‘Can your diet prevent COVID-19?’. “The absolute sales volumes of calming, sleep and mood enhancing products grew by a staggering 330% in March 2020 compared to volumes in March 2019. This was probably driven by the anxiety and stress directly, and indirectly related to COVID-19 e.g. contracting the illness, loss of employment, impact of lockdown. The testing and measurement category grew by 40% in absolute sales volumes, in March 2020 when compared to March 2019, this was due to the fact that the HSE had emphasised a high temperature, along with shortness of breath, and fever as the common symptoms of COVID-19 in the initial phase of the pandemic. If consumers/patients experienced these symptoms, they were to self-isolate and phone their GP to arrange a test12.”
Spikes in Growth Cough and Cold Remedies and Pain Relief markets experienced stockpiling during March 2020. Most of the impact is negated with sales declines during April/May 202013. “Pain relief has always been the most consumed OTC products in Ireland. Double digit growth of 11.5%, in pain relief, was the major growth driver for Ireland’s OTC market in 2019. In the week ending March 15th, 808,000 units of over-the-counter painkillers were supplied to Irish pharmacies; an increase of 164% on the same week in 2019. Pain relief grew by 128% in March 2020 when compared to March 2019, this growth rate has declined by 25% and 31% in April and March respectively.” Similarly, Cough and Cold Remedies grew by 77% in volume in March 2020 versus March 2019. “This growth rate has also declined quite significantly in April and March by 23% and 37% respectively,” she adds. According to Data Bridge Market Research the OTC market is forecasted to gain growth to account for $557.99 billion by 2027, growing at a CAGR of 7%. What impact does IQVIA think COVID-19 will have on the OTC market over the next 5 years? “IQVIA Consumer Health is forecasting the Global OTC market will grow in 2020 by +0.7%; down from a pre-Covid forecast of +4.1%. “IQVIA’s forecast covers the 5 major OTC categories including Cough and Cold Remedies, Pain, Vitamins and Minerals, Skin and Digestive Health. “IQVIA’s pre-COVID CAGR for 2019-2024 was forecasted at 3.8%. IQVIA have now forecasted a reduced CAGR of 1.2% for 2020-2021. This forecast is based on a ‘Low Impact’ scenario as a result of COVID-19.”
PHARMACYNEWSIRELAND.COM | 21
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Key Consumer Behaviour Trends Emerging as a Result of the COVID-19 Pandemic
Top 100 OTC Market recession, with their economic activity reflecting the strong spread of the pandemic in these economies, and the willingness of these countries to engage in costly social distancing measures to reduce infection and death rates14. Emerging and developing economies are also likely to be hit, but with output contracting less severely than in advanced economies. “As a result, consumer confidence is at its lowest in 8 years and this decline is being felt primarily across lower and middle-income households, with large markets for consumer health such as China, USA, India and EU seeing even bigger confidence declines. Despite this IQVIA Consumer Health analysis of conversations on social platforms revealed a decrease in worry and an increase in hopefulness after mid-March as users became accustomed to the ‘new normal’15. “It is an encouraging sign. But this can change rapidly back to fear and worry if infection rates begin to go up. Another lockdown of the scale seen in March and April will likely have a significant negative impact on consumer confidence for the balance of 2020 and well into 2021. Consumers are clearly worried about the future (see below Exhibit). “Large known and trusted consumer brands are preforming well, as people shop quickly and go for the brands they know and trust. Coca-Cola Chief Executive Officer (CEO) James Quincey noted at the beverage giant’s Q1 results that as consumer adjusted to the stay-athome lifestyle they were “making fewer shopping trips and filling bigger baskets often oriented to bigger brands.” Meanwhile, Coca-Cola’s retail customers were “focused on maximising system efficiency by ruthlessly prioritizing… core SKUs and key brands.” Similar trends have been noticed in OTC categories, with bigger and well-known brands doing better than smaller challenger brands. The desire to experiment and seek choice has been replaced by the need for reliable quality and branding.
“Looking further ahead, it is also worth considering the experience of previous periods of economic hardship, where consumers largely Shopper Behaviour continued to treat symptoms—which kept volumes stable—but traded down from premium brands to economy brands, private label and Four key consumer behaviour trends are emerging as some markets Gwynne continues, “Globally we are in a Covid-19 induced recession. Advanced economies generics leading to a loss in terms of value. As economic concerns out of the pandemic and others move past their peak riseactivity as the impact of COVID-19 on the economy becomes clearer, arecome expected to be the hardest hit in this current recession, with their economic (See above Exhibit). it is worth reflecting the strong spread of the pandemic in these economies, and the willingness ofconsidering the potential differences between symptom relieving categories/products—consumers may feel they need to treat • First declining economic activitysocial due to lockdownmeasures and socialto reduce infection these countries to engage in costly distancing and death their symptoms—and aspirational categories, where consumers may is keeping people on edge. rates 14distancing . Emerging and developing economies are also likely to be hit, but with feel output that while they want to aspire to better health, this may be an area • Second, fear of infections and high fatality rates have sent consumers where they can cut back when times are hard15.” contracting less severely than in advanced economies. on a 12-week emotional roller coaster. IQVIA has also mobilised technology and expertise to help monitor the hasconsumer impacted confidence the third trend—a in consumption andthis decline isimpact “As• a This result, is at itsshift lowest in 8 years and being felt of COVID-19 on global pharma and on the EU 5 pharmaceutical shopping primarily acrosshabits. lower and middle-income households, with large markets formarket. consumer To learn more on the pandemic impact on medicine demand and supply, HCP engagement, clinical trials, and hospital systems in health such as China, USA, India and EU seeing even bigger confidence declines. Despite this • Finally, when consumers are buying goods, they are becoming more France, Germany, Italy and Spain, visit https://www.iqvia.com/ on price, andofavailability acrossoncategories. IQVIAfocused Consumer Healthquality analysis conversations social platforms revealedUK, a decrease in library/white-papers/monitoring-the-impact-of-covid-19-on-theworry and an increase in hopefulness after mid-March as users became accustomed to the pharmaceutical-market-eu5.For more information on IQVIA’s COVID-19 Gwynne continues, “Globally we are in a COVID-19 induced recession. ‘new normal’15economies . Advanced are expected to be the hardest hit in this current perspectives, please visit:www.iqvia.com/covid19.
Global Trend of Overall Emotions of COVID-19 – January-May 2020 (Ref: IQVIA Social
“It is an encouraging sign. But this can change rapidly back to fear and worry if infection Media Intelligence) Global Trend Overall Emotions COVID-19 – January-May 2020 (Ref: rates begin to go up.of Another lockdown of theof scale seen in March and April will likely have a IQVIA Social Media Intelligence) significant negative impact on consumer confidence for the balance of 2020 and well into 2021. Consumers are clearly worried about the future. (see below).
antar COVID-19 Barometer. https://www.kantar.com/campaigns/covid-19-barometer/
Kantar COVID-19 Barometer. https://www.kantar.com/campaigns/ “Large known and trusted consumer brands are preforming well, as people shop quickly and covid-19-barometer/ https://www.iqvia.com/library/white-papers/rebooting-consumer-health-thrivinggo for the brands they know and trust. Coca-Cola Chief Executive Officer (CEO) James in-the-post-covid-19-world Quincey noted at the beverage giant’s Q1 results that as consumer adjusted to the stay-athome lifestyle they were “making fewer shopping trips and fillingPHARMACYNEWSIRELAND.COM bigger baskets often | 23 oriented to bigger brands.” Meanwhile, Coca-Cola’s retail customers were “focused on
Source: IQVIA OTC Ireland Monthly Database, May 2020 www.HSE.ie 13 Source: IQVIA OTC Ireland Monthly Database, May 2020 11 12
Making it on to the Top 100 list is a fantastic achievement for all the brands and products. Staying within the Top 100 is something else.
Once again, Solpadeine retains the Number 1 position, quite an achievement; followed of course by Nurofen Plus at Number 2. Nurofen Rapid Relief has made remarkable movement, coming from a position of 51 last year to 11 in 2020.
irstly, I would like to begin by congratulating all of those featured on the following pages for making it into this year’s iconic IQVIA Top 100 OTC Products. PARALIEF DRIVING CASH SALES AND PROFIT IN YOUR PHARMACY the majority of sectors were Paralief the No.1 Paracetamol Brand in Pharmacy* witnessed due to panic buying and stockpiling by consumers. 2000
Products in units (000s)
Irish Pharmacy News has been working with data analysts IQVIA for over 5 years in compiling and bringing this information to our readers, pharmacy professionals of Ireland.
Sales across other categories fell due to numerous factors such as social distancing, isolation and shielding populations. Gwynne Morley, General Manager of IQVIA has presented with readers with an incredibly thorough explanation of all these factors in the preceding pages. 657,350
Throughout the COVID-19 pandemic, community pharmacy has played an important public health role. It has been key in combatting the spread of Covid-19 and is a frontline point of contact for the public; a place in which people can expect to receive accurate and responsible information about the management of their healthcare, virus prevention and treatment. In previous years, the comparison of these Top 100 OTC Products has been within the same Jan-April quarter. Comparison Changes This year, the statistics take on a slightly different view as they reflect the arrival of Covid-19 which changed the OTC market landscape. The figures for 2020 are indicative of Jan through to May as opposed to the annual Jan through to April as per in previous years. Spikes across
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This annual report has now become synonymous for showcasing Ireland’s leading OTC brands, demonstrating their strength within respective category markets, brand leadership and loyalty.
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.
In looking at the pharmacy sector itself, she makes a number of insights into value of the OTC market. “The OTC and front of pharmacy retail business is essential to support the medicines and healthcare service," Gwynne says.
Lemsip also move 4 places to take the number 9 spot, whilst Contour Next has gone from 61 in 2015 to 25 for 2020.
*Disclaimer: Please note that the six year comparison listed opposite details a range from Jan-April for the years 2015-19 and from Jan-May for 2020. These, 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.
24 | PHARMACYNEWSIRELAND.COM
IQVIA Top 100
Pharmacy Products 0
26 29 30 20 26
51 48 55 60 59 60
27 39 47 63 81
77 71 64 62 54 43
28 22 26
53 53 54 59 57 51
29 24 24 24 23 23
79 88 96
30 41 52 88
55 68 67 68 61 59
80 81 98
BENYLIN DAY & NIGHT
31 35 34 34 41 46
56 64 63 75
81 70 71 64 80 52
32 18 38 45 29 32
57 55 46 47 51 42
82 83 62 35 37 55
33 25 33 31 35 29
SILCOCKS BASE OVE
58 60 81 82 79 119
83 76 79 83 76 81
34 34 32 32 28 31
59 52 51 48 44 37
35 27 25 27 30 33
60 47 50 49 52 38
85 89 89 77 71 63
36 33 29 25 33
61 49 56 61 62 62
SEVEN SEAS C L O
86 82 75 71 73 67
37 26 28 22 20 25
62 23 35 40 47 28
87 85 86 84 77 87
38 65 61 51 58 56
63 50 49 41 38 50
88 73 77 67 63 54
39 38 37 33 32 34
89 79 83 78 75 74
40 37 36 37 42 53
65 69 66 66 64 64
90 91 65 36 50 45
41 32 31 28 31 26
66 56 57 56 56 48
91 78 76 70 67 69
ONE TOUCH VERIO
42 40 44 55 65
GAVISCON EXTRA STR
92 90 85 80 91
43 42 40 39 36 35
68 61 60 52 49 44
93 86 82 96 94 82
44 43 42 38 34 30
69 62 59 53 53 41
94 74 78 74 74 85
45 54 23 46
70 44 43 93
95 92 88 79 66 86
46 46 45 44 40 36
71 58 53 50 46 39
47 59 97
48 63 58 42 45 40
73 66 70 65 60 57
86 92 79
49 57 69
74 72 74 69 68 65
50 45 48 57 55 58
BENYLIN DRY N/D
75 75 72 72 69 66
B D MICRO FINE
PHARMACYNEWSIRELAND.COM | 25
DONâ€™T LET PAIN HOLD YOU BACK
ESSENTIAL INFORMATION Solpa-Extra 500mg/65mg Soluble Tablets contain paracetamol and caffeine. For the treatment of mild to moderate pain. Adults and children over 16 years: 1-2 tablets dissolved in water every 4-6 hours. Max 8 tablets a day. Children 12-15 years: 1 tablet disolved in water every 4-6 hours. Max 4 tablets a day. Not suitable for children under 12 years. Contraindications: Hypersensitivity to the ingredients. Precautions: Particular caution needed under certain circumstances, such as renal or hepatic impairment, chronic alcoholism and malnutrition or dehydration. Precautions needed in asthmatic patients sensitive to acetylsalicylic acid, patients on a controlled sodium diet and with rare hereditary problems of fructose intolerance. Patients should be advised not to take other paracetamol containing products concurrently. Pregnancy and lactation: Not recommended during pregnancy and breastfeeding. Side effects: Rare: allergies. Very rare: thrombocytopenia, anaphylaxis, bronchospasm, hepatic dysfunction, cutaneous hypersentitivity reactions. Unknown: nervousness, dizziness. Further information is available in the SmPC. PA 1186/017/001. P. MAH: Chefaro Ireland DAC, Treasury Building, Lower Grand Canal Street, Dublin 2, Ireland. Date of preparation: April 2017. IRE/NHPT/SOL1/2019-003.
IQVIA Top 100 Pharmacy Products
N : Solpadeine o
“FOR HEALTHCARE PROFESSIONALS ONLY”
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.
No:2 Nurofen Plus
3 Nurofen for Children
Nurofen for Children 3 months to 12 years Strawberry 100mg/5ml Oral Suspension is a liquid ibuprofen suspension that provides pain and fever relief for children. • Suitable for babies from 3 months and weighing over 5kg. • Starts to get to work in 15 minutes to relieve fever. • Up to 8 hours fever relief. • Contains Ibuprofen for anti-inflammatory properties. • Non-drip syringe for accurate and easy dosing. • Reduced fever (including fever caused by immunisation). For the relief of mild to moderate pain such as: Teething, toothache, sore throats, ear ache, headache, minor aches, sprains. Relieves symptoms of cold and flu. Nurofen for Children 3 months to 12 years Strawberry 100mg/ml Oral Suspension. Contains ibuprofen. For pain and fever relief. Always read the label. Available in Strawberry and Orange flavour.
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Calpol® Infant & Calpol® Six Plus
Ireland’s No.1 pain & fever reliever*
From fever to blocked noses, Calpol® has got you covered
Lets Kids be Kids MAH: Johnson & Johnson (Ireland) ltd. Airton Road, Tallaght, Dublin 24. Products not subject to medical prescription. Full prescribing information available upon request. Calpol® Vapour Plug & Nightlight is an electrical device and non-medicine. CALPOL® Saline Nasal Spray, CALPOL® Saline Nasal Drops and CALPOL® Blocked Nose Spray are medical devices for congestion relief. *IMS May MAT Units 2020 (For Calpol® Infant and Calpol® Six Plus medicinal products)
IQVIA Top 100 Pharmacy Products
Calcichew 500mg Chewable Tablets are to be chewed as a supplemental source of calcium in the correction of dietary deficiencies or when normal requirements are high. Calcichew 500 mg Chewable Tablets are orange flavoured chewable tablets containing the active ingredient calcium. Calcium is found in the diet and is an important substance in bone formation. Calcichew 500 mg is used to treat and prevent calcium deficiency which may occur if your diet or lifestyle does not provide enough, or when body requirements are increased. This medicine may also be prescribed or recommended for certain bone conditions, for example osteoporosis, or during pregnancy. It may also be given to patients receiving kidney dialysis to remove the phosphate from the blood that cannot be removed by dialysis.
No:6 Panadol Extra
No: Paralief 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 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. MAH: Johnson & Johnson (Ireland) Ltd. Airton Road, Tallaght, Dublin 24, Ireland. Calpol® Infant and Calpol® SixPlus are not subject to medical prescription. Further information available upon request from Johnson & Johnson (Ireland) Ltd. *IMS Volume Sales MAT June 2020 General Pain Relief Paed Category (For Calpol® Infant and Calpol® SixPlus medicinal products) **Calpol® Consumer survey with Mummypages, May 2019 (635 respondents) ***Weighing over 4kg and not premature
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Paralief Tablets: Short-term relief of the symptoms of headache, musculoskeletal disorder, menstrual pains, toothache and for relieving fever, aches and pains and pains of common colds and flu. Fast acting pain relief, gentle on the stomach Paralief Effervescent Tablets: For treatment of mild to moderate pain and/or fever in adults and adolescents aged 12 years and above. Fast acting pain relief, gentle on the stomach.
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DOUBLE YOUR CUSTOMERS CHANCES OF QUITTING WITH NICORETTE * QUICKMIST
STARTS TO RELIEVE CRAVINGS IN JUST 30 SECONDS** *Compared to willpower alone. **Based on 2 x 1 mg dose
Nicorette QuickMist1 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, Butylated hydroxytoluene. 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 should preferably be used in conjunction with a behavioral support program. Dosage: Subjects should stop smoking completely during the course of treatment with Nicorette QuickMist. Adults and Elderly: The following chart lists the recommended usage schedule for the oromucosal spray during full treatment (Step I) and during tapering (Step II and Step III). Up to 4 sprays per hour may be used. Do not exceed 2 sprays per dosing episode and do not exceed 64 sprays (4 sprays per hour, over 16 hours) in any 24-hour period. Step I: Weeks 1-6: Use 1 or 2 sprays when cigarettes normally would have been smoked or if cravings emerge. If after a single spray cravings are not controlled within a few minutes, a second spray should be used. If 2 sprays are required, future doses may be delivered as 2 consecutive sprays. Most smokers will require 1-2 sprays every 30 minutes to 1 hour. Step II: Weeks 7-9: Start reducing the number of sprays per day. By the end of week 9 subjects should be using HALF the average number of sprays per day that was used in Step I. Step III: Weeks 10-12: Continue reducing the number of sprays per day so that subjects are not using more than 4 sprays per day during week 12. When subjects have reduced to 2-4 sprays per day, oromucosal spray use should be discontinued. To help stay smoke free after Step III, subjects may continue to use the oromucosal spray in situations when they are strongly tempted to smoke. One spray may be used in situations where there is an urge to smoke, with a second spray if one spray does not help within a few minutes. No more than four sprays per day should be used during this period. Regular use of the oromucosal spray beyond 6 months is generally not recommended. Some ex-smokers may need treatment with the oromucosal spray longer to avoid returning to smoking. Any remaining oromucosal spray should be retained to be used in the event of sudden cravings. Paediatric population: Do not administer 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 330/37/13. Date of revision of text: PA 330/37/13: May 2019. Product not subject to medical prescription. Full prescribing information available upon request.
IQVIA Top 100 Pharmacy Products
Nurofen Rapid Relief Maximum Strength 400mg Liquid Capsules jumped 40 positions in the top 100 brands of 2020. They arrived into the market in 2019 at number 51 and have gained 40 positions to arrive at number 11 in the total OTC category. Nurofen Rapid Relief sits at 17% share of the Mild Pain category. * Nurofen Rapid Relief Liquid Capsules were launched in February 2019. With the return of the Express range in June, Nurofen now accounts for 49.8% of the Mild Pain market.* Supply Classification: Pharmacy Only. MA Holder: Reckitt Benckiser Ireland Ltd. 7 Riverwalk, Citywest Business Campus, Dublin 24. Full prescribing information is available on www.medicines.ie *IMS Data June 2020 Reference: RB-M-11947. Date of Preparation August 2020.
NICORETTE® is Ireland’s number 1 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® Quickmist is clinically proven to relieve cravings in just 30 seconds**. No other single NRT product is more effective at helping smokers quit for good. NICORETTE® Quickmist is available in Freshmint and Cool Berry for alternative flavours to quit. 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 2020 MAT Value Sales **Based on 2 x 1mg dose
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No:9 Lemsip No:10 Gaviscon
Delivering best-in-class products, service and business support for optimum patient care.
pre-biotic oats*. For
healthier looking, more resilient skin
*in vitro test
IQVIA Top 100 Pharmacy Products
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.
Normal Normal Normal Very Very Very dry, dry,dry, Very Very Very dry, dry,dry, totodry dry toskin dry skinskin irritable irritable irritable skin skinskin itchy itchy itchy skin skinskin AVEENO® is Irelands number one* pharmacy skincare brand with a wide range of products to suit all skin types; from normal to dry, irritable, itchy or sensitive skin. AVEENO® is the highest ranked skincare brand in the Top 100, placing in 12th.
NEW T UC PROD
No:13 Calpol Six Plus
No:14 Nurofen All AVEENO® body moisturisers contain colloidal oatmeal or oat extract, derived in nature and activated by science to provide real skincare benefits. With a continuous focus on innovation to meet the changing needs of consumers, The AVEENO® range now includes the AVEENO® Skin Relief Nourish & Repair Cica Balm. AVEENO® Daily Moisturising Lotion provides healthier looking skin from day 1 and is recommended by 9 out of 10 Irish women**. For more information please contact your Johnson & Johnson Territory Representative. *IMS MAT Volume sales (Pharmacy only), Skincare category from July 2019 – June 2020 **AVEENO® DML Consumer product trial with beaut.ie August/September 2013 (91 respondents).
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IQVIA Top 100 Pharmacy Products
Nexium Contol – GSK Consumer Healthcare
Galfer Capsules contains Ferrous Fumarate, which prevents low levels of iron and replaces iron in the blood from anaemia. Galfer is used for the treatment and prevention of uncomplicated iron deficiency anaemia. Galfer capsules and syrup both contain the active ingredient ferrous fumarate, which is a form of iron. Iron plays a vital role in production of haemoglobin, which is the oxygentransporting substance found in red blood cells. If the diet does not contain enough iron, the body cannot make enough new red blood cells. This results in iron deficiency anaemia, with symptoms such as tiredness, palpitations, shortness of breath, dizziness and fainting.
To treat iron deficiency anaemia, Suitable for people experiencing heartburn. Nexium Control 20mg gastro resistant Tablets Capsul iron supplements such asand this one are needed. The increased iron Esomeprazole, for correct use read the leaflet. intake allows the body to increase its production of red blood cells. The absorption of iron from the gut is decreased if it is taken at the same time as coffee, tea, eggs or milk. Its absorption is enhanced if it is taken at the same time as foods or supplements containing vitamin C (ascorbic acid). Each capsule contains 305mg Ferrous Fumarate for the prevention and treatment of iron deficiency.
thcare m Control is Ireland’s No.1 pharmacy-only heartburn treatment without prescriptio nts for 40% value market share for theand year endingContains May 2020 and is growing at ove . Nexium Control 20mg gastro resistant Tablets Capsules. aflet. f the market at 8%. A high level of continued marketing support is driving the overa brand, with TV, VOD, digital and PR, and following the joint venture between Pfizer m Control will continue to receive a sustained level of pharmacy support from the G Control is Ireland’s No.1 pharmacy-only heartburn treatment merNexium Healthcare representative team. without prescription*. It now accounts for 40% value market share for the year ending May 2020 and is growing at over twice the rate of the market at 8%. A high level of continued marketing support is driving the overall success of the brand, with TV, VOD, digital and PR, and following the joint venture between Pfizer and GSK, Nexium Control will continue to receive a sustained level of pharmacy support from the GSK Consumer Healthcare representative team.
oduct details available on medicines.ie y-only heartburn treatment without prescription*. It now o : 17 Dioralyte N Tablets and Capsules. Contains he year ending May 2020 and is growing at over twice the Full product details available on medicines.ie harmacy only. * IMS Data May 2020 MAT Value Sales For Pharmacy only. * IMS Data May 2020 MAT Value continued marketing support isSales driving the overall No: 19success Panadol PM-IE-NEC-20-00002 ,NEC-20-00002 and following the joint venture between Pfizer and GSK, Compliance Based Buying Group United Drug Retail Solutions sustained level of pharmacy support from the GSK Easy to use software which Best in class quality standards directs your dispensary orders. and clinical governance. m.
Full Transparency – available with net pricing visible on website. www.united-drug.com
IQVIA Top 100 Pharmacy Products
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. MAH: Johnson & Johnson (Ireland) Ltd. Airton Road, Tallaght, Dublin 24, Ireland. Product is not subject to medical prescription. Further information available upon request from Johnson & Johnson (Ireland) Ltd. *IMS Volume Sales MAT June 2020 Nasal Decongestion Category
Hylo Forte® contains a natural occurring substance called Sodium Hyaluronate which replenishes the tear film at a concentration of 0.2% it offers effective relief for more severe and persistent dry eye symptoms. 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.
No:23 Strepsils No:24 Canesten No:21 Nurofen Express
No:25 Contour Next
No:22 Nurofen Cold & Flu
No:26 Duphalac No:28 Dulcolax No:29 Senokot
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IQVIA Top 100 Pharmacy Products
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.
31 Benylin Day
Benylin® Day & Night tablets are the only day & night tablets in the Irish market to provide 24 hour cold and flu relief. The tablets help reduce temperature, relieve aches and pains, help clear catarrh and so aids 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 nights sleep. The Benylin® Cold & Flu range also contains Benylin® 4 Flu for effective relief from flu symptoms including fever, congestion, aches and pains. MAH: Johnson & Johnson (Ireland) Ltd. Airton Road, Tallaght, Dublin 24, Ireland. Product is not subject to medical prescription. Further information available upon request from Johnson & Johnson (Ireland) Ltd.
Easofen (Ibuprofen) is a non prescription pain relief, available in pharmacies only. Easofen tackles your pain head on treating headache, dental pain, period pain, muscle strain and symptoms of head cold and flu. Easofen comes in 200mg and is now available in pack sizes of 12, 24 and 48 and Easofen Max Strength 400mg in a 24 pack now also completes the Easofen range. Always read the label.
No:33 Piriton United Drug Retail Solutions
Ireland’s No.1 Provider of Ostomy Products & Services Complimentary Cutting – Up to 8,000 bags weekly.
Ongoing support for over 20,000 customer care calls annually.
Training partnership with access to stoma nurses in Ireland.
Contact our dedicated Ostomy Care Team: firstname.lastname@example.org
IQVIA Top 100 Pharmacy Products
Nasal symptoms are the most bothersome symptoms of a cold and can impact sleep quality resulting in fatigue and poor concentration.1-4 Patients may try a range of treatment options including home remedies or oral multi-symptom products or oral decongestants. Otrivine offers a full range of science-based, clinically proven nasal health products to help relieve nasal symptoms. Otrivine medicated products provide fast and long-lasting relief of nasal congestion.5 Otrivine medicated nasal sprays contain topical xylometazoline which acts to reduce swelling, relieve nasal congestion and facilitate sinus drainage. Xylometazoline is a trusted ingredient with a demonstrated safety profile.2 GSK will launch a new product in the Otrivine Range for Ireland in October 2020. Otrivine Extra Dual Relief has a unique dual ingredient formulation to help treat both blocked and runny nose as well as congestion and sneezing. 1. Arruda E, Pitkäranta A, Witek TJ Jr, Doyle CA, Hayden FB. Frequency and natural history of rhinovirus infections in adults during autumn. J Clin Microbiol. 1997; 35:2864–2868 2. Graf P, Eccles R, Chen S. Efficacy and safety of intranasal xylometazoline and ipratropium in patients with common cold. Expert Opin Pharmacother. 2009;10(5):889–908. 3. Wynne JW. Obstruction of the nose and breathing during sleep. Chest 1982;82(657):658. 4. Rombaux P, Liistro G, Hamoir M, et al. Nasal obstruction and its impact on sleep-related breathing disorders. Rhinology 2005; 43:242–250 5. Eccles R, Eriksson M, Garreffa S, Chen S. The nasal decongestant effect of xylometazoline in the common cold. Am J Rhinol 2008; 22:491–496.
Muscle and joint pain are amongst the types of pain experienced most often.1 Over half of people buy pain relief in the pharmacy without prescription, highlighting the role of your advice.2 Voltarol Emulgel Extra Strength 2% w/w Gel is a topical pain relief gel containing the NSAID diclofenac and offers all day joint pain relief without a tablet. Voltarol Emulgel is scientifically proven to help relieve pain, reduce inflammation and restore movement. The anti-inflammatory ingredient is retained within the joint tissue, rather than the blood stream and Voltarol has lower systemic side effects vs oral NSAIDs. Voltarol Emulgel Extra Strength should be applied twice daily for all day relief from pain in the muscles and joints. Voltarol is the #1 selling topical pain relief brand and offers an effective alternative to tablets.3 1. GSK data on file, GPI global data 2018 2. GSK data on file, MMR U & A 2018 3. Nielsen, Total Coverage, L12W unit sales, w/e 17.07.2020.
No:38 Paracetamol PZC
No:36 Buttercup Broncho
No:37 Motilium United Drug Retail Solutions
No:39 Daktarin Ireland’s No.1 Provider of Ostomy Products & Services Grow your business and in turn improve patient care. Contact our dedicated Ostomy Care Team: email@example.com
IQVIA Top 100 Pharmacy Products
Maxilief Effervescent Tablets are used for the relief of headache, including migraine, musculoskeletal pain, toothache, backache, common cold, influenza and menstrual pain. Maxilief Effervescent Tablets contain paracetamol 500mg, codeine phosphate hemihydrate 8mg and caffeine 30mg
Difflam™ Spray allows you to deliver just the right amount of fast acting relief2, straight to where it's needed. Suitable for adults and children under 6 years.* It can be used to treat many painful conditions of the mouth and throat including:1,2 • Mouth ulcers, sore throat or gums • Pain and inflammation following dental surgery • Inflammation of the throat (pharyngitis) following surgical removal of the tonsils (tonsillectomy) or the use of a tube passed through the nose into the stomach (naso-gastric tube) Triple Action Relief1,3: Anti-inflammatory - To support the body’s natural healing process and help you feel better sooner. Analgesic - To relieve the pain from a sore throat quickly and effectively. Anaesthetic - To soothe a sore throat so you can get on with your day. Do not use Difflam™ Spray if you are allergic to benzydamine hydrochloride or any of the other ingredients listed in the Patient Information Leaflet. Always read the label and patient information leaflet carefully. Do not use for more than seven days continuously unless under advice from a healthcare professional. Avoid contact with eyes. Keep out of the sight and reach of children. Always use Difflam™ Spray exactly as instructed and check with a healthcare professional if you are not sure. If your symptoms get worse or do not improve, contact your doctor, pharmacist or dentist. *CHILDREN UNDER 6: One puff to be administered per 4 kg body weight, up to a maximum of 4 puffs, 1�-3 hourly. References: 1. Difflam™ Spray Summary of Product Characteristics 2. SimardSavoie, S., (1978). Topical Anaesthetic Activity of Benzydamine. Current Therapeutic Research. 23(6), 734-745 3. Agarwal A et al. An evaluation of aspirin and benzydamine hydrochloride gargle for attenuating postoperative sore throat: a prospective sore throat: a prospective, randomized, single-blind study. Anesth Analg 2006; 103(4): 1001-1003.
No:42 One Touch Verio
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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)
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IQVIA Top 100 Pharmacy Products
Product Information: Please consult the summary of product characteristics for full product information. Vicks Vaporub Inhalation Vapour, Ointment, supply through non-pharmacy outlets and pharmacies. MA Number: PA2294/003/001. Vicks Inhaler Nasal Stick, supply through non-pharmacy outlets and pharmacies. MA Number: PA2294/005/001. Vicks Sinex Micromist 0.05% w/v Nasal Spray, Solution, for supply through pharmacies only. MA Number: PA2294/004/001. MA Holder: WICK Pharma - Zweigniederlassung der Procter & Gamble GmbH, Sulzbacher Str. 40, 65823 Schwalbach am Taunus, Germany. For further information contact the MA holder. Vicks First Defence is a medical device. Read the leaflet carefully for complete product information. Text prepared: August 2020. Distributed in Ireland by PRL â€“ contact firstname.lastname@example.org
Anti-Hist Allergy is an antiallergic medication. Anti-Hist allergy tablets are suitable for adult and children aged 6 years and above. Anti-Hist Allergy Oral Solution is suitable for adults and children aged 2 years and over. Anti-Hist Allergy is indicated for the relief of nasal and ocular symptoms of seasonal and perennial allergic rhinitis and the symptoms of chronic idiopathic urticaria. Clonmel Healthcare are delighted to announce the launch of Eye Drops from the makers of Anti-Hist. Eye Drops From the makers of Anti-Hist are moisturizing and refreshing eye drops. The properties of Sodium Hyaluronate associated with the qualities of Chamomile, Witch-hazel, and Cornflower refresh, soothe and calm irritation, dryness and burning due to environmental elements (wind, sun, smoke) and effects of hay fever (allergic rhinitis).
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No:49 Solpa Extra
No:51 Sudafed Nasal
No:52 Bronchostop Junior
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IQVIA Top 100 Pharmacy Products
Ovelle Silcock’s Base is the No1 emollient of choice for consumers, dermatologists, pharmacists and medical professionals, moving up 23 places in the Top 100 OTC products since 2018. A traditional formulation with a high lipid cream containing 20% w/w white soft paraffin, Ovelle Silcock’s Base helps retain moisture in the skin by reducing the rate of normal evaporation. It can be used both as a moisturiser and soap substitute cleanser for the face and body to prevent dryness and itching or flaking. Suitable for frequent use, it is fragrance, colour and cruelty free, and available in 100g, 250ml and 500g sizes. In 1934, Joseph Gardiner founded Ovelle Pharmaceuticals, the first manufacturing chemist in Ireland, to prepare traditional apothecary for sensitive skin conditions. To this day, as the Gardiner Family Apothecary, we continue creating trusted sensitive skincare solutions at our cGMP manufacturing facility in Dundalk, drawing upon our dermatological skills to create products which combine traditional formulations with licensed medicines, medical devices and biocide specialist skincare. Our experience in producing traditional apothecary products like our Silcock’s Base enabled us to exploit dermatological advances to create Elave Sensitive, which helps prevent flare-ups in sensitive and dry skin conditions. All our formulations are safety-tested to the highest international Pharma and ethical standards, and are independently certified. As a family-run business with deep roots in the community, we are heavily invested in the success of our pharmacy customers and have pledged to back the aims of the Champion Green movement to ‘Support Local’.
No:53 Vermox No:54 Paracetamol PGO No:55 Panadol Actifast No:56 Niquitin No:57 Corsodyl
Every mom wants her baby to spend time exploring and learning, not suffering through a sore bottom from diaper rash. Keeping baby’s delicate skin soft and dry is the best way to prevent irritations. When diaper rash occurs, nothing’s more important than getting the baby comfortable. Caldesene® Baby is just what you need to get the baby comfy fast. Caldesene® helps to heal diaper rash and prevent it from returning. Diaper rash is upsetting to mom and uncomfortable for baby. But the good news is, most diaper rashes can be treated with simple at-home remedies, like Caldesene® Baby. Caldesene® has a unique formula that treats and protects and soothes."
61 Deep Heat
Pain relief with heat therapy with Deep Heat patches. The iconic brand Deep Heat, from Mentholatum, offers pain relief with penetrating heat therapy – and its Deep Heat Pain Relief Heat Patches offer targeted, long lasting relief from muscular aches and pains. The patches are available in two sizes, regular and an extra large size which is hinged to sit comfortably over the spine. Senior brand manager, Kaye Mackay, says: “The Deep Heat patch is the favourite with consumers who are looking for long lasting, drug free pain relief for backs as it can give relief for up to 16 hours and is odourless, discreet and convenient to use”. For more help, encourage sufferers to visit www.mindyourbackeire.com for advice on how to manage and prevent back pain.
No: 59 Fybogel No:62 Zirtek No:63 Artelac No:64 Calpol Vapour No:65 Brolene
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IQVIA Top 100 Pharmacy Products
Sudocrem Antiseptic Healing Cream has been soothing familiesâ€™ skin since 1931. An iconic Irish brand manufactured in Baldoyle, Dublin. Sudocrem Antiseptic Healing Cream helps to soothe and heal skin whilst protecting the area from further infection, making it a staple in Irish households. Sudocrem Antiseptic Healing Cream is licensed to treat nappy rash, cuts and grazes, eczema, sunburn, minor burns, surface wound, acne and bed sores.
Cystopurin is a low-sodium 48 hour treatment for the symptoms of cystitis. Each pack contains six sachets which mix with water to make cranberry flavour drinks. Cystopurin works by counteracting the acidity of your urine, helping to relieve the burning, stinging pain on passing water. Beginning the Cystopurin treatment at the first signs of attack will usually help you feel better within a few hours. Features of Cystopurin natural cranberry juice extract 3g granules 6 sachets Fast acting relief Eases burning and stinging pain Cranberry flavour Low sodium formula.
No:67 Panadol Night
No:72 Nizoral CLH
No:68 Listerine No:73 Rennie No:69 Actifed No:75 Benylin Dry Chesty Coughs
No:71 Nicotinell United Drug Retail Solutions
Safe and Secure Sourcing of Unlicensed Medicines Delivering up to 6 days a week.
Turnaround time as low as 48 hours for emergency orders.
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AbakÂŽ System The most widely used preservative-free bottle in the world
100% Preservative FREE Clinically PROVEN* Suitable for all Dry Eye suferers, including contact lens wearers
www.theapharma.ie * Pinto-Bonilla JC et al. Ther. Clin Risk Manag 2015:11;595-603 ** Schmidl D et al. Cornea 2015;34(4):421-6.
letâ€™s open our eyes
A single drop improves the thickness of the tear film for up to/for 4 hours**
IQVIA Top 100 Pharmacy Products
Thealoz® Duo is the most advanced preservative-free combination of sodium hyaluronate and trehalose for moderate to severe dry eyes, in a hypotonic formulation that can be used with contact lenses. Thealoz® Duo Dry Eye drops are suitable for all Dry Eye sufferers, as they combine both long-lasting relief and protection for the surface of the eye. Clinical studies have shown that a single drop of Thealoz Duo improves the thickness of the tear film for at least 4 hours (6 times longer than sodium hyaluronate alone). In one study, 62% of patients receiving Thealoz Duo were symptom free after 84 days, with significant improvements in blurred vision, stinging and itching KEY FEATURES:
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
• Clinic ally proven to increase the thickness of the tear film which relieves symptoms of Dry Eye
• 0.15% Hyaluronic acid – this acts as a tear lubricant, provides longlasting relief and soothes your symptoms
• 100% Preservative-free
• 3% Trehalose is added to provide protection for the epithelial cells on the ocular surface, improving their resistance to daily stress of dry environments and tear film changes in a dry eye • Suitable for all Dry Eye sufferers, including contact lens wearers
Codeine Phosphate 15mg/5ml Oral Solution is an antitussive for the relief of dry and irritating coughs. ALWAYS READ THE LABEL.
• Uniquely designed, patented, preservative-free ABAK bottle that allows easy application • The 10ml bottle has 300 drops and can be used for up to 3 months after opening
No:79 Cavilon No:76 Buscopan IBS No:77 E45 United Drug Retail Solutions
No:81 Savlon No:83 Zovirax GLX
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IQVIA Top 100 Pharmacy Products
Jakemans confectionary was established in 1907 in Boston, England where they still manufacture to this day. They joined the LanesHealth family in 2007. LanesHealth are leaders in providing alternative natural remedies to many common ailments. More recently Jakemans welcomed the stick packs to the family – a brand new and super handy way to enjoy the marvellous menthol confections on the move. Just like all the bagged sweets, Jakemans stick packs are bursting with menthol - an ingredient that releases natural vapours to help soothe the symptoms of a sore throat and keep noses clear. All Jakemans sweets are made with absolutely no artificial colours or flavours and with only the finest ingredients, for an incomparable taste. For more information on the Jakemans range please contact the BR Healthcare office on 01-8850 800 or your local BR Healthcare representative. You can also log onto www.jakemans.com to view the range.
86 Seven Seas
Seven Seas Cod Liver Oil + Magnesium is the only product to combine Cod Liver Oil and Magnesium. This unique combination provides support for Tiredness & Fatigue, Bones, Energy and Cell Repair. Seven Seas Cod Liver Oil + Turmeric combines a rich source of Omega-3 and vitamin D, to help you maintain good health as you get older, with Turmeric. This provides support for Heart, Bones, Brain and Vision.
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Elave Sensitive continues to impress as a pharmacy-led multi awardwinning brand offering trusted skincare solutions for dry, sensitive, eczema and dermatitis prone skin. Elave’s formulations are available in all categories including Baby, Dermatological, Junior, Dermorenew, Men’s and Sun. Our promise of absolute purity means no sulfates, SLES/SLS, parabens, perfume, formaldehyde, MI, alcohol, soap, colours and more. Our team of formulation scientists believes in skincare which bans unnecessary chemicals and promotes active hydrating ingredients to enhance all skin types, even the most sensitive skin. All our products are clinically tested and dermatologically and paediatrician approved - which is why they are trusted and recommended by pharmacists, as well as medical and healthcare professionals, for the treatment and management of chronic skin conditions and skin barrier protection. In 1934, Joseph Gardiner founded Ovelle Pharmaceuticals, the first manufacturing chemist in Ireland, to prepare traditional apothecary for sensitive skin conditions. To this day, as the Gardiner Family Apothecary, we continue creating trusted sensitive skincare solutions at our cGMP manufacturing facility in Dundalk, drawing upon our dermatological skills to create products which combine traditional formulations with licensed medicines, medical devices and biocide specialist skincare. Our experience in producing traditional apothecary products like our Silcock’s Base enabled us to exploit dermatological advances to create Elave Sensitive. As a family-run business with deep roots in the community, we are heavily invested in the success of our pharmacy customers and have pledged to back the aims of the Champion Green movement to ‘Support Local’.
Grow your Business with United Drug Committed to delivering not only premium products but also high quality tailored solutions to customers in order to optimise their business at every given opportunity.
Mouthwash Actively neutralises bad breath for 12 hours1
Discover the range of CB12 in pharmacies nationwide References 1. Thrane PS, Jonski G, et al. Zn and CHX mouthwash effective against VSCs responsible for halitosis for up to 12 hours. Dental Health 2009; 48(3): 8-12. Mylan IRE Healthcare Ltd, Newenham Court, Northern Cross, Malahide Road, Dublin 17, Ireland. www.mylan.ie Job code: CB12-2019-0161 Date of preparation: June 2019
IQVIA Top 100 Pharmacy Products
No:88 Arret No:89 Cerumol
Pinewood Healthcare Cortopin 1% w/w Cream contains Hydrocortisone 1% and is used to reduce inflammation, relieves irritation & itching. As a topical cream, it can be used in a variety of skin conditions such as mild to moderate eczema, dermatitis caused by irritants or allergens and insect bite reactions.
No: 91 Imodium Plus
Bepantiseptic First Aid Cream We understand that our skin is incredibly special. It forms a protective barrier against harm and has a remarkable ability to heal itself. But when the skin is broken, it can be vulnerable to infection, and may need a helping hand from antiseptic products like Bepantiseptic First Aid Cream. Bepantiseptic First Aid Cream has an antiseptic action to help prevent infections, plus a soothing local anaesthetic effect to numb the pain. Bepantiseptic First Aid Creamâ€™s dual action is an effective treatment for minor cuts and grazes, minor burns, scalds and blisters, stings and insect bites, spots, chapped or rough skin.
No: 92 Gaviscon Extra Strong No:96 Paracetamol ATV
No: 93 Celluvisc
CB12 is a unique mouthwash that not only neutralises bad breath, instead of just masking it1, but also includes fluoride, an ingredient proven to strengthen the teeth14. CB12 mouthwash is based on a clinically proven formula developed at the University of Oslo, Norway.
No:97 Phenergan No:98 Compeed No:99 Vivioptal Junior No:100 BD Micro Fine
This unique composition actively neutralises bad breath by eliminating the substances that cause it as well as preventing their formation. The result is a pleasant, odourless breath that lets you get close to people without concern â€“ and it lasts for 12 hours13. If you're convinced about CB12 mouthwash, you'll also love the other breath products available from CB12.
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Top 100: First Aid
Category Focus: First Aid Sports-related injuries will also be common and so ensure your pharmacy is stocked with a ready supply of external analgesics and hot and cold treatments. First aid is easy to learn, easy to remember and easy to do. Pharmacists have the opportunity not only to demonstrate how easy first aid is, but also to advocate for the public to learn more themselves. • Remove dirt and debris from the wound with tweezers; clean the tweezers with rubbing alcohol before using them • Apply direct pressure with a clean gauze pad to a bleeding cut • Treat the cut with antibiotic ointment • Cover the cut with a bandage (deeper cuts may require a butterfly bandage) • Do not pick at a scab while a cut is healing Treating Bruises Although bruises can be painful, treatment is limited. The best care for bruises involves rest and ice. Ice stops blood flow to the injury site, thus limiting the size of the bruise. Rest allows the site to heal.
While wound care continued to be dominated by sales of sticking plasters/adhesive bandages in 2019, increased participation in a number of strenuous sporting activities such as CrossFit and triathlons, and particularly extreme sports such as mixed martial arts and traditional Gaelic games, is leading to increasing demand for the smaller category of gauze, tape and other wound care. This trend is predicted to continue into the forecast period with the latter recording higher volume growth compared with the review period, driven by the greater likelihood of accidents occurring while participating in these sorts of sports. The smallest category of first aid kits continued to experience increasing demand in Ireland in 2019, as parents engaged in preventative measures by maintaining well-stocked first aid kits to cover all likely scenarios linked to having younger children. Many parents are also learning basic first aid through classes, which help them to understand what they are likely to need in the
case of more serious accidents or the treatment of wounds. Elastoplast is the largest category of sticking plasters/adhesive bandages in addition to enjoying wide distribution. To attract parents of younger children, Elastoplast engages in licencing with recognisable names such as Paw Patrol and Frozen. Cuts, scrapes, and bruises are among the most common injuries, and no family member is safe from minor accidents. Fortunately, these injuries usually can be treated at home without a doctor visit. Pharmacists need to be able to advise patients on how to treat these injuries if medical attention is not necessary, as well as to counsel patients as to when they should seek medical attention. Scrapes (or abrasions) are wounds in which layers of skin are scraped or torn. The most common sites for scrapes are the hands, elbows, and knees. These injuries often are the result of a fall. Although the scrapes may ooze blood, bleeding
does not always occur. Objects penetrating the skin cause cuts (or lacerations). Depending on the depth, cuts often will bleed. Bruises are the result of hard contact with a person or an object. The impact causes an injury to the tissue beneath the skin, and blood from the injury settles near the skin. Bruises usually start out looking red, then within a few hours turn blue or purple, and finally appear yellow as they fade. Treating Cuts and Scrapes Minor scrapes and cuts are easily treated at home with basic wound-care or first-aid supplies. Because cuts can happen at any time, every home should have tweezers, gauze pads, bandages, and antibiotic ointment. Here are some steps that pharmacists should tell patients to follow in treating cuts at home: • Rinse a cut with cool water • Wash around the cut with soap; avoid getting soap into the wound
Here are some further guidelines for patients for treating bruises at home: • Apply ice packs or cold compresses as soon as possible • Reapply ice packs every hour for 10-15 minutes during the first day, if needed • With bruised legs or feet, elevate the legs as much as possible during the first day • Take acetaminophen, if needed, for pain; do not take aspirin • With large bruises, limit activity during the first day • Use heat packs after 48 hours to promote healing Here are some signs that bruises need medical attention: • The bruise swells • The bruise does not start to fade within a week • The bruise occurs easily or for no obvious reason
AWARD WINNING IRISH
SUPER SUPPLEMENT 26 ACTIVE INGREDIENTS*
Revive Active supports energy, immune system and a healthy heart. Enriched with CoQ10 and L-Arginine.
As voted by the Retail Pharmacies of Ireland 2020
Revive Active contains 8 active ingredients that contribute to the normal function of the immune system - Zinc, Copper, Folic Acid, Selenium, Vitamins B12, B6, C, and D.
Call: 091 769803 | Email: email@example.com | Web: reviveactive.com
Top 100: Hayfever
Category Focus: Allergies & Hayfever The allergy and hayfever category has performed well over the last 12 months, with its usual peaks arriving more or less when predicted. Ninety-five percent of hayfever sufferers will react to grass pollen from midMay to mid-June. This category of medication has always indexed well against others as customers are willing to pay more for a perceived product benefit. The over the counter hayfever remedies sold account for around 5% of the total market. Written by Rob Wood, MPSI, MRPharmS DHPH, Superintendent Pharmacist, Cara Pharmacy Group
Preparation in the group involves product review based on sales and margin performance to assign position on shelf or de-listing. New Product Development review is completed in February so that we can align our salesplan with supplier funded counter top displays and marketing campaigns. Although we have an internal medicines course dealing with hayfever, our group always launches a refresher for healthcare colleagues to keep up to date with the provision of correct evidence based advice. The update includes any new products and services we plan to offer in the season. Social media links in for the season launch and with signposting to blogs and an advice drumbeat for the season. The operational platform in terms of attractive merchandising and timely replenishment are key. Pharmacy has always been one of the first ports of call for relief of symptoms by customers and patients, however this year saw the season coincide to some degree with lockdown conditions imposed by the Coronavirus Pandemic situation. Patients do not often need to visit a GP to resolve their symptoms, a small amount of trial-and-error with their pharmacist will result in satisfactory outcomes with minimal cost. Most healthcare professionals agree that the condition is suited to self-care. Around 40% of patients per hayfever season will switch
medications in an effort to find effective relief. Whilst pharmacists will always refer patients for extra care when appropriate, we saw a deluge of patients either not able or not willing to attend their GP as the perceived benefit of a consultation did not outweigh the perceived risks of visiting a primary care setting in the minds of the public. One of the things to be mindful of is the potential that our recommendation may not work as expected and if there is a visit to the GP, obviously we would want to hope that a relationship built with the customer during over the counter consultations would make us the first choice for dispensing the prescription. Our focus is on recommending appropriate pharmacy only products to keep the customer in sector and highlighting the advantage of a bespoke healthcare solution that only pharmacy can offer as a USP above and beyond the supermarket shelf. Demonstrating active care for our customers in a conversational manner, providing all the advice they need and ensuring the leave happy with inspiration to return cannot be matched by other retailers. After some potential reluctance to self-treat or present at a pharmacy to seek advice, the profession rallied behind social media posts attempting to educate our patients on the sometimes subtle differences between COVID-19 symptoms and hayfever. As the
global health community learnt more about the distinctions of the disease, pharmacists were able to offer advice and products to patients with confidence. Weâ€™ve now seen patients returning to pharmacies with confidence in our services and procedures, as we remained steadfast in the face of unprecedented circumstances during lockdown. Consumers now seem to be more open to the use of multiple products to give effective relief or demand tailored, personal healthcare solutions bespoke to their needs. This trend of increasing basket size in the category is driven by customers no longer putting up with less than complete relief. It is not uncommon for the goal posts to move for patients during a season and they often need reassessment at intervals to optimise their treatment. As mentioned, the season tends to arrive predictably enough, however there do seem to be anecdotally more new sufferers each season and patients experiencing worsening of symptoms season on season. The evidence base is building in terms of indicating a proliferation of symptoms going forward. Global warming, poorer air quality and enhanced hygiene conditions compared to recent history are all pointing towards an environment where allergy and hayfever will only become more prevalent. Natural products, non-drug treatments and medical devices
are continually added to the category and continue to perform well when explained and offered as part of a total solution for patients. Saline rinses in particular have seen exceptional growth year on year. Our group aims to partner with patients to explore what is right for them, rather than presume that a customer will only want one product that may not give complete symptom control. Air purifiers and humidifiers also performed strongly this season, although this may have been due to a perceived benefit for Coronavirus for customers rather than allergy relief. The addition of triamcinolone to the over the counter formulary has helped with an enhanced offer, although customers retain a preference for more established ingredients. Our group sales show strong performance for Irish brands. Not only in licenced medicines, but also in related products as the value perception is strong with customers. All pharmacies are keen to offer customers value for money and so we would expect to see first line oral antihistamines from Irish manufacturers feature prominently across the sector. The major factors for the growth of the allergy treatment market include the increasing burden of various types of allergies, increased investment by the manufacturers on the development of novel allergic treatments and rising importance for selfmedication. The future for the category is bright.
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e in ยนCetrine Allergy7 1mg/ml Oral Solution, and available in 200ml bottle and launched 28 in November 2019. Cetrine Allergy 10mg FCT available in 7 and 30 packs, Lorat 10mg Tablets available in 7 and 28 C packs, or Rhinex Relief 50 micrograms/actuation to Nasal report spray, suspension, available as 1 x 60 doses. Medicinal products not subject to medical prescription. For further information, SPC or to report CF adverse drug reactions, No: contact the Marketing Authorisation 22863 Holder: Rowex Ltd., Bantry, Co. Cork. Ireland. Freephone: 1800 304 400. Fax: 027-50417. Date of preparation: (01-20) CCF No: 22863
Top 100: Sexual Health
Category Focus: Sexual Health With greater access to contraception now open for consultation by the HSE, and the recent news that PrEP is to be made available through community pharmacy in Ireland, it is becoming more apparent that pharmacists have a crucial role to play in the area of Sexual Health. Play it Safe The HSE Sexual Health and Crisis Pregnancy Programme (SHCPP), HSE Health and Wellbeing, has launched a new sexual health campaign in partnership with the Irish Pharmacy Union (IPU). The aim of the campaign is to provide young adults with access to helpful information to support them in safeguarding their sexual health and wellbeing during the coronavirus pandemic. The campaign involves making sexual health protection packs available in pharmacies nationwide, which include an information leaflet and a free HSE condom.
Community pharmacy has, for many years, been involved in providing support for sexual health, selling products ranging from condoms, lubricants, emergency hormonal contraception (EHC), sanitary goods, pregnancy and ovulation tests, herbal supplements for the menopause, treatments for cystitis and thrush and, recently, Viagra for erectile dysfunction. This range of products and services is not available from any other single provider and so community pharmacy is wellplaced to position itself as a onestop shop for sexual health. Condoms offer the best protection from both an unplanned pregnancy and sexually transmitted infections (STIs). Encouraging use of condoms is of utmost importance and can be promoted by listing their advantages: 1. Many contain lubricant 2. 92-98% effective 3. Prevention of STI’s 4. Only contraception males have control of
5. Females can be prepared and carry them also If a customer knows or suspects that a condom has failed, they can access services at their local pharmacy to find out if this has happened and/or what the consequences may be. These (obviously) include the sale of pregnancy tests and similar products. However, customers can also access STI screening and detection services at some Irish pharmacies. Screening for common STIs is offered by companies such as Let’s Get Checked. Emergency contraception is a safe, effective and responsible method of preventing pregnancy when regular contraception has failed, no contraception was used, and/or in the case of sexual assault. For those who act quickly, emergency contraception will usually prevent pregnancy. Emergency contraception will not prevent someone from getting a sexually transmitted infection (STI). The main brand of the ulipristal ECP in Ireland is ellaOne. This pill is available from pharmacies without a prescription. It must be taken within 120 hours (5
days) of unprotected sex but is most effective the sooner it is taken. The IPU protocol supports the ulipristal ECP (ellaOne) as being more effective than the levonorgestrel ECP. It’s important to remember that its best not to assume anything about the patient when they approach the pharmacy for advice on sexual health. A person who is asking for information may not be sexually active and just want to be better informed. A person may not already know all the facts. Being prepared to go back to basics and giving information in stages ensures you give a patient time to ask questions about what you have said and clarify any areas of misunderstanding. It can be hard to reduce a whole conversation about sexual health into a 30-second-over-the-counter chat. It is much more beneficial if consultations can take place in an appropriately confidential space if possible. This helps to build up a trusting relationship with the patient as confidentiality is a priority when accessing sexual health services in any setting.
The leaflet contains information on how to reduce the risk of coronavirus if sexually active and when to consider avoiding sex; contraception, emergency hormonal contraception and condoms; STI testing; PrEP and PEP; and the importance of sexual consent. The leaflet directs people to www. sexualwellbeing.ie for further information, and advises that they speak to their pharmacist if they have any queries about their sexual health. The campaign is supported by social media messages. Speaking ahead of the launch Darragh O’Loughlin, IPU Secretary General, said “Pharmacies are an important frontline point of contact for the public and a place where people can get accurate information about the management of their healthcare, and prevention and treatment of illness. The convenience and accessibility offered by community pharmacies is hugely valuable in helping to provide sexual health information and supports. Over a third of 18-30 year olds named pharmacies as somewhere they would like to receive sexual health information, according to research carried out in December 2019. Thus pharmacies are ideally placed in the community to support this campaign”.
Top 100: Beauty
Category Focus: Beauty The outbreak of COVID-19 in Q1 of 2020 in Ireland saw consumers across the country social distancing, with many working and staying at home, impacting buying behaviours for beauty and personal care goods. These changing consumer behaviours are expected to impact overall growth negatively for beauty and personal care in 2020, especially in areas focused on appearance. vitamins and minerals, is required for healthy skin, more and more people are using beauty supplements (nutraceuticals) to help add further benefit. VITAMINS (A, C& E) – it’s widely knownthat vitamins are good for general health. But it’s worth stressing how important these Vitamins A, C, and E are for skin health. • Vitamin A increases cell reproduction and stimulates collagen production. • Vitamin C helps prevent damage to cells, thus facilitating the production of elastin and collagen. • Vitamin E is an antioxidant that protects skin cells and helps maintain moisture.
Beauty and personal care performed positively in Ireland in 2019, with all areas posting solid value growth. Sun care saw the strongest growth, driven by consumers growing awareness of the dangers of the sun, and the benefits of sun protection products. In Ireland, beauty and personal care continued to be led by L’Oréal in 2019, which benefits from its well-established brands, that have recognisable names, established consumer trust and loyalty. In 2019, the player led hair care, skin care and sun care, offering established brands such as Elvive, Garnier, Vichy, La Roche-Posay and Kérastase. The impact of COVID-19 is expected to record a decline in growth for beauty and personal care in 2020. This decline will be recorded by both premium and mass products, with growth expected to decline for items related to appearances, such as colour cosmetics, or high expense, such as fragrances. Physical appearance is very important for many people, and
skin complaints can have a significant impact on confidence. Problems such as ageing, dry and sun damaged skin tend to be very visible and can have a significant impact on confidence and lifestyle. When thinking of ways to address your customers’ skin issues an initial recommendation may be to try a range of topical creams and lotions.
allows the body to produce vitamin D. However, skin is vulnerable to photoageing and damage from overexposure to the sun and excessive exposure to UV carries health risks, including atrophy, pigmentary changes and wrinkling. Ultraviolet B (UVB) is the primary component of sunlight that causes sunburn as well as UV light from tanning beds.
As experts and trusted advisors to your customers it could enhance their experience to also advocate the use of supplements that can target specific beauty concerns, supporting the health and balance of the complexion from the inside out.
The skin is the largest organ of the human body, accounting for approximately 16% of total body weight. Skin is organised into two primary layers; the epidermis and the dermis, and plays a key role in protecting the body from the environmental threats including smoking, sun exposure and pollution. Sun-damaged Skin Sun exposure is important as it
Atopic dermatitis (AD), commonly known as eczema, is an inflammatory condition characterised by skin dryness and intense itching. AD is associated with a reduction in the barrier function of the epidermis, and impacts up to 20% of children and 3% of adults. Factors that can contribute to dry skin include the weather, chemicals and cosmetics. There are several specific nutritional supplements available through pharmacy which can support beauty from the inside out, in addition to the usual skin creams and topical lotions. While a healthy, balanced diet, which includes plenty of essential
Coenzyme Q10- commonly referred to as CoQ10, this antioxidant helps get rid of free radicals and other toxins in the body. Thus, it has the effect of promoting healthy skin and allowing the body to make as much collagen as possible. Biotin -an essential B vitamin, also known as vitamin B7, that helps promote healthy skin, as well as healthy nails and hair. Researchers also think that Biotin works to reduce the death of skin cells. Biotin is found in foods like cheese, beans, eggs, and leafy greens. People can add more of these foods to their diet to ensure they’re getting plenty of Biotin, or can take a tablet as a supplement. Hyaluronic acid – also known as sodium hyaluronate, has strong moisture-retaining properties, which benefits healthy skin. While this compound is an ingredient in many creams and serums, there’s little evidence to suggest hyaluronic acid is effective when applied topically. It’s best to ingest an oral tablet to receive maximum benefits from this skin supplement. Brian Kearney is OTC Pharmacy Manager with McCauley Health & Beauty Pharmacy in Tralee
Top 100: Women's Health
Category Focus: Women’s Health By virtue of their patient access, community pharmacists can provide front-line health education and screenings to female patients. Pharmacists can identify women at increased risk for various diseases and help in early detection of disease. Women form the majority of community pharmacy’s customer base, but can more be done to help them navigate the shelves and find the products they need? Statistics show that women are more likely to use primary care services than men: not only do they visit a GP on average six times per year compared with four visits for men, but they are much more familiar with the inside of a pharmacy, too – an average of 18 visits per year compared with men’s four. Many women’s health problems are still seen as embarrassing to discuss, and although brands are trying to reduce the embarrassment factor of purchasing items such as incontinence products, it’s vital that pharmacy staff are sensitive, and trained to look for ‘tell-tale’ signs of conditions that women might feel reluctant to talk about. Creating a ‘Women’s Zone’ in the GSL section of the pharmacy is one way pharmacies can increase visibility and footfall to women’s health product areas, suggests the brand team for Canesten, increasing visibility and driving sales for products. New research* from Boots Ireland reveals that over half (51%) of women in Ireland have
Boots Pharmacist Heather Feeney
experienced the symptoms of cystitis or another form of a urinary tract infection (UTI) before. The primary symptoms that prompt women in Ireland to seek medical advice are feeling pain, burning or stinging sensations when urinating (78%), urine containing traces of blood (71%) or needing to urinate frequently and urgently, but only passing small amounts of urine (57%). Almost 1 in 5 (19%) of the women surveyed claim to develop symptoms of cystitis or a UTI at least twice a year, particularly those aged 18-34 (35%), and while the vast majority of women (90%) are comfortable visiting their GP for the diagnosis and treatment of cystitis or UTI’s, 2 in 5 (40%) have had time off work to attend a medical appointment, which is inconvenient and costly. Boots Ireland have recently announced the launch of the Velieve Cystitis Test & Treat service – an innovative private service that includes a urine self-testing kit and an app from Healthy.io, which turns a smartphone camera into a clinical grade analyser (compatible smartphone required), to help customers quickly test
for a possible urinary tract infection (UTI) from the comfort of their own homes. Once the urine dipstick test is complete, the test will be reviewed by a healthcare professional and, if appropriate, a prescription for an antibiotic will be issued. Boots Pharmacist, Heather Feeney says, “There is a growing need to use technology to diagnose a variety of medical issues, particularly in light of Covid-19, in order to help reduce some pressure on GPs and the wider health system. Mild cases of cystitis may clear up on their own within a few days, but some cases may need treatment. The introduction of this service shows the enhanced role that community pharmacies can play, while also highlighting the excellent clinical skills our pharmacists can offer to support patients’ health in locations and at times that are convenient to them.” “Our research revealed that there is a strong appetite for an alternative service to diagnose cystitis or a
UTI, with just over 7 in 10 (73%) women aged 18+ showing an interest in attending a pharmacy or using an app. We encourage women who regularly experience cystitis or UTI’s to visit their local Boots or Boots.ie for more information,” continued Feeney. The Velieve Cystitis Test & Treat service is currently exclusive to Boots amongst retailers and costs ¤35 for the test kit, a review of the test by a medical doctor via the Velieve app and a prescription, if required, and excludes treatment. See Notes to Editor for more information on the customer journey. Velieve is the second UTI testand-treat service created by Healthy.io and uses a smartphone camera and machine learning to help test for UTIs in just minutes. The company launched its pharmacy first test-and-treat service with Boots in 2019. Healthy.io, established in 2013 by Yonatan Adiri, has pioneered the transformation of the smartphone camera into a medical device.
Top 100: Gut Health
Category Focus: Gut and Digestive Health Products promoting good gut health have been a constant feature on the shelves of the CarePlus Pharmacy network since the first outlet opened its doors over five years ago. CarePlus Pharmacists are trained to advise on some of the top tips for gut health
"We take a holistic approach to health and that’s reflected in how we guide our customers to the right kind of care for them" Since then, a range of factors have prompted rapid growth in the area and digestive health is now a pillar within CarePlus Pharmacy’s Vitamin and Mineral Supplement (VMS) category. CarePlus Pharmacy figures for 2019 show growth of nearly 50 per cent in probiotic sales units compared to 2018. This year, despite the massive upheaval in the economy, CarePlus Pharmacies are still on track to record a growth in sales of the products. It’s clear to see gut health is becoming a permanent consideration for customers. It’s understandable, given the stream of scientific evidence that’s pointing to the potential benefits of probiotics. Experts believe the digestive tract - which can weigh up to 4lbs, makes up over 70% of the immune system. The gut has also earned a reputation as ‘the second brain’, because bacteria may be able to influence our behaviour via the 100 million neurons present in there. And as the bank of research on gut health grows, so does the value of the market. Before the pandemic hit, some estimates
predicted the digestive enzymes market would be valued at over $1.2bn by 2026. Whether you’re one of the estimated 20,000 people in Ireland who suffer from Irritable Bowel Syndrome or are looking to make small changes in the area of digestive health, there is a well-developed range of products for you. Siobhán Kellett is well-positioned to assess the feedback from Pharmacists and customers in her role as Health and Wellness Manager at the Navi Group, CarePlus Pharmacy's parent. She says: “The message I’m getting is that probiotic products are really popular with our customers. Working with our community Pharmacists they can select the right one for their symptoms, and thanks to our range, the right one for their budget too. We offer several well known brands that would vary in price from the premium level of about ¤100 for a month’s supply, right down to ¤20 - ¤30.” Sinead Mullins is a Pharmacist at CarePlus Pharmacy, Salthill County Galway. She’s been taking probiotics herself for 20 years and believes they have something
to offer most people: “I’ve been recommending them to people for so long now that customers come in saying ‘I hear you’re the woman to talk to about probiotics’! They can be a great help for all kinds of digestive concerns including IBS, diarrhoea, tummy bugs, indigestion and problems people might not expect too, like eczema and other atopic conditions. If a customer comes in and asks about probiotics I’ll have a good chat with them about any existing conditions and medication they’re on before discussing the right kind of product to suit them. It’s amazing that when you ask people how they’re feeling, they might say ‘I’m fine’, but when you delve in, they might say bloating’s an issue, or heartburn, something they don’t see as a major problem. Also I’m a big believer in prevention being better than a cure, and if probiotics can help these issues, why not give them a try?” Sinead says people need to understand that taking a probiotic is not a quick fix: “It can take a really long time to get your gut flora back in order - even after one course of antibiotics - and these
kinds of products work gently to achieve that. It’s not like a painkiller that switches something off straightaway”. Of course, a healthy diet is crucial to good gut health. CarePlus Pharmacists are also trained to advise on some of the top tips for this, including recommendations around fibre, hydration, meat and alcohol intake, vitamin-rich foods, exercise, stress and sleep, as well as pre- and probiotics. Siobhán Kellett says the brand’s commitment to digestive health symbolises CarePlus Pharmacy’s overall approach: “As a network of more than 60 community Pharmacies around the country, we focus on a clear goal: to empower people to lead healthy and happy lives. We take a holistic approach to health and that’s reflected in how we guide our customers to the right kind of care for them. We’re always listening to our Pharmacists and customers and we’re proud to offer a range of digestive health options that our Pharmacists understand and we know our customers trust them to give the best advice.”
AWARD WINNING IRISH
SUPER SUPPLEMENT 26 ACTIVE INGREDIENTS*
Revive Active supports energy, immune system and a healthy heart. Enriched with CoQ10 and L-Arginine.
As voted by the Retail Pharmacies of Ireland 2020
Revive Active contains 8 active ingredients that contribute to the normal function of the immune system - Zinc, Copper, Folic Acid, Selenium, Vitamins B12, B6, C, and D.
Call: 091 769803 | Email: firstname.lastname@example.org | Web: reviveactive.com
Top 100: VMS
Vitamins Performance during Covid-19 The unprecedented events of the past few months have changed the face of community pharmacy in Ireland. With over 80 branches across the country, totalhealth has seen the impact on many different types of pharmacy businesses, from high-street locations to community-based stores. Written by Naomi O'Farrell, Marketing and Communications Manager, totalhealth Pharmacy Group
The overall trends in retail pharmacy have been very much a mixed bag. While some pharmacies reflected results experienced in many retail sectors - declining sales and reduced footfall - other pharmacy locations have maintained good retail sales by adapting their merchandising and product offering. All pharmacies have had to deal with increased investment in protective equipment along with dramatically changing consumer behaviour. Despite the crisis, pharmacies across the country kept their doors open and their patients and customers looked after. Continuing to provide for patient needs has required significant changes to our ways of working, with each other and with those who visit the pharmacy. To minimise risk to our staff and patients, various steps were taken, including refitting pharmacies with protective barriers and screens, reducing stock-holding on the shop floor to allow for safe movement of customers and staff, and limiting the number of customers in the pharmacy at any one time. This obviously led to a reduction in browsing, impulse-purchases and customer self-selection. Key to our strategy in protecting sales while continuing to meet consumersâ€™ needs was supporting our pharmacies with category management, product placement, customer communications, point of sale, and social media activity.
Pharmacy teams worked hard to ensure customers and patients could obtain the products they needed and wanted, despite the restrictions in browsing. Continuous refreshment of windows, signage and product-focus areas was essential throughout the lockdown. The changing needs of customers and patients of course required the sourcing of new products with extremely short time-lines. In the early days of the Covid-19 crisis, demand rocketed for infection-prevention products, which totalhealth moved quickly to source for our members. Pharmacy teams were challenged with stockpiling and wholesaler disruptions. Despite difficult GSL sales, sales of OTC products grew during the first months of the pandemic, with increases on last year of as much as 40% in some areas. Some of the strongest performances, however, have been seen in the vitamins and supplements categories. With the immense amount of media being circulated and consumed, customers were no doubt influenced by the various reports of supplements theorised to increase protection against Covid-19. Demand for immune-support products increased dramatically, originally centred around vitamin C, zinc, and probiotics, but expanding to products with anti-viral claims, like the A. Vogel range and Sambucol.
Sales of vitamin D products also grew rapidly, potentially due to increased time being spent indoors. Such sales spiked in March and April, and while some brands encountered out-of-stocks due to increased demand, other suppliers were able to fill the gap. totalhealth realised early that flexibility in supply options was essential to ensure a continuous service to the consumer. Complications due to wholesaler restrictions meant that suppliers who were able to deliver direct to pharmacy picked up new business. While sales of immune-related products boomed, alongside the PPE-driven categories, other sub-sections of the vitamins and supplements category suffered. With virtually no customers flying, sitting exams, completing driving tests, or commuting to work, sales of sleep, stress and travel products declined. Despite the good weather early in the crisis, sun care sales were flat with only a small number of brands showing good performances. An early hay fever season didnâ€™t prevent a hit to sales of allergy products in early March and April, though this category has rebounded well in more recent months. Interestingly, digestive aids, including products like BioKult and Alflorex, have performed well during the crisis, potentially due to the established links between gut health and overall immunity.
As the country opens back up and people gradually return to work, several products supporting energy and immunity standout, including Revive and Pharmaton among others. May and June have seen ranges return to full stock as pharmacies returned layouts and stock-holding to a new normal. Consumer stockpiling has slowed and sales in some early booming categories have begun to return to near-normal. totalhealth pharmacies have performed extremely well during this crisis by responding quickly to changing restrictions while ensuring ease of access for customers. totalhealth members were supported with local demands by a reactive support office team, willing to source new lines quickly and regularly. Pharmacy teams were able to provide the necessary flexibility to customers and patients in the form of adapted opening hours, increased ordering options and delivery services, meaning footfall and overall sales have held up well. The challenge of managing our pharmacies in a way that is respectful to the safety and wellbeing of staff and customers was achieved, by offering the same, great customer service and access to pharmacist expertise while minimising risk, and this shows in the feedback from our patients and in our business results.
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for Generics As one of the Leading Generic supplier in Ireland, we are proud to offer the medical community throughout the country the choice to prescribe and dispense quality generic treatments. In doing so, we are working with you to help your patients benefit from quality and cost-effective medications. With over 40 years manufacturing healthcare products in Ireland, Pinewood Healthcare is one of the largest generic suppliers with a workforce of over 340 people. We are always committed to providing the Irish market with quality brands at inexpensive prices.
to all the frontline staff during COVID -19 WASH YOUR HANDS â€˘ STAY SAFE
Time to Refocus on the OTC Sector? #COVID19 #CPD #OTC #WeAreAllInThisTogether IPN’s Pharmacy Business Excellence Series is for community pharmacists committed to growing their professional and business knowledge and skills to overcome challenges and thrive as a community pharmacist. IPN is proud to partner with 4Front Pharmacy to bring you the ‘IPN/4Front Pharmacy Business Excellence Series.’ Our goal for you and your team is that you develop the knowledge, skill and the courage to embrace your challenges and opportunities, take the necessary leaps of faith to reap the rewards as you commit to pharmacy business excellence. Each month, Rachel Dungan poses strategic questions aligned with 4Front’s 6Ps of Pharmacy Excellence Framework. She shares best practice tips, insights from pharmacy leaders and showcases examples of pharmacy business excellence in action. LEARNING OUTCOMES
At the end of article, you will be able to… • Review five strategies to increase the performance of OTC Medicines, Pharmacy Consultations and Front Of Shop • Evaluate five Key Performance Indicators relating to Front Of Shop • Prioritise areas of focus for the next 90 days • Record your learning as CPD in your ePortfolio 60 SECOND SUMMARY:
2020 has been a time of unprecedented change – socially, economically, in education and in health. No person, or area of pharmacy practice is exempt. It is said that times of unprecedented change provide unprecedented opportunities for growth. But, in order to glean the learning to grow, (and not repeat the mistakes of the past) it helps to strategically reflect on and record what we have learned, so that we can join the dots and use those insights to create growth opportunities. As luck would have it, along with 20% of my pharmacist colleagues, I have been selected for the 2020/2021 ePortfolio Review. CPD is a reflective process and as I reflect on my career, I realise change has been a central feature, and a prominent driver of my growth and development. Early in my career, I learned the value and importance of 1. OTC Medicines, 2. Pharmacy Consultations and 3. Front Of Shop (FOS) presentation as core professionals activities. COVID19 has demonstrated how central these three are as professional and business drivers. It has also raised questions which highlight the need to adapt our practice to remain relevant in the new reality. In this article, you will receive CPD and business strategy tips from pharmacist coach Rachel Dungan MPSI. You will examine strategies for evaluating and growing your pharmacy business. Finally, you will review a sample CPD Cycle to use as inspiration to take action and record the impact in your own CPD Cycle in your ePortfolio. Share your successes and submit your questions for the IPN/4Front Pharmacy Business Excellence Series to Rachel. Dungan@4FrontPharmacy.ie
PHARMACY BUSINESS TIPS As an adventure seeking young pharmacy graduate, I spent the summer of 1995, on a pharmacy student exchange in South Africa’s winter. Then, as now, was a time of unprecedented change. Looking back, I realise that many of the issues we face in pharmacy practice today, I first faced working in Johannesburg General Hospital Pharmacy Department. Among other things, we faced 1. product shortages 2. a public health crisis (HIV and AIDS) 3. pharmacy consultation challenges and medication safety issues exacerbated by poor health literacy, social injustice and inequality. Product Shortages That summer, I gained shocking insights into the role of finances, purchasing, supply chain, stock management and shrinkage on pharmacy services (and on the entire hospital). Severely curtailed budgets meant that pharmacists had to optimise stock turn and cash-flow in order to assure continued supply of critical medicines.
Public Health Crisis That summer, I experienced the life-saving impact of educating the entire pharmacy team to focus together on key public health messages. ‘Safe sex’ messages provoked lively debate within the pharmacy department, as myths and conspiracy theories were challenged. I learned the immense value of productive conflict. By learning together, it caused otherwise hidden differences to come to the surface, get clarified and reach common ground. Pharmacy Consultations Finally, it was in South Africa, I first truly appreciated the privilege of my education as a pharmacist and became aware of the seismic gap between the education I had taken for granted and the health literacy and numeracy of many of my co-workers and patients. The education gap was compounded by a language barrier, which made pharmacy consultations even more challenging. So how do we translate these 20th century learnings, on a different continent, into a 21st century context?
Business CPD 5. What is the revenue per square metre? This measure helps you to identify the highest and lowest revenue areas of the shop, as it will vary throughout the pharmacy. Remerchandising stock regularly creates a ‘new’ feel in the store. Aim to regularly de-clutter slow moving stock, create more space in the pharmacy, and improve the customer’s shopping experience,. 4FrontPharmacy Mastermind Members have access to webinar trainings on business and leadership topics. LESSON 2: CONVEY CLEAR AND SIMPLE PUBLIC HEALTH MESSAGES
LESSON 1: KNOW YOUR NUMBERS As the saying goes ‘Turnover is vanity. Profit is sanity. Cash is king’. I hadn’t joined the dots between financial management and patient care, until my stint in South Africa. Recent changes due to COVID19 remind us of how closely related finance and patient care truly are. I now wonder if it possible to be a competent pharmacist without having good financial management skills? Altered customer behaviour and supply chain issues affect budgets and cashflow, unless well managed, the challenges can result in key accounts being put ‘on hold,’ drastically affecting service. According to Pareto’s rule, 80% of your sales come from 20% of your stock. . It is therefore vital that you know your numbers and prioritise key products and services so that your business remains profitable, doesn’t run out of cash and has money to invest in emergent opportunities. A monthly meeting with your financial team to review your management accounts
(book-keeper, financial controller and accountant) helps you make timely and informed financial decisions, especially in volatile times.
delivery van..? Have staff costs changed?
Ask yourself, are the following key numbers increasing, decreasing or staying the same? Identify reasons for any changes, so that you can take prompt action.
For example: Shortages of key lines may decrease stock holding, but also reduces sales opportunities. Increased stock holding may indicate a fall in sales, without an aligned reduction in purchases. You don’t have elastic shelves, so if you need to add a product, which product(s) will it replace?
1. What is my revenue per prescription item? For example: This sales indicator is impacted by both Front Of Shop (FOS) and dispensary factors, and is an excellent guide to overall team performance. Examples of dispensary behaviours that may impact this number include claiming accuracy, pharmacist recommendations and pricing policy. Examples of FOS behaviours that impact this number include visual merchandising, stock shortages, point-of-sales signage and the quality of pharmacy consultations. 2. How have my expenses been impacted by COVID? Have you increased capital expenditure such as signage,
3. What is my current stock holding by department?
4. What is my stock turn in each department? Any decrease in stock turn means that more cash is tied up in stock. This cash is unavailable until the stock is sold. For example: If you buy 20 boxes of an OTC product for ¤5 on 30 day credit terms, assuming a 50% mark-up, you will need to have sold 14 boxes in 30 days just to pay the supplier within 30 day credit terms. This equates to a stock turn of 8.4 (the stock of that item is completely replaced 8.4 times per year). Reviewing your stock holding to optimise stock turn, is an ongoing process.
It is not enough to rely on posters and leaflets. It saves time, energy and reduces frustrating misinformation to ensure all staff receive training about the core messages, so that everyone has foundational knowledge. Pharmacists should regularly engage every staff member in debate around key public health topics such as COVID, PPE, flu vaccination for healthcare workers, sun health or appropriate use of analgesics. In South Africa, it was the lively debates around the public health messages at the time that highlighted just how different staff’s opinions initially were. If you do not engage, you risk your staff inadvertently sending mixed messages to patients, family and friends, based on personal opinion rather that evidence based healthcare advice. The risk here is that because they work in your pharmacy, their opinion holds more credibility than if they did not work in a healthcare facility. In addition mixed messages cause confusion and reduce the credibility of the entire team and risks damaging the health of patients. 4FrontPharmacy Members have access to a range of on-demand modules to educate all pharmacy staff on Public Health Topics such as COVID, Vaccination and Infection Control. LESSON 3: MAKE IT EASY FOR YOUR CUSTOMER TO FIND WHAT THEY NEED The number one initiative that summer was focused on improving the quality of pharmacy consultations, with non-pharmacist staff stepping into roles as translators to help overcome language barriers. In 2020, we must overcome additional communication barriers – this time caused by fear, masks and social distancing.
63 What are some ways to increase engagement and reduce barriers? 1. First Impressions Count Review the front of your pharmacy as if for the first time. Despite COVID19 restrictions, does your pharmacy appear clean and welcoming? Is your window display relevant, creative and draw your attention? Are all messages clear and consistent? 2. Keep it Simple Silly (KISS) When you enter the pharmacy, does it appear clean, inviting and uncluttered? This is where analyzing your numbers can help you to get the balance right between having sufficient choice for customers, without cluttering the pharmacy with stock that reduces the visual appeal, ties up cash flow and confuses your customer. Be consistent and relevant. For example: Ensure that any ‘hot spots’ inside the store relate to your window display. Ensure there is room for movement, while social distancing. A well-lit pharmacy, with unambiguous signage and empty space has commercial and health benefits. 3. Online Presence – Website and Social Media Many of your customers remain sheltering at home. Much of the product research they do, advice they seek and products they purchase, are sourced on the internet. In order to meet our customers where they are (at home), your social media and website presence is a key communication tool and sales channel, as is your phone! Again, KISS principles apply. Be consistent. Ensure your social media posts relate to your window display, ‘hot spots’ in store, and that your staff have received recent training on the products and services on offer that month.
staff member. A perceived lack of competence can increase fear, doubt and uncertainty in customers who are already due to COVID19. Ensure every member of the team demonstrates exceptional product knowledge in pharmacy consultations. It conveys confidence, credibility and trust, protects patient safety and results in increased sales and margin. 4FrontPharmacy Members have access to a range of on-demand modules to educate all pharmacy staff on OTC Medicines and the conditions they treat. LESSON 5: NEVER ASSUME OTHERS KNOW WHAT YOU DO In healthcare, ASSUME not only makes an ASS of U and Me. It causes miscommunication, errors and even fatalities. But, by their nature, assumptions are very difficult to catch. The more expert and experienced you become, the harder it is to imagine what it is like for your customers. For example, when I ask students who are just beginning on a Pharmacy Retail Skills Programme, what the ingredients in Lemsip are, somewhere between 70% and 80% do not know that paracetamol is an ingredient in Lemsip. It is so easy to assume others know what we take for granted, especially in our area of subject matter expertise. A fresh pair of eyes is often required to illuminate what has been hidden in plain view, to help us to raise the bar in our pharmacy consultations. Position your value as ‘A Medicine Expert’ to your customers, in a way that is clear, consistent and value-driven. You continue to be at the frontline, supplying essential medicines and pharmaceutical care in a time of heightened fear, high demand but low footfall. How can you position your pharmacy at the front of each customer’s mind, so that they buy their Vaccinations,
Prescriptions, OTC Medicines, Vitamins, First Aid and Skincare products from you? 4FrontPharmacy offers an on-site Pharmacy Assessment Service as a done-with-you compliance tool as a well a fresh set of eyes on pharmacy management and consultation, from a pharmacist’s and a customer’s perspective. So in summary what can you prioritise to maximize your impact? 1. Gather objective data to inform your decision making 2. Track any changes to measure their impact 3. Get the customer journey through your pharmacy (online and bricks and mortar) reviewed with a fresh pair of eyes. Use these insights to target how best to invest your time and effort so you can make a good pharmacy great. 4. If you delegate the sale and supply of OTC medicines to any other staff member, ensure that they receive ongoing staff training to gain and maintain competence. It makes sense from both a commercial and patient safety perspective. 5. Track and respond to how customer behaviour is changing in relation to different sales and communication channels, such as phone calls, deliveries, website, social media. Known as ‘The Pharmacist Coach,’ Rachel Dungan co-founded 4FrontPharmacy Online, a leading edge, online membership platform, designed by pharmacists, for pharmacists and their teams, so that they can continually improve the quality of pharmacy–patient interactions. Created with cofounder and healthcare e-learning specialist David McLean, in consultation with pharmacy
clients, 4FrontPharmacy’s tailored online membership programmes empower pharmacists to do higher-value work, provide more patient consultations, build their people skills, delegate technical and administrative work, and support them to comply with regulations and demonstrate high patient safety standards. 4FrontPharmacy’s goal is to use their knowledge, skills and experience to grow a world-class, social enterprise, whose members raise the global standard of health. Inspired by Nelson Mandela’s belief that ‘Education is the most powerful weapon which you can use to change the world,’ 4FrontPharmacy believes that educating the entire pharmacy team to host effective pharmacy consultations, more than anything, has the power to transform healthcare and the lives of patients. Rachel is an ICF credentialed professional coach, a certified Professional Medical Coach (PMC), a Lifestyle Medicine Practitioner (European Lifestyle Medicine Organisation) and an award-winning executive and leadership coach. Experienced in developing professional online learning communities, she has held positions as Programme Coordinator for the Global Health and Wellness Coaching Community of Practice and facilitator at the World Business and Executive Coaching Summit. 4FrontPharmacy Online has been awarded ‘Best Educational Project in Pharmacy and General Practice’ at the Irish Healthcare Awards.
4FrontPharmacy Members have access to a range of on-demand modules to educate all pharmacy staff on using 4Front’s STEPS Consultation Framework. Enhanced and mastermind members have access to live online workshops, demos and Q&As on pharmacy consultation skills. LESSON 4: KNOW THE OTC MEDICINES YOU STOCK Now, more than ever, customers who phone your pharmacy or present in person want prompt care from a knowledgeable
Business CPD S
RESOURCE ANNOUNCEMENTS 1. For tips to help you solve problems, communicate more powerfully and get buy-in from your team, follow @4Front on Facebook and @4FrontPharmacy on Instagram and @4FrontPharmacy LinkedIn. 2. As an IPN reader, we invite you to register for FREE COVID19 Certified Online Training, go to www.4FrontPharmacy.ie. You can also browse our range of online programmes to support you and your team to develop your consultation skills this summer. 3. 4 FrontPharmacy will be hosting a series of online workshops specifically for pharmacy owners and their teams over the summer. Contact Rachel. Dungan@4FrontPharmacy.ie with expressions of interest or topic suggestions. AUTHOR: Rachel Dungan MPSI, ACC. Rachel Dungan MPSI, ACC. Community Pharmacist. Award-Winning Medical and Leadership Coach and CEO of www.4FrontPharmacy.ie. Known as ‘The Pharmacist Coach,’ Rachel worked for 20 years as a supervising and superintendent pharmacist. Now, more than ever, her vision is to empower, equip, enable and engage pharmacists and their teams with the knowledge and skills required to embrace the future. Since Mar 2020, 1173 pharmacy staff members have become COVID19 Certified. To register for FREE, go to www.4FrontPharmacy.ie
Self-Appraisal WHAT I intend to learn and why I have been called for ePortfolio Review this year. Having completed my Core Competency Self Assessment Tool (CCSAT), I have identified three key areas of focus for my CPD. These are in domain 4 (safety and rational use of medicines), 5 (public health) and 6 (organization and management skills),and specifically • 4.1.11 Effectively supervises non-pharmacist staff in relation to non- prescription medicines. • 5.2.1 Provides information, advice and education for patients and the public on health awareness, disease prevention and control, and healthy lifestyle and wellness. • 6.4.1 Demonstrates the ability to effectively analyse and manage financial data and budgetary information.
Personal Plan HOW I intend to learn it I plan to • 4. Observe OTC pharmacy consultations using Section 2 of the Pharmacy Assessment System to assess how consultations have been affected by COVID19 regulations. • 5. Enrol myself and my staff on 4FrontPharmacy’s Online COVID19 training, to ensure that the information, advice and education we provide patients is consistent with public health advice. • 6. Read business articles to help me to analyses and manage financial data better.
Action What I actually did • 4. I completed my Pharmacy Assessment System Review of OTC pharmacy consultations. • 5. We all enrolled on 4FrontPharmacy’s Online COVID19 training and completed the training. • 6. I read the business article in the IPN regarding ‘Knowing your numbers.’ As a result I met the book-keeper and accountant, with the pharmacy owner on Zoom to review our pharmacy’s business performance and the impact of COVID19. We agreed key performance indicators to track.
Document What I have learned specifically • 4. By reviewing the OTC consultations in the pharmacy, I realised how many OTC consultations are now conducted on the phone. I also noticed that both customers and staff seem more rushed and less present during the consultations resulting in poorer quality consultations. This is an area that needs renewed focus. • 5. After we had completed 4FrontPharmacy’s COVID training, I asked each staff member what was one thing they learned that surprised them. I was frankly surprised by the variety of answers. Despite working in a COVID environment for several months now, there were still surprising gaps in our individual and team knowledge. • 6. By reviewing my business financials, I now realise how important a focus on stock management is to protect cash flow. Adhering to purchasing budgets and growing OTC and FOS sales are key areas of focus for me.
Evaluate ONE example of how I put my learning into practice • 4. We have enrolled as members with 4Front Pharmacy Online Training to refocus on product knowledge and pharmacy consultations as a key professional and business driver. • 5. We have hired 4FrontPharmacy to conduct Pharmacy Assessment Review to assess the degree to which knowledge is transferred into practice. Our goal is to use these observations to demonstrate improve adherence to the PSI Practice Guidance on the Sale and Supply of Non-Prescription Medicines and Public Health Guidelines on COVID 19. • 6. Over the past three months, our revenue per prescription item has been slowly climbing, which is an encouraging sign of better performance in both the dispensary and front of shop. I now feel more confident in my financial management skills.
CCF Domains (and Competencies) The Pharmacist selected Competencies under the following domains for this CPD 1. Professional Practice (Engages in appropriate CPD), 4. Safe and Rational Use of Medicines,5. Public Health 6. Organisation and Management Skills. Contributed by Rachel Dungan MPSI of 4Front Pharmacy. To find out more about how 4Front Pharmacy’s ONLINE training can help you drive your sales, improve patient safety and engage with your patients and team, (even in a pandemic), email Rachel. Dungan@4FrontPharmacy.ie and use the subject line ‘IPN June 2020.’
in the ongoing battle against serious childhood diseases.
School Vaccinations Resume Uptake The HSE school vaccination teams have started contacting parents and guardians to offer vaccination appointments to students who are due 4 in 1 and MMR (Junior Infants) and HPV and MenACWY (1st year students) vaccines. Vaccinations in schools were put on hold due to Covid-19. In June of this year, the Pharmacy representative body, the Irish Pharmacy Union (IPU) repeated their previous call to allow pharmacists to administer flu vaccines in nursing homes and workplaces. In welcoming the announcement by the former Minister for Health, Simon Harris TD, to make the flu vaccine available to all children aged 2-12 and all at risk groups, they said it was a ‘step in the right direction.’ The news follows a recommendation by the IPU earlier for the flu vaccine to be made freely available to everyone who wants it during the coming flu season.
From September last year, secondary school children in firstyear are offered a meningococcal ACWY booster vaccination. The Meningococcal ACWY vaccine will boost children’s protection against group C meningococcal disease. It will also provide additional protection against meningococcal groups A, W and Y. In addition, this vaccine also reduces the risk of carrying the disease so can help protect other people too. MenACWY being used in Ireland is Nimenrix. This is a conjugate vaccine containing Group A, C, W and Y polysaccharides conjugated to tetanus toxoid carrier protein. The vaccine protects against N. meningitidis Groups A, C, W and Y invasive disease. Each year in Ireland about 400 people will be diagnosed with a cancer caused by the HPV virus. The HPV vaccine is endorsed by the Irish College of General Practitioners (ICGP), the Irish Pharmacy Union and the Irish Cancer Society’s HPV Alliance and by major medical and scientific bodies worldwide including the World Health Organization, the Centres for
Disease Control in the USA, the EU funded European Centre for Disease Control and Prevention and the International Federation of Obstetricians and Gynaecologists. Since 2015 more cases of invasive meningococcal serogroups W and Y disease have been seen in Ireland. Prior to 2015 the annual number of both serogroups was low. Between 1999 and 2014 there was an average of two cases for both serogroups reported per year. Between 2015 and 2018, a total of 36 serogroup W and 20 serogroup Y cases were reported, giving an average annual notification rate 9 cases per year of serogroup W and for 5 cases per year of serogroup Y. In view of the emergence of meningococcal serogroups W and Y, the National Immunisation Advisory Committee (NIAC) recommended that one dose of MenACWY vaccine should be given to all students in 1st year of second level education replacing the MenC vaccine in 2019. Meningococcal disease can start very suddenly. Symptoms include fever, stiff neck, headache, joint pains and a rash. Meningococcal disease can
occur at any age, but the highest rate occurs in children under 5 years of age, especially children under 1 year old. The next high-risk group are young people aged 15-19 years. Role of Pharmacy Community pharmacists are in a strong position to provide a major contribution to public health due to their accessibility, distribution and available medicines expertise. Pharmacists are also highly trusted healthcare professionals and can therefore significantly improve communication channels and provide public reassurance on product quality. Importantly for community pharmacists to be aware, they might have school children and/ or their parents presenting to the pharmacy with associated after effects. Some students can have an area of soreness, swelling and redness in their arm where the injection was given. This usually passes after a day or two. Some students may get a headache, feel sick in their tummy or run a slight temperature. If this happens, paracetamol or ibuprofen will help.
Commenting, IPU Secretary General Darragh O’ Loughlin said, “While we would have liked to see the scheme extended further, making the flu vaccination available to children aged 2-12 and to all at risk groups without charge is definitely a step in the right direction. It will help increase our capacity to combat seasonal flu and prevent it from overwhelming the health system during the winter.” Last year, over 1.1 million flu vaccines were delivered in Ireland, an increase of over 60% since pharmacies were first permitted to administer the vaccine a decade ago. Given that the convenience and availability of the vaccine has led to greater uptake, the IPU believes that pharmacists should be allowed to administer the vaccine to people in nursing homes and workplaces. “Every year there is a spike in hospital admissions due to people suffering from flu and related complications. We can and we should do much more to prevent this by making it easier for the vaccine to be offered to wider groups of people in a community setting. Increasing the locations where this is permitted to residential services and to workplaces would significantly increase uptake and help build a herd immunity. We can’t yet stop the coronavirus, but we can stop the flu,” concluded Mr O’Loughlin.
Influencing Change Strategy Leading effectively for impact and business results How information is communicated during change matters more than WHAT is being communicated to employees. A lack of focus on this key consideration or what we can call audience empathy when conveying news about organisational change can cause it to fail. We must work on understanding the culture or ‘audience’ to become effective leaders, who’s results are tangible. This understanding and reflection can make the difference between us being an effective leader, or not. The levels of a leader’s Emotional Intelligence can impact on a business organisation performance at every level. We must consider this as part of a process, not just at the ‘kick off’ of a change initiative. Consideration must be agile, to take in the changing needs and wants which can evolve during every phase of a journey. According to Goleman, the discovery is that certain things leaders do, specifically, exhibit empathy and become attuned to others’ mood can literally affect both their own brain chemistry and that of their followers. Thus, resulting in good business results and performance. This alone will not get us to the cultural change we want, while it is an important factor, we will also need to use tools and models of change Therefore, it was important for us to assess our own EI ; our
Self Awareness Emtional self awareness Accurate self awareness Self Confidence
Self Management Self Control Transparency Adaptability Achievement Drive Iniative
strengths and what we can get better at: Goleman nicely links EI with leadership when he said: “The best leaders don’t know just one style of leadership — they’re skilled at several and have the flexibility to switch between styles as the circumstances dictate.” This concept links us on to explore the Six leadership styles. We can explore these as we look to implement the strategy for change in our organisations. There are Six leadership styles come into effect in part of driving organisational change in this climate; thus, driving performance; which ultimately will drive our business.’ A key encouragement is harmony and inclusion and the ‘why’ behind the business goal. As we consider leadership styles, we can divide the six, four of which encourage harmony and inclusion, and the remaining two which could potentially create disharmony and conflict. To further break down the styles, for the main they are encouraging and create team harmony, however Figure 1: Golemans emotional intelligence model 2002
Social Awareness Empathy Organisational awareness Sercice Orientation
Relationship Management Inspirational Leadership Developing others Influence Change Catalyst Conflict Management Building Bonds Teamwork + Collaboration
Written by Muireann Ryan Business Leadership & Management Strategy & Change Transformation Facilitation pacesetting and coercive styles can lead to resentment, which we will explore in this article. The Coercive style – ‘do what I say’ This type of leadership can sometimes inhibit the organizations flexibility and dampen the motivation of employees. It can be very effective when working with employees who bring challenges however, as it is quite effective in turning around situation. Pacesetting Usually sets a challenge that high performers can achieve, and this can leave less competent people flagging behind and obviously potentially uncomfortable and dissatisfied, resulting in potential resentment. Coaching This style of leadership helps individuals improve their performance, rather than a focus on immediate work-related tasks. However, it can beneficially align employee goals with those of the organisation and works well with employees who want to improve any weaknesses and are open to change. Affiliative - ‘people come first’ Builds relationships and team harmony. This leadership style helps to deal with problem situations between teams. However, its focus on praise can allow under performance to go uncorrected. In addition, leaders with an affiliate orientation rarely offer advice which can leave employees in a dilemma. Democratic - ‘gives workers a voice’ This style can help to create buy-in or consensus by involving people, helping to build organizational flexibility. With this people will feel valued and allow generation of fresh ideas. On the flip side, this can sometimes lead to a team feeling leaderless.
With this style, leaders set challenges that high performers can achieve, which can have a positive impact on self-motivate employees. However, this can leave less competent people falling behind and potentially uncomfortable and dissatisfied or even feel overwhelmed with the demand for excellence. Authoritative - ‘come with me’ Here the leader sets the overall goal but allows people to work by their own means to achieve it. It is effective when a business is adrift, however if the leader is surrounded by more experienced experts it may be less effective. Using consideration on these styles, many leaders will already have established a connection, however an adoption of these styles to suit the various teams you may have to work across, be it in your larger organizations or the businesses you serve. This will allow behavioural influence on performance. It is crucial not to rely on one leadership style exclusively, as all will have various advantages, impact and indeed short term uses: resulting in an agile approach to leading your team, business and/or organisation. It is important as a leader or member of a leadership team
Leadership The self-reflective Emotional Intelligence will help us in leveraging or strengthening our Business performance capabilities.
Motivating Change Overcomig any resistance to change and creating readiness for change
Creating a Vision Construct the vision of the future and describing the Core Ideology
Developing Political Support Assessing the power of key change agents and the power available
Managing the Transition
Identifying Key stake holders
Committment and planning
The Management of structures
However, this reactive change was implemented to react to an acute demand for new ways of working. As a result, it is likely that an overarching vision needs to be established. For this we can look further into the Authoritative style. With the desire to do things differently with the changes we have faced in the last number of months; we need to communicate it throughout our organizations, going on a journey with clear vision. With this considered, we need to fire up enthusiasm, as there are also no doubt people in the organization who are doing things differently and effectively, positive deviants. We can work to help struggling groups in the organization see these people as the ‘go-to’ problem solvers. Because the innovators are peers, resistance will be easier to overcome. This is where the agility in the change management approach I will use is important; here we can allow the ‘community’ to take ownership of the quest for change; using a certain amount of Democratic leadership style – giving workers a voice. A key part of this which I consider also is making it safe to learn for employees. If we allow change to feel natural by introducing internally developed ideas and solutions, the change agent somewhat shares the DNA of the host. We confound the immune defence response; in the words of
Staying the course Building your support system (linking in with Developing Political Support) for your change agents Development of new competencies and behaviours; reinforcement of these new behaviours
Figure 2 that you identified a clear vision, and in turn that this is communicated effectively down. Following the transition to change and adaptation that Covid has brought to organisations, teams and employees have quickly transitioned or reacted to this environment.
Newton: Every action has an equal and opposite reaction. Driving performance and business growth To drive ambitious growth, we will need to have vibrant enthusiasm and clear vision. Step 1 will be to set a mission statement with the Senior Leadership Team or your board, and echo that through to the organization, in addition refresh their enthusiasm for working within the group | business and why they can be proud to do so. Leading Strategically with this style, the mission statement and values can be included on web page and marketing campaigns, growing your mission externally also. Seeking to address the culture in the organization across the group and continuing with strong strategic vision As business may have a keen focus on the strategic goals, this can fall subject to being overshadowed as operational tasks grow in number and importance, which has been the case in 2020 for many organisations. It is important that strategic thinking must continue, however. By setting a strong strategic vision and closely monitoring this vision, making it available and known, we will build support internally from our employees / teams and in turn hopefully our customers and clients, resulting in impactful business performance and ultimately growth. If we can instil a sense of wining together.
1. Soft tactics Consultation and collaboration, inspiration, personal appeals Use soft tactics in somewhat personal appeals, i.e. the ‘why’ behind the importance of certain tasks of Initiatives. There were some occasions where the harder tactics must be used and indeed a mix of rational and business arguments. 2. Hard tactics Pressure, forming coalitions or interest groups While this may not be your first style of leadership, it can be beneficial to use on occasion; with effective results. 3. Rational tactics Business arguments, rational persuasion, rewards, or incentives ; can work well in creating the ‘why’ Successful change; the necessary art of persuasion If we reflect on research which has been done, comparing successful change agents and persuaders to other people; we can look to use these typical approaches to persuasion in our business’. As pointed out in the article, ‘The necessary art of persuasion’ these are logical, straightforward, and ineffective. Beginning the influencing process Once we have mapped the network within our business / organisation / group, we can begin the influencing process by the following steps: 1. Establishing credibility
2. Framing for common ground
Three types of influencing tactics which can be used to address and influence change of value.
3. Providing evidence
4. Connecting emotionally
The networking skills which are important to leverage in relation to the influencing process (steps 1-4 above) are to: • Understand and leverage personal style (both your own and adapt to the people who are in your network / business whilst assessing their style) • Strategically target your activities and systematically plan networking. • Develop relationships, by engaging others effectively this will help us to build relationships. In the words of Lao-tzu, we can capture the substance of the positive deviance tactic as part of our change strategy with the statement: Learn from the people Plan with the people Begin with what they have Build on what they know Of the best leaders When the task is accomplished The people will all remark We have done it ourselves Muireann Ryan Extensive experience at a management level within the Health Care Industry having previously occupied Senior roles at the Uniphar Group and United Drug; Medical and Pharmaceutical and has also worked within the Private hospital sector in Ireland; with 20 years’ experience. Muireann's Business Leadership brings with it a demonstrated history of working in the Life Sciences, Pharmaceuticals and Healthcare industries. Qualified in Pharmaceuticals (Pharm Sciences BTech), Medical Devices, Healthcare Management, Informatics, Operations and Training. Strong STEM, Business Management and Finance professional with clinical knowledge and commercial acumen. Business Postgraduate of Finance in UCD Smurfit Business School and Strategic Growth in Biotech and Pharma Industries. Holds an NFQ Level 9 Masters focused on Business Leadership and Management Practice from UCD Michael Smurfit Graduate Business School. Muireann has most recently undertaken (NFQ Masters Level 9) Organisational Development, Change & Transformation Management, UCD Business School; MSBS. Certified Business Coach and Facilitator. Business Management Change and Transformation Advisory Contact on LinkedIn : https://www. linkedin.com/in/muireann-ryan71754b30/
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Pharmacy Group spearhead Stroke campaign
The CarePlus Pharmacy network has launched a drive to raise awareness of an Irish Heart Foundation programme, which helps the families of people who have suffered strokes around the country. This programme is funded by the Pobal Dormant Accounts Fund.
The HSE and Diabetes Ireland are urging people with concerns about their diabetes to seek medical advice from their Pharmacist, GP or hospital diabetes team.
Eoin McCormack, Managing Director, Navi Retail Group
Looking after a loved one who has had a stroke can be challenging at the best of times, and during the COVID-19 pandemic, many people are finding it more difficult to cope. To remind family carers they’re not alone, the Irish Heart Foundation is highlighting their
scheme which offers carers 6 one-hour professional counselling sessions, completely free of charge. This short-term scheme ends on 30th September 2020. Navi Retail Managing Director Eoin McCormack says the teams at CarePlus Pharmacies
throughout the country are delighted to support this initiative, “It’s great to see the Irish Heart Foundation acknowledging the important role carers play in patient care. More importantly this programme is doing something meaningful and practical to support them.” Patient Support Manager at the Irish Heart Foundation, Tracy Egan, says this partnership provides a great opportunity to spread awareness of their scheme. “At the Irish Heart Foundation, we know that stroke survivors and their carers have faced extra challenges and worries during the coronavirus pandemic. That’s why we’re offering free counselling sessions with a registered therapist to stroke carers around the country. We are delighted to have the support of the CarePlus Pharmacy team in promoting this service to communities across the country.” The Irish Heart Foundation is distributing leaflets on the free counselling support programme to all CarePlus Pharmacies, where teams will share the message with customers.
The positive impacts of pharmacists in supporting medication without harm are described in a new publication from the International Pharmaceutical Federation (FIP).
FIP’s new reference document, entitled “Patient safety — Pharmacists’ role in ‘Medication without harm’”, provides information about what pharmacists can do to promote patient safety at an individual patient level, as well as at organisational and policy development levels. It includes case studies of best practice from Australia, Canada, Finland, India, the Netherlands, Oman, Saudi Arabia, South Africa, and the USA.
“Medication safety has become a global emergency and many nations are placing it on their national health priority agendas. Regardless of whether pharmacists provide direct or indirect patient care, they all have a role in promoting safe and quality health care,” said Parisa Aslani, professor in medicines use optimisation at The University of Sydney, Australia, and co-editor of the document. The reference document highlights a need to shift towards a collaborative systems approach that promotes effective risk management and continuous quality assurance. It also points out that “a culture of blame” neither prevents nor mitigates
Maintaining this selfmanagement will continue to improve the quality of life and reduce the impact on health and the likelihood of complications. Earlier intervention could prevent more serious complications. Professor Sean Dinneen, Consultant Endocrinologist and Clinical Lead, National Clinical Programme for Diabetes, highlights the importance of seeking help despite the current challenges, “We are in a very fluid environment and diabetes services are experiencing significant capacity issues at present as the health service deals with this pandemic.” People with diabetes need to continue to self-manage their diabetes through healthy eating, taking regular physical activity, checking their blood glucose levels if advised to and taking their medications as prescribed. Pharmacists should be aware of those with:
Positive impact of Pharmacy
The World Health Organisation reports that one in four patients is harmed by the care they receive in primary and ambulatory care settings, including harm from medicines. It estimates the global cost associated with medication errors at USD 42 billion per year.
Throughout the COVID-19 pandemic, the diabetes community and diabetes healthcare providers have worked and adapted to support and empower people in self-managing their diabetes at home.
Ongoing high blood glucose or ketone levels. Constantly feeling thirsty or needing to go to the toilet more often than usual.
harm, nor does it enable a positive working environment.”
Any breaks in the skin that are not healing.
“The common challenges facing pharmacists include increasingly complex medicines, polypharmacy and ensuring optimal transitions of care for our patients in spite of fragmented healthcare systems or models of service delivery. There is also the often-reported issue of being under-resourced and timepoor. We can learn a lot from each other, and this reference paper is a personal and professional challenge to all pharmacists to keep patient safety at the forefront of practice and to take new steps towards safer care. We all are advocates of patient safety. As pharmacists, we are particular advocates of medication safety,” Professor Aslani said.
Those with diabetes who are pregnant. Having an unexplained high temperature. Have nausea, vomiting or diarrhoea for longer than 24 hours. Concerns about any aspect of their health. Symptoms of any illness that is not getting better. Professor Dinneen added, “We have now reached a point where a renewed focus upon the needs of people with diabetes is both timely and clinically necessary.”
(pembrolizumab) Injection 25mg/ml
KEYTRUDA® (pembrolizumab) ABRIDGED PRODUCT INFORMATION Refer to Summary of Product Characteristics before prescribing. PRESENTATION KEYTRUDA 25 mg/mL: One vial of 4 mL of concentrate contains 100 mg of pembrolizumab. INDICATIONS KEYTRUDA as monotherapy is indicated for the treatment of advanced (unresectable or metastatic) melanoma in adults. KEYTRUDA as monotherapy is indicated for the adjuvant treatment of adults with Stage III melanoma and lymph node involvement who have undergone complete resection. KEYTRUDA as monotherapy is indicated for the first-line treatment of metastatic non-small cell lung carcinoma (NSCLC) in adults whose tumours express PD-L1 with a ≥50% tumour proportion score (TPS) with no EGFR or ALK positive tumour mutations. KEYTRUDA, in combination with pemetrexed and platinum chemotherapy, is indicated for the first-line treatment of metastatic non-squamous NSCLC in adults whose tumours have no EGFR or ALK positive mutations. KEYTRUDA, in combination with carboplatin and either paclitaxel or nab-paclitaxel, is indicated for the first-line treatment of metastatic squamous NSCLC in adults. KEYTRUDA as monotherapy is indicated for the treatment of locally advanced or metastatic NSCLC in adults whose tumours express PD-L1 with a ≥1% TPS and who have received at least one prior chemotherapy regimen. Patients with EGFR or ALK positive tumour mutations should also have received targeted therapy before receiving KEYTRUDA. KEYTRUDA as monotherapy is indicated for the treatment of adult patients with relapsed or refractory classical Hodgkin lymphoma (cHL) who have failed autologous stem cell transplant (ASCT) and brentuximab vedotin (BV), or who are transplant-ineligible and have failed BV. KEYTRUDA as monotherapy is indicated for the treatment of locally advanced or metastatic urothelial carcinoma in adults who have received prior platinum-containing chemotherapy. KEYTRUDA as monotherapy is indicated for the treatment of locally advanced or metastatic urothelial carcinoma in adults who are not eligible for cisplatin-containing chemotherapy and whose tumours express PD L1 with a combined positive score (CPS) ≥ 10. KEYTRUDA as monotherapy or in combination with platinum and 5-fluorouracil (5-FU) chemotherapy, is indicated for the first-line treatment of metastatic or unresectable recurrent head and neck squamous cell carcinoma (HNSCC) in adults whose tumours express PD-L1 with a CPS ≥ 1. KEYTRUDA as monotherapy is indicated for the treatment of recurrent or metastatic HNSCC in adults whose tumours express PD-L1 with a ≥ 50% TPS and progressing on or after platinum-containing chemotherapy. KEYTRUDA, in combination with axitinib, is indicated for the first-line treatment of advanced renal cell carcinoma (RCC) in adults. DOSAGE AND ADMINISTRATION See SmPC for full details. Therapy must be initiated and supervised by specialist physicians experienced in the treatment of cancer. The recommended dose of KEYTRUDA as monotherapy is either 200 mg every 3 weeks or 400 mg every 6 weeks administered as an intravenous infusion over 30 minutes. The recommended dose of KEYTRUDA as part of combination therapy is 200 mg every 3 weeks administered as an intravenous infusion over 30 minutes. KEYTRUDA must not be administered as an intravenous push or bolus injection. When administering KEYTRUDA as part of a combination with intravenous chemotherapy, KEYTRUDA should be administered first. Treat patients until disease progression or unacceptable toxicity. Atypical responses (i.e., an initial transient increase in tumour size or small new lesions within the first few months followed by tumour shrinkage) have been observed. Recommended to continue treatment for clinically stable patients with initial evidence of disease progression until disease progression is confirmed. For the adjuvant treatment of melanoma, KEYTRUDA should be administered until disease recurrence, unacceptable toxicity, or for a duration of up to one year. KEYTRUDA, as monotherapy or as combination therapy, should be permanently discontinued (a) For Grade 4 toxicity except for: endocrinopathies that are controlled with replacement hormones; or haematological toxicity, only in patients with cHL in which KEYTRUDA should be withheld until adverse reactions recover to Grade 0-1; (b) If corticosteroid dosing cannot be reduced to ≤10 mg prednisone or equivalent per day within 12 weeks; (c) If a treatment-related toxicity does not resolve to Grade 0-1 within 12 weeks after last dose of KEYTRUDA; (d) If any event occurs a second time at Grade ≥ 3 severity. Patients must be given the Patient Alert Card and be informed about the risks of KEYTRUDA. Special populations. Elderly: No dose adjustment necessary. Data from patients ≥ 65 years are too limited to draw conclusions on cHL population. Data from pembrolizumab monotherapy in patients with resected Stage III melanoma, from pembrolizumab in combination with axitinib in patients with advanced RCC, and from chemotherapy combination in patients with metastatic NSCLC, and from pembrolizumab (with or without chemotherapy) in patients receiving first line treatment for metastatic or unresectable recurrent HNSCC ≥ 75 years are limited. Renal impairment: No dose adjustment needed for mild or moderate renal impairment. No studies in severe renal impairment. Hepatic impairment: No dose adjustment needed for mild hepatic impairment. No studies in moderate or severe hepatic impairment. Paediatric population: Safety and efficacy in children below 18 years of age not established. CONTRAINDICATIONS Hypersensitivity to the active substance or to any excipients. PRECAUTIONS AND WARNINGS Assessment of PD-L1 status When assessing the PD-L1 status of the tumour, it is important that a well-validated and robust methodology is chosen to minimise false negative or false positive determinations. Immune-related adverse reactions Immune-related adverse reactions, including severe and fatal cases, have occurred in patients receiving pembrolizumab. Most immune-related adverse reactions occurring during treatment with pembrolizumab were reversible and managed with interruptions of pembrolizumab, administration of corticosteroids and/or supportive care. Immune-related adverse reactions have also occurred after the last dose of pembrolizumab. Immune-related adverse reactions affecting more than one body system can occur simultaneously. See SmPC for full details. Immune-related pneumonitis: Patients should be monitored for signs and symptoms of pneumonitis.. Suspected pneumonitis should be confirmed with radiographic imaging and other causes excluded. Refer to SmPC for information on management of immune-related pneumonitis. Immune-related colitis: Patients should be monitored for signs and symptoms of colitis, and other causes excluded. Consider the potential risk of gastrointestinal perforation. Refer to SmPC for information on management of immune-related colitis. Immune-related hepatitis: Patients should be monitored for changes in liver function (at the start of treatment, periodically during treatment and as indicated based on clinical evaluation) and symptoms of hepatitis, and other causes excluded. Refer to SmPC for information on management of Immune-related hepatitis. Immune-related nephritis: Patients should be monitored for changes in renal function, and other causes of renal dysfunction excluded. Refer to SmPC for information on management of immune-related nephritis. Immune-related endocrinopathies: Severe endocrinopathies, including adrenal insufficiency, hypophysitis, type 1 diabetes mellitus, diabetic ketoacidosis, hypothyroidism, and hyperthyroidism have been observed with pembrolizumab treatment. Long-term hormone replacement therapy may be necessary in cases of immune-related endocrinopathies. Hypophysitis has been reported in patients receiving pembrolizumab. Patients should be monitored for signs and symptoms of adrenal insufficiency and hypophysitis (including hypopituitarism) and other causes excluded. Patients should be monitored for hyperglycaemia or other signs and symptoms of diabetes. Thyroid disorders, including hypothyroidism, hyperthyroidism and thyroiditis, have been reported in patients receiving pembrolizumab and can occur at any time during treatment. Hypothyroidism is more frequently reported in patients with HNSCC with prior radiation therapy. Patients should be monitored for changes in thyroid function (at the start of treatment, periodically during treatment and as indicated based on clinical evaluation) and clinical signs and symptoms of thyroid disorders. Refer to SmPC for information on management of immune-related endocrinopathies. Immune-related skin adverse reactions: Patients should be monitored for suspected severe skin reactions and other causes should be excluded. Based on the severity of the adverse reaction, pembrolizumab should be withheld for Grade 3 skin reactions until recovery to Grade ≤ 1or permanently discontinued for Grade 4 skin reactions, and corticosteroids should be administered. Cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) have been reported in patients receiving pembrolizumab. For suspected SJS or TEN, pembrolizumab should be withheld and the patient should be referred to a specialised
Together we have treated
unit for assessment and treatment. If SJS or TEN is confirmed, pembrolizumab should be permanently discontinued. Caution should be used when considering the use of pembrolizumab in a patient who has previously experienced a severe or life-threatening skin adverse reaction on prior treatment with other immune- stimulatory anticancer agents. Other clinically significant immune-related adverse reactions: The following additional clinically significant, immune-related adverse reactions, have been reported in clinical studies or in post-marketing experience: uveitis, arthritis, myositis, myocarditis, pancreatitis, Guillain-Barré syndrome, myasthenic syndrome, haemolytic anaemia, sarcoidosis, encephalitis and myelitis. For Grades 3 or 4 myocarditis, encephalitis or Guillain Barré syndrome, pembrolizumab should be permanently discontinued. Refer to SmPC for information on management of significant immune-related adverse reactions. Solid organ transplant rejection has been reported in the post-marketing setting in patients treated with PD-1 inhibitors. The benefit of treatment with pembrolizumab versus the risk of possible organ rejection should be considered in these patients. Complications of allogeneic Haematopoietic Stem Cell Transplant (HSCT): Allogeneic HSCT after treatment with pembrolizumab: Cases of graft-versus-host-disease (GVHD) and hepatic veno-occlusive disease (VOD) have been observed in patients with classical Hodgkin lymphoma undergoing allogeneic HSCT after previous exposure to pembrolizumab. Until further data become available, careful consideration to the potential benefits of HSCT and the possible increased risk of transplant-related complications should be made case by case. Allogeneic HSCT prior to treatment with pembrolizumab: In patients with a history of allogeneic HSCT, acute GVHD, including fatal GVHD, has been reported after treatment with pembrolizumab. Patients who experienced GVHD after their transplant procedure may be at an increased risk for GVHD after treatment with pembrolizumab. Consider the benefit of treatment with pembrolizumab versus the risk of possible GVHD in patients with a history of allogeneic HSCT. Infusion-related reactions: For Grades 3 or 4infusion reactions including hypersensitivity and anaphylaxis, stop infusion and permanently discontinue pembrolizumab. With Grades 1 or 2 infusion reactions, infusion may continue with close monitoring. Premedication with antipyretic and antihistamine may be considered. Overdose: There is no information on overdose with pembrolizumab. In case of overdose, monitor closely for signs or symptoms of adverse reactions and treat appropriately. INTERACTIONS No formal pharmacokinetic drug interaction studies have been conducted with pembrolizumab. No metabolic drug-drug interactions are expected. The use of systemic corticosteroids or immunosuppressants before starting pembrolizumab should be avoided because of their potential interference with the pharmacodynamic activity and efficacy of pembrolizumab. Corticosteroids can be used as premedication, when pembrolizumab is used in combination with chemotherapy, as antiemetic prophylaxis and/or to alleviate chemotherapy-related adverse reactions. FERTILITY, PREGNANCY AND LACTATION Women of childbearing potential Women of childbearing potential should use effective contraception during treatment with pembrolizumab and for at least 4 months after the last dose of pembrolizumab. Pregnancy No data on use in pregnant women. Do not use during pregnancy unless the clinical condition of the woman requires treatment with pembrolizumab. Breast-feeding It is unknown whether pembrolizumab is secreted in human milk. A risk to newborns/ infants cannot be excluded. Fertility No clinical data available. SIDE EFFECTS Refer to SmPC for complete information on side effects. Pembrolizumab is most commonly associated with immune-related adverse reactions. Most of these reactions resolved with appropriate medical treatment or withdrawal of pembrolizumab. The most serious adverse reactions were immune-and infusion-related adverse reactions. Monotherapy: Very Common: anaemia, hypothyroidism, decreased appetite, headache, dyspnea, cough, abdominal pain, nausea, vomiting, constipation, musculoskeletal pain, arthralgia, asthenia, oedema, pyrexia, diarrhoea, rash, pruritus, fatigue. Common: pneumonia, thrombocytopaenia, lymphopaenia, hyponatraemia, hypokalaemia, hypocalcaemia, insomnia, neuropathy peripheral, lethargy, dry eye, cardiac arrhythmia (including atrial fibrillation), hypertension, hyperthyroidism, insomnia, dizziness, dysgeusia, pneumonitis, colitis, dry mouth, severe skin reactions, vitiligo, dry skin, alopecia, eczema, dermatitis acneiform, erythema, myositis, pain in extremity, arthritis, influenza like illness, chills, AST and ALT increases, hypercalcaemia, increase in blood alkaline phosphatase, blood bilirubin increased, blood creatinine increased, infusion related reaction. Frequency not known: solid organ transplant rejection. Combination with chemotherapy: Very Common: anaemia, neutropaenia, thrombocytopaenia, hypokalaemia, decreased appetite, dizziness, neuropathy peripheral, dysgeusia, headache, dyspnoea, cough, abdominal pain, alopecia, diarrhoea, nausea, vomiting, constipation, rash, pruritus, musculoskeletal pain, arthralgia, pyrexia, fatigue, asthenia, oedema, blood creatinine increased. Common: pneumonia, febrile neutropaenia, leukopaenia, lymphopaenia, infusion related reaction, hypothyroidism, hyperthyroidism, hyponatraemia, hypocalcaemia, insomnia, lethargy, dry eye, cardiac arrhythmia (including atrial fibrillation), hypertension, pneumonitis, colitis, dry mouth, severe skin reactions, erythema, dry skin, myositis, pain in extremity, arthritis, nephritis, acute kidney injury, chills, influenza-like illness, hypercalcaemia, ALT increase, AST increased, blood alkaline phosphatase increased. Combination with axitinib: Very Common: hyperthyroidism, hypothyroidism, decreased appetite, headache, dysgeusia, hypertension, dyspnoea, cough, dysphonia, diarrhoea, abdominal pain, nausea, vomiting, constipation, palmar-plantar erythrodysaesthesia syndrome, rash, pruritus, musculoskeletal pain, arthralgia, pain in extremity, fatigue, asthenia, pyrexia, alanine aminotransferase increased, aspartate aminotransferase increased, blood creatinine increased. Common: pneumonia, anaemia, neutropaenia, leukopaenia, thrombocytopaenia, infusion related reaction, hypophysitis, thyroiditis, adrenal insufficiency, hypokalaemia, hyponatraemia, hypocalcaemia, insomnia, dizziness, lethargy, neuropathy peripheral, dry eye, cardiac arrhythmia (including atrial fibrillation), pneumonitis, colitis, dry mouth, hepatitis, severe skin reactions, dermatitis acneiform, dermatitis, dry skin, alopecia, eczema, erythema, myositis, arthritis, tenosynovitis, acute kidney injury, nephritis, oedema, influenza like illness, chills, blood alkaline phosphatase increased, hypercalcaemia, blood bilirubin increased. PACKAGE QUANTITIES KEYTRUDA 25 mg/mL: 4 mL of concentrate in a 10 mL Type I clear glass vial. Legal Category: POM. Marketing Authorisation numbers: EU/1/15/1024/002. Marketing Authorisation holder: Merck Sharp & Dohme B.V., Waarderweg 39, 2031 BN Haarlem, The Netherlands. Date of revision: June 2020. © Merck Sharp & Dohme B.V. 2020. All rights reserved. Further information is available on request from: MSD, Red Oak North, South County Business Park, Leopardstown, Dublin D18 X5K7 or from www.medicines.ie. Date of Preparation: July 2020. PSUSA. Adverse events should be reported. Reporting forms and information can be found at www.hpra.ie. Adverse events should also be reported to MSD (Tel: 01-2998700) References: 1. KEYTRUDA Summary of Product Characteristics available at www.medicines.ie 2. Merck And MSD Oncology Statistics Tracker, figure reflects year-end 2019
Red Oak North, South County Business Park, Leopardstown, Dublin D18 X5K7 Ireland
Pharmacy Cybercrime on the Rise Community pharmacies across Ireland need to be aware of the threat posed by cybercrime, as Irish Pharmacy News has learned this month that there has been an increase in attacks. • 41% of Irish firms have experienced at least one cyber attack event in the six months from September 2019 to February 2020, according to recent report by the Hiscox Insurance Group • 6.5% of Irish firms had to pay a ransom following a ransomware attack, with the median cost of these attacks around ¤92,000.
Pharmacy is a prime target. Research in England for example, revealed that 13% of respondents had been the victim of personal medical data theft. 35%, happened not in a hospital setting (29%) or at the GP surgery (19%) but in pharmacies. It’s not just the theft of the data that links to pharmacy, but the subsequent use of that stolen information. The same research suggested that in the majority of cases (42%) it was used to fraudulently fill prescriptions. Despite this, some 77% of those polled said they still had trust in their pharmacy to secure their health data. Just last month, The National Cyber Security Centre (NCSC) Ireland highlighted increased threat arising from the Covid-19 pandemic. This has not only caused health concerns and signiﬁcant disruptions in businesses, but also created growing uncertainties among the public, health care workers, managers and policy makers. Head of Information and Technology with the Irish Pharmacy Union, Alan Reilly says, “Anecdotally there has been an increase in cybersecurity attacks and in particular ‘phishing’. Phishing is where someone fraudulently attempt to trick users into disclosing sensitive information, such as usernames, passwords or credit card details. However, the IPU has not received a noticeable increase of such reports,” he says. “In most cases, the pharmacy’s system vendor is responsible for the protection of patient information and provides the pharmacy with the necessary information security measures e.g. anti-virus software and firewalls.”
The problem is not just confined to Ireland and the rest of the UK but is indeed worldwide. Globally, pharmacies have been targets for ransomware actors, rather than just collateral damage as the NHS was in the WannaCry affair. A number of Australian pharmacies were held to ransom in 2014, and German pharmacies were also targeted last year as electronic prescriptions and digital records become the norm. In the USA, HHS reported 12 data breaches this year where more than 100,000 patients' information was affected. This included over 650,000 in Portland, 550,000 in Elkhart and over 166,000 in Atlanta. “Security awareness training remains a major challenge,” says Meta Compliance, training providers in this field. All employees, at every level of the organisation should receive security awareness training to ensure they have the skills required to identify an attack. Cyber awareness training should be engaging and informative to ensure that staff understand what is required of them and the importance of their role in safeguarding the organisation’s sensitive data.” “Pharmacy IT security keeps me awake at night!”, said Keith McLernon, MD of McLernons. “I know that sounds a bit melodramatic, but it is true. Every day I receive multiple emails advising of cyber attacks on community pharmacies and other healthcare facilities all around the world, and the figures are mind-boggling. “If a pharmacy is the subject of ransom ware, they could potentially lose their business overnight. And that doesn’t take into account any fines which might be imposed by the Data Protection
Commissioner should they be found to have been in breach of the legislation!” Keith added, “We have a great relationship with our customers, built up over years and decades, and they regard us as their pharmacy IT partner. However, there are some things that we cannot do for them, and one of them is retrieve data if they have been hacked into. We have safeguards and checks built into our software, but the pharmacist is still ultimately responsible for their IT network, for the provision of firewalls, for the regular changing of passwords, for carrying out frequent backups and for the training of their staff. We can help give advice on our preferred partners but the pharmacist must make the decision to make increased cyber security a priority. My worry is that at the moment, this isn’t seen as a big deal, and it won’t be a big deal until your system is hacked into and you phone our Customer Service team asking for help. “That is not to say that we can’t help – but it must be proactive on your part. If you are hacked, if you reply to a spam email because you use a cheap or free-to-use email account which doesn’t filter suspect messages, if you are using an old operating system such as Windows 7, if you allow access to other websites from your pharmacy computer, then there is very little we can do to help you. “We have recently switched our remote monitoring and management service, with enhanced antivirus, and we will be rolling this out to all our customers in the next few months. However, individual pharmacies need to carefully review their current cyber security provisions and seek to upgrade them as soon as possible. There are some frightening statistics out there:
• 57% of Irish people admit to opening emails from people they don’t know • Only 26% of Irish internet users regularly change their passwords • 7% were victims of Ransomware Keith concluded, “We are very grateful to the IPN for bringing attention to this very important issue for community pharmacy – the number of phishing attacks on Irish businesses has increased during the Covid-19 pandemic as opportunists seek to exploit weaknesses as people are forced to adapt to new ways of working. Is the laptop that you use at home secure? “Are your CCTV and credit card units on your pharmacy network? I would strongly urge all our customers to review their IT security arrangements and call one of the McLernons team for advice and information, before it is too late.” Alan continues, “The IPU publishes a guide for members called the IPU Information Security Guide for Community Pharmacy, which explains topics such as: Access to information; Password Protection; Data Backup; Data Recovery; and, Disposal of Equipment. The number one key measure to protect a pharmacy from cyberattacks is staff awareness of information security risks and preventative measures. “Pharmacies should promote acceptable use of computer equipment in your pharmacy as a measure to protect employee and patient information; inappropriate use exposes a pharmacy to risks including virus attacks. By promoting a ‘think before you click’ ethos, pharmacy staff will be less likely to open email attachments or click on web links which could infect your computer system with a virus.”
How McLernons can help you improve your IT security With an increasing number of cyber attacks on everything from banks to healthcare trusts we believe that now, more than ever before, it is vital that you do everything you can to protect the integrity of your patient data. As you, the pharmacy owner, is the Controller of the data which you hold – both for your own employees and your patients – the responsibility to keep this data safe rests with you. Robin Hanna, Director, said “As you will know, McLernons can manage all Windows Security updates on your behalf in order to keep your devices secure and upto-date and ensure that there are no conflicts with your pharmacy applications, on your Dispensary and EPOS systems, Head office and networks.” “As part of an ongoing review into your IT security we have sourced a new partner to provide a managed workplace solution, and over the next few months we will gradually be migrating all our customers to this. Not only will this provide an enhanced level of Anti Virus, but will also facilitate an enhanced level of content filtering, ie, denying access to certain websites which have been flagged as potentially unsafe.” “This new application suite allows us to see if laptops and PCs which are accessing your pharmacy PCs have AntiVirus on them as this is a potential ‘back door’ for malware and hacking attempts.” Our solution provides network protection features including: • Anti-Malware – detecting and blocking malware threats before they have a chance to inflict damage to devices.. • Behavioural Analysis – examining the behaviour of a file and determining if the file may be a threat. • Network traffic scans – providing data protection for email and user web browsing in real time, and scanning various types of network traffic for potential security threats. • Content Control – providing a way to restrict what users can access and send over the Internet. • Anti-Phishing – preventing the attempt to obtain sensitive information such as credit card numbers or account information from a bank for malicious reasons • Disk encryption – this will now be managed centrally by McLernons • Password management – we will be implementing password changes on PCs over the coming months.
In order to provide these new enhanced features we have had to increase the cost of this service by ¤10 to ¤30 per terminal per annum, and this increase will only be charged from 1st January 2021.
Robin Hanna, Director, McLernon Computers
What else can you do? An AV package can only help mitigate your exposure to cyber security attacks, it cannot prevent all of them. There are a number of steps which you can take to enhance your pharmacy IT security and ensure that a successful attempt by a hacker doesn’t result in a catastrophic loss of data, which is unlikely to be recoverable. Every day brings news of new phishing attempts, email scams and concerted attacks on pharmacy systems, not just in the US but here in Ireland. The Data Protection Commissioner Helen Dixon has issued a series of warnings, recognising that the rapid adoption of new ways of working during the Covid pandemic means that you might need to share or collect information quickly and in new ways. Steps to improve your IT security We strongly recommend that you implement all of the following recommendations in order to increase the cyber security of your business, and our staff are able to help advise you. • Upgrade to Windows 10 For over a year, we have been urgently requesting that our customers upgrade to a Windows 10 operating platform. We are aware there are still 100s of customers currently running their pharmacies on sub-optimal, unsupported Windows 7 systems. These are no longer routinely supported by Windows, who have only pledged to issue patches for any operating issues for a short period of time to facilitate the upgrading to Windows 10. At some point, this will stop, and if your system becomes corrupted your data will be lost. • Passwords and administration rights We understand how busy a dispensary can be, with more than one member of staff accessing a PC at any one time. However, the
sharing of passwords, or failure to change passwords on a regular basis is putting your business at risk. We will be rolling out password management for MPS over the next few months but you should also think about changing the password on your PCs on a regular basis. • Email security We know that many community pharmacies use unprotected free-to-use email accounts such as Gmail and Hotmail for their pharmacies. In using such email addresses you are effectively leaving the back door of your pharmacy PC unlocked and vulnerable to attack. We can give you advice and guidance on setting up a more secure email account today, and recommend Office 365 with Advance Threat Protection. • Staff training Although your staff are undoubtedly the greatest asset of your business, they are also the inadvertent cause of a successful cyber attack on your business. One of the ways in which the security of your data can be compromised is through what are known as ‘phishing’ or ‘social engineering’ attacks. We can direct you to a number of sources
of help and training, including the ones we use for our own staff training, which provide tips on how to spot such attacks and avoid risks to your patient data. • Firewalls We strongly recommend that pharmacies consider installing a hardware-based firewall, and to review the various devices that you allow to access your network. The basic ISP router which facilitates your access to the internet is not sufficient to protect your pharmacy systems. A firewall works by controlling access to network resources, network services, and to the Internet by specified applications. Take a moment to consider how many other devices are currently on your pharmacy network, such as CCTV, mobiles, laptops and tablets, and credit card units. Are they patched and up-to-date? Should you consider segregating your networks and placing them behind a firewall. Social distancing applies to more than humans in this new world of working! We can provide Firewall solutions from as little as ¤300 per year. Please take time to reflect on how you could strengthen your IT security and call any of our Customer Services or sales teams for further information.
Patient Safety – Pharmacists’ Role The International Pharmaceutical Federation has recently released a new medication safety report, which describes the positive impacts of pharmacists in supporting medication without harm. Professor Parisa Aslani, Professor in Medicines Use Optimisation at The University of Sydney
FIP’s new reference document, entitled “Patient safety — Pharmacists’ role in ‘Medication without harm’”, provides information about what pharmacists can do to promote patient safety at an individual patient level, as well as at organisational and policy development levels. “Medication safety has become a global emergency and many nations are placing it on their national health priority agendas. Regardless of whether pharmacists provide direct or indirect patient care, they all have a role in promoting safe and quality health care,” said Professor Parisa Aslani, Professor in Medicines Use Optimisation at The University of Sydney, Australia, and co-editor of the document.
“The common challenges facing pharmacists include increasingly complex medicines, polypharmacy and ensuring optimal transitions of care for our patients in spite of fragmented healthcare systems or models of service delivery. There is also the often-reported issue of being under-resourced and time-poor. We can learn a lot from each other, and this reference paper is a personal and professional challenge to all pharmacists to keep patient safety at the forefront of practice and to take new steps towards safer care. We all are advocates of patient safety. As pharmacists, we are particular advocates of medication safety,” Professor Aslani added. The World Health Organization (WHO) reports that one in four patients is harmed by the care they receive in primary and ambulatory care settings. Adverse events are responsible for a large proportion of emergency department visits and hospitalisations. Specifically, the global cost associated with medication errors has been estimated by the WHO as $42 billion per year. It is therefore not a surprise that patient safety has become a global emergency and
many nations are placing patient safety on their national health priority agendas. Patient safety is broadly acknowledged as a patient being free from any harm and/ or accidental injuries during the course of receiving health care. Medication safety, recognised as a component of patient safety, refers here to preventing and managing medication-related errors and consequent harm in a person’s medicines-taking/using journey. While the fallibility of humans and their resultant errors appears to be a contributing factor to medication errors and patient harm, errors often do not have a single cause. Healthcare organisations and systems, including people who create legislation and policy, people who implement standards and guidelines, and healthcare professionals who deliver services and provide patient care, are all responsible for ensuring patient safety. To make healthcare systems safer, a shift towards a collaborative systems approach that fosters a safety culture and promotes effective prospective risk management and continuous quality assurance through building system defences, is needed. A “culture of blame” neither prevents nor mitigates harm, nor does it enable a positive working environment. Pharmacists are essential healthcare professionals and are critical members of the whole healthcare team. Pharmacists
work in varied settings such as community and hospital, industry and regulatory affairs. Regardless of where pharmacists work, and whether their roles provide direct or indirect patient care, all pharmacists contribute to safe and quality health care. In promoting patient safety and advocating a safety culture, pharmacists have a number of roles to play. This reference document, entitled “Patient safety — Pharmacists’ role in ‘Medication without harm’”, provides information about what pharmacists can do to promote patient safety at an individual patient level, as well as at organisational and in policy development levels (which may be local/organisational through to national and international). This document encourages each of us to take new steps and make initiatives towards safer care at our workplace. The report is designed to act as a reference document that can serve as a platform to inform policy and practice development of patient and medication safety initiatives in pharmacy practice or country context. At the same time, it is the intention to keep it very practical so that it can serve as a tool for pharmacists to ignite further discussions and to support implementation of services (at the organisational, and even national level) that have been shown to prevent adverse events and reduce the risk of unnecessary harm associated with healthcare provision.
Stacks Pharmacy introduce the ‘Stack Pack’ During times of great challenge sometimes the best innovations are born. Stacks Pharmacy Group have recently introduced a new service which delivers customer’s repeat prescription medicine, straight to the door. This complimentary service is known as the ‘Stack Pack.’ This reliable and convenient initiative offers customers a safe way to manage their medication and takes the hassle out of of ordering and collecting repeat prescriptions.
Ade Stack, Managing Director, Stacks Pharmacy Group
DARZALEX® (DARATUMUMAB) SUBCUTANEOUS FORMULATION REIMBURSED IN IRELAND FOR ALL CURRENTLY APPROVED DARATUMUMAB INTRAVENOUS FORMULATION INDICATIONS The Janssen Pharmaceutical Companies of Johnson & Johnson have announced that DARZALEX® (daratumumab) subcutaneous (SC) formulation for the treatment of adult patients with multiple myeloma (MM), has been reimbursed in Ireland for all current daratumumab approved indications. Daratumumab SC is administered as a fixed dose, which significantly reduces treatment time, from hours to approximately three to five minutes, when compared to daratumumab intravenous (IV) formulation.
Data from studies undertaken ahead of the approval showed that daratumumab SC demonstrated a consistent overall response rate (ORR) and a similar safety profile compared with daratumumab IV in patients with relapsed or refractory MM.1 In addition, there was a nearly two-thirds reduction in systemic infusion-related reactions (IRRs) for daratumumab SC compared to daratumumab IV (13 percent vs. 35 percent, respectively). The novel SC formulation of daratumumab is co-formulated with recombinant human hyaluronidase PH20 (rHuPH20) [Halozyme's ENHANZE® drug delivery technology]. “Multiple myeloma is incurable and often requires time-intensive treatment regimens for patients and clinicians. The availability of the new daratumumab subcutaneous formulation marks an important milestone which will help make a positive difference in the lives of patients who depend on this treatment as it can be administered in considerably less time, reducing the level of time spent in a hospital,” said Dr Denis O’Keeffe, Consultant Haematologist, University Hospital Limerick. “This is even more important against the current backdrop of COVID-19 and the need to limit, as much as possible, time spent in hospital for vulnerable, immune-compromised patients.” “This new formulation was specifically designed by Janssen as the next step in enhancing the treatment experience with daratumumab,” said Laurent de Saint Sernin, General Manager Commercial Operations, Janssen Sciences Ireland UC. “Given all the uncertainties and challenges related to COVID-19, Janssen is particularly proud to bring daratumumab SC to multiple myeloma patients and clinicians
to significantly reduce the need for extended treatment in a hospital setting, thereby freeing up further capacity within the service. We are excited about the potential of this meaningful innovation in transforming the treatment experience for patients with MM.” Only the first dose of daratumumab SC needs to be administered in an environment where resuscitation facilities are available. The approval is supported by data from the Phase 2 PLEIADES (MMY2040) and Phase 3 COLUMBA (MMY3012) studies.
ROCHE’S OCREVUS® (OCRELIZUMAB) SHORTER 2-HOUR INFUSION TIME APPROVED IN EUROPE Roche Products (Ireland) Ltd. (Roche) have announced the approval of a new, shorter twohour OCREVUS® (ocrelizumab) infusion time, dosed twice yearly, for relapsing or primary progressive multiple sclerosis (MS). The news comes after OCREVUS® (ocrelizumab) was made publicly available in Ireland to treat people living with relapsing MS late last year. Pierre-Alain Delley, General Manager for Roche Products (Ireland) Ltd stated, “This approval of a shorter, two-hour infusion time for OCREVUS will help to further improve the treatment experience for patients, and hopefully reduce capacity issues in hospitals across the country. At Roche, we are committed to putting the needs of patients first, and will continue to seek ways in which we can deliver improved solutions and outcomes for people living with MS.’’ Commenting on the news, Bindu Joseph MS Clinical Nurse Specialist Beaumont Hospital stated, “This new, shorter infusion time is a significant change for patients taking OCREVUS as it means less time undergoing treatment and less time in the hospital. This is particularly relevant in the current climate, where many patients feel concerned about the time they are spending in hospitals and clinical settings.” The initial 600 mg dose of Ocrevus is administered as two separate intravenous infusions; first as a 300 mg infusion, followed 2 weeks later by a second 300 mg infusion. Subsequent doses of Ocrevus thereafter are administered as a single 600 mg intravenous infusion every 6 months. The first subsequent dose of 600 mg should be administered six months after the first infusion of the initial dose. If patients did not experience a serious infusion-related reaction
(IRR) with any previous Ocrevus infusion, a shorter (2-hour) infusion can be administered for subsequent doses.1 Full details are available in the Ocrevus SmPC available at www.medicines.ie. The safety of the shorter (2-hour) Ocrevus infusion was evaluated in a prospective, multicentre, randomised, double-blind, controlled, parallel arm substudy to Study MA30143 (Ensemble) in patients with Relapsing-Remitting Multiple Sclerosis that were naïve to other disease modifying treatments.1 Patients were randomised from their second dose onwards (Dose 2 to 6) in a 1:1 ratio to either the conventional infusion group with Ocrevus infused over approximately 3.5 hours every 24 weeks, or the shorter infusion group with Ocrevus infused over approximately 2 hours every 24 weeks.1 From November 1, 2018, to September 27, 2019, 580 patients were randomised 1:1 to the conventional or shorter infusion group. The primary endpoint was the proportion of patients with IRRs occurring during or within 24 hours following the first randomised infusion of Ocrevus.1 The frequency of IRRs was comparable between those who received the two-hour infusion (24.6%) and those who received the 3.5-hour infusion (23.1%). Overall, in all randomised doses, the majority of the IRRs were mild or moderate and only two IRRs were severe in intensity, with one severe IRR in each group. There were no lifethreatening, fatal, or serious IRRs. NANOVATION RECEIVES ¤2.5 MILLION GRANT FROM THE EU TO DEVELOP A NOVEL RESPIRATORY MONITORING DEVICE
Organization. The grant will be utilized within the "SenseGuard" project and will allow NanoVation to further develop and commercialize their SenseGuard™ device for monitoring patients at hospitals and at home. SenseGuard™ is a wireless wearable medical device for continuous monitoring of patients' breathing, based on the startup's unique technology – a first of a kind nano-based respiratory sensor. The device has already gone through clinical trials and received CE marking, proving that the technology is both safe and highly accurate in monitoring the respiration of patients. It is currently being deployed in hospitals in Israel and the EU for further clinical research of its state-of-theart capabilities. Unlike existing solutions, SenseGuard™ is capable of measuring lung-function from patients' regular breathing without any need for cooperation or unpleasant test execution by the patient. Approximately 328 million people worldwide are classified as suffering from COPD. The economic cost is huge and estimated at an annual spending of $49 billion in the U.S. and a similar amount in the EU. Approximately half of all direct COPD costs are associated with hospitalization due to deterioration in the respiratory function of only 6.4% of the patients. These costs could be significantly reduced through a high-quality and simple-to-use home monitoring device that identifies any deterioration early and leads to a dramatic reduction in the need for hospitalization through treatment intervention at the patient's home.
The funding will support NanoVation in the development and commercialization of its SenseGuard™ device, which targets hundreds of millions of patients worldwide with COPD (Chronic Obstructive Pulmonary Disease) and other respiratory diseases
Dr. Gregory Shuster, CEO and co-founder of NanoVation, commented: "Lung function changes indicating a worsening condition can appear up to three weeks before reaching an acute state that often leads to hospitalization and a lengthy rehabilitation. The residual lung damage will impair quality of life, or in the worst-case lead to death."
Israeli medical startup NanoVation has been awarded a ¤2.5 million grant as part of the European Union's prestigious Horizon 2020 EIC Accelerator program. The Haifa based company is developing a new respiratory monitoring device, based on its proprietary nano-sensor technology. The device targets monitoring and management of patients with various respiratory conditions such as Chronic Obstructive Pulmonary Disease (COPD), which was cited as the third leading cause of death in the world by the World Health
"Our pioneering device aims to enable identification of the early signs of deterioration in lung function, and enables early treatment," noted Shuster. "The cost of preventive intervention and treatment ranges from tens to hundreds of dollars, while they minimize unnecessary hospitalizations, which would cost between $10,000 and $40,000 for an individual in the US and between ¤3,000 and ¤10,000 in Europe, and translate into billions of dollars annually for the entire health system."
Cystopurin Cystopurin is from is from thethe makers makers of of
What WhatisisCystitis Cystitis
When Whento torefer refer 2 2 The The following following should should bebe referred referred toto their their GP: GP:
● ●Customers Customers with with severe severe symptoms symptoms such such asas
blood blood in in the the urine, urine, a fever a fever oror pain pain in in the the side side Cystitis Cystitis technically technically means means inflammation inflammation ofof the the bladder; bladder; however, however, it is it is used used asas a term a term forfor a lower a lower 1 1 urinary urinary tract tract infection infection (UTI). (UTI). AA UTI UTI is is usually usually caused caused byby bacteria bacteria from from the the gastrointestinal gastrointestinal tract, tract, such such asas E.coli. E.coli. It is It is one one ofof the the most most common common bacterial bacterial infections infections managed managed in in 1 1 general general practice. practice.
SYMPTOMS: SYMPTOMS: 2 2 The The symptoms symptoms ofof cystitis cystitis are: are:
● ●Needing Needing toto urinate urinate more more often, often, oror with with
more more urgency, urgency, and and a feeling a feeling ofof needing needing toto urinate urinate even even if they if they have have just just been been toto the the toilet toilet ● ●Discomfort Discomfort onon passing passing urine urine (dysuria) (dysuria) ● ●Urine Urine that that may may bebe darker darker than than usual, usual,
cloudy cloudy oror smelly smelly ● ●Lower Lower abdominal abdominal pain pain ● ●Feeling Feeling generally generally ill,ill, with with nausea, nausea,
tiredness tiredness and and cold cold sweats. sweats.
Customers whose whose symptoms symptoms have have not not started started ● ●Customers toto improve improve within within three three days days ● ●Customers Customers affected affected byby frequent frequent recurrence recurrence
ofof cystitis cystitis ● ●Men, Men, pregnant pregnant women women and and children. children.
In In pregnancy, pregnancy, there there is is a risk a risk that that untreated untreated cystitis cystitis may may lead lead toto a kidney a kidney infection, infection, premature premature labour labour oror a low a low birthweight birthweight baby. baby. Children Children can can also also get get cystitis, cystitis, particularly particularly those those aged aged under under two. two. AsAs well well asas the the symptoms symptoms listed, listed, they they may may have have a fever, a fever, feel feel (or(or be) be) sick sick oror lose lose their their appetite. appetite. Cases Cases in in children children should should bebe 2 2 referred referred toto a GP. a GP. 3 3 ADDITIONAL ADDITIONALADVICE: ADVICE:
● ●Wipe Wipe the the bottom bottom from from
front front toto back back after after going going toto the the toilet toilet ● ●Urinate Urinate after after intercourse intercourse toto help help clear clear
any any bacteria bacteria ● ●Go Go forfor a wee a wee whenever whenever the the urge urge is is felt, felt,
trying trying toto empty empty the the bladder bladder fully fully ● ●Stay Stay well well hydrated hydrated
OTC OTCoptions options Mild Mild cases cases ofof cystitis cystitis can can clear clear upup without without any any antibiotic antibiotic treatment. treatment. If customers If customers want want toto purchase purchase something something forfor their their symptoms, symptoms, they they could could consider consider products products based based onon potassium potassium citrate citrate like like Cystopurin. Cystopurin. Cystopurin Cystopurin can can bebe used used byby those those onon a low a low sodium sodium diet. diet. Some Some customers customers who who are are prone prone toto cystitis cystitis may may find find that that drinking drinking cranberry cranberry juice juice oror taking taking tablets tablets containing containing cranberry cranberry extracts extracts helps, helps, but but currently currently 3 3 there’s there’s nono clear clear evidence evidence supporting supporting that that theory. theory.
● ●Wear Wear cotton cotton underwear underwear and and avoid avoid using using
perfumed perfumed products products in in the the area. area.
Cystopurin is from the makers of
What is Cystopurin and what is it used for: Cystopurin is used to relieve the symptoms of cystitis. The active substance in Cystopurin is potassium citrate. Potassium citrate helps to relieve the symptoms of cystitis by making your urine less acidic, reducing the discomfort caused by acidic urine.
How to take Cystopurin? Directions of use for your customer: Dissolve the contents of each sachet in a glass of cold water (200ml) and take straight away. Take the contents of each sachet 3 times a day for 2 days. They can be taken with or without food. All 6 sachets should be taken to complete the course of treatment. Refer your customer to the GP if she is pregnant or breastfeeding, or if symptoms persist after the two day course. Consumers should not repeat the treatment without medical advice.
Cystitis PRODUCT INFORMATION: Cystopurin 3g Granules for oral solution See full Summary of Product Characteristics (SmPC) before prescribing. Composition: Each sachet contains 3g of Potassium Citrate. Indication: For the symptomatic relief of mild urinary tract infections (cystitis). Dosage/Use: For oral administration. Adults (including the elderly and children over 6 years): One 3 g sachet, dissolved in 200 ml of cold water, three times daily for two days. All six sachets must be taken to complete the treatment. Not recommended for children under 6 years of age. Contraindications: Use in patients with renal insufficiency. Warnings and Precautions: This product is intended for short term treatment. Patients should seek doctor's advice if symptoms persist after 48 hours treatment. This product should only be used with caution in patients with cardiac disease. This product contains a source of phenylalanine. May be harmful for people with phenylketonuria. Interactions: Concurrent administration of potassium sparing diuretics or ACE inhibitors may lead to hyperkalaemia. The activity of cardiac glycosides is to some extent dependent upon serum potassium levels. Therefore, there is a possible interaction and caution is advised. Pregnancy and lactation: There is no information available from animal studies and there is no epidemiological evidence of safety of the ingredients of Cystopurin Sachets in human pregnancy, but they have been in wide use for many years without apparent ill consequence. If drug therapy is needed in pregnancy, this drug can be used if there is no safer alternative. However, pregnant women should be advised to seek medical advice on the treatment of cystitis rather than using OTC medicines. Undesirable effects: Potassium salts may give rise to gastric irritation, the effects of which may be minimised by diluting sachet contents well with water. Doses may also be given with or after meals. Additional information available from: MA Holder: Bayer Ltd, The Atrium, Blackthorn Road, Dublin 18. Tel: +353 1 2163300 MA Number: PA1410/42/1. Classification for sale or supply: Pharmacy only. Date of preparation: January 2020. References: 1. NICE CKS Urinary tract infection (lower) â€“ women. https://cks.nice.org.uk/urinary-tract-infectionlower-women 2. NHS Conditions: Cystitis. https://www.nhs.uk/conditions/cystitis/ 3. BUPA UK, Health Information Cystitis. Expert reviewer Professor Raj Persad, Consultant Urological Surgeon. https://www.bupa.co.uk/ health-information/urinary-bladder-problems/cystitis L.IE.MKT.06.2020.2638
The Role of Exercise on Bone Growth School of Pharmacy researchers have shed new light on the role of exercise on bone growth. Professor David Hoey, Trinity’s School of Engineering
One in 4 men and 1 in 2 women over 50 will develop a fracture due to osteoporosis in their lifetime, according to the Irish Osteoporosis Society. The cost of care for these patients is high, as many require hospitalisation and surgery, with an estimated total cost of care of ¤653 million. Finding new ways to treat these diseases will have considerable impact on patients and hospitals. The work of researchers at AMBER, the SFI Research Centre for Advanced Materials and Bioengineering Research and the Schools of Engineering and Pharmacy at Trinity College Dublin, has opened the door to potential new therapies for bone diseases such as osteoporosis. The team discovered that when bone cells (osteocytes) are subjected to physical loading, similar to that experienced during exercise, they produce signals causing human bone marrow
stem cells to grow new bone. This mechanism can be functionalised to create new therapeutic approaches to bone diseases which affect millions of people globally. Bone growth, osteoporosis and exercise Around 300,000 people in Ireland have osteoporosis and many more may live with the disease undetected. It can be particularly problematic as we get older when bone regeneration becomes slower.
While it is well known that exercise – particularly weight bearing/ strengthening exercise – supports bone health, in conjunction with other factors, the specific mechano-biological pathway explaining this relationship has remained elusive. Cellular level insights into the impact of exercise on bone growth The Trinity team found that when osteocytes are subjected to a physical load mimicking exercise they release nano-sized vesicles that enhance bone marrow stem cell differentiation, and promote bone formation. Key to this study, and the possibility to advance therapeutic approaches based on this mechanism, was the teams’ discovery of the precise role of the vesicles in the process of bone generation. The vesicles, when generated by osteocytes under physical loading, act as a communication mechanism, carrying information from osteocytes to bone marrow stem cells. The chemicals inside the vesicles tell bone marrow stem cells to turn into cells fundamental to the process of bone generation. This communication mechanism holds great potential to act as a novel, cell free, therapy to enhance bone regeneration.
Professor Lorraine O’Driscoll from Trinity’s School of Pharmacy
Professor David Hoey, Trinity’s School of Engineering, says, “This work highlights the importance of considering physical factors in biology and medicine, demonstrating an interesting example of where mechanics alone was sufficient to change cell behaviour, and in this case, support bone growth. This gives us significant insight into the role of exercise in bone formation and specifically intra-cellular communication. “This work identified that mechanically activated vesicles can be harnessed to promote stem cell differentiation in the lab. Harnessing these small vesicles we hope to develop new therapies for bone regeneration that mimic the beneficial effects of exercise on bone, potentially transforming how millions suffering from osteoporosis and bone defects are treated each year. Our next step is to test their efficacy in pre-clinical models.” This work was conducted in collaboration with Professor Lorraine O’Driscoll from Trinity’s School of Pharmacy. It was funded by the Irish Research Council, the European Research Council and Science Foundation Ireland. 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. 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. One in 4 men and 1 in 2 women over 50 will develop a fracture due to Osteoporosis in their lifetime. The disease can also affect children.
Benefits highlighted of D-Mannose in Urinary Tract Infections Urinary tract infections (UTIs) are among the most common infections affecting adult women. One-half of all women will experience at least one UTI in their lifetime. Recurrence of UTIs is common, with a reported rate of 25% within 6 months of the first occurrence. blocks FimH adhesin, which is positioned at the tip of the type 1 ﬁmbria of enteric bacteria. D-mannose powder has been available for some time for the treatment of UTIs in horses, cats and dogs. Its efficiency has not been validated in larger studies but it has been shown that in vitro D-mannose applied locally reduces the adherence of Escherichia coli, Pseudomonas aeruginosa and Streptococcus zooepidemicus (important causes of sterility in mares) to endometrial epithelial cells in mares. D-mannose is also widely available and used for UTI prevention in humans as a food supplement, but clinical studies on the topic are lacking.
Urinary tract infection (UTI) is the collective term used to describe infections involving any part of the urinary tract, which includes the kidneys, ureters, bladder and urethra. Infections of the bladder (cystitis) and urethra (urethritis) are known as lower UTIs and infections of the kidneys (pyelonephritis) or ureters are classed as upper UTIs. The use of D-Mannose in the prevention of recurrent UTIs has shown benefit, and with the added potential to offer a valuable alternative to antibiotics. By virtue of their patient access, community pharmacists can provide front-line health education and screenings to female patients. Diagnosis of UTI is based primarily on signs and symptoms. The incidence of UTIs in adult males under age 50 years is low. Up to 40% of women develop a UTI at some point in their life, compared to 12% in men. In men, cystitis is often associated with infection and inflammation of the prostate gland (prostatitis). Anatomically, the female urethra is shorter and located closer to the anus than in males, which makes it easier for bacteria to reach the female urethra and bladder. Adult
women are 30 times more likely than men to develop a UTI, with almost half of them experiencing at least one episode during their lifetime and one-in-three women experiencing their first episode by the age of 24 years. UTIs are most commonly seen in sexually-active young women. If patients present with both dysuria and frequency, the probability of a UTI is greater than 90%, making the diagnosis of UTI (without the need for urinalysis) almost certain. The results of several studies have revealed that antibiotics may promote treatment resistance by causing alterations in the intestinal flora. Symptomatic treatments available over the counter (OTC) from community pharmacies include alkalinising agents, cranberry products, and analgesia. UTIs can be classified as ‘uncomplicated’ (sometimes referred to as a ‘simple’ UTI) or ‘complicated.’ Uncomplicated infections present most frequently in women without any structural or functional abnormality of the urinary tract, any history of renal disease, or other comorbidity (e.g. immunocompromised patients or those with diabetes), which may contribute to more serious
outcomes. Complicated UTIs are associated with a condition or underlying disease that interferes with the patient’s immune mechanisms and increases the risk of acquiring infection. Recurrent UTIs, deﬁned as at least two UTIs in 6 months or three UTIs in 1 year, are a signiﬁcant burden for the patient and result in high costs to the health system. The most commonly prescribed regimens are trimethoprimsulfamethoxazole (or trimethoprim alone), nitrofurantoin, cephalexin and the ﬂuoroquinolones at a quarter of the usual daily dose for 6 months. The downsides of long-term antibiotic prophylaxis are possible adverse reactions (although rare), costs and increasing bacterial resistance to antibiotics; therefore, alternative prophylactic agents, such as cranberry juice and probiotics have been extensively studied. One such agent is D-mannose, which is normally present in human metabolism and has an important role, especially in the glycosylation of certain proteins. The supposed mechanism of action is inhibition of bacterial adherence to urothelial cells. In vitro experiments have shown that D-mannose binds and
One study carried out by Silvio Altarac and Dino Pape� of the Department of Surgery and Urology, Zabok General Hospital and the Department of Paediatric Surgery and Urology, Clinical Hospital Centre Zagreb looked at the use of d-mannose in prophylaxis of recurrent urinary tract infections (UTIs) in women. The results of this study suggest that D-mannose can be an effective prophylactic agent in a selected population. The study authors state, “The latest Cochrane Database review concluded that cranberry products cannot currently be recommended for the prevention of recurrent UTIs, although there are many good-quality studies that clearly showed its efficacy in selected patients. “A possible cause of such a ﬁnding and contrasting results among clinical studies is that in many of them various cranberry products (powder, juice, capsules) without clearly deﬁned potency, dosing and active ingredient contents have been used, which is a known problem with natural food supplements. To avoid such issues with D-mannose, pharmacokinetic studies to determine the exact dosage and optimum regimen for D-mannose should be undertaken in further research. We believe that D-mannose may be a useful agent for the prevention of recurrent UTIs but further clinical trials will be necessary.”
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IPN are now looking for your nominations for the Dynamic 100 The Covid-19 pandemic brought pharmacy professionals even further to the fore of healthcare provision. Do you know someone who went above and beyond during this time of huge challenge? Who has inspired you this year? Who deserves recognition for a special project they have executed this year? Who has shown an ability to get things done during a period of change? Who has developed something new and innovative within their organisation? The Dynamic 100 will represent Ireland's pharmacy industry's most inspiring and enthuiastic people - the industry's very best, nominated by you, the IPN readers, collegues and peers of these individuals. We would like you to nominate (up to 10) indiduals for this years' IPN's Dynamic 100. All we need is a short explanation for their nomination. Nominations are sought from right across the pharmaceutical proffesion in Ireland and may include (but is not limited to) Managing Directors, Commercial Directors, Pharmacists, Superintendents, Brand Managers, Group Representatives, Buyers or Owners - and anyone inbetween! Individuals featured in 2020's Dynamic 100 may be nominated provided that the reasons for nomination relate to a project undertaken during 2020. The Dynamic 100 is a not-to-be-missed 'who's who' of pharmacy in Ireland Please email your nomination(s) to firstname.lastname@example.org or email@example.com before 12/10/20
Original ideas for better access to medicine Offering originality combined with cost savings without sacrificing quality. These are amongst the founding principles of parallel importing company, Originalis.
Kasper Yde, Sales and Business Development Director (left); Thibaut Evers, Project Manager Ireland
"Our size allows us to source Europe’s best prices with great reliability. We have excellent relationships with suppliers in many countries throughout the EU."
riginalis supply original medicine at very attractive prices in Ireland, Germany, the Netherlands, and the UK with more markets on the way. The company offer community pharmacists access to a wide and constantly growing product portfolio with a particular focus on specialty and High Tech medicine. We spoke to the team to find out more about their company history, values and offering to the pharmacy profession within Ireland. Originalis forms part of the Abacus Medicine Group, which is among the market leaders in parallel trade of pharmaceuticals in Europe.
Sales & Business Development Director Kasper Yde explains, “Abacus Medicine was founded by our CEO Flemming Wagner and his father, John Wagner, in 2004.
t this time, John was a practicing Danish doctor and was encountering patients on certain medication that were suffering shortages in Denmark. With the patient always the primary priority, he started looking beyond his own national border and found that he could import the medicine from Germany. “He also found that he could do this at a lower price and therefore provide savings to the patient.”
It was this practice which the pharmaceutical industry has now come to know as ‘parallel distribution’ or ‘parallel importing’ and it was then that Flemming and John made the decision to take their idea further and began focusing on providing access to medicine and savings to more and more pharmacies throughout Denmark. “Some sixteen years later we employ over 1,000 staff across Europe and are operating in 12 European markets providing better access to pharmacies and hospitals,” adds Thibaut Evers, Project Manager for Ireland. Through parallel trade, the medicine suppled to pharmacists
Europe’s highest healthcare costs per capita and, Kasper notes, Irish community pharmacy businesses are frequently squeezed for profits. “We are here to reduce healthcare expenditure by providing the same medicine at better prices through our European network. The main challenges we faced this year were within the context of distribution set-up and reimbursements,” he explains. “We wanted to provide excellent service with next day deliveries nationwide for both ambient and cold chain products. We have also realized that the reimbursement structure in Ireland is a lot more bureaucratic and time consuming compared to most other markets we operate in.” Portfolio Development
he Originalis team are constantly adding new products to the existing portfolio and are in constant dialogue with the national healthcare authorities to provide savings.
Originalis’ local warehousing partner in Ballycoolin Dublin, RxSource
and, eventually patients, is original medicine purchased in another country within the EU. Originalis buy at lower prices in EU member countries and then repackage for the Irish market. “It is our way to offer the same original medicine, but at Originalis prices,” he says. Origins of Growth
riginalis are a very growth oriented business and operate in many markets.
Did you know? • Originalis and Abacus Medicine repackages more than 75,000 packs of medicine every month • The used, old boxes are discarded and the medicine repackage in fresh, new ones • New boxes are good for quality, consistency and patient safety. But paper waste is not necessarily good for the environment • To minimize waste, the company send more than 10 tonnes of shredded paper waste for recycling each month • The paper waste is recycled into new paper products such as napkins and toilet paper
He continues, “Two years ago we started working with Uniphar on a number of pharmacy lines. During 2020, we launched our own distribution in Ireland in order to expand our reach and offering to even more pharmacies. “We continuously strive for excellence to meet our customer needs. One of our key focus areas is the reliability of supply. We have a strong network with European suppliers to ensure reliability of supply. In July we further strengthened our position with the acquisition of Pluripharm, one of the leading full-line wholesalers in the Netherlands.” Maintaining this focus and pursuit of excellence is not without its challenges. Ireland has one of
“We are submitting many applications for which we are able to offer significant savings,” adds Kasper. “In the past few months our list of reimbursable items has been increased substantially and you will see our portfolio of attractive GMS and High Tech lines grow in the future as well.” Turning to distribution, Originalis have decided to partner with the local sales and distribution agent RxSource located in Dublin Ballycoolin. “They are doing a fantastic job in making sure all products are delivered to pharmacists in the most effective way while providing an excellent customer service.”
t has been argued in the past, that the complexity of how parallel imports are supplied can sometimes create problems such as risk of human error
The difference is in a box designed for Ireland A pharmaceutical product from Originalis is a product of the highest quality. The medicine we supply to you is original medicine purchased in another country within the EU. We buy at lower prices in other EU member countries and then repackage for the Irish market. This is what is commonly known as parallel trade. It is our way to offer you the same original medicine, but at Originalis prices. When we repackage medicine, we do so in boxes designed specifically for Ireland. Used, foreign boxes with lots of labels on is not the Originalis way. Instead, we discard the old boxes and deliver the original medicine in fresh, new boxes. This ensures a high and uniform quality appreciated by pharmacies and patients alike.
in repackaging for example. Following the right approaches is key, says Kasper. “Our processes are highly standardized and we follow a best practice approach. The integrity of the medicine is never at risk as we do not open the actual product. What we do is to repackage the outer packaging material. I would argue that we actually reduce the risk of falsification because we have additional falsification checks in place before repackaging. “We are one of Europe’s largest parallel distributors with a revenue in 2019 of 421 million EUR. Our size allows us to source Europe’s best prices with great reliability. We pursue a multi-market strategy and have therefore excellent relationships in many markets further strengthening our ability to source products on a continuous basis. If there is a shortage of an imported product in one country we can still source it from another because we diversify our supply chain. Another important factor is our high focus on quality. “We have excellent quality processes for all our goods and we provide a box design that is called full replica. That means that our products cannot be distinguished from the original distributed in Ireland. Some of our competitors opt for a cheaper portfolio with over-labelling solutions but that is “ not where our focus lies.” Harnessing Innovation
ne of the key objectives set out by the team is to offer the same original medicine that the pharmacists are used to receiving. “Compared to our competitors, you will see that we can offer many High Tech and cold chain items. We help pharmacies realize better bottom line results, easing the financial pressure and allowing them to re-invest that money in more adding value activities for their patients. Further, we are always looking to expand our portfolio to make it even more attractive for pharmacies to order from us. If any pharmacists are interested in collaborating with us or have specific requests, I would urge them to get in touch,” Thibaut says. You can now even open an account with Originalis through IPN on the next page.
Pharmacy Account â€“ Set Up Form Pharmacy Name: PLEASE PRINT Trading As (If different): Pharmacy / Delivery Address:
Invoice Address: (If different)
Company Registration Number:
Pharmacy Contact Details:
Contact Person for Deliveries:
Buyer Contact Number: (If different)
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SEPA Direct Debit Mandate
Please return to: Email: firstname.lastname@example.org Fax: 01 963 1109 Address: Unit 506 B, Northwest Business Park Ballycoolin, Dublin 15, Ireland, D15 KP21
What makes you proud?
Your customers deserve an excellent service. The kind of committed service, one should expect from an Irish community pharmacy. The kind, caring and personal service that makes you proud to be the professional behind the pharmacy counter. Originalis offers you the quality, you can be proud of.
We are looking forward to continue dealing with them. A first class company for Irish pharmacies. John O’Callaghan, Supervising Pharmacist, Jenkinstown Pharmacy
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First Step Treatment in Breastfed Infants with Gastroesophageal Reflux Disease (GERD)1 2018 ESPGHAN guidelines recommend: – Avoid overfeeding – Use thickened feeds – Continue breastfeeding
GMS & ACBS Listed
instant carobel a gelling or thickening agent
Call our dedicated healthcare Professional FREEPHONE carelines
ROI HCP 1800 371 371 Alternatively, visit our website Careline www.cowandgatehcp.ie NI HCP 0800 977 5656 Alternatively, visit our website www.eln.nutricia.co.uk Careline
For the dietary management of habitual or recurrent vomiting and rumination.
Available in pharmacy outlets nationwide References: 1. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (2018), Journal of Pediatric Gastroenterology and Nutrition, 66; 3, 516-554. Important Notice: Cow & Gate instant carobel is a food for special medical purposes for the dietary management of habitual and recurrent vomiting and rumination. Use under medical supervision.
This information is for healthcare professional use only Date of preparation: August 2020
Breastfeeding and the use of Medicines I have breast fed my three children for two years each so I am only too aware of what a marathon sport that breastfeeding is! The Fabulous Pharmacist Laura Dowling
preparations however such decongestant and steroid nasal sprays can be used to treat congestion caused by colds and hayfever. Nasal rinsing with saline and steam inhalations with eucalyptus oil are excellent too. Topical treatments such as vaginal thrush, anti-inflammatory, steroid, anti-viral, anti-bacterial and anti-septic creams and wart treatments can be used safely in breastfeeding. Thrush of the nipple should be treated carefully as it can be passed between baby and mother meaning both need to be treated together with the correct medication.
"There is misinformation out there on social media platforms so it is important that women know where to access the correct advice" As a pharmacist I am also aware that health care professionals (HCP) are always quite hesitant about recommending medicines to breastfeeding mums. This is understandable. No one would ever want to inadvertently advise a breastfeeding mother to take a medicine that could potentially harm her baby. However, I also think that by always erring on the side of caution and by not properly informing ourselves of the facts that we are doing not only mothers but their babies a disservice. We are further boxing breastfeeding off as a difficult task. One in which mothers have to ‘sacrifice’ themselves. It can lead to mothers giving up breastfeeding prematurely and unnecessarily. Many women succumb to the normal bugs and illnesses of
everyday life while breastfeeding. Others may end up in hospital or require surgery. It is unquestionable that there is a real anxiety out there about taking and advising on medications while breastfeeding. However, we know how very important breastfeeding is for both mum and baby. So, in a world where we are trying to improve breastfeeding rates pharmacists should be able to inform breastfeeding mums of the facts about using medicines. The use of medications during breastfeeding will depend on many factors: The benefits to the mother of taking the drug The volume of breastmilk being consumed (an exclusively breastfed six week old will drink much more breastmilk than an older baby who is also eating solids) If the baby is preterm If the drug is highly protein bound and therefore less free to enter the milk or if the drug has low plasma to milk ratio. In general, only 1% of a drug will pass through breastmilk to a baby. We know that it is unethical to do clinical trials on breastfeeding mothers. Also, pharma companies are not obliged to produce safety data on lactation when bringing a new drug to market. It is important however, that women know that
there are medications that are safe to take while breastfeeding. And it is important that pharmacists, doctors and dentists know this too! There is no need for a breastfeeding mother to unnecessarily avoid symptomatic relief for ailments such as colds and flu, thrush and hay fever. Analgesics such as paracetamol and ibuprofen can give great relief for headaches, aches and pains and fever and are safe to use, but the maximum daily dose should not be exceeded. Other NSAIDS are generally safe to use while breastfeeding as they generally pass in relatively small amounts into the breastmilk. Codeine or other opioid drugs may be given to a mother post instrumental or c- section delivery or other operation under the supervision of her medical team. The use of codeine by breastfeeding mothers, if essential, should be at the lowest effective dose for the shortest duration possible. It can pass into the milk and can cause drowsiness, poor feeding and potentially respiratory depression, especially if a mother is a fast metaboliser of codeine. She should be made aware that if any of these symptoms develop in her baby that she should seek medical advice. Oral decongestants should be avoided as studies have shown that they can reduce milk supply and increase wakefulness and irritability in babies. Topical
Studies have shown that allergies such as nettle rash or insect bites may be treated with a course of antihistamines for short periods of time. Many oral antibiotics and antivirals are also safe. If a woman suffers from any chronic illness such as diabetes or a psychiatric illness such as depression it is possible for her and her doctors to come up with a treatment plan which will allow her to breastfeed. The antidepressant of choice for example while breastfeeding is sertraline and taking this in combination with therapy or CBT can keep a mother breastfeeding. Studies have shown that successful breastfeeding can help to protect a mother from post-natal depression so as pharmacists, often the most accessible HCP, it is our duty to be informed and to impart this information! There is misinformation out there on social media platforms so it is important that women know where to access the correct advice when it comes to treating themselves when ill. They should feel empowered and informed. @ thebreastfeedingnetwork is a great online resource. It was developed by Pharmacist Wendy Jones OBE, who has a PhD in drugs in breastfeeding and whose ‘drug factsheets’ I regularly refer to. Lactmed is a fantastic app. As Pharmacists we should educate ourselves so we are better able to support women who need help when feeling unwell.
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The Market in Baby Formula Ireland has one of the lowest breastfeeding rates in the world. Rates are increasing steadily but breastfeeding incidence declines steeply in the early weeks after birth. The Institute of Public Health in Ireland reported last year that breastfeeding rates in the Republic and Northern Ireland were slowly growing and that between 2006 and 2015 the percentage of women breastfeeding when discharged from hospital rose from 49% to 58%. Some 35% of babies in the State continue to receive breastmilk at three months, according to the HSE. brands. It appears, however, that the last item on which consumers seem to economise is baby food. Higher prices are justified by the perceived better nutritional value for babies from high quality branded products. It has been said, that there is a belief among pharmacists that much of their baby feeding sales have been lost to grocery, but others think that taking a different approach can make you a centre for feeding advice and win back sales.
The National Maternity Strategy says that in addition to practical supports provided to mothers, such as support to continue breastfeeding on return to the workplace, a broader societal change is required in order to promote a more positive culture around breastfeeding. This should support women to feel confident about their choice to breastfeed. In essence this means that all mothers should be supported to breastfeed at anytime and anywhere. The National Strategy for Women and Girls 2017-2020 re-affirmed the commitment to advance public support of breastfeeding, and includes an action to extend provision for breastfeeding breaks under employment legislation (currently available to mothers of children under 6 months). However breastfeeding is frequently not a viable option for all. Some of the main reasons given for not continuing to breastfeed following the first few days and weeks include insufficient milk supply; fatigue; difficulty with breastfeeding technique; nipple pain and poor latch; lack of freedom; return to work; not wanting to breastfeed
and embarrassment as a result of negative societal attitudes towards breastfeeding. Parents welcome the advice of healthcare professionals for infant feeding and the community pharmacy will be the first call when looking for guidance. In this article we look at the latest guidance and ask how you can grow your share of this important category. Value and Growth With the highest birth rate amongst the EU Member States and one of the lowest breastfeeding rates in Europe, the Irish market is lucrative for both baby food and milk formula, according to data analyst Euromonitor. Milk formula use is also strengthened by the high proportion of women aged 20-45 years of age that are both employed and work outside the home. Prepared baby food continued to be the most dynamic baby food category in 2019, particularly benefitting from greater need for convenience, good economic growth and high employment rates. Its growth also comes from continuous quality improvements
and an alignment with current health and wellness trends. “Other” baby food is doing well thanks to the snacking trend that is spilling over from “adult” food – referring to the grazing trend that has been going on in packaged food for a while in Ireland, where snacks generally are highly demanded. Whereas in the past, parents in transit may have simply brought a packet of plain biscuits or rusks along to give their children something to nibble on, there is a growing number of specific (and value-added/more expensive) products to be consumed on the go that are addressing that need. Another key characteristic of the global infant nutrition market is the very low penetration of supermarket private labels, at less than 1%, according to Zenith Global. This underlines the high degree of brand loyalty and the opportunities for higher profit margins. High quality and safety credentials are primary criteria for consumers and branded items are more strongly associated with these features. In many food categories, private label products compete successfully on price against
Pharmacists and their teams are ideally placed to provide advice and support to mothers when it comes to infant feeding. From giving practical tips and support on breastfeeding to identifying and advising on potential problems, the pharmacy team can make a real difference to young families in those early months. Many community pharmacists have not realised the full extent of the opportunities that exist for them to provide an advice service in their local communities. The National Childbirth Trust says women can experience unacceptable levels of pressure however they feed their babies from family and friends, as well as from people they hardly know. Mothers who breastfeed their babies often feel pressurised and constrained about whether, where, how often, and how long they breastfeed. Similarly, mothers who use formula milk often feel judged or guilty too, particularly but not only - if they planned to breastfeed. Informed choice must be promoted, many maternity and infant experts advise. Formula Feeding The rapid growth of dairy farming in Ireland has led to its position as one of the leading global exporters of infant milk formula. There is a range of infant formulas available over-the-counter and either a whey or casein based formula is a suitable choice for
infants from birth to the age of 12 months. Follow-on formulas, which contain more iron and vitamin D than ordinary formulas, are available for infants over the age of six months. Cows' milk is not suitable as a main drink for children under the age of 12 months. It contains little iron and vitamin D and may lead to intestinal blood loss in some children. Skimmed and semi-skimmed milks should not be used in infancy because of their low energy content. Semiskimmed milk may be used from the age of 2 years where it is the milk used in the household and the infant's diet is varied. However, skimmed milk should not be used under the age of 5 years. Fruit juice is not necessary, but helps the absorption of iron from fruit, vegetables and cereals. It is important to remember that many parents do not receive instruction on appropriate technique for making up bottles; if formula preparation is not done properly, the baby may be at risk of dehydration and over or under-nutrition. Parents who bottle-feed can feel that they are not given enough impartial information about formula milks. Recent position statements recommended that balanced and relevant information is given to parents choosing to formula feed their babies, whether exclusively or partially, to enable them to do so safely and with support to encourage good bonding. This includes instructions on
cleaning and sterilising equipment and the correct method for making up formula feeds. Pharmacy teams should know the differences between the different types of milks, as this can be bewildering for new parents. While leaflets on bottle feeding are essential, so are one-to-one discussions. Pharmacists must make sure customers understand about good hygiene, washing, sterilising and making up feeds. Signpost to other healthcare professionals if customers need extra help. Whey Based Formulae - The first group are whey based formulae. These are similar to breastmilk because the protein content is made up of more whey than casein. However, the total protein content of infant formulae is higher than breastmilk and as a result, infant formulae are not as digestible as breastmilk. These formulae are the most suitable for newborn and older infants. Casein Based Formulae - The second group are casein based formulae. Babies fed casein based formulae may have to work harder to digest each feed. This means that baby may sleep more - All babies need time every day to be awake and alert, in order for them to grow and develop. "Follow-on" Milks – These are made from modified cow's milk with extra iron and vitamins. Soya Based Formulae - Soya based formulae and other
specialised formulae should not be used without the advice of a dietician or doctor. All infant formulae on the Irish market must conform to the same EU standards and provide the same nutritional value. There should be no reason to change a baby from one "type" of formula to another. Specialist Formula Specialist infant formula is one area where pharmacists could provide a valuable service to those mothers who are unable to breastfeed and whose babies have an intolerance or a sensitivity to regular formula milk, or for those women whose baby has a problem such as reflux, colic or constipation. Many pharmacies can benefit from adopting a merchandising approach, with clear signposting to ‘Ask the pharmacist for advice.’ There has been an increase in the number of babies who do not thrive on standard formulas, which is why much of the growth in the infant formula market over the past year has been driven by an increase in purchases of specialist milks, aimed at addressing feeding problems. This offers a genuine opportunity for pharmacists because such products sit well with the pharmacy’s role as a provider of healthcare advice and remedies. By stocking one or two of these products, the pharmacy would be in a position to provide a possible solution. Hence it is vitally important all pharmacy staff understand the difference between formula types. It is important to stock some alternatives. Some parents may experience various feeding problems with their baby such as reflux, lactose intolerance or allergies. Make sure mums know they can get these specialist formulas on prescription if their baby has a diagnosis, so it’s also important they see their GP. Baby Food Natural Alternatives One of the main trends driving growth in the baby food sector
is a continued interest in natural and organic baby and childspecific products, reflecting higher awareness of ingredients such as parabens. With environmental conditions deteriorating globally, there is a rising anxiety as to the safety of the products we use and, even more so, the food we consume. There is a growing trend towards organic products, which stems from a concern for our health and general wellbeing and, even more so, that of our children. Organic baby products, food in particular, have therefore garnered much attention in recent years. Organic baby food has witnessed rapid adoption due to factors such as rise in parental concerns over baby’s nutrition, growing awareness about the benefits of organic products, improved distribution channels, and ecofriendly farming techniques. Link Sales New parents tend to seek out baby products that help to make their lives easier. Well-stocked shelves will ensure footfall, and encourage cross-category purchases, ensuring the pharmacy is a chosen destination for future family healthcare purchases. There is a great opportunity to have a strong “best for baby” message. Whether online or in-store, pharmacies have that great position of trust. More so in the early years, when information and advice for new parents can feel overwhelming and confusing, community pharmacies have an essential role in offering advice and education on lifestyle issues and product selections, which will encourage a drive to the pharmacy instead of the GP or supermarket. The infant feeding market prospects are strong, proving recession-proof, despite falling birth rates. Nevertheless, the industry is dealing with a highly sensitive consumer. The importance of safety cannot be underestimated. Consumer confidence is key.
Table One: Milk for Infants
After 12 months
Breast or infant Formula
Whole cows’ milk
Semi-skimmed or skimmed milk
Awareness campaign on psoriatic arthritis Sausage-like fingers or toes; a red scaly skin rash; pitted nails; and stiff, painful, swollen joints – these are some of the symptoms of psoriatic arthritis (PsA), which Arthritis Ireland is highlighting in a health awareness campaign launched last month. The patient organisation and research charity is looking to inform people about the autoimmune condition which affects thousands of people in Ireland. It is estimated that up to one-third of people with psoriasis may also develop psoriatic arthritis. As part of the campaign, the charity is undertaking a major survey on the impact of the disease on people’s lives. Psoriatic arthritis is a form of inflammatory arthritis that can cause pain, swelling and sometimes damage to any joint in the body. It is not known exactly
what causes the disease, although research has shown that genetic and environmental factors can play a role. It can affect people at any age. Dr Laura Durcan, Consultant Rheumatologist at Beaumont Hospital, has recorded an information talk about PsA, which is available online. “An early diagnosis is key to ensuring that patients have a normal life,” she said, “like having a job, a family, that the person can play sport and socialise. In order to achieve this, it is vital that patients are seen sufficiently early, before irreversible damage sets in.”
Siobhan Donohoe from Kilkenny, Psoriatic Arthritis patient who is taking part in the campaign Psoriatic arthritis can cause permanent joint damage quickly when not treated. Once damage occurs, it is not reversible and can cause significant pain. “This is a systemic condition, meaning that over time, inflammation can affect multiple joints and even organs. However, research has confirmed that treating PsA early and aggressively often improves the long-term outcomes and significantly reduces damage,” stated Dr Durcan.
Teva launch Tetridar® (teriparatide 20 microgram/80 microlitres Solution for injection) Teva has announced the launch of Tetridar® (teriparatide), the 20 microgram/ 80 microlitres Solution for injection in a pre-filled pen for treating patients living with osteoporosis. The treatment simulates osteoblastic activity and new bone tissue formation, reducing the risk of fracture in those with osteoporosis. The new treatment is bioequivalent and functionally comparable to the original, Forsteo®. it is estimated that there are currently 300,000 people in Ireland living with osteoporosis with only 15% of people diagnosed. Teriparatide is a self-injecting
Instead of Jim Bolger’s and Davy Russell’s teams lining-out in St Conleth’s Park on Tuesday, August 11, a host of stars will take part in a virtual hurling skills challenge to raise much needed funds for the Irish Cancer Society’s cancer research.
device which can be administered at home with a recommended dose of 20 micrograms, to be administered once daily by subcutaneous injection in the thigh or abdomen. Each dose of 80 microlitres contains 20 micrograms of teriparatide and one pre-filled pen of 2.4ml contains 600 micrograms of teriparatide (corresponding to 250 micrograms per ml). Alongside treatment with teriparatide, supplemental calcium and vitamin
D should also be taken by patients if dietary intake is inadequate. Patients must be trained to use the proper injection technique and on the correct use of the pen. The maximum treatment duration should be no more than 24 months and treatment should not be repeated over a patient’s lifetime. Following cessation of teriparatide therapy, patients should be continued on other osteoporosis therapies.
Paul Neill, Director Generics Products Teva Ireland said, “Tetridar® will help with the prevention of osteoporotic fractures and aid the overall management of osteoporosis. It is worrying to see that an estimated 85% of people living with osteoporosis in Ireland are going undiagnosed. A fracture, or worry of one, can have a huge impact on a person’s quality of life, both mentally and physically.”
Cancer Charity Drive goes Virtual Due to Covid-19, Hurling For Cancer Research, the annual charity hurling match between a host of racing, GAA, sports stars and TV personalities, is going virtual for 2020.
Those taking part in the virtual hurling skills challenge are: Frankie Dettori, Davy Russell, Lee Chin, Richie Hogan, Ursula Jacob, Marty Morrisey, Ruby Walsh, AP McCoy, Miriam O’Callaghan, Ger Lyons, Shane Foley, Willie Mullins, Danny Mullins, Paul McGrath, Ashling Thompson, Tommy Walsh and Cian Boland. Everyone’s hurling challenges will be shared on social media. Those participating in the challenge are asked to donate what would have been the match ticket price of ¤10 to the Irish Cancer Society to help the charity continue their vital work to improve the lives of those affected by cancer.
Make a donation via: www.justgiving.com/hurlingforcancer PHARMACYNEWSIRELAND.COM
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 palsy, collagen disorders such as rheumatoid arthritis, corneal or eye lid defects, Sjögren syndrome, and thyroid-related eye disease. Other medical conditions associated with DED include diabetes, lupus, and scleroderma.
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:
• Thyroid disorders.
• 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 changes caused by pregnancy, the use of birth control pills, or menopause. • The use of cold or allergy medicines, antidepressants, and drugs for high blood pressure; acne; birth control; and Parkinson’s disease. • Wearing contact lenses. • An eye injury or other problem with your eyes or eyelids.
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• 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. 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
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. 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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TheaPamex and AOS team up to offer virtual Eye Care Assessments With the COVID-19 crisis still present in every aspect of daily life, TheaPamex (Ireland’s No 1 Eye Health choice) and AOS (Advanced Ophthalmic Systems) have teamed up to offer a pioneering software solution to all eye care professionals that enables a complete in and out of practice assessment of patients. With the AOS mobile app, patients are able to send an image of their eye from their mobile phone, giving the eye care professionals sight of the issue. This, alongside secure live video calls which can be activated at the touch of a button, will provide the opportunity to assess if either an emergency appointment is required or if a minor eye condition can be diagnosed. And the AOS analysis software enables ECPs to provide a subjective and accurate grading for images taken remotely and in-practice via a slit lamp. Eye care professionals have now the opportunity to put clients at ease about receiving eye health advice and recommendations for treatment of potential eye problems efficiently, effectively and most of all safely.
Accord launch patient focused App Following on from the successful launch of its patient-activated, pre-filled injector (PFI) to deliver pegfilgrastim (Pelgraz® Accord Healthcare are delivering another first, with the launch of their Pelgraz® support app in Ireland.
The app is designed specifically for patients who have been prescribed Pelgraz® PFI. “We appreciate that patients undergoing treatment for cancer can feel like they have very little control over their illness and we believe it is important to give patients back some sense of control. We have therefore developed our app to help give patients the confidence to self-administer their treatment from the convenience of their own home, while offering them the peace of mind that they are complying with their prescribed treatment regimen”, says Mr Tony Hynds, Managing Director, Accord Healthcare Ireland Ltd. The app supports patients to administer their medication at the correct time and in the correct way. It also provides relevant educational content and the ability to track side-effects along with highlighting how to report any side-effects. The app allows a patient to set a reminder to administer their treatment, based on when their last chemotherapy session took place and when the clinician indicated to use the product. Once the reminder is opened, the app automatically presents the administration instructions, which includes an animated video and step-by-step instructions. The symptom tracker allows patients to log their side-effects and symptoms post-chemotherapy and track them over a given period, providing the patient with the tools and information to have an in-depth conversation at their subsequent meeting with their healthcare professional should they wish. The ethos behind Accord’s Pelgraz® PFI launch is to give patients the confidence to administer pegfilgrastim from the comfort of their own home. With pegfilgrastim administered at least 24 hours after cytotoxic chemotherapy, patients will often have to return to hospital or await a visit from a home care nurse to administer pegfilgrastim. “Evidence shows that travelling to and attending hospital visits are one of the major contributing factors that negatively impact the quality of life for people living with cancer. Reducing the number of times that a patient must visit the clinic or hospital, at a time when they are living with the side-effects of chemotherapy and when their immune systems are compromised, must be a priority for patients and their healthcare team. Being able to offer the option of spending more time at home during chemotherapy treatment is something I know patients genuinely welcome and also means that the clinic could potentially make more effective use of nurse resources.” said Prof Hartmut Link, Professor of Medicine, external faculty at University Medical Centre, Hannover, Germany. Patients prescribed Pelgraz® can download the support app from the Apple App store and Google Play.
Lifepak 500 Automated External Defibrillator Priority 2 – Warning Safety Notice
Stryker has identified a component wear out issue for the LIFEPAK 500 AED. In high-use environments the device may not detect a patient connection due to mechanical wear-through Medical of the contact Devices plating on the therapy connector. The issue has been communicated in the attached field safety notice (FSN). There have been no reported incidents relating to this issue in Ireland.
Lifepak 500 Automated External The HPRA advises that users: 1 Read the accompanying FSN carefully. Defibrillator 2 Follow the instructions in the FSN to identify whether you have affected devices in use at your facility.
The HPRA is issuing this notice to raise awareness as the LIFEPAK 500 AED has been discontinued by Stryker and the manufacturer is unable to resolve this issue, therefore any devices remaining in service should be retired as soon as practically possible.
3 If during use you experience the issue described in the FSN, remove and reinstall the electrodes to the device or Priority – Warning replace the electrodes and check the patient connection. If the issue with patient2detection continues, immediately obtain a backup device and remove the affected device from use. 4 If during maintenance testing you identify affected devices that exhibitHPRA the issue in the FSN, remove the devices from useDate: immediately. Safetydescribed Notice: SN2020(09) Issue 10 August 2020 5 Acknowledge receipt of the FSN if you have not already done so. 6 Forward a copy of this Safety Notice and the FSN to all relevant personnel within your organisation or to any other organisations/persons to which/ whom these devices have been transferred. MANUFACTURER / SUPPLIER HPRA CASE REFERENCE 7 Report any adverse events/incidents associated with these devices toStryker the manufacturer and the HPRA. Medical V44148
Stryker has identified a component wear out issue for the LIFEPAK 500 AED. In high-use
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A brand new oral hydration solution for children and adults with Lactobacillus Rhamnosus GG
Diacare is an orange flavoured unique food supplement containing a balanced blend of glucose electrolytes, minerals • Lactobacillus Rhamnosus GG may help to restore and and Lactobacillus Rhamnosus GG. repopulate the equilibrium of intestinal micro flora. • Carbohydrate electrolyte solutions enhance the absorption of • Diacare is a powder water during physical exercise. formulation of oral • Diacare contains magnesium which contributes to electrolyte balance. • Contains chloride which contributes to normal digestion by production of hydrochloric acid in the stomach.
suspension. Box consists of 12 dual-chambered sachets (12 servings). Each sachet consists of two chambers.
Balanced Electrolytes plus Digestive Care*
Provides the probiotic strain: A
Lactobacillus Rhamnosus GG
Unit 3, Clonmore Business Park, Mullingar, Co. Westmeath. t: (044) 933 4602 e: email@example.com SM13120-00 - For training purposes only / Confidential document