IPN 2022 August by IPN Communications LTD

August 2022 Volume 14  Issue 8 THE INDEPENDENT VOICE OF PHARMACY In this issue: NEWS: New Appointments in Pharmacy Page 5 REPORT: Key Trends in the Pharmacy Sector Page 10 TOP 100: IQVIA Top 100 OTC Market Report Page 14 MANAGEMENT:CATEGORY Growth in Vitamins, Minerals Supplements& Page 34 CPD: Focus Women’son Health Page 41 FEATURE: Getting to the Core of Digestion Page 49 AWARDS: ¤9000 Raised Page PHARMACYNEWSIRELAND.COM68 This Publication is for Healthcare Professionals Only PEPCID DUO HAS THE BENEFIT OF ANTACIDS AND A H2 BLOCKER Famotidine, Magnesium Hydroxide, Calcium Carbonate. HEARTBURN? H2 BLOCKER Famotidine actively reduces the amount of acid produced. ANTACIDS Calcium Carbonate and thethehydroxidemagnesiumneutralisesexisitingacidinstomach. Pepcid Duo Chewable Tablets Composition: Each chewable tablet contains: Famotidine 10.0 mg, Magnesium hydroxide 165.00 mg, Calcium carbonate 800.00 mg. Pharmaceutical form: Chewable tablet. Indications: Pepcid Duo is indicated in short-term symptomatic treatment of heartburn and acid regurgitations in adults and adolescents 16 years & over. Dosage: FOR ADULTS AND ADOLESCENTS (16 years & over): Chew one tablet thoroughly when symptoms occur, and swallow preferably with a glass of water. Do not exceed 2 tablets per day. Treatment duration is limited to 2 weeks (see section 4.4 Special warnings and Precautions for use). Paediatric population: The safety and efficacy of Pepcid Duo in children under 16 years of age has not yet been established (no data are available). Elderly: No dosage adjustment is required for the elderly. Renal Impairment: This medicine is contraindicated in patients with severe renal failure. Patients with renal impairment should consult their physician before taking famotidine/antacid combination. Hepatic Impairment: No dosage adjustment is required for famotidine/antacid combination in hepatic impairment. Contraindications: Hypersensitivity to the active substances or to any of the excipients. Severe renal failure. Cross sensitivity in H2-receptor antagnonists has been observed. Famotidine/antacid combination should not be administered to patients with a history of hypersensitivity to other H2-receptor antagonists. Special warnings and precautions for use. Warnings: Patients with renal or hepatic impairment should consult a physician before using Pepcid Duo Chewable Tablets. In case of renal failure, monitoring of serum magnesium and calcium should be undertaken. Pepcid Duo is contraindicated in patients with severe renal failure. As some serious underlying conditions can have symptoms in common with simple indigestion, it is recommended patients seek medical advice in case of: indigestion symptoms accompanied by unintentional weight loss, difficulty swallowing, persistent abdominal discomfort, heartburn occurring for the first time or if these symptoms have recently changed. Patients with pre-existing known hypercalcaemia, hypermagnesaemia, hypophosphataemia, hypercalcuria, a history of renal calculi or nephrocalcinosis should consult a physician before using famotidine/antacid combination. As this product contains lactose, glucose and benzyl alcohol: Patients with rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption should not take this medicine. Patients with rare glucose-galactose malabsorption should not take this medicine. This medicine contains 0.000238 mg benzyl alcohol in each tablet which is equivalent to 0.000129 mg/g. Benzyl alcohol may cause allergic reactions. High volumes of benzyl alcohol should be used with caution and only if necessary, especially in subjects pregnant or breastfeeding, or with liver or kidney impairment because of the risk of accumulation and toxicity (metabolic acidosis). With long term use, especially during concomitant treatment with other calcium products and/or Vitamin D products, there is a risk of hypercalcaemia with subsequent kidney function impairment. Patients should stop use and consult a physician if new symptoms develop or if they experience dysphagia (difficulty swallowing) odynophagia (pain on swallowing), sever vomiting, melaena (black stools), choking or chest pain. Precautions for use: If symptoms persist after 2 weeks of continuous treatment or get worse, an etiologic survey must be done and the conduct of the treatment should be re-evaluated. Undesirable effects: Immune system disorders Not known Hypersensitivity, Anaphylactic reaction. Nervous system disorders Common Headache Uncommon Nervousness, Paresthesia, Dizziness Not known Somnolence. Gastrointestinal disorders Uncommon Abdominal discomfort and pain Abdominal distension Nausea Diarrhoea Flatulence Dyspepsia Eructation Dysgeusia Oropharyngeal discomfort and pain Dry mouth, thirst Vomiting Not known Abdominal pain upper. Skin and subcutaneous tissue disorders Not known Pruritus Rash Urticaria Angioedema. General disorders and administration site conditions Not known Asthenia, fatigue. Other side effects noted in isolated reports with higher dosages of famotidine in principle cannot be excluded. There have been very rare reports of: Cutaneous: as with other H2 antagonists, severe skin reactions (toxic epidermal necrolysis). Hypersensitivity reactions: bronchospasm. Hepatic disorders including hepatic cholestasis and such as raised laboratory values for transaminases, gamma-GT, alkaline phosphatase and bilirubin. Neurological disorders such as hallucinations: disorientation, confusion and insomnia, epileptic seizures, drowsiness and agitation and depression related states. These have been reported to be reversible on stopping medication. Blood disorders such as thrombocytopenia, leucopenia, agranulocytosis and pancytopenia. Musculoskeletal disorders, such as muscle cramps. Others such as impotence, reduced libido, breast tension. Alopecia Malaise. The following side effects are generally attributed to antacids containing calcium and magnesium salts: change in stool frequency and consistence, bloating and fullness. MAH: Johnson & Johnson (Ireland) Limited, Airton Road, Tallaght, Dublin 24, Ireland. MA Number: PA 330/47/1. Date of revision April 2022. Product not subject to medical prescription, supply through pharmacies only. Full prescribing information available upon request form Johnson & Johnson (Ireland) Ltd. 3 Neutralises existing acid 3 Reduces acid production 3 Effective relief in just one dose 3 Lasts all day or night WORKS IN 2 MINUTES AND LASTS FOR UP TO 12 HOURS IE-PED-2200007

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“These shortages will lead to pharmacies reducing their hours, reducing their services and in some cases may result in shortened hours or temporary closures,” President Mr Dermot Twomey warned. “There are currently 3,800 community pharmacists working across Ireland’s 1,900 community pharmacies. Our Population is ageing and the demands on our sector are increasing.”

Regulars

Read more about his thoughts on page 8.

Despite the relatively high prevalence of aphasia post-stroke research has shown that there is a very low level of awareness and understanding of the condition among the general public.

News

Given that almost 6,000 stroke patients are admitted to hospital every year in Ireland, there is a considerable number of people affected by aphasia.

of staff to the health service. This has been further exacerbated by the global pandemic. These changes will help employers in Ireland to recruit non-EEA nationals for these critical roles in the health sector.”

graduate of Trinity College Dublin and has 30 years’ experience, working in many facets of the pharmacy profession. She currently works in community pharmacy in Co. Kerry and she has spent more than twenty-five years as a hospital pharmacist, both in Ireland and the USA (California and Washington states). She has been in a pharmacistChief/Superintendentrolesince2001.

PHARMACYNEWSIRELAND.COM 5

She has authored more than 120 peer-reviewed publications and has led more than a dozen research studies as a principal investigator.

The Health Information and Quality Authority (HIQA) is asking for feedback on its Draft recommendations on a model for health information standards to support the delivery of health and social care services in Ireland Health information plays a key role in Irish health and social care services as front-line staff use patients’ data on a daily basis, while this data also informs future public policy decisions.

It also provides useful tables, built from existing FIP resources, that outline the skills, techniques, quality assurance measures and procedures that pharmacy students and practising pharmacists will need to acquire as they develop their competence to provide vaccine-related services.

A feature of “The FIP vaccination reference guide: Knowledge and

This project is aligned with key national eHealth priorities, including Sláintecare, and it also follows on from HIQA’s 2021 paper on the need to reform of Ireland’s health information system, which made six recommendations to achieve reform across health and social HIQA’scare.Director of Health Information and Standards, Rachel Flynn, said, “Through Sláintecare, there has been a commitment to adopt a standards-based approach for delivering a national health information system. However, while some good practice exists, overall this model is underdeveloped and responsibilities are spread across multiple organisations. Unlike in many other jurisdictions, there is no single entity in Ireland with responsibility for health information across both public and private services, or which has a mandate to develop, implement and promote adoption of health information standards.”

The continuing professional development (CPD) chapter is designed to provide a point of reference to the competencies in the FIP global competency framework related to pharmaceutical care and public health. These competencies are expected to be acquired and maintained by pharmacists so that they can effectively fulfil their vaccination-related roles.

PHARMACYNEWSIRELAND.COM 6 News

presented preliminary results on its impact on student pharmacists. She also shared content from the program, including videos and interactive video cases. The program is currently being evaluated as part of a randomized controlled trial in the United States.

Draft recommendations on a model for health information standards to support the delivery of health and social care services in Ireland are available on www.hiqa.ie. To take part in the consultation, please complete the short survey either online or in the feedback form by 5pm on Tuesday, 2 August 2022.

skills to support professional development and inform pharmacy education in vaccination” is that it ties FIP’s 21 Development Goals to the policy enablers required for workforce and education to transform vaccination.

Vaccination Skills Guide for Pharmacy

Professor Delesha Carpenter, Eshelman School of Pharmacy, University of North Carolina with Dr Laura Sahm, School of Pharmacy, UCC

A new reference guide published by the International Pharmaceutical Federation (FIP) is intended to guide practising pharmacists and pharmacy undergraduates in acquiring the necessary knowledge and skills, and to help education providers to develop and/or provide these knowledge and skills.

The chapter covers the knowledge required by pharmacists in this area and the associated skills. We also suggest learning outcomes for CPD courses in vaccination for CPD providers and pharmacists.

HIQA Feedbackseeks

Preparing Pharmacy with Pharm-SAVES

“The guide will directly support national pharmacy organisations and FIP members with education and training needed as continuing professional development for routine vaccination service delivery. In addition, this guide supports academic institutions and FIP’s academic institutional members in developing and delivering education for undergraduates who will then be vaccination ready upon registration,” said FIP CEO Catherine Duggan.

Pharmacists are well positioned in communities to provide vaccine-related services, but variation across the scope and content of available training programmes means they often require support to do so effectively.

Professor Carpenter described the development of a new suicide prevention gatekeeper training program called Pharm-SAVES and

HIQA is now seeking to ensure that patients, their families and carers, healthcare professionals, and the general public can provide their views and contribute to the development of these recommendations. All feedback received will be analysed and used to inform the final recommendations.

Delesha Carpenter, PhD, MSPH is an Associate Professor and Interim Chair of the Division of Pharmaceutical Outcomes and Policy at the Eshelman School of Pharmacy at the University of North Carolina at Chapel Hill. Her educational background includes clinical training in respiratory therapy and public health. She has more than 15 years of experience conducting patientprovider communication research. More recently, she has studied how pharmacists communicate about sensitive topics, such as opioid overdose and suicide and is particularly interested in how community pharmacists can increase access to health services in underserved rural areas.

Professor Delesha Carpenter, Eshelman School of Pharmacy, University of North Carolina recently delivered a guest seminar at the University College Cork School of Pharmacy entitled ‘Preparing pharmacy staff to recognize and respond to individuals with suicide warning signs.’

The undergraduate pharmacy education chapter describes knowledge and skills requirements to equip undergraduate pharmacy students to become vaccine-ready pharmacists upon graduation or registration. It provide country examples to guide readers on

existing programmes, and this chapter can be used by educators and academic institutions to develop undergraduate pharmacy curricula on vaccination or to improve their existing curricula.

The seminar was designed for pharmacists who feel unprepared to interact with individuals who exhibit suicide warning signs.

Please consult the Summary of Product Characteristics (SmPC) for full prescribing information.

Dosage: For nasal use only. Adults and adolescents (12 years of age and over) two actuations in each nostril twice daily (morning and evening). Elderly: no dose adjustment required. Children under 12 years: not recommended. Renal and hepatic impairment: no dose adjustment expected.

Contraindications: Hypersensitivity to the active substance or to any of the excipients. Presence of untreated localised infection involving the nasal mucosa, such as herpes simplex. Recent nasal surgery or trauma until wound healing has occurred. Warnings and Precautions: Instances of nasal ulceration and nasal septal perforation have been reported. Not recommended in case of nasal septum perforation. Patients using Ryaltris™ over several months or longer should be examined periodically for possible changes in the nasal mucosa and for evidence of Candida infection. Instances of epistaxis have been reported. Visual disturbance may be reported with systemic and topical corticosteroid use. Consider referral to ophthalmologist with symptoms such as blurred vision or other visual disturbances as cataract, glaucoma or rare diseases such as central serous chorioretinopathy have been reported after use of systemic and topical corticosteroids. Hypersensitivity reactions, including wheezing, may occur - discontinue. Immunosuppression: use with caution, if at all, in patients with active or quiescent tuberculous infections of the respiratory tract, untreated local or systemic fungal or bacterial infections, systemic viral or parasitic infections, or ocular herpes simplex. Potential systemic effects of corticosteroids include Cushing’s syndrome, Cushingoid features, adrenal suppression, growth retardation in children and adolescents, cataract, glaucoma and more rarely, a range of psychological or behavioural effects including psychomotor hyperactivity, sleep disorders, anxiety, depression or aggression (particularly in children). Hypercorticism and adrenal suppression may appear at higher than recommended dosages or in susceptible individuals at recommended dosages - discontinue slowly. Increased risk of signs or symptoms of hypercorticism and/or suppression of the HPA axis possible with concomitant use with other inhaled corticosteroids. Careful monitoring needed for acute adrenal insufﬁciency in response to stress in patients previously treated for prolonged periods with systemic corticosteroids and transferred to topical corticosteroids. In patients with asthma or other conditions requiring long term systemic corticosteroid treatment, too rapid a decrease in systemic corticosteroids may cause a severe exacerbation of symptoms. Somnolence has been reported following administration of Ryaltris™ in clinical studies. Caution in patients operating machinery or driving a motor vehicle. Avoid concurrent use with alcohol or other central nervous system (CNS) depressants. Increased risk of antihistamine adverse effects with concomitant use of olopatadine or other antihistaminic drugs administered via nasal, ocular or oral route. Paediatric population: It is recommended that the height of children receiving prolonged treatment with nasal corticosteroids is regularly monitored. Contains 0.02 mg benzalkonium chloride in each actuation. Benzalkonium chloride may cause irritation or

Side Effects: Common: dysgeusia, epistaxis, nasal discomfort. Uncommon: dizziness, headaches, somnolence, nasal dryness, dry mouth, abdominal pain, nausea, fatigue. Rare: bacterial vaginosis, anxiety, depression, insomnia, lethargy, migraine, blurred vision, dry eye, eye discomfort, ear pain, nasal inﬂammation, nasal mucosal disorder, oropharyngeal pain, sneezing, throat irritation, constipation, sore tongue, laceration. Frequency not known: pharyngitis, upper respiratory tract infection, hypersensitivity (including anaphylactic reactions, angioedema, bronchospasm, dyspnoea), cataracts, glaucoma, increased intraocular pressure and nasal septum perforation.

1. Ryaltris™ Summary of Product Characteristics July 2021 Two sprays per nostril twice daily 1

Presentation: One delivered dose contains mometasone furoate monohydrate equivalent to 25 mcg mometasone furoate and olopatadine hydrochloride equivalent to 600 mcg olopatadine. White, homogeneous suspension.

Legal Category: POM.

Pack Sizes: One bottle containing 30ml suspension (240 actuations).

Product Authorisation Numbers: PA 1543/002/001

Product Authorisation Holder: Glenmark Pharmaceuticals s.r.o., Hvezdova 1716/2b, 140 78 Prague 4, Czech Republic.

Marketed by: A. foundCo.Farm,2ndPharmaceuticalsonFurtherPharmaceuticalsMenariniIrelandLtd.informationisavailablerequestfromA.MenariniIrelandLtd.,Floor,Castlecourt,MonkstownMonkstown,Glenageary,DublinA96T924ormaybeintheSmPC.

Date of Preparation: June 2022.

*Ryaltris™ is indicated in adults and adolescents 12 years of age and older for the treatment of moderate to severe nasal symptoms associated with allergic rhinitis1

IR-RYL-11-2022 May 2022

Ryaltris™ 25 mcg/actuation + 600 mcg/actuation nasal spray, suspension. Prescribing information

Uses: In adults and adolescents 12 years of age and older for the treatment of moderate to severe nasal symptoms associated with allergic rhinitis.

swelling inside the nose, especially if used for a long time. Interactions: No interaction studies have been performed with Ryaltris™. Any interactions from the combination of olopatadine and mometasone furoate are expected to reflect those of the components taken individually, no pharmacokinetic interaction between olopatadine and mometasone furoate was observed when administered in combination. Olopatadine: No interactions with other drugs expected. Mometasone Furoate: Cotreatment with CYP3A inhibitors should be avoided unless the benefit outweighs the increased risk of systemic corticosteroid side-effects and patients should be monitored. Pregnancy and Lactation: Avoid use during pregnancy unless potential benefit to mother justifies potential risk to mother, foetus or infant. Assess before prescribing in lactating mothers.

Concluding, Mr Twomey called on the Minister for Health to take the lead initiative in addressing this critical shortage. “As of this week, the government is now acknowledging that there is a critical shortage of pharmacists. We need to see action to address this and hiring colleagues from overseas is only a short-term part of that solution. The health service will suffer if this is not add ressed imminently. The question is, will Minister Donnelly sit up and take notice or allow the situation to deteriorate further?”

Paul Reid to step down as CEO

“While this change is very welcome, it is not designed to address the root causes of the shortage,” Twomey cautioned. “The causes are noticeably clear we are simply not training enough pharmacists in this country. There are insufficient third level places to meet the demands of the sector and little has been done to address this.

“These shortages will lead to pharmacies reducing their

“There also needs to be put in place a comprehensive plan which utilises fully the clinical skills of our profession in order to attract young graduates to community pharmacy.

There is now an urgent need for a concerted Action Plan to address the growing shortage of community pharmacists that, the Irish Pharmacy Union (IPU) believes, has the potential to impact on the accessibility of pharmacy services for patients. The IPU has welcomed the addition of pharmacists to the list of occupations that qualify for expedited work permits but said that while this is a welcome step it is only a first step on what is becoming a very acute issue especially over the peak holiday season.

With multiple causes for the shortage of pharmacists and the responsibility for addressing

them residing across the public sector, the IPU is now calling for an Action Plan to be developed and implemented. This plan, the IPU argues, should include the Departments of Health, Higher Education and Enterprise as well agencies such as the HSE, HPRA, and

The CEO of the HSE Paul Reid has advised the Chairman, the Board of the HSE and the Minister for Health that he will be stepping down from his position later this year.

“WhatPSI.is needed in the mediumterm,” Mr Twomey suggested is “a clear pathway to get us to a level where an ample number of pharmacists are being educated each year. But before that is feasible, we need to see concerted action to facilitate improved efficiencies within the sector and a reduction in red tape. Improvements, such as ePrescribing, which have long been promised have been dragged out for years. The only changes that seem to come quickly are those that involve more red tape.”

In a message to staff today Mr Reid said that he was making the decision with a heavy heart, and that it was the hardest decision he had ever made in relation to his own “Havingcareer.previously worked in the

private, not for profit, central and local government sectors, working in the HSE has been by far the greatest period in my career. It has been truly rewarding leading an organisation whose staff come to work every day to make people’s lives better.

Paying tribute to Mr Reid the Chairman of the HSE Mr Ciarán Devane said, “It is with very great regret that I and the Board have heard of Paul’s decision. He has led the health service through what has been the greatest challenge it has ever faced, and done so with relentless dedication and professionalism. We are very grateful that he will stay in his role for a further period to allow us progress the extremely difficult task of replacing him.”

“In addition, the profession is being strangled by red tape and bureaucracy. This is unfortunately leading to an exodus of young well-educated community pharmacists. Filling out forms that provide no benefit to the patient is now a large part of the pharmacist’s day. Were the HSE to address this, it would make the profession more attractive and be an instant boost to retention.”

He said his decision was influenced by two key factors: A desire to spend more time with his family who had made many sacrifices to support him, and a belief that the HSE was entering a new phase and that the appointment of a new leader was now timely.

hours, reducing their services and in some cases may result in shortened hours or temporary closures,” Mr Twomey warned. “There are currently 3,800 community pharmacists working across Ireland’s 1,900 community pharmacies. Our Population is ageing and the demands on our sector are increasing.”

Dire Shortage of Pharmacists Requires Urgent Action Plan

waves of Covid, a criminal cyber attack while driving a significant reform agenda. This has been truly inspirational for me to experience.”

He has agreed with the Chairman that he will step down in December 2022, facilitating a period to advance the process of selecting a successor. He said today that he has no immediate career plans.

Earlier last month, Minister of State Damien English announced the addition of pharmacists to the Critical Skills Occupation List, allowing for faster access to work permits. Mr Twomey welcomed the

PHARMACYNEWSIRELAND.COM 8 News

announcement saying, “This is an important official recognition that community pharmacists are now in short supply. After significant IPU engagement with government and across the political spectrum we are pleased that this change has been made. This will help pharmacies to attract and recruit pharmacists from non-EU countries.

Commenting on the scale and impact of the shortage of pharmacists, IPU President Dermot Twomey said, “The majority of community pharmacists surveyed by the IPU now believe there is an insufficient number of pharmacists in our healthcare system to meet patient needs. This is a dire situation which could develop and has the potential to create profound difficulties for patients, and immediate action needs to be taken to avoid this.

“No organisation will ever match the commitment, dedication and relentless willingness to go beyond the call of duty that I have witnessed as we battled multiple

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Value10 and Sales Growth in Pharmacy

Compared to the previous period in 2021, mobility increased 11% in supermarkets and pharmacies. The largest increase was in Kerry at 36%. Mobility increased across the board, 1% in Dublin, 10% in Cork and 8% in Limerick over the period.

SOURCE: HMR IRELAND

suggests there have been 14 net closures since the 1st December 2021 (the period we ended the Q4 2021 report on due to data availability), bringing the number of community pharmacies in Ireland to 1,897.

SOURCE: PSI New Openings and Closures 13

Value of Sales: CSO 10.7%

Market Pulse

New Openings between 1st December ‘21 – 31st March ‘22 4

Value of Sales

POWERFITZGERALDSOURCE:POWERFITZGERALDSOURCE:Q1 101550 2021 Completed Deals in Q1 by Geographical Location Completed Deals in Q1 by HSE Fees List Position Munster 3 Dublin 4 Ulster/Connacht 0 Leinster 0 €250k and over €175k-249k €100k-174k Under €100k 2 1 2 2 7 3 17 12

Rising prices

As the economy reopens after the pandemic, supply chain issues are starting to be felt in the sector. Pharmacists are calling on Health Minister Stephen Donnelly to allow them to dispense alternatives to hormone replacement therapy (HRT) to address the current shortage of the drug used to manage menopausal symptoms.

Pharmacy market activity

Closures between 1st December ‘21 – 31st March ‘22 14

Inflation in the Eurozone rose to a new high of 7.4%, with energy prices remaining the biggest contributor to accelerating prices, rising 44.7%. Core inflation, which excludes volatile factors such as energy but also food, alcohol and tobacco, remained stable at 3.2%.

SOURCE: CSO

Pharmacy market activity

Labour market shortages

New Openings between 1st December ‘21 – 31st March ‘22 4

According to HMR Ireland research, the Irish prescription market grew by 4.65% in units compared to the same period last Unityear.Growth: HMR Ireland 4.65%

There has been a steep increase in closures over the quarter. This may be partly a consequence of the pandemic changing pharmacists desire to work in the sector. 12

101515105500Completed Deals in Q1 by HSE Fees List Position Completed Deals in Q1 by Pharmacy Type Sold €250k and over Corporate Group Indigenous€175k-249kGroup20 0 01 17

Compared to the previous period in 2021, mobility increased 11% in supermarkets and pharmacies.

The 2021 edition of the Irish Pharmacy Index was released by the Irish Pharmacy Union (IPU) and Behaviour & Attitudes (B&A). Among other findings, the survey found public support for expanding the role of pharmacies is very strong, with 95% favouring pharmacists being allowed to prescribe medications for minor ailments.

Drug shortages

Summary Q1 2022

Market Pulse

McCabes pharmacy announced the acquisition of Finnstown pharmacy and Newcastle pharmacy, both in Dublin. McCabes employs over 300 staff, and following this acquisition now operates 28 stores across Dublin, Dundalk, Kildare, Wicklow, Wexford, Tipperary, and Limerick.

SOURCE: HMR IRELAND

Pharmacy Pulse

The largest increase was in Kerry at 36%. Mobility increased across the board, 1% in Dublin, 10% in Cork and 8% in Limerick over the period.

It was another strong quarter for sales, with Fitzgerald Power estimating seven transactions completed in the 1st Quarter of PSI2022.data

Labour market shortages

survey of over 1,000 pharmacists, conducted by the Irish Pharmacy Union (IPU) with the support of Behaviour Attitudes (B&A), has shown that it is taking an average five months to fill vacant positions in pharmacies. The IPU is calling on Government to increase the availability third level places in pharmacy as a growing shortage pharmacists is becoming a major threat to community healthcare.

There has been a steep increase in closures over the quarter. This may be partly a consequence of the pandemic changing pharmacists desire to work in the sector.

The value of sales, as measured by the CSO, increased by 10.7% in March 2022 against the same period last year.

Revenue Pulse

A survey of over 1,000 pharmacists, conducted by the Irish Pharmacy Union (IPU) with the support of Behaviour & Attitudes (B&A), has shown that it is taking an average of five months to fill vacant positions in pharmacies. The IPU is calling on Government to increase the availability of third level places in pharmacy as a growing shortage of pharmacists is becoming a major threat to community healthcare.

Unit Trends

Drug shortages

Unit Trends

Market Pulse

the economy reopens after the pandemic, supply chain issues are starting to be felt in the sector. Pharmacists are calling on Health Minister Stephen Donnelly to allow them dispense alternatives to hormone replacement therapy (HRT) to address the current shortage of the drug used to manage menopausal symptoms.

According to HMR Ireland research, the Irish prescription market grew by 4.65% in units compared to the same period last year.

Footfall Pulse

SOURCE: PSI New Openings and Closures PHARMACYNEWSIRELAND.COM

Closures between 1st December ‘21 – 31st March ‘22 14

Summary Q1 2022

Net Openings between 1st December ‘21 – 31st March ‘22 10

Changes in Footfall Mobility

The value of sales, as measured by the CSO, increased by 10.7% in March 2022 against the same period last year.

Rising prices

Footfall Pulse

Value of Sales: CSO 10.7% 

Revenue Pulse

Pharmacy sector survey

Overall 11% Kerry 36% Biggest positive movementDublin 1%Limerick 8%Cork 10% 402030100 SOURCE: GOOGLE MOBILITY

Net Openings between 1st December ‘21 – 31st March ‘22 10

Value of Sales

It was another strong quarter for sales, with Fitzgerald Power estimating seven transactions completed in the 1st Quarter of PSI2022.data

Unit Growth: HMR Ireland 4.65% 

Pharmacy sector survey

SOURCE: CSO

An analysis of the key trends in the Irish Community Pharmacy sector, prepared by Fitzgerald Power on a quarterly basis.

It was another strong quarter for sales, with Fitzgerald Power estimating seven transactions completed in the 1st Quarter of 2022. PSI data suggests there have been 14 net closures since the 1st December 2021 (the period we ended the Q4 2021 report on due to data availability), bringing the number of community pharmacies in Ireland to 1,897. There has been a steep increase in closures over the quarter. This may be partly a consequence of the pandemic changing pharmacists desire to work in the sector.

Indeed, a laboratory study published in a recent edition of the International Journal of Pharmaceutics showed that Symprove altered the composition of the gut microbiome of people with Parkinson’s Disease. The role of gut microbiome and the impact of Symprove in the treatment of Parkinson’s Disease is currently being researched in two clinical studies conducted by King’s College London and Sheffield Hallam University, and results are expected later this year.

Community Alcohol Detox Initiative

Oonagh and her team recently scooped two national Awards at the Irish Pharmacy Awards 2022, taking home the GSK Self-Care Award and the Perrigo Superintendent Pharmacist of the Year Award for Elaine Lillis.

PHARMACYNEWSIRELAND.COM 11News

The Community Alcohol Detox (CAD) Initiative is a regional response to address priorities set out in The National Drug Strategy. It’s a collaborative initiative across four Local Drug and Alcohol Task Force areas; Ballyfermot, Canal Communities, Dublin 12, and the South Inner City. The host agency is Community Response, Primary Alcohol Service, based in Dublin.

Oonagh O’Hagan, owner of Meaghers Pharmacy Picture credit Kieran Hartnett

Owned outright by Oonagh, Symprove Ireland will initial deliver the food supplement to 60 stockists across Ireland, including Nourish and Evergreen health food stores.

The project aims to support people who are alcohol dependent who may face barriers to accessing residential detox such as, individuals who are not currently engaged in drug/alcohol services, parents who have childcare arrangements, people in employment, the travelling community, people using Homeless Services, and a variety of other groups.

In 2014, Meaghers Pharmacy Group was the first Irish stockist of Symprove after Oonagh O’Hagan successfully used the product to manage her own symptoms of IBS. She now aims to bring Symprove to as many people in Ireland who suffer with poor gut health, so that they too can have the opportunity to experience some of its many benefits.

Oonagh had been in discussions with Symprove founder Barry Smith for a number of years to establish the distribution company, a period further extended by the outbreak of the Covid-19 pandemic.

“We have seen a phenomenal increase in demand for the product since we started stocking it. There is so much scientific evidence behind Symprove, with many published clinical papers and so many of our patients come back telling us about the positive impact it is having on their symptoms, in fact we have over one thousand customer reviews on our website on Symprove.

Meaghers Pharmacy Chief Launches New Company

Community Alcohol Detox Initiative

Symprove is a unique water-based product that contains four strains of live and active bacteria. It is scientifically proven to restore the balance of good bacteria to the microbiome, the term used to describe the ecosystem of bacteria in our digestive tract, and is now involved in clinical studies for the treatment of Parkinson’s Disease.

normal lives. They have taken back control of their gut health and it can be very emotional but extremely positive to hear their stories daily.

The announcement was made to mark World Microbiome Day, which took place June 27th.

She commented, “I established the distribution business because I firmly believe in Symprove and I could see the benefits it was having for our customers here in Meaghers. Knowing how Symprove helped improve my IBS symptoms and the impact it has had for so many Meaghers customers I wanted to ensure these benefits are available to those outside of our pharmacies too.

While other health supplements contain bacteria that may be freezedried, Symprove is very different using a unique delivery system to deliver live bacteria to improve the number of good bacteria in your gut, known as your microbiome. Supporting and rebalancing the microbiome can alleviate the symptoms of IBS and many other inflammatory bowel conditions.

“Over the last number of years I have spoken to many people who have had even more chronic symptoms than I had; some could not leave their homes at all because of having to use the bathroom up to 18 times a day. Many are now leading

from alcohol in the community, and as a resource for GPs and practice nurses. A website will be launched with the manual which will provide a directory of services, videos on CAD, information on treatment options and other resources. The manual and website will be launched Autumn 2022, with the aim of improving interagency practice and increasing alcohol treatment in the community settings. If you would like to know more, go to www. communityresponse.ie or niamh@communityresponse.iecontact

The aim is to develop a Community Alcohol Reduction manual. This is aimed at supporting people make changes to, reduce, or detox from alcohol in the community, and as a resource for GPs and practice nurses A website will be launched with the manual which will provide a directory of services, videos on CAD, information on treatment options and other resources. The manual and website will be launched Autumn 2022, with the aim of improving interagency practice and increasing alcohol treatment in the community settings. If you would like to know more, go to www.communityresponse.ie or contact niamh@communityresponse.ie

Oonagh O’Hagan, the owner and Managing Director of Meaghers Pharmacy Group, has announced the launch of Symprove Ireland, a new distribution company for the life-changing food supplement Symprove.

The aim is to develop a Community Alcohol Reduction manual. This is aimed at supporting people make changes to, reduce, or detox

Symprove Ireland is purely a distribution company and will initially employ ten people – including salespeople and educators who will train partners on the benefits of Symprove. The company has plans to scale the business within 12 months.

“Other patients are using Symprove to support them to manage their inflammatory skin conditions but one of the most exciting developments is in the area of Parkinson’s Disease. Studies are ongoing into the potential benefits that Symprove could have in the management of symptoms of Parkinson’s Disease.”

being addressed while it’s still manageable, or it being allowed to fester with the consequential impact on health and wellbeing.

As part of Men’s Health week activities, LloydsPharmacy’s highly trained colleagues visited Men’s Shed locations across Ireland to undertake Heart Health Checks and give advice to members.

operate. Partnering with the Men’s Shed networks, allows our LloydsPharmacy colleagues to further integrate and provide an invaluable health check to the men across Ireland. We are delighted to be partnering with the Irish Men’s Association and hope to grow the partnership further in the future.”

sports injuries. Men must take charge of their own health and make use of their local pharmacy for “Tooadvice.often, men put off dealing with their health issues when many of these are preventable and easily detectable. Your local pharmacist can offer advice on health problems in a private consultation room. Pharmacies can act as the first point of contact between men and the

“It is important that we understand the main health concerns facing Irish men and the barriers to seeking treatment that may exist. Pharmacists can advise men and provide treatment for a range of different health issues and minor ailments such as high blood pressure, smoking cessation and

medical world, because they also supply non-medical products such as toiletries and supplements, which men can access from their local pharmacy providing an opportunity to also discuss health matters with the pharmacist,” concluded Mr Conefrey.

As part of Men’s Health week activities, LloydsPharmacy’s highly trained colleagues are visiting Men’s Shed locations across Ireland to undertake Heart Health Checks and give advice to members

News

With one in six people having a stroke at some time in their life, it is very important to take care of our hearts. There are simple lifestyle changes we can make to ensure we are doing the best to prevent heart attacks or strokes. Keeping an eye on your blood pressure is essential for maintaining a healthy heart.

The Irish Men’s Sheds Association was formed in 2011 and through over 450 locations nationwide, they provide support, information and resources to members’ sheds in Ireland, north and south of the Dervilaborder.McGarry, Head of Marketing with LloydsPharmacy said, “At LloydsPharmacy we are committed to serving the communities in which our stores

PHARMACYNEWSIRELAND.COM 12

LloydsPharmacy has teamed Up with Claremorris Men’s Shed to promote Heart Health

LloydsPharmacy has teamed up with the Irish Men’s Sheds Association to encourage all members to look after their heart health. As part of the partnership, LloydsPharmacy’s highly trained colleagues are visiting various Men’s Shed locations across Ireland to undertake checks and offer knowledge and support to Trainedmembers.colleagues from LloydsPharmacy from Claremorris last week visited Claremorris Men’s Shed and undertook free Heart Health Checks. 10 men were checked on this visit to Claremorris Men’s Shed with positive feedback and result from all members.

Tomás Conefrey, a local community pharmacist and member of the Irish Pharmacy Union (IPU), said, “Pharmacy staff are well positioned to talk to and advise men about their health needs and explore possible options. We know from our own experience that men can be reluctant to talk about their health. A quick private conversation with a pharmacist could mean the difference between a problem

The Irish Pharmacy Union is encouraging men to utilise the convenience of their local pharmacy during Men’s Health Week 2022.

Men Must start Addressing their Health Issues

Pharmacists are calling on all men to make a positive difference to their health by asking their local community pharmacist about any health issues they may have. This Men’s Health Week (which was held 1319 June), the Irish Pharmacy Union (IPU) has asked men to do at least one practical thing to improve their own health.

LloydsPharmacy Teams up with Men’s Sheds

Rebecca McLaughlin, Health & Well-Being Manager of the Irish Men’s Association added, “We are delighted to have the opportunity to partner with LloydsPharmacy to bring awareness and understanding of heart and health checks to Shedders. We know that bringing these activities into the informal Shed environment is a really effective way of engaging Men with their Health – helping many to take the first step towards navigating their way through health issues and potential anxiety around dealing with them.”

We spoke to General Manager of IQVIA, Gwynne Morley, to gain further insights into how these statistics are compiled and on the value of this market to pharmacy.

It’s a rolling annual value which includes the 5 major OTC categories including Pain relief, Cough and Cold remedies, Vitamins and Minerals, Skin and Digestive Health.

The information contained over the following pages is widely accepted as the industry standard from which brand performance is measured across the OTC sector.

Focusing on GrowthThe OTC Market in Ireland

14 | PHARMACYNEWSIRELAND.COM

About IQVIA

Presentcountries.in

Value of the OTC Market to Pharmacy

Ireland since 1990, IQVIA pioneered the country as a hub for clinical research. In addition to supporting life sciences in their clinical efforts across Europe and the globe, IQVIA’s activity in Ireland includes supporting the life sciences industry from R&D through to commercialization, as well as healthcare providers, to improve treatment outcomes and patient pathways.

Gwynne Morley, General Manager, IQVIA Ireland,

Irish Pharmacy News has been working with human data science company, IQVIA, for the last seven years to comprise this annual report which highlights the Top 100 Over-theCounter pharmacy brands in Ireland.

“The 5 major OTC categories (including Pain relief, Cough and Cold remedies, Vitamins and Minerals, Skin and

The Top 100 Over the Counter (OTC) Market Report is based on the total value of wholesale sales for OTC products into retail pharmacy over the course of the previous 12 months to April 2022 (May 2021- April 2022).

IQVIA (NYSE:IQV) is a leading global provider of advanced analytics, technology solutions, and clinical research services to the life sciences industry. 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. With approximately 79,000 employees, IQVIA conducts operations in more than 100

Gwynne tells us, “The total value of the Over the Counter (OTC) market in Ireland based on IQVIA’s data for the 12 months, May 2021 to April 2022, was €501 million.1 This market grew by 23.2% (value) & 22.7% (volume) when comparing year-on-year growth.2

sleep and mood enhancing products continue to grow at 19.5% PPG MAT April 2022.2 This category now accounts for 1% of the value of the OTC market compared to 0.3% pre-COVID. This suggests that a significant number of the population continue to struggle with anxiety and insomnia.”

HealthDigestive 13.9%

Protection / Exposure to ailments

has experienced growth each year since the outbreak of the pandemic. This is primarily due to increased awareness of self-care and the benefits of vitamins and minerals, initially to fight COVID-19 by boosting immunity, but now consumers have adopted the consumption of VMS as a “Calming,habit.

Digestive Health) account for €378 million1 of the total value. Please see below the previous period growth rate Moving Annual Total (MAT) April 20222 for each of these four categories:

“After a rough 2020 due to the pandemic, 2021 saw 6.7% growth, led by nutrition and gastrointestinal categories, according to IQVIA Consumer Health’s Global OTC Insights data. Analgesics also picked up significantly. The cough cold category, which was hardest hit during the pandemic, was still behind at -4%, but we expect that to flatten in 2022.3

Figure 2: Top 10 reasons why health has become a proactive priority

Category Previous period growth (PPG) MAT April 20222

Source: NielsenIQ Global Health & Wellness Study of 17 markets , September 2021

IQVIA Confidential | 21 February 2022 | Prepared for OTC Toolbox 47 % 47 % 43 % 41 % 31 % 28 % 27 % 27 % 20 % 18 %

PHARMACYNEWSIRELAND.COM | 15

Re evaluating lifestyle

“IQVIA Consumer Health is forecasting the Irish OTC market will grow in 2022 by +5.5%4

Live a longer healthy life

We asked Gwynne what are the key trends currently affecting/changing the consumer health market in Ireland?

Influence from the news

“Rather than seeking medical treatment, more consumers

Skin 5.8%

Figure 2: Top 10 reasons why health has become a proactive priority

The Cough and Cold remedies category declined significantly in the period from May 2020 to April 2021. Gwynne adds, “In fact the value of this market was 50% of the value for the same period the previous year (i.e., May 2019 to April 2020). This decline was the outcome of successive lockdowns and adherence to the key messaging from government to stay at home, maintain social distancing and adopt good personal hygiene practices – there was significantly reduced transmission of respiratory viruses during this period. Due to the lifting of these restrictions and the return of social interactions, this category has experienced unprecedented growth in 2022 and the value of the market has returned to preCOVID levels.

“In contrast, vitamins and minerals (VMS) have experienced unprecedented growth since March 2020. This category

Want to look / feel healthier

Vitamins & Minerals 8.8%

“Pain relief continues to be the most consumed OTC products in Ireland. The growth of this market declined in 2021, mainly due to the increased demand in over-the-counter painkillers by consumers in March 2020 in anticipation of the pandemic - 808,000 units were supplied to Irish pharmacies; an increase of 164% on the same week in 2019. This unprecedented demand exaggerated the growth in this market in 2020 as consumers had stock-piled pain medication in their homes and, it was perceived that growth in 2021 was poor. This is a contributing factor to the strong growth in this category in 2022.”

Pain relief 32.5%

“The essential role that pharmacies play in delivering healthcare in the community has been ably demonstrated during the COVID-19 pandemic. As the most accessible of all healthcare professionals, community pharmacies have provided a nationwide service to patients and the public in extraordinarily difficult circumstances. Across EU4 countries + UK + Ireland, there has been significant growth across the pharmacy channels –the Irish pharmacy channel grew stronger than the EU4 countries + UK for MAT Q1 20225 (see figure 1). As the public has trouble accessing GPs and services, more patients are turning to their local community pharmacist as a trusted healthcare professional for the treatment of minor ailments and health advice/ guidance. Pharmacy in the future has the opportunity to become a neighbourhood health destination - the integration of personal wellness data from digital apps, should support the coupling of product, service, and data, and enable the community pharmacy to transition from the traditional role of prescription filling to delivering holistic consumer care.

“Coming out of the COVID 19 pandemic, we see some key trends buffeting the consumer health industry. Health has become a proactive priority for consumers and the drivers of influence are diverse. For proactively engaged consumers, reasons range from the desire to live a longer, healthier life, and a desire to look and feel better post lockdown, to the sway of social media and the burden of rising costs of healthcare (see figure 2)

Cough Cold & Other ProductsResp 67.3%

Influence from family / friends

Avoid preventable diseases

Worried about COVID unvaccinated

The Global Over the Counter (OTC) market is recovering faster than expected, following COVID-19 pandemic, Gwynne reflects.

Figure 1: EU4 + UK + Ireland Pharmacy Channel Value Growth (%) and Market Share - MAT Q1 2022 vs. MAT Q1 2021

Influence from Social Media

Influence from adv erti s i ng / ri sing co s ts of heal thcare

sustainability, high quality ingredients, natural products, medication with noside effects, to match their values and Ofaspirations.coursedespite opportunities, there are always challenges in any market.

OTC

Figure 3: Areas where individuals manage their health care7

16 | PHARMACYNEWSIRELAND.COM

Figure 3: Areas where individuals manage their health care7

the contribution of innovation to the OTC market in Ireland increased or decreased over the last 24 5 % 0 % 34%%6% 16 % 6 % 5 % 23 % 10 % 30 % 13 % 2830%% 10 % 34 % GermanyUSChina Czech RepublicRussiaSlovakiaPolandItalyOffline Pharmacy eCommerce 23 % 22 % 13 % 11 % 10 % 6 % 5 % 3 % 0 0 % 20 0 % 40 0 % 60 0 % 80 0 % 100 0 % 120 0 % US Germany China RepublicCzech Russia Slovakia Poland Italy Offline Channels eCommerce US and Germany have the biggest ecommerce share, Italy and China growing the fastest Figure 4 Online and Offline market share and growth IQVIA Confidential | 21 February 2022 | Prepared for OTC Toolbox Market Share 2021 : Offline vs. eCommerce Growth 2021 Source: IQVIA CH Global and Local data + estimates, Statista, Deloitte, eCommerce companies' news and financial releases, local pharmacy associations

We asked Gwynne what are the key trends currently affecting/changing the consumer health market in Ireland?

“We continue to see a blurring of lines between in-store and ecommerce shopping. This trend began before the pandemic, but COVID accelerated consumers’ willingness to engage with digital services and sales using mobile technology. Health and beauty are now leading e-Commerce categories, with consumer health categories such as VMS benefiting from the rise of online subscription models which match the consistent, repeat purchase behaviour of that category’s consumers. Urgent need products, like pain medication and cough and cold products, are still showing strong offline sales due to the inconsistency of their “IQVIAuse.Consumer Health’s e-Pharmacy data shows that already around a fifth of consumer health sales in the US, Germany, and China now goes through e-Pharmacies and other e-Commerce channels (see figure 4). This doesn’t

However, due to hectic lifestyles and dayto-day pressures, not all consumers can dedicate the time necessary to live healthy and balanced lifestyles. Instead, people turn to over the counter (OTC) medicines with 24/7 access for symptomatic relief or vitamins and nutritional supplements to focus on “Consumerswellbeing.nowhave access to a wider range of information at their fingertips. Their purchase decisions are no longer driven by one variable, but several variables working in tandem. The same consumers and shoppers are re-visiting their values and forcing firms to focus on

Of course despite opportunities, there are always challenges in any market. commerce is now a must win channel,” says Gwynne. continue to see a blurring of lines between in store and ecommerce shopping. This trend began before the pandemic, but COVID accelerated consumers’ willingness to engage with digital services sales using mobile technology. Health and beauty are now leading e-Commerce categories, with consumer health categories such as VMS benefitting from the rise of online subscription models which the consistent, repeat purchase behaviour of that category’s consumers. Urgent need products, pain medication and cough and cold products, are still showing strong offline sales due to the inconsistency of their use.

The Market

“Rather than seeking medical treatment, more consumers are opting for self-

“Coming out of the COVID-19 pandemic, we see some key trends buffeting the consumer health industry. Health has become a proactive priority for consumers and the drivers of influence are diverse. For proactively engaged consumers, reasons range from the desire to live a longer, healthier life, and a desire to look and feel better post lockdown, to the sway of social media and the burden of rising costs of healthcare (see figure 2)

“Consumers now have access to a wider range of information at their fingertips. Their purchase decisions are no longer driven by one variable, but several variables working in tandem. The same consumers and shoppers are re visiting their values and forcing firms to

Figure 4: Online and Offline market share and growth - US and Germany have the biggest ecommerce share, Italy and growingChinafast

care interventions for various reasons, including convenience and cost; extending to areas such as fitness, mental wellbeing, and diet to prevent illnesses and ailments; and boosting their natural immunity for the future (figure 3).

effects, to match their values and aspirations.

“E-commerce is now a must-win channel,” says Gwynne.

IQVIA Consumer Health’s e Pharmacy data shows that already around a fifth of consumer health in the US, Germany, and China now goes through e Pharmacies and other e Commerce channels figure 4). This doesn’t mean brick and mortar shops will disappear. But it will require a more cohesive sales and marketing strategy, where e Pharmacies, independent pharmacies, chains, and wholesalers work collaboratively to offer a seamless omnichannel brand experience.

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“Innovation in the OTC market in Ireland has primarily been driven by the launch of new medicinal products recommended for the treatment of allergies and erectile dysfunction. These launches have contributed sales of approximately €10 million MAT April 20222 to the Irish OTC market, which accounts for approximately 50% of total sales attributable to new launches in the Irish OTC market in the past 12 months. Historically, these products were only available on prescription in Ireland. The other new launches were line extensions, new pack

and genetics testing kits. These include 23andMe the personalized gene testing kit company,

“Moreover, the type of innovation itself is far from being disruptive, as it is in many cases limited to pack sizes, new flavours, or forms, as consumer health players slowly pick up new trends such as personalisation and digital health.

also expect more from consumer health players,” she says. “They are more informed, have different expectations (e.g., sustainability, locally sourced, natural) and have a wider access to products and information from many

“Connecteddriver.consumers

“In Ireland, Irish Life has introduced MyLife which is a personalised health and wellness app and online platform that rewards Irish Life Wellbeing members for making better lifestyle choices each day. Consumers are also interested in capturing their health data to guide personal and global health strategies, which is driving interest in fitness trackers, health apps,

“The Consumer Health industry is thriving despite the chaos caused by the pandemic — and in some cases, because of it. The 18 months that consumers spent stuck at home, wearing masks, and avoiding public spaces has spurred innovation in the consumer health sector, and caused consumers to rethink their approach to health and wellness.

online and offline channels. Yet the level of innovation in consumer health remains relatively low compared with other industries, and although it has increased in recent years, it remains hampered by regulatory and structural constraints.

Has the contribution of innovation to the OTC market in Ireland increased or decreased over the last 12-18 months?

The Market

“With consumers forced to avoid shopping centres, they moved more of their day-to-day purchases online, with e-Pharmacies providing a safe and convenient online channel for purchasing essential healthcare products. As a result, e-Pharmacy sales now contribute about 5-10% of the global consumer health market (see figure 5). IQVIA Consumer Health’s e-Pharmacy data indicates that most countries will see high single digit

18 | PHARMACYNEWSIRELAND.COM

What impact is the rise of e-pharmacy and the new ‘digital shopper’ having on the market for OTC medicines in Ireland?

mean brick-and-mortar shops will disappear. But it will require a more cohesive sales and marketing strategy, where e-Pharmacies, independent pharmacies, chains, and wholesalers work collaboratively to offer a seamless omnichannel brand experience.

OTC

sizes or new flavours of existing brands available in the Irish market.”

Figure 5: e-Pharmacy Share of Market Growing Quickly

Gwynne adds that in an environment where growth is becoming harder to achieve through volume or price, innovation has become the main growth and value

“Global growth on the consumer health marketplace is being driven by a growing interest in health and wellness, easy access to digital shopping options and more personalized product selections. Payers are also looking to shift more responsibility for health and wellness to individuals by focusing on prevention as a proactive care option. These health and wellness trends are being bolstered by the adoption of lifestyle apps, wearables, and other health driven technology that encourage healthy behaviour and proactive self care. Many government agencies and insurance providers are now taking advantage of these tools as a strategy to improve population health.

“For example, Fitbit, maker of wearable fitness monitors, recently partnered with the Singapore Health Promotion Board to provide trackers paired with subscriptions and targeted programming to encourage healthy living in the country. Fitbit is also a named covered fitness benefit by 42 Medicare Advantage plans across 27 U.S. states.

While the bulk of online shopping takes place between 9am and 11pm, unbranded organic searches are about twice as likely to occur between 11pm and 9am (about 29%). Online shoppers are six times more likely to visit an e Pharmacy website than Amazon. E-pharmacy and Amazon visitors review paid and organic branded searches before making a ecision. Both groups use price comparison websites. e-Pharmacy and Amazon category relevant actions tend to spike around 11am, 8pm, and between 11pm and 1am. Amazon visitors twice as likely as e Pharmacy visitors to visit the brand’s websites. the Online are six times more to 8pm, and between 11pm 1am.

Irish Over the Counter (OTC) market demonstrated an amazing recovery in the second half of clocking a FY2021 growth of +12% (vs. 2020)6. We expect this double digit growth to reduce to 20224 and we are forecasting 5.6% growth for 20236.”

20IQVIA Confidential | 21 February 2022 Prepared for OTC Toolbox 40% 30% 25% 19% 19% 18% 13% 12% 11% 10% 16% 22% 8% 9% 7% 11% 3% 4% 7% Diet and nutrition Lifestyle and stress Exercise and fitness Healthcare providers/insurance Disease specific 99%% 2015 2017 2020 Wellness management Health condition management 22% 15% 10% 8% 7% 6% 66%% 2% 3% 4% 4% 3% 0% 3% 1% 1% Disease specific n = 2580 apps Medication reminders and info Women’s health and pregnancy Mental health and DigestivesystemHeartDiabetesdisordersbehavioral/circulatorysystem ( GI) Respiratory OtherHematologyKidneyGenitourinaryparasiticInfectiousdiseasesandEndocrinesubcutaneousSkinPainEyesNervousCancerconnectivesystemMusculoskeletalsystemandtissuesystemandearsandtissue,nutritionalmetabolicanddiseasessystemdisease References: 1 Source: IQVIA OTC Ireland Monthly Database, MAT April 2022 2 Source: IQVIA OTC Ireland Monthly Database, Previous Period Growth April 2022 3 Source: Catching the Consumer Health Rebound An IQVIA blog March 2022 4 Source: IQVIA Global OTC Forecast 2022 5 Source: IQVIA CH Global OTC Insights plus estimates of e-Commerce & Mass-market (excluding Venezuela) 6 Source: IQVIA Global OTC Insights 7 https://www.who.int/news-room/fact-sheets/detail/self-care-health-interventions 8 e-Pharmacy Thrives as OTC Growth Begins Recovery An IQVIA Consumer Health Quick View IQVIA Key Trends in Shopper Behaviour Please see below observations about how (and when) consumers shop online:8 • Most category-relevant actions take place between Mondays and Wednesdays with the lowest activity levels during the weekend. • While

shoppers

spike around 11am,

“In Ireland, Irish Life has introduced MyLife which is a personalised health and wellness app and online platform

bulk of online shopping takes place between 9am and 11pm, unbranded organic searches are about twice as likely to occur between 11pm and 9am (about 29%). •

PHARMACYNEWSIRELAND.COM | 19

does Gwynne - think the OTC Medicines market in Ireland will look like for the remainder of going into 2023?

growth for 2023.6”

see below observations about how (and when) consumers shop online 8: Most category-relevant actions take place between Mondays and Wednesdays with the owest activity levels during the weekend.

and

“The Irish Over the Counter (OTC) market demonstrated an amazing recovery in the second half of 2021, clocking a FY2021 growth of +12% (vs. 2020).6 We expect this double-digit growth to reduce to 5.5% for 20224 and we are forecasting 5.6%

• Amazon visitors twice as likely as e-Pharmacy visitors to visit the brand’s websites.

that rewards Irish Life Wellbeing members for making better lifestyle choices each day. Consumers are also interested in capturing their health data to guide personal and global health strategies, which is driving interest in fitness trackers, health apps, and genetics testing kits. These include 23andMe, the personalized gene testing kit company, which now boasts 11 million customers near-80% who have agreed to share their genetic information for disease research.

“In 2020, disease-specific apps represented 22% of all apps in the marketplace (see figure 6). Of those, the leading topics include mental health, digestive, respiratory, musculoskeletal pain, eyes, and ears, which align with consumer health product categories.

What does Gwynne - think the OTC Medicines market in Ireland will look like for the remainder of 2022 going into 2023?

Figure 6: Digital Health Apps by Category and Disease State in 2021 eyes, and ears, which align with c

likely to visit an e-Pharmacy website than Amazon. • E-pharmacy and Amazon visitors review paid and organic branded searches before making a decision. Both groups use price comparison websites. • e-Pharmacy and Amazon category relevant actions tend

to low double digit growth in e-Pharmacy sales through the end of 2021, while offline pharmaceutical sales will stagnate. This shift in shopping behaviour is expected to continue, making e-Pharmacy a major player in the consumer health marketplace in the years to come.

“Global growth on the consumer health marketplace is being driven by a growing interest in health and wellness, easy access to digital shopping options and more personalized product selections. Payers are also looking to shift more responsibility for health and wellness to individuals by focusing on prevention as a proactive care option. These health and wellness trends are being bolstered by the adoption of lifestyle apps, wearables, and other health-driven technology that encourage healthy behaviour and proactive self-care. Many government agencies and insurance providers are now taking advantage of these tools as a strategy to improve population health.

pain,).

Key Trends in Shopper Behaviour

Irish Pharmacy News has been working with data analysts IQVIA for over seven years in compiling and bringing this information to our readers, pharmacy professionals of Ireland. Size: Psheets:100*x75mm50aper:White *glue side IM 01 100 x 75 07/11/2017 Cetrine Allergy Post it pad 11-17 C M Y K 10mg Film-Coated Tablets Size: Psheets:100*x75mm50aper:White *glue side Black IM 01 100 x 75 22/07/2016 Brupro Max Post it pad 07-16 18801 C M Y C Brupro Max Post it pad (07-16).pdf 1 22/07/2016 11:32 PARACETAMOL GKC PARACETAMOLSixPlusPGO

20 | PHARMACYNEWSIRELAND.COM 252423222120191817161514131211109 15102916403550131228323357112018953421876 24123227203013141619549615101811478562139 301118391941201217211413105147853216900 221438471852191221201315101160459832100 181445631988261229211316111032187504900 04/2021 04/2020 04/2019 04/2018 04/2017 IMS MAT Mar 2012 oduPctsinunits(000s) 2000150010005000 ParaliefPanadolExtra PanadolPanadolActifastPanadolSolMaxPanadolNightAnadinParacetamol HedexPanadolAdvance Paratabs Paralief the No.1 Paracetamol Brand in Pharmacy 1,943,176 657,350 517,351 201,819110,098 104,404 74,039 16,233 7,391 234,304

*Disclaimer: Please note that the seven year comparison listed opposite details a range from Jan-April for the years 2017-19 and 2022 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.

“Pain relief continues to be the most consumed OTC products in Ireland. The growth of this market declined in 2021, mainly due to the increased demand in over-thecounter painkillers by consumers in March 2020 in anticipation of the pandemic - 808,000 units were supplied to Irish pharmacies; an increase of 164% on the same week in 2019. This unprecedented demand exaggerated the growth in this market in 2020 as consumers had stock-piled pain medication in their homes and, it was perceived that growth in 2021 was poor. This is a contributing factor to the strong growth in this category in 2022.”

PARALIEF DRIVING CASH SALES AND PROFIT IN YOUR PHARMACY

A copy of the summary of product characteristics is available on request. Medicinal product available for retail sale through pharmacy only. Always read the label.

In looking at this years’ data, General Manager of IQVIA, Gwynne Morley told us “The 5 major OTC categories (including Pain relief, Cough and Cold remedies, Vitamins and Minerals, Skin Digestive Health) account for ¤378 million of the total value.

Paralief 500 mg Tablets. Clonmel Healthcare Ltd., Waterford Road, Clonme Co. Tipperary.

Interestingly, the Consumer Health industry is thriving despite the chaos caused by the pandemic — and in some cases, because of it. The 18 months that consumers spent stuck at home, wearing masks, and avoiding public spaces has spurred innovation in the consumer health sector, and caused consumers to rethink their approach to health and wellness.

The Top 100 data is collated each year and summarises activity from May ‘21 to April ‘22. IQVIA uses data, technology, advanced analytics, and expertise to help customers across healthcare drive health forward. For many of these customers, having an accurate, timely view of product performance is critical to ensuring they are improving both business and patient outcomes. The Top 100 Over the Counter (OTC) Market Report is based on the total value of wholesale sales for OTC products into retail pharmacy over the course of the previous 12 months to April 2022 (May 2021April 2022).

PARALIEF DRIVING CASH SALES AND PROFIT IN YOUR PHARMACY

The Cough and Cold remedies category declined significantly in the period from May 2020 to April Gwynne2021.adds

that in an environment where growth is becoming harder to achieve through volume or price, innovation has become the main growth and value driver. “Connected consumers also expect more from consumer health players,” she says. “They are more informed, have different expectations (e.g., sustainability, locally sourced, natural) and have a wider access to products and information from many online and offline channels. Yet the level of innovation in consumer health remains relatively low compared with other industries, and although it has increased in recent years, it remains hampered by regulatory and structural constraints.

Gwynne adds, “With consumers forced to avoid shopping centres, they moved more of their dayto-day purchases online, with e-Pharmacies providing a safe and convenient online channel for purchasing essential healthcare products. As a result, e-Pharmacy sales now contribute about 5-10% of the global consumer health market.”

PHARMACYNEWSIRELAND.COM | 21 05/2022 04/2021 04/2020 04/2019 04/2018 04/2017 IQVIA Top 100 Pharmacy Products NUROFEN THEALOZBRONCHOSTOPPANADOLANTISINUTABNUROFENSUDAFEDVICKSIMODIUMZIRTEKSOLPADIFFLAMOTRIVINEMAXILIEFPANADOLMOTILIUMVOLTAROLSENOKOTPIRITONDAKTARINNYTOLBUTTERCUPSTREPSILSEXPRESSBRONCHOACTIFASTEXTRALACTULOSEFRSNASALCOLD&FLUHISTALLERGYNIGHTJUNIOR 50494847464544434241403938373635343332313029282726 4186603774548867394936693027474319211723349670260 78526747465148506249433441553735293339362321000 59464863452357423432682627242538332815000000 9745555848356940323167282524333729277000000 44604257403932286822272431332523600000000 DEEP DULCOCERUMOLCORTOPINBENYLINDIORALYTECYSTOPURINZOVIRAXBENYLINRENNIEALFLOREXCORSODYLSAVLONSUDOCREMNICOTINELLBONJELAARTELACVERMOXACTIFEDFYBOGELCAL+A56:B90DESENEBUPLEXNIQUITINBEROCCACALPOLHEATVAPOURDAYNIGHTGLXDRYN/DLAX 75747372717069686766656463626160595857565554535251 247593317182806551666358535545944448614652563800 28899075177483317380578170716663536959604556446461 22799175167276356681557044585650536252475464438049 2683657216747934709846714353574954595150236342560 78367215698334654764935056415953484946753861000 SILCOCKSROWALIEF BASE OVE VIVIO GAVISCONVIAGRAJUNIORCONNECTEXTRA STR PARACETAMOLSTERIMARBEPANTHANARRETTEREVIVEBEPANTISEPTICACTIVE45 ATV SEVENIDEOSOLBAS SEAS C L O STREPSILSSONACODINEXHYLOACICELAVEANUSOLOPTREXNIGHTMAGNESIUMAQUEOUSPLUSBIOKULTPROBIO 100999897969594939291908988878685848382818079787776 999876858479837887894200000000000000 878685997795925800000000000000000 858289737192906000000000000000000 867589776488858100000000000000000 847177676279808200000000000000000 05/2022 04/2021 04/2020 04/2019 04/2018 04/2017 05/2022 04/2021 04/2020 04/2019 04/2018 04/2017

22 | PHARMACYNEWSIRELAND.COMWrittenbyMark

The importance of innovation & retailing standards

Gaynor, Senior Buyer, McCauley Health & Beauty Pharmacy

Consumer habits and the need for value

the year ahead, it is more important than ever that retailers maximise these sales opportunities.

Beauty is back but it has a new face

This has not been without its challenges however: The implementation of EU directives relating to the ban of DHA and Lilial ingredients, resulted in varying levels of supply availability. We experienced a surge in demand for bronzing products right at a time when manufacturers were updating ingredients and packaging to comply with these new directives. Key manufacturers themselves are still grippling with supply chain issues relating to packaging and shipping costs which have still not returned to pre-covid levels. Fulfilment therefore struggled to remain consistent. Additionally, a lot of brands have been pushing through additional price increases, to help compensate them for these extra costs.

The old model of just placing 1m or 1.5 m stands and filling them with stock are no longer enough to drive sales. Influencer brands that bring regular newness and put a local face to a global market are winning sales. Innovation and NPD in both product and stand along with a strong campaign that are targeted locally, are delivering much more consistent sales. These can be individualised rather than one size fits all market approach, and it is proving to be very effective. With potential upheaval in the industry in

While in store shopping has been steadily returning, it is important that retailers maintain excellent levels of service both in store and online. We invested substantially into our Ecommerce platforms over the past 3 years. This included the creation of brand rooms online for selected brands, and the installation of click and collect kiosks in a lot of our locations. This way, we can make these niche beauty brands available to all consumers who regularly shop in store but where that store might not necessarily stock their brand of Ourchoice.E-Commerce platform also enables us to help customers that would not typically operate in the online space. We can utilise the knowledge and expertise of our staff in stores, and with whom our customers have a relationship, to assist them to purchase either in store with click and collect, or in store straight to their door with free online delivery (deliveries over ¤39 are free). This allows us to uphold the high standards our customers are accustomed to, in both bricks and mortar & in the online channel. The future of beauty retailing is therefore threefold: It must be in store, online, and deliver outstanding customer service. market for consumers in general is dynamic and there are many factors contributing to its success and its challenges. The influences on this market are diverse and range from global to local as shoppers return to stores in person in volumes not seen since early 2020.

The self-select

Returning to “Normal” & its challenges

Shopper trends have been changing throughout the year. The initial optimism of a “return to normal” and nightlife – has been dampened by rising inflation and its overall impact on average basket spend. We have seen a more cautious approach from our retail customers who are now looking for value during their weekly shop. We started a campaign back in May launching multiple bundle deals across our platforms (in store, online & click & collect) which has been and is continuing to be well received by customers. Further to this, we recently launched

The massive success of on trend brands from Irish influencers has helped drive new younger customers back into this category. The innovation has helped refresh the self-select offering and continues to drive new and existing customers back to stores. Irish influencers have really dominated the market with the innovation of new products such as My Mascara, Hydra lip, Body base etc. The use of popular social channels such as TikTok and Instagram to teach customers the how-to use of these new and existing products, drives great sales and demand.

2. Full pout with glorious and vibrant reds and you mark the return of the lip

Foundations being the bases that they are, started to make the turn first. As skin became such a focus through the pandemic it seemed as if we were reluctant to cover it up with tints and glows. Trends are pointing towards a fresher face emerging this year. Eyes are being paired back letting the lashes do all the talking and we have seen a pickup in sales along with some key launches in this area. Lips have been hidden behind masks for so long: we are now finding that you are in 1 of 2 camps:

The last 9 months however has seen a temporary return to “normal” with the lifting of the majority of COVID restrictions. Self-select cosmetics traded well through the Christmas period and this upsurge in sales was also reflected in the

recovery of some other key beauty categories. With a return to offices and nightlife, we have seen that a lot or brands have been in growth or have at least seen their sales recover which allows retailers to be cautiously optimistic.

1. Still rocking a nude but with extra sheen, now that wearing masks are no longer required

E-Commerce, accessibility, and customer relations

The Recovery and Challenges of the Beauty Market

Beauty Market

a very successful spend and save campaign in stores (Spend ¤30 and receive a ¤5 voucher redeemable in store). This helps maintain the value message to our customers and encourages them to shop again with us.

DON’T LET PAIN HOLD YOU BACK

*To verify contact verify@perrigo.com

ALAN HARNETT RUTH GRANT CHARLIE RICKARD ANNE MARIE O’NEILL BRENDAN O’KEEFFE PAUL FLYNN OLLIE HIGGINS Nth Leinster Midlands Greater Dublin South Leinster Cork and Kerry Waterford/Tipperary/Limerick/Clare West 086-8189846 086-4679113 086-6011643 086-1749626 086-8189843 086-1427717 087-9533161 For more detail and for any training requirements please contact your Perrigo Pharmacy Business Manager

ESSENTIAL INFORMATION

Solpa-Extra 500mg/65mg Soluble Tablets contain paracetamol and caffeine. For the treatment of mild to moderate pain. Adults and children over 16 years: 1-2 tablets dissolved in water every 4-6 hours. Max 8 tablets a day. Children 12-15 years: 1 tablet disolved in water every 4-6 hours. Max 4 tablets a day. Not suitable for children under 12 years. Contraindications: Hypersensitivity to the ingredients. Precautions: Particular caution needed under certain circumstances, such as renal or hepatic impairment, chronic alcoholism and malnutrition or dehydration. Precautions needed in asthmatic patients sensitive to acetylsalicylic acid, patients on a controlled sodium diet and with rare hereditary problems of fructose intolerance. Patients should be advised not to take other paracetamol containing products concurrently. Pregnancy and lactation: Not recommended during pregnancy and breastfeeding. Side effects: Rare: allergies. Very rare: thrombocytopenia, anaphylaxis, bronchospasm, hepatic dysfunction, cutaneous hypersentitivity reactions. Unknown: nervousness, dizziness. Further information is available in the SmPC. PA 1186/017/001. P. MAH: Chefaro Ireland DAC, The Sharp Building, Hogan Place, Dublin 2, Ireland. Date of preparation: July 2020. Legal Class P – Pharmacy only. IRE/SOL1/2022/02

PHARMACYNEWSIRELAND.COM | 23

We need to ask ourselves what our customers want from us, and also what we want from them. Our value is so much more than selling grocery product lines, we need to capitalise on the fact that we are healthcare professionals and support families with the healthcare and product knowledge that only we as community pharmacists can offer. Our value is in our advice and service and many parents visit pharmacies as they need human reassurance when discussing the health of their precious child. With this in mind, I would like to highlight some of the challenges that I raised on reflection of this market last year.

On a more global scale, birth rates continue to decline in China and America. The birth rates in these countries are anticipated to continue to decline. Birth rate is affected by many factors with economic and social aspects remaining a priority. If families are struggling financially due to increases in interest rates, high mortgage and rental prices, and high childcare costs it can be difficult to consider expanding your family.

• 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

Quarter 1 Decrease

58443 55959 4.4% Increase

The Baby Boom

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 discussing opportunities.

• Streamlining of purchasing habits. Consumers have sped up the trend to do their research on what products they would like online and are not always 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.

The baby market remains dynamic with a sudden raise in the number of births in quarter 3 and quarter 4 of 2021.

24 | PHARMACYNEWSIRELAND.COMWrittenbySheena

11551 13527 1.7% Decrease

The CSO figures make an interesting read:

Quarter 2

16747 14477 15.7% Increase

Mitchell, Pharmacist, Milltown totalhealth Pharmacy

Quarter 3

• The provision of fertility services. We are specialists in health, and we should ensure we are offering fertility dispensing services, supplements and guidance to parents trying to conceive. There are many useful Webinars available through the PSI and IPU which can help update your knowledge.

Written by Sheena Mitchell, Pharmacist, Milltown totalhealth Pharmacy

The baby market remains dynamic with a sudden raise in the number of births in quarter 3 and quarter 4 of 2021.

The baby market will continue to exist whilst the birth rates may fluctuate. The important role of Pharmacists is to ensure that we are delivering a high standard of affordable care to our patients. Never more have our patients relied on us as their first port of call in their healthcare journey, with many parents unable to access GP’s due to high waiting times and high prices. Similar can be said with hospital access. Long waiting times and the threat of spending prolonged periods of time in an environment which may increase the chances of your baby catching an infection are not appealing.

Baby Market

13885 14371 3.3%

Fluctuations in the birth figures are inevitable, and really, your position within the market depends of the quality of the service you provide. The baby market is one which will always exist, but consumer trends and behaviours will continue to evolve. Consumers will buy some low value items online, and from supermarkets, that is inevitable due to convenience. The core focus of our profession should be on what we can do to set ourselves apart, what value do we deliver that is greater than the draw of a slightly lower price. We are uniquely placed as both healthcare professionals and retailers, and we must remain focused on what drives our customers in the doors of our stores. First though, there are some interesting trends in birth rates to consider!

16250 13584 19.6% Increase

The CSO figures make an interesting read:

Quarter 4 Overall

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. We have always been at the heart of our communities, and that has only been amplified by the pandemic over the past two years. Our customers trust us and know that we will always remain accessible and with open doors. This is a huge opportunity for our industry, as we remained accessible and did not push a wedge of distance between ourselves and our customers. That friendly smile, and reassuring advice can be invaluable and can gain you a customer for life.

The Biggest Challenges:

Consumers will buy some low value items online, and from supermarkets, that is inevitable due to convenience. The core focus of our profession should be on what we can do to set ourselves apart, what value do we deliver that is greater than the draw of a slightly lower price. We are uniquely placed as both healthcare professionals and retailers, and we must remain focused on what drives our customers in the doors of our stores. First though, there are some interesting trends in birth rates to consider!

2021 2020 % Change

The Baby Boom

The raise in birth rates corresponds to pregnancies which would have begun in the period of October 2020 to March 2021. During this time in Ireland lockdown restrictions were in place and it has been suggested by many sources that this led to family expansion conversations happening when they may otherwise have been delayed. People were at home and plans for future holidays, new job roles, or mortgages were not as relevant. Obviously, we can only hypothesise about the reasons for the increase in birth rates during Q3 and Q4 of 2021 and it is hard to draw any conclusion over what trends may or may not continue. Whilst the birth rates increased to for the first time since 2009 (an era well known for recession), they still remain significantly lower (21.7%) than in 2011 when 74650 births were recorded.

Nappy Rash?

TENDER CARE AT Every Change Caldesene prevents and treats nappy rash. For topical use only. Cleanse and dry the affected area before applying. A copy of the summary of product characteristics is available upon request. The active ingredient in Caldesene Medicated Powder is Calcium Undecylenate 10% w/w, 20g, 55g, 100g pack size. For supply through general sale. PA 126/152/1 PA Holder: Clonmel Healthcare Ltd., Waterford Road, Clonmel, Co. Tipperary. Date Prepared: October 2019. 2019/ADV/CAL/112H

Time to ecommend Caldesene.

• Prescribing Medicines For Children – Charlotte Barker, Mark Turner, Mike Sharland.

As Pharmacists there are many useful resources that we can use to ensure our knowledge on medicines during pregnancy, breastfeeding and for children is current and clear. Some of my favourite resources include:

26 | PHARMACYNEWSIRELAND.COM

• Childrens Health Ireland professionals/clinical-guidelines/https://www.olchc.ie/healthcare--

• 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 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

Baby Market

• 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 without losing our core values or sacrificing standards. It is important to remember that both online and offline interaction are key to

• 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.

• fact-sheetmedication.co.uk/category/https://breastfeeding-and-

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.

• Community Pharmacy –Paul Rutter

• Parents have become more inclined to purchase more niche brands which include natural or organic products and ecoethicals. Consider swapping out some of your bulky low margin supermarket lines to refined 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.

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. We have also shown this demographic what we will remain the accessible heart of community health when other sectors of shown the opposite.

After a turbulent two years we have shown our professionalism, accessibility, and value to this patient group. The value of this demographic should not be dismissed as the baby market will offer consistent opportunity to engage new patients and families. Good service and strong relationships built on professional trust can convert new parents into lifelong customers.

• Drugs in Pregnancy and Lactation – Gerald G.Briggs

The Opportunities

• Fertility assistance. Products like Pre-Conceive, Proceive, and Medicare Femsense Ovulation Detection Patches 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 is being provided

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.

SMA® Nutrition Ireland. ®Reg. Trademark of Société des Produits Nestle S.A.

ZTC5873a/07/22 | JU001, ITNUB019, ITNU004

www.smahcp.ie/infant-health

IMPORTANT NOTICE: Breastfeeding is best. SMA® Xpert ProCol is not a substitute for breast milk and does not replace o balanced diet. Before using any dietary supplement, please discuss with your healthcare professional. Food supplements should not be used as a substitute for a balanced and varied diet or healthy lifestyle. Do not exceed the recommended doily dose. Keep out of reach of children. SMA® Xpert ProHydrate must be used under medical supervision. SMA® Xpert ProHydrate is intended for the dietary management of gastroenteritis. It is suitable for infants (0-12 months) and children (1-3 years). If the condition does not improve within 24-48 hours of starting SMA® Xpert ProHydrate, the family doctor should be consulted. SMA® Xpert ProHydrate is not suitable for use as the sole source of nourishment. For Enteral Use Only. Always follow medica l advice. For babies, always hold them while feeding and do not leave them unattended as they might choke.

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Current numerical result healthcare professional recommendations should be considered in treatment decisions. Be sure to talk to your healthcare the range limits that are right for you.

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The study also found that Type 2 diabetes was more common in men (12%) than women (7%) and a self-reported history of hypertension, high cholesterol, being centrally obese and having low levels of physical activity also had strong relationships with both diabetes and pre-diabetes.

the top 25% worldwide. Over the last 25 years, the incidence rate has risen from 16.3 cases per 100,000 population <15yrs in 1997 to 27.3 per 100,000 in 2008 but more recent data shows a stabilisation of the rate to 27. cases per 100,000 population in 2018. Management of this chronic condition places huge demands on affected individuals, their families, and the health service. Paediatric T1DM care requires prioritisation because of its high incidence and the significant long-term consequences of suboptimal care.

The National Office of Clinical Audit (NOCA) has announced the publication of the National Paediatric Diabetes Audit Feasibility Study Report.

Educating Patients with Type 2 Diabetes

Burden of diabetes

PHARMACYNEWSIRELAND.COM | 29

The burden of diabetes is continuously increasing. According to a systematic review of Irish evidence on epidemiology of diabetes and its complications, which included 15 studies published before 2016, in adults aged 18 years and over, the national prevalence of doctor diagnosed diabetes significantly increased from 2.2 % in 1998 to 5.2 % in 2015. The prevalence of diabetes complications varied ranging from 6.5 to 25.2 % for retinopathy; 3.2–32.0 % for neuropathy; and 2.5-5.2 % for nephropathy.

This study recommends the development of a National Audit of T1DM, with a phased approach. The first phase includes all paediatric T1DM patients aged under 16 years who attend the 19 paediatric centres nationally.

According to the International Diabetes Federation Atlas 2021 Ireland is ranked 7th in the world for diabetes related health expenditure per person.

disparities in paediatric diabetes care may not be identified. A national audit of paediatric T1DM will highlight areas of good practice, identify areas for improvement and will support data-driven resource allocation.

Emer Gunne, Public and Patient Interest Representative remarked, “Our daughter has had a very positive experience on her patient journey, from an early diagnosis without diabetic ketoacidosis at the age of 11 years through to independently managing her diabetes with her diabetes pump at the age of 14 years, and we envisage a smooth transition to adult services on the horizon in a few years. All children, regardless of which centre they attend in Ireland, deserve to have the highest level of care when diagnosed with type 1 diabetes mellitus (T1DM). Being involved in this feasibility study has meant that I have been able to use our daughter’s experience to be part of the process of improving care for the many children who will be diagnosed with T1DM in Ireland in the future”.

Diabetes

Phase 2 involves extending the audit to include affected young adults aged 16-25 years and Phase 3 will incorporate all patients with T1DM nationally. An Individual Health Identifier (IHI) for all with T1DM would support successful implementation of this audit and would allow linkage to existing datasets. Electronic data capture is essential to allow complete, accurate and efficient data

According to national estimates comparing health-service use between people over 50 with and without diabetes (data from years 2009-2011), diabetes was associated with an 87% increase in outpatient visits, a 52% increase in hospital admissions and a 33% increase in emergency department attendances.

Professorcollection.Nuala Murphy, Chair of the National Paediatric Diabetes Audit Feasibility Steering Committee commented, “As a country, we invest a lot of money in diabetes care over each patients journey but at the moment, most of this spend is in treating preventable diabetes related complications. We know that tight blood glucose control has been shown definitively to prevent diabetes related complications, so investing early and empowering patients to achieve good control makes sense. Audit allows us to see what we are doing well and what we need to improve and we are outliers in international terms as we do not currently have a national paediatric diabetes audit. This feasibility study supports the need for an audit and the next phase is audit development and implementation.”

The economic burden of diabetes on the Irish health care system is becoming a major challenge for the government and the HSE.

Although we have no diabetes register or way to monitor the costs associated with diabetes, the CODEIRE study (2006) suggests that costs associated with diabetes consume between 4% and 6% of the annual healthcare expenditure in Ireland (¤377.2 million to ¤580.2 million in 2006) If the same percentage (4-6%) applied to the healthcare expenses in 2019, the costs would have been as high as ¤1.2 billion to ¤1.4 billion, with most of the costs (approx. 50% according to the CODEIRE study) associated with hospitalisations and treatment of complications. There is a need to further evaluate the economic costs of withoneandmellitusThehealthcarediabetes-relatedexpensesinIreland.incidenceoftype1diabetes(T1DM)amongchildrenyoungpeopleinIrelandisofthehighestinEurope,diabetesincidenceratesin

The Irish Longitudinal Study on Ageing (TILDA) 2015 showed that 10% of adults aged 50 and over in Ireland, have Type 2 diabetes rising to 16% in those aged 80 and over. This study further revealed that one in ten people with diabetes in this population are undiagnosed. A further 5.5% of the older population have pre-diabetes which puts them at an increased risk of developing Type 2 diabetes in the future.

There is no National Diabetes Registry of people living with diabetes in Ireland, therefore all national estimates might not be fully accurate. However, as per a parliamentary question asked of the HSE in September 2021 regarding the prevalence of Type 1 diabetes in Ireland, figures were obtained using the data modelled from the Scottish Diabetes Register.

No national paediatric diabetes audit (NPDA) exists in Ireland, and available data originate from single-centre, stand-alone, or retrospective studies. The lack of reliable data precludes healthcare professionals from making informed decisions about how to improve services, and means that

important, and colleagues should be encouraged to read patient information leaflets and literature from the manufacturers. Many manufacturers now have online training modules for specific ailments and product recommendations. Before recommending more than one product at a time, the colleagues must check with the pharmacist that this is Pharmacistsok.will also exercise their professional judgement and will know if the patient needs to be referred to a GP. On the LloydsPharmacy website, there are links to Online Doctor services. For example, if a patient with asthma is experiencing shortness of breath, if the symptoms have been ongoing for 2 weeks without signs of improvement or if there are signs of an infection such as a sinus infection, chest infection or a sore throat.

Overview of Cough, Cold & Flu Cough,MarketCold,

•

Community pharmacists are most often the first destination for patients with symptoms of cold or flu. Friendly pharmacy colleagues and pharmacists who take the time to engage with the patients, offer some useful practical tips and recommend suitable products to meet their needs can make a real difference to the patient.

•

Cough medicines have experienced the largest demand followed by cold remedies and decongestants.

Written by Denis O’Driscoll, Superintendent LloydsPharmacyPharmacist,

Minimum NPD from year to year.

Size of Market: • The category has doubled in growth YTD, albeit from a low base in 2021 due to lockdown. +6% versus 2020.

A simple WWHAM interview will reveal the patient’s symptoms and the products that they may have tried already as well as any existing medical conditions and current medication. This will allow the pharmacy colleagues to recommend products that will best meet the needs of the patient.

A brand-led category.

•

The season looks like it will continue well into the summer months.

•

the symptoms of a flu? the

What are the symptoms of a cold? NauseaMuscleHighHeadachefeverachesWeaknessCoughingorvomitingDiarrhoeaSorethroatDifficultysleepingLossofappetite Sore throat Runny or blocked nose LossRaisedHeadacheCoughingSneezingtemperatureMuscleachesoftasteand/orsmell SYMPTOMS FLU COLD COVID 19 Fever Common Rare Common Headache Common Rare Sometimes General aches & pains Common Common Sometimes Fatigue, weakness Common Sometimes Sometimes Shortness of breath Sometimes No Sometimes Runny, stuffy nose Sometimes Common Sometimes Sneezing No Common No Sore throat Sometimes Common Sometimes Cough Common* (usually dry) Mild Common* (Usually dry) Diarrhoea, vomiting Sometimes for children No Sometimes Tips on preventing

Flu

For inexperienced colleagues, the cold & flu section is the most challenging section to become familiar with due to the large range of products and the overlap between the products. Staff training is particularly

30 | PHARMACYNEWSIRELAND.COM

SymptomsWhatare

spread of cold and flu 1. Avoid Close Contact Symptoms What are the symptoms of a flu What are the symptoms of a cold NauseaMuscleHighHeadachefeverachesWeaknessCoughingorvomitingDiarrhoeaSorethroat Difficulty sleeping Loss of appetite Sore RaisedblockedRunnythroatornoseCoughingSneezingHeadachetemperatureMuscleachesLossoftasteand/orsmell

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aQIV is the recommended flu vaccine for people aged 65 and older. As we get older, our immune systems may not respond to vaccines the same way. ‘Adjuvanted’ means that the vaccine has an extra ingredient that makes it more effective for people aged 65 and older.

Germs can be spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth.

People aged 65 years and older: For the 2021 flu season , this patient group were offered the adjuvanted Quadrivalent Influenza Vaccine (aQIV). This is a 1 dose vaccine.

school, especially when someone is ill.

Flu Vaccine in Pregnancy

• Painkillers = analgesics

• bronchitis

Flu is dangerous during pregnancy and can lead to:

• Local anaesthetics = numb nerves in local area, found in lozenges and sprays for sore throats

For the 2021-2021 flu season, Children and young people aged between 2 and 17 years could get the nasal flu vaccine for free. It’s called the Live Attenuated Influenza Vaccine (LAIV) nasal spray vaccine

At-Risk Groups

People at higher risk from the flu associated with certain underlying conditions e.g. diabetes can also avail of a free flu vaccine. The HSE specify these groups at the beginning of each flu season.

Stay home from work, school, and errands when you are sick. This will help prevent spreading your illness to others.

4. Clean your hands

32 | PHARMACYNEWSIRELAND.COM

Products and Active Ingredients

• pneumonia

Denis O’Driscoll recommends the following tips on preventing the spread of cold and flu

1. Avoid Close Contact

Getting the flu vaccine is the best way we can protect ourselves and our families from getting the flu. The best time to get the flu vaccine is before the flu season starts. It is available from October to the end of April each year. Last flu season, the vaccine protected against 4 strains of flu. These are

• lower birth weight

Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick too.

Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food.

• Decongestants = shrink blood vessels and decrease the swelling and lining of the nose

• Antihistamines = dry up secretions produced by viral infection, help with sneezing and runny eyes, cause drowsiness

2. Stay home when you are sick

5. Avoid touching your eyes, nose or mouth

• premature birth

Children(encephalitis)withthese complications may need hospital treatment. Some may need intensive care.

•

Washing your hands often will help protect you from germs. If soap and water are not available, use an alcohol-based hand rub.

recommended by the World Health Organization (WHO) as the strains most likely to be circulating during the flu season.. Influenza viruses continuously change and evolve. The periodic replacement of the virus strains contained in influenza vaccines is therefore necessary to keep the vaccines effective Certain patient groups are at higher risk and are eligible to receive a flu vaccine free of charge.

In some children, flu can lead to serious problems such as:

Clean and protect

• stillbirth

3. Cover your mouth and nose

Cover your mouth and nose with a tissue or the crook of your elbow when coughing or sneezing. It may prevent those around you from getting sick. Flu viruses spread mainly by droplets made when people with flu cough, sneeze or talk.

• Caffeine = increases absorption of painkiller

pregnant women in the 2021-2022 flu season was t the Quadrivalent Influenza Vaccine (QIV)

Clean and disinfect frequently touched surfaces at home, work or

*Pregnanthospitalisationwomen should get the flu vaccine. They can get it for free from the pharmacy or GP surgery. The vaccine offered to

The flu vaccine helps to protect children against flu. Most children who get the flu have mild symptoms. But children and young people with chronic health conditions are at risk of serious complications from flu.

• inflammation of the brain

• Vitamin C = may help prevent cold symptoms and decrease duration, anti-oxidant properties and enhance healing

In the last 10 years in Ireland, almost 5,000 children were admitted to hospital with complications of flu. Almost 200 children had treatment in intensive care and 40 children died.

6. Stay healthy and active

Children can catch and spread flu easily. The children’s flu vaccine can help to prevent the spread of flu in schools and at home. This keeps everyone safe.

Cough, Cold, Flu

Promoting uptake of the Seasonal Influenza Vaccine

If a child has been told the nasal flu vaccine is not clinically appropriate, they can receive the flu vaccine as an injection instead.

If a child is under 2 years and at risk of complications from flu, they can receive the flu vaccine as an injection.

LloydsPharmacy OTC colleague recommending OTC product options

Flu Vaccine in Children

120 mg Film-coated tablets Fexofenadine hydrochloride Fast 24NonLongActingLastingDrowsyHourRelief AVAILABLE PRESCRIPTIONWITHOUT Stop your allergies, before they stop you Medical product not subject to medical prescription. A copy of the summary of product characteristics is available upon request or alternatively please go to www.clonmel-health.ie. PA23180/014/001 PA Holder: Opella Healthcare France SAS T/A Sanofi, 82 Avenue Raspail, 94250 Gentilly, France. Distributed by: Clonmel Healthcare Ltd., Clonmel, Co. Tipperary Date prepared: April 2022. 2022/ADV/TEL/052H

Figure 4: Categories of food supplements consumed in the NCFS II

Food and beverage intakes

Multivitamins and minerals were the most common type (30% of all supplements recorded), followed by

The covid-19 pandemic has changed a lot of things in life both for good and bad, and this category is no different. The pandemic has resulted in a lot more people taking an interest in a healthier lifestyle, particularly immune system support. Online shopping for these products is expected to continue to grow as the pandemic causes a shift in consumer habits to more online retailers, however, this has also been a double-edged sword to business’ as consumers are now searching for more bargains/ deals causing decreasing profit margins.

to gather personal information on health indicators without the need to leave their house or interact with medical professionals.

There are only two official national food supplement policies in

The vitamin, mineral and supplement market is one that, despite the cost of living crisis and rising inflation, continues to grow.

VMS Market

In Ireland, there is widespread use of supplements. This has been found in multiple dietary surveys carried out throughout the years. In the National Adult Nutrition Survey (2011), 22% of men and 33% of women (aged between 18-64) reported using a food supplement. Within this survey, supplementation was at its highest in those aged over 65, with 37% of people in that category using food supplements. Although there has not been a published survey

Overall, 22% of children consumed a food supplement over the 4 day recording period. A total of 102 different types (brands) of food supplements were recorded

Continuation of Growth in the VMS Market

NCFS II Summary Report

This food supplement use is not exclusively popular among Irish adults as about one fifth of preschool children and children aged between 5 -12 years old were also regular consumers of nutritional supplements. (National Preschool Nutrition Survey 2012, National Children’s Food Survey II 2019)

on this in more recent years, it can be predicted from sales that this number has increased significantly since then.

The increasing sophistication of digital devices and tools is driving demand for products that integrate health data and provide personalised data points to the user. Various apps including MyFitnessPal are now able to keep a track of certain macro and micronutrients based on the dietary information the user inputs. This has made people more aware of what vitamins and minerals are potentially lacking in their diet and has allowed people to make more tailored decisions when it comes to what they want to supplement. This has been exacerbated by the pandemic as more and more consumers look

multivitamins (25%) (Figure 4). Single vitamin supplements were consumed by 10% of children. The percentage of consumers of food supplements was similar to that reported in 2003 04 (25%). Mineral

Figure 4. Categories of food supplements consumed in the NCFS MultivitaminII &

Food supplements

30% Multivitamin25%Vitamin D10%supplement Vitamin C9%supplement Botanical8%supplementFishliver oil 6% Probiotic6% Other6%

This should include but not be limited to; the importance of vitamin D supplementation, particularly in winter, the benefits of probiotics after sickness/ antibiotic use, when to suggest a full multivitamin and the availability of different formulations, including sprays, chewable tablets and liquids.

Emer King, Pharmacist, Inish Pharmacy

34 | PHARMACYNEWSIRELAND.COM

The different supplement groups most commonly used by children can be seen in the graph below:

Written by Buncrana

Pharmacists are in a unique position here as they encounter parents with children of all age groups who may be in the pharmacy for other reasons and may notice a well displayed supplement section and spark an interest in talking to staff about the best supplements for their children. It can be overwhelming to parents with the number of options available on the market and so all pharmacy staff should be aware of the benefits of certain supplements and ranges.

The most popular category accounting for over 50% is unsurprisingly a multivitamin supplement. This is an area where a lot of parents fear that their children are not getting enough nutrition from the food they eat. This can be due to a variety of reasons, most notably from the NCFSII study was child’s likes/dislikes.

Buying habits within pharmacies in the supplement section are very fluid. They can be reflective of a personal issue, current affairs or a temporary Pharmaciesconcern.should try to adapt marketing strategies to current affairs as it is one of the only buying habits which we can be somewhat prepared for.

The main barriers perceived by parents to providing a healthy diet for the child were the child’s likes/dislikes (64% of parents), convenience (40%), other people minding the child (39%) and food advertising (34%) (Figure 18). There was little difference in the responses

Ireland, consumers are purchasing a lot more than just these two supplements. ‘General health’ is still the biggest driver of sales within this category, however, broader trends of an ageing population, rising levels of obesity and increased awareness of mental health are also causing a surge in sales within this category.

Ireland; folic acid is recommended for all women of child baring age who are sexually active and vitamin D supplementation in infants. This is something which pharmacies are in a unique position to promote. In particular with folic acid supplementation, the pharmacist should advise when giving out prescriptions for the contraceptive pill, that these women should be taking folic acid supplements if they are sexually active, just in case they were to unexpectedly

18. Factors that make it difficult for parents to provide a healthy diet 64 40 39 34 25 21 8706050403020100 likes/dislikesChild's Convenience Other mindingpeopleyourchild advertisingFood Cost Availability Allergies agreedwhoparents%

NCFS II Summary Report

Factors associated with children’s eating behaviour

concerns and personal issues causing a rise in sales in certain areas are harder to plan for. However, pharmacists and staff should be aware of opportunities to give advice and recommendations based on discussions had with customers within the pharmacy. For example; customers buying skincare and discussing their upcoming wedding, may be interested in a supplement to help strengthen their hair, skin and nails. These can range from basic vitamin E supplementation, collagen or a multivitamin containing a range

Figure

Despite the fact that there are only two supplement policies in

18. Factors that make it difficult for parents to provide a healthy diet

Figure

For example; back to school displays containing multivitamins and probiotics for children. This can be done both in store and online using banners across the front page of your website as a reminder to parents to encourage improving their child’s immune health and mental focus for going back to Displaysschool.within the store should be rotated and updated regularly with new brands. This ensures that you maximise what you can offer the Individualconsumer.temporary

PHARMACYNEWSIRELAND.COM | 35

find themselves pregnant. Over a third of all pregnancies in Ireland are unplanned so this portion of the population are unlikely to be supplementing with folic acid before becoming pregnant. Pharmacies could have a major impact in the increased uptake of folic acid supplementation.

provided by parents of younger and older children. Parents who agreed that their child’s likes/dislikes makes it difficult for them to provide a healthy diet also reported children with higher levels of fussy eating in their child. Levels of fussy eating were not associated with any of the other factors examined.

The introduction of a 13.5% VAT rate across vitamin and mineral supplements in January 2020 did cause an unwelcome price increase. It did beg the question at the time, would this cause issues with lower income families being unable to supplement their diets? However, overall, it does not look to have affected the growth within the market at all. The pandemic may

of ingredients e.g. Cleanmarine for Women, Perfectil Hair, Skin & Nails, Swedish Nutra Hair, Skin & Nails (liquid) and Revive Active Beauty Formula which is notably suitable for diabetics, coeliacs and those following a gluten-free diet. Hair thinning is also a common complaint from patients who have issues with their thyroid function. Pharmacists are in a unique position here to offer advice on helpful supplements when handing out prescriptions for levothyroxine and important.offeredwith‘link-sell’advantage.mineralonwithinTherecarbimazole.areotheropportunitiesthepharmacytomaximisesalesinthevitaminandsectoranduseittoourTheabilityofstafftoitemswithinthiscategoryotherproductsorserviceswithinthepharmacyisAnexampleofwhich

While there are high barriers to entry onto the market, pockets of the industry remain underserved and some companies are innovating in these areas.

safe. One instance of note was when they insisted on all individual liquid formulations for a very unstable diabetic patient who would simply not have handled the increased sugar content in the multiple liquid formulations. When questioned they could give no reasonable explanation as to why this patient had to have multiple liquids rather than a safer tablet or single formulation option. This patient was very lucky, he decided to ask in the pharmacy before purchasing any products.

36 | PHARMACYNEWSIRELAND.COM

VMS Market

could be during the flu vaccination service, ensure staff are informed of products which can aid the immune system and help ward off infection. One product in particular which fits into this category is Alflorex Immune. Alflorex Immune is unique in that it has promising results against warding off influenza. The added vitamin D also aids the immune system. This is a product which could be recommended to patients who enquire about the flu vaccine service in pharmacies as it could add an extra layer of protection for them in addition to

in part be responsible for this as people became more aware of their health and a lot of people had more disposable income as they could not go out, go on holidays etc.

Menopause is an area which was often overlooked in terms of treatment; however, women suffer daily with the symptoms associated with it. The introduction of vitamins/ supplements to help reduce these symptoms has had a massive effect on women’s lives. Products like Cleanmarine MenoMin, Health & Her Menopause & PeriMenopause and Revive MenoActive are fast becoming best sellers within the vitamin category as they have listened to what customers want and need from their supplements. These products have the unique selling points that they contain a balance of vitamins, minerals, fish oils and plant extracts in a composition that is most likely to combat the common symptoms of menopause. This has become increasingly important this year due to the shortages and unreliable supply of HRT medication. I have found a lot of women are trying the more natural supplementation route first as they do not want to be started on prescription medication and not know whether they will be able to source it from month to month.

the vaccine, it also covers their need to supplement vitamin D in the winter months due to the lack of sunshine. This means the consumer only needs to purchase one product for the winter months, increasing the cost effectiveness for Thethem.product

In pharmacy in Ireland, I think the consumer holds a lot of the power within this category. This is due largely to the fact that the majority of people (even those with full medical cards) have to pay privately for vitamin and mineral supplements. In store, I find a lot of customers will have done some of their own research and will be intrigued to hear what the best supplement within their area of interest is. They generally want a supplement which is of high quality but also holds value for their money. Customers also tend to stick with well-known or well-advertised brands unless staff are confident in their knowledge of other lesser known, more costeffective Websitesoptions.havehundreds of different options when it comes to supplements, therefore, it is imperative that pharmacists are available to discuss these options with customers to ensure they do get the right supplement and the right price.

I think the biggest risk within this category is patient safety through misinformation. I know I have encountered multiple instances where patients have been to an unregulated healthcare provider (e.g. kinesiologist or homoeopath) and they have recommended products which are simply not

The importance of having customers turn to a healthcare professional for advice rather than health food shops/ unregulated healthcare providers, is something which we should be actively promoting. If we offer advice and good value for money, we can ensure patient loyalty, increasing revenue for us and increasing safety and benefit for consumers.

The message of ‘natural does not mean safe’ is one that was always given to us at university and I think is something we must keep to the forefront of our minds during our day-to-day practice. I think the general public have an askew vision of vitamins and supplements not being able to cause harm, when in actual fact, they can cause massive damage, e.g. iron and vitamin c supplementation in a multi-vitamin for a patient with haemochromatosisunderlying-adisease with high prominence in Ireland.

is available in an orodispersible form which makes it suitable for all patients, including those with swallowing difficulties.

• production of acnecausing bacteria

Pharmacists play a key role in optimising the management of dermatologic conditions, such as hormonal acne, by counselling on medications, promoting treatment adherence, mitigating side effects, and recommending appropriate adjunctive care.

Oral contraceptives specifically used for acne treatment contain ethinylestradiol plus one of the following:

Anti-androgen drugs

• Squeezing or picking at blemishes.

*Vitamin B2 supports the maintenance of normal healthy skin. Vitamin B1 contributes to normal energy yielding metabolism. † Source: Cleanmarine Skincare Survey, December 2020, with 120 Cleanmarine For Women customers

• norgestimate

Hormonal acne may be caused by influxes of hormones from:

• menstruation

95% of women would recommend Cleanmarine® For Women for healthy skin†

Although it’s typically associated with hormone fluctuations during puberty, hormonal acne can affect adults of any age. It’s especially common in women. A number of factors may contribute to this, including menstruation and menopause.

• polycystic ovarian syndrome

Oral contraceptives

Available in Pharmacies & Health Stores

• drospirenone

If the hormonal acne is mild, some sufferers may be able to use topical retinoids. Retinoids are derived from vitamin A.

• High humidity.

• Poor diet (specifically refined carbohydrates and sugars).

Cysts form deep under the skin and don’t come to a head on the surface. These bumps are often tender to the touch.

Specifically, these hormone fluctuations may aggravate acne issues by increasing:

37 PHARMACYNEWSIRELAND.COMNews

This is because hormonal acne typically takes the form of cystic bumps. These bumps form deep under the skin, out of reach of most topical medications.

• Stress.

• Pollution.

It’s estimated that 50 percent of women ages 20 to 29 have acne. It affects about 25 percent of women ages 40 to 49.

Oral contraceptives may not be an option for those who have a history of blood clots, high blood pressure, or breast cancer.

• oil (sebum) production in the pores

Oral medications can work from the inside out to balance the hormones and clear up the skin. Common options include oral contraceptives and anti-androgen drugs.

Retinoids

Focus on Hormonal Acne

Many retinoid creams, gels, and lotions are available over the Thosecounter.whoadd

Treating acne can be different for each individual, but patience is key. Generally, it could take up to four to six weeks to see improvement in the skin after someone begins treatment. Even if they don’t notice that the treatment is clearing their skin, it is recommended that they continue treatment to prevent new acne from forming.

• increased androgen levels

• clogged skin cells in hair follicles

Hormonal adult acne typically forms on the lower part of the face. This includes the bottom of the cheeks and around the jawline. For some people, hormonal acne takes the form of blackheads, whiteheads, and small pimples that come to a head, or cysts.

Healthy Skin From Within*

mild, over-the-counter (OTC) products usually aren’t successful.

A common complaint in puberty, hormonal acne also affects skin health and quality of life for adults of all genders, driving the need for new solutions.

What can make hormonal acne worse?

Anti-androgen drugs work by decreasing the male hormone androgen. Both men and women have natural levels of this hormone. Too much androgen, though, can contribute to acne issues by interfering with hair follicles that regulate skin cells and increasing oil production.

UnlessPropionibacteriumcalledacnesthehormonalacneis

a topical retinoid to their regimen, must be advised to apply sunscreen daily. Retinoids can increase the risk of sunburn.

• overall skin inflammation

• Together,norethindronetheseingredients target the hormones that can contribute to acne. This can be especially helpful during peaks in hormones, such as during ovulation.

• menopause

Even with the rise of social media, it has not dampened down the significance of tv advertising campaigns and features on chat shows. These continue to contribute to the success of the skincare category, particularly in the older age groups. These ads and features highlight that our skin needs change throughout the years and that it is necessary to continually assess our needs and change our routines if need be.

We have noticed that shopper trends tend to change with the launch of new products or brands and from season to season. Once we receive mailings from companies about new product launches, we access how such products are doing in our pharmacy and if there will be a demand for them. For example, our pharmacy sees a lot of demand for moisturising lotions that can be used for all the family from children to adults that require once or twice daily applications. We also see a demand for anti-blemish products that are not too harsh on the skin so when new products are launched we will order them and ensure all staff members have researched and learned about them to be in a position to greatly help consumers make informed decisions regarding their skincare as we like to encourage a proactive approach for consumers regarding their health and skincare needs.

Skincare: More than a ‘One Size Fits All’ Category

The overall value of the skincare category to the pharmacy has been invaluable, it is one, if not our best-selling category with repeat sales very common and going from strength to strength. As before, skincare category is one that has significantly grown over the past few years and continues to do so. It has evolved and has become much more than a ‘one size fits all’ approach as targeted products for specific skin types and conditions have come onto the market.

The

We have seen in the pharmacy a huge growth in the range of products that are at our disposal to stock to ensure a wide variety to choose from to ensure personalised advice and care to

Kara, Supervising Pharmacist, Reidy’s Pharmacy Rathcoole

With the rise in the popularity of social media accounts that specifically post about make up and skincare we have seen a lot of younger consumers especially teenagers ask us for certain products they have seen e.g. to help with acne prone skin. They are more willing to engage with staff and have a consultation regarding which products are best for them, they are more aware of the importance of daily skincare routines and not just a ‘quick fix’ of a cream or gel that may prove harsh on their skin and which could dry and disturb the natural moisture balance of their skin which is still delicate.

Online tools and new diagnostic technology in stores have helped consumers understand their specific skin type and make informed decisions and create awareness that skin requirements differ from person to person and that specific areas of the face can be different e.g. some can be oily around the t-zone and other areas might be dry and that a combination of products is not unusual.

38 | PHARMACYNEWSIRELAND.COMWrittenbyFatimah

Skin Market

Weconsumers.havenoticed that consumers buying habits have changed dramatically with the emergence of brands that are more affordable there has been an upsurge in the demand for complete skincare routines. Whereas before, we would have seen the sales of cleansers and toners be the most popular items for the face, now we have a lot of consumers wanting to expand their routines to include serums, eye creams and separate day moisturisers with included SPF and night moisturisers. And with regards to the body, a lot of consumers are moving away

“Overall, revenue in the skincare category is at an all-time high and continues to grow from strength to strength. As with other categories in the pharmacy, staff training and ensuring knowledge on the category is up to date and of a high standard is crucial to aid consumers and ensure their needs are met accurately….”

from general moisturisers and want specific, long-acting creams, lotions, and gels.

Consumers are now more equipped with easily accessible resources to determine which products and brands are best suited for them with detailed product information and reviews readily available at their fingertips to help them make informed decisions or to come to the pharmacy to ask for advice on what they have researched.

GRAHAM ANTHONY DISTRIBUTION BECOME A STOCKIST TO PLACE ORDER CALL: +35318222711 EMAIL: GRAHAMSALES@GADISTRIBUTION.IEANTHONYDISTRIBUTIONBECOMEASTOCKISTTOPLACEORDERCALL:+35318222711EMAIL:SALES@GADISTRIBUTION.IE

In the majority of cases, the consumer holds the power in the category; they will come to the pharmacy knowing exactly what they want or what type of product they are looking for. However, we encourage some sort of consultation or conversation with

The wide range of products now targeted for all ages from birth upwards is great, in the past it would have just been the original emollients such as Silcock’s Base, Aqueous Cream and Emulsifying Ointment, we now have well known, established brands branching out and providing products that are suitable for infants providing great choice and variety.

From our pharmacy’s point of view, whenever we see prescriptions for skin conditions we will engage with the patient and offer advice on complimentary products such as creams or washes that may be of benefit and we provide samples if Theavailable.onlyrisks that may be present in the category would be if consumers continue to use a product that may not be best suited for them e.g. a product that could be drying out their skin too much or are self-managing a condition which may need to be seen by their GP or a specialist. Thus it is important to engage with consumers to provide the best and most accurate advice especially those in higher risk groups e.g. diabetics.

Another thing that I have noticed is that there seems to be a lack of diversity in the target consumers of these products. There are hardly any advertisements which include men for example and thus have noticed less of an uptake in this group. The only

routine that is personalised and targeted to the consumer. This has led to greater trust and uptake of the category.

the consumer to ensure optimal benefits are obtained from their skincare routine regardless of if the consumer knows what they are looking for or not. This proactive and dynamic approach has proved to be quite effective in our Therepharmacy.arelittle

It would be great if representatives from skincare brands came to the pharmacy for even half a day to engage with consumers and provide consultations and information about the range and types of products available.

the emergence of brands that are very competitive price wise and in terms of reputation as providing skincare of the highest standard have helped to excel the skincare category. The wide variety of choice with regards to targeted products, non-perfumed and hypoallergenic and all price points has greatly improved consumer confidence in the category and continues to do so.

incentives which have improved revenue in the pharmacy such as free gifts with purchase or special offer bundles where a free cream is given when a cleanser is purchased. Quite often, these have resulted in consumers coming back to buy the free product as they have found it effective. I would personally love to see more shelf talkers which highlight what each range specifically targets as I believe these will help consumers engage with ranges that they might be unaware of or even to ask for advice on a product that interest them. More instore promotional material would also increase revenue as I have found that our window displays help spark interest in a particular brand. However, overall, revenue in the skincare category is at an all-time high and continues to grow from strength to strength. As with other categories in the pharmacy, staff training and ensuring knowledge on the category is up to date and of a high standard is crucial to aid consumers and ensure their needs are met accurately and that usage and interest in the category will continue to be high ensuring that the skincare category is very valuable in pharmacy.

There has been huge innovation in the category over the years. Various formulations of cleansers ranging from hydrating to foaming to oil cleansers ensure that the skins natural balance is not disrupted. Also new cleansers which help smooth and soften bumpy skin without harshly stripping the skin of its natural barrier have been very unique and popular. Also, the innovation of gel creams and non-greasy formulations have proved very popular as they provide long acting moisture and relief and soothing hydration.

The only thing holding back the category would probably be the unwillingness of consumers to try alternative brands once they are established on a certain brand. Although not a significant disadvantage, as brand loyalty is high and continues to drive the category, I feel like it would be beneficial for consumers to understand and try different brands which might be better suited to them. However, I am aware that this can be quite costly but instore leaflets highlighting the various products in the different ranges rather than brands relying solely on their information being all online would help particularly in the older age groups and make the information more accessible.

time I see men looking for certain products is after they have been recommended by specialists, however I feel more can be done to make skincare accessible to all and to show that it is not excluded to any certain demographic.

It has been very exciting personally to see how a range of products for a particular skin type e.g. rosacea can have a wide range of products ranging from cleansers right up to serums and soothing gels. This has greatly helped both staff and consumers alike to make decisions and add to their skincare routines, e.g. if we know that a product from the range is particularly effective, then we can easily find a product in the same range to compliment and aid the specific need of the consumer to help build a skincare

Skin Market

40 | PHARMACYNEWSIRELAND.COM

The menstrual cycle is controlled by multiple factors - endocrine, autocrine and paracrine, which regulate ovarian follicular development, ovulation, luteinisation, luteolysis, and endometrial remodelling.

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

In Ireland, 1 in 6 couples are affected by infertility. Female factors generally account for ~40% of cases of infertility with male factors accounting for the other ~40%. In about 20% of cases, no specific cause of infertility is ever found.

Donna graduated with a BSc in Pharmacy from the Royal College of Surgeons in Ireland. She then returned to university to complete a MSc in Neuropharmacology. This led to a PhD investigating the genetics of schizophrenia, followed by a postdoctoral research position in the same area. Currently Donna works as a pharmacist in Galway, and as a clinical writer.

The average woman has a reproductive lifespan of about 36 years on average, starting when menstruation begins, between the ages of 8.5 to 13, until menopause (defined as one year of anovulation), at about 51 years. Puberty in females lasts about 2.3 years (usually between 2 and 5 years), beginning with breast development, then pubic and axillary hair growth, and concluding with the first menstrual period.1

CPD 41CPD: Women’s Health CPD ContinuingDevelopmentProfessional

Figure 1. The menstrual cycle2

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

The most common endometriosis lesions can be subdivided into peritoneal implants, ovarian cysts, and deep nodules/plaques, which can involve and infiltrate other peritoneal structures.

Focus on Women’s Health

60 Second Summary

The average menstrual cycle lasts for 28 days (Figure 1). Prediction of cycle stage and ovulation in individual women is difficult due to the highly variable length of the

AUTHOR: Donna Cosgrove PhD MPSI

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.

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

A symptom diary can aid with diagnosis. If initial treatments do not help, further investigations like a transvaginal or transabdominal ultrasound or laparoscopy can be useful. A laparoscopy is the only definitive way to diagnose the condition.

There are many unique ways in which women’s health differs from men’s. Women have specific experiences related to reproduction, such as periods, pregnancy and menopause. This article will focus on some of the health issues specifically relating to the menstrual cycle that women encounter.

The Menstrual Cycle

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 Publishedfindings.by IPN. Copies can be downloaded Disclaimer:www.irishpharmacytraining.iefromAllmaterialpublished is copyright, no part of this can be used in any other publication without permission of the publishers and author.

menstrual cycle, i.e. 24 to 34 days, even among similarly aged women. It also changes over time.. In the years following the beginning of menstruation and the years prior to menopause, there can be high variability, long cycle lengths and bleeding irregularities.

inflammatory condition that is oestrogen dependent, affecting women in their reproductive year. It is linked to pelvic pain and infertility, and is caused by the occurrence of endometrial-type mucosa (uterus lining) outside of the uterus, predominantly in the pelvic compartment.

3. PLAN If I have identified a

 Dysuria (painful urination, particularly period-related)



Infertility arises often in endometriosis. The reasons for this are not fully understood but it is probably as a consequence of chronic pelvic inflammation, with inflammatory molecules creating an environment unfavourable to conception, in addition to damage to the fallopian tubes and ovaries.4, 5 Treatment

Unfortunately there is still no prevention or cure for endometriosis. The therapeutic goal for endometriosis is to relieve pain, slow the growth of endometrial tissue, improve fertility, and prevent return of symptoms as much as possible. The choice of treatment depends on several factors including age, main symptoms, family planning, attitude to surgical intervention, and previous treatment history.4, 6 Analgesics, either OTC paracetamol/ibuprofen or prescription medication can help to reduce pain. Hormone treatment aims to limit the production of oestrogen, which causes endometriosis tissue to grow and shed. These medications prevent ovulation and make periods lighter and less painful. However, hormone treatment has no impact on adhesions or improving fertility. Low dose oral contraceptives are often used for multiple reasons: they decrease retrograde menstruation, and have demonstrated good levels of overall safety, cost and tolerability. No real differences have been shown between various oral contraceptives, but a good

Dyschezia (i.e. painful bowel movements, particularly periodrelated)

Endometriosis is a chronic, inflammatory condition that is oestrogen dependent, affecting women in their reproductive years.4 It is linked to pelvic pain and infertility, and is caused by the occurrence of endometrial-type mucosa (uterus lining) outside of the uterus, predominantly in the pelvic compartment.5 The prevalence of the disease is estimated to be about 5%, with peak occurrence between 25 and 35 years. One theory on why this happens is called the retrograde menstruation phenomenon: during menstruation, viable endometrial fragments are driven through the fallopian tubes, possibly by uterine contractions. Another theory is that endometrial cells can spread through the bloodstream or lymphatic system. Once in the peritoneal cavity the fragments can implant and grow.

Figure 2. Epidemiological factors involved in developmentendometriosis5

The main symptoms of endometriosis are:4, 5, 6

periods, and a family history also increases risk (Figure 2).



42 CPD: Women’s Health



Difficulty becoming pregnant

Anovulation affects up to 7% of women aged 25-39 with cycles of normal length, but is seen more frequently in women with shorter or longer cycles: 60% of 10-14 year old girls and 34% of women over 50 do not ovulate. Menstrual bleeding is usually the external symptom of the cycle, occurring at the end of the luteal and the beginning of the follicular phase. This lasts on average between 3 and 6 days.

Symptoms and Diagnosis

Period pain, i.e. dysmenorrhoea, that stops a woman from doing her normal activities

Feeling sick, constipation, diarrhoea, or bloody urine during menstruation

The most frequent symptoms are dysmenorrhoea (i.e. throbbing or cramping pain, 80%) and dyspareunia (30%). Intermenstrual pelvic pain unrelated to periods can also occur, but less often. Hyperalgesia is also a feature in some cases. This is characteristic of neuropathic pain, and may be due to the chronic inflammatory environment promoting sensitisation.nociceptorIncreased pain perception as a separate phenomenon can occur due to an increase in the intensity of nociceptive input ascending to the cortex.

The risk of endometriosis is increased with regular, heavy

Dyspareunia (i.e. pain in the genital area or within the pelvis before, during or after sexual intercourse)

Endometriosis

The presence of ectopic tissue leads to inflammation due to overproduction of prostaglandins, cytokines and chemokines. The most common endometriosis lesions can be subdivided into peritoneal implants, ovarian cysts, and deep nodules/plaques, which can involve and infiltrate other peritoneal structures.



Certain psychological changes, as well as physiological, have been known to occur during the fertile phase.3 Features widely thought to be indicative of genetic benefit such as masculinity and symmetry show increased attractiveness ratings to women: women are more attracted to characteristics reflective of high genetic quality in ancestral males, i.e. the presence of genes with beneficial effects, absence of genes with harmful effects, or a low overall number of mutated genes, on high-fertility days of the ovulatory cycle. This is however only the case when these men were evaluated in the context of short term relationships. The same preference did not emerge when women evaluated men as prospective partners for a long-

 Chronic pain in the lower abdomen or back (pelvic pain) –usually worse during your period



term relationship like marriage. Scent cues are also detected by men and women - young women and mothers-daughters can synchronise their menstrual cycles. This may be due to the olfactory detection of 5-alpha-androst-16en-3alpha-ol, an androgen believed to act as a pheromone which is secreted during the fertile phase.

The management of endometriosis related subfertility should have input from a fertility specialist.6 Surgery for adhesiolysis may re-establish better relationships between pelvic organs, reduce inflammation and improve the chance of spontaneous pregnancy. Laparoscopic ovarian cystectomy where appropriate can also improve the chance of spontaneous pregnancy. IVF can be performed, which overcomes potential issues with fallopian tube patency and adhesions, although women with moderate to severe endometriosis still tend to have a

 Smoking

lower chance of pregnancy with IVF than Endometriosisusual.

2. Encouraging egg (ovarian follicle) production with the administration of recombinant FSH. Trans-vaginal ultrasound scans can be performed to monitor follicle size.

 Clomifene or tamoxifen12 promote oestrogen production via effects on the hypothalamus, and can be used to restore or stimulate ovulation. The

(GnRH), which is released by the hypothalamus, and then acts on the pituitary gland. This results in the production and secretion of the gonadotropins, luteinising hormone (LH) and follicle stimulating hormone (FSH), which are transported to the ovaries and testes.

 Damaged or blocked fallopian tubes (where conception usually occurs)

dysfunction(HPA)Hypothalamic-pituitary-adrenalaxis(reproductiveaxis)



aromatase inhibitor letrozole,13 which inhibits conversions of androgens to oestrogens, is also used (unlicensed use)



If conception has not occurred within a year of trying (i.e. unprotected sex every 2 to 3 days), the couple should be clinically assessed. If there is a known clinical cause of infertility, history of predisposing factors, or the woman is 36 or older, earlier clinical assessment is appropriate.8, 9



 Metformin decreases circulating insulin and androgen levels. It can be used to stimulate ovulation, although there is no official clinical trial evidence for this (unlicensed use). It can take ~6 months to have an effect.

Sexually transmitted infections (STIs)

 In inhibitsa(whichhyperprolactinaemiacanblockovulation),dopamineagonistwhichprolactinproduction may

The main causes of infertility in women include:



3. When the eggs are ready for collection, an injection of recombinant human chorionic gonadotropin (hCG) is administered. This mimics an LH surge, which triggers final follicular maturation and ovulation.

1. Suppressing the natural menstrual cycle to take control of the ovulation cycle. One cycle of an oral contraceptive may be given, followed by a GnRH analogue, e.g. buserelin or nafarelin, or a GnRH antagonist, e.g. cetrorelix. Continued stimulation with these desensitises the pituitary, and stops FSH/LH production.

Being underweight or obese for women

 Polycystic ovarian syndrome (PCOS)

Alcohol consumption

for epithelial ovarian cancer and is associated with negative psychosocial consequences including anxiety, depression, isolation, familial and intimate implications including negative emotional impact in partners, decreased quality of life and ability to perform everyday activities, and greater healthcare costs. Affected women lose an estimated 10 hours of work weekly, due to reduced effectiveness at work because of endometriosis symptoms.4

4. Oocyte collection is performed under sedation about 36 hours after the injection. A progesterone gel or pessaries may be prescribed for the woman to use from around now for luteal phase support14 to increase likelihood of implantation and successful pregnancy.

Increasing age in women



 Endometriosis



5. Sperm are mixed with the retrieved eggs to allow fertilisation to occur.

 IVF (in vitro fertilisation)

Early (beforemenopauseage40)

Elevated scrotal temperature in men

 ICSI sperm(intracytoplasmicinjection)

Some prescription drugs, e.g. NSAIDs, spironolactone, neuroleptics in women; sulfasalazine and anabolic steroids in men

 Conditions affecting the cervix or uterus - these include large fibroids or large polyps in the uterus

In females, LH and FSH stimulate the ovarian follicle (which contains a maturing egg) to produce oestrogen. After ovulation, LH (which has caused the egg to be released from the follicle at around day 14, Figure 1) promotes production of progesterone by the corpus luteum (this develops from an ovarian follicle), which contributes to a negative feedback loop, suppressing GnRH release from the hypothalamus, and therefore LH release from the pituitary. If conception occurs, the production of progesterone from the developing foetus helps maintain the pregnancy, and inhibits this loop.

It is important to treat patients with empathy, reassurance and encouragement, with realistic treatment expectations. Delayed diagnosis is often a significant issue for women with endometriosis. This is due to both healthcare professionals seemingly not recognising the significance of the symptoms, and a delay in women seeking help because of the perception that a certain level of pelvic pain is normal.



Recreational drug use

Fertility

 Ovulation disorders

Treatment

In IVF egg production is stimulated, the eggs produced are removed, fertilised, and then transferred back into the uterus. This process involves the following steps:

Surgery to remove patches of endometriosis (laparoscopy) is an option, but as it does not affect the pathogenic origins of the condition, recurrences of lesions and symptoms are common if no postoperative adjuvant treatment is used.5 After surgery, hormonal treatment should be considered in order to prolong the benefits of surgery. Prior to surgery, GnRH analogues, which bring on a temporary menopause by reducing the production of oestrogen, may be prescribed. This helps reduce the amount of endometrial tissue.

 IUI (intrauterine insemination)

approach is to choose one with the lowest possible oestrogen content to prevent endometrial proliferation. Certain progestogens such as oral norethisterone may also help with symptoms. Another option is the insertion of a levonorgestrel IUD, which causes menstruation to stop in about a third of women, and decreases the amount of bleeding in another third. The contraceptive injection, implant or progestogenonly-pill can also be considered. Evidence suggests these hormone treatments are equally effective at treating endometriosis, but they have different side effects. Progestogen therapy however may reduce libido in up to a fifth of women. NICE have produced a patient decision aid7 for the different choices of hormonal treatment (“Hormone treatment for endometriosis symptoms – what are my options?”) describing what each option involves, likely relief of pain and effect on periods and fertility, and how best to stop each one. It also discusses the potential side effects such as possible blood clots and increased risk of breast cancer. If a trial period of e.g. three months with NSAIDs and/or hormonal treatment is ineffective or not tolerated, referral to a specialist should be considered.

The key regulator of the reproductive axis is gonadotropin hormone-releasing hormone

6. After a few days of incubation, the embryo (or embryos) is transferred into the uterine cavity.

There are multiple pharmacological options to help with fertility issues depending on the nature of the problem.

help to normalise levels, e.g. bromocriptine or cabergoline10, 11

is a risk factor

Assisted conception options available through private healthcare in Ireland are:

Mindfulness



Disturbed sleep (aggravated by night sweats)



lubricants can be useful alone or when used in addition to vaginal oestrogen preparations. NICE recommends low dose vaginal oestrogen (vaginal tablets, creams, rings or gels) as first line treatment for vaginal or urinary symptoms caused by the atrophy linked to oestrogen reduction. Due to the low systemic absorption of vaginal oestrogen preparations, no progestogen is needed with these for endometrial protection. These treatments are best started early, before any irreversible changes have occurred. Symptoms often return when treatment is stopped, however. There is some evidence that black cohosh, isoflavones and St John’s Wort may relieve vasomotor symptoms, but it is important to only use reputable brands with good quality constituents in their products. Due to many menopausal products being referred to as ‘natural’, there is the false impression that these ingredients are safer than prescribed medicines. It is important to inform people that there are potential drug interactions with other medications. Phytooestrogens have also been investigated for their effect on menopausal symptoms but evidence is mixed.

Breathing exercises/structured relaxation

To reduce the risk of osteoporosis and fractures, women should be advised to exercise (weight bearing), take vitamin D supplements (especially during the winter months), eat a balanced diet, quit smoking, and only consume alcohol in low to moderate amounts (as this is a dose-dependent risk factor for fractures).

muscle training can help with urinary symptoms, especially for stress and mixed incontinence related to the menopause. Physiotherapists can advise, and there are also numerous apps available for this. Specific vaginal moisturisers and

Depression and other mood disorders like loss of confidence, panic attacks and anxiety

 Increased rate of infections: this is caused by the change of pH that results from alterations in urethral and vaginal microbiomes



The following additional therapies may be useful for improving mental health during the menopause:



SystemicExerciseoestrogen therapy is the most effective treatment for symptoms of hot flushes or night sweats. Women with a uterus need a progestogen also (e.g. as part of a combination patch, tablets or an intrauterine system) to reduce the risk of endometrial cancer that can be caused by using oestrogen alone. Systemic HRT can be used alongside a low dose vaginal oestrogen product if required. Vaginal bleeding is a common side effect of HRT in the first three months of treatmentthe prescriber should be informed at the recommended 3 month review after starting the treatment, and promptly if bleeding occurs after the first 3 months. Taking

The average age of menopause diagnosis in the UK is 51, although this can vary depending on ethnicity. In the estimated 20% of women who have a hysterectomy, the menopause is often earlier than usual, even though the ovaries may be preserved. On average, the symptoms of menopause last from 5-7 years, but in some cases can go on for up to 10-15 years. During the peri-menopause, when the ovaries gradually stop functioning (which lasts for about 4 years on average), the levels of oestrogen and progestogen (and testosterone) fall. This is usually diagnosed based on the presence of vasomotor symptoms, e.g. hot flushes, headaches, palpitations; and irregular periods, as the cycle can shorten to two to three weeks, or conversely, lengthen substantially. Ovarian failure can be caused by radio- or chemotherapy or some types of surgery, and this can lead to severe menopausal symptoms. One in 10 women’s periods will stop abruptly. An estimated 10% of women go through an early menopause between 40-45 years of age. If menopause occurs before this, it is categorised as premature ovarian insufficiency, which happens in about 4% of women. A test for FSH to diagnose menopause may be considered in women under 45 when menopause is suspected.15, 16

Taking a cool shower, using a fan or having a cold drink



Decrease in libido (due both to tissue irritation and diminishing testosterone and oestrogen levels)

Losing weight if overweight

oestrogen levels. Other symptoms include , but are not limited to:

The most common symptoms are hot flushes and night sweats, which are experienced by up to 80% of women. Urogenital symptoms occur in 40%. This is due to thinning and shrinking of the vulval, vaginal, urethral and bladder tissues caused by the reduction in oestrogen. Smoking is linked to earlier menopause, and with more severe symptoms of vaginal dryness. These symptoms increase in severity over time. The risk of osteoporosis and fractures also increases with declining



Trying to reduce stress levels

Summary

Some medicines can worsen menopausal symptoms, e.g. anti-oestrogens, some antihypertensives and antidepressants (e.g. high dose venlafaxine). Women with a higher BMI and/or a greater proportion of body fat may experience more pronounced vasomotor symptoms.

Urinary symptoms such as frequent need to urinate



Management

Vaginal dryness and irritation, also leading to discomfort during sexual activity

Cognitive Behavioural Therapy



Pharmacists have an important role in providing advice on the safe and appropriate use of medicines during all stages of women’s health. This includes providing support and information on menstrual health, menstrual cycle dysfunction, and menopause. Pharmacy teams can do this by initiating conversations and brief interventions, raising awareness, removing stigma, managing symptoms, supplying medication, and referrals.



There are many other medicines and protocols for assisted conception methods. The main side effects of these medications used in assisted conception include headaches, injection site reactions, fatigue, mood swings, hot flushes, bloating, breast tenderness, abdominal pain, and sometimes ovarian hyperstimulation syndrome (OHSS).



Hair and nail changes

SSRIs, SNRIs and clonidine should not be recommended as first line treatments: there is no evidence to suggest that SSRIs/ SNRIs improve mood symptoms attributable to the menopause. Clonidine may however help some women with vasomotor symptom relief in certain cases. Testosterone (produced by the ovaries) supplementation can be considered in cases of low libido that is not helped by HRT. Although fertility declines during the perimenopause, contraception should still be continued for two years after the last menstrual period in women younger than 50, and one year if over 50 and under 55. Using protection for STI prevention is still recommended at all stages.



Non- pharmacological measures to help with hot flushes and night sweats include:

Exercise regularly

Joint, bone, and muscle pain

Irritability

Good sleep hygiene practices

Poor concentration



Keeping the bedroom cool at night

HRT increases the risk of venous thromboembolism, although for women using standard doses of transdermal preparations (as opposed to oral) the risk is no greater. Similarly, there is a slight increase in the risk of stroke, but only from oral preparations. Any potential increased risk in breast cancer is related to treatment duration, and reduces after stopping HRT again. Risk of fractures while on HRT is reduced, and there is also limited evidence that HRT may improve strength and muscle mass.



References Available Upon Request

Symptoms

CBT can also help manage hot Pelvicflushes.floor

44 CPD: Women’s Health



Wearing light clothing

Avoid/reduce potential triggers: spicy food, caffeine, hot drinks, smoking and alcohol



Menopause

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Many of the obstacles associated with in-person visits, such as taking to a in 2020. However, sales have been the in a to continue well in

An interesting aspect of this growth is that men have begun to spend more on consumer goods than women.

A small tweak, such as adding personalised fields to the subject line, can have a significant impact on the open rate of your email. With this shift, many malefocused health and wellbeing

position

According to the Index, retailers personalised their emails 15% more in 2021 thanks to improved personalisation. Personalised emails sent to men between the ages of 18 and 35 saw the greatest increase in open rates (27%).

Written by Stephen Cuffe, Pharmacist, Inish Pharmacy

opportunity to grow. Through social media, brands can express themselves through brand purchases, especially in the lifestyle sector. The use of social media by men is increasing, and causing them to discover products they wouldn’t have noticed otherwise, leading them to make purchases they wouldn’t have made otherwise, and becoming more open to social media as a source of inspiration and Anothermotivation.surprise was the significant increase in men connecting with brands through email marketing channels, as the Voyado Index 2022 revealed. The overall email open rate increased in 2021, young men between the ages of 18 and 25 accounted for the biggest increase (23%) but there were noticeable increases in other age groups too. Men are likely to remain engaged with brands through email marketing based on the data from the Index.

46 | PHARMACYNEWSIRELAND.COM

The challenges in persuading services to change and the benefits to men’s health take time to occur. Women are typically invited to more frequent check-ups throughout their lifetimes, such as prenatal care and cervical cancer screenings. Contrastingly, men may not receive gender-specific screenings and

Despite this, males report greater subjective health than women and are less likely to believe they are at risk for health issues. A lot of men don’t talk about their physical or mental health this may be due to a tendency to minimise or not accurately report symptoms, not wanting to appear weak, or just difficulty in communicating their emotions. Moreover, healthcare is not designed to complement the lifestyles of many men. Success in their careers is often regarded as a great deal of self-worth for men.

Men’s healthcare has a strong connection to three specific benefits. Starting with the obvious, which is attendance. Men have always had difficulty making medical appointments. When a situation is time-sensitive, this hesitation can have terrible consequences.

It is anticipated that the global business of the men’s personal care market will grow at a compound annual growth rate of 9.1% from 2022 to 2030 from USD 30.8 billion in 2021. It is expected that the market will benefit from men’s demand for gender-specific products such as shampoos, conditioners, shaving creams, masks, and haveassimilarbranchedThoseontendAslinesrisingwhileconsumersinretailersThesegoods,thoseinvestingAsmorehasistoe-commerceFurthermore,peels.thethrivingsectorisexpectedboostthemarketgrowth.Thiswherethemostdramaticshiftbeenseen,menarespendingonlineandmorefrequently.aresultofthisincrease,indigitalads,especiallytargetedatmenandmen’sisexpectedtopayoff.salesmayslowdownasfaceamajorchallengetryingtokeeppricesdownfortoremaincompetitiveoffsettingtheimpactofcostsacrosstheirproductandsupplychains.socialmediausegrows,mentosearchforproductsmoresocialmediathanwomen.brandsthathaven’tintosaleselementstowhatsocialsitessuchInstagramandFacebookmadeavailablehaveahuge

sharp drop in consumer spending

companies have popped up offering personalised health and subscription services for men. With men using online services more this may lead to an improvement in their looking after their wellbeing. Regarding men’s health, a specific focus remains urgent. In general, men are particularly bad at looking after their health.

A considerable body of evidence supports the need for genderspecific approaches to engage with men more effectively, as well as the imperative to build upon the progress been made to-date to address gender-based issues of life expectancy and mortality and health disparities between various subpopulations of men.

steadily increasing in 2021, putting

The COVID-19 pandemic led

These were the main reasons which led to the development of Ireland’s National Men’s Health Policy, which was the first of its kind in the world. To the development of Ireland’s National Men’s Health Policy, which was the first of its kind in the world. Although there are areas of success in the policy, it is not a quick fix.

economy

2022.

Advocating for Men’s HealthMen’s Health

may never need health care until being requested to submit a stool sample for a bowel cancer screening program in their fifties. In Europe, men are more likely to engage in unhealthy behaviour than women and are more at risk for all major causes of death.

doing

Men may typically have to take time out of work to seek healthcare. Multiple appointments spread out over a long period may be necessary for full engagement in therapy or treatment. Taking that time off from work is not an option for many men. Men can become more involved in their health to some extent by using the conventional strategy of public health education campaigns through printed media, social media, and television. However, perhaps the key to encouraging men to engage with their health and GP is in digital health technologies. Since the development of digital communication technology, telemedicine has become more and more popular. Additionally, the COVID-19 pandemic’s arrival has brought about many changes and has increased the use of this method of healthcare delivery. In addition to lowering the chance of exposure to an illness, digital health has several other advantages.

becoming a one-stop source for men by assisting them with their health, wellness, and grooming requirements. The benefit of this is that you can get professional advice and expertise about the health issues that matter to you without the embarrassment or privacy concerns that might prevent you from visiting your local pharmacy.

contacting and treating patients, it may not be able to completely replace in-person medical consultations. But it has eliminated barriers that have previously prevented men from obtaining healthcare when they are in need and made it possible for men to receive healthcare more quickly and easily than ever before.

time off work, getting to the office, or passing the time in a waiting room, are eliminated with telehealth. This implies that there is no longer a justification for delaying care. It now only takes twenty minutes to complete an appointment that used to take up a half-day. Not only that, but disclosure is another unexpected benefit of telehealth. In contrast to an in-person consultation, many men feel more at ease speaking candidly during a telemedicine appointment.

PHARMACYNEWSIRELAND.COM | 47

The theme for Men’s Health Week 2022 was ‘MISSION: isPOSSIBLE’ where men and boys on the island of Ireland were asked to step up and accept their own personal health challenge.

The field of health care and methods of delivering healthcare must change and evolve as technology does. Although telehealth has shown its importance as an extra tool for

Commenting Janis Morrissey, the Irish Heart Foundation said, “During Men’s Health Week 2022, take the first steps towards protecting your heart. The good news is that 80 per cent of premature heart disease and stroke is preventable and there are things men can do to reduce their risk. These include stopping smoking, reducing alcohol intake, getting their blood pressure and cholesterol checked, eating a healthy diet, being a healthy weight and being physically active. The

Men’s Health Week is an initiative of Men’s Health Forum in Ireland, a charity that works across the island of Ireland to improve the health of men and boys. Men’s Health Week aims to raise awareness of preventable health problems, support men and boys to live healthier lives, and encourage them to seek help or treatment at an early stage.

The third benefit is having access to specialty care that might not be offered locally. Simply put, there aren’t that many medical professionals with expertise in treating hormone imbalances and improving performance in men’s health. It is a significant improvement in healthcare to be able to see a specialist wherever you (or they) may be.

use the new digital healthcare system. However, we may use this new way of life as a positive catalyst for change to address the problem in male health. There is no question about the importance of men’s health. The goal is to educate men on their risk factors and treatment options so that they become aware of their risks. By advocating for men’s wellbeing and health, pharmacists can help them aid themselves making them aware of the importance of

Both medical professionals and patients had to adapt to and change their behaviour to

The privacy that telehealth provides over in-person care is a contributing factor in this transformation. In the doctor’s office, you might not feel comfortable talking about the symptoms of erectile dysfunction, but a phone call or even a Zoom call may make the discussion less intimidating.

Irish Heart Foundation is delighted to mark Men’s Health Week by holding heart health checks in a number of Men’s Sheds.”

Dr Noel Richardson, Director of the National Centre for Men’s Health in South East Technological University, said, “For me, the key message for Men’s Health Week is that small things can really make a difference – whether it’s going for a walk, taking time out, reconnecting with a friend. It’s about doing something positive for yourself and building momentum towards positive change, one step at a time.”

Men’s Health News

Late presentations by men to health services can also lead to a large number of problems becoming untreatable.

According to MHFI, “all too often we set ourselves unrealistic targets. Therefore, this year,

Mission isPossible for Male Heart Health

visiting their doctor for screening and Manytreatment.onlinepharmacies are now

everyone is asked to focus upon small, simple, and practical things to improve their health.”

Research clearly shows that men are dying too young as a result of ill health with more men than women dying from almost all of the leading causes of death at all ages. Research has also shown that men’s poorer lifestyles are responsible for a high proportion of chronic diseases including heart disease.

For Men’s Health Week 2022 the Irish Heart Foundation urged all men to take the first steps to protect their heart health.

Sarah: “Consumer lifestyle and product design is essentially the key driver here. Working with suppliers that are continually innovating and developing new technologies is essential for growth. The hair product industry is continually evolving and so are we. Our customers trust us to provide innovative new products that will deliver that all important great hair day!

At McCabes Pharmacy, by keeping the customer at the core of our decisions, we’re confident we will always offer them the right product choice.

At McCabes Pharmacy our customers expect expert knowledge, across all product categories.

Rebecca: “We have seen a rise in consumer demand for vitamins and supplements with key ingredients such as Biotin, which is one of the most active ingredients found in hair, skin, and nails. As Biotin isn’t stored in the body you can become low in this if there isn’t enough in your diet. Some foods that contain this vitamin are, egg yolks, some nuts and seeds, avocado, mushrooms, sweet potato, bananas, and broccoli. We recommend adding these into your diet in moderation. In recent years we find a lot of customers are coming into store having gathered their own information online so quite often they are coming in already knowing what they want”.

The right product mix is so important, at McCabes Pharmacy we offer a strong core line, and again top up with trending products. This category relies heavily on technology and brand presence. Brands that come to market offering new USPs drive the growth in this area.

Nails

category is salon based, the growth can also be seen at a retail level, across nail varnishes and polishes as well as accessories and vitamins and supplements that contribute to nail strength and growth.

Similar to haircare we have seen an upward curve in demand for vitamins and supplements. This is echoed across the market with global beauty supplements anticipated to grow at a CAGR of 4.8% until 2027 (Coherent Market Insights). Vitamins and minerals such as Biotin, B Vitamins, Iron, Magnesium, Omega 3 fatty Acids, Vitamins C and Zinc are key factors that contribute to healthy nails. At McCabes Pharmacy, we are seeing a shift in behavior, specifically customers investing in prevention rather than cure, with customers investing in beauty supplements at a younger age. The nail category is certainly a growth area and with restrictions lifted we are seeing significant growth on the cosmetic side, along with consistent growth across beauty supplements.

Recognising Upward Trends

the ‘non-essential’ end which is something to consider when building out a range, we like to offer something to suit all tastes and budgets.

Hair, Nail, Skincare Scalp

Skincare

48 | PharmacyRebeccaPHARMACYNEWSIRELAND.COMMcMahonMcCabesSupervisor

Beauty vitamins are at a growth in pharmacy with supplements to make hair grow thicker and faster, give skin a healthy glow and improve overall nail thickness the most in demand.

Hair

of questions and are guided to the products that best suit their needs. We’ve recently added this service to our newly launched Citywest store, via a touchscreen. Customers love it! Our skincare range is fantastic, with a huge range of products from both premium and cult brands that target everything from wrinkles to dehydration, acne, pigmentation, and rosacea…just to name a few! We’ve noticed our customers are increasingly requesting vitamins and supplements that will work alongside their skin treatment, the most frequently requested skin supplement is collagen”.

Sarah: “Beauty trends increasingly led by social media drive growth in this category. The nail polish market is expected to be growing at a rate of +10% in the forecast period of 2022 to 2029 (data bridge). Nail care has become a ritualistic trend among many of the millennials and gen z’s. Although a large portion of growth in this

Sarah: “This category is particularly driven by our store advisors, the specialist training they receive is something we pride ourselves on.

Rebecca: “This category is particularly driven by our store advisors; we have our expert skincare advisors on duty everyday to help customers choose the right products. Our skincare advice service is also now available on our website mccabespharmacy. com. Customers answer a series

Sarah Fitzpatrick, McCabes Pharmacy Category Analyst and Rebecca McMahon, McCabes Pharmacy Supervisor Swords Pavilions, share their insights into the fast developing Hair, Nail, Skin and Scalp categories.

Every effort is made to ensure we offer them a comprehensive range of products, accompanied by expert advice from our store teams; extensive training is supplied to guarantee superior customer experience.

Due to the re-opening of salons, we are naturally seeing a shift in consumer behavior – going out is the new staying in – we are seeing an increased demand for hair styling product, hair tools, and of course travel minis”.

Due to the nature of this category being condition led, growth here is driven by suppliers and brands developing new technologies and innovations. Without strong assistance and product knowledge from our in-store advisors, this area could be overwhelming to customers, so staff training is crucial, so they are aware of the key differentials of each product, enabling them to match the needs of each individual customer”.

Sarah Fitzpatrick McCabes Pharmacy Category Analyst

This category is driven by a strong mix of central lines with a large topping of trends. We’re always monitoring market trends whilst keeping eyes peeled for new innovations and the next TikTok sensation!

This is a vast category, and there is certainly price sensitivity on

Digital Skin Advisor McCabes Pharmacy Citywest SC

Scalp

Digestive Market

There is huge growth in the rehydration category. Post covid, there has been an increase in runners and gym active customers who are proactively rehydrating post workout with ORS, Dioralyte, Phizz, Oxylent and other rehydration products.

Pro biotics are also growing and expanding and appealing to proactive and reactive consumers alike. Pro-biotic ranges are expanding with new products. Alforex and Zenflore have expanded their range to include new and broader products additions. Patients and customers alike are well informed on the benefits of gut health and good bacteria. There is also increasing awareness of the impact of gut health and diet on our mood and an understanding of the research of Professor Ted Dinon in UCC in this area.

However Gaviscon still is a relevant and strong category leader and is a unique liquid offering in the category.

As Holiday season is kicking off and after nearly 3 years of lockdown, many are heading abroad for a holiday this year. Patients are pro-actively purchasing products like Nexium, Motiulium, Imodium and Dioralyte. We tend to overindulge or try new foods when abroad and no one wants to be caught feeling uncomfortable or suffering when on holidays.

Like all categories currently there has been some supply issues with category leaders. Products like Fybogel, Dioraltye and Nexium have been going in and out of stock over the last 12 months. Alternatives for all these products were available and although patients didn’t always like changing they accepted alternatives and the advice of the pharmacy teams.

Despite the lack of new products, the category is continually in growth. During covid growth came from difficulty accessing GP services and patients need for advice and support with simple digestion problems. Since society has opened up and we are back socialising in restaurants and pubs, the category is growing due to our changes in lifestyle. There have also been the usual tummy bugs and general illness during this time too.

Patient behaviour is changing in this category. Pharmacists are seeing well informed, welleducated patients who are pro-active about their health and wellness as well as the traditional symptom reactive patient.

The key products in the category are well established like Nexium, Dulcolax, Senokot, Imodium,

Lifestyle advice can prevent and alleviate many of the symptoms related to this category. Such as avoiding trans and fatty foods, reducing sugar intake, eating more fibre, drinking water, not smoking, reducing caffeine and alcohol intake, eating regular healthy meals, and staying active. However, this advice is often easier said than done. So throughout our lives, at some stage many of us will need to visit a pharmacy to get something to alleviate digestive discomfort and symptoms.

Gaviscon, Arret. The last new product launch was about 4 years ago when Buscopan went from Rx to pharmacy only product.

The role of the pharmacist is key in selling restricted sale products like Motilium appropriately and sales in this product are also growing and the importance of pharmacist advice and counselling is essential.

PHARMACYNEWSIRELAND.COM | 49

Pharmacists play a vital role in supporting customers with their digestive health wellness and educating them on the different solutions available in pharmacy, lifestyle options and health advice. Pharmacists have a role empowering patient to self-care and self-manage digestive health symptoms.

Many of the products in the Digestive Health category offer patients solutions and symptom relief. Generally the most common concerns presenting in pharmacy are constipation, diarrhoea, bloating, heartburn, and irritable bowel syndrome (IBS).

IBS patients are very well educated and understand the balance of lifestyle and self-management of their Nexiumcondition.isstillthe category leader in heartburn, despite generics entering the marketplace.

The Digestive Health category is core to the OTC offering in pharmacy. There has been little change in the category in recent years with established brands accounting for the majority of revenue and no recent new product launches. The category is well supported with advertising with major campaigns for Gaviscon, Nexium and others running throughout the year.

Written by Emily Kelly, Community Pharmacist, McCauley Health & Beauty Pharmacy

Digestive Health – Core to OTC Market

Stretching from your head to your bottom, the digestive system (made up of the gut, bowel, and stomach) breaks down all that delicious food and drink we consume, absorbing the useful nutrients and energy, whilst getting rid of the waste. It’s a complex system that comes with various health concerns, from simple problems like indigestion to disorders which may be lifelong, such as IBS.

50 | PHARMACYNEWSIRELAND.COMWrittenbyMartin

Hynes, Clinical Governance LloydsPharmacyPharmacist,

The allergies sector is therefore a key focus within Pharmacy to ensure Pharmacy teams can offer their patients the right knowledge, products and advice to help manage symptoms and improve their quality of life.

In LloydsPharmacy, sales of medicines for allergies have increased by 10% in the past 2 years. We experienced 35% growth in this category in the summer of 2021 and in 2022 we are trending at a similar level to last summer.



Allergy Age Profile

itching, tingling, and swelling of lips, tongue, palate and pharynx (IviČeviĆ et al., 2015.

Most common allergens

• House dust mites - In a European study House Dust Mite (HDM) sensitivity was seen 22% of the study population.

• Grass and tree pollens - In a Survey 21% of allergy sufferers had Hay fever (2018 omnibus 1000x people in Ireland)

• 74 % experienced itchy, watery and burning eyes

• 70% experienced either a blocked nose, a runny nose or sneezing

• Ability to concentrate for tasks such as reading or reading screens at work

Allergic rhinitis (AR) in the paediatric population is quite high, making it one of the most common chronic paediatric disorders (Akhouri SA, 2020).) The percentage of children diagnosed with allergic rhinitis and eczema have both trebled over the last 30 years (Gupta R, 2007).

Taking the time to listen to the patient’s past experiences and what products they have previously tried is particularly important. 67% are dissatisfied

Pharmacists will also exercise their professional judgement and will know if the patient needs to be referred to their GP. For example, if a patient with asthma is experiencing shortness of breath, if an allergy rash is particularly aggressive or if the patient has tried multiple products already without any success in achieving relief from their symptoms.

• Ability to exercise outdoors during pollen season

How Pharmacy staff can help Patients

with current treatment options for allergy. (Werkhauser et al.,2015) and around 40% of patients per hayfever season will switch medications in an effort to find effective relief. (IPN,2020). Some patients may prefer oral medication while others may prefer topical treatments e.g., some of the antihistamines used to treat allergic rhinitis, may produce sedation and for practical reasons, people will wish to avoid such products for daytime use.

• New product development from drug free natural remedies has brought a good addition to the category.

Almost half (48%) of sufferers have more than one allergy (Mintel, 2010)

Allergy

• Sick days from work

• Instore information leaflets,

• 34% experienced fatigue

• Sleep disturbance and impact on general mood

• Advice and practical tips on digital screens (symptoms and treatment)

Other ways of supporting this patient group and alerting them to the available supports are via:



Treatments

• 36% experienced an itchy palate Everyday activities impacted by allergies

• Telfast™ moving to OTC was a major development in the category in 2021.

Engagement with patients to learn more about their lifestyles and the nature and severity of their symptoms will allow pharmacy colleagues to recommend a product or a combination of products that will provide relief and make a real difference to their dayto-day routine. is the most common chronic disease in Europe (EAACI, 2015) and Ireland has some of the highest prevalence rates of allergic conditions in the world.

• Food (particularly milk, eggs, wheat, soya, seafood, fruit and nuts)

• 36% experienced puffy eye lids

• 36% experienced a blocked nose

• Pet hair or skin flakes - Allergies to dogs and cats affect 10%-20% of the population worldwide and is a growing public health concern as these rates increase (Chan S, 2018)

The Prevalence of AllergiesFocus Allergies

Allergic rhinitis affects between 10% and 30% of all adults and as many as 40% of children (Pawankar et al., 2013)  Allergic conjunctivitis symptoms are present in up to 71% of patients with allergic rhinitis. (Leonardi et al., 2015) Oral Allergy Syndrome affects almost 46% of Seasonal Allergic Rhinitis sufferers causing

• Fungal or mould spores

• Latex

• Household chemicals Symptoms and Impact on Quality of Life

• Certain medications, such as penicillin and aspirin

• Wasp and bee stings

Research conducted on behalf of LloydsPharmacy by Empathy research with 1000 adults over 18 years old outlined most common symptoms include 76% sneezing, Runny/Blocked nose 72%, Itchy/ watery eyes 71%

Patients with allergies report their symptoms as causing significant

• Travel plans

Community pharmacists are most often the first port of call for patients with allergy symptoms. Friendly pharmacy colleagues and pharmacists who take the time to engage with the patients, offer some useful practical tips and recommend suitable products to meet their needs can make a real difference to the patient’s quality of life.

• Point of Sale displays

• Oral antihistamines are core to the range, across a choice of brands. However, in recent years there has been an increase in choice of nasal and eye products as patients often require more than one treatment.

• Socialising and especially outdoors during pollen season (April to September)

daily disruptions to their lives (Canonica et al., 2008):

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

Interactions: Caution is advised when taken concomitantly with alcohol or other CNS depressants. Cetirizine does not potentiate the e ect 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.

Legal Category: Not subject to medical prescription.

Marketing Authorisation Holder: Rowex Ltd, Bantry, Co. Cork.

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 insu ciency (creatinine clearance CrCl 30-49 ml/min): 5 mg once daily. Severe renal insu ciency (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 insu ciency (creatinine clearance CrCl 30-49 ml/min): 5 mg once daily. Severe renal insu ciency (creatinine clearance ≤30 ml/min): 5 mg once every 2 days. In paediatric patients su ering from renal impairment: Adjust dose on an individual basis taking into account the renal clearance of the patient, his age and his body weight.

FAST RELIEF OF ALLERGIES 24hr Date of preparation: (04 22) CCF: 24955 Supply status: Supply through pharmacies only. Cetrine Allergy 10mg Film-Coated Tablets available in packs of 7s and 30s. Always read the leaﬂet.

Undesirable E ects: Cetirizine at the recommended dosage has minor adverse e ects 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 di culty, 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.

Date of Preparation: March 2021

Product Name: Cetrine Allergy 10mg lm-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 lm-coated tablets, scored on one side. Can be divided into equal halves. Clear, colourless liquid with banana avour. 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.

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.

Pregnancy and Lactation: Caution during pregnancy and breast-feeding.

ABBREVIATED PRESCRIBING INFORMATION

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.

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

Thank you to everyone who participated on-site but also to those who participated off-site and submitted their times. If you would still like to show your support, they are still collecting donations and you can do so using the following link: https://bit.ly/UDAwareJuly

•

• pets in bedrooms.

Check weather reports/apps for

• a damp, cloth. dry dusting as it propels through the

you. House

•

Use a vacuum cleaner with a HEPA filter

Regularly wash and change pets’

• a lawn, someone else it for Dust Mites:

and

• being

Regularly wipe surface with

explaining product choices to her patient Tips and Advice to patients for common allergies brought to you by Martin Hynes, Clinical Governance Pharmacist, HowLloydsPharmacy:canyouprevent allergies, both inside and outside? Hay Fever:

Focus Allergies

52 | PHARMACYNEWSIRELAND.COM

is high

Choosing wood or hard vinyl floor coverings instead of carpet

air. Pets

Regularly wash

or night

Keep pets outside

LloydsPharmacy and United Drug teams cycle the length of Ireland in aid of AWARE

Avoid

when

Shower and change your clothes after

clean

dust

•

outside

ask

• the pollen count indoors if possible, it

and fields,

to mow

• drying clothes bed linen the pollen count

outside when

Wear wraparound sunglasses

•

is high

and stay

• parks particularly in the early morning, evening

Choosing leather, plastic or vinyl furniture instead of upholstery

•

Use allergy proof-covers on mattresses, pillows, and duvets

If you have

Avoid

Avoid grassy areas such as

pets

• and groom (outside!)

• bedding

A massive thank you to all who participated in the LloydsPharmacy and United Drug Aware fundraising initiative from July 5th-7th in Magna Park. Two spinning bikes were placed in the reception over the course of three days and staff were tasked with collectively cycling the length of Ireland (486km) in order to raise much needed funds for our charity partner Aware.

• as much as possible

Vacuuming and cleaning soft furnishings regularly

LloydsPharmacy colleague

Don’t allow

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Dry eye syndrome can be managed using non-prescription artificial tear products. Many OTC products are available, and preservative-free formulations are recommended if the patient experiences itching and irritation with the drops. Dryness can also be prevented by the use of humidifiers.

• Styes

Overview of Market: With pharmacists increasingly becoming the first port of call for many patients, it is useful to have basic knowledge of common eye disorders and their treatment. There has been 19% overall category growth in the past 2 years.

also absorb high-energy blue and ultraviolet light that can damage your eyes. Dark green leafy vegetables are the primary source of lutein and zeaxanthin, as well as other colourful fruits and vegetables like broccoli, corn, peas, persimmons and tangerines.

• recording what we see and sending the information to our brains

Zinc

• No improvement with any OTC medications previously used.

Vitamin C may lower the risk of developing cataracts and when taken in combination with other essential nutrients, it can slow the progression of age-related macular degeneration and visual acu-ity loss. For your daily dose, try incorporating oranges, grapefruit, strawberries, papaya, green peppers, and tomatoes into your diet.

the proper use of ophthalmic drops to patients so that the medication is applied correctly. Leaflets that instruct patients on how to instil eye drops should be made readily available and should be used to reinforce the explanation.

Symptoms that require immediate referral (Elton M. Ocular conditions from A to Z (ii). Pharm J. 2007;278:255-258):

Vitamin B1 is essential for the health of your eyes. Known as one of the “anti-stress” B vitamins, vitamin B1 reduces inflammation.

• Bacterial Conjunctivitis

• Blepharitis

How we can support patients

• Allergic Conjunctivitis

• Meibomian Cysts (Chalazia)

Dry eye product sales have substantially increased in the past 2 years by 25%, which is believed to be due to increased screen time due to many working from home as well as the increase in using hand-held devices instead of watching Pharmaciststelevision.should demonstrate

Dry eye syndrome is due to decreased production of tears or excessive tear evaporation and caus-es discomfort and soreness. Patients may also complain about a sensation of feeling grit in their eye. Underlying causes of dry eye include Sjögren’s syndrome, aging, staring at a screen for

AMD is a leading cause of vision loss. It’s mainly associated with aging, but some forms of macular degeneration affect younger people as well.

O’Driscoll, Superintendent LloydsPharmacyPharmacist,

Also found naturally in your eyes, zinc is a powerful antioxidant that protects against cell damage. Zinc plays a vital role in bringing vitamin A from the liver to the retina in order to produce melanin, a protective pigment in the eyes. Impaired vision, such as poor night vision and cloudy cataracts, has been linked to zinc deficiency. For natural dietary sources of zinc, try red meat, oysters and other shellfish, and nuts and seeds.

Additionally, patients taking such medications as oral contraceptives, antihistamines, and beta-blockers may experience dry eyes.

• Worsening symptoms

Questions to ask during an eyecare consultation in the pharmacy (Elton M. Ocular conditions from A to Z (ii). Pharm J. 2007;278:255-258):

• Foreign Body in the Eye

• Blurred or distorted vision

Vitamin B1 (thiamine)

• Any doubt about the diagnosis

• Subconjunctival Haemorrhage

Marked Growth in Eye CareEye Care

Age-related DegenerationMacular(AMD)

Salmon, tuna and other coldwater fish are the best sources of omega-3 fatty acids and can help reduce inflamma-tion, enhance tear production and support the eye’s oily outer layer.

• Is your vision affected?

• Watery Eyes

• Has it gotten worse or better over time?

54 | PHARMACYNEWSIRELAND.COMWrittenbyDenis

• OtherfocusingCommon eye conditions presented in community pharmacy

AMD occurs when there’s deterioration of light-sensitive cells in the macula area of the retina. This is the part of the eye responsible for:

Lutein and Zeaxanthin are carotenoids. Carotenoids are pigments found in plants and in your reti-na. Supplementing these pigments helps increase their density in your retina. They

• Have you been using a computer screen for prolonged periods of time?

Vitamin C

• seeing fine detail

Photoreceptors cells in the retina contain a large quantity of omega-3 fatty acid. It’s believed that docosahexaenoic acid (DHA), a type of omega-3 fatty acid, helps in the development of retinal cells. It’s also thought to have a role in reducing inflammation and helping cells of the retina and the cornea heal and regenerate after damage due to light exposure and aging.

• Do you know what the problem could be? Is there an obvious cause?

• Floaters

• How long have you had this problem?

• Pain in the eyes

There has also been an increase in recent years in the number of eye care supplements available over the counter in pharmacies. By far the most common OTC eye supplements are those used to prevent and slow the progression of Age-related Macular Degeneration (AMD).

• Have you had this problem before?

• Is there any pain?

What Vitamins and Nutrients may help Eye Health?

Dry Eye Syndrome

Omega-3 fatty acids

too long, blinking problems, and environmental factors.

• What is the pattern of occurrence of this problem?

Lutein and zeaxanthin

• Is there any discharge?

• Red Eye

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• Unflavoured milk and water are the best drinks.

Tooth Decay and Oral Hygiene

Tooth decay is the most widespread non-communicable disease according to the World Health Organization and can be traumatic for both child and adult, and may result in pain, lead to infection and result in hospitalisation and extraction of teeth under general anaesthetic. Good oral health is also essential for healthy ageing, a healthy mouth will improve general wellbeing and quality of life. Tooth loss and ill-fitting dentures in older people affects their ability to

Oral Care

• When a baby is born, the first set of teeth is already under the gums so a clean damp cloth should be used to wipe the gums after a feed. As soon as the first tooth appears brush twice a day (at night-time and one other time with a soft toothbrush and water, do not use toothpaste for under 2’s unless advised by a dentist).

eat, speak or socialise properly. It also puts them at a higher risk for malnutrition, cardiovascular disease and infectious respiratory diseases such as pneumonia.

• Parents/carers should supervise teeth brushing until the age of seven years old and use a pea-sized amount of fluoride toothpaste (at least 1000ppm) for 2–7-year-olds, twice a day.

• Read food labels for sugar content, less than 5g per 100g is considered a low sugar.

It is not only the physical removal of plaque that is important in oral hygiene practices, but also noting that fluoride in toothpaste gives the tooth enamel the potential to heal. The pharmacist can recommend oral health products such as toothbrushes (these should be changed when the bristles are worn, about every 3 months), fluoride toothpaste, interdental brushes, floss etc. However, it is also important that the patient is encouraged to seek oral health advice and a professional opinion from a dentist.

Oral health plays a key role in general health and wellbeing and is important at all stages of life. The available evidence shows that oral diseases share important common risk factors with the four leading chronic disease – cardiovascular diseases, cancer, chronic respiratory diseases and diabetes. Oral diseases such as tooth decay, periodontal (gum) disease and mouth head and neck cancer can be detected with the help of the pharmacy community delivering oral health promotion messages and information. Evidence has also shown that pharmacist-led continuity of care, can and does improve patient outcomes.

• Make healthy food choices by eating more fruit and veg and avoid sugary snacks and drinks between meals.

• Spit out toothpaste but don’t rinse after brushing (as this will wash the fluoride off the teeth

• Adults, brush twice daily with fluoride toothpaste (at least 1000ppm) at night and one other time, spit out toothpaste and don’t rinse. Floss daily.

Poor oral hygiene and frequent consumption of sugary foods and drinks (cakes, biscuits, chocolate, sweets, fizzy drinks) are the main causes of tooth decay. Acidic foods and drinks like fruit juice and smoothies can also cause dental erosion. Tooth decay is largely preventable, and the pharmacist can play a key role in reinforcing messages about healthy eating and good oral hygiene. General advice for both children and adults is as follows:

mouth with warm salt water may also help), until the person visits a dentist.

56 | PHARMACYNEWSIRELAND.COM

Promoting good Oral Health in the Pharmacy

For some people, a visit to the dentist can be put on hold, as something non urgent, for a variety of reasons, and indeed, may only attend if they require treatment. However, people frequently visit their local pharmacy and will listen to advice from the Pharmacist who is well equipped to help. For example, currently it is possible to purchase a temporary filling material repair kit from a pharmacy if a loose filling/crown needs to be repaired (temporarily) before visiting the dentist. A pharmacist may be asked about denture repair kits for broken dentures, or to recommend appropriate over the counter pain medication in the case of a toothache (rinsing the

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Be aware of the factors that affect oral health and know where to go to get the best help and advice: www.dentalhealth.ie

Mouth Head and Neck Cancer

Saliva substitutes are generally available in pharmacies and useful if used just before eating, at night if you wake up because of dry mouth, or first thing in the morning. Sucking sweets regularly e.g., mints, boiled sweets or consuming sugary drinks can give temporary relief but will cause severe tooth decay in the absence of saliva. Chewing sugar-free gum may offer relief. We advise to limit the frequent consumption of drinks sweetened with sugar e.g., soft drinks, sugary tea, and also sugar-free drinks, because sugar/ acid content may cause tooth decay and erosion. Sipping water frequently, and with your meal is best (fluoridated tap water will help to prevent tooth decay).

Forwww.dentist.ieinformation

Gum Disease

https://www.dentalhealth.ie/ assets/files/pdf/savethattooth_ english.pdf

Poorly controlled diabetes increases the risk of periodontal disease development, which in turn can make it more difficult to control diabetes. People with diabetes should be encouraged to have a good oral hygiene routine and regular visits to their dentist.

about dental entitlements see www. citizensinformation.ie Self- Care, Self-Aware …. Healthy Teeth for Life!

It’s also worth noting that hormonal changes during pregnancy can make women’s gums more vulnerable to pregnancy gingivitis. Advice to pregnant women about their oral health during pregnancy is important to both the mother and baby. Studies suggest a link between poor oral health and women delivering pre-term, low birth rate babies. Making healthy choices can positively affect their baby’s development including their teeth.

Medication

Oral Care

A sore or ulcer in the mouth that does not heal, white or red patches inside the mouth, a lump in the mouth or neck. thickening or hardening of the cheek or tongue, difficulty chewing, swallowing or moving the tongue, numbness of the tongue or face, a persistent sore throat and hoarseness persistent nosebleeds and a stuffy nose or unexplained loose teeth.

The current pandemic is stressful and is impacting people in different ways including their eating and snacking habits. Stress can cause a person to clench or grind their teeth resulting in the continuous loss of tooth enamel; a dentist may recommend wearing a bite guard during sleep. Emotional

Support and Resources

Some people require nutritional supplements or fortified drinks to maintain their calorie input, and these can have a high free sugar content, putting them at further risk of dental caries, so recommend a sugar free option if suitable.

Injuries to teeth arise from accidents during normal everyday activities such as playing contact sports. Recommending to always wear a mouth guard is a great preventative measure. In the event that a person presents/contacts a pharmacy about a knocked-out tooth check this ‘Save That Tooth’ poster for advice on what to do:

Some liquid medicines have a high sugar content. The Dental Health Foundation recommends sugar-free alternatives if they are available, especially where medicines are given frequently or are long term.

Mouth Head and Neck Cancer is the sixth most common cancer in the world. Smoking and drinking alcohol are the most important risk factors, alcohol plays a role in up to half of all cancers of the mouth, head and neck in men in Ireland. It is useful to able to be signpost to alcohol and smoking cessation support services such as

Earlyandhttps://www2.hse.ie/alcohol/www.quit.iedetectionsaveslivessoif a

concerned customer has any of the following symptoms for more than 3 weeks refer them to their dentist or doctor:

The Dental Health Foundation is at the heart of oral health promotion for over 40 years and supports all health professionals, including Pharmacists, by providing evidence based best practice resources to increase awareness amongst the public, empowering them to make healthier oral and general health lifestyle choices. Having the right information on tooth tips, diet and general health will help keep teeth healthy for a lifetime. Good oral health is of vital importance to the general health of everyone in Ireland.

Gum disease is caused by a build-up of plaque on the teeth and around the gums, causing red swollen gums which bleed when brushing. If left untreated, gum disease (or gingivitis) will progress to periodontal disease which causes bad breath, receding gums, wobbly teeth and, ultimately, loss of teeth. Smoking also increases the risk of periodontal disease, smokers are more likely to get periodontal disease and prematurely lose their teeth than non-smokers.

Health Promotion is about empowering people to take control of their own lives so make every contact count. For further information about the Dental Health Foundation and to download our free resources please see www.dentalhealth.ie or link in with us on Twitter, Facebook, LinkedIn.

stress is a possible trigger for canker sores/mouth ulcers and customers may look for pain relief medication from their pharmacist. Encourage them to attend the dentist if mouth ulcers do not clear up within a few days, or if this is persistent and frequent enough to cause concern. Their dentist or GP may refer more severe cases to a specialist for a thorough investigation. People often reach for alcohol, or smoke more in times of stress or worry impacting negatively on oral health. Heavy use of alcohol increases the risk of acute respiratory distress syndrome (ARDS), one of the most severe complications of COVID-19. The World Health Organization states

Dry mouth is a side effect of some medication. This is particularly uncomfortable and often gives rise to difficulty in speaking and eating and impacts negatively on quality of life. Furthermore, reduced saliva flow can give rise to an increased incidence of tooth decay, gum disease and also an increase in oral infection, such as candida albicans.

Stress

58 | PHARMACYNEWSIRELAND.COM

A lesser-known fact is that the human papillomavirus (HPV) is also a risk factor for Mouth Head and Neck Cancer. Students in their first year of secondary school are offered the HPV vaccine as part of the school vaccination programme. For more information about mouth head and neck cancer, please see www.mouthcancer.ie

that smoking impairs lung function making it harder for the body to fight off coronaviruses and other respiratory diseases.

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Embrace Your Moment

The Irish Pharmacy Union has long campaigned for emergency contraception to be made available without the need for a prescription.

Pictured is Stephen Watkins, Managing Director of Boots Ireland, Martha Ryan, Head of Human Resources and CSR Lead for Boots Ireland, Louise O’Brien, Corporate Social Responsibility Manager for Boots Ireland, Averil Power, CEO of the Irish Cancer Society, and Bríd McCarthy, an Irish Cancer Society Night Nurse

those who may still be dependent on parents or guardians, or who may be just above the means tested thresholds for the GMS and GP Visit cards, may impose a significant barrier to access; costs for the Pill and similar repeat prescription contraceptives can therefore be estimated at ¤65-100 every 6 months, and the initial costs of long-acting reversible contraception typically range from ¤250-¤320. If the costs of removal are also included, the costs rise to ¤340-¤470.

The Minister added, “I am also delighted to be able to progress

News

Watkins, Managing Director of Boots Ireland, says “We are particularly proud of this partnership and the difference that our Team Members and customers have made to the lives of so many. As a company, we will continue to support those living with cancer through initiatives both in and out of stores. Our beauty advisors and pharmacists receive specific training to support those going through treatment and indeed their carers with the aim of providing a safe and supportive space. We look forward to continued success in supporting the Irish Cancer Society in the wonderful work that they do”.

The government has taken a decision to move forward with a key Green Party Programme for Government commitment to provide free contraception on a phased basis, beginning with women aged 17 to 25.

Green Light for Free Contraception Plan

Those with full eligibility for a GMS (medical) card already have access to most forms of contraception at minimal cost

Since 2012, ¤2.5 million has been raised for the Irish Cancer Society Night Nursing service which equates to 7,200 nights of Night Nursing care. 10 Boots Night Walks have taken place with more than 5,000 participants who walked over 25,000 kilometres. Boots stores across Ireland now have over 190 Boots Irish Cancer Society Information Pharmacists and over 50 Boots Cancer Beauty Advisors, making support and information more available to those who need it Stephenmost.

However, it has been recognised that the cost of accessing contraception, particularly for

The Health (Exemptions from Charges for Acute In-Patient Services) Bill 2022 will be published in the coming days and is expected to commence in the Dáil shortly thereafter.

Celebrating 10 Years of Partnership

Announcing the Cabinet decision to approve the publication of this legislation, Health Minister Stephen Donnelly said, “This legislation, when enacted, will ease the financial burden of parents/ guardians when bringing their child to hospital for in-patient care.”

The Minister for Health also received government approval today to bring a Committee Stage amendment to the Health (Exemptions from Charges for Acute In-Patient Services) Bill 2022 which will insert provisions to provide for the free contraception scheme for women aged 17-25.

This year, Boots Ireland and the Irish Cancer Society celebrate 10 years of partnership. Over the last 10 years, Boots Ireland has raised €2.5 million for the Irish Cancer Society Night Nursing service. Since the relationship began in 2012, Boots Ireland team members, patients and customers have come together to raise funds for this essential service to ensure cancer patients receive the end-of-life care needed allowing them to remain in their own home.

improvements in access to contraception. The proposed contraception amendment aims to remove cost barriers to contraception for women aged 17-25, which will be particularly significant for those who are just above the means tested limits for medical and GP visit cards, or who may still be in full time education and financially dependent on parents and guardians.”

PHARMACYNEWSIRELAND.COM 61

(subject only to the prescription charge; ¤1.50 per item, up to a maximum of ¤15 per month), through the GMS (medical card) scheme, while those with a GP visit card are supported to some extent, as the necessary consultations are free of charge. Patients holding a GP Visit Card receive consultations, fittings and checks free of charge. Furthermore, the Drugs Payment Scheme (DPS), for which anyone ordinarily resident in Ireland is eligible, covers the cost of prescription items, including LARCs, above a limit of ¤80 per month.

“It is part of our public protection remit to ensure that standards are met and maintained for pharmacists seeking to practise in Ireland, and that suitably trained pharmacists are available to provide safe, effective, and high-quality care that the public can continue to rely upon. While the growth in pharmacist registration numbers is less than pre-pandemic levels, there was a small net increase last year of about 80 pharmacists. We will continue to carefully monitor these numbers and impacts on the available pharmacy workforce as part of our pharmacist workforce project in 2022.”

• Implementation of the amended qualification recognition and registration process for applicants with qualifications obtained in the United Kingdom, as a result of the UK’s departure from the European Union.

“COVID-19 had a huge bearing on the operational activities of the PSI and a significant amount of time and resources were engaged as part of the national response during 2021. We had extensive engagement and collaboration with the Department of Health and others to progress the requisite legislation*, systems, guidance, training, and governance to enable the effective participation of

Dr Horgan said that a total of 6,846 pharmacists were registered with the PSI at the end of 2021, with 1,981 pharmacies registered.

Dr Horgan also commented that the PSI receives information in different ways that informs its work. It recorded 607 general queries about pharmacy practice

There were 120 expressions of concern (whereby a member of the public brings a matter to the attention of the PSI but does not want to make a complaint) lodged with the PSI, and a multi-disciplinary team in the PSI assesses what regulatory action may need to be taken with these.

“We launched a single on-line point of contact for registration applications and renewals last year, which has facilitated the movement of several processes online, delivering efficiencies in terms of enhanced online security, improved quality of access, and to reducing administrative burden for users, both internally and externally. It is part of our digital improvement journey.”

• Reviewing 120 expressions of concerns, as well as 80 formal complaints during the year, with 25 complaints during the period referred for further action.

PHARMACYNEWSIRELAND.COM 62 News

It provides a detailed overview of the work undertaken so far in response to the ambitious targets of the PSI Corporate Strategy 2021-2023. Developed against the backdrop of the COVID-19 global pandemic and the significant threat posed to all sectors of society, the strategy, under the direction of the PSI Council, identifies key strategic objectives, including building pharmacy resilience, adopting a “digital first” business approach and developing a robust regulatory model for community pharmacy settings, items the PSI sees as critical to ensuring pharmacy healthcare activity is regulated to a high and consistent standard.

“Dealing effectively with complaints and disciplinary matters is a core feature of the PSI’s remit to maintain standards in pharmacies. During 2021, the PSI received 80 formal complaints. 59 complaints were considered by the PSI’s screening committee, the Preliminary Proceedings Committee, and in total there were 12 inquiries heard by the PSI’s statutory committees of inquiry last year.”

• Management of the registration of 6,846 pharmacists, 254 pharmaceutical assistants and 1,981 pharmacies as part of PSI’s regulatory remit to assure public trust in the standard of pharmacy care and services.

matters in 2021, of which 32% were related to COVID-19.

“Looking ahead, our focus is on ensuring we have the most effective regulatory systems in place that respond and evolve to assure the safety of pharmacy services and to meeting the needs of the developing healthcare system. Together with the President and all of the PSI Council, we look forward to continued beneficial engagement with the Minister for Health, his Department, our registrants and other state agencies, as we undertake our work in the public interest.”

• Implementing a new organisation structure to improve organisational capacity, planning and delivery.

Key activities for PSI during 2021 included:

pharmacists and pharmacies in the national vaccination programme.”

The Pharmacy Regulator has published its annual report for 2021, outlining the significant work undertaken by the agency to protect the health, safety and wellbeing of patients and the public by regulating pharmacists and pharmacies in Ireland. complaintseffectively“DealingwithanddisciplinarymattersisacorefeatureofthePSI’sremittomaintainstandardsinpharmacies”

“Pharmacists and pharmacies played a key role during the pandemic and maintaining public trust in the sector was of critical importance. Throughout the pandemic, pharmacists combined their ‘everyday’ duties with the extra responsibilities and demands brought about by the pandemic, across practice settings. Over 600,000 COVID-19 vaccines were administered in community pharmacies in the course of 2021. Our duty to ensure continued delivery of safe services remained and the ongoing implementation of the PSI’s COVID-19 Operational Standards, developed in 2020, was an important piece of work to provide guidance and support on the operating protocols for pharmacies during this period.”

• Responding to 607 pharmacy practice related queries from pharmacists and members of the public and implementing appropriate follow-up actions to deal effectively with queries.

Commenting on the publication of the annual report, Interim Registrar and Chief Officer Dr Lorraine Horgan said that the regulator had continued to deliver on its statutory remit to ensure public and patient trust in the country’s pharmacy services during the immensely challenging circumstances of the global pandemic.

• Significant work to facilitate pharmacy participation in the national COVID-19 vaccination programme.

• Launch of a new registration portal for PSI applicants and registrants as the first phase of an ongoing digital transformation programme.

Pharmacy Regulator Annual Report

While COVID-19 had a large impact on the pharmacy sector and the regulator’s work in 2021, the PSI continued to deliver on extensive responsibilities and make strong progress in strategic projects, critical to assuring public and patient trust in pharmacy healthcare and services.

Immune support for kids •Contains Black Elderberry & Vitamin C •For kids from 1 year old •Scientifically tested Contains Black Elderberry plus Vitamin C which contributes to the normal function of the immune system. Available to order from Wholefoods Wholesale. Please contact 01 6262315 or your local sales representative. Immunity for whole family CDU available

Creating a Diverse and Inclusive culture

“As Irelands leading Pharmacy chain, our strength is in our ability to provide our Pharmacy teams a strong support network of specialists and peers who are on hand to welcome and support

Hazel adds, “Each year LloydsPharmacy takes part in the 5th Year pharmacy student programme through Appel. Our HR Business Partners and Talent Acquisition teams are available to support and assist overseas candidates and employees when deciding on their career move to join internationalinWhetherLloydsPharmacy.youareagraduatetheAppelProgramme,ancandidateor

“All colleagues also have access to our Online e-learning tool “Book Boon” available 24/7. This provides an opportunity to start a guided development journey, acquiring or brushing up on business skills as well as personal development.

“Every year many of our colleagues reach impressive milestones within the company, and we acknowledge and celebrate their commitment to their teams, their patients, and their local communities,” she adds.

PHARMACYNEWSIRELAND.COM 64 Pharmacy Careers

As HR director of LloydsPharmacy, Hazel believes the commitment to excellence starts from within. She says, “Our people are at the core of our purpose as a company – ‘to advance health outcomes for all’ – and our diversified talent, skills and experiences will help us get there. What sets LloydsPharmacy apart as an exceptional place, is our “Ourpeople.goalis to LloydsPharmacymakearewarding and fulfilling place to work, a place where we recognise achievements and success, and encourage personal development and career growth. We focus on developing a positive, highly engaged culture for all colleagues, through a focus on the employee and their career and personal development journey.”

At LloydsPharmacy, the people strategy is based on looking at the pharmacy career journey from end to end and considering how we can enhance this experience. How we welcome and support Pharmacy Graduates and International Candidates

LloydsPharmacy are committed to creating a more diverse and inclusive workplace environment as Hazel reflects, “We do not just value differences, we seek

them out, we invite them in. And as a result, our ideas are better, our people are stronger, our product and service offering are comprehensive, and our customers are better served. This is evidenced in our culturally diverse workforce with many of our employees coming from international markets who are warmly welcomed by our teams.

Hazel Sullivan, HR Director at LloydsPharmacy Ireland, outlines the progressive people strategy being implemented to support and develop Pharmacists, Technicians, and front of shop colleagues in one of Irelands leading Pharmacy chains.

Your career journey with LloydsPharmacy

“All Pharmacy Managers take part in our bespoke manager programme designed to develop their management capabilities, develop a strategic mindset, encourage innovation and inspiration, and the support to develop their own teams.

Acknowledging Career Milestones

providingLloydsPharmacyguidancetoPharmacyteam

Hazel continues, “For the second year in a row we have acknowledged our employees’ positive impact, dedication, and commitment across our 89 pharmacies through our Internal Employee Recognition Awards. This year we were delighted to acknowledge many of our LloydsPharmacy Pharmacists and teams for the excellent work they do in delivering superb customer service and patient care across their communities.

How we encourage growth through Personal Development

joining LloydsPharmacy from another Pharmacy, we provide a comprehensive and detailed programme which includes a bespoke induction, a dedicated mentor assigned for support and guidance, access to OTC training, support from the Superintendent Pharmacist and Clinical Governance Pharmacist as well as OSCE practical’s to support students for their mocks.”

“Our Pharmacy colleagues are offered a comprehensive range of professional development and training from induction, in-house training sessions, online webinars, learning tools & resources, and new service training,” says Hazel.

“In the recent Recognition awards, we acknowledged one of our International Pharmacists for her use of language skills to create a welcoming, understanding, and safe place for the wider team and across her community.

“During the month of June, we highlighted our support for Pride and our focus on diversity through an array of initiatives including organising webinars and relevant topics on our e-learning library and personal development tool to help our employees understand and embrace our differences.”

Hazel Sullivan, HR Director at LloydsPharmacy Ireland

Denis O’Driscoll Superintendent Pharmacist at

How we recognise our People

Our People Strategy at LloydsPharmacy

“It was no surprise that one of our Pharmacists was the recipient of the highly sought after ‘Employee of the Year’ award. This Pharmacist not only excels at delivering excellent patient care but also actively seeks out colleagues in her team to mentor and support. Another example is the Pharmacy team in Kilbarrack Road who were recognised for their continuous focus on putting their Patient and Customers First, and for going above and beyond the call of duty for their community.”

How our support structure helps you at every stage of your career journey

“Our Employee Communications App ‘Looop’ helps us stay connected where all employees can be kept updated on company news, changes on policies, engagement initiatives and recent successes.”

support you financially

“There are lots of supports in place, in the Pharmacy itself there will typically be a Supervising Pharmacist and larger stores have a Pharmacy Manager to oversee the dispensary and front of shop teams.

“Each Pharmacy is assigned to one of five regional managers who are available to support and direct the teams. Our Pharmacists are also uniquely supported by a Superintendent Pharmacist, and a Clinical Governance Pharmacist to ensure Pharmacists meet all regulatory and contractual requirements. They advise Pharmacists of the latest developments in the community pharmacy sector, share CPD opportunities and are readily available to assist and support with any issues that may arise. In recent months we have appointed a specialist role of Pharmacist Experience Program Manager. They are responsible for the complete end-to-end experience for Pharmacists, ensuring they have a positive and impactful journey throughout their time with LloydsPharmacy. They drive the development and delivery of programs to meet the needs of our pharmacy colleagues to influence an award-winning culture.

You can read about working at LloydsPharmacy on our careers section of our website at Careers –LloydsPharmacy Ireland. We have some open roles for Supervising and Support Pharmacists, Pharmacy

the teams in their new role and development throughout their career. Our aim is to improve our colleague working environment by producing operational efficiencies, processes, training, and tools to make working at LloydsPharmacy an enjoyable and great place to work.

“Our support office structure includes a Sales and Operations team who drive strategy, new projects, and operational efficiencies to guide the Pharmacies. Support is available from other departments including

PHARMACYNEWSIRELAND.COM 65

HR, IT, Finance, Marketing, and “ThroughProcurement.continuously advancing our technology support systems we streamline duties and drive efficiencies. We invest in the latest technology and processes to help support pharmacy teams and improve our customer’s experience within our pharmacies.”

Looking for a career change? Check out the open roles at LloydsPharmacy

Technicians and Retail sales assistants. Job Roles –LloydsPharmacy Ireland

If you are interested in a career move and wish to be part of our team, please contact our Talent Acquisition team Susan O’Meara or Lynne Minto at jobs@lloydspharmacy.ie or through lloydspharmacy-irelandhttps//.linkedin.com/

Hazel Sullivan presenting award to Employee of the Year (Rachel, Pharmacist from Nutgrove) along with Darren Kennedy host at the Awards

How we

Hazel Sullivan with some of her HR team at the Employee Recognition awards in April 2022

Sona Magnesium 500mg contains elemental magnesium for optimal absorption, helping to promote normal muscle function, reduce tiredness, and fatigue and maintain excellent bone health. Supplementation of Sona Magnesium 500mg means that you can choose when is optimal for you to take the supplement. For example, some people like to take it before bed to increase their sleep quality, while others prefer to take it in the morning to balance their nervous system and reduce tiredness.

CoQ10 dietary supplements might help prevent or treat certain heart conditions, as well as migraine headaches.

In addition to Covid-19 recovery, CoQ10 supplements also host a plethora of other benefits for heart health. It is specifically recommended for those who take statins (Lipitor or Atorvastatin), as this medication can deplete natural levels of CoQ10 in the body, leaving patients feeling fatigued.

Levels of CoQ10 in your body decrease as you age. CoQ10 levels have also been found to be lower in people with certain conditions, such as heart disease, and in those who take cholesterol-lowering drugs called statins such as Lipitor and Atorvastatin.

Magnesium 500

Deficiency in Magnesium can cause a range of issues such as tiredness, cramping, fatigue, poor sleep and can even affect our bone health. While consuming more fruit and vegetables can help replenish our magnesium levels, supplementation can help to boost magnesium in our body quickly and will ensure that you are receiving a standardised amount each time.

Coenzyme Q10 (CoQ10) is an antioxidant that your body produces naturally. Your cells use CoQ10 for growth and maintenance.

Sona CoQ10 MAX provides 200mg of concentrated coenzyme Q10 per capsule, including a small amount of oil for optimal absorption into the bloodstream and Vitamin E.

Something which is often overlooked when reducing stress levels is creating a healthier and more balanced diet. Consuming three healthy balanced meals per day, ensuring to include enough protein and fibre, and reducing caffeine intake is one way to manage our blood sugar levels which in turn, helps us maintain a balanced mood throughout the day.

These are just some of the things we are told to do to maintain a healthy mind and body. Reducing and preventing high stress levels is vital for our mental health, however it can be difficult for some of us to find the time to prioritise relaxation.

PHARMACYNEWSIRELAND.COM 66 Advertorial

However, certain nutrients are often low or deficient in our diet due to food processing. Magnesium is an example of one of these nutrients which nearly fifty percent of the population may be low or deficient in, largely due to poor diet but also due to the use of fruit and vegetable processing which depletes the natural levels of magnesium in our soil.

CoQ10 200mg

You don’t have to recover from COVID-19 alone…

CoQ10 may also help you recover faster from ‘long Covid’. Recent evidence has suggested that supplementing with 200mg of CoQ10 each day such as Sona CoQ10 MAX, while recovering from Covid-19 may help to speed up the healing process and reduce feelings of tiredness and fatigue. While evidence is still in the early stages, medical practitioners are introducing the supplement to patients with long covid since medication for the illness is yet to be introduced to the market.

Get eight hours sleep, meditate, get a hobby, get enough exercise…

CoQ10 is found in meat, fish and nuts. The amount of CoQ10 found in these dietary sources, however, isn’t enough to significantly increase CoQ10 levels in your body.

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Magnesium is involved in more than 600 reactions in the human body and is essential for health. Unfortunately, studies suggest that about 50% of people in Europe get less than the recommended daily amount of Magnesium in their diet. 50% of Irish people do not MagnesiumenoughgetSona,thebestsellingMagnesiumsupplementsinIrishpharmacies. SONA provides Magnesium tablets of 250mg, 300mg Time Release and 500mg elemental Magnesium. BLOODMOOD SUGAR HEART BLOODDISEASEPRESSURE Ir I sh v I tam I ns #1 in ireland Sona proudly Support S RCN: 20042462 | CHY: 13534

I would like to extend my warmest thanks to everyone who sponsored a prize or bought a raffle ticket at The Irish Pharmacy Awards on May 21st.

Sadly the prognosis for other cancers is not yet as positive. But the pace of scientific and medical progress is so remarkable that a brighter future for everyone affected by cancer is within our grasp. With sufficient priority and investment, we can deliver a future where no one dies of cancer. Advances like the HPV vaccine mean it will be possible to eliminate some cancers. Others will become chronic, manageable illnesses, just as HIV is now.

We typically receive just 3% of our income from the State. So we are reliant on the compassion and generosity of our donors to fund all of our lifesaving research, as well as vital supports such as our free nursing, counselling and transport services.

Our mission at the Irish Cancer Society is to help bring that day forward. But it won’t happen without a lot more investment.

Once again, I would like to express my gratitude for inviting me to attend The Irish Pharmacy Awards and for choosing the Irish Cancer Society as the benefiting charity of such a wonderful evening. Our work would not be possible without you.

Just over 30 years ago, only three out of ten Irish people survived a cancer diagnosis. Today six out of ten do. Some cancers, like childhood blood cancers, that were previously almost always fatal are now largely curable. Nine out of ten people also now survive prostate, breast and testicular cancer.

Averil Power, CEO of the Irish Cancer Society

Thank you from the Irish Cancer Society

If you ever have a question or concern about cancer, the experienced cancer nurses on our Support Line are at the end of the phone on 1800 200 700 or at generosity,Thanksupportline@irishcancer.ie.youonceagainforyour

Thanks to the generosity of people like you, the Irish Cancer Society is proud to be the largest voluntary funder of cancer research in Ireland. This year we are supporting over 120 researchers in hospitals and academic institutions across the country. Every day, they make more progress in turning today’s terminal cancers into tomorrow’s treatable and survivable ones.

PHARMACYNEWSIRELAND.COM 68 Charity

Together, you raised an amazing ¤9,245.00 for the Irish Cancer Society in memory of your colleague and friend Paolo Iacovelli of PharmaConex who sadly died of cancer last year and was passionate about the importance of cancer research.

Research means new discoveries and new therapies. Better odds and lives saved. More birthdays, hugs and precious moments together. It is the driving force behind improvements in cancer care and the hero of happy endings.

Irish Pharmacy Awards Raises over ¤9,000

Averil Power CEO, Irish Cancer Society

Save the Date Saturday, 27th May, 2023 The Clayton Hotel, Burlington Road, Dublin Awards2023The PharmacyIrish For more information contact: aoife@ipn.ie

N E W K I D S L I Q U I D M U L T I S U P P O R T I N G Y O U R L I T T L E O N E ’ S G R O W T H A N D D E V E L O P M E N T

N E W

C A N S U P P O R T I M M U N I T Y C A N H E L P W I T H N O R M A L B O N E & T E E T H D E V E L O P M E N T C A N S U P P O R T N O R M A L M E N T A L P E R F O R M A N C E C A N A I D H E A R T H E A L T H S U I T A B L E F O R 3 Y E A R S + C A N P R O V I D E E N E R G Y S U P P O R T 1 2 K E Y N U T R I E N T S & M I N E R A L S O R A N G E F L A V O U R E D 3 T O P L A C E A N O R D E R : C O N T A C T Y O U R L O C A L U N I P H A R R E P R E S E N T A T I V E

What other health conditions is psoriasis associated with?

Now more than ever, maintaining a healthy lifestyle and diet is of key importance, with vitamins and supplements playing a vital role in helping prevent against illness and disease.

Specially developed by Irish company Uniphar and exclusive to Irish Pharmacy, the AYA Bio Range is widely available in pharmacies nationwide including @allcarepharmacyirl, @lifepharmacyirl, @hickeyspharma, @mccauleypharmacy, @caraallcare_pharmacy, @yourlocalpharmacygroup, where staff are trained to provide advice on appropriate products.

If you have psoriasis, ask your doctor about your risk for heart disease, type 2 diabetes, high cholesterol and high blood pressure. If you have symptoms of arthritis, you may be referred to a rheumatologist who is a specialist consultant doctor who can diagnose and treat forms of arthritis and other diseases of joints, muscles and bones.

Say Heya to AYA’s New Bio Range

The AYA Bio Range is designed with delayed release technology which helps to protect the bacteria from the stomach acid and ensures maximum delivery, and each product has a unique formula:

What is psoriasis?

The BIOMAP consortium has published a study in the Journal of Investigative Dermatology, exploring what influence the HLA-C*06:02 (a version of a gene called HLA-C) has on the risk of developing other health conditions (often termed comorbidities) in over 9,000 people with psoriasis.

AYA, the leading Irish vitamin and supplement brand for all the family, launches a brand-new Bio range. The latest addition to AYA’s extensive product line consists of three action-packed bios; After Bio, Calm Bio and Digestive Bio which are available from pharmacies nationwide. The range is designed with delayed release technology to protect the bacteria from stomach acid and ensures maximum delivery.

There are a number of other health conditions (comorbidities) that have been associated with psoriasis. People who have psoriasis are at risk of developing psoriatic arthritis, which commonly affects the joints of the fingers, toes and spine. Some people with psoriasis can have an increased risk of type 2 diabetes, high blood pressure, high cholesterol, cardiovascular disease (heart attack, stroke), and obesity. There is also a strong association between psoriasis and depression and anxiety.

• AYA Calm Bio (RRP ¤21.99) is packed with a variety of nutrients, Lactium, Riboflavin, Thiamin and Magnesium which can help to support the normal functioning of the nervous system and to normal psychological function. Calm Bio is a delayed release formula which protects the bacteria from the stomach acid and ensures maximum delivery.

Aine Devlin, Trade and Marketing Manager, Uniphar, comments, “Each product is the new Bio range has been specially developed with a diverse mix of friendly bacteria, nutrients, and enzymes.”

Psoriasis is a chronic systemic inflammatory skin disorder involving the skin and nails, affecting at least 60 million people worldwide and at least 73,000 people in Ireland.

in this area. Environmental and some lifestyle factors can also play a role in those who are susceptible, such as infection, emotional stress, injury to the skin, certain medications, alcohol consumption, smoking and being above a healthy weight.

New Research on Psoriasis

• This product is a delayed release formula which helps to protect the bacteria from the stomach acid and ensures maximum delivery.

The exact cause of psoriasis is still not completely understood. Three central factors contribute to its development, these include; abnormal immune system responses, genetic predisposition and environmental factors. It is a condition that tends to run in families and several different genes have been identified, with research ongoing

• AYA Digestive Bio (RRP ¤16.99) is a unique an powerful combination of six digestive enzymes. Additionally, this product contains lactase which contributes to the breaking down of lactose. The delayed release technology within Digestive Bio can help to protect the bacteria from the stomach acid and ensures maximum delivery.

Psoriasis affects people in different ways. Living with psoriasis can affect you emotionally and socially, as well as physically. If you are feeling anxious or down, it is important to share your feelings with your doctor.

PHARMACYNEWSIRELAND.COM 70 News

• AYA After Bio (RRP ¤9.99) After Bio contains 10 billion friendly bacteria per capsule with six strains of bacteria for a broad spectrum of probiotic activity.

“A person’s genetic make-up is an important determinant factor of health and disease. We know very little about the genes that determine whether a person will develop psoriasis comorbidities, but we know more about the genes that can lead to psoriasis. Of these, a gene called HLA-C is by far the most important.” (Biomap consortium)

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New Range launched by Fabulous Pharmacist

PHARMACYNEWSIRELAND.COM 72 Profile

Formulated and developed by the winner of the prestigious 2022 Pharmacist of the Year Award, Laura Dowling, fabÜ’s scientifically targeted supplement formulations, take the guessing game out of the endless list of supplements available on the market today.

The result is a product range with each formulation combining just six to eight powerful key ingredients tailored specifically to your wellbeing needs. Thanks to

Laura’s incredible fascination with the wonderful powers of plants, herbs and mushrooms from across the world, fabÜ demonstrates perfectly how nature and science can work seamlessly together in absolute harmony.

Havingfrom.”witnessed a large volume of pharmacy customers, overwhelmed by the number of supplements on the market today, and after years of fielding questions, Laura wanted to simplify and improve the supplement offering.

College Dublin in 2002 and for over twenty years, she has been on a mission to optimise wellness by educating and empowering people to achieve sustainable, healthy lifestyles. It was while studying at Trinity that Laura specialised in Pharmacognosy. “As such, I have always had a fascination with the wonderful powers of plants, herbs, and mushrooms from across the world - and how nature and science can be tailored to work together in harmony,” she adds.

“So many people are understandably confused by the vast amount of generic or ‘one size fits all’ nutritional supplements available. Many of those generic supplements or multivitamins do not necessarily target their specific needs. You do not need to take the product with the most ingredients

A pharmacist and scientist by training, Laura graduated from the School of Pharmacy, Trinity

We recently spoke to Laura to gain a further insight into the passion and innovation behind the brand.

Online, Laura is well-known as “The Fabulous Pharmacist”. Her Instagram @fabulouspharmacistchannelis dedicated to sharing relatable and passionate advice about health, family, selfcare and wellbeing. She continues, “I strive to give my 52k+ followers the tools to live a balanced, sustainable, and healthy lifestyle without resorting to short-term crazes or fads. Whether talking about skin concerns, constipation, female incontinence or mental health, I aim to educate my followers and shine a light on topics that others often tend to shy away

Laura Dowling, who has recently launched her new fabÜ range of supplements

Pharmacist of the Year Laura Dowling introduces fabÜ, a unique new range of nutritional supplements that simplifies the search and merges the power of nature with the precision of science.

“I have always aimed to put my patients and customers first. My dedication to the role was recently recognised - I was delighted to be awarded the prestigious 2022 Pharmacist of the Year Award.”

The Dynamic 100 is a network of the most influential professional in the Irish pharmacy industry who act as ambassadors and role models for their peers, colleagues and the rising stars of tomorrow within Community Pharmacy. How to enter:  Please submit 250-800 words, describing how you/they have achieved something special, gone above and beyond or behaved dynamically.  We also require a high-resolution photograph of the entrant for print publication.  Each entry must be within the pharmacy industry. 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. DYNAMIC 100 NOMINATE TODAY Email nomination(s) to aoife@ipn.ie or Kelly-jo@ipn.ie DEADLINE MONDAY 3rd OCTOBER Dynamic

RiskDepression

been a big success, and the feedback from the public has been incredible, which has made it all so worthwhile.”

Higher levels of the stress hormone cortisol may increase the risk of developing depression, according to new research from Trinity. Researchers from The Irish Longitudinal Study on Ageing (TILDA) found that higher cortisol levels in older adults, measured from hair samples collected in 2014, were associated with an increased likelihood of depression during the early months of the COVID-19 pandemic, six years Cortisollater.measured in hair is thought to reflect previous stress exposure as well as other biological and psychological factors, yet to be fully Higherdetermined.levelsare sometimes observed in individuals who are currently depressed, but the findings suggest that cortisol, measured in this way, may also help predict who is vulnerable to depression in the future, following a period of heightened stress.

“fabÜ SHROOMS IMMUNE is so completely different to any other immunity supplement on the market today. It contains six active ingredients with a concentrated extract of two unique, edible mushrooms - Cordyceps and Chaga. Cordyceps mushrooms have been used for over a thousand years in traditional Eastern medicine as a tonic to support energy levels and immune function, while Chaga mushrooms have been used for centuries to support immunity and improve overall health. These have been blended with vitamin D, vitamin C, copper and zinc to support your immune system and protect cells from oxidative stress.”

Product info:

Professor Rose Anne Kenny, TILDA’s Principal Investigator, says, “The measurement of cortisol using hair samples is a very novel approach in a population study. It is also the first time that this has been used on such a large scale in Ireland. This allows us to easily measure hormonal stress effects – which previously required five samples of blood or saliva in one day. Cortisol is linked to fast and slow ageing processes and stress is an important determinant of these and of our biological ageing.”

And what are her future plans for further development? Laura teases, “Ultimately, bringing ‘wellness’ to my fabÜ tribe is what I am passionate about. This is central to how I plan on building out my fabÜ range …so watch this Researchspace!”shows that users of Ashwagandha see an improvement in stress and fatigue within two months.

Available to buy www.fabuwellness.comat and leading pharmacies nationwide

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Labour of Love

PHARMACYNEWSIRELAND.COM 74

with B vitamins and magnesium to support psychological function, nervous system, mental performance and reduce tiredness and fatigue.

fabÜ SHROOMS IMMUNE it is recommended to take two easy-to-swallow capsules daily.

A one-month supply of fabÜ R&R RELAX is priced at ¤28.99rrp

“The botanical extracts in fabÜ R&R RELAX have been chosen because of their traditional use in Ayurvedic, Chinese and European medicine offering relaxation and stress-relieving properties. It has eight active ingredients. It is based on the Ayurvedic herb, Ashwagandha - an amazing Indian ingredient that is my go-to for stress and fatigue, and botanical extracts such as lemon balm, chamomile and L-theanine blended

or every ingredient. And at the other end of the scale, it is not cost effective or practical for people to put together a curated shopping list of the essential ingredients that they “Peopleneed.are so busy nowadaysthey simply do not have the time to figure out how to successfully achieve the outcomes they are looking for. This is why fabÜ is so special - high quality, minimal ingredients brought together using pharmacognosy, demonstrating how nature and science can be tailored to work together in harmony.

There are two products in the range. fabÜ R&R RELAX and fabÜ SHROOMS IMMUNE. Laura adds, “In terms of the outcomes I am targeting with each formulation, the clues are in the name!

“I have devoted the last five years of my life to formulating and developing fabÜ. It has been a labour of love! The launch has

A one-month supply of fabÜ SHROOMS IMMUNE is priced at ¤23.99rrp

Studies show that magnesium, vitamin B3 and vitamin B12 contribute to normal psychological function, the normal functioning of the nervous system and the reduction of tiredness and fatigue. Vitamin B5 contributes to normal mental VitaminperformanceD,vitaminC , copper and zinc will contribute to immune support from day one . Vitamin D, copper and zinc contribute to the maintenance of hair health and users will see a benefit in their hair health within three months

Dr Joanne Feeney, lead author of the study and Senior Research Fellow in medical gerontology at Trinity, said, “As TILDA has been gathering data for years, we were able to look back in time to 2014 to when cortisol levels were measured and investigate whether they were associated with an increased risk of depression during COVID-19.”

Directions for use:

fabÜ R&R RELAX it is recommended to take two easy-to-swallow capsules daily (Take two capsules 1-2 hours before bed or take one capsule twice daily).

The study of people aged 60 and over during the first year of the COVID-19 pandemic found that the results did not differ between men and women.

Launching soon, these scales offer a complete view of your body composition, giving greater insight into overall health.

With options for on-the-go, home, work, travel and sports teams, there is always a First Aid kit to suit your needs.

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Smart thermometer patch and accompanying app that measures and confirms ovulation.

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Contact your Fleming Medical Representative or a member of our team for more details at pharmacy@flemingmedical.ie or call 1800 307777

Easy to use home monitor that connects to the Medicare LifeSense® app via Bluetooth.

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Physiologix is a dynamic support range with varying support and compression levels which help reduce inflammation and pain caused by acute or chronic injuries.

Our Product Development team have been busy adding innovative products to our portfolio this year. Here are our top recommendations to support your patient’s wellbeing.

“As we scale up our efforts to help alleviate the US shortages, we want to assure parents outside of the US that we are increasing production and supply overall and we will continue to serve families in all countries in which we are present.

The gut microbiome has been linked to higher pain responses in women in an APC Microbiome Ireland study led by University College Cork’s Dr Siobhain O’Mahony and Prof George Shorten. The study published in the journal Brain Behaviour and Immunity highlights the possibilities for innovative individual targeted therapies for pain management. Notably women demonstrated different pain thresholds at various stages of their menstrual cycles.

formula brand in Ireland, the United Kingdom and Europe. Through the collaboration with the FDA, it will be made available to American families starting in July.

Danone Ireland Wexford Factory

A company spokesperson told Irish Pharmacy News, Danone has finalised plans, in conjunction with the FDA, to bring 750,000 cans of Aptamil non-medical baby formula manufactured at Danone’s Wexford supply point into the United States to help mitigate the nationwide formula shortage.

The gut microbiota are acknowledged as playing important roles in our health and disease. The microorganisms within our gut and the metabolites they produce can directly and indirectly affect our brain, including pain signalling

Danone Ireland is helping US authorities prepare for shipments of its specialised baby formula amid a national shortage that’s left parents across the country struggling to find supplies.

Holding the Key to Gender Differences in Pain?

Healthy, non-obese men and women (some of whom were using hormonal contraceptives), were recruited. Male subjects were invited to undergo testing once, whereas females were invited three times across the menstrual cycle. On test days, electrical stimulation on the right ankle was performed; stress hormones, inflammation, gut health as well as the gut microbiota and their metabolites were also measured.

“As a leading manufacturer of baby formula globally, at Danone we understand how important it is for families to access these formulas. That is why in response to the baby formula shortages in the United States, and in collaboration with the US authorities, we have

continued to explore ways to increase production and supply to meet this critical need for American families and serve all the babies we can.

“Aptamil is backed by over 50 years of advanced breastmilk research and is the number one

pathways. This study allowed us to investigate if the gut microbiota and critical signalling components influence pain thresholds. And whether sex, menstrual cycle, and hormonal contraceptive use might also play roles for inter-sex differences in pain perception.

Gender differences in pain conditions as well as therapy to reduce pain have been known for some time. While several factors such as genetic, neuronal, hormonal, psychological and social factors have been identified as potentially playing a role in these differences the underlying mechanisms are not fully understood. Yet information on which factors are more important in pain could inform the development of urgent and effective gender specific treatments.

Researchers observed that the pain tolerance threshold/pain sensation threshold ratio was significantly lesser in women than men and that the amount of certain bacteria were linked with pain sensation thresholds and stress hormone levels in women only and during a specific stage of the menstrual cycle. In comparison with men, women displayed overall stronger associations between microbiota metabolites, stress hormones and inflammatory factors in blood and pain levels. Further, hormonal contraceptive use was associated with increased gut permeability markers in blood and specific bacteria in the gut.

Dr Siobhain O’Mahony, an investigator at APC Microbiome Ireland and Senior Lecturer

Danone Steps Up During Baby Formula Shortage

“This news follows the announcement made several weeks ago, that we are making available in the U.S. an additional 500,000 cans of Neocate specialized medical infant formula for babies with cow’s milk allergy, through our Nutricia business. These cans, shipped from our FDA-registered manufacturing facilities in Europe, are in addition to steps we have already taken to increase production and more than double our imports to the United States of Neocate.”

PHARMACYNEWSIRELAND.COM 76 News

and Principal Investigator in the Department of Anatomy and Neuroscience, University College Cork said “This research highlights the need to design innovative sex-specific interventions perhaps for all disorders related to the gut microbiota. Our findings support the hypothesis that the gut microbiota may be one of the influencing factors determining the physiological inter-sex differences in pain perception. We plan to continue this exciting research to unravel the molecular mechanisms by which specific sex hormones and gut microbes modulate pain signaling pathways. This study is one of the first to highlight the novel possibilities for innovative individual microbiota targeted therapies for sex specific pain management.”

Researchers from The Irish Longitudinal Study on Ageing (TILDA) created a “mortality risk index” – a tool to identify those at high mortality risk, who may benefit from additional care and support. They found that difficulty walking 100 m and difficulty lifting 10 lb were both associated with an increased risk of dying in the following four years.

“There is no recognition from the NCPE in their statements that these drugs, known as CFTR modulators, have revolutionised CF care in Ireland as per the CF Registry of Ireland annual report in “Instead,2020.

Fesoterodine is indicated in adults for treatment of the symptoms (increased urinary frequency and/or urgency and/or urgency incontinence) that may occur with overactive bladder syndrome.

Please refer to the Summary of Product Characteristics (SPC) for further information. The SPC will be available from the launch date at www.hpra.ie and for Healthcare Professionals at www.accord-healthcare.ie.

Fesoterodine Accord 8 mg prolonged-release tablets will be available from both full line wholesalers from launch. For further information please contact Accord in Cork on 021 461 9040 or visit www.accord-healthcare.ie

The COVID-19 pandemic has caused many companies to reconsider where they are investing time and resources resulting in a blurring of the future operating models for pharma companies.

These statements have been made in advance of the NCPE undertaking a possible Health Technology Assessment (HTA) of the extension of Kaftrio to 35 children with CF aged 6-11, a real possibility that has been flagged by the HSE on several occasions.

To provide some assistance with navigating this terrain, the Pharmaceutical Managers’ Institute (PMI) have created a new “Leaders Forum” to provide an event where leaders can hear about and discuss current thinking on organisational structure and come away with tangibles that can be implemented within their organisations.

He concluded, “We believe the Government should step in without further delay and approve Kaftrio for the 35 children. Further it should undertake a full review of the NCPE in light of these recent statements.”

The first of these events takes place on September 15th, with guest speaker Professor Patrick Gibbons, Professor of Strategic Management with UCD Smurfit Graduate School who will tackle the move towards matrix and agile working. The event takes place at the Kingswood House Hotel, Naas Road on from 1-2pm.

Researchers from The Irish Longitudinal Study on Ageing (TILDA) have created a “mortality risk index” to identify those at high mortality risk, flagging individuals who may benefit from additional care and Remainingsupport.physically active protects against risk of mortality for people aged over 50, according to a new study from Trinity College Dublin.

Cystic Fibrosis Ireland (CFI) has questioned whether a drug therapy for 35 children with cystic fibrosis (CF) will be fairly assessed following comments from the National Centre for Pharmaco-Economics (NCPE) to a Sunday newspaper.

New Product Launch

“We would challenge the NCPE to take part in a public debate with Cystic Fibrosis Ireland on their recent statements and why 35 children continue to be denied a life-changing drug, when 140 other children with CF have gained access.”

PMI Leaders Forum

Visit www.thepmi.com for booking information.

PHARMACYNEWSIRELAND.COM 77

Accord Healthcare is delighted to announce the launch of another medicine to their already extensive portfolio: Fesoterodine Accord 8 mg which comes in packs of twenty eight prolonged-release tablets.

Soraya Matthews, lead author of the study and Research Assistant in Health Policy and Management at Trinity, explained that people can also take important steps to reduce their mortality risk. She said, “While mortality risk naturally increases as we get older, that’s far from the whole story. There are some risk factors we can’t do much about, like age, sex and disease history. But other factors may be modifiable; in particular difficulty walking, rising and lifting.”

Philip Watt, CEO of CFI stated, “Following recent statements to a Sunday newspaper, our confidence is very shaken that the NCPE has the capacity to act as fair judges in the pricing/ reimbursement of Kaftrio to 35 children with CF.

“The resulting index can support researchers and clinicians in identifying in advance those people with growing mortality risk who may be in need of additional care and supports.”

Questions asked over CF Therapy

the NCPE contend there is ‘no mortality data’. The NCPE will know that Kaftrio has only been on the market a couple of years, so there would be very limited mortality figures available. There is, however, overwhelming data on the overall health impact of Kaftrio from both studies in Ireland and internationally, and there is also emerging very positive mortality data. This data can be provided by CFI.

News

“The NCPE seems to be unaware of Minister Donnelly’s statement to Deputy Kenny ‘Kaftrio has been a life-changing drug for cystic fibrosis sufferers, and I want to see it made available to everyone who needs “Further,it’.”there is no recognition in the NCPE statements of the savings that could be made by further reform of our drugs reimbursement system. Many reports of the system in Ireland have pointed to wastage, including the continued use of outmoded or ineffective medicines, and this is an area that clearly needs more reform.”

Mortality Risk Index

Dr Peter May, Research Assistant Professor, TILDA, is the senior author of the report. He said, “Mortality risk naturally increases across the life course, and in part due to factors beyond our control. Older age, male sex, a history of smoking, a prior heart attack and a prior cancer diagnosis were among those factors associated with increased mortality risk. But the relationship between functional difficulties and mortality reported here was identified after controlling for such factors.

Philip stated that the NCPE statements are deeply problematic from the following perspective.

Pepcid Duo is a new improved version of Pepcid. It combines the benefits of Famotidine (a H2 receptor blocker) and antacids in one chewable tablet to treat the short term symptoms of heartburn, acid indigestion (dyspepsia) and excess acid.

Most patients know what causes their heartburn. Citrus juices, bread, coffee, cucumber, and rich and spicy meals are common triggers. Overindulgence in food and alcohol (especially right before bed), smoking, excess weight, and stress are other common causes.

The groups at risk include those in poor health, particularly the over 55s who are more likely to be overweight and/or have other medical conditions, and people exposed to stress.

Many OTC medications can help relieve heartburn. The options •include:

assist

Calcium Carbonate and magnesium hydroxide neutralise the exisiting acid in the stomach.

Topic Team Training – Heartburn

• bloating and feeling sick

• a hoarse voice

Key Points: preventive measure

• an unpleasant sour taste in the mouth, caused by stomach acid

Antacids, which help neutralize stomach acid. Antacids may provide quick relief. But they can’t heal an esophagus damaged by stomach acid.

Symptoms will probably be worse after eating, when lying down and when bending over.

If someone has heartburn incidences more than three times a week they may have a more serious underlying problem such as gastro oesophagael reflux disease (GORD). This condition results in the contents of the stomach to back up, or reflux, into the oesophagus.

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.



Refer patients to the GP if they:

• are ≥45 years old with new or recently changed indigestion symptoms

 Ensure

Treatments

Pharmacists should ask openended questions about concurrent medications and supplements, such as NSAIDs, aspirin, glucosamine, and others, that may list heartburn among their side Sometimeseffects.

The below providesconsiderationsinformation,andchecklistsupporttoenableyou to

Actions:

run a team training session and identify opportunities for learning within the topic of Heartburn.

• bad breath

to communicate lifestyle advice  Train

• Proton pump inhibitors, which also can reduce stomach acid. Examples include esomeprazole, lansoprazole and omeprazole

Antacids



Include POS with associated condition treatments such as other indigestion

pointed questions about lifestyle can help patients select appropriate lifestyle modifications. Pharmacists should remember that for gastrointestinal reflux, certain symptoms should raise an alarm. If patients report any symptom indicative of one of these, referral to a physician is warranted.

above considerations Consider:  Am I/my team familiar with the differences between heartburn, GORD, indigestion and other GI disorders to make an educated diagnosis?  Am I/my team aware of the symptoms of heartburn?  Am I/my team aware of contributing causes of heartburn in order to advise sufferers of lifestyle changes?  Do I know what to recommend if a customer returns saying the treatment has not worked?  Am I aware of the drug interactions for OTC heartburn medicines?

Ensure efficient sign posting to further help and advice or reputable sources for hheartburn treatment there is a discreet area in which staff can with the team are able the team to meet all the

Some may also have:

advice and product selection  Keep merchandisedproducts together, along with related products to help build sales  Ensure



The main symptoms of acid reflux are:

78 | PHARMACYNEWSIRELAND.COM

H2 Blocker

• a cough or hiccups that keep coming back

Burning Issue

Heartburn is a burning feeling in the chest caused by stomach acid travelling upwards towards the throat (acid reflux).

It is suitable for those aged over 16.

Sufferers should see their doctor if no relief is obtained within two weeks of continuous treatment

• H2 blockers, which can reduce stomach acid. H2 blockers don’t act as quickly as antacids, but they may provide longer relief. Examples include cimetidine (Tagamet HB) and famotidine (Pepcid AC).

Famotidine is effective at reducing the amount of acid the stomach produces.

Community Pharmacists are likely to see many heartburn patients. Heartburn can be relatively benign or become a frequent problem that can have great impact on the patient’s quality of life.

Check your pharmacy team are aware and understand the following key points:  Some antacids contain sodium, which should be avoided by those on saltrestricted diets  Two to three days’ treatment may be needed before the full benefit of proton pump inhibitors is felt  H2 antagonists can be used as soon as symptoms start and as a

Pharmacy Advice

• heartburn – a burning sensation in the middle of the chest

• have been unsuccessfullyself-treatingcontinuously for ≥4 weeks

• have unintended weight loss in association with indigestion

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CORU was established in 2005 as a multi-profession health and social care regulator. The body currently regulates the work of over 23,000 professionals across 12 distinct professions, while a further six have been designated for Launchingregulation.the new strategy

“We are focussed on making similar progress with the other professions designated for regulation. Much work has already been done on advancing the regulation of PsychologistsPsychotherapistsCounsellors,andandthiswillbe a

• Build the capabilitiesorganisationalwhileevolving a sustainable regulatory model

“A new governance structure is required to ensure the efficient delivery of appropriate regulation. We are committed to working with the Department of Health to achieve this and deliver ‘right touch’ regulation while maintaining a relentless focus on public

The Advanced Nurse Practitioners (ANP) will play a critical role in patient care by proactively identifying and managing the care of patients presenting with ‘fragility’ or low-trauma fractures.

• Anchor regulatory interventions in evidence informed research and insights

most vulnerable members of our society this will be a milestone in our mission to protect the public.”

Professor Frances Dockery, Co-Chair of the Fracture Liaison Service Steering Committee welcomed the posts stating that: “Fracture Liaison Services (FLS) provide the best method of identifying, treating and monitoring patients who have just sustained a fragility fracture. These services are proven to improve patient treatment rates for secondary fracture prevention, reduce future fracture numbers, and will substantially reduce the cost burden to the health service”.

Clinical Profiles

FUNDING FOR NEW FRACTURE POSTS

MULTI MILLION EURO STATEOF-THE-ART BREAST CENTRE IN BEAUMONT HOSPITAL OPENS ITS DOORS

building that will fundamentally change breast cancer care for the better. With everything in the one location, including imaging and examination facilities, along with a fully integrated Cancer Clinical Trials Unit under the one roof, this is the key to advancing breast cancer care.”

The National Fracture Liaison Service (FLS) Steering Group has welcomed the funding of six Advanced Nurse Practitioner Posts through the HSE’s National Service Plan 2022.

This brand-new Breast Centre, which cost circa €6m, is spread across three floors in a purposebuilt facility in Beaumont Hospital, Dublin. The building incorporates eight consulting suites, five imaging rooms with the very latest tomosynthesis 3D mammography and breast ultrasound equipment, a prosthesis and post mastectomy underwear fitting suite, and a dedicated counselling suite. The Cancer Clinical Trials Unit which coordinates and facilitates national and international clinical trials / translational research is on the top floor with offices for clerical staff, clinical nurse specialists and data managers. A separate board room will allow the entire multidisciplinary team to discuss personalised patient treatment plans.

CORU, Ireland’s health and social care professional’s regulator, is predicting significant growth in the number of professionals it regulates. By 2026, CORU estimates it will oversee the work of 35,000 registrants, an increase of almost 50% on today’s number of over 23,000. However, the body has cautioned that such growth will require a change in how it regulates to deliver a more sustainable regulatory model.

Professor Arnold Hill and Aisling Hurley, CEO of Breast Cancer Ireland

REGULATOR LAUNCHES NEW STRATEGY

Chairperson Mo Flynn said, “CORU plays a vital role in protecting the public, by ensuring that the country’s health and social professionals consistently deliver care to the highest standards. An absolute priority for CORU over the coming years will be opening statutory registers for all designated professions.

• Progress regulation of the six remaining designated professions

ChairpersonConcludingprotection.”MoFlynn,oftheHealth and Social Care Professionals Council, paid tribute to health and social care workers for their efforts throughout the pandemic. “Our registrants continued to provide care and treatment to the public despite risk of infection, fear of transmission to family members and friends and unprecedented restrictions. Throughout the pandemic, they have been an embodiment of professionalism and demonstrated tremendous dedication to their patients and service users. The country is better off for their efforts.”

Four of the six new posts will be located in the Dublin area - Mater Misercordiae University Hospital, Tallaght University Hospital, Connolly Hospital and St Vincent’s University Hospital and two will be based in the west, at Galway and Sligo University Hospitals.

Professor Arnold Hill, Breast Cancer Ireland Chairman and Professor of Surgery, Beaumont Hospital and a driving force behind the development of the new Breast Centre said “What’s most important is that there are a number of aspects of the

• Ensure regulation protects the public and supports health and social care professionals

Steering Group is part of the National Clinical Programme for Trauma and Orthopaedic Surgery (NCPTOS).

“Significant progress has been made over the past two years and Ireland’s Social Care Workers Register will now open in November 2023. This will be the largest of the 17 professions that CORU will regulate. Considering they often work with some of the

strong focus in the years ahead.”

With a significant increase in the remit of CORU Ms. Flynn cautioned that a more sustainable model of regulation needs to be implemented. “The current model of regulation CORU must operate is too complex, too reliant on a large number of volunteers and requires over 120 statutory meetings a year. As we add more boards these pressures will increase.”

They will manage these patients through their full journey of assessment, treatment, education and monitoring of osteoporosis and falls risk.

Fragility fractures are often the first sign of osteoporosis and usually occur as a result of a minor fall. They are one of the leading healthcare costs across Europe, with data predicting an exponential rise in fragility fracture numbers across Europe by 2030; in Ireland the predicted increase is 58%, the highest of all EU countries because of our ageing demographics. (Ref Kanis et al The2021)(FLS)

Mr Aaron Glynn, FLS Cochair, added: “These posts are welcomed however it is imperative that national implementation with full resourcing occurs in the next two years, which will enable us to definitely address rising fracture numbers, create value for the health service and bring huge benefits to patients who would

The Beaumont Breast Centre, of which Breast Cancer Ireland is a major donor, officially opened its doors with Mrs Sabina Higgins present as Guest of Honour –making the First Lady of Ireland one of the very first to step inside the doors of this world class facility, that will benefit over 10,000 Irish women per year, for decades to come.

CORU has identified five strategic priorities for the coming years:

• Increase awareness of CORU’s role to the public and professionals

81Clinical Profiles

Olbas helps relieve congestion so you can breathe more easily. Olbas helps relieve congestion so you can breathe more easily. For more information please contact your local BR Healthcare representative or our of ce on: 01-8850 800 The Olbas range is available from BR Healthcare, United Drug & Uniphar. The Olbas range is available from BR Healthcare, United Drug & Uniphar. For the relief of congestion. Always read the label.

otherwise go on to sustain repeat fragility fractures”.

The European Commission issued a conditional marketing authorisation for Lunsumio in

Lunsumio is a potential firstin-class CD20xCD3 T-cell engaging bispecific antibody and

therapy and becomes increasingly difficult to treat each time it returns. Clinical trial results have

The Phase 3 CASSIOPEIA trial is a two-part study. Results from this first part of the trial showed that after consolidation, the stringent complete response (sCR) rate was significantly higher in the daratumumab-VTd arm (29 percent) compared to VTd alone (20 percent) (Odds Ratio [OR] = 1.60; 95 percent confidence interval [CI], 1.21-2.12; P<0.0010).2

Janssen, the Pharmaceutical Companies of Johnson & Johnson has announced Darzalex® (daratumumab) in combination with bortezomib, thalidomide and dexamethasone (VTd) has been granted reimbursement in Ireland for the treatment of patients with newly diagnosed multiple myeloma who are eligible for autologous stem cell transplant (ASCT). The announcement follows EC approval of daratumumab based on results from Part one of the Phase 3 CASSIOPEIA (MMY3006) study, published in The Lancet5 in June 2019 and presented at the 2019 American Society of Clinical Oncology (ASCO) Meeting.

Minister of State, Patrick O’Donovan, T.D., officially opened the new Spine Excellence clinic in Limerick, a collaboration between Mater Private Network and the Poynton Spine Care Institute, bringing advanced spine care directly to patients in Limerick and Munster. The new clinic is a centre of excellence delivering comprehensive assessment, diagnosis, treatment and rehabilitation of spine conditions.

Spinal pain is a complex and multifactorial condition that is often poorly understood, incorrectly assessed, and inadequately treated. At Spine Excellence, the expert team have a deep understanding of all aspects of spinal pathology and work with patients to develop a bespoke plan.

“Most spinal pain can be treated successfully by regaining movement, flexibility, and strength, and building confidence in functional movement and exercise. While many people with spinal pain do not need any intervention other than rehabilitation, others may have underlying conditions that require deeper intervention, up to and including surgery. At Spine Excellence in Limerick, we have assembled an expert team, from specialist consultants and surgeons to spine expert physiotherapists to deal with all eventualities and all spinal pathologies.

found that 91% of respondents suffered from back pain, while 46% reported missing either work or college because of their pain. Furthermore, 61% percent of respondents said they have visited their GP as a result of back pain and 53% said that their pain has impacted personal time with family and Spinefriends.Excellence

“Our philosophy is centred around the patient understanding the nature of the problem and building confidence in their own ability to Davidrecover.”Slevin, Deputy Chief Executive of Mater Private Network, said, “Mater Private Network is delighted to deepen our collaboration with the Poynton Spine Care Institute through the establishment of Spine Excellence

GSK Ireland on behalf of ViiV Healthcare is pleased to announce that eligible people living with Human Immunodeficiency Virus (HIV) in Ireland now have access to Vocabria (cabotegravir longacting injection) developed by ViiV Healthcare in combination with Rekambys (rilpivirine long-acting injection) developed by Janssen Sciences Ireland UC (Janssen), one of the Janssen Pharmaceutical Companies of Johnson & Johnson. Vocabria and Rekambys is indicated for the treatment of HIV type 1 (HIV-1) infection in adults who are virologically suppressed (HIV-1 RNA <50 copies/mL), on a stable antiretroviral regimen without present or past evidence of viral resistance to, and no prior virological failure with agents of the non-nucleoside reverse transcriptase inhibitor (NNRTI) and integrase inhibitor (INI) class.1



91% OF IRISH ADULTS SUFFER FROM BACK PAIN

DARZALEX® (DARATUMUMAB)

GSK ON BEHALF OF VIIV HEALTHCARE LAUNCHES VOCABRIA AND REKAMBYS IN IRELAND

Clinical Director and leading Irish spine surgeon, Mr. Ashley Poynton, said, “I am incredibly proud of our team here at Spine Excellence. They will be able deliver a uniquely comprehensive approach to spine care in a stateof-the-art facility and rapid access to the Mater Private Network high tech spinal facilities in the Cork and Dublin hospitals, when needed. Our team has a broad and deep knowledge of spinal pathology from highly complex surgical cases to the most challenging rehabilitation patients and everything in between.

in Limerick. Along with our hospitals in Cork and Dublin, we already have a presence in Limerick as the operator of the Mid-Western Radiation Oncology Centre at University Hospital Limerick. We understand how important it is to make best in class healthcare services more accessible to patients in the region. We are delighted to be part of Spine Excellence in Limerick with outstanding surgeons Mr. Ashley Poynton, Mr. Deb Roy, Mr. Islam Gawish along with the expert team.”

PHARMACYNEWSIRELAND.COM 82 Clinical Profiles

This marks the first time that people living with HIV in Ireland can access a complete, longacting regimen once every two-months. This could reduce the number of days receiving treatment from 365 to 6 per year, when on the continuation injection phase of Professortreatment.SamMcConkey, Head of the Department of International Health and Tropical Medicine at the Royal College of Surgeons said: “Over the last 20 years great progress has been made in developing effective treatments for HIV that can suppress the virus in the body to undetectable levels, however until now it has required daily treatment. The introduction of a long-acting injectable treatment means that eligible people living with HIV will only need to be treated every two months, rather than every day. This approach has the potential to help lessen the burden of treatment and reduce the worry and stigma that comes with having to take treatments daily. We have used IM cabotegravir in the context of a phase III clinical trial in Ireland

Minister of State, Patrick O’Donovan TD with Spine Excellence Clinical Director and leading Irish spine surgeon, Mr. Ashley Poynton, David Slevin, Deputy Chief Executive of Mater Private Network

At a median follow-up of 18.8 months, PFS was significantly improved in the daratumumabVTd group compared to VTd alone (Hazard Ratio [HR] = 0.47; 95 percent CI, 0.33-0.67; P<0.0001), and the median PFS was not reached in either arm.2 The addition of daratumumab to VTd resulted in an 18-month PFS rate of 93 percent compared to 85 percent for VTd alone.2

The most common (≥10%) Grade 3/4 treatment-emergent adverse events (TEAEs) for daratumumabVTd and VTd, respectively, were neutropenia (28 percent vs. 15 percent), lymphopenia (17 percent vs. 10 percent), stomatitis (13 percent vs. 16 percent) and thrombocytopenia (11 percent vs. 7 percent).2 In the daratumumabVTd combination arm, infusionrelated reactions occurred in 35 percent of patients.2



The extent to which Irish people suffer from back pain was made clear in a survey commissioned in conjunction with the official opening of the clinic. Conducted by Bounce Insights for Mater Private Network, the survey among 500 Irish adults (28% of whom were from the Munster region)

APPROVED REIMBURSEMENTFOR IN IRELAND



Dr Thorsten Giesecke, General Manager, Commercial Business, Janssen Sciences Ireland UC, said, “Janssen is committed to providing access for patients to daratumumab in earlier disease stages of multiple myeloma, a type of blood cancer that can have a devastating impact on the lives of those affected. Every year in Ireland about 350 people are diagnosed with this condition, and today’s reimbursement provides those who are newly diagnosed and transplant eligible, with a long-awaited additional frontline therapy.”6

Professor Philip Murphy, Consultant Haematologist, Beaumont Hospital said, “For Irish patients newly diagnosed with multiple myeloma, the importance of early intervention with effective first-line treatments to maximise response cannot be emphasised enough. Improvements in the standard of care to provide patients with valuable extra time are vital. Data from the CASSIOPEIA study demonstrates that the addition of daratumumab in combination with VTd can lead to deep remissions and prolong PFS.”

and the patients in the trial were delighted to participate.”

six out of ten people have direct experience of addiction, we are also now particularly pleased to have the opportunity to work with the HSE and other agencies in addressing the challenge of addiction.”

Sanofi has reported data from two trials, VAT02 Cohort 2 and COVIBOOST VAT013, conducted with its new next-generation COVID-19 booster vaccine

Dr Nneka Nwokolo, Head of Global Patient Affairs at ViiV Healthcare and honorary consultant in sexual health and HIV medicine said: “At ViiV Healthcare, our mission is to ensure that no one living with HIV is left behind and we recognise that there are still unmet needs in both the choice of medication they take, and how often they take it. We understand that no medicine works for every individual living with HIV, so we are committed to offering innovative choices that help address their evolving needs. We are delighted that the first and only complete long-acting injectable HIV medicine is now available in Ireland, allowing us to focus on the people living with the condition and provide them with treatment options that remove the need for regular daily HIV tablets.”

“Smarmorerebuilt.Castle Clinic has

quickly become one of the leading addiction treatment centres in Ireland and we are committed to offering people freedom from addiction. We will continue to improve our services in the months and years ahead, with recovery front and centre of everything that we

“Consideringdo.

The clinic provides a distinctive therapeutic and medical programme for those suffering from alcoholism, drug and behavioural addictions. The treatment plan offered is based on the successful Minnesota Model 12-step treatment programme.

SMARMORE CASTLE CLINIC GAINS MAJOR ACCREDITATIONINTERNATIONAL

delighted to receive this esteemed award which recognises the tireless work undertaken in this clinic towards the rehabilitation of patients. Our healing and selfreflective approach seek to show both patients and their families that there is life after addiction. Lives can be

Stephen O’Hare, Executive Director at HIV Ireland said: “HIV Ireland welcomes the option of longacting injectable antiretroviral treatment for people living with HIV. For those eligible, this choice of treatment could be game changing for people who struggle with their current regimens, by eliminating the daily pill burden. The impact of this new treatment option could greatly improve adherence and reduce the burden for marginalised and harder-to-reach communities who may prefer the 2-monthly regimen to a daily oral pill.”

• 76.1% (95% CI 64.5–85.4) for the Sanofi-GSK next-generation booster, vs

recognition comes as the Health Service Executive (HSE) has entered into an agreement with Smarmore Castle Clinic to provide public funding for patients in need of inpatient detox and rehab from alcohol and drugs.

The prestigious award was received from the Comparative Health Knowledge System (CHKS), a UK health organisation which provides independent recognition of commitment to quality improvement for boards, external regulators and patients. The CHKS award follows a comprehensive assessment by a team of external senior healthcare professionals which examined a range of activities undertaken at Smarmore Castle LocatedClinic.ina13th

Across both studies, the SanofiGSK next-generation vaccine candidate was well-tolerated, with a favorable safety profile. In the VAT02 cohort 2 study, low numbers (less than 4%) of Grade 3 reactions were reported, all transient and non-severe.

PHARMACYNEWSIRELAND.COM 83

century castle, and surrounded by 15 acres of gardens, Smarmore Castle Clinic offers an unrivalled environment in which patients can take the first steps on the road to recovery from Newsaddiction.ofthe

• 63.2% (95% CI 51.3–73.9) for the Pfizer BioNTech D614 booster, and

The clinic also offers a much sought-after dual diagnosis programme that directly treats patients who have both addiction and mental health issues. Indeed, Smarmore’s on-site 24-hour medical team enables the clinic to offer a full medically managed detox where necessary.

In the Phase 3 VAT02 Cohort 2 study, the Sanofi-GSK nextgeneration vaccine candidate induced (at day 15 postimmunization) a significant boost in antibody titers above baseline against multiple variants of concern (15-fold increase against D614 parent virus, 30-fold increase against Beta strain) in adults previously primed with mRNA COVID-19 vaccines. In particular against Omicron, preliminary data show a 40-fold increase against BA.1. The SanofiGSK next-generation booster candidate generated double the number of neutralizing antibodies against Omicron BA.1 and BA.2 compared to the D614-based (original parent virus) booster.

candidate modelled on the Beta variant antigen and including GSK’s pandemic adjuvant.

In this study, which included 247 subjects, all the three vaccines also elicited neutralizing antibodies against the Omicron BA.1 variant, with highest responses generated by the Sanofi-GSK next-generation candidate. Results of COVIBOOST study are available on a pre-print server, pending publication in a peer-reviewed journal.

Moyra Amess, Director, Assurance & Accreditation at CHKS stated, “The accreditation process requires dedication and commitment. Every organisation we make this award to has proved to our external assessors that its standards and process meet international best practice standards. This is a significant achievement.”

For Keith Cassidy, Clinic Manager at Smarmore Castle Clinic, the recognition reflects its high standards of care and successful outcomes for patients. “We are

• 55.3% (95% CI 43.4–66.7) for the Sanofi-GSK D614 (firstgeneration parent booster candidate).

Outlining the need for a less frequent dosing regimen, the largest global HIV patient-reported outcomes study to-date conducted by ViiV Healthcare, Positive Perspectives Wave 2, which included 50 Irish participants, found that when asked about their treatment aspirations and attitudes towards innovative medications, 55% (n=1306/2389) of participants said they would prefer not having to take medication every day, as long as their HIV stays suppressed.2 In addition, 58% (n=1394/2389) noted that taking daily HIV medication acts as a constant reminder of HIV in their lives, while up to 38% (n=906/2389) of participants reported anxiety around the fact that taking daily treatment could increase the chances of revealing their HIV status to others.3

Dr Hugh Gallagher, Medical Director and Keith Cassidy, Clinic Manager

SANOFI-GSK NEXTGENERATION COVID-19 BOOSTER DELIVERS STRONG IMMUNE RESPONSE AGAINST VARIANTS OF CONCERN, INCLUDING OMICRON

Smarmore Castle Clinic, a 32-bed detox and addiction rehab clinic near Ardee, Co. Louth, has been awarded a major international accreditation recognising Excellence in International Best Practice, Legislation and Regulatory Standards.

Smarmore Castle Clinic’s medical team is led by two of Ireland’s leading addiction specialists, medical director Dr Hugh Gallagher and consultant psychiatrist, Professor Gerry Lynch.

In parallel, the independent COVIBOOST (VAT013) study conducted by the Assistance Publique – Hôpitaux de Paris (AP-HP) demonstrated that, following primary vaccination with two doses of Pfizer-BioNTech’s Comirnaty vaccine, the SanofiGSK next-generation booster candidate generated a higher immune response (as measured by neutralizing antibody titers) than Pfizer-BioNTech’s booster or the Sanofi-GSK first-generation booster, both of which target the original D614 parent strain. The proportion of participants with at least a 10-fold increase in neutralizing antibody titers for the original D614 SARS-CoV-2 strain between day 0 and day 15 was:

*Reference SmPC Nurofen Long Lasting 300mg Prolonged Release Hard Capsules. Date of Preparation April 2022 RB-M-100303

LONG LASTING PAIN RELIEF FOR UP TO 12 HOURS* THE PAIN TO dysmenorrhoea. adults and children over 12 years of age Lowest e ective be used for the shortest duration necessary to relieve symptoms. Consult a doctor if symptoms persist or worsen, or if the than children over 12 years of age (weighing over 40kg): 300mg - 600mg (1-2 capsules) up to twice a day as required. Leave at least 8 hours between doses. Do not take more than 1200mg any 24-hour water on an empty stomach or during a meal. This product is contraindicated in children under 12 years of age. Review treatment at regular intervals and discontinue if no bene t is seen or This should not be given to patients with/who have/are experiencing: Severe heart failure (NYHA Class IV), renal failure or hepatic failure. Have a history of gastrointestinal bleeding or perforation related to previous NSAIDs therapy. Have a active, or history of recurrent peptic ulcer/haemorrhage (two or more distinct episodes of proven ulceration or bleeding) or other gastrointestinal disorders. Are hypersensitive (e.g. bronchospasm, asthma, rhinitis, angioedema, urticaria) to aspirin or other non-steroidal anti-in ammatory agents. Are hypersensitivity to ibuprofen or any of the excipients. In the last trimester of pregnancy. Are under 12 years of age. Have cerebrovascular or other active bleeding, coagulation disorders or bleeding diathesis, severe dehydration (caused by vomiting, diarrhoea or insu cient uid intake). Warnings and Precautions: (see SmPC for further information). Undesirable e ects may be minimised by using the lowest e ective dose for the shortest duration necessary to relieve symptoms. Elderly: increased frequency of adverse reactions to NSAIDs especially gastrointestinal bleeding and perforation which may be fatal. Other NSAIDs: Avoid use with concomitant NSAIDs including cyclooxygenase-2 selective inhibitors. Please refer to the full Summary of Product Characteristics for further detail on warnings and precautions in relation potential impacts on the following areas: Respiratory, Renal and Hepatic Impairment, SLE and mixed connective tissue disease, Gastrointestinal E ects GI bleeding and ulceration, Cardiovascular and Cerebrovascular E ects, Severe Skin Reactions: Ibuprofen should be discontinued at the rst appearance of signs and symptoms of severe skin reaction. When Nurofen Long Lasting is administered for fever or pain relieve in relation to infection, monitoring of infection is advised. Impaired Female Fertility: This product may cause impairment of female fertility by an e ect on ovulation. This is reversible on withdrawal of treatment. This medicinal product contains 34.5mg of sucrose per capsule. Patients with rare hereditary problems of fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insu ciency should not take this medicine. There is a risk of renal impairment in dehydrated adolescents. Interaction with other medicinal products: (see SmPC for further information). Simultaneous administration of ibuprofen with the products listed below requires rigorous monitoring of the clinical and biological condition of the patient. Avoid use in combination with: Other NSAIDs including cycloxygenase-2 selective inhibitors, avoid concomitant use of Acetylsalicylic acid (aspirin) as this may increase the risk of adverse reactions. Use with caution in combination with: Oral hypoglycaemic agents, Lithium, Methotrexate, Ciclosporin, Mifepristone, Tacrolimus, Zidovudine, Quinolone antibiotics, Probenacid, Antihypertensives (ACE inhibitors and Angiotensin II Antagonists) and diuretics, Corticosteroids, Anti-coagulants, Anti-platelet agents, selective serotonin reuptake inhibitors (SSRIs), and Cardiac glycosides. Please refer to the full SmPC for further information. Pregnancy, breast-feeding and Fertility: Pregnancy: During the rst and second trimester of pregnancy, ibuprofen should not be given unless clearly necessary. Ibuprofen is contraindicated during the third trimester of pregnancy. Lactation and Breastfeeding: In limited studies, ibuprofen appears in the breast milk in very low concentration and is unlikely to a ect the breast-fed infant adversely. Fertility: There is some evidence that medicinal products which inhibit cyclo-oxygenase/prostaglandin synthesis may cause impairment of female fertility by an e ect on ovulation. This is reversible on withdrawal of treatment. Ability to Drive and Operate Machinery: No impact expected at recommended doses and duration of therapy. Side E ects: Please refer to the full Summary of Product Characteristics for further detail on side e ects and rate of frequency which is available on www.medicines.ie . There have been side e ects reported in the following areas: Blood and Lymphatic System Disorders, Immune System Disorders, Nervous Systems Disorders, Cardiac Disorders, Vascular Disorders, Gastrointestinal Disorders, Hepatobiliary Disorders, Skin and Subcutaneous Tissue Disorders, Renal and Urinary Disorders, Decreased haemoglobin levels, Infections and infestations. Overdose: In children ingestion of more than 400 mg/kg may cause symptoms. In adults the dose response e ect is less clear cut. Please refer to SmPC for further detail on symptoms and management. Name and Address of Marketing Authorisation Holder: Reckitt Benckiser Ireland Ltd, 7 Riverwalk, Citywest Business Campus, Dublin 24, Ireland. PA Number: PA 979/32/15 Legal Category: Supply through pharmacy only Date of Revision of text: May 2022. For full prescribing information, please consult the SmPC which is available on www.medicines.ie. For product queries, please call (01) 630 5429 or contact the MAH above.

For

intolerance occurs. Contraindications:

dose should

US Abbreviated Prescribing Information for Nurofen Long Lasting 300mg Prolonged Release Hard Capsules Please refer to Summary of Product Characteristics for full product information. Active ingredient: ibuprofen 300mg Pharmaceutical form: Prolonged-release hard capsule Indications: For the short-term management of backache and muscular pains and

period. Oral use: Swallow capsules whole with

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product is required for more

(weighing over 40kg). Dosage and Administration: For Oral administration and short-term use only.

3 days. Adults, the elderly and

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CPD: FOCUS ON WOMEN’S HEALTH

CATEGORY REPORT: FOCUS ON ALLERGIES