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August 2021 Volume 13  Issue 8 PHARMACYNEWSIRELAND.COM

THE INDEPENDENT VOICE OF PHARMACY

In this issue: FOR HEALTHCARE PROFESSIONAL USE ONLY

WHY MEDICATE? TRY NUTRITION FIRST 1

NEWS: Magees Pharmacy gets a Disney Makeover Page 6

REPORT: Pharmaceutical Society publishes Annual Report Page 10

VACCINATIONS: Pharmacy Finally Start Vaccinating Page 14

PROFILE: Maeve Goes for Gold Page 16

TOP 100: Gwynne Morley gives Insights into the Irish OTC Market Page 20

For more information, call freephone 1800 923 404 or visit www.nutricia.ie Available to order from United Drug and Uniphar Reference: 1. Rosen R et al. J. Pediatr. Gastroenterol. Nutr. 2018; 66(3): 516-554. IMPORTANT NOTICE: Breastfeeding is best. Aptamil Anti-Reflux is a food for special medical purposes for the dietary management of frequent reflux and regurgitation and must only be used under medical supervision. Date of preparation: February 2021 Nutricia Ireland, Deansgrange, Co. Dublin

This Publication is for Healthcare Professionals Only

FEATURE: Analysis of the Key OTC Categories Page 30

CPD: Infant Nutrition Page 61

CYBER SECURITY: Is your Pharmacy Cyber-Secure? Page 82

NEW

Discover Strength of Balance Introducing JYSELECA (filgotinib)– a preferential JAK1 inhibitor for moderate to severe RA1

Indicated for the treatment of moderate to severe active rheumatoid arthritis in adults who have responded inadequately to, or are intolerant to one or more disease modifying anti-rheumatic drugs.1 May be used as monotherapy or in combination with methotrexate.1 Refer to Summary of Product Characteristics (SmPC) before prescribing, and for full prescribing information. JYSELECA®

filgotinib 100 mg or 200 mg film-coated tablets.

Indication: Jyseleca is indicated for the treatment of moderate to severe active rheumatoid arthritis in adult patients who have responded inadequately to, or who are intolerant to one or more disease modifying anti-rheumatic drugs (DMARDs). Jyseleca may be used as monotherapy or in combination with methotrexate (MTX). Dosage: Adults: 200 mg once daily. Taken orally with/without food. It is recommended that tablets are swallowed whole. Laboratory Monitoring: Refer to the SmPC for information regarding laboratory monitoring and dose initiation or interruption. Elderly: A starting dose of 100 mg once daily is recommended for patients aged 75 years and older as clinical experience is limited. Renal impairment: No dose adjustment required in patients with estimated creatinine clearance (CrCl) ≥ 60 mL/min. A dose of 100 mg of filgotinib once daily is recommended for patients with moderate or severe renal impairment (CrCl 15 to < 60 mL/min). Not recommended in patients with CrCl < 15 mL/min. Hepatic impairment: Mild moderate hepatic impairment: no dose adjustment required. Severe hepatic impairment: not recommended. Children (< 18 years): Safety and efficacy not yet established. Contraindications: Hypersensitivity to the active substance or to any of the excipients. Active tuberculosis (TB) or active serious infections. Pregnancy. Warnings/ Precautions: See SmPC for full information. Immunosuppression: Combination use, with immunosuppressants e.g. azathioprine, ciclosporin, tacrolimus, or biologic DMARDs (bDMARDs) or other Janus kinase (JAK) inhibitors is not recommended as

a risk of additive immunosuppression cannot be excluded. Infections: Infections, including serious infections such as; pneumonia and opportunistic infections e.g. tuberculosis (TB), oesophageal candidiasis, and cryptococcosis have been reported. In some cases, treatment should be temporarily interrupted. There is a higher incidence of serious infections in the elderly aged 75 years and older, caution should be used when treating this population. Treatment should be interrupted if a patient develops a serious infection until the infection is controlled. Patients should be closely monitored for the development of signs and symptoms of infections during and after filgotinib treatment. Tuberculosis: Patients should be screened for TB before initiating filgotinib, and filgotinib should not be administered to patients with active TB. Viral reactivation: Cases of herpes virus reactivation (e.g., herpes zoster), were reported in clinical studies (see SmPC). If a patient develops herpes zoster, filgotinib treatment should be temporarily interrupted until the episode resolves. Screening for viral hepatitis and monitoring for reactivation should be performed. Malignancy: Immunomodulatory medicinal products may increase the risk of malignancies. Malignancies were observed in clinical studies (see SmPC). Fertility: In animal studies, decreased fertility, impaired spermatogenesis, and histopathological effects on male reproductive organs were observed (see SmPC). The potential effect of filgotinib on sperm production and male fertility in humans is currently unknown. Haematological abnormalities: Do not start therapy, or temporarily stop, if Absolute Neutrophil Count (ANC) <1 × 109 cells/L, ALC <0.5 × 109 cells/L or haemoglobin <8 g/dL Temporarily stop therapy if these values are observed during routine patient management. Vaccinations: Use of live vaccines during, or immediately prior to, filgotinib treatment is not recommended. Lipids: Treatment

JYSELECA is now reimbursed and will be dispensed under the High Tech Arrangement effective March 1st 2021

JYSELECA 200 mg offers a balance of sustained efficacy from Week 2 to Week 52,2 with acceptable tolerability and low rates* of JAK inhibitor-associated adverse events1,3† ACR20 response seen by Week 2 in 37% of JYSELECA patients (n=475) vs. 15% of those in the placebo group (n=475; p<0.001)2 By Week 52, 44% of JYSELECA patients had achieved ACR70 response (n=475)2 Similar observed rates of serious infections and herpes zoster vs. adalimumab2,3 * Based on AE rates observed as ‘Uncommon’ (<1% and >0.1%) or of lower frequency in the JYSELECA clinical trials.1,3 ACR, American College of Rheumatology; MTX, methotrexate. † JAK-associated adverse events defined as VTEs, Herpes Zoster Reactivation and Serious Infections.4

Visit strengthofbalance.co.uk to learn more with filgotinib was associated with dose dependent increases in lipid parameters, including total cholesterol, and high-density lipoprotein (HDL) levels, while low density lipoprotein (LDL) levels were slightly increased (see SmPC). Cardiovascular risk: Rheumatoid arthritis patients have an increased risk for cardiovascular disorders. Patients should have risk factors (e.g., hypertension, hyperlipidaemia) managed as part of usual standard of care. Venous thromboembolism: Events of deep venous thrombosis (DVT) and pulmonary embolism (PE) have been reported in patients receiving JAK inhibitors including filgotinib. Caution should be used in patients with risk factors for DVT/PE, such as older age, obesity, a medical history of DVT/ PE, or patients undergoing surgery, and prolonged immobilisation. Lactose content: Contains lactose; patients with rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption should not take filgotinib. Interactions: Co-administration with sensitive OATP1B1 or OATP1B3 substrates (e.g., valsartan, statins) is not recommended. See SmPC for full list. Pregnancy/Lactation: Filgotinib is contraindicated in pregnancy. Filgotinib should not be used during breast-feeding. Women of childbearing potential must use effective contraception during and for at least 1 week after cessation of treatment. Driving/Using machinery: No or negligible influence, however dizziness has been reported. Side effects: See SmPC for full information. Common (≥1/100 to <1/10): nausea, upper respiratory tract infection, urinary tract infection and dizziness. Uncommon (≥1/1000 to <1/100): herpes zoster, pneumonia, neutropenia and blood creatine phosphokinase increase. Serious side effects: See SmPC for full information Legal category: POM Pack: 30 filmcoated tablets/ bottle Price: UK Basic NHS cost: £863.10 Ireland: POA Marketing

authorisation number(s): Great Britain: PLGB 11972/0033, PLGB 11982/0034. Ireland & United Kingdom (Northern Ireland): EU/1/20/1480/001, EU/1/20/1480/003 Further information: Gilead Sciences Ltd, 280 High Holborn, London, WC1V 7EE, Great Britain & Northern Ireland: +44 (0) 8000 113700; Ireland: +353 214825999. ukmedinfo@gilead.com. Jyseleca® is a trade mark. Date of Preparation: February 2021 UK-INF-2021-01-0032 Additional monitoring required Adverse events should be reported. For Great Britain & Northern Ireland, reporting forms and information can be found at www.mhra.gov.uk/yellowcard or via the Yellow Card app (download from the Apple App Store or Google Play Store). Adverse events should also be reported to Gilead to safety_FC@gilead.com or +44 (0) 1223 897500.

Adverse events should be reported. For Ireland, reporting forms and information can be found at www.hpra.ie and can be reported to HPRA on +353 1 6764971. Adverse events should also be reported to Gilead to safety_FC@gilead.com or +44 (0) 1223 897500.

References: 1. JYSELECA SPC. Available at: www.medicines.ie. Last accessed: March 2021. 2. Combe B, et al. Ann Rheum Dis 2021;doi:10.1136/annrheumdis-2020-219214. 3. Genovese MC, et al. Poster presented virtually at the European League Against Rheumatism (EULAR) 2020 E-Congress, June 3–6, 2020. 4. Angelini J, et al. Biomolecules 2020;10(7):E1002. doi: 10.3390/biom10071002. Date of preparation: March 2021 Job code: UK-INF-2021-03-0036

DON’T LET PAIN HOLD YOU BACK

ESSENTIAL INFORMATION *To verify contact verify@perrigo.com 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, The Sharp Building, Hogan Place, Dublin 2, Ireland. Date of preparation: July 2020. Not subject to medical prescription. IRE SOL1 2020 37

Contents

Foreword

Page 6: New President for Irish Pharmacy Union

Summer is officially here and with the good weather we bring an August issue brimming with positive news stories and some fantastic clinically authored features.

Page 7: Illegal Medicines still posing a challenge

As readers are no doubt aware, the August issue features our annual Top 100 OTC Products in association with IQVIA.

Page 11: Syrian refugee pharmacists opens his first store Page 14: Pharmacists across Ireland begin offering vaccinations

Page 16: Triathlete Maeve Gallagher on balancing sports with pharmacy Page 20: IQVIA’s Gwynne Morley gives an in-depth overview of the OTC Market Page 28: IPN’s Annual Top 100 OTC Products Page 72: McCabes Pharmacy launch EasyScript

Page 82: Simon Woodworth asks, “Is your Pharmacy Cyber-Secure?” PUBLISHER: IPN Communications Ireland Ltd. Clifton House, Fitzwilliam Street Lower, Dublin 2 00353 (01) 6690562

EDITOR Kelly Jo Eastwood: 00353 (87)737 6308 kelly-jo@ipn.ie ADVERTISING EXECUTIVE Amy Evans: amy@ipn.ie

CONTINUED PROFESSIONAL LEAD Sibongile Swan Mude swan@ipn.ie CONTRIBUTORS

DESIGN DIRECTOR Ian Stoddart Design PHARMACYNEWSIRELAND.COM @Irish_PharmNews IrishPharmacyNews

IQVIA build the Top 100 Over-the-Counter (OTC) Market Report based on the total value of wholesale sales for OTC products into retail pharmacy over the course of the 12 months to April 2021 (May 2020-April 2021). It’s a rolling annual value which includes the five major OTC categories including cold and cough remedies (CCR), pain, vitamins, and minerals (VMS), skin and digestive health. The information contained is widely accepted as the industry standard from which brand performance is measured across the OTC sector. At the beginning of this special focus, we speak exclusively to General Manager Gwynne Morley as she gives an in-depth look at the market as a whole, the impact of Covid-19 on category values and shopper behaviour. “The economic rebound combined with increasing disposable incomes and awareness levels will be major growth drivers for the OTC market,” Gwynne reflects. “Pharmacies will continue to be the most popular retail channel as consumers trust professional advice from pharmacists. However, pharmacies will face strong competition from e-commerce and supermarkets due to their competitive pricing – especially as consumers become more responsive towards price and promotions.” Turn to page 20 for this year’s report.

MANAGING DIRECTOR Natalie Maginnis n-maginnis@btconnect.com

EDITORIAL/ EVENTS & MARKETING EXECUTIVE Aoife Jackson: aoife@ipn.ie

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.

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

In other news, pharmacies across the province have, finally, began vaccinating against Covid-19. However it hasn’t all been plain sailing. The Irish Pharmacy Union (IPU) has called on the HSE to extend the eligibility for pharmacy vaccinations to match the NIAC guidelines. Pharmacies are only permitted by the HSE to provide the Janssen vaccine to patients aged 50 and over. NIAC currently advises that the Janssen vaccine is appropriate for those aged over 40 however it is expected that it will soon recommend to Government for the age cohort which is eligible for the Janssen vaccine to be significantly lowered. IPU Secretary General Darragh O’Loughlin called on the HSE to take a common-sense approach by addressing this discrepancy. “Pharmacies successfully commenced providing the Janssen Covid-19 vaccine in almost 800 locations nationwide, earlier this month. The response has been overwhelmingly positive from those who have opted to received them. However, the number of people we can vaccinate is artificially constrained to those over 50, despite the fact that NIAC has advised that this vaccine is appropriate for those aged over 40.” I hope you enjoy the issue.

Regulars CPD: INFANT NUTRITION TEAM TRAINING: EPILEPSY FEATURE: RHEUMATOID ARTHRITIS BUSINESS CPD: CLINICAL PR:

P61 P76 P86 P92 P96

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News

Magees Pharmacy ‘Enchanted’ Makeover The picture-postcard village of Enniskerry in Co Wicklow has been undergoing a huge transformation to a Disney movie set which will catapult it onto the world stage. One of the retail businesses that has enjoyed a makeover is Magees Pharmacy. Over the last few months, Disney have been working hard to transform Enniskerry into a fairytale village for filming. Filming of Disenchanted, the follow-up to the blockbuster Enchanted, began filming there recently. It is believed some well known faces have been spotted around the village, including Susan Sarandon, Patrick Dempsey, Amy Adams and James Marsden. The village will be closed for the most part of their filming hours on shoot dates. Magees Pharmacy was only closed for 2 days.

New President for Irish Pharmacy Union Cloyne-based pharmacist, Dermot Twomey, has been appointed President of the Irish Pharmacy Union. Dermot, originally from Cappagh in County Waterford, qualified as a pharmacist from the University of Strathclyde in Glasgow in 1995. He has been running Cloyne Pharmacy in east Cork since 1997. Speaking about his appointment, he said, “The pandemic has been a challenging time for all healthcare professionals. This is particularly the case for pharmacies, who have stayed open during each lockdown and dealt with the added pressures this entails. Supporting the sector in recovering from this crisis will be my top priority.” Dermot said there was now an opportunity to reinvent healthcare, with accessible community care at the centre. “As we emerge from the pandemic we cannot afford to return to ‘business as usual’. Community healthcare needs to innovate and evolve. The Government has made a firm commitment to expand the range services provided by community pharmacies. The profession is eagerly awaiting these moves and my role will be to ensure the government follows through.”

Cloyne Pharmacist Dermot Twomey, President, IPU

Dermot chaired the IPU’s Contractors Committee from 2006 to 2008. In 2010 he helped found the Joint Consultative Group, which was established to address contractual matters between the HSE and the IPU, and served on that group until 2016. He served as Vice President of the IPU from October 2020 until his appointment as President on June 11th.

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Pharmacy Role in Codeine Overdose The PSI has welcomed new research1 from University College Cork and the National Suicide Research Foundation which indicates that the pharmacy regulator’s guidance2 for pharmacists on the safe supply of codeine is linked with a significant reduction in intentional drug overdoses involving the drug. Commenting on the study, Niall Byrne, PSI Registrar, said, “The study demonstrates that the high levels of engagement with the guidance by pharmacists was an important factor in lowering the incidence of harm.” The research shows that the number of people presenting to hospitals with codeine related intentional drug overdoses (IDOs) fell by 20% from October 2010 to December 2013 compared to January 2007 to March 2010. The reductions were more evident in IDOs involving women and while incident levels fell across all age-groups, they were most pronounced amongst those aged under 25. Mr Byrne stated, “We welcome the conclusions on the effectiveness of our guidance, and we remind all pharmacists of the importance of continuing to comply with this guidance and, thereby, protect their patients.” Introduced in May 2010, the PSI guidance obliges pharmacists to advise patients on the correct use of products containing codeine, while also ensuring that patients understand that these drugs are for short-term use only. The guidance also covers the display of products, requiring that they are stored in an area under the direct control of the pharmacist and out of the view of the public. 1 “The impact of guidance on the supply of codeinecontaining products on their use in intentional drug overdose”. Emma Birchall, Ivan J. Perry, Paul Corcoran, Caroline Daly, Eve Griffin European Journal of Public Health 2 Non-prescription Products Containing Codeine – Guidance for Pharmacists on the Safe Supply to Patients

News Exercise and Depression A study by RCSI indicates that exercise is probably the most effective short-term treatment for depression in people with coronary heart disease, when compared to antidepressants and psychotherapy or more complex care. This is the first systematic review to compare treatments for depression in those with coronary disease and the findings provide valuable clinical information to help doctors determine the best treatment plan for patients. The researchers reviewed treatment trials which investigated antidepressants, psychotherapy, exercise, combined psychotherapy and antidepressants, and collaborative care (i.e. treatments devised by a multidisciplinary team of clinicians with input from the patient). To measure effectiveness, the researchers looked at factors including patient adherence to the treatment (dropout rate) and change in depressive symptoms eight weeks after commencing treatment. The strongest treatment effects were found to be exercise and combination treatments (antidepressants and psychotherapy). However, as the combination study results have a high risk of bias, the findings of the review suggest that exercise is probably the most effective treatment. Antidepressants had the most research support, while psychotherapy and collaborative care did not perform very well. "Depression is common in patients with coronary artery disease. Having both conditions can have a significant impact on the quality of life for patients, so it is vital that they have access to the most effective treatments," commented Dr Frank Doyle, Senior Lecturer in Population Health Sciences at RCSI and the study’s first author. "Our study indicates that exercise is likely to be the best treatment for depression following coronary artery disease. Our findings further highlight the clinical importance of exercise as a treatment as we see that it improves not only depression, but also other important aspects of heart disease, such as lowering blood pressure and cholesterol, in these patients.”

1.6m Illegal Medicines Detained in 2020 The Health Products Regulatory Authority (HPRA) has expressed its concern at an increase in detentions of illegal medicines during 2020. It announced recently that its enforcement section detained some 1,610,295 dosage units of falsified and other illegal medicines in 2020, an increase of 58% on 2019. The HPRA states that the supply of these products into and within Ireland is illegal and stresses that consumers can have no guarantees about the safety or quality of prescription medicines they are seeking to buy outside of the regulated pharmacy setting. The national health products regulator also announced it detained a further 103,000 dosage units of illegal prescription medicines as part of its Operation Pangea actions in partnership with Revenue’s Customs Service and An Garda Síochána. In the 12 months of 2020, the most significant categories of illegal products included sedatives (36%), erectile dysfunction medicines (30%), analgesics (9%) and anabolic steroids (6%). The 2020 HPRA figures include: • Sedative medicines - 583,805 units (344,758 units detained in 2019). • Erectile dysfunction - 484,846 units were detained (283,989 in 2019). While the 2020 figure is the highest ever detention in a single year, it includes one detention of over 370,000 tablets. • Anabolic steroids - 101,683 units detained (121,581 units detained in 2019). • Analgesic medicines -145,921 units detained (81,672 units detained in 2019).

• 56,876 units of Covid-19 medicines were detained, the majority of which related to traditional Chinese medicine not approved or authorised for use in Ireland. • 482 websites, e-commerce listings and/or social media pages amended or shutdown. • 3 prosecution cases initiated related to the importation or distribution of anabolic steroid products and eleven voluntary formal cautions issued. According to Dr Lorraine Nolan, Chief Executive, HPRA the year on year increase in illicit medicines being detected and detained is very concerning. “We are also seriously concerned that an escalating number of people are not conscious of the potentially significant health risks they are taking by purchasing potent

prescription medicines online without medical supervision, rather than under the care of their doctor or pharmacist. While, in many cases, those who buy online at best may be simply wasting their money on falsified (including counterfeit) product, at worst, they may be taking very serious health risks. “We know from our investigations and prosecutions that those who seek to profit from illegal medicines have little regard for the health of the end users of the medicines they are supplying. Our detentions over many years have identified that a significant proportion of these products are falsely labelled and do not contain the type or quantity of active ingredient as stated on the product information. Worryingly, they have also been found to contain harmful substances,” Dr Nolan says.

Ger Gets his Running Shoes On! Carrigtwohill Pharmacy’s very own Marathon Man was back on the road again recently, taking part in the 2021 Cork City Marathon. Ger Browne, a former People’s Pharmacist winner at the Irish Pharmacy Awards, runs the Cork Marathon every year, but was unable to this year due to Covid and so he decided to run the full 26.2 miles by himself. Ger acknowledged the fantastic support he had as he ran the route, which he says is a great way to help him unwind after the challenges of running a busy pharmacy, whilst also keeping his fitness levels in top form. “Running, especially during these strange and challenging times, has helped enormously,” he says.

Ger Browne, Carrigtwohill Pharmacy

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News

Nigel’s Efforts to Help Those in Need Nigel Moloney is making sure no-one misses out, as the Carrigaline Pharmacist spent last month helping to vaccinate the homeless.

community, he mounted a major charity operation last Christmas, distributing over 500 care packs for men and women in need.

“Once we engaged and began helping the community, that part of our business soon outgrew the city centre premises, so we moved out and opened our CarePlus Pharmacy at the Primary Care Centre in Carrigaline. Almost half of our 1800sq foot outlet is given over to our dispensary. We use the Consis B2 robot to help to make sure we get it right every time.”

Nigel told Irish Pharmacy News, “I reached a milestone in my professional career in May of this year, when I was asked to help out for an hour with the Covid-19 vaccine rollout to homeless people in Cork city. That hour turned into a 6-day run providing jabs with the social inclusion team and the experience means a great deal to me.

For several years now, Nigel has been making weekly visits to local homeless shelters where he tries to reconcile the records of meds dispensed versus meds actually taken. “I gather as much information as I can and use it to try and encourage patients to follow their treatment plans and also to report concerns or updates on compliance to their GPs.

“It’s about 13 years since I first pitched a pharmacy service to one of the shelters near my pharmacy in Cork city centre. We had chosen our premises based on its proximity to several GP surgeries and when we opened we realised a lot of patients in our catchment areas were either engaged with the homeless services or living in direct provision.

“I’m also available to patients if they need some guidance on using their medications or equipment such as an inhaler. Knowing the patients as we do is also helpful if someone ends up in hospital and the medics there need some information on their care needs.

Nigel, co-owner and supervisor pharmacist at CarePlus Pharmacy Carrigaline

More than 200 Covid-19 vaccinations were administered at the Cork Simon Emergency Shelter on Anderson Quay. Nigel has a reputation for helping vulnerable people in the

“One of our most valuable initiatives is one in which we

provide training to help shelter staff to provide better care for service users. The topics include the role of the pharmacist, antibiotic resistance, taking medications while under the influence, substance withdrawal and opioid substitution therapy. “We try to help people out in as many areas as possible. For example, we distributed over 800 care packs across multiple homeless services in Cork city last Christmas, I’m working towards getting an oral Hepatitis C treatment programme rolled out and we even co-ordinated the prescribing and supply of pulsed monthly Vitamin D supplements to all homeless people in Cork from December to March this year, to help protect them from the effects of infection with Covid-19 “In that first pitch back in 2008, I told the shelter’s team that in time, I hoped they would see me as part of the team - a pharmacist for the homeless community, rather than someone who just hands out medicines. Being part of this year’s vital vaccine rollout, coupled with our experience since day 1 has brought that identity a lot closer.”

New Campaign ahead of new Agreement talks and Budget The Irish Pharmaceutical Healthcare Association (IPHA) has launched #InvestInOurFutures, a campaign aimed at supporting negotiations on a new medicines supply Agreement and advocating for enough funding for new medicines in the Budget. The campaign features five video assets – one hero film and four motion graphics. The hero film makes the case for medicines, treating them as an investment and not just as a cost. The motion graphics break out the economic and clinical impact of medicines innovation, as well as illustrating the access to medicines problem and how it can be fixed. The campaign comes as the industry prepares to start negotiations with the State on a new supply Agreement. New figures show Ireland lagging European peers on speed of access to new medicines. Data, gathered by data analysts IQVIA for EFPIA, the European industry body, puts Ireland in 18th place for time to availability for 152 medicines, with an average of 477 days to reimbursement. Among western European countries, only France and Portugal are slower than Ireland.

Other countries, including Austria, Belgium, Denmark, Finland, Norway, Sweden, Germany, Greece, Italy, Spain, the Netherlands, England and Scotland, are faster. Germany is four times faster than Ireland to make new medicines available to patients through public reimbursement. It takes almost three times as long to make new medicines available to patients in Ireland compared to Denmark. For cancer medicines, Ireland is in 21st place for time to availability, with an average of 606 days to reimbursement. We are in 24th place for time to availability for orphan medicines which treat rare conditions, with an average of 756 days to reimbursement. A new supply Agreement, and a Budget funding announcement, can begin to address Ireland’s problem with introducing innovative new medicines in the health services.

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Oliver O’Connor, Chief Executive at IPHA, said, “This Government, especially the Taoiseach, Micheál Martin, the Minister for Public Expenditure, Michael McGrath, and the Minister for Health, Stephen Donnelly, deserve credit for providing ¤50 million for new medicines this year. The allocation is releasing a backlog of medicines that had gathered due to a funding freeze imposed in 2019. “But data shows Ireland still has a major problem with speed of access to new medicines, compared with peer countries in western Europe. It is not because all these countries’ assessment processes are somehow less stringent than ours. Our processes are not organised to deliver fast access for patients. A funding shortfall in previous years has meant medicines were left unfunded, even when they were deemed cost-effective after price negotiations. We need to fix these

problems, together, through a new supply Agreement and in Budget 2022. “Innovative medicines have significantly improved survival, delivering treatments to patients with chronic diseases, tackling previously untreatable cancers and genetic conditions, eliminating some infectious diseases and addressing unmet medical needs. “In recent years, innovation in medicines has been fast. The industry’s pipeline is strong. The true value of innovation is realised when patients have access to it. So, we need to design a reimbursement process that works better and to build a funding framework that is sustainable for the health system and delivers faster access to innovation for patients. These should be urgent priorities for both industry and the State. “Investing in medicines is investing in our futures.”

Are you looking for a vitamin D supplement that is bioavailable and effective?

Get the proven benefits of sun exposure Without worrying about your skin If we avoid the sun or somehow prevent the UV rays from reaching our skin, it will reduce our ability to make vitamin D. It is difficult to get your full requirement of Vitamin D from diet alone. Therefore, to maintain a reasonable amount of vitamin D in your system it may be a good idea to consider taking a supplement like BioActive D-Pearls.

BioActive D-Pearls are small, soft gelatin capsules with 20, 38, or 75 micrograms of vitamin D in each. This makes it easy for you to choose the right dose for the time of year and for your personal level of sun exposure. • the vitamin D in BioActive D-Pearls is dissolved in cold-pressed olive oil for better absorption • small capsules that are easy to swallow – or chew

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As you know, it is important to protect your skin when the sun is most powerful. Still, sun exposure is necessary in order for our skin to synthesize vitamin D, which contributes to a normal immune defense.

News

Pivoting to Meet Pharmacy Challenge The Pharmaceutical Society of Ireland (PSI) has published its annual report for 2020, which provides an overview of the pharmacy regulator’s activities during the year to promote public and patient health and safety by regulating pharmacists and pharmacies. Niall Byrne, Registrar, PSI

• Conducting 100 registration related inspections and 124 pharmacy inspections. • Registering 1,968 pharmacies, up slightly on 2019 (1,956).

Despite the unprecedented challenges presented by the Covid-19 pandemic, the PSI undertook a substantial work programme across the year, including a range of actions in support of the public health response to the crisis. Key activities for PSI during 2020 included: • A range of significant initiatives to ensure the continuity of safe services for patients and the public in community pharmacies, including working with the Department of Health on emergency legislative provisions, with the HSE on contingency planning for pharmacies, and the development of new COVID-19 Operational Standards for community pharmacies. • Supporting 42 pharmacists and two pharmaceutical assistants to return to practise for the duration of the pandemic. • Progressing a significant digital transformation programme including the development of a new registration system, which will be launched later in 2021. • Adding 320 pharmacists to the professional register, bringing the total number at the end of the year to 6,767, up from 6,506 in 2019 and 6,246 in 2018.

• Maintaining the Internet Supply List, which included 128 pharmacies and 78 nonpharmacies at the end of 2020. This compares to 51 pharmacies and 81 non-pharmacies in 2019. • Reviewing 184 concerns received in relation to matters where a person wants to bring something to the attention of the PSI but does not wish to make a formal complaint. Thirty-seven formal complaints were also considered by the regulator during the year. Mr Niall Byrne, Registrar and Chief Officer, said that, “The PSI had entered into 2020, as any other year, with extensive plans to further the quality of pharmacy in Ireland. We then found ourselves having to pivot quickly to ensure that we continued to deliver on our statutory remit while also recognising the challenging environment in which we, together with everyone else in Ireland, found ourselves. “We worked closely with the Department of Health at the very early stages of the pandemic on emergency legislation provisions that focused on ensuring the continued care and treatment of patients during the pandemic including arrangements for national electronic prescription transfers.” Working in close collaboration with practising pharmacists, the Irish Pharmacy Union (IPU), the Health Service Executive (HSE) and the Department of Health, the PSI also developed new Covid-19

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“The PSI’s focus will remain on assuring the continued provision of safe, quality healthcare within pharmacies and ensuring that pharmacists maintain high standards and enjoy the continued trust of the public” Operational Standards. “These Standards 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 during the pandemic. They are also intended to assure patients and the wider public that their pharmacy is, indeed, a safe and supportive healthcare environment during this pandemic and indeed beyond.” The implementation of these standards is continuing this year with the PSI carrying out visits to pharmacies. “We want to understand how pharmacy owners, superintendent and supervising pharmacists are considering their services against the standards and how they are adapting them when needed,” said Mr Byrne. According to Mr Byrne, the PSI’s digital transformation programme continued in 2021, including in areas that hadn’t been originally anticipated as a result of the pandemic. “We committed under our 2018 – 2020 Corporate Strategy to building the PSI as an agile and high-performing organisation. A key enabler of this is our Business Transformation Programme. We pushed forward with this during 2020 through an extensive programme of work, focussing particularly on the development of a new registration system that will be launched later

this year, providing registrants with a single online point of contact with the PSI.” “Additionally, we were able to move to holding remote hearings of fitness to practise inquiries in December 2020, with the support of new technology. We were pleased to embrace technology in this respect, recognising that an important aspect of any fitness to practise or disciplinary matter is that all parties can have finality to the matter in as short a time as possible,” he said. During 2020, 184 (2019: 144) concerns were received by the PSI while 37 (2019: 74) formal complaints were considered by the PSI’s Preliminary Proceedings Committee (PPC), which decides whether further disciplinary action is taken in relation to a complaint. Mr Byrne noted that the number of concerns and complaints made to the PSI regarding pharmacists remains very low relative to the number of interactions which the public has with pharmacists and pharmacies annually. “Every concern and complaint is viewed as a potentially serious matter and treated accordingly. However, these figures reflect the continued high standards to which pharmacists worked during 2020 during a very challenging year for them and for their pharmacy teams.” The full report is available to download at www.psi.ie

News

Time to Give Back

IMVO launches Corporate Strategy

Syrian Refugee Fadi Almasri opens his first pharmacy in Ballon, Carlow

The Irish Medicines Verification Organisation (IMVO) Board has recently signed off IMVO’s first Corporate Strategy covering the period 2021-2023.

Fadi Almasri, originally from Homs, Syria’s third largest city, has recently opened the doors on his new business in the village of Ballon, Co Carlow. No mean feat for a man who, together with his family, fled Syria in 2011. He was running his own pharmacy when the uprising against Bashar al-Assad began in 2011. He left his homeland for neighbouring Jordan.

Ballon’s newest pharmacy

In 2014, he and his family were amongst the first Syrian refugees to come to Ireland under a resettlement programme operated by the United Nations Refugee Agency and the Irish Government. After spending three months in the Mosney direct provision center, Almasri and his family were relocated to Portlaoise in Co Laois where he says they received a warm welcome. In Portlaoise, Almasri consulted with local pharmacist John Paul Shanahan and asked him for training in the Irish system. “I told him my story and he told me everything about the Pharmaceutical Society of Ireland, the HSE, and how to become a pharmacist here," Almasri told RTÉ. “That was the start of my pharmacy journey in Ireland - a journey which would eventually bring me to Ballon.” Almasri told KCLR that the opening of his pharmacy, Ballon's first, is "an exciting time.” Ireland, Almasri says, has given him and his family a “new opportunity for life, a new opportunity to start your future again.” “It’s the time to pay back Ireland,” Almasri said. “It’s time to start a new future here for me and my family, try to help the community here, and even to offer jobs for people.”

Fadi Almasri standing outside his new pharmacy, a milestone of an achievement of this former Syrian refugee

Since 2017, IMVO has prioritised meeting obligations to set up the Irish Medicines Verification System (IMVS) and connecting over 2000 pharmacies, hospitals and wholesalers, as well as onboarding over 300 marketing authorisation holders whose pack data is hosted in the IMVS. The organisation says, “Our focus from now until 2023 is operational excellence and developing a culture that consistently delivers value to our members, employees, and users of the IMVS through excellence in everything we do. This will be important as we support IMVS users in moving out of ‘use and learn’ and meeting their FMD obligations in full. Activity to achieve operational excellence will be built around four strategic pillars: • Strong governance • System stability and usability • Patient safety and alert management • Partnerships and collaboration “The strategy envisions the IMVO of the future as a collaborative, trusted partner supporting the Irish healthcare system in protecting Irish patients from falsified prescription medicines and working seamlessly with EMVO and other NMVOs to deliver an integrated pan-European verification system.” Visit www.imvo.ie for the full Strategy.

Hickey's Pharmacy Go Green Hickey’s Pharmacy and Photo Centre in Thurles recently became the first community pharmacy in their area to go green. The pharmacy is phasing out single use plastics and are delighted to have a new supplier Enviropharm who provide plant based ziplock bags that can be sanitised and reused. Enviropharm supply cost-effective, innovative, and sustainable dispensary packaging to the retail pharmacy sector. Their ultimate goal is to eliminate single use plastic packaging from community pharmacies.

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News

Entrepreneur Shortlisting for Oonagh Oonagh O’Hagan, Pharmacist and Managing Director of Meaghers Pharmacy Group has recently been revealed as one of 24 finalists of the 2021 EY Entrepreneur of the Year™ Ireland programme. Oonagh O’Hagan, Pharmacist & MD, Meaghers Pharmacy Group

compete across three categories - Emerging, Industry and International - and one overall winner will be selected as The EY Entrepreneur Of The Year™ 2021 in November.

Also shortlisted was Peter Foley, Founder and CEO of LetsGetChecked, a personal health-testing and insights firm that enables people to test themselves for ill health from within their homes.

Now in its 24th year, the programme has established itself as a world-class development programme that supports, promotes, and connects an extraordinary community of entrepreneurs, championing entrepreneurship throughout the island of Ireland and around the world.

The entrepreneurs, which span the retail, consumer, technology, health and leisure sectors among many more, collectively generate annual revenues in excess of ¤1.325bn. The finalists from across the island of Ireland will

Peter Foley, Founder & CEO, LetsGetChecked

PSI appoints President Minister Stephen Donnelly has appointed six members to the PSI Council. The new appointments are John Given, Katherine Morrow, Rory O’Donnell and Grainne Power, alongside Sean Reilly and Marie Louisa Power, who were reappointed for a further four-year term following their re-election. The PSI has also elected Muireann Ní Shuilleabháin as President and Rory O’Donnell as Vice-President of the Council. Muireann is a graduate of Trinity College Dublin and has 30 years extensive experience, working in many facets of the pharmacy profession. More than twentyfive of those years were as a hospital pharmacist, both in Ireland and the USA.

Thanking the team and Aluni for a warm welcome to the EY program, Oonagh commented, “It’s a huge honour to be selected as one of this years 24 finalists here in Ireland. This is a network I’ve admired from afar for many, many years, so it’s a little surreal for this to become reality and to be connected to so many likeminded entrepreneurs. Many of the EY Alumni have been huge role models to me in my business journey despite the fact we might never have met.”

Her overall remit is in Medication Safety and she has been an active advocate for quality and safety in medicines management at a local and national level. Muireann has further experience in Healthcare Management, Clinical Governance, Clinical Pharmacy, Consultancy Pharmacy, Accreditation processes, Pharmacy Practice and Project Leadership. She has been in a Chief/ Superintendent role since 2001.

Become a WPD2021 Pharmacy Champion

Rory has served on the PSI Council from 2015 – 2019 and has been re-elected to the Council. Rory graduated in 1990 from Robert Gordon University, Aberdeen with a BSc(Hons) Pharm degree. He also holds a degree in Natural Science (Chemistry major) from Trinity College Dublin and a diploma in Strategy and Innovation from the Irish Management Institute. Rory served as President of the Irish Pharmacy Union 20122014 and more recently has served as President of the PSI Council for two terms.

93 days before World Pharmacists Day (WPD) 2021, the International Pharmaceutical Federation (FIP) launched its “193 in 93 Challenge”. 193 countries/states are on the list of United Nations members and the federation’s goal is to have colleagues in all 193 and beyond represented on its WPD2021 Champions Wall by 25 September! So far, over 150 colleagues covering 71 countries have become champions, publicly pledging their support for the campaign, which aims to promote and celebrate the pharmacy profession. “The Covid-19 pandemic has highlighted the significance of globalisation, but it has also emphasised the value of solidarity. Our hope is that colleagues in every country/state will take part in advocating our great profession this year,” said FIP CEO Catherine Duggan. Any pharmacist, pharmaceutical scientist, pharmacy educator, pharmacy student or pharmacy technician can become a

#WPD2021 Champion and there is no limit to the number of champions from a single country, state, territory or region. FIP is, however, asking all colleagues to take a look at list of countries/ states represented so far and to help fill in the gaps, either by

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becoming champions themselves or by spreading the word to colleagues in missing countries and asking them to become a WPD2021 Champion. Visit www.fip.org for more details.

He is the current Chair of the totalhealth pharmacy group and has served on several commercial boards as well as having some experience in the charity sector. He operates a community pharmacy in Gweedore, Co. Donegal. Both Muireann and Rory will continue, with the Council, to oversee substantial projects for the remainder of 2021.

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Pharmacy gets Green Light to Vaccinate Following a drawn-out battle with the HSE, community pharmacists across Ireland started offering Covid-19 vaccinations last month (July). The news was welcomed across the sector. Earlier, the Secretary General of the Irish Pharmacy Union had said pharmacists will be glad to get started on the vaccination programme and over 1,000 pharmacies have already applied to be involved in the scheme. Speaking on RTÉ's Morning Ireland, IPU Secretary General Darragh O'Loughlin said there has been a lot of public frustration that people have not been able to get a vaccine in their local pharmacy. He said that pharmacists have been delayed consistently by the HSE from participating in the roll-out, but said he expects pharmacists will initially deliver supplies of the Johnson & Johnson (Janssen) vaccine to those over 50 who have not yet had a vaccination. Boots Ireland was confirmed as the nation’s largest pharmacy chain to be offering Covid-19 vaccinations. In supporting the HSE’s vaccination rollout, Covid-19 vaccines are available in 81 Boots Ireland pharmacies nationwide. In line with the HSE vaccination schedule, at present, Covid-19 Janssen (Johnson & Johnson) Vaccinations are available in pharmacies for people aged 50+ who have missed out on their vaccine or not been able to get to a vaccination centre. Stephen Watkins, Managing Director of Boots Ireland, commented, “We are incredibly proud to be announcing the rollout of the COVID-19 Vaccination Service in 81 of our pharmacies nationwide from June 15th. As the largest pharmacy chain providing vaccines in Ireland, we stand with the HSE and local communities to play our part in this incredibly important milestone.” Caoimhe McAuley, MPSI, Director of Pharmacy and Superintendent Pharmacist at Boots Ireland said, “We are delighted to begin the vital work of administering COVID-19 vaccines throughout the Boots Ireland pharmacy network. Our experience in delivering vaccinations has been well established through the provision of the flu, pneumococcal, shingles and travel vaccinations. We look forward to applying this expertise and experience to vaccinating people against COVID-19 as the country continues to fight the pandemic.”

Boots Ireland were confirmed as the largest chain offering Covid-19 vaccinations

Darragh Connolly, Superintendent Pharmacist, Haven Pharmacy Connollys Dungarvan has started rolling out vaccinations

McCabes Pharmacy Group were delighted to finally be able to offer vaccinations to their customers

Anne Staunton of Stauntons Pharmacy Main Street Castlebar

Pictured is Caoimhe McAuley, MPSI, Director of Pharmacy and Superintendent Pharmacist at Boots Ireland at the launch of the Covid-19 in-store vaccination service in Boots pharmacies nationwide Dorothy Fisher (right) chats to pharmacist Niamh Boden after receiving a Covid-19 Vaccine at the Dunville community pharmacy in Ranelagh. Photograph: Alan Betson

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Maeve Gallagher Going for Gold Pharmacy student Maeve talks about juggling pharmacy with her elite Triathlon achievements International Triathlete Maeve Gallagher wears many hats. Not only is she a member of the Triathlon Ireland Elite Squad, she is also studying to join the world of pharmacy.

“I love a challenge and there is no better one than trying to study a demanding course along with training for three sports. I am very lucky that I was awarded a Quercus Sports Scholarship from UCC and the support and assistance I have received from this scholarship has been vital in helping me balance my studies and sporting demands. Mayo’s Maeve Gallagher, Pharmacy Student and international Triathlete 19 year-old Maeve, who hails from Mayo, has always had a keen interest in the field of pharmacy. She explains, “From a young age I always had an interest in Pharmacy. I was a kind; caring child and I remember setting up my own outdoor plant pharmacy at the age of 7. I was selling dock leaf ointments and plasters to my brothers who destroyed their legs from messing around outside! “This interest grew during my transition year work experience in secondary school, I spent time with Gary Smyth in Heneghan’s Pharmacy in Kiltimagh and with Nuala and Ian Johnson in Total Health Pharmacy Swinford. “I thoroughly enjoyed my two work placements and I loved seeing the attention to detail required and how each pharmacist carefully advised every customer, it was a community helping each other at its best.” And it seems pharmacy and athleticism runs in the family. Maeve adds, “My cousin, Sinead Jennings, who is an Olympian, qualified pharmacist and doctor, has been a role model for me in both sport and academic terms. I achieved the points to gain entry to the MSc Pharmacy programme in UCC and I have just finished my first year and I have really enjoyed the course content so far.”

Maeve credits a strong work ethic, created by her parents who emphasised the importance of hard work from a young age, for her ability to juggle so much. “I love a challenge and there is no better one than trying to study a demanding course along with training for three sports,” she says. “I am very lucky that I was awarded a Quercus Sports Scholarship from UCC and the support and assistance I have received from this scholarship has been vital in helping me balance my studies and sporting demands.” In tandem with her passion for pharmacy, Maeve’s love of sport also began from an early age. She adds, “I have always been incredibly involved in sport and started off playing both Gaelic football and soccer for Mayo when I was younger. I joined my local athletics club age 5 and I fell in love with the sport straight away. “I took part in the Community Games from U6 up to U16 winning some of my first National medals. I loved racing cross country and 1500m track races where I picked up numerous All-Ireland titles, out of a pure love for the sport. In secondary school I joined my local swimming and cycling clubs in Castlebar and discovered the sport of triathlons.”

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Representing Ireland Aged just 18, Maeve achieved something special by representing Ireland in 3 separate European Championships in Cycling, Triathlon and Cross country running. Now at the age of 19, she has 24 National titles in cycling, athletics, and triathlon. She continues, “When I started triathlons at 12, I continued to train and get better with age. I was part of the Triathlon Ireland emerging talent programme and at 16 I was selected to become a member of the High-Performance squad after competing in local triathlons in Ireland. This allowed me to go to international competitions for Ireland. “My first European cup was in Portugal in 2017, age 16 and it was amazing. In 2018 I won my first European Medal in a Triathlon Cup in Romania placing second.

“I managed one better in 2019 by winning my first Elite Triathlon Race in Dakar in Senegal. I have amazing memories from travelling to races in places such as South Africa, Greece, Estonia and Russia with team Ireland and also competing in the Tokyo Olympics test event in 2019 as part of the mixed team relay.” It is her goal, she says, to represent Ireland at the Olympics. “My sights are set on Paris 2024. At the moment I am focused on continuing representing Ireland in various World and European Cup races.” At the time of talking to Irish Pharmacy News, Maeve was in Austria where she raced in the 2021 European Triathlon Championship having achieved 22nd in U23 category.

Pharmacist Kevin Kelly and the team from Kelly’s Pharmacy, Carlow

Maeve Gallagher, focused on the future Focusing on the Future Like every career there are going to be challenges for pharmacy. “The speed at which new technology, methodologies and pharmaceutics are being discovered, are just some of these,” Maeve reflects. However she adds, “I really believe this is a truly rewarding career path to follow and the world of

pharmacy is changing at present. Since the rollout of the Covid-19 vaccines in the local pharmacy stores I believe more day-to-day medical treatments can be offered within the pharmacy setting. “I like the introduction of the consulting room within the pharmacy, and I would love to see more opportunities opened

“I really believe this is a truly rewarding career path to follow and the world of pharmacy is changing at present. Since the rollout of the Covid-19 vaccines in the local pharmacy stores I believe more day-to-day medical treatments can be offered within the pharmacy setting”

up like this that allows a customer to speak in confidence with the pharmacist. I would also love to see more pharmacies specialise in different areas. “As I am very passionate about sport, I teamed up with Kevin Kelly’s Pharmacy in Carlow who are Ireland's No.1 sports pharmacy, and I am a brand ambassador for the Sponser Sports nutritional products which the pharmacy provides. Kevin has been exceptional in advising me on different Sponser products to use, focusing on recovery, energy providing and overall health and vitality. It has been a pleasure working with them and I highly recommend visiting Kevin Kelly’s to get professional advice on suitable nutritional supplements tailored to each individual’s needs.” Pharmacist Kevin adds, “We are delighted to have Maeve as our Brand Ambassador for Sponser Sports Drinks and to assist her with our expertise and with our Sponser Sports Drinks. Maeve is a star in Irish Triathlon and is very highly rated by Sponser Sports Drinks (Switzerland ) whose Brand Ambassador is Nicola Spirig (World Champion Triathlete). Maeve is wonderful ambassador for Irish Sport, The Pharmacy Profession and a wonderful Role Model for young girls especially. Kevin is very proud that this Swiss company

Kelly’s Pharmacy, Carlow

(Sponser Sports Food) continues to support Irish Dairy Farmers close to U.C.C. where Maeve studies. They use Irish Whey produced in Carbery, Co. Cork as the main ingredient in their Pro Recovery Product Range. Kevin looks forward to Maeve qualifying as a Pharmacist as she has promised to locum for all of his holidays. Maeve is a upcoming star in Irish Triathlon and highly rated by Sponser Sports Drink (Switzerland) who have Nicola Spirig [World Champion Triathlete] as their Brand Ambassador. “Equally important, we are delighted that Sponser Sports Drinks continues to support Irish Dairy Farmers by using Irish Whey as their main ingredient in their Pro Recovery Products range. Maeve has promised to do all my holiday cover for the next number of years!” With the athletics and pharmacy world very much at her feet, where does Maeve see herself in five years? “I hope to be qualified with my Pharmacy degree and to be a full-time professional athlete representing Ireland at International races,” she tells us. “I would also like to be an advocate for younger girls allowing them to realise that if they work hard and pursue what they love they can achieve both in the sporting and academic world.”

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News

WIT launches ‘Supplement Certified’ In a bid to assist and offer transparency to the circa 2 billion nutritional supplement industry, Professor John Nolan and Dr Alfonso Prado-Cabrero and their colleagues at WIT have established ‘Supplement Certified’ an independent scientific certification for assessing product label claim. Dr Alfonso Prado-Cabrero and Professor John Nolan, Founders and Directors of Supplement Certified

companies who are working hard to ensure that their products are fit for purpose.” The team at ‘Supplement Certified’ recognise that there has been exponential growth in consumer demand for nutritional supplements over the last decade and that the industry is not officially regulated worldwide when it comes to verifying product label claim. They, therefore, want to be able to furnish the producers and distributors of nutritional healthcare products and consumers with an independent certificate proving that the product lives up to its label claim. The scientists and researchers at ‘Supplement Certified’ hold over 20 years of academic credibility in the area of assessing nutrition for human function, having built up a unique skillset at WIT’s Nutrition Research Centre Ireland. They hold an exceptional ability to efficiently and effectively analyse the composition of nutritional supplements. Research carried out to date by the team at ‘Supplement Certified’ on commercially available nutritional health supplements that are promoted for human function has found that up to 65% do not match label claim.

Professor Nolan says, “Our mission is to help consumers have positive outcomes by supporting nutraceutical companies that produce supplements aimed at enhancing human function. A basic requirement for this is that the claimed active ingredients are actually present in the supplements, which are sold and promoted for eye and brain health. The more products we analyse, the more astonishing the findings. Our independent analysis of products and the opportunity to apply a 'Supplement Certified' stamp of approval to a product will not only offer consumers peace of mind but also those nutraceutical

Speaking about the service Dr Prado-Cabrero added, “It is very satisfying to see how our expertise in the analysis of carotenoids and omega-3 fatty acids helps distributors formulate their products and, above all, will ensure that consumers really get what the label says.” The services provided by Supplement Certified include the provision of access to global thought leaders in the area of nutritional science research and testing. The stages of the process available to nutritional health companies include extensive scientific research performing a delicate process

Fleming Medical Academy Providing valuable training to pharmacy staff and other healthcare professionals has always been a core focus for Fleming Medical. This is why the launch of their new Fleming Medical Academy came as no surprise as they expand their value-added training options to customers. This professional skills training platform offers engaging Continuing Professional Development (CPD) accredited virtual training modules that are interactive, self-led and specially designed to work alongside the hectic schedule of pharmacy staff. Two courses are currently on offer; a First Aid Essentials course, and a Basic Life Support (BLS) course featuring a state-of-the-art interactive cardiac arrest simulation that gives a “hands-on” dimension to the training. To celebrate both the launch of the academy and World First Aid Day in September, they are giving away 20 Free First Aid Essentials courses. For more details on how to enter and for more information on these new professional training programs, contact Fleming Medical at training@flemingmedical.ie or call FREEPHONE 1800 307777. https://www.flemingmedical.ie/training

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of extraction, separation of components, analysis and testing of active ingredients, reporting and if determined suitable, the certification of nutritional health products for carotenoids and omega-3 fatty acids label claim. Professor Nolan says, “Our published research1,2 has already highlighted the issues surrounding commercially available supplements, and also the importance of recommending a supplement that has been independently scientifically tested in terms of efficacy and in terms of meeting its label claim. Supplement Certified is also established to assess the stability of the product over time and will work with companies to provide advice on how to meet standards and label claims, if products do fail following the detailed scientific testing.” Further details on the service provided by Supplement Certified can be found at www.supplementcertified.ie References 1.PHELAN, D., PRADO-CABRERO, A. & NOLAN, J. M. 2017. Stability of commercially available macular carotenoid supplements in oil and powder formulations. Nutrients, 9(10), 1133 https://bit.ly/3nLY4eT 2.PRADO-CABRERO et al. 2016. Assessment of lutein, zeaxanthin and meso-zeaxanthin concentrations in dietary supplements by chiral highperformance liquid chromatography. Eur Food Res Technol, 242(4), 599-608. https://bit.ly/3aZuw8H

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Breakdown of Ireland’s OTC Products Market 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.

About IQVIA

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.

IQVIA creates intelligent connections across all aspects of healthcare through its analytics, transformative technology, big data resources and extensive domain expertise. IQVIA Connected Intelligence™ delivers powerful insights with speed and agility — enabling customers to accelerate the clinical development and commercialization of innovative medical treatments that improve healthcare outcomes for patients.

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. IQVIA build The Top 100 Over-the-Counter (OTC) Market Report based on the total value of wholesale sales for OTC products into retail pharmacy over the course of the 12 months to April 2021 (May 2020-April 2021). It’s a rolling annual value which includes the five major OTC categories including cold and cough remedies (CCR), pain, vitamins and minerals (VMS), skin and digestive health.

IQVIA (NYSE:IQV) is a leading global provider of advanced analytics, technology solutions, and clinical research services to the life sciences industry.

With approximately 72,000 employees, IQVIA conducts operations in more than 100 countries. Present in Ireland since 1990, IQVIA pioneered the country as a hub for clinical research. In December 2020, IQVIA announced the creation of 100+ remote jobs throughout Ireland, which reinforced IQVIA’s capability to fight the pandemic, ensuring vaccines administrated post authorization are safe for the public. In addition to supporting life sciences in their clinical efforts across Europe and the globe, IQVIA’s activity in Ireland includes supporting the life

20 | PHARMACYNEWSIRELAND.COM

Gwynne Morley, General Manager, IQVIA Ireland, sciences industry from R&D through to commercialization, as well as healthcare providers, to improve treatment outcomes and patient pathways.

Value of OTC Market In highlighting the value of the OTC market to community pharmacy Gwynne explains, “The total value of the nonprescription market in Ireland based on IQVIA’s data for the 12 months, May 2020 to April 2021, was €406 million1. “This market declined by 8.3% when comparing year-on-year growth2. The year-to-date (YTD) value of this market at the end of April 2021 was €220 million with a growth rate of -10.9%3. After the initial spike in OTC sales exhibited in March 2020 due to the onset of Covid-19, the market slowed down significantly resulting in a flat growth rate (0%) in 2020, this is in contrast to the 8% growth rate demonstrated for the full year 2019.” Gwynne adds, “The value of the OTC market including the five major categories (cold and cough remedies, pain, VMS, skin and digestive health) based on IQVIA’s data YTD was €185 million4.” With the arrival of Covid-19 onto Irish shores, wholesalers and manufacturers

Exhibit 17: Model of Better Customer Engagement Through Multi-channel Engagement8

Deep customer understanding for… Fully integrated customer data Real insights (preferences, adoption ladder) More data from all channels

… That deliver optimised customer experience

Individualised multi-channel engagement… Data Integration Predictive analytics for recommendation • Virtual clinics & telehealth Right content delivered through automated digital campaigns or new digital solutions

(e.g., time spent on messages)

• Chatbots • Omnichannel conversations • Integration in broader connected care ecosystem

• Relevant content & service • With compelling look and feel • Through preferred channel

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• At most convenient time Digital marketing capabilities to: a) execute content strategy and b) create new compelling digital content

Figure 1: Model of Better Customer Engagement Through Multi-channel Engagement7

faced their own challenges, as Gwynne highlights, “Continuity of supply and demand planning has probably been the key challenges for wholesalers. Export bans imposed by some countries and Brexit have compounded some of these challenges.” According to a Healthcare Professional survey conducted by IQVIA Ireland in September 2020, only 23% of respondents reported issues with medicinal product availability in Ireland5 and we know that these shortages were reported prior to Covid-19 and were un-related to the pandemic. Gwynne adds, “For manufacturers and wholesalers, the restrictions on movement and face-to-face contacts due to Covid-19 have had a major impact on sales force activities and the ability of reps to engage directly with many pharmacists and other healthcare professionals (HCPs). “Overall promotional volumes have declined by 23.4% in May 2021 in Ireland when compared to May 20206. It’s clear that a much more “omni-channel” approach (see figure 1) is likely to be relevant in the future. While the pandemic moved the interactions with reps from face-to-face to remote through force of circumstance, interactions with reps will continue to be a key part of engagement with HCPs through a hybrid model – faceto-face engagement with an increased use of digital and virtual approaches.” “Ways of working across all businesses has had to evolve quickly since social distancing measures were introduced, with team members working from home, meetings happening virtually, and public travel coming to a halt.

Right content delivered through lean, targeted and orchestrated, face-to-face interactions. High prevalence of hybrid roles (remote & face-to-face)

“It is increasingly clear that some restrictions associated with the original pandemic closures may remain, and a hybrid work model is likely to become the norm. In a survey conducted by IQVIA Consumer Health of senior consumer health executives in June 2020, a fifth of respondents called out changes in the way teams collaborate as one of their key priorities looking ahead to the post-COVID-19 world7.”

Unprecedented OTC Demand Across the globe, consumer health manufacturers scrambled to meet the unprecedented demand generated by the pandemic panic buying starting midFebruary to late March of last year and increases in demand for OTC products catapulted just after Ireland recorded its first case.

“However, most of the impact of the increased volume in March 2020 was negated by sales declines during April/ May 20209. The OTC market in Ireland demonstrated flat growth rate in 2020 in comparison to an 8% increase in 201910. IQVIA Consumer Health is forecasting that the Irish OTC market will decline by 1% in 202111. “Whilst community pharmacy has had high and low points over the past 16 months, pharmacies remained open throughout, where many other healthcare professionals were less accessible. “Rising fears in the general population in relation to the virus, and the advice to “stay at home” in March 2020 drove and accelerated changes across the entire healthcare system. As many GPs moved to remote consultations, and emailing prescriptions via Healthmail, community pharmacy became the face of the HSE in many areas.” In April 2020, Covid Emergency Legislative Provisions recognised Healthmail as the national electronic prescription transfer service. Healthmail permits the transfer of a prescription between the prescriber and dispensing pharmacy by electronic means in a secure manner. It removed the need for a paper equivalent during these challenging times. This has led to significant increases in usage of the system in terms of message throughput, volume, and user logins.

“On February 29th, 2020, the first case of Covid-19 on the east coast of Ireland was confirmed8. This catalyzed an increase in volume demand in subsequent weeks, resulting in an 86% volume increase in the second week of March 2020 compared to the same week in 20199.

Gwynne adds, “Pre-Covid, there were less than 200,000 messages sent and received via Healthmail each month. Figure 2 demonstrates that by June 2020, there were greater than 1.6 million messages sent and received by Healthmail.

“Products used to treat pain (+127%), cough and cold remedies (+77%), and vitamins and minerals (+30%) were

Figure 2: Exponential growth in the use of Healthmail due to COVID-1912

Total messages sent and received each month 1,800,000 1,600,000 1,400,000 1,200,000 1,000,000 800,000 600,000 400,000 200,000 Jan 18 Feb 18 Mar 18 Apr 18 May 18 Jun 18 Jul 18 Aug 18 Sept 18 Oct 18 Nov 18 Dec 18 Jan 19 Feb 19 Mar 19 Apr 19 May 19 Aug 19 Sept 19 Oct 19 Nov 19 Dec 19 Jan 20 Feb 20 Mar 20 Apr 20 May 20 Jun 20

(e.g. social medial presence)

amongst those subject to the largest increase in absolute sales volume for the month of March 2020 compared to March 20199. The absolute sales volumes of calming, sleep and mood enhancing products grew by a staggering 330% in March 2020 compared to volumes in March 20199.

PHARMACYNEWSIRELAND.COM | 21

% of patients seen remotely vs. face-to-face Mean %

Mean % W1 (May-20) (n=95)

79%

W1 (May-20) (n=95)

W2 (Sep-20) (n=120)

79%

W1 (May-20) (n=95)

During the lockdown period

W2 (Sep-20) (n=120)

W1 (May-20) (n=95)

W2 (Sep-20) (n=120)

N.A.

47%

39%

Currently, after the lockdown has been lifted

Prior to COVID-19

Mean %

W2 (Sep-20) (n=120)

33%

in March 20199, this points to the fact fact that a significant number of the population continue to struggle with anxiety and insomnia which is directly and indirectly related to Covid-19.

Growth of Online

Mean %

Once the pandemic situation improves and we return to a more normal situation

Mean % 0

Figure 3. HCP Survey Ireland September 2020 * HCPs were invited to participate in a very short primary market research survey. Our invitation to physicians clearly stated that any participation is purely voluntary and should not interfere with their duty to patients. In line with the British Healthcare Business Intelligence Association (BHBIA) guidance, we do not run market research with front line personnel (ICU doctors, pulmonologists, infection disease specialist) and the approach is line with EphMRA and BHBIA recommendations for conducting PMR during COVID-19.

Ecommerce was growing fast before COVID-19 hit. But the pandemic pushed even more consumers online. Ecommerce thrived in 2020 because of store closures and shoppers’ fear of contracting the coronavirus in public. What impact does Gwynne believe this may have on the OTC medicines market? She says, “It is forecasted that the global e-commerce retail sales will reach over US$ 6.5 trillion as evolving consumers and shoppers demand the ability to shop how they want to – anywhere and at any time (see figure 4)13.

Introduction Introduction

“On one level, it could be said that move towards telemedicine by GPs post-pandemic will have little impact on Consumer Health – it’s just a different way for people suffering illness to consult with their doctors. However, there could be more significant long-term implications in the way people manage illness, certainly when it is not serious. Patients are no longer passive recipients of healthcare. In this context, it is not unreasonable to envisage a situation where consumers become less dependent on doctor consultations and more ready to self-treat or to consult pharmacists instore7,” she adds.

OTC Category Impacts

Over next five years the top e-Commerce markets will determination. Consumer health remain unchanged – China, USA, UK, Japan and South be sold online, who can sell health determination. Consumer “In contrast, vitamins and minerals remain unchanged – China, USA, UK, Japan(VMS) and South classes can Korea. Six of the top 10 fastest-growing e-Commerce which product class, the requirement for firms that develop a common have experienced unprecedented growth. Korea. Six of the top 10 fastest-growing e-Commerce firms common countries will continue to hail from the Asia-Pacific e-Pharmacies to that have adevelop physical a presence This category has grown by +16% PPG countries will continue to hail from the Asia-Pacific a self-funding business 2 or not, vision, and cross-border sales regulations. region, by India the Philippines at more MAT led April 2021and . This is primarily duethan vision, a self-funding business region, led by India and the Philippines at more than to the increased awareness of self-care +30% growth and rounded out by China, Malaysia, case and buy-in from all levels “Prescription are not permitted +30% and rounded out by China, Malaysia, casemedicines and buy-in from all levels and thegrowth benefits vitamins and minerals Indonesia and South of Korea. to be sold online in Ireland. It is prohibited of the organization, will reap Indonesia and South against Covid-19 byKorea. boosting immunity.

“Calming, sleep and mood enhancing products continue to grow exponentially at 151.6% PPG MAT April 20212. Considering this category grew by 330% in March 2020 compared to volumes

Four out of the five major categories (CCR, pain, skin and digestive health) have all been severely impacted by the pandemic. See below the previous period growth rate MAT April 20212 for each of these four categories: Category

Previous period growth (PPG) MAT April 2021

CCR -40 % Pain -12.7% Digestive Health

organization, will reap to ‘supplyofbythe mail order’ of prescriptionhuge rewards. only medicines in Ireland”under huge rewards.”

— Amit Shukla, IQVIA Consumer Health — Amit Shukla, IQVIA Consumer Health

Figure 4

Forecasted Growth of Global e-Commerce Sales 2017-2023 Forecasted Growth of Global e-Commerce Sales 2017-2023

-5.6%

Skin -3.2%

22 | PHARMACYNEWSIRELAND.COM

8,000 8,000 7,000 7,000 6,000 6,000 5,000 5,000 4,000 4,000 3,000 $2,382 3,000 $2,382 2,000 2,000 1,000 1,000 0 0 2017 2017

Sales in trillions U.S. dollars Sales in trillions U.S. dollars

“IQVIA captured feedback from 101 general practitioners (GPs) who participated in two waves of an ‘open’ survey*, one in May 2020 and the second one in September 20205. The GPs reported a reduction of 88% and 63% in May 2020 and September 2020 respectively in their patient load. “During lockdown, 79% of patients were seen remotely (Figure 3) versus 9% pre-Covid-19. Interestingly, GPs stated that they will continue to see approximately one third of their patients through remote consultations post-Covid-19.

“That would represent 22% of global retail sales worth around US $30.0 trillion13. COVID-19 has impacted global growthto unevenly across By 2023, global e-Commerce retail salese-commerce are forecasted reach over Byvalue 2023, e-Commerce retail sales are forecasted tocategories reach over The ofglobal these five major categories categories, with several seeing US$ 6.5 trillion asIQVIA’s evolving consumers and shoppers demand the ability in Ireland based on data for the declines, while a few others are seeing atoto 6.5 trillion astoevolving consumers and shoppers demand the ability 12US$ months, May 2020 April 2021, is at massive growth acceleration including shop how they want – anywhere at any time (see Exhibit 1). That similar those into 2018,” Gwynne and OTC products.” shop levels how to they want to – anywhere and atand anyconsumer time (see Exhibit 1). That told us. would represent 22% of global retail sales worth around US$30.0 trillion. Currently the around global e-Pharmacy would represent 22% of global retail sales worth US$30.0 market trillion. “The effects of successive lockdowns is about US$50 billion but growing at an COVID-19 has impacted global e-Commerce growth unevenly across and adherence to the key messaging COVID-19 has impacted global e-Commerce growth impressive CAGRunevenly of +17%14. across from the government, Healthcategories Service categories, with several seeing declines, while a few before others are However Gwynne adds athat categories, several categories seeing declines, while few others are Executive (HSE)with and National Public looking at the commercial opportunities Health Emergency (NPHET) to stay including OTC and consumer seeing a massiveTeam growth acceleration a massive growth acceleration including OTC of e-Pharmacy, it isand it isconsumer important to bear atseeing home, maintain social distancing and products. in mind the regulatory differences that adopt good personal hygiene practices products. impact how e-Pharmacies operate in were the main factors driving these As the size of the global e-Commerce market grows, country. declines. adoption of good hygiene Success with e-Pharmacies As the sizeThe of the global e-Commerce market grows, each “ “Success with e-Pharmacies the annual growth rate evident will continue to taper down practices was also in the data the annual growth rate will continue to taper down “Regulations governing the online will require reliable data, from 28% in 2017 to 15% by 2023. for the hygiene products category. This will require reliable data, sale of healthcare products vary across from 28% in 2017 to 15% by 2023. category grew by +110.9% PPG MAT deep insights and unwavering countries with governments taking Over next five2.years the top e-Commerce markets will deep insights and unwavering April 2021 different approaches across which product

Source: Emarketer Source: Emarketer

$2,928 $2,928

2018 2018

$3,535 $3,535

2019 2019

$4,206 $4,206

2020 2020

$4,927 $4,927

2021 2021

$5,695 $5,695

2022 2022

$6,542 $6,542

2023 2023

iqviaconsumerhealth.com | 3 iqviaconsumerhealth.com | 3

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The No 1 selling topical pain relief brand3 Find out more at our dedicated healthcare website GSKHealthPartner.com *100g pack only. **with twice daily application. †compared with Voltarol Emulgel 1% in vitro study. 1. Quartarone & Hasler-Nguyen 2014; GSK data on file 2. Seefried et al. Ther Adv Musculoskel Dis (2020) Vol. 12: 1-13. 3. GSK data on file, IQVIA value sales data MAT w/c 28/02/2021. Product Information: Please consult the Summary of Product Characteristics for full product information. Voltarol Emulgel Extra Strength 2% w/w Gel (diclofenac). Indications: For the local symptomatic relief of pain and inflammation in trauma of tendons, ligaments, muscles and joints, localised forms of soft tissue rheumatism. Dosage: Adults and adolescents 14 years and over: 2g to 4g of gel, applied topically 2 times daily – morning and evening. Maximum recommended treatment duration is 14 days. Patients should consult their doctor if the condition does not improve within 7 days or worsens. Contraindications: Patients with or without chronic asthma in whom asthma, angioedema, urticaria or acute rhinitis are precipitated by aspirin or other non-steroidal anti-inflammatory agents. Hypersensitivity to diclofenac, acetylsalicylic acid or other non-steroidal anti-inflammatory drugs. Hypersensitivity to any other ingredient of the gel. Use in third trimester of pregnancy. Use in children and adolescents aged less than 14 years. Warnings and precautions: Apply only to intact, non-diseased skin and not to skin wounds or open injuries. It should not be used with occlusion. It should not be allowed to come into contact with the eyes or mucous membranes and should never be taken by mouth. Application over extensive areas for prolonged periods or application in excess of recommended dosage may give rise to systemic effects. These include gastrointestinal disturbances and bleeding, irritability, fluid retention, rash, hepatitis, renal dysfunction, anaphylaxis and rarely blood dyscrasias, bronchospasm and erythema multiforme. Discontinue if rash develops. Use with caution in patients with a history of peptic ulcers, gastrointestinal bleeding, hepatic or renal insufficiency, or bleeding diathesis, or intestinal inflammation. Pregnancy and lactation: The systemic concentration of diclofenac is lower after topical administration, compared to oral formulations. During the first and second trimester of pregnancy, diclofenac should not be given unless clearly necessary. Only use during lactation on the advice of a health professional. Contraindicated during the third trimester of pregnancy. Should not be applied on the breasts of nursing mothers, nor elsewhere on large areas of skin or for a prolonged period of time. Side effects: Very rare: rash pustular, hypersensitivity (including urticaria), angioedema, asthma, photosensitivity reaction. Rare: Dermatitis bullous. Common: Dermatitis (including contact dermatitis), rash, erythema, eczema, pruritus. Overdose: The low systemic absorption of topical diclofenac renders overdosage extremely unlikely. MA Holder: GlaxoSmithKline Consumer Healthcare (Ireland) Limited, 12 Riverwalk, Citywest Business Campus, Dublin 24, Ireland. MA Number: PA 678/140/3. Legal Category: Pharmacy only. Text revised: June 2020. Further information available on request. Contains diclofenac diethylammonium. Always read the label/leaflet. Trade marks are owned by or licensed to the GSK group of companies. PM-IE-VOLT-21-00011.

Regulation 19 of the Medicinal Products (Prescription and Control of Supply) Regulations 2003, as amended.” The Pharmaceutical Society of Ireland (PSI) ‘considers that the optimal and safest way for prescription-only medicines to be supplied to patients, is through direct supply to the patient and/or carer following a faceto-face interaction between a pharmacist and the patient in the pharmacy. This direct communication with the patient and/or their carer during a face-to-face interaction allows the pharmacist to evaluate the patient’s overall health and need, perform a full therapeutic review of the prescription and allow appropriate patient counselling to take place. It also allows the pharmacist to assess and verify the authenticity of the prescription’15. “However, the sale of non-prescription medicines is permitted on-line in Ireland,” 2: How the who e-Commerce she says.is Anyone wishes to sell non-prescription medicines over the healthcare landscape on-line in Ireland must “register with developing the Pharmaceutical Society of Ireland (PSI) and have their name listed on the e-Commerce is a complex channel with regulations, approved Internet Supply List. Those operating models and types of players fragmented websites must also display the EU across markets. When it comes to web healthcare the common logo on every pageinthat offers non-prescription medicines for- sale. e-Commerce space, generalists - such as Amazon The aimand of specialist the EU common is to helpas e-Pharmacies healthcarelogo retailers – such members of the public identify websites single category focused players in the supplement space that can legally sell medicines online. – compete to offer the best healthcare This is a requirement across the EU solutions to consumers, but regulations which was introduced by the generally Falsified 16 Medicines Directive . from offering prevent generalists and specialists the full spectrum of consumer health offerings “As outlined above, e-commerce is athat e-Pharmacies offer. with regulations, complexcan channel

operating models and types of players

Generally, and depending onmarkets. regulations, the e-Pharmacy fragmented across When it

comes healthcare in the e-commerce market is splitto between pure-play online pharmacies, space, generalists suche-Pharmacies as Amazon, such as DocMorris in Germany, tied to

e-pharmacies, and specialist healthcare retailers such as single category focused and omnichannel players like Boots inspace, the UK,compete which players in the supplement offer to e-Pharmacy tied to theirsolutions bricks and mortar offer theservices best healthcare to consumers, but regulations generally pharmacy chain (see Exhibit 8). prevent them from offering the full spectrum of consumer health offerings In terms of e-Pharmacy market share, there are variants that e-pharmacies can offer.by as little as 5 across markets, with some dominated

independent physical bricks and mortar pharmacy stores,

players, and others seeing e-Pharmacy market share spread across numerous different online pharmacy brands (see Exhibit 9). For example, in Germany 90%

Figure 5: Breakdown of the e-Consumer Healthcare Eco-system

“The economic rebound combined with increasing disposable incomes and awareness levels will be major growth drivers for the OTC market. Pharmacies will continue to be the most popular retail channel as consumers trust professional advice from pharmacists” “Generally, and depending on regulations, the e-Pharmacy market is split between pure-play online pharmacies, such as DocMorris in Germany, e-Pharmacies tied to independent physical bricks and mortar pharmacy stores, and omnichannel players like Boots in the UK, which offer e-Pharmacy services tied to their bricks and mortar pharmacy chain (see figure 5).”

The Future for OTC What does Gwynne think the OTC Medicines market in Ireland will look like for the remainder of 2021?

“According to the IQVIA OTC forecast for Ireland in 2021 the OTC market is expected to decline by 1%11. Driven by strong demand for Mineral Supplements (such as iron and magnesium), as of e-Pharmacy sales are split across 30 different Consumer preferences and market e-Pharmacies,are while in France, 111 different e-Pharmacywell as vitamins A, D and C and regulations key to driving Immunostimulant Preparations, VMS and retailers account for 90% of sales. e-Pharmacy sales across different Tonics experienced considerable growth consumer health categories. in 2020. Consumers will continue to seek Taking the Australian market as an example of how products that help with immune support “Across markets covered by IQVIA, complex an e-Pharmacy can become, 8 players during the forecast period, thus benefiting we notice that in Australia, Brazil and dominate the market, their segments being around 50 this category. Nevertheless, growth rates Czech Republic, thedespite non-OTC (personal nutrition e-Pharmacycare, platforms servingand the patient Australian market will slow during the period. care) have 10). a larger share of consumer (see Exhibit “The CCR and Pain Relief categories health sales in the e-Pharmacy channel. experienced substantial stockpiling However, in Germany and Poland, OTC The major pharmacy banner groups in Australia – during Q1 2020, although declines in products have the highest share of online Chemist Warehouse, Priceline and Terry White - also subsequent quarters impacted their sales, with licensed non-prescription have e-Pharmacy platforms operating under various yearly performances. Both categories medicines in Germany accounting for 78% are expected to decline during 2021, due 13 brand names, making difficult to value isolate sales who exactly is . on consumer healthit segment to a significant sales dip in Q1 2021 as a dominating the online space. result of partial lockdown measures and a “Nutritional products including vitamins weaker flu season. and supplements have been available Adding further complexity to the market is that these online through general e-commerce sites “Ireland’s economic growth was leading banner groupseven havebefore split theOTC market somewhat and e-pharmacies, significantly impacted as a result of by OTC category. Chemist medicines wereWhere permitted byWarehouse regulations. COVID-19-related restrictions and This confirms the e-shopper behaviour dominates vitamins, Priceline is more focused on lockdowns. GDP growth slowed from of buying regular use, branded and bulk personal care and cosmetics where Terry White leans 5.9% in 2019 to 2.5% in 2020. The economy quantity products through e-commerce more to OTC medicines such as analgesics, cough and is expected to recover strongly in 2021 channels with convenience, low to free (with growth of 4.2% forecast), as ‘level 5’ cold and allergy. shipping costs and at lower prices vs. lockdown measures were expected to ease physical retail channel. It is likely that in the e-Pharmacy space each group willfrom April 2021. The country’s vaccination rollout is also expected to boost economic “Despite the increasing adoption of seek to dominate in the category areas where their growth, as it could lead to a relaxation of e-pharmacies and clear preference for physical pharmacies are strongest. restrictions from H2 2021. certain categories, the online shopper remains challenging to understand. On top of the banner group complexity, the Australian“The economic rebound combined with They tend to be less loyal, seek different increasing disposable incomes and e-Pharmacy market isvs. alsoin-store host to direct-to-consumer product attributes shoppers, awareness levels will be major growth platforms runwith by thethe manufacturers engage less brands andthemselves, are open drivers for the OTC market. Pharmacies to experimenting with niche brands.” will continue to be the most popular retail channel as consumers trust professional advice from pharmacists. However, pharmacies will face strong competition from e-commerce and supermarkets due to their competitive pricing – especially as consumers become more responsive towards price and promotions.”

Exhibit 8: Breakdown of the e-Consumer Healthcare Eco-system

e-Commerce Players

References 1

Generalists

e--Pharmacies

Specialist

Source: IQVIA OTC Ireland Monthly Database, MAT April 2021

Source: IQVIA OTC Ireland Monthly Database, Previous Period Growth April 2021 2

Source: IQVIA OTC Ireland Monthly Database, PPG YTD April 2021

Pure play e--Pharmacies No No physical stores Source: IQVIA Consumer Health

Pharmacy/ Para-pharmacy websites Stand alone e-Pharmacies tied to a physical pharmacy

8 | e-Pharmacy and the New Consumer

24 | PHARMACYNEWSIRELAND.COM

Omnichannel e-Pharmacies e-Pharmacies tied to pharmacy chains

Source: IQVIA OTC Ireland Monthly Database, YTD April 2021

Source: IQVIA COVID-19 Ireland Market Intelligence – Published June 2nd, 2020 5

Source: IQVIA Channel Dynamics Ireland May 2021

Source: IQVIA Rebooting Consumer Health: Thriving in a PostCOVID-19 World 7

Vitamin D*

Best selling Vitamin D in Irish pharmacies

IMMUNE SYSTEM

BONES

TEETH

MUSCLES

Sona, serving Irish consumers through Irish pharmacies since 1984 SONA D 1000 provides 1000IU of Vitamin D3 per tablet. Vitamin D is important for normal function of the immune system, the maintenance of normal bones and teeth, cell division and normal muscle function. Vitamin D is also required for the absorption and utilisation of calcium and phosphorus, the maintenance of normal blood calcium concentrations and inflammation response.

Also available in the Sona Vitamin D range

SONA SUPPORTING Sona D 1000 and D 2000 are available in 30s and 60s * IQVIA Top 100 OTC Products 2021

IRISH VITAMINS

Top 100: Pharmacy Shopper Behaviour Pre-pandemic, it was recognized that patients were evolving from a passive consumer of healthcare into a proactive and forward-looking consumer which was driving new expectations for the OTC industry. This move towards self-care was also evident in the digital health market, IQVIA’s General Manager Gwynne Morley notes. “The Covid-19 pandemic has rapidly thrust patients and physicians into a world of digital health tools. By severing patients from face-to-face physician interaction for periods it has shifted care provision dramatically to telemedicine for virtual visits.17 At the same time, a concerned public turned to digital media on their smartphones as a source of information on Covid-19 and sought advice to keep themselves safe. They similarly turned to apps, wearables and digital media to help them exercise and maintain their health (see figure 6).

“Digital health had been slowly becoming part of the therapeutic paradigm alongside traditional medicines before COVID-19, and this process has been somewhat accelerated by regulatory agencies adapting to unprecedented times. “For instance, in the U.S. during the pandemic, the U.S. Food and Drug Administration (FDA) recognized that digital therapeutics could provide value in addressing mental health and wellbeing during quarantine and isolation, and waived some requirements to enable

their distribution and use.18 Overall, the pandemic has amplified the need for care provision and remote patient monitoring outside traditional healthcare settings, patient self-monitoring using various connected devices, and digital therapeutics that can deliver interventions via apps.”

Figure 6: Digital Health Tools in the Patient Journey During COVID

Exhibit X: Digital Health Tools in the Patient Journey During COVID Consumer Mobile Apps

Health System Disease Management Apps

Digital Therapeutics

Provided information about COVID19, tracked symptoms, provided home fitness programs

delivered interventions through software for select conditions

enabled remote patient monitoring outside traditional healthcare settings

Care Team Email and Text Messages

Consumer Wearables

Monitored activity and various digital biomarkers of health

Tracked vitals including oxygen saturation and helped patients selfmonitor

Smartphone Cameras to capture skin lesions and other health images and enable remote patient exams via telemedicine

Patient receiving care at home

helped patients communicate with their care team while at home

Clinical Trial Tools

Web-based Interactive Programs

delivered digital care programs, physical therapy, CBT programs for insomnia and other therapeutic interventions

Connected Biometric Sensors

Personal Health Records

were more accessible than ever online, facilitating care continuity

Telemedicine and Virtual Physician Visits supported remote clinician contact and care

In-Home Connected Virtual Assistants

Were still little used but can guide patients to health information, office numbers and EHR data, or push reminders

Report: IQVIA Institute for Human Data Science. Digital Health Trends 2020: Innovation, Evidence, Regulation and Adoption Source: IQVIA Institute, Jun 2021

26 | PHARMACYNEWSIRELAND.COM

collected patient information and enabled virtual trials or trials with virtual elements

Mobile Apps During Covid-19 The pandemic also saw impacts on the apps downloaded and used in 2020, driven by legitimate health anxiety, the search for health information, and the need to manage one’s health during the pandemic and periods of lockdown. Gwynne continues, “This trend occurred across a number of health app categories, including telemedicine app downloads like Doximity in the US that surged 37x from baseline to nearly 7000 downloads per week on just the Google Play store. Globally, exercise apps that helped patients stay healthy saw downloads quadruple, and mental health apps that helped those in need manage suicidal thoughts and depression, and blood pressure apps, increased more modestly by 50-100% (see figure 7).”

Consumer Wearables Consumer wearable devices that enable individuals to track their activity, such as fitness trackers, smartwatches, sleep trackers and actigraphy devices, and parameter-specific biosensors that track various measures like temperature, glucose levels or blood pressure continue to serve as an element supporting patient wellness efforts, with their use increasing over the years. “The downloading of apps tied to Pulse Oximeter devices that allow patients to monitor their oxygen saturation (SPO2) notably spiked in response to the COVID-19 pandemic (see figure 8). As many people with Covid-19 were found to have low levels of oxygen in their blood even when feeling well, pulse oximeters — available at some pharmacies and stores without a prescription — were recommended as a way to track the emergence of low oxygen levels that could be an early warning sign that medical care is needed.19 A scramble to download these helpful health apps occurred in waves around the globe and coincided with peaks in virus cases. Use of these deviceassociated apps increased by 9x-11x in the US and Europe, respectively, for periods then falling, and by 50-300x across other

regions including Latin America and Africa, where the baseline use was lower.”

Gwynne continues, “Regional and local retail pharmacies also experienced an increase in purchasing share as customers stayed local and avoided town centres due to the various lockdown restrictions. Shopping local is likely to continue when considering the government’s National Remote Work Strategy - the overall objective of which is to “ensure remote work is a permanent feature in the Irish workplace” in the future.

She adds, “The growing demand and need for telehealth is likely to drive this trend further, as remote patient monitoring grows. However, at present, the most measured parameters of consumer wearables are heart rate, steps taken, distance traveled, and calories burned, which are linked to activity monitoring devices.”

“Building a base of customer loyalty is a key element of successful brands, whether it be a product or a store. In this changing environment, a three-pronged approach is required to adapt to this change – focus on established brands, invest in brand health tracking, and deliver on the changing needs of consumers is key for post Covid-19 success. First, focus on fewer established brands. Consumers are seeking trust and reliability in what are uncertain times. So larger and betterknown brands will likely win market share and sales growth ahead of smaller challenger brands in your portfolio. Consumers are reluctant to experiment or seek choices, they are not spending time browsing shelves as well.

Trust in Pharmacy Gwynne reflects that more patients are more ready to self-treat or to consult pharmacists in-store. “The ongoing pandemic had shown the vital role pharmacists played, as evidenced by a recent Behaviours and Attitudes (B&A) survey20 in which 30 per cent of people stated that their pharmacists had become more important to them since the Covid-19 outbreak began20, especially now that face-to-face access to general practitioners was, understandably, so much more difficult. “The Ipsos MRBI Veracity Index 202121 published in March on ‘Who do we trust most in 2021?’ showed 96 % of people say that they generally trust local pharmacists. Nurses were second with 95%, followed by doctors with 94%. This was reinforced by the Customer Experience Ireland 2020 Report2, which highlighted that pharmacies were among those sectors that provided the highest level of customer service and experience.

“Second, invest in continuous brand health tracking as the consumer behaviours are evolving every week and their emotional state remains in flux. E-commerce has accelerated in recent months, but it will likely give up some of the gains as physical retail opens-up with easing of restrictions. Third, formulate the marketing and messaging model for your brands. Adopt a holistic approach to your messaging rather than focusing on product benefits. Consumers have limited mind space for processing new communications as their top priority remains with their family, health and finances.”

“In an IQVIA Consumer Health survey of industry executives conducted in June 2020, 39% of the respondents said that consumer behaviour was their key business priority7.” The following consumer behaviours were noted during the pandemic

References

(i) a shift in consumption and shopping habits - consumers were no longer browsing in-store, their purchases were focussed on the basic needs, they were shopping more consciously, buying local and were embracing digital commerce, and

7,000 6,000 7,000 5,000 6,000 4,000 5,000 3,000 4,000 2,000 3,000 1,000 2,000 0 1,000 0

Suicide / Depression Apps Globally Suicide / Depression Apps Globally

3000% 2000% 2000% 1000%

20,000,000 20,000,000 15,000,000

1000% 0% 0%

5,000,000 0 0

200% 200% 150% 150% 100% 100% 50% 50% 0% 0% -50% -50%

300,000 250,000 300,000 200,000 250,000 150,000 200,000 100,000 150,000 50,000 100,000 0 50,000 0

Downloads per week Downloads per week

Exercise Apps Globally Exercise Apps Globally

15,000,000 10,000,000 10,000,000 5,000,000

% Change % Change

Week Week ending ending 2/22/2 2/92/9 2/23 2/23 3/83/8 3/22 3/22 4/54/5 4/19 4/19 5/35/3 5/17 5/17 5/31 5/31 6/14 6/14 6/28 6/28 7/12 7/12 7/26 7/26 8/98/9 8/23 8/23 9/69/6 9/20 9/20 10/4 10/4 10/18 10/18 11/1 11/1 11/15 11/15 11/29 11/29 12/13 12/13 12/27 12/27 1/10 1/10

4000% 4000% 3000%

Blood Pressure and Diary Apps Blood Pressure and Diary Apps

Week 0 Week ending ending

4,000 2,000 2,000 0

Doximity Telehealth in US Doximity Telehealth in US

Report: IQVIA Institute for Human Data Science. Digital Health Trends 2020: Innovation, Evidence, Regulation and Adoption Source: 42 Matters, Janfor 23, 2021. Data Science. Digital Health Trends 2020: Innovation, Evidence, Regulation and Adoption Report: IQVIA Institute Human Note: Install data shown is from the Google Play app store only. Shows percent change vs week ending Feb 2, 2020 Source: 42 Matters, Jan 23, 2021. Note: Install data shown is from the Google Play app store only. Shows percent change vs week ending Feb 2, 2020

Source: IQVIA OTC Ireland Monthly Database, May 2020

Source: IQVIA OTC Ireland Monthly Database, December 2020

Source: IQVIA Consumer Health Global Forecasts, June 2021

Source :https://www.ehealthireland.ie/News-media/ Spotlight/Healthmail.html

Source: IQVIA White Paper: e-Pharmacy and the New Consumer https://www.iqvia.com/library/white-papers/epharmacy-and-the-new-consumer-whitepaper

categories.

8,000 8,000 6,000 6,000 4,000

Source: https://www.rte.ie/news

(ii) when consumers were buying goods, Growth in Globally During 2020Figure 7: Percent ChangeApp OverDownloads Baseline in they were becoming more focused2020on Growth in Health Health App Downloads Globally During COVID-19 COVID-19 Health App Downloads During COVID-19 2021 price, quality and availability across 2021 2020-2021

Source: Fortune Business Insights

Source: Pharmaceutical Society of Ireland (PSI): Draft guidance on the delivery of Prescription-Only Medicines from a Retail Pharmacy Business

400% 350% 400% 300% 350% 250% 300% 200% 250% 150% 200% 100% 150% 50% 100% 0% 50% 0%

Source : PSI Website

Source : IQVIA Institute for Human Data Science. Shifts in healthcare demand, delivery and care during the COVID-19 era: tracking the impact in the United States. 2020 Apr.

Source : U.S. Department of Health and Human Services. Enforcement policy for digital health devices for treating psychiatric disorders during the coronavirus disease 2019 (covid-19) public health emergency: Guidance for industry and food and drug administration staff. 2020 Apr. Available at: https://www.fda.gov/media/136939/download

140% 120% 140% 100% 120% 80% 100% 60% 80% 40% 60% 20% 40% 0% 20% 0%

Source : https://www.health.state.mn.us/diseases/ coronavirus/pulseoximeter.html

Source : On-line Survey carried out by Behaviour & Attitudes for the Irish Pharmaceutical Healthcare Association (IPHA) and Irish Pharmacy Union (IPU), September 2020

Veracity Index 2021 (ipsos.com)

Source : https://thecxcompany.com/wp-content/ uploads/2020/10/2020-CX-Report.pdf

22 2 2

PHARMACYNEWSIRELAND.COM | 27

05/2021

04/2020

04/2019

04/2018

04/2017

04/2016

he IQVIA Top 100 OTC Products has been firmly established as the ‘must read’ overview report of Ireland’s OTC medicines sector for almost a decade.

More patients are more ready to self-treat or to consult pharmacists in-store. The ongoing pandemic had shown the vital role pharmacists played, as evidenced by a recent Behaviours and Attitudes (B&A) survey in which 30% of people stated that their pharmacists had become more important to them since the Covid-19 outbreak began. The Ipsos MRBI Veracity Index 202121 published in March on ‘Who do we trust most in 2021?’ showed 96 % of people say that they generally trust local pharmacists.

This was reinforced by the Customer Experience Ireland 2020 Report , which highlighted that pharmacies were among those sectors that provided the highest level of customer service and experience.

Irish Pharmacy News has been working with data analysts IQVIA for over 6 years in compiling and bringing this information to our readers, pharmacy professionals of Ireland.

social distancing, isolation and shielding populations. Gwynne has presented with readers with an incredibly thorough explanation of all these factors in the preceding pages.

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.

This year we have also included an overview of shopper behaviour during this incredibly challenging time, which should prove invaluable as community pharmacists and PARALIEF pharmacy business owners seek toDRIVING CASH SALES adapt to the new AND ‘normal’PROFIT for IN YOUR PHARMACY their customers. *

In highlighting the value of the OTC market to community pharmacy, IQVIA General Manager Gwynne Morley explains, “The total value of the nonprescription market in Ireland based on IQVIA’s data for the 12 months, May 2020 to April 2021, was ¤406 million. “This market declined by 8.3% when comparing year-on-year growth2 . The year-to-date (YTD) value of this market at the end of April 2021 was ¤141 million with a growth rate of -10.9%3 . After the initial spike in OTC sales exhibited in March 2020 due to the onset of Covid-19, the market slowed down significantly resulting in a flat growth rate (0%) in 2020, this is in contrast to the 8% growth rate demonstrated for the full year 2019.” Sales across some categories fell due to numerous factors such as

Paralief the No.1 Paracetamol Brand in Pharmacy

2000

Covid-19 has dramatically hastened the pace with which digital offerings have become commonplace. Overall, the pandemic has amplified the need for care provision and remote patient monitoring outside traditional healthcare settings, patient self-monitoring using various connected devices, and digital therapeutics that can deliver interventions via apps. 1,943,176

Products in units (000s)

1500

1000

657,350

500

517,351

201,819

234,304

110,098 104,404

74,039 16,233

7,391

e nc

a ta Pa r

va Ad ol

He Pa n

Nig

eta

ac Pa r

Pa n

tifa

Pa n

tra

lie

Pa n

IQVIA build The Top 100 Overthe-Counter (OTC) Market Report based on the total value of wholesale sales for OTC products into retail pharmacy over the course of the 12 months to April 2021 (May 2020-April 2021). It’s a rolling annual value which includes the five major OTC categories including cold and cough remedies (CCR), pain, vitamins, and minerals (VMS), skin and digestive health.

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.

*Disclaimer: Please note that the six year comparison listed opposite details a range from Jan-April for the years 2015-19 & 2021 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.

28 | PHARMACYNEWSIRELAND.COM

2012/ADV/PAR/076

IQVIA Top 100

BEROCCA

52 44 43 42 38 34

BROLENE

77 65 69 66 66 64

PANADOL

28 19 21 20 21 21

BONJELA

53 66 56 57 56 56

E 45

78 77 71 64 62 54

EASOFEN

29 32 18 38 45 29

SUDAFED NASAL

54 51 48 55 60 59

SEVEN SEAS C L O

79 86 82 75 71 73

OTRIVINE

30 34 34 32 32 28

ARTELAC

55 63 50 49 41 38

RENNIE

80 73 66 70 65 60

DIORALYTE

31 17 16 16 15 18

CALPOL VAPOUR

56 64 80

PHENERGAN

81 97

PARACETAMOL PGO

32 54

LEMSIP

14 13 13 13

ZOVIRAX GLX

82 83 76 79 83 76

PARACETAMOL GKC

33 96

NICOTINELL

58 71 58 53 50 46

IDEOS

83 85 89 89 77 71

NYTOL

GLUCOJUICE M+U

OPTREX

BRUPRO

35 30 41 52 88

PANADOL NIGHT

60 67

ANUSOL

SOLPA EXTRA

36 49 57 69

BUPLEX

61 45 54 23 46

BRONCHOSTOP JUNIOR

86 52

ANTI HIST ALLERGY

37 47 59 97

CAVILON

62 79 88 96

BEPANTISEPTIC

87 95 92 88 79 66

DEEP HEAT

38 61 49 56 61 62

SUDOCREM

63 70 44 43 93

VICKS

88 48 63 58 42 45

LACTULOSE FRS

LISTERINE

64 68 61 60 52 49

GAVISCON EXTRA STR

89 92 90 85 80 91

SUDAFED

40 20 19 18 19 19

ALFLOREX

65 80 81 98

B D MICRO FINE

90 100 98

THEALOZ

41 78

SAVLON

66 81 70 71 64 80

D PEARLS

SILCOCKS BASE OVE

42 58 60 81 82 79

IMODIUM

67 50 45 48 57 55

VYGON NELATON CATH

MOTILIUM

43 37 26 28 22 20

BUSCOPAN IBS

68 76 77

CORTOPIN

93 90 91 65 36 50

FYBOGEL

44 59 52 51 48 44

DIFFLAM

69 43 42 40 39 36

ACTIFED

94 69 62 59 53 53

VERMOX

45 53 53 54 59 57

STREPSILS

70 23 28 27 23 22

CB12

95 94 74 78 74 74

NIQUITIN

46 56 64 63 75

CYSTOPURIN

71 74 72 74 69 68

BUTTERCUP BRONCHO

96 36 33 29 25 33

PANADOL ACTIFAST

47 55 68 67 68 61

SONA VITAMIN D3

THERMACARE

CALDESENE

48 60 47 50 49 52

JAKEMANS

73 84

AQUEOUS

ZIRTEK

49 62 23 35 40 47

SINUTAB

74 46 46 45 44 40

BIO KULT PROBIO

CALPOL SIX PLUS

50 13 20 19 26 24

CERUMOL

75 89 79 83 78 75

BARD DRAINAGE

100 0

04/2016

27 41 32 31 28 31

04/2017

MAXILIEF

04/2018

76 87 85 86 84 77

04/2019

ELAVE

04/2020

51 57 55 46 47 51

05/2021

CORSODYL

04/2016

04/2017

04/2018

04/2016

04/2019

04/2017

26 21 15

04/2020

04/2018

NUROFEN EXPRESS

05/2021

04/2019

04/2020

05/2021

Pharmacy Products

PHARMACYNEWSIRELAND.COM | 29

Category Focus: Pain

Targeting Pain in Pharmacy Irish Pharmacy News spoke to Susan Meaney, OTC Team Lead with Murphy’s Pharmacy about the pain relief market and where the sector lies within the OTC medicines landscape. Susan Meaney, OTC Team Lead, Murphy’s Pharmacy

Chronic pain can have a huge effect on quality of life, causing problems with mobility, dexterity, sleep and concentration. It often results in the sufferer changing how they live in order to cope. This, in turn, can have a huge bearing on emotional wellbeing, causing anxiety, helplessness and depression. Susan says there has been a noticeable difference and a higher incidence of people searching for analgesics or pain relief within the pharmacy. Stockpiling Issues

The management of pain places a huge burden on health resources, with the number of patients seeking help for chronic pain increasing due to Ireland’s ageing population. Over the counter (OTC) analgesics containing codeine or dihydrocodeine in combination with other analgesics, such as paracetamol or ibuprofen, are intended for short-term use (no longer than three days) to minimise dependence and addiction. Concerns that codeine or dihydrocodeine containing analgesics are being taken regularly should be discussed with the patient and the patient should be encouraged to seek medical advice and access appropriate services. The biggest problem areas are the lower back, knee, back, shoulder and hip. But it can also involve living with pain in the foot, abdomen, head or ankle. Types of Pain Acute or short-term pain usually has a sudden onset and a clearly identifiable cause, such as sustaining a burn while cooking, and lasts no longer than a few days.

While unpleasant, it often serves a useful purpose in triggering reparative action, eg taking a baking tray out of the oven with bare hands causes pain that results in the individual dropping the tray, thereby minimising further damage. Addressing the cause usually resolves the problem, eg taking heat out of the burned area by applying a towel soaked in cold water. • Recurrent or intermittent pain is acute pain that comes and goes, for example, toothache. Again, addressing the issue usually eases the pain, though the exact cause may be difficult to pinpoint and some conditions – period pain, for instance – require regular management, though usually not for long on each occurrence. • Chronic pain differs from recurrent pain in that it is unrelenting, though there will be times when it feels more severe than others, and it lasts three months or longer. The cause is usually a long-term condition such as arthritis, though it may be less specific, for example a painful back.

30 | PHARMACYNEWSIRELAND.COM

“A lot of this started at the beginning of the pandemic as people were advised to take pain relief in the form of paracetamol to relieve the symptoms of Covid-19, in particular to reduce fever associated with the virus. This, coupled with the anxiety people felt at the time, led to massive panic or bulk buying,” she comments. “People began stockpiling a variety of products for pain and temperature relief, not only for themselves as adults but also for their children. This led to mainstream items like Calpol Suspension for children becoming very difficult for us to get supply of here in the pharmacy as there was shortages of this product. “When word of this got out to the public domain, this in turn led to further attempts to bulk buy this, or similar products. In summary, absolutely our sales of pain relief products have sky rocketed in the last 12 months. “Now, as the Covid vaccines have come on stream, we have seen patients coming into the pharmacy prior to vaccination to buy paracetamol or ibuprofen as they have been advised by their GP to take these to reduce any fever that may occur post vaccination.” As with any OTC category, this market has its own challenges for pharmacy teams when it comes to management and treatment options.

“Educate customers! We are the most accessible part of the healthcare system in Ireland, therefore people come into us first before going to see their GP, and so we can have a huge influence on how those patients manage and treat their pain” Susan continues, “Initially, at the start of the pandemic it was very difficult to get stock of paracetamol as sales went through the roof. We couldn’t keep it on the shelf as people were buying it up so quickly. Furthermore, there were no sales representatives on the road for most of the past year as they were working from home. “Often, people come in to the pharmacy and already have made up their minds what they want. It can be a challenge to get them to be open to our advice on pain relief products. “Moreover, many frequently come in to us and ask “can I have the strongest pain killer you have.” It certainly can be a challenge getting them to try a milder alternative first and see if that helps them before stepping up

to a stronger product, as really they just want the “quick fix.” It takes time & effort, and patience to explain the analgesic ladder to them and help them understand how to manage their pain. Opportunities in the Market “Many people come in looking for codeine based products and this is where our team refer them one of our pharmacists to handle the sale of these products. This can also be challenging when you have repeat customers coming in looking for codeine based products.”

on how those patients manage and treat their pain. “The more we educate our pharmacy OTC team on new products the better care we can provide to our customers. “This category can be a minefield with lots of different brands of the same product, lots of variations of similar products, people often get very confused on what the difference is between them.”

“There is a huge opportunity to educate patients on analgesic ladder and advise them to try paracetamol first line before reaching for the strongest painkillers first, and educating them on the proper use of pain relief,” Susan adds.

Susan goes on to explain the value of this sector to her pharmacy. “The pain relief sector is of very high value to our pharmacy. It accounts for a very high portion of your OTC sales all year round. Often customers come in for one thing, perhaps a prescription, and while they are waiting or at the till, they spot our pain relief products in clear view and will often add them to their purchase as “they are handy to have”.

“Educate customers! We are the most accessible part of the healthcare system in Ireland, therefore people come into us first before going to see their GP, and so we can have a huge influence

“Pain relief products are all located together in a very central position behind our counter, and are always kept at eyelevel, therefore as the customer approaches the till they are clearly

However with challenge, comes opportunity.

within the line of view. The is very important as it further drives the impromptu sales.

“All our staff will be sent on the IPU counter assistant training course,” she adds.

“Signage is also very important here. We have a whole bay dedicated to pain relief products and this is clearly marked by a big sign labelled “Pain Relief” for people to see.”

“This means they are well educated in OTC pharmacy ailments and products used to treat them. We also continuously do in-house training with our staff, this is done by our Training & Development officer Mary Waters.

Susan’s Key Tips  All Pain relief products are to be kept together.  All brands are kept together increases visual impact.  Keep best sellers at eye level.  Keep the area well stocked so you have plenty products on view.  We have some shelf markers too that may draw attention to a particular brand or product.  New products - we might keep them on a promotional stand for a couple of weeks alongside the till to further draw the customers attention to the new product. Susan ensures her pharmacy team are consistently kept up to date with the latest guidance.

“This continued professional development further compounds their education in the area and team members often discuss topics or problems patients have presented with & learn on the job from how another staff member may have dealt with a particular prodlem. Younger staff gain a considerable amount of knowledge listening and observing our experienced OTC staff dealing with customers in real time at the till, this is invaluable experience for them hands on. “Pharmacy representatives are also a valuable source of knowledge to our staff, especially of new products to the market, or new variations of existing products,” she concludes.

PHARMACYNEWSIRELAND.COM | 31

FAST RELIEF OF ALLERGIES

24hr CONTROL

Cetrine Allergy 10mg Film-Coated Tablets available in packs of 7s and 30s. Always read the leaﬂet. ABBREVIATED PRESCRIBING INFORMATION Product Name: Cetrine Allergy 10mg film-coated tablets & 1 mg/ml oral solution. Composition(s): Each tablet contains 10 mg cetirizine dihydrochloride. One ml of the oral solution contains 1 mg cetirizine dihydrochloride. Description(s): White, oblong film-coated tablets, scored on one side. Can be divided into equal halves. Clear, colourless liquid with banana flavour. Indication(s): Tablets: Adults and paediatric patients 6 years and above. Oral solution: Adults and children 2 years and above. Relief of nasal and ocular symptoms of seasonal and perennial allergic rhinitis (hay fever); relief of symptoms of chronic idiopathic urticaria. Dosage: Tablets: Adults, elderly and children aged 12 years and over: 10 mg once daily. Children from 6 years to 12 years: 5 mg (half a tablet) twice daily. Moderate renal insufficiency (creatinine clearance CrCl 30-49 ml/min): 5 mg once daily. Severe renal insufficiency (creatinine clearance ≤30 ml/min): 5 mg once every 2 days. Children under 6 years: Not recommended. Oral solution: Children aged from 2 to 6 years: 2.5 mg twice daily (2.5 ml oral solution twice daily (half a measuring spoon twice daily)). Children aged from 6 to 12 years: 5 mg twice daily (5 ml oral solution (a full measuring spoon twice daily)). Adults and adolescents over 12 years of age: 10 mg once daily (10 ml oral solution (2 full measuring spoons)). Not recommended in children aged less than 2 years. Moderate renal insufficiency (creatinine clearance CrCl 30-49 ml/min): 5 mg once daily. Severe renal insufficiency (creatinine clearance ≤30 ml/min): 5 mg once every 2 days. In paediatric patients suffering from renal impairment: Adjust dose on an individual basis taking into account the renal clearance of the patient, his age and his body weight. Contraindications: History of hypersensitivity to the active substance, to any of the excipients, piperazine derivatives or hydroxyzine. Severe renal impairment < 10 ml/min creatinine clearance. Warnings and Precautions for Use: Cetirizine may increase risk of urinary retention, therefore caution in patients with predisposition factors of urinary retention (e.g. spinal cord lesion, prostatic hyperplasia). Caution in epileptic patients and patients at risk of convulsions. Discontinue use of cetirizine three days before allergy testing. Pruritis and/or urticaria may occur when cetirizine is stopped, even if the symptoms were not present before treatment initiation. In some cases, the symptoms may be intense and may require treatment to be restarted. The symptoms should resolve when the treatment is restarted. Tablets contain lactose. Oral solution contains sorbitol, propylene glycol, sodium (essentially ‘sodium free’), methyl - & propyl-parahydroxybenzoate. Interactions: Caution is advised when taken concomitantly with alcohol or other CNS depressants. Cetirizine does not potentiate the effect of alcohol (0.5 g/l blood levels). The extent of absorption of cetirizine is not reduced with food, although the rate of absorption is decreased. Pregnancy and Lactation: Caution during pregnancy and breast-feeding. Ability to Drive and Use Machinery: Usually non-sedative, patients should take their response to the product into account. In sensitive patients, concurrent use with alcohol or other CNS depressants may cause additional reductions in alertness and impairment of performance. Undesirable Effects: Cetirizine at the recommended dosage has minor adverse effects on the CNS, including somnolence, fatigue, dizziness and headache. In some cases, paradoxical CNS stimulation has been reported. Although cetirizine is a selective antagonist of peripheral H1-receptors and is relatively free of anticholinergic activity, isolated cases of micturition difficulty, eye accommodation disorders and dry mouth have been reported. Instances of abnormal hepatic function with elevated hepatic enzymes accompanied by elevated bilirubin have been reported which resolves on discontinuation of the drug. Uncommon: Agitation, diarrhoea, pruritus, rash, asthenia, malaise, paraesthesia. See SPC for all adverse reactions. Marketing Authorisation Holder: Rowex Ltd, Bantry, Co. Cork. Marketing Authorisation Number: PA0711/075/002-003. Further information and SPC are available from: Rowex Ltd., Bantry, Co. Cork. Freephone: 1800 304 400 Fax: 027 50417 E-mail: rowex@rowa-pharma.ie Legal Category: Not subject to medical prescription. Date of Preparation: March 2021 Adverse events should be reported. Reporting forms and information can be found on the HPRA website (www.hpra.ie) or by emailing Rowex pv@rowa-pharma.ie

Date of preparation: (03-21) CCF: 24055

Category Focus: Baby Market

The Baby Market within Pharmacy The baby market in general is dynamic with many contributing factors. Influences on the market are diverse and range from a global and local reduction in birth rate, education levels within society (as many working mothers will choose to remain longer in the workforce prior to expanding their families), contraception availability, fertility rates and obviously now the Covid 19 Pandemic. Many of these factors overlap, with education linking to contraception awareness, and choice linking to the impacts of secular behaviour. If you keep looking widely it is clear that environmental considerations also play a factor with parents favouring sustainable, natural, organic and ethical products. Birth rate has been declining in both the USA and China for years, and Ireland is no different with the average number of births per 1000 people dropping from 12.69 in 2019 to 12.352 in 2020 and 12.013 in 2021. It was widely reported at the start of the Covid 19 Pandemic that a ‘baby boom’ might occur as is tradition in times of ‘holiday’ type periods like Christmas, New Years and St Patricks Day. The reality has actually been quite different, whilst there was some panic buying and stockpiling initially for baby essentials, the growth of the overall market has reduced. This is likely due to the financial instability of families with people surviving and living with lower incomes and with less certainty about their future job stability. Weaker job prospects generally equate to fewer births, with some families postponing pregnancy and some choosing not to increase their family size at all. A report from America defined the decline in the baby market, in relation to Covid 19 alone as an excess decline of 8.6%. The Brookings Institution expected potentially 14% few births in the USA and the up-to-date data suggests their predictions were near accurate. Challenges and Oportunities So, after that grim summary of the Irish and global baby market it is time to look at it from the context of our own pharmacies! The news is not all bad! I will shortly discuss the biggest opportunities for Irish Pharmacy in the baby market, but first I would

“It was widely reported at the start of the Covid 19 Pandemic that a ‘baby boom’ might occur as is tradition in times of ‘holiday’ type periods like Christmas…... The reality has actually been quite different” just like to highlight a couple of challenges and potential solutions! The Biggest Challenges: • Nappies, formula, wipes, baby food and essential hygiene products. Margins in these areas have never been remarkable and the access to the consumer to these lines in Supermarkets, convenience stores etc has led us to compete with retailers in a larger more price sensitive industry. The challenge is that while many pharmacies have traditionally stocked these lines, it might be worth asking yourself if it’s worth it. By stepping back from these low margin lines we can allow ourselves to step up in other ways which I’ll discuss later when highlighting opportunities. • The decline in birth rate – I’m not suggesting we can do

Written by Sheena Mitchell MPSI, Milltown totalhealth Pharmacy www.wonderbaba.ie

anything about that. However, it is important that we recognise it and realise that while there is psychological economic malaise and instability we should focus our attention on areas where we can prevail. Not all birth rate decline is due to covid as mentioned above, personal choice to remain in the workplace, or not to have a family at all contribute, but so also does the knock on effect of an older generation of potential new mums This can be seen in Ireland with the high uptake of fertility treatments. We are specialists in health, and we should ensure we are offering fertility dispensing services, supplements and guidance to parents trying to conceive. • Streamlining of purchasing habits. With travel restrictions, restrictions to the number of customers we can have in store and general lack of ease with browsing, consumers have sped up the trend to do their research on what products they would like online and have not always been engaging with pharmacy teams for advice. A lot of the products which we sell to parents are OTC meds – they don’t tend to buy these online as the need is generally instant and

a delay in waiting for delivery is not an option. I will speak about this more later as an opportunity. Whilst online is suitable for many lines and many industries, for the baby health market the value of in-store purchasing should not be underestimated. Now that we have considered the biggest challenges facing us in Pharmacy in relation to the baby market, we can realign our strategy to seek opportunity. Evolving with the market is essential and we are ideally placed as healthcare professionals within our communities to engage with our customers and provide them with a high standard of customer experience in a way that worried parents not only need, but will actively seek out. The Opportunities • There is one category which has not shown overall decline in the wider market and thus should be constantly reviewed and considered by pharmacy purchasing teams. Parents have become more inclined to purchase more niche brands which include natural or organic products and eco-ethicals. Consider swapping out some of your bulky low margin supermarket lines to refined

PHARMACYNEWSIRELAND.COM | 33

Category Focus: Baby Market

transactions are easy, smooth and quick. The marketing advice is that retail spaces should aim to become experience centres, not just places to purchase! Signage, technology, and mobile payment options all help with a good experience. • Training – Team members need to be at the top of their game. They need to know their products well and to recommend them appropriately. Team members set the emotional tone for the consumer once they enter the store, and their attitude and engagement can be critical to the consumers journey within your pharmacy. I recommend pharmacy teams to use www.wonderbaba.ie as a training resource to assist with understanding the needs of parents and what the treatment guidelines are. • Click and collect – this is a strong option and for young millennials, it’s a winning facility to gain footfall yet also a customer contact opportunity.

Whilst challenges continue to exist in the baby market, it is clear that there are opportunities we can seize! I think the most important thing is to remember who we are, we are healthcare professionals, trained and experienced with the benefit of being in the hearts of our communities. choices within these niches. The key here is the consumer experience – these are feel good purchases and so need to be merchandised in an inviting and higher end manner. • Fertility assistance. Products like pre-seed, Proceive, ovulation detection tests can be items required by parents trying to conceive. Having a section dedicated to family planning can be useful in some areas. It’s worth testing your market. It is essential to ensure your pharmacy team are well briefed on how to support fertility patients in store with the Pharmacist ensuring a high level of counselling has been provided where required on fertility based prescriptions. Having empathy for this patient cohort can nurture relationships and create a loyal consumer going forward. This particular patient group truly need to have

a professional and warm patient journey through our pharmacies. • The online consumer – There is a tendency for parents to research products before visiting the store to purchase, or for certain lines they will purchase online. The area that we need to focus on is the area that sets us apart! We are healthcare specialists – healthcare is what we do. We are extremely capable and well trained to deliver a valuable service. Engaging with customers is key here to build relationships and create sales opportunities. New parents love nothing more than to have an accessible healthcare professional that they trust to rely on. We serve to allay their fears and identify symptoms. They trust us to respond appropriately by suggesting treatment or referring when needed. We are best served by evolving and innovating

34 | PHARMACYNEWSIRELAND.COM

without losing our core values or sacrificing standards. It is important to remember that both online and offline interaction are key to a positive customer experience. In-store shopping experience will remain strong even in the digital era. We are lucky to have the opportunity to engage on a personal level with our customers in a way which would not be invited in other retail settings. • Merchandising – Parents need buggy accessible stores with easy and clear merchandising. They want to be able to navigate the store quickly and efficiently with a tantruming toddler in tow. We can make the customer journey positive by assisting, smiling and engaging with both the customer and their family! Everyone (big and small!) needs to love visiting their local pharmacy! Pharmacy teams need to ensure that payment

Pharmacy Growth Whilst challenges continue to exist in the baby market, it is clear that there are opportunities we can seize! I think the most important thing is to remember who we are, we are healthcare professionals, trained and experienced with the benefit of being in the hearts of our communities. Hopefully, services like children’s flu vaccinations etc will continue to grow and we can allow ourselves to take the professional platform we deserve. From a retail perspective it is important to understand and know your customer type, I hope I have highlighted their main characteristics and ideals here and you can consider how best to implement the recommendations in your store. Baby is a section which can open opportunities for us to get to know young families and couples in our areas, it is often the first introduction to regular pharmacy visits that families will experience. Providing convenience, an enjoyable experience and a high level of product knowledge can create a loyal customer who will remain a valued part of your growing demographic ongoing.

Category Focus: Diabetes

Diabetes Care – Helping Pharmacy Grow Diabetes affects nearly a quarter of a million patients in Ireland. Experts believe tens of thousands of those may not even realise that they have the condition. As time goes on and pressure mounts on hospitals and GP services, there is an opportunity for growth in the diabetes care services provided by community pharmacists and their teams. Micheál McVann is a pharmacist at McVann’s CarePlus Pharmacy on Shop Street in Westport, County Mayo. He is one of a growing number of pharmacists in Ireland including other CarePlus Pharmacy teams in Headford, Dunboyne and Loughrea - offering HbA1c testing for diabetes. More effective than the usual finger-prick test, this measures a person’s blood sugar levels over a 12 week period and is highly accurate at detecting a possible diabetes diagnosis. It takes about 6 minutes to carry out in the pharmacy. More often performed by a GP or clinical diabetes care team, the HbA1c test has allowed Micheál to detect a growing number of potential cases of diabetes, who are then referred to their doctor for further testing and care. Micheál says providing this test to customers is a good move for a community pharmacist: “To me, this is the future of pharmacy offering more services for more conditions, as much as we can. It builds the relationship with our customers and cements our place in the community as a trusted source of healthcare and information. It also aligns with

CarePlus Pharmacy’s stated goal of empowering people to live healthier and happier lives.” The CarePlus Pharmacy network last year launched a drive to help customers living with diabetes, providing an information pack for people when they collected their monthly prescription containing lots of advice on managing the condition, as well as information on Diabetes Ireland services. The pharmacy group also worked with Diabetes Ireland to educate pharmacy teams about diabetes to allow them to provide the most upto-date advice to customers. Other branches of CarePlus Pharmacy, such as that in Carrigaline, County Cork, have even begun providing retina screening, which can be vital for diabetes patients. Thanks to expert training and the CarePlus Pharmacy awareness campaigns, Micheál McVann and his team are always on the lookout for customers who may be displaying common symptoms of diabetes in its various forms. He has outlined some of the key indicators that someone may display if they have undiagnosed diabetes: “Thirst is a big one, and frequent urination. Dry skin, fatigue

Micheál McVann, pharmacist, McVann’s CarePlus Pharmacy

and unexplained weight loss. The nerve problems associated with diabetes can also cause tingling in the hands and feet, while blurred vision, frequent infections and sores on the skin that are slow to heal would all be symptoms that would make me advise them to consider getting checked.” The team at McVann’s CarePlus Pharmacy provides all diabetes patients with a blood sugar monitor so they can do their regular finger-prick tests and monitor their readings. Just as education among pharmacy staff is important for proper diabetic care, it’s also vital that patients know how the condition affects them and how to manage it. “We work hard to ensure our diabetes patients understand their medication, especially for those newly-diagnosed - as it can be a lot to take in. Sometimes, they won’t check their sugars regularly

or they won’t do it correctly, so we can help with that. Dietary advice is vitally important too because a good diet supports the medication they are on and ensures they will get the full benefit of the medical help.” Micheál believes that diabetes care is a really important sector within retail pharmacy and is only going to grow: “Pharmacies are ideally positioned to help people with diabetes support and care. The outlets’ accessibility on the high street means they can get expert advice in private from a pharmacist immediately. Increasingly, people are having to wait days for doctors’ appointments - and months for non-urgent hospital appointments - so if we can fill that gap with appropriate care and treatment, then it’s a win-win for customers and the pharmacy. When you consider the tens of thousands of people who are going to need care in the future, we provide a really valuable opportunity to relieve some of the pressure on the wider healthcare system.”

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Category Focus: Cough, Cold & Flu

Impact of Covid-19 on Cough, Cold & Flu Market According to the latest report from Euromonitor International, the Covid-19 pandemic has meant that Irish consumers bought more cough and cold remedies in order to treat themselves at home, due to the lockdown which occurred in the spring and the subsequent social distancing restrictions. The pandemic has influenced consumers to purchase OTC medications as part of preventative health measures to prepare a personalised health kit or medicine cabinet, which has resulted in purchases of traditional cough, cold and allergy remedies in case they may need to treat symptoms of any illness at home. Despite the pandemic boosting sales of many categories of OTC medications, including adult cough, cold and allergy remedies, paediatric cough/cold remedies continued to see lower demand as a result of strict regulation by the Irish Health Product Regulatory Authority (HPRA) regarding the sale of cough/cold remedies to younger consumers due to advice from the Food and Drug Administration (FDA) in the US and the Medicines and Healthcare Products Regulatory Agency (MHRA) in the UK which highlighted concerns regarding the safety of cough and cold medicines for use in children, particularly those under two years of age. The use of cough and cold medicines in older children continues to be under review. Cough & Cold The term “common cold” is widely used to describe an upper respiratory tract infection of viral origin. Adults in general suffer from cold approximately two to

four times annually while children can contract the virus three to eight times as their immune systems aren’t as developed. Distinctive symptoms means that people often diagnose and treat themselves through a combination of self-care and OTC products, without needing to go to the doctor. If there is no improvement then an appointment with a doctor should be arranged. A GP can do an investigation to rule out whether the symptoms are being caused by a more serious infection, such as pneumonia or glandular fever. All members of staff should be trained up on when to refer a patient for further medical attention, especially if they present with cold or flu-like symptoms that are accompanied by any of the following: high fever, vomiting, a non-blanching rash, photophobia, severe headache and/or confusion. Children presenting with high-pitched screaming, floppiness, bulging fontanelle, convulsions or stiff neck should go straight to A&E. There is no cure for a cold, but certain measures can be taken to improve comfort levels while the virus dissipates: decongestants, antihistamines and pain relievers might offer some relief from symptoms however they won't stop a cold from developing

38 | PHARMACYNEWSIRELAND.COM

and will not shorten its duration. Vitamin C is useful for people in high risk groups who are at high risk of colds due to frequent exposure — for example, nurses or pharmacy staff. Echinacea and Zinc may also benefit patients during the cough and cold season however people should check with their doctors first as these can interfere with some medications. In general though, the best advice to patients suffering from a cough or cold this winter season is to rest, sip liquids, wash your hands, and to stay away from workplaces and school/college until symptoms have improved. Influenza Influenza is the winter ailment most likely to drive sufferers to the GP or to A&E, and nearly half of them will require antibiotics. The European Commission estimates that the seasonal flu vaccine prevents somewhere in the region of 37,000 deaths per annum in Europe. Pharmacists have been authorised to administer the flu vaccine, once appropriately trained, since October 2011. The uptake on the flu vaccine has increased every year since and research from the NHS has shown that people are more likely to avail of the flu vaccination service if it is convenient, quick and locally available.

As the vaccine can only be developed once the virus has been identified (which can take months), the European Commission and the European Medicines Agency work together to “speed up the marketing authorisation procedure once a pandemic has been declared.” In order for the flu vaccination programme to maintain its ongoing success, there must be a high level of uptake among those aged sixty five years and older. At risk groups should also be targeted by pharmacy teams and the EU urges member countries to commit to vaccinating 75% of at risk groups each year. Those most at risk of developing serious complications from the flu virus include the youngest and the oldest, pregnant women, persons with a BMI over 40, patients with pre-existing long term conditions such as heart, kidney, liver, neurological disease or diabetes, smokers, and patients who are immunosuppressed or immunocompromised. It can also disproportionately affect people with Down syndrome and the virus is known to spread quickly in congregated settings, such as nursing homes or supported living environments. The HSE estimates that over one million people should be vaccinated in Ireland for the programme to be fully effective.

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Easier to understand BG levels1 with the smartLIGHT® feature High Accuracy2 demonstrated with CONTOUR®NEXT test strips Avoid re-lancing with 60 seconds Second-Chance® sampling3 Improved self-management4,5 demonstrated with the free CONTOUR®DIABETES app Contact your local Ascensia Diabetes Care Representative or call 1890 920 111 to order your FREE meters today www.diabetes.ascensia.ie *The smartLIGHT® offers easier understanding of blood glucose readings.1 The app facilitates a more active involvement in diabetes self-management.4,5. The 60 seconds countdown (to add more blood) makes it easier to know when the strip doesn’t have enough blood.2 References: 1. Smartson online survey, Sweden 2017. 352 respondents: People with type 1 and type 2 diabetes, over 18 years old, who tested at least 4–7 times a day. Participants received free meter and tests strips. Survey funded by Ascensia Diabetes Care. 2. Data on File. N=326. Ascensia Diabetes Care. CNext/CTV3 Study. Protocol no. GCA-PRO-2018-006-01. 3. Market Research. Ascensia Diabetes Care, Hall & Partners online market research, conducted April/May 2015. 4. Stuhr A and Pardo S. Impact of Real‐World Use of the CONTOUR®DIABETES App on Glycemic Control and Testing Frequency. Poster presented at the Diabetes Technology Meeting (DTM). November 8‐10 2018, North Bethesda, Maryland, USA. 5. Pardo S et al. Changes in Blood Glucose Excursions After at Least 180 Days Real-world Use of a New Smartphone Application for Blood Glucose Monitoring. Poster presented at the 12th International Conference on Advanced Technologies & Treatments For Diabetes (ATTD); February 20–23, 2019; Berlin, Germany. © 2021 Ascensia Diabetes Care. All rights reserved. Ascensia, the Ascensia Diabetes Care logo, Contour, Smartlight and Second-Chance are trademarks and/or registered trademarks of Ascensia Diabetes Care. Apple and the Apple logo are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc. Google Play and the Google Play logo are trademarks of Google LLC. All other trademarks are properties of their respective owners and are used solely for informative purposes. No relationship or endorsement should be inferred or implied. Date of preparation: July 2021. Code: G.DC.07.2019.PP-CN-Mtr-GBL-0016 IECNEXT_HCPAD_0721

Category Focus: Cough, Cold & Flu

From the flu vaccine to OTC remedies to prescription antibiotics, winter is a good time to drive home the message that the local pharmacy is a one-stop-shop for all those seasonal ailments. Effective Planning The changing season brings opportunities to reorganise your store, to rearrange fixtures and fittings and to develop a clear merchandising plan featuring beacon brands in both the P and GSL sections. Planograms are helpful guides that can be used to assist with arranging retail shelves to help maximise frontend sales. These visual plans, that are backed by research, show exactly where in the store certain products should be placed and they indicate the products that will increase profits and move quickly. Store plans also show how products should be arranged based on the general categories and subcategories with the most profitable products typically going onto the shelf at eye level, known as the ‘cone of vision’. Products that shoppers seek out no matter where they are, called destination items, can go on shelves outside of the cone of vision. Have a look at the shelves that are devoted to winter remedies, both on the shop floor and on the medicines counter, and ask yourself the following questions: • Is it clear to customers and staff which products are suitable for children and which are for adults only? • Are your staff up-to-date and clear on the risk of analgesic overdose due to combination products? • Are staff aware of the sales restrictions for certain decongestants? • How could you make this fixture easier to understand and navigate? • Are all staff clear on the symptoms that should ring an alarm bell if mentioned by a patient with a cough, cold or flu? • Are details about your flu vaccination service clearly displayed? Market Fluctuations At the start of this year, we reported that sales of cold and flu

products at Irish pharmacies fell by as much as 80% in 2020 as a direct consequence of the pandemic.

Cold vs Flu

The sharp decline in sales reflects the reduction in circulation of the usual cold and flu viruses following improved hand hygiene and cough etiquette measures in response to Covid-19. Jack Shanahan of Haven Pharmacy Shanahan's, Castleisland has described the collapse of the cold and flu market as extraordinary. The Kerry based pharmacist said in a remarkable development that sales of such products at his pharmacy have declined by about 80 to 90 per cent since the pandemic began, while colleagues at other pharmacies had also reported similar reductions. “The cough and cold remedy as a category has collapsed, literally collapsed. There are no coughs and colds going round now other than Covid coughs and cold. “We would have been selling hundreds of cold and flu remedies over the winter season usually and they’re down to tens now. Sore throat sprays, cough bottles and cold and flu remedies have all gone down to maybe 10 to 20 per cent of what they normally would be.” “Colleagues are actually looking at the dates on cold and flu remedy stock wondering will they have it sold before they go out of date, which they would have never done. It’s an extraordinary situation.” Intercontinental Medical Statistics (IMS) Industry data reveals a seasonal drop in pharmacy sales in 2020 of 62 per cent for the cold and flu category compared to 2019. The data is based on IMS “buy in” figures only, which are purchases by pharmacies. Secretary General of the Irish Pharmacy Union (IPU) Darragh O’Loughlin said the fall-off was to be expected, given the fact that influenza was not that widely in circulation. “GP consultations for respiratory symptoms for the 2020/2021 season to date are reflecting Covid-19 activity, rather than influenza. That is probably as a result of the lack of international travellers to bring flu into the country along with people’s handwashing, respiratory etiquette,

40 | PHARMACYNEWSIRELAND.COM

Symptoms

Seasonal flu

Cold

Fever

High fever lasts 3-4 days

Rare

Headache

Prominent

Rare

General Aches, Pains

Usual; often severe

Slight

Fatigue, Weakness

Can last up to 2-3 weeks

Quite mild

Extreme Exhaustion

Early and prominent

Never

Stuffy Nose

Sometimes

Common

Sneezing

Sometimes

Usual

Sore Throat

Sometimes

Common

Chest Discomfort, Common; can Cough become severe mask wearing and physical distancing, which has all combined to help prevent the spread of flu and cold viruses.” According to Shanahan, the reduction in sales has been compensated “slightly” by the increase in purchases of vitamins and minerals, which customers are sourcing as part of Covid-19 prevention measures.

Mild to moderate; hacking cough

“There is a huge uptick in Vitamin C and Vitamin D for example. I won’t say they are balancing each other out completely though, as it depends on everyone’s own business model. Sales of Vitamin D at his pharmacy have at least doubled in recent months due to emerging indications it may have a role in boosting immunity, he said.

At-risk patients include: • Persons aged 65 years and older; • Persons 10-64 with a chronic illness requiring regular follow up, e.g. chronic respiratory disease (including chronic obstructive pulmonary disease, cystic fibrosis, moderate or severe asthma and bronchopulmonary dysplasia), chronic heart disease (including acute coronary syndrome), chronic renal disease, diabetes mellitus, haemoglobinopathies, chronic liver disease, chronic neurological disease (including multiple sclerosis, hereditary and degenerative disorders of the central nervous system); • Those who are immunosuppressed due to disease or treatment including those with missing or non-functioning spleens; • All cancer patients; • Patients with any condition that can compromise respiratory function, e.g. spinal cord injury, seizure disorder or other neuromuscular disorder; • Persons with Down syndrome; • Those with morbid obesity, i.e. body mass index over 40; • all pregnant women (vaccine can be given at any stage of pregnancy); • Healthcare workers; • Household contacts of at-risk persons; • Out-of-home care givers to at-risk persons • Residents of nursing homes and other long-stay institutions; • Carers; and • People with regular contact with pigs, poultry or water fowl.

Abbey House, Main St, Clone, Co. Meath | www.brmarketing.ie

Category Focus: VMS

Upsurges in Vitamins, Minerals & Supplements The Vitamins, Minerals and Supplements (VMS) has always been an important category in pharmacy in Ireland. There has been an upsurge in the past few years as people have become more aware of nutrition and what they can take to help aid their bodies to operate to their full capacity. People have begun to learn and understand that VMS are important at any stage of life from birth right up to the elderly. Written by Fathimah Kara, Pharmacist, Reidy’s Pharmacy Rathcoole

The biggest challenges for pharmacy teams were keeping up to date with the ever-changing health advice that was constantly changing on an almost weekly basis. There was always some new article or study that came out and it was important to decipher how accurate and reliable these sources were. Over the past year with the incidence of the Covid-19 pandemic there has been a significant increase in the incidence and demand for the VMS category when compared to previous years. Initially with the outbreak of the pandemic, there was a surge in demand for Vitamin C and Zinc and other products that could aid and strengthen the immune system to help fight off any possible infection. As the year progressed and more information and research about the Coronavirus emerged, there was a significant increase in the requests for Vitamin D. Multivitamins Boost Since then, there has been lots of engagement with the public who are eager to know more about the role of not only Vitamin D but also general multivitamins in helping keep the body functioning at its full potential to help as much as possible with the constant threat of the virus. In addition to this, there was an upsurge in demand in requests for joint care supplements, particularly in the elderly population. With an increase in advertising for such supplements and the mention of turmeric and its anti-inflammatory properties, sales for these items increased as well.

At the very least, the taking of a good multivitamin was greatly encouraged and welcomed by customers for all ages and members of the family. Another big challenge was keeping up with the supply demand, initially at the very start of the pandemic, Vitamin C and Zinc supplements began to go on short supply from the wholesalers as manufacturers were overwhelmed by the demand. However, this issue has been resolved but pharmacy teams had not encountered the likes of this ever before. Link Sales Opportunities The biggest opportunities have been link sales for example if an antibiotic was prescribed then there was an opportunity for discussion for probiotics and their role in protecting gut flora or if the person was interested in a multivitamin or tonic to help build them back up. People were willing to talk and engage with staff members with regards to VMS and how the role they can play in helping to support normal bodily functions and to prevent the incidence of certain conditions for example Lysine for those susceptible to cold sores. The value of the VMS category for our pharmacy has increased significantly since 2020, we

42 | PHARMACYNEWSIRELAND.COM

are constantly seeking more information on new products to ensure that the category in the pharmacy is ever evolving and constantly up to date to offer the best range of choice for customers. We would also make sure to have a wide range to product types from oral liquids, tablets, drops, sprays and effervescent tablets as we discovered that customer preference is important to consider to aid compliance and sustained usage for maximum benefit for the customer. The more informed a person is through discussion with a pharmacy staff member and the more opportunity they have to ask questions and gather as much information as possible, the more confident they were at selecting a product most beneficial to them and their needs. Merchandising Tips The most important thing we take into consideration when merchandising this area in the pharmacy to achieve optimum footfall would be to rotate our displays to reflect the current situation. For example, all the Vitamin D products are always at eye level and then when schools began to reopen, all the multi vitamin and mineral products were

made more visible. Special offers were highlighted in store, e.g. if an item was at a special price or included a free item with purchase these were very eye catching for consumers. I would recommend to my pharmacy team to be aware of any changes in the current climate and health advice and to know all the relevant information on the products that were being recommended and advertised. For example, we made sure all our knowledge on Vitamin D was up to date and what doses and what formulations were available so we could accurately make personal recommendations to customers. Our training of pharmacy staff would generally consist of going through the shelves with staff members and asking questions to ensure their knowledge is accurate and up to date. This role play between staff has been quite beneficial. We also encourage each other that if we see a product being advertised or have seen health advise published to make us all aware and I would generally do the research and print off all the information so we can all learn about the products to ensure the knowledge we provide is of an extremely high standard.

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Category Focus: Men's Health

Men Putting Off Seeking Advice Men’s Health Week took place recently, on 14th June and during that time, LloydsPharmacy and PJ Gallagher called on men around Ireland to make their health a priority and visit a health professional as soon as they have a concern. Denis O’Driscoll, Superintendent Pharmacist at LloydsPharmacy with comedian PJ Gallagher

launched a Men’s Oral Health Postcard on Men’s Health Week (MHW) to encourage and empower men to ‘choose the right tools’ for their teeth and good oral health. The pandemic has shone a light on ‘Lifestyle Medicine’ and the importance of diet, sleep, physical activity, avoiding risky substances and maintaining positive social connections. This postcard is a reminder of the importance of also maintaining good oral health, which is not just about the absence of disease such as tooth decay or gum disease. Part of the overall mission of the Dental Health Foundation is to educate people about their oral health and all person health, and they ensure that their advice is underpinned by science.

Research conducted by iReach on behalf of LloydsPharmacy shows that 42% of men surveyed have put off seeking advice on health concerns and 41% of those men have done so out of fear of finding out what’s wrong, compared to just 27% of women. As early intervention is crucial with health concerns, LloydsPharmacy want to encourage men to prioritise visiting their local pharmacist or GP when health concerns arise. Despite listing weight, stress, blood pressure and depression as key health issues, almost half of men surveyed say they are not likely to reach out to their GP or health professional if they have a health concern. Research by Men’s Health Forum Ireland shows men die, on average, up to four years younger than women, and have higher death rates than women for most of the leading causes of death.1 The main causes of death for men in Ireland are cardiovascular diseases, cancers, and respiratory illnesses2 however up to 80% of all heart disease is preventable through lifestyle changes and adjusting the risk factors associated with heart disease.3

45% of men who have put off seeking advice on health concerns have done so because of cost, the LloydsPharmacy Men’s Health Check Service is a free service available in all 90 pharmacies nationwide. The service is available for those with concerns in heart disease, erectile dysfunction (ED), diabetes, asthma, smoking cessation, sexual health, hair loss and skin conditions. All 89 pharmacies nationwide have a private care room where patients can have a one to one consultation with the Pharmacist about any of these issues or get a free blood pressure or BMI check. High blood pressure is a major risk factor for heart disease and regular monitoring with free checks in a local LloydsPharmacy store can help detect any problems early. The European Association of Urology state there is a high incidence of erectile dysfunction worldwide with one study reporting 52% of men aged 40-70 have experienced erectile dysfunction and another showed one in four had never heard of any of the seven most common treatments for ED.4 Viagra Connect is now sold over the counter in all

44 | PHARMACYNEWSIRELAND.COM

LloydsPharmacy stores without a prescription. Denis O’Driscoll, Superintendent Pharmacist at LloydsPharmacy, said, “When it comes to healthcare, seeking advice from a health professional early on is crucial and for some health issues delaying engaging with health services can leave them untreatable. That’s why this Men’s Health Week LloydsPharmacy want to encourage men around Ireland to make their health a priority and not to delay visiting their GP or local pharmacist. The Men’s Health Check service in LloydsPharmacy stores around Ireland is a private and free service that can help those with concerns around heart disease, erectile dysfunction, diabetes, smoking cessation, mental health, sexual health, hair loss and skin conditions. Free blood pressure and BMI checks are also available as part of the service so we would encourage anyone with concerns in these areas to drop into their local LloydsPharmacy now to talk to a pharmacist.” Meanwhile, the Dental Health Foundation of Ireland has just

Over half of Irish people aged between 65 and 74 have never used the internet. Men who took part in 'Sheds for Life' (the Dental Health Foundation is a partner organisation in this programme) increased their confidence in getting online and staying connected with family and friends online. This new postcard is available for free in both hardcopy and a downloadable electronic copy from www.dentalhealth.ie References [1] Men’s Health in Numbers https://www.mhfi.org/

[2] Analysis of Underlying Cause of Death Data (2020) https://www. cso.ie/en/releasesandpublications/ fr/fr-ucd2020/analysisofunderlying causeofdeathdataincludingcovid19januarytooctober2020/ [3] Croi Heart Conditions https:// croi.ie/health/heart-conditions/ heart-attack/ [4] European Association of Urology- Male Sexual Dysfunction https://uroweb.org/guideline/malesexual-dysfunction/#3

Managing the VMS Categ

Multivitamins play a fundamental role in

the rapidly growing Vitamins, Minerals and Supplements (VMS) category. It has long been the most valuable sub-category, accounting for 33% of all sales, and in the past year it has demonstrated strong growth attracting new shoppers and growing sales over +9%2. For many people multivitamins are the entry point to the category. This, alongside the fact it is the sub-category driving the largest value growth, means it is essential for pharmacies looking to make the most of the VMS category to get multivitamins right in store.

STOCK THE RIGHT RANGE Designed for people looking to enhance their daily wellbeing, multivitamins are loaded with a range of key nutrients to cover all the bases and support overall health. Whilst diet should always be the first choice to get your nutrients, in today’s world a healthy diet is not always easy to achieve, and in that circumstance a multivitamin can help bridge the gap between poor nutrition and optimal health. Stocking the right range means it is important to recognise that not all multivitamins are the same. There are those more suited to males or females,

older adults or children, varying potencies, and choices between tablets and capsules. Pharmacies should be sure to offer key packs in a range of count sizes, formats and potencies to cater for the broad range of people within their community who now buy into the category.

OFFER PREMIUM PRODUCTS Research shows that 58% of VMS buyers prioritise quality3. Brands with proven scientific credentials, like Solgar®, provide shoppers with confidence in the quality of their purchases. Pharmacies can support their customers in finding the best products for their needs by offering a range of more premium quality products, thus providing the opportunity for customers to trade up.

CREATE EFFECTIVE DISPLAYS Clear category merchandising, signposting and point-of-sale materials will ensure pharmacies maximise the multivitamins opportunity. Group similar products together and double-face key sellers to help them to standout on-shelf. An excellent way to increase basket spend is to crosssell with other complementary daily wellbeing products such as fish oils.

ory: Multivitamins

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Solgar® VM2000

• An award-winning, best-selling multivitamin and the next step up from VM75. • Twice-a-day, high potency formula, containing 32 key vitamins, minerals and amino acids. • Includes iron in biglycinate form, which has been shown to be gentle on the stomach. • High doses of B vitamins to support everyday energy levels. • Rich in antioxidants (such as vitamins A, C & E) helping to protect against free radicals. Ideal for anyone feeling run down or lacking in energy.

Solgar® Male Multiple

• A premium-quality, advanced formula with 26 nutrients specifically formulated to provide nutritional support for men’s busy lifestyles. • Includes phytochemicals, vitamins B6, B12, niacin and pantothenic acid, to reduce tiredness and fatigue. • Packed with a wide range of critical minerals. Minerals are larger in size and therefore create larger tablets resulting in a three-a-day product. • Provides cardiovascular and prostate support.

Solgar® Female Multiple

• A unique formula containing 27 nutrients, specially formulated to support the daily well-being of premenopausal women. • Includes high potency B vitamins to support against stress, antioxidants, such as vitamins C & E, zinc and selenium, to help fight free radicals and B12, iron and folic acid to support healthy blood production and flow. The iron comes in bisglycinate form for maximum absorption without irritating the intestines. • Added calcium, magnesium, vitamin K and boron help promote healthy bones.

Solgar® Omnium®

• The ultimate multivitamin for modern life. • Omnium® is a premium award-winning, multivitamin, containing the ultimate combination of advanced nutrients in a convenient twice-a-day dose. • With more than 47 ingredients; it is a unique blend of plant compounds, antioxidants, and specialty nutrients in addition to vitamins and minerals. • A great choice for corporate athletes who may struggle to lead a balanced healthy lifestyle.

Solgar® Formula VM-Prime for Adults 50 Plus

• A unique formula designed to provide nutritional support for adults over 50. • This stage in adult life may be characterized by a significant change to stature and bodyweight, loss of skeletal and muscle tissue and in change to nutritional intake and needs. VM-Prime has been formulated to support these key areas of health and encourage optimal wellbeing. • The two-a-day dosage allows for a smaller, easier to swallow tablet.

Solgar® Formula VM-Prime for Women

• An advanced multivitamin containing 27 key active ingredients designed to provide nutrient levels that meet or exceed nutritional requirements for women over the age of 50 such as vitamin B-12, Manganese, Zinc, Selenium and Chromium. • Designed to support menopausal and post-menopausal women and their specific needs.

ABOUT SOLGAR® An award-winning range of over 350 nutritional supplements. Solgar® has over 70 years of commitment to quality, health & wellness and remains at the forefront of nutritional science. We are proud to say that 98% of Solgar® consumers would recommend our brand.*

For more details on opening an account or to place an order, please call 0044 1442 821 419, email enquiries4@solgar.com *Global Praxis online shopper survey 2017 of 3,882 VMS consumers. 1 Kantar 52 wks to Feb 21 & Kantar 52 wks to April 21. 2 Kantar 52 wks to April 21. 3 Survey of 1000 VMS users in the UK in Dec 2020. Food supplements should not be used instead of a varied balanced diet and a healthy lifestyle. Solgar® is a registered trademark. For business use only.

Category Focus: Hayfever

The Impact of Hayfever in Pharmacy It has been reported that one-in-five Irish people suffer from an allergy to pollen and LloydsPharmacy research shows that a third (33%) of adults have experienced hay fever symptoms in the last 12 months, with people’s everyday lives being impacted quite substantially as a result. Of those experiencing symptoms, 39% said that their sleep has been impacted and 56% are spending less time outside as a result of their symptoms. Written by Denis O’Driscoll, Superintendent Pharmacist, LloydsPharmacy

significant role in the management of hayfever and throughout the season are advising customers on the right regime for each individual customer. Such as knowing when to recommend a nasal spray and/ or eye drops alongside oral medication and our colleagues being able to give customers additional advice such as wearing sunglasses to give eyes extra protection, using nasal rinses to clear pollen out of sinuses etc.

A further survey carried out by the Asthma Society of Ireland and ALK has revealed that 30% of those suffering from hayfever in Ireland have never spoken to a healthcare professional about how to relieve symptoms. Pollen season typically runs from April to September and some people across Ireland can experience hayfever as the pollen levels increase. The start of the season is influenced by where you live in the country, with the north having a later start and a much shorter season, while urban areas will have a lower pollen count than the countryside. Pollen counts this year have been up compared to last year and this has driven sales. We are seeing more customers in stores experiencing hayfever symptoms and the category is experiencing double digit growth as a result. New entrants into the market such as Telfast and Fusion Allergy have also potentially brought new customers into the category. Fusion allergy is a drug free range of Eye Drops, Lozenges, and Nasal Sprays for patients. Telfast was a POM to P switch meaning that patients would have previously needed a script to buy it. Its claim is that it provides 24hour allergy relief and is also non drowsy. These brands are bringing incremental sales to the category

without canablising other brands. They also allowed us to drive a strong allergy message this year – all LloydsPharmacy stores now have a more complete range to meet customer needs. The biggest challenge this year for our pharmacy teams during hayfever season is the pandemic, as symptoms of hayfever and Covid-19 are similar. Therefore, it has been more important than ever to manage hayfever symptoms correctly. LloydsPharmacy research shows some of the most common hayfever symptoms range from sneezing (76%), runny or blocked nose (72%) and itchy, red and/or watery eyes (71%). While there is currently no cure for hayfever, most people can relieve their symptoms with treatment, with many finding an improvement as they get older. It is also important to be able to discuss the right product for the patient when they come in for a consultation. The key to treating hayfever is finding the treatment that works for the patient – there is no magic bullet as each person needs to be holistically treated and advised of all the various products can may help. Our teams give advice that is personal to customers’ symptoms, medical history and lifestyle. Pharmacists and their teams are highly trained health professionals and can play a

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GSL Allergy Gondola displays are working well to disrupt customers on their journey through the store. Using education lead POS has meant customers can self-select off the GSL ends and this is contributing to growth in the category. During hayfever season we advise our pharmacy teams to merchandise GSL/ Med Device SKUs front of counter. Along with having their behind counter planograms in place so high volume P Only SKUs such as Telfast and Cetrine are in easy

reach of colleagues and visible to customers. LloydsPharmacy research found that 1 in 5 of those that have had hayfever symptoms in the past 12 months do not use products or take medication to help relieve their hayfever symptoms. With 20% of people still not treating symptoms its clear there is still massive growth potential in this category. When it comes to deciding on which products to buy, previous experience when using a product (48%) and the advice of the pharmacist (40%) are deemed to be most important according to our research. Notes LloydsPharmacy research was conducted by Empathy Research on behalf of LloydsPharmacy. Research was conducted through an online survey across a nationally representative sample of N=1,000 adults aged 18+. Quotas were placed on gender, age, social class and region with weighting applied to ensure final data was representative of these quotas.

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1. HTC Survey of 144 participants, January 2021 IE-AV-2100044

Category Focus: Skincare

Surges in Growth for Specialist Skincare Irish Pharmacy News spoke to Avril Farrell, Healthcare Buying Manager with Boots Ireland about the emergence of the specialist skincare market and where the sector lies within the OTC landscape. Avril Farrell, Healthcare Buying Manager with Boots Ireland

Market Performance At Boots Ireland, specialist skincare has always been an important part of our OTC offering in pharmacies, commanding a significant share of business and growing consistently, annually. Avril explains further, “Whilst specialist skincare is considered core business, it has become a category of increased interest and particularly during Covid-19. “All sub categories within specialist skincare have experienced a surge in growth. Our customers trust Boots as they continue to seek out the latest condition specific and efficacious cleansers, moisturisers and balms, to aid relief and treat topical conditions such as; rosacea, psoriasis, acne and eczema. “Whilst the level of product innovation to category over the past 12 months has been

slower than we would like, we understand this is largely due to the pandemic and for some suppliers, BREXIT related. In order to drive performance, we have ensured that our range on offer is comprehensive, inclusive and of the upmost standard with regards quality and manufacturing processes. “Our team is confident when it comes to specialist skincare advice and finding the right solution for our customers, no matter what the condition is, championing everyone’s right to feel good!” So why does Avril think these surges have come about? “The level of interest driving the value and volume surge within our specialist skincare category can be attributed, for the majority, to heightened hygiene behaviours due to Covid-19,” she reflects.

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Created and developed by LEO Pharma. This is a promotional advertisement for UK/IE healthcare professionals only.

Learn more at DERMAWorld

Active f lare management and maintenance treatment of adult plaque psoriasis1 Enstilar® is indicated for the topical treatment of psoriasis vulgaris in adults.1

treatment during the active flare…1-4

Prescribing Information for Enstilar® (calcipotriol/betamethasone) 50 micrograms/g + 0.5 mg/g cutaneous foam Please refer to the full Summary of Product Characteristics (SmPC) (www.medicines.org.uk/emc or www.medicines.ie) before prescribing. Indication: Topical treatment of psoriasis vulgaris in adults. Active ingredients: 50 µg/g calcipotriol (as monohydrate) and 0.5 mg/g betamethasone (as dipropionate). Dosage and administration: Flare treatment: Apply by spraying onto affected area once daily. Recommended treatment period is 4 weeks. If it is necessary to continue or restart treatment after this period, treatment should be continued after medical review and under regular supervision. Longterm maintenance treatment: Patients who have responded at 4 weeks’ treatment using Enstilar once daily are suitable for long-term maintenance treatment. Enstilar should be applied twice weekly on two non-consecutive days to areas previously affected by psoriasis vulgaris. Between applications there should be 2-3 days without Enstilar treatment. If signs of a relapse occur, flare treatment, as described above, should be re-initiated. Maximum dose: The daily maximum dose of Enstilar should not exceed 15 g, i.e. one 60 g can should last for at least 4 days of treatment. 15 g corresponds to the amount administered from the can if the actuator is fully depressed for approximately one minute. A two-second application delivers approximately 0.5 g. As a guide, 0.5 g of foam should cover an area of skin roughly corresponding to the surface area of an adult hand. If using other calcipotriol-containing medical products in addition to Enstilar, the total dose of all calcipotriol-containing products should not exceed 15 g per day. Total body surface area treated should not exceed 30%. Safety and efficacy in patients with severe renal insufficiency or severe hepatic disorders have not been evaluated. Safety and efficacy in children below 18 years have not been established. Shake the can for a few seconds before use. Apply by spraying, holding the can at least 3 cm from the skin, in any orientation except horizontally. Spray directly onto each affected skin area and rub in gently. If used on the scalp, spray into the palm of the hand then apply to affected scalp areas with the fingertips. See hair washing instructions in the package leaflet. Wash hands after use (unless Enstilar is used to treat the hands) to avoid accidentally spreading to other parts of the body as well as unintended drug absorption on the hands. Avoid application under occlusive dressings since systemic absorption of corticosteroids increases. It is recommended not to take a shower or bath immediately after application. Let the foam remain on the scalp and/or skin during the night or during the day. Contraindications: Hypersensitivity to the active substances or any of the excipients. Erythrodermic and pustular psoriasis. Patients with known disorders of calcium metabolism. Viral (e.g. herpes or varicella) skin lesions, fungal or bacterial skin infections, parasitic infections, skin manifestations in relation to tuberculosis, perioral dermatitis, atrophic skin, striae atrophicae, fragility of skin veins, ichthyosis, acne vulgaris,

maintenance treatment for long-term control1,5

acne rosacea, rosacea, ulcers and wounds. Precautions and warnings: Adverse reactions found in connection with systemic corticosteroid treatment, e.g. adrenocortical suppression or impaired glycaemic control of diabetes mellitus, may occur also during topical corticosteroid treatment due to systemic absorption. Application under occlusive dressings should be avoided since it increases the systemic absorption of corticosteroids. Application on large areas of damaged skin, or on mucous membranes or in skin folds should be avoided since it increases the systemic absorption of corticosteroids. Visual disturbance may be reported with systemic and topical corticosteroid use. If a patient presents with symptoms such as blurred vision or other visual disturbances, the patient should be considered for a referral to an ophthalmologist for evaluation of possible causes which may include cataract, glaucoma or rare diseases such as central serous chorioretinopathy (CSCR) which have been reported after use of systemic and topical corticosteroids. Due to the content of calcipotriol, hypercalcaemia may occur. Serum calcium is normalised when treatment is discontinued. The risk of hypercalcaemia is minimal when the maximum daily dose of Enstilar (15 g) is not exceeded. Enstilar contains a potent group III-steroid and concurrent treatment with other steroids on the same treatment area must be avoided. The skin on the face and genitals is very sensitive to corticosteroids. Enstilar should not be used in these areas. Instruct the patient in the correct use of the product to avoid application and accidental transfer to the face, mouth and eyes. Wash hands after each application to avoid accidental transfer to these areas as well as unintended drug absorption on the hands. If lesions become secondarily infected, they should be treated with antimicrobiological therapy. However, if infection worsens, treatment with corticosteroids should be discontinued. When treating psoriasis with topical corticosteroids, there may be a risk of rebound effects when discontinuing treatment. Medical supervision should therefore continue in the post-treatment period. Long-term use of corticosteroids may increase the risk of local and systemic adverse reactions. Treatment should be discontinued in case of adverse reactions related to longterm use of corticosteroid. There is no experience with the use of Enstilar in guttate psoriasis. Enstilar contains butylhydroxytoluene (E321), which may cause local skin reactions (e.g. contact dermatitis), or irritation to the eyes and mucous membranes. Pregnancy and lactation: There are no adequate data from the use of Enstilar in pregnant women. Enstilar should only be used during pregnancy when the potential benefit justifies the potential risk. Caution should be exercised when prescribing Enstilar to women who breast-feed. The patient should be instructed not to use Enstilar on the breast when breastfeeding. Side effects: There are no common adverse reactions based on the clinical studies. The most frequently reported adverse reactions are application site reactions. Uncommon (≥1/1,000 to <1/100): Folliculitis, hypersensitivity, hypercalcaemia, skin hypopigmentation, rebound effect,

application site pruritus, application site irritation, application site pain (including application site burning). Not known (cannot be estimated from available data): Blurred vision, hair colour changes. Calcipotriol: Adverse reactions include application site reactions, pruritus, skin irritation, burning and stinging sensation, dry skin, erythema, rash, dermatitis, psoriasis aggravated, photosensitivity and hypersensitivity reactions, including very rare cases of angioedema and facial oedema. Systemic effects after topical use may appear very rarely causing hypercalcaemia or hypercalciuria. Betamethasone: Local reactions can occur after topical use, especially during prolonged application, including skin atrophy, telangiectasia, striae, folliculitis, hypertrichosis, perioral dermatitis, allergic contact dermatitis, depigmentation and colloid milia. When treating psoriasis with topical corticosteroids, there may be a risk of generalised pustular psoriasis. Systemic reactions due to topical use of corticosteroids are rare in adults; however, they can be severe. Adrenocortical suppression, cataract, infections, impaired glycaemic control of diabetes mellitus, and increase of intra-ocular pressure can occur, especially after longterm treatment. Systemic reactions occur more frequently when applied under occlusion (plastic, skin folds), when applied onto large skin areas, and during long-term treatment. Precautions for storage: Do not store above 30°C. Extremely flammable aerosol. Pressurised container. May burst if heated. Protect from sunlight. Do not expose to temperatures exceeding 50°C. Do not pierce or burn, even after use. Do not spray on an open flame or other ignition source. Keep away from sparks/open flames. No smoking. Legal category: POM. Marketing authorisation number and holder: PL 05293/0008 (UK), PA 1025/5/1 (Ireland). LEO Pharma A/S, Ballerup, Denmark. Basic NHS price (UK): £39.68/60 g, £79.36/2 x 60 g. Last revised: March 2021. Reporting of Suspected Adverse Reactions Adverse events should be reported. For the United Kingdom, reporting forms and information can be found at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. Adverse events should also be reported to Drug Safety at LEO Pharma by calling +44 (0)1844 347333 or e-mail: medical-info.uk@leo-pharma.com For the Republic of Ireland, reporting forms and information can be obtained from: HPRA Pharmacovigilance, Earlsfort Terrace, 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 Drug Safety at LEO Pharma by calling +353 1 4908924 or e-mail: medical-info.ie@leo-pharma.com

References: 1. Enstilar® SPC, UK www.medicines.org.uk / IE www.medicines.ie. Last accessed: April 2021. 2. Leonardi C et al. J Drugs Dermatol 2015;14(12):1468–1477. 3. Koo J et al. J Dermatolog Treat 2016;27(2):120–127. 4. King C and Lowson D. Poster 237 presented at the 5th Psoriasis International Network Annual Meeting, Paris, France, 5–7 July 2016. 5. Lebwohl M et al. J Am Acad Dermatol 2020;doi: https://doi.org/10.1016/j.jaad.2020.09.037. Further information can be found in the Summary of Product Characteristics or from: LEO Pharma, Horizon, Honey Lane, Hurley, Berkshire SL6 6RJ, UK. E-mail: medical-info.uk@leo-pharma.com LEO Pharma, Cashel Road, Dublin 12, Ireland. E-mail: medical-info.ie@leo-pharma.com ® Registered trademark

Date of preparation: April 2021 UK/IE MAT-43625 V2

Top 100 OTC Products

“For example, the demand for hand sanitizers, body/ hand wash and products produced with infection control in mind. A more intense and frequent hand washing/ sanitising regime could have had an irritating and drying effect on skin, hence customer’s need for other products to address these issues, such as hand creams and balms. In addition, the use of mandatory face coverings drove new behaviours with customers opting to leave their skin bare i.e. free from make-up/ tanning product, in favour of focusing on their skin care, hence investing in new products benefiting their overall skin health.

qualified healthcare professionals with regards to clinical advice and over-the-counter medicine for a variety of skin conditions. Due to Covid-19, restrictions, as we know, did initially impact footfall market wide. This, coupled with social distancing measures implemented in stores to safeguard our colleagues and customers, brought with it new challenges with regards to looking after our customers and being physically close enough to effectively assess the area of concern. In order to overcome such issues, we leveraged our experience and ensured we could offer an unrivalled service through the quality of our conversations.

“Covid-19 restrictions and lockdowns rendered customers having to spend more time at home, which led to increased engagement online. This in turn prompted in-depth research into skin conditions for which customers may previously have ignored prior or simply being time poor due to long work commutes/ family commitments etc.

“In addition, our trained healthcare advisors are readily accessible in store and can offer assistance by recommending product to aid relief on mild to moderate conditions.

“Customers were also more willing to trial NPD aimed at treating sensitive skin conditions without concern of any potential side effects to treatments playing out in public life. In addition, the pandemic, understandably, contributed to increased levels of stress amongst most of the population, which may have contributed to triggering flare ups of acne and other common skin conditions. “Nonetheless, regardless of the condition, we found our customers quickly identified and embraced their skin care regimes as a way to relax and de-stress, absorbing the product and wellbeing benefits associated with a self-care routine.” Increasing Awareness When looking at the biggest challenges for healthcare teams in pharmacy stores who are advising on skincare conditions, Avril says awareness is key. “Customers are sometimes unaware that there are all sorts of skin conditions that a pharmacist can help with. Our awareness efforts focus on the role of our Pharmacists and the services they can offer to the community, being

“We know there is still a percentage of customers embarrassed to present their condition, who self-diagnose and as a result, sometimes select the wrong product type or formulation to best relieve or treat their condition. We actively engage with our customers through our various platforms to encourage those in need of advice to pop in and have a chat with us.” Avril also says there are opportunities to be had. “NPD and innovation within existing trusted brand portfolios is hugely important to our customers due to the complexities and specific requirements for individuals,” she comments.

fundamental when merchandising specialist skincare. Whilst the majority of customers that shop this are condition led and typically brand loyal, new customers to this area can often be overwhelmed by the extent of product on shelf and variance in formulations, therefore clear brand and product blocking is key. “In addition, an aesthetically pleasing build is more attractive and will drive a degree of impulse opportunity alone. Whilst the level of product innovation to category is slower than we would like, we have ensured that our Boots range and brands supplied by key partners are of the upmost quality with regards manufacturing processes. Trust is a huge factor with regards product selection, we always put our customers first by only listing safe, efficacious product supported by continuity of supply. “We manage our merchandising in house, providing our stores with detailed planograms to execute merchandising on builds in an aesthetically consistent manner. Space in retail pharmacy is always at a premium, therefore we ensure we compile a comprehensive range for our stores, with varied sized product & a mix of brands, customized to scale.

is performing and if we are over-indexed on existing space with a particular sub category or brand that might indeed warrant range rationalisation. “At Boots Ireland, we pride ourselves on colleague expertise. We have extensive training programmes where all our Healthcare advisors have access to the most up to date and relevant content, specific to a condition. Our team is extremely knowledgeable in areas such as atopic eczema, also known as atopic dermatitis, which is a common skin condition in Ireland often running in families. “Our Healthcare advisors are readily available in stores and equipped to have great conversations with regards treatment by way of emollients, they are also confident in understanding the customers’ needs and know when to refer customers to our pharmacists with regards additional options for treatment, such as nonprescription antihistamines and topical corticosteroids. “We also focus our training programmes to cover adult and teenage acne, which is extremely common. Our team is on hand to help all our customers feel good in their own skin.”

“We also leverage supplier insight and market data to ascertain what

“Customers are more informed and constantly seeking out the presence of quality, natural ingredients in formulations, all whilst being produced and packaged sustainably. At Boots, sustainability is high on the agenda for 2021 and ongoing. This can be challenging for manufacturers.” Category Merchandising Avril continues, “Breadth of range, ease of navigation and on shelf availability is

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Category Focus: Beauty

Premium Beauty - Navigating the impact of Covid-19 The Premium Beauty industry in Ireland has faced some very difficult challenges over the past 18 months. The first major change was the permanent closure of Debenhams doors, a department store that played an integral part in the Irish market as a destination for luxury cosmetics and fragrance brands. It saw the impact of travel restrictions removing accessibility to airports where premium beauty brands are a major segment of Duty-Free shopping. The temporary closure of all nonessential retail shops resulted in pharmacies being the only outlet where a customer could physically purchase their much-desired luxury beauty product. The Premium Experience The entire premium beauty industry is constructed around customer experience and excellent service. The customer is paying a premium, so they experience the one-to-one consultation from a Beauty Advisor before they purchase. Whether the customer is looking to purchase a new makeup, skincare or perfume, and whether it is for gifting purposes or a self-treat, the customer wants assistance and reassurance from the Beauty advisor that the product they are purchasing is right for them. This level of service involves the beauty advisor building a good relationship with the customer so they can expertly guide them on shopping the brand. This personalised shopping experience is part of the essence of premium beauty, and this is what Covid 19 pandemic completely removed from the entire industry. The importance of brand loyalty The customer was left with minimal options; to either rely on their previous brand experiences or to look at social media and browse various websites educating themselves on what they wanted to purchase. Well established premium brands really showed why they earned their place in the industry as their loyal shoppers knew exactly what they wanted and made sure they got it by whatever means necessary. Whether it was to purchase via a website or in a pharmacy, they

knew what they wanted and sought it out. Adapting to Change The pharmacy beauty halls however were operating in a very different non-personalised and uninviting environment due to strict Covid regulations. The premium counters & fragrance walls in pharmacies had all their testers removed, signage and point of sale showcasing latest launches and special offers all removed. The Counters were being serviced by generic and OTC staff only by request of a specific product from a customer as premium beauty products were deemed ‘non-essential’. The level of ‘essential’ would be contested however, by tremendously brand loyal customers who couldn’t live without their favourite Advanced Night Repair Eye Cream, Genefique Serum, Clarins Hand Cream or Coco Mademoiselle. Maintaining routines and self-care were some important elements to surviving lockdowns and even though there was no place to go socially, that did not deter our customers who regularly purchased more luxurious products as they continued to shop. Customers want premium products to give themselves some comfort or to gift a loved one who they believed needed some comfort. The premium beauty categories in turn became pillar categories for pharmacy as sales remained positive and consistent whilst keeping existing customers and recruiting new customers with a preference to shop in-store rather than online. Phased return to personalised services As we emerge from this lockdown our pharmacies are building on this positive performance by investing in our Beauty Advisors and fully equipping them to operate safely in the new phase of the pandemic. We have been empowering them with extensive education and training on new processes and brand plans to ensure we are confidently trading into the future and setting genuine targets.

Written by Roisin Murray, Premium Beauty Buyer, McCauley Health & Beauty Pharmacy

Testers and full counter displays are being re-introduced in phases, and we have yet to return to full services on counter concerning sit down consultations and full face make overs. Foundation colour matching and skin consultations are being carried out by providing customers with personalised samples to take home and try the product before purchasing the full-size version. Beauty advisors are working carefully maintaining relationships with their customers by engaging virtually through texts and emails informing them of any promotions and new product launches. This will continue to be the way of working for the next phase before the return to full services in the coming months all going to plan. It should be recognised that the past 18 months have been very challenging for Beauty Advisors, as makeovers and the customer interaction is their passion and motivation and this element was completely removed from their role. E-Retailing standards & the future Whilst the in-store experience remains to be the primary focus for our premium customers, E-commerce continues to be a very important part of the business with some customers fully converted to the convenience of online shopping. We have implemented click and collect hubs in some of our satellite pharmacies to offer more premium products to our more rural customers. E-Retailing premium brands also comes with the expectation of a more premium experience. Customers are expecting an extra special online shopping experience, from the moment they receive a personalised email enticing them to shop, to the moment they open their package when it arrives at their door.

This flawless delivery process is a lot easier said than done and every business is striving to continue to streamline and improve their customers online shopping journey. Substantial investment has been put in place to provide easy navigation of the website, creating brand boutiques for luxury brands, featuring new launches and promotions on web banners and building a simple checkout processes with options to use loyalty or discount codes. Their delivery should arrive within the expected timeframe, containing all items ordered and with very smart packaging that is ticking all the boxes - functional, sustainable, and exceptional presentation. The premium beauty customer expects no less than prestige. This is the motivation for all our operations as we continue to navigate the current climate. It is vital that pharmacies are maximising all available opportunities for growth by ensuring these premium standards are executed both in-store and online. We are doing so by strengthening our service strategies, empowering our beauty advisors, and harnessing all that the latest digital technology has to offer.

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Category Focus: Collagen

Bounce Back Collagen Skincare Collagen-based supplements have become a keystone in the management of the ageing process, with proven ability to repair skin damage, bestowing a youthful and healthy appearance sought in the pursuit of beauty. Of the five types of collagen, type I collagen is the most abundant. This makes sense since this type is found in the skin, the largest organ of the human body. In addition to providing strength and elasticity collagen also helps to replace dead skin cells. Collagen is sometimes added to products designed for direct application on the skin, like face creams. However, it’s most popular as an oral supplement. Oral collagen comes as a powder, tablet, or drink and is usually made from the skin and bones of animals or fish. These products will often contain other complementary ingredients such as vitamin C, which is vital for collagen production.

In recent years, collagen has become a must-have skincare ingredient. Collagen products are available as creams, serums, sheet masks, and even shampoos, but they’re also increasingly popular in the form of edible powders, supplements, and drinks. Collagen is an essential scaffold protein that gives smoothness and elasticity to skin, but its production declines with age. Finding ways to tackle this problem is now strongly promoted as an effective way to transform skin and hair, repairing age-related deterioration. A recent paper published in ‘Recent Advances in Skin Antiaging Treatment’ has emphasised Collagen’s relationship with health, appearance and beauty. “A growing number of scientific studies show exciting evidence that it is possible to rejuvenate ageing or damaged skin, improve function of worn joints, and support personal wellbeing and vitality,” said the paper authors. “In recent times, research on the mechanisms which impact the production of collagen in skin and the ideal organization into

functional fibres which give skin its characteristic elasticity and firmness has provided new insights into how this bio-scaffold can support cells, tissues and organs. The factors which influence collagen production over a lifetime (e.g., puberty, pregnancy, menopause, andropause), intrinsic factors (e.g., genetics, age, ethnicity) and extrinsic factors (e.g., UV-radiation, pollution, smoking) and the potential for new technologies, ingredients and devices to restore collagen and matrix components to their optimal condition are improving the ability to deliver anti-aging strategies with unprecedented results,” they added. The global collagen market demand was estimated at 920.1 kilotons in 2019. It is estimated to develop at a CAGR of 5.9% from 2020 to 2027. Increasing enduse applications such as growing usage in the food and beverage industry along with an upsurge in demand from the cosmetics industry are anticipated to drive the demand. What is Collagen? Collagen is a hard, insoluble,

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and fibrous protein that makes up one-third of the protein in the human body. In most collagens, the molecules are packed together to form long, thin fibrils. These act as supporting structures and anchor cells to each other. They give the skin strength and elasticity. Collagen is the main structural protein of the extracellular space in various connective tissues, including the dermis, the middle layer of skin that lies below the epidermis. The connective tissue of the dermis provides strength and elasticity to the skin through an extracellular matrix composed of collagen and elastin fibers, which are embedded in hyaluronan and proteoglycans. In fact, collagen is the most abundant protein in the human body, making up from 25% to 35% of the whole-body protein content. To date, 29 types of collagen have been described, however, over 90% of collagen throughout the body is of types 1 through 5, with type 1 being the most abundant. Below are the tissues and organs where collagen types 1 through 5 can be found.

Most oral collagen products will contain collagen derived from pigs (porcine), cows (bovine), or fish (marine). Once extracted from the skin and bones it is broken down into short chains called peptides in a process called hydrolisation. This makes it easier for the body to absorb and use the collagen. The type of collagen product that a consumer chooses will depend on their personal preferences. If they don’t eat meat, but do eat fish, for instance, marine collagen will be the best collagen supplement for them. Benefits of Collagen • Bone density • Bone mass and quality • Improved skin elasticity, thickness, and hydration • Nail health • Reducing wrinkle formation & cellulite appearance • Stimulating new blood vessel formation • Arthritis pain and sportsrelated joint pain • Muscle strength and gaining muscle mass • Wound healing

Category Focus: Facial Skin

Facial Skincare - A Virtual Reflection As we cautiously emerge from this global pandemic, we are still understanding how it has radically impacted many industries both negatively and positively. There is no question on the profound impact it has had on the entire beauty industry. For many of the large prestige houses, mainly Estee Lauder companies and L’Oréal Luxe it has been their skincare portfolios that have seen the most positive trends and helped alleviate major declines in other categories. With all forms of communication moving to zooms and skype, video linking with people’s faces on screens became the new normal way to interact with the world. The ritual of ‘getting ready for work’ changed as people were no longer leaving their houses. People embraced the opportunity of working in more casual clothes in the comfort of their own home. Similarly, the ritual of ‘making-up’ the face reformed. Those who wore full coverage foundation, concealer, bronzer, eyeliner, brow product, mascara and lipstick on a daily basis were finding it difficult to justify all this application when their rare contact with the outside world would now likely be a delivery driver. The ardent few continued to put their full face of make-up on for the camera, however the majority soon refined their routine to a more natural concealer and mascara quick fix-up that made them feel a little more presentable for work. Interestingly a recent poll indicated that more than 55% of women are now wearing less make up than they did pre-pandemic. There is no doubt that the immediate switch to the virtual world attributed to an increase in focus on the face. Constantly being able to see your own face on computer certainly makes people more conscious of their appearance. The virtual world highlighting every blemish, imperfection, and line. This recurring reflection combined with the closure of beauty salons and spas meant that those who loved to take good care of their skin with facials and treatments were desperate to try new skincare products to improve their complexion.

The power of social media With the restrictions to reaching beauticians for advice, social media took on the role as being the ultimate platform to educate on what brands to try out. One of the most successful brands of skincare over the past year is Cerave, an affordable American pharmacy brand that was born from the need to create appropriate products for atopic skin. (In Ireland 1 in 5 children and 1 in 10 adults suffer from extreme sensitive atopic skin conditions) Cerave was launched in Ireland in 2019 and was included in the ‘Irish times best beauty launches’ that year. It was performing very well considering its infancy in Europe, nevertheless its feature on Tiktok (the latest social media platform for creating, sharing, and discovering short videos) catapulted the brand into massive global success. A Tiktok influencer with 7m followers reviewed the Cerave products and tutored his viewers on why the brands salicylic acid ingredients are ideal for acne prone skin and why Cerave’s nonstripping hydrating cleanser is best for dry sensitive skin. Even though this ‘skinfluencer’ is not a qualified dermatologist, he has won trust and a loyal following from a massive Gen-Z audience. This sizeable audience caused a frenzy about the brand and soon it was flying off the shelves in pharmacies. Fortunately, there has been a steady supply distribution and the product remains accessible with fewer periods of out of stocks than would have been expected with such a surge in demand. Keeping it local There are many global brands appreciating positive sales spikes recently, however we all know how important it is to buy Irish now more than ever. The goal is to keep money circulating in the community and support Irish businesses and families. We are very fortunate here in Ireland that our desire to grow, manufacture and export quality

Written by Roisin Murray, Premium Beauty Buyer, McCauley Health & Beauty Pharmacy produce is not confined to one single industry. We boast some excellent skincare brands born from Irish people with passion who’ve decided to go for it, entrepreneurs working to the highest standard of innovative skincare creating products championed by experts globally. Pestle & Mortar’s hyaluronic acid, Kinvara’s Natural Skincare Cleansing oil, Green Angel’s Seaweed and Collagen Face cream and Codex Beauty’s Facial oil, to name some of the best products you can get when it comes to skincare and all created on our home soil. Not only are customers more conscious of the origin of what they buy, they are more conscious about what they are putting in their bodies and on their skin. There has been a significant shift in preference for more natural and organic products rather than cosmeceutical brands. In turn, many skincare brands have invested heavily in making their ingredients as ‘clean’ as possible whilst also reviewing their packaging to make it entirely sustainable. We are seeing more and more vegan friendly and eco-friendly products on our shelves as the demand for these brands is rising. External factors leading to growth External factors are also contributing to growth in skincare categories, for example when gyms are closed people are outdoors, running, walking, cycling, swimming all meaning more time exposed to UVA & UVB rays. As people are more aware and invested in their skin, they are purchasing more facial SPF to protect against sun damage which leads to pigmentation & ageing. Face Coverings is another example where people have had to purchase some correction skincare products as they suffered from either ‘Mascne’ acne from blocked

pores due to mask wearing or have suffered from very dry skin and dryness around the eyes. The total lockdown experience has also been very stressful on people who experience various changes to their skin because of stress. Psoriasis flare ups and dermatitis from intensified sanitising and washing. These have attributed the need for further skincare solutions to relieve these problems. Skin experts A very important part of the skincare offering in our pharmacies is our service. Our skilled staff must be able to help our customers shop for the specific skin focus they have. To develop our colleagues, we implemented a Virtual McCauley Master class on our Skin Brands for all our staff who support our skincare category. We carry out intensive brand training over several weeks empowering our colleagues to educate our customers who visit our stores. By keeping up-to-date with latest trends and technology in the industry, with the right skincare product ranges on offer and the skilled service supporting these, both in-store and virtually we are confident we are set up to continue growth into the future.

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United Drug - Expanding Exempt Medicines Range (EMPs) If it’s not on the list it’s on its way United Drug offers a swift and efficient service for supplying and sourcing exempt medicines and pharmaceutical supplies (EMPs) not normally available through regular pharmaceutical distribution channels. This service is called Elements. Elements is a wide product offering of EMPs that is regularly updated and expanded upon to improve your ability to supply your patients with the medicine they need when they need it most. Why Choose United Drug as your EMPs Partner? Just like you, at United Drug the patient is at the centre of everything they do. They pride themselves on providing fast and reliable product & pricing for Exempt Medicine Products.

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Safe and secure worldwide sourcing of Exempt Medicine Products United Drug prides themselves on their quality checks and control measures, with the sourcing, stocking and delivery of exempt medical products conducted under HPRA guidelines. In striving for best-in-class service and providing peace of mind to their retail pharmacy customers, United Drug values excellence: aiming high and insisting on quality wherever possible. Continually Expanding the Product Range with Proactive Sourcing of EMPs The patient is always the priority. The United Drug EMP team are constantly reviewing EMP listings and seeking new ways to improve the products and the customer experience in their search for the right EMP, including: • Increased listing of Irish alternatives where possible. • Avoiding issues with customs or delays where possible.

Visit www.udw.ie or contact our customer care team on Tel: 01 463 2410 • Reduced Lead times & speedy set up • Sourcing and Ordering EMPs on United Drug’s online customer portal Enlist UD’s Dedicated Team to assist you with your sourcing and supply Hazell Armstrong is United Drug’s EMP sourcing specialist with 7 years industry experience. Hazell has added over a thousand EMP’s over her tenure with United Drug. To Hazell, not every patient is the same and the role requires sourcing ad hoc products that are critical to the quality of patients’ lives. Getting a critical medicine that isn’t readily available in Ireland to a patient who really needs it, gives Hazell a lot of job satisfaction.

One thing United Drug do really well is get everyone working together as one team, with the quality team, procurement, operations, dedicated customer care team and Business Development Managers working alongside colleagues like Hazell striving to get the right product, to the right patients, at the right time. Investing In Ongoing Innovation Part of their continuous investment is enhancing their online ordering platform technology so pharmacists will have a greater ease of ordering. For example, it’s now even easier to request non-stocked lines via their new product request form. United Drug will source all your products requests and turnaround delivery as soon as possible once the product is available on the international market. Prescriber

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CPD: Infant Nutrition Continuing Professional Development

CPD

AUTHOR: Dr Anne Doolan, Paediatrician/Neonatologist, Coombe Women & Infants University Hospital Dublin

60 Second Summary Infancy is a time of rapid growth. Breastmilk provides all the nutrition an infant requires as well as having many nonnutritional functions. Support for breastfeeding can be sought from midwives, IBCLCs, public health nurses, doctors, mychild. ie and voluntary agencies. Most medications are safe for use when breastfeeding and specialist breastfeeding resources should be used for information. If families choose to use a breastmilk substitute or formula milk, this should be one suitable for use from birth. There is no evidence that formulas designed for special indications such as colic or reflux are beneficial. Regurgitation or reflux is a normal phenomenon in infancy. Treatment is usually only required if infants have failure to thrive and are under medical supervision. ‘Hungry baby’ formulas are not recommended. First infant milk is suitable for use until the age of one and thereafter breastmilk or regular cows’ milk is recommended. Colic is described as recurrent and prolonged periods of infant crying, fussing or irritability starting and ending before five months with no obvious cause, which cannot be prevented or resolved by caregivers, with no evidence of failure to thrive, fever or illness (Rome IV). The mainstay of treatment for colic is reassurance and support. Excessive infant crying is a risk factor for non-accidental injury. Dietary modification of breastfeeding mothers has not been found to be of benefit. Use of hydrolysed formula has not been shown to reduce crying in any clinically meaningful way. Use of the probiotics have been shown to reduce daily crying times by approximately 30 minutes per day, the most commonly studied agent is lactobacillus reuteri. There is insufficient evidence to recommend their use for formula feeding infants.

1. REFLECT - Before reading this module, consider the following: Will this clinical area be relevant to my practice?

knowledge gap - will this article satisfy those needs - or will more reading be required?

2. IDENTIFY - If the answer is no, I may still be interested in the area but the article may not contribute towards my continuing professional development (CPD). If the answer is yes, I should identify any knowledge gaps in the clinical area.

4. EVALUATE - Did this article meet my learning needs - and how has my practise changed as a result?Have I identified further learning needs?

3. PLAN - If I have identified a

5. WHAT NEXT - At this time you may like to record your learning for future use or assessment. Follow the

4 previous steps, log and record your findings. Published by IPN. Copies can be downloaded from www.irishpharmacytraining.ie Disclaimer: All material published is copyright, no part of this can be used in any other publication without permission of the publishers and author.

Infant Nutrition The importance of nutritional support in infants and coping with colic in babies Introduction: Infancy is a time of rapid growth. Babies double their birth weight by about 5 months and triple it by their first birthday. A healthy baby born at full term (37-42 weeks), requires about 100kcal per kilogram per day to grow normally. This would equate to 7000kcal per day for a 70 kg person! Babies who were born prematurely (born <37 weeks), were low birth weight (<2.5kg at birth) or have medical conditions such as congenital heart disease may have even higher energy requirements and need careful growth monitoring. Babies lose up to 10% of their birth weight in first few days of life. It is expected that they would regain their birth weight by two weeks of life, thereafter, weight gain is 150-210g per week for the first three months of life. Supporting breastfeeding: The WHO recommends that infants should be breastfed until 6 months with continued breastfeeding alongside the introduction of complementary foods until two years and beyond. Breastmilk contains all the nourishment a baby needs for the first six months, however food is only one of its functions. It contains essential amino acids for muscle and brain development, fats which are important components

of the immune, cardiovascular and nervous systems and enzymes to encourage chemical reactions in the body. Human milk oligosaccharides are present to feed healthy bacteria in the gut. Breast milk contains live cells to fight infection and hormones which help regulate appetite and feelings of well-being. Nucleotides are contained in breastmilk which are the building blocks of genetic proteins and help send messages between cells. Growth factors and inflammatory mediators are present to help protect the growing bowel. Breastmilk composition varies

from person to person and changes from feed to feed. While the calorific content of breast milk remains fairly constant over time at approximately 67 kcal/100ml, the protein content decreases as the baby gets older. In the first few days of life, protein content of breast milk is as high as 1.8g/100ml (Gidrewicz & Fenton (2014) BMC Pediatrics), falling to 1.2g/100ml by the end of the first month and below 1g/100ml by the end of the third month. This reflects the rapid initial growth of the baby which slows by around 3 months of age. Breast milk composition is tailored to the age of the baby.

CPD: Infant Nutrition preparation of formula milk is available on mychild.ie. Many types of formula are available to buy and this can be confusing for parents who are selecting an appropriate formula for their baby. First infant milk suitable for use from birth can be used as a breast milk substitute from birth to 12 months, at which point regular cows’ milk can be used. Switching to ‘follow-on’ or ‘stage 2’ milk has no benefits for a baby. The existence of these products is because in Ireland, the WHO Code has been interpreted to allow marketing of breast milk substitutes from 6 months and beyond. There is no biological need to switch milks at 6 months of age. Many formulas claim they have added ingredients to make their product more like breast milk. However many of these additions are derived from cows’ milk and have not been shown to have benefits for human babies. First Steps Nutrition is an excellent resource for HCPs and parents. This website reviews all the formula products available on the UK market and fact checks their claims of benefit. There is large variation in the price of different formulas, with no demonstrable benefit of the more expensive formula over a less expensive product. The HSE recommends that families should consult a healthcare professional before changing their baby’s formula.

When babies are breastfeeding, it is not possible to determine the volumes of milk that the baby is receiving. If babies are gaining weight appropriately 150-210g per week, are having 5-7 wet nappies and are passing 2-3 yellow, seedy stools a day, these are all reassuring signs that breastfeeding is going well. Some babies will pass stools more or less frequently and this can be very normal. Volumes of milk produced when expressing can be different to what the baby receives when directly feeding from the breast. It is not usually useful to ask mothers to express milk simply to measure the volumes that the baby is ingesting. In warm weather, breastfeeding babies may feed more often, however they do not need additional fluids such as water. If breastfeeding babies have vomiting or diarrhoea, they should continue to breastfeed, but should seek medical attention as young babies may get dehydrated quickly if not tolerating milk.

HSE guidelines recommend 5 micrograms of Vitamin D daily for babies who are breastfeeding or receiving less than 300ml per day of formula milk from birth to 12 months. Routine iron or other multivitamin supplementation is not recommended unless prescribed. If a breastfeeding woman requires either prescribed or over the counter medication, it is important she receives accurate information about safety of use in breastfeeding. Most medications are safe for use when breastfeeding, however occasionally a more suitable medication is advised. Please see table for resources for healthcare professionals about medications in breastfeeding. Parents can access support for breastfeeding from the public health nurse, midwife, maternity unit, International Board Certified Lactation Consultant (IBCLC), GP or voluntary/peer support groups.

Support for families who are formula feeding: Some families will choose to use formula only from birth and some will use formula alongside breast milk for many different reasons. It is important for HCPs to adhere to the WHO Code of Marketing of Breast Milk Substitutes (WHO Code) and to share factual advice with families. Infant formula contains adequate nutrition for babies but it confers none of the other health benefits of breast milk. Breast milk continues to be of benefit, even in small amounts. Babies who receive formula milk typically drink approximately 150ml/kg day and gain 150210g per week. Formula should be made up according to manufacturer’s instructions. The Food Safety Authority of Ireland does not recommend the use of formula preparation machines because of hygiene concerns. Impartial advice about

Many specialist-type formulas are available to buy over the counter. Goats milk is a suitable alternative to a cows’ milk based formula, once it is nutritionally complete and suitable for infants from birth. There is no evidence that goats’ milk is less allergenic than cows’ milk. ‘Hungry baby milk’ is a product which contains more casein than whey protein which makes the milk harder to digest. There is no evidence to suggest that babies settle better or drink less milk when fed this type of formula. Also, because it is harder to digest, it can cause constipation. Reflux or regurgitation is a normal physiological event in infancy. NICE guidelines do not recommend treatment of simple reflux in infants. For babies who are being formula fed, conservative management of reflux involves reducing feed volumes and increasing feed frequency. Where there is significant, frequent

63 regurgitation anti-reflux formula may be recommended and used under medical supervision. These milks are thickened with potato starch, carob or locust bean gum. These milks do not seem to reduce regurgitation but may reduce overt vomiting. Because of the thickening agents present in these milks, they are recommended to be reconstituted with cool water rather than at a temperature of 70°C as per HSE guidelines. This increases the risk of bacterial contamination and infection. ‘Hypoallergenic formula’ is 100% whey protein and is partially hydrolysed. It is marketed as reducing the risk of atopic dermatitis, however this claim has not been supported by the European Food Safety Authority (EFSA). This milk is not suitable for babies who have diagnosed food allergy. Only breastmilk has been shown to reduce the risk of allergy and atopy. Diagnosis and treatment of proven cows’ milk protein allergy is outside the scope of this article. Soya protein-based formula should only be used if prescribed by a doctor for specific conditions such as galactosaemia. Some families wish to use them because of a history or suspected cows’ milk protein allergy, but these milks have not been shown to prevent allergy and many children who have cows’ milk protein allergy will also react to soya protein. Because of the presence of phyto-oestrogens and the potential to have a negative effect on future reproductive health, they are not recommended for infants under 6 months (unless prescribed). The primary source of carbohydrate is maltodextrin rather than lactose which can have

a negative effect on the baby’s dental health. The primary source of carbohydrate in breast milk is lactose, so ‘lactose intolerance’ in infants is an extremely rare cause of unsettled behaviour and failure to thrive. Lactose free formulas use glucose as a carbohydrate source and thus are not kind to teeth. They are not recommended in the treatment of infant colic (see below). Comfort milk is marketed as a type of formula that reduces symptoms of colic and/or constipation, however these claims are unsubstantiated. They contain partially hydrolysed whey protein. They are manufactured with reduced amounts of lactose and this is replaced by glucose, corn syrup or maltodextrin depending on the product. There is insufficient evidence to say they reduce symptoms of colic.

of infants. It is equally common in breastfeeding and formula feeding babies. Excessive infant crying is a frequent reason for parents to support from healthcare professionals and is a risk factor for non-accidental injury. Normal infant behaviour: Some would argue that the term colic is outdated, and that infant crying is part of normal newborn behaviour. It would be expected that a newborn infant would cry or be unsettled for 2-3 hours a day, with peak incidence of crying occurring at about six weeks of age. Babies have come from a very warm, secure environment and the outside world can be loud and scary. It is normal for a baby to want to be held and kept close to their parents. Physical closeness is important for establishing breastfeeding and the parental response to crying is what keeps babies safe. Parents often perceive a baby’s cry as pain, however this is only means they have to communicate any discomfort to their caregiver. Infant crying can lead to parental distress and parents should be encouraged to seek support and also be aware of the risk of postnatal depression.

Educational resources for Healthcare Professionals

attention. Similarly, if parents are struggling to cope, they may also need to speak with their doctor. Typically, the ‘colicky’ baby gains weight well and is keen to feed. They frequently appear quite happy and content when they visit the doctor! What causes colic? The aetiology of colic is undefined and is likely multifactorial – behavioural and biological components, gut microflora and dysmotility factors are the focus of research. Lactose intolerance and presence of allergens in formula or breast milk have been investigated as causes. The intestinal microbiome has been found to be different in infants with and without colic. Immature gut motility has also been investigated.

HSEland – Infant Growth and Nutrition, Breastfeeding elearning modules Hale’s Medication and Mother’s Milk Breastfeeding Network medication factsheets (breastfeedingnetwork.org.uk)What is the treatment of colic? Once no red flags are present, First Steps Nutrition (firststepsnutrition.org) the mainstay of treatment is support and parental reassurance. Association of Lactation Consultants of Ireland (alcireland.ie) Resources for families

Coping with colic in babies: What is colic?

Since the 1950’s, colic has been described as unexplained paroxysmal crying for longer than three hours per day, for three days per week, for at least three weeks. More recently the Rome IV diagnostic criteria include infants who are less than five months when symptoms start and stop, who have recurrent and prolonged periods of infant crying, fussing or irritability with no obvious cause, that cannot be prevented or resolved by caregivers, with no evidence of failure to thrive, fever or illness. The condition is most frequent within the first six weeks of life and effects up to a quarter

Local Health Centre/Public Health Nurse HSE – mychild.ie First Steps Nutrition (firststepsnutrition.org) La Leche League Ciudiu Friends of Breastfeeding

What red flags should we be aware of? If parents are concerned about their baby’s crying, they should be encouraged to speak to a healthcare professional and have a clinical exam and weight measurement. Reassurance can be beneficial. Fever (>38°C), bilious vomiting, projectile vomiting, poor weight gain, blood in the stool or any signs of injury are all reasons to seek medical

Babies are unable to self-soothe. Responding to them quickly reduces the crying time. Parents should be reassured that they will not ‘spoil’ their baby by holding them.

The most recent Cochrane Review on Dietary Modifications for Infantile Colic was published in 2018. 15 studies of 1121 infants were included. Modification of the maternal diet to reduce intake of potential allergens was not found to be beneficial. If the breastfeeding mother decides to exclude allergens from her diet, baby’s symptoms should be monitored with reintroduction of normal eating as soon as possible if there is no effect. Longer term dietary modification should be

Colic - recurrent and prolonged periods of infant crying, fussing or irritability starting and ending before five months with no obvious cause, which cannot be prevented or resolved by caregivers, with no evidence of failure to thrive, fever or illness (Rome IV) Red flags - parental concern, fever, bilious vomiting, projectile vomiting, poor weight gain, blood in the stool or any signs of injury Treatment – parental reassurance and support - Probiotics (lactobacillus reuteri) may have a role for breastfeeding infants - No/insufficient evidence to recommend maternal dietary medication, specialist formulas, medications or manipulation therapies

CPD: Infant Nutrition

supported by a dietitian in order to support a healthy balanced diet for the mother.

Questions:

Use of hydrolysed formula has not been shown to reduce crying times in any meaningful way. Similarly reduced lactase intake or use of lactase drops showed no difference in crying times. There is no evidence to say that changing formula type will influence colic or crying times. The different types of formula have been discussed above.

A. Babies triple their birth weight by 1 year of age B. Babies need approximately 100kcal/kg per day to grow normally C. Babies with congenital heart disease often need less than 100kcal/kg per day D. Babies should regain their birth weight by 4 weeks of age

Probiotics have been studied for use in infantile colic (Cochrane 2019). 6 studies of 1886 infants compared probiotics with placebo. There was no evidence to suggest that probiotic use prevented colic. A meta-analysis of three studies showed a reduction in crying time of approximately 30 minutes per day with use of probiotic when compared with placebo, the most studied agent was Lactobacillus reuteri. A meta-analysis (Paediatrics 2018) of probiotics concluded that there was insufficient data to recommend use in formula fed infants. Simethicone is an anti-flatulent medication, however it is no better than placebo at treating colic. Gripe water typically contains sodium hydrogen carbonate and some other agents such as fennel which are thought to reduce wind. Gripe water has not been shown to reduce infant colic. Studies of manipulative therapies (chiropractic, osteopathy or craniosacral therapy) to date have been poorly designed with high levels of bias because of study design and a lack of blinding. While some reduction of crying time has been shown, there is insufficient evidence to recommend these treatments. Infant massage by parents has not been shown to be of benefit in reducing crying, however it is soothing for both parent and child and encourages positive interactions. For crying infants, once red flag signs and symptoms have been out ruled, no treatments have been found to reduce infant crying by any clinically meaningful amount. Parents need support and reassurance. It should be acknowledged that caring for a crying baby is frustrating and tiring and they should be encouraged to ask for help. New parents are vulnerable and tired. Many breastmilk substitutes and medications that are sold as colic remedies are expensive. We have a responsibility to provide evidence based advice.

Q1. Which of the following statements are true?

Q2. Which of the following statements are true regarding breastfeeding? A. Breastmilk continues to have nutritional and immunological benefits for children for the first 2 years of life and beyond B. Breastfeeding is only beneficial if it is done exclusively for six months C. The protein content of breastmilk continues to increase in the first year of life to encourage babies to grow D. In warm weather breastfed babies do not require extra water, however they may feed more frequently than usual Q3. Which of the following statements are true regarding formula milk? A. Formula feeding babies will typically drink 100ml/kg/day of milk B. The Food Safety Authority of Ireland does not recommend use of formula preparation machines C. It is recommended that babies move on to Stage 2 formula at 6 months because first infant milk is no longer nutritionally suitable at this age D. If a baby is allergic to cows’ milk, goats’ milk is recommended in the first instance Q4. A parent is concerned that their formula feeding baby vomits after every feed. What is the best advice to give her? A. You ask about red flags and suggest that they see their GP as soon as possible but you recommend starting anti-reflux formula today without delay B. You ask about red flags and suggest that they see their GP as soon as possible but you recommend starting a different brand of formula C. You ask about red flags and suggest that they see their GP as soon as possible but you recommend more frequent, smaller feeds D. You ask about red flags and suggest that they see their GP as soon as possible but you say that the baby will probably be prescribed anti-reflux medication Q5. Which of the following statements is true regarding infant colic? A. Colic most frequently starts when a baby is over 5 months of age B. Parents should be discouraged from picking their baby up when they are crying because this will ‘spoil’ them C. Maternal dietary medication is unlikely to help treat infant colic D. It may be useful to recommend a probiotic containing lactobacillus reuteri to breastfeeding infants Visit www.pharmacynewsireland.com for the full article, questions and answers.

Educational resources for Healthcare Professionals HSEland – Infant Growth and Nutrition, Breastfeeding elearning modules Hale’s Medication and Mother’s Milk Breastfeeding Network medication factsheets (breastfeedingnetwork.org.uk) First Steps Nutrition (firststepsnutrition.org) Association of Lactation Consultants of Ireland (alcireland.ie) Resources for families Local Health Centre/Public Health Nurse HSE – mychild.ie First Steps Nutrition (firststepsnutrition.org) La Leche League Ciudiu Friends of Breastfeeding

Colic - recurrent and prolonged periods of infant crying, fussing or irritability starting and ending

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Category Focus: Eyes & Ears

Category Focus on Eyes and Ears Eye and ear care may be considered as smaller categories within the scope of pharmacy care; however, eye and ear problems can be unpleasant, and this therefore represents an opportunity where pharmacists can make a big difference when treated properly. Written by Emer Scullion, Pharmacist, Inish Pharmacy Buncrana

Building Loyalty In the last year, with the Covid-19 outbreak, I have found that customers are relying more and more on the pharmacy when it comes to minor ailments as it was almost impossible to get a doctor’s appointment. As a result of this, patients will have gained a lot of trust in the pharmacy profession and should in future know to turn to their local pharmacist for advice before going to the doctor. Pharmacists and pharmacy staff need to keep on top of training in these areas so they can be confident in their ability to recommend certain products and know when to refer on to a GP. This is essential for building up a good rapport with patients, ensuring they will return for your advice in future. It is important that staff have the confidence to ask appropriate questions to establish the level of discomfort a patient is feeling, how long this issue has been occurring, other medications etc. This will help the staff to know whether they can recommend a product for this issue or whether they need to refer this customer to the pharmacist or the GP to ensure they get appropriate treatment. Any educational information available from the product manufacturers should be taken advantage of.

While these companies offer training in order to promote their own products, they should be taken with an open mind and staff can use the knowledge they will gain across a range of different products. These training opportunities help staff to build confidence to be able to offer the best help to patients who will recognise and appreciate the staff knowledge. The company may also provide leaflets or samples, which can help the pharmacy to provide a more knowledgeable and professional service. These training sessions can generally be requested through the sales representative of the company in your area, via phone call or email. Effective Merchandising Eye and Ear care categories should be merchandised appropriately and should be displayed in a way to help boost sales. Eye care should have a place out on the shop floor as well as behind the counter. This enables patients to have a browse allowing for selfselection and consideration while also having the ability to ask for products at the counter when they have brought their other items to the till. Pharmacies should dual site eyecare with allergy treatments as there is some crossover with dry eyes, itchy, watering eyes etc.

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In order to maximise on sales, pharmacies should be looking at marketing hay fever medications from mid-March, as the end of March to early September tend to be the months with the highest pollen count. Having staff put out displays for hay fever medication early, allows them ample opportunity to go through patient information leaflets, guidelines and ask the pharmacist if they have any questions about the products. It also means that you will have customers prepared early and can give them advice on methods of preventing hay fever and the importance of prophylactic use if they tend to have very severe symptoms. It is worth noting the different options available within this category. There are eye drops containing antihistamines to help prevent the allergic reaction, blocking histamines in the body and quickly reducing symptoms like itchy, watery eyes. Examples of antihistamine eye drops include Opticrom and Otrivine. Other eye-drops on the market can help alleviate the symptoms associated with hay fever including eye drops for itchy, watery eyes, however, these do not contain antihistamines. If patients tend to have overly sensitive eyes, pharmacy staff should suggest the single dose eye drops (Opticrom Allergy, Optase Allergy Drops, Fusion Allergy eye drops) as these products do not contain any preservatives which can cause irritation in patients with sensitive eyes. Age-Related Macular Degeneration Age-related macular degeneration (AMD) is one of the leading causes of visual impairment in older adults. It causes gradual loss of sight and blurred vision. A lot of the time, patients get a diagnosis for this condition when the damage is already done. There are certain factors which make patients more susceptible to getting this condition, including smoking, high blood pressure, obesity or a

diet high in unsaturated fat and lack of exercise. Supplements containing all three macula carotenoids Lutein, Zeaxanthin and meso-zeaxanthin like MacuShield, MacuShield Gold, MacuSave MacuPrime and MacuPrime PLUS help to reduce the risk and/or slow the progression of AMD. Lutein Omega-3, MacuPrime PLUS also contain zinc to help maintain normal vision, copper, vitamin C and vitamin E, which contributes to the protection of cells from oxidative stress. MacuPrime and MacuSave are gluten free so they are safe for coeliac customers. Most of these supplements are a once daily tablet which tends to be well tolerated by customers. Pharmacy staff should be well versed in the benefits of these treatments as they should be confident in discussing the benefits of these supplements with patients whom they recognise to be in an ‘at risk’ category. Pharmacies can also take advantage of the cosmetic side of eyecare, including anti-redness eye drops, eye creams and eye brighteners. Dry skin around eyes can often lead to discomfort for patients and pharmacy staff should be well versed on which eye ointments and moisturisers are safe to be used on and near the eyes. In recent years, there has been an increased demand for cosmetic procedures involving the eyes, including lash lifts and tints, semipermanent eyelash extensions and eyebrow tints. As a result of this, more people are suffering with allergic reactions or skin irritation to some of the products being used. Products like Xailin Eye Gel or Hylo-Night can be recommended in these instances as they contain white soft paraffin (Hylo-night also contains liquid paraffin) which will hydrate the skin on the eyelid, locking in moisture, helping to heal the irritation and discomfort for the patient. Hylo-Night also contains retinol palmitate (vitamin A) which helps improve skin tone and prevent collagen breakdown. These products are licensed for use in the eye and so offer a safe option to treat dry/ irritated skin on the eyelid as it doesn't matter if the patient were to accidentally get it in their eye. Pharmacy staff should proactively offer this advice if a customer is discussing getting these treatments done soon.

Pharmacists should also actively offer ear and eye health promotion services. This can include suggesting products for uses which may not come to mind straight away, for example, Blephaclean wipes can be used to remove make-up while also gently cleansing the eyelids and lashes. These wipes are free from parabens, perfumes and preservatives and so are a fantastic alternative to eye-make up removal for patients with extremely sensitive eyes. This will also help prevent eye infections and blepharitis in patients who may be prone to these conditions. For ear health, using products like ‘Audispray’ to clean ear wax, rather than the traditional but unsafe way of using cotton buds. These are common areas where staff would get asked questions on a regular basis so having staff well versed in these areas with helpful hints and tips for patients is essential. This will add value to pharmacy services and should encourage loyalty among customers. It is important to educate patients on the need for proper eye and ear care and the importance of not ignoring problems as these could be signs of a more serious condition. Eyesight and hearing are so precious and so it is vital that we would treat these with care and do everything possible to maintain their health. Product Innovation Continuing product innovation within eye care is providing customers with new options. The latest option in this category is the increasing availability of eye mists/ sprays. This allows for absorption of active ingredients through the eyelids and removes the need for the accuracy of instilling drops. There are currently eye mists/ sprays available for dry and tired eyes, itchy and watery eyes. A lot of patients tend to mention not liking instilling eye drops and so this overcomes that issue as the patient can close their eyes and self-administer. This is also a helpful method to administer eye drops for a patient who has any motor impairment caused by Parkinson’s, Multiple Sclerosis, Motor neuron Disease etc. These patients can maintain their independence by administering a spray as it is easier to use and requires less dexterity and

accuracy than drops. In patients with extremely poor motor function, it may also be easier for a carer or family member to administer the spray to the patient rather than the drops. These are things which pharmacies are in a unique position to be able to give advice on as they can see the patient’s medication history when they are purchasing items in store. Ear care is often overlooked as a section in pharmacy, however, with the availability of ear wax treatments over the counter, it prevents customers from having to wait on doctors’ appointments to solve such an easily fixed issue. This also allows for patients to rule out the cause of the problem being a small ear wax build up, which is helpful for the doctors as they can look at other potential causes and treatments which are more appropriate. Patients will often present to the pharmacy looking for treatment to relieve the symptoms of pain, swelling and itchiness in the ear. This is often called ‘Otitis Externa’ or swimmer’s ear. There are drops available to help ease this, including Cl-ear which work by coating the outer ear canal with a protective film which helps to soothe irritation and swollen tissue resulting from burning, itching, swelling and pain. They work to reduce swelling in the ear and alleviate pain. Children will also often present with what is known as glue ear, this is a condition where the empty middle part of the ear canal fills up with fluid. This can cause pain in the ear, temporary hearing loss or a ringing in the ear (tinnitus). This condition normally clears up on its own and it is important to reassure parents of this, but they can use the Otovent nasal device to reduce symptoms. Pharmacy staff should provide all customers with advice pertaining to what to look out for in cases of infections and if such symptoms should appear, that they would stop self-treating and go to see their doctor. Both categories can provide an excellent service to patients when merchandised properly and when staff are trained to know the different products and feel confident to sell the products and offer advice to customers.

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Category Focus: CBD

Growth of CBD Pharmacy Market The CBD market is one of the fastest growing within the OTC sector. expansion of, and improvements in, our health and social care services,” he said. “One of the improvements in our Health Services that will benefit from this extra funding is the Medicinal Cannabis Access Programme which has been added to the HSE Service Plan for 2021. “The purpose of this Programme is to facilitate compassionate access to cannabis for medical reasons, where conventional treatment has failed. It follows the clear pathway laid out by the Health Products Regulatory Authority in their expert report ‘Cannabis for Medical Use – A Scientific Review’.

The global CBD oil and CBD consumer health market size is expected to reach USD 123.2 billion by 2027, expanding at a CAGR of 25.6% over the forecast period according to the latest market report in this field. However recent legislation changes have provided some confusion within community pharmacies. It was announced last year that CBD companies would have until 31 March 2021 to have a validated novel foods application for each of their products or else risk being removed from shelves. Pharmacies were able to sell CBD products currently on the market until the end of March this year, as long as these were “labelled correctly” and are not “unsafe to eat [or] contain substances that fall under drugs legislation”. The criteria for products which can remain on sale from 1 April 2021 has been updated. Previously, only products which were on sale at the time of the FSA’s announcement (13 February 2020) and were linked to an application which had been validated by 31 March 2021 were to be included. To maximise the opportunity to pass validation, this now includes all products on sale on 13 February 2020 and linked to an application submitted before 31 March 2021 that is subsequently validated. Irish rules on CBD stand in line with the European Union’s Novel

Food Regulation. This regulation classifies CBD as a novel food, which doesn’t have a significant history of consumption in Europe before May 15, 1997. Besides the “history of consumption” rule, the Irish authorities included an additional standard for CBD products — the type of the extraction process. According to Irish laws, CBD extracted with solvents or supercritical CO2 extraction requires a novel food permit from the European Commission (EC). Otherwise, it can’t be marketed as a food product or health supplement. However, the Food Safety Authority of Ireland (FSAI) stated that if the CBD oil is extracted by cold pressing it is legal for sale. One brand that uses this process is Emerald Farm – which is cold press and 100% compliant. Medicinal Cannabis Access Programme At the start of this year, Minister for Health, Stephen Donnelly TD, announced provision for the delivery and funding of the Medicinal Cannabis Access Programme. “The Budget in October 2020 saw an extra ¤4billion added to the Health Budget. This increase is indicative of how determined we in Government are to fund an

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“Ultimately it will be the decision of the medical consultant, in consultation with their patient, to prescribe a particular treatment, including a cannabis-based treatment, for a patient under their care. It is important to state that there are no plans to legalise cannabis in this country.” Once suitable medical cannabis products are made available by suppliers, the Access Programme will make it possible for a medical consultant to prescribe a listed cannabis-based treatment for a patient under his or her care for the following medical conditions, where the patient has failed to respond to standard treatments: • spasticity associated with multiple sclerosis • intractable nausea and vomiting associated with chemotherapy • severe, refractory (treatmentresistant) epilepsy. Ground-breaking Projects CÚRAM, the SFI Research Centre for Medical Devices based at NUI Galway, has announced a new research partnership with B. Braun, one of the world's leading providers and manufacturers of healthcare solutions. The partnership will see the development of a novel drug delivery system for cannabinoids for more effective treatment of wound pain and improved wound healing, and the development of a device for the management of wound odour.

Chronic wounds affect up to 4% of people over 65 years, with venous leg ulcers being the most prevalent of these, accounting for approximately 70% of all ulcers of the lower limbs. Chronic wounds are associated with reduced quality of life and affect the individual in physical, psychological and psychosocial domains. This in turn can impact family members and the individual’s ability to contribute to society fully. Among the many symptoms associated with chronic wounds, pain is cited as one of the worst aspects. While multiple forms of pain relief exist, these do not provide relief for all patients, and people with chronic wounds regularly state they do not wish to take more medication and have a fear of addiction. Professor Georgina Gethin, CÚRAM Investigator, project colead, and Director of the Alliance for Research and Innovation in Wounds, explains, “Members of our patient panel in Alliance for Research and Innovation in Wounds have recounted using a trial and error process to alleviate pain and often take to resting until the pain goes away. They have identified that research to develop interventions to relieve pain is a priority for them. The endogenous cannabinoid (endocannabinoid) system plays a key role in pain modulation and also regulates wound healing. It represents a novel target for more effective dual management of both pain and wound healing.” Professor David Finn, an Investigator in CÚRAM, Head of Pharmacology, and Co-Director of NUI Galway’s Centre for Pain Research is a co-lead on the project. He brings over 20 years of expertise in cannabinoids, the endocannabinoid system and pain to the project. His group will play a key role in advancing understanding of the endocannabinoid system in wound pain and healing, and in preclinical testing of the novel cannabinoideluting delivery system for more effective treatment of wound pain and improved wound healing.

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Category Focus: Digestive Health

A Closer Look at the Digestive Market In addition to allowing nutrients and vitamins to reach your body, the digestive system also helps remove waste from your body. However, People may experience discomfort when something goes wrong with their digestive system. In fact, four out of every ten adults in the world experience digestive problems at any one time. Written by Stephen Cuffe, Pharmacist, Inish Pharmacy, Carndonagh Shopping Centre, Carndonagh  Bloating & Gas 263% increase  Cramping & IBS 256% increase.

Many digestive complaints such as constipation, diarrhoea, heartburn, bloating, and irritable bowel syndrome can be alleviated with lifestyle changes. Eliminating high sugar, fat, refined carbohydrates, and low fibre typical in many of our diets should be considered first. However, given many of our cravings for such foods, and the ever increasing fastfood options that tempt us, it is unlikely that there will be any mass population changes in eating habits overnight. As such, community pharmacists can help patients with effective products that alleviate while also educating them. Referral to a doctor will be recommended if something more serious is suspected. Drop in Footfall Despite remaining open during the pandemic, our pharmacies experienced a considerable drop off in footfall. However, in addition to prescription medications, one over the counter category that was notable was the digestive ailment category. The demand

and sales of products in this sector increased throughout the pandemic. However, as people stayed at home much more, there was a definite shift in sales to online and we noticed this with our own on-line channel. To show the increase in online sales in this sector I am sharing a comparison on sales from January and February 2020 with sales from January and February 2021. I have broken this sector down into six sections – constipation, haemorrhoids and piles, acid indigestion and reflux, diarrhoea, bloating and gas and cramping, and IBS. Each section saw a substantial increase with the largest increase in the acid indigestion & reflux section, which rose by 609%. All the increases are as follows:  Constipation 239.5% increase  Haemorrhoids & Piles 334% increase  Acid Indigestion & Reflux 609% increase  Diarrhoea 169% increase

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The period shown in 2021 was during level 5 restrictions. With these restrictions, people were required to stay at home except for travel for work (only if essential), education, or other essential purposes. With a lot of people having to work from home and home-school and nonessential services closed it may have been a stressful period. In addition to causing you to lose your appetite and slow down your digestion, stress can also provoke issues such as constipation, diarrhoea, indigestion, or upset stomachs. This may explain part of the increase. Other factors which may have skewed the figures are product availability (shortages), limited access to GPs. No doubt most customers would have traditionally gone to their local pharmacist rather than purchasing

on-line in the past. So there is no surprise that on-line sales increased in trend with a general shift to online shopping during the pandemic. Increased Demand So what’s your take away from our figures? Well I’d suggest that as the pandemic is not over then there is likely to still be an increased demand for products in this category. People are still experiencing changes to lifestyle and work and increased levels of stress. Access to GPs is still limited. As such, it is certainly an area that we as community pharmacists can help with. With restrictions easing and footfall in shopping areas returning we anticipate the on-line demand to reduce and a return to in-store demand. Within our pharmacies, we do not actively advertise specific brands. However, I would advise that you make your customers more aware that you have products available that could help their symptoms. Make these categories more visible by choosing noticeable shelf locations and category specific marketing.

News

United Drug – Irelands Leading Provider of Ostomy and Urology Products and Services Providing best in class sourcing and customer service for Ostomy and Urology The foundation of the United Drug business is exceeding expectations in sourcing and supply chain excellence. With a continuous focus on the latest products, innovations and processes United Drug strives for best-in-class customer service every time. As a part of the retail solutions offering within United Drug Wholesale, the ostomy and urology care team are the market leaders and endeavour to provide service excellence, enabling retail pharmacists to improve the quality of life for ostomy patients across Ireland. Why Choose United Drug for Your Ostomy Requirements? The focus on the customer and the ostomy patient drives everything, including: • Continually expanding their extensive product range- Over 3000 products • Partner with all leading manufacturers of Ostomy products • Complimentary bag cutting service-cutting in excess of 8000 bags weekly • Best in class supply chain ensuring reliable and timely delivery to Pharmacy daily • Supply complimentary bags and wipes for your clients use. Continuously Investing to Enhance Customer Service: United Drug continues to invest in state of the art cutting technology, cutting over 8,000 ostomy bags every week. United Drug’s ostomy bag cutting service provides the best possible fit and guarantees increased precision for every single cut. This complimentary service affords patients optimum comfort and peace of mind, giving them the highest level of security. The additional products that can make the difference to quality of life: From the 3,000 products available from United Drug Wholesale there are a range of additional solutions for the patients who may be struggling with some issues. • Leakage Solutions: elastic tape, pouch belts, mouldable rings • Odour Solutions such as lubricating deodorant • Skin irritation solutions: adhesive remover sprays and wipes,

skin barrier spray, wipes and cream, ostomy powder and skin protection sheets. • Discomfort & Discretion Solutions: ladies and men’s briefs and vests, specialist swimwear, hernia belts and support waist bands. Dedicated, highly experienced customer care team to support Pharmacy teams: It’s not required to start out as an expert in order to offer additional support for your ostomy customers. United Drug provides support for over 20,000 customer care queries annually with 5 dedicated members on the Ostomy Care Team. • The customer care team upskills their product knowledge every 6 weeks, this high level of training allow them to deal sensitively and efficiently with your queries. • They are highly trained to deal sensitively and efficiently with your queries. Their depth of knowledge of stoma-care solutions enables them to offer best in class support to you and your customer.

currently receive with many suffering in silence with symptoms that pharmacy products may help them manage or alleviate. Tips when talking to your Ostomy patients, there are some signs to watch out for. • Increased bag usage. • Increased usage of powders or creams. • Problems with odour control.

Get In Touch: If at any stage United Drug’s Ostomy Pharmacy clients can reach out to the company’s dedicated customer care team on 01 4632347 to get up to the minute advice on how to best serve their ostomy customers. For more information about the UD Ostomy and Urology product range contact the UD BDM for your area or visit www.udw.ie

Generations of Family Pharmacy Success McCabes Pharmacy Group are celebrating 40 years in business this year. Managing Director Sharen McCabe recently took to social media to share this image alongside her father who started the business, Roy McCabe. “It’s simply one of the greatest privileges of life to get to work with a parent at some point in a career, never mind celebrate 40 years in pharmacy and healthcare,” she reflected.

How Pharmacy Teams Can Enhance the Quality of Life for Stoma Patients: The Gastrointestinal Nursing journal published an article in March 2017 titled “Assessing Ostomates’ Quality of Life in the Republic of Ireland”, where it was revealed that ostomy and urostomy patients in Ireland have a lower quality of life than the international average. In the event of stoma prolapse, blockage, high output or dehydration you should advise your patient to consult their GP. As a pharmacist, you are a part of your ostomy clients’ patient care team. For many patients you’ll be their only regular medical engagement and their first line of support. Therefore, it can be critical to their well-being to be able to have a conversation in a private consultation room at their local pharmacy with someone who cares. Once discharged from their hospital’s specialist nurse, this is more care than many ostomates

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News

McCabes Pharmacy introduces new digital prescription service: Easy Script Mum-to-be Síle Seoige was on hand to meet the newest addition to McCabes, as the family-owned pharmacy unveiled its Digital Prescription Service, Easy Script. The “new arrival” is the first web based digital prescription service in Ireland, and it comes as McCabes Pharmacy celebrates 40 years in business this year. At the launch in McCabes Pharmacy, Gorey, Co. Wexford, Síle Seoige was joined by store pharmacist Colin Ryan for a demo of the new service

services, on the retail side it has also seen people keen to continue supporting their local McCabes Pharmacy online. An analysis by McCabes of customer shopping habits on www. mccabespharmacy.com reveals some interesting trends about customers’ health and beauty priorities in recent months. Trending in Lockdown At the launch in McCabes Pharmacy, Gorey, Co. Wexford, Síle Seoige was joined by store pharmacist Colin Ryan for a demo of the new service. With Easy Script, customers can order their prescription instantly and collect from their nearest pharmacy in 3 simple steps: • Complete the order form on the McCabes website www. mccabespharmacy.com (alternatively via the McCabes app available on Apple and Android) • Take a photo of your prescription and upload it • Select the McCabes pharmacy you want to collect from Customers receive a text when their prescription is ready for collection (within 3 working hours). To make it even easier, there is no need to register online, and customers do not have to be a pre-existing patient at McCabes. The service is open to everyone! McCabes Managing Director, Sharen McCabe, explains, “McCabes Easy Script gives

customers a new way to manage their medication needs from home. We know from talking to busy parents and timepressed family carers, that they want certainty about when their prescription will be ready to collect. We see so many customers who have limited time in their day to run errands while juggling other commitments at home. With no need to wait in store, we hope that Easy Script will meet a real need in a very innovative way.” Easy Script marks 40 years of firsts McCabes has led the way on innovation since the family-run business first opened its doors in 1981. For the past four decades, the brand has continued to adapt as customer needs evolved. Easy Script is the latest in a growing list of market firsts for the innovative Irish family brand. In the past year, McCabes has also been first to introduce the Morning After Pill using a pay online, click and collect-in store service. Other milestone firsts over the years include the introduction of

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health checks into a pharmacy setting, the setting up of health education seminars with consultants, the use of open plan dispensaries so that the pharmacist is always visible to the customer, and the introduction of Sunday openings and late-night dispensing. Digital first for 20 years McCabes has always been an early adopter of new technologies, with an e-commerce website dating back to 2000. Investment in digital continues today, with more services available online than ever before, including Video Consultation, Live Online Pharmacist Chat for answers to health and medication queries, and an Online Doctor Service, enabling customers to see a GP from the comfort of home with services starting from just ¤25 and appointments available 7 days a week for new or repeat prescriptions, referral letters, sick notes and general medical advice. Covid-19 & Consumer Trends While the impact of Covid-19 has accelerated innovation in

• Treats – people invested more to treat themselves to luxury items including premium skincare products, larger sized and more expensive bottles of fragrance. • Natural Look – fewer opportunities to socialise combined with mask-wearing saw a huge move to more natural make-up, and a much bigger focus on skincare overall. • Maskne – customers, including more male shoppers, bought skin care products to help treat skin conditions such as acne exacerbated by face masks. • Vitamin Boost – demand grew for vitamins to support immunity, notably Vitamin D. • Lockdown Locks – with hair salons closed, hair dyes and root touch-up products were a popular purchase for customers keen to cover the grey. • Menopause supports – with more open discussion re the impact of menopause, demand increased for vitamin and supplement supports to help to manage symptoms.

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Biosimilars – Increasing Access to Medicines The 2021 Virtual Summit on Biosimilar Medicines was held recently, a series of live webinars which looked at the current challenges and opportunities within this field. The 2021 Biosimilar Medicines Virtual Summit explored the latest developments in biosimilar medicines policies. In a novel online format, each live session was complemented by resources such as recorded interviews and presentations, infographics and reports.

for chronic disease patients including those with cancer. Smart policies that expand biosimilar medicines use have led to efficient outcomes for patients, healthcare professionals and healthcare systems.” To deliver their full potential, biosimilar medicines need:

Fifteen years after the first global approval, biosimilar medicines systemically increase access to medicines for patients who need them, while contributing to the sustainability of our healthcare systems.

• The right market conditions and incentives

Medicines for Europe commented, “We are at a unique moment for pharmaceutical policy, given the ongoing pressure from Covid-19 and the upcoming opportunities to build healthcare efficiency presented by the European Commission Pharmaceutical Strategy. “Biosimilar medicines have always been a strong asset to offer equitable access to treatment

• A fit-for-purpose regulatory environment, tailored to their specificities • To be part of standard patient care. Isabell Remus, Chair of the Biosimilar Medicines sector group, commented “Covid-19 will have a lasting impact on national health systems in Europe and their recovery will be absolutely crucial for all patients. For 15 years, biosimilar medicines provide an effective solution to balance patient access and healthcare sustainability. There are many more opportunities ahead for biosimilar

medicines. Their smart use must be facilitated in practice but also in policies, like recognised in the EU Pharmaceutical Strategy and the EU Beating Cancer Plan.” The Biosimilar Medicines Group is a sector group of Medicines for Europe representing the leading companies developing, manufacturing and/or marketing biosimilar medicines across Europe. With more than 10 years of positive patient treatment experience and 20 products successfully launched, biosimilar medicines provide today a huge opportunity to deliver significantly improved access to modern therapies for millions of European patients in both chronic and acute care. Medicines for Europe members bring competition to the biological medicines market, thereby increasing access to highly innovative treatments to patients, in Europe and around the world, and supporting the sustainability of the European healthcare systems.

The Resilient Pharmacist Podcast The Irish Institute of Pharmacy (IIOP) has launched a new podcast, The Resilient Pharmacist (The Resilient Pharmacist Podcast) hosted by Dr Catriona Bradley. Dr Catriona Bradley, IIOP

Each fortnight, through 10 episodes, guests speak candidly about their experiences in pharmacy. The series includes fascinating stories about pharmacy hold-ups, burnouts, breakthroughs, and everything in between. Guests share their stories so that others may learn from their experiences and so that we can start new conversations about pharmacy. Podcast Host, Dr. Catriona Bradley says, “This is a wonderful collection of human stories that may shock and surprise you, but there are heart-warming moments too, all of which speak to the resilience at the heart of the pharmacy profession in Ireland.”

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The first episode: “Ailbhe Harnedy. Frightening Experiences” is available to download on podcast platforms. A new episode will be released fortnightly. The Resilient Pharmacist podcast has been developed in collaboration with the IIOP Mental Health and Wellbeing working group and the IIOP Mental Health Ambassador Network. The Irish Institute of Pharmacy (IIOP) manages the Continuing Professional Development (CPD) system for pharmacists in Ireland. This includes supporting pharmacists engaging with CPD, managing the CPD quality assurance systems and commissioning and delivering education and training programmes. RCSI is the managing body for the Irish Institute of Pharmacy (IIOP) on behalf of the Pharmaceutical Society of Ireland (PSI). Visit www.iiop.ie for further details.

New Ways to Treat Superbug Research led by scientists in NUI Galway has identified a new way to make MRSA vulnerable to antibiotic treatment. The MRSA superbug is resistant to penicillin-type antibiotics making infections difficult to treat. The microbiology research team, discovered that when a gene called sucC in MRSA is mutated, it leads to the build-up of a molecule called succinylCoA. This increase in succinylCoA can change numerous proteins in MRSA, which makes the bacteria more sensitive to antibiotics again. The study has been published in the flagship journal of the American Society for Microbiology, mBio, and was funded by the Health Research Board and the Irish Research Council. The research was carried out by the Discipline of Microbiology at NUI Galway in collaboration with the Pacific Northwest National Laboratory and the University of Nebraska Medical Centre in the US, and the University of Umeå in Sweden. Summarising the discovery Dr Chris Campbell, co-first author and NUI Galway microbiology PhD graduate, said, “A mutation that affected the way in which MRSA uses glucose to fuel growth unexpectedly switched off antibiotic resistance.” Co-first author and NUI Galway microbiology PhD student Claire Fingleton explains, “If we can find other ways to increase succinyl-CoA in MRSA, for example by developing drugs that have the same effect, it opens up the possibility that MRSA infections can be more easily treated with antibiotics. It would mean that penicillin-type antibiotics, which are currently ineffective for MRSA infections, could become successful once more in treating this superbug.” “Penicillin-type antibiotics remain among the safest and most effective treatment options for bacterial infections, but unfortunately many bacteria including MRSA are now resistant to these drugs.” according to study co-author and NUI Galway microbiology postdoctoral fellow Dr Merve Zeden.

Accord’s Accord’s Commitment Commitment to to Biosimilars Biosimilars

At At Accord, Accord, our our mandate mandate is is to to deliver deliver aff affordable ordable medicines medicines that that make make aa real real diff difference erence to to patients’ patients’ lives. lives.

Associated member of: Associated member of:

Oncology & Oncology & Haematology Haematology

Date of preparation: February 2021 IE-01603 Date of preparation: February 2021 IE-01603

Topic Team Training – Epilepsy A community pharmacy environment that fosters teamwork ensured high levels of consumer satisfaction. This series of articles is designed for you to use as guide to assist your team in focusing on meeting ongoing CPD targets and to identify any training needs in order to keep the knowledge and skills of you and your team up to date. malformed veins or areas which have not developed normally. Genetic factors can be unique to the person or hereditary. Most people with epilepsy have no family history of it but some epilepsies are more common in some families. A low seizure threshold, which can reduce the brain's resistance to a seizure, may run in families. Some epilepsies are genetic but may not be inherited. A genetic change may be part of the person’s unique genetic makeup but may not affect their family members. Research into genetics and epilepsy is finding more and more genetic causes for epilepsy. An ambulance should be called if;

In half of cases there is no known cause. The person has no illness, disease or damage to explain epilepsy. This is called Idiopathic epilepsy. Some causes are inborn or developmental such as genetic abnormalities or structural problems in the brain like

Key Facts • 1 in 115 people in Ireland have epilepsy • That’s nearly 37,000 men, women, and children over age 5 • More than 10,000 are

Key Points: Check your pharmacy team are aware and understand the following key points:  One in every 115 people in Ireland suffer from epilepsy

 The impact of epilepsy on work, school and leisure

76 | PHARMACYNEWSIRELAND.COM

• But a person can be diagnosed on a first seizure in some cases

• Most people have no family history

 Am I, my team, aware of the importance of medication adherence in epilepsy patients?

 Am I and my team educated on offering advice to epilepsy patients?

• Diagnosis is usually based on 2 or more unprovoked seizures

• the seizure lasts over 5 minutes (where normal duration is not known) for major seizures;

Consider:

 Does my team know what to do when a patient suffers an epileptic seizure?

• Diagnosis is based on EEG, CT, MRI, other tests, history and clinical opinion

• In around 50% of cases the cause is not known

 Who is at risk of developing epilepsy

 Are the team trained in all epilepsy treatments available and the suitability to each patient group?

• More than 50 million people worldwide have epilepsy

• the seizure lasts longer than normal;

• the person is injured, pregnant, has another medical ondition or you are in any doubt.

Epilepsy is a neurological disorder which affects the brain. It is a tendency to have repeated seizures. This tendency can be long term but the seizures can be controlled meaning that a person can have epilepsy but they may not have active seizures. Seizures can start in a part of the brain or happen in both sides of the brain at once.

• Anyone can develop epilepsy at any age

• it is the first known seizure;

• there are concerns about breahting

Nearly 40,000 people in Ireland have epilepsy as do 50 million people worldwide. For many people, their epilepsy affects them most while seizures are active. For others, the impact of having epilepsy may be longer term, if their seizures continue.

• Rates of epilepsy are rising among the over 65’s

• Many people have normal tests and scans but can be diagnosed with epilepsy

• more seizures follow without recovery;

The below information, considerations and checklist provides support to enable you to run a team training session and identify opportunities for learning within the topic of Epilepsy.

children, 10,000 are women of childbearing age

 How to avoid/minimise seizure triggers  The danger of epileptic seizures  The diagnosis of epilepsy  Lifestyle tips and advice

• 70% of people have their seizures controlled by medication • But 30% continue to have seizures that are more difficult to control • Epilepsy medication is free to all on the Long Term Illness Scheme Learning Epilepsy Ireland – www.epilepsy.ie

Actions:  Include POS with associated condition treatments  Ensure efficient sign posting to further help and advice or reputable sources for epilepsy  Keep products merchandised together, along with related products to help build sales  Ensure that this important category is fully stocked at all times  Ensure that I know the recommendations for OTC medications which may impact on epilepsy sufferers  Train the team to meet all the above considerations

BE PREPARED WHEN SEIZURES STRIKE BUCCOLAM (R) is indicated for the for treatment of prolonged, convulsive seizures infants, toddlers, childreninand adolescents (from 3 children months to and <18 years). BUCCOLAM is indicated the treatment ofacute, prolonged, acute, inconvulsive seizures infants, toddlers, adolescents (from 3 months to <18 years). BUCCOLAM® must only be used by parents/carers where the patient has been diagnosed to have epilepsy. For infants between 3–6 months of age, treatment should be in a hospital setting where BUCCOLAM (R) must only be used by parents/carers where the patient has been diagnosed to have epilepsy. For infants between 3-6 months of age, treatment should be in a hospital setting where monitoring is monitoring is possible and resuscitation equipment is available. 1 Please consult the Buccolam® Summary of Product Characteristics (SmPC) before prescribing. ® possible and resuscitation equipment is available. References: 1. Buccolam . Summary of Product Characteristics. Further prescribing information is available on request from Neuraxpharm or the Summary of Product Characteristics - eMail: medinfo@neuraxpharm.com or Tel.: +353 (1) 4688 202 Marketing Authorisation Holder: Laboratories Lesvi S.L. Avinguda Joan Despi, 08970 Barcelona, Spain. Marketing Authorisation Number: EU/1/11/709/001-004 Legal Classification: POM CD. Pricing Information: POA Adverse events should be reported to: medinfo@Neuraxpharm.com - Tel: +353 (1) 4688202 or the Health Products Regulatory Authority - www.hpra.ie – e: medsafety@hpra.ie Tel +353 (1) 676 4971 Fax: +353 1 6767836 ®

Neuraxpharm is delighted to commence operations in Ireland Many of us will suffer mental or neurological disorders at some point in our lives. The wellbeing of those suffering from these disorders is at the heart of what we do. This is why we investigate and develop new solutions. Our commitment has led us to become a European leader in developing medicines for Central Nervous System disorders. We strive to support our doctors, pharmacists, nurses and the families affected. Now that we have located in Ireland, we look forward to working as part of the Irish Healthcare System, supporting patients and healthcare professionals in reducing the impact of Central Nervous System disorders in the lives of patients.

Hepatitis C

Champions of Elimination, our HCV Hepheros On World Hepatitis Day 28th July 2021, The Hepatitis C Partnership (HCP), a national Hepatitis C charity in Ireland, is highlighting the experiences of patients and healthcare workers working on the roadmap to Hep C elimination in Ireland. Written by Kristy Hayes, Advocacy and Development Officer, The Hepatitis C Partnership experienced Hepatitis C herself, could relate to the psychological impact as well as the health stigma often associated with this infection. “People feel more secure being tested in a supportive, friendly environment with guaranteed confidentiality” Susan commented.

To date, over 5,000 patients in Ireland have been treated with highly effective DAA's for Hepatitis C (HSE National Hepatitis C Treatment Programme). 95% of those who undergo treatment are successfully cured. Addiction treatment services, OST clinics, Sexual Health Clinics, and Hepatology units across Ireland have been championing efforts to find those living with an undiagnosed infection and support them to access treatment. Peer support workers have been pivotal in linking our most vulnerable and at-risk populations to care. People like Susan from Gender, Orientation, Sexual Health, HIV (GOSHH), an integrated person-centered BBV service in Limerick. Susan, having

Recent evidence from the HepCare EU project in 2019 highlighted the efficacy of highly trained peers to identify individuals exposed to HCV, achieve high rates of engagement with treatment services, and maintain high rates of treatment success amongst a population with complex needs (From peer-based to peer-led, 2019). Peers and patients have an important role to play across the HCV care continuum and it's more important than ever that we recognise and utilise their experiences as we approach World Hepatitis Day 2021. Annually, on the 28th of July patients, their families, medical practitioners, patient organisations, and researchers unite under a unified theme to raise awareness about the global burden of viral hepatitis. It is a day to celebrate the progress we have made and to continue to meet the current and future challenges. It is also

an opportunity for us to increase awareness and live up to our responsibilities to ensure Hepatitis C becomes a rare disease in Ireland. To mark World Hepatitis Day 2021, we are highlighting patients' stories as well as the fantastic work of civil society organisations and medical professionals across the HCV care cascade in Ireland. This year's theme for the HCP, “HepHeroes” celebrates the work of individuals, patients, organisations, and institutions against and despite some of the most challenging times for our health services. We are also promoting an innovative new project called RoadMap which aims to map out the current operational Cascade of Care for Hepatitis C and to identify and progress recommendations for a post-COVID-19 care pathway in Ireland. We will be calling on all stakeholders in the coming weeks to seek their input in relation to the following: imagining a greater integrated response, simplifying community-based delivery, and strengthening joint responses to HCV. We want to strengthen the efforts of our National Hepatitis C Treatment Programme in this challenging post-COVID-19 landscape. We want to look at opportunities generated and explore innovative disease management approaches such as telemedicine and digital

health. More decentralized, people-centered, and sustainable approaches to care are the only way to mitigate the disproportionate impact of this infection and its associated complications such as Cirrhosis and Liver Cancer for those who are economically disadvantaged. Every year 1.5 to 2.5% of those infected with Hepatitis C will go on to develop hepatocellular carcinoma (HPSC Hepatitis C in Ireland, 2019). Incidence rates of liver cancer in Ireland have increased by 300% in the 21-year period from 1994 to 2014. (National Cancer Registry Ireland). In Europe 21% of Liver Cancer cases are a result of HCV infection (Epidemiology of Liver Cancer, Europe). While oral medications (DAAs) have transformed treatment curing 9 out of 10, significant barriers remain in accessing our vulnerable and hard to reach populations. Stigma, high levels of undiagnosed and untreated HCV infection in Irish prisoners and PWUD populations, geographical inequalities, and a lack of accurate epidemiological data on chronic infection rates outside of OST clinics pose an ongoing challenge. We must embrace opportunities to integrate and link services and responses to provide people-centered services across regions. With a person dying every 30 seconds from a hepatitis-related illness, “Hepatitis Can't Wait” for us to act (World Hepatitis Alliance, 2021). We must innovate to drive community engagement, community-based service delivery, and community-led monitoring of Hepatitis C in Ireland. COVID-19 has demonstrated the capacity of our health service to adapt in the face of extraordinary circumstances and innovate in great haste to ensure access to care. It is our belief that these successes can and should be applied to the future management of HCV in Ireland. For more information on World Hepatitis Day visit and the Roadmap project please visit: www.hepcpartnership.ie The Hepatitis C Partnership is a member of the World Hepatitis Alliance the leading organisation fighting global efforts against viral hepatitis and a current sitting member of the National Hepatitis C Programme Advisory Group (PAG).

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MAVIRET ® is contraindicated in patients with severe hepatic impairment (Child-Pugh C) and not recommended in patients with moderate hepatic impairment (Child-Pugh B).1 * Refers to GT 1–6, excluding decompensated cirrhotic patients and liver or kidney transplant recipients. MAVIRET® is not indicated in decompensated cirrhosis. The recommended duration of MAVIRET® is 12 weeks in liver or kidney transplant recipients, with or without cirrhosis.1 ‡ Tablets should be swallowed whole, taken at the same time with food and not chewed, crushed, or broken.1 ITT = intent-to-treat Fleet Street

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Maviret ▼ 100mg/40mg film-coated tablets PRESCRIBING INFORMATION. Temple BarPRESENTATION: Each film-coated tablet contains 100 mg glecaprevir and 40 ®

mg pibrentasvir. Please refer to the Summary of Product Characteristics (SmPC) before prescribing. INDICATION: For treatment of Chronic Hepatitis C Virus (HCV) in adults and in adolescents aged 12 to <18 years. DOSAGE AND ADMINISTRATION: Oral. Treatment to be initiated and monitored by physician experienced in the management of patients with HCV infection. See SmPC for full posology. Dosage: Adults and adolescents aged 12 to <18 years: The recommended dose of Maviret is 300 mg/120 mg (three 100 mg/40 mg tablets), taken orally, once daily at the same time with food. Treatment Duration: Patients without prior HCV therapy (GT 1, 2, 3, 4, 5, 6): No cirrhosis: 8 weeks. Cirrhosis: 8 weeks. Patients who failed prior therapy with peg-IFN + ribavirin +/- sofosbuvir, or sofosbuvir + ribavirin: GT 1, 2, 4-6: No cirrhosis: 8 weeks. Cirrhosis: 12 weeks. GT 3: No cirrhosis: 16 weeks. Cirrhosis: 16 weeks. Special Populations: HIV-1 Co-infection: Follow the dosing recommendations as above. For dosing recommendations with HIV antiviral agents, refer to SmPC for additional information. Elderly: No dose adjustment required. Renal impairment: No dose adjustment required. Hepatic impairment: No dose adjustment recommended in patients with mild hepatic impairment (Child-Pugh A). Maviret is not recommended in patients with moderate hepatic impairment (Child-Pugh B) and is contraindicated in patients with severe hepatic impairment (Child-Pugh C). Liver or kidney transplant patients: 12 weeks in liver or kidney transplant recipients with or without cirrhosis, with 16 week treatment duration to be considered for GT 3-infected patients who are treatment experienced with peg-IFN + ribavirin +/- sofosbuvir, or sofosbuvir + ribavirin. Paediatric S f adjustment required in adolescents aged 12 to <18 years. Population: Noudose folk The safety and efficacy Soft Maviret in children aged less than 12 years have not yet been established. DiabeticrePatients: et Diabetics may experience improved glucose control, potentially resulting in symptomatic hypoglycaemia, after initiating HCV

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direct acting antiviral treatment. Glucose levels of diabetic patients initiating direct acting antiviral therapy should be closely monitored, particularly within the first 3 months, and their diabetic medication modified when necessary. CONTRAINDICATIONS: Hypersensitivity to the active substances or to any of the excipients. Patients with severe hepatic impairment (Child-Pugh C). Concomitant use with atazanavir containing products, atorvastatin, simvastatin, dabigatran etexilate, ethinyl oestradiol-containing products, strong P-gp and CYP3A inducers (e.g., rifampicin, carbamazepine, St. John’s wort (Hypericum perforatum), phenobarbital, phenytoin, and primidone). SPECIAL WARNINGS AND PRECAUTIONS: Hepatitis B Virus reactivation: HBV screening should be performed in all patients before initiation of treatment. HBV/HCV co-infected patients are at risk of HBV reactivation, and should, therefore, be monitored and managed according to current clinical guidelines. Hepatic impairment: Maviret is not recommended in patients with moderate hepatic impairment (Child-Pugh B) and is contraindicated in patients with severe hepatic impairment (Child-Pugh C). Patients who failed a prior regimen containing an NS5A- and/or an NS3/4A-inhibitor: GT 1-infected (and a very limited number of GT 4-infected) patients with prior failure on regimens that may confer resistance to glecaprevir/pibrentasvir were studied in the MAGELLAN-1 study. The risk of failure was, as expected, highest for those exposed to both classes. A resistance algorithm predictive of the risk for failure by baseline resistance has not been established. Accumulating double class resistance was a general finding for patients who failed re-treatment with glecaprevir/pibrentasvir in MAGELLAN-1. No re-treatment data is available for patients infected with GT 2, 3, 5 or 6. Maviret is not recommended for the re-treatment of patients with prior exposure to NS3/4A- and/or NS5A-inhibitors. Lactose: Maviret contains lactose. Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicinal product. INTERACTIONS: See SmPC for full details. Contraindicated:

References: 1. Maviret Summary of Product Characteristics. AbbVie Ltd. Available at www.medicines.ie. 2. HSE 2020, National Hepatitis C Treatment Programme Clinical Advisory

W ic k lo w S t Group Community Treatment Guidelines. Accessed January 2021. Available at: https://www.icgp.ie/go/library/catalogue/item?spId=FE497472-496A-4229-99A1783EA2C8095B. re3.eZuckerman E, Gutierrez JA, Dylla DE, et al. 8-Week Glecaprevir/Pibrentasvir Is Safe and Efficacious in Treatment-Naïve Hepatitis C Patients: An Integrated Analysis. Clinical t Gastroenterology and Hepatology 2020. IE-MAVI-210002 | Date of Preparation: February 2021

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Dabigatran etexilate, carbamazepine, phenytoin, phenobarbital, primidone, rifampicin, ethinyloestradiolcontaining products, St. John’s wort, atazanavir, atorvastatin, simvastatin. Not Recommended: darunavir, efavirenz, lopinavir/ ritonavir, lovastatin, ciclosporin doses > 100 mg per day. Use Caution: digoxin, pravastatin, rosuvastatin, fluvastatin, pitavastatin, tacrolimus. Monitor Levels: Digoxin, Monitor INR with all vitamin K antagonists. No dose adjustment: Losartan, valsartan, sofosbuvir, raltegravir, elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide, levonorgestrel, norethidrone or norgestimate as contraceptive progestogen. FERTILITY, PREGNANCY AND LACTATION: Maviret is not recommended in pregnancy. It is not known whether Maviret and its metabolites are excreted in breast milk. No human data on the effect of glecaprevir and/or pibrentasvir on fertility are available. SIDE EFFECTS: See SmPC for full details. Very common side effects (≥1/10): headache, fatigue. Common side effects (≥1/100 to <1/10): diarrhoea, nausea, asthenia. Frequency not known (cannot be estimated from the available data): pruritus.

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▼ 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; website: www.hpra.ie. Suspected adverse events should also be reported to AbbVie Limited on 01-4287900. LEGAL CATEGORY: POM(S1A) MARKETING AUTHORISATION NUMBER/ PRESENTATIONS: EU/1/17/1213/001 – blister packs containing 84 (4 x 21) filmcoated tablets. MARKETING AUTHORISATION HOLDER: AbbVie Deutschland GmbH & Co. KG, Knollstrasse, 67061 Ludwigshafen, Germany. Further information is available from AbbVie Limited, 14 Riverwalk, Citywest Business Campus, Dublin 24, Ireland. DATE OF REVISION: January 2020. PI/1213/008.

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News

Pharmacy Automation: Crucial Part of Health

The global pharmacy automation market exhibited strong growth during 2015-2020, according to the latest market research report: Global Pharmacy Automation Market Report 2021: Industry Trends, Share, Size, Growth, Opportunity and Forecast.

ooking forward, the global pharmacy automation market is expected to grow at a CAGR of around 7% during the forecast period (2021-2026). Pharmacy automation refers to the use of mechanized systems for digitalizing medical and healthcare workflow processes. These systems aid in performing multiple functions to systematize routine tasks and reduce human intervention. Some of these tasks include inventory management, click & collect of medication and the last mile from the pharmacy to the customer. They also aid in eliminating errors during the preparation of prescriptions. The increasing need to reduce errors in medical processes, along with the decentralization of pharmacies, represent as the key factors driving the growth of the market. Pharmacy automation is becoming a crucial component of the modern healthcare industry, as they are highly flexible and self-adaptive.

Pharmacy robots have improved the way in which pharmacies operate, capable of storing, administering, filling prescription medications effectively and securely. A robotic medicine dispensing machine can dramatically increases prescription preparation efficiency in comparison to manual operations. This can significantly reduce the waiting time for patients leading to higher patient satisfaction. The need for automated drug dispensing systems has been further driven by their ability to allow community pharmacists to engage in more effective time management, allowing them to spend longer engaging with consumers. They also help address organisation within the pharmacy, something many have struggled with owing to issues such as similarities across medicines packaging and naming. Other factors, including the implementation of various government policies to make quality healthcare facilities accessible to all and the utilization of robots for

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maximizing medical storage and dispensing prescriptions, are projected to drive the market in the coming years. The emergence of automation within the community pharmacy setting has been gathering pace for some time. The idea of using robots in the dispensing of medicines is not a new one. Automated dispensing devices have been used widely in hospitals around the world since the mid-1990s as a way of reducing medication errors, improving patient safety and increasing efficiencies. Over the last decade these devices have expanded into community pharmacy settings as financial pressures have driven the search for efficiencies. The traditional task of community pharmacists lies in providing their patients with the required medication; but yet the mechanics of this are renowned for being tedious and repetitive. This is, of course in addition to the realms of human error. However in the world of automation, pharmacists are finding

solutions. Robots rarely make errors, they don’t get bored or distracted. Furthermore, they give pharmacists and technicians the glorious gift of time, valuable time with their patients and customers for more profitable clinical services. Over the last few years, automation is becoming more widely embraced in Ireland. Developing innovations for the patient and pharmacists is something that drives the team at BD Rowa, whose developers work tirelessly on innovative products to overcome the new challenges in healthcare and other sectors. Pharmacy robots from BD Rowa™ offer more space and flexibility right across the board. Pharmacists get more time for their customers, more space for their ideas, and more availability for their employees and themselves. Next issue of Irish Pharmacy News will feature an exclusive talk with BD Rowa looking in more detail about this expanding market and their offerings within community pharmacy in Ireland.

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Cyber Security

Employing Cyber Resilience Almost two months ago, the Health Service Executive (HSE) of Ireland was hit by a ransomware attack that represented the most significant cybercrime attack on the Irish state to date and understood to be the responsibility of a criminal actors using Conti Ransomware. Written by Nick Emanuel, Senior Director of Product at Webroot, an OpenText Company

help there from vendor guides, government advice and of course bringing in expert help though an IT Security provider. Ambulance services, GP and pharmacy systems were not directly hit but the impact was, and continues to be felt community wide…so the question is what can I do about it, how does it affect a Community Pharmacy?

Despite the growth in attacks, the National Cyber Security Centre, which advises Government on cyber threats, has an annual budget of just ¤5 million and no dedicated headquarters nor Director.

2. Deploy the community Install reputable cyber-security software that uses real-time threat intelligence gathered from devices all over the globe to protect users by blocking attacks.

Given the pandemic and the widespread shifts and disruptions over the past year, we have all been faced with re-evaluating our ability to face unprecedented threats or preventing ransomware attacks.

Are there practical steps community healthcare providers can take? The good news is yes, you can reduce both risk and impact of an attack by increasing overall cyber awareness as a business, an effect we call ‘cyber resilience’

3. School is in! - training staff about phishing and spam, and common techniques used by criminals is easy with a range of Security Awareness training products. Look for one that specializes in micro-learning (bite size chunks) to help busy pharmacies and staff get trained with minimum disruption.

Some ask if it’s even possible to mount a cyber defence with the view that Government has deep pockets and expertise and it still couldn’t prevent a devastating and disruptive attack. Still others will say I’m too small to be targeted. The EU Agency for Cybersecurity (ENISA) regards the health sector as vulnerable to cyber incidents and crises, noting in their 2019 Threat Landscape report that “more than 66% of healthcare organisations experienced a ransomware attack in 2019.” The FBI identified at least 16 Conti ransomware attacks targeting U.S. healthcare and first responder networks in the year prior to the attack on the HSE.

Think of cyber resilience as digital fitness. It’s the ability to keep moving forward in the face of adverse cyber threats. Understanding the threat, taking precautions, and layering security will lower the risk to you, and should the worst happen, reduce the disruption, and allow for quicker recovery. Here are some cyber resilience tips that busy pharmacy and dispensary teams can put in place and improve their digital fitness. 1. You won’t be an expert in a day, it takes time to reach a healthy level of cyber awareness! There is a lot of

4. Make it tougher for the bad guys - don’t share accounts or passwords, not with each other or with other programmes/ software. Reinforce a strong password policy and make multi-factor authentication mandatory wherever possible. 5. Be cautious of the free tool - Free email accounts like Hotmail, Gmail or similar can be tempting, but a secure, managed email account from an IT provider with Anti-Spam and Phishing controls will make you less vulnerable to many common attacks.

6. Upgrade and Patch - Few treatments are one pill and done, and they need to be taken on time. You PC or device is the same – upgrade to the newest operating system and update/ patch software. Take advantage of the security protection that vendors have rolled into those upgrades to combat new threats. 7. Back Up - Shake out and test your data backup plans. Ask yourself: is everyone/every device covered, is the data being successfully backed-up, have you tested recovering your data, are the back-ups secured off site or in the cloud? Prescriptions are templates with unique additions to tailor treatment to the patient, your digital fitness is similar. By ensuring staff understand they play a critical role in ensuring security, adopting a cyber resilient mind set and taking precautions you can keep safe from a range of common threats and be more cyber resilient!

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Cyber Security

8 Simple Steps for Securing your Community Pharmacy The HSE ransomware attack is no longer dominating the news but the HSE is still feeling its aftereffects. Despite being given a decrypt key for its data, it will cost the HSE at least €100m and months of work to restore its systems. Of course, the HSE has support from the exchequer and access to expert help. Small businesses including community pharmacies do not have these luxuries, so prevention is especially important. Simon Woodworth BSc MSc PhD Director, MSc in Cyber Risk for Business, Cork University Business School

online research and pick one that suits your business. Don’t have two antivirus products installed and running at the same time. Step 4: Mind your accounts and passwords

Step 1: Operating System fully licenced and up to date All your PCs should be running Windows 10. Windows 7 is out of support. This means that if a bug is discovered in Windows 7 and Windows 10, then only Windows 10 will be patched. As the bug and patch have been made public, this makes your Windows 7 system even more vulnerable because an exploit is much easier to develop. Note that is it possible sometimes to upgrade to Windows 10 using your existing Windows 7 license key.

Every user should have their own account and passwords for login to any application should be secure. In general, passwords should be at minimum 12 characters long and contain small letters, capitals, numbers, and symbols. These can be very hard to remember, though. Try coming up with longer passwords made up of 4 words strung together, which make a scene that you can recall easily. Never pick a password that contains personal or work-related information. As mentioned in Step 1, most users do not need and should not have admin privileges. This limits the damage an inexperienced staff member can do to your systems, and it can also limit the damage

Step 2: Software fully licenced and up to date All your pharmacy, accounting and office software should also be fully up to date and fully licensed. This ensures that you receive all the necessary patches and bug fixes when available. Pharmacy PCs should NOT be used for any purpose other than business and staff should not have admin privileges to install new software or change settings. Step 3: Antivirus installed At minimum you should have Windows Defender switched on and up to date. This provides adequate protection, but you may prefer your own antivirus product. There are many to choose from and some are free, so do some

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a virus or malware can do if accidentally downloaded. Step 5: Secure your router and network No customer should have access to your network. Make sure you change the default username and password on your broadband router. If you offer customer WiFi, it must be kept separate from your business WiFi and LAN. Your router may support such a setup. If not, adding a second cheap router and connecting it to your network via its WAN port will provide a simple way of keeping customers away from your business data. Step 6: Make backups Your pharmacy most likely uses online applications that back up your data elsewhere. Check that this is the case. For your local files and applications, consider backup up to a USB drive that can be removed from the premises. Alternatively, subscribe to a cloud backup service like Microsoft OneDrive or Google Drive. Remember that all backups should be tested regularly, otherwise they may let you down. Step 7: Don’t click that link! This step and the next are all about staff awareness. First, never click on a link on an unsolicited email or

an unfamiliar website. This is how ransomware attackers gain access to your systems. It’s much easier to fool a member of staff into doing something silly than hack into your computers. For similar reasons, avoid plugging in USB drives unless you are absolutely certain it is from a known trusted source. Step 8: Beware of scams and frauds Small business can be particularly vulnerable to invoice fraud. This is where a fraudster submits a fake invoice for a known supplier, with different bank details. Always check the bank details are those originally provided by the supplier from a legitimate email or postal address. Beware of other phone or email attempts to extract banking or personal details. Never provide passwords or PIN numbers over the phone. In conclusion, there are a number of technical steps you can take to make your pharmacy secure and to greatly reduce the risk of damage from a cyberattack. However, technical security solutions are worthless unless staff are properly trained on the safe use of the computers in your business. They need to be very aware of potential scams and frauds. Securing your pharmacy properly will build trust with your customers and suppliers.

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Rheumatoid Arthritis Clinical Presentation, Diagnosis and Pharmacological Treatment (DMARD’s)

heumatoid arthritis (RA) is a chronic systemic inflammatory autoimmune condition with periods of exacerbation and remission, characterized by synovitis and joint destruction mediated by cytokines, chemokines, and metalloproteases. RA can affect any body part but most commonly the peripheral joints, interphalangeal, metacarpophalangeal and wrist, as well as the ankles and metatarsophalangeal joints, leading to progressive destruction of articular structures and accompanied by systemic symptoms. Triggers and etiology of RA are unclear but hormones, genetics, stress, smoking and environmental factors are thought to be contributing factors. An autoimmune etiology is currently the most widely accepted.

affects the hands and/or feet, although any joint lined by a synovial membrane may be involved. Severity fluctuates over time, but chronic RA results in the progressive development of various degrees of joint destruction, deformity, and a significant decline in functional status. Extra-articular involvement of organs such as the skin, heart, lungs, and eyes can also be significant.

Clinical features and presentation of rheumatoid arthritis

A diagnosis of RA is based on specific clinical, laboratory and imaging features and the ACR/EULAR Classification Criteria. The ACR ‘RA Disease Activity Measures’, define the ranges and level of disease activity. All patients with suspected RA should be referred urgently to a rheumatologist.

Approximately 10% of patients with rheumatoid arthritis have an abrupt onset, but in most cases onset is insidious and initial presenting symptoms can be vague, including fatigue, malaise, morning stiffness, weight loss and low-grade fever. Progression of the illness leads to joint inflammation and swelling which causes difficulty performing activities of daily living, such as dressing, standing, walking, or use of the hands. Clinical features of RA are persistent symmetric polyarthritis (synovitis) which

Patients with RA are at an increased risk of co-morbidities such as CVD, severe infections, and over-lapping autoimmune disease, e.g. mixed connective tissue diseases, autoimmune thyroiditis and lymphoma.

Criteria for diagnosis of rheumatoid arthritis

Medical history refers to current presenting symptoms, past medical history, family medical history, medications including any OTC medications, allergies and lifestyle factors such as smoking and alcohol intake. Presenting symptom history includes

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Written by Theresa Lowry-Lehnen (PhD) CNS, GPN, RNP and National PRO Irish General Practice Nurses Educational Association questions about the type, duration, location and pattern of pain experienced, how it affects mobility and lifestyle, and whether it is affecting sleep and causing fatigue. Past medical history and other medical illnesses will be discussed as some medical problems tend to occur along with RA and may be suggestive of the disease. A family medical history is important due to the hereditary component to RA, and information about any close relative with the condition or any other autoimmune disease will provide more information on the individual’s risk. Smoking is a high risk factor, and alcohol which effects the liver, can promote inflammation and interact with some NSAID and methotrexate medication. Therefore, a knowledge of lifestyle factors is also important in the diagnosis and treatment of RA. Physical examination is a key part of the assessment process. In addition to checking general vital signs, including temperature, blood pressure, pulse rate, heart and lung function, the doctor will

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jected under the skinAMGEVITA® (a subcutaneous injection) withpen 40mg SureClick® Pre-filled ned pen called SureClick® or using a pre-filled syringe. You should inject in the tummy, or the tops of your legs ( see diagram below.

The medicine travels into your bloodstream to work on t that are inflamed and causing your symptoms.

AMGEVITA® 20mg Pre-filled syringe Your doctor, pharmacist or nurse will show t in the tummy, or the tops of your legs (thighs), you or your parent/carer how to give the ow. injection. It’s important the injection is given correctly it to avels into your bloodstream tofor work onwork. the areas

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d and causing your symptoms. You may have the injection in hospital or at home. You can give it to yourself or your parent/carer can do this for you. Usually, the ® RIGHT armacist or nurse willinjection show AMGEVITA 40mg Pre-filled syringebut your is given every 2LEFT weeks, ent/carer how to givedoctor the may change this to best suit what portant the injection is givenfor you. works o work. You need to follow the advice of your he injection in hospital or healthcare team and ask to speak to them n give it to yourself or yourare not feeling well. if you available on request n do Further this information for you.is Usually, the or in the Summary of Product Characteristics (SmPC) at www.medicines.ie. For full and detailed instructions on how to n every 2 weeks, but your administer your AMGEVITA®, please read the A nge this to best suit what instructions provided in the product carton. ©2021 Amgen Inc. All rights reserved. IE-AMB-0321-00001. Date of preparation: April 2021.

▼This medicinal product is subject to additional monitoring. Adverse events should be reported directly 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 Amgen Limited on +44 (0)1223 436441.

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Indications: AMGEVITA is indicated for the treatment of rheumatoid arthritis, juvenile C axial spondyloarthritis, psoriatic arthritis, psoriasis, paediatric B idiopathic arthritis,

ow the advice of your and ask to speak to them eling well. ®

Marketing Authorisation Holders: Amgen Europe B.V., Minervum 7061, NL-4817 ZK Breda, The Netherlands.

plaque psoriasis, hidradenitis suppurativa, Crohn’s disease, paediatric Crohn’s disease, ulcerative colitis, uveitis and paediatric uveitis. For full indications and more information, see full Summary of Product Characteristics.

The ACR/EULAR Classification Criteria, is associated with a point value. Diagnosis of RA can be made when a total of 6 points or more is reached across the separate criteria. used in combination with methotrexate or as monotherapy if patients have contraindications or are intolerant of methotrexate. Concurrent use of tsDMARDS with bDMARDs is however contraindicated and tsDMARDs cannot be used with live vaccines. Combination therapy which allows for lower dosage of an individual drug, may reduce the risk of adverse effects that can occur with higher doses. Methotrexate, leflunomide and sulfasalazine have similar efficacy, however methotrexate is considered the ‘anchor drug’ for the treatment of RA. It is prescribed in up to 70% of patients as a monotherapy or as combination therapy with other DMARDs. evaluate the patient’s joints in detail, paying particular attention to function, swelling, and pain. The physical exam will help determine the severity of the illness and help guide treatment decisions. Laboratory blood tests required to determine a diagnosis suggestive of RA or inflammatory disease include: • Rheumatoid factor (RF) • Anti-citrullinated protein antibodies (ACPA) (including anti-CCP and antiMCV antibody tests) • Erythrocyte sedimentation rate (ESR) • C-reactive protein (CRP) • Antinuclear antibody (ANA) • Full blood count (FBC) Imaging tests include x-rays taken of symptomatic joints which can reveal signs of joint involvement (inflammation) and damage (bone erosion) indicative of RA. Other imaging tests useful in diagnosis of RA include magnetic resonance imaging (MRI) and ultrasound. The ACR/EULAR Classification Criteria, is associated with a point value. Diagnosis of RA can be made when a total of 6 points or more is reached across the separate criteria.

DMARD’s and the pharmacological treatment of rheumatoid arthritis Current pharmacological management of RA includes the initiation of DMARDs by a rheumatologist and medication for symptom control such as a corticosteroid. The lowest dose possible for the shortest period of time is recommended when using corticosteroids. NSAIDs are typically prescribed to control pain and inflammation in the RA patient. The ACR and EULAR guidelines recommend that if used NSAIDs be prescribed in the lowest dose that provides symptom relief, and the dose reduced when a good response to DMARDs is achieved. DMARDs, (Disease-modifying antirheumatic drugs) are also called immunesuppressive or slow-acting anti-rheumatic drugs (SAARDs). They are classed in two major groups; synthetic (sDMARDs) and biological (bDMARDs). These groups are then further subdivided and classed as conventional synthetic (csDMARDs) or targeted synthetic (tsDMARDs). Conventional synthetic (csDMARDs) include methotrexate, leflunomide and sulfasalazine. Targeted synthetic DMARDs (tsDMARDs) example Tofacitinib and Baricitinib are a new therapeutic class that inhibit JAK (Janus kinase inhibitors). They can be

ACR recommendations for the measurement of RA disease activity. ACR recommendations for the measurement of RA disease activity

DMARD’s and the pharmacological treatment of rheumatoid arthritis

88 | PHARMACYNEWSIRELAND.COM Current pharmacological management of RA includes the initiation of DMARDs by a rheumatologist and medication for symptom control such as a corticosteroid. The lowest dose

Methotrexate as the DMARD of choice in the treatment of rheumatoid arthritis Methotrexate (MTX), a disease-modifying anti-rheumatic drug (DMARD), interferes with the production and maintenance of DNA, the genetic material in the cells of the body. It is not known exactly how methotrexate works in rheumatoid arthritis, but it can reduce inflammation and slow progression of the illness. Methotrexate is the most common DMARD used to treat rheumatoid arthritis. It may be used in the early stages to prevent progression of the illness and in combination with other DMARDs. It is effective in relieving joint inflammation and pain, slowing RA progression, and preventing disability by delaying joint destruction. Methotrexate produces a beneficial effect in 2-6 weeks and is given once weekly. The initial weekly dose is 7.5-15 mg but can be increased up to 25mg per week if required, based on assessment of response and side effects. It can be administered by oral, intramuscular or subcutaneous routes. Rheumatoid arthritis patients taking methotrexate must be monitored closely for signs of infection and require regular FBC, LFT and renal function blood tests. Intensive monitoring is required when initiating therapy, changing doses and in patients with co-morbidities. FBC, LFTs and U&Es are required every two weeks when initiating therapy until blood tests are stable for 6 weeks. This is followed by monthly blood tests until the dosage and illness is stable for 1 year. Thereafter, blood test monitoring may be reduced in frequency to every 2-3 months based on clinical judgement and discussion with the specialist team. Patients must be closely monitored when taking methotrexate as it is associated with many adverse side effects including infections, gastrointestinal problems, leukopenia, headache, dizziness; fatigue, raised LFTs, rash and alopecia. Some side effects may be

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FIND OUT MORE AT GSKHEALTHPARTNER.COM *compared to standard paracetamol. **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, StevensJohnson 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-21-00017.

reduced by taking folic acid at a dose of at least 5mg/week, taken on a different day from the methotrexate. Patient education about their weekly methotrexate regimen, folic acid requirement and the risk of drug interactions is important as a number of medications such as salicylates, hypoglycaemics, sulphonamides, phenytoin, and trimethoprim have the potential to interact with methotrexate. Drug interactions can enhance the action of methotrexate resulting in an increased risk of methotrexate toxicity. Live

vaccines should be avoided, however, flu and pneumococcal vaccination is recommended. Screening for TB and infections such as hepatitis B and C should be performed prior to initiating treatment and screening for varicella zoster is also recommended by some experts. It is advisable that if a person with RA develops an infection, requires antibiotic treatment or develops shingles or chicken pox, that they stop taking their antirheumatic medication until the infection has cleared. Advice on smoking cessation, contraception when applicable, and the risks associated with alcohol consumption

while taking methotrexate should be provided for the patient. Assessment, monitoring, audit and evaluation for disease activity, progression, and effects of the therapeutic regime on a patient with rheumatoid arthritis is a continuous process. Implementing person-centred care, monitoring and evaluating symptoms, outcomes and responses to therapy plays a pivotal role in managing the illness and improving the patient’s quality of life. References available on request

Third Level Places for Pharmacy Additional places for medicine and pharmacy students in universities will be included in a plan by Minister for Further and Higher Education Simon Harris to create 4,500 extra third-level places, it has emerged. indicated that the Minister for Higher Education Simon Harris TD is seeking approval to fund 4,600 new third level places, with pharmacy being among the areas set to benefit.

A spokesperson for Mr Harris has been unable to confirm as yet, how many extra places will be created.

Welcoming the proposal Secretary General of the Irish Pharmacy Union Darragh O’Loughlin said, “Pharmacy is an exciting and diverse career that offers practitioners the opportunity to play an active role on the frontline of healthcare in their communities. There has always been a high demand for the limited number of third level places in Ireland. Many students have been required to study in the UK, which is now more complicated because of Brexit. Any increase in the provision of third level pharmacy education would be extremely welcome.

The Irish Pharmacy Union (IPU) has welcomed a proposed increase in the number of third level places for pharmacy students. Reports have

“As evidenced by our efforts in the COVID-19 vaccination rollout the role of the pharmacist has expanded and should expand more in the

years ahead. As Sláintecare is implemented it will place care in the community at its core, the very essence of community pharmacies. All of this indicates there will be a sharp increase in the demand for pharmacists and it is appropriate that the education system prepares for this. “Throughout the pandemic, when GPs and other healthcare providers were unavailable, many people sought advice from their community pharmacy. The dispensing of medicines is of vital importance to the wider health system and requires significant expertise when managing medicines for patients with complex needs. Our universities currently offer an excellent level of training and graduates are in high demand due to their knowledge and expertise. With an increase in pharmacy places the Irish population will benefit from this expertise in their local communities.”

McKesson Ireland ‘Best Employers’ Accolade McKesson Ireland were delighted to have been recently listed in “The Sunday Independent/Statista list of Ireland’s 150 Best Employers. This list is based on a comprehensive research project of companies with more than 200 employees. It comprised of tens of thousands of evaluations, the opinions of thousands of employees and the scores for hundreds of companies. A spokesperson commented, “At McKesson Ireland our workplace culture follows the principles of Integrity, Customer-First, Accountability, Respect and Excellence (ICARE) and they are the foundation for our interactions with our customers, our business partners and with each other. Our shared values guide us in our mission of improving healthcare in every setting- one product, one partner, one patient at a time. “Our aim at McKesson Ireland is to move up on the list next year!”

New packaging for TheaPamex TheaPamex, Ireland’s No 1 choice for Eye Health, is raising its bar with its new OTC packaging! Starting from June its OTC product portfolio will be fully upgraded with a new, more dynamic and consumer-friendly packaging. Best selling eye care solutions such as the award winning Thealoz Duo eye drops, Hyabak, Blephaclean (Ireland’s number one daily eyelid cleanser) will now enjoy a new packaging that will communicate more efficiently and effectively their core characteristics and benefits while also being much more eye catching on the pharmacy shelves helping both Pharmacists and patients choose their ideal solution. TheaPamex’s new branding is meant to reflect the company’s ongoing dedication to providing simply the best, most innovative, 100% preservative free eye health solutions for all. Most importantly, all of its core features and formulations are remaining unchanged. TheaPamex will still be making its products with the same premium quality, honest, and natural standards that has been widely known for many years.

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Business CPD

The Future of Pharmacy - Part 2 Optimising Sales – Promotion Beyond Category Management LEARNING OUTCOMES

In the July Busines CPD article,

P – Promoting a culture of

IPN 4Front Pharmacy Business Excellence Article JUNE 2021 we identified 4Front’s Personal excellence that is open and honest,

At the end of article, you will be able to… • Outline how 4Front’s Promotion pillar is influenced by the other 5P’s of Pharmacy Excellence • Define ‘Promotion’ • Recognise FIVE trends in community pharmacy to inform your promotion strategy • Explain how you can leverage these trends to influence your customer experience • Identify ways that 4Front’s STEPS™ Consultation Framework can improve the Pharmacy/Patient Consultation and enhance professional reputation and sales.

• Prioritise your highest leverage activities • Take action INTRODUCTION:

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.

leadership pillar as the foundation amplifies individual and collective of Pharmacy Excellence. In this strengths and encourages growth. article we focus on 4Front’s Through collaborative teamwork, Promotion pillar. What does customer care, commitment, accountability and results are ‘Promotion’ mean in in the context multiplied. Tragically, many of 4Front’s 6Ps of Pharmacy pharmacy workplaces promote Excellence? What current and a more fear-based culture in future trends are affecting how which ‘Accidental Diminishers’ Pharmacy Promotes it value? (Liz Wiseman) dominate. These How does mastery of Promotion workplaces drain energy and foster depend on mastery of the dysfunctional cultures, which Personal Leadership pillar? What may be described as controlling, can you do to respond to market political, paternalistic, hierarchical, trends and promote the value of rigid, risk-averse, individualistic, pharmacy in a way that future In this article we take a deep dive into what ‘Personal Leadership’ means in in the context of constantly crisis, passive proofs6Ps your career, your business 4Front’s of Pharmacy Excellence and why Personal Leadership is THE in critical foundation on which personal, professional and business life mastery isetc. founded. Such cultures may have and our profession? individuals that get overwhelmed doing everything, but also keep colleagues helpless by rescuing them. If you’re workplace has an unhealthy work culture, that energy is promoted to customers, locums and your community. (People).

P – By wholeheartedly executing integrated promotional strategies, you quickly gather data to identify the degree to which your existing In this series, you will apply 4Front’s 6P’s of Pharmacy Excellence and innovative products and to navigate the ‘Future of Pharmacy.’ services solve your customers’ problems and meet their needs. 4Front’s 6P’s of Pharmacy Excellence are Half-hearted or unfocused 1. Personal Leadership promotion of products and services, or lack of appropriate 2. Professional Practice reflection about the effectiveness Promotion is a key pillarfrom of the inside out, its of While personal leadership develops effects felt not only by you and thearepromotional strategy limit 3. Person-Centred Care (Patients/Customers/Staff/Other your family, but Excellence. also by your employees, colleagues and your Pharmacy Withyour customers, your success. (Products community. Furthermore, without a strong personal leadership foundation, the other 5Ps and Services). Healthcare Professionals) an excellent ability to promote suffer. (see image above) P – By proactively creating the value of health, the value 4. Products and Services • P - Making ethical decisionsof becomes difficult (Professional). promotional of pharmacy, the value your increasingly customer-centric • P - Demonstrating empathy in teamwork, customerstrategies care and conflict becomes that enrich your products and services, and 5. Promotion increasingly limited (People). customer’s experience, you the value of your professional 6. Prosperity (Profit and Time) inspire trust, goodwill, loyalty and expertise, your ability to add value Rachel Dungan – 4Front Pharmacy 31 May 2021 prosperity. By habitually having a to your patients and customers is Each month, Rachel Dungan ‘The Pharmacist Coach,’ guides you short-term, hap-hazard, reactive amplified. (see image above) to apply 4Front’s 6Ps of Pharmacy Excellence Framework to approach, much time is often P – Continual personal growth create your pharmacy future. While Rachel is the creator of this wasted on low value activities framework and the author of these articles, YOU are the author of enables you to promote the value that do not give you a return of your skills, behaviours and on your time or financial your career, your future. The future of pharmacy is in your hands, experiences in interviews, business investment. (Prosperity) in your heart, in your head. and professional contexts and in What is ‘Promotion’? customer consultations. Personal Your mission, should you choose to accept it, is to use this stagnation, on the other hand, framework as a guide to Dictionary definitions of increases the risk of rigid thinking, ‘promotion’ fall into three main • (re)activate your inner scientist, so you run the experiments playing small, holding back and categories. Promotion is: required to take your next bold move towards an ever more waiting for others to act. (Personal) - activity that supports or provides compelling future P – Promoting the value of health active encouragement for the and the value of pharmacy are • develop mastery as you embrace your challenges furtherance of a cause, venture, PSI core competencies. Those and opportunities or aim e.g. "disease prevention who hold conflicting beliefs about and health promotion" • take PRIDE in what you do as you create an ever more professionalism and promotion may hold back from developing - the publicisation of a product, prosperous future mastery in this core competency service, organisation, or venture • equip, enable, engage and empower yourself, your team and and risk unintentionally slipping so as to increase sales or public your patients to become more proactive about managing your awareness e.g. “promotion of into passivity, blame or judgement. pharmacy vaccination services” (Professional) own health and wellbeing. Page

IPN is proud to partner with 4Front Pharmacy to bring you the ‘IPN/4Front Pharmacy Business Excellence Series.’

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93 - the action of raising a person or profession to a higher position or rank “pharmacist designated for promotion to group superintendent"·

- Which are sabotaging you (and your team) from serving others?

- More recognition that mental fitness is part of overall health

- What could you and your team do to begin to bridge any gaps?

In pharmacy, the word promotion is used in all these contexts.

FIVE trends in community pharmacy to inform your promotion strategy

This shift is reflected in changes in the front of shop sales mix in pharmacies. For example, in many pharmacies, there has been a significant decrease in sales of OTC Cough, Cold and Children’s Analgesics and a corresponding increase in sales in the Vitamin, Mineral and Supplement Categories.

In a marketing context, pharmacy promotion refers to any type of marketing communication used to inform your customers, patients and community of the value of pharmacy in general, your pharmacy and brand in particular and the relative merits of your products and services. In a health context, ‘Health Promotion’ is a PSI Core Competency. Health promotion is, as stated in the 1986 World Health Organization (WHO) Ottawa Charter for Health Promotion, "the process of enabling people to increase control over, and to improve, their health.

1. The Accelerated Shift from Reacting to Illness Towards Whole-Person Wellness 2. Shift in Healthcare Access and Use During COVID-19 3. The Accelerated Shift from Real World to Virtual 4. Trend Towards Diversity and Inclusivity in an epidemic of Loneliness and Isolation 5. Shift in the balance of Power in the Patient/Pharmacy Relationship

Promotion Challenges and Opportunities Pharmacy has a present opportunity to - promote itself more and more as care destinations, at the heart of the community, - to be seen as a one-stop shop, in sickness and in health, - to partner with patients to move up the illness-wellness continuum, towards optimal health.

patients continue to limit pharmacy visits and instead avail of delivery via representatives, or pharmacy delivery services. Promotion Challenges and Opportunities How patients engage with staff, products and services to inform their buying decision has changed. In the past, patients had to physically attend their GP, walk in the door of the pharmacy, bearing a physical prescription and personally collect their medications, beauty or OTC products. In so doing, they walked passed your window display, visual displays, merchandise, shelf talkers and offers. 3. The Accelerated Shift from Real World to Virtual Remote working. Healthmail. Telehealth & Video conferencing. Cyber-Security. Alexa. Chat bots. Mobile commerce. Data analytics. Wearable technology. Machine Learning. Growing demand for Personal, Video Communication.

The aim of promotion is to increase awareness, create interest, generate sales and enhance personal and professional reputation and/or brand loyalty.

These five trends have fundamentally changed how your current and future patients take care of their own health and wellbeing, navigate the health system, and engage with your pharmacy.

What is your attitude to Marketing and Promotion?

IPN 4Front Pharmacy Business 2.Excellence Article Access AUG 2021 Reacting to Illness Towards Shift in Healthcare and With more virtual freedom,

For Seth Godin when he uses the work ‘marketing’ he means ‘the generous act of helping others become who they seek to become. It involves creating honest stories – stories that resonate and spread. Marketers offer solutions, opportunities for people to solve their problems and move forward.’ When YOU use the word ‘marketing,’ - What does it mean to you? - What judgements do you have about marketers and marketing? - Do you see yourself as a marketer? As a promoter? - To what degree do you see marketing and promotion as a core competency? - What feelings and emotions surface as you contemplate marketing and promotion in a professional context?

1. The Accelerated Shift from

- Support more people, to live well, for longer, at home it is not only good for communities. It is good for business.

Optimising Wellness

Use During COVID-19

Promotion Challenges and Opportunities

pharmacies need to be more proactive to build and maintain Pre-COVID, the consumer trend During the pandemic, customer loyalty. Keeping up already indicated a move AWAY The Accelerated Shift from Reacting to Illness Towards Optimising Wellnesspace of with the breathtaking from the more passive symptom GP practices shifted from Pre-COVID, the consumer trend already indicated a move AWAY from the morecan passive technology changes be management approach to health almost exclusively in-person daunting. However, learning symptom management approach to health TOWARDS a more proactive approach to TOWARDS a more proactive consultations to predominantly how to capture the attention of approach disease prevention, phone consultations. disease to prevention, lifestyle interventions and whole-person wellbeing. The following are your patients and add value to lifestyle interventions and wholeexamples of some of the factors the change. them on a 12cm x 6cm screen Many patient supports, such person wellbeing. The following are - accelerating (their phone) is a non-negotiable as to out-patient clinics, dental, Necessity. With access healthcare hugely curtailed, patients sought ways to examples -of some of the factors promotional requirement and a physiotherapy and other accelerating the change. take matters into their healthcare own hands to reduce their health risks. huge opportunity for those that appointments were master it. of all respiratory - Necessity. access to - With Increased public healthpostponed education, has reduced transmission indefinitely. healthcare hugely curtailed, infections. 4. Trend Towards Diversity and - At a time of great uncertainty, patients sought ways to take in an epidemic and worry, pharmacy was awareness impact of our lifestyle choicesInclusivity (for better and worse)ofon matters-intoMore their own hands to of thefear Loneliness and Isolation one of the few parts of the reduce theirour health risks. health healthcare system that stayed is increasing awareness that - public Morehealth recognition that open mental fitness part of overallThere health - Increased to the public,isfor in-person people do not need to live alone to education, has reduced consultations. Public trust in feel misunderstood, marginalised transmission of all respiratory local pharmacists remains high. or pharmacies. lonely. The COVID-19 This shift is reflected in changes in the front of shop sales mix in For pandemic infections. Veracity Index 2021 (ipsos.com) has affected different generations, example, in many pharmacies, there has been a significant decrease in sales of OTC different cultures, people working However, due to ongoing - More awareness of the impact Cough, Cold choices and Children’s andregard a corresponding increase in industries sales in the concerns with to COVID in different and people of our lifestyle (for better Analgesics transmissibility indoors, many with different health care conditions and worse)Mineral on our health Vitamin, and Supplement Categories. Image Attributed to John W Travis MD

- From your perspective, how should other people respond to your marketing and promotion? - How do you feel if their response doesn’t meet your expecations? - How would each member of your team answer these questions? How do you know? - Which of these meanings, feelings, identities and judgements about marketing and promotion are enabling you (and your team) to serve others at the highest level?

Image Attributed to John W Travis MD

PHARMACYNEWSIRELAND.COM

IPN 4Front Pharmacy Business Excellence Article AUG 2021

Business CPD--

offer context specific advice (not generic) and safety net with (not for) your patient.

in different ways. Pharmacies that proactively respond to diverse customer needs, and communicate how they are listening and adapting, will have a competitive advantage. Mitigate Against Unconscious Bias Sensory Input matters. Visuals and colour in category management matters. Words matter. Scents and tastes matter. Texture and experience matters. Context matters. Identical inputs can mean very different things to each of us. Not everybody thinks like you! themselves. I have found that when Constant And Never Ending patients both inside your The meaning we attach is driven Feedback (CANI). It requires that both pharmacists and patients pharmacy and inside by (often) unconscious, habitual youtrends continually havecan developed reallyleverage good their world? How you can these to positively influence your customer thinking patterns, experiences, healthcare consultation skills, the assumptions, attitudes, beliefs master your own Saboteurs, For each engagement channel, experience? results are transformational. and values. Judgements and Stress (an what specifically is the ONE next essential pre-requisite for Living Well is a free group selfstep you want them to take? When promoting your products and The new normal requires that pharmacies do more active outreach, to continue to engage demonstrating real empathy) management programme for services, be aware of unconscious - Have you conducted a patients living with theirTHEY long-term with patients where are. -Consider theempathy following team,management to help you decide bias. Do not assume you know demonstrate (not with your category audit health condition. Over six weeks, what your customers think or want. on the highest value promotional strategy sympathy),to implement. and re-fit in your pharmacy to we facilitate workshops designed One of the most effective ways reflect thesystem? changes inWhat customer to help-them make choices toyour patients’ Can you map journeys through the healthcare has stay curious long enough to to do this is to seek input from a buying patterns? improve their health such as understand your patient’s ideas, changed? What has stayed the same? How has that affected them? diverse range of people, who becoming more active, eating more concerns and expectations - Is your messaging, and brand can shine a light on your personal, - andHave yousmoking. conducted a category management audit and re-fit in your pharmacy healthily stopping (not assume), consistent across all platforms professional or cultural blind-spots. It may also to include more complex reflect the changes-inidentify customer buying patterns? e.g. in-store, window display, the cause the problem tasks such as taking medication, 5. Shift in the balance of delivery website, social (not just respond to symptoms), What social medial platforms are they currently using? For van, what purpose? monitoring their symptoms, coping Power in the Patient/Pharmacy media, stationery etc? with the aspects the Relationship - emotional Do you knowofwhere you can engage with them? - offer context specific advice (not Social media? If so, which - Are you and your staff promoting condition and communicating generic) and platform? Email? Local club or group? At home? At their workplace? For years, pharmacy (and other free self-management resources with healthcare professionals. Be healthcare professionals) have safety net with (not for) yourin the past have their needs- and interests changed 18asmonths? such the Living Well sure to-referHow suitable patients/ had an unsatisfactory relationship patient. Programmeand to patients? colleagues who live withyou a longHow can engage with patients both inside your pharmacy inside their with ‘patient-centred care’. In term condition to this programme. How can you can leverage these - Have you considered ways to the traditional, paternalistic world? Patients can also self-refer. trends to positively influence against unconscious healthcare system, patients often You can outeach moreengagement at - find For channel, what specifically is themitigate ONE next step you want your customer experience? bias in your promotional feel disempowered, intimidated Living Well programme them to take? E.g. Phone the pharmacy? Click a link to your website? Text strategy? and passive managers of their The new normal requires that HSE.ie health. Healthcare providers and ‘Yes’ for prescriptionpharmacies renewal. doContact their GP? Comment on a social media more active - Have you completed a recent patients alike collude to create the Promotion Challenges and outreach, toappointment continue to engage technology audit in your post? Click a link to book an with the pharmacist via the online illusion that the healthcare provider Opportunities with patients where THEY are. pharmacy to ensure it is fit manages the patient’s health. Of calendar? Consider the following with your As more patients embrace for purpose? course, on objective reflection, we to help you decide on theaudit and re-fit in your pharmacy - asHave ateam, category management their role CEO ofyou theirconducted life, know this is untrue,in all but the - What could sabotage the value promotional strategy pharmaciesto have the opportunity reflect the changeshighest inimplement. customer buying patterns? success of your promotion most ethical cases. to to embrace being a central activities?e.g. (personal, - of Is messaging, and brand consistent across all platforms in-store, More and more patients are waking member theyour patient’s team. - Can you map your patients’ professional, people, up to the fact that a person living Expanding window this opportunity will delivery display, van, through website, media, services, stationery etc? products/ journeys the social healthcare promotion, prosperity?) with a long term health condition require innovations such as system? What has changed? - Are you and your staff promoting free self-management resources such as the may have 60 mins per year with What has stayed the same? - How will you compete for your - building relationships andProgramme Living Well to has patients? (Remember, more proactive patients their pharmacist (5 mins once per How that affected them? patients hearts and minds make two-way referral pathways month), 20 mins a year with their higher value customers) in the future of pharmacy? with self-management support - Have you conducted a category practice nurse, 20 mins a year with What business model will you service suchconsidered as the - providers Have you ways to mitigate against management audit and re-fit unconscious bias in your their GP and perhaps a 20 mins adopt? What time and financial Living Well Programme. in your pharmacy to reflect appointment with a consultant. promotional strategy? E.g. Use different languages ininvestment messaging? Hiring multiis required? What the changes in customer For better or worse, the remaining - promoting paid pharmacy about thisand business model will lingual, multi-cultural staff? Use different digital platforms styles of buying patterns? 8,758 hours of the year, the patient services to equip, enable, attract your ideal customers is managing their OWN health. Overcome barriers to access to information, expertise and empowermessaging? and engage patients and provide you with a - What social medial platforms to be proactive about managing pharmacy and other health services? prosperous life? are they currently using? For To empower the pharmacy/patient their own health and wellbeing, what purpose? consultation, one of my projects Summary: In summary, you during the pandemic has been - building more expertise in - Do you know where you can explored how 4Front’s Promotion supporting the HSE to bring the Lifestyle Medicine and Health engage with them? Social pillar means in the context Living Well Programme Online Behaviour Change Skills and media? If so, which platform? of 4Front’s 6Ps of Pharmacy Email? Local club or group? Dungan – 4Front Pharmacy 28 June 2021 Excellence. You examined what Over the past 12 months, I have Rachel - developing mastery in using At home? At their workplace? promotion means to you. You had the privilege of learning from 4Front’s STEPS Framework in identified five market trends hundreds of inspiring patients, as Pharmacy Consultations. - How have their needs and and discussed ways to leverage they learn the self-managemet interests changed in the past opportunities to inform your While it is easy to intellectually skills to become CEO of their 18 months? promotional strategy and future life. Some have even gone on understand how to apply this growth opportunities. to become programme leaders framework, mastery requires - How can you engage with

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95 Next Steps

Promoting the Future of Pharmacy in the New Normal

- Document and measure your baseline promotional strategy where possible - Review promotion, growth and risk mitigation ideas with your team - Decide on your decision making criteria and prioritise your next steps - Review the 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 to rachel@racheldungan.com

Self-Appraisal WHAT I intend to learn and why COVID19 has changed how pharmacy is perceived in society, the methods by which we engage with each other and the healthcare system and customer shopping behaviour. I want to evaluate existing patterns and future trends so that I can future proof my career and my pharmacy business in the new normal.

Personal Plan HOW I intend to learn it I plan to • Review national and international trends in front of shop sales • Identify and leverage technology changes

RESOURCE ANNOUNCEMENTS 1. As an IPN reader, we invite you to register for FREE pharmacy team training 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. 2. 4FrontPharmacy Solutions will be hosting two cohorts of the Positive Intelligence® flagship 8-week Mental Fitness Programme specifically for pharmacists and their teams over the summer. Contact rachel@racheldungan.com with enquiries or expressions of interest. AUTHOR: Rachel Dungan MPSI, ACC. Rachel Dungan MPSI, MICF, ACC. Community Pharmacist. Lifestyle Medicine Advisor. Positive Intelligence Certified Coach. European Mentoring & Coaching Council Senior Practitioner. Award-Winning Wellbeing and Leadership Coach 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 focus on what is most important, rediscover joy and happiness and help them build the habits to put their own oxygen mask on first.

• Engage in qualitative research with my customers • Gather quantitative customer behaviour data • Identify potential barriers to myself and my team fully embracing opportunities

Action What I actually did • My book-keeper completed management accounts and compared front of shop sales by category, year on year. We reviewed our till data analytics and loyalty card data. • I reviewed IPU Behaviours and Attitudes most recent survey, read the IPN business CPD article on Optimising Sales Aug 2021 and made an appointment to speak to the article author Rachel Dungan MPSI. • I conducted two customer focus groups by zoom to gain their insights • I held a staff meeting by zoom to brainstorm trends, changes in customer. behaviour, explore ways to leverage technology changes and expand pharmacy services. We also explored strengths, weakness, opportunities and theats and what would be required to address these constraints and leverage opportunities.

Document What I have learned specifically • Year on year sales analysis shows a 50% sales reduction in OTC Cough, Cold and Children’s Analgesic Categories and 44% sales increase in Vitamin, Mineral and Supplement Categories. • I had not appreciated how significantly the profile of pharmacy had changed for patients or how important our accessibility has become. The customer journey has changed radically in the past year due to healthmail, technologiy, COVID restrictions, lack of access to other healthcare services etc. • I learned how stressed, overwhelmed and worried my staff are, and how this is impacting their ability to plan for and respond to professional opportunities.

She is co-founder of www.4FrontPharmacy.ie.

• I learned compelling research that individuals with positively primed brains consistently demonstrate x3 more creativity, x10 higher engagement, 31% more productivity and 37% higher sales than those who are more negatively predisposed. Changing the positivity/negativity ratio in our team has major implications for the future of our pharmacy in the new normal.

Its mission is to raise the global standard of pharmacy consultations by empowering pharmacists and their teams to expand their perspective, knowledge and skills to create sustainable health behaviour change.

Evaluate ONE example of how I put my learning into practice

• My team has re-merchandised the Front of Shop to reflect the change in increase in demand for proactive wellness supports and reduction in reactive symptom relief. • In response to this trend towards a focus on wellness, we plan to expand our paid pharmacy service offering over the next 6 months • Since this will involve both knowledge and skill update for the entire pharmacy team, I have enrolled my team for 4Front Pharmacy’s Online OTC and Consultation Skills Training. I have also enrolled our entire team for 4Front’s 6-week Positive Intelligence® Leadership and Service Excellence Programme to support us to improve morale, wellbeing and team performance, develop a positive mindset towards opportunity, growth and sales and improve patient safety

CCF Domains (and Competencies) The Pharmacist selected Competencies under the following domains for this CPD Professional Practice (Engages in appropriate CPD), 2. Personal Skills (Leadership Skills, Decision Making Skills, Team-Working Skills, Communication Skills) Contributed by Rachel Dungan MPSI of 4Front Pharmacy. To find out more about how 4Front Pharmacy’s Positive Intelligence® Programme and Coaching can help you improve morale, wellbeing and team performance, drive your sales and improve patient safety email rachel@racheldungan.com and use the subject line ‘IPN Aug 2021.’

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Clinical Profiles

EMPAGLIFLOZIN (JARDIANCE®) APPROVED IN IRELAND FOR THE TREATMENT OF HEART FAILURE WITH REDUCED EJECTION FRACTION The European Commission has granted marketing authorisation for Empagliflozin (Jardiance®) as a treatment for adults with symptomatic chronic heart failure with reduced ejection fraction (systolic heart failure) in Ireland, Boehringer Ingelheim and Eli Lilly and Company have announced. The extension of the indication follows a positive recommendation by the Committee for Medicinal Products for Human Use (CHMP) on 20 May 2021. Marketing authorisation is based on results from the EMPEROR-Reduced trial in which empagliflozin showed a significant 25 percent reduction (ARR 5.2%) in the combined relative risk versus placebo of cardiovascular death or hospitalisation due to heart failure. The findings from the primary endpoint were consistent in subgroups with or without type 2 diabetes. Key secondary endpoint analyses from the trial demonstrated that empagliflozin reduced the relative risk of first and recurrent hospitalisation for heart failure by 30 percent (ARR 8.7%) and significantly slowed kidney function decline. “Empagliflozin was the first SGLT2 inhibitor to demonstrate cardiovascular protective effects and improve cardiovascular outcomes in patients with type 2 diabetes,” said Dr Douglas Clark, Head of Medical Affairs for UK and Ireland at Boehringer Ingelheim. “We are delighted to now be able to offer empagliflozin to people with heart failure with reduced ejection fraction, regardless of diabetes status, and to provide an additional treatment option for the thousands of people who live with heart failure and important metabolic conditions. We look forward to collaborating with NCPE to ensure access to this trusted therapy.” Heart failure is often associated with other diseases of the cardiorenal-metabolic systems such as type 2 diabetes and kidney disease. Due to the interconnected nature of these systems, improvement in one system can lead to positive effects throughout the others. Heart failure is a very common and severe complication of a heart attack and occurs when the heart cannot pump sufficient blood to the rest of the body.[iv],[v] There are two forms of the condition; heart failure with reduced ejection fraction means the heart cannot contract normally, while preserved ejection

fraction means the heart cannot properly fill with blood. People with heart failure often experience breathlessness and fatigue, which can severely impact their quality of life. The EMPEROR-Reduced trial is part of the EMPOWER clinical programme, exploring the impact of empagliflozin on the lives of people across the spectrum of cardio-renal-metabolic conditions. The safety profile was similar to the established safety profile of empagliflozin. DUPIXENT® (DUPILUMAB) SMPC UPDATED WITH LONGTERM DATA REINFORCING WELL-ESTABLISHED SAFETY PROFILE IN ADULTS WITH MODERATE-TO-SEVERE ATOPIC DERMATITIS Long-term safety data from a study of adults with moderate-tosevere atopic dermatitis treated with Dupixent will be added to the Dupixent Summary of Product Characteristics (SmPC) following a positive opinion issued by the European Medicines Agency's Committee for Medicinal Products for Human Use. Data from a single-arm Phase 3 open label extension (OLE) trial showed the long-term safety profile in adults with moderate-tosevere atopic dermatitis treated with Dupixent and observed up to three years was generally consistent with what was observed in the controlled pivotal Phase 3 trials. The OLE trial assessed the long-term safety of Dupixent 300 mg weekly in adults who had previously participated in Dupixent trials or had been screened for a Phase 3 trial. The approved Dupixent dose in adults is 300 mg every other week. Atopic dermatitis is a chronic inflammatory disease of the skin that can be debilitating. Moderate-to-severe atopic dermatitis is characterized by intense persistent itch and skin lesions that can cover much of the body, resulting in skin dryness, cracking, redness or darkening, crusting and oozing. Itch is one of the most burdensome symptoms for patients. Moderate-to-severe atopic dermatitis can also have a substantial emotional and psychosocial impact on patients and their families, causing sleep disturbance, anxiety, depression and feelings of isolation. Dupixent is the only biologic approved in the EU for children as young as six with severe atopic dermatitis and for adolescents and adults with moderate-tosevere atopic dermatitis who are candidates for systemic therapy.

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Dupixent is a fully human monoclonal antibody that inhibits the signaling of the interleukin-4 (IL-4) and interleukin-13 (IL-13) proteins. IL-4 and IL-13 are key and central drivers of the type 2 inflammation that plays a major role in atopic dermatitis, asthma, chronic rhinosinusitis with nasal polyposis (CRSwNP) and eosinophilic esophagitis (EoE). Dupixent is not an immunosuppressant and does not require ongoing lab monitoring. Dupixent is currently approved in more than 60 countries, and more than 260,000 patients have been treated globally. HSE REIMBURSES NEW SUBCUTANEOUS FORMULATION OF TYSABRITM (NATALIZUMAB) TO TREAT ADULTS LIVING WITH HIGHLY ACTIVE RELAPSING REMITTING-MULTIPLE SCLEROSIS Biogen Ireland have announced that the HSE has agreed to reimburse a subcutaneous (SC) injection of TYSABRITM (natalizumab) for adults living with highly active relapsing-remitting multiple sclerosis (MS). The announcement follows the European Commission’s (EC) decision on the 30th March 2021 meaning that the new route of administration is now approved in Ireland. Natalizumab SC offers comparable efficacy and safety and builds on the long-term data and established clinical benefits of the natalizumab intravenous (IV) formulation. Natalizumab is the only high-efficacy disease modifying therapy for RRMS that offers two routes of administration providing patients and healthcare professionals (HCPs) with the flexibility to choose the one that best fits their individual needs. The SC and IV formulations of natalizumab 300 mg, are administered once every four weeks by a HCP in a clinical setting. The new SC formulation expands the clinical setting beyond infusion centres, potentially bringing care closer to home, e.g., via community healthcare centres, offering patients treatment convenience whilst still providing medical oversight of treatment administration. The administration by a HCP allows for ongoing disease monitoring, including screening for progressive multifocal leukoencephalopathy (PML), identifying and treating potential hypersensitivity reactions and

ensuring adherence to treatment. As well as the shorter SC administration time, compared to the IV formulation, the SC injections also provide the option for HCPs to reduce or remove the 1-hour post-dose observation period, after the first six doses, based on clinical judgement. “This is an important treatment option for people living with MS, as it provides individuals with more flexibility around how they would like to receive their treatment. It still provides people with the opportunity to access their MS Care team but will minimise the time spent receiving treatment and can potentially be administered in more convenient locations, closer to home” said Ava Battles, CEO, MS Ireland. The approval of the SC route of administration for natalizumab is based on data from the DELIVER (Phase 1) and REFINE (Phase 2) studies. The SC formulation of natalizumab 300 mg has shown comparability to the Q4W IV administration of 300mg natalizumab in efficacy, pharmacokinetic (PK) and pharmacodynamic (PD) profiles. The safety of natalizumab SC in both the DELIVER and REFINE studies was generally consistent with the well-established benefitrisk profile of natalizumab IV in other clinical studies and the post-marketing setting, with the exception of injection site pain which can occur with SC injections. “This unprecedented year has put the HSE under significant resource pressures and created new challenges for those living with long-term conditions, like MS, when accessing vital, life impacting treatments,” said Dr Bronagh Hayden, Head of Medical Affairs Biogen Ireland. “As our healthcare and everyday environment evolves, we must continue to provide solutions to address capacity and resource concerns within the health service, whilst addressing patient needs. Reinforced by nearly 15 years of real-world evidence and post marketing experience with natalizumab IV, SC offers a new method of delivery that can help to reduce patient time in a hospital setting and increase convenience in clinical practice.” LEO PHARMA ANNOUNCES MHRA AND EC APPROVAL OF ADTRALZA (TRALOKINUMAB)



LEO Pharma UK and Ireland, a leader in medical dermatology, has announced that the Medicines and Healthcare products Regulatory Agency (MHRA) and the European

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Clinical Profiles

Commission (EC) has approved tralokinumab for the treatment of moderate-to-severe atopic dermatitis in adult patients who are candidates for systemic therapy.

will be available in a 150 mg/mL prefilled syringe for subcutaneous injection with an initial dose of 600 mg followed by 300 mg every other week.

The MHRA and EC approvals make tralokinumab the first and only approved biologic that specifically targets the IL-13 cytokine alone, a key driver of atopic dermatitis signs and symptoms.

Tralokinumab can be used with or without topical corticosteroids (TCS). “Atopic dermatitis can be an intensely itchy, challenging and unpredictable skin condition for some. As clinicians, we always want more options for patients and the approval of tralokinumab means that clinicians across the UK and Ireland now have an important new treatment option for patients with moderate-to-severe atopic dermatitis in adult patients”

Tralokinumab is the first high affinity, human monoclonal antibody developed to specifically bind to and inhibit the IL-13 cytokine in adult patients with uncontrolled moderate-to-severe atopic dermatitis. Tralokinumab

NEED FOR SPEED IN CARDIAC ARREST PATIENTS The quick action of team mates and officials to save the life of Danish footballer Christian Eriksen has highlighted the need for bystanders to react with speed to a cardiac arrest, the Irish Heart Foundation insisted recently. Eriksen collapsed on Saturday during the first half of Denmark’s opening Euro 2020 match against Finland before being treated on the pitch and hospitalised. “We know that without CPR or a defibrillator, your chances of survival decrease by 10% every minute, so because of the quick actions of everyone around him, Christian Eriksen survived,” said Brigid Sinnott, Resuscitation Manager at the Irish Heart Foundation. “He was fortunate that it happened in such a public place with people on hand to immediately begin CPR. “We know that 70% of cardiac arrests happen in the home, so it is vital that people understand what to do in that situation. “Speed is of the essence – speed in recognising cardiac arrest, calling the emergency services, performing compressions and in using the AED (automated external defibrillator). It is the difference between life and death. “In Christian Eriksen’s case, it was recognised early that he was having a cardiac arrest, he was helped immediately and they had a defibrillator on his chest very quickly. “And the fact that it was his teammates who were first to perform CPR on him before the medics got there, shows that anyone can do it."

A cardiac arrest occurs when the heart beats fast and wildly or stops beating altogether. This can happen due to an abrupt disturbance in the heart’s internal electrical system that normally regulates the heartbeat. The heart cannot pump blood to the brain, lungs and other vital organs and without treatment, the outcome is usually fatal. Data from the 2019 Out-of-Home Cardiac Arrest Report shows that Ireland has bystander CPR rates (members of the public who perform CPR in such emergencies) of 84%. “If the electrics in your heart go wrong you need a defibrillator to reset them, while CPR compressions act as a pump for the heart,” said Ms Sinnott. “We need to get more defibrillators on chests and we would ask everyone to check where their nearest one is and whether it is accessible all the time. “We have some easy to follow instructional videos on our website irishheart.ie and we encourage everyone to watch them, even if you have been trained in CPR in the past. “The first step in CPR is to call 112 or 999 and the second is to push hard and fast on the centre of the chest. “It is really important for people to realise that they don’t have to be a trained doctor or medical professional to perform CPR – anybody can do it and you cannot do any harm.” As a leading training provider, the Irish Heart Foundation has courses across all the links in the chain of survival. To find out more, go to www.irishheart.ie

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said Professor Anthony Bewley, Consultant Dermatologist at Barts Health NHS Trust. Dr Amit Aggarwal, Medical Director, LEO Pharma UK and Ireland said, “Tralokinumab was developed based on the advanced understanding of the immune processes underlying atopic dermatitis, which is fundamental to our mission of pioneering medical dermatology.” ]The approval is based primarily on safety and efficacy results from the ECZTRA 1, 2 and ECZTRA 3 pivotal Phase 3 trials, which included more than 1,900 adult patients with moderate-to-severe

Brigid Sinnott, Resuscitation Manager, Irish Heart Foundation

AD. 5 Safety data was evaluated from a pool of five randomized, double-blind, placebo-controlled trials, including ECZTRA 1, 2 and ECZTRA 3, a dose ranging trial, and a vaccine response trial.5 LEO Pharma is working closely with key stakeholders to support access to tralokinumab for eligible patients. The MHRA and EC decisions are valid in the UK and all European Union Member States, Iceland, Norway, and Liechtenstein. Additional regulatory filings are underway with [the U.S. Food and Drug Administration (FDA) and other] health authorities worldwide.

99 TAKEDA, RCPE, INSILICOTRIALS AND THE UNIVERSITY OF GRAZ PARTNER UP Biopharmaceuticals are large and complex drugs that mimic the action of the molecular mechanisms in living organisms. In the past decade, the number of deaths due to cancer and HIV/AIDS have been significantly reduced and the treatment of several chronic diseases, such as diabetes and cardiovascular diseases, has been enhanced due to the emergence of biopharmaceuticals. Biopharmaceuticals represent one of the fastest growing segments in current drug pipelines, but their large-scale manufacturing and processing pose specific challenges to the drug formulation scientist, as these large and complex molecules are rather sensitive to variations of environmental conditions and process-induced stress. Filling is the final step of the manufacturing process for liquid protein formulations and the focus of this project. A 36-month joint project between the manufacturing site in Vienna of Takeda, one of the world's largest pharmaceutical companies, the Research Center Pharmaceutical Engineering (RCPE), the technology company InSilicoTrials, and the University of Graz has been initiated to establish the mechanistic basis of the relationship between process parameters and the effect of the resulting stresses on the characteristics of protein based drugs. Takeda and RCPE are in the process of building an ongoing partnership which has

been and is currently being used to increase the scientific knowledge for biopharmaceutical products and processes. This project will enhance the understanding of the processinduced mechanisms for proteinbased biopharmaceuticals. Participation in collaborative programs of this kind will also be supportive to product and process development of protein-based drugs in the future, resulting in reduced material requirements and drug development timelines. This collaboration will adopt an innovative approach between Takeda and the partner companies where a lab scale version of one of Takeda's filling line will be designed and assembled. The line will be used to simulate the Takeda filling process on a smaller scale, comparing the effect of various settings of process parameters (filling speed, vial shape, protein concentration etc.). In addition, computational fluid dynamics simulations will be performed to estimate the shear forces, as well as size and dynamics of interfaces the concentrated protein solution is exposed to during the filling process. The generated experimental and simulation data will then be used to train and test algorithms based on state of the art machine learning models, to predict the potential impact of these parameters on the properties of the protein molecule. The final goal is a set of in-silico tools that can be used to guide the design and parameterization of the filling process.

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S E O R E H D Y COVI A D O T E T A N I NOM

IPN are looking for your nominations for Ireland’s Pharmacy industry’s most inspiring and enthusiastic people.  Do you know someone who has

went above and beyond in Pharmacy?

 Who deserved recognition

for a special project they have executed?

 Who has shown an ability to

get things done during a period of change?

 Who has developed something

new and innovative within their organisation?

Pharmacists have continued to provide a first-class service in the face of adversity, with each pharmacy team displaying the highest levels of resilience, determination, and courage. And now the time has come to reward that resilience. That determination. That courage… Nominations are sought from across the pharmacy profession in Ireland. Email nomination(s) to aoife@ipn.ie or Kelly-jo@ipn.ie DEADLINE MONDAY 4th OCTOBER