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January 2018 Volume 10  Issue 1

THE INDEPENDENT VOICE OF PHARMACY

In this issue: NEWS: Court Date set for claim against pharmacy chain Page 4

NEWS: Pharmacist training to help people suffering from addiction Page 5

NEWS: Rare Artefact to go on display at local Pharmacy Page 6

PROFILE: Community Pharmacy across the nations Page 9

REPORT: Brexit could lead to higher prices in border pharmacies Page 14

CPD: Digestive Health Page 31


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Foreword

Contents

First of all, we would like to say a very Happy New Year to all our readers and take this opportunity to wish everyone a happy and successful year! We are looking forward to continuing to be an independent voice for community pharmacy in Ireland and bringing you the most up to date news, reports and features.

Page 10: Chronic Pain Campaign supported by IPU launched

Page 22: IPU launch New Medicine Service Pilot

As January begins, we at IPN are planning a busy year ahead with a number of events to get excited about including, the 4th Annual OTC Product awards set to take place 1st March 2018. With a vast number of entries the bar is set even higher than last year and looks to be the best OTC Product Awards yet!

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Page 24: License for Medicinal Cannabis granted for the treatment of Chronic Pain

In this issue of IPN we start by saying a big congratulations to IIOP Executive Director, Dr Catriona Bradley who won not 1 but 2 awards at the Clanwilliam Pharmacist awards! Winning the Professional Excellence category and also overall Pharmacist of the Year, it was a big and well deserved night for Catriona. Full story on page 5.

Page 26: Meagher's helps to wrap up homelessness Page 36: Asthma Advising on Inhaler Technique

Elsewhere, Retail Excellence Ireland have released figures which have indicated there is a significant increase in cyber sales with pharmacy and cosmetics coming out the most popular categories with online shoppers. The survey conducted, was representative of all the retail sectors in Ireland reported a 20 -60% increase in sales for retailers. Page 6

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Meanwhile on page 14 we look at what Brexit could mean for border pharmacies. With Brexit, undoubtedly an ongoing, hotly debated topic, we spoke to a Murray Pharmacy group owner, Tom Murray, who owns a number of pharmacies in Donegal to get his take on what the implications could be for his business.

PUBLISHER IPN Communications Ireland Ltd. Clifton House, Lower Fitzwilliam Street Dublin 2 00353 (01) 6690562 MANAGING DIRECTOR Natalie Maginnis n-maginnis@btconnect.com IPN COMMUNICATIONS GROUP EDITOR Kelly Jo Eastwood kjeastwood@hotmail.com ACCOUNTS Jon Dickinson accounts@ipncommunication.com COMMERCIAL MANAGER Barry Maguire Barry@ipnirishpharmacynews.ie ADVERTISING MANAGER Nicola McGarvey nicola@ipnirishpharmacynews.ie EDITORIAL CO-ORDINATOR Laura Greenhill Editorial@ipnirishpharmacynews.ie PHOTOGRAPHY DESIGNER Matt Wright Matt@ipnirishpharmacynews.ie CONTRIBUTORS Eamon Brady Amy Oates Paul Mullholland January IPN AD-tony.pdf

Regulars

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In other news, the IPU have launched the New Medicine Service Pilot. The reports main findings show that a NMS in Ireland would lead to more effective medicine taking, improve patients’ health outcomes and reduce the health budget. We have the full story on page 22.

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Lastly, with the bitterly cold weather kicking in across the nation, one pharmacy has been going all out to help one of the most vulnerable groups of people in the community. Meaghers Pharmacy have been involved in a number of campaigns including sleeping in the street outside their Baggot street store, all in aid of the Peter McVerry Trust, who renovate and provide homes for people who have become homeless. There was an increase of 20% in the number of homeless people in Ireland in 2017 with the figures showing that 8,347 people were registered as homeless in September of last year. We have the full story of Meaghers fundraising efforts on page 26.

Irish Pharmacy IRISH News is circulated PHARMACY to all independent, NEWS multiple and hospital pharmacist, government officials and departments, pharmacy managers, manufactures and wholesalers. Buyers of pharmacy groups and healthcare outlets. Circulation is free to all pharmacists subscription rate for Irish Pharmacy News ¤60 plus vat per year. 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 of transmitted in any form without written permission. IPN Communications Ltd. have 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. 22/12/2017

14:07

In this issue we also have a number of features including advising on asthma inhaler technique and the current trends in the Vitamins, Minerals and Supplements market as well.

CPD: Digestive Health

31

Feature: VMS

42

Feature: Sports Injuries

51

Feature: Asthma

36

Feature: Fertility

46

Feature: Psoriasis

57

Take control of your pharmacy in 2018 “The payback in the first year is well in excess of 10 times its cost” ‒ Tony McEntee, Former CEO of Allcare Pharmacy

Unit C3, The Exchange, Calmount Park Calmount Avenue, D12 ET20, Ireland Email: pharmacy@realworldanalytics.com Call: 01 693 1433

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News news brief COURT DATE SET FOR CLAIM AGAINST PHARMACY CHAIN The 24th January has been announced as the court date scheduled for the formal hearing of a claim made by workers at Lloyds Pharmacy. The claim is expected to cover core issues including, a fair pay increase, the introduction of incremental pay scales across grades, Improvements in annual leave entitlements and public holiday premiums, greater security of working hours (eliminating zero hour contracts) and the introduction of a sick pay scheme. The case, which was brought to the Labour Court by Trade Union, Mandate Trade Union, who represent staff in retail pharmacies across Ireland, including approximately twothirds of all Lloyds Pharmacy locations in Ireland, have encouraged more members of staff at Lloyds to join the Union. In statement on their facebook page the Mandate said “If you have not done so already, reach out again to colleagues not yet in in the Union and encourage them to join today.” Lloyds have yet to comment about the claim but were asked by Irish Pharmacy News for a comment and have received no response at the time of going to print. Stating the reasons for taking the claim to court Gerry Light, Mandate Assistant General Secretary, said: “After ignoring our requests to address the issues of concern for Lloyds workers earlier this year, the Company eventually agreed to attend talks at the Workplace Relations Commission (WRC). “However, after just one session at the WRC, management withdrew unilaterally from the process. Unfortunately this means our members have been left with no option but to escalate the matter to the Labour Court.” “It is of course our hope the company will re-consider its position and engage positively in order to address our members’ issues and concerns without delay Lloyds operates 94 stores in Ireland, employs almost 1,000 people.

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New system for High Tech Medicines Scheme A High Tech Hub Ordering and Management System is being developed to streamline administration of the scheme for pharmacists and to provide enhanced visibility of stock management and spending on this scheme to the HSE. The initial phase of the High Tech Hub went live at beginning in December 2017, and will be fully rolled out on an incremental basis. The HSE has engaged with stakeholders in the High Tech Medicines scheme, including the Irish Pharmacy Union, to develop the initiative. The expenditure for these medicines exceeded ¤600 million for the first time in 2016, and this is likely to reach ¤700 million in 2017. Due to the significant increase in spend and issues raised in a report by the Comptroller and Auditor General (C&AG), the HSE is implementing an electronic ordering and management system for high tech medicines. The implementation of this electronic purchasing and stock control system, which will address a number of key principles and concerns raised by the C&AG,

is hoped to result in a number of benefits for the pharmacy. For example, it will provide a ‘one stop shop’ for pharmacies for all high tech medicine orders and will allow for the tracking of an order from request to delivery. Also the High Tech Hub will be a central submission point for patient details and high tech prescriptions, while also minimising wastage with ordering only occurring by the nominated pharmacies for patients with a valid prescription. It will also provide automated order verification resulting in reduction in error. In a circular to pharmacists, the HSE outlines a number of activities to be undertaken as a result of the new system. “A list of patients who attend your pharmacy for High Tech medication, but for whom you are

not currently listed as their High Tech Nominated Pharmacy, is attached if applicable,” according to the HSE. “This will afford you the opportunity to assist these patients in completing the Change of Nominated Pharmacy form, which is available on PCRS online services, to ensure you continue to receive High Tech patient care fees for professional services provided by your pharmacy.” Pharmacies must also complete an online order for high tech medication via the High Tech Hub Order and Management system later in 2017. “Given the significant cost of these medicines, and the need for the HSE to have a full overview of the stock management and spend in the area of High Tech, we very much appreciate your continued co-operation,” according to C the circular.

Arsenic and lead detected in counterfeit cosmetics The Health Products Regulatory Authority (HPRA) and the Health Service Executive (HSE) are advising consumers to be vigilant for counterfeit ‘high-end’ beauty products on. Tests carried out by the HSE on a number of the 728 counterfeit and imitation products the HPRA have detained, identifies some contain harmful substances, such as arsenic and lead, which can be potentially harmful to people’s health. Kylie Cosmetics by Kylie Jenner and Urban Decay were among some of the forged cosmetic brands which were found to contain these illegal substances. The counterfeit products detained by the HPRA include, Kylie Holiday-Burgundy and Bronze eyeshadow palettes, Kylie Matte liquid lipstick and lip liner, and Urban Decay eyeshadow palettes. The HPRA has strongly urged shoppers to avoid these potentially harmful products.

based outside of the EU and are being sold to Irish consumers online and through social media. They have also been found in some trade shows and at markets throughout the country. Aoife Farrell, Cosmetics Compliance Manager, HPRA, said: “The HPRA is extremely concerned that highly toxic substances, such as arsenic and lead, have been detected in products which are available to Irish consumers. “Prolonged exposure to both of these banned substances can severely damage your health causing potential harm to your brain and kidneys, among other organs. The suppliers of these products are unconcerned about the health of the consumers who purchase them.

The HPRA states that over the past few months significant quantities of counterfeit and imitation cosmetics have been seized on entry to the country by Revenue’s Customs Service. The majority of counterfeit cosmetic products seized have been eye-shadows and lip products.

“As well as the possible toxic ingredients which may be contained in counterfeit cosmetics, the way the products are manufactured and the safety and cleanliness of the production environment is unknown, which is another reason to avoid purchasing and using these cosmetics at all cost.”

Some of these products can be purchased online from websites

“Beauty brands usually list their licensed retailers on their websites

and this is an easy way for consumers to ensure that they are purchasing a genuine cosmetic product. If a product is much cheaper than in a high street store or pharmacy, consumers should be immediately suspicious and think twice before buying the beauty product,” Ms Farrell advised. HPRA ADVICE ON HOW TO SPOT A COUNTERFEIT COSMETIC • Is it significantly cheaper than on the high street? • Is the distributor reliable? Beauty brands usually list their licenced sellers on their website. • Physically check counterfeit cosmetics for: • Uneven fill levels e.g. in eyeshadow palettes • Faded packaging • Misspelling on the packaging or in the information leaflet • Slight differences in the name of the product or shade • A different print (font or style) on the container • Mirrors that don’t quite fit or are of bad quality


News Two Pharmacy Awards for IIOP Director The executive director of the IIOP has scooped two awards at the Clanwilliam Pharmacist Awards. Dr Catriona Bradley was the winner in the Professional Excellence category and was also named as the overall Pharmacist of the Year.

Eileen Byrne, Managing Director, Clanwilliam Health said: “At Clanwilliam Health, we recognise that pharmacists play a vital role in the healthcare system and we are delighted to celebrate these professionals tonight who have become a trusted adviser to some and who have their patients’ best interests at heart. “Through the Patient Nominated Award, we have heard some truly inspiring stories from patients on how their pharmacist has positively

Jimmy Tolan has been appointed Chairman while Tony Keohane has been appointed a Non-Executive Director.

Left to right: Bobby Kerr, Noel Stenson (Pharmacy Benevolent Fund), Catriona Bradley, Paul Reilly (MD, United Drug), Eileen Byrne (MD, Clanwilliam Health)

impacted their life. A pharmacist is more than a dispenser of medicines and it’s really important to acknowledge that, like we have tonight. “From all of us at Clanwilliam Health, congratulations to all of our winners, plenty to celebrate tonight!” Noel Stenson, President of the Pharmacy Benevolent Fund said:

“Awards shows like this provide an opportunity to recognise the phenomenal work which takes place across all pharmacy sectors every day in Ireland. It’s been a very exciting night for all our pharmacists and each and every one of them are so deserving of their award and indeed, those who were shortlisted should be very proud of themselves too.

Pharmacist training to help people suffering from addiction Training for addiction staff, pharmacists and level 2 GPs in relation to buprenorphine/naloxone has recently commenced, according to the HSE. Pharmacists have been provided with training on buprenorphine and buprenorphine /naloxone as part of their accredited training module on harm reduction. It is envisaged that in conjunction with the Irish Institute of Pharmacy (IIOP), the training will be available as an additional online resource. The Irish College of General Practitioners (ICGP) will provide training for level 2 GPs. The combination therapy is used to treat opioid dependence/ addiction. Buprenorphine belongs to a class of drugs called mixed opioid agonist-antagonists. Buprenorphine helps prevent withdrawal symptoms caused by stopping other opioids. Naloxone is a narcotic antagonist

TWO NEW APPOINTMENTS FOR SAM MCCAULEY GROUP Two new appointments to the board of directors have been made with the company, hoping to double its size in the coming years.

An adjudicating panel comprised of respected pharmacists from various branches of the profession selected three finalists for each category, which were announced in October. A winner was then selected for each category and was revealed on the Awards night. These awards do not have finalists so the award recipients were announced for the first time on the night with Diarmuid O’Donovan receiving the Liz Herbert Award and Catriona Bradley winning the Overall Pharmacist of the Year.

news brief

that blocks the effect of opioids and can cause severe opioid withdrawal when injected.

programme began on a demand led basis in the second half of 2017.

Withdrawal is less likely when naloxone is taken by mouth, dissolved under the tongue, or dissolved on the inside of the cheek. It is combined with buprenorphine to prevent abuse and misuse of this medication.

“Foil provision will also allow people to smoke heroin and may prevent People Who Use Drugs from moving to injecting,” according to the HSE.

Also, a pharmacy training programme in relation to Pharmacy Needle Exchange is currently being piloted in two community healthcare areas and will be evaluated at the end of 2017. Subject to positive evaluation, the programme will be extended to the rest of the country in 2018. The provision of foil through the Pharmacy Needle Exchange

“It also has the additional potential benefit of providing those who inject heroin with the choice of smoking rather than injecting. It has been shown that foil provision may have the potential for a decrease in blood borne viruses; increased contact and engagement with pharmacists to discuss their healthcare needs; and direct to treatment and support services, as appropriate; reduced systemic infections and soft tissue and venal damage; lower risk of overdose; and reduced litter.”

A former Chief Executive of the VHI and former head of PWC's healthcare advisory business, Jimmy Tolan has in-depth knowledge of Ireland's healthcare sector. During his time as CEO of the VHI he oversaw a number of innovations including the VHI adopting a focus on wellness and positive healthcare outcomes for VHI customers. Tony Keohane is a veteran of Ireland's retail sector with over 30 years' experience including six years as Chief Executive of Tesco Ireland, before being appointed Chairman of the company from 2013 - 2015. He is current chair of Ervia and of Repak and also sits on the board of Bord Bia. His retailing experience will be invaluable to as Sam McCauley seeks to strengthen its position as the country's leading Irish owned pharmacy group. Speaking about the appointments, Tony McEntee, CEO of Sam McCauley Chemists said: 'Jimmy and Tony bring a wealth of experience to our board at a time when we are pursuing an aggressive growth strategy. 'As chairman, Jimmy will provide a strategic focus to our expansion plans. An increasing focus on healthier lifestyles underpins growth in the Health, Wellness & Beauty market for the foreseeable future and Jimmy's VHI experience will be particularly beneficial as we seek to grow in this market. 'My priority as CEO is to expand our customer touchpoints while maintaining a strong retail presence in communities throughout Ireland. As one of Ireland's most successful retailers, Tony's insights and advice will be pivotal in the delivery of this strategy,' he said.

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News news brief PHARMACY AND COSMETICS SALES BOOM WITH ONLINE SHOPPERS Retail Excellence Ireland have reported a significant increase in cyber sales with pharmacy and cosmetics coming out the most popular categories with online shoppers. The figures compiled by the industry body show a sales lift of 60% year on year during the final week on November. Lorraine Higgins, Deputy Chief Executive of Retail Excellence Ireland said “The survey was representative of all the retail sectors here and the fact retailers were reporting a 2060% increase in sales is very, very positive story. Due to events such as Cyber Week, retailers are changing their sales strategy and elongating the Christmas shopping period and are therefore benefiting as a consequence. This obviously benefits the Exchequer as well.” After Budget 2018, Ms Higgins said that more money is being put into people’s pockets, which is impacting positively on consumer sentiment. Although she add that the retail sector is not without its challenges and the amount of spending that is “leaking out” of the country is one of those challenges. Two thirds of consumers’ online spend is going out the country and further supports for retailers to take on the European online stage are needed. “Currently there is a lot of support for manufacturing and processing companies. Now it s time that agencies like Enterprise Ireland also support retailers. ” “Online sales are a very important part of retailer’s business and I believe it will take over the world. It will become up to 30% of retailers’ business so it is too big to ignore. There are difficulties due to poor broadband services in some areas of the country, but ¤602 billion is being spent by European consumers online and Irish retailers have to get a slice of that ever increasing pie. According to the Department of Communications figures, 84% of Irish consumers will buy frequently online by 2020.”

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Pharmacist allegedly submitted invalid claims The Pharmaceutical Society of Ireland is conducting an inquiry into the professional conduct of a pharmacist who is alleged to have submitted invalid claims to the Primary Care Reimbursement Scheme in 2013. The Professional Conduct Committee must decide whether Beatrice Ross submitted claims to the scheme for 669 medications that were never dispensed from two pharmacies in Fermoy, Co Cork and Cahir, Co Tipperary; or if the medications claimed were dispensed to people other than the named patients and without prescription.

one person and that person owned the pharmacy".

It is alleged that if the medications were dispensed to named patients, Ms Ross and two family members, that the medications were not clinically appropriate.

The committee heard that Ms Ross failed to produce copied prescriptions when asked to do so.

The allegations relate to the registered pharmacist based at Beatrice Ross Pharmacy Limited, Corrin Court, Fermoy, Co Cork, and Ross Pharmacy, Glengall House, The Square, Cahir, Co Tipperary, on dates between February and July 2013. The claims for reimbursement came to the attention of the Primary Care Reimbursement Service in 2013, and inspections were carried out at both pharmacies. Head of Pharmacy at the PCRS, Kate Mulveena told the Professional Conduct Committee that it was "an unusual claiming pattern against

In respect of reimbursement claimed for medications in the name of Ms Ross's family members, who were minors, Ms Mulveena said the amount of medications was "just astronomical" for the profile of the patients.

The committee also heard that the medications that the pharmacist sought reimbursement for are expensive and while she did supply a number of invoices for that period, they did not tally with the amounts allegedly dispensed. Louise Creed, a Primary Care Pharmacist with the HSE, carried out inspections. She gave evidence at the inquiry. She said she asked Ms Ross why she had claimed reimbursement for three stations in her own name. The pharmacist said she was using them to reduce her own cholesterol, and had chopped and changed between the three.

Ms Creed told the committee that there was no medical rationale for anyone to be on more than one statin. She said Ms Ross had told her she was self-medicating and was not using them on the advice of her doctor. Primary Care Pharmacist with the HSE, Mel Cox, said he was asked to carry out an inspection at the pharmacy in Cahir by the PCRS, because of "the number of unusual claims coming from the pharmacy". He told the committee that he sought prescriptions for Ms Ross and family members but no prescriptions were found for them on the premises. He said there were no repeat prescriptions for them on file either. He said he was never provided with prescriptions subsequent to his inspections. Mr Cox also told the committee that on all days identified as days that medications were dispensed to Ms Ross and family members, Beatrice Ross was on duty except for one day. The inquiry continues.

Rare Artifiact to go on display at MacManus Pharmacy John MacManus has acquired a rare letter written by 1916 signatory and Kiltyclogher native, Seán MacDiarmada at auction last week. The item was part of a rare book auction, organised by Fonsie Mealy Auctioneers. Seán MacDiarmada is described as one of the main architects of the Rising of 1916. He, along with John Clarke - whose father hailed from Carrigallen, Co Leitrim - were instrumental in planning the Rising and also key in introducing the main players and bringing them together as a group during the 1915/16 period.

overnight and this letter could be one of those blocks building towards the rebellion of 1916,” he pointed out.

Speaking about his purchase, the new owner of the historic document, Pharmacist John told how has been collecting memorabilia linked to Seán MacDiarmada for over 10 years.

“I am very proud to have this letter coming back to Leitrim and especially to north Leitrim, where Seán MacDiarmada was born and raised. He was such an important man. He was the only one of the signatories that worked as a full time revolutionary and I think that the role he played in planning the revolution, is often undervalued.

“This letter could be very important because Seán MacDiarmada always wrote in code. While the letter talks about an Emmett celebration, it is very possible that this may be a coded letter. The rebellion didn't just happen

John's family has strong links with that of the 1916 signatory. When Sean MacDiaramada went to Belfast in the early 1900s he worked in John's Great Grand Uncle's pub for a time.

“I am lucky enough to own some other items belonging to Seán MacDiarmada but this (new letter)

is very special as letters or any items linked with him are just so rare,” he said. “I think it is very important that we respect our history and it is vital for ourselves as a community to value our culture and heritage. “To be able to bring something back to north Leitrim, something with such a link to Seán MacDiarmada, is an honour for me. These items should be kept for the community, seen by the people, not just locked away in private collections.” John has already taken a number of items from his collection of Seán MacDiarmada artifacts to show school children in the north Leitrim area and he hopes to put his latest acquisition on display in MacManus' Pharmacy, New Line, Manorhamilton in the New Year.


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Profile

Community Pharmacy across the nations Ireland has long looked to its UK counterparts to help evolve its community pharmacy service. According to Parr, the document aims to “transform the role of pharmacy across all areas of pharmacy practice, increase capacity and offer person-centred care”. In 2012, the Pharmacists’ Defence Association (PDA) said that pharmacy in Scotland has been diverging from the rest of the UK for some time and “has, arguably, the most advanced models of practice anywhere in the UK”. A Nuffield Trust report says the country’s smaller size enables it to support a more personalised, less formal approach, than in larger areas.

Rose Marie Parr, Chief Pharmaceutical Officer, Scotland It is something which England, Scotland, Wales and Northern Ireland have been doing since 1999 when devolved powers allowed them to develop the service to suit their own needs. Each has since been able to learn from each other by comparing and contrasting how they deliver services. Ireland has always kept a keen eye on its neighbours. This year’s All Ireland Pharmacy Conference in October saw the Chief Pharmaceutical Officer for Scotland, Professor Rose-Marie Parr deliver an engaging keynote address which focused on the strategy for achieving excellence in pharmaceutical care in Scotland. The lessons being learned between the four nations were highlighted in detail in a recent report from a Royal Pharmaceutical Society publication with fascinating insight. While a number of reports have analysed the differences in the four systems since devolution few have looked specifically at pharmacy. The key themes are broadly the same across the four nations; the integration of pharmacists and pharmacy technicians into the wider health team; promoting the role of pharmacists in relieving press on GPs and accident and emergency; and medicines optimisation. The success of various initiatives does differ between the countries.

For example, in the case of minor ailment services, Scotland now has a nationally commissioned service while in England, minor ailment services have been decommissioned and access is down to a postcode lottery. The new study looked at the advances and needs of each area: Wales A key focus in Wales is the redesign of the community pharmacy contract which will see an increased emphasis on improving medication safety and service quality. Community Pharmacy Wales (CPW) is working closely with the Welsh government to agree future funding. According to Judy Henley, director of contractor services at CPW, in future, the focus will be “less on dispensing prescriptions and more on value and quality community based services.” Announced in March 2013, the national common ailment service in Wales called Choose Pharmacy has now been rolled out to more than half of community pharmacies. From April of next year funding will be available to enable all pharmacies to access the IT application needed to run the service by the end of 2020. The aim is to reduce the number of people who

need to be referred to GP out-of-hours services and A&E departments, as well as to improve patient safety. Also having an impact is the 111 Wales telephone helpline service, which originally started life as a pilot but has answered almost 145,000 calls over the past year. Wales has also seen an expansion of the role of pharmacists in general practice. This was boosted in 2015, when additional funding was provided to 64 primary care clusters — groups of neighbouring GP practices and partner organisations, including pharmacists, which provide services to local populations of between 30,000 and 50,000 people. The majority of GP practices now having routine input from pharmacists in patient-facing roles. The Scotland Perspective IT infrastructure is a priority for the Scottish CPO, Rose Marie Parr, who, at the RPS’s 2017 Scottish National Seminar, said that improvements to Scotland’s “clunky” pharmaceutical IT systems were essential for the nation to “move into the 21st century”. The government has made nine commitments for pharmacy which are summed up in the “Achieving excellence in pharmaceutical care” report published in August 2017.

One very successful service in the country is its national minor ailments scheme, which is currently being expanded to all patients. Previously it was just available to those aged over 60 years, under 16 years, pregnant women and people with medical exemptions or on low incomes. “At a time when financial pressures are leading to other NHS bodies decommissioning minor ailments services where they do exist, NHS Scotland is heading in the opposite direction, recognising the clear benefits to patients by protecting and potentially investing further in this valuable service,” says Amanda Rae, head of policy and development for Community Pharmacy Scotland (CPS).

The cuts led to an exodus of the country’s best and brightest newly quali ed pharmacists, many of whom came to the Republic of Ireland. 9


Profile conditions and career progression. Overworked and clinically understimulated pharmacists with little time for patient interaction have been leaving the profession to different career paths.” Like Wales, the country is also working towards a new community pharmacy contract but with the current political upheaval and no government sitting at Stormont work has come to a halt. Gerard Greene, chief executive of Community Pharmacy NI (CPNI), says that it is almost impossible for community pharmacy contractors to plan for the future.

Pharmacy First is also the newest community pharmacy service to be rolled out across health boards in Scotland. It will allow patients access to treatment for uncomplicated urinary tract infections and impetigo from a community pharmacy without the need for a GP appointment or prescription. This will not only improve access for patients, but save on costs to the NHS and free up GP time. The one area where Scotland falls behind colleagues in England, and for which CPS is still campaigning, is access to patient records. This is having a significant impact on pharmacists who have a limited ability to tackle priority issues, such as polypharmacy, without a holistic view of the patient’s history. CPS has also been lobbying for pharmacists to be able to provide the NHS influenza vaccination. The England Perspective This is in stark contrast to England where the provision of NHS flu vaccinations in community pharmacy is one area that the Pharmaceutical Services Negotiating Committee (PSNC) identifies as a key success for pharmacy practice in the country. It is a service that the public has appreciated with 99% of those vaccinated in a community pharmacy saying they would be willing to have it at a pharmacy again and 64% said they would swap to pharmacy from other settings.

Access to the summary care record (SCR) has been another positive area of development for England, enabling community pharmacists to better support patient care by reducing the need to contact GP practices to check key information, although organisations are still campaigning for ‘write’ access to the complete patient health record. CPO for England Keith Ridge says that he believes the Quality Payments Scheme, introduced by the Department of Health (DH) as part of the Community Pharmacy Contractual Framework in 2017–2018, is helping to improve the quality of practice and healthcare for patients, including more effective treatment of asthma and better care for people with dementia. Significant investment has been made to deploy pharmacists and pharmacy technicians across GP practices, care homes, NHS 111 and integrated urgent care centres to optimise patients’ medicines in order to relieve the pressures on GPs and hospital admissions. Hundreds of places on training programmes starting in 2018 are being developed with Health Education England to develop pharmacy practice which include independent prescribing qualifications for up to 2,000 pharmacists in general practice, NHS 111, integrated urgent care centres and care homes, and a new training pathway for pharmacists and pharmacy technicians in care homes.

The success of various initiatives does differ between the countries. 10

Clinical and professional ~leadership development for 600 pharmacists and pharmacy technicians is also available with the NHS Leadership Academy. However in terms of GP practice pharmacists, other nations have a more joined-up, far-reaching and long-lasting plan, than England. For instance, Scotland has produced two strategy documents dedicated to pharmaceutical care and has plans which include changes to undergraduate courses, ongoing career-long training support, a national competency framework, career structure and associated salary framework. Severe financial pressures experienced in England, primarily because of the cuts to community pharmacy funding, have had a significant impact on pharmacy practice and morale. In October 2017, it was announced that 190 Lloyds Pharmacy stores will be closed or sold off because they are no longer considered ‘commercially viable’. Ian Strachan, chairman of the National Pharmacy Association, said at the time that the closures were an indication of the “immense pressure” independent pharmacies areunder. The Northern Ireland perspective Pharmacy in NI is still recovering from the aftershocks of funding cuts five years ago. Leon O’Hagan, a practice-based pharmacist in Belfast, says the cuts led to an exodus of the country’s best and brightest newly qualified pharmacists, many of whom came to the Republic of Ireland. He said: “I also think it led to community pharmacy falling behind in what it offers pharmacists in terms of working

“Contractors continue to operate in a period of instability and uncertainty which is not sustainable for the long term,” he explains. However, NI CPO Mark Timoney, says the Department of Health in NI is working hard to address the ongoing challenges in pharmacy by overseeing the implementation of a ‘Medicines optimisation quality framework’, which was launched in March 2016, and a ‘Strategy for pharmacy in the community’ both are promoting the role of pharmacy within a health and social care service undergoing modernisation. In partnership with the wider health service, the DH’s Medicines Regulatory Group has also established the Controlled Drugs Reconciliation Project (CDRP) in NI. Working closely with the pharmaceutical wholesaling sector and with community pharmacies, the CDRP adds an additional dimension of security into the medicines distribution chain for controlled drugs. It is focused on the possible diversion of lower scheduled drugs, such as diazepam and tramadol, prescription medicines, including gabapentin and pregabalin, and over-the-counter medicines, including codeine-containing preparations. The GP pharmacist programme in NI has also been a success and has received full support from GPs in the country. There are currently around 160 pharmacists working in GP practices in NI and by 2020 it is hoped there will be around 300 pharmacists. However it is felt that, like Scotland, NI is behind in terms of technology. Electronic prescribing which has been available in England for a number of years is still not widely used.


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News

Chronic Pain Campaign supported by IPU launched Pharmacists across the country are being asked to help promote a new campaign to encourage people living with chronic pain to speak out. for those who live with chronic pain? It may be difficult for those who do not have chronic pain to relate to and understand what those who do have chronic pain go through on a daily basis. The #TodayIsBetter campaign aims to empower those with chronic pain to have their say on how we all can help them live a better today.” Commenting on the campaign Daragh Connolly, President of the Irish Pharmacy Union (IPU) said: “Chronic pain does not command significant attention but it is a debilitating condition, which can seriously affect the quality of life of a sufferer.

Pictured L-R- Daragh Connolly, President, Irish Pharmacy Union, John Molony, Business Unit Lead, Pfizer Healthcare Ireland, Luke Fitzgerald, former Ireland and Leinster rugby player with Michael G Stewart, Inflammation & Immunology Lead, Pfizer Healthcare Ireland The #TodayIsBetter initiative led by Pfizer is supported by the Irish Pharmacy Union and a number of patient groups including Arthritis Ireland, Chronic Pain Ireland, Fibro Ireland, the Irish Cancer Society and the Migraine Association of Ireland. Former Irish and Leinster rugby star Luke Fitzgerald was one of the first to talk about his personal experience of living with chronic pain at the launch of #TodayIsBetter in November. It is hoped that by sharing their stories, patients will provide an insight into how they live, allowing society at large to help them to lead a better quality of life. A dedicated campaign website, www.TodayIsBetter.ie has also been set up to give those with chronic pain an opportunity to have their say on what would really help them to have a better day. Speaking at the launch, Luke Fitzgerald said: “Many people are aware of the injuries I have had in the past that affected my rugby career. “However, what people might not be aware of is the chronic pain I live with every day. I first

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experienced chronic pain in 2015 after being diagnosed with bulging discs in my cervical spine. “I try alleviating the pain with regular exercise and by ensuring my neck is in a neutral position/ non-aggravating position while doing everyday tasks. “Like many people with chronic pain, everyday things cause me considerable pain. For example, staring at a computer screen for prolonged periods of time can really cause me a lot of discomfort, from headaches to stiffness and loss of feeling.” The launch of the campaign follows research by Pfizer which revealed that 10% of the population are living with chronic pain. Other research has shown the community prevalence of chronic pain in Ireland to be 35.5%2 and that 25% of people aged 50-plus often have moderate or severe pain. Arthritis was the most common cause of pain affecting 36% of respondents with back pain the second most common at 34%. Almost half of those living with

chronic pain (46%) said their condition had a significant impact on their overall quality of life with 59% forced to give up hobbies and 56% admitting to socialising less. The vast majority rely on their GP/ Doctor (99%) and Pharmacist (85%) for ongoing support on chronic pain. Campaign material has been distributed by Pfizer to pharmacies across the country, encouraging them to show their support for the #TodayIsBetter campaign and inspire the public to engage and share their experience of what it’s like to live with chronic pain. John Molony, Business Unit Lead at Pfizer Ireland said: “Chronic pain can be isolating, debilitating and hard to explain. “We need to ask as a society, what can we all do to make today better

“Chronic pain can negatively affect patients’ functional ability, quality of life and mood. Pharmacists have a key role to play in pain management by providing advice and helping patients to categorise the type of pain they are experiencing in order to provide the best treatment options as quickly and as effectively as possible.” Gráinne O’Leary, Acting CEO and Head of Services at Arthritis Ireland said: “Being heard is an important contributor to well-being. While it doesn’t lessen the physical sensation, increased awareness and understanding of what it’s like to live with chronic pain can have a direct impact on people’s quality of life. This is particularly true for those living with an invisible condition like arthritis.” And John Lindsay, Chairperson, Chronic Pain Ireland commented: “People living with Chronic Pain are living with an invisible illness as often the person does not have any visible symptoms. Your colleague at work or the person standing next to you on the bus or train could have chronic pain, and you would never know it.”

The vast majority, rely on their GP/ Doctor (99%) and Pharmacist (85%) for ongoing support on chronic pain.


Report Brexit could lead to higher prices in border pharmacies A Donegal businessman has warned that the uncertainty of Brexit could have a devastating impact on border pharmacies. The pharmacist heads the Donegal branch of Border Communities Against Brexit, a group of people from both sides of the border representing the business, community and farming sectors, and individuals, who have come together out of concern that the North’s remain vote will not be respected. He said: “We were initially optimistic when we saw the deal and what it said about the border. Yes it was an ambiguous deal but it seemed to have something to keep all sides happy. I had read it three times before 9am on the Friday morning. Of course it only took a day or two for the Tory hardliners to start picking it apart. Fortunately the EU seems to be taking a tough line with them and insisting it must be legally binding. “Most border pharmacies like us do an element of purchasing in the North and this helps to keep our prices low and allows us to maintain a level of competitiveness in the High Street. “It goes without saying that any border or any change to the customs union will inevitably lead to different competitive zones and different prices.”

Tom Murray, Director of Murray Pharmacy group in Donegal

Tom Murray, who owns three Murray’s Pharmacy shops in Donegal, also warned that Brexit could have serious implications for the viability of Ireland as a location for the distribution of medicines. Currently pharmacists offer a joint inititative which allows patients to get medicine at any pharmacy north or south of the border, irrespective of the location of the GP responsible for the prescription. The British Government and the EU have decided to move on to the next stage of Brexit talks after reaching agreement on a number of issues including the fact that there would be no hard border in Ireland.

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But within days alarm bells were sounded in the EU when the British Brexit Secretary David Davis said guarantees on the Northern Ireland border were not legally binding unless the two sides reached a final deal. He told Andrew Marr that guarantees designed to avoid a hard border on the island of Ireland were a "statement of intent". But the Irish government said that as far as it was concerned the agreement signed on Friday between the EU and the UK was binding. Mr Murray said Mr Davis’ remarks had done nothing to reassure border businesses already fearful about the potential impact of Brexit.

He added: “Currently if we are getting deliveries from the north then there is a seamless border. But if there is any form of border imposed then couriers will have to start imposing levies and this will lead to significant new costs for us.” Mr Murray said pharmacies and other border businesses needed urgent clarity about the border situation. “Currently, in purely business terms, the border is imaginary. Goods can flow back and forward without restriction. If there is any sort of new arrangement then we are into the area of levies being imposed and this will have a significant impact on prices which the customer has to pay. “This is a huge issue for us but unfortunately we are a pawn in

a game where Theresa May is clinging on to power and dealing with her internal demons within her own party and the House of Commons.” Mr Murray added: “My other concern is that if the British Government and the 27 EU states do indeed now begin to move on to talk about trade then we will become less and less significant. How steadfast will the border be in upholding our rights and how important will a 300-mile border and the rights of border businesses and pharmacies be in the bigger picture? “There are many challenges to be faced. If you look at Ireland, it is currently viewed as a single market for the distribution of medicines. If you separate that into two then serious questions have to be asked about whether the market is viable. This could lead to an increase in drugs prices or, perhaps, even some drugs being withdrawn.”

"It goes without saying that any border or any change to the customs union will inevitably lead to different competitive zones and different prices.


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Report The uncertainty caused by the Brexit referendum result is already damaging trade and investment and causing currency fluctuations which are impacting on cross-Border business. Mr Murray said Border Communities Against Brexit would continue to lobby hard across Europe so the voices of small border businesses would be heard. “We’ve been to the Dail, to London, to Brussels, we’ve met the DUP and delegations from most of the member states. At the end of the day every community in Ireland benefited from the stability brought about by the Good Friday Agreement and any imposition of a border could significantly damage that. We will keep on the pressure so that the British government respects the north’s Remain vote.

damaging trade and investment and causing currency fluctuations which are impacting on crossBorder business. But all of that will be overshadowed if we see the imposition of tariffs and the restriction of the free movement of goods, services and people across the border.” It is as yet unclear what the ‘regulatory alignment’ agreed between the British and Irish governments as a way to avoid a so-called hard border would mean for Irish pharmacists. Dr Elaine Fahey, a reader in Law at the City Law School in London said she believed ‘Regulatory

“We cannot allow this Brexit vote, which wasn’t even supported by the majority in the north, from impacting on all commiunties on this island in this way. It makes absolutely no sense to have one part of Ireland operating within the EU and another outside it. “However, the British Government insists that it will impose Brexit against the democratic wishes of the majority of people living there. “Brexit will have a devastating impact on border communities here in Donegal. Donegal is bordered by the Counties of Derry, Tyrone and Fermanagh all of which are now be dragged out of the EU. That is why communities, farmers and business people in Donegal are demanding that the British and Irish Governments respect the North’s remain vote.” Mr Murray added; “The uncertainty caused by the Brexit referendum result is already

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Border Communities Against Brexit campaign group

alignment’ would continue to allow doctors North of the Border to write prescriptions for patients to take to their pharmacist South of the Border, with knowledge of the drug standards and systems applicable on the Island through the operation of EU law. She said: “Regulatory alignment is, however, also the only likelihood between the UK and EU for the development of a ‘deep and special’ partnership cum trade agreement. Whether alignment with EU law is called that or convergence does not matter in principle, as the Irish Taoiseach has repeatedly

emphasised to the international media, a core question is: What form of ‘regulatory alignment’ the Prime Minister is committing to?” Throughout last summer, British, Irish and EU officials undertook a detailed “mapping” exercise intended to examine all the areas of north-south co-operation which would be affected by Brexit. They identified more than 140 such areas. The exercise has served to underline the serious challenges posed by any regulatory divergence between the Republic and the North. Healthcare is one area that stands to be profoundly affected. Joint membership of the single market ensures single standards for medical devices, mutual recognition of medical qualifications, mutual acceptance of cross border ambulance activity and so on. Patients on the island of Ireland can fill prescriptions written by doctors on one side of the border in pharmacies on the other side of the border. But for this to happen, doctors and pharmacists need to be working to the same standards and need to know medicines are approved in both the North and South. The EU provides the legislative framework to make this possible. Continued regulatory harmonisation is the only way to ensure it continues to be so.


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News news brief CarePlus Carer of the Year Winner Announced QUINTILES IMS BECOMES IQVIA

Ireland’s Carer of the Year 2017 and four regional Young Carers of the Year were celebrated at a special ceremony held in The Westin, in Dublin.

Quintiles IMS is now trading under the name IQVIA as a result of the merger of IMS Health and Quintiles. IQVIA is a provider of information, innovative technology solutions and services in the field of clinical contract research, which uses data and scientific methods to help health industry stakeholders find better solutions for their clients. “This is a critical moment for our organisation, as we are launching a new name that underlines our vision of helping healthcare stakeholders move forward with healthcare,” said IQVIA Chairman and CEO Ari Bousbib. “IMS Health and Quintiles have joined forces because our customers wanted better and faster ways to bring innovation to patients and to achieve the improvements that the industry has been seeking. Since the merger, we have been working to integrate our expertise in advanced analytics, leading technologies and therapeutic expertise to translate these into powerful, differentiated offerings. We are working to anticipate the inevitable shift in healthcare – with a focus on helping our clients better prepare for the future.” IQVIA was born out of the merger of IMS Health and Quintiles and offers a broad range of solutions that leverage advances in health information, technology, analytics and IQVIA employee skills and experience to spur healthcare. IQVIA enables companies to optimize their concepts of clinical development and commercialization, to foster innovation in the confidence of success and to accelerate the achievement of meaningful results. Currently the company employs approximately 55,000 people in over 100 countries. IQVIA's ongoing commitment to compliance with privacy and security practices coupled with decades of experience are critical to the company's global leadership. IQVIA continues to engage in a variety of governance practices, as well as administrative, technical and physical safeguards and controls to protect the privacy of individuals.

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Catherine Cox, Head of Communications Family Carers Ireland, Mary Kennedy; Paula Robinson, CarePlus Carer of the Year 2017; Marty Whelan; Niamh Lynch, Commercial Director, CarePlus Pharmacy. 48-year-old Paula Robinson from County Cavan was named as The CarePlus Pharmacy Carer of the Year 2017. Paula juggles being a mum to two children with providing full-time, round-the-clock care for both her parents. Her mother Mary has Alzheimer’s disease and her father Jimmy is living with bowel cancer.

provide care for more than one person. Family carers prop up an inadequate health system, often at a high personal cost financially, physically and emotionally.

We really appreciate the support of our new sponsor, CarePlus Pharmacy, and are very proud to announce Paula as our Carer of the Year 2017.”

Paula was presented with her award by broadcasters Marty Whelan and Mary Kennedy, who are both patrons of Family Carers Ireland.

One in twenty people in Ireland today is a family carer, collectively providing ¤10 billion in unpaid care each year. Family Carers Ireland estimate there are 360,000 family carers*. By 2030, demographic changes will require one in five to take on a caring role and an increasing number of carers

Catherine Cox, Family Carers Ireland spoke about the reason for hosting the awards and dedicated a special mention to CarePlus as a new sponsor saying “We host these awards to recognise the huge contribution of our carers. It’s fantastic to be here and see our carers celebrate with their families.

Speaking about their involvement in the Awards, Niamh Lynch, Commercial Director at CarePlus Pharmacy said: “Our pharmacists and their teams meet carers in their communities every single day. We are aware of the enormous sacrifices that carers make and CarePlus is committed to doing its part to help them as much as we can. The relationship between pharmacist and carer is vital, which is why we are a proud sponsor of these awards.”

Operation Mam & Dad sees 1000 gift boxes distributed to housing crisis affected families The campaign launched by CarePlus in partnership with Barnardos was designed to help children affected by homelessness to give their parents a gift for Christmas. CarePlus donated 1,000 gift sets which were distributed nationwide by Barnardos as part of their family and parent support programmes. Speaking about the campaign Niamh Lynch, Commercial Director of CarePlus Pharmacy said “ We can not imagine how difficult it is to live without a permanent home , but sadly there are hundreds of families who face that prospect this Christmas. As a group of community pharmacies, we realise that its important to look after the whole family. Every parent deserves a little something for all the hard work they do for their children. We hoped that “Operation Man and Dad” would add a little extra magic on Christmas Morning.”


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News

IPU launch New Medicine Service Pilot Details of how a New Medicine Service would operate in Ireland have been outlined at the launch of a report by the Irish Pharmacy Union. short-term savings of £75.4 million and long-term savings of £517.6 million.

was delighted to support this important programme undertaken by the IPU.

Speaking at the launch of the report on the pilot programme, the President of the Irish Pharmacy Union (IPU), Daragh Connolly, said that official Irish data suggested that by 2020, around 40% of the adult population in Ireland would have a chronic disease.

“While significant resources are directed to patient care in Ireland, the desired outcomes are not always achieved and one reason for this is poor drug adherence.

Mr Connolly, a pharmacist based in Dungarvan, Co Waterford, said the report showed that the pharmacist-led intervention “resulted in a positive effect on patient adherence for a total of 85% of all patients in the pilot; 77% of patients achieved a 9% improvement in adherence and 8% were referred back to their GP. I believe these findings support the roll-out nationally of an appropriately funded New Medicine Service”. The results also provided information on barriers to implementation of such a service, he said, linked mainly to lack of time and staffing issues, alongside a lack of patient information and indications for new medicines they were prescribed.

Daragh Connolly, President, IPU

The Union says the findings of the pilot support the roll-out nationally of an appropriately funded New Medicine Service. The report follows a pilot NMS programme conducted by 79 pharmacists, and involving 394 patients, across Ireland earlier this year. The main findings showed that a NMS in Ireland would lead to more effective medicine taking, improve patients’ health outcomes and reduce the health budget. The service would also help people who are prescribed a new medicine for certain long-term conditions to better manage their symptoms and improve their medication adherence through clinical support.

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The pilot which, was supported with an educational grant from Pfizer Healthcare Ireland, showed that adherence increased from 37% to 77% after the intervention and support of a community pharmacist. Overall the scheme showed that a pharmacist-led service had a positive effect on patient adherence for 85% of patients. In the pilot; 77% of patients achieved a 9% improvement in adherence, and 8% were referred back to their GP. Economic analysis of a similar service which has operated in the UK since 2011 has found that it offers the NHS increased health gain at reduced overall cost, and provides

The pilot was undertaken in response to the Sláintecare Report which recommended the delivery of healthcare at the lowest level of complexity, in a safe and efficient manner for patients, and with a strong focus on medicines management. Also, the Future Pharmacy Practice in Ireland – Meeting Patients’ Needs, published last year by the Pharmaceutical Society of Ireland, recommended that pharmacists should provide a structured education and adherence programme for newly diagnosed chronic disease patients in order to improve adherence and their health outcomes. Speaking at the launch of the report, the Medical Director of Pfizer, Dr Declan O’Callaghan, said: “Pfizer Healthcare Ireland

“The value of drug adherence can be seen in the unnecessary costs that are often incurred, and the opportunities to advance public health that are lost, when medicines are not taken for their full prescribed course. “ He added: “We look forward to observing how the findings of the report could be applied in a national setting under a New Medicine Service.” The pilot was carried out in conjunction with the School of Psychology in NUI, Galway and registered as a clinical trial. Dr Gerry Molloy, School of Psychology, NUI Galway, said: “Many people with chronic health problems unnecessarily end up in our struggling A&E departments because they did not take their medications as originally prescribed. “A major reason for this is that there is limited support available to people with taking their medications. This is particularly needed when people have been prescribed multiple medications for different health conditions. “New strategies to provide structured ongoing support within the context of community pharmacy have the potential to improve the long-term management of chronic diseases. This could reduce the likelihood of many people experiencing the ordeal that is a prolonged visit to the A&E, and reduce the associated unnecessary healthcare costs that are crippling our public health service.”


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News

License for Medicinal Cannabis granted for the treatment of Chronic Pain A licence for medicinal cannabis has been granted for the treatment of chronic pain for the first time. The move has been described by the medical profession as an “important development.” demonstrates a recognition by Irish medical professionals and the minister for health of the potential therapeutic value of medicinal cannabis for the treatment of chronic pain,” said Prof Finn.

There was a three-week turnaround from the time of application to a licence being granted.

“Chronic pain is the most researched indication for cannabinoids, and the majority of clinical studies, meta-analyses and systematic reviews conclude that cannabis or cannabinoids can be effective in alleviating certain types of chronic pain.

William McLoughlin, national secretary of CPI

Last February, Health Minister Simon Harris announced that he would implement a Health Products Regulatory Authority recommendation that cannabisbased products be made available to some patients with multiple sclerosis and epilepsy, and those suffering nausea in chemotherapy.

The Department of Health approved a three-month licence for tetrahydrocannabinol (THC) for the treatment of severe chronic pain.

However, chronic pain was not included in Mr Harris’ plan. It was on this basis that Chronic Pain Ireland applied to the minister for a licence, for one of their members, along with their medical consultant.

It is the second time such a licence has been granted after Cork boy Tristan Forde, 3, who has a severe form of epilepsy, became the first person in Ireland legally allowed to use cannabis for medicinal purposes, last year. The development has been described by medical professionals and campaigners as hugely significant, as about 20% of the population has chronic pain. At the moment, it is illegal to use medicinal cannabis for medical reasons but a patient’s consultant can apply to the minister for health for a licence on a case-by-case basis. Yesterday, Chronic Pain Ireland announced the licence for THC for chronic pain had been granted as it played a major role in applying for the licence. “It is the first time that the Department of Health has recognised that THC can be used for the treatment of chronic pain,” said William McLoughlin, national secretary of Chronic Pain Ireland.

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“It is the first time that the Department of Health has recognised that THC can be used for the treatment of chronic pain,” said William McLoughlin, national secretary of Chronic Pain Ireland.

A licence for medicinal cannabis has been granted for the treatment of chronic pain for the first time. The move has been described by the medical profession as an “important development”. The Department of Health approved a three-month licence for tetrahydrocannabinol (THC) for the treatment of severe chronic pain. It is the second time such a licence has been granted after Cork boy Tristan Forde, 3, who has a severe form of epilepsy, became the first person in Ireland legally allowed to use cannabis for medicinal purposes, last year. The development has been described by medical professionals and campaigners as hugely significant, as about 20% of the population has chronic pain. At the moment, it is illegal to use medicinal cannabis for medical reasons but a patient’s consultant can apply to the minister for health for a licence on a case-by-case basis. Yesterday, Chronic Pain Ireland announced the licence for THC for chronic pain had been granted as it played a major role in applying for the licence.

There were no formal application guidelines from the Department of Health, so Mr McLoughlin created one from scratch. This is now available on Chronic Pain Ireland’s website. The application included how THC would be administered, details of the patient’s medical consultant, and what dosage they would potentially start on. The patient can take the medicinal cannabis either through tea or by vaping. “Some people are desperate due to chronic pain,” said Mr McLoughlin. “I personally know of people who use cannabis for chronic pain. Some say it works, some say it doesn’t. But you must always go to your doctor.” Professor of pharmacology and therapeutics David Finn, who is also the co-director of the Centre for Pain Research at NUI Galway, said the granting of the licence was an “important development”. “This is a very interesting and important development which

“Approximately 20% of the Irish population suffers from chronic pain, and up to 40% of patients report that the management of their pain is inadequate, either due to the limited efficacy of existing treatments or unacceptably high levels of side-effects.” Solidarity-People Before Profit Alliance TD Gino Kelly has been a longtime campaigner for legalising cannabis for medicinal purposes and brought forward an opposition bill towards this end. The Cannabis for Medicinal Use Regulation Bill 2016, is now entering its third stage of debate and will go before the Oireachtas health committee early next year. “The tide has now turned. It is a significant day for people with chronic pain in Ireland,” said Mr Kelly. A three month licence can be granted on foot of an application made directly to the Minister for Health under section 14 of the Misuse of Drugs Act. Under guidelines from Chronic Pain Ireland, the THC would NOT be consumed via smoking. A patient would ideally take it by vaping or in their tea. Under the strict terms, a medical professional would administer a starting dose, monitor the patient and adjust the dose accordingly, they say. Patients will be placed under constant medical supervision.


News Carrolls Pharmacy using organic nutritional supplement Following the continuing the success of Cellnutrition Quinton, we are featuring another one of the local independent stores, Carroll’s Pharmacy, who are sharing their success. The pharmacy formed a close love for the brand since they were first introduced to the product. Peter is the Head Pharmacist at Carroll’s Pharmacy, in Waterford, and has been working with Carroll’s for many years. Carroll’s is a family run Pharmacy that was founded in 1942 and developed with a strong belief in their pharmacy being the community’s first stop for healthcare. Today, they continue to carry on their original ethos, making the community their main priority and to provide a service that fits their needs. Carroll’s Pharmacy was first introduced to Cellnutrition Quinton by a customer whose child had difficulty with sleeping and eating and had some behavioural issues.The customer had been introduced to Quinton Isotonic through Facebook support groups, where users within this community had suggested that the product had helped many children to regulate sleeping patterns and improve their behaviours. The Pharmacy were asked if it was possible to stock Cellnutrition Quinton Isotonic as no other Pharmacy in Waterford did. This introduction was the first time that the product was brought to Peter’s attention, which lead him to therefore carry out further research into the products benefits to see whether it would be a suitable product to stock in the pharmacy After researching the product himself, Peter discovered the many benefits of the two flagship Cellnutrition products, Quinton Hypertonic and Quinton Isotonic. He discovered that Quinton Isotonic is a product that is suitable for all ages, from birth to pregnant women and the elderly, which is a huge selling point for them. Isotonic mirrors the body’s internal ocean, helping to rebalance and repair the cells to stimulate the immune system and boost the body’s defences against infections. Hypertonic enhances the quality of life for those who live healthy and active lifestyles. The more concentrated

It is estimated there are 55,000 people in Ireland currently living with dementia, with that number expected to rise by more than double by 2040.

Carrolls have now stocked the product for 3 months, and have shared their experience.

The TV ad is part of the Dementia: Understand together initiative and features a family’s story, sharing their experience of caring for a family member who was diagnosed with early stage Alzheimer’s disease. T

What results have your customers experienced since using Cellnutrition Quinton?

What benefits have they noticed? Our customers have noticed increased energy, better sleeping habits and hair and nails growing better and feeling stronger. Why do you think Carroll’s have been so successful selling Cellnutrition Quinton? As a team we have all tried Cellnutrition Quinton and we have also started to get our family members to try it too, all of who can really feel the results. Seeing the benefits for yourself helps us to sell a supplement such as this as it makes it easier to understand the product and its uses. It also helps us promote the product to customers who

TV CAMPAIGN LAUNCHED BY HSE & ALZHEIMER SOCIETY OF IRELAND A new campaign launched by the HSE in partnership with the Alzheimer Society of Ireland has been designed to focus on the difference support from family and friends can make to someone who is caring for a loved one with Dementia.

nature of Quinton Hypertonic provides a boost of energy as it enhances glucose metabolism as well as enhancing cellular nutrition. It is therefore beneficial to those prone to fatigue, and those with a busy or stressful lifestyle.

Since we started selling Cellnutrition Quinton we have had some great feedback from our customers. We have had reports from customers who have found they have more energy, are sleeping better and generally feel great. We also have customers who work night and day shifts who have noticed that it has helped to regulate their sleep, so when they come off the night shift they are finding it easier to get their sleep pattern back to it's normal routine. We have had some amazing feedback from parents whose children have ASD, who have said Cellnutrition Quinton Isotonic has helped to regulate their sleep and also calm some of their behaviours.

news brief

Peter Buchanan, Head Pharmacist, Carroll's Pharmacy

are looking for a supplement to help reduce fatigue and increase energy levels, regulate sleep and want a natural remedy. How important is the supplement market to Carroll’s and its customers? The supplement market is forever growing, but it’s always great to recommend a product that everyone can see really works. The product sells itself and we find it truly inspiring to hear the positive feedback from customers when they return for their next boxes. What is your favourite element with regards to selling Cellnutrition Quinton? We love showing our customers how to use the product and telling them about the benefits it has on their cellular health and wellbeing.

Dr Stephanie O’Keefe, HSE National Director of Health and Wellbeing, speaking about the campaign said “With this campaign, we are hoping to create a greater sense of solidarity in our communities, so that we include people with Dementia and those caring for them, more in our lives. Part of that is seeing the day-to-day reality from a carer’s perspective, and knowing how our help can make a big difference – whether its calling in or phoning a neighbour for a chat, or as a business, undertaking dementia awareness training for customers – each one of us can make a difference in our personal and community lives, while our health service takes on the ongoing challenge of meeting the health and social needs of people living with dementia.” Professor Brian Lawlor, Consultant Psychiatrist and Chair of the Dementia: Understand Together campaign is encouraging people to reach out more to carers. “Carers play an immensely valuable role; however, it can be challenging. Many of those who have received a diagnosis, their families and loved ones often tell of feeling isolated within their communities because family and friends don’t know what to do or what to say. If you know someone who is a carer, don’t be shy or embarrassed, don’t underestimate the difference that continued friendship and emotional support can make.”

25


News

Meagher's helps to wrap up homelessness Staff from Meagher's Pharmacies have been helping to tackle Dublin's homelessness crisis with a series of fund-raising events. "They are people just like you or me and they have fallen into an unfortunate situation and a lot of it is not their fault at all." Oonagh told how she had been inspired to start the campaign after meeting a woman who had been left homeless after her rent was increased. She said the encounter moved her to tears and the next day she contacted the Peter McVerry Trust. She said: "In 2016 we raised 25,000 euros but we aim to double that this time. "I didn't know how to help, I didn't know if giving money was the right thing to do or not. What I like about the Peter McVerry Trust is that they come up with solutions. "They solution to this to this is permanent homes. We want to give seven people the keys to their own homes." Pippa O’Connor, Fashion, Beauty and Style Blogger and Oonagh O’Hagan, Owner and MD of Meaghers Pharmacy Meagher's teamed up with the Peter McVerry Trust to hold a number of charity events throughout December with the aim of raising 50,000 euros. The Peter McVerry Trust has a list of properties throughout Ireland which it is aiming to renovate to provide homes for people who have become homeless. But it costs 7,000 euros to renovate every property and this led to Meaghers and the Trust joining forces for their Christmas Charity #WrapUpHomelessness campaign. One of the most popular events was an exclusive Christmas Market, hosted by Meaghers in association with TV3's Xposé, held at Meetinghouse Square in Dublin. The event featured a selection of favourite household names including Pippa Collection, Waxperts, Cleanse Off Mitt, Sculpted by Aimee, Clarins, Flormar, Blank Canvas, Spotlight Teeth Whitening, BPerfect, REN Skincare and Stylpro. The specially created market square featured a number of exclusive brands while Christmas

26

drinks were provided by Butler's Chocolates and mince pies by Aldi. A specially erected big screen featured a Christmas movie and live music added to the festive atmosphere.

There was an increase of 20% in the number of homeless people in Ireland in 2017. The figures showed that 8,347 people were registered as homeless in September of last year. The campaign's aim is to raise enough money to give someone the gift of a home. Almost half of people experiencing homelessness in Ireland are 24

years of age or younger and there are 10 empty houses in Dublin for every homeless adult. In 2016, Peter McVerry Trust placed 98 people in their own homes In 2016 #Wrap4Homeless focus was on providing beds for the night for those in need. The aim of the latest campaign is to raise enough money to create a permanent solution to homelessness for some people. A more permanent solution, a key in the door, a hearth, a home. This is the long-term vision of Peter McVerry Trust and #WrapUpHomlessness. Ways people helped Donating in store at any Meaghers Pharmacy Donating at www.meaghers.ie and selected ‘Gift Wrap’ to make a donation when they purchased Donated at https://give. everydayhero.com/ie/meaghers and Texting WRAP to 50300 to donate ¤4. Texts cost ¤4. Peter McVerry Trust received a minimum of ¤3.60. With the help from all their customer donations, Meaghers reached their target of ¤50,000.

The first 100 attendees were rewarded with a special goodie bag. Other events in the campaign included a Beauty Breakfast, a Save or Shave fundraiser and a company sleep-out. Meagher's pharmacist Oonagh O'Hagan explained why they become involved with such a worthy cause. She said: "We have stores in eight locations around Dublin and we have a lot of homeless people around them and we know them well. People make assumptions about homeless people, thinking that it is their own fault or they have fallen into addiction but everybody has their own story. It could be anybody's son or daughter, sister or brother. "We know a lot of them by name, they come into our stores every day and swap their change for notes, we know them well.

Meaghers Pharmacy Staff outside the Baggot Street store, sleeping outside the store in solidarity for #wrapuphomelessness campaign


Establishing a healthy gut in infancy has significant benefits for health and wellbeing1 Breastfeeding is best for gut health2

If moving on from breastfeeding... Cow & Gate first infant milk contains a unique blend of prebiotic oligosaccharides*, clinically proven to support the gut microbiota of bottlefed babies3-5 Benefits include: Increased levels of bifidobacteria (good bacteria)3-5 and softer stools3-4 similar to that of a breastfed baby.

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Important Notice: Breastfeeding is best for babies and will protect them from illnesses such as ear infections, stomach upsets, diabetes and obesity. Infant formula is suitable from birth when babies are not breastfed. It is recommended that all formula milks are used on the advice of a doctor, midwife, public health nurse, dietitian, pharmacist or other professional responsible for maternal and childcare. References: 1. Bischoff S. BMC Med. 2011; 9:24. 2. Shamir R, et al., Gut Health in Early Life: Significance of the Gut Microbiota and Nutrition for Development and Future Health. Essential Knowledge Briefing, Wiley, Chichester (2015). 3. Moro G. et al., J Pediatr Gastroenterol Nutr 2002; 34(3):291-295. 4. Moro GE. et al., Acta Paediatr 2003; Suppl 441: 77-79. 5. Knol J. et al., J Pediatr Gastroenterol Nutr 2005; 40(1):36–42. *scGOS/lcFOS: short chain galacto-oligosaccharides/long chain fructo-oligosaccharides

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OBESITY –

A

modern,

mismanaged

&

misunderstood malady – By Dr. Heli Goode, MD, Naturopath CPD 86: AsDIGESTIVE HEALTH published in Positive Health Online – Issue 232, August 2016

a growing and serious health concern that has, by Biography - Dr. Heli Goode,Obesity ARH, isSOH, TCM, specialised in Ear, Nose & now, reached epidemic proportions, mostly in the Westernised Throat surgery in her native Estonia before starting her complementary practice world. Increased consumption of unhealthy food coupled with in England nearly 20 years ago. She integrates naturopathy, homoeopathy, decreased physical activity, in part, has led to rising obesity acupuncture, hypnotherapy rates and over traditional Chinese Medicine. She is available for the past three decades. The WHO (World Health consultations from her clinics in Leicester and Harley Street, London. Dr. Goode Organisation) reports that since 1980, worldwide obesity ratesis a lecturer for holistic medicinal practices. have increased by almost 200%. By the end of 2015 nearly 2.3

billion adults were reportedly overweight and 700 million of these obese. Obesity has been linked to certain cancers, diabetes and may shorten the human lifespan bybased eight to ten years.1 Welcome to the Continuing Professional Development Module. CPDcardiovascular is mandatorydiseases, professional requirements for pharmacists. Journal A grim prediction by theand government suggests that obesityThis will module continue can to rise up toin50% education programmes are an important way of keeping up to date with personal clinical professional development. be -used your personal learning log and can be completed in the magazine orofonline byand completing thewill reflection questions at the end Youwill canhave women 60% of men be overweight by 2050 and up of to the 25%module. of children 2 also track your progress of you development by going to www.pharmacynewsireland.com/cpdtraining where you can register to record your learning. weight issues by that indicated timeframe.

Who is classed as overweight or obese?

INTEGRATIVE HEALTHCARE: MICROBIOME; MISINTERPRETATION & MODERN ISSUES

Reflection - Is this area relevant to my In the 17th Century, a Belgian mathematician and astronomer, Lambert-Adolphe-Jacques practice? What is your existing knowledge Quetelet, became fascinated in possible of numerical links area? between different human any body parts. the subject Can you identify knowledge in the topicinarea? After some calculations he concluded that by taking agaps person‟s weight kilograms (kg) and dividing it by the height in meters (m2),Planning it would -give specific numerical figure which is Willathis article satisfy those unique to every individual. He termed knowledge it the Body Mass to gaps Index or will(BMI) more which, readingaccording be some experts, expresses the correlation required? between the bodyresources weight, coronary insufficiencies, What are available? cholesterol level and expected lifespan. Even though the BMI does not take into account the Action - After reading differences in people‟s ethnic background, ethnic characteristics and the way some the article complete the summary chopped-up, unrecognisable, chemicallyindividuals store fat, in clinical practice it is still a widely used method for assessing questions at www.pharmacynewsireland. altered mixture is treated to even more weight/health-related issues. A greater BMI leads to aand greater riskyour of learning developing cocom/cpdtraining record powerful agents, digestive enzymes, for future usefigure and assessment morbidities as type 2These diabetes. Anyone‟s BMI of more thanin25your indicates “the which are released by thesuch pancreas. personal log. and is classified as overweight.3 In level at which there is a significant increase in mortality” pancreatic enzymes are mighty enough our healthcare system is a key factor in deciding whowill qualifies surgical weight Evaluation - How you putforyour learning to break down proteins, animal fatsit and into practice? reduction procedures.4,5

“Human physiology and the capacity e is absorbed and separated from the solids and this is followed by a process of slow to resist disease will only be fully understood when that microbial organ posting and drying, ready to be formed and packed into small, easily manageable, pellets-like is as well understood as any other organ in the body.” will soon to be eliminated from the whole system. Waste water is directed back ments, which such as or coffee; hence Many of and us are familiar with Hippocrates’ circulation towards the urinaryfoods system tochocolate be enzymes eliminated as urine.I identified By thefurther time the whole the reason whyMany these clinicians have been learning historically famous quote “All disease prefer the Waist Have Circumference Measure to BMIneeds? - a simpler by chemical industry and added in the gut”, and as recent anthropometrical measure whichweight is “also a criterion for the stool metabolic is syndrome”. A waist unt ofbegins processed food is ready to copied exit, one third of the dry of the actually to all sorts of domestic cleaning studies indicate, it is a wisdom which is measurement of moreproducts than 35 inches (88cm) for women and 40 inches (102cm) for men and washing powders. presence of intestine. completes theprocessor next task,and its becoming more acceptable as in our indicates aThe significant health risk.it Still, however we weigh orfood measure it, obesity ria. However, aswidely unexacting it sounds, there is much more to than a This simple fats in the concoction causes a release operating like a waste disposal unit. The current modern healthcare paradigm. related conditions are costing the healthcare system nearly £6 billion annually. It is estimated of specific hormones, persuading the waste absorbed and separated ating within our that by 2050 the cost will have risen toliquid £50 billion per is single year. Our physical andbodies. limbic health is closely 1

3

6

related to digestion and our long-suffering microbiome.2 For many of us, the digestive system revolves around the stomach as a simple organ somewhere in the abdominal cavity. Throw in some antacids, fortified yoghurts, a couple of ‘healthy’ cookbooks or the latest ‘ground-breaking’ diet, promising quick and permanent weight loss with eternal happiness, and that basically covers a large portion of the views held on normal digestion.

gallbladder to pump out bile; an incredibly strong, highly concentrated miracle of nature. Its main purpose is to emulsify fats. Emulsification helps this greasy, messy mass to become water soluble for easier absorption in the next zone, the small intestine.

ROBIOME: THE FORGOTTEN ORGAN

from the solids and this is followed by a 1 process of slow composting and drying, ready to be formed and packed into small, easily manageable, pellets-like excrements, which will soon to be eliminated from the whole system. Waste water is directed back into circulation and towards the urinary system to be eliminated as urine. By the time the whole amount of processed food is ready to exit, one third of the dry weight of the stool is actually bacteria. However, as unexacting as it sounds, there is much

entire digestive tract with its different parts, cells and biochemistry also involves trillions of tiny ria living within our intestines. These a bigger part in our lives than ever Themicro-organisms small intestine, operatingplay like a sorting station, extracts vital nutrients and sends ght and are regarded by some asthe the forgotten leftovers – water, wasteorgan. and a hugeCollectively, it is known as the proportion of bacteria towards the exit, obiome. the last part of the processor, or the large SIMPLE DIGESTIVE TRACT

Too often,is wealook at the digestiveworld tract as microbiome microscopic more or less something purely mechanical, divided into separate units, working like single-celled bacteria, fungi, a simple food processor. The mouth and teeth;viruses. operating like a chopper - to grinding, ea and Invisible the tearing, cutting up food, then mixing it lubricating saliva combined with a d eye,withthese non-human microportion of initial enzymes, producing sonisms,called with their genes, live bolus. With aown push from the lever - or to be anatomically correct, the tongue daily- thelife boluseverywhere; travels down a long outside tube, the oesophagus, ending up in a mechanical nsidehuman of the body. helpWith food mixing bowl,They the stomach. the addition of a strong hydrochloric acid, essing,moreregulate metabolic rate, magic chemistry happens, with the bolus vigorously churning and moving into ce hormones, control immune a soapy liquid mass called chime. When this is ready, it is pushed through the onses muscular and so on. They are also sphincters into the next part of the ‘processor’; the duodenum. Here the ble of influencing our mental , mood and behaviour - basically affecting every part of the whole body. It is estimated that the


CPD 86: DIGESTIVE HEALTH more to it than a simple food processor operating within our bodies. MICROBIOME: THE FORGOTTEN ORGAN The entire digestive tract with its different parts, cells and biochemistry also involves trillions of tiny bacteria living within our intestines. These micro-organisms play a bigger part in our lives than ever thought and are regarded by some as the forgotten organ. Collectively, it is known as the microbiome. The microbiome is a microscopic world of single-celled bacteria, fungi, archaea and viruses. Invisible to the naked eye, these non-human micro-organisms, with their own genes, live their daily life everywhere; outside and inside of the body. They help food processing, regulate metabolic rate, balance hormones, control immune responses and so on. They are also capable of influencing our mental state, mood and behaviour - basically affecting every part of the whole body. It is estimated that the microbes we harbour make up 90% of the body’s total cell count, meaning that about 10% of the rest belongs to the human host. Microbiome is a full collection of genes of all the microbes, fungi and viruses living as a community, constantly adapting and adjusting to the changing environments, actions, toxins, foods and medicines we as hosts are offering them. The human microbiome is considered and recognised as a counterpart to the human genome, and the genes in our microbiome outnumber the genes in our own genome by 100:1.2,3 This bacterial, fungal and viral colony’s every single cell contains its own cellular parts and genes. In an ideal world, we should exist in perfect harmony and synergy with each other, including the human cells, therefore orchestrating the existence of the whole ecosystem taking it “for better, for worse, in sickness and in health.” Microbes are minute primitive forms of life which have colonised planet Earth long before humans occupied it. Ever since we learned to observe them through the lens of a microscope and, especially since antibiotics were discovered, we have waged an on-going war against these tiny microbes. Although too small to be seen, they are powerful enough to be pathogenic and in some cases, even lethal. Bacteria stands accused of all sorts of human maladies. Even though antibiotics have saved thousands of lives, and are undoubtedly needed in certain medical

circumstances, their effect on killing not only pathogens but also healthy bacteria has lead to unintended consequences of proliferating opportunistic bacteria. This shift in microbiome has been linked to the rise of recent Western health problems such as autism, allergies, asthma, skin problems, inflammatory processes, diabetes, obesity, autoimmune disorders, cancers, depression, Alzheimer’s disease and other mental illnesses.4,5 HELICOBACTER PYLORI: ENEMY OR FRIEND? One example of enthusiastic eradication action and its possible consequences to the microbiome involves Helicobacter pylori, a highly intelligent and adaptable micro-organism found in human stomach walls, deeply hidden and well protected against its acid environment, and now declared a public health hazard and medical enemy. Stomach, due to its production of strong, concentrated hydrochloric acid, has been thought to be free from any bacteria, and that pH values less than 4 were capable of keeping the stomach sterile. This was until the early 80s; two Australian doctors, Drs Warren and Marshall, suggested a possible link between the existence of the bacteria, which was named Helicobacter pylori and its pathological effects on its human host, causing gastritis and ulcers.6 It is also argued that H. pylori may be a part of the natural stomach ecology, as over 80% of infected individuals are asymptomatic.7 Dr Martin Blaser, a professor of microbiology at New York University Langone Medical Center and a leading expert in microbiome studies, says: “we know from genetic studies that humans have carried H. pylori for at least 100,000 years, which is as far back as we can determine using available methods. It is reasonable to assume that we have had the microbe with us since the origin of homo sapiens, about 200,000 years ago in Africa.”4 Modern H. pylori derives from ancestral populations having gone through radical transformations as a result of people’s travelling and racial mixing, carried in the stomachs as illegal contraband. Billions of them live in the protective layer of thick mucus inside the human stomach’s corrugated walls, with approximately more than 50% of the world’s population harbouring bacteria in their stomachs.6 Babies acquire their own microbiome from breast milk, their environment and close contact with their mother’s skin. It is not yet understood exactly how this bacteria ends up in baby’s gut but

mothers with eradicated H. pylori, and therefore altered microbiome, bring up children with lowered protection. Dr. Blaser predicts most of our children are growing up with a totally different acid regulation and poor absorption of vitamin B12. Heartburn in young children is increasing alarmingly and children are being treated with acid-regulating medicines similar to their parents.4 Individuals with H. pylori infection may never present with any symptoms related to it, such as acute gastritis, pain - especially with an empty stomach - nausea, dyspepsia, bloating, belching, bleeding or blood in the stool. It is also associated with hypochlorhydria, duodenal ulcers and gastric cancer.6,8 Statistics from numerous studies say that patients colonising H. Pylori have a 10-20% risk of developing peptic ulcers and a 1-2% risk of getting stomach cancer, as well as its link with colorectal polyps and cancer.4 Even outside the GI tract is not safe: H. pylori infections can cause inflammation throughout the body involving connective tissue, and relating to Raynaud’s Syndrome, acne rosacea, ischemic heart disease and lymphoma.8 It is a very intelligent, resilient bacteria, capable of burrowing into the stomach’s mucous lining and reaching the epithelial cells, where it is less hostile and cosily protected from the acidic environment. It neutralises acid around itself by producing urease, which in turn breaks down the stomach urea into carbon dioxide and ammonia. The inflammation caused by this virulent bacteria spreading near the pyloric antrum stimulates G-cells to excrete the hormone gastrin. Gastrin has a negative effect on the parietal cells in the fundus, secreting increasing amounts of corroding acid and contributing to the development of duodenal ulcers. Colonisation in other areas of the stomach also leads to inflammatory reactions with consequent atrophy of the stomach lining, causing the development of stomach ulcers and increasing the risk of stomach cancer.4 Those with low stomach acid levels are at risk of acquiring it too. Stomach acid helps digest food, but it also prevents infections. As we age, we naturally produce less acid, which may suggest why over-50s tend to exhibit a higher prevalence of this infection. Low stomach acid is related to poor digestion, decreased absorption of vitamin B12, and as a pre-curser – to H. pylori infection. It is possible that deficiency of vitamins E and C additionally promote the proliferation of this


CPD 86: DIGESTIVE HEALTH controversial bacterium.8 This is a growing health concern, no doubt, and Dr. Blaser points out “doctors believe that the only good Helicobacter pylori is the dead one” and the only way to control the infection is through a prescription of antibiotics and proton pump inhibitors.4 PROTON PUMP INHIBITORS & HOW THEY AFFECT THE MICROBIOME PPIs are a group of medicines, well known and widely prescribed, which assist the reduction of stomach acid production by blocking the enzyme in the stomach wall. They are used in combination with antibiotics for eradicating H. pylori. They have been associated with 65% increased risk of Clostridium difficile and other enteric infections, and with a significant increase in intestinal pathogens like Enterococci, E. coli, Streptococci and Staphylococci. Recent research indicates “PPI is associated with decreased bacterial richness and profound bacterial changes in the gut microbiome: 20% of the identified bacteria in this study showed significant deviation.” Dr. Floris Imhann claims the effects of PPIs are more prominent then the effects of antibiotics or other commonly used drugs altering the gut microbiome.9 There is also concern that PPIs may interfere with vitamin B12 absorption. John V. Dommisse, MD, an expert in vitamin B12 biochemistry, indicates a strong link between deficiency and neuropsychiatric manifestations including loss of proprioception in the lower limbs, loss of sense of smell, depression, poor memory, psychoses, paranoia, bipolar-1 and -2, saying that “most cases of socalled Alzheimer’s dementia is actually B12 deficiency”.10 Supporting this line of thought, Dr. David Perlmutter and other scientists conclude that depression and its close relative, anxiety, are found to be related to a disrupted gut microbiome, with higher levels of inflammatory processes in the gut, higher cortisol levels, increased gut permeability and extreme stress responses. 2,11 The lack of emotional well-being is a major immediate concern for healthcare authorities, with 7.8% of people meeting criteria for diagnosis of psychological conditions. The most common mental health problem in the UK is mixed anxiety and depression. In 2014, 19.7% of people aged 16 and over showed such symptoms – a 15% increase from 2013. Mental health problems are responsible for the largest burden of disease – 28% of the burden compared to 16% each for cancer and heart disease.12

Long-term use of PPIs is said to be associated with hypomagnesemia, osteoporosis, increased risk of heart attacks, reduced kidney and liver function, pancreatitis, Steven-Johnson syndrome, allergic reactions and deteriorating gastric atrophy, particularly in H. pylori infected patients. It was also recently found that long-term use of PPIs is associated with an increased gastric cancer risk in subjects even after the Helicobacter pylori eradication therapy.13,14

damaging effects on the whole colony. “The intestines of overweight or obese people are found to be dominated by Firmicutes, as opposed to Bacteroidetes, which are predominant in the guts of lean people”, says Dr David Perlmutter.2 Loss or shifts in friendly bacteria due to early childhood exposure to antibiotics, or even through lifestyle choices, can also relate to changes in height and weight among the general population. Nowadays, children are commonly taller and heavier.4

BENEFITS OF HELICOBACTER PYLORI

Among some farmers, it is a well-established practice to give antibiotics to livestock in order to promote growth and weight gain without increasing calories in food. The growth spurt on young farm animals exposed to sub-therapeutic doses of antibiotics in order to make them grow faster most probably has an effect on their microbiome as well.4 The fact that antibiotics are used to promote weight gain in animals leads us to question: would the same happen to children who are exposed to antibiotics in their early years?

Emerging studies, however, are now suggesting that aside from its pathogenic aspect, H. pylori may offer some benefit, in that the colonisation of nonpathogenic H. pylori in the stomach may be purposeful. Its presence is reported to reduce the prevalence of asthma attacks, allergies, rhinitis, dermatitis, inflammatory bowel disease, GORD and oesophageal reflux. According to some researchers, it also offers protective faculties in multiple sclerosis.15 A Canadian study revealed that “antibiotic use in the first year of life was associated with a significantly greater chance of having asthma at the age of seven.”4 Additionally, it was confirmed that “the presence of H. pylori was associated with fewer reactions to the allergens, suggesting that H. pylori can protect against allergy.”4 Further studies are needed; however, what we know so far does suggest a link between decline of this pathogen and a rise in asthma, allergies, hay fever and skin reactions. This indicates protective properties, despite its commonly-regarded culpability for other health issues. Therefore, if the H. pylori infection is introduced as early as possible, the better protection it may provide against several illnesses. However, infections later in life are associated with higher incidences of inflammation and gastric cancer.4,8 H. pylori non-pathogenic strains also help regulate and normalise the secretion of stomach acid. It is found to be closely related to the secretion of hormones like leptin and ghrelin2,3,4,16,17 Both hormones are related to appetite regulation, satiety and weight issues. After a meal, levels of ghrelin are falling, but not in patients without H. pylori. The levels of ghrelin remain stable, telling the brain to carry on eating and inevitably cause weight gain.4,16 WEIGHT GAIN There is also known weight gain among patients who have had their bacteria eradicated by antibiotics due to the

A large cohort UK study lead by Dr Frank I. Scott published in 2016 assessed the association between antibiotic exposure before the age of two and signs of obesity by the age of four. It concluded that administration of three or more courses of antibiotics before the age of two is associated with an increased risk of early childhood obesity. This was due to the possible effect on gut flora, altering the composition and function of the microbiome, predisposing children to obesity as previously seen in livestock.18 Ergo, it is highly possible that antibiotics combined with poor diets work synergistically, leading to weight gain.2,4 GASTRO-OESOPHAGEAL REFLUX DISEASE (GORD) Excess weight and obesity are also confirmed risk factors for gastro-oesophageal reflux disease (GORD). It is more common in men, affecting about 25% of adults, of which 5% suffer daily symptoms. GORD is now one of the fastest-growing health complaints in the developed world, affecting between 10-20% of adults in the UK.4, 19 It can sometimes result in severe complications, leading to oesophageal bleeding, ulcers, chronic scarring and Barrett’s oesophagus which may increase the risk of oesophageal cancer.17 Oesophageal adenocarcinoma, related to obesity and alcohol intake, is the most common oesophageal cancer in the UK.19 Although there is not enough evidence to suggest the H. pylori infection directly


CPD 86: DIGESTIVE HEALTH

causes GORD, there is still an association between them. 80-100% of patients with gastric ulcers and 70% with duodenal ulcers harbour H. pylori in their stomachs, putting this category of patients at risk of further gastro-intestinal complications.8 Altered gut microbiome, over-eating, obesity, alcohol, smoking, coffee, certain medical conditions like hiatus hernia, abnormalities of the lower oesophageal sphincter and some drugs such as calcium-channel blockers or tricyclic antidepressants have produced a new generation of people with more complicated issues related to acid secretion and reflux. For these patients, the rising stomach content mixed with hydrochloric acid, additional enzymes and sometimes bile, causes even more damage to the gullet, creating a need for regular acid-reducing medications. Bile is particularly caustic and reflux of duodenal content is more severe and damaging than from reflux of gastric contents alone. This all makes the treatment of gastro-intestinal issues more complicated and presents the healthcare community with new challenges. SUMMARY It is important to respect the forgotten organ. While invisible to the naked eye, we have seen just how influential it is in daily life. Eradication of specific microbiome members, such as H. pylori, may change the body’s metabolism and disturb microbial composition to the point that it affects the whole ecosystem. It even has an effect on children, who grow up with missing microbes and develop totally new ecosystems of their own. Altered microbiome is a 21st century concern. With our over-enthusiastic war against H. pylori, we have ignored and altered the combined bacterial population, which should be viewed as a system of the body that is indispensable for life. “There is a growing consensus that the composition of the intestinal flora is closely related to health”, says T. Mitsuoka, one of the most influential microbiologists today. If a certain infection, especially H. pylori, is established in the early childhood, it may actually offer protection from several modern health maladies such as chronic stress, autoimmune issues, food allergies, skin problems, asthma, diabetes, cancers and psychological concerns. By allowing the immune system to naturally adjust and adapt, it may help strengthen the body’s natural responses, preventing the development of such diseases. December 2017

REFERENCES 1. Dwayne C Savage. Microbial Biota of the Human Intestine: A Tribute to Some Pioneering Scientists. University of Tennessee, Department of Microbiology. Curr.Issues Intest. Microbiol. (2001) 2(1): 1-15. 2. Dr David Perlmutter, with Kristin Loberg. Brain Maker. Yellow Kite Books. 2015. ISBN 978-1-473-61935-7. 3. Emeran Mayer. The Mind-Gut Connection. Harper Wave. 2016. ISBN: 9780062376558. 4. Martin Blaser. Missing Microbes: How Killing Bacteria Creates Modern Plagues. One World Publications. 2015. ISBN-13: 978-1780746883. 5. Olli Turta and Samuli Rautava. Antibiotics, obesity and the link to microbes – what are we doing to our children?. BMC Med. 2016; 14:5. 6. Alexander Sheh, James G Fox. The Role of the Gastrointestinal Microbiome in Helicobacter pylori Pathogenesis. Gut Microbes. 2013 Nov 1; 4(6): 505-531. 7. P. Bytzer et al. Diagnosis and Treatment of Helicobacter pylori infection. Clinical Guideline. DAN MED BUL. 2011; 58(4):B4271 8. Jordan Reasoner “The Helicobacter pylori Controversy: Does it Really Cause Heartburn, Acid Reflux, and GERD?” 2015 SCD Lifestyle http:// heartburnhelp.scdlifestyle.com 9. Floris Imhann, et al. Proton pump inhibitors affect the gut mircobiome. GUT 2016; Volume 65, Issue 5: 740748. 10. Jerry Tennant. Healing is Voltage. 3rd edition 2013 Pastoral Medical Association.

11. C.K. Zang, J. Hewett, J. Hemming et al. The influence of depression on quality of life in patients with inflammatory bowel disease. Inflammatory Bowel Diseases, vol. 19. no. 8, pp. 1732-1739, 2013. 12. Mental health facts and statistics. www.mind.org.uk. 13. MedicineNet.com. Proton pump inhibitors (PPIs) Drug Class. 14. Helge Lyder Waldum, Reidar Fossmark. Proton pump inhibitors and gastric cancer: a long expected side effect finally reported also in man. Gut 2017; - Published Online First: 20 Nov 2017. Doi:10.1136/gutjnl-2017-315629. 15. Ah-Mee Park, Seiichi Omura et al. Helicobacter pylori and gut microbiota in multiple sclerosis versus Alzheimer’s disease: 10 pitfalls of microbiome studies. 2017. Clinical and Experimental Neuroimmunology. Vol 8, Issue 3 p.215-232. 16. Raphael Kellman. The Microbiome Diet. Da Capo Lifelong Books. 2015. ISBN-13: 978-0738218113. 17. Edward F. Goljan. Rapid Review: Pathology. 4th edition 2014 p.140,181, 428-29. 18. Frank I. Scott, Daniel B. Horton, Ronac Mamtani et al. Administration of Antibiotics to Children Before Age 2 Years Increases Risk for Childhood Obesity. Gastroenterology, 2016; DOI: 10.1053/j.gastro.2016.03.006. 19. Heartburn and gastro-oesophageal reflux disease (GORD)- NHS.UK http:// www.nhs.uk


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Feature

Asthma - Advising on Inhaler Technique Asthma is a long-term condition that can cause a cough, wheezing and breathlessness. The severity of the symptoms varies from person to person. It is an auto-immune condition so exact causes are not known. This article discusses treatment. Non-Pharmacological Management Asthmatics should be advised strongly not to smoke and to lose weight.2 Allergen avoidance measures may be helpful but the benefit of avoiding allergens such as dust mite, animal fur has not been proven in studies.3, 4 Currently there is insufficient or no evidence of the clinical benefit of complementary therapy for asthma such as Chinese medicine, acupuncture, breathing exercises and homeopathy.5 Treatment There is no cure for asthma. Treatment is based on relief of symptoms and preventing future symptoms and attacks from developing. Reliever inhalers A short-acting beta 2-agonist opens the airways. These work quickly to relieve asthma. They work by relaxing the muscles surrounding the narrowed airways. Examples of beta 2-agonists include salbutamol and terbutaline. They are usually blue in colour. They are generally safe medicines with few side effects, unless they are over used. It is important for every asthmatic to have a beta-2 agonist inhaler. If asthmatics need to use their beta agonist inhaler too regularly (three or more times per week) should have their therapy reviewed. The main side effects include a mild shaking of the hands, headache and muscle cramps. These usually only occur with high doses of relievers and usually only last for a few minutes. Excessive use of short acting relievers has been associated with asthma deaths.5, 6 This is not the fault of the reliever medication, but down to the fact that the patient failed to get treatment for their worsening asthma symptoms. In exercise induced asthma, suffers are advised to use a short acting beta 2-agonist, 10-15 minutes before they exercise, and again after two hours of prolonged exercise, or when they finish.

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Preventer inhalers Preventer inhalers are slower acting inhalers that reduce inflammation in the airways and prevent asthma attacks occurring. The preventer inhaler must be used daily for some time before full benefit is achieved. The preventer inhaler usually contains an inhaled corticosteroid. Examples of preventer medicines include beclometasone, budesonide, and fluticasone. Preventer inhalers are often brown, red or orange. The dose of inhaler will be increased gradually until symptoms ease. For example, a patient may start on a beclamethasone 100mcg inhaler and may be put on a beclamethasone 250mcg inhaler if there is not sufficient improvement in symptoms. Preventer treatment is normally recommended if the patient: • has asthma symptoms more than twice a week • wakes up once a week due to asthma symptoms • has to use a reliever inhaler more than twice a week

Regular inhaled corticosteroids have been shown to reduce symptoms, exacerbations, hospital readmissions and asthma deaths.5, 7, 8-11 Most patients require a dose of less than 400mcg per day to achieve maximum or near maximum benefit. Side effects are minimal at this dose. Smoking can reduce the effects of preventer inhalers. Preventers are very safe at usual doses, although they can cause some side effects at high doses, especially over long-term use. The main side effect of preventer inhalers is a fungal infection (oral candidiasis) of the mouth or throat. This can be prevented by rinsing the mouth with water after inhaling a dose. The patient may also develop a hoarse voice. Using a spacer can help prevent these side effects. Long-acting reliever inhaler If short acting bets 2-agonist inhalers and preventer inhalers are not providing sufficient symptom relief, a long-acting reliever (long acting beta 2-agonist) may be tried. Inhalers combining an

inhaled steroid and a long-acting bronchodilator (combination inhaler) are more commonly prescribed than long acting beta 2-agonists on their own. Long acting beta 2-agonists work in the same way as short-acting relievers, but they take longer to work and can last up to 12 hours. A salmeterol (Serevent®) inhaler is an example of a long acting reliever inhaler used in Ireland. Long-acting relievers may cause similar side effects to short-acting relievers, including a mild shaking of the hands, headache and muscle cramps. Long-acting reliever inhalers should only be used in combination with a preventer inhaler. Studies have shown that using a long-acting reliever on its own (without a combination corticosteroid) can increase asthma attack and can even increase the risk of death from asthma, though increased risk of death is small.17 In November 2005, the Food and Drug Administration in the United States issued an alert indicating the potential increase risk of worsening symptoms and sometimes death


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Feature associated with the use of long acting beta 2-agonists on their own.18 Combination inhalers Examples of combination inhalers containing long acting beta 2-agonist and steroids include Seretide® and Symbicort®. Combination inhalers containing beta 2-agonists and corticosteroids can be very effective in attaining asthma control. They have been shown to have better outcomes compared to leukotriene receptor antagonists such as montelukast.19 Both treatment options lead to improved asthma control; however, compared to leukotriene receptor antagonists, the addition of longacting beta 2-agonist to inhaled corticosteroids is associated with significantly improved lung function, symptom-free days, need for short term beta 2-agonists, night awakenings, and quality of life.19 Although the magnitude of some of these differences is small.19 Other Preventer medication If treatment of asthma is still not successful, additional preventer medicines can be tried. Two possible alternatives include: • leukotriene receptor antagonists (Montelukast): act by blocking part of the chemical reaction involved in inflammation of the airways • theophyllines: helps widen the airways by relaxing the muscles around them If asthma is still not under control, regular oral corticosteroids may be prescribed. This treatment is usually monitored by a respiratory specialist. Long-term use of oral corticosteroids has possible serious side effects, so they are only used once other treatment options have been tried. Theophylline is known to cause potential side effects, including headaches, nausea, insomnia, vomiting, irritability and stomach upsets. These can usually be avoided by adjusting the dose. Leukotriene receptor agonists do not usually cause side effects, although there have been reports of stomach upsets, feeling thirsty and headache. When can therapy be reduced? Once control is achieved and sustained, gradual stepping down of therapy is recommended.5 Good control is reflected by the absence of night time symptoms, no symptoms on exercise and the

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use of relievers less than three times a week. Patients should be maintained on the lowest effective dose of inhaled steroids, with reductions of 25-50% being considered every three months. Spacer devices Spacers are large plastic or metal containers with a mouthpiece at one end and a hole for the inhaler at the other. The medicine is puffed into the spacer by the inhaler and it is then breathed in through the spacer mouthpiece. Spacer devices in combination with metered dose inhalers (MDI) have many advantages: a) no need to co-ordinate inhaler activation with inspiration, b) improvement in lung deposition and c) reduction in oropharyngeal deposition (resulting in fewer local side effects and lower systemic absorption).2 Some inhalers emit an aerosol jet when pressed. These work better if given through a spacer, which increases the amount of medication that reaches the lungs and reduce side effects.6 Some patients, especially children and elderly patients, find using inhalers difficult, and spacers can help. When a spacer device is being used, only one puff of the inhaler must occur at a time. Asthma and pregnancy

However, if leukotriene receptor antagonists are needed to control asthma during pregnancy, the GP or asthma clinic may recommend that they are continued. This is because the risks to the patient and child from uncontrolled asthma are far higher than any potential risk from this medicine. Theophyline is often avoided during pregnancy and breastfeeding because of reports of neonatal irritability and apnoea. Written and researched by Eamonn Brady (MPSI), owner of Whelehans Pharmacy in Mullingar References 1. Brennan N, O’Connor T. Ireland needs healthier airways and lungs – the evidence (INHALE). June 2003 2. Stenius-Aaniala B, Pousa T, Kvarnstrom J, Gronlund EL et al. Immediate and long-term effects of weight reduction in obese people with asthma: randomised controlled study. BMJ 2000; 320: 827 3. Cochrane Review on House dust mite control. BMJ 1998; 317: 1105-10, Cochrane Database of Systemic Reviews. 2004 Oct 18; 4

10. Blais L, Ernst P, Boivin J-F, Suissa S. Inhaled corticosteroids and the prevention of readmission to hospital for asthma. American Journal Respiratory and Critical Care Medicine 1998; 158: 126-32 11. Suissa S, Ernsst P, Benayoun S, Baltzan M Et al. Low dose inhaled corticosteroids and the prevention of death from asthma. NEJM 2000; 343: 33236 12. Bucknall CE, Slack R, Godley CC et al on behalf of SCIAD collaborators. Scottish Confidential Inquiry into Asthma Deaths (SCIAD), 19946. Thorax (BMJ) 1999; 54: 978-84. 13. Burr ML, Davies BH, Hoare A et al. A confidential inquiry into asthma deaths in Wales. Thorax (BMJ) 1999; 54: 985-89 14. www.asthmasociety.ie/ all-about-asthma/AsthmaStatistics (accessed by E Brady in 2012) 15. Strachan DP (November 1989). Hay fever, hygiene, and household size. BMJ 299 (6710): 1259–60

Medication used for asthma will not cause any problems for the developing baby in the womb. Due to the changes that take place in the body during pregnancy, asthma symptoms may change during pregnancy. For some women asthma improves, for others asthma worsens and for others asthma stays the same. The most severe asthma symptoms experienced by pregnant women tend to occur between the 24th and 36th week of pregnancy. Symptoms then decrease significantly during the last month of pregnancy.

4. Woodcock A, Forster L, Matthews E Et al. Control of exposure to mite allergen and allergen-impermeable bed covers for adults with asthma NEJM 2003 Jul 17; 349 (3): 225-36

16. Gibson PG, Henry RL, Shah S, Powell H, Wang H (September 2003). "Migration to a western country increases asthma symptoms but not eosinophilic airway inflammation". Pediatric Pulmonology. 36 (3): 209–15

5. British Guideline on the Management of Asthma BTS, SIGN, Revised edition April 2004 www.sign.ac.uk (Guideline 63)

17. Shelley R. Salpeter; Nicholas S. Buckley; Thomas M. Ormiston; Edwin E. Salpeter. Meta-Analysis: Effect of Long-Acting Beta-Agonists on Severe Asthma; Exacerbations and Asthma-Related Deaths. Annals of Internal Medicine. Volume 144, No. 12. June 2006: 904-912

Only 10% of women experience asthma symptoms during labour and delivery, and these symptoms can normally be controlled using reliever medicine.

7. Cates C Chronic Asthma – Extracts from “Clinical Evidence”. BMJ 2000; 323: 976-9

Asthmatics who are pregnant should manage their asthma in the same way as before pregnancy. The medicines used for asthma have been proven to be safe to take during pregnancy and when breastfeeding. The one exception is leukotriene receptor antagonists (Singulair®). There is no evidence that it can harm babies during pregnancy and breastfeeding. However, there is not enough evidence about its safety compared with other asthma medications.

6. Spelman R Guidelines for the diagnosis and management of asthma in general practice ICGP 2003 (Jan)

8. Hatoum HT, Schumock GT, Kendzierski DL. Metaanalysis of controlled trials of drug therapy in mild chronic asthma: the role of inhaled corticosteroids. Ann Pharmacotherapy 1994; 28: 1285-1289 9. O’Byrne PM, Barnes PJ, Rodriquez-Roisin R et al Low dose inhaled budesonide and formoterol in mild persistent asthma. American Journal Respiratory and Critical Care Medicine 2001; 164: 1392-97

18. Advair Diskus, Advair HFA, Brovana, Foradil, Perforomist, Serevent Diskus, and Symbicort Information (Long Acting Beta Agonists). Post Market Drug Safety information for patients and providers. www.fda.gov. November 2005 19. Ducharme FM, Lasserson TJ, Cates CJ. Long-acting beta2-agonists versus antileukotrienes as add-on therapy to inhaled corticosteroids for chronic asthma (Review). Cochrane Review. 2009 (Issue 3):1-107


Your body is designed to move Solgar® 7: The Next Generation In Joint Comfort, Mobility & Flexibility Solgar® 7 brings together seven bio-active nutrients that work together to balance the release of joint enzymes, and structurally support collagen building blocks and sensitive joint cartilage. This unique formulation including a specialised form of collagen (UC-II®), boswellia, turmeric root, and vitamin C:

. Targets multiple pathways

. Provides support for joint stressors brought on by exercise, sports or physical activity

. Helps the body’s range of motion, mobility and flexibility.

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The Science Behind UC-II® and Boswellia Clinical trials indicate undenatured collagen (UC-II®) as more effective than glucosamine and chondroitin, resulting in significant support for daily activities and quality of life.2 Studies also show UC-II® is effective in supporting joint mobility, flexibility and comfort during strenuous exercise in healthy subjects and has been shown to support longer periods of exercise before experiencing joint discomfort.3 A 2011 clinical study showed a compound of Boswellia (Aflapin) effectively supports joint function.4 For more information contact your Solgar® Territory Account Manager or call 01442 890 355

solgar.co.uk/solgar-7

1. The vitamin C in this product helps collagen formation for the normal function of cartilage and bones. It also helps to protect cells from oxidative damage (stress). 2. D. C. Crowley et al. Safety and efficacy of undenatured type II collagen in the treatment of osteoarthritis of the knee: a clinical trial. Int. J. Med. Sci. 2009, 6. 3. J.P. Lugo et al. Undenatured type II collagen (UC-II®) for joint support: a randomized, double-blind, placebo-controlled study in healthy volunteers. Journal of the International Society of Sports Nutrition 2013, 10:48. 4. A. Vishal et al. A Double Blind, Randomized, Placebo Controlled Clinical Study Evaluates the Early Efficacy of Aflapin® in Subjects with Osteoarthritis of Knee. Int. J. Med. Sci. 2011, 8. Food supplements should not be used instead of a varied balanced diet and a healthy lifestyle. Solgar® is a registered trademark. UC-II® is a registered trademark of InterHealth N.I.


News Scholarship for pharmacy student A Tipperary student who wants to open his own community pharmacy has been awarded a prestigious scholarship. Emad Asaleh was awarded a JP McManus All Ireland Scholarship toward his third level education. The awards ceremony took place at the University of Limerick. Minister of State for Higher Education, Mary MitchellO’Connor, TD, presented the awards and the special guest was President, Michael D Higgins. Sponsored by JP McManus, the scheme is set to provide financial assistance to many high achieving students who completed their Leaving Certificate in 2017. Emad Asaleh commented, “It’s amazing, the best part is being recognised by the school and everyone that you won an ‘All Ireland Scholarship. “I’m interested in manufacturing medicines and then after a while I’ll open up my own community Pharmacy.” This is the tenth year of the scholarships, which are sponsored by JP McManus. A total of 125 students from both north and south or Ireland were presented with a third level scholarship certificate. JP McManus has contributed ¤32m to fund the provision of these scholarships each year

Former St Mel's College student Emad Asaleh, accepting his JP McManus All Ireland Scholarship. Also in the photo are St Mel's College Declan Rowley and Minister of State, Mary Mitchell O'Connor

and it is estimated that over 1,300 students from the 32 counties will benefit from the scheme over its duration. The awards are administ ered by the Department of Education and Skills and the Department of Education in Northern Ireland.

The All Ireland Scholarship Scheme provided 25 scholarships to the topperforming students in receipt of the Educational Maintenance Allowance (EMA), who reside in NI and attend a grant aided Post Primary school or further education in NI.

Six scholarships were awarded to the top level three extended diploma students from the further education colleges and 19 scholarships were awarded to top A level students from grant aided post primary schools.

Campaign launched to raise awareness of Shingles In Ireland it is estimated that 1 in 4 people have a chance of getting shingles in their lifetime. A new campaign supported by Age Action and Chronic Pain Ireland, has been launched to make people more aware of the risk of developing shingles. 95% of Irish adults have had chicken pox when they were young so could be at risk of getting shingles when they are older. Usually characterised by a rash which usually affects one side of the body (mainly the torso) less commonly the head, neck and around the eye can also be affected. Commenting on the campaign, John Lindsay, Chairman of Chronic Pain Ireland said “Shingles can greatly affect your quality of life. If you experience long-term pain from shingles, for some people even a slight breeze against the skin can be painful and distressing. The majority of people who experience Post-Herpetic Neuralgia say they have less enjoyment of life and find their sleep, work and social life disrupted. The older you are the more likely you are to have long-lasting nerve pain.” The campaign aims to dispel the many myths and misconceptions about shingles such as: • Can you catch shingles from someone with chicken pox? No, you can only get shingles if you have already had chicken pox. However, if you have never had chicken pox, you can catch it from someone with shingles. • Does shingles only affect old or ill people? No, anyone who has had chicken pox can develop shingles, but it is much more common amongst those over 50. • Can I get shingles if I can’t remember having chicken pox? If you definitely never had chicken pox then you can’t develop shingles, but people often can’t remember so should talk to their local pharmacist or GP about the risk of developing shingles. • Can I get shingles more than once? Yes, some people experience more than once episode of shingles, so should talk a healthcare professional such as their pharmacist about the risk of developing it again.

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Feature

Increased interest in VMS In recent years it is evident that the public have become more health conscious, increasingly interested in their own personal health and ways in which they can look after it themselves.

There is a lot of interest in health and wellness supplements, including vitamins and minerals to be included as part of a daily wellness routine. With social media and social influencers (bloggers) playing a large part in today’s society, people are more aware of the supplements out there and more keen to try nutritional supplements and herbal remedies as part of a balanced lifestyle. I often have people ask me in the pharmacy about a product they have seen advertised on TV or online. Many brands now employ a well-known face as a brand ambassador to help reach their desired target groups. GAA star Valerie Mulcahy was the brand ambassador for Sona throughout the year, and in particular was heavily involved the campaign “Support like No Other” which saw Sona sponsors the Ladies Gaelic Football on TG4. This new interest in health and wellness is somewhere where Pharmacists can get involved;

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using their knowledge and expertise to give people the best appropriate advice. According to Euromonitor International sales of vitamins and dietary supplements in Ireland has grown by 1% in current value terms in 2016 with sales in the category valued at ¤59 million. Euromonitor has predicted an increase of vitamins and dietary supplements at a value CAGR of 1% at constant 2016 prices over the forecast period to reach EUR63 million in 2021. A strong economy, prevalence of obesity ad allergies has fuelled this growth in VMS. Seven Seas Ltd is currently the category leader within vitamins and dietary supplements in 2016 with a value share of 22%. Seven Seas is a well-known and trusted brand amongst Irish consumers and has an expansive product portfolio including multivitamins, fish oils/omega fatty acids and dietary supplements such as evening primrose oil. Overall

sales of pharmaceutical and cosmetic products grew by over 11% in Ireland in 2017 according to Ireland’s Central Statistics Office. Community pharmacies actively promote healthy lifestyles through information events, weight loss programmes, smoking cessation, health checks and many more. With some pharmacies struggling in today’s market, health and wellness is certainly an area to focus on. While supermarkets are a main competitor price wise, pharmacies should actively promote the advantage of expert advice and knowledge available to customers through their pharmacy. Effervescent Vitamin C is the country’s best selling supplement, the likes of Rubex and Berrocca. Sales of children's vitamins are higher than adult one but sales of vitamins for women, such as for pregnancy and menopause, are actively growing. There are many

supplements that specific groups of patients are recommended to take, such as Vitamin D and folic acid. The Department of Health & Children has endorsed the Food Safety Authority of Ireland’s (FSAI) recommendation that ‘All infants, whether breastfed or formula fed, should be given a daily supplement of 5µg (or 200I.U) Vitamin D. This should be provided by a supplement containing vitamin D exclusively’. Results from the latest survey for Safefood’s folic acid campaign have revealed that, while over 95% of women are now fully aware of the benefits of taking folic acid, only 1 in 3 actually routinely take it. The survey coincides with the most recent phase of their campaign, ‘Babies Know the Facts about Folic’. This survey encourages women to take folic acid supplements and help address Ireland’s high incidence rate of Neural Tube Defects (NTDs) like Spina Bifida among new-born babies. Recently-published Irish


Feature Dietary supplements in Ireland has grown by 1% in current value terms in 2016 with sales in the category valued at ¤59 million. research has also shown that 3 out of 4 women who attend for antenatal care have not taken folic acid supplements at the most critical time which is before they become pregnant. There are many ways in which pharmacists can utilise their skills and benefit from the growth of interest in VMS. Pharmacists know their customers and have developed good long-lasting relationships which will enable them to advise and recommend the best products for their needs. Link selling is a way of recommending a specific VMS product with a prescription or another purchase. At this time of year, antibiotic prescribing is at its highest and can leave patients susceptible to adverse effects. The gut flora is very sensitive and the balance cane be affected by illness, poor diet, stress, aging, infection by food poisoning and the use of medications, in particular antibiotics. Antibiotics are unable to distinguish between good and bad bacteria which leaves the bowel vulnerable for the invasion of potentially dangerous bacteria. This disruption of the beneficial bacteria results in side effects such as gastrointestinal upset, involving diarrhoea, wind and bloating. During consultation with patients receiving antibiotics, it would be appropriate to advise them to buy a probiotic to take during and after the course of antibiotics. There are many brands available, and can be taken for different durations, so consultation will aid decision of a suitable product. Some probiotics are available specifically for after antibiotic use, and may be a good start of product to recommend to patients who have never taken them before. Most women visit a pharmacy on a monthly basis, seeking

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products and treatment for menstruation symptoms. Every woman’s cycle is different, with some women experiencing more severe symptoms than others. During this time of the month the body loses key vitamins during menstruation and VMS products can be of huge benefit to women. VMS products can replace essential vitamins lost and ease symptoms experienced by women at this time. This can often be an embarrassing issue to talk about, with many women uncomfortable discussing their symptoms. A way in which Pharmacists can reach these patients is through link selling. Women purchasing sanitary products could be offered a sample of some VMS products that can be of benefit to them. The consultation area is readily available to

have a quick chat about the benefits of certain vitamins and minerals. Typically, most women experience symptoms a week before menstruation, known as PMS. These symptoms can include moodiness, irritability, water retention, fatigue and menstrual pain. A daily supplement of Vitamin 3 400Âľcan help to alleviate symptoms of PMS. Iron and vitamin C are essential nutrients lost during menstruation which can lead to fatigue. An iron supplement taken with a glass of orange juice or an effervescent vitamin C supplement can be recommended. Vitamin B supplements again alleviated fatigue, and also bloating and mood. Cleanmarine For Women is a unique all-in-one product designed specifically for women aged 15-45 years

to give nutritional support especially during menstruation. The product includes Omega 3, Rosemary Oil and Soy Isoflavones as well as a wide range of vitamins to provide extra nutritional support for menstruating women. This is an ideal product for pharmacists to recommend to women, and can be easily promoted through link sales and samples. VMS is a huge area that pharmacies can benefit from. Pharmacies should aim to increase their sales of VMS through link selling and offering various promotions on different products. There is the unique selling point of offesring free pharmacists advice and recommendation with VMS sales through a pharmacy over supermarkets and health food stores. Pharmacists are available to patients in the community, providing expert professional advice without the need for an appointment. With public interest in leading a healthy lifestyle and diet on the increase, pharmacies can easily target and promote sales in this area.


Cleanmarine ÂŽ For Women is a unique all-in-one omega 3 and multivitamin blend designed to regulate hormones throughout the month as well as maintain healthy skin, reduce tiredness and support energy levels. A recent consumer survey confirmed that over 75% of fans purchase Cleanmarine ÂŽ For Women to "help balance hormones throughout the month". How many of your female customers could benefit? Maximise this opportunity and order your Free POS today.

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Feature

One in six couples in Ireland struggle with fertility issues While it’s true that 59% of couples will conceive in about the first three months of trying, that means that a full 41% will not. After six months of trying, about 80% of couples end up conceiving, which leaves 20% of couples questioning why it’s not happening for them.

What are the most common male and fertility issues? Whilst once couples were encouraged to start a family in their twenties, it is now commonplace to delay parenthood, so much so that the average age a woman first gives birth in Ireland is 32. However, it is estimated that one in six couples will experience difficulties trying to conceive. Infertility affects both men and women. In about one in three couples who experience infertility, no cause has been found but it is know that improving nutrition and lifestyle can make a difference. Age can be a factor: • Fertility peak - For women is mid-twenties, begins to decline in their 30s, the decline accelerating from the age of 35.

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• For men, the highest sperm mobility is under age 25. From age 40, sperm genetic quality decreases (Source: ReproMed) • Unhealthy Lifestyle- poor nutrition, smoking, alcohol excess • Weight issues (over and underweight) • Stress • Medical conditions • Irregular periods/hormonal issues For women: • The main issues they face relate to ovulation -are you ovulating regularly and are your eggs healthy?

• Women are born with around 1-2 million follicles (immature eggs). This is their complete supply and they don’t make any more. At puberty the number of eggs has dropped by over half down to 400,000-500,000. With each menstrual cycle up to 1000 follicles begin getting ready for ovulation. Only 1 becomes mature enough to do so. The other 999 or so are lost, so once you start your regular menstrual cycles, you begin to lose eggs on a monthly basis. • Because women are born with their full complement of eggs, they age with the ageing process of the female body. For example eggs aged 20 are fresher at 20 years of age than those at 30 and 40. The older the eggs, the higher the risk of chromosomal or genetic abnormalities occurring.

• Nutrients in food do have the ability to affect our genetic material. This is called our DNA or otherwise known as our blue print. Egg quality refers to whether an egg is genetically normal or has abnormalities. The primary cause of damage to an egg is the ageing process. Simply, egg quality declines with age. As women age, so too do the eggs. If they are bathed in a body that is exposed to excess alcohol, smoking, chemicals from fat cells, poor diet and stress, the egg quality starts to become affected. When the damage goes to a genetic level, it is not possible to reverse it. Thankfully, each month many follicles are produced and with natural selection a healthy body releases the best egg.


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Feature What Else Affects Fertility?

These nutrients continue to be required during the pregnancy as the foetus develops a constant supply of amino acids are essential for protein production. Antioxidants and Immune support

Unhealthy lifestyle poor nutrician, smoking, alcohol excess

Being overweight or underweight

For men: • Low sperm counts, poor quality sperm or both are believed to be the reason for 90% of male infertility causes. Other reasons include genetic issues, possible hormonal imbalances or anatomical issues as well as unexplained reasons which may be caused by an infection which interfere with sperm health. • Sperm takes around 74 days to mature and then around 20 additional days to become capable of fertilisation. This means this is a three month process. It is often possible to improve sperm count by having a good diet and a healthy lifestyle. Where your diet is lacking, taking key nutrients can enhance your everyday diet and help when trying for a baby.

Sress

Medical conditions

KEY NUTRIENTS WHICH CAN HELP AID CONCEPTION (Nutritional information provided by Proceive) Minerals Minerals are essential for both male and female reproductive health. Minerals work together creating a synergy. Multiple mineral deficiencies are common amongst many Irish women. Iron is a vital ingredient required for the production of blood, while zinc plays a pivotal role in the immune system of both the male and female. Vitamins C,K,E and D. B vitamins are vital for the production of energy in the body. Sufficient energy production is required for reproductive health. Sperm production is dependent on a

Irregular periods

steady supply of energy. The female hormone cycle is very delicate. At different times of the month energy requirements fluctuate. Vitamins are the body's helpers which add further support to it energy production. Taking a supplement that contains folic acid is very important to support the developing foetus while B6 is a key player in female hormonal balance and supports the immune system. Amino Acids Amino acids are the building blocks of proteins necessary for growth and repair in the body. L'arginine plays a crucial role in the maintenance of blood flow to both the female and male reproductive organs. L'Citruline works synergistically with L'arginine to enhance this process.

Antioxidants help the body to detoxify and prevent the cells from becoming damaged. Oxidation occurs daily in the body and effects every cell of the body. Sperm is produced in the body and depending on the environment it is produced in determines the health and quality of the sperm. The ovaries release an egg each month. The quality of the egg is dependent on the environment it is immersed in. The role of the immune system in conception and pregnancy is now better understood. Supporting the immune system during this time is now considered of great benefit to reproduction. HOW CAN PHARMACY STAFF HELP ADVISE ON FERTILITY • Be sensitive to the customer needs • Recommend appropriate product with nutrients mentioned in this article. Be aware that some customers may be older than the average age for children or they may have been trying for a year or more and suggest the product with the higher dosage levels of relevant minerals and vitamins to help those trying for a baby.

EXPERT OPINIONS

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Dr. Phil Boyle from Neo Fertility

Gaye Godkin, health nutritionist

Nutrition is essential to conception, so even if you have a healthy, balanced diet, invest in a good quality vitamin for you and your partner. I would always recommend taking a supplement with a comprehensive formulation; women should make sure that they take something that includes B vitamins and magnesium as well as folic acid, whilst men should ensure they are boosting the quality of their sperm with selenium and arginine.

The need to support fertility with good nutrition is increasingly important. Research has shown how vital nutrients are for the development of a healthy foetus, but many people don’t realise how nutrition can make a significant impact during conception too. The reproductive system is very complex and nutritional deficiencies can contribute to difficulties when trying for a baby.


When someone’s put a bit too much of their back into it, recommend Voltarol Gel. Diclofenac diethylammonium

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Voltarol, Ireland’s No.1 Topical Pain Relief Brand†

*than non-medicated gel. †Quintiles IMS, Topical Pain, MAT ending October 2017. Voltarol® Emulgel® P 1% w/w Gel contains diclofenac diethylammonium. Always read the label/leaflet. Trade marks are owned by or licensed to the GSK group of companies. CHGBI/CHVOLT/0278/17. Product Information: Please see Summary of Product Characteristics for full product information: Voltarol Emulgel P 1% w/w Gel (diclofenac). Indications: Trauma of the tendons, ligaments, muscles and joints, e.g. due to sprains, strains and bruises. Localised forms of soft tissue rheumatism. Dosage: Adults: Depending on the size of the affected site to be treated 2-4g (a circular shaped mass approximately 2.0-2.5cm in diameter) should be applied 3-4 times daily. It is recommended that treatment be limited to 7 days. In children aged 14 years and over, consult doctor if required for more than 7 days or if symptoms worsen. Contraindications: Patients with or without chronic asthma in whom attacks of asthma, urticaria or acute rhinitis are precipitated by aspirin or other non-steroidal anti-infl ammatory agents. Hypersensitivity to diclofenac, acetylsalicylic acid or other non-steroidal anti-infl ammatory drugs. Hypersensitivity to any other ingredient of the gel. Use in third trimester, children and adolescents aged less than 14 years iscontraindicated. Warnings and Precautions: Possibility of systemic adverse events if used on large areas of skin and over a prolonged period. Caution with oral NSAIDs as may result in unwanted side effects. Avoid use with other products containing diclofenac. To be applied only to intact, non-diseased skin and not to skin wounds or open injuries. Should not be used with airtight occlusive dressing. Discontinue if skin rash develops. Use with caution in patients with a history of peptic ulcers, gastrointestinal bleeding. Should not be allowed to come into contact with eyes or mucous membranes, should never be ingested. Pregnancy and Lactation: The systemic concentration of diclofenac is lower after topical administration, compared to oral formulations. During the first and second trimester of pregnancy, diclofenac should not be given unless clearly necessary. Diclofenac is contraindicated during the third trimester of pregnancy. Should not be applied on the breasts of nursing mothers, nor elsewhere on large areas of skin or for a prolonged period of time. Side effects: Very rare: rash pustular, hypersensitivity (including urticaria), angioneurotic oedema, asthma, photosensitivity reaction. Rare: Dermatitis bullous. Common: Dermatitis (including contact dermatitis), rash, erythema, eczema, pruritus. Overdose: The low systemic absorption of topical diclofenac renders overdosage extremely unlikely. MA Holder: GlaxoSmithKline Consumer Healthcare (Ireland) Limited, 12 Riverwalk, Citywest Business Campus, Dublin 24, Ireland. MA Number: PA 678/140/2. Legal Category: Pharmacy only. Text revised: December 2017. Further information available on request.


Feature

How to treat and manage sports injuries Knowing how to advise customers to avoid, treat and manage a range of sports injuries correctly can help them steer clear of long-term muscular pain and joint damage. A worringly high percentage of people simply ignore niggling sports injuries or treat them incorrectly. A survey found that men are three times more likely to injure themselves playing sport than women (27 per cent versus 9 per cent), and that a fifth of adults injure themselves playing sport and leave the injury untreated. According to the survey, the commonest injuries that put people out of action for a fortnight or more are: • Backache (15 per cent) • Muscle strains (9 per cent) • Muscle inflammation (7 per cent) • Neck ache (6 per cent). Most sprains and strains can usually be treated with self-care such as the PRICE technique (protection, rest, ice, compression and elevation), and should improve within six to eight weeks – although severe muscle strains may take longer. However leaving an injury untreated can lead to long-term, serious implications. COMMON CONDITIONS Running Injuries Its important that runners look after their joints as well as their muscles. Acute knee injuries include runner’s knee (patellofemoral pain syndrome), which is caused by the impact of running irritating the site where the patella rests against the femur, resulting in sharp or dull pain and swelling. Jogger’s nipple Another common condition – not just experienced by runners – is the obviously named jogger’s nipple. This is caused when the nipples are irritated by chafing against clothing during physical activity. Again, taking a break from running will give the nipple time to heal and an antiseptic cream can help treat the irritation and prevent infection. Shin splints Anyone taking part in strenuous exercise that involves impact or a lot of stopping and starting (e.g. long-distance running, tennis and basketball) can suffer from shin splints – the general term for exercise-induced pain at the front of the shins.

MTSS The commonest cause is medial tibial stress syndrome (MTSS), which is the result of frequent and intense periods of exercise when the body is not used to it. It is important that sufferers don’t continue to exercise in case the pain is a sign of an injury to the bone and surrounding tissues. Customers should be advised to take a break from load-bearing exercise for at least a fortnight and to speak to their GP if the problem persists. Tennis elbow Tennis elbow (lateral epicondylitis) is a self-limiting condition usually caused by overuse of the muscles attached to the elbow that straighten the wrist, leading to pain around the outside of the elbow when bending, extending or lifting the arm. If these muscles and tendons are strained, tiny tears and inflammation can develop near the bony lump (the lateral epicondyle) on the outside of the elbow. Despite its name, tennis elbow is caused by any activity that places repetitive stress on the elbow. Avoiding the activity should help the symptoms to improve, as will applying a cold or gel compress to the area. Paracetamol can help with the pain and ibuprofen will reduce any swelling, but customers should consult their GP if the condition persists. Feet first All kinds of activities can lead to blisters, which are the skin’s way of protecting itself from excessive heat, moisture and friction. Although painful, most blisters will heal on their own unless they become infected, but they can be easily prevented in the first place by covering tender spots with a friction-resistant dressing or plaster. IT is advised that patients who have diabetes have to be particularly vigilant when checking for blisters, as their foot injuries take longer to heal due to poorer blood circulation. Joint action Joints can also benefit from a bit of ongoing care and attention. Injury can occur when a joint is taken outside of its comfortable range of motion, so stronger stabiliser muscles and increased flexibility

lessen the likelihood or severity of an injury. Managing pain Topical analgesics are a popular and effective treatment for the sprains, strains and knocks but it is important that the appropriate product is chosen for the needs of each individual. For example, when someone has suffered a sprain or strain, it should be treated with a cold or freeze product for the first 72 hours to help reduce swelling and inflammation and only when that period is over, the injury should be heated in order to help increase blood flow to the affected area bringing oxygen, proteins and other nutrients to help promote healing. Cold and heath therapies can be used however they are not always practical, which is why many patients use topical analgesics. They are a convenient option and there are a choice of rubs, sprays and patches that combine ease of use with effectiveness. Topical NSAID products that offer an anti-inflammatory action together with pain relief are another option to help with muscle and joint aches and pains arising from sports injuries. Sports supplements While it remains important to follow a varied and balanced diet and healthy lifestyle, some people believe that sports supplements have a role to play in boosting their performance and recovery, and helping them avoid injury. Exercise puts added strain on the body, such as the immune system, muscles and heart. While a balanced, high carbohydrate diet

with plenty of fluid should be the cornerstone of any advice, dietary supplements can also help those taking part in regular exercise. • Multinutrient supplements, which deliver recommended amounts of vitamins and minerals. These are useful as research shows that intakes of vitamin D, iron, calcium, selenium and magnesium are low in the general population, especially women • Omega-3 fatty acids and antioxidant nutrients (e.g. vitamins C and E, selenium) help to reduce inflammation and may help muscle soreness • Vitamin C, vitamin D and zinc are proven to support immune function and may reduce the duration of respiratory illnesses • Products high in nitrates, such as beetroot and spinach, have been shown to boost endurance performance • Products containing caffeine which, if taken before endurance sports such as marathons or long cycle races, can reduce fatigue and improve alertness • Creatine supplements can help build muscle and improve high intensity exercise (e.g. weight) Patients should visit their pharmacy for help in treating minor problem. Pharmacists and counter staff are essential when it comes to offering advice to patients to help them make the appropriate choices about their care. Having a selection of lines from trusted manufacturers gives customers a good choice of market-leading products whilst encouraging the importance of self care.

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News

Amazon in talks about entering pharmaceutical industry Amazon Inc is reportedly in talks with drugmakers about entering the pharmaceuticals market.

It’s more likely that Amazon, which is essentially a logistics powerhouse, would try to get into the wholesale pharmacy business than to try selling directly to consumers. The e-commerce giant has held conversations with Mylan and Sandoz, a unit of Novartis, though it is not clear whether Amazon plans to enter as a drug wholesaler or retailer.

Public records in the US report that Amazon has over the last year gathered regulatory approval from a dozen US states to become a wholesale pharmaceutical distributor.

While the talks have reportedly taken place in the US, speculation is growing about what it could mean for drug manufacturers around the world.

It does not appear that Amazon has the licences it would need to get into pharmacy retail.

Investment Leerink said in a note to investors that President of Sandoz US, Peter Goldschmidt, had "met and discussed with Amazon its plans for getting into the U.S. healthcare market" at a recent biopharma event. The talks are centred on Amazon taking a role in drug purchasing and general manufacturers are keen to establish a relationship with the company next year. But concerns have been raised that such a move could threaten leading distributors.

According to US analysts, Amazon might simultaneously explore both opening a retail pharmacy and contracting generic drugmakers as the two have "low barriers to entry." The market for generic drugs in the US would be a good one for Amazon -- Morgan Stanley says it represents a $79 billion gross profit opportunity across the supply chains. Retail pharmacy, too, could cushion the bottom line with a $52 billion profit pool. In a 70-page report, analysts at

Morgan Stanley broke down all of the potential ways Amazon could get into the US industry, at varying degrees of involvement. "Amazon’s disruption of healthcare is a foregone conclusion," the analysts wrote. "Recent hires and public statements make it clear that Amazon is already moving into medical supply distribution." If Amazon wanted to go all-in and get into the pharmacy business, especially by opening pharmacies at Whole Foods locations, it could be a major boost to Amazon Prime membership in one key demographic: People over 55. "We note too that the older demographic still under-indexes toward Prime membership...which speaks to the opportunity for Pharma to help Amazon further penetrate the ~80 million 55+

However, some in the US industry have raised doubts on the possibility of Amazon dipping its toes into the pharmacy space. Walgreens Boots Alliance CEO Stefano Pessina said he doesn't see it happening because of the regulatory challenges of the US market. "I believe that they will not come in an industry so complicated as our industry. I believe in the end they will use their technology in a different way." It’s more likely that Amazon, which is essentially a logistics powerhouse, would try to get into the wholesale pharmacy business than to try selling directly to consumers—if indeed it decides to get into the industry at all.

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Stefano Pissina, Wallgreens Boots Alliance, CEO

population in the United States," Morgan Stanley analysts wrote in the note. In particular, getting into the pharmacy business might be the right avenue to approach potential Prime members who are over 55 because they're already internetsavvy when it comes to finding cheaper prices or coupons to help them afford their medications. Prime is a big advantage that Amazon has over other online retailers. According to survey data from RBC Capital Markets, more than half of the 2,200 people the group surveyed signed up for Amazon Prime, with more than half of that group spending more than $800 a year on Amazon. Whole Foods doesn't have a pharmacy, though it does sell vitamins and supplements. Setting up pharmacies within Whole Foods could generate an estimated $2.3 billion of pharmacy sales within stores as well, Morgan Stanley analysts said, as well as drive Amazon's Prime Now business, which has free two-hour delivery. "Offering this benefit of convenience will help it compete against traditional retail pharmacies and will provide yet another benefit to being a Prime member," the report said.


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from *Provides significant improvement in quit rates vs. patch alone. †216 person sensory study. NiQuitin Fresh Mint 2/4 mg Medicated Chewing Gum is to be used for the treatment of tobacco dependence by relief of nicotine withdrawal symptoms and cravings. Indicated in adults (18 years and over). NiQuitin Fresh Mint Medicated Chewing Gum 2 mg is suitable for who smoke who smoke 20 cigarettes or less. NiQuitin Fresh Mint Medicated Chewing Gum 4 mg is suitable for smokers who smoke 20 cigarettes or more. Gums should be chewed as directed whenever there is an urge to smoke, to maintain complete abstinence from smoking. Maximum 15 per day. In general, the use of the medicated chewing gum is 2-3 months then the use of gums may be reduced gradually. When daily use is 1-2 gums, use should be stopped. Abrupt cessation: Use a lozenges whenever there is an urge to smoke, maximum of 15 lozenges a day. Continue for up to 6 weeks, then gradually reduce lozenge use. Adolescents (12-17 years): only with advice from a healthcare professional. Contraindications: hypersensitivity to nicotine or any of the excipients and children under the age of 12 years. Precaution: Supervise use if recent MI, unstable or worsening angina, severe CA, uncontrolled hypertension or recent cerebrovascular accident, diabetes, renal/hepatic imapairment, phaeochromocytoma, uncontrolled hyperthyroidism, GI disease. Side effects: Allergic reactions, anaphylactic reactions, insomnia, irritability, dizziness, headache, lightheadedness, tremor, palpitation, tachycardia, atrial fibrillation, hiccups, sore throat, pharyngitis, cough, pharyngolaryngeal pain, dyspnoea, nausea, GI discomfort, sore mouth, vomiting, indigestion, mouth irritation, mouth ulceration, dyspepsia, abdominal upper pain, diarrhoea, dry mouth, constipation, flatulence, oral discomfort, stomatitis, erythema, urticaria, increased sweating, jaw pain, chest pain, arthralgia, myalgia, malaise, parageusia, metallic taste, taste perversion. Legal classification: GSL: PA 1186/19/1 & PA 1186/19/2 MAH: Chefaro Ireland DAC, Treasury Building, Lower Grand Canal Street, Dublin 2, Ireland. RRP (ex. VAT): 30’s €9.99 100’s €24.99. SPCs: http://www.medicines.ie/medicine/17205/SPC/NiQuitin+Fresh+Mint+2mg+Medicated+Chewing+Gum/ NiQuitin 21 mg/24 hrs transdermal patches is indicated for the relief of nicotine withdrawal symptoms including cravings as an aid to smoking cessation. Indicated in adults and adolescents aged 12 years and over. NiQuitin patches should be applied once a day, at the same time each day and preferably soon after waking and worn continuously for 24 hours. Therapy should usually begin with NiQuitin 21 mg/24 hrs. Therapy schedule: Step1 NiQuitin 21 mg/24 hrs transdermal patches for 6 weeks, Step 2 NiQuitin 14 mg/24 hrs transdermal patches for 2 weeks, Step 3 NiQuitin 7 mg/24 hrs transdermal patches for final 2 weeks. Light smokers (e.g. those who smoke less than 10 cigarettes per day) are recommended to start at Step 2 (14 mg) for 6 weeks and decrease the dose to NiQuitin 7 mg/24 hrs for the final 2 weeks. Apply a patch to non-hairy clean dry skin surface, a new skin site should be used every day. Contraindications: non-smokers, children under 12 years and occasional smokers. Precaution: Supervise use if hospitalised for MI, severe dysrhythmia or CVA, If haemodynamically unstable, susceptible to angioedema, urticara, discontinue if severe persistent skin rash. Renal/hepatic impairment, hyperthyroidism, diabetic, phaeochromocytoma, current/previous epilepsy. Pregnancy and lactation: oral formats preferable to patches unless nauseous. Remove patches at bedtime. Side effects: Transient rash, itching, burning, tingling, numbness, swelling, pain urticaria, heaviness, hypersensitivity reactions. Headache, dizziness, tremor, seizures, sleep disorders, nervousness, palpitations, tachycardia, dyspnoea, pharyngitis, cough, GI disturbance, dry mouth, sweating, arthralgia, myalgia, asthenia, malaise, influenza-type illness, fatigue and anaphylaxis. Legal classification: GSL: PA 1186/18/1, PA 1186/18/2 and PA 1186/18/3. MAH: Chefaro Ireland DAC, Treasury Building, Lower Grand Canal Street, Dublin 2, Ireland. RRP (ex. VAT): 14 Day €37.73, 7 Day €20.94. SPCs: http://www.medicines.ie/medicine/6829/SPC/NiQuitin+7mg+24hrs+transdermal+patch es/, http://www.medicines.ie/medicine/4308/SPC/NiQuitin+14+mg+24hrs+transdermal+patches/, http://www.medicines.ie/medicine/4311/SPC/NiQuitin++21mg+24hrs+transdermal+patches/


News

Website offers tips on how to manage everyday illnesses In the winter months the strain on pharmacists and doctors can be at its most intense. Undertheweather.ie was developed by the HSE. The website features information on a number of common ailments such as colds, ear infections, sore throats and bouts of vomiting along with information on how to get through them. It advises when a antibiotic is needed and when you should visit your doctor or pharmacist.

But now a new website launched by the HSE allows patients to educate themselves at home and pick up tips on how to manage common illnesses. The website www. undertheweather.ie features an abundance of information from Irish pharmacists and GPs. Tom Mehar from Duleek Pharmacy appears on the site in an ‘Ask your pharmacist’ video.

Dr Nuala O’Connor explained: “Under the Weather is all about giving people easy to read content to help guide you on how to treat a condition yourself and how to get better – and also when you need to ask for expert help. “Sometimes people feel they need to visit a GP for common illnesses,or when a cold or cough last more than a few day. The site explains how long common viral illness can last, and aims to give

you the confidence to get better at home, without unnecessary antibiotics.” Learning how to manage everyday illnesses with confidence and common sense is a great life skill. Whether dealing with a cold, flu, tummy bug or other minor complaint, the advice on this website is trustworthy because it comes from doctors and pharmacists in Ireland.

It features information about antibiotics are useless against common illnesses such as colds, flu, earaches, tummy bugs and rashes. This is because these infections are caused by viruses and antibiotics don’t work on viruses. Using antibiotics when they’re not needed causes harm, wastes money and creates stronger, bugs that don’t respond to antibiotics. If we become infected with these stronger bugs in the future, we may become very ill and antibiotics may not work. The website can’t ever replace the advice you might get from a health professional.

Accord Ensuring highest quality medicines for Irish Patients The company are preparing for the 2019 Falsified Medicines Directive. Managing Director Tony Hynds commented saying “We in Accord Healthcare are committed to Ireland and ensuring the highest quality products across a wide therapeutic area are available to Irish customers post Brexit. We foresee the problems and we in Accord are working to meet these head on and this is why we have expanded our Regulatory and Quality Teams to ensure we are ready. Our manufacturing and supply chain capabilities are core to our business. Our parent company Intas currently manufactures over 20 billion tabs worldwide and continues to invest in manufacturing capabilities”. The Accord Ireland Quality Team have said how they are preparing for Brexit and FMD requirements and why the main goal of remaining patient focused will not change.

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Natasha Lahart, QA Leader for Accord Healthcare Ireland says “Quality is managed through a robust management system focusing on the patient, therefore delivering a fit for purpose product, which is safe, effective and of the highest quality. Good Distribution Practice (GDP) and Good Manufacturing Practice (GMP) compliance is ensured through tight controls on several quality elements through trending and tracking them. We take our responsibility of ensuring the highest quality products are available to Irish customers very seriously, and of course we stand over the quality of every single batch released onto the market”. The QA team monitor every single pack of medicine. They review items such as, temperature data during transportation to Ireland, storage conditions, quantities

delivered, packing lists, batch release certificate and certificates of analysis, licence numbers etc. only then, after all these rigorous checks are completed and found to be within specification, will a product be released for sale to the market. Another element of paramount importance to the role of the QA team is auditing suppliers. “Ensuring Accord sites are compliant with both our requirements and all applicable EU and international directives. We have internal procedures which guide us on the frequency and scope of audits depending on the service provided by that site. We also have developed a robust supplier verification process whereby each new supplier is verified through numerous check”, explains Natasha.

“The Falsified Medicines Directive which we will be implementing by February 2019 will help strengthen our supply chains further and is a great opportunity to prevent falsified medicines from possibly coming onto the market and adversely impacting patients. There is a responsibility to ensure that we will be fully compliant with the EU Falsified Medicines Directive in order to prevent the possibility of a falsified medicine entering the supply chain. It is well documented that there is a risk to patient if a falsified medicine enters the supply chain, so there is a lot of work going on behind the scenes in all our departments and plants to be ready for February 2019, but we believe it is in the best interests of patient safety and are happy to comply.”


News Biggest commercial deal in world in 2017 struck in Pharmacy sector A US pharmacy chain has promised to deliver a more "personalised health care experience" for customers through its planned merger with a major health insurance provider. CVS Health announced that it had agreed to acquire Aetna in a deal worth approximately $69 billion. The takeover which is reported to be the biggest commercial deal to be struck anywhere in the world in 2017, is awaiting shareholder and regulatory approval, but means that consumers would benefit from a uniquely integrated community health care experience as a result of the merger.

Larry Merlo, CVS Health President

Larry Merlo, CVS Health President and Chief Executive, said: "This combination brings together the expertise of two great companies to remake the consumer health care experience. The merger will allow us to address the growing cost of treating chronic diseases, such as diabetes.”

CVS Health also outlined the benefits to be gained from making better use of data, including potentially halving the existing 20% rate of hospital readmissions. "The entire health care system will also benefit from broader use of data and analytics, leading to improved patient health at substantially lower cost, readmission rates can be cut in half if patients have a complete review of their medications after discharge from the hospital to help them manage their care at home. In addition, home devices to monitor activity levels, pulse, and respiratory rates can be used to prevent readmissions." The companies are said to be expecting to close the deal in the second half of 2018.

Scotland calls for change as Wales announce patient access for pharmacies Director for the Royal Pharmaceutical Society in Scotland, Alex MacKinnon has said the country has been left “lagging behind” following the Welsh government’s decision to hand its pharmacies access to the general practice record. The Pharmacy’s professional leadership body expressed its disappointment with the way ministers have reacted to its calls to ensure pharmacists in the country are able to refer to the patient records. A GP record pilot started in pharmacies in Wales is expected to be rolled out across the entire pharmacy network in March this year. Scotland has often been regarded as a progressive country when it comes to community pharmacy, especially in recent years. In particular pharmacy leaders in England, believe Scotland to be forward thinking about the sector, but it has been a different story when it comes to pharmacists accessing patient records. MacKinnon urged the Scottish government to ensure community pharmacists in Scotland have access to patients’ records as a matter of the “highest priority.”

Alex MacKinnon, Director for the Royal Pharmaceutical Society in Scotland

Meanwhile A Scottish government spokesperson said: “Community pharmacists across Scotland already have access to essential patient information through a dedicated NHS 24 phone line.”

McKinnon speaking about the announcement said “This is great news for patients and community pharmacists in Wales. In England, community pharmacists have had access to the summary care record since 2015. It is clear Scotland is now lagging behind,” he said. “Patients expect healthcare professionals to have the information at hand to enable them to provide the best and safest care and to ensure that the patient journey is seamless across services. “I would encourage the Scottish government to ensure this now takes highest priority to fully enable the transformation of our primary care services.” The RPS said: “We strongly believe that by enabling community pharmacists to access the GP record, people will receive better, safer and more accessible care. “A commitment was made in the previous e-health strategy in Scotland that community pharmacists would have access to the emergency care summary by 2014 but this commitment has yet to be delivered.”

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Events

IACPT host CPE training day The Irish Association of Community Pharmacy Technicians have hosted a Continuing Professional Development training day in Cork. Featuring a sessions on how Neurological Pain blockers work and updates on prescribing guidelines, Benzodiazepine changes and recognizing addictions, the event was a great success.

and regulation of pharmacy technician’s in conjunction with other professional and regulatory bodies, its events like these that help provide the highest possible standard of support for the IACPT members.

The event sponsored by Pfizer, Fleming Medical and PharmaConex offered delegates the chance to expand their continuing professional education as well as have any recruitment or locum questions answered by the PharmaConex team.

Other aims of the association include:

Elaine Lorigan McSweeney, President of the IACPT, is a qualified Pharmacy Technician with over 20 years dispensary experience and was voted in as president, a role which she feels honored to uphold. Working endlessly to achieve the body’s goal of helping attain recognition

• Creating and maintaining links between technicians in Ireland and around the world. • Promoting Community Pharmacy Technicians as an integral part of the patient care team. • Protecting the title of Pharmacy Technician through pursuit of registration and regulation. For more information on events and how to join the IACPT head to http://www.iacpt.ie/

Staunton’s Pharmacy team up with Irish Osteoporosis Society for Awareness Event Staunton’s Pharmacy Group, Castlebar, have teamed up with Irish Osteoporosis Society to host an event to raise awareness of Osteoporosis. The event led by Supervising Pharmacist Joanne Sheridan, was designed with the aim of raising awareness on the importance of calcium and vitamin D supplementation as well as having a health balance of diet and exercise. The event was a huge success with the Irish Osteoporosis Society providng a range of learning materials, to help inform and educate people on the risk of Osteoporosis and what support and guidance can be offered to those who suffer the condition. Supervising Pharmacist, Joanne, who’s idea it was to hold the event explained “I wanted to explain to people what a DXA scan is and who should have one as well as increase awareness about the importance of a balanced healthy diet that includes exercise and supplements that are available.” “One of the services I enjoy the most as a pharmacist is holding information and awareness events. Everyone involved, the Irish Osteoporosis Society, the Mayo Clinic, local physiotherapists and the companies who sent information have all been very supportive so it went really well.”

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Save the Date! Our annual OTC and Retail Pharmacy Product Awards are coming! 1st March will see a celebration and showcase of product innovation, marketing and value to customers, as we recognise the achievements of leading manufacturers and distributors who bring new products and service to retail pharmacies. Now in their fourth year, the awards have become tremendously popular with both manufacturers and pharmacists, attracting a wide-ranging variety of entries and engaging readers every year. Some of the Categories featured in the awards includes:  Most Innovative Product  Best Skincare Product  Best Beauty Product  Best Cough, Cold & Flu Product  Best Pain Relief Product The entries received every year represent those leading the way in innovation, product function, design packaging as well as a number of additional areas. All products entered will be judged by an expert judging panel, which is drawn from independent and multiple-pharmacies across Ireland; from marketing, procurement, right through to shop floor. Our expert panel are made up of professionals with vast experience in the pharmacy field and knowledge of the OTC and front of shop market. The winners will be announced at the annual event, taking place on Thursday 1st March, at the Radisson Blu, Dublin. The winner of each category will be showcased in the April issue of IPN.

Joanne Sheridan, Pharmacist, Stautons Pharamcy overseeing Oesteoprosis event

For more information about the awards contact Natalie Millar, natalie.millar@ ipnirishpharmacynews.ie


Feature Measuring Happiness amongst Psoriasis Sufferers For the 140,000 of Irish people living with psoriasis, it is not just a skin condition. Psoriasis also has a huge effect on mental and psychical health, which is often overlooked. According to the recently published World Psoriasis Happiness report, Psoriasis appears to have a greater negative impact on women. Although both men and women are very much affected physically, emotionally, and psychologically, the data analysis shows, women, on average, experience lower levels of happiness and higher levels of stress and are more often lonely. Impact on Women According to the World Happiness Report, women report higher levels of happiness than men. Although these differences are slight, they are statistically significant in size. However, when it comes to living with psoriasis, the opposite holds true. By looking at gender, the report found a very different happiness gap for men and women. In all severity groups, men consistently score lower than women – for instance, women with severe psoriasis experience a happiness gap of -18.5%, while men ‘only’ experience a gap of -11.3%. To get a clearer picture, the report grouped the scale (Cantril Ladder, where people rate their happiness relative to others on a scale from 0 to 10) into three brackets: 0 - 4, 5 - 6, and 7 - 10. The results show that 47% of women place themselves in the highest, happiest bracket, compared to 52% of men. What is even more interesting and concerning, however, is the fact that roughly 25% of both men and women are placed in the lowest, least happy bracket, painting a rather dismal picture. Confidence and Stress Only 38% of women with psoriasis report that they have often felt good about themselves in the last week, compared to more than half of the men (52%). Similarly, 49% and 56% of women and men respectively reported ‘often’ when asked about feeling loved in the last week. What really stands out is that only slightly more than one in five people feel confident - and this applies to both men as well as women. This only goes to show how psoriasis manifests itself as insecurity in a world that is ever more focused on appearance, looks and perfection. In the same vein, people living with psoriasis are generally

also more stressed, nervous and more easily influenced by outside factors in a negative way. By applying Cohen’s Perceived Stress Scale, there is a clear picture that women with psoriasis are consistently worse affected than their male counterparts. For instance, more than 60% of women, or more than 3 in 5 women, report that they have very or fairly often felt nervous and stressed in the last month. The corresponding amount of men is 42% (approximately 2 in 5), which, although large in itself, is still significantly smaller than for women. Furthermore, when it comes to problems and difficulties, around one in four men (24%) feel that in the past month, they have fairly or very often been unable to overcome them. For women, the number is 36%, equalling more than 1 in 3 feeling this way. 44% of women also report that they have fairly or very often been angered by things outside of their control – once again a number much larger than the 31% for men. Consequently, for people living with psoriasis, a considerably larger number of women than men are negatively affected in their ability to handle personal problems and outside factors.

Feelings of loneliness Psoriasis affects the stress levels, mental wellbeing and ability to handle problems and difficulties of a much larger percentage of women than men. In addition, women also feel lonelier. More than 1 in 4 women (25 - 28%) report that they always feel isolated, left out and lacking in companionship. While still worryingly high, the corresponding amount of men ranges between 19-24%. The picture painted is further confirmed when the report looked at feelings of pride, achievements, accomplishments, etc., as measured by the Rosenberg scale. Slightly more than 50% of women and 44% of men report that they feel useless at times. Both numbers are worryingly large, but, once again, it stands out that women are more affected than men. The same is true when looking at pride: 43% of women agree or strongly agree with the statement that they feel they do not have much to be proud of, compared to 37% of men.

countries, including Ireland. According to the report, 31% of Irish men living with psoriasis reported feeling “left out” all the time, compared to the global male average of 19%. This feeling was also higher among Irish women living with the condition, with 32% per cent feeling “left out”, compared to the global female average of 25%. Almost a quarter (22%) of Irish women reported feeling good about themselves often, while only a third of men (35%) with the condition reported feeling confident. These figures are significantly lower than the global averages of 37% for women and 54% for men. The report also revealed more than 82% of Irish people living with psoriasis feel there is a lack of public awareness about their condition. Just 36% of female Irish sufferers agreed that HCPs fully understand the impact that the condition has on their mental wellbeing and only 29% from the same group felt that they had been informed about all the different treatment options.

Ireland in the Report The research looked at more than 120,000 people in 184

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News Pharmacy Celebrates 10 year birthday Tullyallen Pharmacy in Co. Louth marked its 10 year anniversary by hosting a festive birthday party, inviting all their customers, suppliers and service providers as well as the local community to join them as the marked the occasion. Offering customers 10% discount off instore, the day included arts and crafts activities, as well as some festive caroling and a visit from Santa and his reindeer. The family run pharmacy owned by Pharmacist Dermot Smyth, had a very successful day, with many customers taking to social media to share pictures from the day and saying thank you to the pharmacy for just a great day. Dedicating the pharmacies’ success to the support received from the local community, Dermot commented “Its hard to believe it's 10 years since we opened the door here in Tullyallen Pharmacy. Its been a great journey so far. Of course there have been challenges but thanks to our customers support that we have overcome most of them and managed to keep the door open! Here’s to the next 10 years!”

Pharmacist Dermot Smyth, welcoming guests to their festive themed brithday celebration

Global Pharmacy Technician Symposium Date and location announced The Global Pharmacy Technician Symposium will take place 1-2 September in Glasgow. The event will be held during the 78th World Congress of Pharmacy and Pharmaceutical Sciences and the symposium will be the 7th annual symposium held for pharmacy technicians and support workforce. The theme for this years symposium will be “Partners in Health” and will feature discussions focusing on the roles, education programmes and services that have evolved and serve to define pharmacy technicians and other pharmacy support groups in a variety of contexts globally, particularly as part of the global mid-level health workforce cadre. Featuring high level plenary sessions, interactive discussions and workshops covering a wide range of topics and choices to cater to different interest areas and groups, registration for the event is open now. The parallel sessions to be featured are a first for the Global Pharmacy Technicians Symposium and the programmes will see several clusters of parallel sessions and workshops running concurrently. The sessions are a great opportunity to widen the scope for discussion for all participants and better meet the needs of two distinct target audiences- pharmacy technicians and pharmacists working in partnership and pharmacy administrators, educators, regulators and professional advocates looking to develop the pharmacy workforce within a broader context with health care systems. One of the featured presentations at the symposium will be a talk from Dr Timothy Chen from University of Sydney, who will look at “Interprofessional education” which he believes is an essential component of a health professionals training. “To get the best outcomes, humanistic, clinical and economic – health care professionals must be able to work effectively in teams.” Dr Chen will share his experiences of taking a smallscale programme of IP learning to a large scale, award winning, embedded IP programme across all health disciplines.

Save the date Diabetes Ireland are holding their annual conference and exhibition on the 23rd February 2018. The conference will focus on “Improving Person Centred Diabetes Care through Implementation, Integration, and Innovation.” Offering delegates, a practical and in-depth insight, the conference will contain 3 conference streams which will run concurrently and is intended to meet increased demand with the cycle-of-care programme well embedded across the country, for diabetes information on a variety of topics from top professionals in the field. For more information and to book your place at this years conference visit https://www.diabetes.ie/dice-2018/

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My patient called to say My patient My patient it’s stilltoworking called called to say say it’s working Now I’ve seen Sarah it’sthatstill still working achieve sustained results*1 Now that I’ve seen Sarah with Cosentyx 300mg I know Now that I’ve seen Sarah *1 sustained Iachieve don’t have to waitresults to use it. achieve sustained results*1 with Cosentyx 300mg I know with Cosentyx 300mg I know I don’t have to wait to use it. I don’t have to wait to use it.

100 80 80 100 8/10

achieved clear or almost clear skin at week 162 achieved clear achieved 8/10 or almostclear clear psoriasis or almost clear psoriasis skin at week 162 patients skin at week 162 3 patients Sustained efficacy up to 5 years psoriasis patients 8/10

Sustained efficacy up to 5 Sustained efficacy up to 5

years years

3 3

▼ ▼ ▼

ABBREVIATED PRESCRIBING INFORMATION ▼ COSENTYX 150 mg solution for injection in pre-filled pen. 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. See section 4.8 of the SmPC for how to report adverse reactions. Please refer to the Summary of Product Characteristics (SmPC) before prescribing Presentation: COSENTYX 150 mg solution for injection in pre-filled pen. Therapeutic Indications: The treatment of moderate to severe plaque psoriasis in adults who are candidates for systemic therapy; the treatment of active ankylosing spondylitis in adults who have responded inadequately to conventional therapy; the treatment, alone or in combination with methotrexate (MTX), of active psoriatic arthritis in adult patients when the response to previous disease-modifying anti-rheumatic drug (DMARD) therapy has been ABBREVIATED PRESCRIBING INFORMATION inadequate. Dosage & Method of Administration: Plaque Psoriasis: Recommended dose in adults is 300 mg given as two subcutaneous injections of 150 mg. Dosing at Weeks 0, 1, 2, 3 and 4, followed by monthly maintenance dosing. ▼ COSENTYX 150 mg The solution for injectiondose in pre-filled pen. This medicinal product is subject to additional monitoring. This will allow quick identification of new safety information. Healthcare professionals are asked to report any Ankylosing Spondylitis: recommended ABBREVIATED PRESCRIBING INFORMATIONis 150 mg by subcutaneous injection with initial dosing at Weeks 0, 1, 2, 3 and 4, followed by monthly maintenance dosing. Psoriatic Arthritis: For patients with concomitant moderate to suspected adverse reactions. See section 4.8 ofinadequate the SmPC for how to report adverse reactions. refer to the Summary ofinjection Productwith Characteristics before prescribing COSENTYX 150 mg solution for injection in severe plaque psoriasis or who are responders, the recommended dosePlease isto300 mg by subcutaneous initialidentification dosing(SmPC) at Weeks 0, 1, 2, 3 and 4,Presentation: followed by monthly maintenance 300 any mg ▼ COSENTYX 150 mg solution for anti-TNFα injection in pre-filled pen. This medicinal product is subject additional monitoring. This will allow quick of new safety information. Healthcare professionals aredosing. asked Each to report pre-filled pen. Therapeutic Indications: The treatment ofFor moderate to severe plaque psoriasis in adults who are mg candidates for systemic therapy; theinitial treatment ofatactive ankylosing in adults who havemaintenance responded inadequately dose is given as two subcutaneous injections 150 mg. all other patients, thereactions. recommended by subcutaneous with dosing Weeks 0, 1, 2, 3spondylitis and 4, followed by monthly suspected adverse reactions. See section 4.8 ofofthe SmPC for how to report adverse Pleasedose referisto150 the Summary of Product injection Characteristics (SmPC) before prescribing Presentation: COSENTYX 150 mg solution fordosing. injectionFor in to conventional therapy; theavailable treatment, alone or in that combination with methotrexate (MTX), of active psoriatic arthritis in adult Consideration patients whenshould the response totoprevious disease-modifying anti-rheumatic drugshown (DMARD) therapy has been all of the above indications, data suggest a clinical response is usually achieved within 16 weeks of treatment. be given discontinuing treatment in patients who have no response up to 16 pre-filled pen. Therapeutic Indications: The treatment of moderate to severe plaque psoriasis in adults who are candidates for systemic therapy; the treatment of active ankylosing spondylitis in adults who have responded inadequately inadequate. Dosage & Method of Administration: Plaque Psoriasis: Recommended dose in adults 300 mg given as two subcutaneous injections of 150 Dosing Weeksbelow 0, 1, 2,the 3 and byhave monthly maintenance dosing. weeks of treatment. Some withalone initially partial response may subsequently improve with is continued treatment beyond 16 weeks. andmg. in at children age4,offollowed 18 yearsdrug not yet been established. to conventional therapy; thepatients treatment, or in combination with methotrexate (MTX), of active psoriatic arthritis in adult patients whenThe the safety response toefficacy previous disease-modifying anti-rheumatic (DMARD) therapy has been Ankylosing Spondylitis: The hypersensitivity recommended dose is 150tomg byactive subcutaneous injection with initial dosing atClinically Weeks 0, 1, 2, 3 and active 4, followed by monthly maintenance dosing. Psoriatic Arthritis: ForInfections: patients with concomitant to Contraindications: reactions the substance or to any of in the excipients. infection (e.g. active has themoderate potential to inadequate. DosageSevere & Method of Administration: Plaque Psoriasis: Recommended dose adults is 300 mg given important, as two subcutaneous injections of 150tuberculosis). mg. Dosing atWarnings/Precautions: Weeks 0, 1, 2, 3 and 4, followed by Cosentyx monthly maintenance dosing. severe plaque psoriasis or whoInfections are anti-TNFα inadequate responders, recommended dose is upper 300 mg by subcutaneous injectionsuch withasinitial dosing at Weeks 0, 1, 2, 3treatment and 4, followed by monthly maintenance dosing. Each 300 mg increase theSpondylitis: risk of infections. observed clinical arethe mainly mild orwith moderate respiratory nasopharyngitis not requiring Non-serious mucocutaneous candida Ankylosing The recommended dose is in 150 mg bystudies subcutaneous injection initial dosing at Weeks 0,tract 1, 2, 3infections and 4, followed by monthly maintenance dosing. Psoriaticdiscontinuation. Arthritis: For patients with concomitant moderate to dose is given as two subcutaneous injections of 150 mg. For all other patients, the recommended dose is 150 mg by subcutaneous injection with initial dosing at Weeks 0, 1, 2, 3 and 4, followed by monthly maintenance dosing. For infections morepsoriasis frequently reported for secukinumab than responders, placebo in psoriasis clinical studies. in patients with a chronic infection or a history Instruct patients seek medical advice dosing. if signs Each or symptoms severe plaque or who are anti-TNFα inadequate the recommended dose Caution is 300 mg by subcutaneous injection with initial dosingofatrecurrent Weeks 0,infection. 1, 2, 3 and 4, followed by to monthly maintenance 300 mg all of the above available suggest thataa serious clinical infection, response close is usually achieved within 16 weeks of treatment. should beShould given to discontinuing treatmentwith in patients who have shown no response up to 16 suggestive of as anindications, infection occur. If injections a data patient develops monitoring and discontinue treatment until Consideration the infection resolves. not beWeeks given to active tuberculosis. therapy dose is given two subcutaneous of 150 mg. For all other patients, the recommended dose is 150 mg by subcutaneous injection with initial dosing at 0, patients 1, 2, 3 and 4, followed by monthlyAnti-tuberculosis maintenance dosing. For weeks of treatment. Some patients with partiallatent response may subsequentlydisease: improveCaution with continued beyond 16 weeks. The safety and indisease children the age of years disease, have notinyet been established. should beabove considered prior to initiation in initially patients tuberculosis. betreatment exercised when prescribing to patients withefficacy Crohn’s asbelow exacerbations of 18 Crohn’s some cases serious, all of the indications, available data suggest with that a clinical response isCrohn’s usually achieved within should 16 weeks of treatment. Consideration should be given to discontinuing treatment in patients who have shown no response up to 16 Contraindications: Severe hypersensitivity reactions topatients the active substance or to any of thewith excipients. Clinically important,reactions: active infection (e.g.studies, active tuberculosis). Warnings/Precautions: Infections: Cosentyxinhas the potential to were observed in clinical studies. Close monitoring of with Crohn’s disease treated Cosentyx. Hypersensitivity In clinical rare cases of anaphylactic reactions have been observed patients receiving weeks of treatment. Some patients with initially partial response may subsequently improve with continued treatment beyond 16 weeks. The safety and efficacy in children below the age of 18 years have not yet been established. increase the riskanaphylactic of infections.orInfections observed in clinical studies are mainly mild or moderate upper respiratory tract infections such astherapy nasopharyngitis not requiring treatment discontinuation. Non-serious candida Cosentyx. If an other serious allergic reactions occur, administration should discontinued immediately and active appropriate initiated. Latex-sensitive individuals: The removable cap of themucocutaneous Cosentyx pre-filled Contraindications: Severe hypersensitivity reactions to the active substance or to any of thebeexcipients. Clinically important, infection (e.g. active tuberculosis). Warnings/Precautions: Infections: Cosentyx has the potentialpen to infections more frequently reported for secukinumab than placebo in psoriasis clinical studies. Caution in patients with a chronic infection or a history of recurrent infection. Instruct patients to seek medical advice if signs or symptoms contains the a derivative of naturalInfections rubber latex. Vaccinations: vaccines shouldmild not be concurrently with Cosentyx. Patients may concurrent inactivated or treatment non live vaccinations. Concomitant immunosuppressive increase risk of infections. observed in clinicalLive studies are mainly or given moderate upper respiratory tract infections suchreceive as nasopharyngitis not requiring discontinuation. Non-serious mucocutaneous therapy: candida suggestive of an infection occur. If a patient develops a serious infection, close monitoring discontinue treatment until thevaccines infection resolves. Should not be given towith patients with In active tuberculosis. Anti-tuberculosis therapy Use in combination with immunosuppressants, including or psoriasis phototherapy have not and been evaluated. Interactions: Live not be concurrently Cosentyx. a study in subjects withifplaque no infections more frequently reported for secukinumab thanbiologics, placebo in clinical studies. Caution in patients with a chronic infection should or a history of given recurrent infection. Instruct patients to seek medical advice signs orpsoriasis, symptoms should be considered prior to initiation in patients with latent tuberculosis. Crohn’s disease: Caution should be exercised when prescribing to patients with Crohn’s disease as exacerbations of Crohn’s disease, in some cases serious, interaction was and midazolam 3A4 substrate. No interaction seen whentreatment administered with methotrexate (MTX) and/or Fertility, Pregnancy and Lactation: Women suggestive of anobserved infectionbetween occur. Ifsecukinumab a patient develops a serious(CYP infection, close monitoring and discontinue untilconcomitantly the infection resolves. Should not be given tocorticosteroids. patients with active tuberculosis. Anti-tuberculosis therapy were observed potential in clinicalshould studies. Close monitoring of patients with Crohn’s disease treated with Cosentyx. Hypersensitivity reactions: clinical studies, rare ofCosentyx anaphylactic reactionsashave been observed in patients of childbearing use an effective method of contraception during treatment for at least 20be weeks after when treatment. It isInpreferable to avoid thecases use of in pregnancy aredisease, no adequate datacases fromreceiving the use should be considered prior to initiation in patients with latent tuberculosis. Crohn’s disease:and Caution should exercised prescribing to patients with Crohn’s disease as exacerbations of there Crohn’s in some serious, Cosentyx. If an anaphylactic or otherItserious allergicwhether reactions occur, administration should be discontinued immediately and appropriate therapy initiated. Latex-sensitive individuals: The removable cap of theorCosentyx pre-filled pen of secukinumab in pregnant women. is not known secukinumab is excreted in human milk. A decision on whether to discontinue breast-feeding during treatment and up to 20 weeks after treatment to discontinue therapy were observed in clinical studies. Close monitoring of patients with Crohn’s disease treated with Cosentyx. Hypersensitivity reactions: In clinical studies, rare cases of anaphylactic reactions have been observed in patients receiving contains a derivative of made natural rubber latex. Vaccinations: Live vaccines shouldtonot given concurrently with Cosentyx. Patients may receive concurrent inactivated or on non live vaccinations. Concomitant immunosuppressive therapy: with Cosentyx be account the benefit of breast-feeding thebe child and benefit of Cosentyx therapy to the woman. The effect of secukinumab fertility not beencap evaluated. Undesirable Effects: Cosentyx. If anmust anaphylactic ortaking otherinto serious allergic reactions occur, administration should bethe discontinued immediately and appropriate therapy initiated. Latex-sensitive human individuals: Thehas removable of the Cosentyx pre-filled pen Use in combination with immunosuppressants, including Common biologics,(≥1/100 or phototherapy have not beenrhinorrhoea, evaluated. Interactions: Live vaccines should not be given concurrently with Cosentyx. In a study inexterna, subjects with plaqueconjunctivitis. psoriasis, no Very common (≥1/10); Upper respiratory tract infections. to <1/10); Oral herpes, diarrhoea, urticaria Uncommon (≥1/1,000 to <1/100); Oral candidiasis, tinea pedis, otitis neutropenia, contains a derivative of natural rubber latex. Vaccinations: Live vaccines should not be given concurrently with Cosentyx. Patients may receive concurrent inactivated or non live vaccinations. Concomitant immunosuppressive therapy: interaction was observed between secukinumab and midazolam 3A4 substrate. NoCharacteristics interaction seen administered concomitantly with methotrexate (MTX) and/or corticosteroids. Fertility, Pregnancy and Lactation: Women Rare to <1/1,000) Anaphylactic reactions. Please see(CYP Summary of Product forwhen further information onvaccines undesirable effects. Legal POM. Marketing Authorisation Holder: Novartis Europharm Use in(≥1/10,000 combination with immunosuppressants, including biologics, or phototherapy have not been evaluated. Interactions: Live should not be givenCategory: concurrently with Cosentyx. In a study in subjects with plaque psoriasis,Ltd, no of childbearing potential should use GU167SR, an effective method of contraception during treatment and for at least 20 weeks after treatment. is preferable to avoid the use of Cosentyx in pregnancyAugust as there are no datainformation from the use Frimley Business Park, Camberley, Kingdom. Marketing Authorisation Numbers: EU/1/14/980/004-005. Date ofIt Revision of Abbreviated Prescribing Information: Fulladequate prescribing is interaction was observed between secukinumabUnited and midazolam (CYP 3A4 substrate. No interaction seen when administered concomitantly with methotrexate (MTX) and/or corticosteroids. Fertility,2017. Pregnancy and Lactation: Women of secukinumab in pregnant women. It Ireland is not known whether secukinumab is excreted in human milk.Park, A decision on whether to discontinue breast-feeding during treatment and up on to 20 weeks after treatment or toondiscontinue therapy available upon request from: Novartis Limited, Vista Building, Elm Park Business Park, Elm Dublin 4. Tel: 01-2204100 or at www.medicines.ie. Detailed information this product is also available the website of the of childbearing potential should use an effective method of contraception during treatment and for at least 20 weeks after treatment. It is preferable to avoid the use of Cosentyx in pregnancy as there are no adequate data from the use with Cosentyx must be madehttp://www.ema.europa.eu taking into account the benefit of breast-feeding to the child and the benefit of Cosentyx therapy to the woman. The effect of secukinumab on human fertility has not been evaluated. Undesirable Effects: European Medicines Agency of secukinumab in pregnant women. It is not known whether secukinumab is excreted in human milk. A decision on whether to discontinue breast-feeding during treatment and up to 20 weeks after treatment or to discontinue therapy Very common (≥1/10); Upper respiratory tract infections. Common (≥1/100 to <1/10); Oral herpes, rhinorrhoea, diarrhoea, urticaria Uncommon (≥1/1,000 to <1/100); Oral candidiasis, tinea pedis, otitis externa, neutropenia, conjunctivitis. with Cosentyx must be made taking into account the benefit of breast-feeding to the child and the benefit of Cosentyx therapy to the woman. The effect of secukinumab on human fertility has not been evaluated. Undesirable Effects: Rare (≥1/10,000 toon<1/1,000) Anaphylactic reactions. Please see Summary of Product Characteristics forrepresentative further information undesirable effects. Legal Category: POM. Marketing Authorisation Holder: Novartis Europharm Ltd, Quotes are based verbatim text from dermatologists’ with individual and are not the on entire patient population. Very common (≥1/10); Upper respiratory tract infections. experiences Common (≥1/100 to <1/10);patients Oral herpes, rhinorrhoea, diarrhoea,ofurticaria Uncommon (≥1/1,000 to <1/100); Oral candidiasis, tinea pedis, otitis externa, neutropenia, conjunctivitis. Frimley Business Park,response Camberley, GU167SR, Kingdom. Marketing Authorisation Numbers: EU/1/14/980/004-005. Date of Revision of Abbreviated Prescribing Information: August 2017. Full prescribing information is 1 *Strong levels of to PASI sustained up toUnited 3 years. Rare (≥1/10,000 <1/1,000) Anaphylactic reactions. Please see Summary of Product Characteristics for further information on undesirable effects. Legal Category: POM. Marketing Authorisation Holder: Novartis Europharm Ltd, available upon request from: Novartis Ireland Limited, Vista Building, Elm Park Business Park, Elm Park, Dublin 4. Tel: 01-2204100 or at www.medicines.ie. Detailed information on this product is also available on the website of the Frimley Business Park, Camberley, GU167SR, United Kingdom. Authorisation Numbers: EU/1/14/980/004-005. Date of Revision of Abbreviated Prescribing Information: August 2017. Full prescribing information is References: 1. Bissonnette et al. Br J Dermatol June 2017. 2. Marketing Thaçi D et al. J Am Acad Dermatol 2015; 73(3): 400-409. European Medicines Agency Rhttp://www.ema.europa.eu available upon R. request from: Novartis Ireland Vista Building, Elm Park Business Park, Elm Park, Dublin 4. Tel: 01-2204100 or at www.medicines.ie. Detailed information on this product is also available on the website of the 3. Bissonnette et al. Presented as P2223 at Limited, EADV 2017. European Medicines Agency http://www.ema.europa.eu Quotes are based on verbatim text from dermatologists’ experiences with individual patients and are not representative of the entire patient population. *Strong levels of PASI October response2017 sustained up to 3 years.1 Date of Preparation: Quotes are based on verbatim text from dermatologists’ experiences with individual patients and are not representative of the entire patient population. IE02/COS17-CNF041b References: R etsustained al. Br J Dermatol June 12017. 2. Thaçi D et al. J Am Acad Dermatol 2015; 73(3): 400-409. *Strong levels1.ofBissonnette PASI response up to 3 years. 3. Bissonnette R. et al. Presented as P2223 at EADV 2017. References: 1. Bissonnette R et al. Br J Dermatol June 2017. 2. Thaçi D et al. J Am Acad Dermatol 2015; 73(3): 400-409. 3. Bissonnette R. et al. Presented as P2223 at EADV 2017. Date of Preparation: October 2017 IE02/COS17-CNF041b Date of Preparation: October 2017 IE02/COS17-CNF041b

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Claricell® IT'S ALL ABOUT IMMUNITY Ocean Healthcare is marketing and distributing Claricell with its unique ingredient Wellmune®, developed by Kerry Foods. Wellmune® is a Beta 1,3/1,6 Glucan which is clinically proven to support the immune system.

There are two products in the range - Claricell® Junior with Wellmune® (50mg) which increases the resistance to infection, reduces the symptoms of allergies and has a high concentration of Omega 3 DHA (350mg) and Vitamin D (5µg). It is a unique easy to swallow orange ew product thatsoft aims todrop alleviate the symptoms of Irritableformat Bowel Syndrome. It is flavor and is sugar free.

nted 2QR-complex which is a natural bio-active compound derived from plants ® ® Essential Wellmune (350mg) which increases the resistance to Claricell ely neutralise harmful bacteria. This coupled withwith COLODEX IBS’s innovative fibres estinal activity and improve stool consistency.the Thesesymptoms also act as powerful infection, reduces ofprebiotics allergies, provides immunity protection for adults, promoting colonisation by supporting microbial growth, development & diversity. the elderly contains vitamin D (10µg) 200% of NRV. day course which is very discrete,and easy tofor carrysportspeople and its lemon & lime and flavour tastes all leading pharmacies. Contact info@pharmed.ie for more information.

Available from Ocean Healthcare (01 296 8080) and Wholesalers.

Ocean Healthcare is marketing Ocean Healthcare and distributing is marketing Claricell andwith distributing its unique Claricell ingredient withWellmune®, its unique ingredient developed Wel by Kerry Foods. Wellmune® by Kerry is aFoods. Beta 1,3/1,6 Wellmune® Glucan is awhich Beta is 1,3/1,6 clinically Glucan proven which to support is clinically theproven immune to suppo system. system.

COLODEX IBS

There are two products There in the are range two products - Claricell® inJunior the range with- Claricell® Wellmune® Junior (50mg) with which Wellmune® increases (50mg) the which resistance to infection,resistance reduces the to infection, symptomsreduces of allergies the symptoms and has a high of allergies concentration and hasof a high Omega concentration 3 DHA product that aims to isalleviate theis symptoms oforange Irritable (350mg) and Vitamin D(350mg) (5µg). Itand aVitamin unique D soft (5µg). dropIteasy a unique to swallow soft format drop easy to swallow flavor and format is sugar orange fla is based on the free. patented 2QR-complex which is a natural free.

A revolutionary new Bowel Syndrome. It bio-active compound derived from plants which can selectively neutralise Claricell® Essential with Wellmune® Essential (350mg) withwhich Wellmune® increases (350mg) the resistance which increases to infection, the resistance reduces the to infectio harmful bacteria. This coupled with Claricell® COLODEX IBS’s innovative fibres help symptoms of allergies,symptoms provides immunity of allergies, protection providesfor immunity adults, the protection elderly for andadults, for sportspeople the elderly and and for spo stimulate intestinal activity stool consistency. contains and vitaminimprove D (10µg) contains 200%vitamin of NRV.D (10µg) 200% of NRV. These also act as powerful prebiotics to ‘good’ bacteria Available from Ocean Available Healthcare from (01 Ocean 296 8080) Healthcare and Wholesalers. (01 promoting 296 8080) and Wholesalers. colonisation by supporting microbial growth, development & diversity. The formula is a 5 day course which is very discrete, easy to carry and its lemon & lime flavour tastes great. Available in all leading pharmacies. Contact info@pharmed.ie for more information.

A Head Start for Hair in 2018 with Viviscal What fuels our body is also a key factor for hair health. New Year is also synonymous with the start of many weight loss programmes and faddy diets. Hair follicles are among the most metabolically active in the body and are highly sensitive to calorie deficiency, protein malnutrition and sudden weight loss as well as micronutrient deficiency, effecting hair structure and growth. It’s a fact that by having a well-balanced diet and taking a quality, targeted hair supplement such as Viviscal daily, not only helps hair grow thicker but stronger too. Viviscal’s unique formula is backed by over 25 years of scientific research and is proven to reduce hair shedding by 18% and increase hair thickness by 7%, and contains a rich compound of marine extracts, zinc and biotin to nourish hair from within starting at the hair roots.

New All-Natural Super-Combo: Cannabis Sativa and Turmeric Carun’s new Active Hemp Soap effectively combines both to provide a luxuriously rich but gentle cleansing bar that is naturally antiinflammatory and protective for sensitive skin.

NEW ALL-NATURAL SUPER-COMBO: CANNABIS SATIVA AND TURMERIC

RECOVER – PESTLE & MORTAR’S ULTRA REJUVENATING EYE CREAM Recover – Pestle & Mortar’s Ultra Rejuvenating Eye Cream

An eye-cream formulation which is packed with multi-tasking goodness. The active ingredient, Palmitoyl tripeptide-5 is a powerful peptide which stimulates collagen production from the inside-

out, making it a super-effective anti-ageing tool. Recover hydrates, protects, smooths, soothes and

restores the skin around the eye area. An eye-cream formulation which is packed RRP €38.00 with multi-tasking goodness. The active ingredient, Palmitoyl tripeptide-5 is a powerful peptide which stimulates collagen production from the inside-out, making it a super-effective anti-ageing tool.

Carun’s new Active Hemp Soap effectively combines both to provide a luxuriously rich but gentle cleansing bar that is naturally anti-inflammatory and protective for sensitive skin. Cannabinoids and curcuminoids work together to reduce inflammation, pain, itch, redness and dryness. The super-hydrating effect means it is also suitable for people with psoriasis or eczema.

Cannabinoids and curcuminoids work together to reduce inflammation, pain, itch, redness and dryness. The super-hydrating effect means it is also suitable for people with psoriasis or eczema. Order Line: 0208 544 6908 or info@carun.uk www.carun.uk

Order Line: 0208 544 6908 or info@carun.uk www.carun.uk

Bioxsine for Hair Loss is on TV in January

Recover hydrates, protects, smooths, soothes and restores the skin around the eye area.

Bioxsine is back on national TV on RTE, TV3 and TG4. Bioxsine is scientifically proven to reduce hair loss and increase hair growth. Bioxsine contains Herbal BIOCOMPLEX B11 with unique mineral and vitamin ingredients. The range is formulated to suit the needs of both men and women and has a stronger Forte range for those experiencing greater Bioxsine hair loss. for Hair Loss is on TV in January Available from Ocean Healthcare (01 296 8080) and Wholesalers.

RRP ¤38.00

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Bioxsine is back on national TV on RTE, TV3 and TG4. .

Bioxsine is scientifically proven to reduce hair loss and increase hair growth. Bioxsine contains Herbal BIOCOMPLEX B11 with unique mineral and vitamin ingredients. The range is formulated to suit the needs of both men and women and has a stronger Forte range for those experiencing greater hair loss.


Physiologix – a dynamic new support range designed by Irish Physiotherapists using the latest in innovative design & fabric technologies to provide outstanding comfort and uncompromising support to aid in the recovery of injuries. Now available to pharmacies nationwide.

FREEPHONE 1800 307 777 • FREEFAX 1800 313 395 pharmacy@flemingmedical.ie • www.flemingmedical.ie

DO YOU KNOW A GRADUATE CONSIDERING A CAREER IN PHARMACY? APPLICATION FOR GRADUATE ENTRY PHARMACY NOW OPEN

NOW ACCEPTING APPLICATIONS FOR SEPTEMBER 2018 For further information please visit rcsi.ie/eu-pharmacy-graduate-entry APPLICATION DEADLINE – MARCH 1st 2018

RCSI DEVELOPING HEALTHCARE LEADERS WHO MAKE A DIFFERENCE WORLDWIDE


Clinical Profiles EUROPEAN COMMISSION APPROVES TREMFYA® (GUSELKUMAB) FOR THE TREATMENT OF MODERATE TO SEVERE PLAQUE PSORIASIS IN THE EUROPEAN UNION Janssen’s guselkumab is the first biologic to be approved that selectively blocks interleukin (IL)-23 Janssen announced that the European Commission (EC) has approved TREMFYA® (guselkumab) for the treatment of adults with moderate to severe plaque psoriasis who are candidates for systemic therapy. Guselkumab is the first biologic that selectively blocks interleukin (IL)-23, a key driver of the immune inflammatory response in psoriasis. Guselkumab is a self-injectable (following training) treatment for psoriasis. Treatment requires two starter doses, one initially and the other four weeks later, followed by a maintenance dose once every eight weeks (q8w) thereafter. The EC approval is based on data from three Phase III clinical studies. The VOYAGE 1 and 2 trials, which compared guselkumab with placebo and HUMIRA® (adalimumab), showed high levels of skin clearance after just 16 weeks, with at least a 90% reduction in Psoriasis Area and Severity Index score (PASI 90) in 73.3% and 70.0% of patients receiving guselkumab, compared with 49.7% and 46.8% in patients receiving adalimumab, respectively (P<0.001).

NEW DATA SHOW SYMPTOM IMPROVEMENT WITHIN ONE WEEK FOR PATIENTS WITH MODERATELY TO SEVERELY ACTIVE CROHN’S DISEASE TREATED WITH STELARA® (USTEKINUMAB) Janssen presented new late-breaking data from UNITI-1 assessing Crohn’s disease symptom improvement in patients during the first 2 weeks after an intravenous (IV) infusion dose of STELARA® (ustekinumab). The data presented at the 25th United European Gastroenterology Week (UEGW 2017) showed that patientreported symptom improvement began as early as day 1 post ustekinumab IV infusion and was observed consistently at day 8 and beyond when compared with placebo.

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This analysis from the UNITI-1 trial involved patients with moderately to severely active Crohn’s disease who were intolerant or refractory to anti-TNF treatment. Patients received an IV infusion dose of ustekinumab (130mg or ~6mg/kg) or placebo at Week 0 (baseline). Symptom improvement was assessed using patient-reported outcomes from the Crohn’s Disease Activity Index (CDAI), three components were measured: daily frequency of loose stools (SF), abdominal pain (AP) and general wellbeing (GWB). Patients collected CDAI data in diaries from week 0, allowing investigators to identify when patients first experienced symptom improvement. Janssen also presented new data from an analysis of the UNITI programme evaluating the efficacy of ustekinumab at week 16 in patients who either had or had not responded to ustekinumab at week 8.[ii] The data showed that of the 219 patients who did not respond after ustekinumab IV induction (~6 mg/kg) in UNITI-1 and UNITI-2, 37.6% and 60.5% respectively had responded at week 16, 8 weeks after their first subcutaneous (SC) ustekinumab 90mg maintenance dose. For patients receiving an IV induction dose of 6mg/kg in UNITI-1 response and remission rates were 37.8% and 20.9% respectively at week 8 and had increased to 47.4% and 24.1% at week 16 (8 weeks after the first SC ustekinumab 90mg maintenance dose). For patients receiving an IV induction dose of 6mg/kg in patients in UNITI-2 response and remission rates were 57.9% and 40.2% respectively at week 8 and had increased to 73.7% and 55.5% at week 16.

ACCORD LAUNCH ENTECAVIR 0.5 MG FILM-COATED TABLETS Accord Healthcare is delighted to announce the launch of Entecavir 0.5 mg Film-coated Tablets in pack sizes of 30 tablets. Entecavir 0.5 mg Film-coated Tablets are indicated for the treatment of chronic hepatitis B virus (HBV) infection in adults and children aged 2 to 18 years. Please refer to the Summary of Product Characteristics (SPC) available at www.accord-healthcare.ie for further information.

Your Accord Representatives are: John MacHale, 086 884 1114, Cork, Kerry, Limerick, Waterford, Kilkenny. Richard Doherty, 087 667 1725, Clare, Donegal, Galway, Tipperary, Mayo, Offaly, Sligo. Louise Mooney, 086 044 3956, South County Dublin, Carlow, Kildare, Laois, Wexford, Wicklow.

NEW LIXIANA® SUB-ANALYSES FROM THE ENGAGE AF-TIMI 48 TRIAL PRESENTED AT THE AMERICAN HEART ASSOCIATION ANNUAL SCIENTIFIC SESSIONS 2017. Daiichi Sankyo Europe GmbH announced results of two subanalyses from its global phase 3 ENGAGE AF-TIMI 48 trial that evaluated the safety and efficacy profile of edoxaban (brand name LIXIANA®) in patients with AF. The first sub-analysis explored the implications of bleeding severity as defined by commonly used clinical classification scales for patients with AF. The second included a post-hoc analysis from the ENGAGE AFTIMI 48 trial, providing insights on edoxaban in AF patients with established CAD, and found those on an edoxaban regimen (60/30 mg) versus warfarin had greater reductions in ischaemic events, compared to those without CAD. The data was presented at the American Heart Association (AHA) Scientific Sessions on 11 – 15 November in Anaheim, California. In the sub-analysis that assessed bleeding event severity in AF patients, findings showed that across four commonly used definitions, there was an over four-fold difference in the number of bleeding events in patients with AF at elevated risk of stroke. When patients were ranked based on severity of bleeding events they experienced, the data demonstrated that for those taking edoxaban, bleeding risk reductions increased with greater severity of bleeding.

Entecavir 0.5 mg Film-coated Tablets are now available from Uniphar and United Drug.

Significantly lower rates of bleeding were observed in patients taking edoxaban compared to warfarin, including ISTH major bleeding events (2.8 versus 3.4%), TIMI major bleeding events (1.1 versus 1.7%), BARC type 3c+5 bleeding events (0.4 versus 1.0%) and GUSTO severe/life-threatening bleeding events (0.6 versus 1.2%).

For further information please contact your Accord representative, call Accord in Cork on 021-461 9040 or visit www.accord-healthcare.ie

In the second sub-analysis, findings showed that among AF patients with known CAD, those treated with edoxaban compared to warfarin, had greater reductions

in stroke/systemic embolic events (SEE) (1.4 versus 2.1%) and myocardial infarction (MI) (1.4 versus 2.0%), compared to patients without CAD [stroke/SEE in edoxaban vs warfarin (1.6 versus 1.7%); MI in edoxaban vs warfarin (0.5 versus 0.4%)].2 Major bleeding rates in patients who received edoxaban were significantly lower than in patients who received warfarin, regardless of CAD status [CAD patients on edoxaban versus warfarin (3.6 versus 4.4%); patients without CAD on edoxaban versus warfarin (2.5 versus 3.2%)].

NOVARTIS ANNOUNCES PHASE III STRIVE DATA PUBLISHED IN NEJM DEMONSTRATING SIGNIFICANT AND SUSTAINED EFFICACY OF ERENUMAB (AMG 334) IN MIGRAINE PREVENTION Novartis announced that the New England Journal of Medicine (NEJM) published positive results from the six-month Phase III STRIVE study evaluating erenumab in the prevention of episodic migraine (defined in STRIVE as 4 to 14 migraine days per month). Erenumab delivered clinically meaningful and statistically significant differences from placebo for all primary and secondary endpoints including those measured by the novel, validated Migraine Physical Function Impact Diary (MPFID)2. Treatment with erenumab was well tolerated, with a safety profile comparable to placebo. Erenumab is the first and only fully human monoclonal antibody of its kind, designed to specifically block the CGRP receptor, which plays a critical role in migraine activation. STRIVE enrolled 955 patients, who were randomized to receive either placebo or subcutaneous erenumab 70mg or 140mg once a month, for six months. Patients taking erenumab at the higher dose experienced a significant 3.7day reduction in monthly migraine days from the baseline of 8.3 days (3.2-day reduction with 70mg, 1.8day reduction with placebo, both p<0.001). Fifty percent of patients taking erenumab 140mg had their migraine days cut by at least half, representing a significantly higher likelihood of achieving this response compared to placebo (43.3% with 70mg; 26.6% with placebo, both p<0.001; odds ratios of 2.8 and 2.1 respectively for 140mg and 70mg). STRIVE endpoints were assessed from baseline to the average of the last three months (months 4, 5, 6).


Pharmacy for Sale â&#x20AC;&#x201C; Kerry

This is an excellent opportunity to acquire a growing pharmacy business in Co. Kerry. The pharmacy operates from a new, purpose built unit which adjoins a busy GP surgery and benefits from strong retail activity and growing dispensary trade. This business is well positioned to service the health, wellbeing and beauty needs of local consumers and the bustling tourist market.

All enquiries to sfitzgerald@fitzgeraldpower.ie 051 870152

Supervising Pharmacist

Required for a small busy pharmacy in Ballinalsoe, Co. Galway Excellent package for the right candidate Excellent Headoffice support and great team Candidates must be customer focused and be commercial savvy

Contact Philip 086 8934558 or email; jobs@mcgoriskspharmacy.com


January 2018 - Irish Pharmacy News  
January 2018 - Irish Pharmacy News