IPN 2021 February

February 2021 Volume 13  Issue 2 PHARMACYNEWSIRELAND.COM

THE INDEPENDENT VOICE OF PHARMACY

In this issue: NEWS: Garda confusion over pharmacy window displays Page 5

PROFILE: Uniphar maximizing pharmacy ownership Page 9

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The impact of Brexit to community pharmacy Page 16

FEATURE: Sporting Injuries in the Pharmacy Page 33

TEAM TRAINING: Strengthening the Immune System Page 44

CPD: Management of Mental Wellbeing Page 49

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OTC & Retail Pharmacy Awards 2021 Finalists Page 57

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Contents

Foreword

Page 6: Collapse of OTC sector to Irish market?

A new year is now truly underway; and whilst many harboured a great need to say farewell to the challenging year that was 2020, it appears that 2021 is bringing no respite. Unfortunately, the ringing of the bells at midnight on December 31st did not bring an end to pandemic life and soon, stories of a ‘new strain’ began to emerge – closely followed by a new lockdown.

Page 12: Pharmacy offers the Best Shot at vaccinations

12

Page 16: IPN speaks to pharmacists about shortages

As well publicised, the Government has now formally agreed a ¤91 million plan which will see GPs and pharmacists administer the Covid-19 vaccine to about 1.5 million people.

Page 20: Pharmacy in talks to open Drive-Thru vaccination centre Page 46: Differences across biosimilars reporting found

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

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CONTRIBUTORS

Niamh Cahill Colm Moore Louise Brent Michelle Lacey Joan Johnston Professor J.J Gilmartin Allison Dunne Dental Health Foundation

DESIGN DIRECTOR Ian Stoddart Design

PHARMACYNEWSIRELAND.COM @Irish_PharmNews

IPU Secretary General Darragh O'Loughlin said the IPU had been given no information on when pharmacists and their teams will be vaccinated for Covid-19, despite being a core part of the National Covid-19 Vaccination Programme.

In our lead news, on page 6 of this issue, we examine how sales of cold and flu products at Irish pharmacies fell by as much as 80% in 2020 as a direct consequence of the pandemic.

MANAGING DIRECTOR Natalie Maginnis n-maginnis@btconnect.com

ADVERTISING EXECUTIVE Amy Evans: amy@ipn.ie

The new scheme will come into effect as soon as practicable after the AstraZeneca Covid-19 vaccine is approved by EU regulatory authorities and supplies are delivered to Ireland, possibly at the end of January or early in February.

However, as IPN was going to press, it was revealed that community pharmacists are feeling ‘sidelined’ from the programme. The Irish Pharmacy Union said it had been given no written explanation as to why vaccination of patients over 70 is to be done exclusively by GPs.

Page 57: OTC & Retail Pharmacy Products Awards 2021 Finalists

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

Although we are clearly not out of the woods just yet where Covid-19 is concerned, there are some glints of light in the gloom as vaccinations have been rolling out across the country.

2021 57

& Retail 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.

Our exclusive report also looks at the potential impact of Brexit on medicine supplies to pharmacy. Whilst Covid-19 is, without a doubt the biggest threat for community pharmacies, what of Brexit and its impact on the sector to date? Is the virus clouding our view of potential trouble down the track as the UK finally breaks away from the EU? Niamh Cahill reports on page 16.

I hope you enjoy the issue.

Regulars FEATURE: PROMOTING GOOD ORAL HEALTH IN THE PHARMACY FEATURE: NON-PHARMACOLOGICAL MANAGEMENT OF COPD TEAM TRAINING: IMMUNE SYSTEM HEALTH CPD: MENTAL WELLBEING CLINICAL PR

P28 P42 P44 P49 P97

IrishPharmacyNews

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News

Pharmacists warn that Brexit will affect UK online prescriptions The Irish Pharmacy Union has warned people to get informed on the implications of Brexit on some UK prescriptions pointing out that if you use an online teleconsultation to get your prescription, even if it’s via an Irish website, if the prescriber is based in the UK (including Northern Ireland), your prescription will not be valid in Ireland.

New legislation introduced postBrexit allows for hard copies of medical prescriptions from a face-to-face consultation with a UK-based prescriber to continue to be recognised; this is to enable continued access to healthcare of citizens travelling between jurisdictions, i.e. being able to fulfil a prescription from your home country when in the other.

However, online prescriptions or prescriptions written by UK-based prescribers for the purposes of enabling mail order supply issued to people living in Ireland are no longer valid. This means that, if a teleconsultation is carried out by a UK- based doctor for a patient based in Ireland (even if accessed through an Irish website), neither a digital nor a physical prescription resulting from that teleconsultation will be acceptable.

IPU Secretary General Darragh O’Loughlin said, “We know people are increasingly using online medical consultations, especially

since the pandemic started because local GP services are less accessible, and the person may also prefer not to see someone face-to-face. However, if you are using a medical teleconsultation service, you need to be mindful of where the doctor is based. Even if it is an Irish-based website, if the doctor is based in the UK and the consultation is online, the prescription is not valid in Ireland and therefore cannot be dispensed by a pharmacist here.

“The intention of the new legislation is to prevent prescriptions being issued by information society services (ISS) or cross-border telemedicine services, based in the UK or other third countries. The current Brexit deal covers trade, not services, and the issuing of a prescription in such a manner is regarded as a service with a third country.”

UK prescriptions written before 1 January 2021 following a

teleconsultation which are still in date are still valid.

Mr O’Loughlin concluded, “It is really important that people are aware of this change. Pharmacists are no longer able to accept prescriptions from UK-prescribers that came from a teleconsultation, and this could leave patients in a very difficult position. If you are using a teleconsultation service, you need to be very mindful of this change and ensure the prescriber is based in Ireland. Pharmacies are open and supporting people in their communities at what is a very stressful and anxious time because of the ongoing pandemic. Brexitrelated issues with a prescription is the last thing our patients need, so it is really important people understand this change.”

Turn to page 16 to read our exclusive report on the potential impact of Brexit to community pharmacy in Ireland.

Chief Pharmacist backs Campaign Pictured is Ireland’s Chief Pharmacist Kate Mulvenna with Covid-19 vaccinations at St Mary’s Hospital in Dublin where recently, approximately 800 GPs and nurses received the first doses of the Moderna vaccine.

According to Dr Ray Walley, GP and VP of The Standing Committee of European Doctors, she was on site to receive the vaccines at 05.30am and still working at 9pm that evening – on top of she and her team being some of the busiest professional public servants in the pharmaceutical industry within Ireland.

Also pictured is Dr Walley as Clinical Lead on the Dublin arm of mass vaccinations of GPs and Practice Nurses with the support of Medical Personnel from Irish Defence Forces, Paramedics from National Ambulance Service and administration and pharmacy support from the HSE.

New Guide to prevent Falsified Medicines A curriculum guide to support educators in ensuring that pharmacists are better able to prevent substandard or falsified (SF) medicines and medical products from reaching patients has been published by FIP in partnership with the World Health Organization (WHO).

The curriculum guide is a tool for education on SF medical products, which can be adapted to the needs of individual training institutions. It contains a competency framework and practical tips and is supplemented with modules that align with the WHO prevention-detection-response strategy so that pharmacists know how to: identify medicines at high-risk of being SF; prevent these products reaching the supply chain and, if they have, detect them and report them to appropriate regulatory authorities; and intervene to prevent patient harm.

These materials, which offer pharmacy educators teaching resources and practical guidance, were developed with the support of the European Commission, and in collaboration with the International Conference of French-Speaking Chambers of Pharmacists, the Commonwealth Pharmacists Association and five universities in sub-Saharan Africa, a region that is particularly vulnerable to these products.

“SF medical products are a constant, pervasive and unacceptable public health threat. The WHO’s holistic strategy of prevention, detection and response to SF medical products requires full inclusion of pharmacists. The unique position of pharmacists as guardians of the supply chain’s integrity allows them to safeguard the quality and safety of medical products before distribution and their vigilance is indispensable.

However, too few pharmacists receive formal training on this issue during or after education,” said Ms Pernette BourdillonEsteve, team lead (a.i.) Incidents and Substandard/Falsified Medical Products, WHO. In 2017, the WHO estimated that one in 10 medicines in low and middle-income countries was SF, risking harm to people and reducing the quality of patient care.

PHARMACYNEWSIRELAND.COM

News Pharmacy Call to Action The Pharmaceutical Group of the European Union recently held a roundtable to present the numerous and diverse pharmacy services provided in Europe including a wide array of pharmacy interventions on Covid-19.

The event brought together Members of the European Parliament, senior officials from the European Commission, representatives of patients and other health care professional organisations, the OECD, national health authorities and PGEU members to discuss the role of community pharmacists in health promotion and prevention and their contribution to the health of people and to the resilience and sustainability of healthcare systems.

PGEU President Duarte Santos stated, “National experiences show that community pharmacists can provide highquality, efficient and patient centred health care. Moreover, the COVID-19 pandemic undeniably demonstrated community pharmacy capacity to quickly adapt to difficult situations and to provide an effective response in the emergency.

“The 400,000 European community pharmacists are eager to use their competencies and experience to reinforce the delivery of core pharmacy services and to go further, assuming new responsibilities through several advanced pharmaceutical services that have proven to be beneficial for patients’ quality of life, public health, and health systems’ sustainability.

“We call on health policy makers to exploit the full potential of the network of 160,000 community pharmacies operating in Europe and maximise the benefits of the community pharmacist’s intervention through expanding pharmacy services, improving patients’ safety, therapeutic adherence, and health outcomes.

“This can be achieved by granting community pharmacists access to relevant patients’ health information while respecting data protection, allowing them to provide the full range of medicines and medical devices patients request, supporting community pharmacists in offering health screening, medicines management and health promotion programmes and adequately remunerating them for the services they provide.”

5

Gardai Confusion on Pharmacy during Lockdown Moves have been made to alleviate confusion among members of An Garda Síochána about the sale of non-prescription products at community pharmacies.

It comes after it emerged that during lockdown a number of pharmacies reported receiving visits from members of the force requesting that they prohibit the sale of over the counter and other products deemed non-essential.

One pharmacist, who did not wish to be named, said the Gardaí visited her outlet and in a bizarre turn of events advised her to avoid advertising OTC products in her shop window when strict lockdown restrictions were in place.

Pharmacies are one of the few retail outlets permitted to open during Ireland’s Level 5 lockdown, as they sell essential items under legislation.

In late October, the IPU issued an advisory note to members, describing the incidents as an “unnecessary intrusion” into pharmacy business.

It read: “It has come to our attention that a number of pharmacies around the country have received visits from the Gardaí requesting that nonessential items be cordoned off from the public.

“We have been in touch with

Garda HQ and, in response to our concerns, they confirmed that, while they are currently visiting all open retail outlets including pharmacies on Government instruction, they intend to engage collaboratively with retailers.

“They are aware that, in addition to medicines, other healthcare, personal hygiene and personal maintenance products also qualify as essential. They also acknowledged the difficulties for

pharmacies in separating items that could be deemed to be nonessential including, for example, giftware and non-traditional pharmacy products, and would only be insisting on separating these items from the public where they are in clearly defined areas of the pharmacy that can be easily cordoned off. We will be engaging directly with Government on this unnecessary intrusion into, and restriction on, pharmacy businesses.”

Welcome move on OTC Medication Pharmacists welcome the launch of Viagra Connect (sildenafil) as an over-thecounter medication. Erectile dysfunction drugs are among the medicines most often bought online and purchasing them in this way from unregulated sources can pose a major health risk to consumers.

Viagra Connect is for the treatment of the symptoms of erectile dysfunction in men aged 18 and over, and as of 11 January, is available without prescription as a pharmacy-only medicine.

Community pharmacist Tomás Conefrey said, “Pharmacists play a key role in supporting people to manage their health conditions. In order to purchase Viagra Connect, men aged 18 and over will need to answer questions from their pharmacist about their symptoms, their general health, and any other medications they are taking, so that the pharmacist can determine whether Viagra Connect is suitable for them. In cases where pharmacists believe the product is unsuitable for clinical reasons, they will advise men to see their doctor for further assistance.”

The ongoing problem with online medicines was highlighted by the seizure in 2020 of over 49,000 illegal medicine products by the Health Products Regulatory Authority (HPRA), and erectile dysfunction products were among the most common items found.

Mr Conefrey said many of these products sold on websites and social media pages are falsely advertised and the reality is that medicines and lifestyle products from unregulated online sources pose a major health risk to consumers. They sometimes contain none of the active ingredient, or sometimes too much or too little of some ingredients, which are also of questionable quality.

Mr Conefrey concluded, “There are also other risk factors that people may not fully consider when purchasing medication online, including the importance of risk assessments. Your local community pharmacist is a medicines expert, who will ensure that any medicine you get from them is suitable for you and won’t react with any other medications you are taking. However, when purchasing medication online, all the established safety nets are bypassed. We welcome this week’s launch of Viagra as an over-the-counter medication as it will allow for people to speak with their pharmacist and be assured that they are not receiving a counterfeit product, and that a risk assessment can be carried out.”

PHARMACYNEWSIRELAND.COM

6

News

Collapse of OTC Category to Pharmacy?

Sales of cold and flu products at Irish pharmacies fell by as much as 80% in 2020 as a direct consequence of the pandemic, it has emerged.

Jack Shanahan, Pharmacist, Haven Pharmacy Shanahan’s Castleisland

The sharp decline in sales reflects the reduction in circulation of the usual cold and flu viruses here this winter following improved hand hygiene and cough etiquette measures in response to Covid-19.

seasonal drop in pharmacy sales in 2020 of 62 per cent for the cold and flu category compared to 2019. The data is based on IMS “buy in” figures only, which are purchases by pharmacies.

Jack Shanahan of Haven Pharmacy Shanahan's, Castleisland has described the collapse of the cold and flu market as extraordinary.

Secretary General of the Irish Pharmacy Union (IPU) Darragh O’Loughlin said the fall-off was to be expected, given the fact that influenza is not in circulation here so far this winter.

The Kerry based pharmacist said in a remarkable development that sales of such products at his pharmacy have declined by about 80 to 90 per cent since the pandemic began, while colleagues at other pharmacies had also reported similar reductions.

“The cough and cold remedy as a category has collapsed, literally collapsed. There are no coughs and colds going round now other than Covid coughs and cold.

“We would have been selling hundreds of cold and flu remedies over the winter season usually and they’re down to tens now. Sore throat sprays, cough bottles and cold and flu remedies have all gone down to maybe 10 to 20 per cent of what they normally would be.”

“GP consultations for respiratory symptoms for the 2020/2021 season to date are reflecting Covid-19 activity, rather than influenza. That is probably as a result of the lack of international travellers to bring flu into the country along with people’s handwashing, respiratory etiquette, mask wearing and physical distancing, which has all combined to help prevent the spread of flu and cold viruses.”

According to Shanahan, the reduction in sales has been compensated “slightly” by the increase in purchases of vitamins and minerals, which customers are sourcing as part of Covid-19 prevention measures.

“Colleagues are actually looking at the dates on cold and flu remedy stock wondering will they have it sold before they go out of date, which they would have never done.

It’s an extraordinary situation.”

“There is a huge uptick in Vitamin C and Vitamin D for example. I won’t say they are balancing each other out completely though, as it depends on everyone’s own business model.

Intercontinental Medical Statistics (IMS) Industry data reveals a

Sales of Vitamin D at his pharmacy have at least doubled

PHARMACYNEWSIRELAND.COM

“The cough and cold remedy as a category has collapsed, literally collapsed. There are no coughs and colds going round now other than Covid coughs and cold” in recent months due to emerging indications it may have a role in boosting immunity, he said.

For Covid treatment, he said the products purchased at pharmacies vary depending on a person’s symptoms.

“For a lot of people it [Covid] is like a nasty flu type illness so you’re talking Paracetamol, plenty of fluids, bed rest. One presentation that is coming more often is a sinus presentation and there are decongestants and painkillers available for that,” he advised.

“Sometimes we are seeing doctors prescribing cough bottles for a Covid cough but that cough is, I don’t think, very amenable to treatment…for a dry cough the usual treatment would be a cough suppressant which is probably not a good idea in someone who potentially has reduced lung function so you wouldn’t typically recommend it as it could increase the risk of things going wrong with a patient if they start deteriorating.”

“There are very few viruses out there at the moment other than Covid,” he added.

Surge in Pharma Exports Irish goods exports increased in value by ¤2 billion in November on the back of a surge in exports of medical and pharmaceutical products linked to the pandemic.

The latest trade numbers from the Central Statistics Office (CSO) show the value of goods exports rose month on month by 17% to ¤14.4 billion in November.

The strong performance was led by exports of medical and pharmaceutical products, which were up by 74% at nearly ¤7 billion compared with November 2019.

The CSO said pharma exports accounted for 48% of the total value of goods exports in November.

The Republic is a global hub for pharma and medtech, playing host to 24 of the top 25 biggest players, including Pfizer, Johnson & Johnson, Roche, Novartis and AbbVie. These companies have been ramping up production to meet soaring demand for medicines and products connected with the treatment of Covid-19.

On the import side, the figures show seasonally adjusted goods imports increased by 21 per cent to ¤8.4 billion, which resulted in a trade surplus of just under ¤6 billion million in November.

The pick-up in imports was driven other transport imports, excluding aircraft leasing, which was up by 16 per cent to ¤6.9 billion on same month in 2019.

Medical and pharmaceutical imports were also up by 78 per cent to ¤1 billion.

As the Brexit deadline approached, exports to Britain rose by ¤382 million (+35%) to ¤1.4 billion, again driven by exports of medical and pharmaceutical products However, the value of goods exports to Britain in the first 11 months of 2020 was ¤11.4 billion, which represented a decrease of 9% compared to 2019.

The EU accounted for just over ¤5.9 billion or 40 per cent of total goods exports in November, of which ¤1.9 billion went to Belgium.

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Profile: Medicine Shortages

9

Shortages continue to impact on Pharmacy There is a continued high incidence of medicines shortages across Europe. This the main realisation from the results of the most recent Medicine Shortages Survey, carried out amongst 26 European countries, including Ireland.

Each year Pharmaceutical Group of the European Union (PGEU) conducts a survey among its membership to map the impact of medicine shortages across Europe from the community pharmacists’ perspective. The 2020 PGEU Medicine Shortages Survey Results cover the responses from 26 European countries.

The 2020 Survey was open to all PGEU member organisations and has been conducted between 9 November – 11 January 2021.

Almost all responding countries in case of a shortage. Generic However, some of these solutions indicated that they believe are subject to restrictions (e.g. new substitution (80% of countries), medicine shortages cause distress prescription is needed) and can be importing the medicine from and inconvenience to patients cumbersome and time-consuming a country where it is available (96%). Interruption of treatments for the patient and the pharmacist. PGEU (50%) and sourcing the same (80% of countries) increased Medicine Shortagesand Survey 2020 Results co-payments as a result of more medicine from alternative In the majority of responding expensive/non-reimbursed authorised sources, such as countries (65%), over 200 alternatives (57%) are also other pharmacies, (46%) are the medicines were listed as in short perceived Question 3. If yes, which medicines have been in short supply? Tick all that apply. as common negative solutions which can be provided in supply at the time of completing consequences of medicine (% of responding countries) the survey. shortages on patients. most of the European countries.

Medicines

Responding countries (%)

Cardiovascular medications Vaccines Nervous system Respiratory system Gastro-intestinal medications Antiinfectives for systematic use (e.g. antibiotics) Classes of Medicine Systemic hormonal preparations All classes of medicines are Genito-urinary system and sex hormones affected by medicine shortages Antineoplastic and immunomodulatings agents in community pharmacies Musculo-skeletal system across Europe. Cardiovascular PGEU Medicine Shortages Results medications have been short in Survey 2020 Dermatologicals supply in community pharmacies Blood and blood forming organs in the highest percentage of Various countries (92%).

Antiparasitic products, insecticides and repellents Across Europe, strong differences exist in terms of legal solutions Sensory organs

92.31% 88.46% 84.62% 84.62% 80.77% 76.92% 76.92% 73.08% 69.23% 65.38% 65.38% 61.54% 57.69% 50.00% 50.00%

All responding countries experienced medicine shortages in community pharmacies in the past 12 months, and in the majority (65%) of countries, respondents indicated that the situation got worse compared to 2019.

Survey Results

community pharmacists can offer

Question 1. In the last 12 months, have you experienced medicine shortages in your country?

Question 4. How many medicines are short in supply at the time of completing this survey?1 (% of responding countries) (% of responding countries)

100%

Don’t know (1/26)

90%

>400 (8/26)

80% 70% 60% 50%

3.85%

100% of responding countries ex-

30.77% perienced medicine shortages in

300-400 (3/26) 200-300 (6/26)

23.08%

100-200 (4/26)

40%

50-100 (3/26)

30%

0-50 (1/26)

the last 12 months.

11.54%

15.38% 11.54%

In 2019, medicine shortages were also experienced in all countries.

3.85%

20% 10% 0%

1The quantification takes into account the national definition of a medicine shortage in each responding country, which can show differences between them. The comparison of these numbers should therefore be interpreted as an indication rather than exact comparison.

Yes (26/26)

No (0/26)

Question 2. If yes, compared to the previous 12 months, the situation has:

PHARMACYNEWSIRELAND.COM

5

10

Profile: Medicine Shortages The Story in Ireland

Medicine shortages affect community pharmacy businesses in most countries by financial loss due to the time invested in mitigating shortages (92% of countries), reduced patient trust (80%) and reduced employee satisfaction (76%).

It was warned in July of last year, that Irish patients are at risk due to shortages of medicines becoming an increasing problem.

This statement came from the Irish Pharmacy Union (IPU), following a survey of its members which found that 97% of the country’s community pharmacists had observed an increase in medicine shortages over the previous 12 months.

Time Spent on Shortages The time pharmacy staff has to spend on dealing with medicine shortages is 6.3 hours per week on average.

Speaking about the survey findings, Darragh O’Loughlin, Secretary General of the IPU said “Almost every pharmacist across the country reports experiencing a worsening of medicine shortages.

It’s part of a pharmacist’s role to use their expertise and experience to source appropriate substitute medicines for patients but this is becoming an ever-increasing challenge. The most worrying Community pharmacists receive statistic is that almost half of the relevant information on pharmacists (48%) believe shortages mostly from medicine shortages are potentially impacting agencies (65%), manufacturers PGEU Medicine Shortages 2020 Results (57%) and wholesalers (50%). Surveyon patients’ health.

23% of responding countries indicated that there is still no reporting system for shortages in place which can be used by community pharmacists in their country, despite that pharmacists often experience or foresee supply difficulties before the industry or wholesalers are aware that there is, or will be, a problem.

“Our approach to medicine pricing is one of the biggest challenges we face,” according to Mr O’Loughlin.

“Over half of pharmacists (55%) believe that HSE pricing policy is contributing to shortages. In Ireland we take a cost-based approach rather than being focussed on patients, which has resulted in significant reductions in medicine prices. However, too often that means when a global shortage emerges Ireland is at the back of queue, as a small country that is constantly driving down the price of medicines and unwilling to pay market prices.

“Since the onset of COVID-19 we have seen how other, larger, countries are competing for medicines, with the USA buying up the global supply of remdesivir during the summer and the UK pre-emptively ordering 100 million doses of a COVID-19 vaccine that is still being trialled. The Department of Health and the HSE need to take a realistic and pragmatic approach to medicine pricing to ensure that Irish patients do not end up going

without as a result of a fixation on ever-lower prices.”

PGEU President Alain Delgutte commented, “The 2020 results show the continued high incidence of medicine shortages in Europe and their daily and burdensome impact on patients and pharmacy practice. The COVID-19 pandemic has made the general public aware of the vulnerability of supply chains for medicines and medical equipment, a structural issue pharmacies have been faced with for over a decade already. Community pharmacists have been doing everything in their power to prevent further worsening of shortages and have in several European countries also been successfully empowered in this role by their authorities. We sincerely hope that the increased attention of policy makers to this phenomenon will allow us to report more positive progress in the coming years and finally bring meaningful solutions to patients and healthcare professionals across Europe.”

Question 7. Which solutions can legally be offered by pharmacists in case of a shortage?2 Tick all that apply (% of responding countries)

80.77%

50.00%

46.15%

42.31%

Generic substitution (21/26)

Importing the medicine from another country (13/26)

Soursing the same medicine from alternative authorised sources (12/26)

Preparing a compounded formulation (11/26)

34.61%

23.08%

Changing to the Therapeutic substisame medicine with tution (6/26) a different strength (9/26)

Comments received: News

First for Cara Pharmacy Belgium

France

The Cara Group has become the first Age Friendly Pharmacy Group. All thirteen sourcing medicines from "Changing Age to theFriendly same medicine with a different strength of theSystematically Cara Group stores throughout the country have completed still available, and adjusting therapy posology acother pharmacies is not permitted.

It isChampion, pertraining, have appointed an Age Friendly and when have implemented three simplemitted changes in store tocircumstances make the environment, and the customer experience, in exceptional such as cordingly": in that case, the pharmacist must get the conmore shortages. appropriate for older customers. sent of the prescriber and note "replaced after medical advice" onthem therespond prescription.

"Therapeutic substitution": Age Friendly Ireland is currently rolling out training for businesses all over Ireland to help to our rapidly ageing demographic in a positive and supportive way. These businesses recognise that, despite the challenges of Covid19, it is important to focus on encouraging andrecthis is done for some medicines, following a specific supporting older customers to continue using the products and services they need and enjoy.

Bulgaria

ommendation from health authorities. "Preparing a com-

Rob Wood, Superintendent Pharmacist for CARA says, “We’re delighted to be the very first accredited Age Friendly Pharmacy Group in Ireland. We pounded formulation": this can happen, e.g. when there know all of our customers have different needs and undertaking the work with Age Friendly had given us the tools to tailor our products, services and care for our older customers and patients.

We’re looking forward to a productive long termof relationship with Age Friendly.” were shortages corticoids.

Very rarely the preparation of compounded

formulation is the solution. Generic substitution is not allowed. The other possible soluPHARMACYNEWSIRELAND.COM tions neither.

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12

News

Pharmacy offers #Bestshot for Vaccine Cabinet ministers last month gave the go ahead for pharmacists and GPs across the country to administer the Covid-19 vaccine.

The ¤91 million deal approved will allow doctors and pharmacists to start administering the vaccine as early as this month to vulnerable groups.

The news came after numerous local community pharmacies signed up to the #bestshot campaign which was initiated by the Leinster Leader and KildareNow to fast-track Covid-19 vaccines to local pharmacies.

People are being urged to sign a petition on the issue which will be delivered to the Minister for Health, Stephen Donnelly so the people of Kildare can let the government know that they believe that the vaccine should be delivered straight to local communities, through local pharmacies.

Joan Kilgallon from Burkes Pharmacy in Naas told the paper, "Pharmacists who manage the medications for at risk groups, are ideally positioned to identify and vaccinate these vulnerable members of our society.

“Pharmacists currently provide 13% of all flu vaccinations.

Since pharmacists first started vaccinating in 2011, flu vaccine deliveries through the National Immunisation Office (NIO) have increased overall by 29% and, within that, deliveries to GPs are up 8%, demonstrating that when pharmacists vaccinate, public awareness increases, and vaccination rates increase through all channels.

“However, we need a vaccination roll out to be in place, ahead of EU vaccine authorisation, so that we are positioned to start the vaccination administration. To date, we have no information on roll out, and cannot advise our customers, of the expected vaccine date.”

in Laois in protecting the public through vaccination was Liz Dalton of Kilminchy Pharmacy in Portlaoise.

1

She said vaccination at pharmacies is set to begin in March and is planning for a seven-day week vaccination campaign.

2

Minister for Health brought the deal to cabinet which will see a payment of ¤60 for each patient vaccinated made to members of the Irish Medical Organisation and the Irish Pharmacy Union.

It expected that doctors and pharmacists will be administering the Oxford/AstraZeneca vaccine as it does not need to be held at as low a temperatures as other vaccines.

4

Taoiseach Micheal Martin said, “The vaccination programme is progressing well, with targets to date exceeded. The volume of vaccines available to us will ramp up in time ahead.

3

“There will be bumps in the road, but we need to stay focussed. In the meantime, stay home, wash your hands, minimise contacts.

Be Safe."

However IPU Secretary General Darragh O’Loughlin says that now it is essential that pharmacy staff themselves can now be vaccinated without delay.

“Pharmacists, as with anyone giving the vaccine, must be vaccinated themselves in order to do so safely. People using pharmacy services, especially medically vulnerable patients, deserve the assurance that their pharmacist and pharmacy team have been vaccinated. Any further delays in vaccinating pharmacists could severely impact the pace of the national rollout.”

Endorsing the Leinster Express #BestShot petition campaign backing the role of pharmacists

5 6 1: Peter McElwee of McElwee totalhealth Pharmacy; 2: Freshco Pharmacy Over-The-Counter Sales Manager Carmel McGuinness (left) and Superintendent Pharmacist Stella Furey (right); 3: Liz Dalton and the team at Kilminchy Pharmacy in Portlaoise; 4: Ciaran Sheehy, Manager of Newpark Pharmacy, Newpark Shopping Centre; 5: Leitrim Pharmacists John Slowey and Ryan Jones of RJS Pharmacy Drumshambo; 6: James Crotty and his wife Susan at their new pharmacy in Bennettsbridge

Pregnant and Breastfeeding Women The Institute of Obstetricians and Gynaecologists together with the National Immunisation Advisory Committee at the Royal College of Physicians of Ireland have compiled information for women who are pregnant or breastfeeding and their doctors about the Covid-19 vaccine. This information has also been endorsed by the HSE National Women and Infants Health Programme.

“Today we are issuing information to help to inform women who are pregnant or breastfeeding about the Covid-19 vaccine and also for their doctors which can help to inform discussions at this critical time,” said Dr Cliona Murphy, Chair of the Institute of Obstetricians and Gynaecologists.

She continued, “It is important that women seek trusted information about the vaccines and can assess their risks with regards to Covid-19 and the vaccine in consultation with their healthcare providers.”

The information, titled Questions and Answers for pregnant or breastfeeding women and their doctors about COVID-19 vaccination, is available on The Royal College of Physicians of Ireland’s website at www.rcpi.ie

PHARMACYNEWSIRELAND.COM

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14

News New Research from TILDA

Letter to the Editor Jennifer Winder-Baggot, MPSI, Morehampton Pharmacy

Almost three-quarters of Irish adults in Ireland aged 58 years and older have two or more medical conditions, according to a new report.

The report, by Trinity College Dublin’s Irish Longitudinal Study on Ageing (TILDA), provides a picture of the social, financial, mental and physical state of Ireland’s ageing population before the pandemic dramatically impacted their lives.

Researchers say the report will serve as a useful resource for policymakers and planners tasked with identifying gaps and solutions to improve supports for older people following the unfolding of the crisis.

Dear Editor, Thank you to Oisin Ó hAlmhain for his article in the December 2020 issue, "Tackling packaging in Pharmacy."

I have long been disturbed by the mountain of packaging retail pharmacists discard daily. I hope the article will lead to more efforts to reduce pharmacy waste and especially use of plastic, and will also encourage Supervising and Superintendent pharmacists to make recycling an essential part of the dispensary and the OTC area.

When I was a supervising pharmacist about ten years ago I followed my mother Colette's initiative in the dispensary, ordering varying sizes of small boxes instead of plastic zip bags for dispensing blisters of tablets.

This is a good way for pharmacists to reduce their use of plastic.

The manufacturing of 28 size packs of tablets should be phased out in favour of 30 size packs. Pharmacists can demand this from pharmaceutical companies. We can start by favouring generics that package their tablets in packs of 30 or multiples of 30. I believe that the public would be shocked if they realised the amount of plastic pharmacists and pharmaceutical companies send out into the world every day. It is time pharmacists show that they care not only for their patients today, but for the earth's future. I know pharmacists are usually too busy to engage in lobbying, but using paper-based or biodegradable rather than plastic-based packaging would be an effective first step. Perhaps Irish Pharmacy News could publicise which suppliers provide these options.

The IPU and the HPRA could encourage and demand, respectively, more earth-friendly alternatives from our pharmaceutical and manufacturing companies.

I hope this new year, pharmacists can make efforts toward a cleaner, greener future.

Best wishes and a safe and happy new year!

Researchers said understanding the prevalence of chronic conditions (such as diabetes, hypertension or asthma), lifestyle factors that influence health across age groups and medication use is crucial for planning and delivery of healthcare during critical periods like a pandemic.

They found 74% of adults aged 58 years and older report the presence of two or more medical conditions; with 8% reporting no chronic conditions.

Multi-morbidity [co-occurring diseases] becomes increasingly prevalent as older adults age, according to the report. Almost one in six adults aged 58 years and older are frail, though researchers outline that frailty is not inevitable, and can even be avoided, delayed or reversed with appropriate and timely interventions.

Almost half of adults aged 75 years and older report regular use of five or more medications, which increases with age.

Jennifer Winder-Baggot, MPSI, Morehampton Pharmacy

Increase in Vaccine Uptake Predictions Three-quarters of people will take a Covid-19 vaccine, according to the results of a survey by Ipsos MRBI for the Irish Pharmaceutical Healthcare Association (IPHA) which represents the international research-based biopharmaceutical industry.

The survey shows that 75% of people will take a Covid-19 vaccine. Almost one-fifth, or 18%, were unsure while 7% said they will not take one.

respectively, said they will take the vaccine. Of the 7% of people overall who said they will not take it, this level was highest among 25 to 34-year-olds.

As many women as men, or 75%, said they will take a Covid-19 vaccine.

The figures show a 20-point rise in the number of people who will take a Covid-19 vaccine since the last published results in October of the Ipsos MRBI Covid-19 vaccine tracker survey for IPHA. Then, 12% of people said they would not take it - down five points to 7% in this latest set of

The age group most likely to take a Covid-19 vaccine were the over-65s, followed by people aged between 55 and 64. In these groups, 86% and 80%,

PHARMACYNEWSIRELAND.COM

results. The number of people who said they were unsure is down 15 points since October.

Oliver O’Connor, Chief Executive of IPHA, said: “Our latest survey shows there is a strong public appetite for taking a Covid-19 vaccine. Immunisation on a sufficient scale is all that separates us from an indefinite series of lockdowns. It is vital that as many people as possible get vaccinated so that we can

all return to normality or, at least, some version of it.”

During Covid-19, the pharmaceutical industry continues to manufacture medicines and supply them to patients, contribute to the search for COVID-19 vaccines and treatments, help local charities, hospitals and voluntary groups, and create significant economic value through exports, jobs and tax revenue.

Esomeprazole Krka Krka Esomeprazole

Esomeprazole Esomeprazole Capsules, Capsules, hard, hard, 20 20mg, mg,40 40mg mg

Innovative Innovative formulation, formulation,predictable predictableresponse response • The most prescribed esomeprazole in most prescribed esomeprazole inaalarge large part of Europe.(1) of Europe.(1) • Favourable Favourable pharmacokinetics: pharmacokinetics:demonstrates demonstrates good predictability of antisecretory good predictability of antisecretoryresponse response(2) (2) •• Innovative Innovative synthesis synthesisand andformulation formulation(pellets) (pellets) has has been been granted grantedan anEuropean Europeanpatent patent(3) (3) References: 1. ePharma Market, CEGEDIM, IQVIA, INTELLIX, MEDICUBE, PHARMSTANDART, SOFTDENT 2019 TM 23, IQVIA, HmR 2019 (4 markets – AT, DE, IE, PT).

References: 1. ePharma Market, CEGEDIM, IQVIA, INTELLIX, MEDICUBE, PHARMSTANDART, SOFTDENT 2019 TM 23, IQVIA, HmR 2019 (4 markets – AT, DE, IE, PT).

2. Kyrilovich SA, Chekalina EA, Belkovets AV, Scherbakova LV. Dose-related antisecretory effect of esomeprazole: the results of long-term monitoring of 2. Kyrilovich SA, Chekalina EA, Belkovets AV, Scherbakova LV. Dose-related antisecretory effect of esomeprazole: the results of long-term monitoring of intragastric pH. Russian J of Gastroenterol. Hepatol. Coloproctol. 2016; 3: 32-39. 3. European Patent Office (EPO), Munich. Granted 25.6.2014, published in intragastric pH. Russian J of Gastroenterol. Hepatol. Coloproctol. 2016; 3: 32-39. 3. European Patent Office (EPO), Munich. Granted 25.6.2014, published in bulletin 2014/26 (EP 2376476 B1). Available from [http://www.epo.org]. bulletin 2014/26 (EP 2376476 B1). Available from [http://www.epo.org].

Composition: Each hard capsules contains 40 mg of esomeprazole (as esomeprazole magnesium Composition: Each hard capsules contains 20 20 mgmg andand 40 mg of esomeprazole (as esomeprazole magnesium dihydrate).

Therapeutic indications, posology method of administration: Adults aged 18 and above: dihydrate).

Therapeutic indications, posology andand method of administration: Adults aged 18 and above: treat heartburn caused gastro-esophageal reflux disease (GERD): 40 mg once a day 4 weeks (food ToTo treat heartburn caused byby gastro-esophageal reflux disease (GERD): 40 mg once a day for 4for weeks (food pipe (gullet) slightly damaged) 4 weeks.

Your doctor extend further 4 weeks if your gullet pipe (gullet) slightly damaged) dayday forfor 4 weeks.

Your doctor maymay extend further 4 weeks if your gullet has has not healed. once a day once gullet healed. severe problems: 20 mg daily. not yetyet healed.

2020 mgmg once a day once thethe gullet hashas healed.

ForFor severe liverliver problems: 20 mg daily.

To To treat ulcers caused Helicobacter pylori infection to stop them coming back: 20 mg twice a day treat ulcers caused byby Helicobacter pylori infection andand to stop them coming back: 20 mg twice a day for for one week.

Doctor also take with antibiotics example amoxicillin(1g) clarithromycin one week.

Doctor willwill also telltell youyou to to take with antibiotics for for example amoxicillin(1g) andand clarithromycin (500 mg).

ToTo treat stomach ulcers caused by by NSAIDs (Non-Steroidal Anti-Inflammatory Drugs): 20 mg (500 mg). treat stomach ulcers caused NSAIDs (Non-Steroidal Anti-Inflammatory Drugs): 20 once mg once a day forfor 4 to 8 weeks.

To To prevent stomach ulcers if you areare taking NSAIDs: 20 mg once a day.

To treat too too a day 4 to 8 weeks. prevent stomach ulcers if you taking NSAIDs: 20 mg once a day.

To treat much acid in in thethe stomach caused by by a growth in the pancreas (Zollinger-Ellison syndrome): 40 mg twice much acid stomach caused a growth in the pancreas (Zollinger-Ellison syndrome): 40 mg twice a day.

Maximum dose is 80 mg twice a day.

Prolonged treatment after prevention of rebleeding of ulcers a day. Maximum dose is 80 mg twice a day. Prolonged treatment after prevention of rebleeding of ulcers with intravenous esomeprazole: 40 40 mgmg once a day for for 4 weeks.

Adolescents aged 12 or To treat with intravenous esomeprazole: once a day 4 weeks.

Adolescents aged 12above: or above: To treat heartburn caused byby gastroesophageal reflux disease (GERD): 40 mg once a day for 4forweeks (food pipepipe heartburn caused gastroesophageal reflux disease (GERD): 40 mg once a day 4 weeks (food (gullet) slightly damaged) dayday forfor 4 weeks.

Your doctor maymay extend further 4 weeks if your gullet has has not not yet yet (gullet) slightly damaged) 4 weeks.

Your doctor extend further 4 weeks if your gullet healed.

2020 mgmg once a day once thethe gullet hashas healed.

ForFor severe liver problems: 20 mg daily.

TakeTake at any timetime healed. once a day once gullet healed. severe liver problems: 20 mg daily. at any of of thethe day with food or on an empty stomach.

Swallow it whole with water.

Trouble swallowing capsules: Open day with food or on an empty stomach. Swallow it whole with water. Trouble swallowing capsules: Open thethe capsule and empty thethe pellets into halfhalf a glass of still (non-fizzy) water.

Do not useuse anyany other liquids.

ThenThen capsule and empty pellets into a glass of still (non-fizzy) water.

Do not other liquids. drink thethe mixture straight away or or within 30 30 minutes.

Always stir stir thethe mixture justjust before drinking it. Unable drink mixture straight away within minutes.

Always mixture before drinking it. Unable to to swallow thethe capsules viavia normal oraloral route: Dissolve it initainglass of still water, putput intointo a syringe, andand deliver swallow capsules normal route: Dissolve a glass of still water, a syringe, deliver viavia gastric tube.

Contraindications: Hypersensitivity to esomeprazole andand to any of the excipients.

Special gastric tube.

Contraindications: Hypersensitivity to esomeprazole to any of the excipients.

Special information about some of the ingredients: Contains sucrose and sodium.

Intolerance to some sugars, information about some of the ingredients: Contains sucrose and sodium. Intolerance to some sugars, contact your doctor before taking thisthis medicinal product.

Special Precautions andand Warnings: Have severe contact your doctor before taking medicinal product.

Special Precautions Warnings: Have severe liver, kidney problems, vitamin B12B12 deficiency, andand osteoporosis or taking corticosteroids.

HadHad a skin reaction liver, kidney problems, vitamin deficiency, osteoporosis or taking corticosteroids. a skin reaction after treatment with a medicine similar to Esomeprazole Krka thatthat reduces stomach acid.acid.

DueDue to have a speafter treatment with a medicine similar to Esomeprazole Krka reduces stomach to have a specific blood test (Chromogranin A).A).

GetGet a rash on on your skin, especially in areas exposed to the sun sun tell your doc-doccific blood test (Chromogranin a rash your skin, especially in areas exposed to the tell your tortor asas soon as you can, as you may need to stop your treatment with Esomeprazole Krka.

Any other ill-effects soon as you can, as you may need to stop your treatment with Esomeprazole Krka. Any other ill-effects like pain in in your joints.

Esomeprazole Krka may hide thethe symptoms of other diseases.

Therefore, if weight like pain your joints.

Esomeprazole Krka may hide symptoms of other diseases.

Therefore, if weight loss, trouble swallowing, indigestion, vomit food or blood, blood stained faeces happens to you before you you loss, trouble swallowing, indigestion, vomit food or blood, blood stained faeces happens to you before start taking Esomeprazole Krka or or while youyou areare taking it, talk to your doctor straight away.

Interactions start taking Esomeprazole Krka while taking it, talk to your doctor straight away.

Interactions with other medicinal products and other form of medicines: If taking: Nelfinavir and Atazanavir (for HIV); with other medicinal products and other form of medicines: If taking: Nelfinavir and Atazanavir (for HIV); Digoxin (for(for heart problems); Antifungals (e.g.

Ketoconazole, itraconazole or voriconazole ); Erlotinib (for (for can-canDigoxin heart problems); Antifungals (e.g.

Ketoconazole, itraconazole or voriconazole ); Erlotinib cer); Ant-depressants (e.g. citalopram, imipramine or clomipramine); Diazepam (to treat anxiety, relaxrelax muscles cer); Ant-depressants (e.g. citalopram, imipramine or clomipramine); Diazepam (to treat anxiety, muscles oror in in epilepsy); Phenytoin (used in epilepsy); Warfarin and clopidogrel (blood thinners).

Cilostazol (a pain in in epilepsy); Phenytoin (used in epilepsy); Warfarin and clopidogrel (blood thinners). Cilostazol (a pain your legs when you walk which is caused by by an an insufficient blood supply); Cisapride (for (for indigestion and and your legs when you walk which is caused insufficient blood supply); Cisapride indigestion heartburn); Methotrexate (to treat cancer); Tacrolimus (organ transplantation); Rifampicin (tuberculosis treatheartburn); Methotrexate (to treat cancer); Tacrolimus (organ transplantation); Rifampicin (tuberculosis treatment); St John’s Wort (Hypericum perforatum) (for depression).These drugs may have an effect on Esomement); St John’s Wort (Hypericum perforatum) (for depression).These drugs may have an effect on Esomeprazole Krka or vice versa interaction on these drugs. Pregnancy and breast-feeding: If you are pregnant, prazole Krka or vice versa interaction on these drugs. Pregnancy and breast-feeding: If you are pregnant, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before thinkthis youmedicine. may be pregnant or are to haveyou a baby, ask your doctor or Krka pharmacist for advice taking Your doctor willplanning decide whether can take Esomeprazole during this time. Itbefore is taking this medicine. YourKrka doctor willinto decide whether you can take during thisKrka time.if It is not known if Esomeprazole passes breast milk. Therefore, you Esomeprazole should not takeKrka Esomeprazole not known if Esomeprazole Krka passes into breast milk.

Therefore, you should not take Esomeprazole Krka if you are breast-feeding. Possible side effects: Common: Headache. Effects on your stomach or gut: diarrhoea, you arepain, breast-feeding.

Possible side effects: Common: Headache.

Effectssick on (vomiting). your stomach or gut: diarrhoea, stomach constipation, wind (flatulence).

Feeling sick (nausea) or being Benign polyps in pain, constipation, wind (flatulence).

Feeling sick (nausea) or being sickcapsules (vomiting).

Benign polyps in thestomach stomach.

Other: Very rare, rare and uncommon.

Contents in the pack: 28 hard contains esomethe stomach.

Other: VeryPrescription rare, rare and uncommon. in theMay, pack: 28 hard capsules contains esomeprazole.

Legal Category: only medicine. Contents Revised date: 2017.

Marketing authorisation prazole.

Legal Category: Prescription only medicine. date:Slovenia.

May, 2017.

Marketing authorisation holder: KRKA, d.d., Novo mesto, Šmarješka cesta 6, 8501 Revised Novo mesto, Marketing authorisation holder:20 KRKA, d.d., Novo mesto,40Šmarješka cesta 6, 8501 Novo information mesto, Slovenia.

Marketing authorisation number: mg: PA1347/017/001; mg: PA1347/017/002.

Further is available on request. number: 20 mg: PA1347/017/001; 40 mg: PA1347/017/002. Further information is available on request.

10/2020, Ireland, 106104-2020, RB/MB.

Esomeprazole Esomeprazole Krka Krka

Esomeprazole Esomeprazole

10/2020, Ireland, 106104-2020, RB/MB.

Capsules, hard, hard,20 20mg, mg,40 40mg mg Capsules,

16

Report

Brexit – The next big Impact on Community Pharmacy?

For a long time it seemed that Brexit was the only talking point among Irish businesses. Then Covid-19 came along almost a year ago and derailed the economy.

Amidst all the fear and uncertainty surrounding the virus, on 31st December 2020 the Brexit transition period arrived with little fanfare.

Without a doubt the biggest threat for community pharmacies remains the pandemic. But what of Brexit and its impact on the sector to date? Is the virus clouding our view of potential trouble down the track as the UK finally breaks away from the EU? Niamh Cahill reports.

Too early to tell Jack Shanahan, pharmacist at Haven Pharmacy Shanahan’s, Castleisland, Co Kerry believes there has been very little visible impact of Brexit on pharmacies to date, but that this will change in the future.

Jack Shanahan, Pharmacist, Haven Pharmacy Shanahan’s, Castleisland

Rory O'Donnell, Pharmacist, O'Donnell's Pharmacy, Donegal

stock in Ireland in warehouses.

I think at the moment there isn’t really an impact and part of that is to do with the fact that sales are depressed in a lot of areas in community pharmacy at the moment because of Covid and there’s less people going out. I think the impact has yet to be seen.”

Mr Morrissey has been informed that the product “Estradiol in a pump tube for women” has been affected by Brexit and is now unavailable here.

For months the Department of Health and Health Products Regulatory Authority (HPRA) advised that Brexit would not have a major impact on medicines supply in Ireland.

So far it would appear that their forecast has come to pass. But for how long?

Rory O’Donnell, Donegal Pharmacist, says it is simply too early to say how Brexit will affect medicines supply.

He is not shocked that there has been no impact to date, arguing that “we are only a few weeks into it”.

Furthermore, he believes that “folks are more concerned about Covid”, which is diverting attention away from any potential impact Brexit may be having or yet have on the sector.

“I think people are living in a fool’s paradise when it comes to the impact of Brexit,” he argued.

For Jonathon Morrissey, pharmacist at Marrons Pharmacy, Co Kildare, Brexit has yet to have any negative affect.

“Prior to Christmas a lot of suppliers would have hoarded

He says “it’s too early to tell” yet how Brexit will play out.

“If it’s happened I haven’t seen it,” he remarked in response to a question about any disruptions to the medicines supply chain and stock price increases to date.

Dublin based community pharmacist Dave Gilsenan agrees, and has yet to see any negative impact from Brexit.

“But because I can still get an equivalent from United Drug and Uniphar I wouldn’t even consider that an affect yet,” he surmised.

are no issues with tariffs or delays so far.”

“This does not guarantee that this will remain the case. Our wholesalers keep three months’ supply of most medicines in the supply chain so any short term issues in transport or border controls should not impact this.”

Subtle changes But while the vast majority of pharmacists are caught up with the turmoil caused by the pandemic, it is evident that subtle, minor changes have occurred following Brexit.

Privately, he recently purchased a product from the UK and “got hammered with VAT” to the tune of ¤70 on top of what he paid for the item. Will this affect products purchased for his business in the future he wonders?

Secretary General of the IPU Darragh O’Loughlin confirmed there has been no disruption to medicine supply to date, “broadly speaking”.

“There have been one or two cases of specialised products that have been held up for one or two patients,” he confirmed.

According to Mr Shanahan, “there are little niggles” visible already.

“These are specialist products that the pharmacist was getting in for a patient that were not available in the Irish market. The disruption to supply is to do with customs and logistics, not a regulatory disruption.”

“If you have a UK supplier and you want to pay them by bank transfer you have to pay an international bank transfer charge now, which in my case with AIB is ¤15. That’s a hidden cost and it was free up to Christmas,” he explained.

Furthermore, he advised there have been “some reports of UK suppliers refusing to transport to the Republic of Ireland and a number of members who import product from UK complaining of increased costs, which the UK supplier is attempting to pass on”.

Whether or not these difficulties will increase in the future remains to be seen. Their presence however, should strike a note of caution among community pharmacies about potential challenges in the future.

Drug shortages

According to Mr Gilsenan, “the vast majority of suppliers we deal with are based in Ireland so there

Mr O’Donnell is concerned about possible drug shortages in the future. In fact, it remains his principal Brexit fear.

Jonathon Morrissey, Pharmacist, Marrons Pharmacy, Kildare

Dave Gilsenan, Pharmacist, Hilton's Pharmacy, Dublin

PHARMACYNEWSIRELAND.COM

Ireland’s new licensed fast-release, 3mg melatonin drug

Available on prescription only.

Melatonin is available on prescription in Ireland and we are now introducing Melatonin Pharma Nord, a high-quality medical drug that only contains pure melatonin without any unnecessary additives. The fast-release formula enables the melatonin content to deliver a swift and reliable effect.

Sleep problems like jet lag that are a result of disrupting your 24hour clock can be most frustrating. Restore your rhythm with the natural compound melatonin.

Each tablet of Melatonin Pharma Nord contains 3 milligrams of high-quality, pharmaceutical-grade melatonin.

Pharma Nord products, Melatonin Pharma Nord is manufactured with the main focus on bioavailability, safety, and documentation.

1. What Melatonin Pharma Nord is and what it is used for Melatonin Pharma Nord contains the active substance melatonin. Melatonin Pharma Nord can be used for treatment of jet-lag in adults. Jet-lag can be recognized by sleep disturbances, daytime tiredness, fatigue, mild mental impairment, irritability and digestive system disturbances experienced after flying.

How Melatonin Pharma Nord works Melatonin is a hormone produced by the body that synchronizes the body’s biological dayand-night rhythm. The biological rhythm can be disturbed by travelling across time zones.

This is known as a jet-lag. The symptoms and their severity vary between individuals, but are generally worse and last longer the more time zones are crossed. Melatonin Pharma Nord can help restore the normal day-and-night rhythm and reduce the symptoms.

You must talk to a doctor if you do not feel better or if you feel worse after 5 days.

2. What you need to know before you take Melatonin Pharma Nord Do not take Melatonin Pharma Nord • if you are allergic to melatonin or any of the other ingredients of this medicine (listed in Section 6).

Warnings and precautions Talk to your doctor or pharmacist before taking Melatonin Pharma Nord • if you have epilepsy. Melatonin may increase seizure frequency in patients with epilepsy • if you have an autoimmune disease (where the body is ‘attacked’ by its own immune system) • if you have diabetes or impaired glucose tolerance, as this medicine may increase the level of glucose in your blood • if you suffer from significantly impaired liver function or kidney function • if you smoke. Smoking may reduce the effect of Melatonin Pharma Nord as components of tobacco smoke can increase the breakdown of melatonin by the liver.

Children and adolescents Do not give this medicine to children and adolescents between 0 and 18 years as its safety and efficacy are unknown.

Other medicines and Melatonin Pharma Nord Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other medicines.

• Fluvoxamine (used for the treatment of depression and obsessive-compulsive disorder), as fluvoxamine may increase the effect of melatonin.

• Psoralens (used for the treatment of skin disorders e.g. psoriasis), as psoralens may increase the effect of melatonin.

• Cimetidine (used for the treatment of stomach problems such as ulcers), as cimetidine may increase the effect of melatonin.

• Estrogens (used in contraceptives or hormone replacement preparations), as estrogens may increase the effect of melatonin.

• Quinolones (used in the treatment of bacterial infections), as quinolones may increase the effect of melatonin.

• Rifampicin (used in the treatment of bacterial infections), as rifampicin may decrease the effect of melatonin.

• Carbamazepine (used in the treatment of epilepsy), as carbamazepine may decrease the effect of melatonin.

• Benzodiazepines and non-benzodiazepine hypnotics (medicines used to induce sleep, e.g. midazolam, temazepam, and zaleplon, zolpidem, zopiclone), as melatonin may enhance the sedative effect of such medicines, and may enhance certain side effects of zolpidem (morning sleepiness, nausea, confusion).

Fertility Melatonin Pharma Nord is not recommended in women and men planning to have a baby as there is insufficient information on the effects of melatonin on female and male fertility.

Melatonin Pharma Nord with food and alcohol • This medicine should not be taken with food (see Section 3).

• As alcohol can impair sleep and potentially worsen certain symptoms of jet-lag (e.g. headache, morning fatigue, concentration) it is recommended that alcohol is not consumed while taking this medicine.

If you take more Melatonin Pharma Nord than you should If you have taken more Melatonin Pharma Nord than recommended and you do not feel well, please contact your doctor, hospital or pharmacy.

The most common symptoms of overdose are drowsiness, headache, dizziness, and nausea.

Pregnancy, breast-feeding and fertility If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.

If you forget to take Melatonin Pharma Nord If you forget to take a tablet(s) at bedtime and wake during the night you may take the forgotten dose but at no later than 04:00 hr.

Do not take a double dose to make up for a missed dose.

Pregnancy Melatonin Pharma Nord is not recommended if you are pregnant. Melatonin crosses the placenta and there is insufficient information on the risk this may pose to the unborn child. If you are a woman of childbearing potential you have to use contraception.

Breast-feeding Melatonin Pharma Nord is not recommended if you are breast-feeding. Melatonin is excreted in human milk, and a risk to the breast-fed infant or child cannot be excluded.

Driving and using machines Melatonin Pharma Nord may cause drowsiness and may decrease alertness for several hours after intake. Therefore, this medicine should not be taken prior to driving or using machines.

3. How to take Melatonin Pharma Nord Always take this medicine exactly as described in the spc or as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure.

The recommended dose for adults and elderly is 1 tablet daily for a maximum of 5 days. When the effect of Melatonin Pharma Nord is inadequate, 2 tablets can be taken simultaneously.

The first dose should be taken on arrival at destination at your usual bed-time. Intake on the following days should also be at your usual bed-time. Tablet(s) should not be taken before 20:00 hr or after 04:00 hr.

Tablets should be swallowed whole with water or other liquid (e.g. milk, fruit juice). Food should not be consumed 2 hours before or 2 hours after intake of Melatonin Pharma Nord.

Melatonin Pharma Nord 3 mg may be taken for a maximum of 16 treatment periods per year.

If you stop taking Melatonin Pharma Nord If you stop taking Melatonin Pharma Nord, it will not have any harmful effects or withdrawal symptoms.

If you have any further questions on the use of this medicine, ask your doctor or pharmacist.

4. Possible side effects Like all medicines, this medicine can cause side effects, although not everybody gets them.

Serious side effects If you experience any of the following serious side effects stop taking this medicine and contact your doctor immediately: Uncommon side effects (may affect up to 1 in 100 people) • Chest pain.

Rare side effects (may affect up to 1 in 1.000 people) • Reduced number of white blood cells in the blood.

• Reduced number of blood platelets, which increases the risk of bleeding or bruising.

• Disorientation.

• Fainting.

• Visual impairment, including blurred vision.

• Feeling your heartbeat (‘pounding chest’).

• Blood (red blood cells) in the urine.

Not known (frequency cannot be estimated from available data) • Severe allergic reaction resulting in swelling of the tongue or lining of the mouth.

Non-serious side effects If you experience any of the following non-serious side effects contact your doctor or pharmacist: Common side effects (may affect up to 1 in 10 people) • Headache.

• Drowsiness.

Uncommon side effects (may affect up to 1 in 100 people) • Irritability, nervousness, restlessness, abnormal dreams, anxiety.

• Dizziness.

• High blood pressure.

• Abdominal pain, upper abdominal pain, indigestion, mouth ulceration, dry mouth, nausea.

• Itching, rash, dry skin.

• Excretion of glucose in the urine, excess protein in the urine.

• Feeling unwell.

• Weight increase.

• High levels of certain fat molecules (triglycerides) in the blood.

• Altered mood, aggression, increased sex drive.

• Memory impairment, restless legs syndrome, ‘pins and needles’ sensation.

• Watery eyes.

• Hot flushes.

• Vomiting, wind, excess saliva, bad breath, inflammation of the stomach lining.

• Nail disorder.

• Arthritis, muscle spasms.

• Passing large volumes of urine.

• Prolonged erection that might be painful, inflammation of the prostate gland.

• Thirst.

• Abnormal levels of electrolytes in the blood.

Not known (frequency cannot be estimated from available data) • Hypersensitivity reactions.

• High blood glucose level.

• Flow of milk from the breasts (also in men).

Reporting of side effects If you get any side effects, talk to your doctor or pharmacist. Reporting forms and information can be found at: https://www.hpra.ie/.

6. Contents of the pack and other information What Melatonin Pharma Nord contains • The active substance is melatonin.

Each tablet contains 3 mg melatonin.

• The other ingredients are: magnesium stearate, colloid silica anhydrous, maltodextrin, microcrystalline cellulose, carmellose sodium.

Film coating: hypromellose.

What Melatonin Pharma Nord looks like and contents of the pack Round, biconvex, clear-coated, white to offwhite tablet. Size 7.5 mm.

Blister pack containing 30 film-coated tablets.

Marketing Authorisation Holder and Manufacturer Pharma Nord ApS Tinglykke 4-6 DK-6500 Vojens Denmark

Rare side effects (may affect up to 1 in 1,000 people)

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

IE_Melatonin_Ad_IrishPN_A4_1220

Prescribing Information – Ireland For full prescribing information refer to the Summary of Product Characteristics.

18

Report

“Whether that is a direct consequence of Brexit or as a result of any increased demand due to people thinking there is going to be a drug shortage, that’s the biggest fear right now that I have”

“What remains to be seen is what the effect is on drug shortages; that’s going to be the big one. Whether that is a direct consequence of Brexit or as a result of any increased demand due to people thinking there is going to be a drug shortage, that’s the biggest fear right now that I have.”

they arise”, but cautioned that this was based on “normal use of medicines”.

existing stock levels and hamper the supply of medicines for other patients”.

But, as Mr Gilsenan notes, pharmacists are already “very used to dealing with shortages”. For him, short term supply problems represent a “daily headache”.

“There is no need for healthcare professionals to order extra quantities of medicines, or for doctors to issue additional prescriptions. Similarly, patients and the general public are asked not to seek supplies of medicines over and above their normal requirements. Doing so will disrupt existing stock levels and hamper the supply of medicines for others.”

“All involved must balance the interests of their patients and wider society where challenges may arise. Pharmacists and other health professionals have an important role to play in providing accurate information to people to avoid disruption and aid understanding of Ireland’s medicines supply arrangements.”

A spokesperson for the Department of Health said “Ireland is unlikely to face general medicine supply issues and is well placed to deal with these as

According to the Pharmaceutical Society of Ireland (PSI), the impact of ordering extra quantities of medicines would have a “knock-on effect on managing

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The DOH spokesperson said medicine shortages “are a feature of health systems around the world”.

“The potential shortage of any specific medicine will be managed through the existing Medicine

19

“We are a small market and low margin, low usage products could easily be impacted if there are changes to costs of supply to our market”

Meanwhile, Mr Gilsenan remains unsure whether or not the impact of tariffs will lead to some products being removed from the Irish market.

notice any difference in your ordering process with us in 2021 and we are not aware of you having to complete any extra paperwork”.

“We are a small market and low margin, low usage products could easily be impacted if there are changes to costs of supply to our market.”

They added that the Northern Ireland Protocol allows Northern Ireland to have a unique position within the UK with regards to medicines and regulation, which means it will be much more closely aligned with the EU than the UK.

He has been heartened, however, by the fact that many suppliers have made changes to avoid Brexit supply difficulties.

“We get supply directly for a particular diabetic product direct from UK but they have rerouted through Germany so it shouldn't be an issue. We also deal with a company in Northern Ireland who have said that nothing will change.”

Shortages Framework to prevent the shortage from occurring where possible or, where it does occur, to manage the impact in terms of identifying alternative treatments.

“In the case of medicines used most often in Ireland, there are typically multiple forms, strengths, brands, and generic medicines available from a range of sources.

In the event that there are some supply issues for individual medicines, it is expected that alternative options such as alternative strengths, brands and generic medicines will be available to ensure continuity of treatment.

If a patient has any concerns about their medicine, they are encouraged to speak with their pharmacist or GP.”

Mr Shanahan believes that one of the problems is that “Ireland was always treated as a province of the UK by a lot of major suppliers”, with the two markets intrinsically linked for decades.

“That’s just a harsh reality of commercial life with a small population we were just seen as an offshoot, even to the extent that when we want to make queries in relation to certain medicines it is UK phone numbers we have to ring. There is no Irish representative available for particular medicines.”

Northern Ireland One Northern Ireland based supplier has reached out to pharmacies here on how the transition is operating to date.

In a recent advisory note, the supplier confirmed to pharmacists that “we do not expect you to

The Health Products Regulatory Authority (HPRA) has confirmed that the supply of exempt medical products can continue following the Brexit transition period deadline.

A spokesperson for the HPRA said that “to date no issues have been identified that have affected supply to community pharmacies”.

“The Department of Health, the HSE, and the HPRA together with the manufacturers of medicines, wholesalers and pharmacists continue to monitor the situation closely. The processes and systems to mitigate against any Brexit related issues are functioning well and are kept under constant review by each agency.

“As part of this coordinated response, all stakeholders continue to be committed to developing approaches and implementing contingencies to address any identified concerns should they arise.”

Additional stocks A DOH spokesperson said that unlike the UK supply chain, there are already additional stocks of medicines routinely built into the Irish medicines supply chain.

“The pharmaceutical industry and wholesalers have provided direct assurances that they are confident they have sufficient stocks to bridge any initial issues at ports.”

They added that a “refresh of previous assessments” on potential delays to the supply chain were recently undertaken to “ensure the resilience of the medicines supply chain”.

According to a spokesman for the IPHA, risks to the continued supply of medicines in the Brexit context could never be fully discounted but they can be managed.

Since the UK voted to leave the EU in 2016, “our industry began preparing for potential medicines supply implications”, said the spokesman.

“Contingency work was critical in minimising the risk of disruption to the supply of medicines to patients, whatever the outcome of the long negotiations. The industry is proud of the role it played in protecting patients who need vital medicines. That there have been no significant supply disruptions so far shows that work was valuable and well thoughtthrough. The new environment is evolving, though, and we will continue to monitor the situation closely.

“The Government, especially the Department of Health and the HPRA, deserves huge credit for consulting stakeholders, including ourselves, on medicines supply continuity. Continuity of care for patients is a goal all of us share.”

Future Community pharmacies have to date remained largely unaffected

by Brexit, in particular the supply of medicines remains unchanged and stock price increases are, as yet, absent.

But it is yet unclear whether or not the current period or “fool’s paradise”, as described by Mr Shanahan, will continue in the months ahead.

Owing to the fact that the pandemic has badly hit the sector and will continue to do so for some time, it would be a welcome relief for pharmacists if Brexit, after all the uncertainty and anxiety it created, would quietly fade away without too many hiccups.

PHARMACYNEWSIRELAND.COM

20

News

McGreals Pharmacy in ‘Drive-Thru’ Talks Kilian McGreal of McGreals Pharmacy Group is in late stage discussions with the office of the Minister for Health Stephen Donnelly about establishing a drivethrough Covid 19 vaccination centre at McGreals Primary Care Centre car park in Blessington.

Kilian McGreal, McGreals Pharmacy Group

There are two car parks in the Primary Care Centre and one of them could be converted into a drivethrough vaccination centre.

There is no reason why we can't set up on the vaccination centre in conjunction with the HSE and local GPs. We already have the perfect physical set-up.'

The Minister for Health is set to ask the Cabinet to approve an agreement with doctors and pharmacists to administer Covid-19 vaccines.

Talking about the proposed drivethrough vaccination centre, Kilian McGreal, Managing Director McGreals Pharmacy Group said: 'It is an ideal way of administering the

vaccine safely to large numbers.

We have a pharmacy co-located on the grounds of the Primary Care Centre in Blessington, so a drive-through vaccination centre could be coordinated through the pharmacy.

'We have the traffic flow management and physical infrastructure already in place.

A change in vaccination legislation means people can remain in their cars to receive the vaccination during the cold winter months.

An observation area would be established so those who have just received the vaccination can park for 15 minutes and remain inside their vehicles while being observed.

'We believe Pharmacists can play a key role in the nationwide Covid 19 vaccination roll out and we look forward to being a part of it,' added Kilian.

Asthma Education Inclusion Project The Asthma Society of Ireland, in collaboration with HSE Social Inclusion South East Community Healthcare and Pavee Point Traveller and Roma Centre, have launched their Asthma Education Inclusion project, providing culturally appropriate, literacy friendly resources and materials for Roma, Refugees, People Seeking International Protection and the Traveller community.

The aim of this project is to improve the respiratory health of these communities by developing literacy friendly information resources to support intercultural health workers and healthcare professionals to communicate key messages relating to asthma to their client groups.

• An educational ‘5 Step Rule’ animation video outlines what an asthma attack is and what to do if someone is experiencing an attack. The video is available in eight languages; Romanian, Arabic, Brazilian Portuguese, English, French, Georgian, Urdu and Portuguese Iberian.

These resources include:

• An asthma educational video, featuring Consultant Respiratory Physician Professor Stephen Lane, provides information on asthma and asthma management, explains what triggers are and emphasizes the importance of completing an Asthma Action Plan with a GP. This video has been translated into Romanian, Arabic, Brazilian Portuguese, English, French, Georgian and Pashto.

• ‘Top Tips for Asthma Management,’ providing ten tips for asthma management and outlines what an asthma attack is and the steps to follow when someone is having an asthma attack (5 Step Rule) as well as detailing what triggers are.

The leaflet is available in eight languages; Romanian, Arabic, Brazilian Portuguese, English, French, Georgian, Urdu and Portuguese Iberian.

• ‘Traveller, Asthma, COPD & COVID-19; Living with

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Coronavirus’ offers targeted advice on how to stay well during COVID-19 for people with asthma and/or COPD and where to seek additional help.

These comprehensive resources will be shared with intercultural health workers and healthcare professionals, working with these communities.

Record numbers of people require the Asthma Society’s help right now. 380,000 in Ireland are living with asthma, with 890,000 likely to develop it in their lifetime. The Asthma Society operates two support services, the HSE funded Nurse-led Asthma and COPD Adviceline service on 1800 44 54 64, and the Sláintecare funded Nurse-led Asthma and COPD WhatsApp messaging service on 086 059 0132.

New Model of Care Last month saw the launch of the HSE’s ADHD in Adults National Clinical Programme Model of Care by Mary Butler T.D., Minister of State for Older People and Mental Health.

While ADHD is well recognised in 5 -7% of children, it is not so widely known that it persists in 1.5% of adults. The ADHD in Adults National Clinical Programme addresses the lack of public services for adults with ADHD. Dr Amir Niazi, National Clinical Advisor Group Lead for Mental Health in the HSE, in welcoming the Model of Care said, “This Programme will ensure the provision of skilled assessment and diagnosis together with treatment encompassing ADHD specific medication and psycho-social therapies.”

Dr Niazi explained it provides access for three groups of adults: • those diagnosed as children with significant ADHD symptoms persisting into adulthood • parents of children with ADHD, of whom 25% may have ADHD • adults of all ages in whom ADHD was not recognised in childhood The Model of Care developed is based on the Sláintecare principle of integrated care across mental health and primary care services, voluntary agencies such as ADHD Ireland and also third level education and employment services.

Dr Margo Wrigley, HSE Clinical Lead, ADHD said, “The Programme conceptualises ADHD as an altered ability rather than a disability. Effective management of its core symptoms and negative impacts enables people to unlock the positive aspects of ADHD and lead fulfilling lives.”

The assessment and treatment of ADHD in adults was prioritised by the Health Service Executive (HSE) Mental Health and Clinical Design and Innovation, in conjunction with the College of Psychiatrists of Ireland (COPI), for development as a Clinical Programme because of the absence of such services in Ireland.

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21

Pharmacy Solution offering Respiratory Relief These days, everyone is concerned about their immunity and looking after more natural ways to help their respiratory system, especially those prone to common cold and flu, asthma, bronchitis, sinusitis or COPD. The Solution is Salt Therapy and SaltAir UV should not be missing from any house in these times.

Throughout history, pure, unrefined rock salt has long been recognized for its antibacterial and antimicrobial benefits. Salt therapy goes a long way back, in ancient Greece, where Hippocrates used to prescribe salt water steam inhalation to patients suffering from respiratory problems. Nowadays, in Europe, more and more medical institutions are being built around salt caves and patients with chronic respiratory conditions are successfully treated.

Since traveling to a salt cave can be time consuming and pricey for some people, or they just wanted to continue their treatment at home in between the Salt Room sessions Halotherapy devices (halos – salt in Greek) were developed with the purpose of simulating the salted atmosphere of salt mines. This is how Saltair UV was born, so that anyone in need can benefit from salt therapy.

How SaltAir UV Works?

SaltAir UV is a ultrasonic salinizer that mimics the respiratory healing benefits of natural salt mines. Using ultrasonic frequency vibrations, the device transforms salt into micro particles, dispenses them into the surrounding indoor space and enables them by breathing to penetrate deep inside the lungs.

As a result, breathing becomes much easier for anyone suffering from respiratory problems such as asthma, shortness of breath, hay fever, allergies, bronchitis, bronchiectasis, COPD, sinusitis, coughs, wheezing, snoring, common cold and flu and other ailments of the lungs and even building Immunity and increase sport performance.

These breathable salt particles penetrate deep into the lungs, up to the alveoli, cleaning the mucus, killing bacteria, reducing inflammation and humidifying the whole respiratory tract. The salt aerosols have a very good effect in cleaning the indoor air as well, due to the bactericide property of salt and the high concentration of negative ions that stick to the positively charged particles of dust, bacteria, and viruses. The dry salt aerosol works as a “bronchial brush” for the airways.

Who Can use SaltAir UV? SaltAir UV can be effectively used in any chronic respiratory disease, already mentioned above, as it reduces inflammation, unclogs the blockages, cleans the respiratory system, and eases breathing.

As a preventive method, the device offers protection against allergens, colds and flu by maintaining good hygiene and strengthening the immunity of the respiratory system and increasing sport performance It is a very safe therapy for all people and ages, including infants and pregnant women, and does not interact with any salt-free diet or medication. The device can also be used for respiratory problems in pets.

Perfect for infants with a stuffy nose! Babies under 4 months old can only breathe through their noses, so when they get congested

“I am very grateful for this device. I live with COPD, and there is no doubt that it has significantly improved my ability to sleep and breath…Would certainly recommend” “I have been using the salt air salinizer since November 2019. It is absolutely brilliant. I had constant sinus headaches or infections before buying the machine but not anymore. I bought one for my Mam too and she is delighted with it. Life changing!”

it is hard for them to nurse. Using a Saltair device will help a stuffed-up infant breathe easier.

How often should be used?

The ultrasonic salinizer SaltAir UV, is easy to operate and it works while you’re asleep or awake, offering the extended exposure necessary to heal certain conditions. To get the best results, use the device every day and night because salt therapy has cumulative effects in time. Use it in your bedroom, in your office or living room! The longer you use it, the better you will feel!

In a chronic condition, it is recommended to use the SaltAir UV during the night sleep, to provide 7-8 hours of exposure.

SaltAir devices are compliant Medical Device Class I with the Food and Drugs Act (FDA) and Health Canada Medical Device Regulations. They are manufactured and controlled by ISO 9001 Certified Management System and conform to all aspects of the agreed specification.

They comply with the essential requirements and provisions of European Council Directive MDD 93/42/EEC for Medical Device Class I and conform to standards: IEC60601-1: 2005/EN 60601-1: 2006, IEC/EN 60601-1-2: 2007, CE Marking.

Available in selected Mulligans Pharmacy and McCauley Health and Beauty Pharmacies around the country as well as online on their website and ours at www.KilkennySaltTherapy.ie

Additional Features: • SaltAir UV uses saline solution to create the salt aerosol, salt particles, majority under 2 microns, into the indoor air, for breathing.

• With SaltAir UV device, the quantity of salt particles generated is constantly the same and can be easily adjusted and controlled by increasing the saline solution concentration when needed.

• The SaltAir has no replacement filter, just Rock salt that will last over 6 months use.

• The Ultrasonic salinizer SaltAir UV has timer for 3h, 6h and 9h especially for overnight use or kids room.

Visit www.KilkennySaltTherapy.ie or call 056 774 0993 for more information how to buy directly or for trading.

PHARMACYNEWSIRELAND.COM

22

News

Pharmacists issue appeal on Vitamin D CarePlus Pharmacy is urging people in Ireland to consider adding a Vitamin D supplement to their diet. The appeal’s been issued as discussion continues among medical and scientific experts about whether Vitamin D may play an important role in battling coronavirus.

Irish authorities recommend babies should get a Vitamin D3 supplement every day up to the age of 12 months.

While regular multivitamins do sometimes contain some Vitamin D, typically the amounts are not very large and would not be sufficient to correct a deficiency in Vitamin D. There are a range of Vitamin D supplements available over the counter and some on prescription.

CarePlus Pharmacist in Dublin’s Templeogue Cormac Spooner says, “We’ve known for many years about how important Vitamin D is for the body so if it does protect against Covid-19, then it’s another great reason to keep on top of your intake. People in Ireland have earned a reputation for being at risk of Vitamin D deficiency so it’s a good idea to chat to your Pharmacist about it”.

Here are the key things you need to know about Vitamin D: It’s made naturally in our bodies when we’re exposed to sunlight.

Spending a lot of time indoors, such as during coronavirus restrictions, or during winter conditions, will reduce your natural vitamin D production.

Vitamin D is important for healthy bones and teeth.

Vitamin D occurs naturally in eggs and oily fish, and is added to some ‘fortified’ foods, like milk, breakfast cereal and yogurts.

Older people’s bodies have to work harder to produce Vitamin D. Given an equal amount of sun exposure, a 70-year old produces just 25% of the Vitamin D made by a 20 year old.

People with dark skin or dark complexion require longer exposure to sunlight to make the same amount of Vitamin D as light-skinned people.

Obesity may make it more difficult for a body to produce Vitamin D.

Cormac says pharmacy teams are happy to discuss these with customers. “It seems that every day we see new evidence around the benefits of supplements, and indeed the potential risks of not getting enough Vitamin D. So while the debate over its role in protecting against Covid-19 continues, everyone should consider taking a daily supplement containing 10 micrograms of Vitamin D anyway. Pharmacists can identify a suitable supplement, depending on a customer’s age, general health and any other medications they may be taking.

There are a number of health conditions which rule out the use of a Vitamin D supplement - which is another good reason to have a chat with your local community Pharmacist and their team.”

FMD Use and Learn Period to continue into 2021 The Safety Features Oversight Group continues to oversee progress with FMD implementation in Ireland. Because of the unique circumstances in which we find ourselves this year and the need to ensure that the medicines supply chain can cope with whatever challenges the Covid-19 situation and Brexit may bring over the next 2-3 months, the Group has decided that FMD will remain in a use and learn phase into 2021.

In the meantime, the advice is as follows: 1. Pharmacies, hospitals and wholesalers are expected to comply with their obligations under the Commission Delegated Regulation (EU) 2016/161 to scan packs and verify safety features during use and learn. The PSI and HPRA are monitoring compliance with this obligation. a. If an alert or any other unexpected message is flagged when a pack is scanned, the pack should still be supplied to the patient in line with your existing procedures, unless you have overriding concerns that a falsified medicine is involved.

b. If you have grounds for believing that a pack has been interfered with or could be falsified, please report this to the HPRA, by email to qualitydefects@hpra.ie or using the HPRA’s online reporting system https://www.hpra.ie/ homepage/about-us/reportan-issue (select the link called ‘Report an issue’, then ‘Medicine Quality Issue / Defect’).

2. If you have any queries about your FMD obligations, please contact either the PSI (Retail Pharmacy Businesses), HSE FMD project team (public hospitals), HPRA (wholesalers, MAHs, manufacturers, parallel importers, parallel distributors).

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3. Parallel importers and parallel distributors should continue to comply with the guidance issued to them by the HPRA on 7th February 2020.

4. Please contact IMVO if you have queries about your connection to the national system (including new locations, log in queries, change of FMD software provider, connection problems etc.) or want to follow up on specific alerts or scanning issues.

The Safety Features Oversight Group will closely monitor the situation over the coming weeks and new dates for ending the use and learn period will be notified in due course.

First in HIV Treatment ViiV Healthcare has announced the authorisation of Vocabria (cabotegravir injection and tablets) in combination with Janssen Pharmaceutical Companies of Johnson & Johnson’s Rekambys (rilpivirine injection) and Edurant (rilpivirine tablets), in the EU, for the treatment of HIV-1 infection in adults who are virologically suppressed.

Cabotegravir injection is indicated, in combination with rilpivirine injection, for the treatment of HIV-1 infection in adults who are virologically suppressed (HIV-1 RNA <50 copies/mL) on a stable antiretroviral regimen without present or past evidence of viral resistance to, and no prior virological failure with agents of the NNRTI and INI class. This authorisation represents the first time people living with HIV in Europe may be able to receive a long-acting injectable treatment that removes the need to take daily oral tablets, following the oral initiation phase.

Outlining the need for a less frequent dosing regimen, the largest global HIV patientreported outcomes study to date conducted by ViiV Healthcare, Positive Perspectives Wave 2, found that when participants were asked about their treatment aspirations and attitudes towards innovative medications, 55% (n=1306/2389) would prefer not having to take medication every day, as long as their HIV stays suppressed. In addition, 58% (n=1394/2389) noted that taking daily HIV medication acts as a constant reminder of HIV in their lives, while up to 38% (n=906/2389) of participants reported anxiety around the fact that taking daily treatment could increase the chances of revealing their HIV status to others.

Dr Antonio Antela, University Hospital, Santiago de Compostela, Spain, said, “The long-acting regimen of cabotegravir and rilpivirine was as effective as treatment with current daily antiviral therapy in the clinical trials in maintaining viral suppression, is generally well tolerated, and could change the treatment experience for some people living with HIV that may have challenges with daily HIV therapies.”

References available on request

A world-class DIGITAL PHARMACY has just launched at Conaty’s CarePlus Pharmacy, Dunboyne, Co. Meath.

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+353 87 715 5034 | jerrymcdonnell@navi.ie

24

Falls

Preventing falls and fractures and the importance of knowing about bone health Often the first time a person knows there may be something wrong with their bone density (how strong the bones are) is after suffering a fracture (broken bone). Fractures known as fragility fractures (meaning that the bones are fragile) are usually caused from a fall from standing height. If your bone density is normal it is unlikely that a fall from standing height will result in a person breaking a bone, however if that bone is weaker due to a condition known as osteopenia or osteoporosis then a fall from standing height can lead to a fracture. The types of fragility fractures often seen in the hospital are wrist fractures, pelvic fractures and fractures in the spine. However the most devastating type of fragility fracture is a hip fracture (broken hip).

Written by Louise Brent, Irish Hip Fracture Database & Major Trauma Audit Manager

• Impaired postural stability linked to diseases (such as arthritis, stroke and Parkinson’s disease) • Sight, hearing or cognitive impairment • Poor mobility, balance and coordination due to inactivity.

To measure the care and outcomes of patients who suffer hip fractures in Ireland, the Irish Hip Fracture Database was established in 2013 by the National Office of Clinical Audit (NOCA). This database is supported clinically by the Irish Institute of Trauma and Orthopaedic Surgery (IITOS) and the Irish Gerontological Society (IGS).

The database shows that 3,700 people over the age of 60 years break their hip in Ireland each year. By measuring the care of this group of patients there is now a very good understanding of who our hip fracture patients are.

out to protect ourselves when falling down can get slower, so when a fall occurs the hip takes the main force of the fall and due to osteoporosis, fractures more easily.

Environmental factors include:

Impact of Falls and Fractures

• Poorly fitted rugs and mats

As people get older, they may fall more often. While falls can obviously result in physical injury that can be serious such as a fracture or head injury, they can also have psychological effects, such as a fear of falling itself.

This loss of confidence can then lead to a self-restricted reduction in physical activity and social interactions.

• Poor lighting

Falls are costly to the individual and to society because they lead to additional GP visits, ambulance call-outs, A&E attendances, hospital stays and increased social care costs.

As the number of older people in society increases, the impact of falls is likely to grow. Falls are not a normal part of ageing and there are many causes.

These include: • Side-effects of medicines

Typically hip fracture patients are over the age of 80 years old, two-thirds of them are women and over 80% of them are living at home. Half of patients are able to walk independently before the fracture. Ninety-five percent of hip fractures occur from a low trauma fall and the majority of these occur in the patient’s own home. As we get older reflexes that would normally allow us to get our hands

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• A lack of, or poorly positioned, hand rails • Uneven or slippery flooring

• Poorly fitting footwear.

Often a combination of these factors leads to falls, so a multifactorial risk assessment (including medication reviews and home assessment) is needed to identify the risks.

Consequently, there is a variety of possible solutions (e.g. disease and medicines review, physical alterations in the home, cataract surgery and improved activity).

The Irish Hip Fracture database measures a number of clinical standards that are known to impact on how well a patient will recover from a hip fracture. These standards include - How quickly a patient is seen in the Emergency Department and admitted to an orthopaedic specialist ward.

- How quickly the patient has surgery to fix the hip fracture.

Surgery is usually done using plates, screws, nails or an implant and is a serious operation.

- Other standards include whether or not a patient develops a pressure ulcer (also known as a pressure injury or sore), these can be very painful and debilitating.

- It measures whether the patient is seen by a geriatrician (a medical specialist in the care of older people), - Whether or not the patient is mobilised on the day of or after their operation, - Whether the patient’s bone health is assessed (to ascertain history of previous fractures and risk of future fractures) and - Whether they have a specialist falls assessment (to ascertain history of falls and risk or further falls).

By ensuring these standards are met, it improves the likelihood of a patient making a good functional recovery and decreasing the risk of further falls and fractures occurring. Sadly, 5% of patients pass away in hospital following a hip fracture and only 24% of patients return directly home from hospital. Many patients will need more support then they needed prior to the fracture.

Date of Item Dec 2020 IE20071 IR-REL-120-2020

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26

Falls

REMOVE REMOVE CLUTTER CLUTTER BEDROOM: If you

BATHROOM: BATHROOM: Install grab rails.

Installmat. grab rails.

Use a non-slip a non-slip Be carefulUse on wet floors. mat.

BEDROOM: If you feel off balance feel off balance or have difficulty or have difficulty dressing yourself, sit dressing yourself, sitand get on the bed there. on the beddressed and get dressed there.

Be careful on wet floors.

CORDS AND CABLES: Remove cords and cables CORDS AND CABLES: from walkways.

Remove cords and cables from walkways.

KITCHEN: Mop up spills KITCHEN:straight away.

Do not climb on Mop up spills chairs to reach straight away. high cupboards.

LIGHTING: Ensure adequate lighting in all rooms, steps and stairs.

LIGHTING: Ensure Use nightadequate lights insidelighting and in all sensor lights outside.

rooms, steps and stairs.

Use night lights inside and sensor lights outside.

Do not climb on chairs to reach high cupboards.

STAIRS AND STEPS: Mark edges of steps clearly.

Use slip-resistant strips. Install handrails the full length of the STAIRS AND STEPS: stairs/steps.

Mark edges of steps clearly.

Use slip-resistant strips. Install handrails the full length of the stairs/steps.

In the recently published Irish Hip Fracture Database National Report 2019 a focus was put on prevention of hip fractures. An infographic has been produced highlighting the most common causes of falls in the home and by paying attention to this it is hoped people can prevent harmful falls at home.

Another audit managed by NOCA is the Major Trauma Audit which measure the care of patients who suffer severe trauma leading to life threatening or life changing injuries. The leading cause of major trauma in Ireland is also falls of less than two metres (58%) and half of accidents happen in the home. The synergies between both of these trauma audits strengthens the importance of the public health message for falls prevention. Falls can happen to people of any age however as we get older we are more likely to suffer serious harm like a fracture due to the fact that many people are unaware that their bone health may be compromised .i.e. osteoporosis.

Pro-active screening of bone health presents an opportunity to prevent fractures. If you are over the age of 50 or if you have had a low trauma fracture you should speak to your General Practitioner about bone health. Equally if you have had a fall(s), feel unsteady or have difficulties with your sight

PETS: Be aware of where your pets are.

PETS: Be aware of where your pets are.

FLOORS: Secure rugs (or remove them). Have FLOORS: non-slip floors.

Secure rugs (or remove them). Have non-slip floors.

GARDEN AREAS: Make sure that paths are even and free of moss. Keep paths GARDEN AREAS: free of garden tools.

Make sure that paths are even and free of moss. Keep paths free of garden tools.

seeking advice can help minimise the risk of harm from a fall.

• Medicines use reviews to identify high-risk medication

The IHFD sis a supporting member of the international Fragility Fracture Network which aims to reduce fragility fractures globally and ensure that those who do have a fragility fracture receive secondary prevention for falls and fracture and multidisciplinary rehabilitation. They have developed two open access resources which can be downloaded freely.

• Helping people adhere to osteoporosis therapy

Medications that can increase the risk of falling

• Integration with falls prevention services

 Blood Pressure medicines

Health promotion and signposting - Older people and their families need to be aware of how to prevent falls and how to access services that reduce the risk of falls. The community pharmacy team can provide information and advice, passively and actively through discussion with patients, family members and carers.

Information can be provided about suitable local exercise classes and online resources.

 Antihistamines  Antidepressants  Parkinson’s Disease medicines  Anti-psychotics  Benzodiazepines  Decongestants  Opioids  Muscle relaxers  Sleep medicines  Urinary antichollinergics The Role of Community Pharmacy The community pharmacy team can help identify patients who are at risk of falling in several ways:

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• Health promotion – advice and information for older people and their families on healthy living, including exercises • Signposting to other services (sight, hearing, exercise) • Specialist falls services

Many older people are reluctant to accept advice about preventing falls.

There are many reasons for this, such as they think it is only relevant to people older and frailer than themselves; they feel confident of their capabilities and do not want to be stigmatised as ‘old and frail’ and some people

who have fallen do not believe they will fall again because they attribute falling to momentary inattention or illness rather than persistent vulnerability.

Rather than focusing on the risk of falls, it is better to talk to an older person about the benefits of improving strength and balance, staying active, and maintaining mobility and independence.

Targeting people according to their age, risk of falling or fear of falling is unlikely to be effective and advice given in an overly didactic tone is unlikely to be well received.

People are more likely to make use of information and opportunities if they can choose the advice and activities that will suit their abilities, needs, priorities and lifestyle.

Further Reading Fragility Fracture Nursing: Holistic Care and Management of the Orthogeriatric Patient https://www.springer.com/gp/ book/9783319766805 Orthogeriatrics: The Management of Older Patients with Fragility Fractures https://www.springer.com/gp/ book/9783030481254 For further information about the Irish Hip Fracture Database and the National Office of Clinical Audit please visit www.noca.ie

DON’T WAIT UNTIL OSTEOPOROSIS STRIKES AGAIN Rebuild bone before it breaks again—with Movymia®1

MOVYMIA®: THE NEW TERIPARATIDE BIOSIMILAR FROM CLONMEL HEALTHCARE

RELIABLE: Movymia®’s quality, safety and efficacy is highly similar to its reference product1,2,* EFFECTIVE: Anabolic MoA effectively rebuilds bone through the stimulation of osteoblasts1,3 AFFORDABLE: Allows more eligible patients to benefit due to its cost advantage4,5 RE-USABLE: One high quality reuseable pen for the entire treatment period1 MOVYMIA 20 MICROGRAMS/80 MICROLITERS SOLUTION FOR INJECTION Each dose of 80 microliters contains 20 micrograms of teriparatide. One cartridge of 2.4 ml of solution contains 600 micrograms of teriparatide (corresponding to 250 micrograms per ml).

Presentation: Glass cartridge. Indications: Movymia is indicated in adults. Treatment of osteoporosis in postmenopausal women and men at increased risk of fracture. In postmenopausal women, a significant reduction in the incidence of vertebral and non-vertebral fractures but not hip fractures has been demonstrated. Treatment of osteoporosis associated with sustained systemic glucocorticoid therapy in women and men at increased risk for fracture. Dosage: The recommended dose is 20 micrograms administered once daily. Patients should receive calcium and vitamin D supplements if dietary intake is inadequate. The maximum total duration of treatment is 24 months. The 24 month course should not be repeated over a patient’s lifetime. Following cessation of teriparatide therapy, patients may be continued on other osteoporosis therapies. Teriparatide must not be used in severe renal impairment. Use with caution in moderate renal impairment and impaired hepatic function. Teriparatide should not be used in paediatric patients (less than 18 years), or young adults with open epiphyses.

Method of administration: Movymia should be administered once daily by subcutaneous injection in the thigh or abdomen. It should be administered exclusively with the Movymia Pen reusable, multidose medicine delivery system and the injection needles which are listed as compatible in the instructions provided with the pen. The pen and injection needles are not included with Movymia. However, for treatment initiation a cartridge and pen pack should be used. Movymia must not be used with any other pen. Patients must be trained to use the proper injection techniques. Contraindications: Hypersensitivity to the active substance or excipients. Pregnancy and Breast-feeding. Pre-existing hypercalcaemia, severe renal impairment, metabolic bone diseases other than primary osteoporosis or glucocorticoid-induced osteoporosis, unexplained elevations of alkaline phosphatase, prior external beam or implant radiation therapy to the skeleton, patients with skeletal malignancies or bone metastases. Warnings and precautions: In normocalcaemic patients, slight and transient elevations of serum calcium concentrations have been observed following teriparatide injection. Serum calcium concentrations reach a maximum between 4 and 6 hours and return to baseline by 16 to 24 hours after each dose of teriparatide.

Therefore, if blood samples for serum calcium measurements are taken, this should be done at least 16 hours after the most recent teriparatide injection. Routine calcium monitoring during therapy is not required. Teriparatide may cause small increases in urinary calcium excretion, but the incidence of hypercalciuria did not differ from that in the placebo-treated patients in clinical trials. Teriparatide should be used with caution in patients with active or recent urolithiasis because of the potential to exacerbate this condition. In short-term clinical studies with teriparatide, isolated episodes of transient orthostatic hypotension were observed. Typically, an event began within 4 hours of dosing and spontaneously resolved within a few minutes to a few hours. When transient orthostatic hypotension occurred, it happened within the first several doses, was relieved by placing subjects in a reclining position, and did not preclude continued treatment. Caution should be exercised in patients with moderate renal impairment. Experience in the younger adult population, including premenopausal women, is limited. Treatment should only be initiated if the benefit clearly outweighs risks in this population. Women of childbearing potential should use effective methods of contraception during use of teriparatide. If pregnancy occurs, teriparatide should be discontinued. The recommended treatment time of 24 months should not be exceeded. Contains sodium. Interactions: Digoxin, digitalis. Fertility, pregnancy and lactation: Women of childbearing potential should use effective methods of contraception during use of teriparatide. If pregnancy occurs, Movymia should be discontinued. Movymia is contraindicated for use during pregnancy and breast-feeding.

The effect of teriparatide on human foetal development has not been studied. The potential risk for humans is unknown. Driving and operation of machinery: Teriparatide has no or negligible influence on the ability to drive and use machines. Transient, orthostatic hypotension or dizziness was observed in some patients. These patients should refrain from driving or the use of machines until symptoms have subsided. Undesirable effects: Nausea, pain in limb, headache, dizziness. Refer to Summary of Product Characteristics for other adverse effects. Pack size: 1. Reporting of suspected adverse reactions: Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via HPRA Pharmacovigilance, Earlsfort Terrace, IRL - Dublin 2; Tel: +353 1 6764971; Fax: +353 1 6762517. Website: www.hpra.ie; E-mail: medsafety@hpra.ie. Marketing authorisation holder: STADA Arzneimittel AG, Stadastrasse 2-18, 61118 Bad Vilbel, German. Marketing authorisation number: EU/1/16/1161/001-003. Medicinal product subject to medical prescription. Date last revised: July 2019.

1. Movymia® SmPC. 2. Movymia® EPAR – public assessment report, available at: https://www.ema.europa.eu/documents/assessment-report/movymia-epar-public-assessment-report_en.pdf 3. Brixen KT et al. Basic Clin Pharmacol Toxicol. 200494(6):260–70. 4. Lyman GH et al. N Engl J Med. 2018378(21):2036–2044. 5. Janjigian YY et al. Future Oncol. 201814(23):2403–2414.* Forsteo®

October 2019. 2019/ADV/TER/122H

Promoting good Oral Health in the Pharmacy

O

ral health plays a key role in general health and wellbeing and is important at all stages of life.

The available evidence shows that oral diseases share important common risk factors with the four leading chronic disease – cardiovascular diseases, cancer, chronic respiratory diseases and diabetes. Oral diseases such as tooth decay, periodontal (gum) disease and mouth head and neck cancer can be detected with the help of the pharmacy community. Evidence has also shown that pharmacist-led continuity of care, can and does improve patient outcomes.

Some patients are poor at attending their dentist (and may only attend if they require treatment) but frequently visit their local pharmacy and will listen to oral health promotion information from the Pharmacist, who may advise to visit the dentist. The Pharmacist is also well equipped to help with other issues. For example, currently it is possible to purchase a temporary filling material repair kit from a pharmacy if a loose filling/crown needs to be repaired (temporarily) before visiting the dentist. A pharmacist may be asked about denture repair kits for broken dentures, or to recommend appropriate over the counter pain medication in the case of a toothache (rinsing the mouth with warm salt water may also help), until the person visits a dentist.

Tooth Decay and Oral Hygiene Tooth decay is the most widespread non-communicable

disease according to the World Health Organization and can be traumatic for both child and adult. It may result in pain, lead to infection and result in hospitalisation and extraction of teeth under general anaesthetic.

Good oral health is also essential for healthy ageing. A healthy mouth will improve general wellbeing and quality of life. Tooth loss and ill-fitting dentures in older people affects their ability to eat, speak or socialise properly.

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

Poor oral hygiene and frequent consumption of sugary foods and drinks (cakes, biscuits, chocolate, sweets, fizzy drinks) are the main causes of tooth decay. Acidic foods and drinks like fruit juice and smoothies can also cause dental erosion. Tooth decay is largely preventable, and the pharmacist

28 | PHARMACYNEWSIRELAND.COM

can play a key role in reinforcing messages about healthy eating and good oral hygiene. General advice for both children and adults is as follows:

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

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

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

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

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

• Unflavoured milk and water are the best drinks.

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

It is not only the physical removal of plaque that is important in oral hygiene practices, but also noting that fluoride in toothpaste gives the tooth enamel the potential to heal.

The pharmacist can recommend oral health products such as toothbrushes (these should be changed when the bristles are worn, about every 3 months), fluoride toothpaste, interdental

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brushes, floss etc. However, it is also important that the patient is encouraged to seek oral health advice and a professional opinion from a dentist.

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

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

It’s also worth noting that hormonal changes during pregnancy can make women’s gums more vulnerable to pregnancy gingivitis.

Advice to pregnant women about their oral health during pregnancy is important to both the mother and baby. Design: Studies suggest a link agrand.ie between poor oral health and women delivering pre-term, low birth rate babies. Making healthy choices can positively affect their baby's development including their teeth.

Mouth Head and Neck Cancer Over 700 cases of Mouth Head and Neck Cancer are diagnosed in Ireland every year. Smoking and drinking alcohol are the most important risk factors. Alcohol plays a role in up to half of all cancers of the mouth, head and neck in men in Ireland. It is useful to able to be signpost to alcohol and smoking cessation support services such as https://www2. hse.ie/alcohol/ and www.quit.ie Early detection saves lives so if a concerned customer has any of the following symptoms for more than 3 weeks refer them to their dentist or doctor.

A sore or ulcer in the mouth that does not heal; white or red patches

·OHF

Dental Health Foundation Ireland

inside the mouth; a lump in the mouth or neck; thickening or hardening of the cheek or tongue; difficulty chewing; swallowing or moving the tongue; numbness of the tongue or face; a persistent sore throat and hoarseness persistent nosebleeds; and a stuffy nose or unexplained loose teeth.

frequent consumption of drinks sweetened with sugar e.g., soft drinks, sugary tea, and also sugar-free drinks, because sugar/ acid content may cause tooth decay and erosion. Sipping water frequently, and with your meal is best (fluoridated tap water will help to prevent tooth decay).

A lesser-known fact is that the human papillomavirus (HPV) is also a risk factor for Mouth Head and Neck Cancer. Students in their first year of secondary school are offered the HPV vaccine as part of the school vaccination programme.

For more information about mouth head and neck cancer, please see www.mouthcancer.ie

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

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

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

Saliva substitutes are generally available in pharmacies and useful if used just before eating, at night if you wake up because of dry mouth, or first thing in the morning.

Sucking sweets regularly e.g., mints, boiled sweets or consuming sugary drinks can give temporary relief but will cause severe tooth decay in the absence of saliva.

Chewing sugar-free gum may offer relief. We advise to limit the

Stress The current pandemic is stressful and is impacting people in different ways including their eating and snacking habits. Stress can cause a person to clench or grind their teeth resulting in the continuous loss of tooth enamel. A dentist may recommend wearing a bite guard during sleep. Emotional stress is a possible trigger for canker sores/ mouth ulcers and customers may look for pain relief medication from their pharmacist. Encourage them to attend the dentist if mouth ulcers do not clear up within a few days, or if this is persistent and frequent enough to cause concern.

Their dentist or GP may refer more severe cases to a specialist for a thorough investigation.

People often reach for alcohol, or smoke more in times of stress or worry impacting negatively on oral health. The World Health Organization (WHO) states that the heavy use of alcohol increases the risk of acute respiratory distress syndrome (ARDS), one of the most severe complications of COVID-19. The WHO also states that smoking impairs lung function making it harder for the body to fight off coronaviruses and other respiratory diseases.

Sport Injuries to teeth arise from accidents during normal everyday activities such as playing contact sports. We recommend to always wear a mouth guard as a great preventative measure. In the event that a person presents/contacts a pharmacy about a knocked-out tooth check this ‘Save That Tooth’ poster for advice on what to do: https://www.dentalhealth.ie/assets/ files/pdf/savethattooth_english.pdf Visit the Dentist It is highly recommended that everyone visits a dentist at least once a year, (even if they have no teeth of their own or wear dentures). The dentist will ensure that teeth and gums stay healthy and will also carry out a mouth cancer examination.

Support and Resources The Dental Health Foundation is at the heart of oral health promotion for over 40 years and supports all health professionals, including Pharmacists, by providing evidence based best practice resources to increase awareness amongst the public, empowering them to make healthier oral and general health lifestyle choices.

Having the right information on tooth tips, diet and general health will help keep teeth healthy for a lifetime. Good oral health is of vital importance to the general health of everyone in Ireland.

Health Promotion is about empowering people to take control of their own lives so make every contact count! For further information about the Dental Health Foundation and to download our free resources please see www.dentalhealth. ie or link in with us on Twitter, Facebook, LinkedIn. Be aware of the factors that affect oral health and know where to go to get the best help and advice: www.dentalhealth.ie www.dentist.ie For information about dental entitlements see www.citizensinformation.ie Self- Care, Self-Aware ….

Healthy Teeth for Life!

PHARMACYNEWSIRELAND.COM | 31

Unit 3, Clonmore Business Park, Mullingar, Co. Westmeath.

T • (044) 933 4602 E • info@pharmed.ie Unit 3, Clonmore Business Park, Mullingar, Co. Westmeath.

T • (044) 933 4602 E • info@pharmed.ie

Become a stockist today by contacting our reps: Become a stockist today by contacting our reps: Andrea: 0872288359 0872288359 •• Moya: Moya: 086 086 4114597 4114597 •• Ursula: Ursula: 086 086 0235901 0235901 Andrea:

Prevention and management of sporting injuries in the pharmacy

I

t’s hard to believe it has been almost a year since the world was hit with the Covid-19 pandemic and with it came numerous restrictions on various sports and activities. However, despite these restrictions, Sport Ireland highlighted in a series of recent reports that the number of adults participating in sport and recreation during the Covid-19 restrictions is unprecedented in the history of Sport Ireland.

These reports highlight that 51% of adults are participating in sport, with exercise, running, and cycling being the predominant ones. Additionally the proportion of adults described as sedentary in the National Sport Policy has also declined to 11 % compared to 22 % during the same period in 2019. This is reported to be the lowest level of sedentarism ever recorded by Sport Ireland.

Consequently, the Spring of 2021 is likely to see an increase in injuries in a variety of populations.

Such as those who have been inactive for a period of time during lockdown and then suddenly increase their activities, those who have been filling their spare time with a significant increase in activity and those that have spent their time in their gardens.

The International Olympic Committee (IOC) define sports injury as a new or reoccurring musculoskeletal complaint incurred during competition or training that requires medical attention regardless of the potential absence from competition. The following are further subgroups that may present to a pharmacy. Acute injury refers to a single event that leads to a singular macrotrauma on previously healthy tissue, e.g. sudden ankle sprain, joint dislocation or a ruptured tendon.

Overuse injuries, also referred

to as chronic injuries, occur as result of repetitive loading, usually with inadequate recovery causing repeated injury to muscles, tendons, ligaments and bones, e.g. rotator cuff tendinopathy.

An acute on chronic injury is an acute exacerbation of a chronic injury. Pain associated with any sport injury is generally classified as acute (pain duration up to 6 weeks), subacute (pain duration between 6-12 weeks) or chronic (pain duration of 3 months or longer). However, of note, the IOC advise how pain can occur without injury and sports injury may not necessarily manifest with pain, they are therefore not synonymous.

Whether adults are beginning exercise from a sedentary lifestyle or returning to activity from a period of lockdown, the following tips, that apply to all age groups, may help.

Wear correct comfortable clothing and shoes: Recent

Written by Michelle Lacey, Chartered Physiotherapist, Trinity College Dublin

research advises people to choose footwear and clothing that are comfortable rather than succumbing to advertising pressures and marketing gimmicks suggesting certain sports clothing will make you perform better. If you are not comfortable you can’t perform or enjoy your activity.

Ensure you include a warm up and cool down: The aim of a warm up is raise your heart rate and to prepare your body and neuromuscular system for performance. Equally important is a cool down, which aims to lower your heart rate and blood pressure.

Warm-up examples include 5-10 min of jumping jacks or jogging on the spot and warm-down

PHARMACYNEWSIRELAND.COM | 33

examples include a light jog / walk followed by light stretching.

Studies investigating sport specific warm-up programs such as the “ FIFA 11” or “GAA 15” have shown injury rates can be reduced by as much as 70 %. Elderly patients may want to participate in a lower intensity warm up – such as a fast walk, however if they have any pre-existing health conditions they may want to speak to their GP first.

Always increase or start off any exercise programme gradually. It is estimated that 80% of running injuries are due to overuse. i.e excessive load by doing too much too soon.

Patellofemoral pain, patella tendinopathy and ITB syndrome are associated with a change in training volume and achilles tendinopathy, calf overuse injuries and plantar fasciopathy are associated with change in training pace. A general overall guide is don’t increase both at the same time. Increase duration of training first followed by intensity and only increase by 10 % of each per week. For example, one week increase duration and the following week increase intensity.

Factor in sleep and recovery time.

Always have 1 or 2 rest days within the week and try to follow a hard day with an easy day, equally follow a hard week with an easy week and within the month a rest / decreased activity week. While everyone’s

sleep needs vary, it is generally recommended to have at least 7-9 hours sleep per night. With adequate sleep, muscle protein synthesis occurs and human growth hormone is released, both of which are necessary for neuromuscular recovery and are essential for progression.

Include strength training and some variety to a routine. Strength training has been shown to reduce the risk of acute injury by 30% and overuse injuries by 50%.

Increasing the strength in your muscles will allow them to take more load and demand. Equally adding variety to an exercise program, such as cross training, will work your muscle groups differently which will prevent repetitive stress on certain muscle groups. An example for both of the above includes body weight circuits. As we get older balance training should also become an essential part of our training regime. Persons over 65 years of age are at higher risk of falls and therefore would benefit from including balance exercises into their program.

Do remember there are several non-musculoskeletal factors that can place people at higher risk of certain injuries such as diet, age, high or low BMI, metabolic factors, e.g. Chrohns Disease and hormonal changes.

Additionally there a numerous psychological factors that may contribute to injury that should

34 | PHARMACYNEWSIRELAND.COM

be considered such as stress, mood, thoughts and beliefs, fear, motivation, rehab behaviours and attitude to exercise.

Most musculoskeletal (MSK) Chartered Physiotherapists are in a position to guide persons on all the topics discussed above. It is advised to build a relationship with the local Physiotherapists in your area, who patients can be referred to should they present with certain sports injuries or pathologies. Regardless of increased emphasis on injury prevention advice as described above, reinjury occurrence and presentations to Physiotherapists for musculoskeletal injuries remains prevalent.

Rehabilitation of soft tissue injuries can be complex and as reinjury rates can be high for certain injuries, initial optimal management is key. Over the years acronyms guiding their acute management have included ICE (Ice, Compression, Elevation) to RICE (Rest included), PRICE (introduction of Protection), then onto POLICE (Protection, Optimal Loading, Ice, Compression and Elevation). POLICE is predominantly promoted for the majority of injuries, with the ‘Optimal loading’ replacing Rest as the only major innovation from the older used acronyms.

Protection in the early stages (1-3 days) of injury is essential to reduce bleeding, reduce risk of

aggravating an injury and prevent distention of injured fibres. This may involve shielding the area or restricting joint movement for various periods and at various levels of restrictions. This level of protection may require taping, a support or brace or even a short period of non-weight bearing.

Essentially the level of protection is guided by the nature of the injury and should be advised following assessment by an experienced clinician. Therefore, while there are numerous products of braces and supports on the market the specific recommendation of one can be advised by an experienced clinician.

The afore-mentioned ‘Rest’ element in injury management is less definitive and risks misinterpretation, therefore has been replaced with ‘Optimal Loading’. Prolonged rest can produce adverse changes in muscle strength, tensile strength, tissue morphology, and biomechanical properties.

Thus, early progressive tissue loading is thought to be superior to rest as it can promote cellular responses that promote tissue structure change, restore mobility strength and function after injury.

Again, this should be guided by an experienced clinician depending on the nature of the injury.

Ice, Compression and Elevation remain stable components of injury management. Ice, cold therapy, can be used to cool injured tissue

Diclofenac Sodium Teva 2% w/w gel Concentrates relief deep at the source by absorbing into the skin to fight pain and inflammation

New

Helps aid recovery from acute strains

Applied directly to the source of pain

Relieves pain and inflammation

Dic-IE-00001. Date of Preparation: January 2021. Digital Office Centre Swords, Suite 101-103, Balheary Demense, Balheary Road Swords, Co Dublin, K67E5A0, Ireland

Adverse events should be reported. Reporting forms and information can be found at www.hpra.ie. Adverse events should also be reported to Teva UK Limited on +44 (0) 207 540 7117 or medinfo@tevauk.com Please refer to the Summary of Product Characteristics (SmPC) for full details of Prescribing Information. Diclofenac Sodium Teva 2% w/w gel Abbreviated Prescribing Information. Presentation: White to almost white, homogeneous gel. 1g of gel contains diclofenac as 23.2mg diclofenac diethylamine corresponding to 20mg of diclofenac sodium. Indications: Local symptomatic treatment of pain in acute strains, sprains or contusions following blunt trauma. For short term treatment only. Dosage and administration: For cutaneous use. Apply to affected parts of the body thinly and gently rub into skin. Wash hands after application unless area to be treated. Allow gel to dry on skin before applying bandages. Adults and adolescents aged 14 years and over: depending on the size of the affected site, apply a cherry to walnut size quantity 2 times a day (preferably morning and evening). Should not be used for longer than 1 week without medical advice. Children: no data in children and adolescents under 14 years of age. Elderly: no dosage adjustment required. Monitor patient carefully. Renal and hepatic impairment: no dosage adjustment required. Contraindications: Hypersensitivity to active substances or excipients; patients with a history of hypersensitivity reactions such as asthma, bronchospasmus, urticaria, acute rhinitis in response to acetylsalicylic acid or non- steroidal anti-inflammatory drugs (NSAIDs); open injuries, inflammations or infections of the skin as well as on eczema or mucous membranes; in the last trimester of pregnancy; in children and adolescents under 14 years of age. Precautions and warnings: Systemic undesirable effects cannot be excluded if applied on larger areas of skin over a prolonged period of time. Must only be applied to intact, not diseased or injured skin. Must not come into contact with eyes and oral mucous membranes. Must not be taken orally. May be used with non-occlusive bandages, but not with airtight occlusive dressing. Consult doctor if symptoms worsen or do not improve after 3-5 days. Patients suffering from asthma, hay fever, swelling of nasal mucous membranes (so called nasal polyps) or chronic obstructive pulmonary disease, chronic respiratory infections (particularly associated with hay fever-like symptoms), and patients with hypersensitivity to painkillers and anti-rheumatic medicinal products of all kinds are rather at risk to asthma attacks (so called analgesic intolerance / analgesic asthma), to local skin or mucous membrane swelling (so-called quincke edema) or to urticaria than other patients when treated with Diclofenac Sodium Teva 2% w/w Gel. In these patients, Diclofenac Sodium Teva 2% w/w Gel may only be used under certain precautions (emergency preparedness) and direct medical supervision. The same applies for patients who are also allergic to other substances e.g. with skin reactions, itching or urticaria. Discontinue treatment if skin rash occurs. Photosensitivity can occur with the appearance of skin reactions after exposition to sunlight. Avoid children coming into contact to the skin areas where the gel has been applied. Contains butylhydroxytoluene which may cause local skin reactions or irritation to the eyes and mucous membranes. Contains fragrance with benzyl alcohol (0.15mg/g), citral, citronellol, coumarin, eugenol, farnesol, geraniol, d-limonene and linalool which may cause allergic reactions. In addition, benzyl alcohol may cause mild local irritation. Interactions: None known. Pregnancy and lactation: Should not be used during first and second trimester unless clearly necessary. Contraindicated during third trimester. Should only be used during breast-feeding under advice from a healthcare professional and should not be applied on the breasts, nor elsewhere on large areas of skin for a prolonged period of time. Effects on ability to drive and use machines: No or negligible influence. Adverse reactions: Hypersensitivity, angioedema, dermatitis bullous, Common: dermatitis (including contact dermatitis), skin rash, erythema, eczema, pruritus. Consult the Summary of Product Characteristics in relation to other side effects. Overdose: Wash skin with water where applied. If ingested, apply general therapeutic measures normally adopted to treat poisoning with non-steroidal anti-inflammatory medicinal products. Gastric lavage and use of activated charcoal should be considered. Legal category: Pharmacy.

Marketing Authorisation Number: PA1986/093/002. Marketing Authorisation Holder: Teva B.V., Swensweg 5, 2031GA Haarlem, Netherlands. Job Code: MED-IE-00010. Date of Preparation: January 2021.

with the aim of reducing pain and tissue damage and enhancing function. Cooling skin to less than 15’C should be advised for 10-15 minutes every 2-4 hours. Whilst there is a common assumption that ice decreases inflammation, unfortunately muscle tissue cannot be readily cooled and thus is difficult reach low temperatures to reduce cellular metabolism.

Compression and Elevation : Oedema, i.e. excessive fluid, is a sign of inflammation postacute injury and though aspects of inflammation are essential for tissue healing, prolonged excess fluid can lead to increased tissue pressure causing pain, movement restrictions and muscle inhibition.

Compression, usually in the form of bandage application can assist with the above however depending on the time since injury and injury type, a bandage may be applied for protection purposes to prevent further bleeding, i.e pitch side management. Therefore, bandage application should be guided by a clinician experienced in acute care.

Elevation is thought to decrease the fluid in the affected joint by raising it higher than the heart, as a general guide, and for the first 72 hours.

While following POLICE it is also important to. avoid HARM in the first 72 hours: Heat (e.g hot bath, sauna), Alcohol, Running and Massage).

The treatment of any musculoskeletal injury, either acute, chronic or acute on chronic, predominantly focuses on reducing pain, facilitating restoration of safe functioning or return to sports, while reducing the risk of re-injury / any other injury and any psychological stress, and promote health. To go into detail on the management of all injuries likely to be seen in the community pharmacy is beyond the scope of this article and thus the author has focused on 3 prevalent injuries.

Back Pain Almost everyone will suffer an episode of low back pain in their lives and it’s important to note that even the most severe episodes of low back pain can resolve within 6-8 weeks. Additionally, research has shown that pain does not equal damage. Whilst most people believe having an MRI or X ray will identify the source of their pain, this is rarely the case and thus the NICE guidelines advise not to recommend imaging in a non-specialist clinic and to only consider imaging when it will likely change the management of their low back pain. Interestingly, usage of scans can lead to worse (not better outcomes) when used too frequently. A GP or Physiotherapist should be able to identify signs and symptoms which may warrant further imaging and if someone has severe, persistent

or reoccurring low back pain they should see a GP or Physiotherapist to further assess, and educate the patient, and introduce possible interventions which may reduce the incidence and severity of low back pain flares ups. The NICE guidelines do recommend providing people with advice and information on the management of low back pain, (https://www. nhs.uk/conditions/back-pain/) and sciatica and encouragement to continue with normal activities.

These guidelines advise limited use of paracetamol as a stand-alone treatment for low back pain and to consider use of oral NSAIDS for managing low back pain, taking into account potential differences in gastrointestinal, liver and cardiorenal toxicity, and the person's risk factors, including age. For a more in depth explanation please see https://www.nice.org.uk/ guidance/conditions-and-diseases/ musculoskeletal-conditions/lowback-pain Ankle sprain Lateral ankle sprain (LAS) injury is a highly prevalent injury in the general population. A first-time ankle sprain can lead to chronic ankle instability (CAI), which is defined as persistent complaints of pain, swelling and / or giving way in combination with recurrent sprains for at least 12 months.

This in turn can lead to long term

Table 1 Medication management for acute pain and same-day return to play mild to moderate pain Paracetamol Loading dose up to 2 g, then 325–1000 mg PO every 4–6 hours, up to 4 g (oral) per 24 hours • ► Ibuprofen: 400–800 mg every 4–6 hours with food, up to 3200 mg per 24 hours • ► Naproxen: 250–500 mg 2× daily with food • ► Ketorolac: 10 mg every 4–6 hours with food, up to NSAIDs (oral)

40 mg per 24 hours • •

► Celecoxib: 200–400 mg 2× daily ► Etoricoxib: 90–120 mg once daily

• • •

► Rubefacients: methyl salicylate; turpentine oil; ammonia water ► Cooling sensation: camphor; menthol ► Vasodilation: histamine dihydrochloride; methyl

Topical analgesics

nicotinate •

► Irritation without rebefaction: capsaicin; capsicum oleoresin

Taken from Hainlain B, Derman E, Vernec A, Budgett R, Deie M, Dvorak J, Harle C, Herring S A, McNamee M, Meeuwisse W, Moseley G L, B, Orchard J, Pipe Pluim B M, J, Siebert C, Stewart M,C, Stuart M, Taken from Hainlain B,Omololu Derman E, Vernec A,A,Budgett R,Raeder Deie M, Dvorak J, Harle Herring Turner J A, Ware M, Ziderman D and Engerbretsen L. (2017). International Olympic Committee consensus S A, McNamee M, Meeuwisse W, Moseley G L, Omololu B, Orchard J, 1245-1258.

Pipe A, Pluim B M, statement on pain management in elite athletes.

British Journal of Sports Medicine.

(51) pp

Raeder J, Siebert C, Stewart M, Stuart M, Turner J A, Ware M, Ziderman D and Engerbretsen L. (2017). International Olympic Committee consensus statement on pain management in elite athletes. British Journal of Sports Medicine. (51) pp 1245-1258.

36 | PHARMACYNEWSIRELAND.COM

absence from activity / sport and in some cases work. There has been debate on the use of pharmacological treatments post LAS, however a recent systematic review has advised that NSAIDs may be used by patients for the primary purpose of reducing pain and swelling. Care should be taken in NSAID usage as it is associated with complications and may suppress or delay the natural healing process.

This systematic review further advises that the use of a brace or taping should be considered to prevent further ankle sprains.

It is important to note again that although there is a huge amount of supports and braces on the market it is difficult to recommend specific types as all injuries generally require an assessment first in order to advise on an intervention.

It might be worth getting to know your local Physiotherapist and liaising with them on the braces and supports they are most likely to recommend for their patients for a variety of injuries.

Shoulder pain Disorders of the rotator cuff (RC) tendons are the most common pathology of the shoulder, with RC tendinopathy accounting for 35 % to 50% of rendered diagnoses.

RC tendinopathy is a generic term used to describe a pathology in a RC tendon and again a recent systematic review has advised the use of NSAIDS to improve pain and function however not beyond 2 weeks.

The IOC has recommended the use of oral paracetamol, NSAIDS and topical analgesics in the management of athletes with acute pain. Please see table 1 with reference, for more details. They also advise that medications should not be a stand-alone treatment and it is essential to diagnose the injury and the cause of the pain and to begin rehabilitation to address both. For those with chronic pain, non-pharmacological strategies addressed by a GP or Physiotherapist may be the best way forward. Long term use of pharmacology treatments is not recommended.

Whilst pharmacists may face numerous presentations in the community, it’s important to note that most injuries have physiological contributing factors and should a patient wish to prevent reinjury, reduce pain further and maximise function they should be assessed by a Chartered Physiotherapist. However, if a patient presents with pins and needles, numbness, weakness, new loss of any function an onward referral to a Chartered Physiotherapist or GP is essential.

References available on request

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38

Educational

Recognising International Epilepsy Day Written by Paddy McGeoghegan, Communications Officer, Epilepsy Ireland

International Epilepsy Day is major day for Epilepsy Ireland and I was delighted to be asked to provide the readers of Irish Pharmacy News with an update on the behalf of Epilepsy Ireland regarding our plans for the day.

One of the myths associated with seizure first aid that Epilepsy Ireland focussed on as part of their International Epilepsy Day campaign in 2020

this survey will ask the public what exactly they believe they should be doing in the event of a seizure; while also seeking to establish the general public’s attitudes to issues of importance to people with epilepsy.

Of course, most important of all to our campaign will be testimony from people with epilepsy themselves. Epilepsy is an extremely individual condition and the day represents an opportunity for them to tell their own story.

It is through these personal experiences that the public can learn more about the individual nature of the condition.

While we are very excited about International Epilepsy Day, it would be amiss of me to not remind readers about the steps involved in seizure first aid. For generalised (tonic-clonic) seizures: 1) Time the seizure (If the seizure goes over 5 mins, call an ambulance) 2) Remove any harmful objects away from the person 3) Cushion the head if possible 4) Let the seizure run its course 5) When seizure finishes, put person in recovery position 6) Stay with the person after the seizure until you know they’re ok.

Epilepsy is a very common in Ireland – with approximately 40,000 people living with the condition in our country.

around seizure first aid – i.e, what NOT to do during a seizure.

This year, our messaging will be focussed on WHAT to do.

Unfortunately however, the condition is one that is still very much misunderstood by the wider public - be it in terms of stigma associated with the condition and indeed, misconceptions around what to do in the event of a person having a seizure.

We will be presenting epilepsy to the wider public in a way they can relate to the condition. For example, as a person who doesn’t have epilepsy, I have always related immediately to the idea of a seizure being likened to a power cut.

International Epilepsy Day is a day in which we as an organisation and of course, people with epilepsy themselves aim to educate the wider public about the condition and what it is like to actually live with epilepsy.

Envisage sitting in your living room – the lights flicker, the power cuts out and in most cases, the power will come back on within a few minutes. Things won’t be as they were before as it takes time for things to get back to normal.

Your fridge is making a bit more noise than it was before the power went out, your oven clock needs

This year we are building on our campaign from 2020 – which focussed on some of the myths

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reset and your microwave might be beeping but eventually, with time & care, everything will return to normal. These are comparisons that can really help members of the public to easily understand what is happening in the brain before, during & after a seizure.

Our campaign will be building on this “electrical glitch” aspect and while I would love to be able to share campaign materials with you in this article – I’m afraid you will have to wait until the day itself to see this idea in action!

Another aspect of our campaign will be results of a survey of 1,000 members of the public seeking to establish the public’s attitudes and awareness towards the condition.

This will make for interesting reading as questions included in

For focal (partial) seizures, the steps are almost the same except in steps 2 & 3, replace this with guiding the person away from danger and do not restrict their movements. For full seizure first aid posters which may be useful to your professional setting, please visit our website at the link below: http://bit.ly/39zRWQr Hopefully you will join with us in spreading our message on International Epilepsy day – either in a personal or professional capacity – on the behalf of the 40,000 people living with epilepsy in Ireland today. Follow our social media channels and check out our website (www.epilepsy.ie) on the day to see our campaign!

Please contact me on pmcgeoghegan@epilepsy.ie if you have any questions or indeed, if you would like to be linked in with our services in your area.

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40

Advertorial

Superberries – the best healthy berries When you think of berries, do you picture small, round, juicy fruits that are often sweet and delicious? This is certainly the case for strawberries, blackberries, raspberries and blueberries, but other, less frequently-eaten berries can also offer powerful nutritional benefits.

What is a berry? Botanically, a berry is a small, pulpy fruit, without a stone, that develops from the ovary of a single flower. Strictly speaking, this definition does not include strawberries, raspberries, and blackberries, which form from several ovaries merging together (aggregate fruits). It does, however, include many fruits that are not commonly thought of as berries, such as grapes, tomatoes, cucumbers, chillies and even bananas, watermelons and pumpkins.

Elderberry - Archaeological evidence suggests that elderberries were eaten as part of the Neolithic diet. Nowadays, they are most often used to make elderberry jam, wine or medicinal syrups.

Their dark purple-black colour is due to an abundance of antioxidant pigments, known as polyphenols, which have powerful anti-viral actions. Elderberries also provide vitamins A, B6, C and folate, plus iron, copper and zinc, which have beneficial effects on immunity.

Elderberry extracts are used medicinally to help reduce the severity and duration of common cold and influenza infections. This activity is partly due to blocking viruses from entering cells, and partly due to unique 'ribosomeinactivating proteins' which reduce the ability of viruses, fungi and bacteria from making the proteins they need to grow.1, 2 These proteins help to protect elder trees from infection and, when consumed, appear to have similar effects to help protect us against the viruses that cause influenza and the common cold.

Research shows that elderberry extracts are active against influenza types A and B, including the most virulent strains. Elderberry extracts help to lessen influenza symptoms and shortens the duration of illness. For example, in a trial involving 60 adults who had had flu-like symptoms for up to 48 hours, those taking elderberry extracts were relieved of influenza symptoms, on average, four days earlier than those taking placebo. Levels of antibodies were significantly higher in those taking elderberry extracts than in those taking placebo.3 Recent laboratory studies suggest that elderberry extracts

are also active against coronavirus infections.4 Sea Buckthorn - The orange fruit of sea buckthorn has a long history of use as a traditional remedy for skin conditions, coughs, colds, digestive problems and dry eyes. Sea buckthorn is rich in antioxidant vitamins C, E plus carotenoids and polyphenols, while its oil offers a blend of omega-3s, -6s, -7s and -9s.

Clinical trials show that taking 2g sea buckthorn oil daily for three months can help to reduce redness and burning associated with dry eyes by increasing the protective effects of our natural tear film.5 Sea buckthorn is also used to help improve female intimate dryness and postmenopausal thinning (atrophy).6 Acai berry - Acai berries are the fruit of a Brazilian palm tree and, rather like olives, are oily and ripen from green to a dark, purple-black. Acai berries are a good source of omega-3s and omega-9, especially oleic acid – the same monounsaturated fat that's found in olive oil. Acai are also a source of calcium, iron, manganese, plant sterols (mainly beta-sitosterol), antioxidant polyphenols and lignans (a type of phytoestrogen).

The freeze-dried pulp and skin of acai berries have one of the highest antioxidant potentials of any food tested, and have a powerful anti-inflammatory action similar to that of non-steroidal anti-inflammatory drugs (NSAIDs) to help reduce pain, stiffness and swelling. Acai berries have beneficial effects on inflammatory markers of cardiovascular disease and are currently being trialled for their effects against COVID-19 inflammation.7, 8 Cranberry - Cranberries are sour, red berries that grow in the peat bogs of North America. Their pulp was traditionally used as a poultice to dress wounds, and to prevent or treat scurvy due to its high vitamin C content.

Sales of Elderberry supplements increased by 116% in the first half of 2020. Healthspan’s NEW ImmunoVit Elderberry Plus with added Zinc, Vitamin C and Vitamin B12 is now available to pharmacies from Wholefoods

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Cranberries are also a rich source of unique polyphenols, known as A-type proanthocyanidins (PAC), which have a powerful antibacterial action. These lock on to the feeler-like structures (fimbriae) of E. coli bacteria so they are unable to stick to cells lining the mouth, intestines and urinary tract. This 'anti-adhesin' activity allows the bacteria to be naturally flushed out, helps to reduce the incidence of urinary infections and may also help to protect against the stomach infection (Helicobacter pylori) associated with peptic ulcers.

A meta-analysis of 7 studies, involving 1,498 women, found that cranberry products reduced the risk of urinary tract infections by 26% compared with placebo.9 NB: if you suspect you have a urinary tract infection, always seek medical advice.

Bilberry - Bilberries are a purple-fleshed fruit that, like blueberries, contain antioxidant anthocyanidins, but in a higher concentration leading to a purple flesh compared to the pale flesh of blueberries. Also known as whortleberries, bilberries also provide vitamin C, vitamin E and manganese.

They have been used medicinally for over a thousand years to help treat diarrhoea, menstrual cramps and eye disorders (including cataracts and diabetic retinopathy), to strengthen the connective tissues that support blood vessels (such as in those with varicose veins or haemorrhoids) and to lower uric acid levels to help prevent gout.

Recent research shows that bilberries help to reduce the lowgrade inflammation associated with metabolic syndrome (pre-diabetes),10 and help to protect the eyes of office workers from fatigue associated with using computer screens.11 In conclusion Berries are an important part of a healthy diet as they are rich in vitamins, minerals and antioxidants as well as fibre, while being relatively low in sugar. Aim to eat at least one serving of berries per day, either as a breakfast smoothie, or as a delicious dessert. And if you're looking for an antioxidant, antiinflammatory supplement, one of the superberries featured here are worth considering.

References on request

NEW

TREATS HEARTBURN AND ACID REFLUX. ONE TABLET PER DAY. LASTS 24 HOURS. AVAILABLE IN PACKS OF 7s AND 14s.

Marketed by

CCF:22656 Date of preparation: (10-19)

ABBREVIATED PRESCRIBING INFORMATION Product Name: Emazole Control 20 mg Gastro-Resistant Tablets Composition: Each tablet contains 20 mg esomeprazole (as magnesium dihydrate).

Description: Light pink oval film coated tablet.

Indication(s): Proton Pump Inhibitor (PPI): Short-term treatment of reflux symptoms (e.g. heartburn and acid regurgitation) in adults. Dosage: Swallow tablets whole with liquid, do not chew or crush. Disperse in half a glass of non-carbonated water if difficulty in swallowing. Stir until tablets disintegrate, drink liquid with pellets immediately or within 15 min, or administer through a gastric tube. Do not chew or crush pellets. Adults: The recommended dose is 20 mg esomeprazole (one tablet) per day. It might be necessary to take the tablets for 2-3 consecutive days to achieve improvement of symptoms. Duration of treatment is up to 2 weeks. Once complete relief of symptoms has occurred, treatment should be discontinued. If no symptom relief is obtained within 2 weeks of continuous treatment, the patient should be instructed to consult a doctor. Elderly (≥ 65 years old): As per adults. Paediatric population (< 18 years): Not recommended. No relevant use in this group in the indication: “short-term treatment of reflux symptoms (e.g., heartburn and acid regurgitation)”. Severe impaired renal function: Caution. Severe liver impairment: 20 mg max daily dose.

Contraindications: Hypersensitivity to esomeprazole, substituted benzimidazoles or any of the excipients. Not with nelfinavir. Warnings and Precautions for Use: On demand treatment: Contact a physician if symptoms change in character. In the presence of any alarm symptom (e.g. significant unintentional weight loss, recurrent vomiting, dysphagia, haematemesis or melaena) and when gastric ulcer is suspected or present, malignancy should be excluded, as treatment with esomeprazole may alleviate symptoms and delay diagnosis. Treatment with proton pump inhibitors (PPIs) may lead to a slightly increased risk of gastrointestinal infections such as Salmonella and Campylobacter and in hospitalised patients, also possibly Clostridium difficile. Patients should consult their doctor before taking this medicinal product if they are due to have an endoscopy or urea breath test. Absorption of vitamin B12 may be reduced due to hypo- or achlorhydria. Not recommended for long-term use as the following may also occur: Hypomagnesaemia; Risk of fracture. Consider stopping Emazole Control in cases of Subacute cutaneous lupus erythematosus (SCLE) accompanied by arthralgia. Interference with laboratory tests: Increased Chromogranin A (CgA) level may interfere with investigations for neuroendocrine tumours. To avoid this interference, Emazole Control treatment should be stopped for at least 5 days before CgA measurements. If CgA and gastrin levels have not returned to reference range after initial measurement, measurements should be repeated 14 days after cessation of PPI treatment. Contains glucose and sucrose.

Interactions: Effect of esomeprazole on other drugs: Co-administration with atazanavir is not recommended. If the combination of atazanavir with a PPI is judged unavoidable, close clinical monitoring is recommended in combination with an increase in the dose of atazanavir to 400 mg with 100 mg of ritonavir; esomeprazole 20 mg should not be exceeded. Esomeprazole is a CYP2C19 inhibitor. When starting or ending treatment with esomeprazole, the potential for interactions with drugs metabolised through CYP2C19 should be considered. Serum levels of cilostazol, cisapride, tacrolimus, methotrexate may be increased. An interaction is observed between clopidogrel and esomeprazole, but the clinical relevance is uncertain. As a precaution, concomitant use of esomeprazole and clopidogrel should be discouraged. Gastric acid suppression by PPIs increase or decrease absorption of drugs with pH dependent absorption (decreased absorption of ketoconazole, itraconazole); esomeprazole inhibits CYP2C19 metabolising enzyme and could increase plasma concentrations of diazepam, citalopram, imipramine, clomipramine, phenytoin (monitor plasma levels of phenytoin), etc. resulting in need of a dose reduction; monitor INR when given with warfarin or similar. Caution as absorption of digoxin can increase. Effect of other drugs on esomeprazole: CYP2C19 and CYP3A4 inhibitors (clarithromycin, voriconazole) may increase the esomeprazole exposure. Dose adjustment not regularly required, except in severe hepatic impairment and long-term use. CYP2C19 and/or CYP3A4 inducers (rifampicin and St. John’s wort) may lead to decreased esomeprazole serum levels by increasing the esomeprazole metabolism.

Pregnancy and Lactation: Caution in pregnancy due to lack of clinical data. No studies in lactating women, therefore, not recommended during breast-feeding. Ability to Drive and Use Machinery: Minor influence on the ability to drive or use machines. Adverse reactions such as dizziness (uncommon) and blurred vision (rare) have been reported. If affected, patients should not drive or use machines.

Undesirable Effects: Common: Headache, abdominal pain, constipation, diarrhoea, flatulence, nausea/vomiting, fundic gland polyps (benign). Uncommon: Peripheral oedema, insomnia, dizziness, paraesthesia, somnolence, vertigo, dry mouth, increased liver enzymes, dermatitis, pruritis, rash, urticaria, fracture of the hip, wrist or spine. For other side effects refer to the SPC. Marketing Authorisation Holder: IQ Pharmatek Ltd., Gurtnafleur, Old Waterford Road, Clonmel, Co. Tipperary. Marketing Authorisation Number: PA 22777/001/001. Further information and SPC are available from: Rowex Ltd, Bantry, Co. Cork. Freephone: 1800 304 400 Fax: 027 50417. E-mail rowex@rowa-pharma.ie Legal Category: Not subject to medical prescription.

Date of Preparation: September 2019 Adverse events should be reported. Reporting forms and information can be found on the HPRA website (www.hpra.ie) or by emailing medsafety@hpra.ie or by emailing Rowex pv@rowa-pharma.ie

42

COPD

The Non-pharmacological management of COPD Written by Ms. Joan Johnston, National Co-ordinator COPD Support Ireland Email: nationalcoordinator@copd.ie | Professor J.J.Gilmartin, Chair COPD Support Ireland. Email: chair@copd.ie

Chronic Obstructive Pulmonary Disease (COPD) has a prevalence of approximately 380,000 patients in Ireland. With the iterations of the GOLD (Global Initiative for Obstructive Lung Disease 2020) the pharmacological management of COPD by severity class has been well established. Additionally, there is now significant evidence-based literature on non-pharmacological interventions showing improvements in dyspnoea, quality of life and even life expectancy. COPD Support Ireland (COPDSI ) is a national patient oriented charity with over 30 patient support groups around the country.

Joan Johnston, COPD Support Ireland

Nationally we have an advocacy role with links to the National Respiratory Programme, the ICGP, HSE and most recently on the Vulnerable people subgroup of NPHET. As per public health guidance we stood down our support groups and exercise programmes in March 2020, however we have been actively working with our members and health care professionals across Ireland to deliver alternative supports during COVID. COPDSI in conjunction with the National Clinical Programme have updated the “COPD & Me” information booklet, outlining many of the non-pharmacological options for patients with COPD. In this article we will review some of these interventions and the potential benefits in the management of COPD even during COVID-19: • Pulmonary Rehabilitation • Physical Activity • Peer Support • Breathlessness management • Anxiety management • Breathing Pattern Disorders Where do non-pharmacological interventions fit in?

Declining activity levels in this patient demographic often happen long before diagnosis, the symptoms either go unnoticed or are easily explained away by progressing age, smoking history, weight gain etc. Initiation of Non-pharmacological management of COPD is just as important from diagnosis as the

pharmacological management.

Enabling patients to manage their symptoms when well, provides a broad ranging ‘toolbox’ to draw upon during times of exacerbation or disease progression.

Pulmonary rehabilitation This is the gold standard for improving quality of life, decreasing dyspnoea, and increasing life expectancy in COPD patients.

These programmes are a one stop shop for the individually tailored, holistic management of COPD and commencing early after a COPD hospitalisation in now becoming the norm.

They include a supervised exercise programme two to three times a week for 6-8 weeks with clear guidance on progressing exercise tolerance and understanding safe levels of exertional dyspnoea.

The Borg scale of breathlessness is used with optimum exercise intensity resulting in moderate dyspnoea equivalent to a 3-4 on the Borg scale. In lay terms they should be able to “talk but not sing” during physical activity.

Key to any pulmonary rehabilitation (PR) programme is to effect a lifestyle change that lasts beyond the 6–8-week programme, it is only with ongoing activity and self-management that the enduring benefit of PR can be found at 12-24 months post intervention.

PR also provides education sessions covering topics such as pathophysiology of COPD, Inhaler technique, airway clearance, breathlessness management, anxiety, dietary advice, and

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smoking cessation delivered by the multidisciplinary team, and the interactive nature of these sessions can help cement those lifestyle changes. Unfortunately, PR programmes, while improving in number and capacity, can still have service gaps and waiting lists dependant on geography. COPDSI has used its group network to deliver key elements of PR where these gaps exist and recruits new members, for ongoing PR and peer support. During COVID-19 we have been rolling out the use of virtual solutions such as Zoom to deliver ongoing exercise, education, peer support and a singing for lung health programme for people living with COPD. Physical Activity & Peer Support 20-30 minutes of moderate intensity exercise 3-4 times per week maintains both physical and mental wellbeing in the general population and this is more important when living with COPD. People are conditioned to “listen” to their bodies and if something does not feel right, then avoid it so it’s unsurprising that a person with COPD limits their activity levels. This leads to a vicious cycle of breathlessness with reduced activity causing deconditioning and subsequent increased respiratory rate and oxygen demand during any future physical activity. Education on the benefits of physical activity specific to COPD using the basic premise of “use it or lose it” can resonate in this population. This is especially important during the current COVID-19 pandemic with advice for people at high risk to stay home. As an organisation we have maintained contact with our 33 support group exercise classes around the country and they have all strongly attributed their physical and mental well being to that exercise. The loss of this support is the single biggest challenge they currently face, in response to this we launched a “Living Well with COPD during COVID” information pack which includes an updated COPD & Me book detailing the self-management of COPD including simple exercises to be

done at home and our Top Tips to Protect your Physical and Mental Health during COVID. Breathlessness, Anxiety and Breathing Pattern Disorders The symptoms of these often coincide, overlap, or mimic each other and attempting to address one without considering the others can result in incomplete or futile interventions. Anxiety and depression are common comorbidities in COPD and can be associated with higher morbidity and mortality, increased disability, and increased healthcare service use. Where dyspnoea appears to be poorly controlled despite optimal bronchodilation and activity levels, anxiety is often the first consideration. While there are pharmacological interventions available to us, there are also proven non-pharmacological interventions. Cognitive behavioural therapy (CBT) has been shown to alleviate symptoms of anxiety in COPD through exploration of the link between a

43 patient’s situation, their symptoms, belief system and emotions.

Retraining people with COPD to recognise that breathlessness is not always harmful can be a slow process. Patients may have had years of experiential and iatrogenic reinforcement of the negative thinking, that dyspnoea is directly correlated with oxygenation and that low oxygen levels are something to be avoided.

Addressing this anxiety around breathlessness requires a change in the patients thinking but also in that of the healthcare professional.

Brief interventions in CBT have been shown to improve the HADSAnxiety subscale scores with statistical significance in an RCT performed by Heslop-Marshall et al (2018). To deliver CBT to a wider group of COPD patients several Respiratory Nurse specialists were trained to deliver such interventions which also found that these interventions were in fact more cost effective than provision of information leaflets alone at 12 months post intervention.

Breathing pattern disorders are the second comorbidity to consider in the persistently dyspnoeic patient.

They have been well described in the literature particularly in relation to exercise induced bronchospasm or asthma, however they can also be present in COPD. In a COPD patient with poor bronchodilator relief a Nijmeigan questionnaire may be helpful in identifying non somatic causes of breathlessness.

The interventions for breathing pattern disorders with or without anxiety can be as simple as retraining the breathing pattern,

anxiety management, inspiratory muscle training and sinus rinsing.

The following are common interventions used by physiotherapists in the management of the breathless patient. Breathing control where the patient is encouraged to breathe gently, with arms supported and hands and shoulders relaxed and is particularly helpful to regain control of breathing. This, when combined with a position of ease such as forward lean in sitting, resting elbows on knees or a table; or in standing, leaning against a wall, helps to optimise the length tension relationship of the diaphragm and increase its efficacy during each breath.

Purse lip breathing helps maintain control of the breath during activity and has been shown to result in lower VO2 and respiratory rate and an increased recovery rate in patients with COPD (Jones et al, 2003 as cited in Bott et al, 2009).

“Blow as you go”, where the patient is told to blow out during exertion, like the instruction given in the gym when lifting weights,

patients are instructed to blow out through pursed lips during the exertional part of the activity such as standing up from sitting.

Diaphragmatic breathing, where the abdominal wall is encouraged to excurse outwards against a hand resting on the abdomen during inspiration can also reduce VO2 and respiratory rate in COPD patients. Describing how a small child breathes with their tummy after running around is a helpful analogy to draw when teaching this technique. It is important to note here that patients with Severe COPD found this technique increased their experience of dyspnoea despite there being improvements in oxygenation and thus is not recommended for those with severe disease (Bott et al, 2009).

Conclusion The GOLD guidelines (2020) provide an algorithm for the initiation of non-pharmacological interventions alongside pharmacological management from diagnosis with a follow-on algorithm for the review of these

interventions and continuation if benefit is demonstrated. The overall message is clear, nonpharmacological management of COPD is key to its successful management or more accurately its self-management. “COPD & Me” details a number of these non-pharmacological interventions and is a great first step in addressing their optimisation in the COPD patient.

“Living well with COPD during COVID” information pack can be downloaded from www.copd. ie, alternatively patients can text the word “COPD” plus their name and address to 51444 to receive a free pack in the post. (standard network charges apply) The “COPD & Me” book can be downloaded from www.copd.ie alternatively email info@copd.ie to order copies for your service.

The “Living Well with COPD in a COVID world” conference can be viewed on our website homepage www.copd.ie.

References Bott J, Blumenthal S, Buxton M, et al Guidelines for the physiotherapy management of the adult, medical, spontaneously breathing patient Thorax 2009;64:i1-i52.

Global Initiative for Chronic Obstructive Lung Disease (GOLD). GOLD 2020 global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease, 2020 report.

Professor JJ Gilmartin

Heslop-Marshall K, Baker C, CarrickSen D, et al. Randomised controlled trial of cognitive behavioural therapy in COPD. ERJ Open Res. 2018;4(4):000942018. Published 2018 Nov 23. doi:10.1183/23120541.00094-2018

PHARMACYNEWSIRELAND.COM

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News

Life Pharmacy partner with Nationwide Life Pharmacy are pleased to announce their new six-month sponsorship with one of RTE’S largest shows Nationwide.

Shooting for the RTE Nationwide sponsorship recently took place across Life Pharmacies

The new TV campaign will help to spread awareness and reach a wider audience for Life Pharmacy Group across Ireland.

“We’re delighted to partner with Nationwide, it enables us to showcase Life Pharmacy to a national audience and to highlight Life’s expert health services to a broader demographic,” said

Siobhán Flynn, Marketing Director at Life Pharmacy.

Each 10-second ad highlights the expert healthcare provided

by Life pharmacists across the country through various customer and pharmacist scenarios. The ad campaign features Life members Laura Armstrong, Colm Kennelly, Vincent Dempsey and Mairead Reen and was filmed in Armstrong Life Pharmacy in Arklow, Co. Wexford.

With over 90 Life pharmacies across Ireland, the campaign’s tag line ‘Get Expert Care Nationwide’ is a perfect fit for the brand and partnership with Nationwide.

Allcare Pharmacy invests in Sponsorship Allcare Pharmacy are pleased to announce their sponsorship with The Brendan O’Connor Show on RTÉ Radio 1. The popular weekend show presents a live mix of news, interviews and discussion and will help build further awareness of the Allcare brand across Ireland.

“We’re delighted to partner with The Brendan O’Connor Show, which as one of the highest rated radio shows in Ireland, enables us to showcase Allcare Pharmacy to a national audience,” said Siobhán Flynn, Marketing Director at Allcare Pharmacy.

The Brendan O’Connor show, which is aired every Saturday and Sunday, 11am – 1pm, will include 10-second Allcare stings, similar to mini-ads, with additional stings also aired on other prime-time shows throughout the week, each focused on specific benefits and services offered by the pharmacy group.

“We are incredibly proud of the growth and success of Allcare over the past 7 years, a testament to the great teams in Allcare Pharmacies providing a top-class healthcare service and customer experience to communities across Ireland. Our partnership with The Brendan O’Connor Show, which is listened to in communities across the country, is a perfect fit for us” said Siobhán Flynn, Marketing Director at Allcare Pharmacy.

United Drug maintain Product Support As the country continues its ongoing battle with Covid-19, the United Drug team continue to focus on improving the Ostomy and Urology product range, services and customer care to support Retail Pharmacies and their Ostomy patients.

As market leaders in Ostomy and Urology Pharmaceutical supplies, United Drug work with multiple suppliers to provide a comprehensive product range that can enhance the quality of life for patients and improve patient care.

They have a team of 6 dedicated Ostomy specialists who have an incredible combined experience of over 40 years dealing with Pharmacies across Ireland to enhance Ostomy patient care in every way possible. As pharmacies battle the pressure

of Covid restrictions and staff shortages, they really depend on the Ostomy advice and support they can call upon each day.

The team provides support for over 20,000 customer care queries annually and with the guidance of 35 leading manufacturers, over 3000 products to choose from and the alignment of their nurses, United Drug can organise direct to patient support if required.

In addition, United Drug continues to invest in state of the art cutting technology allowing them to

PHARMACYNEWSIRELAND.COM

provide up to 10,000 pouches cut to individual patient specifications ensuring the best possible fit and guarantees increased precision for every single cut. This complimentary service affords patients optimum comfort and peace of mind, giving them the highest level of security.

For more information about the UD Ostomy and Urology product range contact the UD BDM for your area or the Ostomy Care team on 01 01 4632347 or visit www.udw.ie

Potential new therapy for breast cancer Scientists have discovered a molecule that can selectively kill cells of a hard-to-treat subtype of breast cancer, which could lead to a new therapy.

The study, led by researchers at RCSI University of Medicine and Health Sciences, is published in the current edition of Science Advances.

Triple negative breast cancer is a subtype of breast cancer which is mainly treated with chemotherapy. Unfortunately, up to 70% of patients with this form of breast cancer develop resistance to treatment.

The researchers tested different molecules to see if they could selectively kill the cells of this type of breast cancer while sparing normal cells. They found that a specific molecule, BAS-2, was able to do this.

“Our aim now is to develop the small molecule into a more drug-like compound and to assess if we can harness the new function for potentially improved treatment of patients,” said Dr Tríona Ní Chonghaile, the study’s corresponding author and an RCSI lecturer in Physiology and Medical Physics.

To better understand how the molecule killed the cells, the researchers confirmed that it inhibited an enzyme called HDAC6.

Using state-of-the art mass spectrometry, the researchers identified, for the first time, that HDAC6 plays a key role in altering energy in these cancer cells.

The work was funded by the Wellcome Trust Seed Award, L’Oreal-UNESCO For Women in Science Programme and Science Foundation Ireland’s Frontiers for the Future Programme.

In addition to those from RCSI, the work was carried out by researchers from the UCD Conway Institute of Biomedical and Biomolecular Sciences, NYU Langone Medical Center, Penn State University, the Koch Institute for Integrative Cancer Research at MIT and the Dana-Farber Cancer Institute at Harvard Medical School.

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News

Differences in Biosimilar Quality Reporting An attempt to understand whether regulatory and scientific sources are consistent with each other in their reporting of quality attributes (QAs) for biosimilars has demonstrated general conformance between these 2 sources of biosimilar information.

Reporting of biosimilar quality attributes (QAs) is “inconsistent but reasonably complementary” between regulatory and scientific publications, according to the study comparing European public assessment reports (EPARs) from the European Medicines Agency (EMA) with peer-reviewed scientific publications on biosimilars.

Investigators looked at the reporting of 2 general categories of biosimilar QAs: structural and functional. Structural qualities include amino acid sequence, which must be similar between biosimilars and their reference products. They also concern purity of the drugs and physicochemical properties. Functional QAs include immunochemical activity and biological activity, such as antibody binding to the target ligands necessary to achieve a clinical response.

QAs, therefore, “describe specific physical, chemical, biological or microbial properties” of a biosimilar, and although the aims of scientific and regulatory

reporting differ, data on QAs should be consistent, according to the authors. Limited information about the consistency and complementarity of QA reporting made this study necessary, they wrote.

“Along with the surge of biosimilars introduced to the European market over the last decade, the need for comprehensive and reliable information among decision makers (eg, clinicians, pharmacists, payers, and regulators) about the justification of biosimilarity has become pertinent,” the authors wrote.

The authors argued bringing greater consistency to reporting of QAs between sources could ultimately contribute to increased acceptance and use of biosimilars by clinicians. “A comprehensive and consistently reported set of QAs is needed to understand the science behind regulatory approval and increase confidence in biosimilars in clinical practice,” they wrote.

Reduction in the Cost of Medicines Towards the end of last year, Medicines for Ireland (MFI), the Irish pharmaceutical trade association and the supplier of the majority of medicines in Ireland, launched ‘Reductions in the Cost of Medicines’, a report outlining how the Government can achieve a national saving of up to ¤1 billion over the next five years by switching to generic and biosimilar medicines. To put into context, ¤200 million of additional saving per annum could be redirected towards additional HSE resources, paying for 6,000 additional nurses or 3,500 extra nursing home beds.

Commenting on the report which was shared with Oireachtas members, Chair of Medicines for Ireland, David Delaney said: “It is well recognised by the HSE and the Department of Health that the increased use of generic medicines has delivered ¤1.6 billion in savings to the Irish health system since 2013. These savings have been delivered by the members

of MFI who supply the majority of medicines to the HSE and to patients directly.

“Covid-19 has placed added pressure on an already overstretched health system. The policy proposals set out in this report outline the opportunity for Government to free up significant HSE resources by avoiding an annual spend of hundreds of millions of euro on high cost patented medicines. Over the last decade, the increased use of generic medicines in Ireland has helped dramatically reduce the cost of everyday health care.

These reductions have helped families across the county access a greater range of medicines due to generic competition. While this has resulted in the era of the big brand being dealt a blow, an increased use of generic and biosimilar medicines will help protect public finances and the HSE budget, with the possibility of redirecting savings into other much needed HSE resources.”

New Programmes from IIOP The Irish Institute of Pharmacy has announced the following Addiction Services online courses are now available on their website:  Harm Reduction & Opioid Substitution Treatment  Brief Intervention & Needle Provision Service They have been developed by the Health Service Executive (Addiction Services) and the IIOP would like to thank them for their work on the programmes. Both programmes can be accessed on the IIOP website at www.iiop.ie

First patient receives Covid Vaccine Annie Lynch, a 79 year-old woman from Dublin, became the first person in Ireland to be vaccinated against Covid-19. She got the vaccine on January 4th at St James’s Hospital in Dublin 8, alongside healthcare workers from the hospital who were also vaccinated.

Bernie Waterhouse is an Clinical Nurse Manager working in a designated COVID-19 ward in St James Hospital, and is the first healthcare worker in Ireland to get the COVID vaccine. She said as she received her vaccine, “I wanted to get the vaccine to protect myself, and the people I work with and care for every day, from Covid-19.”

Annie Lynch is pictured being the first to receive the Covid-19 vaccination

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Annie’s vaccine was the first Pfizer BioNTech COVID-19 Vaccine to be administered by vaccinators at 4 hospitals across the country – St James’s Hospital and Beaumont Hospital in Dublin, Cork University Hospital, and University Hospital Galway. The vaccines given were

from the first delivery of 10,000 doses received by the HSE on December 26th.

Paul Reid, HSE CEO said, “This vaccine has the power to protect people from COVID-19, and reduce the illness and deaths caused by this terrible virus. I am very proud to see the vaccinations commence today, safely, with thorough vaccinator training and patient centred communications at its heart. As we know, the vaccines will be delivered in stages - we’re starting in acute hospitals initially, and will move into long-term care facilities from next week, but this is a great start to an historic process.”

The Pelgraz® Patient App Find out how the Pelgraz® Patient App can help your patients to confidently self inject from home

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Confidence, Convenience, Compliance Abbreviated Prescribing Information Please refer to the Summary of Product Characteristics (SmPC) before prescribing Pelgraz▼(pegfilgrastim) 6 mg solution for injection in pre-filled injector.

Presentation: Each pre-filled injector contains 6 mg of pegfilgrastim* in 0.6 mL solution for injection. The concentration is 10 mg/mL based on protein only**. *Produced in Escherichia coli cells by recombinant DNA technology followed by conjugation with polyethylene glycol (PEG). ** The concentration is 20 mg/mL if the PEG moiety is included. Indications: Reduction in the duration of neutropenia and the incidence of febrile neutropenia in adult patients treated with cytotoxic chemotherapy for malignancy (with the exception of chronic myeloid leukaemia and myelodysplastic syndromes). Dosage and Administration: Pelgraz therapy should be initiated and supervised by physicians experienced in oncology and/or haematology. Posology: One 6 mg dose (a single pre-filled injector) of Pelgraz is recommended for each chemotherapy cycle, given at least 24 hours after cytotoxic chemotherapy. Safety and efficacy of Pelgraz in children and adolescents has not yet been established and no recommendation on a posology can be made. No dose change is recommended in patients with renal impairment, including those with end-stage renal disease. Method of administration: Pelgraz is for subcutaneous use. The injections should be given subcutaneously into the thigh, abdomen or upper arm. See SmPC for instructions on handling of the medicinal product before administration. Contraindications: Hypersensitivity to pegfilgrastim or any of the excipients in Pelgraz. Warnings and precautions: To improve the traceability of biological medicinal products, the trade name of the administered product should be clearly recorded. The long-term effects of pegfilgrastim have not been established in acute myeloid leukaemia (AML); therefore, it should be used with caution in this patient population. Granulocyte-colony stimulating factor (G-CSF) can promote growth of myeloid cells in vitro and similar effects may be seen on some non-myeloid cells in vitro. The safety and efficacy of pegfilgrastim have not been investigated in patients with myelodysplastic syndrome, chronic myelogenous leukaemia, and in patients with secondary AML; therefore, it should not be used in such patients. Particular care should be taken to distinguish the diagnosis of blast transformation of chronic myeloid leukaemia from AML. The safety and efficacy of pegfilgrastim administration in de novo AML patients aged < 55 years with cytogenetics t(15;17) have not been established. The safety and efficacy of pegfilgrastim have not been investigated in patients receiving high dose chemotherapy. This medicinal product should not be used to increase the dose of cytotoxic chemotherapy beyond established dose regimens. Pulmonary adverse reactions, in particular interstitial pneumonia, have been reported after G-CSF administration. Patients with a recent history of pulmonary infiltrates or pneumonia may be at higher risk. The onset of pulmonary signs such as cough, fever, and dyspnoea in association with radiological signs of pulmonary infiltrates, and deterioration in pulmonary function along with increased neutrophil count may be preliminary signs of Adult Respiratory Distress Syndrome (ARDS). In such circumstances pegfilgrastim should be discontinued at the discretion of the physician and the appropriate treatment given. Glomerulonephritis has been reported in patients receiving filgrastim and pegfilgrastim. Generally, glomerulonephritis resolved after dose

www.accord-healthcare.ie

reduction or withdrawal of filgrastim and pegfilgrastim. Urinalysis monitoring is recommended. Capillary leak syndrome has been reported after G-CSF administration and is characterised by hypotension, hypoalbuminaemia, oedema and haemoconcentration. Patients who develop symptoms of capillary leak syndrome should be closely monitored and receive standard symptomatic treatment, which may include a need for intensive care. Generally asymptomatic cases of splenomegaly and cases of splenic rupture, including some fatal cases, have been reported following administration of pegfilgrastim. Spleen size should be carefully monitored (e.g. clinical examination, ultrasound). A diagnosis of splenic rupture should be considered in patients reporting left upper abdominal pain or shoulder tip pain. Treatment with pegfilgrastim alone does not preclude thrombocytopenia and anaemia because full dose myelosuppressive chemotherapy is maintained on the prescribed schedule.

Regular monitoring of platelet count and haematocrit is recommended. Special care should be taken when administering single or combination chemotherapeutic medicinal products which are known to cause severe thrombocytopenia. Sickle cell crises have been associated with the use of pegfilgrastim in patients with sickle cell trait or sickle cell disease. Therefore, use caution when prescribing pegfilgrastim in patients with sickle cell trait or sickle cell disease, monitor appropriate clinical parameters and laboratory status and be attentive to the possible association of this medicinal product with splenic enlargement and vasoocclusive crisis. White blood cell (WBC) counts of 100 x 109 /L or greater have been observed in less than 1% of patients receiving pegfilgrastim. No adverse reactions directly attributable to this degree of leukocytosis have been reported. Such elevation in WBCs is transient, typically seen 24 to 48 hours after administration and is consistent with the pharmacodynamic effects of this medicinal product. Consistent with the clinical effects and the potential for leukocytosis, a WBC count should be performed at regular intervals during therapy. If leukocyte counts exceed 50 x 109 /L after the expected nadir, this medicinal product should be discontinued immediately. Hypersensitivity, including anaphylactic reactions, have been reported with pegfilgrastim. Permanently discontinue pegfilgrastim in patients with clinically significant hypersensitivity. Do not administer pegfilgrastim to patients with a history of hypersensitivity to pegfilgrastim or filgrastim. If a serious allergic reaction occurs, appropriate therapy should be administered, with close patient follow-up over several days. Stevens- Johnson syndrome (SJS), which can be life-threatening or fatal, has been reported rarely in association with pegfilgrastim treatment. If the patient has developed SJS with the use of pegfilgrastim, treatment must not be restarted at any time. As with all therapeutic proteins, there is a potential for immunogenicity. Rates of generation of antibodies against pegfilgrastim is generally low. Binding antibodies do occur as expected with all biologics; however, they have not been associated with neutralising activity at present. Aortitis has been reported after filgrastim or pegfilgrastim administration in healthy subjects and in cancer patients. The symptoms experienced included fever, abdominal pain, malaise, back pain and increased inflammatory markers (e.g. C-reactive protein and WBC count). In most cases aortitis was diagnosed by CT scan and generally resolved after withdrawal of filgrastim or pegfilgrastim. The safety and efficacy of Pelgraz for the mobilisation of blood progenitor

Oncology & Haematology

cells in patients or healthy donors has not been adequately evaluated. Increased haematopoietic activity of the bone marrow in response to growth factor therapy has been associated with transient positive bone-imaging findings. This should be considered when interpreting bone- imaging results. This medicinal product contains 50 mg sorbitol in each unit volume, which is equivalent to 30 mg per 6 mg dose. Pelgraz contains less than 1 mmol (23 mg) sodium per 6 mg dose, that is to say essentially ‘sodium-free’. The needle cover contains dry natural rubber (a derivative of latex), which may cause allergic reactions. Pregnancy and Lactation: Pegfilgrastim is not recommended during pregnancy and in women of childbearing potential not using contraception. A decision must be made whether to discontinue breastfeeding or to discontinue/abstain from pegfilgrastim therapy taking into account the benefit of breastfeeding for the child and the benefit of therapy for the woman. Adverse Events include: Adverse events which could be considered serious include: Common: Thrombocytopenia. Uncommon: Sickle cell crisis, capillary leak syndrome, glomerulonephritis, hypersensitivity reactions (including angioedema, dyspnoea, anaphylaxis), splenic rupture (including some fatal cases), Sweet’s syndrome (acute febrile dermatosis), pulmonary adverse reactions including interstitial pneumonia, pulmonary oedema and pulmonary fibrosis have been reported. Uncommonly cases have resulted in respiratory failure or ARDS which may be fatal. Rare: Aortitis, pulmonary haemorrhage, Stevens-Johnson syndrome. Other Very Common adverse events: Headache, nausea, bone pain. Other Common adverse events: Leukocytosis, musculoskeletal pain (myalgia, arthralgia, pain in extremity, back pain, musculoskeletal pain, neck pain), injection site pain, non-cardiac chest pain. See SmPC for details of other adverse events. Shelf Life: 3 years. Store in a refrigerator (2°C – 8°C).

Pelgraz may be exposed to room temperature (not above 25°C ± 2°C) for a maximum single period of up to 72 hours. Pelgraz left at room temperature for more than 72 hours should be discarded. Do not freeze. Accidental exposure to freezing temperatures for a single period of less than 24 hours does not adversely affect the stability of Pelgraz. Keep the container in the outer carton in order to protect from light. Pack Size: One prefilled injector with one alcohol swab, in a blistered packaging. Marketing Authorisation Number: EU/1/18/1313/002. Marketing Authorisation Holder (MAH): Accord Healthcare S.L.U, World Trade Center, Moll de Barcelona, s/n, Edifici Est, 6a planta, Barcelona, 08039 Spain. Legal Category: POM. Full prescribing information including the SmPC is available on request from Accord Healthcare Ireland Ltd, Euro House, Little Island, Co. Cork, Tel: 021-4619040 or www.accord-healthcare.ie/products. Adverse reactions can be reported to Medical Information at Accord-UK Ltd. via E-mail: medinfo@accord-healthcare.com or Tel: +44(0)1271385257.

Date of Generation of API December 2019. IE-01454

Adverse events should be reported. Reporting forms and information can be found on the HPRA website (www.hpra.ie), or by e-mailing medsafety@hpra.ie. Adverse events should also be reported to Medical Information via email; medinfo@accord-healthcare.com or tel:0044 (0) 1271 385257

May 2020. IE-01429

Enabling people with depression to feel, think and do better1

Brintellix is indicated for the treatment of major depressive episodes in adults1 Brintellix® (vortioxetine) film-coated tablets Prescribing information: Please refer to the full Summary of Product Characteristics (SPC) before prescribing, particularly in relation to side effects, precautions and contraindications.Presentation: Tablets containing 5, 10, 15 or 20mg of vortioxetine (as the hydrobromide). Indication: Treatment of major depressive episodes in adults. Dosage: 10mg once daily. Dose may be increased to a maximum of 20mg daily or reduced to 5mg if necessary. After depressive symptoms resolve, treatment for at least 6 months is recommended. Can be taken with or without food. Elderly (≥65 years): Initial dosage is 5mg once daily. Caution advised if using doses above 10mg daily as data are limited. Children and adolescents (<18 years): Not recommended as safety and efficacy not established. Cytochrome P450 inhibitors and inducers: Consider a dose reduction of vortioxetine if a strong CYP2D6 inhibitor is added. Consider a dose adjustment if a broad CYP450 inducer is added to treatment. Renal or hepatic impairment: No dose adjustment is needed, however exercise caution given that these subpopulations are vulnerable and data on the use of Brintellix is limited. Contraindications: Hypersensitivity to the active substance or excipients.

Concomitant use with non-selective, monoamine oxidase inhibitors (MAOIs) or selective MAO-A inhibitors (e.g. moclobemide). Fertility, pregnancy and lactation: Should only be administered to pregnant women if the expected benefits outweigh the potential risk to the foetus. Limited data on the use of vortioxetine in pregnant women. Animal studies have shown reproductive toxicity. Use of SSRIs in pregnancy, particularly in late pregnancy, may increase the risk of persistent pulmonary hypertension in the newborn (PPHN). It is expected that vortioxetine will be excreted into human milk, and a risk to the breastfeeding child cannot be excluded. Animal data showed no effect on fertility, sperm quality or mating performance. Human case reports with some SSRIs have shown that an effect on sperm quality is reversible. Impact on human fertility has not been observed so far. Warnings & Precautions: Closely supervise patients, especially those at high risk, for suiciderelated behaviours during first few weeks of treatment and during dose changes. Use with caution in patients: at risk of hyponatraemia; with a history of mania/hypomania; aggression/agitation; undergoing ECT; with unstable epilepsy (discontinue if seizures begin for the first time or increase in frequency); with bleeding tendencies/disorders, taking anticoagulants or medicines affecting platelet function; in patients on lithium or tryptophan; with increased intraocular pressure, or those at risk of acute narrow angle glaucoma. Monitor patients for appearance of serotonin syndrome or neuroleptic malignant syndrome and discontinue if occurs. Patients may experience feelings of aggression, anger, agitation and irritability. Patients/caregivers should seek medical advice if such behaviour emerges or aggravates. Brintellix tablets contain sodium (<1mmol/tablet). Drug interactions: Alcoholic drinks not advisable. Vortioxetine is extensively metabolised in the liver, primarily through oxidation catalysed by CYP2D6 and to a minor extent CYP3A4/5 and CYP2C9.

Potential for interactions with: MAOIs, MAO-A and MAO-B inhibitors; serotonergic medicines (e.g. triptans or tramadol); St John’s wort; products which may lower the seizure threshold, e.g. antidepressants (tricyclic, SSRIs, SNRIs), neuroleptics (phenothiazines, thioxanthenes and butyrophenones), mefloquine or bupropion. Depending on individual patient response, a lower dose of vortioxetine may be considered if strong CYP2D6 inhibitor (e.g. bupropion, quinidine, fluoxetine, paroxetine) is added to vortioxetine treatment. Additionally, these effects may be greater in patients who are poor metabolisers of CYP2D6. A dose adjustment may be considered if a broad

cytochrome P450 inducer (e.g. rifampicin, carbamazepine, phenytoin) is added to vortioxetine treatment. There have been reports of false positive results in urine enzyme immunoassays for methadone in patients taking vortioxetine. Exercise caution in interpreting positive drug screen results. Effects on ability to drive and operate machines: No or negligible influence however, as dizziness has been reported, use caution at the start of treatment or when the dose is changed.

Adverse events: The most common adverse reaction is nausea, which is usually mild or moderate, transient and occurs within the first two weeks of treatment. The following have been reported in clinical trials and during post-marketing use: Very common (≥1/10 patients); nausea. Common (≥1/100 to <1/10); abnormal dreams, dizziness, diarrhoea, constipation, vomiting, pruritus, including generalised pruritus. Uncommon (≥1/1,000 to <1/100); flushing, night sweats. Rare (≥1/10,000 to <1/1,000); mydriasis (which may lead to acute narrow-angle glaucoma). Not known (from post-marketing reports); anaphylactic reaction, hyponatraemia, insomnia, agitation, aggression, serotonin syndrome, haemorrhage (including contusion, ecchymosis, epistaxis, gastrointestinal or vaginal bleeding), angioedema, urticaria, rash. Sexual dysfunction: The 20mg dose of vortioxetine was associated with an increase in sexual dysfunction. Class effect: Studies in patients ≥50 years of age, show an increased risk of bone fractures in patients receiving SSRIs and TCAs. Not known if relevant to vortioxetine. Prescribers should consult the full SPC in relation to other side effects. Overdose: Management consisting of treating clinical symptoms and relevant monitoring. Legal category: POM, for non-renewable supply. Brintellix Tablets, blisters of: 5mg (EU/1/13/891/002) 28 tablets. 10mg (EU/1/13/891/010) 28 tablets. 15mg (EU/1/13/891/019) 28 tablets. 20mg (EU/1/13/891/028) 28 tablets. Further information available from: Lundbeck Ireland Ltd, 4045 Kingswood Road, Citywest Business Park, Co. Dublin. Tel: 01 468 9800. Date of last revision of PI: July 2020. Reference: IE-BRIN-0214. Brintellix® is a Registered Trade Mark.

Job number: IE-BRIN-0222 Date of preparation: July 2020 Reference: 1. Brintellix Summary of Product Characteristics. Available at https://www.medicines.ie/medicines/brintellix-10-mg-film-coated-tablets-34817/smpc (Accessed: July 2020).

Adverse events should be reported. Reporting forms and information can be found at www.hpra.ie. Adverse events should also be reported to Lundbeck on: 01 468 9800 Email: SafetyLuIreland@lundbeck.com

CPD: Mental Wellbeing Continuing Professional Development

CPD

AUTHORS: Allison Dunne is a mental health pharmacist based at University Hospital, Galway.

Allison has an MSc in Psychiatric Pharmacy Practice (Aston University) and an MA in Health Promotion (NUI Galway) and is currently working towards a PhD under the supervision of Professor Steve Haake at Sheffield Hallam University. She is a member of the Irish Institute of Pharmacy Mental Health Working Group.

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

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

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

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

3. PLAN - If I have identified a

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

4 previous steps, log and record your findings.

60 Second Summary

Published by IPN. Copies can be downloaded from www.irishpharmacytraining.ie

Mental wellbeing is something we all experience. Lifestyle techniques such as the Five Ways to Wellbeing can be used to support mental wellbeing in the general population.

Pharmacists can support the mental wellbeing of patients who are prescribed psychotropic medications.

Disclaimer: All material published is copyright, no part of this can be used in any other publication without permission of the publishers and author. Lundbeck has no editorial oversight of the CPD programmes included in these modules.

Mental Wellbeing This article will describe mental wellbeing and how it can be supported and improved. The information will be equally applicable to pharmacists looking after their own mental wellbeing, and for pharmacists supporting their patients living in the local community. There will also be a discussion around how to maintain good mental wellbeing in people who are prescribed medication for mental health conditions and how to support this patient group.

What is mental wellbeing?

Mental wellbeing is sometimes described as positive mental health. It is something we all have and can fluctuate from good to bad over the course of a day, week, month or year. Someone with good mental wellbeing can be described as flourishing, enjoying life to the full, happy and satisfied with life. Ideally, we would experience good mental wellbeing for the majority of our life. However, we probably all know someone who experiences periods of poor mental wellbeing; they are unhappy, not really enjoying life, experiencing sudden mood changes, and not sleeping well.

Short periods of poor mental wellbeing are normal, especially in response to situations like the current Covid-19 pandemic.

Prolonged periods of poor mental wellbeing can lead to poor quality of life and productivity and may lead to a physical or mental illness if not addressed.

Wellbeing Categories

49

Three areas where pharmacists can make an impact to improve patient care are with medicines information, side effect management and support with medication concordance.

The Irish Institute of Pharmacy have recently launched an online Mental Health and Wellbeing Hub where pharmacists can quickly access information and guidance on looking after their own mental wellbeing in addition to promoting the positive mental health and wellbeing of their patients.

Mental Wellbeing

Objective

Subjective

Eudaimonic (meaning and purpose)

Hedonic Figure 1. Mental Wellbeing Categories

Continued Professional Development module (CPD) is sponsored by Lundbeck.

Lundbeck has no editorial oversight of the content included in these modules.

Date of item: January 2021 | Item Code: IE-NOTPR-0089

(pleasure and satisfaction)

50

CPD: Mental Wellbeing

Mental wellbeing can be categorised as subjective or objective (see Figure 1).

Subjective wellbeing is how the person describes their own feelings, happiness and experiences. Objective wellbeing is how an outside observer measures wellbeing and it may include quality of life indicators or standard of living.

Subjective wellbeing can be further categorised into hedonic (relating to immediate pleasure and satisfaction) and eudaimonic (personal growth, meaning in life). The two concepts are not mutually exclusive, they combine to give an overall feeling of mental wellbeing.

Mental wellbeing is sometimes measured using scales which measure one aspect of wellbeing such as happiness, life satisfaction or quality of life. A tool which measures a combination of hedonic and eudaimonic wellbeing is the Warwick Edinburgh Mental

Wellbeing Scale (Tennant et al., 2007). This scale measures only the positive aspects of mental health and is commonly used in research on the mental wellbeing of populations. The scale contains 14 questions such as • I’ve been feeling optimistic about the future • I’ve been feeling useful • I’ve been feeling interested in other people The full scale can be found in Tennant et al.’s report (2007).

There are few, if any, reports of the scale being used by pharmacists in the care of their patients, but there is no reason why this tool could not be used by pharmacists. It would be particularly useful to use if a pharmacist was organising a mental wellbeing project or event and could be used as a “before and after” scale to explore the impact of a mental health promotion intervention.

C0nnect C0nnect be A ctive be A ctaivkee t t c e t i c o e N n n 0 C akeC0nnect t NloKtieceep ive C0nnKecteabrenAinctg ve leaerenpin be A cti g e G v i I t V Etaktiece e c A be

o N GIeVE Ntaoktice tNaoktice lKeaeerpning Keep rning l e a Keep learning GIVE E

GIVE

Diagnosed mental health conditions As you are already aware, there are many diagnosable mental health conditions. These include anxiety disorders, depression, schizophrenia, bipolar affective disorder and sleep disorders.

The treatment for these conditions includes medicines, psychological supports, social support and occupational therapy.

A combination of treatments works well for most people but not all services may be available or appropriate in all situations.

For example, medication may be preferable for someone who finds engaging in psychological therapy difficult or distressing, and nonmedication treatments may be more appropriate for someone who is pregnant or has significant physical co-morbidities.

If a person has a diagnosed mental health condition they may still experience good mental wellbeing. Conversely someone without a formal diagnosis of

a mental health condition may experience periods of poor mental wellbeing. This is illustrated in the case studies below. (Please note, the case studies are for illustrative purposes only, they are not based on any particular individual).

Prolonged poor mental-wellbeing is a stressor that may lead to development of a mental illness.

Case Study One – John John is a 32-year-old male who was diagnosed with schizophrenia 11 years ago. John receives an injection of a long acting antipsychotic every month. He has not had an admission to a mental health ward for 9 years and does not experience any regular symptoms of schizophrenia.

John is now working full time as a researcher in a university. He plays tennis with his friends twice a week and enjoys walking with his two dogs every day. He sleeps well and feels relaxed most of the time. John would describe his mental wellbeing as being good most of the time.

Case Study Two – Sally

FIVE WAYS TO WELLBEING SIMPLE ACTIONS YOU CAN DO IN YOUR EVERYDAY LIFE TO FEEL GOOD & FUNCTION WELL CONNECT With the people around you at home, work, school and in your local community.

BE ACTIVE Step outside. Go for a walk, cycle, garden or dance. Discover a physical activity that suits your lifestyle.

TAKE NOTICE Savour the moment whether you are walking, eating or talking. Be aware of the world around you and what you’re feeling.

KEEP LEARNING Try something new. Rediscover an old interest.

Take on new responsibilities. Fix a bike.

Learn how to cook your favourite meal.

GIVE Do something nice for a friend. Thank someone.

Volunteer. Join a community group.

Sally is a 43-year-old female with no history of mental illness.

Sally works full time in a busy community pharmacy. She lives with her husband who is unable to work or drive due to a recent back injury at work. The couple have two children, one of whom is a toddler who does not sleep through the night. Sally has very little time to see friends, do exercise or enjoy any hobbies.

She does not sleep well as she is woken by the toddler most nights.

Sally would describe her mental wellbeing as poor most of the time.

What can pharmacists do to improve or maintain mental wellbeing?

One health promotion strategy to improve wellbeing is the Five Ways to Wellbeing. The strategy was first described by the New Economics Foundation (Aked, Marks, Cordon, & Thompson, 2008). It has since been used by the Health Service Executive (HSE) and charities such as Mental Health Ireland.

The Five Ways to Wellbeing are shown in Figure 2;

‘The Five Ways to Wellbeing’ (NEF, 2008)

GIV

Continued Professional Development module (CPD) is sponsored by Lundbeck.

Lundbeck has no editorial oversight of the content included in these modules.

Date of item: January 2021 | Item Code: IE-NOTPR-0089

Figure 2. The Five Ways to Wellbeing (Mental Health Ireland, 2020).

51 • Connect

new hobby or skill for enjoyment outside of work.

• Be Active

Supporting the mental wellbeing of people with diagnosed mental health condition

• Take Notice • Give • Keep learning These can be interpreted to suit the individual. For a community pharmacist they may look like this; Connect – with other pharmacists working locally to form a support network.

Be Active – walk or cycle to work.

Try to move around whilst at work if sitting at a computer.

Take Notice – be mindful during the day. Pause for a few minutes during the working day to breathe deeply, check posture and notice the sights and sounds around you.

Give – pharmacists already spend a large part of their day helping others. Take stock of this and recognise the contribution you make to your customers wellbeing and health.

Keep learning – pharmacists doing regular continuing professional development already cover this, but it could be interpreted as taking up a

For people who have been prescribed medicines for a diagnosed mental health condition there are several things that we can do as pharmacists to support their mental wellbeing and help in their recovery journey. In this section the phrase “psychotropic medicines” is used to describe any medicines such as antidepressants, antipsychotics, mood stabilisers and anxiolytics.

One or more of these medicines can be used to treat mental health conditions such as depression, bipolar affective disorder, schizophrenia and anxiety disorders. Often the indications for each medicine overlap. For example, a patient with severe depression may have their antidepressant augmented with a mood stabiliser such as Lithium. Or a patient with an anxiety disorder such as Obsessive Compulsive Disorder may be treated with an anti-depressant and a low dose of an antipsychotic.

Medication concordance As with any long-term condition, some people who are prescribed psychotropic medicines may have dose or medication changes during the course of their treatment. This can be a good time for pharmacists to check on the wellbeing of their patient and see if they need further information or support around taking medication. People taking long term medication are sometimes tempted to reduce their doses or stop medication before the prescriber has intended. A large number of patients who are prescribed medication for mental health conditions will experience a relapse in their mental health condition when they stop taking medication. Non-concordance with prescribed medication is a common reason for readmissions to inpatient mental health wards.

As a pharmacist you can do the following to support concordance with long term medication for mental health conditions: 1. Provide information There are several sources of mental health medication information online including

manufacturers leaflets and resources from the Royal College of Psychiatry in the UK. A popular website among mental health pharmacists in Ireland is Choice and Medication. This is a well-researched, patient-friendly website. It has many printable fact sheets about mental health conditions, individual medications, side effect management, and use in pregnancy or breastfeeding.

Some are available in a variety of languages, reading level and print size suitable for people and some are designed to be helpful for groups such as children and adolescents, or for people with intellectual disabilities. The HSE subscribe to the site to allow free access to all healthcare professionals and patients living in the Republic of Ireland. https://www.choiceandmedication. org/ireland 2. Reinforcement of the need for long term medication to reduce the risk of relapse A good way of reinforcing the need for long term medication with a patient is to describe it as an insurance policy. The patient may be feeling well and be tempted to

Figure 3. Figure 3. Irish Institute of Pharmacy Covid Hub: Mental Health and Wellbeing

Continued Professional Development module (CPD) is sponsored by Lundbeck.

Lundbeck has no editorial oversight of the content included in these modules.

Date of item: January 2021 | Item Code: IE-NOTPR-0089

52

CPD: Mental Wellbeing

stop their medication. But taking regular medication is like an insurance policy which reduces the risk of their symptoms returning.

Sometimes the long-term dose of a psychotropic medicine might be lower than the treatment dose during a symptomatic phase. If a patient talks to you about wishing to stop their medication advise them to talk to their prescriber, and to request a lower dose for maintenance if possible. It might be a good way to keep the channels of communication open between the patient and the prescriber and could prevent a complete stop of medication. The Choice and Medication website also has a useful tool to identify the degree of risk for people considering stopping medication.

3. Management of side effects To maximise the chance of a patient continuing long term medication it is important to minimise the side effects that the patient may experience.

Sometimes a simple timing adjustment can minimise the side effects of psychotropic medicines. For example, taking a sedative medication slightly earlier in the evening may reduce morning drowsiness the following day. Or ensuring that an SSRI antidepressant is taken in the morning if the patient sleeps poorly or experiences unusual dreams following night time doses.

Other ways to manage side effects are by recommending lifestyle changes. For example, if a patient experiences constipation as a side effect the addition of more fruits and vegetables to the diet, alongside regular exercise and fluids, may reduce the constipation risk. Weight gain can be common with many mental health medications. Pharmacists are wellplaced to offer advice on diet and lifestyle management to reduce the impact of weight gain on patients’ physical health.

People with schizophrenia die 15-25 years younger than the general population due to physical health co-morbidities such as cancer, heart disease, and stroke (Wildgust et al., 2010). Another important intervention pharmacists can do, therefore, is to offer help with smoking cessation.

The potential effects of smoking cessation on plasma levels of medication should always be considered e.g. there may be significant changes in clozapine and olanzapine levels (amongst others) with changes in smoking patterns. Pharmacists should advise patients of this interaction where relevant and recommend that they keep their care team aware of their plans to cut down or stop smoking (or if they subsequently recommence).

Referral pathways for mental health treatment In an emergency, such as immediate suicidal intent or intention to harm another person, the patient should attend the local hospital Emergency Department (or you can call 999).

For non-urgent first referrals, such as a persistent low mood, the patient should be initially referred to their GP, who may be able to treat the patient through primary care. The GP can then refer to secondary care mental health services if required.

If a patient is referred to mental health services they will be under the care of a Consultant Psychiatrist and their multidisciplinary team (MDT). MDT members include pharmacists, community mental health nurses, occupational therapists, psychologists and social workers.

Many mental health services now take place in a community setting, as described in the Irish government’s mental health policy Sharing the Vision (Department of Health, 2020).

Sometimes you may know a patient’s Community Mental Health Nurse or other members of their Team if they drop off prescriptions or collect medication on behalf of their patient. It is helpful to get to know these professionals so that you can input into a patient’s care if the patient wishes.

If you would like to learn more about recognising the signs and symptoms of poor mental wellbeing, and how to support people in times of mental distress, look out for Mental Health First Aid courses in your local area. The HSE regularly fund these courses and they are available online during the Covid-19 pandemic period https://www.mhfaireland.ie/.

Mental wellbeing resource for pharmacists – The Covid Mental Health and Wellbeing Hub In response to the Covid-19 pandemic the Irish Institute of Pharmacy (IIOP) designed an online Covid Information Hub (figure 3). The aim was to collect useful resources in one place for pharmacists to access quickly.

One section of the Hub is for mental wellbeing, as a response to reports that healthcare professionals were experiencing poor mental wellbeing during the pandemic. It contains a wide range of resources for pharmacists to use for their own wellbeing or to share with patients. The IIOP mental health working group regularly review the content of the Mental Wellbeing Hub and add new resources as they become available. The Hub can be accessed using this link https://iiop.ie/content/mentalhealth-wellbeing The IIOP Mental Health and Wellbeing Hub includes links to; • Living Works Start – a free online suicide prevention course • Silvercloud Health courses on stress, sleep, resilience and challenging times.

CPD questions 1. What are the Five Ways to Wellbeing?

2. Mood stabilisers are one category of psychotropic medication. Name three more.

3. Where could you look to find patient information about citalopram in the Polish language?

4. Where can you find the Mental Health and Wellbeing Covid Hub for pharmacists?

5. What is one thing you can do today to look after your own mental wellbeing?

6. What course could you complete to understand more about how to support a person experiencing mental distress?

Continued Professional Development module (CPD) is sponsored by Lundbeck.

Lundbeck has no editorial oversight of the content included in these modules.

Date of item: January 2021 | Item Code: IE-NOTPR-0089

• Recordings of IIOP seminars for pharmacists. Recent topics include “Developing Resilience in Pharmacy” and “Living a Life of Purpose.”

• Links to HSE mental health resources including “Minding Your Mental Health During Covid.”

In conclusion, mental wellbeing is something that we should all be aware of. Sometimes small changes can help to improve our mental wellbeing, and this is especially important during stressful times such as the Covid-19 pandemic. There are many resources available for pharmacists to support their own mental wellbeing, and that of their patients. One patient group which may need additional support are people with diagnosed mental health conditions. Pharmacists have a key role in supporting medication concordance, giving lifestyle advice, and signposting to local services.

Acknowledgements The author would like to acknowledge the assistance of Ciara Ni Dhubhlaing (Chairperson of the IIOP Mental Health Working Group) and Ciara McEvoy (Community Pharmacist representative, IIOP Mental Health Working Group) with the editing and proofreading of this article. Also thank you to Dr Helen Quirk (Sheffield University, UK) and Dr Alice Bullas (Sheffield Hallam University, UK) for their contributions to an early draft of this article.

Aked, J., Marks, N., Cordon, C., & Thompson, S. (2008). Five Ways to Wellbeing: A report presented to the Foresight Project on communicating the evidence base for improving people’s well-being. London: New Economics Foundation.

Department of Health. (2020) Sharing the vision: a mental health policy for everyone. Dublin: Government of Ireland.

Mental Health Ireland (2020). The Five Ways to Wellbeing. Retrieved on 15th January 2021 from https://www. mentalhealthireland.ie/five-ways-towellbeing/ and used with permission from Mental Health Ireland.

Tennant, R., Hiller, L., Fishwick, R., Platt, S., Joseph, S., Weich, S., . . .

Stewart-Brown, S. (2007). The WarwickEdinburgh Mental Well-being Scale (WEMWBS): development and UK validation. Health and Quality of Life Outcomes, 5(63), 63.

Wildgust HJ, Hodgson R, Beary M. (2010). The paradox of premature mortality in schizophrenia: new research questions. Journal of Psychopharmacology.24(4 Suppl):9-15.

VITAMIN

2000IU

3

Contributes to: • maintenance of normal bones • normal function of the immune system • maintenance of normal muscle function MADE IN IRELAND Food supplements should not replace a varied, balanced diet and a healthy lifestyle.

Mylan Ireland, Newenham Court, Northern Cross, Malahide Road, Dublin 17, Ireland. www.mylan.ie Date of Preparation: April 2020 Code: COL-2020-0004

54

News

Is Your Pharmacy Business Trading Online Yet? 2020 was the year that changed the face of Irish retail more than any previous year in history, with the impact of COVID-19 wreaking untold effects on how we live our lives. According to figures from the Central Statistics Office, Irish online sales reached a record high of 15.3% of all retail sales in April, versus pre-pandemic levels of 3.5%, as non-essential retail businesses closed, and we sheltered in our homes, establishing a new way of life, called ‘lockdown’.

Paul Montwill, CEO and Chief Technology Architect of Magico

“All the industry data shows that there’s no such thing as a single channel customer any more – your customers want to access your store online as well as on the high street. And now, with the multiple lockdowns and disruptions to bricks & mortar retail, this shift is even more important to recognise” Paul Montwill, CEO and Chief Technology Architect of Magico This change in consumer behaviour was mirrored across the globe, with 49% of global shoppers in a McKinsey survey, confirming they shopped more online during 2020 than they had before COVID, and global ecommerce sales growing >32% year on year.

What are the Key Learnings for Pharmacy Retail in Ireland?

1) Online shopping is here to stay. Forbes Magazine predicts that in a post-COVID world, ‘E-commerce will continue to see a major boost, especially now that many consumers have made online shopping part of their regular routines’.

2) Pharmacy services are in-demand online. One of the biggest areas of global ecommerce growth was overthe-counter medicine at roughly +44% vLY. 3) Your customers want to shop local. 39% of the respondents in the McKinsey survey also shared that they are now ‘more likely’ to buy from local /independent brands after the pandemic. This sentiment reflected in the Irish market, with a plethora of ‘Buy Irish’ and ‘Click Green’ initiatives gaining traction.

What supports are out there for Pharmacies looking to go online?

Retailers should consider the Online Retail Support Scheme

– a Department of Business, Enterprise and Innovation (DBEI) Scheme, administered by Enterprise Ireland. This fund enables successful Irish-owned retailers to enhance their digital capability and to develop a more competitive online offering, helping to increase in their customer base and build a more resilient business going forward. Successful applicants will be awarded a maximum grant of ¤40,000 to invest in their business.

Pharmacy eCommerce specialists, Magico has helped multiple retailers secure grant funding via this programme, and so far, enjoys 100% success rate from application to approval.

Magico can help you create your application for this scheme, and support you through the process with expert advice and guidance Why choose Magico as your Pharmacy eCommerce Partner?

Magico (www.magico.com) is a client-first, innovative Website Development Company based in Ennis, Co. Clare, that has been delivering websites for Irish retailers since 1999, and specialises in getting retailers online & growing them fast.

With over 20 Pharmacy Retail Clients, a Team dedicated to the Pharmacy Sector and Integrations with prominent Pharmacy EPOS/ERP systems, Magico is undoubtedly Ireland’s leading Pharmacy eCommerce Specialist.

PHARMACYNEWSIRELAND.COM

The robust & powerful Retail CMS, AB Commerce, enables Magico’s Pharmacy Retailers to not only get online but also grow their online presence fast without undertaking a complex custom design & development project.

Integrations with Prominent Pharmacy EPOS/ERP Systems Successful existing integrations with 11 EPOS/ERP systems including prominent pharmacy systems such as McLernons, Touchstore, Retail Solutions, Opus and Retail Integrations.

- Multi Offer and Free Gift Promotions - Flexible Online Forms e.g.

Order your Prescriptions, Book your Vaccination - Upselling capabilities - Integrations with leading Pharmacy suppliers e.g. Refill Assist, Smart Scripts and others Experienced and Dedicated Pharmacy Onboarding and Account Management Team With over 20 Pharmacy Retailers successfully trading online, the Magico onboarding and Account Management team are highly specialised in the Pharmacy Industry. They understand your needs and your pain points, and will have you trading online and growing your online sales as quickly as possible Partnership with leading Digital Content Gateway solution Magico recognise that sourcing and formatting product content is a significant and time consuming challenge for Pharmacists, for that reason have partnered with Content Llama, Irelands leading Digital Content Gateway in the Pharmacy Industry to provide flexible automation that will empower you to grow.

An Analytics Engine & Analytics Support to Grow your Business

If Magico haven't already integrated with your ERP/EPOS don't worry, AB Commerce is demonstrably faster at integrating with third parties than other solutions.

AB Commerce is built on top of its own analytics platform so that clients can easily see how users are using their website & make marketing and trading decisions accordingly.

Functionality tailored to the Pharmacy Industry

To go to the next level, website managers need analytics that are easy to understand and give them confidence to implement changes to their website.

Using AB Commerce Analytics, Pharmacy Retailers can browse their website and see statistics all around the website in a combination of detailed reports, digestible dashboards and in-built heatmapping.

In consultation with Pharmacy Retailers, the Magico Development Team have developed functionality tailored for the Pharmacy Industry and delivered as regular upgrades with no additional costs - Validation Checkboxes at Checkout e.g. I am Over 18 - Maximum Order Quantities for certain medicines - Multiple and Flexible Product Description Fields - Tiered Pricing Options

Contact Magico today: magicoqueries@magico.com www.magico.com +353 (0)65 686 4580

Nappy Rash?

Time to ecommend Caldesene.

Caldesene prevents and treats nappy rash.

TENDER CARE AT

Every Change

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

4

3

Based on combined MAT sales data. To verify contact: verify@perrigo.com 2Associated with a cold.

Bronchostop Junior is a medical device according to Directive 93/42/EEC, used to relieve any cough (dry & chesty) associated with a cold for children from 1 year. Children under 3 years of age should consult with a doctor to exclude more serious diseases being present. Use in children under 1 year of age is not recommended. Children aged 1 year and above 5ml up to 3 times daily. Children 2 to 3 years: 5ml up to 4 times daily. Children 4 to 5 years: 7.5ml up to 4 times daily. Children 6 to 11 years: 15ml up to 4 times daily. Always read the leaflet.

4 Buttercup Bronchostop Cough Syrup contains thyme herb extract and marshmallow root extract. A traditional herbal medicinal product for the relief of coughs, such as chesty, dry, tickly, irritating coughs and catarrh, exclusively based upon long-standing use. Adults and children over 12 years: 15ml every 4 hours. Max dose 90ml per day. Not recommended for children under 12 years. Seek medical advice if symptoms persist after 7 days or if dyspnoea, fever or purulent sputum occurs. Contraindications: Known hypersensitivity to ingredients, rare hereditary intolerance to some sugars. Caution: Not recommended for use in Pregnancy and lactation. Contains methyl parahydroxybenzoate and propyl parahydroxybenzoate, which may cause allergic reactions. Side effects: Hypersensitivity reactions and stomach disorders. TR 2006/1/1. TR Holder: Kwizda Pharma GmbH, Effingergasse 21, A-1160 Vienna, Austria.

SPC: https://www.medicines.ie/medicines/buttercup-bronchostop-cough-syrup-31510/spc IRE BRO 2020 18 1 3

OTC Awards

57

The OTC and Retail Pharmacy

Product Awards 2021 2021 & Retail Pharmacy Product Awards 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.

OTC Market Overview On a global scale, the over-thecounter (OTC) market continues to flourish. Growth has been attributed to propelling factors such as product innovations, high penetration in the emerging market and an inclination of pharmaceutical companies towards OTC from prescription medicines.

Within Ireland, the OTC market grew by 6.8% when comparing year-on-year growth between June 2019 to May 2020, despite the arrival of the Covid-19 pandemic.

According to data analyst IQVIA, the total value of the nonprescription market in Ireland for the same period, was ¤669million.

The year-to-date (YTD) value of this market at the end of May 2020 was ¤283 million with a growth rate of 5.2%. This is 1.6% lower than the growth experienced in 2019, despite the unprecedented demand experienced in the second week of March, due to Covid-19.

According to Euromonitor, Consumer Health in Ireland was positively impacted by

the Covid-19 pandemic due to Irish consumers taking on a preventative health approach focusing on having sufficient medical supplies should they need to treat symptoms of illness while social distancing measures remain in place. In particular, consumers stocked up on key categories such as VMS and allergy (hay fever) remedies and analgesics, which are also predominantly used to treat mild symptoms of the virus.

Value of OTC Medicines Over the following pages, we showcase those products which have been shortlisted as finalists across 19 categories, including Best Beauty Product, Best Marketing and Training Campaign, Best Baby Skincare Product, and Most Innovative Product.

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 than 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 products 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.

Due to the current lockdown restrictions, the OTC & Retail Pharmacy Product Awards will take place virtually in March. Full details in our next issue.

PHARMACYNEWSIRELAND.COM

VIVIO® Junior 2021 & Retail Pharmacy Product Awards

Best Children and Baby Product Baby care and child-specific products have an important role to play in pharmacy particularly in Ireland as birth rates here are currently higher than the EU average.

The birth rate in Ireland remains relatively high this year with 14.4 babies born per 1,000 residents compared to an average of 10.1 in the rest of the EU. By offering good advice from birth onwards, pharmacy teams can play a vital role in helping parents deal with the many self-limiting ailments that occur during childhood. These conditions range from colic to paediatric cold and flu.

58 | PHARMACYNEWSIRELAND.COM

Vivioptal Junior is now VIVIO® Junior!

This familiar heritage brand has been enhanced and improved to meet the demands of modern day life for kids.

It is still packed with all 12 vitamins loved before, including Vitamin D, C and B12 but now with increased levels of zinc and added iodine to support growth in children, their immune system and cognitive function.

VIVIO® Junior is a delicious tasting multivitamin tonic suitable from 1year+ and specifically formulated in accordance with the latest research and nutrient guidelines for children.

MyPro Kolicare

Junior Revive

BabyD & ToddlerD

Launched in late 2019, MyPro Kolicare is a clinically proven probiotic formula that effectively prevents and treats the early childhood indications of Colic, whilst promoting a healthy digestive system for baby. The 100% natural, safe and easy to use formula supports babies’ gut microbiota maturation. It is suitable for both formula and breast-fed babies and is allergen free.

Junior Revive is a super supplement formulated specifically for children aged from four to 12 years of age. It is unflavoured and comes in a powder formula, making it easy for kids to take in water, juice, yogurt, or a smoothie. It contains no fillers, binders, sugar, caffeine or preservatives. Junior Revive contains a unique blend of prebiotics and probiotics, 4 fruit and vegetable powders, 18 vitamins & minerals and Wellmune® a natural yeast beta 1,3/1,6 glucan, all of which aims to provide optimum support for a growing child’s physical and psychological needs.

BabyD and ToddlerD are part of Irish company Kora Healthcare’s newly expanded range of Vitamin D3 supplements, FamilyD.

• For babies, infants and children, from 0+ months.

• 5 drops once a day and can be mixed with warm milk or given directly onto the tongue.

• Formulated with two different strains of probiotic bacteria with targeted benefits. Tested daily dose 1 billion CFU(1E9).

• Clinically proven to; reduce episodes of colic and babies daily crying time.

Increase gut bacteria diversity, improve GI transit and is non-bloating.

• Easy to administer and effective regardless of the type of feeding (breastfeeding or formula), type of birth, gender or weight.

• 100% natural probiotic.

BabyD is specially formulated for infants from the day of birth. Each dose provides 200IU (5 micrograms) of Vitamin D3 supplement required for babies who are breastfed or taking <300mls infant formula a day (recommended by HSE).

BabyD is available with an oral dosing pump or an oral dosing syringe, both ensuring accurate measurement and administration.

BabyD is odourless and tasteless and free from sugar, colours, flavours, preservatives, gluten, lactose and nuts.

ToddlerD is designed specifically for children from 12 months onwards. The convenient oral spray format delivers 200IU (5 micrograms) per spray, in line with new HSE recommendations of a liquid, Vitamin D-only supplement of 200IU for children aged 1-4 during winter.

ToddlerD has a pleasant natural orange flavour, and is free from sugars, sweeteners, preservatives, artificial colours and flavours, gluten, lactose and nuts.

PHARMACYNEWSIRELAND.COM | 59

Mustela Stelatopia Balm 2021 & Retail Pharmacy Product Awards

Best Baby Skincare Product There are many skin conditions that can affect babies, ranging from dermatitis, eczema, cradle cap and prickly heat which can be treated effectively with OTC products. These can have a big impact on not only babies but concerned parents. The community pharmacy is the first place they will turn to for advice on selecting the best products and how to manage these conditions.

Consumers are very much concerned not only about what they feed to their baby but are also equally concerned about what they are applying on their baby’s skin. People prefer products which are chemical free and full of natural/organic ingredients for their children. Millennial parents are much more concerned about the ingredients that are being used in the baby skin care products.

Product innovation, attractive packaging, impact to the customer, unique selling point, and manufacturer support are all important if a baby product is to be successful in an already saturated marketplace.

60 | PHARMACYNEWSIRELAND.COM

Mustela is a French natural skincare product range for babies and young children. For over 70 years Mustela has used the best ingredients from the plant world extracting effective and gentle key active ingredients, using technologies that respect people and the environment.

Mustela has developed a unique expertise in the physiology of young children’s and babies’skin. Mustela discovered four types of baby skin types with different characteristics: normal, dry, very sensitive and atopy-prone skin. With this discovery Mustela developed products accordingly, using specific active ingredients which are perfectly suited for each type of skin.

Mustela Stelatopia Emollient Balm is an emollient skin care product which may be used on the face and body, from birth on.

This special formula, developed especially for dry and atopic skin, eczema, dermatitis, moisturizes, nourishes, and replenishes lipid levels in the skin. An innovative combination of active ingredients of natural origin, such as avocado Perseose Pure affinity with baby’s skin and sunflower oil distillate, soothes the skin while reducing discomfort and redness.

ABCDerm Péri-oral Treatment to soothe, purify and protect irritated skin around the mouth of babies and children. This irritation caused by saliva coming into contact with the skin (repeated rubbing of a dummy, thumb or favourite object) may be maintained or aggravated by the cold and wind.

ABCDerm Péri-oral contains the Amylpriv™ patent that inhibits the activity of amylase, an enzyme present in saliva that may be irritating to the delicate skin around the mouth. Péri-oral combines an insulating and protective texture with purifying, soothing and protective dermatological agents to: - Promote the decrease of perioral irritations - Participate in reinforcing the cutaneous barrier - Soothe redness and help restore skin comfort Can be used from birth (except premature babies).

RELIFE Relizema spray&go - zinc + panthenol

Elave Sensitive Sun Paediatric SPF50+ Elave Sensitive Sun Paediatric SPF50+ offers very high broad spectrum UVA, UVB, and infrared thermal protection.

Launched in April 2019 by RELIFE Ireland by Menarini, RELIFE, the Italian, dermatology and aesthetics skincare brand, rolled out its first product range, Relizema, which helps manage conditions like eczema, dermatitis and dry and sensitive skin, in pharmacies nationwide.

Paediatrician approved from newborn helps shield delicate skin from harmful UVA and UVB rays that cause sunburn.

This water resistant sunscreen protects without irritating the skin. A lightweight non-greasy formula that doesn't clog pores. Hypoallergenic and free from worrying irritants.

The Relizema product range, which consists of six products includes Relizema spray&go - zinc + panthenol, a protecting and soothing spray suitable for delicate and sensitive skin of babies and adults. The Relizema spray&go - zinc + panthenol is ideal to relieve and prevent the reddening sensation, particularly on the genital area and the buttocks, by forming a protective film against external irritant agents.

PETA approved - Cruelty Free and Vegan.

Made in Ireland.

Eighty per cent of Irish mums, who trialled RELIFE Relizema spray&go - zinc and panthenol noticed an improvement after using it.

RELIFE is stocked in 300+ pharmacies nationwide.

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Voltarol Emulgel Extra Strength 2% 2021 & Retail Pharmacy Product Awards

Best Pain Relief Product

Voltarol Emulgel Extra Strength 2% w/w Gel is a Powerful Anti-inflammatory that targets the source of pain and can be applied twice a day to provide all-day relief from joint & muscle pain.

New 100g pack comes with a unique easy-open Flip-top cap to make life easier for your patients suffering from pain in their hands. This 100g tube is equivalent to 72 x 200mg tablets of ibuprofen and has a reduced risk of systemic side effects or drug-drug interactions.

Overall, adult analgesics recorded a sharper increase in demand due to the pandemic.

Consumers increased their consumption of OTC analgesics in order to prepare themselves for the lockdown which occurred in Ireland, as consumers bought pain medications to treat themselves and those in their household at home instead of going to the doctor.

However, the massive effect of stockpiling was prevented as the Irish Pharmacy Union (IPU) warned members of the public not to stockpile medicine amid the initial panic advising that there were adequate stocks of medicine for people throughout Covid-19 precautions and that, people were allowed to have one month’s supply of any medicines that they require.

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Solpadeine Solpadeine is Ireland’s number 1 pharmacy only pain relief brand. In 2017 we launched a SOLPA EXTRA a sub brand within the Solpadeine range with a combination of Paracetamol and Caffeine to offer fast relief from mild to moderate pain.

The brand has an extensive history in pharmacy and adding this new Solpa Extra Paracetamol and Caffeine product to the range in 2017 only further strengthened the brand's presence in Irish Pharmacy.

Brupro Max 400mg Brupro Max 400mg Film-coated tablets work where they’re needed - at the site of pain. They quickly relieve pain, reduce inflammation and lower temperature.

Brupro Max provides fast and effective relief from: • headaches • muscular pain • dental pain • cold and flu symptoms • period pain • fever • backache Brupro Max 400mg Film-coated tablets: each tablet contains 400 mg of ibuprofen.

The shelf life is 5 years. Available in packs of 12s and 24s. Always read the leaflet.

Incrediwear Knee Sleeve

Sumatran Relief 50mg Tablets x 2

The Incrediwear Knee Sleeve is an innovative, non-invasive, 100% natural alternative to traditional pain medication.

Using semi-conductors (carbon and germanium) embedded in the material, the Sleeve harnesses the body’s heat to increase blood flow, decrease inflammation, and rid the area of pain.

Sitting lightly on the skin, the Knee Sleeve can be worn pre, during and post exercise and has been shown effective against osteoarthritis pain in a clinical trial.

Sumatran Relief 50mg Tablets x 2 was launched in October 2018 and is the first ever OTC Sumatriptan available in Ireland and an exclusive OTC product for pharmacies only.

It is comfortable to wear and can be worn under clothes. It is also recommended for Injury prevention due to the Natural Increase of Blood Circulation and ha no side effects.

Incrediwear was founded in 2009 after Jackson Corley suffered spinal injuries after a mountain bike accident. He needed a solution, a new way to heal, a way to be free from the limitations of inflammation and pain and get back to his active life.

Sumatran Relief is indicated for the acute treatment of migraine attacks with or without aura.

Sumatran Relief is very unique as it is the only OTC Sumatriptan available in Ireland.

While there are other pain relief products at OTC level, this product is targeted specifically for the treatment of migraines.

• It is the first and only OTC Sumatriptan available in Ireland.

• Previously diagnosed Migraine sufferers will be able to avail of the product, having consulted with the pharmacist, thus saving the patient additional visits to the Doctor.

• A relationship with the Pharmaceutical Society of Ireland (PSI) and the Migraine Association of Ireland ensures that the product is strongly promoted and supported.

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2021 & Retail Pharmacy Product Awards

Best Non-Oral Pain Relief Product

Physiologix

Body Clock TENS

Physiologix is a dynamic support and tape range with varying compression levels which help reduce inflammation and pain caused by acute or chronic injuries. Developed by Fleming Medical alongside physiotherapists and professional athletes, the Physiologix range uses the latest in innovative design and fabric technologies which provide outstanding comfort and uncompromising support to aid in injury recovery.

Body Clock TENS, are attractive easy to TENS use units for drug free pain management of chronic and acute pain and for labour pain management.

The therapeutic range includes Kinesiology, Cohesive and heavy-duty Zinc Oxide tapes and four different levels of supports Essential, Advanced, Ultimate and Custom Fit. The Ultimate and Custom Fit supports are designed with Airflex technology which provides maximum breathability, compression and heat retention to improve blood circulation, reduce pain and speed-up recovery time.

Non-oral pain relief can often be used to help relieve pain, including musculoskeletal pain such as lower back pain, neck and shoulder pain, stiff and aching muscles, joint pain and less serious arthritis pain.

Community pharmacists are in a unique, trusted position to play a bigger role in front-line management to support joint pain sufferers and help them live a fuller life.

Pharmacy teams have a vital role in helping their customers make good lifestyle choices and advising them on how to choose OTC products to help relieve pain.

According to Euromonitor, the niche of non-oral pain relief continued to gain popularity last year, and will continue to do so over the forecast period. The boost in sales was caused by the lifestyle restrictions caused by the Covid-19 pandemic.

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The SMART TENS is a sophisticated ‘next generation’ TENS machine recommended for conditions such as arthritis, sciatica, back pain, tendonitis, sprains and strains, period pain.

The ELLE TENS 2, is our most popular labour TENS, ergonomically designed with added features such as contraction timer, pre-set modes, backlit display and optimax for extra power.

TENS treatment consists of passing mild electrical impulses through your skin to alleviate pain and stimulate your body to produce its own pain killing and antiinflammatory substances.

Recommended by health professionals Body clock units are highly effective, easy to use and competitively priced.

Body Clock Tens are distributed and supported in Ireland by New Vision Healthcare. Contact sales@newvision.ie

Flexiseq Flexiseq is a topically applied gel specially formulated to help fight against the effects of osteoarthritis and joint wear & tear. Entirely drug free, Flexiseq can be used long-term and alongside traditional pain medications without drug-to-drug interactions, free from systemic side effects or exacerbating pre-existing conditions.

Through its lubricating action, Flexiseq’s Sequessome Technology offers a unique treatment option.

Flexiseq Osteoarthritis is clinically proven*, drug free relief from the pain and stiffness of osteoarthritis. A drug-free, sustainable solution to effectively relieve the pain and stiffness of osteoarthritic joints to keep you moving. *Tested in Phase III Clinical Trials among mild to moderate osteoarthritis patients.

Conaghan P, et al. Current Medical Research & Opinion 2013, 1-13

Voltarol Emulgel Extra Strength 2%

Incrediwear Knee Sleeve

Voltarol Emulgel Extra Strength 2% w/w Gel is a Powerful Anti-inflammatory that targets the source of pain and can be applied twice a day to provide all-day relief from joint & muscle pain.

The Incrediwear Knee Sleeve is an innovative, non-invasive, 100% natural alternative to traditional pain medication.

Using semi-conductors (carbon and germanium) embedded in the material, the Sleeve harnesses the body’s heat to increase blood flow, decrease inflammation, and rid the area of pain.

Sitting lightly on the skin, the Knee Sleeve can be worn pre, during and post exercise and has been shown effective against osteoarthritis pain in a clinical trial.

New 100g pack comes with a unique easy-open Flip-top cap to make life easier for your patients suffering from pain in their hands. This 100g tube is equivalent to 72 x 200mg tablets of ibuprofen and has a reduced risk of systemic side effects or drug-drug interactions.

It is comfortable to wear and can be worn under clothes. It is also recommended for Injury prevention due to the Natural Increase of Blood Circulation and ha no side effects.

Incrediwear was founded in 2009 after Jackson Corley suffered spinal injuries after a mountain bike accident. He needed a solution, a new way to heal, a way to be free from the limitations of inflammation and pain and get back to his active life.

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A.Vogel Echinaforce® 2021 & Retail Pharmacy Product Awards

Best Natural Product Natural OTCs are drug-free and may contain natural, plant, or herbal ingredients, or be homeopathic, and are used to support, prevent, maintain, or treat minor ailments such as colds, insomnia, aches and pains, or skin problems.

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

Driven by consumer interest in all things natural, the market for natural products available OTC has increased over the last number of years. Consumers are purchasing these for both prevention and immune boosting properties as well as to help promote overall health and wellbeing.

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A.Vogel Echinaforce® Cold and Flu drops and tablets are a licensed traditional herbal remedy for colds and flu. It helps the body fight the symptoms of these infections by supporting the immune system, helping to maintain the body's resistance.

A study by the Common Cold Centre (Cardiff) on the preventative use of Echinacea (Echinaforce) over a 4-month period. The development of recurrent colds reduced by 59 per cent, as well as the severity of cold symptoms. In September 2020, an invitro study in Switzerland published in The Virology Journal revealed that a fresh, whole plant liquid extract of Echinacea purpurea could be effective as prophylactic treatment for a spectrum of human coronaviruses, including newly occurring strains such as SARS-CoV-2 (CoVid-19).

1. Jawad M et al. Safety and efficacy profile of Echinacea purpurea to prevent common cold episodes: A randomised, double-blind, placebocontrolled trial. Evidence-Based Complementary and Alternative Medicine 2012; doi: 10.1155/2012/841315

Alflorex® The unique 35624® culture in Alflorex® has been clinically tested by leading scientists and gastroenterologists.

Alflorex is the only product in Ireland that contains this culture. ®

It has been recognised by an expert panel of Irish pharmacists and industry experts, voting it the winner of Best Gastrointestinal Product 4 years in a row at the Irish Pharmacy News OTC Awards.

The bacterial culture in Alflorex® occurs naturally in the human gut. It's part the Bifidobacterium family, one of the first kinds of bacteria passed by mothers to their babies at birth. To ensure this natural culture reaches your gut with its properties intact, PBG has created a special formulation and confirmed it's activity in the gut using the highest standards of scientific testing and human clinical trials.

No refrigeration is required Alflorex® is one of the best-selling Pharmacy products in Ireland* making a difference to the lives of thousands of people in Ireland. *(source IQVIA Value Share - 2020)

BabyD, ToddlerD, DailyD

Immune Phix from Phytaphix®

BabyD, ToddlerD and DailyD form Irish company Kora Healthcare’s newly expanded range of Vitamin D3 supplements, FamilyD. Available in various formats, including pump and syringe for babies, sprays for 1 year+ and capsules for adults, this range has a Vitamin D3 solution for every member of the family.

Immune Phix provides natural immune and energy support. It’s a premium and research based, powdered product which is also delicious, and convenient, suitable for addition to any food or drink.

Food based nutrients are safer, better absorbed and provide additional nutrients. This combined with his own experiences living with multiple sclerosis and asthma inspired Dr. Conor Kerley to start Phytaphix.

The proprietary formula contains Irish mushroom, elderberry, Acerola cherry, strawberry, Irish Sea minerals, organic Japanese Matcha Green Tea and more.

This powerful combination provides vitamins B12, C and D3, magnesium, selenium and zinc. Uniquely a single serving naturally contains the same amount of antioxidants as 5 carrots and the amount of flavonoids as 15,000 bananas! Immune Phix is fully recyclable and suitable for adults, children, vegans, vegetarians and gluten free with no artificial sweeteners, colours or flavours.

A spoonful provides your daily fix of natural goodness for immunity and energy!

All products contain only high-quality ingredients and are free from sugars, sweeteners, preservatives, artificial colours and flavours, gluten, lactose and nuts.

ToddlerD and DailyD fast absorption sprays are suitable for vegetarians and the DailyD spray is also available in a highstrength vegan- friendly formula to reflect the higher needs of a vegan consumer.

The sprays have a toothkind formulation with a natural orange flavour. DailyD capsules contain no bulking agents.

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GSK Health Partner 2021 & Retail Pharmacy Product Awards

Best Marketing/ Training Campaign of the Year

GSK Health Partner is a new and valuable resource for experts that supports their greatest needs with trusted information & resources to help them deliver the best care to their patients.

It sits at the heart of our omni-channel strategy and allows us to create a community of healthcare professionals and drive recommendations, trust and advocacy of GSK brands.

Quickly access content, download resources for patients and participate in CPD-conscious webinars and articles.

Graham Anthony Distribution Graham Anthony Distribution Training Department is committed to providing customers with training to ensure that all pharmacy staff, and Pharmacists are confident that they can offer the best possible advice and service.

Our training team are educated in all cutting edge research and knowledge regarding the brands they represent.

They attend international conferences and training courses constantly updating their knowledge to ensure they are well versed in skin conditions to ensure the training is best in class. They are trained in skincare science, development and new trends. Training during Covid has included onboarding new pharmacy staff and familiarisation with brands distributed by the Graham Anthony Distribution, the unique selling points of each brand and most importantly the customer best served by the brands. Refresher training and new sku launches are offered weekly to Pharmacy staff and staff completing training are all sent product to ensure product trial to completement the training.

Effective marketing & training campaigns have a way of sticking with people, because they make companies memorable. They promote a focused effort that guides consumers towards a desired action. They also give brands identity and personality.

Marketing and training 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 and/or training campaign can do that for you.

The Best Marketing/Training Campaign Award recognises a marketing, training, 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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health partner

health partner

Nurofen At Nurofen, consumer safety is our number one priority. Ibuprofen is a well-established medicine that has been used with a good safety profile as a fever and pain reducer, for more than 30 years.

As a responsible, science-led organisation, we are always engaging with the relevant health authorities. We remain committed to communicating any additional information or guidance necessary for the safe use of our products should the need arise.

At RB we wanted to share the facts with consumers and HCPs to ensure they could make an informed decision about the OTC pain relief product that was right for them.

We launched the biggest ever PR and Marketing campaign in Nurofen’s history: The ‘Share the Facts’ campaign was a Category focused approach.

Nurofen Rapid Relief Maximum Strength 400mg Liquid Capsules contain Ibuprofen.

For mild to moderate pain and fever.

Always Read the Label.

Please refer to Medicines.ie for full prescribing information.

Skin Conscious Incrediwear Knee Magazine and Website Sleeve – RELIFE Marketing The Incrediwear Knee Sleeve is an innovative, non-invasive, 100% natural Campaign 2020 alternative to traditional pain medication.

In 2019, the Skin Conscious Magazine was launched in Ireland in tandem with the launch of RELIFE, the Italian, premium, dermatology and aesthetic skincare brand. Skin Conscious is an expert guide to skin health and was created as part of the marketing segment of the RELIFE patient education campaign in 2019. The onus and ethos of the publication is based around RELIFE’s motto – My skin says how I feel.

Published within the Irish Daily Mail – 145,000 readership – Skin Conscious is also distributed to the 300+ pharmacies around Ireland, which stock the RELIFE brand.

In 2020, skinconscious.ie was launched as the digital platform to host Skin Conscious Magazine and associated social, videos and online RELIFE content.

Using semi-conductors (carbon and germanium) embedded in the material, the Sleeve harnesses the body’s heat to increase blood flow, decrease inflammation, and rid the area of pain.

Sitting lightly on the skin, the Knee Sleeve can be worn pre, during and post exercise and has been shown effective against osteoarthritis pain in a clinical trial.

It is comfortable to wear and can be worn under clothes. It is also recommended for Injury prevention due to the Natural Increase of Blood Circulation and ha no side effects.

Incrediwear was founded in 2009 after Jackson Corley suffered spinal injuries after a mountain bike accident. He needed a solution, a new way to heal, a way to be free from the limitations of inflammation and pain and get back to his active life.

RB-M-25337. Date of Preparation: Jan 2021

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Alflorex® 2021 & Retail Pharmacy Product Awards

Best Digestive Product Digestive remedies continue to experience stable demand due to a common diet that is high in sugar, fats, refined carbohydrates and low in fibre. As more consumers opt for fast food options and maintain poor diets, they will continue to reach for products that offer them fast relief from the resulting symptoms of heartburn and indigestion.

Before the pandemic, the digestive health sector benefited from consumer preferences shifting towards preventative health remedies. Digestive remedies benefited further from a small boost as stomach upset and diarrhoea were declared symptoms of Covid-19 and consumers bought preventative products.

IBS, which is characterised by abdominal pain, excess gas and diarrhoea or constipation, is becoming a common gastrointestinal disorder in Ireland. The condition is predominantly seen in young and middle-aged females as women are twice as likely to experience IBS than men.

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The unique 35624® culture in Alflorex® has been clinically tested by leading scientists and gastroenterologists.

Alflorex® is the only product in Ireland that contains this culture.

It has been recognised by an expert panel of Irish pharmacists and industry experts, voting it the winner of Best Gastrointestinal Product 4 years in a row at the Irish Pharmacy News OTC Awards.

The bacterial culture in Alflorex® occurs naturally in the human gut. It's part the Bifidobacterium family, one of the first kinds of bacteria passed by mothers to their babies at birth. To ensure this natural culture reaches your gut with its properties intact, PBG has created a special formulation and confirmed it's activity in the gut using the highest standards of scientific testing and human clinical trials.

No refrigeration is required Alflorex® is one of the best-selling Pharmacy products in Ireland* making a difference to the lives of thousands of people in Ireland. *(source IQVIA Value Share - 2020)

Nexium Control

Bio-Kult Boosted

Gaviscon

Nexium Control is Ireland’s No.1 pharmacy-only heartburn treatment without prescription*. It now accounts for 40.2% value market share for the year ending December 2020. A high level of continued marketing support is driving the overall success of the brand, with TV, VOD, digital and PR, including Heartburn Awareness Week, a category initiative to help drive awareness of the condition and ultimately encouraging the sufferer to talk to their pharmacist about treatment.

Bio-Kult Boosted is a unique extra strength multi-strain live bacteria supplement with vitamin B12 to support the digestive & immune system.

Gaviscon is the No 1. Brand1 for consumers in the Gastral Indigestion category and saw great growth in 2020.

This year we expect an increase in Heartburn and Indigestion occasions with an increase in indulgence behaviors & increased stress occasions driving higher incidence levels2.

With continued strategic investment planned for 2021 as well as a high level of pharmacy support from the GSK Consumer Healthcare representative team, there is further projected growth predicted within the brand.

Full product details available on medicines.ie For Pharmacy only. * IMS Data December 2020 MAT Value Sales PM-IE-NEC-21-00003

This supplement contains the same great 14 strains of live bacteria found in Bio-Kult Advanced but 4 times the concentration in just one capsule a day.

A great travel companion (no need to refrigerate), can be used daily or alongside antibiotics and the capsules can be pulled apart with the contents sprinkled onto food or mixed with a drink.

It also provides 100% of your NRV of Vitamin B12, a key vitamin to help support your immune system and reduce tiredness and fatigue.

In 2021 we are very excited to announce the expansion of our OTC range with Gaviscon Advance Oral Suspension, available in 600ml and 300ml. The Pharmacy exclusive Gaviscon Advance products help to provide long lasting relief for up to 4 hours from acid reflux symptoms such as heartburn and indigestion with its double strength alginate raft. It gets to work in seconds.

Gaviscon Advance Oral Suspension 300ml & 600ml.

Contains Sodium Alginate and Potassium Bicarbonate for heartburn and indigestion. ALWAYS READ THE LABEL. Full prescribing information is available on www.medicines.ie. Date of preparation Feb 21 RB-M-32130 1. Based on MAT Dec 2020 IMS read 2. 12784 RB Gaviscon Covid Report - W3 V1 - Toluna

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2021 & Retail Pharmacy Product Awards

Best Launch of the Year 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 it’s marketing, social media or sales.

Vital Proteins®

New Vision Skincare

Collagen is the glue that holds everything together, it is the body’s most abundant protein, and helps give structure to our hair, skin, nails, bones, ligaments and tendons. Collagen is also behind helping hair shine and skin glow. As we age, our body’s production of it declines and our diets contain minimal collagen, so collagen supplements are vital way to sustain a healthy balance.

New Vision Skincare is a new Irish skincare brand based in Co. Wicklow.

Vital Proteins® is the ever-glowing Jennifer Aniston-approved range, of high quality, sustainably sourced collagen supplements, that work to safeguard your hair, skin and joints.

The bestselling Collagen peptides provide you with a way to boost your collagen intake effortlessly with, sustainably sourced, whole food based, versatile, soluble Collagen. You can add a scoop to your favourite foods (like sweets or sauces) or drinks (like smoothies/water) to give you the wellness boost you need to support, more luminous skin and healthy hair, nails and joints from within.

The finalists in this category have demonstrated that consistency is key when launching a new product within the OTC market.

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We create beautiful and nourishing skincare products scientifically formulated using natural and beneficial ingredients.

After years of research and testing we launched our first five products in November 2020.

In keeping with Covid-19 restrictions we adapted a digital launch strategy and set the stage for our live Instagram launch on 18th November @newvisionskincare.

Invites were sent via email and announcements made via social and print media.

The launch was well attended, and New Vision Skincare was officially born. We were delighted to share our story and proud to introduce Ilumesa, VeraPanthen, Smooth & Silky, Vapocal Kid & Baby and Arnicalm to the Irish skincare scene.

Over the next year we plan to continue growing our audience on social media, to explore opportunities in television/ radio and to develop and support new partnerships with pharmacy retail outlets.

Spotlight Oral Care Water Flosser In September 2020, Spotlight Oral Care launched a new product, the Water Flosser, with a marketing campaign across social media, both paid and organic, Google ads, influencer marketing and traditional media all heightening the customers interest into this must have oral care product that was to come.

In advance of the launch, suspense was built via our email marketing and our Instagram Stories with messaging around ‘Something new is coming’. On launch day, virtual launches with Dr Lisa & Dr Vanessa Creaven were hosted for editors and influencers to educate them on the importance of flossing and its benefits to your overall oral health with lots of people admitting that they never flossed as it was too awkward. When beginning to use the product, education and practice is needed and Dr Lisa & Dr Vanessa explained this through live Q&As and videos on Spotlight Oral Care social channels.

As the media drove interest, the demand for the product grew and sold out in the first 2 months making it one of Spotlight Oral Care’s most successful launches to date.

Nytol

Dettol

Perrigo launched Nytol One- A -Night in January 2020 and it is now Ireland’s no 1 sleep aid brand. Nytol One-ANight is available over the counter in pharmacy to help customers suffering from temporary sleep disturbance. Nytol One-A-Night can be taken for up to 7 nights to help get the sleep pattern back on track. Each tablet contains 50mg Diphenhydramine Hydrochloride, which can help those suffering from temporary sleep disturbance.

Dettol’s history has always been in killing germs and illness prevention. The Dettol pharmacy launch ensured a range of antibacterial products were available to customers at a time when the desire for protection and illness prevention were at an all time high.

With consumer focus very much on prevention versus treatment the importance of hygiene came to the fore and the Dettol launch into pharmacies now allows consumers to shop all their hygiene needs in one destination shop in store. The launch was supported by a heavyweight in store and media programme.

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2021 & Retail Pharmacy Product Awards

Best Oral Care Product A rising focus on health and wellbeing contributes to growth, as Irish consumers increasingly spend more time on their routines to maintain both oral care and health, and an attractive appearance.

Sales of oral care are now expected to grow by 2% in 2020 in 2019 constant value terms. This aligns to the expected 2% rise forecast for 2020 during research conducted at the end of 2019 before the spread of Covid-19.

All products in oral care are predicted to record growth this year, unaffected by the Covid-19 pandemic. The most resilient areas were dental floss, mouthwashes/dental rinses, toothpaste and electric and manual toothbrushes.

The strength of the market may be due to consumers having to be more self-aware of their own dental hygiene owing to lockdown restrictions. This suggests that the pandemic will have no impact on the industry, and consumers in Ireland will continue to purchase their regular oral care items.

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Perfect White Extreme White Toothpaste Extreme White’s next generation teeth whitening formulation uses high grade Japanese Pyrophosphates and Hydrated Silica to provide an Extreme Whitening effect to your smile. This toothpaste takes whitening and oral healthcare to the next level by preventing food particles settling on the teeth in the first place, with ingredients Pentasodium Triphosphate and Isosorbide providing a long-lasing freshness.

To help keep your teeth in tip -top condition and to help prevent those dreaded fillings, Perfect White Extreme white toothpaste also includes Sodium Fluoride to help strengthen and harden tooth enamel for cavity protection.

Jordan Green Clean Oral Care Jordan Green Clean Oral Care is a range that includes Adult Toothbrushes and Toothpastes and Children’s Toothbrushes and Toothpastes. The aim of this range is to offer consumers a oral care products that are made with sustainable quality materials whilst being stylish, designed by an award-winning Scandinavian designer Andreas Engesvik and are comfortable to use but care about the environment.

Jordan Green Clean Toothbrushes combine great functionality, modern design and sustainable materials. In the design process, nothing is left to chance, and all materials are carefully selected with the environment in mind. Jordan Green Clean Toothbrush is available in soft and medium bristles and in 4 different colors.

Jordan Green Clean Toothbrush is the first toothbrush on the market to use 100% recycled FDA approved plastic in its handle. The plastic handle is made from yoghurt cups and other food containers that can be recycled.

Sonic Toothbrush 90% of oral health is dependent on what is done at home, as opposed to while sitting in the dentist's chair which is why prevention is so important. Maintaining a good oral care routine at home will help prevent issues such as decay, bleeding or receding gums, enamel erosion and so on.

Spotlight Oral Care’s Sonic toothbrush is scientifically proven to help keep gums healthy, remove plaque and stains and stop tooth decay. A game changer, the Sonic Toothbrush uses professionally designed sonic technology which allows the gentle feel of a manual toothbrush with an actual deep clean effect. Efficient, highfrequency brush movements ensure both toothpastes and oxygen are delivered to even the most inaccessible places.

The sonic toothbrush was designed with both efficiency and comfort in mind which makes it gentle and effective in removing plaque and discoloration, ensuring an amazing clean and in turn, long term oral health. Three different settings with various amplitude ranges suit every individual need. It's important to remember we only get one set of teeth and they don't grow back!

Kin Gingival Complex Mouthwash Kin Gingival Complex Mouthwash contains Chlorhexidine digluconate which helps prevent the build-up of dental plaque and protect sensitive gums from inflammation.

Kin Gingival Complex Mouthwash contains Alpantha, a complex formed by provitamin B5 (Panthenol) and Allantoin which enhances the absorption of both substances. This makes the mouthwash more effective at improving the condition of the gums.

Kin Gingival Complex, a pharmacy only product, promotes the reduction of the dental biofilm and strengthens and tones gums. This antibacterial mouthwash is also useful after dental procedures to help promote healing and good oral hygiene.

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Benoxor 2021 & Retail Pharmacy Product Awards

Best Skincare Product Research has shown that many Irish consumers are heavily invested in their skin care routines, seeking products to make their skin look its best, particularly interested in preveanting signs of ageing. There has been significant innovation within skin care in recent years, particularly within anti-ageing and multifunctional products.

Citrine Healthcare, a new Irish company, are delighted to announce the launch of a new product in the management of Acne. Benoxor, contains a unique combination of Benzoyl Peroxide 4%, Retinyl Palmitate 0.5% and Zinc Sulphate 1%. in a 30ml airless bottle. These agents work synergistically and are effective against the four main causes of acne – Hyperkeratinisation (Comedone formation), C, acnes, androgen induces seborrhoea and inflammation.

Acne is a well-known but often mismanaged dermatological disease which can also have a significant impact on emotional wellbeing.

Benoxor, is available only through pharmacies and gives pharmacists a new weapon in the fight against acne.

For more information please contact us www.citrinehealthcare.com

Due to Covid-19 there are some purchasing habits that have changed. Frequent hand-washing and sanitisation can cause dryness, sensitivity and soreness which has led to an increasing number of people presenting to pharmacy with contact dermatitis.

Face masks also create an occlusive, or closed up, environment that increases the amount of moisture next to the skin. For those with a history of acne, rosacea, perioral dermatitis, eczema, or allergic contact dermatitis, they may find that their condition is being worsened by prolonged face mask wearing.

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Eucerin Aquaphor Soothing Skin Balm Eucerin’s Aquaphor Soothing Skin Balm is a water-free ointment that soothes the skin and is clinically proven for use on all of your dry skin needs, from extremely dry to chapped, chafed or cracked skin.

Fragrance- and preservative-free, and formulated with only seven ingredients, dermatological studies show it is extremely tolerable and gentle enough to be used on highly sensitive skin as well as on babies. Eucerin Aquaphor Soothing Skin Balm protects the skin by creating a breathable protective barrier, allowing oxygen and water vapour to circulate to and from the skin, allowing skin to ‘breathe’ and strengthen its natural barrier function. With this protective barrier in place, the skin’s regeneration process is accelerated.

Eucerin Aquaphor Soothing Skin Balm is also available in a 40G tube.

Ilumesa Hyaluronic Eye & Neck Serum

Nuxe Huile Prodigieuse

Ilumesa is a refreshing and revitalising hyaluronic eye and neck serum recommended for reducing the appearance of fine lines and brightening the skin.

With seven precious botanical oils and 98% of natural ingredients, this legendary skincare treatment provides long-lasting hydration for the face, body and hair.

Its antioxidant action, anti-pollution properties and its efficacy on stretch marks are unique, just like its inimitable dry oil texture and its addictive fragrance.

Committed to women’s beauty and to the environment, it truly embodies Nuxe’s values in the world of the French Pharmacy: nature, science and hedonism.

Enriched with 2% premium hyaluronic acid and natural moisturizing ingredients: aloe vera, panthenol (pro vitamin B5) and Jojoba. The unique nourishing formulation helps to slow down the skin aging process.

The light and delicate texture is pleasant to apply leaving the skin feeling refreshed and radiant.

Created by Irish brand, New Vision Skincare, Ilumesa is dermatologically tested with ‘Excellent’ score by DermaTest Germany and attractively priced at ¤32.00 RRP.

Aliza Jabès, President and founder of Nuxe says, “This year, we celebrate the 30th birthday of Huile Prodigieuse®, born from my imagination, created by our talented R&D in 1991, and loved by millions of men and women around the world.” Happy birthday Huile Prodigieuse®!

RELIFE U-Life Range Launched in 2020, U-Life is the second skincare range to be rolled out in Ireland

by RELIFE Ireland by Menarini, the Italian, dermatology and aesthetics skincare brand. U-Life is a range of eight products containing urea, with hydrating and keratolytic action (exfoliating and softening action for hard skin), specifically for the face, body, scalp, hands, feet, and for localised areas of hyperkeratosis. Urea is naturally present in our skin and is an important component of the skin’s natural moisturising factor (NMF), which helps maintain hydration levels. In addition to moisturising properties, at higher concentrations, urea also possesses keratolytic properties helping to exfoliate and soften dry, hard skin.

The U-Life range offers innovative solutions for people with common skin complaints.

RELIFE is stocked in 300+ pharmacies nationwide.

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Active Iron Pregnancy Plus 2021 & Retail Pharmacy Product Awards

Best Women's Health Product Health issues and care strategies for women’s health is 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.

Women today 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.

Although only a slow-rising demographic, young women are becoming more economically empowered, due to their increasing tendency to further their education, gain professional employment and delay marriage and starting a family – often until their 30s or 40s.

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Active Iron Pregnancy Plus has been specifically developed to optimise vitamin and mineral absorption while being kind on your stomach. Containing 21 essential nutrients, like iron, omega 3 and folic acid, it delivers the optimum combination, to provide complete care for mum and baby.

Active Iron Pregnancy Plus includes 30 capsules of our strongest 25mg dose of Active Iron non-constipating formula, with 2x better absorption and clinically proven to increase iron levels, making it both Kind & Strong.

Active Iron Pregnancy Plus is a multi-component pack with an RRP of ¤29.99, it is also gluten free, sugar free and free from artificial preservatives.

Utipro Plus AF

Nua for Women

Bio-Kult® Pro-Cyan®

For the Control and Prevention of Urinary Tract Infections (UTIs).

Nua for Women is the first-of-its-kind, pre-natal fertility supplement with a gut health focus which combines key vitamins, minerals and good bacteria tailored to help support female fertility.

Nua for Women is an all-in-one capsule recommended by doctors for women who are thinking, planning or trying for a baby.

An advanced multi-action formulation with cranberry extract and vitamin A to target the urinary tract

UtiproÒ Plus AF is the latest innovation in the therapeutic approach to UTIs. It is an oral capsule that acts at the uropathogenic reservoir at the intestinal level, to provide fast relief from symptoms of acute uncomplicated UTIs such as cystitis and to prevent from further recurring UTI’s, caused by pathogens such as E. coli and other gram (-) bacteria.

It contains a combination of XyloglucanGelose, Hibiscus and Propolis extracts.

Xyloglucan-Gelose creates a film that covers the surface of the intestinal mucosa preventing the adhesion and growth of bacteria, reducing transmission to the urinary tract.

The Hibiscus and Propolis mildly acidify urine, helping to eliminate E. coli and control the symptoms of UTI’s, including painful urination, frequent urination, urgent urination and bladder tenderness/pain.

The bespoke formula concentrates on the essential nutrients to support preparation for pregnancy and healthy conception.

The good bacteria supports the gut to function optimally and strengthens vaginal health.

Nua Fertility is proud to have brought this innovative Irish brand to market, backed by science and inspired by personal experience of infertility.

Bio-Kult® Pro-Cyan® is scientifically developed to work with the body to help maintain normal levels of bacteria in the gut designed to target the urinary tract.

It provides 36mg of cranberry extract PACs per dose, two specifically selected live bacteria strains and vitamin A to contribute to the normal function of the immune system and maintenance of healthy mucous membranes which can be found lining the gut, mouth and urinary tract.

Backed by clinical research, it is suitable for everyday use as part of a healthy lifestyle and does not need to be refrigerated.

Utipro Plus AF is a pharmacy only product and has a RRP of ¤9.95

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Nuasan Active Bodycare Kit 2021 & Retail Pharmacy Product Awards

Most Innovative Product These days, product innovation is crucial in an already packed market. In order to make an impact, companies be able to think outside the box and present unique solutions to consumer demand.

Nuasan, an innovative and Irish-made range of natural bodycare products specifically for active people, has introduced the Nuasan Active Bodycare Kit. The kit contains Nuasan Active Body Wash, enriched with arnica and magnesium to help sore and tired muscles recover faster. The Body Wash, also contains Nuasan’s unique active ingredient L+pH Control, as well as peppermint and macro-algae, ensuring you feel and smell better for longer.

The Kit also comes with Nuasan Active Body Wipes, which are plant-based, 100% biodegradable and also enriched with L+pH Control, aloe and bamboo.

These natural, scientifically-proven products are packaged in The Active Bodycare Kit with a luxury black, microfibre sports towel, complete with a secret pocket, perfect for storing valuables, like your phone or keys.

Successful product innovation can be not only about developing something new and original, it can also be taking something which already exists, and making it much better!

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MyPro Diacare Launched in late 2019, MyPro™ Diacare is an Irish brand of oral hydration solution for children and adults that contains the probiotic, Lactobacillus Rhamnosus GG. Diacare is an orange flavoured unique food supplement containing a balanced blend of glucose electrolytes, minerals and Lactobacillus Rhamnosus GG. Available in a powder formulation, Diacare is suitable from 3+ years that consists of 12 dual-chambered sachets which are equal to 12 servings.

Unlike its competitors within the rehydration category, Diacare also contains a probiotic, Lactobacillus Rhamnosus GG, that ensures the equilibrium of good bacteria in the patient’s gut is restored to an optimal level by reducing the bad bacteria that may be lingering. This is a unique offering for patients and ensures a comprehensive solution to aid recovering especially from any common stomach bugs.

Active Iron Pregnancy Plus Active Iron Pregnancy Plus has been specifically developed to optimise vitamin and mineral absorption while being kind on your stomach. Containing 21 essential nutrients, like iron, omega 3 and folic acid, it delivers the optimum combination, to provide complete care for mum and baby.

Active Iron Pregnancy Plus includes 30 capsules of our strongest 25mg dose of Active Iron non-constipating formula, with 2x better absorption and clinically proven to increase iron levels, making it both Kind & Strong.

Active Iron Pregnancy Plus is a multi-component pack with an RRP of ¤29.99, it is also gluten free, sugar free and free from artificial preservatives.

Minami Platinum

SVR Xerial 50

Minami Platinum is one of the most impressive products in the MINAMI range and is specially formulated for active individuals.

SVR Laboratoires XERIAL 50 Extrême Crème Pieds Feet Care is a foot cream that helps to reduce and prevent corns and calluses in just a week. Formulated with 50% Urea, to intensely desquamate extremely dry, keratonized dry skin, Shea Butter to intensely nourish dry skin, the treatment acts like a pumice to slough off dead cells and leave skin soft and smooth. Sinking in effortlessly without leaving a greasy finish, the cream can also be used at various strengths, depending on the severity of the thickened skin of elbows and knees to leave the whole body silky and supple.

It has the highest levels of omega-3 per softgel (up to 90-95%) and because it is in triglyceride form, it’s absorbed more quickly and easily by your body.

Each softgel contains a 1100mg omega 3 including 764mg EPA and 236 DHA. - Taken together, EPA and DHA are proven to help with normal heart function*1.

- DHA helps to support healthy brain function and vision2* - EPA and DHA contribute to the maintenance of normal blood pressure and triglyceride levels* Minami Platinum not only provides a concentration ultra-pure omega-3, it also contains 1000IU Vitamin D3 in every easy to swallow softgel. Vitamin D, often known as the sunshine nutrient, helps support the immune system as well as muscle function, so it is a perfect omega-3 supplement for those with active lifestyles.

XERIAL is a urea-based skincare range for dry, rough, peeling or flaking skin, tackling all levels of dryness. XERIAL products' concentration of Urea varies between 5% and 50% providing different types of skincare action accordingly. Dry, rough skin regains softness, calluses, corns, deep cracks and areas of hard skin are eliminated.

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Uriage Xemose eye 2021 & 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 consumers’ 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.

This anti itching treatment soothes the sensations of irritation around the eye area.

It nourishes, protects and improves the comfort of very dry Atopic eyelids. Irritated eyelids often results in redness, a feeling of tightness and sometimes flaking. In order to take care of this fragile area of the face, Uriage has created a formula based on nourishing and soothing active ingredients.

This soothing eye care prevent the occurrence of recurrence for 48 hours. To achieve this result, Uriage has formulated its treatment a patent exclusive to Uriage, Chronoxene, an anti inflamatory, to reduce inflamation with the addition of shea butter. This treatment also incorporates hydrating glycerin, which will strengthen the skin's natural defenses. It contains raspberry seed oil, which has multiple virtues. It prevents dehydration, soothes, nourishes the skin and it also reduces redness. Finally, it provides softening and softening rapeseed sterols. This treatment is formulated with Uriage thermal water.

This is renowned for its ability to relieve the skin. Thus, it is quickly calmed down, and recurrences are avoided.

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.

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Atoderm Intensive Eye Daily 3-in-1 care for irritated eyelids: soothes, repairs and removes makeup. The skin of the eye contour area is particularly delicate: it is 3-4 times thinner than that of the rest of the face. The eyelids are therefore prone to irritation, which is characterised by the following symptoms: dryness, itching, redness, swelling. It is mainly related to one of eyelid disorders: atopic dermatitis, allergic or irritant contact dermatitis. This irritation can be triggered or aggravated by direct contact with irritants (make-up), contact with air (pollen, dust), contact with elements on hands (nail polish, nickel, fragrance, hair dye).

With Atoderm Intensive eye, Bioderma at last is offering a unique solution, adapted to the specific characteristics of the extremely fragile eye contour area.

Thealoz Duo

Macu-SAVE

Hy-Opti Eye Drops

Thealoz Duo is Europe’s No 1 Dry Eye drop solution and a pioneering product that has been widely credited for opening new doors and horizons in eye care and ophthalmology. It is the most advanced preservative-free combination of sodium hyaluronate and trehalose for moderate to severe dry eyes, in a hypotonic formulation that can be used with contact lenses.

Thealoz Duo Dry Eye drops are suitable for all Dry Eye sufferers, as they combine both long-lasting relief and protection for the surface of the eye. Clinical studies have shown that a single drop of Thealoz Duo improves the thickness of the tear film for at least 4 hours (6 times longer than sodium hyaluronate alone). In one study, 62% of patients receiving Thealoz Duo were symptom free after 84 days, with significant improvements in blurred vision, stinging and itching.

Recently rebranded in September 2020, Macu-SAVE™ is a once a day, easy to swallow food supplement; helps to provide advanced nutrition for the eyes with all three key macula carotenoids.

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.

Age Related Macular Degeneration (AMD) is a progressive eye condition of the macula, that is located at the centre of the retina is responsible for the clarity of central vision. Macu-SAVE™ helps to block damaging blue light that can harm the sensitive cells in the retina. Boosting the diet and enriching the macular pigment with macula carotenoids; Lutein 10mg, Zeaxanthin 2mg and MesoZeaxanthin 10mg. 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. This 10, 10, 2 formula is clinically proven and recommended by opticians.

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

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.

• Information leaflets.

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2021 & 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 ever-changing 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.

Minami Platinum

Love Your Immunity

Minami Platinum is one of the most impressive products in the MINAMI range and is specially formulated for active individuals.

With clearly communicated product positioning and stand out shelf presence, Love Your Immunity has been developed to be the natural choice for anyone looking to support their immune system.

It has the highest levels of omega-3 per softgel (up to 90-95%) and because it is in triglyceride form, it’s absorbed more quickly and easily by your body.

Each softgel contains a 1100mg omega 3 including 764mg EPA and 236 DHA. - Taken together, EPA and DHA are proven to help with normal heart function*1.

- DHA helps to support healthy brain function and vision2* - EPA and DHA contribute to the maintenance of normal blood pressure and triglyceride levels* Minami Platinum not only provides a concentration ultra-pure omega-3, it also contains 1000IU Vitamin D3 in every easy to swallow softgel. Vitamin D, often known as the sunshine nutrient, helps support the immune system as well as muscle function, so it is a perfect omega-3 supplement for those with active lifestyles.

According to latest market research reports, vitamin 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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Love Your Immunity combines three carefully chosen vegan friendly supplements in a single monthly pack: - Vegan friendly Vitamin D3 - An elderberry complex containing Zinc and Vitamin C - A high-quality probiotic capsule containing 20 billion live bacteria The supplements within Love Your Immunity are packed in convenient calendar packaging, marked with the days of the week to make sure consumers don’t miss a single dose. This helps to maximise the efficacy of the product and ensures regular repurchase. Daily tear strips have been included to make it easier for customers to take their supplements on the go.

Centrum

Zest Active

Busy lifestyles, work or family commitments can make achieving a healthy and balanced diet a challenge.

Centrum is a multivitamin there to provide tailored nutrition support for each life stage, with a range that is suited to gender and age there is a product available to suit each individual customer.

Zest Active is an innovative super supplement from Irish Supplement company Revive Active. Zest Active is scientifically formulated with 25 active ingredients including vitamins, minerals, amino acids and Wellmune®, all carefully selected to support energy, the immune system, brain, and muscle function.

With 35 years of scientific expertise, expertly formulated and carefully validated ingredients it is no wonder Centrum is the world’s No 1 multivitamin.†

Each sachet contains a range of B Vitamins (Riboflavin (B2), Niacin (B3), Pantothenic Acid (B5), B6, Folic Acid (B9), B12 which ensures that Zest Active contributes to a normal energyyielding metabolism. It contains a natural sweetener, steviol glycosides and is suitable for vegetarian, vegan, diabetic, and gluten free diets. With a refreshing orange flavoured blend, Zest Active delivers the daily nutrients you need, to help you unlock your true potential.

In a growing VMS category, up 2.5% in 2020, Centrum is the biggest growth driver up 12% & has overtaken Berocca to become #2 in the Multivitamins market*. With heavy and strategic 2020 investment and ambitious 2021 brand campaigns including TV, VOD, digital and in store activation there is further projected growth within in the brand. †Based on worldwide sales data. *IMS Data December 2020 PM-IE-CNT-21-00001

BabyD, ToddlerD, DailyD BabyD, ToddlerD and DailyD form Irish company Kora Healthcare’s newly expanded range of Vitamin D3 supplements, FamilyD. Available in various formats, this range has a Vitamin D3 solution for every member of the family. All products contain only highquality ingredients and are free from sugars, sweeteners, preservatives, artificial colours and flavours, gluten, lactose and nuts.

Each product is specifically formulated for the relevant age group and in line with HSE recommendations.

BabyD is specially formulated for infants from the day of birth and is available with an oral dosing pump or an oral dosing syringe, both ensuring accurate measurement and administration.

ToddlerD is designed specifically for children from 12 months onwards, available in a convenient oral spray format with a pleasant natural orange flavour.

DailyD is aimed at older children and adults, available in an oral spray or easy to swallow capsule in various strengths.

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Nytol 2021 & Retail Pharmacy Product Awards

Best Pharmacy Only Brand While more is being done to promote awareness regarding the importance of the safety and appropriate use of OTC drugs, pharmacists are still the patients 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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Perrigo launched Nytol One-A-Night in January 2020 and it is now Ireland’s no 1 sleep aid brand. Nytol One-A-Night is available over the counter in pharmacy to help customers suffering from temporary sleep disturbance. Nytol One-A-Night can be taken for up to 7 nights to help get the sleep pattern back on track. Each tablet contains 50mg Diphenhydramine Hydrochloride, which can help those suffering from temporary sleep disturbance.

Ginkgo Biloba Pharma Nord

Voltarol Emulgel Extra Strength 2%

Sumatran Relief 50mg Tablets x 2

Ginkgo Biloba Pharma Nord is the only OTC ginkgo biloba product available in Ireland. Do you have cold hands and feet? Ginkgo biloba has been taken for centuries to improve circulation and Ginkgo Biloba Pharma Nord has been proven to alleviate the symptoms of poor blood flow in cold hands and feet. Pharma Nord products are made to pharmaceutical standard and it is due to the raw material used and the manufacturing method that Pharma Nord received a THMP licence to sell ginkgo biloba in Ireland. This product is recommended for over 18's and long term use.

Voltarol Emulgel Extra Strength 2% w/w Gel is a Powerful Anti-inflammatory that targets the source of pain and can be applied twice a day to provide all-day relief from joint & muscle pain.

Sumatran Relief 50mg Tablets x 2 was launched in October 2018 and is the first ever OTC Sumatriptan available in Ireland and an exclusive OTC product for pharmacies only.

New 100g pack comes with a unique easy-open Flip-top cap to make life easier for your patients suffering from pain in their hands. This 100g tube is equivalent to 72 x 200mg tablets of ibuprofen and has a reduced risk of systemic side effects or drug-drug interactions.

Sumatran Relief is indicated for the acute treatment of migraine attacks with or without aura.

Sumatran Relief is very unique as it is the only OTC Sumatriptan available in Ireland.

While there are other pain relief products at OTC level, this product is targeted specifically for the treatment of migraines.

• It is the first and only OTC Sumatriptan available in Ireland.

• Previously diagnosed Migraine sufferers will be able to avail of the product, having consulted with the pharmacist, thus saving the patient additional visits to the Doctor.

• A relationship with the Pharmaceutical Society of Ireland (PSI) and the Migraine Association of Ireland ensures that the product is strongly promoted and supported.

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Revive Active 2021 & Retail Pharmacy Product Awards

Best Irish Pharmacy Brand Product

Revive Active is an award-winning super supplement with 26 active ingredients working together, helping put back what life takes out.

This Irish super supplement is delivered in powdered format and contains a comprehensive combination of vitamins, minerals and amino acids in one convenient daily powdered sachet. The daily sachet can be added to water, juice or a smoothie and due to the powdered format, it offers higher bioavailability as vitamins and minerals dissolved in liquid form are absorbed in the body more easily than in tablet or capsule form.

The product is designed for active people balancing work, home and family life while maintaining a healthy immune system, heart health and energy.

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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Vitamin D3 2000IU1 From Viatris/Mylan Vitamin D3 is a food supplement that contributes to: · normal function of the immune system · maintenance of normal bones · maintenance of normal muscle function Take one tablet daily (swallow whole or crushed). Do not exceed recommended dose. Keep out of sight and reach of children.

Deficiency in Vitamin D may be associated with conditions including bone health such as osteoporosis, hypertension, cardiovascular disease, diabetes, autoimmune diseases, depression and cancer2.

Food supplements should not replace a varied, balanced diet and a healthy lifestyle.

Made in Ireland. Available to purchase over the counter.

References: 1

Patient information leaflet

Holick Michael F. Deficiency of Sunlight and Vitamin D. Fortification of foods and advice on sensible sun exposure are urgently needed. Volume 336. BMJ 2008;336:1318-9 2

Elave Sensitive Sun Paediatric SPF50+ Elave Sensitive Sun Paediatric SPF50+ offers very high broad spectrum UVA, UVB, and infrared thermal protection.

Paediatrician approved from newborn helps shield delicate skin from harmful UVA and UVB rays that cause sunburn.

This water resistant sunscreen protects without irritating the skin. A lightweight non-greasy formula that doesn't clog pores. Hypoallergenic and free from worrying irritants.

PETA approved - Cruelty Free and Vegan.

Made in Ireland.

Panadol Extra Soluble

Active Iron Pregnancy Plus

We are very proud that Panadol has been Made in Ireland since 1981. The 700 GSK employees at our site in Dungarvan, Co. Waterford play a vital role in Panadol’s global success, which is now exported to over 70 countries worldwide and the site produces over 6.5 billion tablets annually.

Panadol Extra Soluble is indicated against 5 types of tough pain, only available in pharmacies, and contains a second active ingredient (caffeine), that amplifies the analgesic effect of paracetamol, making it up to 30% more powerful than standard paracetamol tablets.

Active Iron Pregnancy Plus has been specifically developed to optimise vitamin and mineral absorption while being kind on your stomach. Containing 21 essential nutrients, like iron, omega 3 and folic acid, it delivers the optimum combination, to provide complete care for mum and baby.

Active Iron Pregnancy Plus includes 30 capsules of our strongest 25mg dose of Active Iron non-constipating formula, with 2x better absorption and clinically proven to increase iron levels, making it both Kind & Strong.

Active Iron Pregnancy Plus is a multi-component pack with an RRP of ¤29.99, it is also gluten free, sugar free and free from artificial preservatives.

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Skin Magic Wonder Balm 2021 & Retail Pharmacy Product Awards

Best Beauty Product

TanOrganic’s Skin Magic Wonder Balm is a multi-purpose skin balm that hydrates, nourishes, and heals. It’s potent mix of hydrating oils and the innovative and amazing vegan certified Japanese wax tree that retains skin moisture like no other.

It can be used for all of your skin solutions, including, skin moisturiser, natural first aid kit, hair mask for conditioning, lip balm, after shave balm, hand cream and cuticle moisturiser, makeup primer, makeup remover, eye cream, tattoo aftercare, hydrating skin mask, burns, cuts & scrapes. It’s the perfect product for those with sensitive skin, eczema & psoriasis.

With consumers employing more social distancing, with many staying and working at home, there has been an impact on buying behaviour for this category.

More are now making purchases online to meet their beauty and appearance needs.

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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Vital Proteins Collagen is the glue that holds everything together, it is the body’s most abundant protein, and helps give structure to our hair, skin, nails, bones, ligaments and tendons. Collagen is also behind helping hair shine and skin glow. As we age, our body’s production of it declines and our diets contain minimal collagen, so collagen supplements are vital way to sustain a healthy balance.

Vital Proteins is the ever-glowing Jennifer Aniston-approved range, of high quality, sustainably sourced collagen supplements, that work to safeguard your hair, skin and joints.

The bestselling Collagen peptides provide you with a way to boost your collagen intake effortlessly with, sustainably sourced, whole food based, versatile, soluble Collagen. You can add a scoop to your favourite foods (like sweets or sauces) or drinks (like smoothies/water) to give you the wellness boost you need to support, more luminous skin and healthy hair, nails and joints from within.

Nuxe Huile Prodigieuse With seven precious botanical oils and 98% of natural ingredients, this legendary skincare treatment provides long-lasting hydration for the face, body and hair.

Its antioxidant action, anti-pollution properties and its efficacy on stretch marks are unique, just like its inimitable dry oil texture and its addictive fragrance.

Committed to women’s beauty and to the environment, it truly embodies Nuxe’s values in the world of the French Pharmacy: nature, science and hedonism.

Aliza Jabès, President and founder of Nuxe says, “This year, we celebrate the 30th birthday of Huile Prodigieuse®, born from my imagination, created by our talented R&D in 1991, and loved by millions of men and women around the world.” Happy birthday Huile Prodigieuse®!

Filorga Time Filler For over 40 years Doctor Michel Tordjman’s expertise in cellular ageing and the philosophy that aesthetic medicine can be natural have put this cutting-edge brand at the top of people’s skincare shopping list when it comes to age related skin concerns. Filorga is available in over 60 countries, has won over 123 beauty awards since 2008, is the #1 Anti- Ageing brand in France. 1 Meso-Mask is sold every 20 seconds in China.

Proven by independent laboratories Filorga is committed to always offering formulas that have demonstrated visible effectiveness after 7 days, Formulas with ultra-sensory textures and a unique olfactory signature ensure that every application is an experience to enjoy.

Harnessing the power of a Botox-like Tripeptide, the highly concentrated formula helps contract and relax the skin and facial muscles for a visible smoothing effect. Encapsulated Hyaluronic Acid delivers deeply penetrating moisture and fills the appearance of wrinkles, while an NCEF-infused peptide works to stimulate collagen synthesis for tighter and firmer feeling skin.

Codex BIA Skin Superfood Skin Superfood by Codex Beauty. Deeply hydrates, nourishes and smooths.

• Contains BiaComplex, a patented blend of 5 native Irish plants, each hydrate, and lock in moisture in complementary ways.

• Clinically proven to increase hydration - Stratum Corneum Hydration increases 42.5% - Trans Epidermal Water Loss decreases 13.4% - Improves smoothness - Desquamation decreases 40.5% (2019 Derma test: 28-day independent clinical study involving 30 women).

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A.Vogel Echinaforce® Sore Throat spray 2021 & Retail Pharmacy Product Awards

Best Cough, Cold and Flu Product Due to the pandemic Irish consumers have bought more cough, cold and allergy remedies in order to treat themselves at home, due to the lockdown which occurred in the spring and the subsequent social distancing restrictions. The pandemic has influenced consumers to purchase OTC medications as part of preventative health measures to prepare a personalised health kit or medicine cabinet, which has resulted in purchases of traditional cough, cold and allergy remedies in case they may need to treat symptoms of any illness at home.

with coughs, colds and flu, exclusively based upon long-standing use as a traditional remedy. This remedy has a specially designed nozzle and spray pump, designed to deliver echinacea and sage extracts to the painful and irritated parts at the back of the throat. It is convenient to use and does not require water to take.

Viral infections account for at least 65% of all sore throats, so the use of antibiotics only plays a minor part in the treatment of sore throats.

Echinacea has both a direct antiviral and antibacterial effect, and also reduces inflammatory responses during infections, thus lessening the unpleasant side effects of a cold or flu attack. The localised effect of the spray is pleasantly numbing, reducing pain felt by the sufferer.

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Vicks First Defence Vicks First Defence inactivates the source of the cold: the virus!

Vicks First Defence acts directly in the nose, where the viruses develop (that’s why it is a nasal spray). Its microgel traps and inactivates the cold viruses, helping to prevent them from developing and spreading.

It then naturally helps your body to remove the inactivated viruses by blowing your nose.

When used in the first 36 hours of a cold, Vicks First Defence has been shown to help stop a cold in its tracks, and not develop into a full-blown cold.

Night Nurse Liquid

Lemsip

SaltAir UV

Night Nurse Liquid relieves major cold and flu symptoms, helping you to get a good night's sleep and to wake feeling better. Taken before bedtime Night Nurse helps relieve: sore throat pain, shivers, aches and pains, tickly cough, runny nose. Each measure at bedtime, of the concentrated Night Nurse formulation, contains: Promethazine, decongestant to dry up runny nose and sniffles, so easing breathing. Dextromethorphan, to reduce the tickly cough often associated with colds. Paracetamol to relieve aches, pains, shivers, and reduce temperature.

Lemsip is the Number 1 Cold and Flu brand in Ireland* and its range of effective cold and flu remedies have been tried and trusted for generations.

SaltAir UV is the only ultrasonic salinizer, using ultrasonic frequency vibrations, it transforms salt into micro particles under 5 microns, dispenses them into the surrounding indoor space and enables them by breathing to penetrate deep inside the lungs, killing bacteria and eliminating mucus. This is a natural and drug-free solution for building immunity, very effective in Cold and flu, coughs, congestion, sinusitis, bronchitis, as well as other chronic respiratory conditions ie.

Asthma or COPD.

All in the demulcent syrup which aids restful sleep.

*Based on IMS unit sales, MAT Nov 2019

• Formulated to be take at night-time • Treats cold and flu symptoms

Over the years our product range has extended, and we offer a wide range of formats from capsules, tablets and liquids to the more traditional hot drink sachets, so you can recommend a product that best suits your patient’s combination of cold and flu symptoms - whether they are aches and pains, sore throat, cough & blocked noses.

Highly recommended for babies, infants, pregnant women and elderly, it does not require the active user involvement therefore it can be used at all times, day and night during sleep and does not require holding a mask on the face or a mouthpiece.

• Offers quick relief

PHARMACYNEWSIRELAND.COM | 93

Phyto Novathrix 2021 & Retail Pharmacy Product Awards

Best Hair, Nail and Scalp Product

Phyto Novathrix Hair Loss Treatment is the quintessential expert anti-hair loss product by Botanical hair brand Phyto.

It combats sparse strands and work towards a thicker, fuller head of hair with.

Formulated with 99% natural and plant-based ingredients, the effective treatment provides locks with the appropriate nutrients to reduce the potentiality of hair loss, thinning and snapping. Suitable for men and women, the formula works to strengthen strands and encourage resilience.

Tulip Extract fortifies the roots to help minimise the chances of hair loss. Celery Seed Extract boosts Wnt activity, a recently discovered mechanism in antihair loss that assists in the promotion of individual strand growth, while Globularia Stem Cells aid in advancing cellular energy. The expert combination of restoring and replenishing ingredients targets 16 biological factors of hair loss to reduce the possibility of unwanted thinning and breakages.

Consumers are becoming more confident in asking for advice about hair and scalp problems.

There has been much media coverage about imminent ‘cures’ 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.

94 | PHARMACYNEWSIRELAND.COM

Global Beauty Happy Scalp Brush Healthy hair starts with the scalp, so it’s time to make the most of your shampoo routine and take it to the next level with Global Beauty’s “Happy Scalp Brush”.

Suitable for both adults and children, the Happy Scalp Brush is an essential tool in your haircare routine. Scalp Brushes have grown in popularity over the last number of years, and have been known to have a variety of benefits for both your hair and scalp health.

The Global Beauty Happy Scalp Brush has fast become a sell-out cult product for the brand, and it’s no surprise with its endless hair loving benefits. From removal of excess oils and product build up, to exfoliating the scalp and enhancing blood circulation, the Global Beauty Happy Scalp Brush also makes the most of your shampoo and conditions, ensuring the product is massaged into the scalp and not absorbed by the fingers.

Cost - ¤10.99 Where to buy - https://globalbeauty.ie/ and stockist nationwide.

RELIFE U-Life 10 ecofoam

Skin, Nails and Hair Formula

U-Life 10 ecofoam is a moisturising and smoothing foam with urea (10 per cent) that is specifically formulated for the scalp and is part of the second product range, which RELIFE, the Italian, dermatology and aesthetics skincare brand, has launched to the Irish market.

Discover the little big difference to hair, skin and nails with this natural partner to your daily beauty regime. Premium, unique complex designed to help build collagen, a major component of skin, to support skin structure, a youthful glow and elasticity.

The U-Life range of products is specifically for the face, body, scalp, hands, feet, and for localised areas of hyperkeratosis offering relief for dry, rough and thickened skin at varying concentrations; and offers innovative solutions for people with common skin complaints. U-Life contains urea, which maintains the skin's hydration levels and also possesses keratolytic properties helping to exfoliate and soften dry, hard skin.

• Contains essential beauty nutrients including zinc, copper and vitamin C

In a study of users with seborrheic or psoriasiform dermatitis of the scalp, consecutive use of the U-Life 10 ecofoam product once daily for 28 days significantly reduced the skin peeling/shedding in 85 per cent of users.

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

RELIFE is stocked in 300+ pharmacies nationwide.

• Vegan, Vegetarian, Kosher, Halal

• 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

Naturigin Naturigin was founded by husband and wife Mette and Stig From Denmark.

Mette was diagnosed with breast cancer. TThis forced them to rethink their lifestyle. Luckily, Mette recovered but this experience spurred them on to make a change and to avoid chemicals where possible. In the search for quality natural organic sustainable hair colour the family started their journey to create a healthier alternative to chemical hair colour.

Naturigin was borne, available in 19 shades.

Manufactured in Denmark using windfarm energy.

Derived from 98.2% natural ingredients containing 12 organic Ingredients.

Naturigin is suitable for Vegans, post chemo customers, customers with sensitive and itchy scalps, and people who care about the environment and sustainability. It is cruelty free.

• Protects against free radical damage

PHARMACYNEWSIRELAND.COM | 95

96

Finance

Lifetime Cash flow modelling – Replacing Aspirations with Goals and Specifics Those of us working in the financial services sector often trade in intangibles, future projections and protecting people from things we and they hope will never happen. Those starting out on the road of retirement planning are often looking at documents with projected final values that mean very little to their reality today or allow them to visualise the future.

We analysed this and identified • Should I sell our investment Many of you reading this will have growth and inflation scenarios over a series of meetings areas for been collecting financial products taking into account life goals property or keep the rental improvement including from various providers for years and objectives to give you the income coming in? but often no detailed financial plan ability to see clearly where you • Putting a better pension in place • What effect will downsizing the is in place or even a clear idea of current financial planning path with a lower fee and better fund family home have in later life? what your total future income to is taking you. The real benefit of managers end of life would look like when modelling is that the implications • Will we be able to afford a you retire. Even if many of these of changes you make now are • Building up a nest egg holiday home in later life?

What sort ofcollected scenarios bemapped mapped out? policies you have are canfully out for your lifetime.

• Accelerating debt repayments fine on their own, typically they This planning allows you to see • What if you want to spend ¤10k on better loan terms do not fit well with each other why an adviser is recommending per annum on holidays from when•viewed holistically.

Multiple certain actions over others.

When Can I take early retirement? the age of 60 to the age of 75, • Put a plan in place sources of advice all having a clients see the impact a decision what effect will this have on your • Will my expected retirement income sustain my required levels of spending over longer piece of the puzzle is not the way • This wasthe all done within term? existing they make in their 40s has on your assets? to get the best outcomes. cash flows wealth in your 80s appreciation • Should I sell our investment property or keep the rental income coming in?

• How much will I need if I want to for the financial planning process Anyone getting on a plane journey The final point is crucial. Be using makein provisions for Long Term accelerates.

The intangible is • What effect will downsizing the family home have later life? does so in the expectation that the what they already had in a properly Care? now tangible.

What if scenarios pilot has checked the equipment advised process we were able to • Will we be able to afford a holiday home in later life? are modelled with a simple is working and fit for purpose, • What is the potential inheritance help them achieve their life goals Once your model is built it has a•flight What plan, knows whatwant will if they the plan the model tax bill for my estate? if you toinput. spend €10k per annum on holidays from the age of 60 tostick thetoage of 75, what becomes a template for planning happen when the plane lands and shows them they can afford and going forward and can be adjusted • Do I need this much investment effect will understands what the nextthis leg have on your assets? took them to a scenario where as needed for changes as they risk on the table? of his journey looks like because went from not having enough How out much will I need if Iinwant to make provisions for Long Term Care? they happen real time. this is•all mapped in advance money to having enough left to • Can I help my children with a factoring multiple is scenarios retire earlier if they wanted to.

What are the benefits of Cash • inWhat the potential inheritance tax bill for myhouse estate? purchase? and contingencies. Yet many Flow Modelling?

Setting a target for a future date new clients haveI attempted to much investment risk on the table?

• Do need this • Do I have enough financial and showing where you are and • Easy to understand visual plans make the journey to retirement protection in place if suddenly I the destination will help to focus • having CananyI help my children with a house of your financial future.purchase? without of the same could no longer work? your advisor’s work and bring to key information required at their • Gives youprotection context and outcomes • Do I have enough financial in placeTypical if suddenly I could no longer work? life both the benefits and the risks disposal to give us the clarity and Scenario so informed choices can be of the various options available to certainty we all want. made. you. For some people achieving Below we can see the scenario What do clients want? their stated goals may require mapped out for a client when Typical Scenario • Retirement funding shortfalls are radical changes and for others it they presented their data to us. highlighted.

In a recent survey by Investment may just be small modifications.

They were Managers Portfolio Metrix for • Allows you to map out different The most important consideration a paper on the value of advice Below we can see the scenario mapped out for a client• when they presented their data us. were Overpaying for pensions scenarios. is that bothto you andThey your adviser they did what all firms should do are on the same page when and they asked clients what they • Becomes a vital tool in estate • Had no back up savings or it comes to what you want to wanted. The results indicated that planning. safety net achieve and how you wish to • number Overpaying for pensions after the one requirement get there.

• Crucially it gives you peace of • Had Expensive debt that they were dealing with a • Had no back up savings or safety net mind. suitably qualified adviser (see our • No Plan recent articles on Dealing with a • Had Expensive debtWhat sort of scenarios can be Certified Financial Planner ™) that mapped out?

As you will see represented by Cashflow modelling was the next • No Plan the red bars under the axis on this • Can I take early retirement? most important need. savings over time simulation when they got to age 75 they • Will my expected retirement This highly desired service is a were a scenario where they income sustain my required picture your assets, liabilities, As youof will see represented by the red bars under the axisinon this savings over time simulation when they could no longer fund the lifestyle levels of spending over the income and expenditures Customer scenario before advice got to age 75under theyvarious were in a scenario nowanted. longer fund the lifestyle they wanted. they longer term? where they could projected forward

We analysed this and identified over a series of meetings areas for improvement including PHARMACYNEWSIRELAND.COM

about whether these portfolios are

helps turn your aspirational goals

Cashflow modelling has changed

after advice tting aCustomer targetscenario for a future date andsuitable showing where you are destination will help tothefocus rules ofyour the game and you for your overall needs or and intothe a reality. need to on the same pitch as those can deliver the returns necessary dvisor’s work and bring to life both for theyoubenefits and the risks of the various options available to you.

For The general impression is that benefiting from this service to fully to live the lifestyle you financial and advice is all about it may just realisebe your goals. want. We oftenrequire meet newradical clients changes me people achieving their stated goals may for others small investments, pensions, and who when they see the bigger Colm Moore CFP™ is a Certified odifications. The most important consideration that and your adviser are on the same page insurance policies.

But proper picture understandisthat theyboth you Financial Planner whose business Financial Planning is about the are taking excess unnecessary hen it comes to what you want to achieve and how you wish tomuch get bigger there.

Moore Wealth Management has picture – it is about

risk and also new clients whose been advising the pharmacy helping people to make life portfolios are so conservative Many of you will have invested community for 20 years. changing decisions with the right that they will never grow enough to significant sums of money into a any ofrange youofwill have invested significant sums of money into a range of low, medium, or high-risk information from the right tools achieve their goals. Having low, medium, or highHe can be contracted on at their disposal for their future your own bespoke lifetime cash about risk Too portfolios.

Toothis oftenisthis is | www.mwm.ie ortfolios. often done without having any context whether these portfolios086-8603953 are suitable flow model changes all this and done without having any context security and happiness.

r your overall needs or can deliver the returns necessary for you to live the lifestyle you want. We often eet new clients who when they see the bigger picture understand that they are taking excess nnecessary risk and also new clients whose portfolios are so conservative that they will never grow nough to achieve their goals. Having your own bespoke lifetime cash flow model changes all this and elps turn your aspirational goals into a reality.

Clinical R&D

THE SCALP CARE EXPERT

allows easy and precise

Please contact Clonmel Healthcare

Minerals, including iron, support

growth and development and application. twiceinvestments, on 01-6204000 if you require LAUNCHES NIZORAL NIZORAL he general impression is that financial adviceSimply is allapply about pensions, andany insurance policies. ensure our bodies function a day, or as often as required, additional information.

CARE SCALP TONIC ut proper Financial Planning is about theonto much picture – it is about helping people optimally. to make life Iron is present mostly directly dry orbigger wet scalp and PA 126/312/001-005. PA Holder: Clonmel Healthcare is delighted in animal protein such as lean massage gently. Do not rinse. The angingtodecisions with the right information from the right toolsClonmel at their disposal for their future security Healthcare Ltd., Clonmel, announce the launch of an meats and seafood, but also in tonic can be used before blowCo. Tipperary. Date prepared: innovative new solution to soothe nuts, tofu and white beans in drying. and be combined with nd happiness. and moisturise a dry scalp from the January 2021. 2021/ADV/ ®

smaller amounts. Iron supports the production of haemoglobin, the Please contact Clonmel Healthcare crimson pigment in red blood cells, SOLGAR ashflow modelling has changed the rules of the and you needNEW to LAUNCH on the same pitch as those on 01-6204000 if yougame require any that helps carry oxygen around Nizoral® Care Scalp Tonic restores additional information. ® the body.

It also helps energise the enefiting service to fully realise your goals.

Solgar is delighted to announce the from natural this balance of the scalp body, and athletes, for example, the launch of its newest innovation Always read the label.

Date with a soothing complex of natural may need more iron to support Solgar® Earth Source® Koji Iron prepared: January 2021. 2021/ ingredients derived from magnolia oxygen transport to muscles so 27mg.

The new supplement is ADV/NIZ/005H olm Moore CFP™ is The a Certified Financial Planner whose business Moore Wealth Management has been and cactus plant. tonic they can keep exercising. designed to support consumers’ provides protection from itchy OLMESARTAN MEDOXOMIL dvisingand theirritated pharmacy community for 20 years. He can be contracted onenergy 086-8603953. everyday levels and useswww.mwm.ie scalp. The scalp feels / AMLODIPINE / an innovative koji fermentation hydrated and relaxed again.

HYDROCHLOROTHIAZIDE process to transform mineral iron CLONMEL Other properties of Nizoral Care into an iron-rich fermented food Scalp Tonic are: which is high in bioavailability, Clonmel Healthcare is delighted easy to absorb and gentle on the to announce the launch of  Protection from itching sensation stomach.

Olmesartan medoxomil /  Soothes and moisturises dry Amlodipine / Hydrochlorothiazide Available now in a 30-capsule scalp Clonmel 20 mg/5 mg/12.5 mg, 40 bottle (Trade Price £6.50 - RRP mg/5 mg/12.5 mg, 40 mg/5 mg/25 £13.99/¤14.50), each capsule will  With antibacterial properties to mg, 40 mg/10 mg/12.5 mg & 40 provide 27mg of naturally sourced support the natural balance of mg/10 mg/25 mg Film-coated koji food fermented iron. The the scalp tablets. convenient one-a-day formulation scalp care expert Nizoral®; Nizoral Care Scalp Tonic.

 Pleasant cooling effect

 Leave-in formulation with quick absorption, no rinse  Light, non-greasy texture suitable for everyday use  Easy & precise application with innovative applicator The innovative SofTip applicator

other hair care or styling products.

Olmesartan medoxomil / Amlodipine / Hydrochlorothiazide Clonmel is indicated for the treatment of essential hypertension.

Full prescribing information is available on request or alternatively please go to www.clonmel-health. ie. Medicinal product subject to medical prescription.

OLM/006H

offers a number of health benefits including:

- Supporting energy and reducing tiredness and fatigue - Contributing to the formation of haemoglobin and red blood cells - Supporting cognition - Supporting immune defences

$16,000,000,000,000

(That’s $16 Trillion) That’s what it cost to get stock markets back off the ground in 2020.

The unfolding Covid crisis wiped 35% off the value of world markets early last year. An unprecedented worldwide $16 Trillion fiscal stimulus package is the main reason markets bounced back.

This level of intervention is not sustainable and has consequences for investors that roll into 2021 and further.

Get in touch with Kieran or Colm for a FREE and confidential pension review to see how you may be impacted.. www.mwm.ie

colm@mwm.ie

086 860 39 53

|

kieran@mwm.ie

086 380 18 68

Moore Wealth Management Limited trading as Moore Wealth Management is Regulated by the Central Bank of Ireland Reg number 55195

Genuair -has it ‘clicked’ yet? ®

The ONLY prefilled inhaler with visual and audible feedback for confirmed dose delivery 1-4

Genuair - a simple to use inhaler for patients with COPD 4

LAMA + LABA

LAMA Abbreviated Prescribing Information Eklira® Genuair® 322 micrograms inhalation powder. Please consult the Summary of Product Characteristics (SPC) for the full prescribing information. Presentation: Inhalation powder in a white inhaler with an integral dose indicator and a green dosage button. Each delivered dose contains 375 µg aclidinium bromide equivalent to 322 µg of aclidinium. Also, contains lactose. Use: Maintenance bronchodilator treatment to relieve symptoms in adult patients with chronic obstructive pulmonary disease (COPD). Dosage: For inhalation use. Recommended dose is one inhalation of 322 micrograms aclidinium twice daily. Patients should be instructed on how to administer the product correctly as the Genuair inhaler may work differently from inhalers used previously. It is important to instruct the patients to read the Instructions for Use in the pack. No dose adjustments are required for elderly patients, or those with renal or hepatic impairment. No relevant use in children and adolescents.

Contraindications: Hypersensitivity to aclidinium bromide or to any of the excipients. Warnings and Precautions: Stop use if paradoxical bronchospasm occurs and consider other treatments.

Do not use for the relief of acute episodes of bronchospasm. Use with caution in patients with myocardial infarction in the previous 6 months, unstable angina, newly diagnosed arrhythmia within the previous 3 months, or hospitalisation within the previous 12 months for heart failure functional classes III and IV. Dry mouth, observed with anticholinergic treatment, may be associated with dental caries in the long term. Use with caution in patients with symptomatic prostatic hyperplasia or bladder-neck obstruction or with narrow-angle glaucoma. Do not use in patients with rare hereditary problems of galactose intolerance, total lactose deficiency or glucose-galactose malabsorption.

Interactions: Do not administer with other anticholinergic-containing medicinal products. No other interactions expected. Please consult the SPC for more details. Fertility, pregnancy and lactation: No data on use in pregnancy. Risk to newborns/infants cannot be excluded. Consider risk-benefit before using during lactation. Unlikely to affect fertility at the recommended dose. Side-effects: Common (1-10%): Sinusitis, nasopharyngitis, headache, cough, diarrhoea, nausea. Uncommon (0.1-1%): Dizziness, blurred vision, tachycardia, palpitations, dysphonia, dry mouth, stomatitis, rash, pruritus, urinary retention. Rare (0.01-0.1%): hypersensitivity. Not known: angioedema, anaphylactic reaction. Pack sizes: Carton containing 1 inhaler with 60 unit doses. Legal category: POM Marketing Authorisation Number: EU/1/12/778/002 Marketing Authorisation holder: AstraZeneca AB, SE151 85 Södertälje, Sweden. Marketed by: A. Menarini Pharmaceuticals Ireland Ltd., Castlecourt, Monkstown Farm, Monkstown, Glenageary, Co. Dublin A96 T924. Further information is available on request to A. Menarini Pharmaceuticals Ireland Ltd. or may be found in the SPC. Last updated: February 2020

This medicinal product is subject to additional monitoring. This will allow quick identification of new safety information. Healthcare professionals are asked to report any suspected adverse reactions to: HPRA Pharmacovigilance, Earlsfort Terrace, IRL - Dublin 2, Tel: +353 1 6764971, Fax: +353 1 6762517, Website: www.hpra.ie, e-mail: medsafety@ hpra.ie. Adverse events should also be reported to A. Menarini Pharmaceuticals Ireland Ltd. Phone no: 01 284 6744.

Date of item: November 2020. IR-BRI-10-2020

References:

1. MIMS Ireland November 2020 2. Eklira® Genuair® Summary of Product Characteristics, last updated November 2019 3. Brimica® Genuair® Summary of Product Characteristics, last updated August 2019 4. Magnussen, H et al. COPD. 2019 Apr;16(2):196-205

Abbreviated Prescribing Information Brimica® Genuair® 340 micrograms/12 micrograms inhalation powder. Please consult the Summary of Product Characteristics (SPC) for the full prescribing information. Presentation: Inhalation powder in a white inhaler with an integral dose indicator and an orange dosage button.

Each delivered dose contains 396 µg aclidinium bromide (equivalent to 340 µg of aclidinium) and 11.8 micrograms of formoterol fumarate dihydrate. Also, contains lactose. Use: Maintenance bronchodilator treatment to relieve symptoms in adult patients with chronic obstructive pulmonary disease (COPD). Dosage: For inhalation use. Recommended dose is one inhalation of 340 µg/12 µg twice daily. Patients should be instructed on how to administer the product correctly as the Genuair inhaler may work differently from inhalers used previously. It is important to instruct the patients to read the Instructions for Use in the pack. No dose adjustments are required for elderly patients, or those with renal or hepatic impairment. No relevant use in children and adolescents.

Contraindications: Hypersensitivity to the active substances or to any of the excipients. Warnings and Precautions: Do not use in asthma. Stop use if paradoxical bronchospasm occurs and consider other treatments. Do not use for the relief of acute episodes of bronchospasm. Use with caution in patients with myocardial infarction in the previous 6 months, unstable angina, newly diagnosed arrhythmia within the previous 3 months, or hospitalisation within the previous 12 months for heart failure functional classes III and IV. Discontinue if increases in pulse rate, blood pressure or changes in ECG occur. Use with caution in patients with a history of or known prolongation of the QTc interval or treated with products affecting the QTc interval. Use with caution in patients with severe cardiovascular disorders, convulsive disorders, thyrotoxicosis and phaeochromocytoma.

Hypokalaemia may occur, is usually transient and supplementation not needed. In patients with severe COPD, hypokalaemia may be potentiated by hypoxia and concomitant treatment. Use with caution in patients with symptomatic prostatic hyperplasia, urinary retention or with narrow-angle glaucoma. Dry mouth, observed with anticholinergic treatment, may be associated with dental caries in the long term. Do not use in patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption. Interactions: Do not administer with other anticholinergic and/or long-acting β2-adrenergic agonist containing medicinal products.

Caution in use with methylxanthine derivatives, steroids, non-potassium-sparing diuretics, β-adrenergic blockers or medicinal products known to prolong the QTc interval. Please consult the SPC for more details. Fertility, pregnancy and lactation: No data on use in pregnancy. Consider risk-benefit before using during lactation. Unlikely to affect fertility at the recommended dose. Sideeffects: Common (1-10%): Nasopharyngitis, urinary tract infection, sinusitis tooth abscess, insomnia, anxiety, headache, dizziness, tremor, cough, diarrhoea, nausea, dry mouth, myalgia, muscle spasms, peripheral oedema, increased blood creatine phosphokinase. Uncommon (0.1- 1%): Hypokalaemia, hyperglycaemia, agitation, dysgeusia, blurred vision, tachycardia, electrocardiogram QTc prolonged, palpitations, angina pectoris, dysphonia, throat irritation, stomatitis, rash, pruritus, urinary retention, increased blood pressure. Rare (0.01-0.1%): Hypersensitivity, bronchospasm, including paradoxical.

Not known: anaphylactic reaction, angioedema. Pack sizes: Carton containing 1 inhaler with 60 unit doses. Legal category: POM Marketing Authorisation Number: EU/1/14/963/001 Marketing Authorisation holder: AstraZeneca AB, SE-151 85 Södertälje, Sweden. Marketed by: A. Menarini Pharmaceuticals Ireland Ltd., Castlecourt, Monkstown Farm, Monkstown, Glenageary, Co. Dublin A96 T924. Further information is available on request to A. Menarini Pharmaceuticals Ireland Ltd. or may be found in the SPC. Last updated: October 2019 This medicinal product is subject to additional monitoring. This will allow quick identification of new safety information. Healthcare professionals are asked to report any suspected adverse reactions via HPRA Pharmacovigilance, Earlsfort Terrace, IRL - Dublin 2; Tel: +353 1 6764971; Fax: +353 1 6762517. Website: www.hpra.ie; E-mail: medsafety@ hpra.ie. Adverse events should also be reported to A. Menarini Pharmaceuticals Ireland Ltd. Phone no: 01 284 6744.

Now reclassified as over-the-counter pharmacy only medicine Order from

United Drug & Uniphar Available in

4 & 8 tablet pack sizes For more information please contact one of the following members of the sales team:

VIAGRA CONNECT® (Sildenafil) Name of product: VIAGRA CONNECT 50 mg film-coated tablets Active ingredient: sildenafil. Supply classification: Pharmacy only. Indications: For erectile dysfunction in adult men.

Dosage and Method of use: Adults: one 50 mg tablet taken with water approx. one hour before sexual activity. The maximum dosing frequency is once per day. the onset of activity may be delayed if taken with food. Patients should be advised that they may need to take Viagra Connect a number of times on different occasions (max of one 50 mg tablet per day), before they can achieve a penile erection satisfactory for sexual activity. If patients are still not able to achieve a sufficient penile erection they should be advised to consult a doctor. Elderly: no dosage adjustments required (≥ 65 years old).

Renal Impairment: No dosage adjustments for patients with mild to moderate renal impairment. Dosage adjustments required for those with severe renal impairment, see SmPC. Hepatic Impairment: Dosage adjustments required for those with mild-moderate hepatic impairment, see SmPC. Viagra Connect in contraindicated for patients with severe hepatic impairment (see contraindications). Use in patients taking other medicinal products: individuals receiving concomitant treatment with CYP3A4 inhibitors must be advised to consult their doctor before taking Viagra Connect, dosing adjustments may be required, see SmPC. Patients receiving alpha blocker treatment should be stabilised on therapy prior to initiating sildenafil treatment and must be advised to consult their doctor before taking Viagra Connect as dosing adjustments may be required, see SmPC. Side Effects: The most commonly reported adverse reactions in clinical studies among sildenafil treated patients were headache, flushing, dyspepsia, nasal congestion, dizziness, nausea, hot flush, visual disturbance, cyanopsia and vision blurred. For full list of side effects see SmPC section 4.8. Warnings and Precautions: Erectile dysfunction can be associated with a number of contributing conditions, e.g. hypertension, diabetes mellitus, hypercholesterolaemia or cardiovascular disease. As a result, all men with erectile dysfunction should be advised to consult their doctor within 6 months for a clinical review of potential underlying conditions and risk factors associated with erectile dysfunction (ED). If symptoms of ED have not improved after taking Viagra Connect on several consecutive occasions, or if their erectile dysfunction worsens, the patient should be advised to consult their doctor. Cardiovascular risk factors: Since there is a degree of cardiac risk associated with sexual activity, the cardiovascular status of men should be considered prior to initiation of therapy. Agents for the treatment of erectile dysfunction, including sildenafil, are not recommended to be used by those men who with light or moderate physical activity, such as walking briskly for 20 minutes or climbing 2 flights of stairs, feel very breathless or experience chest pain. For a list of patients who are considered at low cardiovascular risk from sexual activity see SmPC. Patients previously diagnosed with the following must be advised to consult with their doctor before resuming sexual activity: uncontrolled hypertension, moderate to severe valvular disease, left ventricular dysfunction, hypertrophic obstructive and other cardiomyopathies, or significant arrhythmias. Sildenafil has vasodilator properties, resulting in mild and transient decreases in blood pressure. Patients with increased susceptibility to vasodilators include those with left ventricular outflow obstruction (e.g. aortic stenosis), or those with the rare syndrome of multiple system atrophy manifesting as severely impaired autonomic control of blood pressure. Priapism: Patients who have conditions which may predispose them to priapism (such as sickle cell anaemia, multiple myeloma or leukaemia), should consult a doctor before using agents for the treatment of erectile dysfunction, including sildenafil. Prolonged erections and priapism have been occasionally reported with sildenafil in post-marketing experience. In the event of an erection that persists longer than 4 hours, the patient should seek immediate

087 188 1350

Keith Duggan West of Ireland

086 220 1539

Brendan Dunne Dublin/Leinster

087 260 0160

Michael Green Munster/South Leinster

087 646 9695

medical assistance. Concomitant use with other treatments for erectile dysfunction is not recommended. Effects on vision: Patients should be advised that in the event of any sudden visual defect, they should stop taking Viagra Connect and consult a physician immediately. Concomitant use with CYP3A4 inhibitors: patients should be advised to consult a doctor before taking Viagra Connect as a 25 mg tablet may be more suitable for them. Concomitant use with alpha-blockers: Caution is advised when sildenafil is administered to patients taking an alpha-blocker, as the co-administration may lead to symptomatic hypotension in a few susceptible individuals. This is most likely to occur within 4 hours post sildenafil dosing. In order to minimise the potential for developing postural hypotension, patients should be hemodynamically stable on alpha-blocker therapy prior to initiating sildenafil treatment. Thus, patients taking alpha blockers should be advised to consult their doctor before taking Viagra Connect. Treatment should be stopped if symptoms of postural hypotension occur, and patients should seek advice from their doctor on what to do. Effect on bleeding: the use of sildenafil is not recommended in those patients with history of bleeding disorders or active peptic ulceration, and should only be administered after consultation with a doctor. Hepatic impairment: Patients with hepatic or renal impairment must be advised to consult their doctor before taking Viagra Connect., since a 25 mg tablet may be more suitable for them. Lactose: The film coating of the tablet contains lactose. Viagra Connect should not be administered to men with rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption. Sodium: This medicinal product contains less than 1 mmol sodium (23 mg) per tablet. Patients on low sodium diets can be informed that this medicinal product is essentially ‘sodium-free’. Use with alcohol: Drinking excessive alcohol can temporarily reduce a man’s ability to get an erection. Men should be advised not to drink large amounts of alcohol before sexual activity. Contraindications: Hypersensitivity to the active substance or to any of the excipients. coadministration with nitric oxide donors (such as amyl nitrite, nitrates, ritonavir guanylate cyclase stimulators, such as riociguatis contraindicated. Agents for the treatment of erectile dysfunction, including sildenafil, should not be used by those men for whom sexual activity may be inadvisable, and these patients should be referred to their doctor.

This includes patients with severe cardiovascular disorders such as a recent (6 months) acute myocardial infarction (AMI) or stroke, unstable angina or severe cardiac failure.

Sildenafil should not be used in patients with severe hepatic impairment, hypotension (blood pressure < 90/50 mmHg) and known hereditary degenerative retinal disorders such as retinitis pigmentosa (a minority of these patients have genetic disorders of retinal phosphodiesterases). Sildenafil is contraindicated in patients who have loss of vision in one eye because of non-arteritic anterior ischaemic optic neuropathy (NAION), regardless of whether this episode was in connection or not with previous PDE5 inhibitor exposure. Viagra Connect should not be used in patients with anatomical deformation of the penis (such as angulation, cavernosal fibrosis or Peyronie’s disease). Viagra Connect is not indicated for use by women. The product is not intended for men without erectile dysfunction. This product is not intended for men under 18 years of age.

Legal Category: Product not subject to medical prescription Marketing Authorisation Number: PA0822/234/001 Marketing Authorisation Holder: Pfizer Healthcare Ireland, 9 Riverwalk, Citywest Business Campus, Dublin 24, Ireland. For further information on this medicine please contact: Pfizer Medical Information on 1800 633 363. For queries regarding product availability please contact: Viatris Newenham Court, Northern Cross, Malahide Road, Dublin 17. Phone number: +353 1 871 1600.

Date: 01/2021. Ref: VC 1_0

Brought to you by VIATRIS of Unit 35, Baldoyle Industrial Estate, Dublin.

PP-VCO-IRL-0057 | Date of preparation: January 2021

James O’Connor Sales Manager