IPN January 2026 Digital

January 2026 Volume 18  Issue 1 PHARMACYNEWSIRELAND.COM

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In this issue: NEWS: Dáil Debate Exposes Deep Division Over Funding of Blister Packs Page 4

REPORT: How the Common Conditions Service Will Change Community Pharmacy Page 6

EDUCATION: 2025/26 ePortfolio Review Page 10

RESEARCH: Iron Deficiency in Pregnancy Page 32

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AWARDS: Turn your Work into a Winning Entry Page 44

CONFERENCE: Irish College of Ophthalmologists Winter Meeting Page 52

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Contents

Foreword

Page 5: PGEU empowering pharmacists

January is traditionally a month of reset for community pharmacy — but as this issue makes clear, 2026 is beginning with anything but a clean slate. Instead, pharmacists find themselves at the intersection of service expansion, political scrutiny and growing clinical complexity, all unfolding at once.

Page 6: From Counter to Clinic: How the Common Conditions Service Will Change Community Pharmacy Page 10: Pharmacy Management of the 2025/26 ePortfolio Review

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Page 12: School of Pharmacy Researchers recognised for Excellence Page 14: Optimising Polypharmacy in Practice Page 22: Stronger Action on Medicine Shortages

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Page 28: Smoking Cessation in the Community Pharmacy: Why January Matters Page 46: Irish Cancer Society 2025 Focus PUBLISHER: IPN Communications Ireland Ltd. Clifton House, Fitzwilliam Street Lower, Dublin 2 00353 (01) 6690562

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MANAGING DIRECTOR Natalie Maginnis natalie@ipn.ie EDITOR Kelly Jo Eastwood: 0044 787654 8989 kelly-jo@ipn.ie SALES DIRECTOR Debbie Graham debbie@ipn.ie +353 8727 99317 CONTRIBUTORS Mary McDonald Averil Power Denis O’Driscoll Áine Barrett DESIGN DIRECTOR Ian Stoddart Design

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46 Irish Pharmacy News IRISH PHARMACY is circulated to all NEWS independent, multiple Pharmacists and academics in Ireland.

All rights reserved by Irish Pharmacy News. All material published in Irish Pharmacy News is copyright and no part of this magazine may be reproduced, stored in a retrieval system or transmitted in any form without written permission.

IPN Communications Ltd. has taken every care in compiling the magazine to ensure that it is correct at the time of going to press, however the publishers assume no responsibility for any effects from omissions or errors.

Central to this issue is our detailed examination of the Common Conditions Service (CCS), one of the most significant developments to emerge from the new Community Pharmacy Agreement. CCS represents a further step towards pharmacists operating as firstcontact clinicians within the health system. For many, it formalises work already happening daily at the counter and in the consultation room. Yet as our report explores, the success of CCS will depend not just on ambition, but on the realities of workload, consultation time, professional indemnity and sustainable funding. Opportunity and pressure are arriving hand in hand.

Those pressures were laid bare in the recent Dáil debate on monitored dosage systems (blister packs), another major focus of this issue. The debate revealed deep concern across the political spectrum about patient safety, medication adherence and the impact of additional charges on vulnerable patients. For pharmacists, it also exposed the uncomfortable space between policy intent and operational reality — where professional judgement, regulatory oversight and financial sustainability collide.

Our coverage unpacks what was said, what was clarified and what remains unresolved.

Clinical complexity is also a defining theme this month.

Polypharmacy is now an everyday reality in community pharmacy, particularly as Ireland’s population ages and multimorbidity increases. In this issue, we explore what community pharmacists can take from the iSIMPATHY programme — an Irish serviceevaluation study examining pharmacist-led, person-centred medicines reviews in general practice. While the intervention took place in GP settings, its lessons are highly relevant to community pharmacy: structured reviews, shared decision-making, deprescribing where appropriate, and a clear focus on patient goals. As pharmacy services become more protocol-driven and integrated, the principles underpinning iSIMPATHY offer a practical blueprint for medicines optimisation in the real world.

Professional accountability is another key strand running through this January edition. From this month, approximately 1,800 pharmacists will be required to submit evidence of Continuing Professional Development as part of the Irish Institute of Pharmacy ePortfolio Review. Áine Barrett, ePortfolio Review Project Lead, provides a clear guide to the process, timelines and available supports — a timely reminder that CPD is not just a regulatory obligation, but a foundation for confident, safe practice in a rapidly evolving role.

Taken together, the stories in this issue reflect a profession adapting in real time — clinically, politically and professionally. Our aim, as always, is to provide context, clarity and support as pharmacists navigate what lies ahead.

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4

News

Dáil Debate Exposes Deep Division Over Funding of Blister Packs

Safe Use of Cosmetics

A Dáil debate has brought renewed attention to the future funding of monitored dosage systems (MDS), commonly known as blister packs, following their exclusion from the new Community Pharmacy Agreement 2025.

New HPRA research published recently reveals that the majority of Irish adults continue to use cosmetic products beyond their expiry date or recommended shelf life. According to its national survey, six in 10 (60%) people are willing to disregard expiry dates or the ‘open jar’ symbol – an oversight that may pose health risks. The findings also highlight a significant gap in consumer understanding of cosmetic product labelling, with just four in 10 (41%) aware of the ‘open jar’ symbol. This symbol indicates the timeframe after opening during which the product remains safe to use.

After this time, it may begin to degrade and pose a risk to consumers.

Opposition TDs brought forward a motion calling on the Government to reinstate reimbursement for blister packs for patients who require them on clinical grounds, warning that changes under the new agreement could leave vulnerable patients facing new monthly charges from January 2026.

Blister packs are widely used in community pharmacy to support medication adherence and safety, particularly for older people, people with disabilities and those managing complex medication regimens. While never formally funded by the State, the service had been provided free of charge in many cases, with costs often absorbed through the phased dispensing reimbursement mechanism.

Under the new agreement, reimbursement for phased dispensing has been tightened and monitored dosage systems are explicitly excluded, prompting concern that patients who previously received blister packs at no direct cost would now be charged.

Speaking in the debate, Sinn Féin health spokesperson David Cullinane said many patients were shocked to learn they could face charges of ¤20 to ¤50 per month. He argued that regardless of how the service had been funded previously, the immediate issue was the financial impact on

patients who rely on blister packs for safe medicine use.

TDs from across the Opposition described blister packs as a patient safety measure rather than a convenience, warning that reduced access could lead to missed doses, double dosing and avoidable hospital admissions. Several speakers highlighted the added pressure loss of the service could place on carers and families, and its impact on independent living.

In response, Minister for Health Jennifer Carroll MacNeill said blister packs have always been a private service and that there had been no withdrawal of State funding. She stated that some pharmacies had provided the service free of charge, while others had incorrectly claimed reimbursement under the phased dispensing scheme, contrary to HSE guidance.

The Minister confirmed that implementation of aspects of the pharmacy agreement has been paused until the end of the first quarter of 2026 to allow further engagement and reduce confusion for patients. She said the Primary Care Reimbursement Service (PCRS), alongside the pharmacy regulator, will review phased dispensing claims to identify any inappropriate billing.

She emphasised that phased dispensing remains a Statefunded safety measure for certain high-risk medicines and patient

groups, but is distinct from blister packing, adding that public funds must be used only for their intended purposes.

While acknowledging the anxiety caused, the Minister said further work would be undertaken to identify patients who may clinically require additional medication management supports and how these could be delivered transparently.

The Government did not oppose the Opposition motion but did not commit to a new reimbursement scheme for blister packs. A strategic collaboration group under the pharmacy agreement is expected to consider medicines optimisation services in 2026.

For community pharmacists, the debate highlights increased scrutiny of long-standing practices and uncertainty about how medication management services should be funded. While many TDs praised pharmacists for supporting patients at their own expense, the Government signalled that informal cross-subsidisation through existing schemes will not continue.

As discussions continue, pharmacists and patients are awaiting clarity on whether a targeted, needs-based mechanism for blister packs will be introduced or whether monitored dosage systems will remain a private service outside State reimbursement.

Boots open New Pharmacy in Letterkenny Boots Ireland have announced the official opening of a new, larger Boots store in Letterkenny Retail Park.

Managing Director Stephen Watkins commented, “This investment is another important step in our ongoing commitment to enhance our estate and deliver the very best experience for our customers across Ireland. The new store gives us more space, an improved layout, and an expanded range of health and beauty services - all designed to make shopping with us easier and more enjoyable.”

Members of the Pharmacy team at Boots Letterkenny

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"Cosmetics are a staple in many people’s daily routines with half of adults (49%) using four or more products each day. When used as intended, cosmetics are generally very safe,” said Lisa Byrne, Cosmetic Product Manager at HPRA. The research also found: • More than a quarter (28%) of respondents have purchased what they suspected were counterfeit cosmetics. Of these, four in ten made their purchase online.

• Over one in three (35%) Irish adults reported experiencing a side effect from cosmetic products, most commonly skin irritation or rashes.

• Reports of side effects increased to 41% among those willing to use cosmetic products beyond expiry and use by dates, and to 54% among those who may have purchased counterfeit products.

• Consumers were far more likely to ‘always’ review instructions (37%) and ingredients (30%) on labels than to check period after opening / best-before dates (23%).

• When deciding which cosmetic products to purchase, value for money was the most important factor (32%), followed by the product’s benefits (15%) and brand (15%).

News HSE Quit Smoking Campaign The HSE Tobacco Free Ireland Programme have launched the Financial Incentives to Stop Smoking (FISS) Programme pilot in Kilrush & targeted areas of Limerick city.

This initiative is designed to offer enhanced support and motivation to residents who want to quit smoking, reinforcing the HSE’s commitment to improving health in communities where support is needed most.

The scheme, which began in March 2025, offers individuals who smoke, gift vouchers (financial incentives) of up to ¤400 over 12 months when they engage with a comprehensive stop smoking support programme and successfully quit smoking.

International evidence clearly demonstrates the power of combining expert support with financial incentives. When paired with intensive support from services like HSE QUIT, financial incentives have been shown to double a person’s chances of successfully quitting smoking long-term.

To be eligible to participate in this pilot, participants need to be living in the key target community areas and hold a medical card. "We know most people who smoke want to quit," said Niamh Keating, Health Promotion and Improvement Officer, Health and Wellbeing, HSE Mid West.

“Financial incentives, alongside intensive professional support, are a proven way to make that ambition a reality, especially in communities with higher smoking rates. This programme is about empowering residents in Kilrush and targeted areas of Limerick city with the practical assistance and motivation to make this positive, lasting change.”

Tobacco use remains one of the leading causes of preventable illness in Ireland. Smoking rates are higher in disadvantaged areas, resulting in poorer health outcomes for many people.

The Tobacco Free Ireland Government Strategy set a target of reducing smoking prevalence to less than 5% nationally.

Despite some progress, smoking rates have remained largely unchanged since 2019, with rates up to 25% for some groups and communities.

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Unlocking Pharmacy’s Full Potential Community pharmacists are among the most accessible healthcare professionals in Europe, providing first-line care to more than 46 million people every day across over 160,000 community pharmacies. In its new Position Paper on Cardiovascular Health, PGEU outlines how empowering pharmacists to take a greater role in prevention, screening, and long-term medication management could improve patient outcomes, increase system capacity, and strengthen the overall resilience of Europe’s health services.

The safe and appropriate dispensing of medicines remains a core service of pharmacies, which is being further enhanced by patient-focused cardiovascular services. Across Europe, pharmacists deliver lifestyle counselling, risk screening and risk factor management, vaccination administration, medication reviews, therapeutic adherence support, anticoagulation counselling, dose titration, referral and care coordination, and digital follow-up services that empower patients.

PGEU President, Clare Fitzell says, “The vast majority of premature cardiovascular disease is preventable, and pharmacists are uniquely positioned to help patients take action early. Through our extensive local pharmacy networks, we provide accessible cardiovascular prevention, screening, and pharmaceutical care services that support communities across Europe. However, we could do even more if fully enabled.

With appropriate remuneration structures, access to relevant health data, and a clearly defined role within clinical care pathways and public health policies, pharmacists could further strengthen preventive care, identify warning signs earlier, and ultimately save lives while

Clare Fitzell, PGEU President

reducing the burden on Europe’s health systems.”

To advance pharmacy services in cardiovascular health, PGEU calls for: – Integration of community pharmacists in national and EU cardiovascular programs, including the forthcoming European Commission Plan on Cardiovascular Health and the European Parliament’s owninitiative report.

– Formally promote, recognise and remunerate pharmacy services that contribute to CVD prevention, screening, and management.

– Expansion of pharmacists’ scope of practice across Europe to ensure equitable access to preventive, diagnostic and therapeutic services.

– Security of supply of essential medicines and stronger EU coordination to prevent and mitigate shortages.

– Pharmacists’ integration in the European Health Data Space (EHDS), with read/write access and the ability to contribute with relevant patient health data.

– Responsible use of AI and digital tools in pharmacy practice to enhanced screening, early detection, and personalised support, with healthcare professional oversight.

Ireland ‘Top’ for Self-Health The Minister for Health Jennifer Carroll MacNeill TD has highlighted that Ireland has retained its position as the EU country with the highest self-reported rate of good health.

Data in the latest State of Health in the EU Country Health Profiles shows that four in five (80%) Irish adults rated their health as good or very good in 2024. This is the highest proportion in the European Union, and maintains the high rate recorded in 2023.

Country-specific profiles, published by the OECD and European Observatory in cooperation with the European Commission, provide an overview of health and health systems in the EU/European Economic Area, and highlight areas of strong performance as well as challenges.

Inpatient care accounted for 35% of health expenditure in 2023, above the EU average of 28%, underscoring the challenges facing Sláintecare’s ambition to shift care demand toward strengthened primary and community settings.

In 2024, 5% of adults in Ireland reported unmet needs for primary care, above the EU average of 3%. The report also highlighted delays in access to new medicines, due to protracted Health Technology Assessment processes and pricing processes.

This year’s Country Health Profile also notes a rise in the number of young people using e-cigarettes.

In 2022, 19% of adults in Ireland were classified as having obesity, four percentage points higher than 2017 (15%) and also above the EU average of 15%.

Minister for Public Health, Wellbeing and the National Drugs Strategy Jennifer Murnane O’Connor said, “While I welcome the recorded reduction in smoking rates, the increase in vaping continues to be a concern, one which we are proactively tackling.

“Ireland has long been a world leader in tobacco control and I look forward to seeing the impact of our current policy measures reflected in future Country Health Profiles.”

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Pharmacy Report

From Counter to Clinic: How the Common Conditions Service Will Change Community Pharmacy Ireland’s Community Pharmacy Agreement 2025 (CPA25) marks one of the most significant shifts in Community Pharmacy Practice in decades — not just because it increases core funding, but because it formally moves pharmacists further into front-line primary care. The centrepiece of that change is the new Common Conditions Service (CCS), which enables participating pharmacists to assess, advise, and — where appropriate — prescribe and supply certain prescription-only medicines for a defined list of minor, often self-limiting conditions, under national clinical protocols.

For Irish community pharmacists and their teams, CCS is both an opportunity and a stress test: it creates a new clinical role with clear public value, but it also introduces fresh operational complexity around training, workflow, consultation capacity, governance, and how pharmacy services are funded and understood by the public.

What CPA25 is Trying to Do The Department of Health frames CPA25 as a modernisation agreement negotiated with the HSE and the Irish Pharmacy Union (IPU), designed to expand what pharmacy can deliver in the community and improve timely access to care.

While CCS is the headline, CPA25 is broader than a single service launch. It sets out a pathway that includes: • Expanded clinical services (with CCS first out of the gate) • A development / collaboration structure intended to support new services and medicines optimisation work into 2026.

• Additional initiatives referenced in public communications around the agreement, including pneumococcal vaccination programme involvement and a national medicines return/ disposal service through community pharmacies.

From a policy perspective, the strategic logic is familiar across Europe: if health systems want faster access and less pressure on GP and hospital services, they

need more care delivered safely in the community — and community pharmacy is an obvious capacity point.

What the Common Conditions Service Actually is Under CCS, community pharmacists can provide a structured consultation, deliver advice and safety-netting, and where indicated, issue a prescription and supply specific medicines under agreed national protocols. This is not “independent prescribing” in the broadest sense; it is protocoldriven prescribing within a defined service — a designed first step that supports governance, quality and consistency.

Initial Eight Conditions The first CCS rollout covers eight conditions (as set out in HSE/PSI materials), including: • allergic rhinitis/allergic conjunctivitis • cold sores • acute infective conjunctivitis • oral thrush • shingles • impetigo • uncomplicated lower UTI (cystitis) • vulvovaginal thrush The HSE has published conditionspecific protocols and operational guidance for delivery, and PSI has published regulatory guidance

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supporting pharmacists delivering the service.

The Legal and Regulatory Scaffolding CCS is underpinned by new regulations enabling pharmacist prescribing for the defined service.

In November 2025, the Department of Health announced the Minister had signed regulations to enable pharmacists to prescribe for specified common conditions “for the first time,” as part of the CCS. On the regulatory side, CCS is explicitly defined in Irish statutory instruments as a service that may be provided by a registered pharmacist in a retail pharmacy business, including the possibility of prescribing following consultation, advice and counselling.

The PSI has also set out education/ training expectations and practice guidance, emphasising that delivery must align with protocols and that training completion is a prerequisite.

For superintendent pharmacists and owners, this matters because it makes CCS a fully regulated clinical service, not an informal extension of OTC advice. That

brings credibility — and also a higher bar for documentation, governance and standard operating procedures.

Funding model: Consultation Fees and Drug Scheme Reimbursement One of the most important practical points for patient communication (and for managing expectations) is the payment model.

Under CPA25 and HSE implementation guidance: • A consultation fee applies for all patients availing of CCS (i.e., it is not automatically free at the point of care).

• Where a medicine is supplied and is reimbursable, dispensed medicines are reimbursed in line with the patient’s eligibility under HSE Community Drug Schemes.

This design creates both opportunity and friction. It supports a new revenue stream for pharmacy through consultation fees (a point highlighted by the Minister in public statements), but it also raises equity questions: patients who can’t easily access a GP may still face a fee at

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Pharmacy Report

“Each day in pharmacies across Ireland patients present with common selflimiting conditions, where pharmacists have the clinical knowledge but, until now, lacked the authority to provide the appropriate treatment. These conditions include hay fever, cold sores, and uncomplicated localised infections such as certain UTIs or conjunctivitis.

The CCS will change that, enabling pharmacists to deliver timely care and treatment, easing the burden on the wider healthcare system by offering care at the lowest level of complexity. We look forward to participating fully in the upcoming training and to playing a key role in improving access to care in our communities.”

Tom Murray, President, Irish Pharmacy Union the pharmacy counter for the consultation element, even if the medicine itself is covered under a scheme.

new service, describing it as enabling pharmacists to prescribe treatments for a range of common conditions.

keeping expectations and implementation steps.

In the early public rollout, some providers have published their consultation fee openly (for example, Boots Ireland lists a ¤35 fee), which gives a flavour of how patients may experience the service in practice.

IPU communications around implementation have also focused on practical readiness (training, operational detail, timelines), reflecting that for many contractors the biggest question isn’t “is this good policy?” but “how do we deliver it safely and sustainably?”

Even before CCS is fully embedded nationally, CPA25 has already had its first flashpoint: changes to phased dispensing and confusion around blister packs/ monitored dosage systems (MDS).

Opt-in, “All Eight Modules”, and Start-up Supports CCS is not automatic: pharmacies must opt in. Under the agreement and HSE circulars: • Participation is opt-in, and pharmacies must deliver the full suite of all eight modules (partial participation is not permitted).

• There is a once-off ¤2,000 establishment allowance, linked to sign-up and commencement requirements (including deadlines around confirming participation and commencing service delivery by set dates).

Operationally, this pushes pharmacy owners to make a deliberate decision about readiness — staffing, consultation room capacity, and workflow redesign — because once you opt in, you’re committing to a complete national service offering rather than cherry-picking the “easiest” conditions.

Pharmaceutical Society of Ireland (PSI) The PSI’s CCS material positions the service as enabling pharmacists to provide advice and expanded treatment options, and its guidance documents stress protocol adherence, training requirements, and professional responsibility for prescribing decisions.

PSI consultation reporting on draft rules/guidance (mid-2025 consultation) offers insight into stakeholder concerns that commonly arise when new prescribing services are introduced: training burden, consistency, governance, and clarity around responsibilities and records.

Government / Department of Health / HSE

Irish Pharmacy Union (IPU)

Government statements have framed CCS as a way to improve timely access to care and to allow healthcare professionals to work at the top of their training, with the Minister describing CCS as a new revenue stream for pharmacists and a patient-access measure.

The IPU welcomed publication of CPA25 and explicitly highlighted CCS as a major

The HSE has published detailed protocols, FAQs and operational guidance, including record-

What Has Been Said so Far

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Issues and Controversies

In December 2025, proposed dispensing rule changes were delayed after political backlash and public anxiety about possible new patient charges for blister packs; the Irish Times reported the delay amid debate over the practical impact on patients.

Separately, advocacy group ALONE raised concerns that changes linked to CPA25 could limit phased dispensing supports for older people, framing it as a medication safety issue.

For pharmacists, this matters even if CCS is your main focus, because it illustrates a wider challenge: public understanding of what is

funded, what is private, and what sits in a grey zone created by historical practice. CCS introduces a consultation fee model that will require careful, consistent messaging — and the MDS controversy shows how quickly confusion can become political and reputational.

The Operational Challenges CCS will succeed or fail in day-to-day practice based on operational reality. Key challenges pharmacy teams are already talking about include: 1) Capacity and workflow A proper CCS consultation is not a quick “over-the-counter chat”. It involves structured history-taking, red-flag screening, protocol-based decision-making, documentation, and safety-netting. That needs time, trained staff, and physical space. HSE operational guidance and FAQs underline record-keeping requirements, and PSI expects pharmacists to maintain evidence of training and compliance.

2) Staffing and skill-mix To avoid CCS simply piling more clinical work onto alreadystretched pharmacists, many pharmacies will need to invest in: • trained technicians and counter teams to protect pharmacist time, • appointment/queue management, • and SOPs so the whole team knows how to triage, book, and support consultations.

3) Clinical risk and antimicrobial stewardship Some CCS pathways involve antimicrobials (for example impetigo and uncomplicated

"The Common Conditions Service will expand community pharmacists’ ability to further support patients in the management and treatment of certain common conditions and, where appropriate, enable them to prescribe certain medicines."

Joanne Kissane, Registrar and Chief Officer, Pharmaceutical Society Ireland

9 UTI). Protocol-driven prescribing helps, but pharmacists will still need robust red-flag screening, referral thresholds, and clear patient instructions to reduce inappropriate antibiotic use and ensure follow-up where symptoms persist. The HSE protocols exist for exactly this reason — but they must be operationalised.

4) Patient expectations and pricing

This is a cultural shift for some pharmacies — especially those that have historically delivered lots of clinical advice but with lighter documentation.

The Oppportunities Despite the challenges, CCS offers real upside for pharmacists and patients:  A new clinical identity (with legal authority)

CCS is new for the public, and the “pharmacy can now prescribe” message can easily become “pharmacy is replacing the GP for free”. The agreement is clear that a consultation fee applies, even if medicines may be reimbursed under schemes.

Pharmacists have long managed minor ailments informally. CCS turns that into a nationally recognised, protocol-governed service with prescribing authority.

That strengthens pharmacy’s clinical standing and supports broader scope expansion later.

How pharmacies set the fee, explain it, and avoid confrontation at the counter will be a major implementation factor.

 Better access and earlier intervention

5) Documentation and audit readiness CCS embeds pharmacy deeper into formal healthcare delivery, which means: • stronger expectations on record keeping, • audit/inspection readiness, • and clear governance for prescribing decisions.

In many communities, GP access remains difficult for minor but disruptive conditions. CCS is designed to offer a faster route to advice and treatment — and to free up capacity elsewhere in primary care.  A sustainable service model If delivered well, CCS can provide a structured, repeatable clinical service line — with clearer professional fees and service value than the traditional “free advice + product sale” model. Government

statements explicitly position CCS as creating a revenue stream for pharmacy.

by professionalism and patient experience as much as by clinical protocol.

 A platform for future pharmacy services

5. Document consistently from day one: if the service is inspected or audited, “we usually do X” won’t be enough.

CPA25 points toward a longerterm development path (including collaboration structures and future consideration of additional pharmacist-delivered services). If CCS is implemented safely and consistently, it becomes proof that community pharmacy can deliver protocol-based clinical care at national scale.

What Pharmacists Can Do Now For contractors, superintendent pharmacists, and managers, a few practical priorities stand out: 1. Treat CCS like a clinical service line, not a bolt-on: map patient flow, allocate time, and protect consultation capacity.

2. Train the whole team on triage and expectations: the pharmacist delivers the clinical element, but the team determines whether CCS is smooth or chaotic.

3. Build patient communication scripts around: what CCS is, when it applies, the consultation fee, and when referral is needed.

4. Audit your consultation space and privacy: CCS will be judged

The Bottom Line CPA25 is not just another funding agreement; it is a signal that Irish policy now expects community pharmacy to function as a firstcontact clinical setting for defined conditions, backed by legislation, protocols and regulatory oversight.

CCS is the most tangible expression of that shift. If pharmacies can embed it safely, consistently, and in a way that doesn’t burn out teams, it could be the foundation for wider pharmacist prescribing and expanded service delivery over the next decade. But early controversies around other parts of the agreement (notably phased dispensing/MDS confusion) also show how quickly public trust can be shaken when funding models are unclear or poorly communicated.

For Irish pharmacists, the opportunity is to shape CCS into a service that proves community pharmacy can deliver high-quality, protocol-led clinical care at scale — and to use that credibility to drive the next wave of expanded practice.

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10

ePortfolio

2025/26 ePortfolio Review In October 2025, the Irish Institute of Pharmacy (IIOP) sent an email to approximately 1800 pharmacists who have been selected for the 2025/26 ePortfolio Review. The IIOP also sent a reminder email to pharmacists in early December. In January 2026, these selected pharmacists will be required to submit evidence of their Continuing Professional Development (CPD) to the IIOP via their ePortfolio.

Here, Áine Barrett, ePortfolio Review Project Lead, gives an overview of the process. We talk about the key dates, the process and where you can get more support.

So Áine, how will pharmacists know whether they are selected for the 2025/26 ePortfolio Review?

In addition to the email communications that selected pharmacists have received from the IIOP, at this point selected pharmacists will also notice a Pending sign on their ePortfolio.

This sign will remain in place until the submission period is closed (25 January) and will not change when they have submitted cycles.

When the first submission period closes this will change from Pending to Active. This means that the review process is happening and is not specific to a particular pharmacist. The Active sign will remain in place until the ePortfolio Review process is complete in early May. If I’ve been selected, when will I have to submit my ePortfolio extract?

On Monday 5 January 2026 an email will be sent from the ePortfolio System (info@iiop.ie) to your IIOP registered email address inviting you to submit CPD cycles from your ePortfolio for review.

You will have until Sunday 25 January to submit your extract.

You may submit cycles at any stage during the three-week submission window, and you may make more than one submission.

Pharmacists must have their current, active email address registered on their IIOP profile in order to ensure they receive communications from the IIOP about the 2025/26 ePortfolio Review. Should you need help in accessing the website, retrieving your password or editing your details contact the IIOP at info@iiop.ie.

How does the ePortfolio Review process work?

The ePortfolio Review process incorporates two elements: • A System Based Review Each extract (i.e. the cycles you choose to submit) will be

automatically reviewed against the System Based Standards which are pre-set within the IIOP ePortfolio system.

• A proportion of the ePortfolio extracts submitted will be reviewed against the Review Standards. This will include: o All ePortfolio extracts submitted in the first submission period that do not meet the System Based Standards o A random sample of ePortfolio extracts submitted in the first submission period that do meet the System Based Standards o All ePortfolio extracts submitted in the second submission period How will I know which cycles I should submit as part of my ePortfolio Review?

To help selected pharmacists ensure the cycles they submit as part of their ePortfolio extract meet the System Based Standards,

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the IIOP developed the Ready Reckoner tool. The Ready Reckoner will be available to pharmacists selected for ePortfolio Review when the submission period opens in January.

Pharmacists can use the Ready Reckoner in two ways; • Before submission Pharmacists can use the ‘Check readiness’ function before submission to identify cycles to submit which collectively meet all of the System Based Standards.

• After Submission - The Ready Reckoner automatically appears when one or more cycles are submitted for review and uses green and red lights to show progress against the System Based Standards.

In the event that one of the standards has not been met, a red light and a warning icon are shown, and pharmacists can click on the warning icon for an overview of the action they need to take to meet this standard.

I can’t find the “Ready Reckoner” on the IIOP website, where is it?

The Ready Reckoner will only become available to pharmacists included in the 2025/26 ePortfolio Review when the submission period opens on Monday 5 January. It can be found within the Completed Cycles section of the ePortfolio.

I have undertaken CPD but not yet had the opportunity to record it in my IIOP ePortfolio.

Can I backdate these records to reflect when the work was completed?

Yes, you can backdate cycles to reflect the date the CPD was undertaken. Simply choose the relevant date when entering the ‘Cycle Start Date’. You can find further information on recording your CPD retrospectively in the How to meet the cycle from previous four years standard support resource which can be found on the 2025/26 ePortfolio Review Support page on the IIOP website.

11 Since I began using the IIOP ePortfolio, I have been recording entries in my ePortfolio but I haven’t completed all of my CPD cycles. I have been selected for the 2025/26 ePortfolio Review, if I completed a cycle now will it count as CPD from the year I created it?

Yes, it will count from the date it was created e.g. if a cycle is created in 2023 and completed in 2024, the system will count it as a cycle for 2023. We understand that people work in different ways, and the IIOP ePortfolio has been built to reflect this. While some people may like to complete a cycle and finish it right away other people may like to work on them over time.

I understand that the Core Competency Self-Assessment Tool (CCSAT) has been retired.

How do I meet the standard for self-assessment against the PSI Core Competency Framework (CCF) in the current year?

Yes, the CCSAT was retired in 2023. The 2025/26 ePortfolio Review standards require that at least one cycle is created and submitted following selfassessment against the Core Competency Framework for Pharmacists in the current year.

For the purposes of the 2025/26 ePortfolio Review, the current year is considered to be 2025 and up to 25 January 2026 i.e. the end of the submission period. Having self-assessed against the CCF, you can demonstrate evidence of this by selecting the tick box under the Self-Appraisal stage of the relevant cycle 'Completing self-assessment against the Core Competency Framework'.

I completed the CCSAT in January 2023 and completed a CPD cycle based on the outcome in July 2023. Can I submit this as a cycle which originated from my selfassessment against the PSI Core Competency Framework for assessment in the 2025/26 ePortfolio Review?

The 2025/26 ePortfolio Review Standards require that you submit one cycle created following selfassessment against the PSI’s Core Competency Framework in the current year, therefore the cycle submitted to meet this standard must have a creation date in 2025 to the end of the submission period in January 2026. This is in line with the legislative requirement to regularly self-assess against the Core Competency Framework. A cycle created in 2023 will not meet this standard, however, you may wish to submit this cycle as evidence of one of the cycles that you created in the previous four years.

I have completed some of the CPD training programmes available through Irish Pharmacy News (IPN) and I have also completed IIOP online training programmes, are there other activities that I could record in my ePortfolio?

Many pharmacists are surprised to realise the breadth of what counts as CPD. Traditionally, many pharmacists focus their CPD on their clinical expertise. The PSI Core Competency Framework indicates that pharmacists must be competent across a range of domains. It is important to aim to keep upskilled across all domains – not just those domains relating to medicines. This requires engaging in a breadth of learning.

Consequently, there are many different types of activities that can be recorded in your ePortfolio as CPD. Completing the IPN CPD modules, for example, is a very valuable means of undertaking CPD. Other examples of activities that can be recorded in your ePortfolio as CPD include: • Attending a live learning course • Reading an article • Having a discussion with a colleague • Attending a conference • Researching a new drug that has been prescribed for a patient It is important to remember that recording any learning activity may be appropriate as long as you can demonstrate how it has contributed to your professional development. It may be helpful to refer to the 2025/26 ePortfolio Review Standards (available on the ePortfolio Review Support Resources page on the IIOP website) to see types of criteria within the scope of the Review.

How much information should I record in my CPD cycles?

There is no right or wrong answer to this. Each pharmacist will have their own style; some choose to use bullet point information, while others prefer to be more detailed. What is important, however, is that you sufficiently outline what you have learned and how that learning has contributed to your understanding, benefited your practice, improved patient outcomes or advanced your continuing professional development. You will find some sample CPD cycles on the IIOP website, in IIOP newsletters or by attending ePortfolio Review information events. You should write in a way that works for you and allows you to reflect on what you have done.

What happens if my ePortfolio extract does not meet the 2025/26 ePortfolio Review Standards?

The ePortfolio Review enables pharmacists to demonstrate evidence of appropriate and ongoing engagement with CPD, in the interest of outcomes-focused professional development. All pharmacists’ ePortfolio extracts are reviewed against the specific standards, mapped to the legislative requirements, which have been set for that year’s ePortfolio Review.

All pharmacists who submit their cycles within the submission period in January 2026 will be provided with feedback on their ePortfolio extract, should one or more of the standards not be met in the first instance. They will then have an opportunity to resubmit cycles based on this feedback to meet the standards.

In the event that a pharmacist does not meet the standards at the end of their first ePortfolio Review process, they are automatically entered into the following year’s ePortfolio Review. The PSI is not informed at this stage. However, if at the end of the second ePortfolio Review the pharmacist does not meet the standard or does not reengage with this process in year 2, the IIOP is obliged under the terms of the ePortfolio Review Policy to refer the pharmacist to the PSI. Will the PSI be aware of how I perform in the ePortfolio Review process?

The IIOP undertakes the ePortfolio Review process to enable pharmacists to demonstrate evidence of CPD, in line with the legislation. Whilst the PSI is responsible for selecting pharmacists for ePortfolio Review, the IIOP undertakes the review process itself, at arm’s length from the PSI. The IIOP will not share any aspect of a pharmacist’s ePortfolio with the PSI. In the event that the IIOP cannot ascertain that a pharmacist is meeting his or her CPD obligations (i.e. if the standard is not met at the end of two years ePortfolio Review, or if the pharmacist fails to submit an ePortfolio extract for review within the timeframe provided) then the IIOP has a statutory obligation to refer the pharmacist to the PSI. No information from your cycles is communicated to the PSI. When I was selected for ePortfolio Review, I didn’t apply for an exemption due to extenuating circumstances, but my circumstances have now

changed and I will be unable to submit my ePortfolio. Is it too late to apply for an exemption?

The PSI manages the selection process for ePortfolio Review including all applications for exemptions from ePortfolio Review under its Extenuating Circumstances process. If circumstances apply to you which would have an impact on your ability to submit an extract from your ePortfolio, you should contact the PSI. The PSI's Extenuating Circumstances Policy and the relevant application form are available on the PSI website.

All applications submitted will be managed by the PSI on a confidential case by case basis.

Where can I get more information?

The ePortfolio Review Support Page can be accessed via the IIOP homepage and is the main source of information relating to the 2025/26 ePortfolio Review including information on communication from the IIOP, timelines and ePortfolio Review Information Events. The ePortfolio Review support resources are also hosted on this page.

You may also wish to attend an Information Event. The IIOP hosted a series of Information Events from September 2025 until January 2026 to support pharmacists selected for the 2025/26 ePortfolio Review. All events are facilitated by a Peer Support Pharmacist and specifically focus on the key requirements of the 2025/26 ePortfolio Review so that pharmacists will know exactly what to expect at each point in the process. Pharmacists who took part in previous ePortfolio Review processes consistently highlight the IIOP Information Events as a key source of support in their preparation. They felt more confident in participating in ePortfolio Review and had a clear understanding of what the standards were and how to access support if needed, after attending an event. There are two information events (webinars) scheduled on 7 and 20 January 2026. You can book via the IIOP website, under the ‘Courses & Events’ tab. There is also a recorded version of the webinar available to view in your own time on the ePortfolio Review support resources page on the IIOP website.

The IIOP team are always happy to hear from you with any queries you may have, and you can contact the team on info@iiop.ie

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News

School of Pharmacy Recognition Researchers from the School of Pharmacy, University College Cork were recognised for excellence in research, engagement, industry impact, and professional development at the 2025 SSPC Awards. SSPC is the Research Ireland Centre for Pharmaceutical Research.

Professor Abina Crean, Dr Ayat Elgammal, Dr Ayse Kont and Claudia Giannachi

The SSPC Investigator of the Year award was presented to Professor Abina Crean in recognition of her outstanding contributions to pharmaceutical sciences. A leader

in her field, Professor Crean’s work spans pharmaceutical formulation, impactful industry collaborations, and the mentorship of future scientific leaders.

Dr Ayat Elgammal was awarded SSPC Education & Public Engagement (EPE) Champion of the Year. She has demonstrated an inspiring commitment to making scientific knowledge accessible and engaging for the wider community.

In industry-focused categories, Dr Ayse Kont received the SSPC

Industry Impact of the Year Award for her collaborative project with Boston Scientific and SSPC. Her work demonstrated how academic research can deliver measurable improvements within industry settings, supporting innovation and contributing to advancements in pharmaceutical and medical technologies. This recognition highlights the value of strong partnerships between universities and industry.

PhD student Claudia Giannachi was a joint recipient of the SSPC Industry Placement Award, alongside Aoife Cotter from the University of Limerick, for their five-month placement at MSD Cork, where they contributed to critical development work supporting vaccine manufacture.

United Drug Retail Solutions – Supporting the Future of Pharmacy In today’s fast-moving retail pharmacy environment, United Drug enables you in having the right products at the right time. To run a successful, sustainable business, pharmacies need more than just a reliable wholesaler, they need a strategic partner who understands the challenges and provides practical, real-world solutions.

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Built Around Your Business At the core of United Drug Retail Solutions is a simple promise: we help you do more with less time and effort. Whether it’s smarter purchasing, streamlined operations, reliable access to specialist medicines or training for your team, our goal is to help pharmacies thrive.

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Features include: • Alerts at the point of dispensing • Regular alert saving for repeat issues • Auto-downloads of GMS, DPS and methadone booklets • Highlighting of hardship payments • Clean, readable reports that save time and reduce error

Our Knowledge Hub brings together everything you need to stay ahead of the curve, all in one place on UDW.ie: • Award-winning webinar series for ongoing professional development • Pharmacy podcast covering current trends, insights and challenges • Category sales insights and articles to help you plan ahead • Training tools and sales aids for your whole team • POS kits to help support your in-store sales We’re always adding new content and updating resources to reflect what’s happening in the industry.

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Optimising Polypharmacy in Practice Polypharmacy as a Growing Reality Person-centred polypharmacy in practice: what community pharmacists can take from iSIMPATHY

who may feel overwhelmed, fatigued by complex regimens, or unsure why they are taking certain medicines at all.

Polypharmacy is now an everyday reality in community pharmacy. As multimorbidity rises worldwide, each additional chronic condition typically brings additional medicines, monitoring requirements, and potential for harm. Polypharmacy—often defined as the concurrent use of five or more regular medicines— can be entirely appropriate and clinically beneficial when it reflects best evidence and an individual patient’s goals.

However, polypharmacy can also increase treatment burden, reduce adherence, and raise the risk of potentially inappropriate prescribing (PIP), including underprescribing of medicines that should be started. The practical challenge for community pharmacy teams is balancing the benefits of multiple medicines against the risks, while supporting patients

In Ireland, hyperpolypharmacy (10 or more regular medicines) has been documented at significant levels, particularly in older age groups, and it is likely higher today than earlier estimates. For community pharmacists, that translates into a steady stream of patients who are clinically complex and at increased risk of medicines-related harm—falls, bleeding, renal impairment, confusion, constipation, hypotension, sedation, and avoidable hospital admissions.

A major Irish service-evaluation study provides useful direction on what “good” can look like when medicines optimisation is delivered in a structured, personcentred way. The evidence summarised in this article is drawn from “Evaluating the impact of general practice pharmacist-led person-centred medicines reviews

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on medicines appropriateness and patient-reported outcome measures” by Clare Kinahan, Ciara Kirke, Leon O’Hagan, Frank Moriarty, Kevin D. Murphy, Laura J. Sahm, Cian O’Mahony, Emma J. Coyle, Stephen Byrne, and Kieran Dalton (the iSIMPATHY general practice substudy, Ireland). While the intervention in that study was delivered by pharmacists embedded in general practice, its lessons are highly relevant to community pharmacy, particularly as Ireland moves toward more structured, protocol-driven services and closer integration across settings.

time, and whether the patient can realistically live with it.

From a patient perspective, polypharmacy often brings: • confusing instructions (“before food,” “with food,” “morning only,” “avoid grapefruit,” etc.), • multiple devices (inhalers, pens, spacers), • monitoring demands (BP, glucose, renal function, INR), • side effects that may be accepted as “just ageing,”

Why person-centred medicines optimisation matters

• and reduced confidence, particularly after transitions of care.

Polypharmacy is not automatically a problem to be “fixed.” Many patients need multiple medicines to prevent stroke, reduce cardiovascular risk, stabilise respiratory disease, manage diabetes, and preserve function.

The issue is whether the overall regimen remains appropriate over

Community pharmacists are well placed to identify early signals of strain—late refills, missed collections, frequent “I stopped it because…”, “I only take it when…”, requests for sedatives, repeated OTC purchases that mask adverse effects, and caregiver concerns.

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What the iSIMPATHY work reinforces is that patient experience is not a “soft” outcome—it is directly linked to adherence, safety, and health service utilisation. Medicines optimisation should improve both prescribing appropriateness and patient-reported outcomes.

Shared decision-making: the foundation, not an add-on A key theme in the source study is shared decision-making (SDM): a joint process where a healthcare professional and a person work together to reach decisions about care. SDM is not simply offering a choice; it is helping a person understand the pros and cons of options, exploring what matters most to them, and agreeing a plan that is clinically sensible and personally sustainable.

For community pharmacy, SDM is especially important because many polypharmacy problems cannot be solved by “telling” a patient what to do. Deprescribing sedatives, adjusting pain regimens, stepping down PPIs, switching anticholinergics, or addressing duplicate therapy requires trust, explanation, and follow-up.

Even small SDM behaviours can change the quality of a consultation: • “What’s the hardest medicine for you to manage day-to-day?”

• “Which side effect bothers you most?”

• “What’s your main goal—less pain, more energy, better sleep, fewer tablets?”

• “Would you be open to me speaking with your GP about simplifying this?”

What iSIMPATHY showed: scale, structure, and measurable improvement The Irish general practice component of iSIMPATHY evaluated structured, personcentred medicines reviews delivered to a high-risk population over a two-year period. Patients were typically older (mean age in the mid-70s), with multiple comorbidities and high baseline medicine counts. The reviews were based on the “7 steps to appropriate polypharmacy” approach and included follow-up.

Three categories of outcomes were particularly informative: 1) High-risk prescribing indicators (“polypharmacy indicators”) A set of 69 case-finding indicators was used to identify markers of

potential harm (e.g., bleeding risk, falls risk, renal concerns, electrolyte issues). In the study, indicators were found in nearly half of patients reviewed, and the majority were “resolved” by followup—suggesting that structured review can reduce measurable risk.

2) Medicines appropriateness (PC-MAI) The study used the PersonCentred Medication Appropriateness Index (PC-MAI), an adaptation of the Medication Appropriateness Index, to measure improvement. High baseline inappropriateness scores fell substantially after review, with almost all patients showing improvement in appropriateness.

3) Patient-reported outcome measures (PROMs) PROMs captured outcomes that patients recognise: understanding, side effects, impact on daily activities, and adherence behaviours. Most patients reported improvement in at least one domain following review, with particularly strong gains in understanding and side-effect burden.

For community pharmacists, the take-home message is not that you must replicate the entire general practice model tomorrow.

It is that structured, personcentred medicines optimisation is measurable, improves safety markers, and improves the lived experience of medicines.

The community pharmacy reality: less access, but huge opportunity The study authors note an important constraint: comprehensive reviews require time and access to detailed clinical information—resources community pharmacists often lack. Yet community pharmacy is also where medicine use becomes real: collections, adherence, OTC additions, side effects, and practical administration issues are most visible at the counter.

So what can community pharmacy teams do, now, that aligns with the evidence?

1) Build a “polypharmacy lens” into routine interactions You do not need a 60–90 minute appointment to make meaningful progress. A polypharmacy lens means you are alert to:

• high-risk combinations (NSAID + anticoagulant; sedative + opioid; multiple anticholinergics), • repeated early or late refills, • confusion about purpose, • new OTC purchases that suggest uncontrolled symptoms or side effects (e.g., laxatives, antacids, sleep aids).

A simple prompt such as “Would you like a quick medicines check-in next time you’re in?” can open the door to a more structured review.

2) Use a short pre-review questionnaire to surface priorities One of the most practical ideas from the evidence base is the value of a short questionnaire before a review. Its purpose is not bureaucracy; it helps patients articulate goals and burdens they may not otherwise mention.

In community pharmacy, you can adapt this to a one-page “Medicines Check-In” that asks: • “Which medicine do you worry about most?”

• “Any side effects you think might be caused by medicines?”

• “Do your medicines interfere with sleep, energy, mood, appetite, balance?”

• “What would you most like to improve?”

This shifts the interaction from “compliance” to collaboration.

3) Focus on outcomes patients care about PROMs in the iSIMPATHY study improved most strongly in understanding and side effects.

That’s encouraging for community pharmacy, because these are areas where pharmacists already excel— when given the time and structure.

A practical approach is to choose one domain per interaction: • Understanding: “Tell me what you think this one is for.”

• Side effects: “Any dizziness, constipation, bruising, or nausea since starting it?”

• Daily activities: “Is anything making it harder to get out, walk, or sleep?”

meaningfully contribute to high-risk prescribing reduction by spotting red flags early and communicating clearly with prescribers. In the study, bleeding, falls, and renal concerns were prominent. In community pharmacy, that could translate to: • flagging NSAID use in patients on anticoagulants/antiplatelets, • highlighting sedative burden in older adults with falls, • questioning dose appropriateness where renal function is known or suspected to be reduced, • identifying duplicate therapy or unclear ongoing need (e.g., long-term PPI without indication), • and ensuring monitoring is being done where required.

A concise, clinically framed message to the GP is often the difference between “noted” and “acted upon.” Where possible, include: the concern, the patient impact, and a suggested next step.

5) Make deprescribing a supported process, not a one-off suggestion One of the reasons some medicines are hard to stop is that stopping is a process. Community pharmacy can support safe deprescribing by: • explaining taper plans in plain language, • scheduling follow-up check-ins, • supporting symptom management strategies (e.g., sleep hygiene when tapering hypnotics), • and reinforcing that discomfort during tapering is common and manageable with the right plan.

Even when you cannot prescribe, you can stabilise the patient experience—often the missing ingredient.

Workflow ideas that work in busy pharmacies To translate evidence into practice without overwhelming the team, consider a “tiered” approach: Tier 1: Opportunistic microreview (2–3 minutes)

• Adherence: “How often do you miss it in a typical week—and what gets in the way?”

• Identify high-risk patients (≥10 medicines; older; postdischarge).

• medicine counts (especially ≥10),

4) Identify and escalate high-risk prescribing concerns

• Ask one SDM question.

• recent hospital discharge,

Community pharmacists can

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• Record one key issue (side effect, confusion, burden).

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• Offer follow-up or GP liaison.

Tier 2: Scheduled check-in (10–15 minutes) • Use a short questionnaire.

• Reconcile what the patient actually takes vs what is prescribed.

• Identify 1–2 priority issues.

• Communicate one focused recommendation to the GP. Tier 3: Structured medicines optimisation appointment (20–30 minutes) • Best for complex patients, carers, or repeated problems.

• Review risks (falls, bleeding, renal, sedation).

• Agree goals and a plan.

• Document and follow up.

This mirrors the study’s emphasis on structured review and follow-up, but in a way that fits community workflow.

Communication: the clinical skill that unlocks safety The iSIMPATHY evidence reinforces that medicines

optimisation improves patient understanding and experience when it is delivered in a personcentred way. For community pharmacy, communication is also how you correct misconceptions: • “More tablets” is not always “better care.”

• “Strong” painkillers are not always safer.

• Sedatives are not benign.

• “I’ve always taken it” is not a reason to continue indefinitely.

• “The hospital started it” does not mean it should never be reviewed.

Equally, communication is how you validate: • “You’re not imagining it— dizziness can absolutely be medicine-related.”

• “If you’re struggling to manage this routine, that’s important information.”

• “It makes sense you’d feel overwhelmed—let’s simplify what we can.”

Where this is heading in Ireland A consistent thread in the study background is the gap in pharmacist integration into general practice in Ireland compared with other countries. The iSIMPATHY work demonstrated that when pharmacists are embedded and enabled to run structured reviews, medicines appropriateness and patient experience improve, and broader evaluations have shown meaningful economic implications as well.

For community pharmacy, the direction of travel is clear: more protocol-driven services, increasing expectations around medicines optimisation, and a system that will increasingly value pharmacists not only as dispensers, but as medicines safety clinicians who prevent harm before it becomes an admission.

Conclusion: what to do next The study by Kinahan and colleagues provides a strong signal that person-centred medicines reviews—structured, outcomes-focused, and

grounded in shared decisionmaking—can reduce high-risk prescribing indicators, improve medicines appropriateness, and improve patient-reported outcomes for people with complex polypharmacy.

Community pharmacists may not yet have the same access to full clinical records or the same protected time as general practicebased pharmacists, but the core principles are transferable: • make the patient’s experience visible, • identify and escalate risk early, • use brief, structured tools to capture priorities, • and follow up, because optimisation is a journey, not a single transaction.

If you take only one step, make it this: build one structured SDM question into every interaction with a high-risk polypharmacy patient.

Over time, that changes the culture from “here are your medicines” to “let’s make your medicines work for you.”

News

Strengthening Approaches to Childhood Obesity The introduction of strict new junk food advertising rules in the UK has reignited calls for Ireland to strengthen its approach to childhood obesity — a public health crisis that community pharmacists are increasingly encountering at ground level.

From this month, Britain has implemented a blanket ban on paid online advertising of unhealthy foods, alongside a 9pm watershed for TV advertising of such products.

The measures are designed to reduce children’s exposure to highfat, salt and sugar (HFSS) foods and curb rising obesity rates.

The Irish Heart Foundation says the contrast with Ireland is stark — and increasingly difficult to justify.

According to the Foundation, children in Ireland are exposed

Chris Macey, Irish Heart Foundation Director of Advocacy

as eight, while some teenagers are showing cardiovascular profiles comparable to much older adults.

to far higher levels of junk food marketing than their UK counterparts, despite overwhelming evidence linking advertising exposure to overconsumption and long-term cardiovascular harm.

Despite this, the Irish Heart Foundation argues that Ireland’s existing restrictions on junk food advertising have been steadily eroded. Current rules on children’s television advertising, it says, are so weak that even four- and five-year-olds are exposed to more than 1,000 junk food ads annually.

For community pharmacists, this is not an abstract policy debate. Many are already seeing the downstream effects: children presenting earlier with weight-related health issues, families seeking advice on dietlinked conditions, and increasing demand for blood pressure checks, diabetes risk discussions and cardiovascular prevention — often years earlier than expected.

The State’s own research estimates that more than 85,000 children currently living on the island of Ireland will die prematurely due to overweight and obesity. Cases of elevated blood pressure are now being recorded in children as young

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“This is a crucial measure for children’s future health that stands in stark contrast to lax rules which offer little protection to children in Ireland,” said Irish Heart Foundation Director of Advocacy, Chris Macey.

“Children in Northern Ireland will now have greater protection than their counterparts here from unscrupulous online targeting tactics by junk brands that we know are rampant. “They result in overconsumption, which in turn causes high rates of overweight and obesity that are damaging children’s long-term health.”

For pharmacists, who are increasingly positioned as accessible public health advisers, this creates a growing mismatch: pharmacies are being asked to support prevention, behaviour change and early intervention, while wider policy continues to allow aggressive marketing that undermines those efforts.

The Irish Heart Foundation points out that Ireland is not short on recommendations. The Oireachtas Committee on Children and Youth Affairs previously called for stronger controls on food marketing to children, while the 2020 Programme for Government committed to examining advertising restrictions through a proposed Public Health Obesity Act — legislation that has yet to materialise.

While the UK’s new regulations are not perfect — they still permit brand advertising and do not fully address influencer marketing — the Foundation views them as a meaningful step that Ireland has yet to take.

News

19

Vision for the Future of Community Pharmacy The Pharmaceutical Group of the European Union (PGEU) has published a new strategic document, A Vision for Community Pharmacy in Europe, outlining how the profession can play a central role in addressing some of the most pressing challenges facing European health systems over the coming decades. Representing around 500,000 community pharmacists working in more than 200,000 pharmacies across 33 countries, PGEU describes community pharmacy as Europe’s most widely distributed and accessible healthcare network, serving over 500 million citizens clinical, digital and public health capabilities.

The Vision is set against a backdrop of growing pressure on health systems from population ageing, rising prevalence of chronic disease, medicine shortages and increasing expectations for accessible, personalised care. The COVID-19 pandemic is highlighted as a pivotal moment that demonstrated the value of community pharmacies as trusted, frontline healthcare providers. During the crisis, pharmacists maintained continuity of care, supported vaccination programmes, managed medicine supply disruptions and acted as a key source of reliable information for the public, reinforcing their role as

an essential part of primary care and public health infrastructure PGEU’s document emphasises that community pharmacists already provide far more than traditional dispensing services.

Across Europe, pharmacists support safe and effective use of medicines, promote adherence, deliver vaccination and prevention services, manage minor ailments and contribute to chronic disease monitoring, often with extended opening hours and without the need for appointments. Building on this foundation, the Vision sets out an ambition for pharmacies to evolve further into integrated health hubs, combining local accessibility with advanced

Key initiatives outlined include delivering safe, continuous and person-centred care, with pharmacists ensuring uninterrupted access to medicines and providing personalised counselling and pharmacovigilance. Pharmacies are envisaged as everyday centres for prevention, screening and immunisation, particularly in rural or underserved areas where access to other healthcare services may be limited. The document also highlights an expanded clinical role for pharmacists, including structured management of minor conditions, closer collaboration with prescribers, use of point-of-care diagnostics and, in the longer term, involvement in areas such as pharmacogenomic counselling and protocol-based prescribing Crisis preparedness forms a central pillar of the Vision. PGEU argues that Europe’s dense network of community pharmacies constitutes a decentralised safety system that should be fully integrated into national and EUlevel emergency planning. Future

roles may include supporting disease surveillance, frontline triage, and the distribution of essential medicines, vaccines and protective equipment during public health emergencies, underpinned by structured training in crisis communication and logistics.

The Vision also addresses structural challenges that currently limit the profession’s potential.

Persistent medicine shortages, fragmented digital infrastructures and increasing administrative burdens are placing pressure on pharmacy teams and reducing time available for direct patient care. PGEU calls for coordinated policy action to strengthen workforce sustainability through fair remuneration, modern education and clear career pathways, as well as investment in digital tools that enhance safety and connectivity while preserving the human, patientcentred nature of pharmacy practice. Sustainable funding models that recognise the full value of clinical and public health services are seen as essential to ensure long-term economic resilience and innovation.

Pharmacy Vaccination Toolkit A new FIP toolkit designed to support countries in advancing pharmacists’ roles in vaccination and improving access to life-course immunisation has been launched.

Vaccination remains one of the world’s most effective public health interventions, preventing between 3.5 and 5 million deaths annually.

Yet, despite decades of progress, recent disruptions have highlighted the need for resilient, accessible vaccination systems. “Drawing on data from 117 countries collected through FIP’s global vaccination surveillance, this toolkit equips countries with no legal framework for pharmacist-administered vaccination, those exploring pilot models, and those seeking to broaden or optimise their existing programmes,” said FIP CEO Catherine Duggan.

Pharmacy-based vaccination (PBV) is no longer an emerging model, it is a proven, scalable solution that strengthens public health outcomes, addresses health workforce shortages, and promotes healthy ageing.

Across countries and settings, pharmacists have demonstrated their value as accessible immunisers, educators, and advocates. Their integration into vaccination strategies enhances population coverage, reduces disease burden, and supports system-wide sustainability.

Through FIP’s involvement in life-course immunisation, the organisation aims to promote global pharmacy-based vaccination by providing timely, life-saving vaccinations to all ages, strengthen global immunity against preventable diseases, tackle vaccine hesitancy and complacency by driving collaborative action, and champion pharmacists as key players in lifecourse immunisation.

With this new publication, FIP aims to support member organisations and individual pharmacists with evidence to understand how they

can contribute to improving and expanding PBV in their national context. This framework presents a comprehensive, structured approach for integrating PBV into national immunisation efforts. It highlights pillars of life-course immunisation through PBV to include policy regulations and advocacy, workforce development, vaccination equity and promotion, access to vaccination records, and funding models. The framework ensures that PBV services are safely, effectively, and sustainably implemented while aligning with broader public health objectives.

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20

Technology

Building the Infrastructure Layer for the Future of Pharmacy Clinical Service Delivery Community pharmacy in Ireland is in the middle of a structural shift. Clinical service delivery is expanding rapidly, scopes of practice are widening, and pharmacies are increasingly recognised as first-contact healthcare settings. Yet while expectations have grown, the infrastructure underpinning pharmacy services has not evolved at the same pace.

PharmaFAST was created to address that gap. Not as another booking tool, but as the infrastructure layer needed to support safe, compliant and scalable clinical service delivery in community pharmacy.

An infrastructure-first approach

Integration over replacement

PharmaFAST takes a different position. Rather than seeing booking as the product, it treats booking as one component of a broader clinical service infrastructure.

As its founders put it: booking is the easy part. Delivering structured clinical services at scale is not.

A key principle behind PharmaFAST is integration rather than displacement. The platform is designed to work alongside existing pharmacy systems, not replace them.

At its core, PharmaFAST combines fixed appointment scheduling with dynamic, on-demand booking, layered with standardised, compliance-ready clinical workflows for each pharmacy service. The emphasis is not on transactions, but on enabling pharmacies to operate as fully fledged clinical service providers.

Through exposing an API, PharmaFAST integrates directly with pharmacy PMR and POS systems, allowing service data and revenue to flow back into systems pharmacists already use. Industry vendors such as Navi, McLernons and TouchStore continue to drive innovation in Irish pharmacy technology; PharmaFAST aims to provide them with a turnkey clinical service layer directly in their systems.

PharmaFAST is mission driven, operating out of the business and innovation centre NUIG. The problem: why booking tools aren’t enough Since COVID and the the beginning of the phased rollout of the Pharmacy Clinical services model. Most focus on the most visible element of service delivery: appointment booking. But for pharmacists, booking is only the front door. The real complexity lies underneath — in clinical protocols, governance, documentation, reporting, and integration with existing systems.

Broadly, three types of solutions dominate the market Managed service providers (MSPs) emerged rapidly during COVID, often bundling website development with basic booking functionality. In many cases, the booking software itself is not owned by the provider, limiting clinical depth, adaptability, and long-term innovation.

Consultancies and off-the-shelf platforms typically repackage third-party software. While they may solve isolated pain points, they are rarely designed around pharmacy workflows and remain constrained by roadmaps set outside the profession.

Third-party patient registers, originally built for GP or primary care settings, now offer pharmacy booking add-ons. These systems often prioritise data capture over service delivery and do not support the full clinical lifecycle of pharmacy services.

The result for pharmacists is fragmentation: multiple tools, partial solutions, and increasing friction when trying to scale services beyond isolated pilots.

In practical terms, the platform is perhaps best understood as 20 per cent booking and 80 per cent clinical protocol management, compliance, and service enablement. Clinical best practice is embedded from the outset, rather than added retrospectively.

This approach reflects a recognition that pharmacy practice is expanding faster than the systems designed to support it.

Infrastructure needs to anticipate that expansion, not react to it.

Rethinking competition Interestingly, PharmaFAST does not position itself as competing directly with booking vendors or MSPs. Those solutions, it argues, only partially address appointment management and add complexity rather than solve appointment management, while not providing any solution to the surface layer of a much deeper problem.

Instead, the platform focuses on enabling pharmacies to deliver, manage, evidence and scale clinical services in a way that aligns with national and European health data strategies.

In that sense, the comparison is not between booking tools, but between infrastructure models.

This distinction matters forpharmacists as they transition from a traditional dispensaryonly model to fully fledged Clinical Service providers, needing technology that supports governance, auditability, compliance and best practice at every step— not just appointment diaries.

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For pharmacies, this means access to clinical service infrastructure without having to change core systems. For vendors and symbol groups, it opens new service revenue streams and the ability to view performance across mixed estates.

Beyond booking: what comes next PharmaFAST’s roadmap reflects its infrastructure mindset. Planned developments include two-way patient communication, patient engagement and CRM tools, loyalty and retention programmes, and deeper clinical service analytics.

AI, the company says, is native rather than bolted on. Rather than marketing itself as “AI-driven”, the focus is on whether automation and agent-based services genuinely improve operations and patient care. The technology is intended to evolve only when it delivers tangible value in practice.

Aligning with the future of health data Looking further ahead, PharmaFAST’s long-term vision aligns with European health data exchange goals towards 2030. The ambition is to become a connective layer linking service delivery, analytics and reimbursement, and a natural extension point for national health service portals.

For pharmacists, that could mean consolidated service delivery on a single screen. For health systems, it offers standardised, interoperable clinical service data generated at community level.

A mission-driven model Finally, the ethos behind PharmaFAST is deliberately long-term. Operating under a dual non-profit and limited company structure, the organisation has chosen to turn down venture capital funding that did not align with its mission.

The stated focus is on meaningful healthcare change rather than growth at any cost — a perspective that may resonate with pharmacists navigating increasing professional responsibility within tight operational constraints.

As community pharmacy continues to evolve, the question is no longer whether pharmacists will deliver more clinical care, but whether the infrastructure exists to support them safely, sustainably and at scale. PharmaFAST addresses that question — by building the appointment booking and clinical protocol layer that sits on top of existing Pharmacy software infrastructure.

For healthcare professionals in Ireland only.

Abbreviated Prescribing Information can be found below.

Smoking Cessation Medicine

Varenicline Teva Film-coated Tablets varenicline

Available on private prescription only.

Indications Varenicline Teva 0.5 mg and Varenicline Teva 1 mg Film-coated Tablets (initiation pack) and Varenicline Teva 1 mg Film-coated Tablets Varenicline Teva is indicated for smoking cessation in adults.

Varenilcine 0.5mg and 1mg Film-Coated Tablets Abbreviated Prescribing Information Presentation: Each film-coated tablet contains varenicline citrate equivalent to 0.5mg and 1mg varenicline. Indications: Varenicline is indicated for smoking cessation in adults. Dosage and administration: Oral use. Adults: The recommended dose is 1mg Varenicline twice daily following a 1-week titration (see SmPC for details). Children: Not recommended for use. Elderly: No dosage adjustment is necessary. Elderly patients are more likely to have decreased renal function, prescribers should consider the renal status of an elderly patient. Renal impairment: No dosage adjustment is necessary for patients with mild (estimated creatinine clearance >50ml/min and ≤80ml/min) to moderate (estimated creatinine clearance ≥30ml/min and ≤50ml/min) renal impairment. For patients with severe renal impairment (estimated creatinine clearance <30ml/min), the recommended dose of Varenicline is 1mg once daily. Hepatic impairment: No dosage adjustment is necessary. Contraindications: Hypersensitivity to the active substance or to any of the excipients. Precautions and warnings: Physiological changes resulting from smoking cessation, with or without treatment with Varenicline, may alter the pharmacokinetics or pharmacodynamics of some medicinal products, for which dosage adjustment may be necessary (examples include theophylline, warfarin and insulin). As smoking induces CYP1A2, smoking cessation may result in an increase of plasma levels of CYP1A2 substrates. Changes in behaviour or thinking, anxiety, psychosis, mood swings, aggressive behaviour, depression, suicidal ideation and behaviour and suicide attempts have been reported in patients attempting to quit smoking with Varenicline. Depressed mood, rarely including suicidal ideation and suicide attempt, may be a symptom of nicotine withdrawal. Clinicians should be aware of the possible emergence of serious neuropsychiatric symptoms in patients attempting to quit smoking with or without treatment. If serious neuropsychiatric symptoms occur whilst on Varenicline treatment, patients should discontinue Varenicline immediately and contact a healthcare professional for re-evaluation of treatment. Smoking cessation, with or without pharmacotherapy, has been associated with exacerbation of underlying psychiatric illness (e.g. depression). In clinical trials and post-marketing experience there have been reports of seizures in patients with or without a history of seizures, treated with Varenicline. Varenicline should be used cautiously in patients with a history of seizures or other conditions that potentially lower the seizure threshold. At the end of treatment, discontinuation of Varenicline was associated with an increase in irritability, urge to smoke, depression, and/or insomnia in up to 3% of patients. In such instances, tapering should be considered. Patients taking Varenicline should seek immediate medical attention if they experience signs and symptoms of myocardial infarction or stroke. Hypersensitivity reactions including angioedema (swelling of the face, mouth neck and extremities) have been reported in patients treated with varenicline. Some rare life-threatening reports required urgent medical attention due to respiratory compromise. Rare and severe cutaneous reactions (Stevens-Johnson-Syndrome and

Teva Pharmaceuticals Ireland, Digital Office Centre Swords, Suite 101 - 103, Balheary Demesne, Balheary Road, Swords, Co Dublin, K67E5AO, Ireland.

Erythema Multiforme) have also been reported in post-marketing reports. Due to the life-threatening nature of these conditions, varenicline should be discontinued and a healthcare provider should be contacted immediately. Interactions: Varenicline has no clinically meaningful drug interactions (see SmPC for further details). No dosage adjustment of Varenicline or co-administered medicinal products listed below is recommended. In vitro studies indicate that Varenicline is unlikely to alter the pharmacokinetics of compounds that are primarily metabolised by cytochrome P450 enzymes. Furthermore, since metabolism of Varenicline represents less than 10% of its clearance, active substances known to affect the cytochrome P450 system are unlikely to alter the pharmacokinetics of Varenicline, therefore a dose adjustment of Varenicline would not be required. Varenilcine is not known to affect the pharmacokinetics of metformin, digoxin, bupropion and warfarin. Co-administration of cimetidine, with Varenicline increased the systemic exposure of varenicline by due to a reduction in varenicline renal clearance. In patients with severe renal impairment, the concomitant use of cimetidine and Varenicline should be avoided. Pregnancy and lactation: As a precautionary measure, it is preferable to avoid the use of varenicline during pregnancy.

A decision on whether to continue/discontinue breast-feeding or to continue/ discontinue therapy with varenicline should be made taking into account the benefit of breast-feeding to the child and the benefit of varenicline therapy to the woman. Effects on ability to drive and use machines: Varenicline may have minor or moderate influence on the ability to drive and use machines. Varenicline may cause dizziness, somnolence and transient loss of consciousness, and therefore may influence the ability to drive and use machines. Adverse reactions: Diabetes mellitus, suicidal ideation, depression, hallucinations, psychosis, seizure, cerebrovascular accident, transient loss of consciousness, myocardial infarction, angina pectoris, tachycardia, atrial fibrillation, electrocardiogram ST segment depression, gastritis, haematemesis, severe cutaneous reactions including Stevens Johnson Syndrome and Erythema Multiforme, angioedema.

Very Common: Nasopharyngitis, abnormal dreams, insomnia, headache, nausea.

Common: Bronchitis, sinusitis, weight increased, decreased appetite, increased appetite, somnolence, dizziness, dysgeusia, dyspnoea, cough, gastrooesophageal reflux disease, vomiting, constipation, diarrhoea, abdominal distension, abdominal pain, toothache, dyspepsia, flatulence, dry mouth, rash, pruritus, arthralgia, myalgia, back pain, chest pain, fatigue, liver function test abnormal. Consult the Summary of Product Characteristics in relation to other side effects. Overdose: In case of overdose, standard supportive measures should be instituted as required. Legal category: POM. Marketing Authorisation Number: 0.5mg PA1986/129/001, 1mg PA1986/129/002, 0.5mg & 1mg Initiation Pack PA1986/129/003. Marketing Authorisation Holder: Teva B.V., Swensweg 5, 2031GA Haarlem, Netherlands. Job Code: MED-IE-00093. Date of Preparation: May 2025.

Adverse events should be reported. Reporting forms and information can be found at www.hpra.ie.

Adverse events should also be reported to Teva UK Limited on +44 (0) 207 540 7117 or medinfo@tevauk.com

Freephone: 1800 - 201 700 | Email: info@teva.ie

Prescription Only Medicine.

Date of Preparation: October 2025 | Job Code: GEN-IE-00155 Further information is available on request or in the SmPC. Product Information also available on the HPRA website.

22

News

Stronger Action on Medicine Shortages EU Parliament Backs Stronger Action on Medicine Shortages Under Critical Medicines Act Members of the European Parliament have signalled strong political backing for a tougher EU response to medicine shortages, following the adoption of a report by the Parliament’s public health committee supporting the proposed Critical Medicines Act. Director General, Adrian van den Hoven

What happens next?

The SANT Committee report will now feed into the European Parliament’s final position on the Critical Medicines Act, ahead of a full plenary vote. If adopted, the Parliament’s position will form the basis for negotiations with the Council of the EU (representing Member States) before the legislation is finalised.

While the Act will not resolve shortages overnight, it is intended to create a long-term framework for improving supply security, resilience and transparency across the EU medicines market.

The report, adopted by the Parliament’s Subcommittee on Public Health (SANT), sets out recommendations aimed at strengthening the security of medicine supply across the EU and reducing Europe’s reliance on fragile global supply chains — an issue that has had direct consequences for community pharmacies in Ireland in recent years.

The Critical Medicines Act, proposed by the European Commission in 2024, is intended to address persistent shortages of essential medicines by tackling structural weaknesses in manufacturing, procurement, pricing and distribution. It builds on lessons learned during the COVID-19 pandemic, when supply disruptions exposed Europe’s dependence on a small number of global manufacturers for widely used off-patent medicines.

Addressing the economic causes of shortages A key focus of the SANT Committee’s report is the economic drivers behind medicine shortages — an issue that pharmacists are acutely familiar with at practice level. Unlike many other industrial goods, medicines are subject to strict costcontainment measures through public procurement, pricing and reimbursement systems.

MEPs argued that these policies can unintentionally exacerbate shortages by driving prices so

low that manufacturers withdraw from the market or consolidate production, reducing resilience in supply chains. This is particularly relevant for older, off-patent medicines, which make up a significant proportion of the products most frequently in short supply.

The committee called for medicine supply security to be explicitly considered in national pricing, reimbursement and procurement decisions, rather than focusing solely on lowest cost. For Irish pharmacists, this reflects growing recognition at EU level that shortages are not just logistical failures, but the result of longstanding economic pressures within the medicines market.

Financial support for European manufacturing The report also strongly supports the creation of a Critical Medicines Security Fund within the EU’s next multiannual budget (the Multiannual Financial Framework, or MFF).

The fund would provide targeted financial support to strengthen manufacturing capacity for critical medicines within Europe.

In practical terms, this could include investment in upgrading production facilities, reshoring manufacturing from outside the EU, and supporting innovation in more efficient and environmentally sustainable production processes.

The committee also called for new, fit-for-purpose EU state aid rules to

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support the off-patent medicines sector, recognising that existing frameworks — such as Services of General Economic Interest (SGEI) — may not be suitable.

For pharmacists, these proposals matter because the majority of medicines affected by shortages in Ireland are long-established, lowmargin products. Strengthening the economic viability of their production is seen as central to improving supply stability.

European solidarity and stockpiling concerns Another issue addressed in the report is the growing use of national stockpiling measures by some larger Member States.

Countries such as Germany and France have introduced extensive stockpiling requirements to protect domestic supply.

While intended to enhance national security, the committee warned that uncoordinated stockpiling risks diverting medicines away from smaller markets, including countries such as Ireland, the Netherlands, Sweden and Finland. MEPs argued that EU-level coordination and solidarity are essential to ensure medicines reach patients rather than being locked into inefficient or duplicative stockpiles.

This point reflects concerns long raised by pharmacists and wholesalers in smaller Member States, where supply disruptions can be felt more quickly when manufacturers prioritise larger markets.

Industry group Medicines for Europe, which represents manufacturers of generic, biosimilar and value-added medicines, welcomed the committee’s position.

Its Director General, Adrian van den Hoven, said the Parliament had demonstrated that it had learned lessons from the pandemic by supporting measures to strengthen critical medicines supply and reduce shortages.

“This is the way forward for EU health security,” he said.

For pharmacists in Ireland, the Critical Medicines Act represents a shift towards addressing medicine shortages at their source, rather than relying on short-term mitigation measures at dispensing level. Persistent shortages increase workload, complicate patient care and place additional pressure on pharmacy teams to source alternatives, manage substitutions and reassure patients.

While implementation will take time and depend on national policy choices, the Parliament’s stance signals growing political consensus that medicine shortages are a systemic problem requiring coordinated EU action.

As negotiations continue, pharmacists can expect increased focus on supply security, procurement reform and the sustainability of the off-patent medicines market — all issues that directly affect daily practice in Irish community pharmacies.

News

23

Irish Pharmacy in 2026: A Sector Redefined by Technology, Capacity Pressures and Patient Expectation Irish pharmacy in 2026 is not simply evolving — it is undergoing a structural shift. The pressures that have been building for a decade have now converged: chronic workforce shortages, rising clinical demand, new national service frameworks, and a patient population that expects digital convenience as standard.

Pharmacies are being asked to do more, with less, for patients who want faster, clearer, and more personalised communication.

• Notify patients when prescriptions are ready

• Targeted to specific patient groups

• Send reminders for uncollected items

• Delivered automatically

• Provide updates on delays or stock issues • Share service invitations or follow‑up messages • Reduce inbound phone calls by up to 70% 2. Integrated Booking Solutions

Yet within this challenge lies the most significant opportunity the sector has seen in years.

Technology, once viewed as a “nice to have,” has become the backbone of modern pharmacy operations. And nowhere is this more evident than in the rapid adoption of automated communication, booking, and payment platforms such as ScriptLife — tools that are quietly reshaping how pharmacies run, how patients engage, and how care is delivered.

A New Era of Patient Expectation Patients in 2026 live in a world of instant messaging, one‑tap payments, and frictionless digital experiences. They book GP appointments online, track deliveries in real time, and expect reminders for everything from dental check‑ups to car servicing.

Pharmacy, historically built on walk‑ins and phone calls, is now expected to match that level of convenience. Patients want: • Automatic reminders for prescription readiness • Clear communication about delays or substitutions • Easy ways to book services like vaccinations or medication reviews The pharmacies that meet these expectations are seeing measurable improvements in patient satisfaction, workflow efficiency, and repeat business.

Those that don’t are increasingly

overwhelmed by phone calls, missed appointments, and administrative bottlenecks.

The Capacity Crunch: Why Automation Is No Longer Optional Pharmacists are delivering more clinical services than ever — from contraception and emergency medicine supply to expanded vaccination programmes. But every minute spent answering the phone, chasing payments, or manually contacting patients is a minute not spent delivering care.

This is where automation steps in as a force multiplier. Platforms like ScriptLife are not replacing human interaction; they are protecting it. By removing repetitive administrative tasks, they free pharmacists and technicians to focus on what only they can do: clinical decision‑making, patient counselling, and service delivery.

ScriptLife: Filling the Gaps That Have Held Pharmacy Back ScriptLife has emerged as one of the most practical, pharmacy‑centred technologies in the Irish market. Its strength lies not in flashy features, but in solving the real, everyday pain points that pharmacies face.

As pharmacies deliver more clinical services, managing appointments has become a major operational challenge.

ScriptLife’s booking system: • Allows patients to book services directly through WhatsApp or a link/online • Syncs with pharmacy workflows • Reduces no‑shows through automated reminders • Provides clear visibility of upcoming appointments For services like flu vaccination, COVID boosters, contraception consultations, and medication reviews, this level of automation is transformative.

3. Seamless Payment Collection Uncollected prescriptions and unpaid service fees drain pharmacy revenue and time.

ScriptLife’s payment tools allow pharmacies to: • Request payment automatically • Reduce queueing and congestion • Secure payment before collection • Track outstanding balances • Improve cashflow predictability Patients appreciate the convenience; pharmacies appreciate the certainty.

1. Automated WhatsApp Communication Flows

4. Campaign Tracking and Measurable Impact

WhatsApp is the most widely used communication channel in Ireland — and ScriptLife leverages it intelligently. Automated flows allow pharmacies to:

Pharmacy health campaigns have historically been difficult to measure. ScriptLife changes that. Campaigns — from smoking cessation to flu season — can be:

• Tracked for engagement • Analysed for conversion For the first time, pharmacies can see which campaigns work, which don’t, and where to focus their efforts.

A Future Where Technology and Human Care Co‑Exist The narrative that technology threatens the personal touch of pharmacy is outdated. In reality, automation enhances it. When administrative noise is reduced, pharmacists gain the time and headspace to deliver meaningful, face‑to‑face care.

Irish pharmacy in 2026 is defined by this balance: digital efficiency paired with human expertise.

ScriptLife and similar platforms are not replacing the pharmacist– patient relationship; they are strengthening it by ensuring communication is timely, clear, and consistent.

The Road Ahead The next phase of Irish pharmacy will be shaped by those who embrace digital transformation early. As service delivery expands, reimbursement models evolve, and patient expectations continue to rise, pharmacies that integrate automation will be better positioned to thrive.

ScriptLife represents more than a tool — it represents a shift in mindset. A recognition that pharmacy can be both clinically driven and digitally enabled. A belief that efficiency and empathy can coexist. And a commitment to meeting patients where they already are: on their phones, in their messages, and in their everyday digital routines.

Irish pharmacy is changing. The question for 2026 is no longer if technology will reshape the sector, but how quickly each pharmacy chooses to adapt.

Contact for further information: info@acornrxtechnologies.co.uk www.acornrxtechnologies.co.uk

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24

Winter Ailments

Merchandising for Cough, Cold & Flu It’s no coincidence that more people get ill over the holiday period than any other time of year.

Parties, late nights, bad weather, over-indulgence in food and drink, not to mention concerns about the bank balance, all take their toll on people’s bodies.

With the winter season just around the corner, now is the time for community pharmacists and their teams, to be promoting the message that consumers should visit them first, for advice and treatment of common winter ailments.

ailments such as coughs and sore throats were equally good regardless of whether patients were treated at a pharmacy, A&E or GP practice, highlighting community pharmacy as a solution to the increasing burden on a stretched health service.

the likelihood of disease and to restore health after illness or injury.

Research shows that 18% of GP appointments are for minor ailments. Community pharmacists are in fact, best placed to advise on these conditions and over-the-counter available and appropriate medications.

Community pharmacy can have an extremely positive impact on the health of the communities it serves due to the engagement pharmacy teams have with their patients every day. Pharmacists will offer advice on conditions and medications, and if appropriate, they will refer a patient to their GP if they feel it necessary.

Research from Behaviour & Attitudes1 confirms that there is a clear desire from the majority of people (92%) to be involved in decisions about their own health and medication, with 80% expressing their view that they see their pharmacist as a key partner in maintaining their health.

Furthermore, the winter months provide the perfect opportunity for pharmacy to drive home the self-care message and ease the pressure on GP surgeries and A&E departments.

The Government has previously stated that the range of medicines provided without a prescription will continue to expand as part of the drive towards a National Health Service that promotes self-care and greater public choice. However, self-medication may not be appropriate for every patient in view of pre-existing medical conditions or because of interactions with other prescription and non- prescription medications.

This reinforces the importance of pharmacists, who have been trained to ask the right questions so they can give appropriate advice.

It has been previously revealed that treatment results for common

Emphasis of Self-Care Research indicates that, despite good intentions, many people do not know how to self-treat conditions such as coughs and colds and therefore visit their GP or A&E for advice.

Visiting pharmacy as an alternative could save up to 950,000 GP consultations every year. Pharmacies need to be aware of the crucial role they can play in educating customers about relieving symptoms of minor winter ailments.

Self care is a healthcare philosophy which emphasises the role of ordinary people in taking ownership of their health and wellbeing and includes taking actions to prevent and decrease

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It is the first step and first choice for Irish people who are taking an increasingly active role in their healthcare and looking to improve their health and wellbeing.

The role of community pharmacists is pivotal to the successful development of self care and its more widespread adoption, according to the Irish Pharmacy Union (IPU) and the Irish Pharmaceutical Healthcare Association (IPHA), who, at the end of last year, launched a self care awareness campaign, entitled ‘Be Well this Winter – Think Pharmacy’.

The campaign was rolled out through the extensive deployment of social media, as well as a series of posters displayed nationwide in retail pharmacies.

Winter campaigns are frequently run on an annual basis by many major pharmaceutical companies, encouraging customers to selfcare when suffering from colds, flu, sore throats and other associated symptoms. It is important therefore

that pharmacists are aware of these and educated in the key, core messages.

Preparing monthly displays about particular subjects, or a dedicated winter health display could be a perfect opportunity to promote self-care for colds, coughs and other winter ailments. Look out for printed leaflets and booklets that can be displayed on a healthy living pharmacy display table and handed out to customers or attached to prescription bags.

Engage with those ‘at-risk’ Using Self-Care and targeted campaigns as a tool to drive footfall to the pharmacy also gives you the perfect opportunity to engage with those people who are most at risk of flu.

For people aged 65 and over and those with long-term health conditions, including diabetes and kidney disease, flu can be particularly dangerous. If you feel that a customer falls into one of those categories, it might be worth advising them to book in for a flu jab as soon as possible to reduce their risk. Remind them that your pharmacy can offer this service, particularly if they are eligible for a free vaccine.

Although the World Health Organisation works to produce timely vaccines based on information available at the time, if the strain of flu mutates it may not

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26

Winter Ailments

be as effective. That’s why it’s also important that you take the time to advise people on how to tell the difference between symptoms of flu and symptoms of a common cold, so that they can treat themselves accordingly with the right OTC medicines if they fall ill.

If someone has a lot of symptoms and asks for advice on what medicines to take, it might be worth recommending an OTC medicine that can treat a number of symptoms e.g. temperature and muscle aches at once. However, it’s important to remind them not to ‘double dose’ on paracetamol or ibuprofen if the flu medication also contains these.

Efficient Merchandising The cough and cold season could also provide the perfect opportunity to reorganise fixtures in your pharmacy with a clear merchandising plan featuring beacon brands in both the P and GSL sections.

You really need to think about the winter season and make a proper planogram, that provides a merchandising tool on a tablet, so that any member of staff can scan the fixture and see what it should look like. Make sure that you feature the national bestsellers, as these beacon brands act as visual clues for customers and direct them to the products they are looking for.

There needs to be some offers that make the pharmacy look competitive and it is crucial that staff are trained to provide advice on seasonal ailments and OTC products.

and whether they would like help to quit. They won’t necessarily think the water tablets they are taking for their blood pressure are important but they could react with the decongestant in a cold remedy and cause problems. This could be a cue for the pharmacist to check through their medication records to ensure they are getting appropriate advice.

Ailment Overview Common Cold The common cold is a condition that is prevalent in the community and is associated with a variety of symptoms. Typically, it is an acute, self-limiting viral infection of the upper respiratory tract that is most frequently caused by rhinoviruses.

Symptoms commonly associated with the common cold include coughing, nasal congestion, low-grade fever, and fatigue, usually presenting 1 to 2 days after exposure. Generally, most symptoms subside within 7 to 10 days, although some symptoms can persist for up to 3 weeks.

The common cold is often mistaken for the flu. The flu is caused by the influenza virus, classified as type A, B, or C. Types A and B affect humans, with type A generating more severe symptoms. The influenza virus can be dangerous in older people and in those patients who are immunocompromised.

Nevertheless, people with influenza are sicker than those experiencing common cold symptoms and commonly manifest such signs and symptoms as temperatures greater than 102°F, chills, headaches, myalgia, and malaise.

Staff should also deliver public health messages by reminding customers to have a flu jab (see Panel) and, for example, when selling cough medicine finding out if the customer is a smoker

Sore Throat

MEDICATION SUMMARY:

conjunction with one another but should be taken two to three hours apart for maximum benefit.

Decongestants - These help to reduce nasal congestion by constricting the dilated blood vessels in the nasal mucosa. This reduces swelling and oedema of the nasal mucosa, making it easier to breathe. Decongestants are not suitable for pregnant and breastfeeding women and patients with hypertension. Nasal sprays and oral tablets should not be used concurrently.

Oral analgesics - Analgesics and antipyretics help to reduce pain and fever associated with sore throats and colds. Ibuprofen also reduces inflammation, which can help if sinuses are inflamed. Paracetamol and ibuprofen can be used in

Sore throat is a hallmark symptom of both viral and bacterial infections of the upper respiratory tract. Sore throat is a self-limiting

Combination products - Can contain ingredients such as a decongestant, analgesic, cough suppressant, antihistamine or an expectorant. These can be used up to their maximum dose for up to seven days unless they contain sedating antihistamines, when they should only be used for up to three days. Antihistamines work by drying up nasal secretions and should be used with a decongestant as they are relatively ineffective on their own. They can also cause drowsiness, so are often found in combination products to aid insomnia associated with having a cold.

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complaint, resolving within three days in 40% of sufferers and within one week in 85% of people - even in those cases with a bacterial aetiology. The key symptom of sore throat is pain at the back of the mouth, which can vary from localised mild discomfort to intense pain on swallowing.

For sore throat sufferers presenting in pharmacy, regular use of paracetamol or ibuprofen-based products can be recommended to relieve pain (soluble analgesics can be gargled to provide targeted pain relief). Customers can also be advised to use simple mouthwashes at frequent intervals (e.g. warm, salty water) until the discomfort and swelling subsides.

Sucking pastilles or lozenges stimulates saliva secretion, which lubricates the throat, and many throat sweets also contain soothing ingredients, such as glycerine and honey, to help relieve irritation.

Nasal Congestion Nasal congestion is a blocked, stuffy or bunged-up feeling in the nose. Depending on the cause, it can last a short while (a few days) or can be persistent. In adults and children it is usually an annoying symptom rather than a serious one. In babies, however, a blocked-up nose may make it difficult to breathe or feed.

Some of the causes of nasal congestion include: • Infections: the common cold and other respiratory tract infections, including influenza (flu) and sinusitis.

• Allergies, including hay fever.

• Persistent rhinitis.

Sinusitis The sinuses are small, air-filled spaces inside the cheekbones and forehead which drain into the nose.

Inhalants, vapour rubs and saline products - Inhalants work by helping to clear the nasal passages, while steam inhalation will help ease nasal congestion by loosening mucus. Saline preparations relieve congestion by helping to liquefy mucous secretions. Inhalants, rubs and saline products can be used daily until symptoms are cleared. They can be used as an alternative by patients who cannot tolerate decongestants.

Sore throat treatments - Most sore throats are caused by a viral rather than a bacterial infection, so don’t need antibiotics. Medicated lozenges or anaesthetic sprays can help relieve the symptoms of sore throat. Gargling regularly with an

Sinusitis means inflammation of a sinus. Most bouts of sinusitis are caused by an infection. Most cases of sinusitis are acute (lasting 1-4 weeks) but some may go on to a more persistent (chronic) sinusitis.

The symptoms of sinusitis are mainly nasal congestion, and pain in the area of the affected sinus.

This is most commonly in the forehead or cheeks on one or both sides of the nose. The pain may be worse on bending down. Other symptoms which may occur are dizziness and fever.

Sinusitis is usually treated with painkillers and decongestants.

Indigestion The holidays aren’t the holidays without an overload of food.

Indigestion can cause heartburn, nausea and discomfort or even pain in the chest shortly after eating. Over-the-counter remedies can relieve the pain, but those getting regular bouts or experiencing other symptoms such as loss of weight, persistent vomiting, difficulty swallowing or blood in their vomit or stool, should be referred.

Alcohol Consumption The festive season often means endless parties, catching up with old friends, eating and drinking.

Research has found people drink much more than the annual monthly average during December.

Regularly drinking above the daily unit guidelines during Christmas can cause temporary effects, such as headaches, sickness, diarrhoea and may also negatively affect mood, weight and sleep. Frequently consuming alcohol can also lead to liver damage. Advise on drinking responsibly, staying within the safe daily unit guidelines , to drink water or soft drinks between each alcoholic drink and to eat a filling meal before alcohol consumption. antibacterial mouthwash or warm, salty water can reduce any swelling and inflammation, while sucking pastilles or lozenges will stimulate saliva secretion to lubricate the throat and help relieve irritation.

Cold sore treatments - Cold sores usually clear up without treatment within seven to 10 days but antiviral creams, such as aciclovir or penciclovir, can be used to ease symptoms and speed up the healing time. Antiviral tablets are generally more effective than creams at treating severe cold sores, but are usually only prescribed in more intractable cases. Patches that contain a hydrocolloid gel can be placed over the cold sore to hide the affected area while it heals.

Winter Wellness Made Easy Immune Support For All The Family Junior Revive

Revive Active

Ages 4 to 12

Age 30+

Zest Active

Teen Revive

Ages 18 to 30

091 769803

Ages 13 to 18

customerservice@reviveactive.com

Or contact your local area sales representative. *Source Euromonitor International Limited; Consumer Health 2025 Edition; Retail Value RSP, 2024 Data.

28

Smoking Cessation

Smoking Cessation in the Community Pharmacy: Why January Matters — and Why It’s Not About Resolutions Every January, the same narrative resurfaces. Smoking cessation campaigns intensify, media headlines focus on New Year’s resolutions, and pharmacies brace for an uptick in nicotine replacement therapy (NRT) sales. For many community pharmacists, the month can feel predictable — even formulaic.

Beyond advice: the pharmacist as behavioural intervention Smoking cessation is often discussed in terms of information — risks, benefits, products, dosages. Yet most people who smoke are already acutely aware of the harms. What they lack is not knowledge, but support that bridges intention and action.

Community pharmacists occupy a unique position in this space.

They are accessible, credible, and embedded in the daily lives of patients in a way that few other healthcare professionals are. In Ireland, many people will interact with their pharmacist far more frequently than with a GP, particularly during the early stages of a quit attempt.

The value pharmacists bring is not simply recommending NRT or explaining dosing schedules. It lies in normalising relapse, reframing failure, and offering continuity.

A brief, non-judgemental conversation at the counter can be the difference between a quit attempt that lasts two days and one that lasts two weeks — and those incremental gains matter.

Rethinking “motivation” in smoking cessation

Yet January’s significance for smoking cessation has far less to do with willpower or seasonal optimism than is often assumed.

Instead, it reflects something deeper: a convergence of health awareness, social reset, and opportunity for professional intervention. For community pharmacists in Ireland, this period offers a chance not merely to dispense products, but to influence outcomes in ways that extend well beyond the pharmacy counter.

This article explores smoking cessation through a different lens — one that emphasises behavioural context, patient readiness, and the pharmacist’s role as a trusted health

professional, rather than retail tactics or calendar-driven campaigns.

Why January still matters — but not for the reasons we think It is well established that January sees a spike in quit attempts.

However, framing this solely as a consequence of New Year’s resolutions oversimplifies what is actually happening. Research consistently shows that quit attempts increase during periods of identity transition — moments when people are already reassessing habits, finances, routines, and health.

In Ireland, January is a month shaped by multiple stressors and

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reflections: post-holiday financial pressure, return to routine, heightened health messaging, and for many smokers, the cumulative effects of winter respiratory illness. These factors create what behavioural scientists describe as a “teachable moment” — a time when individuals are more receptive to change, even if they are not fully confident in their ability to succeed.

Crucially, many people who attempt to quit in January do not self-identify as being “ready”.

They present with ambivalence, previous failed attempts, and low confidence. This is precisely where the community pharmacist’s role becomes critical.

One of the most persistent myths in smoking cessation is that people must be fully motivated before they can quit. In practice, motivation fluctuates, often daily. Pharmacists are well placed to work with this reality rather than against it.

Instead of asking, “Are you ready to quit?”, more effective engagement often comes from questions such as: • “What made you think about stopping now?”

• “What’s been hardest about previous attempts?”

• “What would make the next few days easier?”

These questions shift the interaction from persuasion to problem-solving. They also signal respect for the patient’s experience — a critical factor in maintaining engagement.

The end of erectile problems?

Touch wood.

Available over the counter. No prescription required.

Always read the leaflet. Available in a 4 or 8 pack.

ABBREVIATED PRESCRIBING INFORMATION Product Name: Sidena 50 mg Tablets.

Composition: Each tablet contains, 50 mg sildenafil (as citrate) .

Description: Light blue, round, slightly dotted tablets. Cross breaking notch on one side and marked ‘50’ on the other side. Can be divided into equal quarters. (Only two quarters of the 50 mg is covered by posology).

Indication(s): Treatment of men with erectile dysfunction, which is the inability to achieve or maintain a penile erection sufficient for satisfactory sexual performance.

Dosage: Adults and elderly: 50 mg taken as needed approximately one hour before sexual activity. Dose may be decreased to 25 mg. Max dose: 50mg once daily. Impaired renal and hepatic function: Sildenafil clearance is reduced in hepatic and severe renal impairment. Consider a dose of 25 mg. Dose may be increased step-wise to 50 mg if tolerated. Children and adolescents below 18 years of age: Contraindicated. Use in patients using other medicines: Starting dose of 25 mg with CYP3A4 inhibitors (not advised to use with ritonavir). To minimise postural hypotension in patients receiving and alpha-blocker, stabilise patient first on the alpha blocker and use a starting dose of 25 mg sildenafil.

Contraindications: Hypersensitivity to sildenafil or any of the excipients. Concomitant with ritonavir, nitric oxide donors or nitrates in any form, guanylate cyclase stimulators e.g. riociguat.

In patients that sexual activity is inadvisable (e.g. severe cardiovascular disorders such as a recent (6 months) acute myocardial infarction (AMI) or stroke, unstable angina or severe cardiac failure). Refer these patients to a doctor. Patients with loss of vision in one eye due to NAION. Known hereditary degenerative retinal disorders. Severe hepatic impairment. Hypotension.

Anatomical deformation of the penis. Not intended if no erectile dysfunction. Women.

Warnings and Precautions for Use: First diagnose erectile dysfunction and determine potential underlying causes (e.g. hypertension, diabetes mellitus, hypercholesterolaemia or cardiovascular disease), before considering pharmacological treatment. Consider the cardiovascular status of patients, since there is a degree of cardiac risk associated with sexual activity.

Serious cardiovascular events, including myocardial infarction, unstable angina, sudden cardiac death, ventricular arrhythmia, cerebrovascular haemorrhage, transient ischaemic attack, hypertension and hypotension have been reported post-marketing in temporal association with the use of sildenafil. Most, but not all, of these patients had pre-existing cardiovascular risk factors. Sildenafil has vasodilator properties, resulting in mild and transient decreases in blood pressure. Caution: Patients with anatomical deformation of the penis (such as angulation, cavernosal fibrosis or Peyronie’s disease), or in patients who have conditions which may predispose them to priapism (such as sickle cell anaemia, multiple myeloma or leukaemia). Advise patients that in case of priapism, prolonged erections (longer than 4 hours) or sudden visual defect, they should stop taking sildenafil and consult a physician immediately. Administer to patients with bleeding disorders or active peptic ulceration only after careful benefit-risk assessment, as there is no safety information available.

Interactions: See SPC for detailed information. Inhibitors of the cytochrome P450 (CYP) isoforms 3A4 (major route) and 2C9 (minor route) isoenzymes such as CYP3A4 inhibitors: Itraconazole, ketoconazole, erythromycin, cimetidine, HIV protease inhibitor saquinavir: May reduce sildenafil clearance and increase sildenafil plasma levels. Consider a starting dose of 25 mg. Strong CYP3A4 inducers e.g. rifampicin may increase sildenafil clearance and decrease sildenafil plasma concentrations. Grapefruit juice: May give rise to modest increases in plasma levels of sildenafil. Nicorandil (Hybrid of potassium channel activator and nitrate): Due to the nitrate component it has the potential to have serious interaction with sildenafil. Sildenafil potentiates the hypotensive effect of nitrates. Alpha blocker: Concomitant administration of sildenafil may lead to symptomatic hypotension in a few susceptible individuals. Patients should be hemodynamically stable on alpha-blocker therapy prior to initiating sildenafil treatment. Sildenafil potentiates the antiaggregatory effect of sodium nitroprusside in vitro. Not recommended in patients with a history of bleeding disorders or active peptic ulceration. Not recommended to use with other pulmonary arterial hypertension treatment containing sildenafil. Caution when sildenafil is initiated in patients treated with sacubitril/valsartan. May result in a increase of bosentan availability.

Ability to Drive and Use Machinery: Minor influence, dizziness and altered vision were reported. Patients should be aware of how they react to sildenafil before driving or using machinery. Undesirable Effects: Very common: Headache. Common: Dizziness, visual disorders, visual colour distortion, vision blurred, flushing, hot flush, nasal congestion, nausea, dyspepsia. See SPC for more adverse effects.

Marketing Authorisation Holder: Rowex Ltd, Bantry, Co. Cork. Marketing Authorisation Number: PA 0711/170/002. Further information and SPC are available from: Rowex Ltd., Bantry, Co. Cork. Freephone: 1800 304 400 Fax: 027 50417 E-mail: rowex@rowa-pharma.ie Adverse events should be reported. Reporting forms and information can be found on the Legal Category: Not subject to medical prescription.

HPRA website (www.hpra.ie) or by emailing Rowex pv@rowa-pharma.ie Date of Preparation: Jan 2024 Date of preparation: (10-24) CCF: 26643

Supply status: Supply through pharmacies only.

30

Smoking Cessation

January, with its heightened sense of transition, offers fertile ground for these conversations. Even patients who present “just browsing” cessation products are often open to brief, supportive dialogue when approached thoughtfully.

The Irish context: trust, continuity, and community In Ireland, community pharmacies are deeply woven into local life.

This matters. Smoking cessation is not a one-off intervention; it is a process that unfolds over weeks and months. Patients are far more likely to persist when they feel recognised and supported across multiple encounters.

Unlike national campaigns or digital tools, pharmacies offer relational continuity. A pharmacist who remembers a patient’s previous quit attempt — even briefly acknowledging it — reinforces a sense of accountability and care that no leaflet can replicate.

This is particularly important given that many smokers attempting to quit do so privately. Shame, stigma, and fear of judgement remain powerful barriers.

Community pharmacists, by virtue of their approachability, can reduce these barriers simply by being visible, consistent, and calm.

Nicotine dependence as a chronic, relapsing condition Another way to move beyond “January resolutions” is to reframe smoking not as a bad habit, but as a chronic, relapsing condition.

This perspective aligns with modern understanding of nicotine dependence and has practical implications for pharmacy practice.

Moving beyond products without ignoring them While this article deliberately avoids merchandising advice, products still matter. The key distinction is how they are positioned. Rather than being presented as solutions in themselves, NRT and other cessation aids are most effective when framed as tools that support behaviour change, not replace it.

Pharmacists can add value by: • Explaining combination therapy in clear, practical terms • Normalising adequate dosing rather than underuse • Addressing misconceptions about nicotine safety • Helping patients match products to their daily routines These conversations are clinical, not commercial. They reinforce the pharmacist’s role as a healthcare provider and build trust that extends beyond the cessation journey.

Why success should be measured differently One reason January can feel discouraging for healthcare professionals is that many quit attempts do not result in permanent cessation. However, success in smoking cessation should not be measured solely by abstinence at 12 months.

From a public health perspective, success includes: • Increased quit attempts • Longer smoke-free intervals • Reduced daily consumption • Improved confidence and self-efficacy

Not all quit attempts are announced. Many smokers reduce consumption gradually, experiment with alternatives, or make repeated short attempts before committing fully. These “quiet quitters” often go unnoticed in formal cessation metrics, yet they represent a significant opportunity for intervention.

Community pharmacists influence all of these outcomes, often without seeing the final result. Recognising this broader impact is essential for sustaining professional engagement and avoiding burnout.

January is a peak time for this group. Patients may ask about patches “just in case”, enquire about side effects, or mention cutting down rather than stopping.

These moments should not be dismissed as indecision. They are signals of engagement.

A brief check-in — “How is that going for you?” — can open the door to further support without pressure. Over time, these small interactions accumulate into meaningful change.

• Encouraging repeated quit attempts without judgement

Digital tools, national services, and the pharmacist’s role

• Adjusting NRT regimens rather than abandoning them

Ireland has invested in national smoking cessation supports, including quit services and digital resources. While these are valuable, uptake and adherence remain variable. Community pharmacists can act as bridges between national programmes and individual patients.

This approach is particularly relevant in January, when many quit attempts are fragile. A patient who relapses after two weeks may still have reduced consumption significantly — a meaningful health gain that should be acknowledged.

January often brings renewed visibility for these services.

Pharmacists who are familiar with referral pathways and can explain them conversationally — rather than transactionally — enhance their effectiveness.

The overlooked group: “quiet quitters”

When relapse is treated as failure, patients disengage. When it is treated as expected — even anticipated — patients are more likely to return. Pharmacists can reinforce this by:

• Emphasising harm reduction where complete cessation is not immediately achievable

into practice. Importantly, they can do so in a way that feels personal rather than institutional.

By reinforcing messages, clarifying expectations, and encouraging follow-through, pharmacists help translate policy

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Looking beyond January While January provides momentum, smoking cessation is not seasonal. The challenge — and opportunity — for community pharmacists is to carry forward the supportive, reflective approach

that January invites into the rest of the year.

Patients who do not succeed in January may return in March, June, or October. The memory of being treated with respect and understanding can determine whether they return at all.

By reframing January not as a deadline but as an opening, pharmacists can position themselves as long-term partners in change rather than short-term motivators.

Conclusion: a quieter, more powerful influence Smoking cessation does not usually hinge on dramatic moments. More often, it unfolds through quiet persistence, repeated attempts, and small shifts in behaviour. Community pharmacists in Ireland are uniquely placed to influence this process — not through slogans or seasonal campaigns, but through everyday professionalism.

January matters not because it produces instant success, but because it creates space for conversation. What pharmacists do with that space — how they listen, respond, and follow up — can shape outcomes long after the calendar turns.

In a healthcare system increasingly focused on prevention, the role of the community pharmacist in smoking cessation is not supplementary; it is essential. And its greatest impact may lie not in what is said loudly in January, but in what is supported consistently throughout the year.

Beyond the Prescription Date for your Diary The Irish Institute of Pharmacy (IIOP) and the National Cancer Control Programme (NCCP) are collaborating for RCSI Charter Week with a session being held on 12th February, 2026.

IIOP will co-host an interprofessional session with NCCP entitled ‘Beyond the Prescription – The Pharmacist’s Role in Cancer Care’. The session will take place on Thursday, 12 February, in-person in RCSI, from 14:15-16:15.

The IIOP/NCCP session will bring together pharmacists, general practitioners, and other multidisciplinary colleagues to highlight how cancer care is evolving, and how pharmacy practice is adapting to meet patient needs.

To register please visit: https://rcsi.eventsair.com/charter-meeting-2026/facultyiiop

For healthcare professionals in Ireland only.

Abbreviated Prescribing Information can be found below.

Generic Product Launch

Rivaroxaban Teva film-coated tablets rivaroxaban

Indications Rivaroxaban Teva 10 mg film-coated tablets Prevention of venous thromboembolism (VTE) in adult patients undergoing elective hip or knee replacement surgery.

Treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and prevention of recurrent DVT and PE in adults.

Rivaroxaban Teva 15 mg film-coated tablets/Rivaroxaban Teva 20 mg film-coated tablets Prevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation with one or more risk factors, such as congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, prior stroke or transient ischaemic attack.

Treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and prevention of recurrent DVT and PE in adults.

Rivaroxaban Teva Film-Coated Tablets Abbreviated Prescribing Information Presentation: Rivaroxaban Film-coated Tablets contain 10 mg, 15 mg and 20 mg rivaroxaban. Indications: For 10 mg, prevention of venous thromboembolism (VTE) in adult patients undergoing elective hip or knee replacement surgery. For 15 mg and 20 mg, prevention of stroke and systemic embolism in adult patients with nonvalvular atrial fibrillation with one or more risk factors, such as congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, prior stroke or transient ischaemic attack. For all strengths, treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and prevention of recurrent DVT and PE in adults.

Dosage and administration: For oral use. Adults: Prevention of VTE in adult patients undergoing elective hip or knee replacement surgery: The recommended dose is 10 mg rivaroxaban taken orally once daily. The duration of treatment depends on the individual risk of the patient for venous thromboembolism which is determined by the type of orthopaedic surgery. Treatment of DVT, treatment of PE and prevention of recurrent DVT and PE: The recommended dose for the initial treatment of acute DVT or PE is 15 mg twice daily for the first three weeks followed by 20 mg once daily for the continued treatment and prevention of recurrent DVT and PE. When extended prevention of recurrent DVT and PE is indicated (following completion of at least 6 months therapy for DVT or PE), the recommended dose is 10 mg once daily. In patients in whom the risk of recurrent DVT or PE is considered high, such as those with complicated comorbidities, or who have developed recurrent DVT or PE on extended prevention with Rivaroxaban Teva 10 mg once daily, a dose of Rivaroxaban Teva 20 mg once daily should be considered. Children: Rivaroxaban Teva is not recommended for use in children below 18 years of age. Renal impairment: Limited clinical data for patients with severe renal impairment (creatinine clearance 15 - 29 ml/min) indicate that rivaroxaban plasma concentrations are significantly increased.

Therefore, Rivaroxaban Teva is to be used with caution in these patients. Use is not recommended in patients with creatinine clearance < 15 ml/min. When the recommended dose is 10 mg once daily, no dose adjustment from the recommended dose is necessary. Hepatic impairment: Rivaroxaban Teva is contraindicated in patients with hepatic disease associated with coagulopathy and clinically relevant bleeding risk including cirrhotic patients with Child Pugh B and C. Contraindications: Hypersensitivity to the active substance or to any of the excipients. Active clinically significant bleeding. Lesion or condition, if considered to be a significant risk for major bleeding. This may include current or recent gastrointestinal ulceration, presence of malignant neoplasms at high risk of bleeding, recent brain or spinal injury, recent brain, spinal or ophthalmic surgery, recent intracranial haemorrhage, known or suspected oesophageal varices, arteriovenous malformations, vascular aneurysms or major intraspinal or intracerebral vascular abnormalities. Concomitant treatment with any other anticoagulants, e.g. unfractionated heparin (UFH), low molecular weight heparins (enoxaparin, dalteparin, etc.), heparin derivatives (fondaparinux, etc.), oral anticoagulants (warfarin, dabigatran etexilate, apixaban, etc.) except under specific circumstances of switching anticoagulant therapy or when UFH is given at doses necessary to maintain an open central venous or arterial catheter. Hepatic disease associated with coagulopathy and clinically relevant

bleeding risk including cirrhotic patients with Child Pugh B and C. Pregnancy and breast-feeding. Precautions and warnings: Clinical surveillance in line with anticoagulation practice is recommended throughout the treatment period. As with other anticoagulants, patients taking Rivaroxaban Teva are to be carefully observed for signs of bleeding. It is recommended to be used with caution in conditions with increased risk of haemorrhage. Rivaroxaban Teva administration should be discontinued if severe haemorrhage occurs. In patients with severe renal impairment (creatinine clearance < 30 ml/min) rivaroxaban plasma levels may be significantly increased (1.6-fold on average) which may lead to an increased bleeding risk.

Rivaroxaban Teva is to be used with caution in patients with creatinine clearance 15 - 29 ml/min. Use is not recommended in patients with creatinine clearance < 15 ml/ min. In patients with moderate renal impairment (creatinine clearance 30 - 49 ml/ min) concomitantly receiving other medicinal products which increase rivaroxaban plasma concentrations Rivaroxaban Teva is to be used with caution. Rivaroxaban is not recommended in patients with an increased bleeding risk. Patients with prosthetic valves: Treatment with Rivaroxaban Teva is not recommended for these patients. Direct acting Oral Anticoagulants (DOACs) including rivaroxaban are not recommended for patients with a history of thrombosis who are diagnosed with antiphospholipid syndrome. Rivaroxaban has not been studied in interventional clinical studies in patients undergoing hip fracture surgery to evaluate efficacy and safety. Rivaroxaban Teva is not recommended as an alternative to unfractionated heparin in patients with pulmonary embolism who are haemodynamically unstable or may receive thrombolysis or pulmonary embolectomy since the safety and efficacy of rivaroxaban have not been established in these clinical situations. To reduce the potential risk of bleeding associated with the concurrent use of rivaroxaban and neuraxial (epidural/spinal) anaesthesia or spinal puncture, consider the pharmacokinetic profile of rivaroxaban. Placement or removal of an epidural catheter or lumbar puncture is best performed when the anticoagulant effect of rivaroxaban is estimated to be low. At least 18 hours should elapse after the last administration of rivaroxaban before removal of an epidural catheter. Following removal of the catheter, at least 6 hours should elapse before the next rivaroxaban dose is administered. If traumatic puncture occurs the administration of rivaroxaban is to be delayed for 24 hours. If an invasive procedure or surgical intervention is required, Rivaroxaban Teva 10 mg should be stopped at least 24 hours before the intervention, if possible and based on the clinical judgement of the physician. If the procedure cannot be delayed the increased risk of bleeding should be assessed against the urgency of the intervention. Rivaroxaban Teva should be restarted as soon as possible after the invasive procedure or surgical intervention provided the clinical situation allows and adequate haemostasis has been established as determined by the treating physician. For the elderly population, increasing age may increase haemorrhagic risk. Serious skin reactions, including Stevens-Johnson syndrome/toxic epidermal necrolysis and DRESS syndrome, have been reported during post-marketing surveillance in association with the use of rivaroxaban.

Rivaroxaban should be discontinued at the first appearance of a severe skin rash (e.g. spreading, intense and/or blistering), or any other sign of hypersensitivity in conjunction with mucosal lesions. Interactions: CYP3A4 and P-gp inhibitors: The use

Teva Pharmaceuticals Ireland, Digital Office Centre Swords, Suite 101 - 103, Balheary Demesne, Balheary Road, Swords, Co Dublin, K67E5AO, Ireland.

Freephone: 1800 - 201 700 | Email: info@teva.ie

Product subject to prescription which may be renewed (B)

of Rivaroxaban Teva is not recommended in patients receiving concomitant systemic treatment with azole-antimycotics such as ketoconazole, itraconazole, voriconazole and posaconazole or HIV protease inhibitors. The interaction with clarithromycin, erythromycin and Fluconazole is likely not clinically relevant in most patients but can be potentially significant in high-risk patients. Given the limited clinical data available with dronedarone, co-administration with rivaroxaban should be avoided.

Anticoagulants: Enoxaparin did not affect the pharmacokinetics of rivaroxaban. Due to the increased bleeding risk care is to be taken if patients are treated concomitantly with any other anticoagulants. NSAIDs/platelet aggregation inhibitors: Care is to be taken if patients are treated concomitantly with NSAIDs (including acetylsalicylic acid) and platelet aggregation inhibitors because these medicinal products typically increase the bleeding risk. SSRIs/SNRIs: As with other anticoagulants the possibility may exist that patients are at increased risk of bleeding in case of concomitant use ith SSRIs or SNRIs due to their reported effect on platelets. Warfarin: No pharmacokinetic interaction was observed between warfarin and rivaroxaban.

CYP3A4 inducers: Cncomitant administration of strong CYP3A4 inducers should be avoided unless the patient is closely observed for signs and symptoms of thrombosis. Other concomitant therapies: Rivaroxaban neither inhibits nor induces any major CYP isoforms like CYP3A4. No clinically relevant interaction with food was observed. Laboratory parameters: Clotting parameters (e.g. PT, aPTT, HepTest) are affected as expected by the mode of action of rivaroxaban. Pregnancy and lactation: Rivaroxaban Teva is contraindicated during pregnancy and breastfeeding. Effects on ability to drive and use machines: Minor influence on the ability to drive and use machines. Adverse reactions like syncope and dizziness have been reported. Patients experiencing these adverse reactions should not drive or use machines. Adverse reactions: Thrombocytopenia, angioedema, anaphylactic reactions including anaphylactic shock, cerebral and intracranial haemorrhage, syncope, eye haemorrhage, hypotension, haematoma, cholestasis, hepatitis, Stevens-Johnson syndrome/ Toxic Epidermal Necrolysis, haemarthrosis, muscle haemorrhage, compartment syndrome secondary to a bleeding, urogenital tract haemorrhage, renal impairment, renal failure (including acute renal failure), postprocedural haemorrhage, contusion, wound secretion, vascular pseudoaneurysm. Common: Anaemia, dizziness, headache, epistaxis, haemoptysis, gingival bleeding, gastrointestinal and abdominal pains, dyspepsia, nausea, constipation, diarrhoea, vomiting, increase in transaminases, pruritus (incl. uncommon cases of generalised pruritus), rash, ecchymosis, cutaneous and subcutaneous haemorrhage, pain in extremity, fever, peripheral oedema, decreased general strength and energy (incl. fatigue and asthenia). Consult the Summary of Product Characteristics in relation to other side effects. Overdose: In case of overdose, the patient should be observed carefully for bleeding complications or other adverse reactions. A specific reversal agent (andexanet alfa) antagonising the pharmacodynamic effect of rivaroxaban is available. The use of activated charcoal to reduce absorption in case of rivaroxaban overdose may be considered. Legal category: POM. Marketing Authorisation Number: PA22579/002/001-03. Marketing Authorisation Holder: TEVA GmbH, Graf-Arco-Str. 3, 89079 Ulm, Germany. Job Code: MED-IE-00077. Date of Preparation: February 2024

Adverse events should be reported. Reporting forms and information can be found at www.hpra.ie.

Adverse events should also be reported to Teva UK Limited on +44 (0) 207 540 7117 or medinfo@tevauk.com

Date of Preparation: October 2025 | Job Code: GEN-IE-00160

Further information is available on request or in the SmPC. Product Information also available on the HPRA website.

32

Research

New Pregnancy Iron Research Implications for Community Pharmacy Practice New research from University College Cork (UCC) is prompting renewed calls for routine screening for iron deficiency in pregnancy — a development that carries clear implications for community pharmacists and their teams, who are often the first point of contact for pregnant women seeking advice on nutrition, supplements and maternal health.

Dr Elaine McCarthy, Lecturer in Nutrition at UCC

placing pharmacy teams in a pivotal early-support role.

The findings underline that waiting for anaemia to develop may be too late to protect optimal foetal brain development.

This shifts the emphasis towards earlier awareness, appropriate supplementation, and consistent messaging across healthcare settings.

Moving the focus from anaemia to iron status Lead researcher Dr Elaine McCarthy, Lecturer in Nutrition at UCC, said the study highlights the limitations of relying solely on anaemia as a marker of risk.

The study, published in The Journal of Nutrition, suggests that iron deficiency in early pregnancy — even in the absence of anaemia — may be associated with lower language and motor development scores in children at two years of age. While iron deficiency in pregnancy is already recognised as common, the findings highlight that when iron deficiency occurs may be as important as whether it occurs.

Despite being a generally healthy, low-risk group, more than 40 per cent of women had low iron stores by mid-pregnancy. Babies born to mothers who were iron deficient early in pregnancy were also found to have lower iron stores at birth, indicating a direct link between maternal iron status and infant iron levels.

For pharmacists, the research reinforces the importance of early conversations, informed supplement advice, and a more proactive role in supporting maternal nutrition long before anaemia is diagnosed.

Children were assessed at two years of age using the Bayley Scales of Infant and Toddler Development, a widely used and internationally recognised measure. The researchers found that early pregnancy iron deficiency may be associated with lower motor and language development scores at that age.

Iron deficiency: earlier and more widespread than assumed

Why this matters in community pharmacy

The study builds on major Irish research published last year showing that four in five pregnant women in Ireland are iron deficient by the third trimester. What is new — and particularly relevant for community pharmacy — is evidence that iron deficiency much earlier in pregnancy may influence a child’s neurodevelopment.

For community pharmacists, this research is significant because iron deficiency without anaemia often goes undetected. Many women may not be identified through routine antenatal blood tests, as current practice tends to focus on haemoglobin levels rather than iron stores.

The latest research was carried out by the Irish Centre for Maternal and Child Health Research (INFANT) at UCC, in collaboration with international partners. It followed 189 mother–child pairs who took part in the IMPROvED and COMBINE cohort studies.

Pharmacists frequently encounter pregnant women — or those planning pregnancy — seeking advice on fatigue, diet, supplements, nausea, or gastrointestinal side effects of iron products. These interactions may occur weeks or months before a first antenatal appointment,

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“Iron deficiency is very common in pregnancy, even in high-resource, low-risk settings like Ireland,” she said. “This research provides an early indication of the lasting consequences of iron deficiency without anaemia, emphasising the importance of adequate iron nutrition during pregnancy.”

For pharmacists, this distinction is important. Women may be told they are “fine” based on haemoglobin results, yet still have depleted iron stores. Pharmacists advising on supplements or diet can help bridge this gap by explaining the difference between iron deficiency and anaemia in clear, accessible terms.

A practical opportunity for pharmacy teams The study strengthens the case for pharmacists to: • Encourage early discussion of iron intake during pregnancy and preconception • Reinforce adherence to prescribed iron where indicated • Help manage side effects that commonly lead to poor compliance • Provide dietary advice to support iron absorption • Signpost credible educational resources Importantly, the researchers stress that the goal is not to alarm women, but to support them. With

appropriate information and early intervention, iron deficiency is considered highly treatable.

New patient-facing resources Following last year’s findings, UCC researchers and the Ireland South Women & Infants Directorate developed a free patient resource, A Guide on Iron During Pregnancy. The guide provides clear explanations of why iron matters, practical food-based advice, and simple recipes using accessible ingredients.

For community pharmacies, this type of evidence-based resource can support consistent messaging and help counter misinformation around supplementation, dosage, and safety.

Screening gaps and policy implications At present, routine screening for iron deficiency — as distinct from anaemia — is not part of standard antenatal care in Ireland, and there is no universally agreed diagnostic threshold for iron deficiency in pregnancy.

The research team argues that growing evidence now supports earlier screening, clearer diagnostic guidance, and increased awareness among healthcare professionals. While any changes to national screening policy will take time, pharmacists are likely to see the practical consequences first — in the form of questions, confusion, and unmet needs at community level.

As primary healthcare professionals with frequent patient contact, pharmacists are well positioned to translate emerging research into practical support — particularly during the early stages of pregnancy when intervention may have the greatest impact.

While further research and policy development are needed, the message for community pharmacy is clear: iron matters earlier than previously thought, and pharmacists are already part of the solution.

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34

Eye Health

Awareness Month: Age-Related Macular Degeneration Pharmacists cannot stop the progressive loss in central vision that comes with age-related macular degeneration, but they can help patients understand the treatment options.

Age-Related Macular Degeneration (AMD) is a chronic disease leading to progressive central vision loss.

The symptom of central vision loss is due to the fact that the damaged macula is in the centre of the retina. Patients with AMD may be unable to recognise faces, read, or drive a vehicle.

AMD is the most common cause of sight loss in people over the age of 50 in Ireland and it's estimated that 7% of Irish people over 50 years of age are living with AMD. On account of our ageing population, the number of people in Ireland affected by this condition is expected to increase.

Symptoms of AMD include decreased central vision, central scotoma, and metamorphopsia.

Scotoma is an area of partially diminished vision surrounded by a field of normal or well-preserved vision. Metamorphopsia is a visual defect that causes people to see objects in a distorted manner; straight objects appear wavy or curvy. Patients will complain of distorted vision, lack of bright colours, or blurred vision.

There are 2 types of macular degeneration: dry and wet. All AMD begins as “dry.” In some cases, it progresses to “wet,” which is a more severe form characterised by abnormal blood vessel growth that produces fluid in the retina. Wet Age-Related Macular Degeneration (wet AMD) is

the leading cause of severe vision loss and legal blindness in people over the age of 65 in North America, Europe, Australia and Asia.

Dry macular degeneration, also known as the nonexudative form, is more common and found in approximately 90% of AMD patients. The onset of dry AMD is subacute. Management of dry AMD includes attempts to prevent progression to and frequent monitoring for the development of wet macular degeneration Wet (also known as exudative or neovascular) macular degeneration occurs in about 10% of AMD patients. It is the more acute form and more likely to cause vision loss.

Wet AMD (Age-Related Macular Degeneration) is a chronic, degenerative condition characterised by abnormal blood vessels that grow underneath the retina. The condition gets worse as these faulty blood vessels leak fluid in the back of the eye. This may lead to swelling and damage of the macula, the part of the retina that lets you see colour and maintain sharp vision.

A healthy retina is a dry retina. If this fluid isn’t controlled, central vision will gradually get worse, leading to difficulty doing everyday activities such as reading, recognising faces and driving.

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The leaky blood vessels are caused by an excess of a tiny protein called Vascular Endothelial Growth Factor (VEGF). Most eye doctors agree that the best way to control these tiny proteins is with an anti-VEGF treatment.

Treatments that help control fluid and stop blood vessels from leaking may slow the progression of wet macular degeneration.

What are the symptoms?

• Gaps or dark spots (like a smudge on glasses) may appear in their vision, especially first thing in the morning. Objects in front of them might change shape, size or colour or seem to move or disappear.

• Colours can fade.

• Sufferers may find bright light glaring and uncomfortable or find it difficult to adapt when moving from dark to light environments.

• Words might disappear when they are reading.

• Straight lines such as door frames and lampposts may appear distorted or bent.

In Dry AMD symptoms are often mild, such as needing stronger glasses or better lighting for reading. When progression to Wet AMD occurs, the patient may notice the onset of blurring of reading vision with distortion (due to fluid or blood under the

macula). Sometimes patients are unaware until they take a moment to cover or close one eye at a time. At this stage, the progression can be rapid and patients should seek help promptly from their eye doctor.

Amsler Grid An Amsler Grid (on the top of page 36) is a simple test designed to pick up symptoms of Wet AMD. However, it is not a substitute for an eye examination. The patient checks each eye separately with reading glasses on. If they notice new blurring or distortion of the lines on the grid this could indicate the presence of Wet AMD and they should be examined promptly by their eye doctor.

Causes The exact cause of AMD is unknown. However, extensive research efforts over the last decade are playing an important role in uncovering some of the clues as to what may be causing the disease.

Researchers know that certain genes can cause AMD, but they don’t know what triggers the gene. While AMD can be inherited, many lifestyle choices can make progression of the disease worse.

Some risk factors that are believed to increase the chances of developing AMD include being

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patients should seek help promptly from their eye doctor.

36 Eye Health Amsler Grid usually better in the early stages of Wet AMD, although even later stages can be stabilised. In some cases, individuals may notice improvements in their vision.

It is important to remind patients at risk for AMD to have regular eye exams, even when they are symptom-free. Patients complaining of a recent or chronic loss or change of vision should be urged to see an ophthalmologist immediately. A healthy lifestyle may help prevent AMD. This includes not smoking, eating a healthy diet, and being physically active.

Following the recommended guidelines and the use of appropriate pharmacologic agents may help patients with AMD slow vision loss progression, increase visual acuity, and experience a greater quality of life.

Knowing the symptoms and signs to be aware of: 1. Symptoms: look out for straight lines appearing wavy or distorted, e.g. a doorframe.

If you see a smudge, gaps or dark spots appearing in your field of vision, or have difficulties in reading small print, even with glasses, or difficulty in recognising faces, it is recommended to make an appointment with an eye doctor, optometrist or GP as soon as possible.

pressure, or have been exposed to prolonged periods of sunlight, then you should also have regular check-ups.

3. Healthy diet: eat a diet low in saturated fats and rich in omega 3 fatty acids (oily fish and walnuts). Green, leafy vegetables (spinach and kale) contain antioxidants, eggs and yellow/orange-based fruit contain nutrients such as lutein, zeaxanthin and beta-carotene – all work to protect the macula.

4. Vitamin supplements: certain nutritional supplements containing vitamins C and E, zinc, copper, lutein and zeaxanthin can slow down the progression of AMD in people already showing signs of the condition.

5. Get moving and stop smoking: every week we should engage in 150 minutes of medium-level activity such as brisk walking, swimming and light jogging.

Smoking poses a significant risk for AMD especially in women.

risk of progression of Early An Amsler Grid is a the simple test designed to pick up symptoms of Wet AMD. Howe AMD to late-stage AMD. The recommendations include substitute for an eyesupplements examination.

The patient checks each eyeFurther separately with readin information resources: containing vitamins C and E, zinc, copper, lutein • The Irish College of and zeaxanthin. they notice new blurring or distortion of the lines on the grid this could indicate the pr Because the exact causes of AMD Ophthalmologists Treatment for Wet AMD is are not yet known, some people www.eyedoctors.ie through a seriespromptly of AMD and shouldmost beoften examined by their eye doctor. may develop AMDthey even in the over the age of 50 and having a family history of AMD. Having high blood pressure, a poor diet or being overweight are also thought to be risk factors for this condition.

absence of these risk factors.

Age-Related Studies (AREDS1 and AREDS2) have shown that a combination of vitamins and antioxidants may help reduce

Causes

injections into the eye using a drug called anti-VEGF (Anti-Vascular Endothelial Growth Factor). This treatment works by reducing the growth of new blood vessels.

Response to this treatment is

2. Risk groups: People over 50 should have a regular eye exam (every 2 years or as directed by the doctor). If you have fair skin, light eyes, high blood

• The Macular Society www.macularsociety.org

• Retina International also has an international AMD toolkit on their website

News The exact cause of AMD is unknown. However, extensive research efforts over

decade are playing an important role in uncovering some of the clues as to wha

Two causingTrinity-led the disease. Projects receive HRB investment

Trinity-led mental health research projects focused on children in care and adults living with HIV are among ten projects to be funded by the Health Research Board (HRB). An investment of €2 million in a total of ten Researchers know that certainof genes can cause AMD, but they don’t know wha projects was announced today

by Minister State for Mental Health Mary Butler.

gene. While AMD can be inherited, many lifestyle choicesDrcan make progressio Professor in Clinical Health in the School of Psychology’s Gráinne Gorman, Chief Psychology David Hevey said of new Research Centre for the Executive of the HRB, said: disease worse.

• Improving Outcomes for his project, “Children placed in Developing Person. Subject to The Trinity projects are:

Children in Care, led by Prof.

David Hevey and Prof. Ben Butlin (Trinity College Dublin) and Robert O’Connor (Tusla Child and Family Agency).

the care of the state are at risk of experiencing a range of negative outcomes; key questions for Tusla include what therapeutic help to offer, to whom and when?

Unfortunately, the evidence base to inform such decision-making remains unclear. One explanation for this evidence gap is that the screening tools widely used in traditional mental health settings are unable to detect the core difficulties of children in care.

Tusla approval we will apply psychological science to design and test a screening and outcome measurement framework that can be implemented nationally.”

“We welcome the Minister’s continued commitment to advance mental health research which has seen the HRB’s dedicated mental health research budget triple since 2022.

‘Collaborative Research Network’ in mental health which will be led by Maynooth University, in partnership with the University of Galway, and the National Suicide Research Foundation at University College Cork.

demonstrates the power of coproduction and collaboration in driving research that improves mental health and wellbeing, especially among priority and underserved populations, across the island of Ireland.”

Some risk factors that are believed to increase the chances of developing AMD being over the age of 50 and having a family history of AMD. Having high blood • Understanding and Addressing separate grant of ¤1 million poor dietLoneliness or being overweight are also Awill thought toall-island be risk factors for this conditio Mental Health, and “This recent investment establish a new Quality of Life in Older People Living with HIV in Ireland: A Pathway to Social Prescribing, led by Dr Louise Brennan (Trinity College Dublin) and Professor David Robinson (St James’s Hospital Dublin).

“Working with our partners in Tusla, this novel project is based

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For healthcare professionals in Ireland only.

Abbreviated Prescribing Information can be found below.

Generic Product Launch

Pazopanib Teva Film-coated Tablets pazopanib 30 film-coated tablets

High Tech Prescription Medicine

Indications Renal cell carcinoma (RCC) Pazopanib Teva is indicated in adults for the first-line treatment of advanced renal cell carcinoma (RCC) and for patients who have received prior cytokine therapy for advanced disease.

Soft-tissue sarcoma (STS) Pazopanib Teva is indicated for the treatment of adult patients with selective subtypes of advanced soft-tissue sarcoma (STS) who have received prior chemotherapy for metastatic disease or who have progressed within 12 months after (neo) adjuvant therapy.

Efficacy and safety has only been established in certain STS histological tumour subtypes.

Pazopanib Teva Film-Coated Tablets Abbreviated Prescribing Information.

Presentation: Each film-coated tablet contains pazopanib hydrochloride equivalent to 200mg and 400mg pazopanib respectively. Indications: Indicated in adults for the first-line treatment of advanced renal cell carcinoma (RCC) and for patients who have received prior cytokine therapy for advanced disease. Also, indicated for the treatment of adult patients with selective subtypes of advanced soft-tissue sarcoma (STS) who have received prior chemotherapy for metastatic disease or who have progressed within 12 months after (neo) adjuvant therapy. Dosage and administration: Oral use. Adults: The recommended dose of pazopanib for the treatment of RCC or STS is 800mg once daily. Children and Adolescents (Aged <18 years of age): Not suitable for use. Elderly: There are limited data on the use of pazopanib in patients aged 65 years and older. Overall, no clinically significant differences in safety of pazopanib were observed between subjects aged at least 65 years and younger subjects, but greater sensitivity of some elderly patients cannot be ruled out. Renal impairment: No dose adjustment is required in patients with creatinine clearance above 30ml/min.

Caution is advised in patients with creatinine clearance below 30ml/min as there is no experience of pazopanib in this patient population. Hepatic impairment: Administration of pazopanib to patients with mild or moderate hepatic impairment should be undertaken with caution and close monitoring of tolerability. 800mg pazopanib once daily is the recommended dose in patients with mild abnormalities in serum liver tests. A reduced pazopanib dose of 200mg once daily is recommended in patients with moderate hepatic impairment. Pazopanib is not recommended in patients with severe hepatic impairment. Contraindications: Hypersensitivity to the active substance or to any of the excipients.

Precautions and warnings: Cases of hepatic failure (including fatalities) have been reported during use of pazopanib and is not recommended in patients with severe hepatic impairment. Serum liver tests should be performed before initiation of treatment with pazopanib, at weeks 3, 5, 7 and 9, then at months 3 and 4, with additional tests as clinically indicated. Periodic testing should then continue after month 4. In clinical studies with pazopanib, events of hypertension including newly diagnosed symptomatic episodes of elevated blood pressure (hypertensive crisis) have occurred, therefore, blood pressure should be well controlled prior to initiating pazopanib. Patients should be monitored for hypertension early after starting treatment (no longer than one week after starting pazopanib) and frequently thereafter to ensure blood pressure control. Pazopanib should be discontinued if there is evidence of hypertensive crisis or if hypertension is severe and persists despite anti-hypertensive therapy and pazopanib dose reduction. Posterior reversible encephalopathy syndrome (PRES)/Reversible posterior leukoencephalopathy syndrome (RPLS) and Interstitial lung disease (ILD)/Pneumonitis have been reported in association with pazopanib and can be fatal. Patients developing PRES/RPLS/ILD/pneumonitis should discontinue treatment with pazopanib. The risks and benefits of pazopanib should be considered before beginning therapy in patients who have pre-existing cardiac dysfunction. The safety and pharmacokinetics of pazopanib in patients with moderate to severe heart failure or those with a below normal left ventricular ejection fraction (LVEF) have not been studied. Interruption of pazopanib and/or dose reduction should be combined with treatment of hypertension in patients with significant reductions in LVEF, as clinically indicated. Patients should be carefully monitored for clinical signs or symptoms of congestive heart failure. Baseline and periodic evaluation of LVEF is recommended in patients at risk of cardiac dysfunction. Pazopanib should be used with caution in patients with a history of QT interval prolongation, in patients taking antiarrhythmics or other medicinal products that may prolong QT interval and in patients with relevant pre-existing cardiac disease. In clinical studies with pazopanib, myocardial infarction, myocardial ischaemia, ischaemic stroke and transient ischaemic attack were observed, with some events being fatal. Pazopanib should be used with caution in patients who are at increased risk of thrombotic events or who have had a history of thrombotic events. In clinical studies with pazopanib, venous thromboembolic events including venous thrombosis and fatal pulmonary embolus have occurred. Thrombotic microangiopathy (TMA) has been reported in clinical studies of pazopanib as monotherapy, in combination with bevacizumab, and in combination with topotecan.

Patients developing TMA should permanently discontinue treatment with pazopanib. In clinical studies with pazopanib haemorrhagic events have been reported, including fatal haemorrhagic events. Pazopanib should be used with caution in patients with significant risk of haemorrhage. Before initiating pazopanib, this risk of aneurysm and/or artery dissection formations should be carefully considered in patients with risk factors such as hypertension or history of aneurysms. Pazopanib should be used with caution in patients at risk for gastrointestinal perforation or fistula, as fatal perforation events have occurred in clinical studies. Pazopanib should be discontinued in patients with wound dehiscence. In clinical studies with pazopanib, events of hypothyroidism have occurred. All patients should be observed closely for signs and symptoms of thyroid dysfunction on pazopanib treatment. In clinical studies with pazopanib, proteinuria has been reported. Baseline and periodic urinalysis during treatment is recommended and patients should be monitored for worsening proteinuria. Pazopanib should be discontinued if the patient develops nephrotic syndrome.

The occurrence of Tumour lysis syndrome (TLS), including fatal TLS, has been associated with the use of pazopanib.

Patients at risk should be closely monitored and treated as clinically indicated. Patients on pazopanib treatment should

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be observed closely for signs and symptoms of pneumothorax. Cases of serious infections (with or without neutropenia), in some cases with fatal outcome, have been reported. Interactions: Pazopanib metabolism is mediated primarily by CYP3A4, with minor contributions from CYP1A2 and CYP2C8, therefore, inhibitors and inducers of CYP3A4 may alter the metabolism of pazopanib. Coadministration of pazopanib with strong inhibitors of the CYP3A4 family (e.g. ketoconazole, itraconazole, clarithromycin, atazanavir, indinavir, nefazodone, nelfinavir, ritonavir, saquinavir, telithromycin, voriconazole) may increase pazopanib concentrations. Grapefruit juice contains an inhibitor of CYP3A4 and may also increase plasma concentrations of pazopanib. Concomitant use of pazopanib with a strong CYP3A4 inhibitor should be avoided. If no medically acceptable alternative to a strong CYP34A inhibitor is available, the dose of pazopanib should be reduced during concomitant administration. In such cases there should be close attention to adverse drug reaction, and further dose reduction may be considered if possible drug-related adverse events are observed. Combination with strong P-gp or BCRP inhibitors should be avoided, or selection of an alternate concomitant medicinal product with no or minimal potential to inhibit Pgp or BCRP is recommended. CYP3A4 inducers such as rifampin may decrease plasma pazopanib concentrations. Co-administration of pazopanib with potent P-gp or BCRP inducers may alter the exposure and distribution of pazopanib. In vitro studies with human liver microsomes showed that pazopanib inhibited CYP enzymes 1A2, 3A4, 2B6, 2C8, 2C9, 2C19, and 2E1. Concomitant use of pazopanib and simvastatin increases the incidence of ALT elevations. If a patient receiving concomitant simvastatin develops ALT elevations, follow guidelines for pazopanib posology and discontinue simvastatin. Concomitant use of pazopanib and other statins should be undertaken with caution. Administration of pazopanib with a high-fat or low-fat meal results in an approximately 2-fold increase in AUC and Cmax, therefore, pazopanib should be administered at least 1 hour before or 2 hours after a meal. Concomitant administration of pazopanib with esomeprazole decreases the bioavailability of pazopanib by approximately 40%, and co-administration of pazopanib with medicines that increase gastric pH should be avoided. Pregnancy and lactation: Pazopanib should not be used during pregnancy unless the clinical condition of the patient requires treatment with pazopanib. If pazopanib is used during pregnancy, or if the patient becomes pregnant while receiving pazopanib, the potential hazard to the foetus should be explained to the patient. Patients of childbearing potential should be advised to use adequate contraception during treatment and for at least 2 weeks after the last dose of pazopanib and to avoid becoming pregnant while receiving treatment with pazopanib. Male patients (including those who have had vasectomies) should use condoms during sexual intercourse while taking pazopanib and for at least 2 weeks after the last dose of pazopanib to avoid potential exposure to the medicinal product for pregnant partners and female partners of reproductive potential. Breast-feeding should be discontinued during treatment with pazopanib, as a risk to the breastfed child cannot be excluded. Effects on ability to drive and use machines: No or negligible influence on the ability to drive and use machines. A detrimental effect on such activities cannot be predicted from the pharmacology of pazopanib.

The clinical status of the patient and the adverse event profile of pazopanib should be borne in mind when considering the patient’s ability to perform tasks that require judgement, motor or cognitive skills. Patients should avoid driving or using machines if they feel dizzy, tired or weak. Adverse reactions: Thrombocytopenia, neutropenia, leukopenia, thrombotic microangiopathy, hypothyroidism, tumour lysis syndrome, peripheral sensory neuropathy, transient ischaemic attack, cerebrovascular accident, ischaemic stroke, posterior reversible encephalopathy/reversible posterior leukoencephalopathy syndrome, bradycardia, cardiac dysfunction, myocardial ischaemia, venous thromboembolic event, hypertensive crisis, haemorrhage, aneurysms and artery dissections, interstitial lung disease/pneumonitis, pancreatitis, rectal haemorrhage, gastrointestinal haemorrhage, melaena, anal haemorrhage, large intestine perforation, mouth haemorrhage, upper gastrointestinal haemorrhage, enterocutaneous fistula, haematemesis, haemorrhoidal haemorrhage, ileal perforation, oesophageal haemorrhage, retroperitoneal haemorrhage, hepatotoxicity, jaundice, hepatic failure, palmar-plantar erythrodysaesthesia syndrome, haemorrhage urinary tract, vaginal haemorrhage, metrorrhagia. Very Common: Decreased appetite, dysgeusia, headache, hypertension, diarrhoea, nausea, vomiting, abdominal pain, hair colour change, alopecia, rash, proteinuria, fatigue. Common: Infections, hypophosphataemia, dehydration, insomnia, dizziness, lethargy, paraesthesia, vision blurred, flushing, epistaxis, dysphonia, dyspnoea, haemoptysis, stomatitis, dyspepsia, flatulence, abdominal distension, mouth ulceration, dry mouth, hyperbilirubinaemia, hepatic function abnormal, skin hypopigmentation, dry skin, pruritus, erythema, skin depigmentation, hyperhidrosis, arthralgia, myalgia, muscle spasms, musculoskeletal pain, mucosal inflammation, asthenia, oedema, chest pain. Consult the Summary of Product Characteristics in relation to other side effects. Overdose: Pazopanib doses up to 2000 mg have been evaluated in clinical studies. Grade 3 fatigue (dose-limiting toxicity) and Grade 3 hypertension were each observed in 1 of 3 patients dosed at 2000 mg and 1000 mg daily, respectively. There is no specific antidote for overdose with pazopanib and treatment of overdose should consist of general supportive measures. Legal category: POM. Marketing Authorisation Number: PA22579/006/001- 002. Marketing Authorisation Holder: Teva GmbH, Graf- Arco-Str. 3, 89079 Ulm, Germany. Job Code: MED-IE- 00101. Date of Preparation: October 2025

Adverse events should be reported. Reporting forms and information can be found at www.hpra.ie.

Adverse events should also be reported to Teva UK Limited on +44 (0) 207 540 7117 or medinfo@tevauk.com

Date of Preparation: October 2025 | Job Code: GEN-IE-00153

Further information is available on request or in the SmPC. Product Information also available on the HPRA website.

CPD: Adult Female Urinary Incontinence Summary

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

has my practise changed as a result? Have I identified further learning needs?

Urinary incontinence is a common and distressing condition affecting a significant proportion of adult women in Ireland. It is defined as the involuntary leakage of urine and occurs when the normal processes of bladder filling, storage and emptying are disrupted. Although prevalence increases with age, incontinence is not an inevitable part of ageing and can affect women at all stages of life, including during pregnancy, after childbirth and following menopause. The condition can have a profound impact on quality of life, leading to physical discomfort, sleep disturbance, social withdrawal and psychological distress.

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

5. WHAT NEXT - At this time you may like to record your learning for future use or assessment. Follow the 4 previous steps, log and record your findings.

There are several types of urinary incontinence, most commonly stress, urge and mixed incontinence. Stress incontinence results from weakness of the pelvic floor and urethral sphincter and is triggered by activities that increase intra-abdominal pressure, such as coughing or exercise. Urge incontinence is caused by involuntary contractions of the detrusor muscle and is characterised by sudden urgency, frequency and nocturia. Overflow and continuous incontinence are less common but may occur in the presence of bladder outlet obstruction, neurological disease or sphincter damage.

Community pharmacists play a key role in the identification and management of urinary incontinence. Through sensitive consultation, pharmacists can assess symptoms, review medicines that may contribute to bladder dysfunction and provide advice on lifestyle modification, including fluid management, caffeine reduction, weight control and pelvic floor muscle training. Pharmacists also support appropriate use of pharmacological therapies for overactive bladder, recommend suitable continence products and provide guidance on skin care and catheter management where required. By offering accessible, confidential and evidence-based support, community pharmacists can help reduce stigma, encourage early intervention and significantly improve quality of life for women living with urinary incontinence.

3. PLAN - If I have identified a knowledge gap - will this article satisfy those needs - or will more reading be required?

4. EVALUATE - Did this article meet my learning needs - and how

39

Continuing Professional Development

CPD

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

Pharmacy Management of Adult Female Urinary Incontinence in Ireland Introduction Urinary incontinence is defined as the involuntary leakage of urine and occurs when the normal processes involved in bladder filling, storage and emptying are disrupted. It is a highly prevalent condition affecting millions of women worldwide and a significant proportion of women in Ireland.

Although the prevalence increases with age, urinary incontinence is not an inevitable consequence of ageing and can affect women at all stages of life, including during pregnancy, the post-partum period and the menopausal transition. Despite its frequency, many women do not seek help, often due to embarrassment, fear of stigma or the belief that incontinence is a normal part of ageing or childbirth that must simply be endured.

The impact of urinary incontinence on quality of life can be considerable. Physically, women may experience discomfort, skin irritation, recurrent urinary tract

infections and sleep disturbance due to nocturia. Functionally, the condition can restrict mobility and participation in social, occupational and physical activities. Psychologically, urinary incontinence is associated with anxiety, low mood, reduced self-esteem and social isolation.

Concerns about odour, visible leakage and the need for frequent access to toilet facilities may lead to avoidance of social situations, travel and exercise.

Intimate relationships and sexual function may also be adversely affected, further compounding emotional distress.

Community pharmacists are often the first healthcare professionals approached by women with bladder symptoms or those seeking continence products.

The pharmacy provides an accessible and trusted setting in which sensitive health issues can be discussed confidentially.

Pharmacists therefore have a key role in identifying symptoms, providing education

and reassurance, reviewing medicines that may contribute to incontinence, recommending lifestyle modifications and appropriate continence aids, and facilitating timely referral to general practitioners and specialist services. A sound understanding of the types of urinary incontinence and their management is essential for pharmacists involved in the care of adult women.

Types of Urinary Incontinence Urinary incontinence is a symptom rather than a diagnosis and may arise from a variety of underlying mechanisms. It is commonly classified into stress, urge, overflow, continuous and mixed incontinence. Differentiating between these types is important, as management strategies differ.

Stress Urinary Incontinence Stress urinary incontinence occurs when the pressure within the bladder exceeds the ability of the urethra to remain closed. This typically happens during activities

Table 1: Types of Urinary Incontinence – Key Features Type

Typical Symptoms

Common Triggers

Underlying Mechanism

Stress incontinence

Leakage on coughing, sneezing, exercise

Increased intraabdominal pressure

Weak pelvic floor / urethral sphincter

Urge incontinence (OAB

Sudden urge, frequency, nocturia

Cold, posture change, running water

Detrusor overactivity

Overflow incontinence

Dribbling, weak stream, incomplete emptying

Bladder overdistension

Impaired detrusor or outlet obstruction

Mixed incontinence

Stress + urge symptoms

Combination

Dual mechanisms

Continuous incontinence

Constant leakage

None specific

Sphincter failure / fistula

40

CPD: Adult Female Urinary Incontinence

that increase intra-abdominal pressure, such as coughing, sneezing, laughing, running, jumping or lifting heavy objects.

The amount of urine lost may be small, such as a few drops, or may be more substantial, depending on the degree of sphincter and pelvic floor weakness.

The underlying cause is usually weakness or damage to the pelvic floor muscles and the urethral sphincter, which normally support the bladder neck and maintain continence. Pregnancy and vaginal childbirth are major risk factors, as stretching, nerve injury and trauma to the pelvic floor can compromise muscle strength and coordination.

Instrumental deliveries, prolonged second stage of labour and large birth weight further increase risk.

Menopause also contributes, as declining oestrogen levels lead to thinning of the urethral mucosa, reduced vascularity and loss of collagen, all of which impair the urethral closure mechanism.

Other contributing factors include hysterectomy and other pelvic surgeries, obesity, chronic cough, constipation, heavy manual work and connective tissue disorders.

Urge Urinary Incontinence and Overactive Bladder Urge urinary incontinence is characterised by a sudden, intense desire to void that is difficult to defer and may result in leakage before the woman reaches the toilet. It is often accompanied by urinary frequency and nocturia and may be triggered by changes in posture, cold exposure or sensory stimuli such as the sound of running water. In some women, urgency and incontinence may also occur during sexual activity.

The constant need to plan toilet access can significantly disrupt daily routines and reduce quality of life.

The pathophysiological basis of urge incontinence is involuntary contraction of the detrusor muscle

during the bladder filling phase.

This condition is commonly referred to as overactive bladder.

Detrusor overactivity may be idiopathic or secondary to other conditions, including urinary tract infection, bladder stones, tumours and inflammatory disorders such as interstitial cystitis. Neurological diseases, including stroke, Parkinson’s disease, multiple sclerosis and spinal cord injury, can disrupt the neural control of bladder function and lead to urgency and incontinence. Lifestyle factors also play a role; caffeine, alcohol and artificial sweeteners can irritate the bladder and exacerbate symptoms.

Overflow Incontinence Overflow incontinence occurs when the bladder fills but cannot empty completely, leading to chronic urinary retention and the leakage of small volumes of urine.

Women may experience difficulty initiating micturition, a weak or intermittent urinary stream and a

sensation of incomplete emptying.

Unlike urge incontinence, the sensation of urgency may be absent or reduced.

This type of incontinence may result from impaired detrusor contractility, often due to diabetic neuropathy or neurological conditions such as multiple sclerosis and Parkinson’s disease.

Obstruction of the bladder outlet can also lead to retention and overflow, for example due to pelvic organ prolapse, urethral stricture, bladder stones or tumours.

Residual urine in the bladder creates an environment conducive to bacterial growth, increasing the risk of recurrent urinary tract infections and, in severe cases, upper urinary tract damage and renal impairment.

Continuous and Mixed Incontinence Continuous or total incontinence is characterised by constant leakage of urine due to the inability of the

41 bladder to store urine. This may be caused by severe sphincter damage, fistula formation following pelvic surgery or radiotherapy, or congenital abnormalities. Many women, however, experience mixed incontinence, most commonly a combination of stress and urge symptoms.

Mixed incontinence is particularly common in older women and can be challenging to manage, as both mechanisms must be addressed.

Risk Factors A number of factors increase the likelihood of developing urinary incontinence. These include advancing age, pregnancy and multiple vaginal deliveries, menopause and oestrogen deficiency, obesity, smoking, chronic respiratory disease associated with coughing, constipation, previous pelvic or urological surgery, neurological disorders and a family history of incontinence. Socioeconomic factors and reduced access to healthcare may also delay presentation and treatment.

Awareness of these risk factors allows pharmacists to identify women who may benefit from early advice and intervention.

Medicines Associated with Urinary Incontinence Several commonly used medicines can precipitate or exacerbate urinary incontinence by altering bladder function, urethral tone or urine production. Diuretics increase urinary output and may worsen urgency and frequency.

Angiotensin-converting enzyme inhibitors can cause chronic cough, thereby aggravating stress incontinence. Alpha-blockers relax smooth muscle in the bladder neck and urethra and may reduce outlet resistance. Anticholinergic medicines, opioids and some antidepressants can impair

bladder emptying and contribute to overflow incontinence.

Sedatives and hypnotics may reduce awareness of bladder filling and impair mobility, increasing the risk of functional incontinence, particularly in older adults.

Hormone replacement therapy may influence lower urinary tract symptoms, with variable effects.

Medication review is therefore an essential component of the pharmacist’s role. Identification of potentially contributory drugs, assessment of dose and timing, and discussion with the prescriber regarding possible alternatives can help to reduce symptom burden.

Assessment in the Community Pharmacy When a woman presents with symptoms suggestive of urinary incontinence, the pharmacist can undertake a brief but structured and sensitive assessment. This should explore the pattern and frequency of leakage, the presence of urgency, nocturia or dysuria, obstetric and surgical history, current medicines, fluid and caffeine intake and the impact of symptoms on daily activities and emotional wellbeing. The pharmacist should also be alert to red flag symptoms, such as visible haematuria, recurrent urinary tract infections, pelvic pain, unexplained weight loss or sudden onset neurological deficits, which warrant urgent medical referral.

Conservative and Lifestyle Management Lifestyle modification forms the foundation of first-line management for most types of urinary incontinence. Adequate hydration should be encouraged, as both excessive and insufficient fluid intake can worsen symptoms.

Many women restrict fluid intake in an attempt to reduce leakage, but

this can lead to concentrated urine, bladder irritation and increased risk of infection. Reduction of caffeine and alcohol consumption is particularly important in women with urgency and frequency, as these substances have diuretic and bladder-irritant effects. Weight loss in overweight and obese women can significantly improve stress incontinence by reducing intra-abdominal pressure. Smoking cessation is beneficial in reducing chronic cough and improving tissue health. Management of constipation through dietary fibre, adequate fluid intake and physical activity can reduce straining and pelvic floor stress.

Bladder training, which involves scheduled voiding and gradual extension of the interval between toilet visits, can be effective in urge incontinence. Pelvic floor muscle training is the mainstay of treatment for stress and mixed incontinence and is also beneficial in urge incontinence. Regular, correctly performed exercises strengthen the pelvic floor and improve urethral support and sphincter function. Many women benefit from referral to a specialist continence physiotherapist for assessment and supervised training. Pharmacists can reinforce the importance of adherence, as improvement may take several weeks or months and long-term maintenance is required.

Pharmacological Management Pharmacological therapy is primarily indicated for urge urinary incontinence and overactive bladder. Antimuscarinic agents, including oxybutynin, tolterodine, solifenacin and darifenacin, reduce involuntary detrusor contractions by blocking muscarinic receptors in the bladder. The beta-3 adrenergic agonist mirabegron promotes relaxation of the detrusor

Table 2: Management Overview by Incontinence Type

muscle during the storage phase and may be an alternative for patients who cannot tolerate antimuscarinic side effects.

Common adverse effects of antimuscarinics include dry mouth, constipation, blurred vision and, particularly in older adults, potential cognitive impairment.

Pharmacists have an important role in counselling patients about these effects, encouraging adherence, monitoring for drug interactions and advising on measures to alleviate side effects, such as sugar-free gum for dry mouth and adequate fibre intake for constipation.

For stress urinary incontinence, pharmacological options are limited. Duloxetine, a serotoninnoradrenaline reuptake inhibitor, may increase urethral sphincter tone and reduce leakage in some women, but its use is often limited by nausea, dizziness and withdrawal symptoms. Topical vaginal oestrogen may be beneficial for post-menopausal women with urogenital atrophy and may improve mild urinary symptoms by enhancing urethral mucosal integrity and blood flow.

Continence Products and Skin Care Many women require continence products to manage symptoms and maintain dignity and independence while undergoing treatment or when cure is not possible. A wide range of absorbent pads, pants and bed protectors are available, varying in absorbency, size, fit and design. Product selection should be individualised, taking into account the severity and pattern of leakage, mobility, manual dexterity, skin sensitivity and lifestyle.

Advice on regular changing, gentle cleansing and the use of barrier creams is important to prevent skin irritation, breakdown and infection.

Pharmacists can also provide guidance on odour control and discreet disposal of used products.

Catheter Use in Women

Incontinence Type

First-Line

Second-Line

Specialist / Other

Stress

Pelvic floor exercises

Vaginal oestrogen, duloxetine

Surgery (TVT, colposuspension)

Urge

Bladder training

Antimuscarinics, mirabegron

Botox, neuromodulation

Overflow

Treat cause, ISC

Indwelling catheter

Urology referral

Mixed

Pelvic floor + bladder training

Combination drug therapy

Multidisciplinary care

A urinary catheter is a thin, flexible tube inserted into the bladder to allow drainage of urine when voluntary voiding is not possible or practical. Female catheters are shorter than male catheters and are designed to accommodate female anatomy. Catheterisation may be intermittent or indwelling and may be required on a short- or long-term basis depending on the underlying condition.

42

CPD: Adult Female Urinary Incontinence Locating products in a clearly labelled but discreet section of the pharmacy, rather than in hard-toreach or hidden areas, can reduce the sense of stigma. At the same time, care should be taken to avoid positioning these products in very high-traffic or highly visible areas where customers may feel self-conscious browsing.

Signage that uses positive, clinical language such as “Bladder Health” or “Continence Care” can help frame incontinence as a common medical issue rather than an embarrassing problem.

Indications for catheter use in women include overflow incontinence due to chronic urinary retention, acute retention following surgery or childbirth, neurological bladder dysfunction and, in some cases, palliative care.

Intermittent self-catheterisation is often preferred where feasible, as it is associated with a lower risk of infection and preserves bladder function. Long-term indwelling catheters, either urethral or suprapubic, may be required in women who are unable to perform intermittent catheterisation.

While catheters can provide effective bladder drainage and reduce leakage, they are associated with complications, including urinary tract infections, blockage, encrustation, bladder spasms and urethral trauma.

Education on catheter care, hand hygiene, adequate fluid intake, drainage bag management and recognition of signs of infection is essential. Community pharmacists can support patients and carers by providing advice on catheter accessories, such as leg bags and night bags, and by reinforcing the importance of prompt medical review if problems arise.

Referral Pathways and Services in Ireland In Ireland, women with urinary incontinence are usually assessed initially by their general practitioner, who may initiate investigations, prescribe treatment or refer to specialist services. Continence advisory services, pelvic floor physiotherapy, urology and gynaecology clinics play important

roles in the assessment and management of complex cases.

Public health nurses are central to the care of patients requiring catheterisation and continence support in the community.

Pharmacists can assist by encouraging appropriate referral, providing information on available services and supporting adherence to treatment plans.

The Role of the Community Pharmacist The community pharmacist has a pivotal role in the holistic management of urinary incontinence in adult women.

Through sensitive communication and a non-judgemental approach, pharmacists can create an environment in which women feel comfortable discussing bladder symptoms. Early identification of incontinence, medication review, lifestyle counselling, reinforcement of pelvic floor training, recommendation of appropriate continence products and timely referral to medical and specialist services can all contribute to improved outcomes.

By normalising discussion of bladder health and providing evidence-based advice, pharmacists can help to reduce stigma, empower women to seek help and support them in managing a condition that is common, distressing and, in many cases, highly treatable.

Practice in Focus: Supporting Women with Incontinence in the Community Pharmacy – Team Communication and Merchandising

Urinary incontinence remains a highly sensitive and stigmatised condition, and many women delay seeking help due to embarrassment or fear of being overheard. The way in which continence products and advice are presented within the community pharmacy can therefore have a significant influence on whether patients feel comfortable approaching staff and accessing appropriate care.

Creating a supportive, discreet and informative environment is an important part of the pharmacist’s professional role and should involve the entire pharmacy team.

From a communication perspective, all staff members, including counter assistants and technicians, should be trained to recognise common requests that may indicate underlying bladder problems, such as frequent purchases of absorbent pads, barrier creams or urinary tract infection treatments. Team members should be encouraged to respond in a calm, non-judgemental and respectful manner, using clear and empathetic language. Where possible, customers should be offered the opportunity to speak privately with the pharmacist in the consultation room. Simple phrases such as “The pharmacist is available for a confidential chat if you would like” can help open the door to further assessment without causing discomfort.

Merchandising of continence products also plays an important role in normalising the condition and improving access to care.

A structured range that includes light, moderate and heavy absorbency options, male and female specific products, bed protection and skincare items allows staff to make tailored recommendations based on individual need. Shelf-edge information cards or discreet leaflets outlining the different types of incontinence and available supports can empower patients to self-identify symptoms and seek advice. These materials should emphasise that effective treatments are available and that professional help can improve quality of life.

Pharmacy teams should also be familiar with local referral pathways, including general practice, continence advisory services, pelvic floor physiotherapy and public health nursing services.

Being able to signpost patients to appropriate supports enhances the pharmacy’s role as an integrated part of the primary care network.

In Ireland, awareness of HSE continence services and eligibility for medical card or long-term illness scheme support for certain products is particularly valuable.

Finally, regular team training and discussion can help build confidence in addressing sensitive topics such as incontinence.

Role-play scenarios, updates on new products and review of communication strategies can ensure that all staff members provide consistent, compassionate and professional support. By combining thoughtful merchandising with skilled interpersonal communication, community pharmacies can create an environment in which women feel reassured, respected and empowered to seek help for urinary incontinence, ultimately improving both clinical outcomes and patient experience.

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Awards

Turn Your Work Into an Award Unlocking Success: Expert Tips for Entering the 2026 Irish Pharmacy Awards Entering awards for your pharmacy business is an excellent opportunity to gain recognition, establish credibility, and celebrate your achievements.

Winning an Award can boost your business’s visibility, attract new customers, and set your pharmacy apart from competitors. However, entering any Awards can be a competitive process that requires careful planning, attention to detail, and a strong strategy.

In this article, we will provide tips and advice on how to successfully enter the 2026 Irish Pharmacy Awards, focusing on the essential elements of the process, crafting your application, and standing out from the competition.

1. Understand the Awards You Are Entering Before you start the application process, it’s crucial to thoroughly research the awards you’re interested in. Different awards have various categories, eligibility criteria, and judging processes.

Understanding these aspects is the first step to ensuring that you apply for awards that align with your pharmacy's strengths and objectives.

• Research the Award’s History and Reputation: Look into the prestige of the Award and how long it has been running. An award with a solid reputation in the industry can offer more value than one that is relatively new or lacks credibility.

• Understand the Categories: Many awards have different categories, such as Customer

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Service Award, Innovation and Service Development, Pharmacist of the Year and SelfCare. Ensure your pharmacy’s strengths align with the category you choose. For example, if your pharmacy has a successful medication management programme, entering a category that recognises innovation in healthcare services might be the best fit.

• Eligibility Requirements: Some awards have specific eligibility criteria. Ensure your pharmacy meets these before proceeding.

If there are prerequisites, like a minimum number of years in operation or specific types of services provided, make sure to confirm that your business qualifies.

2. Identify Your Unique Selling Points (USPs) One of the key steps in the award application process is identifying the unique qualities of your pharmacy business that make it stand out. Think about what makes your pharmacy different from others in your area and how this can be a point of distinction in your application.

• Innovative Services: If you’ve introduced unique services that benefit your customers, such as specialised health consultations or a personalised medication management system, highlight these. Any innovation that improves customer care or

pharmacy operations can be a great selling point.

• Customer Service Excellence: The level of service you provide to your customers can be a deciding factor in awards. For instance, if your pharmacy staff go the extra mile by offering consultations, reminder services for prescriptions, or creating a welcoming and professional environment, these details should be emphasised.

• Community Involvement: Pharmacies often play a key role in their local communities.

If your pharmacy is involved in charity work, health education campaigns, or community outreach programs, be sure to showcase these initiatives.

• Quality of Products and Services: Emphasise the quality and range of products you offer, including any specialised or hard-to-find items. If you have exceptional quality control, customer satisfaction rates, or other metrics that showcase your commitment to excellence, include these in your submission..

3. Plan and Organise Your Application Entering an award requires a well-organised and thoughtfully crafted application. Judges are typically looking for clear, concise, and compelling information that highlights your achievements.

45 Here are some strategies to help you plan and structure your application effectively: • Follow the Guidelines: Each award application will come with a set of instructions. Carefully read these and ensure that you follow the guidelines regarding word counts, document formatting, and any additional materials you need to submit, such as photos, videos, or testimonials.

• Use Clear and Engaging Language: Be sure to communicate your points clearly. Avoid jargon or overly complex language. Instead, focus on how your pharmacy meets or exceeds the award criteria. Engage the reader by using examples, statistics, and evidence wherever possible.

• Tell a Story: While it’s important to be factual, storytelling can make your application more compelling. Consider describing how your pharmacy has evolved, challenges you’ve overcome, and how you’ve grown or improved over time.

This narrative can help the judges relate to your journey.

• Provide Evidence: Your application should include measurable evidence to support your claims. This might include customer satisfaction surveys, success rates for your services, testimonials, or case studies.

Numbers are particularly persuasive; for example, “Our customer satisfaction score has increased by 25% over the past year” or “We’ve helped over 500 patients manage chronic conditions through our personalised care program.”

• Highlight Achievements and Impact: Focus on both the tangible and intangible results of your work. For example, don’t just list the services you offer, but also explain how they positively impact the lives of your customers or the wider community.

4. Focus on Customer Experience Many awards, especially those in the healthcare or service industries, will place a strong emphasis on customer experience.

This is one area where your pharmacy can truly shine, as personalised care and excellent service are often what sets a pharmacy apart.

form of letters, online reviews, or short quotes that can be integrated into your application.

Positive feedback from your patients can add authenticity and weight to your application.

• Highlight Customer-Centric Policies: If you have customerfriendly policies, such as flexible hours, home delivery services, or patient advice, make sure to describe these in your application. Explain how these services enhance the overall customer experience and make life easier for your patients.

• Measure Customer Satisfaction: If possible, collect and present data about your customers’ satisfaction levels. This can be done through surveys, reviews, or customer retention rates. Showing that your customers consistently rate your services highly can be a strong endorsement of your pharmacy’s commitment to quality care.

5. Leverage Your Team Your team is the backbone of your pharmacy business, and their hard work and dedication should be recognised. Highlighting your team’s contributions to the success of your pharmacy can strengthen your application.

• Celebrate Employee Contributions: Showcase your employees’ dedication and how they contribute to the pharmacy’s success. This could be through their expertise, teamwork, or exceptional customer service.

• Training and Development: If your pharmacy invests in employee training and development, mention this in your application. Continuous learning and improving skills not only benefit your staff but also your customers, and it can make your pharmacy stand out.

• Leadership and Management: If you or your management team have been instrumental in driving the success of the pharmacy, describe your leadership style and any strategies you have employed to improve business performance. Good leadership can be a significant factor in award applications.

6. Be Thorough with the Submission Once you have compiled your application, take the time to double-check everything before submission. Small errors can detract from the overall professionalism of your entry.

• Proofread: Ensure there are no spelling or grammatical mistakes in your application. A wellwritten and polished submission will leave a positive impression on the judges.

• Review Your Evidence: Make sure that all evidence you’ve submitted is clear, relevant, and supports your claims. Include any documents or links as required, and ensure that they are properly formatted.

• Meet the Deadline: Make sure that you submit your application before the deadline. Late entries may be disqualified, so it’s important to leave ample time for last-minute edits and submissions.

7. Engage in the Award Ceremony If your pharmacy is nominated or wins an award, be sure to fully engage in the ceremony.

This is a significant milestone, and it’s important to take full advantage of the exposure and networking opportunities.

• Celebrate Your Success: Whether you win or are nominated, it’s important to celebrate the achievement.

Share the news with your customers through social media, press releases, and in-store displays. This recognition can build trust with your customers and elevate your brand.

• Network with Other Professionals: Award ceremonies offer a chance to network with other pharmacy owners, industry professionals, and potential partners. Take the opportunity to learn from others, share ideas, and discuss industry trends.

your pharmacy, mention it in advertising materials, and incorporate it into your brand messaging. Awards offer social proof of your pharmacy’s excellence, and it can help boost credibility and attract new customers.

8. Keep Improving Even if you don’t win, the process of entering awards can be a valuable learning experience.

Use the feedback from judges to identify areas for improvement in your pharmacy business. Awards are not only about recognition— they can also be an opportunity for growth.

• Identify Strengths and Weaknesses: Reflect on the feedback you received and use it as a guide to continue refining your services and operations. Identifying areas for improvement can help you become more competitive in future award cycles.

• Set New Goals: Based on your experience, set new goals for your pharmacy business.

Whether it’s expanding your services, improving customer satisfaction, or investing in new technology, aim to build on your strengths.

Conclusion Entering the Irish Pharmacy Awards for your pharmacy business, staff and teams, can be an exciting and rewarding process.

By carefully selecting the right Award categories, highlighting your pharmacy’s strengths, and crafting a compelling application, you can enhance your chances of success.

Remember that the application process is not only about winning but also about showcasing your pharmacy’s achievements, gaining recognition, and setting the stage for future growth. Use the tips and advice outlined above to guide your efforts and ensure that your pharmacy stands out in the competitive landscape of Pharmacy Awards.

• Leverage Your Award: If you win an award, use it as a marketing tool. Display the award prominently in

• Testimonials and Feedback: Collect testimonials from customers who have had positive experiences with your pharmacy. This can be in the

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46

Irish Cancer Society

Irish Cancer Society 2025 Focus: Confronting Delays, Championing Equity and Supporting Patients Through Rising Demand 2025 was a pivotal and challenging year for cancer care in Ireland. The Irish Cancer Society continued to act as the leading national voice highlighting critical gaps in the system, championing equity in access, and providing essential services to thousands of patients at a time of growing need. From campaign-driven advocacy to major service demands and policy interventions, the Society played a central role in calling for urgent investment and systemic reform.

Irish Cancer Society CEO Averil Power

Society again saw rising use of its Support Line, Daffodil Centres, and Night Nursing programme.

Transport Service drivers covered millions of kilometres helping patients access chemotherapy— support that many describe as “a lifeline” during the hardest periods of their illness.

A National Wake-Up Call on Cancer Delays The most urgent warning of the year came in July, when the Society published stark new data showing extensive delays in cancer diagnosis and treatment. These delays—affecting chemotherapy, radiotherapy, and urgent breast and prostate assessments— varied dramatically depending on where patients live. The Society condemned this “postcode lottery” and pointed to serious systemic causes: insufficient staffing, outdated facilities, and inadequate equipment in cancer centres.

CEO Averil Power warned that treatment delays are directly costing lives. Research shows that every four-week delay in starting treatment can raise mortality by 10%, and Ireland already has the third-highest cancer mortality rate in Western Europe. With cancer incidence projected to double by 2045, the Society’s message was

unequivocal: Budget 2026 must significantly expand investment in cancer staff, infrastructure and equipment.

Budget 2025: Exposing Years of Underfunding In June, the Society launched its Budget 2025 submission, revealing that the National Cancer Strategy has been underfunded by almost ¤180 million since 2017.

Underinvestment has hindered screening expansion, delayed surgery, limited radiotherapy capacity, slowed clinical trial development and impeded access to new cancer medicines.

The country’s leading oncology bodies united behind the Society’s call for a ringfenced annual investment of at least ¤20 million for the National Cancer Control Programme, alongside multiannual funding to plan effectively for a growing cancer burden.

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Breast Screening and Tackling Inequality In October, ahead of Breast Cancer Awareness Month, the Society warned that screening uptake remains too low— particularly among marginalised and underserved communities.

While Ireland reached a 71% uptake in 2023, leading countries exceed 80%. The Society pressed Government to expand targeted outreach and remove barriers faced by people with disabilities, migrants and economically disadvantaged groups. Early detection saves lives, and the Society stressed that Ireland must strive for world-leading performance.

A Year of Extraordinary Patient Support Demand 2025 also saw dramatic increases in demand for the Society’s free patient support services. Building on record figures from 2023, the

With the State providing only 5% of its funding, the Society relied heavily on public generosity for Daffodil Day. Averil Power appealed to communities to “go all in against cancer,” underscoring the ¤25 million needed yearly to sustain and expand these essential services.

Looking Ahead: A Call for Equity, Investment and Action Across 2025, one message was constant: Ireland cannot continue to accept delays, inequalities and underfunding in cancer care. As incidence rises and services strain, the Society is doubling down on its mission—ensuring every person affected by cancer receives timely treatment, compassionate support and the best chance of survival.

With targeted government investment, expanded screening, stronger cancer staffing and modernised infrastructure, Ireland can reverse mortality trends and deliver the high-quality cancer care its population deserves. The Irish Cancer Society ends 2025 with a clear mandate for change—and a renewed commitment to advocate, support and fight for every patient in 2026 and beyond.

Awards The Irish Pharmacy

2026

Save the Date Irish Pharmacy Awards

Saturday, 6th June, 2026 The Clayton Hotel, Burlington Road, Dublin Further details on Award Categories and Opportunities in the IPN December Dynamic 100 Issue For enquiries and sponsorship please contact Kelly Jo Eastwood – Kelly-jo@ipn.ie

48

2025 Asthma Focus

Ireland’s Asthma Crisis: What 2025 Revealed and What Must Change in 2026 Asthma is one of Ireland’s most common chronic respiratory conditions, affecting around one in ten people. In 2025, major progress was made in understanding and managing the disease through innovative strategies aimed at improving outcomes and reducing preventable deaths. National healthcare reforms and updated GINA guidelines are driving personalised community care, emphasising early intervention, better inhaler technique, and reduced reliance on short-acting relievers to improve control and cut hospital admissions.

These developments reflect a growing emphasis on proactive care, education, and community support.

Written by Mary McDonald, Patient Services Manager, Asthma Society Ireland

times in 2025 for consultant-led diagnostic clinics. Direct GP referrals for diagnostics and education bring treatment closer to home.

GP feedback shows integrated community systems deliver high-quality asthma care, with 87% reporting better outcomes.

However, the phased rollout prioritises areas with the longest waits and highest disease burden, leaving some rural regions without hubs. Further pressures arise from shortages of respiratory nurse specialists and physiologists in some hubs.

Asthma is one of Ireland’s most common chronic respiratory conditions, affecting around one in ten people. In 2025, major progress was made in understanding and managing the disease through innovative strategies aimed at improving outcomes and reducing preventable deaths. National healthcare reforms and updated GINA guidelines are driving personalised community care, emphasising early intervention, better inhaler technique, and reduced reliance on short-acting relievers to improve control and cut hospital admissions. These developments reflect a growing emphasis on proactive care, education, and community support.

The Asthma Society of Ireland plays a central role in advancing patient-centred care within this evolving landscape. We empower patients through our free services, education campaigns, and tailored resources. Our policy priorities – including free MART inhalers and a severe asthma registry – focus on equity, efficacy and prevention.

Ireland’s collaborative approach – uniting policymakers, clinicians, and patient organisations – offers a promising path forward. With targeted action and investment in key areas, we can build a healthier future for those living with asthma. This review highlights the challenges and opportunities ahead in asthma care.

Challenges and pressures Asthma affects an estimated 450,000 people in Ireland and remains a major public health challenge, compounded by under-diagnosis, poor symptom control, and unequal access to care. Environmental shifts, an ageing population, the effects of poor housing, and overreliance on treatments to relieve symptoms are adding pressure to the healthcare system. Asthma-related deaths have increased by 42% in five years – from 66 in 2019 to 94 in 2024 – while emergency visits and hospital admissions consistently exceed the EU average.

Despite welcome Sláintecare reforms, pressures on hospital respiratory services continued to intensify throughout 2025.

Many hospitals experienced sustained demand for urgent reviews during exacerbations, alongside long waiting lists for pulmonary function testing and challenges in accessing specialist severe asthma pathways. These pressures increasingly affect continuity of care between hospital and community settings, highlighting the importance of integrated care and consistent guideline implementation. The HSE’s Adult Asthma Model of Care aims to tackle these challenges.

Ambulatory respiratory hubs, focusing on chronic disease prevention and management, have significantly reduced waiting

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Critically, Ireland is an outlier among our European counterparts in not having a national severe asthma registry to support service planning, outcome tracking, and research. Approximately 5% of asthma patients develop severe asthma. The Asthma Society raised this need in this year’s pre-budget meetings with the Minister for Health and Oireachtas health committee members, along with the need for equitable access to severe asthma care and treatments.

Continued investment into the Chronic Disease Management (CDM) Programme has yielded favourable results. Yet certain challenges are evident. While GP participation has grown steadily in 2025, some practices – particularly rural – continue to face capacity challenges. Resource constraints hinder consistent 2025 GINA and BTS guideline implementation.

Studies indicate that GPs would welcome further training and support in implementing them, particularly around Pulmonary Function Test interpretation, inhaler device selection, and distinguishing COPD from asthma.

Regrettably, there is no dedicated paediatric asthma model of care. This limits timely access to specialist care for children and risks inconsistent management due to the absence of a standardised pathway across care levels.

In 2025, intermittent shortages of certain asthma medications occurred, but the HPRA, GPs, and pharmacists provided excellent

guidance and advice on suitable alternatives to support patients.

Medication accessibility was further hindered by cost-of-living pressures in 2025. In an Asthma Society survey, over half of respondents reported struggling to make ends meet in the previous 12 months and 24% reported going without asthma medication in the previous three months due to financial constraints.

Persistent health inequalities and environmental factors, such as poor air quality, remain major concerns. Ireland’s housing crisis also impacts asthma patients, with substandard accommodation, poor ventilation and air quality exacerbating – and even causing – asthma.

These combined pressures result in increased morbidity and mortality, school and work absences, and reduced quality of life. They also contribute to rising system costs and strain across healthcare services.

Progress and achievements In 2025, asthma management in Ireland advanced through updated international guidelines and national reforms. GINA 2025 advised discontinuing SABA-only treatment due to links with severe asthma and mortality. The updated BTS/NICE/SIGN guideline, published in late 2024 promotes accurate diagnosis, monitoring, and long-term management for all age groups to improve control and reduce attack risk.

The rollout of Integrated Respiratory Hubs under Sláintecare and the HSE’s Enhanced Care in the Community programme has transformed asthma care. The Programme prioritises community-based, patient-centred approaches to reduce hospital admissions and improve quality of life. Previously, patients faced waits of up to three years for specialist care. In 2025, many regions reported substantial reductions in specialist wait times through community-based diagnostic services.

49 Patients are now supported to manage their asthma at home and in the community, reducing reliance on specialist care and empowering greater control over their health. Asthma action plans, inhaler technique training, symptom monitoring, and self-management strategies are key priorities.

Pharmacists played a particularly important role in 2025 by supporting patients with correct inhaler technique, medicines optimisation, and adherence monitoring — areas where errors remain highly prevalent across all age groups.

Pharmacists also contributed to antimicrobial stewardship by helping patients distinguish between asthma exacerbations and respiratory infections. Further integration of pharmacists into multidisciplinary asthma care presents an opportunity to reduce exacerbations and improve longterm disease control.

Growing demand for our patient services in 2025 reflects the continued need for accessible support and education to strengthen self-management. Our Asthma Adviceline (1800 44 54 64) offers free 30-minute calls, as required, with our nurse or physiotherapist. We will handle close to 5,000 calls by year’s end – an increase of 50% on last

year. Our webinar series was viewed by 1,040 patients and healthcare professionals. These services are delivering measurable system value: evaluation data from Q1–Q3 show that 57% of users reported fewer GP visits and 48% avoided ED or hospital attendance, contributing to an estimated ¤3 million in avoided healthcare costs annually. The service improves health, reduces unscheduled care, and empowers self-management.

It is not an emergency service and is complemented by signposting to expert online and written resources.

Healthcare professionals, including pharmacists, can now refer people directly to the Asthma Adviceline via a short referral form on asthma.ie. Our Nurse WhatsApp messaging service (086 059 0132) is ideal for busy parents – with our short videos and infographics delivered straight to their phone. All information booklets were updated and approved by the Medical Advisory Group to reflect the latest asthma management guidelines.

The Asthma Society has through our ongoing advocacy influenced policy and budgetary discussions on affordability of and access to MART combination inhalers advanced therapies, the need for a national severe asthma registry and enhanced specialist care.

Looking ahead to 2026 For 2026, priorities for asthma care and the Asthma Society include improving access, affordability, and quality of care. Key goals are the phased subsidisation of MART combination inhalers, the establishment of a national severe asthma registry, reviewing asthmarelated deaths, and improving access to high-tech medications.

National priorities align, focusing on strengthening communitybased services, and integrating digital health tools for better monitoring and continuity of care.

In 2026, the Asthma Society will continue to build engagement across healthcare settings, including working with GPs to support the implementation of asthma guidelines.

Two key guideline updates are planned for 2026. The ICGP Asthma Control in General Practice guidelines will be revised to align with the latest evidence, aiming to standardise primary care and improve outcomes. The National Clinical Guideline for Managing Acute Asthma Attacks in Adults is also under review, ensuring best practices for patient safety and consistent emergency care across all settings.

The Society also plans to expand our multidisciplinary patient services team, enable seamless referrals by healthcare professionals to our Adviceline and extend our reach into underserved communities.

We will leverage digitalisation, automations and strategic partnerships to reach more patients and improve outcomes.

The HSE Digital Health Strategy will introduce virtual reviews, digital action plans and integrated records for asthma patients.

Innovations like INCA devices and platforms such as Phyxiom track inhaler use and provide real-time adherence data. The Asthma Society actively promotes the adoption of these strategies and collaborates on digital innovation projects that use smart devices to monitor asthma, air quality, and wellbeing, supporting earlier intervention and self-management.

In 2026, for example, we will begin a multi-stakeholder research programme funded by the European Commission to develop an asthma fitness app for coaches and patients.

Moving into 2026, the Society remains committed to advocacy, education, and policy development to improve asthma and quality of life outcomes for the 450,000 people we represent.

News

Influencers in Vitamin D Status Trinity researchers have led a new collaborative study, combining large genetic datasets with satellite weather data and uncovering over 30 distinct genes that influence vitamin D status, many of which were not previously known.

The study involved collaborators from Maynooth University, the Netherlands, UK, Denmark, Austria, and Germany and is published in the journal Nature Communications.

Sunshine, specifically UVB radiation, induces production of vitamin D in exposed skin, leading to a seasonal trend: vitamin D concentration usually peaks in the summer and is lowest at the end of the winter. Vitamin D deficiency, which can lead to other illness, is very common in Europe due to our indoor lifestyle and northerly location.

The authors analysed data from over 330,000 participants from the UK Biobank and included a more sophisticated measure of sunshine exposure than earlier research.

Other studies often only consider whether vitamin D was measured in the summer or winter, which does not accurately account for

the changing intensity of sunshine throughout the year and allows strong environmental influences to overshadow small genetic effects.

In this new study, the authors used satellite data to retrieve daily UVB measurements at each participant’s home address over the 5 months period up to the date of vitamin D measurement. This was used to calculate a precise ambient UVB dose for each person.

The approach proved to be highly successful. By quantifying the environmental influences and investigating the links between genes and sunshine (geneenvironment interactions), the authors identified over 300 genetic variants to be linked with vitamin D status, pointing to its various functions in the body.

Firstly, several of the newly identified genes are linked with

circadian rhythm, the body’s natural 24-hour cycle. This suggests, for the first time, a link between vitamin D status, circadian rhythm, and an innate seasonal rhythm. Although it is still unclear in humans, many animals are known to have seasonal rhythms, which are natural built-in cycles of metabolism or behaviour such as shedding fur or hibernation.

Secondly, many of the identified genes are important for steroid and lipid metabolism. This indicates that BMI and vitamin D status may be intertwined, with individuals who are vitamin D deficient being more likely to develop higher BMI and vice versa. BMI is also thought to change by season—higher in winter than summer.

Finally, several of the genes produce enzymes that are important for the excretion of a wide variety of molecules from the

body, such as drugs, hormones, or vitamin D. Sometimes this process is reversible, which suggests that some forms of discarded vitamin D metabolites can be recycled back into its active form (25-hydroxyvitamin D). This could have important clinical implications: if there are metabolites beyond 25-hydroxyvitamin D that can be converted into the active form, we may need to reevaluate how we measure vitamin D deficiency.

The study paves the way for the development of a new generation of personalised vitamin D supplementation recommendations, which could be made possible in the future by integrating genomic information with detailed environmental measures, including sunshine availability where an individual resides.

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News

¤3m Investment in Mental Health Research Minister for Mental Health Mary Butler TD has announced a €3 million investment in mental health research to advance understanding in areas such as youth mental health, ADHD in adults, women’s mental health, and loneliness in older people.

Health Research Board CEO, Gráinne Gorman

Health) – led by Professor Sinead McGilloway from Maynooth University, will receive ¤1 million over five years from the Health Research Board. This network was called for in the National Mental Health Research Strategy.

The CO-PRIME Network will: • Embed lived experience and co-production in mental health research • Build capacity through training and career development for researchers from a variety of backgrounds

dedicated mental health research budget provided by the Minister for Mental Health, which has tripled since 2022, underscoring the Minister’s strong commitment to evidence-based policy and innovation in mental health.

A grant of ¤1 million will establish a new all-island ‘Collaborative Research Network’ in mental health which will be led by Maynooth University, in partnership with the University of Galway, and the National Suicide Research Foundation at University College Cork. The new research network will embed lived experience in mental health research through co-production of studies between academics and public involvement, whilst also building capacity and career opportunities for researchers in the area of mental

health. The network will also coordinate mental health research by identifying research gaps and fostering partnerships between academic institutions in Ireland and internationally.

A further ¤2 million will fund 10 separate mental health research projects, directly delivering on commitments in the National Mental Health Research Strategy and Sharing the Vision – A Mental Health Policy for Everyone.

These investments are supported by the Health Research Board’s

Health Research Board CEO, Gráinne Gorman said, “We welcome Minister Butler’s continued commitment to advance mental health research which has seen the HRB’s dedicated mental health research budget triple since 2022. This recent investment demonstrates the power of coproduction and collaboration in driving research that improves mental health and wellbeing, especially among priority and underserved populations, across the island of Ireland.”

Collaborative Research Network The Collaborative Research Network – CO-PRIME (Coproducing and Promoting Research & Innovation in Mental

• Identify knowledge gaps and support translation of research into policy and practice • Foster all-island collaboration and international partnerships Project funding for 10 new studies The Health Research Board has also invested ¤2 million in 10 new mental health research projects through the Applied Partnership Awards scheme, which brings together knowledge users and researchers to co-develop projects that address real-world needs in health and social care.

In this round of the scheme, the Health Research Board specifically requested applications in mental health, and there was a very high level of interest across the research community. The funded projects reflect Sharing the Vision’s emphasis on the need for whole-of-government and whole-of-population approaches to mental health.

Cosmetic Association Annual Show 2026 The Cosmetic Association was formed almost 40 years ago to offer the Pharmacy sector a one-stop-shop for their Christmas trade. As the years went by, exhibitors took the opportunity of introducing new brands at the Trade Fair and this was a welcome addition. For Buyers to see a full stand of cosmetics, or a display of perfumes, or a range of jewelry or a display of wrapping / bags, in one day, and in one place, is a huge benefit.

We have extended in a full selection of ‘front of house’ products in Pharmacy.

Our event is aimed primarily at the Pharmacy sector. It is the only event organised to help Pharmacy buyers see as much front of house stock as possible, under one roof. We have now included gift retailer, garden center shops and some beauty salons with retail section.

The event will be the most colourful to date and we hope you will all enjoy your visit. On registration you will receive a brochure, floor plan and a voucher for tea/coffee and a pastry to help you get started, or give you a break during your visit.

Our event is scheduled for 17th, 18th and 19th May 2026 in the Main Hall and Hall 3, in the RDS, Merrion Road, Ballsbridge, Dublin 4, and we will be delighted to see you all there. Registration is available at the door.

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Conference

Irish College of Ophthalmologists Winter Meeting and Montgomery Lecture 2025 The Irish College of Ophthalmologists held their Winter Meeting and Montgomery Lecture 2025 towards the end of last year. Presenters included Dr Patrick Nicholson, Consultant Neurointerventional Radiologist, Beaumont Hospital and Beacon Hospital, Ms Áine Ní Mhéalóid, Consultant Ophthalmic Surgeon, Royal Victoria Eye and Ear Hospital, Ms Lisa McAnena, Consultant Ophthalmic Surgeon, Beaumont Hospital and Mater Misericordiae University Hospital and Mr Gerry Fahy, President, Irish College of Ophthalmologists and Consultant Ophthalmic Surgeon, Blackrock Health Galway.

Mr Gerry Fahy, President of the Irish College of Ophthalmologists, introducing Professor Anthony King, Consultant Ophthalmologist at Nottingham University Hospital, NHS Trust, who presented the Annual Montgomery Lecture 2025 at the ICO Winter Meeting at the Albert Theatre, Royal College of Surgeons in Ireland, on Friday, November 21st

Dr Patrick Nicholson, Consultant Neurointerventional Radiologist, Beaumont Hospital and Beacon Hospital, Ms Áine Ní Mhéalóid, Consultant Ophthalmic Surgeon, Royal Victoria Eye and Ear Hospital, Ms Lisa McAnena, Consultant Ophthalmic Surgeon, Beaumont Hospital and Mater Misericordiae University Hospital and Mr Gerry Fahy, President, Irish College of Ophthalmologists and Consultant Ophthalmic Surgeon, Blackrock Health Galway

The session was dedicated to the subspecialty of Neuroophthalmology, featuring a distinguished panel of experts from both Ireland and the United Kingdom. Joining the panel of speakers on the day were Miss Ruchika Batra, Consultant Neuro-ophthalmologist at Queen

at the same venue that evening.

The lecture entitled "Journey of an Accidental Academic” was delivered by Professor Anthony King, Consultant Ophthalmologist at Nottingham University Hospital, NHS Trust whose primary research interest is in the clinical management of glaucoma, focusing particularly on advanced glaucoma and patient-centered delivery of care.

Victoria Eye and Ear Hospital, Mr Gerry Fahy, President, Irish College of Ophthalmologists, Dr Tasanee Braithwaite, Consultant Ophthalmologist in Neuroophthalmology and Uveitis at the Medical Eye Unit, Guy's and St Thomas' Hospital in London and Ms Lisa McAnena, Consultant Ophthalmic Surgeon, Beaumont Hospital and Mater Misericordiae University Hospital.

Keynote speakers included Miss Ruchika Batra, Consultant Neuro-ophthalmologist at Queen Elizabeth Hospital Birmingham, NHS Foundation Trust, Ms Áine Ní Mhéalóid, Consultant Ophthalmic Surgeon, Royal

Annual Montgomery Lecture 2025

Elizabeth Hospital Birmingham, NHS Foundation Trust and Dr Tasanee Braithwaite, Consultant Ophthalmologist in Neuroophthalmology and Uveitis at the Medical Eye Unit, Guy's and St Thomas' Hospital in London.

The Annual Montgomery Lecture, hosted by the ICO, took place

Professor Anthony King delivering the Montgomery Lecture 2025 - "Journey of an Accidental Academic”

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Professor Anthony King, Consultant Ophthalmologist at Nottingham University Hospital, NHS Trust, presented the Annual Montgomery Lecture 2025 at the ICO Winter Meeting on Friday, November 21st.

Professor King’s primary research interest is in the clinical management of glaucoma, focusing particularly on advanced glaucoma and patient-centered delivery of care.

53

Miss Ruchika Batra, Consultant Neuro-ophthalmologist at Queen Elizabeth Hospital Birmingham, NHS Foundation Trust, Ms Áine Ní Mhéalóid, Consultant Ophthalmic Surgeon, Royal Victoria Eye and Ear Hospital, Mr Gerry Fahy, President, Irish College of Ophthalmologists, Dr Tasanee Braithwaite, Consultant Ophthalmologist in Neuro-ophthalmology and Uveitis at the Medical Eye Unit, Guy's and St Thomas' Hospital in London and Ms Lisa McAnena, Consultant Ophthalmic Surgeon, Beaumont Hospital and Mater Misericordiae University Hospital

Professor Anthony King (pictured right), Consultant Ophthalmologist at Nottingham University Hospital, NHS Trust

1

In his lecture, entitled "Journey of an Accidental Academic”, Professor King discussed the importance of definitions when reporting outcomes of glaucoma trials and the management of patients presenting with advanced glaucoma. His talk charted his experience along the pathway from a rookie researcher to a randomised controlled trial (RCT), discussing the realities of undertaking research, while strongly encouraging young

3

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ophthalmologists to embark on this journey.

Professor King is currently the Chief Investigator of the NIHR funded Treatment of Advanced Glaucoma Study (TAGS). He is a past President of the UK and Eire Glaucoma Society and previously served as the Royal College of Ophthalmologist glaucoma lead for the development of a national ophthalmic database for trabeculectomy.

1. Mr Brendan Cummings, Dr Sarah Powell, Dr Aine Kelly, Dr Alison Greene and Dr Ross Layden 2. Dr David Gildea, Miss Marie Hickey Dwyer and Dr Ed Ahern 3. Dr Michele Coffey-Harkin and Dr Mary Jo Ryan

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4. Dr Brian Woods, Dr Deirdre Harford and Dr Fiona Kearns 5. Dr Emer Henry, Professor Anthony King, Annual Montgomery Lecturer 2025 and Mr John Stokes 6. Mr Jim O'Reilly and Dr Margaret Morgan

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Topic Team Training – Management and Treatment of Menstrual Pain Menstrual pain (dysmenorrhoea) is one of the most common gynaecological complaints, affecting up to 80% of menstruating people at some point. For many, community pharmacy is the first — and often only — point of contact for advice and treatment. Pharmacy teams therefore play a vital role in improving quality of life, reducing unnecessary GP visits, and identifying red flags that require referral.

Understanding Menstrual Pain Menstrual pain is typically categorised as: Primary dysmenorrhoea – pain without underlying pelvic pathology, usually starting within a few years of menarche and linked to prostaglandin release.

Secondary dysmenorrhoea – pain caused by an underlying condition such as endometriosis, fibroids, adenomyosis, or pelvic inflammatory disease.

Primary dysmenorrhoea is far more common in younger patients and is usually responsive to OTC treatments.

• Associated symptoms (heavy bleeding, intermenstrual bleeding, pelvic pain outside periods) This helps differentiate between primary and secondary dysmenorrhoea and guides treatment choice.

Pharmacological Management NSAIDs – First-Line Treatment Non-steroidal anti-inflammatory drugs (NSAIDs) are the treatment of choice for primary dysmenorrhoea due to their prostaglandin-inhibiting effect.

Common options include:

Typical Symptoms

• Ibuprofen

• Cramping lower abdominal pain

• Naproxen

• Pain radiating to the back or thighs

• Mefenamic acid (where appropriate)

• Nausea, vomiting or diarrhoea

Counselling points:

• Headache, fatigue

• Start at onset of pain or up to 24 hours before menstruation if cycles are predictable

• Pain beginning 1–2 days before or at onset of menstruation Pharmacy Consultation: Key Questions A structured but sensitive consultation is essential. Ensure privacy and use inclusive, nonjudgemental language.

Ask about: • Age and time since menarche • Onset and duration of pain • Severity (e.g. does it interfere with work, school, or sleep?)

• Cycle regularity • Current medicines (including hormonal contraception) • Response to previous treatments

• Take regularly for the first 48–72 hours

mechanisms of action — central analgesia from paracetamol and peripheral anti-inflammatory effects from ibuprofen — without increasing the dose of either component beyond standard OTC strengths.

Hormonal Management – Awareness and Signposting Hormonal contraception can reduce menstrual pain by suppressing ovulation and reducing prostaglandin production.

Pharmacy teams should: • Be aware of the role of combined and progestogen-only contraception in dysmenorrhoea • Support patients accessing contraception services • Encourage follow-up if pain persists despite hormonal treatment Non-Pharmacological Advice Alongside pharmacological treatment, non-pharmacological measures can play a valuable supportive role in the management of menstrual pain. The application

• Take with food • Avoid in patients with contraindications (e.g. NSAIDsensitive asthma, peptic ulcer disease, renal impairment) Paracetamol Paracetamol is suitable where NSAIDs are contraindicated or not tolerated. While less effective alone, it can be useful in combination with an NSAID. Combination Analgesia Combination products containing paracetamol and ibuprofen may be an appropriate option for some patients. This approach offers dual

Consider:  Are I/my team confident in identifying menstrual pain that can be managed in the pharmacy versus symptoms that require referral, and are we up to date with guidance on appropriate OTC treatment choices?  How can this knowledge help us improve conversations with patients, particularly around validating pain, setting realistic expectations for relief, and encouraging timely follow-up if symptoms persist?  What practical steps can we implement immediately in the pharmacy, such as proactive questioning, consistent advice on medicine use and non-pharmacological options, and clear signposting to GP or specialist care where appropriate?

54 | PHARMACYNEWSIRELAND.COM

of local heat, such as a hot water bottle or heat patch, can help relax uterine muscles and reduce cramping. Gentle physical activity, including walking or stretching, may also alleviate symptoms by improving blood flow and releasing endorphins. Relaxation techniques and stress reduction strategies, such as breathing exercises or mindfulness, can further support pain management, particularly for individuals who experience heightened discomfort during periods of stress. Adequate sleep is equally important, as fatigue can lower pain tolerance and exacerbate symptoms.

These approaches should be recommended as complementary measures, used alongside appropriate analgesia rather than as substitutes for effective pain relief.

Key Points:  Reinforce that period pain is common but not “something to suffer through” and that effective treatment options are available in the pharmacy.  Ensure the team can confidently recommend appropriate OTC analgesia, including NSAIDs and paracetamol, tailored to pain severity, medical history and patient preference.  Promote awareness of red flags and referral criteria, particularly severe or worsening pain, poor response to treatment, heavy bleeding or symptoms suggestive of secondary causes such as endometriosis.  Encourage supportive advice alongside medicines, including heat therapy, gentle activity and reassurance, while using empathetic, inclusive language to validate the patient’s experience.

Actions: Ensure support staff understand the following key points:  The typical features of primary menstrual pain, including cramping lower abdominal pain, back pain and associated symptoms such as nausea or headache, and how these differ from symptoms that may indicate an underlying condition.  How to recommend appropriate OTC treatment options for menstrual pain, including the correct use of NSAIDs and paracetamol, and when combination therapy may be appropriate.  How to recognise when referral is required, including poor response to treatment, severe or worsening pain, heavy or irregular bleeding, or symptoms suggestive of secondary dysmenorrhoea.  The role of nonpharmacological measures, such as heat therapy, gentle activity and reassurance, and the importance of using empathetic, nonjudgemental language when supporting patients.

HIT PAIN HARD FASTER LONGER LASTING MORE EFFECTIVE relief than standard painkillers* alone

NUROMOL DUAL ACTION COMBINES THE POWER OF IBUPROFEN & PARACETAMOL IN ONE TABLET. *Standard Painkillers refers to Standard ibuprofen and standard paracetamol. Date of preparation August 2025. RT-M-1JlEzP Abbreviated Prescribing Information for: Nuromol Dual Action Film-Coated Tablets, Paracetamol 500 mg, Ibuprofen 200 mg Please refer to Summary of Product Characteristics (SmPC) for full product information. Full prescribing information available upon request and also available on www.medicines.ie.

Nuromol Dual Action Film-Coated Tablets contain Paracetamol 500 mg and Ibuprofen 200 mg. Indications: For the short-term symptomatic treatment of mild to moderate pain associated with migraine, headache, backache, period pain, dental pain, muscular pain, cold and flu, and sore throat. This product is especially suitable for pain which has not been relieved by ibuprofen or paracetamol alone. This medicinal product is indicated in adults aged 18 and older. Dosage and Administration: Not for use in under 18 year olds. Adults: One tablet to be taken orally up to three times per day with water. Leave at least six hours between doses. If the one tablet dose does not control symptoms, a maximum of two tablets may be taken up to three times a day. Do not take more than six tablets (3,000 mg paracetamol, 1,200 mg ibuprofen) in any 24 hours period. Elderly: No special dosage modifications required. Those with renal or hepatic impairment please refer to SmPC. Contraindications: In those with hypersensitivity to any of the ingredients, history of hypersensitivity reactions. With active or history of recurrent peptic ulcer/haemorrhage. History of, or an existing gastrointestinal ulceration/perforation or bleeding. Patients with defects in coagulation, severe hepatic failure, severe renal failure or severe heart failure. Concomitant use with other paracetamol or NSAID products. During the third trimester of pregnancy. Warnings and Precautions: For short term use (not more than 3 days). Do not exceed recommended dose. Interaction with Other Medicinal Products: Do not take with other medicinal products containing paracetamol, ibuprofen, acetylsalicylic acid, salicylates or with any other NSAIDs unless under a doctor’s instruction.

Pregnancy: There is no experience of use of this product in humans during pregnancy. Breastfeeding: Ibuprofen can pass in very small amounts into the breast milk. No know harmful effects. Paracetamol is excreted in breast milk but not in a clinically significant amount. It is not necessary to interrupt breastfeeding for short-term treatment. Side Effects: Very Common: None listed. Common: Oedema, Abdominal pain, vomiting, diarrhoea, dyspepsia, nausea and abdominal discomfort, Hyperhidrosis, Alanine aminotransferase increased, gamma-glutamyltransferase increased, Liver function tests abnormal. Blood creatinine increased, and blood urea increased. Report any suspected adverse reactions via HPRA Pharmacovigilance. Website: www.hpra.ie. Name and Address of Marketing Authorisation Holder (MAH): Reckitt Benckiser Ireland Ltd, 7 Riverwalk, Citywest Business Campus, Dublin 24, Ireland. PA Number: PA0 979/086/001. Legal Category: Product not subject to medical prescription. Supply through pharmacy only. Date of Preparation: August 2025. SmPC: Available on www.medicines.ie. Product queries Please call (01) 630 5429 or contact the MAH above.

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Feature

Hypertension Management in Women With a Multidisciplinary Approach Written by Niloofar Nobakht MD a, Yalda Afshar MD, PhD e, Marmar Vaseghi MD, PhD b, Zhaoping Li MD, PhD c, Ines Donangelo MD, PhD d, Helen Lavretsky MD, MS f, Thalia Mok MD e, Christina S. Han MD e, Susanne B. Nicholas MD, MPH, PhD a a Division of Nephrology, Department of Medicine, at the David Geffen School of Medicine at University of California, Los Angeles, CA, USA b Division of Cardiology, Department of Medicine, at the David Geffen School of Medicine at University of California, Los Angeles, CA, USA c Division of Clinical Nutrition, Department of Medicine, at the David Geffen School of Medicine at University of California, Los Angeles, CA, USA d Division of Endocrinology, Department of Medicine, at the David Geffen School of Medicine at University of California, Los Angeles, CA, USA e Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, at the David Geffen School of Medicine at University of California, Los Angeles, CA, USA f Department of Psychiatry at the David Geffen School of Medicine at University of California, Los Angeles, CA, USA

Hypertension is a significant global health problem and an important cause of morbidity and mortality worldwide, serving as an important risk factor for cardiovascular disease (CVD), chronic kidney disease (CKD), stroke, and dementia. The prevalence of hypertension was estimated to be 1.27 billion globally, with ∼626 million women living with hypertension, worldwide.1 Nearly 1 of 2 adults in the United States has hypertension (116 million), with more than 50% reported to be women (44.9 million women and 40.8 million men).2 Optimal management of hypertension can improve both cardiovascular outcomes and mortality. It has become evident that, although hypertension is more prevalent in men,3 the risk factors for developing hypertension and the blood pressure thresholds for its diagnosis may differ by sex.

However, the current guideline does not provide different blood pressure values for men and women.4 Specific risk factors related to lifecycle changes are present in women that affect both development and management of hypertension. A multidisciplinary approach may lead to better blood pressure (BP) control in hypertensive females. This review, which was conducted using PubMed, OVID, EMBASE, and Cochrane library databases between 1995 and 2023, provides a comprehensive summary of the presentation and treatment of hypertension as it relates to women across the lifespan and includes reference to specific racial and ethnic minority groups. It describes relevant clinical studies and ongoing challenges and outlines unanswered questions pertinent to the optimal management of hypertension in women.

The 2017 American College of Cardiology/American Heart Association Clinical Practice

hypertension guideline recognises the importance of risk calculators to determine when to initiate antihypertensive therapy. It also includes major changes in BP values, lowering the treatment target from less than 140/90 mm Hg to less than 130/80 mm Hg,5 and supporting improved cardiovascular outcomes with treatment aimed at lower targets.

These changes were derived from evidence of increased CVD risk associated with BP 130-139/80-89 mm Hg, along with data supporting better associated cardiovascular outcomes.3 According to the new guideline, BP is “normal” if it is less than 120/80 mm Hg. The guideline also categorises hypertension by stages: patients with systolic BP between 130 and 139 mm Hg or diastolic BP between 80 and 89 mm Hg have stage 1 hypertension, whereas those with a systolic BP greater than or equal to 140 mm Hg or diastolic BP greater than or equal to 90 mm Hg have stage 2 hypertension.5,6 The guideline remains consistent for both men and women, targeting BP less than 130/80 mm Hg for patients with coexisting coronary artery disease (CAD), diabetes mellitus (DM), CKD, peripheral vascular disease, and cerebral vascular accident (CVA) events without consideration for patient sex or physiological state at different life cycles.5,6 In this review, several sex-specific strategies to achieve optimal management of hypertension in women using a multidisciplinary approach are discussed.

Importantly, socioeconomic conditions and transitions across different life stages from premenopause to menopause are also considered.

Risk of Hypertension Across the Woman’s Lifespan The prevalence of hypertension increases with age in both sexes, particularly after 40 years of age.7 In women, the prevalence is slightly

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lower than in men between the ages of 40 to 59 years (59.4% in men vs 49.9% in women). However, by 60 years of age, women have nearly caught up with men, with hypertension prevalence of 75.2% in men and 73.9% in women.7 The current guideline does not provide specific recommendations related to the management of hypertension by sex. According to all major society guidelines, accurate measurements, diagnosis of hypertension with repeat visits, ambulatory blood pressure monitoring (ABPM), or home BP monitoring via commercial devices are important in the diagnosis of hypertension for both women and men. Home and ABPM measurements are less likely to be confounded by white coat or masked hypertension.

Although nearly all major clinical trials use clinic BP readings, ABPM can supplement these readings because data indicate that ABPM is a stronger predictor of clinical outcomes compared with clinic measurements8, 9, 10 and allows

for measurement of nocturnal pressures.11, 12, 13 A 10% to 20% decrease in nighttime BP compared with daytime is expected,5,6 and patients who are nighttime “nondippers” or “reverse dippers” have higher risk for stroke, cardiac hypertrophy, and silent CVA events.8,11,14,15 Reverse and nondipping BP, for women more than men, increase the risk of cardiovascular events with age.

Middle-aged and postmenopausal women who are nondippers are at highest risk for cardiovascular events, particularly if they present with comorbid conditions.16 Nondipping is associated with a higher left ventricular mass in both sexes, although this is the case to a greater extent in women.17 Ambulatory BP monitoring has also allowed for assessment of important changes in BP over the lifetime of males vs females. Using ABPM data in 15,913 women and 14,600 men, diastolic BP was noted to fall at a very early age (22.3 years) in women, whereas

57 in men, diastolic BP begins to fall at age 46.5 years.18 Finally, there is a greater prevalence of masked hypertension in men than women, as detected by ABPM.19, 20, 21 Hypertension During Reproductive Age Epidemiological studies have shown associations between clinical BP or diagnosed hypertension in youth with atherosclerotic CVD and premature mortality.22 The menstrual cycle affects arterial compliance and may change systolic and diastolic BP; however, these variations in normotensive women appear to be modest and larger studies are needed.

Although most patients have primary (essential) hypertension, the proportion of individuals affected by secondary hypertension is higher in women of reproductive age, despite a lower prevalence of primary hypertension in this age group. The diagnosis of secondary causes requires a high index of suspicion, and appropriate testing based on clinical presentation. Early detection of secondary hypertension is pivotal because timely diagnosis and management of underlying condition allow for prevention of hypertension-mediated organ damage (HMOD).

Several recognised endocrine causes of secondary hypertension include primary aldosteronism (PA), pheochromocytoma, Cushing syndrome, thyroid disease, acromegaly, and hyperparathyroidism.23 Primary aldosteronism is the most common cause of secondary hypertension, with a prevalence of ∼5% among patients with hypertension, and up to 20% in individuals with resistant hypertension.24,25 The most common cause of PA is bilateral adrenal hyperplasia, followed by aldosterone-producing adrenal adenoma, representing in 60% and 30% of cases, respectively.26 Unilateral PA is more common in men, whereas bilateral adrenal hyperplasia is more common in women.27 Observed differences in incidence are further modified by age, where women diagnosed with unilateral adrenal hyperplasia are more likely to be younger than men.

The inverse of this is true for bilateral adrenal hyperplasia, as male patients with this diagnosis tend to be younger than female patients.27 The prevalence of PA is similar in men and women, but estrogen can affect plasma renin concentration (PRC), and may interfere with laboratory investigation of PA. Although there is good correlation between plasma renin

activity (PRA) and PRC, estrogen use or pre-ovulatory (luteal phase) estrogen surge in women is associated with false positive case detection testing when using PRC but not PRA. Plasma renin activity may be more suitable for PA case detection in premenopausal women or in those taking oral estrogen.26,28 Salt-sensitive BP characterised by an increase in BP following salt loading or a drop in BP following salt depletion is reported in up to 50% of hypertensive patients.29 This is more common in women than men and increases with age.30,31 The mineralocorticoid pathway may be implicated in the mechanism for salt-sensitive hypertension in younger women. Premenopausal women may have heightened aldosterone production to stimuli and expression of endothelial mineralocorticoid receptor (MR) mediated by sex hormones that lead to endothelial dysfunction and hypertension. Therefore, MR antagonism may be preferred in the treatment of salt-sensitive hypertension in premenopausal women.32 The role of MR activation and augmented aldosterone production diminishes after menopause. In postmenopausal women, as in men, dysfunctional renal physiology leading to impaired natriuresis is the main contributor to salt-sensitive hypertension.16,32 Renovascular hypertension is among the most common causes of secondary hypertension, primarily from atherosclerotic lesions (60%-90%) followed by fibromuscular dysplasia (10%-30%).33 Fibromuscular dysplasia has a female/male ratio of 84%/16% in the United States and is predominantly diagnosed in middle-aged subjects.33 It is a noninflammatory disease of medium-size arteries which may lead to stenosis, occlusion, and or dissection.34 Approximately 90% of these patients have hypertension, and a significant proportion of them may present with major vascular events such as CAD, cerebrovascular and renal events including ischemia, infarction, and renal failure. Earlier diagnosis and vascular interventional treatment with angioplasty will improve outcome and adverse events.33,34 Preconception Care Optimising the care of the pregnant person with hypertension, even before pregnancy, is the ideal. As such, a preconception consultation with a multidisciplinary care team, including maternal-fetal medicine, is recommended in reproductive-age people who desire pregnancy.43 The goal of

preconception care is to affirm pregnancy intention, mitigate potential harm, and recognise modifiable risk factors related to pregnancy while stratifying pregnancies on a continuum of low to high risk.43 Although most patients with wellcontrolled hypertension will have uncomplicated pregnancies, patients with hypertension should have a clear understanding of the possible complications in pregnancy, potential effects of pregnancy on BP, and the need for heightened increased maternal and fetal surveillance. Patients with modifiable risk factors such as obesity, smoking, and poorly controlled diabetes may benefit from a discussion on lifestyle modifications. These include weight loss, diet, exercise, and smoking cessation to improve BP control and decrease rates of hypertension disorders of pregnancy (HDP) and associated adverse maternal and fetal outcomes.44,45 All patients in need of renin-angiotensin-aldosterone (RAAS) blockade agents should have a discussion of effective contraceptive options along with negative pregnancy test before.

Selection of Antihypertensive Agents in Pregnancy Specific antihypertensive therapy is required for: (1) chronic treatment to gradually lower BP to maintain goal range, or (2) acute lowering of severe-range BP. The timing and setting of intervention along with the selection of antihypertensive agents will differ between these scenarios. Labetalol or nifedipine extended release are preferred for the long-term treatment of hypertension in pregnancy.55 Methyldopa, previously considered first-line, has shown lower efficacy with greater adverse effects.77 Diuretics can be considered second- or third- line HDP treatment, and their use during pregnancy and breastfeeding is generally tolerated but should be closely monitored.78 Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers are avoided due to potential teratogenic risks and associations with fetal growth restriction and neonatal kidney failure.79 There is evidence demonstrating the risk of beta-blockers, primarily atenolol, and its association with small for gestational age infants.79 For severe hypertension (systolic ≥160 mm Hg or diastolic ≥110 mm Hg) and if it is persistent (>15 minutes) requires prompt pharmacologic treatment. Therapy should be initiated within 30 minutes of diagnosis to decrease

maternal risks. Medications used include intravenous labetalol, hydralazine, or oral immediaterelease nifedipine.80 Hypertension disorders of pregnancy require timely treatment because CVA and hypertensive encephalopathy occur at lower BPs compared to outside of pregnancy. Pregnancies complicated by HDP should undergo increased antenatal surveillance for maternal health and risks to the neonate, including fetal growth restriction. Delivery timing depends on the underlying HDP diagnosis and the control of the disease process. The delivery mode (ie, vaginal vs cesarean birth) is not dictated by HDPs and is based solely on routine obstetrical indications.52 Hypertension and Menopause Changes in BP after menopause seem to be related to alterations in estrogen and progesterone levels along with other factors including genetic predisposition, obesity, type 2 DM, endothelial dysfunction, salt sensitivity, and arterial stiffness.83 Estrogen plays a significant role in the observed sex differences in hypertension and CVD.16,84 The mechanism for its vascular protective role is complex, and many pathways remain to be clarified. Estrogen contributes to vascular homeostasis by upregulation of endothelial nitric oxide pathway, augmenting prostacyclin release, reducing oxidative stress and fibrosis, and stimulating angiogenesis. Decline in estrogen has been associated with augmentation of ACE and angiotensin II pathways and lower MR expression.32,85 Estradiol deficiency results in RAAS system dysregulation with switch to proinflammatory pathways that contributes to impaired immune response and CVD.86 Estrogen modulates sympathetic tone by attenuating α-adrenergic receptor-mediated vasoconstriction, while enhancingβ-adrenergic receptor effect. This may be a cause of age-related increase in hypertension among women that is at least in part caused by falling estrogen levels during menopause.16,84 Although observational studies in humans and experimental studies in animals provide evidence that estrogen replacement protects post-menopausal women against CVD, randomised control trials did not support this concept.87 The reason for the disparity remains unclear; yet, it is hypothesised that several factors, including the type of estrogen used, interaction with progesterone, women’s age, and timing of the treatment, contribute to these

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Feature

results.88,89 There is evidence that estrogen therapy may be cardioprotective if started around menopause transition and may be harmful if started >10 years after menopause.90 Replacement with endogenous 17 β-estradiol shows superior cardiovascular benefit compared to replacement with oral conjugated equine estrogen, which is associated with a greater risk of hypertension development.91,92 Data on possible benefits of hormone replacement therapy on CVD are controversial.93, 94, 95 International medical societies, including the American Association of Clinical Endocrinologists, Endocrine Society, American College of Obstetricians and Gynecologists, and North American Menopause Society recommend against menopausal hormone therapy for primary or secondary prevention of CVD, especially for those older than 60 years or more than 10 years after menopause.96 Estrogen is a safe option for treatment of menopausal symptoms when initiated in healthy women younger than 60 years of age or within 10 years of menopause onset when it is used at the lowest effective dose and for the shortest total duration based on risk benefit analysis (typically <5-10 years).97

However, estrogen may have a plaque-destabilising effect in the setting of advanced atherosclerosis, favoring thrombosis. Therefore, it is contraindicated in women with atherosclerotic CVD, BP greater than 180/110 mm Hg, venous thrombosis or pulmonary embolism, cerebrovascular disease, and congenital heart disease.98 Selected younger (<60 years of age) women with one or more cardiovascular risk factor including obesity, controlled hypertension, diabetes, and dyslipidemia may use menopausal hormone therapy; however, the transdermal route of estrogen is preferred and there should be an emphasis on optimising primary prevention efforts. Additionally, cardiovascular risk must be regularly reassessed.93, 94, 95 Additional studies are needed to better understand the consequences of menopause on CVD and to determine the value, timing, and dosing of hormone replacement therapy on BP. Lifestyle Modifications and Hypertension Management in Women Lifestyle modification plays a pivotal role in preventing and managing hypertension. In fact,

Figure 1. Lifestyle modifications have potential positive impacts that measurably reduce blood pressure. Data from the American College of Obstetricians and Gynecologists.5 DASH, Dietary Approaches to Stop Hypertension.

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24.3 million (21%) adults with hypertension can be treated with lifestyle modifications alone, without the need for antihypertensive medications.110 Nutrition and Hypertension Management in Women The Dietary Approaches to Stop Hypertension (DASH) diet has emerged as a balanced dietary strategy for preventing and treating hypertension.111 This diet emphasises fruits, vegetables, and low-fat dairy products and recommends reduced amounts of saturated fat, total fat, and cholesterol and is rich in potassium, magnesium, calcium, and fiber. Importantly, the DASH diet lowers BP beyond the level achievable by simply reducing sodium intake. It has been demonstrated that it not only results in the expected lower BP, but can benefit cardiometabolic health, decreasing body mass index (BMI), body fat content, fasting glucose, insulin, and leptin concentrations.112,113 The consensus from studies on sex differences in dietary patterns and hypertension outcomes remain unclear. One study on sex differences in those between 40 and 69 years of age found that diets higher in the consumption

of vegetables, potatoes, fruits, beans, and seaweeds were related to lower BP.114 Another study concluded a diet rich in whole grains and legumes was inversely associated with the risk of hypertension in women, suggesting sex differences in association with diet and hypertension.115 Additional studies are needed to evaluate diet-based recommendations for women in the various stages of life cycle relative to hormonal alterations, aging, sodium retention after menopause and by race and ethnicity.

Weight and Body Mass and Hypertension in Women Increased BMI greater than 25 kg/m2 is associated with greater risk of hypertension and mortality, whereas weight loss can reduce risk of hypertension.121,122 Data support up to a 20-mm Hg drop in BP with 10 kg of weight loss.123 Combined use of DASH diet and weight loss can further lower BP.5 Results from a study on women who had a BMI greater than 25 kg/m2 at the age of 18 years showed a relative risk of 2.2 for developing hypertension.121 Recent data indicate that indices of central adiposity including waist circumference (WC), and waistto-height ratio (WHtR), may have

59 better predictive value for the risk of hypertension in women.124 The WC and waist to hip ratio and WHrR may increase with parity and is consistently associated with an increase in WC and a reduction in hip circumference in women 18 to 30 years of age.125 Impact of Physical Activity on Hypertension in Women Approximately 80% of US adults are insufficiently active. Regular, mild-to-moderate aerobic activity can independently decrease BP by 5 to 8 mm Hg in women, regardless of weight loss.126,127 Few studies have assessed the combined impact of body weight and physical activity in relation to hypertension among women.

A report studying a large cohort of French women concluded that higher physical activity was associated with a lower risk of hypertension, but only within a BMI range of 22.5 to 25.0 kg/ m2.128 Further studies are needed to provide guidance on the

duration and intensity of physical activity on BP reduction and HMOD in women.

Impact of Sleep on Hypertension in Women Sleep disturbances are associated with increased risk of morbidity and mortality.129 Key sleep disorders that can impact BP are obstructive sleep apnea (OSA), short sleep duration, and poor sleep quality.130, 131, 132 One study of 277 perimenopausal women with a mean age of 56 years and a mean BMI of 28 kg/m2 showed that women with moderate to severe OSA were more likely to be hypertensive, use more medications to reduce BP, and have higher awake and nocturnal BP and increased arterial stiffness.133 Results from the Nurses’ Health Study supported the need for sufficient sleep to reduce hypertension incidence and prevalence.131 The prevalence of hypertension was significantly higher among women who slept 5 hours or less per night.

Studies suggest that night shift work, short sleep duration, or poor

sleep with circadian disruption might increase the risk of hypertension because acute sleep restriction has been shown to increase BP and sympathetic nervous system activity.131,134 Figure 1 summarises the effects of lifestyle modifications on BP with the largest impacts being from the DASH diet and weight loss.5 Pharmacotherapy Treatment for Women with Hypertension Antihypertensive therapy choices vary among women across different phases of life. Therapy choices are limited during the reproductive age including the preconception phase and during pregnancy given the risk of teratogenicity and the side effects on the fetus. This limits access to RAAS blockade agents for patients with diabetes, CKD, or cardiac disease.55,79 Therapy choices during perimenopause and post menopause are more similar to those with men in relation to comorbidities; there is greater

attention to MR antagonists as a preferential treatment for premenopausal women who have been diagnosed with salt-sensitive hypertension with recent evidence that aldosterone production is sex-specifically heightened in salt-sensitive hypertensive women.5,32 Adverse effects of antihypertensive therapy can be higher in women than men with some class of medications such as ACE inhibitor–induced cough or edema with calcium antagonists.

Conclusion There is a significant clinical need for the diagnosis and optimal management of hypertension in women across the lifespan. With the continued growth of hypertension in women and the anticipated increase in prevalence of HDPs due to the obesity epidemic, increasing maternal age, and the rising prevalence of metabolic syndrome, additional strategies in a multidisciplinary fashion are needed to address unmet needs.

References available on request

News

Introducing Aura Sport Aura Sport: A New Non-Prescription Option for Targeted Muscle and Joint Pain Relief Community pharmacists are increasingly encountering patients seeking effective pain relief while wishing to avoid oral analgesics, particularly codeine-containing products and non-steroidal anti-inflammatory drugs (NSAIDs). Concerns around dependency, tolerance, gastrointestinal side effects and drug–drug interactions mean that suitable non-prescription alternatives are an important part of modern pharmacy practice.

Aura Sport is a new topical muscle rub developed to address this gap. It delivers an intense, fast-acting heating sensation that patients can feel immediately on application, helping to soothe sore muscles and stiff joints. The product is designed for topical use and is massaged into the affected area two to three times daily, providing localised relief with minimal systemic absorption and therefore a low risk of drug interactions.

The formulation combines chilli pepper extract (Capsicum frutescens) for prolonged warming with a blend of well-recognised natural ingredients including arnica, menthol, aloe vera, wintergreen and camphor. Together, these components provide a balance of heat, cooling and soothing effects, making Aura Sport suitable for sports people, physically active individuals and those experiencing muscular strain, back pain or joint discomfort. It may also be considered as an alternative for patients who request codeine for musculoskeletal pain but would benefit from a non-opioid option.

Aura Sport is manufactured in Ireland and has been formulated by an Irish pharmacist, reflecting a focus on quality, safety and practical use in the community pharmacy setting. Due to the lack of safety data, it is not recommended for use in pregnancy or breastfeeding, in children under 12 years of age, or in individuals with known sensitivity to any of the ingredients.

With an RRP of ¤19.95, Aura Sport offers pharmacies a premium, nonprescription option for customers seeking strong, localised relief that they can feel working, while supporting responsible pain management and reducing reliance on oral analgesics.

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Medicines Reconciliation

Closing the Gap at Discharge: Why Pharmacist-Led Medicines Reconciliation Matters More Than Ever Medication safety at the point of hospital discharge remains one of the most persistent and costly challenges in healthcare. For pharmacists working across hospital and community settings, the consequences of poorly managed transitions of care are familiar: unclear discharge prescriptions, undocumented medication changes, omitted medicines and follow-up phone calls to resolve discrepancies that should never have reached the patient.

Lead author Dr Aoife Fleming

without access to the full clinical picture. The result is inefficiency, frustration and risk — for patients and professionals alike.

Hospital pharmacists are ideally placed to intervene at this critical juncture. International evidence consistently shows that pharmacist-led discharge MedRec improves prescription accuracy, enhances communication and reduces readmissions linked to medication harm. What has been less well established in Ireland is the scale of the clinical and financial benefit — and whether such services are feasible within existing hospital resources.

Internationally, this problem is well recognised. The World Health Organization identified transitions of care as a global patient safety priority through its Medication Without Harm initiative, highlighting discharge as a key risk point for avoidable harm.

Evidence suggests that between one-quarter and four-fifths of patients leave hospital with at least one medication discrepancy.

When these discrepancies go unnoticed, they can persist into primary care, increasing the risk of adverse drug events (ADEs), avoidable readmissions and longterm morbidity.

A recent Irish pilot study offers timely and compelling evidence that pharmacist-led discharge medicines reconciliation (MedRec) can significantly reduce these risks — while also delivering substantial cost savings for the health system.

For pharmacists, the findings strengthen the case for formalising and resourcing discharge services as a core element of patient safety rather than an optional add-on.

The study was authored by Rachel MacCarthy, Peter Kidd, John Given and Aoife Fleming from the Pharmacy Department at Galway University Hospital, University Hospital Limerick, University College Cork and Mercy University Hospital Cork.

Below is an overview of the original study recently published in the European Journal of Hospital Pharmacy.

The Irish Context: Why Discharge Remains a Weak Point In Ireland, transitions of care have been highlighted repeatedly as a patient safety concern. Both the HSE Patient Safety Strategy and inspection frameworks emphasise the need to reduce medicationrelated harm (MRH) during handover between care settings.

Yet structural challenges persist.

The absence of a national electronic health record continues to fragment communication between hospitals, GPs and community pharmacies. Discharge prescriptions are typically transcribed from handwritten inpatient charts into electronic discharge systems, often by junior doctors under time pressure. Patients leave hospital with a printed prescription for dispensing, while discharge summaries are sent electronically to GPs — sometimes incomplete, sometimes delayed, and frequently unclear about what has changed during admission.

For community pharmacists, this creates a familiar scenario: discrepancies identified after the patient has already returned home, requiring retrospective clarification

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Inside the Study: A Real-World Irish Pilot This pilot study evaluated a pharmacist-led discharge service on a surgical ward in a large Irish university teaching hospital.

Conducted over eight weeks, the study focused on adult patients taking three or more medicines who had already received admission MedRec and were discharged during pharmacy working hours.

The pharmacist reviewed draft electronic discharge prescriptions and summaries before discharge, identifying prescribing and communication errors and discussing them directly with prescribers. Importantly, prescribers were not informed in advance about the study to minimise behaviour change during the evaluation period.

Fifty discharge prescriptions were reviewed, covering 646 individual medicines. While 10 prescriptions required no intervention, the remaining 40 contained a total of 184 discrepancies — an average of more than four per patient.

What Went Wrong at Discharge?

The majority of errors identified were prescribing errors (68.5%), with the remainder classified as communication errors (31.5%).

The most common prescribing issues were:

• Omission of medicines (both newly started and pre-admission medicines) • Incorrect doses • Errors involving high-risk drug classes Cardiovascular medicines were most frequently implicated, followed by endocrine, gastrointestinal and nervous system drugs — a pattern that will be immediately recognisable to both hospital and community pharmacists.

Communication errors were equally concerning. These included failures to document medication changes clearly, missing dose adjustments and undocumented discontinuations. In the absence of pharmacist intervention, these inaccuracies would likely have been passed directly into primary care, where they could persist unchecked.

Crucially, more than 91% of pharmacist recommendations were accepted by prescribers, reflecting the value of real-time, face-toface or direct communication.

Where changes could not be made immediately due to discharge pressures, pharmacists followed up with GPs or community pharmacists to mitigate patient risk — highlighting again how medication safety responsibilities often spill beyond formal service boundaries.

Assessing Harm: More Than “Minor Errors” To understand the potential clinical impact, each discrepancy was reviewed by a multidisciplinary expert panel using validated scoring tools.

The findings are sobering: • Nearly 85% of errors had the potential to cause moderate harm • Four errors were deemed potentially severe, with risk of lasting impairment or death • Only a small minority were considered unlikely to cause harm

Call for papers: make your contribution to Irish Pharmacy News  Articles  Research Papers  Reviews  Programme Descriptions  Reports Case Reports  Letters to editor  In-depth review articles critique fundamental concepts, issues, and problems that define a field of research or practice and support advanced practitioners as well as aspiring early-year pharmacists.  Practice reports share innovations on any area of practice, including delivering clinical services, pharmacy administration, or new approaches to inform and engage with patients with the aim to improving pharmacy practice.  Perspective articles focus on a specific field or discipline and discuss current advances or future directions, and may include original data as well as expert insight and opinions.

Contact: Kelly Jo Eastwood at: kelly-jo@ipn.ie or Robyn Maginnis robynmaginnis@ipn.ie

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Medicines Reconciliation Standard discharge practice

Prescriber prepares a discharge summary and prescription on EDS

Pilot pharmacist discharge service

are spared the time-consuming and often frustrating task of retrospective reconciliation — work that is rarely visible or resourced.

Prescriber prepares a discharge summary and prescription on EDS

In this sense, pharmacist-led discharge services support not only patient safety but also professional sustainability across the continuum of care.

Prescription and discharge summary are screened by a pharmacist before validation

Pharmacist notifies the prescriber of prescription error or discrepancy

Prescriber validates and prints discharge summary and prescription

Prescriber reviews and amends the prescription and/or discharge summary

Prescriber validates and prints discharge summary and prescription

Prescription given to patient on discharge and discharge summary sent electronically to GP

High-risk medicines featured prominently in the most serious cases, including anticoagulants, antiplatelets, insulin and opioids.

These are precisely the drugs that community pharmacists frequently encounter in post-discharge problem-solving — often without the benefit of hospital context.

The panel also estimated the likelihood that errors would lead to an ADE if left uncorrected. Almost one-third of discrepancies carried at least a medium probability of harm, underlining how “routine” discharge errors can translate into real clinical consequences.

The Cost of Getting It Wrong — and Right Medication-related harm carries a significant financial burden.

Globally, medication errors are estimated to cost health systems tens of billions annually. In Ireland, while national figures are less well defined, the downstream impact is clear: GP visits, emergency

Prescription given to patient on discharge and discharge summary sent electronically to GP

department attendances, hospital readmissions and additional prescribing — much of it avoidable.

Using established economic models, the study estimated the cost of ADEs that could have arisen from the identified discrepancies at over ¤34,000 during the study period alone.

When extrapolated to annual ward activity, this equated to more than ¤565,000 in avoidable ADErelated costs.

By contrast, the cost of providing the pharmacist discharge service — including pharmacist and prescriber time — was modest. Even using conservative assumptions, the annual cost was just over ¤10,500.

The result was a net annual cost benefit of approximately ¤555,000, with a cost–benefit ratio exceeding 50:1 under the study’s primary analysis. Even when recalculated using a more conservative fulltime equivalent costing model,

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the service still delivered a strong positive return.

For pharmacists, this is a powerful message: discharge MedRec is not only clinically valuable, it is economically compelling.

Why This Matters Beyond the Hospital One of the most striking findings was the projected reduction in remedial healthcare utilisation.

Without pharmacist intervention, the expert panel estimated that around one-third of patients would likely have required GP followup, additional prescriptions or specialist input after discharge.

Preventing these downstream interactions has wider system benefits, particularly in the context of GP shortages and growing pressure on primary care. It also directly affects community pharmacy workload. When discharge discrepancies are resolved before the patient leaves hospital, community pharmacists

Looking Ahead: What Needs to Change?

Despite the clear benefits demonstrated, widespread implementation of pharmacistled discharge MedRec in Ireland faces barriers. Resource constraints, staffing pressures and infrastructure gaps remain significant challenges.

The study’s findings support several important next steps: • Formal recognition and resourcing of discharge MedRec as a core pharmacy service • Standardised national approaches to measuring cost avoidance and clinical impact • Improved prescribing collaboration, including exploration of pharmacistsupported or collaborative prescribing at discharge • Stronger integration between hospital and community pharmacy services While pharmacist prescribing in Irish hospitals is not yet legislated, international experience suggests that enabling pharmacists to amend discharge prescriptions in collaboration with prescribers could deliver further efficiency gains and safety improvements.

The authors concluded: “This pilot study underscores the positive clinical and financial impact of a pharmacist discharge service in reducing prescription errors, as well as the potential risk of patient harm and its associated ADE costs. This service showed significant potential for cost savings and a reduction in remedial healthcare utilisation, highlighting the key role of hospital pharmacists at discharge in managing medication discrepancies and improving communication during transitions of care.

“While previous studies have demonstrated the clinical and financial benefits of these interventions, few have focused on their impact on remedial healthcare utilisation. The findings from this pilot study suggest a

63 significant benefit of a pharmacist discharge service, supporting further development of the service within the hospital. Standardising cost calculations through a Health Technology Assessment and enabling collaborative prescribing within a multidisciplinary team are key steps to improving efficiency, patient safety and

cost effectiveness in the hospital discharge process.”

A Strong Case for Expansion This pilot study provides robust Irish evidence that pharmacist-led discharge medicines reconciliation reduces clinically significant errors, prevents avoidable harm and delivers substantial cost

savings. Importantly, it highlights benefits that extend beyond hospital walls — easing pressure on primary care and supporting safer, more efficient practice in community pharmacy.

For pharmacists reading this in practice, the message is clear: transitions of care remain one of the most dangerous points in

the medicines pathway, but they are also one of the most impactful opportunities for pharmacist intervention.

As health systems continue to grapple with capacity, safety and value, the case for embedding pharmacists at discharge is no longer just persuasive — it is compelling.

News

All-Island Mental Health Research Network The first all-island mental health collaborative research network – CO-PRIME – has been set up to help combat mental ill health in a more coordinated way right across Ireland and will be headed up by Professor Sinead McGilloway, Maynooth University (MU).

“By combining mental health research expertise and resources north and south, this initiative – which is the first of its kind in Ireland – will bring real benefits to people who are affected by mental health difficulties and their families” said Professor Sinéad McGilloway, who is working in collaboration with Co-Leads, Dr Eve Griffin from the National Suicide Research Foundation and Professor Brian McGuire from the University of Galway.

The five-year CO-PRIME (COproducing and Promoting Research and Innovation in Mental HEalth) initiative funded by the Health Research Board and launched today, aims to reshape some of the ways in which mental health research is conducted and, in particular, how the knowledge and evidence arising from research is used across the island to help inform services and shape government policy.

“The launch of CO-PRIME is a very important moment for mental health research across the island of Ireland,” said Prof.

McGilloway, speaking about the exciting initiative. “For the first time we are bringing together diverse voices, including those with lived experience, to build a truly collaborative, inclusive and evidence-informed approach to understanding and addressing mental health needs.”

“As well as helping people with mental health difficulties, this network will benefit other stakeholders working in the area including health and social care services, researchers, policy makers, community organisations and the general public.”

“CO-PRIME has many specific goals it aims to achieve. It will support meaningful and sustained collaboration across Northern Ireland and the Republic of

Ireland. Crucially, it will embed the involvement of people with lived experience of mental health difficulties across all of its activities”.

“We will also foster a culture of wide stakeholder involvement in the design, conduct and application of research, including perspectives from marginalised and underrepresented communities” said Co-Lead, Dr Eve Griffin “and we will promote evidence-informed, rights-based approaches in mental health policy and practice”.

“We will aim to build capacity across the mental health ‘ecosystem’ through training, education and researcher development” said Co-Lead, Professor Brian McGuire.

“We know that mental health difficulties affect directly or indirectly every community, family

Maynooth University - Professor Sinead McGilloway and part of society, and through CO-PRIME we are working to address that in a more coordinated, all island fashion” said Professor McGilloway.

Why January Is a Key Moment for the Fertility Category January has become one of the most significant moments in the fertility calendar. As couples reset their priorities for the year ahead, interest in conception rises sharply. Google search data shows that queries for “how to have a baby” increase by around 50% every January, reflecting a clear shift in behaviour as many begin planning for pregnancy.

For pharmacies, this surge represents an important opportunity. Pharmacies are often the first place individuals and couples turn when looking for guidance, reassurance and practical steps to support their fertility journey. With more people seeking information in January than at any other time of year, the category deserves particular attention during this period.

A growing number of couples now understand that fertility is a longer-term process. It takes several months for the body to build the nutritional foundation needed to support conception, making the pre-conception window crucial. This is where tailored nutritional support plays a key role. Brands such as Proceive®, which focus specifically on fertility and the three months before trying to conceive, are seeing increased interest at this time of year because consumers are actively looking for targeted, evidence-informed solutions.

For pharmacies, ensuring the fertility fixture is clear, well-presented and easy to navigate can make a significant difference in January.

Staff confidence is equally important; being able to explain why pre-conception health matters and what differentiates specialist fertility supplements from general multivitamins helps customers feel supported at a sensitive and often emotional time.

Consumers today are more discerning and more proactive. They are seeking comprehensive formulations that are aligned with the specific nutritional needs of conception for both men and women. Products such as Proceive®, which offer high-strength, tailored formulations, align well with this shift towards informed decision-making.

Ultimately, January is more than a seasonal spike in search behaviour. It is a moment when couples are motivated, engaged and looking for support. By being well-prepared and well-stocked, pharmacies can play a meaningful role in helping customers take confident, practical steps towards starting or growing their family in the year ahead.

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Clinical Profiles

BIOGEN RECEIVES EUROPEAN MEDICINES AGENCY AUTHORISATION OF NATALIZUMAB SUBCUTANEOUS, SELF-ADMINISTRATION Biogen Idec (Ireland) Ltd has has announced that natalizumab subcutaneous (SC) via self-administration is now available for use in Ireland for patients with relapsing-remitting multiple sclerosis (MS,) This follows an authorisation update from the European Medicines Agency (EMA) in May, following a positive assessment from the Committee for Medicinal Products for Human Use (CHMP) and the Pharmacovigilance Assessment Committee (PRAC), as well as local approval of natalizumab risk management materials in November.

"The option to self-administer natalizumab (Tysabri) subcutaneously at home is a very positive development for people living with MS in Ireland.” said Ava Battles, Chief Executive of The Multiple Sclerosis Society of Ireland. “It reduces the disruption that can be caused by regular hospital visits and may offer greater convenience, autonomy and quality of life, while maintaining the same trusted effectiveness of treatment.

Developments like this reflect meaningful progress for our community".

MS is a central nervous system autoimmune condition affecting areas of the body such as the brain, spinal cord and optic nerves.5 Relapsing-remitting MS is the most common form of the condition, accounting for approximately 85% MS patients.

In Ireland, approximately 10,000 people are currently living with MS.1 Diagnosis usually occurs between 20 and 40 years of age.

Natalizumab SC originally received authorisation from the European Commission (EC) in 2021 after demonstrating comparable efficacy and safety to the natalizumab intravenous (IV) formulation and has been used to treat more than 32,800 patients worldwide.

Approximately 40% of patients treated with natalizumab in Ireland receive treatment subcutaneously.

Currently, the SC and IV formulations of natalizumab are dosed at 300mg, administered every four weeks (Q4W) by a healthcare provider (HCP). For eligible patients, natalizumab SC can be self administered or administered by a caregiver, no longer requiring administration from a HCP. Each natalizumab SC dose is given as two prefilled 150mg syringes. Patients and their HCPs may choose the option of self-administration provided the patient has successfully tolerated

at least six administrations of natalizumab (IV or SC), including two doses administered subcutaneously under the supervision of an HCP. “Self-administration of natalizumab represents a significant step forward for patients managing MS,” said Mihaela Vlaicu, Head of Medical Europe at Biogen. “This option has the potential to reduce the logistical challenges typically associated with treatment in hospital, freeing up resources, while offering a pathway to greater flexibility and convenience for patients without compromising on the trusted efficacy natalizumab provides.”

“This milestone reinforces Biogen’s leadership in addressing the needs of the MS community” said Declan Connolly, Country Lead at Biogen Ireland. “We remain committed to advancing innovative solutions that enhance patient comfort, independence, and provide meaningful benefits for those we support."

HEALTHCARE ABROAD PARTNERS WITH MADRID CENTRE OF EXCELLENCE TO ENHANCE CROSS-BORDER ENDOMETRIOSIS CARE FOR IRISH PATIENTS Healthcare Abroad, Ireland's leading cross-border healthcare facilitator, has announced a new partnership with the Endometriosis Centre of Excellence at Viamed Santa Elena Hospital in Madrid, significantly expanding access to specialist care for Irish women living with endometriosis. Through the EU Cross Border Directive, the collaboration will offer Irish patients timely access to internationally recognised expertise, advanced diagnostics, and complex surgical treatment.

The multidisciplinary centre is led

by Dr. Lucas Minig, internationally renowned Gynaecologic Oncologist and expert in complex endometriosis minimally invasive surgeries. With more than 20 years’ experience, Dr. Minig travels from Valencia to Madrid regularly and has capacity to perform up to 20 surgeries per month, prioritising Irish patients.

Endometriosis is one of the most debilitating and underdiagnosed conditions affecting women’s health. The disease occurs when tissue similar to the lining of the uterus is found elsewhere in the body, often causing moderate to severe period pain, chronic pelvic pain, and in some cases fertility issues. According to the Endometriosis Association of Ireland, an estimated 155,000 women in Ireland are affected,

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• High-contrast MRI and enhanced diagnostic imaging upon patient arrival • Comprehensive treatment for all stages of endometriosis • Advanced surgical care adhering to the global gold standard of excision

Dr. Lucas Minig and many women are facing lengthy waits to access specialist assessment and treatment.

Paul Byrne, COO of Healthcare Abroad, said, “For too long, Irish women suffering with endometriosis have faced prolonged waits and limited access to the gold-standard care they need. This partnership represents a major step forward in providing real, practical solutions for women who cannot afford to wait. By connecting Irish women with leading international specialists like Dr. Minig, we are ensuring they receive the timely, expert treatment they deserve.”

Dr Lucas Minig added, “Endometriosis is a complex disease that requires specialised surgical expertise and a truly multidisciplinary approach. We focus on fully removing the endometriosis using minimally invasive surgery, which helps patients get back to their normal routines within a few weeks. With this centre, our goal is to offer women from Ireland the highest world-class standard of care, without experiencing long waiting lists. Every woman deserves access to treatment that can restore her quality of life, and we are proud to help make that possible.”

The internationally recognised gold-standard treatment, excision surgery, can be difficult to access due to the limited number of specialists able to perform this advanced procedure in Ireland.

The Centre of Excellence in Madrid responds directly to this unmet need, and will offer Irish patients access to expert assessment, advanced diagnostics, and specialist surgical care under the EU Cross Border Directive, a HSE-backed EU wide scheme that allows Irish residents to receive planned medical treatment in any EU country.

Under the EU Cross-Border Healthcare Directive, Irish residents are entitled to travel to any European Union country to receive planned medical treatment. Residents can access any treatment that is publicly available and funded in Ireland, with medical costs reimbursed by the HSE. Healthcare Abroad has a strong track record of helping women access timely and specialised gynaecological care unavailable domestically.

The new partnership reflects the organisation’s commitment to improving pathways to high-quality endometriosis management and supporting domestic health services as they work to expand capacity.

UNIVERSITY HOSPITAL GALWAY EMERGENCY DEPARTMENT WINS BRONZE ACCREDITATION FOR SUSTAINABILITY EXCELLENCE The Emergency Department (ED) at University Hospital Galway (UHG) took part in the Royal College of Emergency Medicine (RCEM) GreenED initiative and has been awarded Bronze Accreditation by recognising the team’s commitment to environmental responsibility and innovative waste-reduction practices in one of the hospital’s busiest clinical areas.

GreenED is an RCEM initiative which aims to measure and reduce the environmental impact in the ED. This is the first sustainability framework developed specifically for secondary-care settings and aims to reduce the carbon emissions of a department through sustainable and cost-saving practices, whilst maintaining or improving patient care. It provides a structured set of evidence-based actions, organised into Bronze, Silver, and Gold levels, along with the supporting guidance and resources needed to implement and achieve them.

The Centre provides:

The ED at University Hospital Galway alongside the ED at Mayo University Hospital, are among the first emergency departments in Ireland to receive this prestigious accreditation. The department now looks forward to building on this success as it works toward achieving Silver and ultimately Gold status.

• A multidisciplinary team across gynaecology, surgery, and urology

James Foley, Consultant in Emergency Medicine at University Hospital Galway said, “This

65 • A delicious Summer Berries flavour, ideal year-round • Made with only the finest ingredients • No artificial colours or flavours • Long-lasting, soothing menthol vapours Availability Jakemans Sugar Free Summer Berries Menthol Lozenges are now available for order directly through BR Healthcare or via your preferred wholesaler, with an RRP of ¤2.39 SECOND NATIONAL MATERNITY EXPERIENCE SURVEY

GreenED Initiative at University Hospital Galway, from left: Conor O’ Donovan, Senior House Officer; Naeem Akbar, Registrar; Laura Heffernan, Consultant; James Foley, Consultant; Prof. James Binchy, Consultant; Elaine Mulchrone, Clinical Nurse Facilitator; Mishal Khan, Consultant; Sunitha Soman, Staff Nurse; Marianbee Mohammed, Staff Nurse; Sandeep Kumar, Clinical Nurse Manger 1; Kerryn Futcher, Senior House Officer; Maurice Herlihy, Senior House Officer; Niall Owens, Consultant; and John O’ Donnell, Consultant achievement reflects a truly inclusive, multi-disciplinary effort across the department. Our team has embraced innovation and sustainability and these changes have not only reduced waste and improved efficiency but have also supported more patientcentred care.”

“This bronze medal demonstrates the commitment of UHG’s Emergency Department to creating a more environmentally conscious healthcare system. We are proud of the team for leading by example and contributing to a cleaner, more sustainable future for our hospital and community.”

Key initiatives implemented over the past year include:

The ED at UHG remains committed to further advancing sustainable healthcare practices and continuing its leadership in environmental stewardship within emergency medicine in Ireland.

1. Reducing unnecessary blood tests 2. Improving recycling systems and appropriate bin use 3. Staff training programme 4. Transition to 100% recycled paper 5. Rolling out waste-reduction strategies

JAKEMANS UNVEILS NEW SUGAR FREE SUMMER BERRIES MENTHOL LOZENGES IN IRELAND A refreshing, flavour-led addition to the fast-growing menthol confectionery brand.

Jakemans is delighted to introduce its newest innovation to the Irish market: Jakemans Sugar Free Summer Berries Soothing Menthol Lozenges. Crafted with the finest ingredients and offering a vibrant, fruity twist, this new variant delivers the same comforting menthol sensation consumers trust—now with no sugar and a burst of delicious summer berry flavour.

With a loyal following and strong brand recognition, Jakemans continues to expand its appeal by combining soothing menthol vapours with contemporary flavour profiles that attract both new and returning shoppers. Sugar Free Summer Berries taps into the rising demand for health-conscious confectionery, particularly products offering functional benefits without compromising on taste.

Callum Swift, SpR in Emergency Medicine and lead for the Galway ED Sustainability initiative said, “We are absolutely delighted to receive this recognition. Working in such a fast-paced environment, sustainability can be challenging but our team has shown that even small changes make a major difference. This award reflects the dedication and collective effort of everyone involved.”

A Modern Take on Menthol Relief

Chris Kane, Hospital Manager at Galway University Hospitals praised the achievement saying,

• Sugar free formulation to meet growing demand for reducedsugar options

Jakemans Sugar Free Summer Berries lozenges are designed to help soothe the throat and clear the airways while providing an uplifting, fruity taste experience. Each lozenge is made using the brand’s traditional methods, ensuring a smooth, premium texture packed with menthol vapours.

Key features include:

The results of the second National Maternity Experience Survey have been published, capturing the views of women who gave birth in Ireland’s 19 maternity hospitals and units, and at home, during February and March 2025. This follows the first survey of its kind delivered by the National Care Experience Programme in 2020, with the experiences shared by women who gave birth in 2025 offering clear insight into the improvements implemented since the initial survey.

Compared to 2020, the 2025 survey showed progress in seven areas, particularly in involvement in care decisions, opportunities to ask questions, as well as emotional support from healthcare professionals when babies were in the neonatal unit. Four of the areas that saw more positive scores this year were identified as priorities for improvement in 2020, showing that maternity services listened to what women said in the 2020 survey and took targeted actions to improve care. Nevertheless, some areas saw a decline from the 2020 survey, including information on physical changes and nutrition during pregnancy, support with feeding the baby at home and communication with GPs after birth.

Overall, 83% of participants in 2025 rated their maternity care as ‘good’ or ‘very good’, while 17% of participants rated their maternity care as ‘fair to poor’.

The majority of women reported positive experiences of care, with most women saying they felt treated with dignity and respect, and had confidence and trust in the healthcare professionals that cared for them.

Although there has been progress since 2020 in opportunities to ask questions about labour and birth, this area requires further improvement. For example, some women felt that they did not have the opportunity to ask questions about the labour and birth after their baby was born, and communication

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Clinical Profiles

between the maternity service and their GP during their pregnancy was not good.

The survey also found differences in women’s experiences depending on their socioeconomic background. Women from disadvantaged areas were more likely to report positive postnatal care experiences at home or in the community, while women from affluent areas were more likely to feel involved in decisions during pregnancy and birth.

Responding to the survey findings, Minister for Health, Jennifer Carroll McNeill said: “It is important that we listen to the voices of women receiving maternity care and use their experiences to continue to improve our services, my thanks to them for engaging with this survey. The results of the survey show that while women’s experiences of our maternity services are positive, there are also areas that we can address to make improvements. I would like to acknowledge the hard work of our many healthcare professionals who have contributed to improvements in the services, including through initiatives such as our new Postnatal Hubs and deploying additional lactation consultants. As we enter the final year of the National Maternity Strategy in 2026, we must ensure that we use this feedback to continue driving improvements.”

Angela Fitzgerald, HIQA’s Chief Executive Officer, stated: “We recognise that listening to the lived experiences of women and prioritising clear communication with them are essential components in understanding and meeting their needs. The National Maternity Experience Survey is vital for amplifying women’s voices and ensuring their experiences drive meaningful improvements in Ireland’s maternity services.”

Bernard Gloster, HSE Chief Executive Officer, said: “I want to thank the women who took part in the survey. Their feedback and contributions provide us with valuable insights that help us to enhance and improve our maternity services. Our HSE ‘Listening, Responding and Improving’ report, also published today, highlights improvement initiatives already underway. We’re committed to enhancing the quality of maternity services and the experiences of women and their families.’’

RESTRICTIVE PRACTICES IN IRISH MENTAL HEALTH CENTRES FALL TO LOWEST LEVEL ON RECORD, NEW REPORT SHOWS The combined use of restrictive practices in Irish mental health

centres has fallen to its lowest level since national reporting began in 2008, according to a new report published by the Mental Health Commission (MHC).

Entitled The Use of Restrictive Practices in Approved Centres – Activities Report 2024, the report documents the use of seclusion, physical restraint and mechanical restraint across 66 approved inpatient mental health centres nationwide during 2024. This is the MHC’s sixteenth report on the use of seclusion, mechanical means of bodily restraint and physical restraint in approved centres and forms part of its statutory remit to report independently on the quality and safety of mental health services in Ireland.

The report shows that total restrictive practices decreased by 18% in one year, from 3,467 episodes in 2023 to 2,836 episodes in 2024. Over a five-year period, the number of restrictive practice episodes has reduced by almost half, falling by 48.64% from 5,830 in 2020 to 2,836 in 2024.

This represents the lowest annual total since reporting commenced in 2008.

As part of this ongoing downward trend, the report highlights a sustained reduction in both physical restraint and seclusion, alongside the continued rarity of mechanical restraint. The findings reflect the impact of strengthened oversight, enhanced reporting requirements and the impact of the revised Rules and Codes of Practice introduced by the MHC in January 2023, underpinned by human rights and person-centred care principles. The MHC also acknowledges the ongoing efforts of service providers to adopt a human-rights approach to care and treatment which is resulting in reduction and elimination of restrictive practices.

The Chief Executive of the Mental Health Commission, John Farrelly, said: “From 2008 to 2018, episodes of physical restraint and the number of residents that were being physically restrained increased year-on-year. It is, therefore, encouraging to note that our work with service providers over the past number of years has continued to result in substantial reductions in restrictive practices, including seclusion. The data for 2024 demonstrates that clinicians and services are increasingly embedding therapeutic, rightsbased approaches that prioritise dignity, safety and recovery.”

The Director of Regulation at the Mental Health Commission, Gary Kiernan, said: “The continued decline in restrictive practices signals important and sustained

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progress in how mental health services are delivered in Ireland.

These reductions demonstrate a strong commitment to protecting the human rights of people receiving care and ensuring that coercive interventions are used only as a last resort in strictly controlled circumstances.”

products that support wellbeing, Olbas Shower Gel brings a unique point of difference to the category.

Its powerful blend of essential oils—including eucalyptus, peppermint and cajuput—creates uplifting vapours that help clear the senses while gently cleansing the skin.

The introduction by the MHC of the revised Rules and Code of Practice on 1 January 2023 was informed by international developments in human rights, advances in traumainformed and person-centred care, and growing evidence that restrictive practices can cause physical and psychological harm.

Key features of Olbas Shower Gel include:

“The revised Rules reinforce a rights-based approach to care, requiring approved centres to recognise each person’s inherent dignity and freedom and to ensure that restrictive practices are used only when absolutely necessary, proportionate and for the shortest possible duration,” added Mr Kiernan. “While continued focus is required, the 2024 data provide strong grounds for cautious optimism that restrictive practices will continue to decline.”

• Trusted Olbas formulation now in a shower-friendly 250ml pack

OLBAS® INTRODUCES NEW MENTHOL-INFUSED SHOWER GEL TO THE IRISH MARKET A revitalising in-shower experience designed to help consumers breathe easy Olbas®, the trusted household brand known for its natural decongestant remedies, is expanding its well-loved range in Ireland with the launch of Olbas Shower Gel, a refreshing menthol-infused shower gel designed to invigorate the senses and support easy breathing.

Olbas Shower Gel blends pure plant oils with energising menthol vapours to create a rejuvenating shower experience perfect for mornings, workouts, and times when consumers need to refresh, reset, and breathe more easily. The new 250ml pack is formulated to deliver the signature Olbas sensation in a convenient everyday format.

Meeting Consumer Demand for Wellness-Driven Bath & Body Care With consumers increasingly seeking functional personal care

• Refreshing menthol vapours for easy breathing • Formulated with pure plant oils • Invigorating fragrance that awakens the senses

• Ideal for use during colds, after workouts, or to start the day refreshed A Strong Opportunity for Retail and Pharmacy Channels "Olbas Shower Gel marks an exciting evolution for the Olbas brand in Ireland," said Laura Payne, Head of Healthcare, BR Healthcare. "It brings a trusted decongestant heritage into the bathroom category at a time when consumers are prioritising wellness, self-care, and products that offer real functional benefits.

We expect strong demand across grocery and pharmacy as shoppers look for ways to elevate their daily routines."

Availability Olbas Shower Gel is now available for order directly through BR Healthcare or via your preferred wholesaler, with an RRP of ¤6.99 PROPLUS® EXPANDS ITS ENERGY PORTFOLIO WITH THE LAUNCH OF PROPLUS FIZZ IN IRELAND ProPlus®, the iconic energy brand known for helping consumers stay alert and energised, is delighted to announce the launch of ProPlus Fizz, now available across Ireland. This new berryflavoured effervescent tablet format marks a major expansion for the brand, offering retailers a fresh opportunity to recruit new shoppers into the energy category.

ProPlus Fizz has been developed to meet growing consumer demand for fast-acting, convenient, and great-tasting energy solutions. Each tube contains 20 effervescent tablets formulated with a blend of caffeine, guarana, ginseng, and vitamins B12, B2, and B6, supporting energy release and helping consumers feel alert and focused throughout the day.

Perfect for modern energy needs.

67 Whether it’s busy workers, students preparing for exams, gymgoers, or anyone juggling the demands of daily life, ProPlus Fizz offers a refreshing and easy-to-take alternative to traditional energy tablets. Simply dissolve one tablet in water for a berryflavoured energy boost anytime, anywhere.

Key product benefits include: • Refreshing berry effervescent format • 20 tablets per tube • Contains caffeine, guarana and ginseng • Includes B vitamins for energy release • Ideal for consumers seeking a quick, enjoyable energy lift ProPlus Fizz is now available to order through BR Healthcare & your preferred wholesaler with an RRP of ¤11.95.

IRISH HEADACHE SOCIETY AT MIGRAINE IRELAND Migraine Ireland is proud to announce the official launch of the Irish Headache Society at Migraine Ireland (IHS-MI), a new professional and academic society dedicated to advancing the understanding and treatment of headache disorders in Ireland. The HIS-MI will bring together leading neurologists, GPs, pharmacists, Nurses (Clinical Nurse Specialists, Advanced Nurse Practitioners), and other HCPs including psychologists, physiotherapists, Occupational Therapists, Dietitians, S&L Therapists to address the significant impact of migraine and other headache disorders on the Irish population.

The IHS-MI is the first multidisciplinary headache society of its kind in Ireland. It aims to foster a collaborative environment where healthcare professionals can share research, best practices, and new developments in the field.

By creating a unified platform, the society will work to improve patient care, increase public awareness, and promote high-quality research into headache disorders, which are often misunderstood and underdiagnosed.

"The establishment of the IHSMI marks a pivotal moment for headache and migraine care in Ireland," said Theodore Mavridis, Chairperson Designate of the IHS-MI and a prominent neurologist. "Pascal Derrien, CEO of Migraine Ireland, added, 'For too long, the care pathway for people with headache disorders has been fragmented. This new society will act as a central hub, bringing together the expertise of our country’s top specialists to create a more integrated and effective approach to treatment in primary settings.'"

these challenging times. The survey findings revealed:

Migraine affects approximately one in seven people in Ireland, making it one of the most common neurological conditions. Despite its prevalence, many people struggle to access timely and effective care.

The IHS-MI will be instrumental in bridging this gap by providing education and resources to healthcare professionals across the country.

• 31% say world news is influencing their mental health and wellbeing

Looking ahead, the IHS-MI plans to host regular educational events, including an annual conference in 2027, to ensure that Irish healthcare professionals remain at the forefront of headache medicine. The society thru Migraine Ireland will also advocate for policy changes to improve access to specialist care and innovative treatments.

For more information about the Irish Headache Society at Migraine Ireland, please contact Migraine Ireland.

ST PATRICK’S MENTAL HEALTH SERVICES’ ANNUAL SURVEY ILLUSTRATES IMPACT OF GLOBAL UNCERTAINTY ON MENTAL HEALTH In a year marked by economic uncertainty, international conflict and an accelerating pace of global change, international and national crises are sources of increasing concern to Irish people, new survey findings have revealed.

According to the 2025 Annual Attitudes to Mental Health and Stigma Survey published by St Patrick’s Mental Health Services, almost half of respondents (48%) say international conflict, such as the situations in Gaza and Ukraine, is of greatest concern to them as a societal challenge, while economic concerns, housing concerns and climate change are all noted as issues influencing mental health and wellbeing.

Against the backdrop of these findings, St Patrick’s Mental Health Services, Ireland’s largest independent mental health service, is reminding everyone of the importance of seeking support for their mental health as we navigate

• 88% believe there is a worrying amount of anxiety in society • 49% identify economic challenges as influencing their mental health and wellbeing in daily life, with 64% of respondents noting their concerns about broader economic factors • 48% of people report that international conflict is a societal issue of most concern to them; an increase of 7% from 2024

• 24% cited housing concerns as influencing their mental health and wellbeing • 14% say climate change concerns are influencing their mental health and wellbeing.

While the findings highlight the mental health effects of the uncertain times we are living through, they also reveal some positive trends: • 65% of respondents report satisfaction with their mental health • Since 2020, there has been a noticeable increase in the number of people seeking support for their mental health.

In 2025, 67% of respondents had sought mental health support compared to just 35% in 2020 • 74% of respondents who have disclosed or know someone who has disclosed a mental health difficulty at work, at home or in the local community have reported positive experiences • Since 2020, there has been a 12% decrease in the number of people who believe that being treated for a mental health difficulty is still seen by Irish society as a sign of personal failure • 77% of respondents believe that people with mental health difficulties experience less stigma and discrimination than 10 years ago.

Speaking about this year’s findings, Paul Gilligan, CEO, St Patrick’s Mental Health Services, and Clinical Psychologist, said: “St Patrick’s Mental Health Services’ annual Attitudes to Mental Health and Stigma Survey has been carried out for over a decade and illustrates positive long-term shifts in attitudes toward mental health. Yet with each new iteration, emerging pressures, from digital determinants of mental health to

climate anxiety and geopolitical instability, reinforce the need to continue challenging mental health stigma while ensuring timely, effective support is available for all.

Encouragingly, over the last number of years, we have seen more and more people reach out for support when they need it. If you are struggling, you are not alone. Feelings of anxiety, stress or overwhelm are normal reactions to the increasingly difficult times we live in. Reaching out for help is not only a sign of strength but also a vital way to protect your wellbeing.”

Technology has also emerged as a significant factor perceived as influencing mental health, with findings illustrating: • 78% of respondents believe social media and/or smartphone use is associated with mental health difficulties among adults • 80% believe social media and/or smartphone use is associated with mental health difficulties among children • 12% followed mental health information online that later turned out to be inaccurate, with younger people (aged 18 to 24) more likely to have experienced negative impacts from inaccurate information.

Speaking about the impacts of unprecedented challenges on young people in particular, Paul Gilligan added: “The survey has shown younger generations are more likely to report dissatisfaction with their own mental health than older generations. This, combined with significantly higher levels of concern about issues like housing, economic factors and technology, is indicative of the unique challenges facing young people today.

While young people have demonstrated incredible resilience in navigating these pressures, it is vital that we continue to provide the right supports, resources and guidance to protect and enhance their wellbeing while also taking urgent action to address the critical issues driving these mental health impacts.”

The release of this year’s findings follows St Patrick’s Mental Health Services’ annual Founder’s Day conference, which focused on the theme of mental health in turbulent times. The conference explored issues such as digital determinants of mental health, megatrends influencing youth wellbeing, climate change and mental health impacts, psychiatry in humanitarian emergencies, and the impact of international conflict; echoing many of the themes highlighted in the survey.

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