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February 2019 Volume 11  Issue 2 PHARMACYNEWSIRELAND.COM

THE INDEPENDENT VOICE OF PHARMACY

In this issue: NEWS: No deal Brexit medicines concerns Page 5

PROFILE:

Nu

Going into the Tunnel Page 9

MAMA MOBILE APPLICATION

FEATURE: Talking Man to Man Page 40

Paperless Medication Management The MAMA Mobile Application is setting the standard within the healthcare sector in Ireland and the UK for medication administration management by making the move to a paperless environment a reality.

PERSPECTIVE: Working in a Hospital Pharmacy Page 44

Pharmacists, Nursing Homes and Doctors can now all work in tandem to deliver the highest levels of care for patients while maintaining the most rigourous compliance standards.

CPD: Emergency Contraception Page 49

MAR Charts and Cardex created during medication rounds are now all stored and signed electronically providing highly dynamic reporting, simplifying audit requirements and reducing costs significantly.

AWARDS: OTC Product Award Finalists Page 53

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Contents Foreword

Page 5: Controversy over 23% tax rise on supplements

The impact of Brexit continues to be felt, dominating the regional and national press.

Page 9: Brexit – Time for cool heads Page 16: Spotlight on Pharmacy transactions market

One of the first casualties became apparent towards the end of last month as the European Medicines Agency, one of the biggest EU regulators, closed its doors in the UK for the last time with the loss of 900 jobs.

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Page 22: Emerging Health Trends in Ireland

Bernard Mallee, Director of Communications and Advocacy with the Irish Pharmaceutical Healthcare Association (IPHA), believes that whilst the scale of the Brexit challenge is huge, industry and Government must work together.

Page 46: Financial planning for your Pharmacy Page 53: OTC Product Awards Finalists announced

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

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CONTRIBUTORS Dr Deirdre Lundy Rob McOwan PHARMACYNEWSIRELAND.COM

@Irish_PharmNews

IrishPharmacyNews

2018 was a busy year within this market, with sales of pharmacies in 2018 (33) almost double those in 2014 (17). Average deal values remained steady year on year, ranging from between ¤1million to ¤1.5million, with the greatest demand for opportunities in Dublin reflected in the prices achieved. Turn to page 16 for the full details. In other news, this issue features the finalists for the annual OTC and Product Awards 2019. The OTC and Product Awards identify and reward product development and innovation in the pharmacy sector and recognise the marketing efforts of Irish based manufacturers and distribution companies.

EDITOR Kelly Jo Eastwood 00353 (87)737 6308 kelly-jo@ipn.ie

ADVERTISING SALES Louie French 00353 (1) 6690562 louie@ipn.ie

“Brexit is one of those rare political events whose response requires extreme industry-Government collaboration. While risks to the continued supply of medicines post-Brexit can never be fully discounted, they can be managed. And that is what pharmaceutical innovators, in partnership with others, have been spending time and money doing,” he says. Turn to page 9 for more of his thoughts. In our Special Report pages we take an in-depth look at the pharmacy transactions market. Irish Pharmacy News has obtained a copy of the Bank of Ireland and Fitzgerald Power Pharmacy Watch document which analyses key trends over the last two years.

MANAGING DIRECTOR Natalie Maginnis n-maginnis@btconnect.com

ADVERTISING DIRECTOR Debbie Graham 00353 (87) 288 2371 debbie@ipn.ie

Staff lowered and folded up the 28 national flags that adorned the lobby in the company’s Canary Wharf headquarters in London last month, bidding it farewell before moving to their new offices in Amsterdam, scheduled for March of this year. Further details are on page 4.

From page 53, we showcase more than 100 newly launched and well-established, category specific OTC products, which will now be carefully evaluated by an independent and expert panel.

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

The OTC and Product Awards will held on March 7th with all the winners featured in our April issue. Don’t miss it.

Regulars FEATURE: MUSCULOSKELETAL DISORDERS

P30

FEATURE: WINTER SKIN

P34

TIME TO TREAT: COUGH

P38

CPD: EMERGENCY CONTRACEPTION

P49

PRODUCT NEWS

P98

PHARMACYNEWSIRELAND.COM


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News

New poll highlights supply concerns A new poll, carried out by the team at Pharmabuddy, has shown that over 70% of community pharmacists in Ireland believe that Brexit will affect the supply of medication to their patients. However wholesalers here are keen to assure the profession that they are working very closely with the relevant bodies to ensure continuity of supply.

Pharmabuddy poll: The impact of Brexit on supply of medicines

David Keyes, Distribution and Hospitals Director with United Drug, told Irish Pharmacy News, “United Drug plays a major role in the provision of a safe, secure and efficient pharmaceutical supply chain. As a distributor, accounting for over 50% of all prescription medications in Ireland, we have engaged extensively with our manufacturer partners, the regulator and the HSE to assess the risk of Brexit and, where required, we are putting in place initiatives to mitigate against the risk of shortages.”

A spokesperson for the Uniphar Group also told IPN the supply of medicines remains a priority and again warned against stockpiling.

The Pharmabuddy poll, shown above, highlights that 121 agree with the statement whilst only 9 disagree. 32 remain unsure.

“Continuity of supply of medicines is a priority in supply chain management with significant contingency already built in to

prevent shortages from occurring regardless of Brexit,” they state. “Uniphar is working with industry partners; manufacturers, the PSI, the HPRA and other industry stakeholders in planning for all scenarios. Notwithstanding their concerns, it is important that pharmacists continue to purchase as normal in line with their patient needs. They do not need to stockpile or bulk buy as this unnecessary buying behaviour creates a spike in demand and could in itself create blockages in the supply chain. We will maintain communication with stakeholders throughout this period as the situation evolves.”

European Medicines Agency closes its doors The European Medicines Agency, one of the biggest EU regulators and one of the first casualties of Brexit, has closed its doors in the UK for the last time with the loss of 900 jobs. Ireland tactically withdrew its application at the last minute in the hope of winning the bid for the European Banking Agency, only to be beaten by Paris. In a tweet, the agency said, “Today, EMA staff lowered the 28 EU flags and symbolically said goodbye to their London offices. [EMA executive director,] Guido Rasi expressed his thanks to the UK for its contribution to the work of the Agency and for having been a gracious host of EMA since 1995.”

Staff lowered and folded up the 28 national flags that adorned the lobby in the company’s Canary Wharf headquarters in London last month, bidding it farewell before moving to their new offices in Amsterdam.

The EMA evaluates medicines throughout the EU but was forced to relocate to the Dutch capital because pharmaceuticals regulation should be done in a member state. Amsterdam won the bid to host the agency in 2017.

PHARMACYNEWSIRELAND.COM

The European Medicines Agency (EMA) will physically relocate to the Netherlands in early March 2019. The Dutch authorities have already officially handed over the temporary building, the Spark building in Amsterdam Sloterdijk, to EMA’s Executive Director Guido Rasi on 9 January 2019 and EMA is now preparing for its physical move.

HPRA cost increases debated Health Minister Simon Harris, in response to a question from John Brassil TD, Kerry, Fianna Fáil, recently said he has discussed the proposed increase in fees by the HPRA in 2019. Deputy Brassil asked the Minister for his views on the proposal by the Health Products Regulatory Authority to increase its fees by 8% in 2019, further to an increase in fees in 2018, if his attention has been drawn to the rationale for these fee increases and his views on whether such an increase is justified against a backdrop of increased costs for pharmaceutical and other healthcare providers resulting from Brexit in 2019. “While it is anticipated that the Health Products Regulatory Authority's fees will increase in 2019, I have not yet given formal consideration to any such increase,” the Minister confirmed. “It should be noted that the Authority's last significant fee increase was in 2010. In 2011 and 2012, the HPRA reduced fees, and there were no fee increases between 2013 and 2017. Fees were increased by approximately 2% in 2018. “The impact of new EU legislation continues to be felt across the organisation. For example, the Falsified Medicines Directive will commence in 2019, and the Clinical Trials Regulation is scheduled to be implemented in 2020. The regulatory model for medicines is becoming more complex, and EU pharmacovigilance legislation has led to an increase in the number of referrals and regulatory actions arising from the outcome of these referrals. Public scrutiny and the role of the regulator in relation to medicines such as the HPV vaccine has increased, while compliance activity is also increasing. “Over the last several years, the HPRA has continued to enhance services to support the pharmaceutical industry in Ireland.”


News Government ‘sneaking’ in tax increase The Government has been accused of ‘sneaking’ in a 23% rise in the price of food supplements, including vitamins and minerals, by Labour Party leader Brendan Howlin in the Dáil. The Irish Pharmacy Union, alongside Health Stores Ireland, the trade association for Ireland's health stores, have been campaigning against the price increases. Food supplements in Ireland have been exempt of VAT, until now, following a review by the Irish Government. The Revenue Commissioners have decided this special concession should no longer be applied to food supplements. “This is a tax on the health of the people of Ireland,” said the Health Stores Ireland spokesman Matt Ronan. “It is a tax on the elderly, the young and the vulnerable.” Mr Howlin claimed the increase, which comes into effect on 1 March, was not provided for in the Budget 2019 legislation and it was "sneaked in". Responding to Mr Howlin, Minister for Finance Paschal Donohoe acknowledged that this issue was not dealt with in the Finance Bill or legislated by the Dáil. Defending the decision, he explained, "What it refers to now is an interpretation of our tax code by the Revenue Commissioners who are, as everyone knows, independent of direction from me. The way I had been aiming to deal with the matter was through the Tax Advisory Group which publishes papers on topics like this each summer that allow the Government and stakeholders to explore how this issue can be dealt with". He added, "The Revenue Commissioner has now made a decision in relation to the interpretation of the law that I have to accept their right to do and accept the consequences of that.”

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Building towards Electronic Record continues The Healthcare Information Quality Authority (HIQA) has published a National Standard on information requirements for a national electronic patient summary. A national electronic patient summary contains the minimum patient information that is needed to help healthcare practitioners make more informed clinical decisions at the point of patient care. For example, when the patient’s clinical information is unknown to the clinician because the patient is unconscious or cannot remember the medications they are taking. This National Standard defines the information requirements for an electronic patient summary for the purpose of unscheduled care, for example, out-of-hours and emergency care. The type of information included in the national electronic patient summary includes: demographics, health problems (diagnosis), medications, allergies, procedures and vaccinations. The national electronic patient summary is

intended to be accessed by authorised healthcare practitioners who work in emergency departments or out-of-hours care and by the patient’s usual general practitioner. Ultimately, the patient should have access to their national electronic patient summary. HIQA’s Director of Health Information and Standards, Rachel Flynn, says, “A national electronic patient summary can deliver significant benefits for patients and healthcare practitioners. It can improve patient safety considerably by providing the most accurate, relevant and up-todate clinical information about the patient at the point of care. “For example, if a patient can't remember their allergies, a healthcare practitioner can check the electronic patient summary to make sure the medication they

give the patient is safe for them to take.” The Sláintecare Implementation Strategy published in August 2018 prioritises the implementation of summary care records to support information sharing, patient empowerment and the development of digital services. Ms Flynn continued, “A national electronic patient summary can also benefit healthcare practitioners by enabling a more efficient way of working and quicker access to patient information. It also encourages good record keeping and improves data quality in primary care. "The National Standard published today is a key building block in the development of an Electronic Healthcare Record in Ireland and will ultimately help improve patient safety.”

Call for Medicines Contingency Group The representative group for the largest suppliers of medicines to the HSE, Medicines for Ireland, has called on the Government to establish a Medicines Contingency Stakeholder Group to mitigate the risk of medicines shortages following Brexit. Together, Medicines for Ireland members represent the biggest suppliers of medicines to the HSE, supplying more than 60% of all medicines in Ireland. The Group has expressed its concerns about the lack of consistent and meaningful engagement with the Department of Health and HSE in relation to ongoing shortages and planning for a no-deal Brexit. Medicines for Ireland Chairperson, Owen McKeon, said: “The prospect of a no-deal Brexit, for those of us who work in healthcare, creates a greater challenge than for practically any other part of our economy and society. We can’t adopt a ‘wait-and-see’ approach. Patients don’t have that luxury.” “Our concern is that decisions are being taken about very complex regulatory, transport and safety

matters without sufficient industry consultation”, noted Mr McKeon. While Brexit has brought to the fore the risk of medicines shortages, it is now exacerbating a problem which has existed for many years in Ireland. “Our procurement and supply of medicines, has for many years in Ireland, been dysfunctional with medicines shortages continuing to grow year-on-year. At the heart of the problem is the failure to create a dynamic, competitive market to foster true competition, such as multiple medicine suppliers avoiding reliance on just one supplier for some medicines as is often the case. With Brexit in mind, we need to be looking at our medicines supplies in a more holistic, sustainable manner”, said Mr McKeon. “Medicines suppliers need to be on the inside, working with the

Owen McKeon, Chair of Medicines for Ireland and Country Manager for Mylan Department of Health and HSE in real time to collaborate together on medicines supplies as a whole, and to quickly respond to medicines shortages if they arise. In a Brexit scenario, this level of coordination is all the more important”, he added. “The success of the National Emergency Coordination Group on Severe Weather in 2018, in responding to severe weather disruption, provides a template on how effective meaningful collaboration can be” added Mr McKeon.

PHARMACYNEWSIRELAND.COM


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News

The time is right to optimise Pharmacy The Irish Pharmacy Union has adamantly called on the Government to recognise the vital role played by community pharmacies within the primary care remit. Mr Darragh O’Loughlin, Secretary General, IPU

Whilst the Government faces increasing and often competing demands from across the healthcare industry, the IPU has urged them to remain focused on their primary care objectives and to deliver new and efficient ways to treat patients in their communities. There are over 1,800 community pharmacies nationwide and the range of services they provide could be significantly enhanced. However, according to the IPU, the Government has consistently failed to progress a series of commonsense proposals, creating missed opportunities for patients and the system as whole. Darragh O’Loughlin, Secretary General of the IPU said, “Community Pharmacy is the most accessible part of our healthcare system, with four out of five members of the public visiting a pharmacy at least once a month. It is clear that our patients want to avail of more services from the convenience of their local pharmacy, but a lack of action from Government is consistently preventing us from

doing so. Crucially, there are many people currently being treated by GPs, who could be treated in pharmacies. GP practices are already under severe pressure, with many reportedly unable to take on new patients. With GPs overwhelmed, it makes absolute sense to expand the scope of services provided by community pharmacists, which will reduce the burden on this overstretched part of the healthcare system.” Services which the IPU recommend rolling out to Irish Pharmacies include: • Minor Ailment Scheme: This scheme would enable medical card patients receive treatment for common illnesses such as hay fever, migraine or skin conditions free of charge direct from their local pharmacy. Currently medical card patients are required to visit a GP and obtain a prescription for treatments ordinarily available over the counter. Implementing this scheme prevent the requirement for up to 950,000 GP consultations each year. • New Medicine Service: A structured pharmacy-led monitoring service for patients on newly prescribed medications for long term illnesses including COPD and Type 2 Diabetes. A pilot in Ireland has already shown this improves ‘optimal adherence’ to medications and could bring savings to the health system.

• Chronic Disease Management: Envisaged as a collaborative initiative between GPs, Pharmacists and other healthcare providers this scheme would see pharmacists would monitor important health indicators and refer any concerns to GPs. A pharmacy-based blood pressure management service could for example save the state ¤1.36bn over 30 years. “Irish pharmacists are ready, willing and waiting to enhance the levels of care they provide,” said Darragh O’Loughlin. “Unfortunately, time and again, despite all the successful pilots and studies, community pharmacists’ positive intentions and desire to help patients is left to gather dust on a shelf. “There is a stark contrast with the range of services that can be provided in pharmacies in other countries such as the UK, Canada and New Zealand, in comparison to here in Ireland. If the Government is serious about delivering primary care in the community they can no longer afford to ignore these proposals, which have the potential to ease so many of the bottlenecks which currently frustrate patients and frontline workers in the health system.” Darragh O’Loughlin concluded that, “The time is right to optimise our delivery of primary care by providing appropriate convenient, accessible and cost-effective healthcare through pharmacies in communities throughout the country. Patients cannot afford to wait.”

Vulnerability leads to medicines ‘watch list’ Taoiseach Leo Varadkar has revealed that twenty-four medicines have been added to a ‘watch list’ over supply in Ireland. With over 60% of the 4,000 medicines marketed in Ireland coming via the UK, the country is vulnerable to any supply disruptions in the event of a no-deal Brexit. However, the Taoiseach said the Irish government had been advised against stockpiling medicines more widely. Irish opposition parties were briefed about the no-deal Brexit plans in Dublin recently. It came on the same day that Westminster MPs overwhelmingly

rejected British Prime Minister Theresa May’s Brexit plan. Addressing the Dáil Éireann Mr Varadkar repeated that he believed a no-deal outcome was still unlikely but that the Irish government needed to prepare for every possibility. He was responding to Fianna Fáil leader Mícheál Martin who said there are 240 medicines listed Medicine 'watch list' part of nodeal plan as being in short supply and pharmacists are noticing this. A meeting of the Irish cabinet was

PHARMACYNEWSIRELAND.COM

held which discussed four detailed memos on no-deal planning. They focus on the Common Travel Area (CTA), transport, medicine supply and legislation needed for all of it, said Mr Varadkar. He said the government was opposed to stockpiling medicines as it may cause a block to supplies but that a plan had been put in place, namely a watch list of medicines that the government would "particularly have to look out for" if a no-deal Brexit occurred.

Sale and Supply of Medicines The Pharmaceutical Society of Ireland (PSI) has recently published Guidelines on the Sale and Supply of Non-Prescription Medicinal Products from a Retail Pharmacy Business. The guidelines set out the requirements for effective patient consultations and apply to a situation when an individual attends the pharmacy in person, or makes an online request for a non-prescription medicine through a pharmacy website. All medicines supplied from a pharmacy, i.e. pharmacy only and general sale medicines, must be supplied by or under the personal supervision of a pharmacist. The supervision of a pharmacist is necessary to ensure the correct medicine is selected, and appropriate advice and support is provided to the patient or their representative. It also ensures that the medicine is being used to treat the correct condition and does not mask or delay the diagnosis of a more serious condition which may require immediate referral to a doctor or other healthcare professional. This provides timely access to healthcare for patients and reduces the burden on other healthcare services. The guidelines are available at www.thepsi.ie

Lung Cancer could Double Recent research by the National Cancer Registry of Ireland (NCRI) has shown that lung cancer incidence could double by 2045, with the possibility of substantial increases in the numbers of women being diagnosed with the disease. The lung cancer numbers, set out in the NCRI Annual Report, suggest that going by population changes alone, cases could double in numbers. However, if increases in female rates and decreases in male rates continue, female cases may substantially outnumber male cases in coming decades with projections showing a 176% increase. AstraZeneca Information Development Manager Aoife McNamara, said, “It’s really important for everyone to know the signs and symptoms of lung cancer and the importance of getting checked out.”


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Going into the Tunnel T

here’s a saying in Brussels called going ‘into the tunnel’. It’s when negotiators get together to try to plot a path to resolving Brexit. For the past two years or more, pharmaceutical innovators have been in a tunnel of their own. In the multinational research-based pharmaceutical companies that discover and make branded, prescription medicines, teams have been working on Brexit planning, investing huge time and money on potential changes in how medical products get to patients after the UK leaves the European Union. Journey of Medicines The journey a medicine makes, from early research through development and adoption by patients, has several touchpoints. The process can take up to 13 years, with the rest of the 20-year patent life used as time on the market before others are allowed to make copies of the drug. The research and development phase, which can cost up to ¤2 billion, involves intensive testing and four stages of clinical trials, before more practical elements like labelling, packaging and distribution are considered. All of these steps can cross multiple geographies, with the European

Medicines Agency acting as the regulatory body for the single market for medicines. Until now, regulatory alignment and free trade have meant that medicines can get to patients across the European Union and the UK without barriers. Brexit changes that because the UK will no longer be be in a single, harmonised regulatory jurisdiction. Brexit is one of those rare political events whose response requires extreme industry-State collaboration. It is up to all of us, the relevant industry and State players, to work together on a collective Brexit response. Our common, overriding priority must be the patient. This is a time for

calm, for planning, for taking responsibility, and for teamwork and coordination. Pharmaceutical innovators identify with these traits and, since June 2016 when the UK voted to leave European Union, they have lived all of them. Scale of the Challenge The scale of the challenge we collectively face is huge. Ireland has a critical reliance on the UK as a source of medicines. About 4,000 medicines are marketed in Ireland. Of these, between 60% and 70% come from, or transit through, the UK. We know that the supply of a small number of these products may be vulnerable

for reasons such as their short shelf life, special storage and transport needs, and single supplier reliance. The HSE and the medicines regulator, the HPRA, are implementing contingency plans. Revenue is helping to smooth transport channels and prevent delays. The research-based pharmaceutical industry accounts for just over half the volume of medicines on Irish market. We have a responsibility, both to patients and the State, to invest in scenario-planning for Brexit, whether deal or no deal. Preparations for Brexit have been intense. While risks to the continued supply of medicines

PHARMACYNEWSIRELAND.COM | 9


Brexit demands us all to work together to secure the supply of medicines to patients, writes Bernard Mallee, Director of Communications and Advocacy with the Irish Pharmaceutical Healthcare Association (IPHA).

to manufacturing problems or changes in demand. To deal with that, the HPRA has, for several years, been working on a Medicine Shortages Framework. It’s aimed at averting stock deficits and reducing the impact of shortages by coordinating how they are managed. The framework is already used to manage an average of 45 shortage notifications each month. The HPRA’s list of resolved shortages, for the past six months, has a list of 24 medicines. As an extra safeguard, the regulator is giving consideration to categories of medicines considered most pressing for public health. That work will continue. Pharmaceutical companies are examining their product portfolios so that, if bridging stocks are required in certain cases, they can easily be made available. This is done through the shortages framework.

It’s vital that all of them are engaged in a collective Brexit response, co-ordinated centrally by the State

Brexit preparations were essential. Planning, as best we can, for every eventuality, is the responsible and pragmatic thing to do. Our industry has engaged closely with all the relevant State actors - the HPRA, the HSE, the Department of Health, Customs and others. Lots of healthcare players have a stake in the delivery of medicines and medical innovation to patients. It’s vital that all of them are engaged in a collective Brexit response, co-ordinated centrally by the State. No Need to Stock Up

post-Brexit can never be fully discounted, they can be managed. That’s what pharmaceutical innovators have been spending time and money doing. For more than two years, they have been reorganising supply chains and revising regulatory approvals. Companies have made complex logistical and supply chain arrangements, including in some cases re-routing transport away from the UK. This work is critical in minimising the risk of disruption to the supply of medicines to patients after March 29th.

Much has been made of the need for patients to stock up on medicines. We do not think that is necessary. Continuity of supply of medicines is part of the standard day-to-day responsibility of pharmaceutical companies. It’s part of the deal we have with the State on the supply of medicines. Since we are an island nation, there are always two to three months’ supply of medicines in the system anyway. These stocks will help to absorb any short-term delays that may arise. There is no need for hospitals, pharmacists or patients to order extra quantities of medicines, or for doctors to issue extra prescriptions. That would risk disrupting existing stock levels and hinder the supply of medicines for other patients.

The importance of medicines to human health means detailed

Occasionally, disruptions in medicines supply occur due

10 | PHARMACYNEWSIRELAND.COM

As Brexit approaches, this is a time for policymakers across the EU and the UK to set aside politics and work together to protect patients. Every month, around 45 million packs of medicines leave the UK destined for patients in Europe. Some 37 million packs go the opposite way. That’s one billion packs of medicine crossing the border between the UK and the EU every year. Soon, when the UK leaves the EU and regulatory harmonisation stops, the rules around the development, manufacture, packaging, safety testing and regulation of medicines will no longer benefit from mutual recognition. Transport delays at the border are possible, too. These risks must be anticipated and managed.

He called out the industry for “very significant work” undertaken in planning for Brexit, saying it had “well-developed supply chains”. The National Director of Acute Strategy and Planning at the HSE, John Hennessy, said preparations for Brexit had been multi-stakeholder, and planning was well advanced for continuity of the supply of medicines after the UK leaves the European Union on March 29th. He said key risks in the short term relate to “potential disruption and delay to supply chains”. “The key supply chain challenges in the short or immediate term are likely to be related to medicines with a short shelf life, refrigerated supply chains, compounded products and time critical logistics,” said Mr Hennessy. The Government believes there are no immediate risks to health of the population due to Brexit. IPHA recently took part in a Brexit stakeholder event, organised by the regulator, the HPRA, for manufacturers, distributors and marketing authorisation holders operating in Ireland or the UK. IPHA will be represented by Loretto Callaghan, General Manager of Novartis, who leads the IPHA Brexit Project Group. Ireland has a critical reliance on the UK as a source of medicines. About 4,000 medicines are marketed in Ireland. Of these, between 60% and 70% come from, or pass through, the UK. Continuity of supply of medicines is part of the standard day-to-day responsibility of pharmaceutical companies. It’s part of the deal IPHA has with the State on the supply of medicines. There is always two to three months’ supply of medicines in the system anyway. These stocks will help to absorb any short-term delays that could arise.

The Government has recognised the industry for “very significant work” in planning for Brexit.

Risks to the continued supply of medicines after Brexit can never be fully discounted. But, crucially, they can be managed. That’s what pharmaceutical innovators have been spending time and money doing. Companies have made complex logistical and supply chain arrangements, including in some cases re-routing transport away from the UK. This work is critical in minimising the risk of disruption to the supply of medicines to patients after March 29th.

At the Oireachtas Committee on Health recently, the Secretary General of the Department of Health, Jim Breslin, outlined the steps the health authorities, working with industry and other stakeholders, are taking to secure the supply of medicines to patients after Brexit.

Whatever the outcome of the turbulent politics of Brexit, there is a need for unity of purpose when it comes to preparing for the practical implications of the UK’s decision to leave the European Union. Our industry, in working with the State on a joint response, is doing the right thing by patients.

As Westminster weighs the next political moves following the defeat of the vote on the Withdrawal Agreement, Ireland must continue to plan a coordinated response to a ‘no-deal’ outcome. For pharmaceutical innovators, patients remain our core focus. They must be everyone else’s, too. Government Recognition


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12

News

McManus signs with the All Stars John McManus, Owner and Superintendent of McManus Pharmacy in Manorhamilton is a well known face not just within community pharmacy but also in the field of GAA as a sponsor of the Leitrim GAA Senior County Jersey.

He recently attended the Rainbow Centre in north Leitrim as Glenfarne/Kiltyclogher GAA celebrated a momentous past 12 months at its Annual Dinner Dance. He is pictured here with All Ireland winner and nine-time All-Star Pat Spillane from Kerry as he signed the sponsored jersey with Terence Boyle, Chair, Leitrim GAA.

National Cancer Strategy Implementation Report The Minister for Health, Simon Harris T.D. on World Cancer Day, has launched the first implementation report on the National Cancer Strategy 2017-2026. The report sets out the progress achieved on the implementation of the 52 recommendations of the Strategy and the degree to which the key performance indicators are being met. “This Report highlights key developments in implementing the recommendations of the National Cancer Strategy 2017-2026” said the Minister. “It is particularly fitting to mark World Cancer Day with the release of this Implementation Report.

• the uptake rates for cancer screening.

“Much progress has been made since the launch of the Strategy last year. I know that the work being done in implementing the Strategy is making a real difference in the prevention and early detection of cancer, while ensuring that the supports are in place for those living with and beyond a cancer diagnosis.”

• the commissioning of 2 new linear accelerators in St Luke’s Hospital;

Prevention and Early Diagnosis highlights include: • legislation on standardised retail packaging for tobacco; • the passage of the Public Health Alcohol Act 2018; • the integration of cancer prevention into the messaging under the Healthy Ireland Initiative; • progress towards a national skin cancer prevention plan; and

Highlights in Treatment and Survivorship include: • new posts in medical and surgical oncology;

• the progress of construction work on a new radiation oncology centre in Cork University Hospital towards completion in Q1 2019; • publication of a Model of Care for Oral Anti-Cancer Medications • the commencement of the roll-out of a National Cancer Information System; • the progress being made by Working Groups on Survivorship and Psycho-Oncology; • the appointment of a National Clinical Lead for psycho- oncology; and • establishment of a Cancer Patient Advisory Committee.

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Minister Harris added, “The challenges facing us in cancer are significant. The recent annual report of the National Cancer Registry indicated that approximately 22,640 cases (excluding non-melanoma skin cancers and non-invasive cancers) are diagnosed each year. While projections indicate that the number of people with cancer will increase significantly with our increasing and our ageing population, we have a pathway laid out in the Strategy that will lead to many potential cancers being prevented, and to continuous improvements in the treatment and follow-up services available to patients with cancer. “The past year also brought significant challenges with regards to cervical cancer. We will take a number of very important steps this year towards achieving our goal of effectively eradicating this cancer.” Continued implementation of the National Cancer Strategy is identified as a key priority in the HSE’s National Service Plan for 2019, which will build on the progress made on the Strategy recommendations to date.

Community Pharmacy Vision Paper The Pharmaceutical Group of the European Union (PGEU) has published its vision for the pharmacy profession in a paper titled “Pharmacy 2030: A Vision for Community Pharmacy in Europe”. PGEU President Michał Byliniak stated, “This year PGEU celebrates its 60th anniversary. It is time to acknowledge the pharmacy profession’s vital contribution to the health of people over the last decades and to look to the future to how the profession can further enhance this contribution and help to strengthen Europe’s health systems.” The PGEU Vision for Community Pharmacy 2030 outlines 10 key recommendations: 1. Maximise the benefits of the community pharmacist’s intervention for patients and healthcare systems by promoting pharmaceutical services to improve treatment outcomes and adherence and to minimise risks; 2. Involve community pharmacists in collaborative care models; 3. Grant community pharmacists access to all relevant patients’ health information and the list of medications they are taking; 4. Consult pharmacists on the integration of new digital solutions in healthcare; 5. Allow pharmacists to help progress the digitalisation of healthcare as trusted sources for health information; 6. Support pharmacists in integrating pharmacogenomics, validated clinical rules and realworld data in their daily practice to improve patient safety; 7. Support community pharmacists in offering health screening, medicines management, health promotion and education to help reduce the overall burden of chronic diseases; 8. Establish regulatory frameworks to maximise the value of the highly-accessible community pharmacies network to the communities they serve; 9. Ensure that community pharmacists can provide patients with the full range of medicines and medical devices they need; 10. Ensure that remuneration for community pharmacists properly reflects their contribution to improving pharmaceutical care, reducing the burden on other health services and supporting the sustainability of health systems.


14

News

New Code to provide for conscientious objection The Council of the Pharmaceutical Society of Ireland have approved a new Code of Conduct for pharmacists, Irish Pharmacy News has learned. Mattie McGrath, TD

as pharmacists, as this could have the effect of blocking a woman’s access to a lawfully provided and, in some cases, medicallyindicated treatment.” However he added, “I understand that the Council of the Pharmaceutical Society of Ireland has approved a new Code of Conduct for pharmacists, which it will be submitting to the Competition and Consumer Protection Commission for approval before it comes to me as Minister for approval. The news comes on the back of a question, from Mattie McGrath TD to Health Minister Simon Harris in the Dáil. Deputy McGrath asked the protections for conscientious objection provided for student midwives, pharmacists and doctors in the Health (Regulation Termination of Pregnancy) Act 2018. In response Minister Harris stated, “I brought amendments to this section in the Dáil to ensure that it is clear that conscientious objection extends

to all those who may be asked to directly participate in providing termination of pregnancy services, including students. The amendments ensured that student nurses and midwives are clear that they may refuse to participate in termination of pregnancy procedures on the grounds that they have a conscientious objection. Medical practitioners were already covered by Section 22. “It would not be reasonable to include any other personnel such

“Part 5 of Principle 4 on page 9 of the proposed Code of Conduct makes provision for conscientious objection, subject to the pharmacist referring a patient to an alternative provider if the pharmacist cannot provide a professional service or medicinal product, so that patient care is not jeopardised or compromised. “A footnote to the Principle makes specific reference to a pharmacist transferring the care of a pregnant woman who wishes to avail of services for the termination of pregnancy.”

‘Worrying’ health statistics A recent survey carried out by LloydsPharmacy, has found that 27% of Irish adults worry about their health all the time, with a further 16% claiming to worry about it at least once a week. For 24% of Irish people surveyed, maintaining weight was the most concerning health aspect, with 16% claiming they worry about not getting enough sleep. Those aged 18-24 are significantly more likely to be concerned about their diet/nutrition than any other age group, while those aged 65+ are significantly more likely to be concerned about their blood pressure. The research was commissioned by LloydsPharmacy ahead of the launch of the Change Your

Health Direction programme for 2019. The LloydsPharmacy Change Your Health Direction is a free 8-week programme offering people the chance to kick start their health journey for 2019 with a personal transformation plan, and make long term improvements in areas including smoking cessation, nutrition advice, weight management, low energy levels, trouble sleeping, blood pressure and more. The research also found that 4 in 10 adults claim they are likely to

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make a health-related New Year’s resolution in 2019, with those aged 18-24 significantly more likely to do so (54%). And while many of us are still battling to keep them, the research found that 28% of adults lose interest in their New Year’s resolutions - with 21% claiming they are likely not to keep their resolution if they get too busy. Those aged 18-24 claim that being not motivated and it being too much effort are the main factors which may stop them from keeping their resolutions.

Communities relay for cancer Communities across Ireland have raised over ¤4.4million for cancer patients by passing on the Relay For Life baton for a decade. This is a 24 hour community event that celebrates the lives of cancer survivors, remembers those lost to the disease and encourages people to fight back by raising awareness and funding vital research and support services of the Irish Cancer Society. Relay For Life first began in 2009, and since then 25 communities have hosted close to 100 relay events, raising over ¤4.4m between them. This money has been invested in cancer research projects and a range of free support services to help those affected by cancer.

GSK Chair steps down Drugs giant GlaxoSmithKline has announced last month that Sir Philip Hampton, its Chairman since May 2015, is looking to step down and that a search for his successor has begun. The news comes just weeks after GSK said it would pool its consumer healthcare assets with those of US rival Pfizer potentially paving the way for a break-up of the company. Announcing his decision to move on, Sir Philip said: "I believe this is the right moment to step down and allow a new chair to oversee this process through to its conclusion over the next few years and to lead the board into this next phase for GSK."

Diet Risks APC Microbiome Ireland scientists based at University College Cork have shown for the first time that a high fat “western” diet reduces the efficiency of the immune system to fight infectious disease particularly in the gut, and to infection with the foodborne pathogen, listeria monocytogenes. The researchers found that feeding mice with a “westernised” diet, which is high in fat and low in fermentable fibre, affected both the immune system and the bacteria resident in the gut (the gut microbiota). Increased human consumption of a ‘westernized’ diet has been linked to the dramatic rise in conditions such as obesity and type 2 diabetes, and research has demonstrated the direct effects of dietary fats upon both the immune system and the gut microbiota.


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

PALEXIA® and PALEXIA SR® Prescribing Information Refer to the Summary of Product Characteristics (SmPC) before prescribing. Presentation: Palexia: 50 mg (white), 75 mg (pale yellow) and 100 mg (pale pink) film-coated tablets contain 50 mg, 75 mg and 100 mg of tapentadol (as hydrochloride) respectively. Palexia SR: 50 mg (white), 100 mg (pale yellow), 150 mg (pale pink), 200 mg (pale orange) and 250 mg (brownish red) prolonged-release tablets contain 50 mg, 100 mg, 150 mg, 200 mg and 250 mg of tapentadol (as hydrochloride) respectively. Indication: Palexia is indicated for the relief of moderate to severe acute pain in adults, which can be adequately managed only with opioid analgesics. Palexia SR is indicated for the management of severe chronic pain in adults, which can be adequately managed only with opioid analgesics. Dosage and method of administration: Individualise according to severity of pain, the previous treatment experience and the ability to monitor the patient. Swallowed whole with sufficient liquid, with or without food. Palexia SR: should not be divided or chewed. The tablet shell may not be completely digested and eliminated / seen in the patient’s stool which has no clinical significance as the active substance will have already been absorbed. Palexia dosage: Initial dose 50 mg every 4 to 6 hours. On the first day of dosing, an additional dose may be taken 1 hour after the initial dose, if no pain control. The first day’s dose should not exceed 700 mg. Maximum maintenance daily dose of up to 600 mg. Palexia SR dosage: Initial dose 50 mg twice a day. Switching from other opioids may require higher initial doses. Titrate in increments of 50 mg twice a day every 3 days for adequate pain control. Total daily doses greater than 500 mg not recommended. Duration of treatment: Palexia: The possibility of switching to Palexia SR should be considered if longer term treatment is required, and pain relief is achieved with Palexia in the absence of intolerable adverse events. Discontinuation of treatment: Taper dose gradually to prevent withdrawal symptoms. Renal/hepatic impairment: Not recommended in patients with severe cases. Caution and dose adjustments with moderate hepatic impairment. Elderly: May need dose adjustments. Children below 18 years: Not recommended. Contraindications: Hypersensitivity to ingredients, suspected or having paralytic ileus, acute intoxication with alcohol, hypnotics, centrally acting analgesics or psychotropics. Not for use when mu-opioid receptor agonists are contraindicated (e.g. significant respiratory depression, acute or severe bronchial asthma or hypercapnia). Special warnings and precautions: Abuse and addiction potential of Palexia should be considered where there is increased risk of misuse, abuse, addiction or diversion. All patients should be carefully monitored for signs of abuse and addiction. At high doses or in mu-opioid receptor agonist sensitive patients, dose-related respiratory depression may occur. Caution and monitoring required with impaired respiratory function. Should not use in patients susceptible to intracranial effects of carbon dioxide retention (e.g. increased intracranial pressure, impaired consciousness or coma). Use with caution with head injury, brain tumors, moderate hepatic impairment, biliary tract disease including acute pancreatitis. Not recommended if history of or at risk of seizures or with severe renal or hepatic impairment. Care should be taken when combining with mixed mu-opioid agonists/antagonists (e.g. pentazocine, nalbuphine) or partial mu-opioid agonists (e.g. buprenorphine). Should not use with hereditary problems of galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption. Interactions: Use with benzodiazepines, barbiturates and opioid analgesics, antitussive drugs and substitutive treatments may enhance the risk of respiratory depression. Central nervous system (CNS) depressants (e.g. benzodiazepines, antipsychotics, H1-antihistamines, opioids, alcohol) can enhance the sedative effect and impair vigilance. Consider dose reduction with respiratory or CNS depressant agents. In isolated cases, there have been reports of serotonin syndrome in a temporal connection with the therapeutic use of tapentadol in combination with serotoninergic medicinal products (e.g. serotonin re-uptake inhibitors). Use with strong inhibitors of uridine diphosphate transferase isoenzymes (involved in glucuronidation) may increase systemic exposure of Palexia/Palexia SR. Caution if concomitant administration of strong enzyme inducing drugs (e.g. rifampicin, phenobarbital, St John’s Wort) starts or stops as this may lead to decreased efficacy or risk for adverse events, respectively. Avoid use in patients who have taken monoamine oxidase inhibitors (MAOIs) within the last 14 days, due to cardiovascular events. Pregnancy and lactation: Use in pregnancy only if the potential benefit justifies the potential risk to the foetus. Not recommended during and immediately before labour and delivery. Do not use during breast feeding. Driving and using machines: May have major effect on ability to drive and use machines, especially at the beginning or change in dosage, in connection with alcohol or tranquilisers. Undesirable effects: Very common (≥1/10): dizziness, somnolence, headache, nausea. Palexia only: vomiting. Palexia SR only: constipation. Common (≥1/100, <1/10): decreased appetite, anxiety, sleep disorder, tremor, flushing, diarrhoea, dyspepsia, pruritus, hyperhidrosis, rash, asthenia, fatigue, feeling of body temperature change. Palexia only: confusional state, hallucination, dry mouth, muscle spasms, constipation, abnormal dreams. Palexia SR only: depressed mood, nervousness, restlessness, disturbance in attention, involuntary muscle contractions, dyspnoea, vomiting, mucosal dryness, oedema. Other important undesirable effects observed in clinical trials and/or postmarketing: convulsion, impaired gastric emptying (rare ≥1/10,000, <1/1000). Palexia only: respiratory depression (uncommon ≥1/1000, <1/100), drug hypersensitivity including angioedema, anaphylaxis and anaphylactic shock, depressed level of consciousness, (rare ≥1/10,000, <1/1000). Palexia SR only: drug hypersensitivity, depressed level of consciousness, mental impairment (uncommon ≥1/1000, <1/100), respiratory depression, angioedema, anaphylaxis and anaphylactic shock (rare ≥1/10,000, <1/1000). No evidence of increased risk of suicidal ideation or suicide with Palexia/Palexia SR. Additional information is available on request. Overdose: Seek specialist treatment (see SmPC). Legal classification: POM, CD (Schedule II). Marketing Authorisation numbers and pack sizes: Palexia: 50 mg: PA 2242/12/1, 28 and 56 packs; 75 mg: PA 2242/12/2, 28 and 56 packs; 100 mg: PA 2242/12/3, 28 packs. Palexia SR: 50 mg: PA 2242/12/4, 28 and 56 packs; 100 mg: PA 2242/12/5, 56 pack; 150 mg: PA 2242/12/6, 56 pack; 200 mg: PA 2242/12/7, 56 pack and 250 mg: PA 2242/12/8, 56 pack. Marketing Authorisation Holder: Grünenthal Pharma Ltd, 4045 Kingswood Road, Citywest Business Park, Citywest, Co. Dublin, Ireland. IRE/P18 0017. Date of Preparation: May 2018. Reference: 1. Palexia SR Summary of Product Characteristics. 2. Palexia Film Coated Tablets Summary of Product Characteristics. 3. Kress, et al. European Journal of Pain, 2010. Date of Preparation: July 2018. IRE/P18 0027


There will possibly be more sellers than buyers as we go through the uncertainty about mature income and there are concerns around not just reimbursement levels but also the regulatory costs

Pharmacy Watch: Shining a Spotlight on the Pharmacy Transactions Market 2018 was a busy year in the pharmacy transactions market with sales of pharmacies in 2018 (33) almost double those in 2014 (17). Average deal values remained steady year on year, ranging from between €1million to €1.5million, with the greatest demand for opportunities in Dublin reflected in the prices achieved.

Despite industry predictions since 2014 that the number of retail pharmacies would reduce, they have risen by 7.3%

I

nvestors, lenders and operators remain bullish about the sector’s prospects despite challenges to pharmacy profitability from on-going Reference Pricing adjustments, changing HSE reimbursement policies and wage inflation. This is reflected in the number of pharmacy purchases, greenfield openings and store refurbishments that were carried out in 2017 and 2018 together with the appetite for continued investment as we move into the new year. A new report has been launched in Ireland, providing an overview of the pharmacy transactions market and analysing key trends over the last two years. Based on this positive sentiment and the existing pipeline of acquisition opportunities, the authors believe this momentum will be maintained in 2019. The report’s findings are based on the single pharmacy transactions only and exclude group transactions such as Carlyle Cardinal Ireland’s purchase of Sam McCauley Chemist in 2017

16 | PHARMACYNEWSIRELAND.COM

and Uniphar’s proposed purchase of Bradley in 2018. These would have ramped up 2017 and 2018 figures further. Average Values Average deal values remained steady year on year, ranging from between ¤1million to ¤1.5million, with the greatest demand for opportunities in Dublin reflected in the prices achieved. Regionally Munster was the busiest for pharmacy sales (21) over the two year period with Connacht / Ulster showing less activity (12) due to fewer available opportunities and a reduced number of active consolidators in those regions. Findings for 2017 are based on information provided by the HSE’s Primary Care Reimbursement Service (PCRS), The Pharmaceutical Society of Ireland (PSI), Bank of Ireland and Fitzgerald Power. These four data points provide a precise view of the pharmacy transactions market in that year.

As the PCRS have not yet published data for 2018 analysis for that year is based on information provided by Bank of Ireland and Fitzgerald Power which is then aggregated to present a complete market view. Findings for 2018 will be updated to account for PCRS statistics in next year’s report. Speaking about the findings Sharen McCabe, Managing Director, McCabe Pharmacy Group added, “There will possibly be more sellers than buyers as we go through the uncertainty about mature income and there are concerns around not just reimbursement levels but also the regulatory costs. We are interested in scaling our business to provide patient-centric healthcare services; we want to build around what we think is the demand for accessible, fast, cost-effective primary healthcare, drug dispensing and point of care services.” Transaction Increase The number of transactions in the community pharmacy market has increased steadily since 2014. This


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Given the level of activity in Dublin and Munster in 2017 it was Munster was the busiest region for unsurprising that these regions pharmacy sales over the two year recorded the highest level of total The Pharmacy Transactions Market review period. Connacht / Ulster deal value in that year. The Rest (grouped together in the analysis) of Leinster was consistent in was the least active area due both years and Connacht / Ulster to fewer available opportunities again lagged behind while overall and a limited number of active deal values fell in 2018 (as per the current estimate) due to the purchasers in those regions. Geographical Split

The Pharmacy Transactions Market

I.70Annual deal volumes 67 702014 to 2018 67

67

70 60

53

50

37

40

29

30 20

33

27

17

2014

2015

2016

2017

2018

Sources; PSI, PCRS, Fitzgerald Power, Bank of Ireland

Note; the shaded areas of the above graph incorporate the Sam McCauley Chemists deal in 2017 and the Bradley Pharmacy Group sale 2018

increased activity has been driven by improved economic conditions, positive lender and investor We are interested in sentiment, clarity regarding the scaling our business to impact of profit pressures from FEMPI and Reference Pricing and Connacht provide patient-centric 6 / Ulster pent up demand amongst vendors healthcare services; we wishing 6 to sell.

II. Geographical split of transactions 2017 and 2018

Munster was the busiest region for pharmacy sales Dublin want to buildover around the two year review period. Connacht The report authors state that/ Ulster 10 believe the noted (grouped in do thenot analysis) was the least what we think is the togetherthey reduction in activity in 2018 9 active area due to fewer available opportunities demand for accessible, represents a market slowdown. and a limited number ofthe active purchasers in those Given relatively small number fast, cost-effective regions. of pharmacies in Ireland 8 and

primary healthcare, drug dispensing and point of care services.

27

29

10 0

60 60We do not believe the noted reduction in activity 53 in 2018 represents a market slowdown. Given 53 the 50 50relatively small number of pharmacies in Ireland and the corresponding number of acquisition 40 37in any one opportunities that this pool can create 40year the data is consistent year-on-year. 37 We expect 33 33 29 this consistency to continue in 2019. 30

Rest of the corresponding number of 10 thatLeinster acquisition opportunities this pool can create in any one year the data is consistent year-on-year.

13 Sharen McCabe, to continue in 2019. For clarity 8of presentation the findings Managing Director, throughout this report exclude McCabe Pharmacy Group Munster 37 33 Carlyle Cardinal Ireland’s

30 27 For clarity of presentation the findings throughout 20 report 17 exclude Carlyle Cardinal Ireland’s this 20 17 purchase of Sam McCauley Chemists in 2017 and 10 Uniphar’s proposed purchase of the Bradley 10Pharmacy Group in 2018. Were these transactions included the respective figures for pharmacy 0 acquisitions and 2018 would2017 be 67 and 53. 2014in 2017 2015 2016 2018 0 2014 2015 2016 2017 2018 Sources; PSI, PCRS, Fitzgerald Power, Bank of Ireland

60We do in 201 50relativ and th oppor 40year th this co

30 For cla this r 20 1 purch and U 10Pharm includ acquis 0 20

Note; the shaded areas of the above graph incorporate the Sam McCauley Chemists deal in 2017 and the Bradley Pharmacy Group sale 2018

II. Geographical split of transactions 2017 and 2018 Connacht

6 Connacht / Ulster 6 / Ulster Munster was the busiest6region for pharmacy sales Dublin 6 over the two year review period. Connacht Dublin / Ulster 10 (grouped together in the analysis) was the10 least 9 active area due to fewer available opportunities 9 and a limited number of active purchasers in those regions.

8

Rest of of Leinster 10 Rest Leinster 10 8

‘We expect this consistency

National purchase of Sam McCauley National 2017 Chemists in 2017 and Uniphar’s2018 proposed purchase of the Bradley Pharmacy Group in 2018. Were these transactions included the respective figures for pharmacy acquisitions in 2017 and 2018 would be 67 and 53,’ says the report.

I. A 70201

13

13

8 8 Munster Munster

37 37 National

2017 National 2017

33 33 National

2018 National 2018

Sources; PSI, PCRS, Fitzgerald Power, Bank of Ireland

18 | PHARMACYNEWSIRELAND.COM Pharmacy Watch: Shining a Light on the Pharmacy Transactions Market, 2018

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smaller number of transactions and decreases in average deal values. The type of pharmacies sold in 2018 was the principal cause of deal value contraction. Generally shops with smaller turnover and profit bases changed hands in that year compared to 2017. Average deal values were lowest in Munster in 2017 while the lowest average prices in 2018 were noted in The Rest of Leinster. Connacht / Ulster more or less matched the national average in both years whilst pharmacies sold in Dublin returned the highest average value in 2017 and the second highest in 2018 due to the greater demand for pharmacy opportunities in the capital. Average prices achieved are a factor of the type of opportunity which came to the market in both years. There was a marginal change in average

valuation multiples year-on-year but again this was due to the type of pharmacies that were sold in both years. Greenfield Pharmacy Investment The number of new greenfield openings in 2018 was broadly similar to 2017. According to PSI records, 38 new greenfield pharmacies opened in Ireland in 2017 versus 36 in 2018. The average investment per unit was ¤215,000 in 2017 and ¤227,000 in 2018, an increase of 5.3%. While there was a small contraction in the number of new openings the total national investment remained consistent due to the increase in the average investment per unit. Speaking about the report, Hilary Coates, Head of Healthcare at Bank of Ireland said, “Despite industry predictions since

The Vendor’s View: Roma O’Loughlin recently sold her pharmacy in Monkstown, Co. Dublin in 2018. She owned and operated this business for more than 30 years Why did you decide to sell? I had always intended retiring early, influenced by the premature death of my father in 1992, just as he had begun to consider retiring. The recession slowed that down. 2016 was my original plan but I pushed that out to 2021. However, despite all my efforts, growing the business again post-recession proved very challenging. I joined the Indepharm Co-Op and rebranded. This helped me improve my margins greatly but growing turnover was more difficult without making some major changes. The nature of pharmacist’s relationships with our regulatory body and our main payor, together with the ever-increasing burden of admin meant that, for me, my role was less enjoyable in recent years. Most importantly, I realised that I could afford to retire and was advised that there was little additional financial benefit to stay on for three more years. What were the biggest challenges? I was warned in advance about the demands there would upon my time, particularly towards the end of the process and that was not an exaggeration. Emails and calls were coming from multiple solicitors as well as accountants, pharmacists & other representatives of the buyer, all needing immediate answers. Last minute problems with leases reared their ugly heads and third party lawyers did not understand the urgency of the situation. However, it all came together. Having professional, expert people on my side who knew exactly what was required was a life saver. I feel that if I had tried to do this with my own accountant and solicitor who do not specialise in this area, I might still be in the pharmacy.

20 | PHARMACYNEWSIRELAND.COM

2014 that the number of retail pharmacies would reduce, they have risen by 7.3% from 1,737 in 2014 to 1,864 retail pharmacies in 2018 (IPS register Jan 2019). “Looking ahead, I expect it will be a busy consolidation market in 2019. Though the role of the independent pharmacist will continue to be significant, they will have to look at their business models and see how can they increase efficiencies while driving down costs with initiatives such as group buying and shared services models in areas like HR, recruitment and online sales. “Bank of Ireland is the leading lender to the healthcare sector as a result of our proven financial capabilities, combined with comprehensive sectoral expertise, and our priority continues to be

in supporting the success of pharmacy businesses nationwide.” Stuart Fitzgerald, Director, Fitzgerald Power commented, “2018 was a busy year in the pharmacy transactions market. Investors, lenders and operators remain optimistic about the sector’s prospects despite challenges to pharmacy profitability from on-going Reference Pricing adjustments, changing HSE reimbursement policies and wage inflation. “2019 is going to be a busy year and maybe even more active than 2018. Our pipeline is very strong, and we are seeing a higher number of pharmacies coming to market. Consolidators are active, and it remains a good time for vendors to exit.”

The Consolidator’s View: Sharen McCabe is the Managing Director of the McCabe pharmacy group, a multi-generational pharmacy chain which operates 30 pharmacies across Ireland together with an online store Have you bought or sold or attempted to buy/ sell a pharmacy in the last twelve months? We are continually looking at both new acquisitions and acquiring existing businesses and greenfield sites. In the last year, we opened two greenfield sites and in the previous 18 months we bought two existing businesses. We have 30 stores in the McCabe pharmacy group now. It’s been a strategy that has worked for us - to go nice and steady, reasonably cautiously. What factors are driving you to scale your business? Demographics are still very much in the pharmacist’s favour and volume activity I think will continue to grow as our population ages. We have more extended survival rates, we have a wider range of available treatment and ongoing care for patients as they age. These are all the factors that are driving demand but if you take the other side we have the declining dispensary value. The only way to be able to manage the growth in the market is to be able to scale. What are the challenges of integrating a new pharmacy into your group? When buying a new pharmacy or an existing one you have to pay attention to some significant factors. Determining what are the sustainable dispensary values in the pharmacy is the most significant factor to be assessed. What is the sustainable income coming in, what can you rely on in six years, that’s really what you’re buying. Working that out is essential. Part of that is knowing about the continuity of the existing staff members, having good co-operation with the current owner and solid relationships with local primary healthcare providers.


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22

Report: Health Trends

Emerging Health Trends in Ireland A striking health trend in Ireland is the growth in the number of people aged over 65. Each year this cohort increases by almost 20,000 people and this is set to continue, having implications for future planning and health service delivery here.

T

efficient way possible and that people can access high-quality care in a reasonable time.

his was just one of the key statistics arising from the 11th edition of ‘Health in Ireland: Key Trends’ published by the Department of Health. The findings from this Report provide a base from which community pharmacy can evaluate the health status of their local communities. In order to be able to provide high-quality services as the population continues to age, there needs to exist the ability to assess the performance of the health system in a way that ensures that valuable and finite health care resources are used in the most

The main aim of any performance assessment should be to improve the health status of the population, with people continuing to live longer, healthier lives. Increase in Life Expectancy The report shows that life expectancy in Ireland has increased by almost two and a half years since 2006, with male life expectancy consistently higher than the EU average throughout the last decade.

Much of this increase in life expectancy is due to significant reductions in major causes of death such as circulatory system diseases and cancer. The overall mortality rate has reduced by 14.9% since 2008. As seen in most European countries however, the rate of improvement in Ireland’s life expectancy has begun to slow in recent years.Population ageing clearly has major implications for the planning and provision of health services; it is also a measure of improvement in health and life expectancy. Life expectancy is continuing to increase, currently standing at 83.6 years for women and 79.9 years for men.

Ta

Table 1

Self-Perceived Health Status, Ireland and EU-28, 2016 Very Good Age Group 16-24 25-34 35-44 45-64 65+ Total EU-28

Good

Fair, Bad, Very Bad

% Male

% Female

% Male

% Female

% Male

% Female

65.4 56.6 45.8 33.2 18.6 41.6 22.2

64.4 54.8 47.2 36.1 17.5 41.5 19

30.5 34.3 42.5 45.9 45.5 41.1 47.8

30.3 37 41.9 42.8 49.8 41.3 46.1

4.1 9.1 11.7 20.9 35.9 17.3 29.9

5.3 8.2 10.9 21.1 32.7 17.2 34.9

Source: EU-SILC, Eurostat.

Table 2.2

PHARMACYNEWSIRELAND.COM People with a Long-Standing Illness or Health Problem, Ireland and

EU-28, 2016

Se in lem

Ag Gro

16 45 65 75

Tot

EU

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24

Report: Health Trends

Life expectancy for women is higher than for men, as in most countries. However this gap has narrowed in the past decade, and male life expectancy in 2016 was 3.7 years below female life expectancy compared to 5.6 years in 1996. The greatest gains in life expectancy have been achieved in the older age groups reflecting decreasing mortality rates from major diseases. In addition to living longer, women in Ireland typically experience a slightly higher number of healthy life years than men. The proportion of life expectancy at age 65 to be lived in good health is higher for both men and women in Ireland compared with the EU average. Overall, there are more people in Ireland and we are living longer lives than before. These trends are set to continue into the coming decades. The report touches on several areas, including demographics, population health, hospital and primary care, health service efficiency, employment and expenditure, highlights the significant achievements that Ireland has made for key health outcomes in the past decade.

Primary Care and Community Services The report shows that in the last year, almost 80% of people have visited their GP and, interestingly, the number of cases in treatment for problem drug use (including alcohol) has increased by 15.4% during the period 2008-2017. The number of cases in treatment for problem drug use (excluding alcohol) has increased by 42.7% over the same period. There has been a decrease of 6.3% in new entries for drug and alcohol treatment between 2016 and 2017. 33% of the population had a medical card at the end of 2017, compared with 30.1% in 2008 whilst the number of people registered for the Drugs Payments Scheme has decreased by 22.5% between 2008 and 2017. It also shows that the average cost per item dispensed under the General Medical Services (GMS) scheme decreased by over 4% from 2016 to 2017. The use of pharmaceutical generics can increase costeffectiveness and efficiency in health care provision and spending. Percent share of generics has more than doubled in Ireland since 2008, while the OECD average has increased by 36.6% in the same period. However, Ireland is still significantly below other OECD countries for use of generics.

However, it also highlights the challenges that persist in terms of the accessibility of timely and efficient healthcare across the population.

Perceptions in Health Status

In welcoming the report, the Minister for Health Simon Harris said, ‘Health in Ireland: Key Trends’ gives us the opportunity to assess the performance of the Irish health system, and highlights where things are going well, and where we need to improve.

Ireland has the highest selfperceived health status in the EU, with 83% of people rating their health as good or very good. The number of people reporting a chronic illness or health problem is also better than the EU average, at around 27% of the population. However, health status reflects

income inequality, with fewer low income earners reporting good health both in Ireland and across the EU. Age-standardised mortality rates have declined for all causes over the past decade. This decrease is particularly strong for mortality rates from stroke (-39%), breast cancer (-16%), suicide (-26%) and pneumonia (-39%). Ireland is currently below the EU average for suicide rates for both men and women. After a rise in the male suicide rate from 2008 to 2012, the three-year moving average has decreased and the latest figures (2015) have fallen below the EU average for the first time since 2010. However, improvements in mortality rates and high levels of self-rated health can mask variations between regions, age groups and other population subgroups. A death is considered treatable, or amenable, if it could have been avoided with optimal quality healthcare. For example, if a person under 50 years of age suffers from diabetes, then timely health care is very likely to successfully prevent this individual dying because of their diabetes. A death from diabetes among this group is therefore considered treatable. Ireland performs better than the European average for treatable deaths, at 113 treatable male deaths and 88 treatable female deaths per 100,000. Breast, cervical, colon and rectal cancer survival rates have improved in Ireland but remain below the OECD average except in the case of rectal cancer. Cigarette consumption has decreased by almost 60% since 1997. Alcohol consumption has also decreased over the same period, but not as dramatically. In

Figure 1.5

Included for the first time this year are statistics on Human Papillomavirus (HPV) immunisation rates among girls in second-level schools. There has been a large drop in HPV vaccine uptake since the introduction of the vaccine, from 82% in 2011 to 51% in 2017. Immunisation uptake rates for most other major illnesses have remained mostly stable and above 90%, with the exception of Meningococcal vaccination uptake at 88%. “In order to be able to provide high-quality services as our population continues to age, we need to have the ability to assess the performance of the health system in a way that ensures that valuable and finite health care resources are used in the most efficient way possible and that people can access high-quality care in a reasonable time. The main aim of any performance assessment should be to improve the health status of the population, with people continuing to live longer, healthier lives,” concluded Minister Harris.

Twelve Key Trends: 1. We are living longer 2. The life expectancy gap between men and women has narrowed from 5.6 years to 3.7 years 3. Irish men are living longer than their European counterparts 4. Increase in life expectancy is due to significant reductions in major causes of death such as circulatory system diseases and cancer 5. We think we are healthier than our European neighbours

Older Age Groups: Population 2018 and Projected Population 2023-2038 30%

Percentage of Total Population

2017, Irish people consumed 11 litres of alcohol per capita, based on Revenue figures.

6. We are getting better at curing cancer

25%

7. We are seeing a reduction in deaths from suicide

20%

8. Men are more inclined to binge drink than women 85+

15%

75-85 65-74

10%

5%

9. The average length of hospital stay is 5.6 days 10. The number of patients waiting for an Inpatient or Day Case procedures has fallen by 24% 11. 11am to 2pm on a Monday is the busiest time for Irish emergency departments

0% 2018(e.)

2023

Source: Central Statistics Office. Notes: (i) See notes under Table 1.4 (ii) (e.): The current CSO population estimate was used for 2018 figures.

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2028

2033

2038

12. Less than 2% of the population donate blood


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26

News

Concept Launch in Dublin Pharmacies The end of 2018 witnessed an emerging trend in pharmacy groups embarking on new concepts, and the start of 2019 has been no different. This time is was the turn of Johnson & Johnson who tested a concept of launching their latest product in community pharmacies across Dublin. Having started their QUIT Smoking Campaign from the beginning of January across TV, OOH and all Pharmacies Point of Sale, the team conducted a ‘Launch Day’ in chosen Pharmacy Accounts.

Kate Nagle, Pharmacist, Christine Murphy, OTC and Cosmetics Advisor, Grace Cheevers, Ecommerce and Marketing Manager, all Medipharm Pharmacy and Orla Gleeson, Johnson & Johnson Representative

Johnson & Johnson representatives were on hand to provide advice to potential quitters and gave further information on their latest product, launched in October of last year, Quickmist Cool Berry.

Johnson & Johnson Representative Anne Marie Curran with Aneta Walczynska, Pharmacy Manager, Remedi Pharmacy, IFSC Dublin

The launch days were held in Remedi Pharmacy, Your Local Pharmacy Ballinteer and Medipharm Pharmacy.

Date for the Diary: The United Drug Pharmacy Trade Show will take place this year on April 14-15th in the Aviva Stadium, Dublin. For 2019 the Pharmacy Trade Show, Ireland’s only dedicated pharmacy retail event, promises to be even bigger and better than before with expert speakers, educational sessions and workshops to help community pharmacists keep up with developments and grow their business. Further details of this, the agenda and speakers will feature in the March issue of Irish Pharmacy News. For further information please contact Laura Payne laura.payne@united-drug.com

Johnson & Johnson Representative Bridget Dooley advising a customer at Your Local Pharmacy, Ballinteer

Cheque Presentation to Hugh’s House President of the Pharmaceutical Manager’s Institute (PMI) Eoin McAtamney alongside Commercial Manager Fiona Dunphy recently dropped into Hugh’s House to present the charity with a cheque for €9,166.21. Maria Kirby, House Mammy, Hugh’s House,Fiona Dunphy, Commercial Manager and Eoin McAtamney, President, PMI and Ade Stack, Founder and Pharmacist, Hugh’s House The money was proceeds raised at the PMI’s Annual Charity Lunch and was presented to Hugh’s house Founder and Stack’s Pharmacy Group Managing Director, Ade Stack. Ade plans to use the money to fund the installation of two bathrooms in the long-stay house. In other news, the PMI will hold their annual ‘Women in Leadership’ event on Thursday, February 28th in the Kingswood House Hotel, Naas Road. Supported by Star Medical, this series aims to showcase trail-blazing, glass-ceilingshattering women across various industries to inspire and motivate all PMI members.

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The format is a relaxed “fireside chat” with a leading business woman, and an option to pose questions. This is followed by an informal lunch, which provides an opportunity for conversations

off-line and the building of relationships, both with peers and with industry leaders. Key speaker will be Bronwyn Brophy, Global Vice President, Women’s Health with Medtronic.


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28

News

Pharmacy students secure ban lift Following on from last month’s news that pharmacy students across the country are facing mental and financial stress owing to the new Pharmacy Programme, Irish Pharmacy News has learned APPEL, the Affiliation for Pharmacy Practice Experiential Learning, has lifted the ban on payment for placement. The Union of Students in Ireland (USI) have recently launched the 2019 Pharmacy Students’ Campaign Report on the financial burden placed on students by the new integrated Pharmacy programme. Directly after the launch, over 500 students rallied outside the Dáil to express their anger at unpaid placements and increased fees.

Furthermore, as 5th year students we are expected to undertake an eight month unpaid placement, with an increased cost of fees from ¤3000 to ¤7,500 in UCC, ¤8,500 in TCD and ¤9000 in RCSI. As a result, each pharmacy student faces an approximate deficit of at least ¤25,000. In 2018, USI alongside the Irish Pharmacy Students’ Association (IPSA) launched a survey aimed at 4th year Pharmacy students while on placement. These students were the first cohort to face the brunt of a ban on receiving payment for their labour. The ban

People from both sides of the border will benefit from new health and social care research trials thanks to a new Cross-Border Healthcare Intervention Trials in Ireland Network (CHITIN). CHITIN aims to improve the health and wellbeing of people living in Northern Ireland and the border region of Ireland (Donegal, Leitrim, Sligo, Cavan, Monaghan, and Louth) through cross border research collaborations. The research will look at key health challenges such as youth mental health, obesity, asthma and stroke. CHITIN has received ¤8.8m in funding from the European Union’s INTERREG VA Programme, managed by the Special EU Programmes Body (SEUPB).

USI and IPSA cautiously welcomed the ban lift and have called on the Pharmaceutical Society of Ireland to clarify its position and work with students’, pharmacists and colleges to protect the rights of students on placement. We revealed in our January issue that under the terms of the new integrated Masters of Pharmacy programme, 4th year pharmacy students are presently undertaking a four month unpaid placement.

Cross Border Initiative

was introduced by the pharmacy regulator, the Pharmaceutical Society of Ireland, and enforced by APPEL. In Autumn 2019 these students will also be the first to face increased fees in 5th year, ranging between ¤7,500 and ¤8,500. January’s rally at that Dáil gained widespread cross-party support against these fees. USI President, Síona Cahill said, “Our future pharmacists are being exploited with extortionate fees and unpaid labour. “The Union of Students in Ireland has long defended the rights of students as workers, and with this report we aim to highlight the exploitation of our future pharmacists while on placement.

“After the pharmacy programme changed in Ireland to an integrated model, pharmacy students are now feeling the significant financial and personal pressure of increased fees in their 5th year, while working on placement for a total of 12 months completely unpaid. These pressures are the result of decisions taken by the pharmacy regulator – decisions enforced by their Schools. Decisions taken by those who should have valued the students under their care.” In previous years, students on placement in 4th and 5th year could earn up to ¤22,000 for the full-time work they were undertaking. The 2019 Pharmacy Students Campaign Report is supported by pharmacy professionals across the country, by TDs, and by the Irish Pharmacy Union (IPU).

Mairead Nally from Roscommon & Lara Moehle from Drumcondra outside Leinster House on Kildare Street, Dublin during the pharmacy student protest. Photo: Gareth Chaney Collins

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Match-funding for the project has also been provided by the Department of Health in Northern Ireland and Ireland. Welcoming the launch of the CHITIN project, Dr Janice Bailie, Assistant Director, Research and Development, Public Health Agency and lead partner on the project said, “Funding of ¤8.8m for the CHITIN project is great news for health research. Not only is CHITIN going to help benefit the health and wellbeing of people and help prevent illness, it means that those people who may not have been able to access health research previously have the opportunity to do so in Northern Ireland and the border region of Ireland.” Janice added: “In addition to this, a network of health and social care research professionals will be created and this will help shape research in the future whilst working towards a shared goal so people can enjoy the benefits health research can bring them in the future.” According to Darrin Morrissey, Chief Executive at the Health Research Board, “Health research and trials can transform people’s lives. They help prevent illness, improve patient care and advance health policy. I believe the learning and health benefits that we get from this initiative will extend throughout the island of Ireland.”


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Treating MSD Pain over-the-counter Musculoskeletal Disorders Musculoskeletal disorders (MSDs) are extremely common. These conditions affect all aspects of everyday life, by limiting what people can do and their ability to be independent. This in turn can have a devastating impact on a person’s overall quality of life. In fact, musculoskeletal disorders remain the leading cause of years lived with disability (YLDs) and the third largest cause of disability adjusted life years (DALYs). Musculoskeletal disorders are a costly and growing problem. The prevalence of MSDs is expected

to continue to increase, due to our ageing population, rising levels of obesity and physical inactivity. The latter two are major modifiable risk factors in the development of a musculoskeletal condition. In most cases, these are chronic conditions that cannot be cured. Arthritis is the leading cause of disability in people aged 55 years and over and hence is the greatest cause of health service usage (Vos et al., 2015). Over 1 in 5 people have some form of arthritis (Arthritis Ireland, 2015) and the condition accounts for over 30% of all general practitioner (GP) visits (Bevan et al., 2009a). A report from the Central Statistics

30 | PHARMACYNEWSIRELAND.COM

Office confirmed that chronic back pain is the second commonest condition among adults after hypertension. The Institute of Public Health MSK briefing document in September 2012 found that 169,000 adults (5.1% of the population) had rheumatoid arthritis in the previous 12 months, which had been clinically diagnosed. MSDs can have a significant impact both on a personal and societal level. An individual’s home life, relationships and work can all be affected, causing repercussions for society and the wider economy, for example through the cost of treatment or lost productivity.

MSDs are the number one cause of work absence in Ireland, accounting for 50% of all absences and the direct cost to the economy is estimated to be ¤750m per annum. It is difficult to quantify precisely the extent of MSDs in the working age population of Ireland due to inadequate data. Despite this, there is sufficient evidence in Ireland to argue strongly for MSDs to be a policy priority in the coming years. Two of these key reasons are: 1. The Irish workforce is ageing and, with it, the risk of increasing MSD prevalence over the next 20 or 30 years. Experience from economies with older


Table 1: Common Specific MSDs Osteoarthritis and Regional musculoskeletal pain

One of the ten most disabling diseases in developed countries with 500,000 people affected in Ireland. Affects 18% women and 10% men over 60 years (Woolf & Pfleger, 2003) – rates for asymptomatic osteoarthritis much higher. 80% of people with arthritis have limitations in movement. 25% cannot perform the ADL. In Europe nearly � of adults are affected by longstanding musculoskeletal problems that limit everyday activity.

Rheumatoid Arthritis

Affects 1 in 100 people; 40,000 people in Ireland have RA. 70% of people with RA cannot work outside of home due to their disease, costing the state ¤1.6 billion (Bevan et al., 2009a). Early intervention can significantly improve outcome.

Spondyloarthropathy (SpA

SpA includes a number of related diseases such as ankylosing spondylitis (AS) (recently re-named Axial SpA) and psoriatic arthritis (PsA). AS is an inflammatory condition predominantly affecting the spine. Over 44,000 people in Ireland are affected: 2-3 times more common in males (Bevan et al., 2009a). Typically earlier onset than RA and associated with the skin rash psoriasis, PsA affects 0.25% of population; 10,000 people in Ireland affected. Often poor outcome with progression despite therapy. Joint damage and deformity can be severe in some cases.

Osteoporosis

Present in 15% of Caucasians aged 50-59 years and 70% of those over 80 years. It is estimated that 300,000 people in Ireland have Osteoporosis. 1 in 5 men and 1 in 2 women over the age of 50 will develop a fracture due to osteoporosis in their lifetime (Irish Osteoporosis Society) The most serious is hip fracture, fatal for 20% of patients, permanent disability for 50% (Stafford et al., 2004).

Systemic Rheumatic Disease: Connective Tissue Disease and Vasculitis

Relatively uncommon; Estimated 2,000 people in Ireland affected. Multisystem diseases with high morbidity and frequently requiring acute hospital intervention. Specialist care can improve outcomes and quality of life.

Juvenile Idiopathic Arthritis (JIA

A group of disorders of unknown origin characterised by joint pain, swelling and stiffness in children less than 16 years of age. Many present between 1-3 years at a crucial time of development and growth and occurring more commonly in females (Hoffart et al., 2010) Affects 1,200 children in Ireland (Arthritis Ireland, 2016) who require specialist care within months of diagnosis, so as to prevent permanent joint damage and growth retardation.

Fibromyalgia

One of the most common reasons for patients to visit a GP is widespread MSK pain attributed to abnormal pain processing (Department of Health, 2006) Poorly understood: prevalence 2% in women, aged 20-55. Multidisciplinary intervention, education and self-management strategies are recommended (Braun et al., 2011)

Hypermobility Syndrome

Hypermobility means that one can move some or all of their joints more than most people can. It’s often known as being double-jointed and can be referred to as joint hyperlaxity. Hypermobile joints are very common, and most people won’t have any problems. However, a minority of people with hypermobile joints experience pain or other symptoms. There are a number of different syndromes e.g. Ehlers Danlos syndrome where patients present with significant complications (Arthritis Research UK, 2015).

episodes occur in one year for a duration of less than six months as acute if an episode lasts for less than six weeks, as sub-acute (7-12 weeks) and as chronic if it endures for over 12 weeks. Back pain is a recurrent problem for many people, although this does not mean that symptoms will worsen. For the majority of people pain will disappear on its own within four to six weeks. For most people the cause of back pain is unknown. It may arise from any number of pain-sensitive structures in the lumbar spinal column, including joints, ligaments, muscles, and soft tissues. Persons at high risk of low back pain include those whose jobs involve physical labour, especially lifting, pushing, or pulling heavy objects, or twisting during lifting. Another risk factor for low back pain is cigarette smoking and poor physical fitness may also contribute to it. 2. Work-related upper limb disorders: Work-related neck and upper limb disorders (WRULDs) are MSDs affecting the upper part of the body caused or aggravated by work and the working environment. WRULDs, are also commonly referred to as ‘sprains or strains’, ‘repetitive strain injuries or disorders’, or ‘cumulative trauma disorders’. Symptoms of WRULDs can present in the tendons, muscles, joints, blood vessels and/or the nerves and may include pain, discomfort, numbness, and tingling sensations in the affected area. Examples of WRULDs by body part include the following:  Elbow: Epicondylitis (tennis or golfer’s elbow)  Hand, wrist and forearm: Carpal tunnel syndrome; repetitive strain injury (RSI), de Quervain’s syndrome  Shoulder: Tendinitis of the shoulder

age distributions shows that the burden of MSDs can have significant economic and social consequences 2. The growth of obesity in Ireland is a risk factor for bone and joint conditions. Data suggests that Ireland has the fourth highest prevalence of overweight and obese men in the EU and there are 300,000 Irish children who are clinically obese, with those numbers increasing by 10,000 each year. The term ‘musculoskeletal disorders’ is often used to include a broad range of health conditions affecting the bones, joints, muscles and spine, as well as

rarer autoimmune conditions such as lupus. There are more than 100 different types of musculoskeletal disorders, ranging from the very common to the extremely rare. Many of these conditions share similar symptoms, such as joint or muscle pain and inflammation, but they all have their own unique symptoms also. Non-specific MSDs are episodic conditions which may frequently be caused by, or made worse by, work. They manifest themselves in different ways and may cause periods of intense discomfort and incapacity which may affect the ability of the

individual worker to carry out their work. They may also abate for long periods. Many people with these conditions, never seek treatment and most recover on their own but the conditions can cause significant absence from work or lost productivity. Non-specific MSDs are described in relation to two main categories: 1. Back Pain: Back pain is a very common complaint and is episodic, with half of the episodes being solved within a week and 90% going away within a month. It can be described as recurrent if several

 Neck: Neck pain Targeting Pain There are a host of OTC medications available that aid in providing symptomatic relief for various mild to moderate pain symptoms. Musculoskeletal pain is the most frequent type of pain for which patients elect to self-treat with non-prescription analgesics. This pain typically originates from the muscles, bones, joints, and connective tissue, and can be classified as acute or chronic. The causes of musculoskeletal pain vary and may be the result

PHARMACYNEWSIRELAND.COM | 31


Prior to recommending the use of any analgesics, it is imperative to assess the appropriateness of self-treatment by evaluating the patient’s symptoms; reviewing the patient’s current medical history, drug profile, and allergy history; and screening for drug– drug interactions and possible contraindications. Patients with pre-existing medical conditions, those taking prescription medications, and pregnant or lactating women should always be reminded to consult their GP before electing to use any medications. Heat/Cold therapy Applying hot or cold packs (sometimes called thermotherapy or cryotherapy) to the joints can also relieve pain. A hot-water bottle filled with either hot or cold water and applied to the affected area can be very effective in reducing pain. Special hot and cold packs that can either be cooled in the freezer or heated in a microwave are also available, and work in a similar way. Superficial cold therapy (e.g. ice, gels, sprays, patches) is used to reduce inflammation, pain and oedema. Superficial heat therapy (e.g. patches, gels, creams, hot water bottles) works by increasing the temperature of the skin and underlying tissue, increasing blood flow to promote healing of the affected muscle or joint and stopping pain signals from reaching the brain. Nutritional Supplements

of trauma or injury to an area, repetitive movements, overuse of joints and muscles, and prolonged immobilisation. Types of musculoskeletal pain may include lower back pain, tendonitis, bursitis, sprains, strains, and osteoarthritis. In general, the goals for treating musculoskeletal pain involve identifying the cause of the pain and decreasing or eliminating its severity and duration. Patients experiencing pain may present with symptoms of localised or widespread pain that may worsen with any movement, achiness or stiffness, and possible fatigue and sleep disturbances because pain can interfere with the quality of sleep and overall quality of life. Pharmacists are in a pivotal position to guide patients in the proper selection and use of the various non-prescription analgesics available, as well as direct patients to seek counsel from their GP when warranted, especially if self-treatment is not appropriate, the patient is having severe pain, or further evaluation is needed.

Topical Analgesics

Oral Analgesics

Where the pain is localised, topical analgesics can be as effective as oral treatments but with fewer side-effects. They offer effective, targeted pain relief, applied at the site of muscle or joint aches, pains and discomfort. They can be used to relieve lower back pain, neck and shoulder pain, stiff and aching muscles, joint pain and less serious arthritic pain, such as that arising from osteoarthritis.

Oral analgesics include nonsteroidal anti-inflammatory drugs (NSAIDs) (ibuprofen and naproxen sodium) and acetaminophen. These medications are often used as initial therapy for musculoskeletal pain.

There are an array of topical analgesics available to treat musculoskeletal pain, including joint and back pain, which can be used in conjunction with oral analgesics when appropriate or as the sole therapy of choice. They are available as gels, sprays, ointments, creams, lotions, and patches. During counselling, patients should be advised to only apply topical products to skin that is intact and to not cover areas treated with counterirritants with tight bandages or an occlusive dressing. Patients should also be advised not to use heating devices when using topical counterirritants.

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NSAIDs and acetaminophen are used as combination therapy when no potential contraindications or drug–drug interactions are present. However, because of its reduced adverse effect profile, acetaminophen is preferred over NSAIDS as the drug of choice for the treatment of osteoarthritis when inflammation is not a chief concern. NSAIDs are the therapy of choice when inflammation is also present and there are no potential contraindications or drug–drug interactions. Patients should be advised to only take the recommended dosages and to adhere to the directions for taking these medications to avoid potential adverse drug reactions. For examples of nonprescription oral analgesics.

A number of nutritional supplements are available for treating musculoskeletal conditions, such as osteoarthritis. Two of the most common supplements are chondroitin and glucosamine. Glucosamine hydrochloride has not been shown to have any beneficial effects, but there is some evidence that glucosamine sulphate and chondroitin sulphate help symptoms and do not cause many side effects. Vitamin D, curcumin and magnesium for fibromyalgia have also been discussed as potentially beneficial. Pharmacists can make recommendations about employing a variety of non-pharmacologic measures that may alleviate muscle and joint pain. RICE (rest, ice, compression, elevation) helps reduce swelling and inflammation associated with acute muscle and joint injuries, and localised heat therapy may be useful for patients with non-inflammatory pain. Moreover, patients with severe, continual pain or recurring pain should be encouraged to seek further care from their GP when necessary, and especially if they see no signs of improvement after using OTC analgesics or if pain worsens.


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Know your Skin Market in Winter Winter is renowned for dark mornings, freezing temperatures and a surge in those suffering from cold and flu. However it can also cause severe problems with those suffering from skin conditions, such as psoriasis, eczema, acne and dry skin.

emphasises the need for medicine management support to improve outcomes for those with conditions such as eczema and psoriasis.

Central heating and lower humidity can aggravate skin dryness. One area for which there is a considerable demand in primary care for advice and support is dermatology and some evidence suggests that many people with skin problems manage their condition through self-care. Pharmacists have the potential to facilitate effective self-care for patients with dermatological problems. Furthermore the chronic nature of many skin conditions

So as the temperature gauge plummets, we look at some ways in which community pharmacists can help to combat this seasonal phenomenon. Dry skin occurs when the epidermis does not hold on to sufficient moisture, so skin can feel tight, rough, flaky and itchy. A number of things can contribute to its development, for example; too frequent bathing, use of harsh drying soaps, the ageing process

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(the production of natural oils in the skin slows as we age, and sun damage is cumulative so a lifetime of sun exposure and sun damage can result in thinner skin that doesnâ&#x20AC;&#x2122;t retain moisture so well), or certain conditions such as eczema or psoriasis.

Psoriasis is a chronic, systemic, inflammatory skin disorder in which there is an increase in the rate at which skin cells are produced and shed from the skin. Psoriasis can affect any part of the skin surface, but most commonly involves the elbows, knees, scalp, and the sacrum (lower back).

Winter can be a difficult time for those living with psoriasis. It's a challenge to keep warm enough to protect the skin from the effects of the colder weather, while also ensuring the central heating doesnâ&#x20AC;&#x2122;t dry it out, and that the extra layers of clothing donâ&#x20AC;&#x2122;t irritate.

Psoriasis is a condition which tends to run in families. Several different genes have been identified but the exact way in which the disorder moves from generation to generation has not yet been established. What is known is that both the immune system and genetics are important


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Essential Information: Adex™ Gel Presentation: White opaque gel. Uses: Highly moisturising and protective emollient with an ancillary anti-inflammatory medicinal substance for the treatment and routine management of dry and/or inflamed skin conditions such as mild to moderate atopic dermatitis, various forms of eczema, contact dermatitis and psoriasis. Directions: Adults, the elderly and children from 1 year of age. For generalised all-over application to the skin. Apply three times daily or as often as needed. Adex Gel can be used for as long as necessary either occasionally, such as during flares, or continuously if the added anti-inflammatory action is beneficial. Seek medical advice if there is no improvement within 2-4 weeks. Contra-indications, warnings, side effects etc: Do not use if sensitive to any of the ingredients. Keep away from the eyes, inside the

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nostrils and mouth. Temporary tingling, itching or stinging may occur with emollients when applied to damaged skin. Such symptoms usually subside after a few days of treatment, however, if they are troublesome or persist, stop using and seek medical advice. Rarely skin irritation (mild rashes) or allergic skin reactions can occur on extremely sensitive skin, these tend to occur during or soon after the first few uses and if this occurs stop treatment. As safety trials have not been conducted during pregnancy and breast-feeding, seek medical advice before using this product. Care should be taken as emollients which soak into clothing, pyjamas, bedlinen etc. can increase the flammability of these items. Patients should avoid these materials coming into contact with naked flames or lit cigarettes etc. As a precaution, dressings and clothing, etc., should be changed frequently and laundered thoroughly.

Ingredients: Carbomer, glycerol, isopropyl myristate, liquid paraffin, nicotinamide, phenoxyethanol, sorbitan laurate, trolamine, purified water. Pack sizes: 100g tube and 500g pump pack. Legal category: Class III medical device with an ancillary medicinal substance. Further information is available from the manufacturer: Dermal Laboratories, Tatmore Place, Gosmore, Hitchin, Herts, SG4 7QR, UK. Date of preparation: August 2017. ‘Adex’ is a trademark. Adverse events should be reported to Dermal.

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in its development. So although the potential to develop psoriasis is genetically inherited, it is by no means certain that it will ever occur. People who have psoriasis are at risk of developing psoriatic arthritis, which commonly affects the joints of the fingers, toes and spine. Trehalose Psoriasis is associated with a slightly higher risk of diabetes, high blood pressure, high Sodium Hyaluronate cholesterol, cardiovascular disease (angina, heart attack, stroke), and obesity. There is also a strong Hypotonic association betweenformulation psoriasis and depression.

(long-term) inflammatory skin condition. While the exact cause is not known, certain factors are thought to be important in its development, these include an inherited (genetic) predisposition to have a weakened skin barrier, as well as altered inflammatory and allergy responses. Atopic eczema most frequently begins in infancy but may also develop for the first time in adulthood. It affects approximately 1 in 5 children and 1 in 12 adults in Ireland.

For most children affected, the disease is mild. However, often those who have seemingly outgrown the condition will Some Preservative symptoms that free may be & phosphate freeto have life-long sensitive continue associated with psoriatic skin and may have recurrences of arthritis include; eczema following long symptomSafe for up to 3 months after freeopening spells.  Joint pain, especially with redness, swelling, and Atopic eczema can run in families tenderness and frequently occurs alongside other atopic conditions, including  Pain in the heel(s) or hay fever and asthma. tennis elbow Symptoms include red, dry,  A finger or toe that was itchy skin, which can sometimes completely swollen (sausage weep, become blistered, crusted shaped) and painful for no and thickened. However, the apparent reason appearance of eczema and the locations of the body affected can  Morning stiffness/pain in the vary greatly depending on the age back that improves of the person affected. with movement STERILE DROPS The main symptom is an intense Those presenting into the itch. Scratching only provides pharmacy who suffer from temporary relief, and leads to more psoriasis and exhibit any of these itching and scratching (the itchsymptoms, should be referred to scratch cycle), which can worsen their local GP for follow-up. eczema and make the skin more vulnerable to infection. Scratching The words eczema (which comes in response to itch can cause from the Greek word meaning some of the changes seen on the ‘to boil’) and dermatitis (meaning skin in eczema. inflammation of the skin) are often used interchangeably to describe The main aim is to improve several conditions that cause the symptoms and achieve longskin to become dry, itchy, inflamed term control. In atopic eczema, or irritated. the skin’s protective barrier is weakened which allows moisture There are a number of different to be lost, and irritants and types of eczema but the term ABAK ® SYSTEM is most often used to referThetomost widely allergens to pass through the skin more easily. Some common used preservative free atopic eczema (also called bottle in the world everyday substances e.g. soap, atopic dermatitis). contribute to the weakening of the skin’s barrier and should The word atopic refers to be avoided. hypersensitivity reactions to something in the environment. Sometimes it can be difficult Atopic eczema is a very common, for children or indeed anyone non-contagious, chronic who suffers with eczema to find

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Ocular surface protection1,2,8 3,4 comfortable clothing, particularly Hydrates and Lubricates

when there has been a flare up of the condition. Clothing can aggravate eczema as skin can be Helps combat hyperosmolarity very hot and heat increases itch.

in dry eye15

parents for children InAdvise line with expert opinion16

suffering from the condition to avoid harsh synthetic fabrics, seams, wool anddesign fabrics which Unique bottle & economical don’t allow the skin to breathe. At bedtime they should consider using eczema specific clothing, using soft cotton or silk sheets and avoid woolen underlies, blankets 4: Avoid harsh soaps and plastic mattress protectors. Ordinary soaps and bubble baths can dry out the skin by stripping Self Care Tips away its natural oils. Skin pH is a Here are 6 tips pharmacists measure of acidity and alkalinity, and pharmacy staff can ranging on a scale form 0 (most advise sufferers on as efficient acidic) to 14 (the most alkaline). self-care management: Healthy skin is naturally acidic, with a pH of around 5.5. This 1: More moisturiser acidity plays an important role in skin barrier function and skin Emollients are moisturisers that health. Soaps and detergents are used in two ways: applied raise skin pH which disrupts this directly to the skin as a leave delicate balance. on moisturiser, and as a soap

FOR ALL PATIENTS WITH DRY substitute instead of soap and shower gel. Dry skin itches. Moisturising rehydrates the epidermis, seals in moisture, and soothes dry, itchy skin. In winter, sufferers may need to moisturise more frequently and/or use a ‘heavier’ moisturiser such as an ointment rather than a cream or lotion; ointments tend to work better when the skin is very dry.

Use emollient wash products (soap substitutes) when hand-washing, bathing or showering, which leave the skin coated with a protective film afterwards.

2: Choose products that are bland, un-fragranced and preservative free

5: Wear sunscreen

3: One quick daily dip!

Humidifiers moisten the air to increase the level of humidity. To combat the drying effects of central heating and lower humidity during winter, some may want to consider using a humidifier indoors when the heating is on.

After bathing or showering, gently pat the skin dry. This is a great time to apply emollient all over as it helps to seal in moisture while skin is still damp.

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Staying in the bath or shower too long can be dehydrating, so keep the duration short (5-10minutes) and the water temperature should be lukewarm rather than hot.

6: Consider using a humidifier

36 | PHARMACYNEWSIRELAND.COM 1. Hill-Bator A et al. Biomed Res Int 2014(2014):ID 292139 ◆ 2.  Hovakimyan M et al. Curr Eye Res 2012;37(11):982-9 ◆ 3.  Nakamura M et al. Cornea 1993;12(6):433-6 ◆ 4.  Snibson G et al.


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Topic Team Training – Consider Cough 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. Cough can be classified as acute or chronic and can be due to exposure to irritants or allergens, certain medical conditions, or the use of certain medications. Acute coughs usually only last up to about three weeks and are usually caused by a virus. This cough may be either productive (produces mucus) or non-productive (dry, no mucus). An acute cough is usually caused by illness such as cold, flu and pneumonia. Common causes of a persistent cough in adults are; smoking; postnasal drip (mucus dripping down the throat from the back of the nose, caused by a condition such as rhinitis); asthma; gastrooesophageal reflux disease. Consider The below information, considerations and checklist provides support to enable you to run a team training session and identify opportunities for learning within the topic of Cough. Cold and flu season is the time of the year when pharmacists are more likely to see patients scanning the pharmacy shelves in search of the perfect remedy to manage a cough. Patients may be overwhelmed by the numerous

OTC cough products, but pharmacists are in an ideal position to evaluate and aid patients in selecting a cough product for selftreatment, as well as to encourage patients to seek further medical care when warranted. Cough is the most common symptom for which people seek medical advice. Annually, consumers spend billions on OTC medications for treating and managing coughs.

 Have I, or any of my team, established the type of cough?  Can I, or any of my team, explain the benefits of each cough medication?  Is the pharmacy team aware of the guidelines for children under the age of 6?  Is the pharmacy team confident in informing pharmacy customers on the recommended treatment?

Types of Cough Type

Symptoms

Chesty Cough

A cough that comes from the chest is often triggered by excessive mucus. This type of cough is sometimes referred to as a “productive cough” because the act of coughing gets rid of mucus in the chest. If the patient reports irritation from the cough, pharmacists can recommend an expectorant cough medication to help loosen the mucus for easier coughing

Dry/Tickly Cough

Occurs when the throat doesn’t produce enough mucus, resulting in throat irritation. Recommend a demulcent to coat the throat and relieve irritation in the upper respiratory tract. Acceptable demulcents include water, hard candy, lemon, honey, menthol, or simple syrup.

Bronchitis

Produces yellow-gray phlegm and is normally accompanied by cold-like symptoms such as stuffy nose, headache, and fatigue. The best treatment is rest and fluids, which can prevent dehydration and also thin the phlegm

Whooping Cough

Initially presents with mild, cold-like symptoms that snowball into severe coughing episodes over the course of a few weeks. The severe coughing phase also produces thick phlegm, and the condition is highly contagious. The best way for patients to protect themselves is to get vaccinated against whooping cough and ensure that their kids also get the vaccine, as whooping cough is particularly dangerous for young children.

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 Is the pharmacy team educated and knowledgeable on the dosage and contra-indications for all cough medications?  Is there any further training required to assist the team discussing cough remedy advice with customers? Key Points Check your pharmacy team are aware and understand the following key points:  Customers that should be referred to the pharmacist  Those with persistent cough that should be referred to their GP  Lifestyle and smoking habits which may need considered in product selection  Customers should be advised of non-pharmacological measures, such as adequate hydration and proper rest Actions  Prior to recommending OTC cough products, pharmacists should ascertain whether selftreatment is appropriate  Pregnant and lactating women and those with chronic medical conditions should always consult their GP before using any OTC cough medication.  Those with a smoker’s cough should be advised to take part in the pharmacy smoking cessation programme  Update the team’s knowledge of available cough remedies by type/cause, indications and doses to ensure appropriate product selection for each customer  Train the team to meet all the above considerations Learning  The HSE Under the Weather website offers further educational information - http:// undertheweather.ie/welcome-tounder-the-weather  Knowing the types of cough, and the causes for each, will help pharmacists and their teams make the best recommendations – See Table.


News IMPACT in the Community Five Irish healthcare charities have been named as winners of the GSK Ireland IMPACT Awards 2018, with each organisation receiving €10,000 in unrestricted funding. A further five runner-up charities each receive €2,000 in unrestricted funding.

Niall Mulligan, HIV Ireland, Joe Geraghty, Vision Sports Ireland, John Davis, Walkinstown Resource Centre, Sarah Benson, Ruhama and Adam Harris, AslAm

C

M

Y

The GSK Ireland IMPACT Awards, now in their fourth year, are designed to recognise and reward community-based charities who contribute to the improvement of people’s health and wellbeing in Ireland, as well as acknowledge the positive outcomes these charities have on patients and their local community. There are hundreds of small healthcare charities all over the country providing critical services, which are, in many cases, filling a gap in healthcare support or provision. What’s unique about the GSK Ireland IMPACT Awards

is that the winning charities are CM selected for how their organisation is managed and run, as well as the MY services they actually deliver. CY The five winning charities named CMY at the GSK Ireland IMPACT Awards K 2018 were:  AsIAm – AsIAm (short for Autism Spectrum Information Advice and Meeting Point)  HIV Ireland  Ruhama  Walkinstown Greenhills Resource Centre  Vision Sports Ireland

Migraine product now OTC Migraine sufferers in Ireland are now, for the first time, able to access a sumatriptan product without a prescription thanks to the OTC launch of Rowex’s Sumatran Relief. The first OTC Sumatriptan in Ireland for pharmacies only, Sumatran Relief can be used to relieve acute migraine attacks that happen with or without warning signs (aura), such as sensitivity to light, feeling sick, in patients who have a well established pattern of symptoms and who have previously been diagnosed with migraine.

Migraine symptoms may be caused by the temporary widening of blood vessels in the head. Sumatriptan is believed to reduce the widening of these blood vessels. This in turn helps to take away the headache and relieve other symptoms of a migraine attack, such as feeling or being sick (nausea or vomiting) and sensitivity to light and sound.


Let’s Talk – MAN TO MAN There remains an urgent need to maintain a specific focus on men’s health. This is grounded in continued sex differences in life expectancy and mortality, health inequalities between different subpopulations of men, a substantial body of evidence supporting a gender-specific approach to engage more effectively with men, and the imperative to build on progress achieved to date.

W

hat is clear, is that many forces shape men’s health behaviours and lifestyle routines, but what is not always well recognised is that men do want to talk about their health, they just need the right environment in which to do so. Community pharmacists are ideally positioned to engage men about their health and wellbeing and provide advice on issues facing every male. This feature focuses on current issues pertinent to male health, and provides strategies for pharmacists to encourage men to discuss and manage their health. “A quick private conversation with a pharmacist could mean the difference between a problem being addressed while it’s still curable, or it being allowed to fester with the consequential impact on health and wellbeing,” says Tomas Conefrey, Pharmacist with Conefrey’s Pharmacy, Dublin. “We know from our own experience that men are reluctant to talk about their health. By opening up more about how they feel and any symptoms they are experiencing, men are more likely to identify health issues

early, maximising the chance of a problem being resolved before it becomes untreatable.”

• Although smoking rates are declining, more men smoke (24%) than women (21%).

Championing the Male Population

• The proportion of men who are overweight (43%) and obese (25%) is higher than for women (31% and 22% respectively).

Ireland was the first country in the world to adopt a National Men’s Health Policy, and other countries are now building upon the pioneering spirit and practical learning from the Irish experience. Ireland’s pioneering role in men’s health policy development has been described by the British Medical Journal as ‘a particular source of inspiration for other countries.’ It is known that the broader social determinants significantly influence men’s health outcomes as well as how they engage with their health and manage themselves within health and social services. Against this backdrop, evidence suggests that underpinning men’s higher mortality rates for chronic diseases are poorer lifestyle behaviours. The recent Healthy Ireland survey highlights continued disparities in lifestyle behaviours between men and women: • Overall alcohol consumption and frequency of binge drinking is higher in men than in women.

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• Men’s diets are less healthy than women’s diets. • On a more positive note, men are much more likely to be physically active than women. Although male life expectancy in Ireland has increased by almost three years since 2003, and the gap between male and female life expectancy has narrowed over the same period, male life expectancy remains four and half years lower than female life expectancy (78.7 and 83.2 respectively), and men in Ireland continue to have higher death rates for most of the leading causes of death and at all ages. In particular, suicide is an issue that continues to be a particular concern among men, with men being 4.5 times more likely to die by suicide than their female counterparts - which is the largest sex mortality ratio. The importance of targeting lifestyle modification early in life

among those men engaged in health damaging behaviours has been well recognised: Health promotion and preventative efforts need, therefore, to start with boys. In recent times, there has been some good evidence of substantive positive change in boys’ lifestyle behaviours. It is well established that lifestyle behaviours developed early in life are predictive of behaviours in adulthood. Continued efforts are, therefore, needed to target early years’ lifestyle interventions among boys. Heart Health Many of Ireland’s men over the age of 45 are at risk of developing heart disease leading to a heart attack. Combined with rising levels of obesity, diabetes and smoking, many are literally a ticking time bomb. Research shows that men are nearly three times more likely than women to die prematurely from cardiovascular disease. Inactivity is a major risk for heart attack and stroke. Men typically spend 40 minutes longer sitting down in comparison to women. Blood pressure is also higher in men (69%) compared with women (59%).


DESIGNED TO STOP IRRITATION


Erectile Dysfunction While not life-threatening, erectile dysfunction can be devastating for any man to experience. It also has an upsetting effect on partners. Together with the loss of a satisfying sex life is the concomitant loss of self-esteem. Impotence may be the result of a medical condition, such as diabetes, or can be an unwelcome side-effect of some types of surgery. But surprisingly, it is anxiety and stress that are most commonly to blame for a man's inability to sustain an erection. Abusing drugs or alcohol can also be a source of the problem. The recommendations for heart failure within the Cardiovascular Disease Policy are underlined by a desire to shift the centre of heart failure care from the hospital to the community setting. The policy proposes the development of an integrated communitybased approach to heart failure management, led by primary care teams.

and the underlying skin appears normal. There is no specific treatment. The hair growth usually returns to normal within a few months.

Pharmacists have long undertaken roles in the prevention and management of cardiovascular disease (CVD) that extend beyond the traditional dispensing of medicines. These roles range from provision of educational materials, through screening and monitoring of conditions such as blood pressure, to interventions in areas such as smoking cessation, lifestyle modification, medicines management and medicines adherence.

The most common type of baldness is male pattern baldness (androgenic alopecia). Most people recognise this type of baldness immediately. The hairline begins to recede at the temple, and the hair at the top of the head starts to thin out. After a period of time, the crown area may become completely bald, leaving a piece of hair around the back and sides of the head only.

Pharmacists can help teach the warning signs of a heart attack. A man’s risk of heart attack greatly increases at 45 so it’s important that all men at the age of 45 (or earlier if a known family history) see their GP for a heart health check to calculate their risk of having a heart attack. Pharmacists can also educate on heart disease risk factors and encourage male patients to take their health seriously, being well placed to provide men with a wide range of advice, including, the importance of taking their medications, quitting smoking, engaging in regular physical activity and eating a healthy diet. Hair Loss A recent study has found that 49% of young Irish men under the age of 30 believe themselves to be experiencing some form of hair loss. Hair loss can be caused by a number of conditions, with some being more “permanent” than others. Traumatic alopecia: This is a manmade form of hair loss caused by hairdressing techniques. For example, damaging the hair with strong chemicals, such as bleach. Alopecia areata: In this condition, there are localised areas of hair loss. The cause is unknown

Telogen effluvium: This is a type of hair loss that happens two to three months after the body has suffered something very stressful, such as a major surgery.

Follicles are the cells that are responsible for growing hair. In some people, they may slow down production and start to shrink. While the follicles remain living tissue, they don't produce normal, visible hair. Some men have areas on their scalp which are very sensitive to the male sex hormones known as androgens (hence the name androgenic alopecia). It is these hormones which cause the follicles to shrink. This sensitivity to sex hormones, which can lead to baldness, is passed on from generation to generation. Therefore, baldness tends to run in families. Because hair loss may cause emotional distress and affect self-esteem, pharmacists and pharmacy staff should be supportive and empathetic to men experiencing it. There is only one medicine licensed to treat male-pattern baldness In Ireland, Minoxidil, available as a lotion which is rubbed on the scalp every day. The medication contains either 5% or 2% minoxidil. Some evidence suggests that the stronger version (5%) is more effective. Other evidence has shown that this is no more effective than the 2% version. However, the stronger version may cause more side effects, such as dryness or itchiness, where it is applied.

42 | PHARMACYNEWSIRELAND.COM

For those men who are struggling with a medical issue that inhibits their ability to perform, new drug treatments offer new hope. Everyone is now aware of the existence of the drug sildenafil (Viagra), the first of a number of well-known anti-impotence medications to come on the market. But there are alternatives to drug treatments for people with erectile dysfunction. Injections and oral medications can be used to increase arterial supply to the penis. These can be taken a number of hours before sexual intercourse is expected to take place. Vacuum pump devices have also been available for many years. Mental Health Pharmacies tend to focus on services for physical health problems, such as weight management and heart health, and mental health is often neglected in the pharmacy setting. According to the Mental Health Foundation, men are almost 50% more likely to never seek medical support for a mental health problem than women and are 40% more likely than women to wait over two years or never tell friends or family about their mental health problem at all. In Ireland men are 5 times more likely to die by suicide than women, and worldwide the rates average out at about three men to one woman. University College Dublin Sociologist Anne Cleary found a common theme among 52 young Irish men who survived suicide attempts: all expressed reluctance to disclose to anyone the “significant, long-lasting” emotional pain they felt. Instead they used alcohol and drugs to cope, worsening their levels of distress, and ultimately leading to a time where suicide seemed to be the only credible way of managing their pain. As pharmacy is at the centre of the community, it is important for pharmacists, and their teams, to be in tune with the signs and symptoms of depression in men and be proactive. They are not going to visit to pick up antidepressants because 75% of

men with a mental health issue will not see a health professional, so you can’t rely on this to open up the conversation. Learn to identify the indicators of mental and emotional distress in men and increase awareness of how men express mental and emotional distress. Look out for changing patterns; risky behaviours; excessive work or exercise; or somatic problems like aches, pains, or digestive problems. If they are coming into the pharmacy with injuries, are irritable or angry, losing concentration, dishevelled and socially isolated, these are factors whereby you should be thinking there might exist some symptoms of mental health issues.

Is your Pharmacy male friendly? By getting involved in Men’s Health Week and other similar campaigns (such as Movember in November), pharmacists may attract more men in-store and discuss relevant pharmacy services. Think about offering a special ‘well man clinic’ with blood pressure, diabetes and cholesterol tests. If you are able to spot a medical condition that requires further treatment, then it is likely you will have a loyal customer for the future. However, the problem often lies in men being reluctant to come into a pharmacy in the first place, so pharmacists may want to consider window displays that highlight products and services that are relevant to this audience. Men perceive health and community services as feminine and feminised and as such, think it is not set up for them. Those interested in focusing on men’s health should consider the store’s colour scheme, layout, signage, product placement and the health information available. Do you have signs with pictures of men on them? What products do you stock that appeal to men, and where are they placed? Displaying and disseminating health information in nonthreatening retail settings may improve men’s health awareness and encourage men to visit their pharmacy and/or GP more regularly. You will also often see men coming into their local community pharmacy for a range of OTC medicines or treatments for minor injuries such as sports injuries. This gives you further opportunity to target the male population.


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44

Perspectives

A Tale of Two Worlds?

In this article, Sarah Kelly, Hospital Pharmacist with St Vincent’s University Hospital lifts the veil on working life as a Pharmacist within the hospital setting in Ireland.

A

hospital pharmacist’s job has always been something of an enigma to those in my life outside of my colleagues, classmates and parents (the latter, through listening to me during years of study, probably couldn’t forget if they tried). Yet since qualifying, I’ve lost count of the times those family and friends that are a bit more distant from the relatively small world of pharmacy have asked; “So what exactly is it that you do in work every day?” Considering my own interest in hospital pharmacy was sparked during my first week as a pharmacy student, incidentally the first time I had ever heard of the career in the hospital setting, their

PHARMACYNEWSIRELAND.COM

questions are reasonable. With this article, I thought maybe here’s a chance to lift that veil a little; through my own experience as a recently qualified member of the profession.

medicines prescribed to a patient are clinically appropriate ensuring their drug therapy is both safe and effective during their stay.

Being trained from student to working professional within an Irish teaching hospital’s pharmacy department, I have been lucky enough to have worked across different areas unique to the profession. These each differ from the classical view most Irish people have of pharmacy.

Working alongside the multidisciplinary team, we ensure the correct guidance and drug treatment pathways for a patient’s clinical condition are used and applied correctly; from the treatment of a blood clot to life-threatening sepsis. We also advise on the management of their pre-admission medications around their new, acutely unwell situation; such as the complex drug management of conditions like diabetes in someone undergoing major surgery.

Clinical Pharmacy Clinical pharmacists work directly with patients and members of the multidisciplinary team on the ward. We confirm that any

Minimising Risk and Errors


45

I still get nervous holding a vial of medicine worth more than my yearly rent in Dublin We enable enquirers to make informed decisions on the use of medicines in their patient; thoroughly assessing evidence on their behalf and summarising it in a clear and practical manner. This is where I started working as a qualified pharmacist, it gives a great background once working as a ward-based clinical pharmacist to know the right places to look for your information. Aseptic compounding

Further drug management issues can arise when patients become sicker or increasingly unstable during their admission – such as a decline in renal function requiring dosage changes and we monitor our patients on a regular basis to check for these. Where appropriate, we will also educate patients on discharge about any medicines newly started whilst in hospital, in order to help their understanding upon heading home. Medicines Information Any recommendations made regarding a patient’s drug treatment are always rooted in a sound evidence-base; and so here medicines information pharmacists make their appearance. We gather answers to specific questions on medication usage by accessing reliable and up-to-date sources of information. Questions can involve anything to do with a medicine, from the weird and wonderful (advising on suitable alternatives to an unavailable, foreign medicine) to the routine (which of a list of medicines are appropriate to take in the first trimester of pregnancy).

Aseptic pharmacists are a rare sight within most hospitals – dressed apart from the pharmacist norm in scrubs and usually found inside their clean compounding unit. This role is very fulfilling; involving the safe and effective supply of chemotherapy products to patients. Working as a team within the unit alongside pharmaceutical technicians, the process we work through forms a protective layer between the patient and their chemotherapy. It is cyclical work, with each stage being checked and overseen by multiple members of the team in order to minimise the risk of error. While challenging, it is also great to work alongside a team with the common goal of ensuring any chemotherapy supplied is thoroughly screened, precisely manufactured and safely administered to patients waiting on the ward. Although I still get nervous holding a vial of medicine worth more than my yearly rent in Dublin! This is one of the great benefits to working as a hospital pharmacists, something I have experienced across all of the areas I’ve mentioned, the sense of teamwork and being part of a department that comprises pharmacists, pharmaceutical technicians, pharmacy aides, administrative staff and porters – all striving for

Sarah Kelly, Hospital Pharmacist, St Vincent’s University Hospital

their collective actions to make a positive impact on the care of patients within our hospital. Yet, like all careers, hospital pharmacy comes with its challenges too. Although I’m relatively new to its world, some of these have certainly crossed my mind more than once. Dealing with Time Pressures From clinical pharmacy, to medicines information, to aseptic compounding; we are routinely put under substantial time pressure;often juggling the responsibility of multiple wards with long lists of patients to see. Time pressure is no stranger to anyone working any job; but what often suffers in its wake is the time needed to speak with a patient about their medicines – something which can really make a difference to someone’s experience of hospital once they leave for home. I’d like to see this improve with an increased employment and utilisation of hospital pharmacists in Ireland. This is the major reason why (aside from my own anecdotal impatience

at answering that much-loved question) I believe in an increased awareness of hospital pharmacy throughout the general public. The services I’ve described are currently at a different standard across all Irish hospitals, depending on those old familiar factors of budgeting, resources and employment. As a profession we are currently in the process of standardising the structure of our vocation; how we are trained and utilised in Irish hospitals, because we know the benefits of our contribution to a patient’s hospital journey. With that, being a hospital pharmacist is a career path that is challenging, but ultimately rewarding; a path I hope evolves to meet the needs of an evolving Irish health service in terms of development and expansion. For me, it has been an interesting and gratifying experience so far; I hope I’ve shed a bit of light on the subject. As a final disclaimer, to those reading because I’ve directed you this way upon asking what exactly it is that I do every day, I hope you can forgive me.

PHARMACYNEWSIRELAND.COM


46

Finance

The Recession In Ireland Recession Contributory Factors.

There were a lot of factors. Many experts believe the Lehman Brothers Bank collapse in the U.S.A was the catalyst. Most factors were outside our control. What was within our control was Government The heading could be a title for a film about thewould 2009 Global Recession andand events in Ireland in the years leading up to spending. Control of this have required advice the best decisions by the Dept. of Finance. it. The timeline for the film to be the birth of the Celtic Tiger economy in 1995 with the end being June 2007. The main Unfortunately advice was not forthcoming and bad decisions were often made.

characters would be bankers and politicians. The people and businesses of Ireland play supporting roles. The story line to be how careless spendingExamples and reckless lending damagedata the country andInquiry its people. of this were discussed Banking in 2014. A Canadian expert, Rob Wright, spoke

I

about a report he wrote in 2010. He had identified shortcomings in communication, leadership,

Government. They were not t would show that Ireland did not compared with 60% in Canada.” now about the recession, it is expertise and resources in the Dept. of Finance. He said: heard. Advice that there would have enough money to fund its Source: Oireachtas Banking reasonable to say that people who not be a crash wonevery time. spending needs when the crash Hearings on Crisis May 2014. should have known better did not, happened. That all the wealth One consequence of not listening there was no plan and effective “Morale was low; the department was not properly structured or managed. Staff were fearful of giving Will There Be Another was the ¤46.7 billion bail-out of created in an economy that had management and resources with Global Recession? the banks. (Source:Central Bank boomed was gone. expertise were missing. It looks like written October advice which could possibly get into the public domain and potentially embarrass their 2017.) we were doomed from the start! Yes is the easy answer. Many experts have written about minister. There was also a lack of certain skills. Just 39 economists of master’s level out of a headcount Recession Contributory Factors the crash. I am not an expert. 1975 there has been compared with 60% infour Canada.”Avoiding Risks;Your Business / This is my humble opinion on of 54.This was 7% cent of the total staff,Since Personal Finances global recessions. The average There were a lot of factors. Many how some mistakes could have Source: Oireachtas Banking Hearings on Crisis May 2014.recessions is 8.5 gap between experts believe the Lehman been avoided with better financial It is not possible to avoid years based on 1975 as the start Brothers collapse in See belowBank an example ofthe business risk management: planning and management. completelythe risks a national or date for the first one and the U.S.A was the catalyst. Most Will There Be Another Global Recession? global recession brings. However last one in 2009. Following this factors were outside our control. Think About It one way to reduce risks is take recession pattern it is reasonable What was within our control was Managing Business Risk We were the Celtic Tiger economy to say that the next global a recession into account in your Government spending. Control of Yes is the easy answer. from the mid 1990’s. The envy recession is overdue. this would have required advice personal or business financial plan. of the World. We paid a lot of and theDescription best decisionsby A the Dept.or national recession may cause financial It ischallenges not a complicated process. Risk global to my business The latest update is that on gap the between there Unfortunately has been four global recessions. The average recessionsofiscompleting 8.5 yearsa tax and the Government spentSince 1975 of Finance. advice The advantages 23/1/2019, the I.M.F. told world it quickly. Many people became was not forthcoming and bad risk profile are this that writing based on 1975 as the start date for1the one and3 the in 2009. Following recession Risk Likelihood Scale: low.first 2 medium. high Medium 2it down leaders in Davos thatlast the one global asset rich. Ownership of two or decisions were often made. forces actions and decisions. So economy hasrecession started 2019 in more houses looked like normal. pattern it is reasonable to say that the next global is overdue. even if it is not a recession but potential for a Examples of this were discussed Banks sent literature in the post Risk Impact Scale: 1 low.arecession 2declinewith medium. 3 high Medium 2 or a only a slowdown in business in 2020. asking us to call about a loan. They at the Banking Inquiry in 2014. change in income, you will have A Canadian Wright, The latest update expert, is thatRob on the 23/1/2019, the I.M.F. told world leaders in Davos that the global gave us suggestions about what In summary, all that we know Riskplanned Risk Rating Likelihood multiplied bywith Impact. Rating and prepared in advance. 4 spoke about a report he wrote to do with the money! A quote economy has started 2019 in a in 2010. He had identified from a politician of that time, who My business plan and budget includes tolerances and if there was a down in communication, said; “when I have it I will spend decline shortcomings with potential for a recession 2020 leadership, expertise and turn in business. These are categorised under all key performance indicators and when I don’t I won’t.” In Risk Management in 2020.resources in the Dept. of Finance. addition to this thinking, bankers 1st in 1975 and are reviewed with professional advisors regularly. 2000 He said: “Morale was low; the broke mortgage lending rules. department was not properly Affordability or collateral 2nd in 1982 Rating Colour Coding. In summary, with that weStaff know structured orall managed. were checking prior to approval did not 1980 fearful of giving writtenitadvice always happen. Third in 1991 now about the recession, is Low Impact: Monitorget Situation. Medium Impact: Review Plans. High Impact; Take Action. which could possibly into the 1960 reasonable to say that people who Then it stopped. It felt like it was public domain and potentially Fourth in 2009 boom to bust almost overnight. embarrass their minister. There should have known better did not, 1940 We were the first European was also a lack of certain skills. Next One in 20?? country to go into a recession.there It Justbelow 39 plan economists of master’s was no and effective See an example of personal risk management. happened in June 2007. There was level out of a headcount of 54.This Recession Pattern management with a gradual erosion of confidence. wasbelow 7%and cent of the totalof staff, See anresources example business risk management: Government, banks, individuals, expertise were missing. It looks like families and businesses suffered Managing Personal Risk the consequences. We had record we wereManaging doomedBusiness from the start! Managing BusinessRisk Risk unemployment levels. Businesses Risk Description A change in my income would cause financial challenges. that had been successful were AvoidingRisk Risks; Your Business / Personal Finances without revenue and cash flow. Description A global or national recession may cause financial challenges to my business Many closed. Others struggled Risk Likelihood Scale: 1 low. 2 medium. 3 highor global recession Medium 2 way It is not possible to avoid completely the risks a national brings. However one to survive. Banks asked for Risk Likelihood Scale: 1 low. 2 medium. 3 high Medium 2 capital guarantees. Some were to reduceRisk risks is take a recession account in your personal or business Impact Scale:into 1 low. 2 medium. 3 high High financial plan. It is3not a nationalised. The construction process. The advantages of completing a risk profile are that writing it down forces industry collapsed. The value complicated of Risk Impact Scale: 1 low. 2 medium. 3 high Medium 2 expensive houses fell sharply.actions and Riskdecisions. Rating Likelihood multiplied by Impact. Risk Rating 6 in So even if it is not a recession but only a slowdown in business or a change Negative equity was normal.

Risk will Rating Likelihood multiplied by Impact.includes ongoing Risk Rating income, you have planned prepared in advance. Myand personal financial planning assessment of my

We had been “living beyond our means”, as the Government often told us after the crash! Could Things Have Been Different? Yes is the easy and only answer. Some economists predicted the crash and recommended preventative actions to the

4 discretionary income after all expenses are paid to ensure there is no over My business plan and budget includes tolerances and if there was a down spending. There isThese an emergency fund inunder case of loss of income. My Risk Risk Management Management turn in business. are categorised all sudden key performance indicators income is protected in the event of sickness, serious illness, accident or and are reviewed with professional advisors regularly. untimely death. All plans are reviewed regularly with my financial adviser. Rating Colour Coding. Rating RatingColour ColourCoding Coding. Low Impact: Monitor Situation. Low Impact: Monitor Situation.

Medium Impact: Review Plans. Medium Impact: Review Plans.

See below an example of personal risk management.

PHARMACYNEWSIRELAND.COM

High Impact; Take Action. High Impact; Take Action.

2


See example on the bottom of page 46 business risk management:

Q14. Avoid taking on debt repayments whenever possible, especially short term loans.

Financial Plan Design & Content

Q15. Avoid tax whenever possible, including income tax and inheritance tax.

If the Government and Banks had created a simple, jargon free financial plan during the Celtic Tiger years a lot of financial pain could have been avoided. The fact that they donâ&#x20AC;&#x2122;t appear to have had one that challenged their decisions and actions is remarkable. If they had built one consistent with their vision and mission they would surely have behaved differently. Building a financial plan should be a simple jargon free process. All risks costs and benefits must be explained and understood. The 18 sample questions listed below are common to both business and personal financial planning. The answers help in creating a personal or business report which identifies the current financial planning situation, ensures all current plans are doing what they are supposed to do.It may include recommendations for improvements, whenever appropriate. Q1. Know and manage your personal or business financial risks. Q2. Set a budget and spend less. Q3. Create goals and plan how to achieve them. Q4. Focus on what you can control: risk, costs, taxes, goals & priorities.

Q16. Understand every financial decision you make and then check it again. 17. Learn from life and business experiences and avoid making the same mistakes twice. 18. Make a Will Answers to these questions and others that may arise during a review meetinghelps with creating a personal confidential planning report or a financial business plan that makes sense. Whenever we complete a report, in addition to our own area of expertise, we work closely with all other professional advisers to ensure our financial planning service is aligned with all other professional advice and business planning. Contact Details If you would like to learn more about our personal and business financial services, please donâ&#x20AC;&#x2122;t hesitate to call 0868 961223 or email; Rob.McOwan@CleverMoney.ie. Alternatively visit www.FinacialExperts.ie Follow me on Twitter https://twitter.com/RobMcOwan & Facebook: https://www. facebook.com/FinancialExperts.ie/

Q5. Review and reconfirm your thoughts, actions, current plans and needs. Q6. Spend less than you earn. Q7. Create an emergency fund. Calculate the fund you need. Calculation: divide what you spend each month into what you have available to spend. Is that enough to survive and for how long? Q8. Diversify investments. Think about a portfolio of short, medium and long-term investments. Q9. Insure/protect your family for life, health and disability. Q10. Insure and protect your business and the people working in it who need protection. Q11. Plan to invest some of your income now in tax efficient plans for income in the future. Q12. Have a tax efficient succession and wealth extraction plan from your business. Q13. Save as much as you can afford.

About the Author Rob McOwan is an Independent Financial Advisor with CleverMoney. Rob also has a strong connection to the Pharma Industry having worked alongside numerous pharmaceutical organisations to assist with the design and launch of key brands. He has significant experiences creating, building and supporting pharma companies within the Irish and European markets and in his current role is now ideally positioned to present financial advice within the pharmacy industry to owners and employees.


Continuing Professional Development

CPD

CPD 99: EMERGENCY CONTRACEPTION (EC) & PREVENTING PREGNANCIES This module is suitable for use by community pharmacists as part of their Continuing Professional Development. After reading this module, in the magazine or online, complete the post-test on our website at www.pharmacynewsireland.com and include in your personal CPD ePorfolio.

Biography - Dr Deirdre Lundy, A graduate of UCD, Dr Deirdre Lundy is coordinator for sexual and reproductive education courses in the Irish College of General Practitioners; L.A.R.C Tutor with I.C.G.P. Coordinator and Trainer in ICGP/NMH, Holles Street and the Rotunda clinics She also participates in sessional GP in private 'well-woman' practice in Bray, Co. Wicklow.

Emergency Contraception (EC) & Preventing Pregnancies 60 SECOND SUMMARY In May of 2017 the UK Faculty of Reproductive & Sexual Health issued an update on Emergency Contraception (www.fsrh-guideline-emergencycontraception-2017). This raised important points about the timing of use for emergency contraception (EC) and what methods are likely to be most effective at which stages of the menstrual cycle. There have been many different forms of post coital or “emergency” contraception available (off license for the most part) in Ireland in the last 40 years. Currently we have three main options available for our patients: taking either of the two, licensed oral hormonal products available (UPA or LNG) or electing to have a copper bearing IUCD inserted into the uterus. When studies are done looking at all women who present for EC advice - regardless of their age or when in the cycle they had the UPSI- the pregnancy risk is sometimes quoted as about a 5% overall. Statistically speaking, Cu IUCD devices are by far the most efficient form of EC and in a review of cumulative data observing7000 post-coital (emergency) insertions only 6 pregnancies resulted (a failure rate of <.1% or 99.9 % effectiveness is quoted). 1.5mg of the progestin LNG will have a variety of effects. It interferes with sperm migration & function throughout the genital tract and when taken before the LH surge it delays or prevents ovulation for several days allowing time for the sperm in the genital tract to die before an ovum appears. It causes luteal dysfunction also. There are a several disadvantages of EC-UPA when compared to EC-LNG. ECUPA cannot be used during active breast feeding and mothers who choose it must use formula alternatives for one week after taking EC-UPA.

In May of 2017 the UK Faculty of Reproductive & Sexual Health issued an update on Emergency Contraception (www.fsrh-guidelineemergency-contraception-2017). This raised important points about the timing of use for emergency contraception (EC) and what methods are likely to be most effective at which stages of the menstrual cycle. Quite a complex set of recommendations had already been in place concerning the relative efficacies of the three main EC options available in Ireland namely; Copper IUDs, ulipristal acetate (EC-UPA) and levonorgestrel 1500microg (EC-LNG). Issues concerning weight, time elapsed after exposure and the drug interactions between EC-UPA and other hormonal contraception made prescribing& dispensing EC quite challenging. This most recent FSRH bulletin doesn’t make life any easier for care providers as it emphasises what was already suspected that neither oral EC pills are likely to be effective after the ovulation event has occurred. Background There have been many different forms of post coital or “emergency” contraception available (off license for the most part) in Ireland in the last 40 years. Currently we have three main options available for our patients: taking either of the two, licensed oral hormonal products available (UPA or LNG) or electing to have a copper bearing IUCD inserted into the uterus. Copper devices do not have a specific Irish license, but many are available here under European medical appliance licensing. All EC’s may reduce the chances of becoming pregnant after unprotected consensual sex or assault but how they work, how effective they are and what restrictions surround their use are all completely different. Who needs EC? The risk of becoming pregnant after unprotected sexual intercourse (UPSI) depends on the age and relative fertility of the lady and

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

timing of the intercourse. The highest risk part of a cycle starts approximately 5 days before ovulation to approximately 2 days after ovulation but when those days occur may be hard to predict. When studies are done looking at all women who present for EC advice regardless of their age or when in the cycle they had the UPSI- the pregnancy risk is sometimes quoted as about a 5% overall. That is to say, if 1000 women (of any reproductive age) have UPSI (at any day of the cycle) only about 55 of them are likely to see a positive pregnancy test. (Glasier AF, et. Al. Lancet 2010). The impact of the different types of EC will reduce that risk even further. Obviously younger women who have UPSI right around the mid cycle, LH surge and follicle rupture are much more likely to conceive. Women who take hormonal contraception but make errors, or are exposed to liver enzyme inducing medications that impair their hormonal contraception may also choose to use EC.


CPD 99: EMERGENCY CONTRACEPTION (EC) & PREVENTING PREGNANCIES they are in almost all family planning clinics, the service may not free and may not be covered on the GMS. Another counseling point is the possible connection with placing an intrauterine device through the cervix of a woman who may have just had unprotected sex. If STI exposure is a concern, then close surveillance and screening after IUCD placement will be very important. Without question though, if a woman is at high risk of conception and wants to avail of the most effective means of post coital contraception than the Cu IUCD is the best choice.Ideally all pharmacists should know and share contact information for nearby EC -Cu coil inserters. A facilitated and funded EC copper coil service might be a very effective way to reduce crisis pregnancy in this country. BUT WHAT OF THE HORMONAL OPTIONS? There are two hormonal methods of EC routinely used today and either of them may be purchased over the counter directly from the pharmacist. They are: 1. The high dose (1500microgram (1.5mg)), progestin-only levonorgestrel (LNG) tablet – marketed under the names ‘Norlevo’ or ‘Prevonelle’. We will call both EC-LNG from hereon EC OPTIONS Copper IUCDs The Cu IUCD which is available in the ROI (under European license) for long term contraceptive protection has a profound and immediate effect on sperm. Within minutes of copper ions entering the uterine cavity a marked inflammatory response occurs. Leucocytes converge in the endometrium and into the fluid that fills the uterus and fallopian tubes. Levels of prostaglandin also rise. There is a direct toxic effect of copper on both sperm and the ova as well as an impairment in sperm motility. When inserted before fertilisation a Cu IUCD will have significant pre fertilisation contraceptive effect. When inserted after fertilisation, the effects of copper on tubal motility and endometrial receptivity will have a significant post fertilisation but pre-implantation contraceptive effect. Once implantation has occurred, copper appears to have no contraceptive effect and so is not considered to be abortifacient in any way. Statistically speaking, Cu IUCD devices are by far the most efficient form of EC and in a review of cumulative data observing7000 post-coital (emergency) insertions only 6 pregnancies resulted (a failure rate of <.1% or 99.9 % effectiveness is quoted). It has the added advantage of protecting against further episodes of UPSI in the month of insertion and beyond for 5-12 years or more depending on the size and style of the device inserted. The other advantage of a Cu IUCD over hormonal

methods of EC is that the timing is much wider. Because copper has pre-fertilisation, post fertilisation and pre-implantation effects(and as implantation is only likely to occur at least 5 days after ovulation) then a copper coil may be placed up to the 19th day of a 28-day menstrual cycle- regardless of what day or how many episodes of UPSI have occurred in that cycle. You can adjust the insertion timing for longer or shorter cycles. That is, if a woman has had several episodes of UPSI during a cycle, and if her usual cycle is 30 days long, she can have a Cu coil placed at any time before the 21st day of that cycle (“adjusted day 19”) and have great confidence that an unintended pregnancy will not result.Cu devices can be used in addition to either of the hormonal EC options if a patient goes on to choose a Cu device after having taken a hormonal EC as long as she is within the “adjusted day 19” time frame or still less than 5 days after the UPSI. Now there are obvious drawbacks to a Cu IUCD for emergency contraception. It can be uncomfortable / painful to have one inserted; although practitioner expertise will play a large part in this. Failure to insert at all is unlikely but a possibility. It may be hard to access copper coils in some parts of the ROI. Many IUCD inserting doctors are unfamiliar with sourcing and insertion techniques for copper devices; although the ICGP is trying to improve this. Another issue arises in that some doctors who routinely offer copper devices as an ongoing contraceptive choice do not offer emergency insertion. Money, as always is a big issue in that even where EC Cu coils are available; as

or 2. The high dose (30mg), progesterone receptor modulator ulipristal acetate (UPA) tabletmarketed under the name ‘EllaOne’ which we can refer to as EC-UPA. Both can be very effective at reducing the risk of unintended pregnancy although neither is as effective as the Cu IUCD. They work in slightly different ways; one being an artificial form of progestagen contraceptive hormone and the other being a combined progestagen antagonist + partial agonist. Looking first at the levonorgestrel (LNG) method of EC or EC-LNG: 1.5mg of the progestin LNG will have a variety of effects. It interferes with sperm migration & function throughout the genital tract and when taken before the LH surge it delays or prevents ovulation for several days allowing time for the sperm in the genital tract to die before an ovum appears. It causes luteal dysfunction also. Post-ovulation effects of EC-LNG have not been shown in vivo. Unfortunately, if there is a further act of UPSI in that cycle conception could still easily take place as the LNG will only delay ovulation, not prevent it altogether. Recent information from the FSRH has warned that EC-LNG is likely to be completely ineffective if used after the LH surge. Efficacy statistics depend on the time delay between the UPSI and the administration of the LNG. When taken within the first 24 hours after a single episode of UPSI (before the LH surge) EC-LNG is highly effective with a failure rate estimated at about 22 continuing pregnancies per 1000


CPD 99: EMERGENCY CONTRACEPTION (EC) & PREVENTING PREGNANCIES exposures (which can also be expressed as 98% effective). Once the first 24 hours have passed the failure rates climb. EC-LNGis actually licensed for up to 72 hours post UPSI,but it can be taken up to 120 hours after UPSI (off license) but is most likely useless after about 96 hours. Its efficacy is highly dependent on using it before the LH surge (which is generally expected to occur 2 days before ovulation)but being able to pinpoint when the ovulation event takes place in a patient’s cycle – even a regular 28-30 days cycle- is very challenging. EC-LNG has other disadvantages. It affords no on-going contraceptive protection (unlike a Cu IUCD). It will only delay ovulation if it works at all so a subsequent episode of UPSI could result in a pregnancy. It is impacted by liver enzyme inducers so if a woman is currently on or has been on LEI medications within the previous 4 weeks or, so she should be offered at least a double dose of EC-LNGwith no guarantee of improved effectiveness in that stronger dose. Ideally a Cu IUCD should be offered in this situation. Body mass and weight may have an impact on the efficacy of EC-LNG and even though data is limited and further research ongoing the UK FSRH have suggested that woman with a BMI of > 26 or a weight of > 70 kg should be offered a double dose of LNG (3mg) with the advice that no data to confirm that this is necessary or indeed effective if there does turn out to be a weight issue surrounding the use of EC-LNG!When weight concerns exist the FSRH recommends Cu-EC or EC-UPA. Lastly, EC-LNG should not be offered to a woman who has already taken EC-UPA in the previous 5 days of that same cycle.

Looking at the 30mg ulipristal acetate EC hormone (EC-UPA); it is a more complex EC option than EC-LNGand while it may have superior efficacy to EC-LNG in some situations, if it is dispensed inappropriately, it may well increase a woman’s risk of unintended pregnancy.

There are some advantages of LNG over other EC choices. It is safe for use more than once in a cycle as it is unlikely to have any harmful effect on an implanted pregnancy that may have already occurred. It is perfectly safe for use in breast feeding mothers and it is relatively cheap and accessible. Major side effects have not been linked to its use and the few reported minor side (headache, nausea & vomiting) are usually mild. Another big advantage of LNG is that If a woman would like to avail of ongoing contraception then she need not wait until her next mens starts. If she is willing, she may “quick start” the combined pill/ patch/ ring or a progestagen only pill or injectable contraceptive on the same day as she takes the EC-LNG. It is also more useful for “just in case” EC for women who are in the COCP/ POP and think they have made an error. A woman on the COCP who forgets a pill or two in the middle of the pack has virtually no risk of pregnancy, but she may prefer to use EC for peace of mind. If she is offered EC-LNG, she may continue her COCP as usual without any impact from the EC. She will have full protection back immediately. By contrast, if that lady were to take EC-UPA in that same situation, disastrous pregnancy exposure might occur. See below to find out why!

EC-UPA is a synthetic selective progesterone receptor modulator. It has antagonist and partial agonist effects on progesterone receptors. It can suppress the LH surge and has been shown to delay ovulation even when taken after the LH surge has commenced (which distinguishes it from EC-LNG). It can impact endometrial development and can induce endometrial shedding, but this does not appear to contribute to its post coital efficacy as it, like EC-LNG, appears significantly less effective when used after ovulation has already occurred.Unfortunately, if there is a further act of UPSI in that cycle conception could still easily take place as the EC-UPA will only delay ovulation, not prevent it altogether. If that happens a woman could opt to take a second dose of EC-UPA within that cycle and if still within the pre-ovulation stage of that cycle it will likely afford protection. When taken within 5 days of a single episode of UPSI and before ovulation,EC-UPA is a superiorly effective post coital contraceptive with a failure rate estimated at about 14 continuing pregnancies per 1000 exposures (which can also be expressed as 98.6 % effective). EC-UPAis licensed for up to 120 hours post UPSI and its efficacy appears just as high at day 5 post UPSI as it is in the first 24 hours (an additional advantage over EC-LNG).

Other advantages of EC-UPA include the fact that it isdirectly available from the pharmacy;although much more expensive,and just as with EC-LNG, major side effects have not been linked to its use, but minor side effects are possible (see below). There are a several disadvantages of ECUPA when compared to EC-LNG. EC-UPA cannot be used during active breast feeding and mothers who choose it must use formula alternatives for one week after taking EC-UPA. As it is influenced by the effect of liver enzyme inducing drugs it is likely to be less effective if a woman has been exposed to those medications in the previous 4 weeks but there is no data on increasing the EC-UPA dose and, unlike the concomitant use of an LEI and EC-LNG, the FSRH recommends against using EC-UPA at all for women on liver enzyme inducers (Cu IUCD being the obvious best choice there). It is contraindicated too for women with severe asthma being controlled by oral steroids. It may be affected by drugs that increase gastric pH. It is known that the pharmacokinetics of UPA 5mg (known as “Esmya”and licensed for the treatment of smaller fibroids) has been shown to be altered by use of esomeprazole. As a result, there may be an interaction between EC-UPA and gastric reflux drugs, but it has not been studied. The SmPC for EC-UPA advises that the clinicalsignificance of concomitant use of these two drugs is unknown. EC-UPA can cause headache, nausea & vomiting just like EC-LNG but the main disadvantage of EC-UPA relates to its effect


CPD 99:

Dr Lundy lecturer in Clinical Skills for the Department of International Health & Tropical Medicine. She also lectures on Reproductive Health at the UCD Schools of Medicine, Public Health and Nursing & Midwifery and is a member of the 'Ask the Experts' panel for GP EMERGENCY Buddy CONTRACEPTION (EC) & PREVENTING PREGNANCIES website.

on progesterone receptors and concomitant use of hormonal contraception. We know EC-UPA acts on progesterone receptors but if those receptors are already full of synthetic progesterone (e.g. the combined pill/ patch/ ring or the mini pill or a subdermal implant or an injectable progestagen or even the much lower doses of progestogens found in hormone replacement therapies) then the UPA may not be able to act as efficiently on those receptors. So, if EC is needed because of an error in pill taking or a delay in returning for scheduled contraceptive injections or the planned reinsertion of an implant, then it would be better to avoid EC-UPA and consider a Cu IUCD if high risk or EC-LNG if relatively low risk. This is an important learning point for some pharmacies who have apparently stopped stocking EC-LNG! Another caution surrounding the use of EC-UPA is the possible interaction between it and the prior use of EC-LNGwithin the previous 7 days of the cycle. As EC-UPA is a progestagen receptor modulator, it may impair the effect of EC-LNG if both are taken in that same cycle. Additionally, the efficacy of EC-UPA itself may be undermined by prior exposure to EC-LNG in that same cycle. For this reason, a woman should not take UPA-EC if she has already used EC-LNG in the last week if she is still in the same cycle. And this issue arises frequently as some women have been known to go from pharmacy to pharmacy buying both types of oral EC for use in the same cycle; possibly negating the impact of the products. The difficulties with EC-UPA apply to future contraception choices and their efficacy too. If a woman has used EC-UPA, then her progesterone receptors are altered by that drug. She cannot then start (or restart) hormonal contraceptives for 5 days in order to allow the receptors to return to the pre-EC-UPA state. Once hormonal contraception is begun or recommenced the patient should not rely on that method for some days- how many exactly will depend on the chosen method! Complicated indeed. In a nutshell, you cannot “quick start” hormone contraception after taking EC-UPA. A table is available from the FSRH to facilitate prescribers when offering ongoing contraception after UPA use. There are many more issues surrounding EC use. What is a high-risk episode of intercourse. How can we identify whether or not a woman is likely to have ovulated? What about errors with contraception? Omitted pills in a pack of COCP is a common cause of failures for that method but the risk is greatly affected by which pill(s) have been forgotten – some pill mistakes being much more likely to result in pregnancy than others. It is a huge challenge to provide comprehensive evaluation of a woman, her actual risk of pregnancy and which option might suit her best in a pharmacy situation (or a busy general practice for that matter). There are some decision-making tools available on the FSRH website under www.fsrh.org/ documents/ceu-clinical-guidance-emergencycontraception-march-2017/ Well worth a read and perhaps a printout and laminate!

EC method Cost Timing:

LNG-EC <20 euro Within 72 hrs

Efficacy:

97.8% within 24 98.7 % within 120 hrs 99.9% before hrs adjusted day 19 Up to start of LH Up to ovulation – even Up to implantation surge after the LH surge starts

Likely window of activity On-going contraceptive protection

Use with LEI

None

UPA-EC <40 euro Within 120 hrs

Cu IUCD 100-200 euro

At any time up to “adjusted day 19 of cycle”

None

Immediate

Will be affected Double dose

Will be affected but double dose not recommended Use in BMI>25 or May be affected Unlikely to be affected Wgt >70kg Double dose Breast milk Avoid for 7 days Safe impact?

Unaffected Unaffected Safe

Restarting hormone contraception afterafter UPA-EC Restarting hormone contraception UPA-EC

Method

Time until “safe “again

Most COCP’s (or patch or ring) OR Subdermal progestagen implant (ImplanonNXT) OR Injectable progestagen (DepoProvera)

Wait an additional 7 days

WAIT at least 5 DAYS AFTER USING UPA-EC then restart method of Qlaira COCP choice. Will be safe again after….

Desogestrel POP (Azalia or Cerazette)

Wait an additional 9 days Wait an additional 2 days

Modified from the FSRH Guideline; Emergency Contraception March 2017

Modified from the FSRH Guideline; Emergency Contraception March 2017

References:

References: 1. FSRH Guideline; Emergency Contraception March 2017 (updated May 2017)

emergency contraception: A randomised non-inferiority trial and meta-analysis. Lancet 2010;375(9714):555–62.

6. Brache V, Cochon L, Deniaud M,2017) Croxatto 1. FSRH Guideline; Emergency Contraception March 2017 (updated May Ulipristalby acetate ovulation 2. Contraception Your Questions AnsweredAnswered HB. 2. Contraception Your Questions (7th edition) John prevents Guillebaud & Anne more effectively than levonorgestrel: Analysis (7th edition) by John Guillebaud & Anne MacGregor of pooled data from three randomized trials MacGregor 3. Emergency contraception Gemzell-Danielsson K, Rabe T, Cheng L. in Gingerol of emergency contraception regimens. Endocrinol. 2013 March 3. Emergency contraception GemzellContraception 2013;88(5):611–18. 4. David Akintomide Danielsson K, AL, Rabe T, Cheng L.HinPresenting Gingerol risk information in sexual and reproductive health care 2013 J Fam PlanRepro’d Health Care 2016;42:213-219. Endocrinol. March

5. Glasier AF, Cameron ST, Fine PM, et al. Ulipristal acetate versus levonorgestrel for

Dr Lundy lecturer in Clinical Skills for the 4. David AL, Akintomide H Presenting A risk emergency contraception: randomised non-inferiority trial and meta-analysis. Department of International Health & Tropical information in sexual and reproductive Lancet 2010;375(9714):555–62. Medicine. She also lectures on Reproductive health care J Fam PlanRepro’d Health Care 6. Brache V, Cochon L, Deniaud M, Croxatto HB.atUlipristal ovulation Health the UCD acetate Schools prevents of Medicine, Public 2016;42:213-219. more effectively than levonorgestrel: Analysis of pooled data from three Health and Nursing & Midwifery andrandomized is a 5. Glasiertrials AF, Cameron ST, Finecontraception PM, et al. of emergency regimens. Contraception 2013;88(5):611–18. member of the 'Ask the Experts' panel for GP Buddy website. Ulipristal acetate versus levonorgestrel for


OTC Awards

53

The OTC and Retail Pharmacy

Product Awards 2019

The Irish consumerâ&#x20AC;&#x2122;s drive towards the self-care, health and beauty market shows no signs of abating, making the over-the-counter arena the jewel in the crown of Irelandâ&#x20AC;&#x2122;s community pharmacy retail sector. One of the most eagerly anticipated events in the Irish retail calendar, Irish Pharmacy News OTC and Retail Pharmacy Product Awards are the only industry awards that specifically recognises and rewards the companies and their products within the OTC market. The OTC and Retail Pharmacy Product Awards act as a celebration and showcase of product innovation, marketing and value to its customer. Originally launched in 2008, they are designed to recognise product development and innovation in the pharmacy sector. Over the following pages, we showcase those products which have been shortlisted as finalists across 22 categories, including Best Beauty Product, Best Product Marketing Campaign, Best Baby Product, and Best Product Innovation. As pressure on hospitals and doctors in Ireland grows, so does the emphasis on the pharmacist as the first link in the healthcare chain. Pharmacy services, diagnostic

testing and of course over-thecounter medicines and remedies now have a larger role to play that ever before. The pharmacy retail market has never been stronger. The OTC market is continuously faced with threats from large supermarkets and budget retail chains. Product knowledge, education and marketing are factors that the retail pharmacist must develop a firm strategy for. The OTC Awards mark the standards of excellence and investment into product marketing that pharmacists use to add value to their customers. With outside retailers and the buying power of symbol groups ever on the increase, innovation across the OTC market is crucial. With the rise of the internet as both reference and shopping tool, consumers are now managing more and more ailments without the help of either doctor or pharmacist. However, the pharmacist does still have a key role to play in helping their customers make informed healthcare decisions.

With a greater emphasis being placed on self-care and self-medication, so is the emphasis placed on consumers and patients to ensure they select product that are safe and effective for their needs. All products entered will now be judged by an expert judging panel, which has been drawn from independent and multiple pharmacies across Ireland, during our official judging evening in the Clayton Hotel, Burlington Road Dublin The 2019 Awards will take place on March 7th in the Radisson Blu Hotel, Golden Lane, Dublin with over 150 Independent Pharmacists, Buyers, Distributors and suppliers expected in attendance.

PHARMACYNEWSIRELAND.COM


2019 & Retail Pharmacy Product Awards

Best Allergy Product

Cetrine Allergy

Cetriz

Cetrine Allergy is Ireland’s favourite allergy relief product, having been number 1 at pharmacy for the last 5 years (Source: IMS Data, 2014-2018). Cetrine Allergy is available in a 7 and 30 pack, exclusive to pharmacies.

Cetriz 10mg Film-coated Tablets contains the active ingredient Cetirizine dihydrochloride 10mg. It is indicated for the relief of nasal and ocular symptoms of seasonal and perennial allergic rhinitis and relief of chronic idiopathic urticaria.

Taking only one tablet of Cetrine Allergy provides fast effect relief of allergies and 24-hour control. Cetrine Allergy has been Ireland’s favourite allergy relief for many years and from our base in Bantry, each year we continue to further develop the OTC brand.

Features: • Available in a 7 and 30 pack. • Can be divided into equal halves • Can use from age 6 upwards • No expected interactions with other medicines • Supplied through pharmacies only

Our unique selling points for Cetrine Allergy include:

Benefits include: • Easy dose adjustment • Reduces need for separate formulations • Easy to swallow and can be used with other medications

• 24 hr control.

The global allergic rhinitis drugs market is expected to post a CAGR of nearly 4% during the period 2019-2023, according to the latest market research report by Technavio.

• Fast relief of allergies. • One tablet per day.

Always read the leaflet carefully. Contains Lactose.

Cetrine Allergy also relieves the symptoms of urticarial (hives) and pruritus (itching of the skin).

Patients should ask their pharmacist or doctor for advice.

A key factor driving the growth of the market is the increasing awareness about allergic rhinitis. The increasing awareness improves patient access to the treatment in the early stages of the disease. It also increases the chances of accurate diagnosis. Globally, the prevalence of allergic rhinitis has increased due to which there has been an increase in the number of initiatives to increase understanding of the disease.

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Nasacort

Zirtek

Nasacort is an intranasal corticosteroid that offers superior relief in nasal hay fever/allergic rhinitis symptoms compared to intranasal anti-histamines and oral antihistamines. The active ingredient is Triamcinolone Acetonide and it is indicated for relief of nasal congestion, sneezing, runny nose and itchy nose.

Zirtek is an established, market leading, second generation antihistamine that features the proven, non-drowsy active ingredient cetirizine dihydrochloride.

Nasacort Allergy Spray is a once-a-day treatment. It starts working from day one and is clinically proven to significantly improve nasal symptoms as early as 12 hours after the first dose. It stays where it is sprayed, with a unique patented thixotropic formula for an optimal effect. To support the new launch and ensure that it is successful, the business has invested significantly to start building the Nasacort brand within a highly competitive market. As the market is highly seasonal, the communication was targeted during the hay fever season when it is most relevant to consumers.

Zirtek Oral Solution provides effective round the clock relief from the symptoms of hay fever and other allergies in a single treatment, specially formulated for children and adults aged two and above.

Marimer Nasal Hygiene MARIMER NASAL HYGIENE is a seawater solution naturally high in mineral salts and marine dietary elements. The formula helps to decrease symptoms of allergy and facilitates the gently evacuation of nasal secretions that can sometimes make life miserable. Our nose, our primary bacterial filter, is exposed to many attacks. After entering the mucosa cells, the attacker multiplies. This is how the first signs of a blocked nose, a runny nose and sneezing begin. To combat these symptoms, the first thing to do is protect the nose from pathogenic secretions using MARIMER BLOCKED NOSE.

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2019 & Retail Pharmacy Product Awards

Best Baby Product About 65,000 babies are born in Ireland every year and over 130m globally, with parents here spending up to ¤5,000 on baby products in that first year. That’s a big market.

Elave Skincare Range – clinically safe for sensitive skin Ovelle pharmaceuticals are passionate about skincare and fundamental to our business is our customer promise of absolute purity, which means no elave product will ever contain sulfates sles/sls, MI, parabens, perfume, formaldehyde, alcohol, soaps, colours and more. Their research team continually strive to create the cleanest, safest skincare for sensitive skin. They only use purified water, all their raw materials and ingredients undergo rigorous pharmaceuticals testing before use and their formulations are safety tested to the highest standards. Made in Ireland. Pharmacy confined. Ovelle Pharmaceuticals skincare solutions for sensitive skin since 1934.

Parental care is an essential part of human nature. Parents, regardless of the level of wealth, always want to give the best to their children. In Ireland, much like the rest of Europe, parents are spending more on their children, offering a wealth of opportunities for babies’ and children’s products.

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KidsClin Cradle Cap From the makers of PoxClin® Sensitive Cool Mousse. Pharmed are delighted to introduce the new KidsClin® Cradle Cap Treatment Kit that offers everything needed for the effective treatment of Cradle Cap. Cradle Cap (Infantile Seborrhoeic Dermatitis) is a very common condition. Formulated to remove, treat and prevent Cradle Cap, the kit includes a deep-acting serum, a brush with a soft sponge and a comb for instant and safe removal of scales. • Removes, treats and prevents Cradle Cap • Includes comb and brush • Child-friendly and safe For further information contact: info@pharmed.ie


Marimer Baby Nasal Spray Up to the age of 6 months, infants breathe exclusively through their nose. Good nasal hygiene for baby will help protect their nasal mucosa from external attacks and help prevent ENT infections. Using Marimer baby nasal hygiene will help the nose to breathe from birth. Marimer Baby comes with an anti-reflux valve and a very wide collar designed for the delicate anatomy of the infant's nose. Benefits of the special Baby nozzle • A gentle microdiffusion process. • A safety nozzle for non-invasive, gentle insertion into baby's nose.

Mustela

Waterwipes

Mustela Gentle Cleansing Gel is a gel that thoroughly cleanses the baby and child’s skin whilst respecting their delicate scalp. It gives a soothing effect to the skin and compensates for the drying effects of bathing.

WaterWipes® are made with 99.9% water and a drop of fruit extract, and are carefully designed to be suitable and safe for sensitive skin and even gentle enough to use on premature babies’ skin.

Suitable for baby and child. In light of their discoveries on baby and child’s skin, Mustela researchers designed a complete range for cleansing, bathing and taking care of normal skins, with an exclusive patented natural active ingredient: Avocado Perseose. Mustela have specialised in skincare products for babies and their mothers for more than 60 years throughout the world.

A baby’s skin is much more delicate than that of an adult, so it should be cleaned with the gentlest essentials possible. That is why WaterWipes, the world’s purest baby wipes, are made with just 99.9% water and a drop of fruit extract. When a baby is born, the outermost layer of their skin is incomplete, making their skin much thinner and more delicate than their parents’. Carefully designed to be gentle on babies’ sensitive skin, WaterWipes offer skincare peace of mind for everyone and they only use the purest ingredients.

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2019 & Retail Pharmacy Product Awards

Best Beauty Product Despite the prolonged doom and gloom on the high street, waning consumer confidence, restricted budgets and the shadow of Brexit challenges, the beauty sector has maintained its appeal. Indeed consumers will be prepared to pay even more over the next five years, with annual spend per head forecast to rise.

Catwalk HQ Self Tan Remover

Ella & Jo Hydrating Spray

CatwalkHQ was the result of wanting to bring a new brand to the Irish market, a brand that strives to deliver quality luxury products. All their research, development and manufacturing is carried out here in the west of Ireland and they are very proud to be an Irish company with sights on making it a global brand.

Ella & Jo Hydrating Spray is a soothing facial spritz with extracts of Chamomile, Cucumber, Witch-hazel, Aloe Vera & Green Tea. Specially formulated with mild ingredients including Hyaluronic Acid to help hydrate, condition and protect the skin.

CatwalkHQ was developed with natural nontoxic ingredients in mind, with intensive research and development and talks with consumers on the perfect tan, CatwalkHQ was born! They know the frustrations of not being able to wear tan due to different skin conditions e.g. psoriasis or eczema so this was also at the forefront of their minds when it came to developing their tan and the growth has been phenomenal. CatwalkHQ is run by a small close knit team, It’s great to see their products on the same shelves as the international brands and they have no doubt CatwalkHQ products will be joining them on a lot more shelves for a long time to come.

Innovation continues to be a significant factor in the continued growth of the beauty OTC market in Ireland. With the category remaining highly competitive, innovation is just one way to maintain consumer interest in brands.

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• Spritz on to cleansed bare skin for an instant burst of hydration. • Spritz before makeup to act as a moisturising agent • Spritz directly after makeup application to set liquid and powders giving a dewy finish to the skin • Spritz throughout the day onto bare skin or over makeup to re-hydrate the skin and re-set makeup that may have moved due to hydration levels.


Nature's Bounty® Hair, Nailner Treat Skin & Nails Gummies and Colour for Fungal Nails Nature's Bounty Hair, Skin & Nails ®

Gummies are a beauty tip that's easy to swallow. #1 Hair, Skin & Nails Brand with 50% Market Share1 in the USA!

Nailner Treat & Colour combines treatment with breathable nail polish for healthy and beautiful nails all year round.

Containing key vitamins and minerals required for luscious hair, glowing skin and healthy nails, these delicious gummies provide effortless beauty support.

Nailner Treat & Colour combines the technology of treating the infection while also covering the unsightly look on the nails allowing female sufferers to wear sandals or go barefoot with confidence.

• Convenient chewable pectin based gummies, free of gluten

Nailner Treat & Colour is an extension of the Nailner brand, however it uses the innovative formula of covering the problem as well as treating the underlying issue. Nailner is proven effective against fungal nail infections (supported by clinical studies).

• Beauty nourishing nutrients including zinc, vitamins C and E, biotin and collagen • Essential nutrients to support hair growth and a healthy shine • Delicious natural mixed berry flavour These gummies have been made with clean beauty in mind.

Fungal Nail Infections are unsightly and therefore lead to embarrassment for many sufferers particularly in the summer months when sandals are the footwear of choice. Normal nail polish can hurt or worsen the issue. Nailner Treat & Colour treats the nail fungus as the nail polish covers the problem areas without worsening the nail fungus.

The Holos Love Your Skin product is hand produced in Ireland using the finest of essential oils - Rose, Palmarosa, Benzoin resin oil and Frankincense blended with unadulterated Moroccan Argan oil. It was launched in 2014 but was made available to Pharmacy in 2017. Love Your Skin Anti-ageing Facial oil by Holos Skincare, reported by 82% of users as providing "noticeable improvements" in their skin, contains essential fatty acids that replace lost lipids, plump the skin and smooth out fine lines as well as locking water in to keep the skin hydrated. Suitable for oily, dry, dehydrated or sensitive skin, its blend of essential oils of Rose, Palmarosa, Benzoin and Frankincense are especially suited to pigmented or blemished skin.

MISSING PRODUCT NAILNER

• Essential nutritional vitamin and mineral formula to support hair, skin & nails

Holos Love Your Skin Anti-ageing Facial Oil

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CALPOL® Infant Sugar Junior Revive Free Suspension Junior Revive is a multi-vitamin for 2019 & Retail Pharmacy Product Awards

Best Children and Baby Product Parents, regardless of the level of wealth, always want to give the best to their children, and that includes looking after their healthcare needs, offering a wealth of opportunities for the overthe-counter children and baby market.

CALPOL® Infant Sugar Free Suspension provides soothing relief from pain and fever for children. It starts to work on fever in just 15 minutes but is still gentle on delicate tummies and can be used from 2 months. Each pack comes with an easy dose syringe. CALPOL® Infant suspension is part of the CALPOL® range of products for children’s illnesses and symptoms. The CALPOL® range contains products for infants from 2 months and children from age Six Plus. CALPOL® pain and fever relief comes in a variety of handy packs such as Infant Suspension Sachets and SIXPLUS™ Fastmelts for on the go. The CALPOL® range also includes congestion relief products made up of blocked nose sprays, saline drops and vapor plug in device. CALPOL® has been supporting parents and carers for over 50 years. CALPOL® is the number one brand for children’s pain relief in pharmacy* and the number one in the total market**. *IMS MAT Nov 2018 **IMS MAT Nov 2018, combined with Nielsen Scantrack MAT Dec 2nd 2018.

Health and personal care products for children and babies cover a wide range of needs including hygiene, skin and hair care, wound care and oral health. The demand for these products will be market specific and dependent on lifestyle and family issues. For example, although mothers increasingly recognise the benefits of breastfeeding, those who need to resume working quickly still rely on infant formula.

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children aged 5-12 years of age. Benefits include immune support, brain function, bone development and heart health. Junior Revive is a brand extension of Revive Active Super Food Supplement. The company received calls on a regular basis from parents who were using Revive Active and enjoying the benefits, wanting to know if their children could take Revive Active as well. This repeated request prompted the Revive Active R&D Department to start working on a formulation that was specifically created for children and that is how Junior Revive came about. While researching the formulation the Director of R&D discovered a revolutionary ingredient called Wellmune, which is supplied by the Kerry Group. The formula includes the recommended daily dose for this age category of 50mg of Wellmume. Find out more about this ingredient at https://www.wellmune.com/.


Mustelaâ&#x20AC;&#x2122;s unique and gentle Stelatopia Foam Shampoo is specially designed to clean the hair and scalps of babies with eczema-prone skin. Their tear-free and pH balanced formula is enriched with a blend of Sunflower Oil Distillate, to soothe and moisturise, and Avocado PerseoseÂŽ, a patented natural ingredient to help protect and strengthen baby's delicate skin. This is a Brand Extension on the Mustela Stelatopia Range. Mustela developed this range to combat the fact that Atopic dermatitis or atopic eczema affects 1 in 5 children, starting at birth! Mustela have specialised in skincare products for babies and their mothers for more than 60 years throughout the world.

Nurofen for Children Nurofen for Children have been supporting parents for over 20 years by providing effective relief for children suffering from pain, fever and cold and influenza. The ibuprofen based oral suspension provides relief for children. It starts to work in just 15 minutes and lasts for up to 8 hours for fever. Nurofen for Children is recommended by 9 out of 10 mums*. Full prescribing information available on www.medicines.ie *Survey by Empathy carried out in Ireland on 121 mums who would recommend Nurofen for other parents. (August 2013)

Wartie Cool Wart & Verucca Remover Wartie Cool Wart & Verucca Remover, which falls under the Wartie umbrella, is an easy to use wart remover home treatment suitable for children aged 4+ and has the strongest claims in the market among the OTC treatments. These claims include - As fast as 1 application - Best freezing performance - Precise & Safe Application - No harm to surrounding skin - Innovative & Easy to use. Thanks to the ingenious design, the treatment of a wart with Wartie can be accelerated without the skin coming into direct contact with the liquid gas in the spray can. Because cold releases through a metal tip, the freezing can be controlled by the amount of pressure exerted on the canister during treatment.

MISSING PRODUCT NAILNER

Mustela Stellatopia Foam Shampoo

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2019 & Retail Pharmacy Product Awards

Best Cough, Cold and Flu Product The cold and flu season represents one of the biggest revenue generators for the over the counter products market. Global consumer spend was $29 billion (source: IQVIA OTC Global Analysis) in 2017 and growing demand of these products are expected to continue for the next five years.

Alchemlife PhytoRelief-CC™

BENYLIN® Day and Night Tablets

Alchemlife PhytoRelief-CC™ is a clinically tested, herbal food supplement (12 lozenges), that is a blend of natural active ingredients selected, formulated and tested to help manage your day; as a seasonal immune support.

BENYLIN® Day and Night tablets are the number one cold or flu remedy product in Ireland* and are the only day & night tablets for 24 hour cold and flu relief. Each white tablet contains 500mg Paracetamol and 60mg Pseudoephedrine hydrochloride. Each blue tablet contains 500mg Paracetamol and 25mg Diphenhydramine hydrochloride. BENYLIN® Day and Night Tablets provide the consumer with different benefits for different usage occasions. The pack contains Day Time Tablets and Night Time Tablets. Day time tablets are to be taken in the morning, afternoon and evening, to provide relief from symptoms so the sufferer can get on with their day. The night time tablet relieves fever and aids a good night’s sleep. Each pack contains 12 ‘’day’’ tablets and 4 ‘’night’’ tablets. BENYLIN® DAY & NIGHT tablets are part of the BENYLIN® portfolio of products.

Containing Pomegranate, Turmeric and Ginger extracts that work in harmony to help support immune function. Ginger extract helps to maintain a healthy respiratory tract and Gingerol, the active ingredient is known for its anti-inflammatory properties. Turmeric which for centuries has been boiled with milk in Ayurveda medicine to relieve winter ills, helps to control inflammatory response and Pomegranate contains antioxidants such as tannins, anthocyanins and ellagic acid. For further information contact: info@pharmed.ie

It is a huge market, but players also face stiff competition and have a limited window of opportunity to generate these sales. This puts huge pressure on marketing, sales and distribution teams to maximise category management and secure the right “share of shelf,” or risk losing their market potential.

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*IMS – Value sales, Cold or Flu Remedies, MAT Nov 2018.


Lemsip

Bronchostop

Perrigo

Lemsip is the number one cold and flu brand in Ireland* and its range of effective cold and flu remedies have been tried and trusted for generations.

Bronchostop is used for the relief of any cough based on traditional use. If consumers don’t know what type of cough they have or if their cough changes from one to another, Bronchostop takes the hassle out of finding a solution.

Perrigo Cold & Flu products are a new branded product from Perrigo. It is the first Perrigo branded product in Ireland.

Over the years the product range has extended, and it offers a wide range of formats from capsules, tablets and liquids to the more traditional hot drink sachets, so you can recommend a product that best suits your patient’s combination of cold and flu symptoms - whether they are aches and pains, sore throat, cough, blocked nose etc. Full prescribing information available on www.medicines.ie *Based on IMS unit sales, MAT January 2018

Bronchostop’s unique combination of ingredients is traditionally used for the relief of any coughs such as chesty coughs and dry, tickly, irritating coughs and phlegm. Whether a consumer prefers using a syrup at home or convenient pastilles on the go, it is available in a choice of formats. Since launching Bronchostop, marketing campaigns have been awareness driven. The pharmacy team plays a vital role in helping customers to take the confusion out of cough by assessing coughs in pharmacy.

Perrigo has launched a total of six products. These are across two categories. Four products were launched in the Cold & Flu category while the other two are in the analgesic category. 1) Perrigo Cold & Flu Tablets 2) Perrigo Cold & Flu Multi-Relief Capsules 3) Perrigo Cold & Flu Multi-Relief Max Powder for Oral Solution 4) Perrigo Cold & Flu Powder for Oral Solution 5) Perrigo Paracetamol 500mg Film-Coated Tablets 6) Perrigo Ibuprofen 200mg Coated Tablets Perrigo went live on TV from launch in October 2018 and will continue to the end of February. The team have also launched a website PerrigoProducts.ie which allows the brand to connect to consumers on their products.

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Alflorex Only Alflorex contains the unique 35624® bacterial culture:

2019 & Retail Pharmacy Product Awards

Best Digestive Product Gut health is top of mind for consumers. They are thinking more carefully about it, and actively seeking products to feel better. As a result, trends in the digestive health space are tracking more closely to others than ever before.

 proven in 2 landmark double-blind placebo controlled clinical trials in Europe. Subsequent publication in leading journals (Gut, Gastroenterology). Over 2000 citations of these papers to date.  impact demonstrated on ALL the cardinal symptoms of IBS  a best seller in the IBS category, endorsed by the experiences of thousands of Irish consumers  the No 1 recommended culture by Gastroenterologists and Doctors in the US In addition, this natural culture has a safety profile equivalent to placebo. It can be taken with antispasmodics, antidiarroheals, laxatives and peppermint oil.

With the strong influence of social media in the daily lives of consumers, both young and old, information regarding healthier lifestyle choices is now easier to access. The health and wellness trend continues to rage in Ireland and as a result of this trend a greater number of consumers started eating healthier foods, taking vitamins and supplements and exercising more.

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Bio-Kult Advanced Multi-strain Bio-Kult is a scientifically developed multispecies, multi-strain supplement with 14 strains of beneficial bacteria. This means that Bio-Kult can deliver high concentrations of beneficial bacteria to the colonisation sites in the gut and therefore be able to help a more diverse range of digestive disorders. Bio-Kult has been proven to survive the high acidity of the stomach, does not need to be refrigerated, it is gluten free, suitable for children & pregnant women (always consult doctor first). It has also been clinically proven to reduce IBS gut symptoms* - 69% decrease in abdominal pain, 86% decrease in moderate to severe symptoms & 33.7% said their symptoms completely disappeared after 16 weeks.


Buscopan® Tablets

Dulcolax®

DulcoSoft

Buscopan® Tablets is an antispasmodic that specifically target the source of abdominal cramping or the pain and discomfort associated with IBS. It starts to work within 15 minutes, acting directly on the muscle spasm in the bowel to quickly and effectively relieve painful cramps and discomfort.

Dulcolax®, the world’s No: 1 selling laxative*, is an effective solution to relieve occasional constipation. Suitable for adults and children from 10 years; Dulcolax® should be taken before bed for a predictable overnight relief within 6-12hours. Available in small size, Dulcolax® bisacodyl tablets are easy to swallow and their gastro-resistant comfort coating ensure it only works where needed.

DulcoSoft®, the latest innovation from the Dulco range, is a gentle yet effective solution for comfortable relief of constipation. DulcoSoft® is suitable for all the family including children from 2 years*, pregnant* and breastfeeding women*. DulcoSoft® contains macrogol, which binds with the water to soften the stools and make evacuation more comfortable. Also, sugar-free and gluten-free, the flavourless solution, can simply be added in a drink once daily in the morning.

Buscopan can be used at the first sign of a flare-up as needed as very little is absorbed into the bloodstream. It is also unlikely to cause any side effects such as drowsiness.

Dulcolax® was supported with 360 campaign including a new TV and PharmaSeen, as well as new trade advertising and detail aid to support the pharmacist on how to recommend the right Dulco product at the right time to the right patient. *based on sales data. Full product details available on www.medicines.ie

DulcoSoft® was supported with 360 campaign including TV, PharmaSeen, educative consumer leaflet and point of sales as well as trade advertising and detail aid to support the pharmacist recommending DulcoSoft®. *For children 2-8 years, pregnant and breastfeeding women, advice from a GP is recommended. Not for children under 2 years.

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Blephaclean 2019 & Retail Pharmacy Product Awards

Best Eye Care Product Consistently strong growth is expected within the OTC Eye Care market in the future. Screen time is having a negative impact on consumersâ&#x20AC;&#x2122; eyes, which often dry out and become sore. Innovation is likely to also fuel growth over the coming years. Many Irish consumers suffer from eye conditions such as blepharitis, where the eye lid becomes blocked and enflamed. Furthermore, Ireland experienced a prolonged period of hot weather last year, with temperatures soaring above average and partial drought conditions being experienced across most of the country. This had a positive impact on overall sales of allergy eye care in particular as demand increased due to the high pollen count in the country.

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Blephaclean is a preservative free medical device, clinically proven to provide symptomatic relief from; Blepharitis, Meibomian Gland disease, Chalazion and Ocular Surface Disease e.g. Dry Eye. Blephaclean contains 20 individual sterile eyelid wipes and can be used on children from 3 months or older. Blephaclean wipes are impregnated with an aqueous Micelle solution to gently absorb debris and impurities, Sodium Hyaluronate a natural moisturiser, Centella Asiatica a natural restorative agent for skin and Iris Florentina which helps to regulate the oil production on the eyelids. There is no need to rinse after use.


Hy Opti

Macu-SAVE™

Thealoz Duo

Hy-Opti Eye drops are a moisturising ophthalmic solution available in 10ml and 20ml containing sodium hyaluronate.

Pharmed in partnership with Fighting Blindness are delighted to introduce Macu-SAVE™, a once a day, easy to swallow; food supplement, which provides advanced nutrition for the eyes.

Thealoz Duo is a preservative free drop for dry eyes which hydrates, lubricates and protects the ocular surface. Thealoz Duo contains Sodium Hyaluronate and Trehalose which when combined are clinically proven to increases tear film thickness for longer than Sodium Hyaluronate alone.

Hy-Opti Eye Drops are preservative free and provide soothing relief from the effects of dry-eye. The unique selling points for Hy-Opti include: • Fast acting moisturising ophthalmic solution • Available in 10ml and 20ml • Hy-Opti Eye Drops are preservative free and provide soothing relief from the effects of dry-eye. The product is innovative as we offer two strengths, 10ml and 20ml at a lower cost than the brand leader • Investment for the brand includes: • Trade advertising with IPN. • Pharmacy flyers.

As we grow older our eye health comes under increasing pressure and in particular; the macular, the most delicate part of the retina can become damaged. Boosting the diet and enriching the macular pigment with all three key macula carotenoids; 10mg Lutein, 2mg Zeaxanthin and 10mg Meso-Zeaxanthin. These are found in high concentrations at the back of the eye within the macular pigment, which protects against damaging visible blue light or oxidative stress.

Thealoz Duo contains a unique ingredient Trehalose which uniquely protects cell membranes from extremes of dryness, cold, heat and hyperosmolarity. Thealoz Duo 10ml comes in a patented easy to use ABAK bottle and requires 3 times less force than other preservative free bottles; meaning it is ideal for patients with dexterity issues.

For further information contact: info@pharmed.ie and visit: www.fightingblindness.ie

• Information leaflets.

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John Frieda Original Serum 50ml 2019 & Retail Pharmacy Product Awards

Best Hair and Scalp Health Product

Instantly eliminates frizz and transform your hair from frizzy to smooth with our iconic, award-winning hair serum. A few drops protect and create a barrier against frizz. This anti-frizz serum protects each strand against the on-set of frizz, smoothes, hydrates and tames while providing heat protection, so that you can take on each day with long-lasting, smooth styles. Containing film-forming silicones, it seals in moisture, hydrates dry hair leaving your hair glossy, soft and manageable and helping to prevent it from getting frizzy. Suitable for all levels of frizz. Safe for colour-treated and chemically-treated hair.

Research has demonstrated that consumers are becoming more confident in asking for advice about hair and scalp problems. There has been much media coverage about imminent â&#x20AC;&#x2DC;curesâ&#x20AC;&#x2122; for baldness but this media speculation proves that the hair and scalp category is an important area for shoppers. The category has witnessed new product development over the last 12 months and this is expected to continue. Whilst hair care has registered a marginally slower retail value growth recently but economic recovery should see the sector increase.

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Luna The LUNA by Lisa Jordan brand was launched in September 2017 with a range of lip glosses. In December 2017 the brand launched the leave-in treatment, which has become the most popular product to date. Since then the brand has also released a range of lipsticks, eyeshadows, a makeup bag and a face palette - all of which have had phenomenal reviews throughout the country. Lisa Jordan began her career as a Beauty Therapist, but always had a passion for makeup. She moved from a Beauty Therapist to a Makeup Artist with MAC Cosmetics. During this time she also launched her own fashion and beauty blog both of which led to creating the LUNA brand. She now works full time as a mother, blogger and product creator with big plans for 2019.


Viviscal Developed by a Scandinavian professor who studied the habits of the Inuit people in the Canadian Artic. He observed that they had beautiful, full, shiny hair as a result of their protein-rich diet. He went on a quest to isolate these proteins to make them available for everyone who wanted beautiful hair. And so Viviscal was born. Viviscal has been researching the science of hair for the last 25 years and have developed one of the most researched hair growth food supplements. The efficacy of Viviscal food supplements are supported by 11 clinical trials. Key ingredients are AminoMarC, AnaTel Complex and Silica (horsetail extract).

Elave Sensitive Shampoo

Bioskin Haircare Range

Elave sensitive shampoo is an extremely gentle, sulfate free shampoo suitable for all hair types including dry, damaged, coloured and heat processed hair. The easy to lather formula, combined with conditioning Polymers and natural Glycerin cleanses and repairs hair providing immediate and lasting scalp comfort, leaving hair shiny, soft and easy to style.

Salcuraâ&#x20AC;&#x2122;s Omega Rich Sea Buckthorn Shampoo & Conditioner have been a firm favourite for those with sensitive scalp who are looking to avoid harsh, scalpupsetting chemicals. Both harmonising products are packed with Omegaâ&#x20AC;&#x2122;s 3, 6, 7 & 9 and other vital skin-essential nutrients to help soothe, moisturise and protect the scalp.

Contains camomile to soothe dry irritated scalp and to protect scalp from dryness and flaking. Dermatologically approved, Kind to eyes and suitable for use during pregnancy. Made in Ireland by Ovelle Pharmaceuticals.Pharmacy confined.

People with irritated, itchy and flaky scalp conditions will find relief in using these products. The products do not contain any Steroids, Paraffin, Sodium Laureth Sulfate and Sodium Laurel Sulfate (SLES & SLS), Parabens, Petroleum Jelly, Diethanolamine (DEA), Phthalates or Synthetic Fragrances. They are also suitable for people who may be prone to eczema and psoriasis on the scalp.

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Alflorex 2019 & Retail Pharmacy Product Awards

Best Irish Pharmacy Brand Product

The bacterial culture in Alflorex® was discovered and developed in Ireland by an Irish company, Alimentary Health/ PrecisionBiotics. This Irish product is now one of the bestselling products in the IBS category, supported by • landmark double-blind placebo controlled clinical trials in people with IBS and subsequent publication in leading journals (Gut, Gastroenterology) • impact on ALL of the cardinal symptoms of IBS • the experiences of thousands of Irish consumers Now the No: 1 recommended culture by Gastroenterologists and Doctors in the US.

In an increasingly borderless world, many consumers are favouring Irish pharmacy brand products. Research has shown that a brand’s country of origin can be as important as other purchasing criteria such as price and quality with many Irish pharmacy shoppers wanting to support local businesses, finding local more trustworthy and more attuned to their needs and wants. With OTC Products available from global companies also, Irish brands must work hard to establish themselves in order to get ahead of the competition.

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Elave Skincare Range – clinically safe for sensitive skin Ovelle Pharmaceuticals are passionate about skincare and fundamental to their business is their customer promise of absolute purity, which means no elave product will ever contain sulfates sles/sls, MI, parabens, perfume, formaldehyde, alcohol, soaps, colours and more. Their research team continually strive to create the cleanest, safest skincare for sensitive skin. They only use purified water, all our raw materials and ingredients undergo rigorous pharmaceuticals testing before use and the formulations are safety tested to the highest standards. Made in Ireland. Pharmacy confined. Ovelle Pharmaceuticals skincare solutions for sensitive skin since 1934.


Green Angel Seaweed & Collagen Face Cream Green Angel Seaweed & Collagen Face Cream combines four hand harvested Organic Irish seaweeds and Botanical Collagen. This special formulation gives an altogether luxurious product which will help to visibly firm and minimise the appearances of fine lines, for a smooth, radiant, younger looking skin. Full of vitamins and minerals, Green Angel Seaweed & Collagen cream contains vitamins A, B, C and E. It is also rich in potassium, calcium, iodine, magnesium and iron. Completely unique to Green Angel in all their face care products is an organic blend of root and flower extract to soothe, tone and brighten the spirit.

Sudocrem

Panadol

Sudocrem Antiseptic Healing cream has been manufactured in Dublin since 1931. Exported to over 40 countries worldwide, the product has reached iconic status with the Irish consumer.

Panadol includes variants Panadol Extra, Panadol Base, Panadol Actifast and Panadol Night.

Sudocrem Antiseptic Healing Cream contains the active ingredients, Zinc Oxide, Lanolin, Benzyl benzoate, Benzyl alcohol, Benzyl cinnamate. Sudocrem is used to treat nappy rash, eczema, bed sores, sunburn, minor burns, surface wounds, acne and chilblains. Always read the label carefully.

For the first time, Panadol’s Irish heritage was brought to life through an innovative new brand campaign focusing on the fact that Panadol is Made in Ireland called ‘This is what we’re made of’. The campaign, which launched in September 2017, celebrates the brand’s Irish manufacturing ties and what it believes has been its “best-kept secrets”: namely that its manufacturing site, GSK in Dungarvan produces over 6 billion Panadol tablets every year, exporting to over 70 countries worldwide. The campaign features employees from the Waterford site, and aims to highlight its strong ties to Ireland and celebrate the Irish team who are such a big part of the brand’s global success story. Panadol continued focusing on its Made in Ireland campaign in 2018.

New convenient pack format

Always read the label carefully

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2019 & Retail Pharmacy Product Awards

Best Launch of the Year Product

Lemlift

Perrigo

Lemlift is a food supplement with Vitamin C and Zinc to help support the normal function of the immune system. The Lemlift range was launched in September 2018 with in store FSDUs and sampling and a TV and Digital campaign.

Perrigo Cold & Flu products are a new branded product from Perrigo. It is the first Perrigo branded product in Ireland.

The Lemlift range is related to the well-established Lemsip brand. However, it is a food supplement that supports a healthy immune system, as appose to a medicine. Lemlift is available in two different formats; chewable and effervescent tablets. Lemlift offers Vitamin C and Zinc to help support the normal function of the immune system. Lemlift offers a combination of Vitamin C and Zinc. Our bodies cannot produce or store Vitamin C and Zinc. Vitamin C and Zinc are critical to the normal function of the immune system.

When launching a new product there are several steps to success that are crucial for any business, taking time and careful planning. These include understanding your target audience and how to reach them effectively, looking at what makes your product innovative or different and unifying the product team across all channels, whether itâ&#x20AC;&#x2122;s marketing, social media or sales. The finalists in this category have demonstrated that consistency is key when launching a new product within the OTC market.

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Perrigo has launched a total of six products. These are across two categories. Four products were launched in the Cold & Flu category while the other two are in the analgesic category. 1) Perrigo Cold & Flu Tablets 2) Perrigo Cold & Flu Multi-Relief Capsules 3) Perrigo Cold & Flu Multi-Relief Max Powder for Oral Solution 4) Perrigo Cold & Flu Powder for Oral Solution 5) Perrigo Paracetamol 500mg Film-Coated Tablets 6) Perrigo Ibuprofen 200mg Coated Tablets Perrigo went live on TV from launch in October 2018 and will continue to the end of February. The The team have also launched a website PerrigoProducts. ie which allows the brand to connect to consumers on their products.


TePe GOOD Introducing TePe GOOD - A new toothbrush with the same qualities, design and feeling, as you would expect from TePe, but made from 96% bio-based plastic. Thanks to the use of good renewable raw materials sugar cane and castor oil, they manage to recirculate up to 95% of the CO2 emissions during its life cycle. Naturally, it’s produced with 100% green energy, partly from their own solar panels. Good for the environment and Good for you.

Nature's Bounty® Hair, Holos Skincare Skin & Nails Gummies The 'This is More' range from Holos With nearly 50 years of combining innovation with the finest ingredients, to provide supplements of unsurpassed quality and value, the USA #1 Pharmacy brand* launched to the Irish market. Nature's Bounty® Hair, Skin & Nails Gummies contains key vitamins and minerals required for luscious hair, glowing skin and healthy nails. These delicious chewable gummies provide effortless beauty support and have been made with clean beauty in mind, free of gluten, artificial colours and flavours. • For luscious hair, glowing skin and healthy nails

Skincare is a multi-use range of products that focuses on MORE simplicity, MORE functionality and MORE fun in skincare. Each product contains active plant ingredients that feed the skin to improve its health and help prevent the signs of ageing. Each 'This is More' product has several uses. The multi-use plant oil is a cleansing oil, makeup remover, facial oil or masque, bath oil or body oil. The Hyaluronic Face and Eye serum provides hydration for both face and eyes meaning you dont need seperate products and The Get Better Butter is a rich dry skin treatment for face, hands and body.

• Delicious chewable gummies • With zinc, biotin & collagen

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2019 & Retail Pharmacy Product Awards

Best Marketing Campaign Marketing campaigns are the perfect way to reach customers, clients, and leads. They can be the game-changing move. Producing campaigns with a series of touchpoints will grab someone’s attention better than a single advertisement. With a need to break through the clutter when promoting a product, an effective marketing campaign can do that for you.

Nasacort

NiQuitin Quit to Fit

Nasacort is an intranasal corticosteroid that offers superior relief in nasal hay fever/allergic rhinitis symptoms compared to intranasal anti-histamines and oral antihistamines. The active ingredient is Triamcinolone Acetonide and it is indicated for relief of nasal congestion, sneezing, runny nose and itchy nose.

NiQuitin offers a range of products specifically designed to help customers stop smoking. NiQuitin aims to partner with all pharmacies ensuring that their staff and comfortable in the recommendation of all NRT products which best suit their customer’s needs. The Quit to Fit: 10-week programme centred around three core pillars: Weekly Health and Fitness Challenges, designed to improve health and help to distract from cravings; Motivational Support, support on the psychological impact of quitting smoking; NRT Support, information and education on NRT showing how to use supports successfully to complete the smoking cessation journey.

Nasacort Allergy Spray is a once-a-day treatment. It starts working from day one and is clinically proven to significantly improve nasal symptoms as early as 12 hours after the first dose. It stays where it is sprayed, with a unique patented thixotropic formula for an optimal effect. To support the new launch and ensure that it is successful, the business has invested significantly to start building the Nasacort brand within a highly competitive market. As the market is highly seasonal, the communication was targeted during the hay fever season when it is most relevant to consumers.

The Best Marketing Campaign Award recognises a marketing, PR or advertising campaign that has proved to be original, innovative and particularly effective. This can be a one-off campaign or part of a sustained strategy.

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A Point of Sale (POS) kit highlighted the launch of the new advertising campaign, developed with the consumer journey in mind, taking into account all the opportunities to engage the shopper.

Motivational Support - We enlisted Lifestyle and Ad psychological impact of quitting smoking. Through a range of emotions smokers experience during their participants and readers to stay on track Advertising:  NRT Support - NiQuitin supported our participants t Perrigo cr eated a ne w to test imon education on NRT showing use suppor Feb, ial ca May-Juthem ne, anhow d Au gSep-Oct. Th journey Out of Home, search and go ogle ad Social Media - Social Media is a key medium to directly-w digital campaign, we closely followed our participants th home audience through social media. This involved send Instagram stories and encouraging our core participants using the Quit to Fit hashtag. 

Measuring Results - To ensure we had a real and accura V02 fitness tests were conducted on each participant at to document any change in their fitness

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Solgar Campaigns

Cetrine Allergy

NiQuitin

For more than 70 years Solgar have had one vision to develop the most trusted brand in health and wellness, providing solutions for all life stages. Today, they have more innovated products in more global markets than any other vitamin brand, that meet our industry recognised “Gold Standard” for excellence. This is shown and maintained in all their marketing campaigns to show their standards of excellence and what they are best known for. In fact, 98% of Solgar consumers state they would recommend the brand.*

Cetrine Allergy is Ireland’s favourite allergy relief product, having been number 1 at pharmacy for the last 5 years (Source: IMS Data, 2014-2018). Cetrine Allergy is available in a 7 and 30 pack, exclusive to pharmacies.

NiQuitin offers a range of products specifically designed to help customers beat both the underlying physical addiction and sudden cravings.

Their supplements use naturally sourced ingredients, free from sugar, salt & starch, whatever your lifestyle choice: vegan, vegetarian, gluten-free or dairy free there is a supplement for you.

• Sponsorship of the Pollen Report and Pollen tips on TV3 Weather.

Cetrine Allergy is supported at pharmacy level with a robust marketing campaign. Activities include: • Nationwide TV campaign featuring their 20” ad. Comprising of over 300 hours of advertising.

• Summer long Window Displaycompetition which always has a huge uptake with Pharmacists.

Most of the products are kosher and halal certified.

• Trade advertising campaign with IPN.

*Global Praxis online shopper survey 2017, which included 3,882 VMS consumers.

• Cetrine Allergy window display material available for free and installed by a member of their merchandising team.

Marketing for NiQuitin has covered a number of initiatives. A series of adverts for the NiQuitin Mini Lozenges were ran in several trade magazines with the caption “They’re Back” in the months coming up to launch. Field Sales Force were out in trade delivering high end training, not only on the NiQuitin range, but also on the NRT category. In order to ensure accurate benchmarking to track participants’ progress, V02fitness tests were conducted on each participant the beginning and end of the 10-week programme to document any change in their fitness. Point of Sale (POS) kits to highlight the launch of the new advertising campaign were developed.

POS which is readily available for free to the pharmacist.

Beauty is in our nature Skin, Nails and Hair Formula with vitamin C, zinc and silica nourishes your body from within for inner wellbeing that shows.* Find out more at solgar.co.uk or find us on social media at @solgaruk1947 Unlock the power of nature from within

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

Facebook “f ” Logo

CMYK / .eps

Facebook “f ” Logo

CMYK / .eps

Social icon

Rounded square Only use blue and/or white. For more details check out our Brand Guidelines.

SG0150

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Back to Your Best De Facto with Active Iron & B De Facto is a 100% natural shaving oil gives you the closest shave you’ll Complex Plus for Men which ever experience, and its kind to your skin, ®

2019 & Retail Pharmacy Product Awards

Best Men's Product There remains an urgent need to maintain a specific focus on men’s health. This is grounded in continued sex differences in life expectancy and mortality, health inequalities between different subpopulations of men, a substantial body of evidence supporting a gender-specific approach to engage more effectively with men, and the imperative to build on progress achieved to date.

Active Iron & B Complex Plus for Men is specially designed for men to help boost energy levels*. It combines the ground-breaking Active Iron protein formula with high strength B vitamins. Active Iron for Men has clinically proven twice the absorption of standard ferrous sulfate** and is non-constipating. It contains a specially formulated B Complex with targeted delivery system to improve absorption. Active Iron for Men supports muscle function***, mental performance**** and immunity*****. Active Iron & B Complex Plus for Men helps you get back to your best. * Iron Vitamin B1, B2, B3, B5, B6, B12 cotribute to normal energy yielding meabolism in the body ** Wang et al, Acta Haematologica 2017; 138: 223232. **** Biotin & Zinc support healthy skin whilst selenium & Zinc supports healthy hair & nails ***Vitamin D contributes to the maintenance of normal muscle function ****Vitamin B5 contributes to normal mental performance ***** Vitamins A, C, and D contribute to the normal function of the immune system

What is clear, is that many forces shape men’s health behaviours and lifestyle routines, but what is not always well recognised is that men do want to talk about their health and are becoming more confident in doing so.

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making razor cuts a thing of the past.

If you’re one of the millions of people who view shaving as a dreaded task, and who are left afterwards with sore and bumpy skin – De Facto® will change your life. Yes, change your life. Given that the average man spends a total of around 150 days of his life shaving, we know you deserve a more pleasant experience. And we’ve done something about it! Each 25ml bottle contains sufficient oil for over 200 incredible shaves and lasts at least 5 times longer than your average can of foam or gel!


Gillette Skinguard

Perspirex

Gillette® SkinGuard is Gillette’s first razor specifically designed for men with sensitive skin and razor bumps. The razor shaves hair and protects the skin thanks to its unique SkinGuard positioned between the blades. It works to minimise tug and pull and cut hair at skin level, helping to prevent irritation.

Perspirex for Men Regular is the first extra-effective antiperspirant available to the male segment.

The precision trimmer on the back is great for hard-to-reach areas and styling facial hair. For great results, use with SkinGuard Sensitive by shaving gel or SkinGuard Sensitive shaving foam.

Perspirex for Men Regular controls odour and is clinically proven to provide extra-effective protection against sweat for 3-5 days. Perspirex for Men Regular features an active skin care system which improves skin comfort. The perfume-free formulation is clinically proven to provide superior protection from sweat and odour, ensuring maximum dryness.

Proceive® Advanced Fertility Supplement Proceive® is the result of 5 years research using clinical data from over 600 studies highlighting there was a need for an advanced fertility supplement for both men and women with high level nutrients. The Proceive® men’s range is available in two variations so that, whatever stage the man is at trying for a baby, he has a choice with the range. Proceive® Men’s Capsules, superior formulation contains 26 key nutrients specially tailored for men when they are deciding to start trying for a baby. Proceive® MAX Sachets, the highest level dosage formulation, contains 33 key nutrients (including Omega 3 DHA) specially formulated for men over the age of 40 or for men who have been trying for a baby for one year or more.

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Eskimo Brain 3.6.9 2019 & Retail Pharmacy Product Awards

Best Natural Product More and more consumers are in search of natural solutions to their ailments, including both homeopathic remedies and supplements supportive of a healthier lifestyle.

Boost your Brain - Whether you’re doing exams or just looking to increase brain power, Eskimo Brain 3.6.9 is the food supplement for you. Omega-3 DHA is brain food. Just as calcium is essential for building strong bones, 250mg DHA daily is essential for good brain health. DHA helps to improve learning, mood, memory and concentration.

Eucarbon Herbal Tablets Eucarbon herbal tablets is a traditional herbal medicinal product for use in the short term relief of occasional constipation exclusively based on long-standing use. Eucarbon herbal tablets contains senna leaf, dry extract of rhubarb root and vegetable charcoal. Compounded vegetable charcoal tablets with herbal extract.

Vitamin D3 is essential for strong bones, a healthy immune system and muscular function. With high levels of omega-3 DHA along with Seed Oils, vitamin D3, E and CoQ10, your brain power will surge in no time. 100% Pure, Natural and Proven.

• The active ingredients in Eucarbon Herbal Tablets are of vegetable origin and stimulate digestion. They act together to provide a laxative effect

www.eskimo3.ie

The product is exclusive to pharmacies, available in a 30 pack and has a 3 year shelf life.

Driven by consumer interest in all things natural, the market for natural products available over-the-counter has increased over the last number of years. Consumers are purchasing these for both prevention and immune boosting properties as well as to help aid healing when they are sick.

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• Contains essential mint and fennel oils


Solgar® Full Spectrum Curcumin Using science, Solgar® has unlocked the power of curcumin with a micellised form of curcumin which significantly increases it’s bioavailability by 185 times1. Solgar® Full Spectrum Curcumin provides a full range of natural curcuminoids, in a highly bioavailable and rapidly absorbed form. Available in one a day softgel, in a form readily available to be used where it is needed in the body. Available in 30s & 90s Softgels. 1. Compared to standard turmeric extract.

Zerochol Plant Sterols Alflorex Your First Step in Lowering Cholesterol - Zerochol is a 100% natural food supplement containing plant sterols, proven to lower cholesterol. Plant sterols block cholesterol being absorbed into the blood and therefore help to maintain healthy cholesterol levels. In clinical trials, Zerochol has been shown to lower total cholesterol by 12% and LDL “bad” cholesterol by 17% in just 12 weeks. Improving your diet is an important part to keeping your heart healthy, so Zerochol has developed a diet & lifestyle program to follow alongside taking Zerochol plant sterols tablets. Sign up today to receive diet & lifestyle tips, recipes and snack ideas daily. www.zerochol.ie

The unique 35624® culture in Alflorex® is a naturally occurring bacteria, found in the human gut. This natural culture in Alflorex is supported by pharmaceutical level evidence: • landmark double-blind placebo controlled clinical trials and subsequent publication in leading journals (Gut, Gastroenterology) • impact on ALL the cardinal symptoms of IBS • the No: 1 recommended culture by Gastroenterologists and Doctors in the US This unique culture is taken daily by thousands of Irish people and is a best seller in the IBS category.

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Kin Gingival Complex 2019 & Retail Pharmacy Product Awards

Best Oral Health Product Oral care is set to continue to see positive retail value growth in the future months. Growth will be marginally slower compared to previous years due largely to a decline in demand for mouth fresheners and a falling need for dentures. Oral hygiene (and gum protection) is set to be an important trend among consumers as many younger consumers are aware of the effectiveness of introducing good oral hygiene into their oral care routine.

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Kin Gingival Complex is indicated to promote the reduction of dental biofilm, to help strengthen and tone delicate gums and good oral hygiene during dental interventions. Kin Gingival Complex offers patients a great tasting effective mouthwash for their gums, reducing the symptoms of gingivitis and other periodontal disorders. A powerful combination of 0.12% Chlorhexidine and Alpantha works to reinforce and soothe gums whilst offering reduced staining and no impairment of taste resulting in maximum patient compliance.


TePe Good

UltraDEX

Introducing TePe GOOD - A new toothbrush with the same qualities, design and feeling, as you would expect from TePe, but made from 96% bio-based plastic.

UltraDEX One GO On the Go Mouthwash Liquid Sachets are convenient to carry, discreet and easy to use. Each sachet contains the recommended 15ml dose of UltraDEX Daily Oral Rinse Mint.

Thanks to the use of good renewable raw materials sugar cane and castor oil, we manage to recirculate up to 95% of the CO2 emissions during its life cycle. Naturally, it’s produced with 100% green energy, partly from their own solar panels. Good for the environment and Good for you.

Simply tear the perforated end of the sachet, pour into the mouth and rinse for 30 seconds to fully cleanse the mouth and destroy Volatile Sulphur Compounds for instant fresh breath which will last 12 hours. UltraDEX One GO meets the needs of people wanting a fully clean and fresh mouth on the go, with the familiarity of a mouthwash that is discreet and above all effective. Perfect to pop in a pocket, bag, car, desk drawer, travel case, or gym kit.

PapayaGold® Paw Paw Balm Enriched with bioactive Manuka Honey 20+, PapayaGold® Paw Pawis a topical balm that soothes, relieves and moisturises dry, sensitive, chaffed, irritated skin and dry chapped lips. It can be used by those prone to eczema, psoriasis and dermatitis and is also suitable for children. The enhanced formulation combines the benefits of Australia’s tropical Paw Paw (Papaya) fruit, further enriched with New Zealand’s bioactive Manuka Honey. Farmed at altitude from the Nectar, its healing properties have been celebrated for centuries, it is considered therapeutic and has been hailed “miracle” honey. Paw Paw contains the enzyme Papain which helps to lower inflammation and to improve healing from burns and cuts. Available as a Moisturising Balmand Lip Balm. For more information contact: info@pharmed.ie

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2019 & Retail Pharmacy Product Awards

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

Alchemlife FlexiQule

Easolief DUO

AlchemlifeFlexiQule™is a clinically tested blend of concentrated Boswellia (Indian Frankincense) and Ginger extract. Boswellia helps to maintain healthy joint function, mobility and flexibility, whilst Ginger helps to manage the inflammatory response. FlexiQule™ combines the power and safety of its all-natural active ingredients with Alchlemlife’s unique PhytoAdvance™ technology.

Easolief DUO is a combination of 500mg Paracetamol/150mg of Ibuprofen in one convenient, film-coated tablet indicated for short-term symptomatic treatment of mild to moderate pain. Easolief DUO provides 30% more pain relief than the same daily dose of paracetamol or ibuprofen alone, ensuring it gets to work fast.

FlexiQule™ helps to relieve the symptoms of arthritis through improved flexibility and mobility with decreased stiffness, easing joint pain. AlchemlifeFlexiQule™ was launched in Ireland in Autumn 2018. It has been extremely well received with pharmacies and consumers, and continues to grow into a well-known brand, available at leading pharmacies nationwide. Further new product launches are scheduled for Q4 in 2019, adding to the ever growing Alchemlife product family available in Ireland.

OTC analgesics used to treat pain can sometimes be particularly difficult for patients to self-manage. Community pharmacists and their teams have an opportunity to educate and advise within this area.

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Easolief DUO has a double action formula that works on pain that is often not relieved by a single painkiller. Easolief DUO is a completely unique product offering to the Irish market. Easolief DUO offers a much simpler dosing regime to patients – simply take 1 -2 tablets every 6 hours versus 14 tablets daily for a patient who is alternating between paracetamol and ibuprofen. Easolief DUO provides fast acting, powerful relief and is codeine free.


Flexiseq: Targeted Care for Joint Wear & Tear When joint pain and stiffness hold you back from doing the things you love, Flexiseq’s unique drug-free action works where it’s needed to lubricate joints affected by osteoarthritis and joint wear & tear. • Clinically proven to reduce pain & stiffness and improve mobility • Drug free and can be used alongside traditional pain medications • Free from systemic side effects associated with painkillers • Twice daily application and no restrictions on the length of use • Available in two strength formulations to suit the needs of all joint pain sufferers

ZinCuFlex Ginger and Curcumin Complex

Voltarol Emulgel Extra Strength 2% w/w Gel

Nourish your Joints - ZinCuFlex is an innovative food supplement containing Ginger, Curcumin and vitamin C. Ginger and Curcumin (the active part of Turmeric) are well known for their benefits for Joint Health.

Unlike products that work by only cooling or heating the skin, Voltarol Emulgel Extra Strength 2% w/w Gel contains a non-steroidal anti-inflammatory drug (NSAID), called diclofenac. Voltarol 2% Gel is applied locally, targeting pain at the source. It works by blocking production of some of the body’s chemicals that cause inflammation, pain, tenderness and swelling.

Ginger is an extract which helps to maintain joint mobility and avoid morning stiffness. Curcumin helps to control inflammatory responses in the body, helps to protect joints and helps to maintain joint flexibility. ZinCuFlex uses a patented complex, to improve absorption by up to 100 times compared to ordinary curcumin, making it more bioavailable and therefore more effective. Whatever your passion… Get Moving with ZinCuFlex! More Information: www.zincuflex.ie

This product introduced innovation to the market in 2016 and continues to improve joint pain sufferers’ lives. With a ¤600k marketing investment in 2018, Voltarol drove the Topical Pain Category in Pharmacy and encouraged consumers to have conversations with pharmacists about managing their joint pain.

Let’s Get Moving.

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Carnation Footcare 2019 & Retail Pharmacy Product Awards

Best Pharmacy Only Product While more is being done to promote awareness regarding the importance of the safety and appropriate use of OTC drugs, pharmacists are still the patient's best resource in the proper selection of OTC products. Moreover, while it is important for all patients to properly use OTC products, individuals of advanced age, individuals with pre-existing medical conditions such as diabetes, those currently using prescription drugs and those requiring pharmacy-only products must always consult their pharmacist when considering the use of OTC drugs to avoid possible contraindications, drug interactions, and/or dosing errors.

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Carnation Footcare are leaders in innovative foot care products, with over 90 yearsâ&#x20AC;&#x2122; experience, they have a comprehensive range of solutions, including licensed general sale products, to almost any foot problem. They offer a complete range of foot care solutions to almost any foot problem from the licensed (general sale) best seller Carnation Corn Caps to new and innovative products such as the New Rechargeable/Regenerating Charcoal Shoe Deodorisers and Silver Socks. Pharmacy confined.


Sumatran Relief 50mg Uriage Keratosane 30 Tablets x 2 Uriage Keratosane 30 is a high tolerance

Voltarol Emulgel Extra Strength 2% w/w Gel

Rowex Ltd. is pleased to announce the launch of the first ever OTC Sumatriptan in Ireland: Sumatran Relief 50mg x 2.

Unlike products that work by only cooling or heating the skin, Voltarol Emulgel Extra Strength 2% w/w Gel contains a non-steroidal anti-inflammatory drug (NSAID), called diclofenac. Voltarol 2% Gel is applied locally, targeting pain at the source. It works by blocking production of some of the body’s chemicals that cause inflammation, pain, tenderness and swelling.

Sumatran Relief is indicated for the acute treatment of migraine attacks with or without aura. Sumatran Relief should only be used where there is a clear diagnosis of migraine. Sumatran Relief is an exclusive OTC product for pharmacies only and has a 5 year shelf life. Those who have diagnosed with Migraine should ask their pharmacist about Sumatran Relief (sumatriptan).

cream gel that is a complete treatment for callused skin to help restore the skin's smooth, soothed and soft appearance, without areas of roughness. With 30% Urea, the highest available in Ireland, its especially effective against thickening of skin caused by Psoriasis, but can be used by all. The Urea produces a powerful keratolytic action on rough or very thick skin areas of the body, such as the body, elbows or scalp. Thermal Spring Water from Uriage is the key ingredient in all Uriage product ranges, as it is 52 times richer than any other Thermal Water available.

This product introduced innovation to the market in 2016 and continues to improve joint pain sufferers’ lives. With a ¤600k marketing investment in 2018, Voltarol drove the Topical Pain Category in Pharmacy and encouraged consumers to have conversations with pharmacists about managing their joint pain.

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2019 & Retail Pharmacy Product Awards

Bio-Kult training initiative

Solgar & Nature’s Bounty Training

The main objective of the training is to create awareness and build knowledge around the important role the gut flora plays on our overall health. This is done in the following stages:

Solgar & Nature’s Bounty Training offers bespoke training for pharmacies to suit their needs.

 Introduction to microbiome  The six roles gut flora has on humans

Best Pharmacy Training Initiative of the Year

 The role our gut flora plays in pregnancy and infants health  The importance of having a more diverse microbiome – touching on the different indications linked to a lack of diversity  Understand the role probiotics play in our overall health  Overview of Bio-Kult probiotic range, including scientific studies linked to the products & the indications to which each product is suitable

Excellence in training initiatives is a crucial component for many pharmaceutical companies in the promotion of their OTC offering, whether it be for an existing or a new product and/or service.

INTRODUCING BIO-KULT PROBIOTICS

INTRODUCING BIO-KULT PROBIOTICS

Training presents a prime opportunity to expand the knowledge base of your audience, ensuring consumers enjoy a consistent experience and background knowledge.

Workshops can be arrange and tailored to meet the demands of the pharmacies especially if there are multiple locations. Webinars on online training are also available for those not able to attend in person. For 70 years Solgar® has been unwavering in its dedication to introducing high quality, innovative vitamin, mineral and botanical supplements to serve the needs of consumers. Their broad range of over 320 ‘gold standard’ products is testament to their belief that in health one size doesn’t fit all. Consumers are able to select the specific product, or combination of products, that are right for their specific needs and dietary requirements, including gluten, dairy and wheat-free, and vegetarian and vegan options.

THE SOLGAR® ACADEMY LEARNING HUB

AC A D E M Y

N EAR GET TS & POIN ARDED REW OR F G ININ TRA

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

In today’s competitive market place, you need to stay abreast of industry developments. Effective training will ensure your product is promoted in the most effective way.

THE SOLGAR® ACADEMY LEARNING HUB N EAR GET TS & POIN ARDED REW OR F G ININ TRA

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AC A D E M Y


Perrigo Cinemars

Fleming Medical

Macu-SAVE™

This year Perrigo brought their training to the cinema, receiving overwhelmingly positive feedback on the forum. The Cinemar innovation brings together training and development with the added benefit of having a social event for pharmacy staff. The training focussed on the area of headlice. Discussing the market, headlice and nits, detection methods, recommendation and finally, the Lyclear products.

Fleming Medical under their first aid brand, Medicare, and the Irish Red Cross have collaborated in the roll out of first aid workshops available to OTC pharmacy teams nationwide.

Pharmed in partnership with the charity Fighting Blindness are delighted to introduce Macu-SAVE™, a once a day, easy to swallow; food supplement, which provides advanced nutrition for the eyes.

The interactive workshops are delivered by qualified Irish Red Cross Instructors from local Red Cross branches with attendees receiving a certificate on completion.

In order to enhance understanding of Macu-SAVE we have implemented the following training initiatives:

Perrigo also previewed the launch of the Perrigo brand at the Cinemar, allowing those in attendance a sneak peek of the activation that was coming down the line.

Topics covered in the 4 hour workshop include Burns, Strains, Choking, Dressing of wounds Recovery position and more. In 2018 over 600 attendees carried out the Medicare/ Irish Red Cross First Aid Workshop in Ireland, the highest annual figure today.

73% of attendees took the time to complete the feedback form – allowing the Perrigo team to further develop the concept for 2019. They have also grown their attendance of training events by 40% this year.

Medicare and the Irish Red Cross also roll-out 2 hour consumer workshops in pharmacies nationwide on Parent & Child First Aid & First Aid Advice for the Elderly - over 1,200 consumers attended workshops in 2018.

 Pharmed OTC product - NationalTrainer in Pharmacy.  Our national sales team of 3 also provides product training during calls; face to face with pharmacists, technicians and counter staff.  Printed / visual product information aids - detailing product information and key ingredient information.  Online information;supplied via the dedicated Macu-SAVE Facebook Page. Posting about product information, Age Related Macular Degeneration(AMD), plus Eye Health andFoods which aid in eye health.  Planned product training via the in-house Pharmed training academy.  Affiliation with the charity Fighting Blindness.

Why Macu-SAVE™? If the macular pigment becomes depleted then its protective function become s compromised - leading to macular damage. Each Macu-SAVE™ capsule

Macu-SAVE™ Proven Benefits to Eye Health…

contains

10mg Meso-Zeaxanthin , 10mg Lutein and 2mg Zeaxanthin

Enrich the macular pigment with ALL three key macular carotenoids MESO-Z EAXANTHIN AND LUTEIN, ZEAXANTHIN.

PRACTICAL FIRST AID COURSE WORKBOO K

Crucially these are the same three macular caroteno ids found in high concentrations within the macular pigment .

Enhance the vital protectiv e function of the macular pigment.

Research from the Waterfo rd Institute has shown that this precise formulation, with the particular inclusion of Meso-Zeaxanthin to be the optimum combination required to improve macular health.

Protect the macula against the damaging effects of visible blue light and oxidative stress. Improve visual perform ance in the healthy eye.

Combat the progression of Age Related Macular Degeneration.

Macu-SAVE™ is the most economical eye health supplement available containi ng ALL three macular carotenoids.

Don’t Turn a Blind Eye to Macular Degeneration

A guide to Age-related Macular Degeneratio n

Education Guide Web: www.macu-save.vision

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2019 & Retail Pharmacy Product Awards

Best Skincare Product

Love Your Skin

P20 Face

Love Your Skin Anti-ageing Facial oil by Holos Skincare, reported by 82% of users as providing "noticeable improvements" in their skin is an Irish made facial oil naturally packed full of antioxidants to fight off free radicals that cause premature ageing.

P20 Face is a lightweight consistency, clinically proven for use under make-up or as an addition to your regular skincare regime.

This absorbant Argan oil contains essential fatty acids that replace lost lipids, plump the skin and smooth out fine lines as well as locking water in to keep the skin hydrated. Suitable for oily, dry, dehydrated or sensitive skin, its blend of essential oils of Rose, Palmarosa, Benzoin and Frankincense are especially suited to pigmented or blemished skin.

Overall skin care in Ireland has seen steady retail value growth as its performance is not overly influenced by economic conditions. However, if consumer confidence does slow down there could be trading down to more affordable skincare products if consumers start to feel the pinch. The quest for youth is expected to continue among both male and female consumers. The global skincare market is fast growing and expansive, vast and evolving quickly with forecasts that indicate a global market of ¤81.9 billion in 2028, growing significantly from ¤44.1 billion in 2018.

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Made with a convenient pump design, the new non-greasy, alcohol-free cream leaves a moisturising feel on the skin and spreads easily, containing no added fragrance or colorants. Similar to the existing P20 range, P20 Face is highly water resistant (Europe’s highest classification for water resistance) and is durable up to 10 hours. It provides UVA protection at a level that far exceeds EU recommendation and is rated at 5 out of 5 stars. P20 Face may be used also to protect the neck, chest and ears from harmful sun exposure.


Elave Skincare Range – clinically safe for sensitive skin

Uriage Bariéderm Repairing CICA-Cream

Ovelle pharmaceuticals are passionate about skincare and fundamental to their business is their customer promise of absolute purity, which means no elave product will ever contain sulfates sles/sls, MI, parabens, perfume, formaldehyde, alcohol, soaps, colours and more.

The Uriage Bariéderm Repairing CICA-Cream (RRP ¤10) is a first aid product that provides fast healing and immediate relief and prevents scarring for the entire range of cuts, perfect also for minor surgeries and procedures.

Their research team continually strive to create the cleanest, safest skincare for sensitive skin. They only use purified water, all their raw materials and ingredients undergo rigorous pharmaceuticals testing before use and the formulations are safety tested to the highest standards. Made in Ireland. Phar macy confined. Ovelle Pharmaceuticals skincare solutions for sensitive skin since 1934.

This Repairing CICA Cream is a velvety cream that is easy to massage in for a quick absorption. Uriage is one of the leading dermo-cosmetic brands on the international market. Thermal Spring Water from Uriage is the key ingredient in all Uriage product ranges, as it is 52 times richer than any other Thermal Water available.

Zeoderm Suffering from a severe skin condition can be absolutely torturous; dry, cracked skin that’s itchy, sore and unsightly can make life miserable and it’s difficult to find a treatment that works. Steroids are often prescribed for flare ups, but these are for short term use and often cause nasty side effects. Zeoderm is an amazing 99% natural moisturiser for eczema and other skin conditions. As it is steroid-free, it can be used any number of times and is suitable for use on the face. Zeoderm can be used for severe cases of: • Eczema • Psoriasis • Dermatitis • Urticaria • Rosacea • Other dry skin conditions Zeoderm uses a patented ingredient called ZeomaZ that’s made from natural volcanic micro porous silicate minerals.

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Catwalk HQ - Dark 2019 & Retail Pharmacy Product Awards

Best Tanning Product The self tanning market is still booming, not just in Ireland but globally. With an increase in the number of cases of non-melanoma skin cancer, consumer awareness around long-term sun exposure is increasing and, along with it, the willingness to use self-tanners. As the lines between self-tanning and skincare categories continue to blur, innovation in formulation and product ranges will remain paramount to the success of the self-tanning market, say market research reports.

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CatwalkHQ was the result of wanting to bring a new brand to the Irish market, a brand that strives to deliver quality luxury products. All our research, development and manufacturing is carried out here in the west of Ireland and we are very proud to be an Irish company with our sights on making it a global brand. CatwalkHQ was developed with natural nontoxic ingredients in mind, with intensive research and development and talks with consumers on the perfect tan, CatwalkHQ was born! We know the frustrations of not being able to wear tan due to different skin conditions e.g. psoriasis or eczema so this was also at the forefront of our minds when it came to developing our tan and the growth has been phenomenal. CatwalkHQ is run by a small close knit team, Itâ&#x20AC;&#x2122;s great to see our products on the same shelves as the international brands and we have no doubt CatwalkHQ products will be joining them on a lot more shelves for a long time to come.


Tan Organic’s Self-Tanning Oil Tan Organic’s Self-Tanning Oil gives a natural looking tan while deeply nourishing and hydrating your skin. A hero product made with a unique blend of plant oils including Borage Seed, Argan Oil, and Orange Peel Extract. Tan Organic’s Self-Tanning Oil has a subtle citrus fragrance which combats any harsh fake tan smell. The application is unique and easy; apply with your hands as a moisturising body oil, massaging until fully absorbed; just use baby wipes to take the tan off your palms. You can wear your white top or sleep in your white sheets directly after and there will be no transfer.

Body Blur

CatwalkHQ - Medium

Body Blur is an award winning body make-up that blurs imperfections and gives you an instant bronze for a flawless HD skin finish.

CatwalkHQ was the result of wanting to bring a new brand to the Irish market, a brand that strives to deliver quality luxury products. It was developed with natural non-toxic ingredients in mind, with intensive research and development and talks with consumers on the perfect tan, CatwalkHQ was born!

Available in 5 shades, you can choose the colour you are to enhance your natural glow or go for a deeper tone to give you a body bronze finish. Body Blur also highlights your limbs and smooths your skin for an even tone. The product achieves it's natural and nourishing results from the brand's Advoganic Technology, full of botanical ingredients such as Aloe Vera and Shea Butter. Your go-to-glow adored by celebrities and makes-up artists.

CatwalkHQ Medium is safe to use during chemotherapy and safe to use during pregnancy. It is kind to skin and so is suitable for those with eczema, psoriasis and dry skin, developed to suit every skin type. CatwalkHQ is run by a small close knit team, with all research, development and manufacturing carried out in Ireland.

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Revive Active 2019 & Retail Pharmacy Product Awards

Best VMS Product Increasing numbers of people are taking a proactive approach to their health and the wellbeing trend is sweeping the nation. Keeping up with consumers or even getting a bit ahead of their desires is the name of the game. In the everchanging and extremely fickle vitamins, minerals and supplements (VMS) category, it is even more vital to stay on pace or ahead of the curve with those visiting their local pharmacy.

Irish Supplement Revive Active is a highquality blend of 26 active ingredients delivered in one convenient sachet. The unique blend of vitamins and minerals provide a multitude of health benefits which include naturally sustained energy, without the use of sugar and caffeine, as well as contributing to immune system support. The inclusion of L-Arginine and Coenzyme Q10 further improves Revive Active’s ability to enhance energy, vitality and support a healthy immune system in consumers. Suitable for vegetarians, vegans and gluten free, Revive Active is the best source for increased natural sustained energy, improved immune system function and heart health.

According to latest market research reports, vitamins sales are expected to continue growing as consumers increasingly look towards preventative measures over cures. A growing number of consumers are expected to monitor their health through blood tests, which will result in greater awareness of vitamin and other deficiencies.

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Sevens seas Jointcare Supplex & Tumeric The only product to combine Turmeric extract with Glucosamine & Omega-3. Seven Seas JointCare® Supplex® & Turmeric has been formulated with: • Vitamin C contributes to normal collagen formation for the normal function of bones and cartilage • Vitamin D to help maintain normal bones • Vitamin C to support the normal function of the immune system • Manganese contributes to the normal formation of connective tissue Features - Support for Cartilage (Vitamin D); Bones (Vitamin D), Muscles (Vitamin D), Connective Tissue (Manganese). Seven Seas has been supporting family health since 1935 and Seven Seas JointCare® experts understand how important it is to have support so people can continue doing the things they love.


Solgar® full Spectrum Curcumin

Solgar Skin, Nails & Hair Formula

Using science, Solgar® has unlocked the power of curcumin with a micellised form of curcumin which significantly increases it’s bioavailability by 185 times1.

A comprehensive formulation designed to help build collagen, and also to support healthy hair and nails. Premium daily beauty support formula containing essential beauty nutrients supportive of skin, nail and hair health, including zinc, copper and vitamin C

Solgar® Full Spectrum Curcumin provides a full range of natural curcuminoids, in a highly bioavailable and rapidly absorbed form. Available in one a day softgel, in a form readily available to be used where it is needed in the body. Available in 30s & 90s Softgels. 1. Compared to standard turmeric extract.

Vivioptal Junior Vivioptal® Junior is a multivitamin liquid that has been specifically developed for active children of all ages from aged 1+ years, to provide a carefully balanced, comprehensive range of 12 essential vitamins and 7 trace minerals with a delicious orange taste.

• Supports a youthful glow, skin structure and elasticity • Helps to prevent damage to skin cells that may be linked to premature ageing • Supportive of skin complexion and hair colour, as copper contributes to normal skin and hair pigmentation as well as to the protection of cells from oxidative stress

The formulation includes the fat-soluble vitamins A, D and E, and the water-soluble vitamins B1,2,3,5,6,7,12, C and Folic Acid. Vivioptal® Junior provides an ideal nutritional safeguard during a time when children have a high nutrient requirement in relation to body size, to support their rapid physical growth and development of bones, muscles, blood volume and the brain.

• Also provides MSM, silica as red algae powder (L corallioides, silicon dioxide), and amino acids (L-Lysine and L-Proline)

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2019 & Retail Pharmacy Product Awards

Best Women's Product

Active Iron & B Complex Plus for Women

Always Discreet

Active Iron & B Complex Plus for Women is specially designed for women to help tackle tiredness and support hormonal balance. It combines the ground-breaking Active Iron protein formula with high strength B vitamins. Active Iron & B Complex Plus for Women has clinically proven twice the absorption of standard ferrous sulfate and is non-constipating. It contains a specially formulated B.

Affecting 1 in every 3 women at some point in their lives, incontinence is not uncommon. They understand that for women with sensitive bladders these conditions are awkward and not easy to manage in everyday life, but they believe it should not deny anyone from doing things they love.

Complex with targeted delivery system to improve absorption. Active Iron & B Complex Plus for Women helps tackle tiredness, supports hormonal balance and supports healthy skin, hair and nails. Stay energised with Active Iron & B Complex for Women.

Health issues and care strategies for women’s health are far more wide-reaching than just pregnancy and gynaecology. Research has shown that increased global focus on women’s health disorders and an overall aging female population are helping to drive growth of the women’s health products over-the-counter. Today’s women are much more well informed with consumers leaning towards self-care and self-medication and thus the outlook has been witnessing a dramatic transformation in recent years.

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Always Discreet offers a line of Incontinence products to support women with sensitive bladders.

This is why they developed new Always Discreet, a range of products designed for female incontinence. Always Discreet for Sensitive Bladder are made with a new generation of ultra thin materials, that will keep women with sensitive bladders protected while remaining discreet.


Arkopharma Cys-Control® Plus Arkopharma Cys-Control® Plus is a Cranberry, Heather and D-Mannose based dietary supplement. Formulated to treat and prevent the recurrence of UTI’s. The 14 sachet pack is the most complete and effective 100% natural treatment for recurring UTI’s, thanks to the complementary action of Cranberry and D-Mannose on E.Coli. Heather is included in the formulation which contains anti-bacterial properties and promotes the “auto-flush” phenomenon. Cys-Control Plus® is suitable for use during pregnancy and contains 100% plant-based active ingredients. Cys-Control® Plus Use:  From the first symptoms of a urinary infection  As a compliment to antibiotics  As a prevention to recurring episodes For further information contact: info@pharmed.ie

Bio-Oil® Skincare Oil

Vagisil Crème

Bio-Oil® Skincare Oil dry oil formula contains a unique ingredient called PurCellin Oil™ which ensures all ingredients can be easily absorbed deeper into the skin without an oily residue.

Vagisil Crème is an intimate cream delivering Instant, long-lasting relief from intense itch, especially itch associated with antibiotics, discharge, imbalance in PH and irritating vaginal conditions.

Bio-Oil® Skincare Oil contains vitamins A and E and natural plant oils which work together to improve the skin’s health and elasticity. • Supports the skin during pregnancy and periods of rapid growth to help  maximise skin elasticity and reduce the formation of stretch marks (striae) • Helps improve the appearance of scarring (new and old) and help maintain elasticity of scar tissue on joints and other high mobility areas • PurCellin Oil™, lowers the viscosity of the formulation making it a ‘dry oil’, so that it can be easily absorbed into the skin, rather than acting superficially on the surface.

For over 40 years, Vagisil has been on a mission to improve the intimate health of women. Around the world, they have seen first-hand that when women take charge of their intimate health, have access to effective products and accurate information, they are more focused, productive, comfortable and confident. It enables women to be at their best. The Brand has three key pillars, Itch, Odour & Freshness. The Vagisil intimate Crème falls under the itch category. The product launched on the Irish market in 2018.

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2019 & Retail Pharmacy Product Awards

Most Innovative Product

Easolief DUO

Medicare Effigerm

Easolief DUO has been welcomed by pharmacists as the “new innovation” in the analgesic category. Easolief DUO is a combination of 500mg Paracetamol/150mg of Ibuprofen in one convenient, film-coated tablet indicated for short-term symptomatic treatment of mild to moderate pain.

Medicare is Irelands No.1 pharmacy confined First Aid brand & has been trusted by Irish pharmacists for over 30 years.

Easolief DUO is a completely unique product offering to the Irish market, offering a much simpler dosing regime to patients – simply take 1 -2 tablets every 6 hours versus 14 tablets daily for a patient who is alternating between paracetamol and ibuprofen. Easolief DUO provides fast acting, powerful relief and is codeine free, providing 30% more pain relief than the same daily dose of paracetamol or ibuprofen alone.

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

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Medicare Effigerm First Aid Spray is Anti-bacterial, Fungal, Viral and kills 99.9% germs. This Irish product has been dermatologically tested and is hypoallergenic, free from alcohol & preservatives – the amazing thing is that it is as natural as water and so is safe to use in the home. Due to the HPRA’s withdrawal of wound wash products with Chlorhexidine on shelf, this is the perfect solution as it is 100% safe to use on open wounds for cleansing purposes.


Nicorette® Nicorette® is the number one brand within NRT with an impressive 71% share*. Nicorette® QuickMist is the only spray format available within the entire category, it was launched in 2013 and accounts for 15% of total NRT sales clearly demonstrating the appeal of this unique proposition*. Nicorette® QuickMist CoolBerry is an extension of this range and provides consumers with a new flavour offering within this innovative segment. It is the fastest acting format on the market in that it starts to relieve cravings in just 30 seconds (based on 2 x 1mg dose) and is clinically proven to be 2.5 times more effective at helping smokers quit verses willpower alone. Contact your Johnson & Johnson Territory Representative for further details. MAH: Johnson & Johnson (Ireland) Ltd. Airton Road, Tallaght Dublin 24. Products not subject to prescription. Further information available upon request. *IMS Value Sales Mat Nov 18

Nurofen Durance 200mg Medicated Plasters

Flexiseq: Targeted Care for Joint Wear & Tear

Ireland's first ibuprofen medicated plaster was launched in April 2018. Nurofen Durance is the first ibuprofen medicated plaster in Ireland which offers 24 hours duration. It is a convenient and effective product for muscle and joint pain with stretchable and flexible design.

When joint pain and stiffness hold you back from doing the things you love, Flexiseq’s unique drug-free action works where it’s needed to lubricate joints affected by osteoarthritis and joint wear & tear.

Full prescribing information available on www.medicines.ie

• Clinically proven to reduce pain & stiffness and improve mobility. • Drug free and can be used alongside traditional pain medications. • Free from systemic side effects associated with painkillers. • Twice daily application and no restrictions on the length of use. • Available in two strength formulations to suit the needs of all joint pain sufferers. Let’s Get Moving.

PHARMACYNEWSIRELAND.COM | 97


Product Profile

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RHINEX RELIEF 50 MICROGRAMS/ACTUATION NASAL SPRAY, SUSPENSION DG 19/12/18 - V2. Rowex Ltd. is pleased to announce the launch of Rhinex Relief 50 micrograms/actuation nasal spray, suspension. Each actuation of the pump delivers a metered dose of 50 micrograms of mometasone furoate (as mometasone furoate monohydrate). The total weight of one actuation is 100 mg. Therapeutic Indications: Rhinex Relief is indicated for use in adults to treat the symptoms of seasonal allergic rhinitis, after a seasonal allergic rhinitis has been diagnosed by a physician. For further information or to order contact our Rowex® Telesales Team: Irene, Jeanne Marie or Rita on 1800 304 400 Product not subject to medical prescription. Further information and SPC are available from the Marketing Authorisation Holder: Rowex Ltd., Bantry, Co. Cork, P75 V009 Freephone: 1800 304 400 Fax: 027 50417 E-mail: rowex@rowa-pharma.ie Date of preparation: (09-18) CCF No: 21334

Bio-Oil® Dry Skin Gel, A New Way To Treat Dry Skin

Say goodbye to dry skin with Bio-OilThe creators of Bio-Oil®, the world’s best-selling scar and stretch mark oil**, are delighted to launch their first new product in over 30 years, Bio-Oil® Dry Skin Gel. Specifically created to tackle dry, dehydrated the breakthrough gel Way to oil formula is the Dry Skin Bio-Oil® Dryskin, Skin Gel, A New To Treat result of sixteen years of research and development, and offers a highly Say goodbye to dry skin with Bio-Oil® Dry Skin Gel, an innovative new body ca effective and economical solution to dry skin.

that’s 100% active, andWay clinically proven to Skin significantly improv Bio-Oil® Dryeasily Skin absorbed Gel, A New To Treat Dry

Say goodbye to dry skin with Bio-Oil® Dry Skin Gel, an innovative new body care product ® The creators Bio-Oil , the world’s that’s 100% active,ofeasily absorbed and clinically proven to significantly improve dry skin.*

best-selling scar and stretch mark oil**, are delighted to launch their first new product in over 30 years, Bio-Oil® Dry Skin Gel. Specifically created to tackle dry, dehydrated skin, the breakthrough gel to oil formula is the result of sixteen years of research and development, and offers a highly effective and economical solution to dry skin.

creators of Bio-Oil®, thebest-selling world’s best-selling scarmark andoil**, stretch mark oil**, are delight TheThe creators of Bio-Oil®, the world’s scar and stretch are delighted to launch ® dry skin, choose Bio-Oil DryGel. Skin Gel, available from their firstFor newrelief product in over 30 over years, Bio-Oil® DryBio-Oil® Skin Specifically created to tackle dry, their first new from product in 30 years, Dry Skin Gel. Specifically created t 1st skin, February at McCabes, Sam Bio-Oil stockists dehydrated the breakthrough gel to oil formula is the result and ofissixteen years of research dehydrated skin, theLloyds, breakthrough gel to McCauleys oil formula the result of sixteen and years of development, and offers RRP a highly effective and economical solutionand to dry skin. (200ml). nationwide, ¤6.95 (50ml); ¤11.95 (100ml) ¤19.95 development, and offers a highly effective and economical solution to dry skin.

Seechoose www.bio-oil.com for more information. For relief from dry skin, Bio-Oil® Dry Skin Gel, available from 1st February at Lloyds, For reliefSam from dry skin, Bio-Oil®nationwide, Dry Skin Gel, available from 1st Februar McCabes, McCauleys andchoose Bio-Oil stockists RRP €6.95 (50ml); €11.95 McCabes, Sam McCauleys stockists nationwide, RRP €6.95 (50ml (100ml)and andBio-Oil €19.95 (200ml). See www.bio-oil.com for more (100ml) andinformation. €19.95 (200ml).

See www.bio-oil.com for more information.

To Let

Carrigtwohill Pharmacy Unit CASTLE COURT, MAIN STREET, CARRIGTWOHILL, CO. CORK

CONTACT

All offers due by no later than 3.00pm, Thursday 6th March, 2019

High profile retail unit, in a HSE anchored Primary Healthcare Centre

Local GP practice overhead with an excellent client base

Adjacent to Aldi and at the entrance to the Castlelake residential development

Located close to the Carrigtwohill Business and Technology Park

Major local employers include GE Healthcare, Stryker, AbbVie and Gilead Sciences

Fota Retail Park anchored by Meadows and Byrne is nearby

Direct off street and multi storey car parking

Easily accessible off the N25 Cork / Waterford Rd

DENIS O’DONOGHUE D: +353 (0)21 491 7255 E: denis.odonoghue@cbre.com

www.carrigtwohillpharmacy.ie

PHARMACYNEWSIRELAND.COM


This is the beginning of a GOOD story Introducing TePe GOOD� - A new toothbrush with the same qualities, design and feeling, as you would expect from TePe, but made from 96% bio-based plastic. Thanks to the use of good renewable raw materials sugar cane and castor oil, we manage to recirculate up to 95% of the CO2 emissions during its life cycle. Naturally, it’s produced with 100% green energy, partly from our own solar panels. Good for the environment and good for you.

AD18787UK

For more information visit www.tepe.com/good

Introducing TePe GOOD® Toothbrush An all-new sustainably produced good quality toothbrush that’s developed in close cooperation with dental experts and made from 96 % bio-based plastic. Made in Sweden

Available from your dental wholesaler November 2018


Carton House

Located on Dublinâ&#x20AC;&#x2122;s doorstep set upon 1,100 historic acres, Carton House is a world of its own. Experience all the resort has to offer from championship golfing to exquisite dining, Carton House Spa and so much more.

cartonhouse.com

Profile for IPN Communications LTD

IPN 2019 February  

IPN 2019 February