July 2017 Volume 9 Issue 7
THE INDEPENDENT VOICE OF PHARMACY
In this issue: NEWS: Reimbursement bureaucracy presses Pharmacists Page 5
REPORT: Medicine Prices to fall Page 7
starts relieving hayfever eye symptoms in just 2 minutes Opticrom Allergy Single Dose Eye Drops Preservative free Suitable for use with contact lenses* Handy for on-the-go use Suitable for adults and children
EDUCATION: Lack of Obesity Policy costing HSE Page 24
CLINICAL: Cancer Trials participation to double Page 34
CPD: Irritable Bowel Syndrome Page 41
* Refer to instructions for use with contact lenses. Contact lenses should be removed before each application and inserted after 15 minutes. OPTICROM ALLERGY SINGLE DOSE 2% W/V EYE DROPS, SOLUTION ABBREVIATED PRODUCT INFORMATION Presentation: Opticrom Allergy Single Dose 2% w/v Eye Drops, solution containing sodium cromoglicate 2% w/v. Indication: For the relief and treatment of seasonal and perennial allergic conjunctivitis. MA Holder: Sanofi-aventis Ireland Ltd. Trading as SANOFI, Citywest Business Campus, Dublin 24 or
contact IEmedinfo@sanofi.com Tel: (01) 4035600. Legal Classification: P. Information about this product, including adverse reactions, precautions, contraindications, and method of use can be found at: www.medicines.ie/medicine/17160.
Date of preparation: June 2017 SAIE.CRO.17.06.0134
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AWARDS: Case Study Winner’s Profiles Page 46
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Clarityn 10mg Tablets (Loratadine) For full details, please refer to full SmPC. Presentation: Tablet containing 10mg loratadine. Indication: For the symptomatic treatment of allergic rhinitis and chronic idiopathic urticaria in adults and children over the age of 2 years with a body weight more than 30 kg. Dosage and Administration: Adults and children over 12 years of age: 10 mg/1 tablet orally once daily. Children 2 to 12 years of age with body weight > 30 kg: 10 mg once daily. Use other formulations for children 2 to 12 years old with a body weight 30 kg or less. The safety and efficacy in children under 2 years have not been established. Renal impairment: No dosage adjustments are necessary in patients with impaired renal function. Hepatic impairment: Patients with severe liver impairment should be administered a lower initial dose because they may have reduced clearance of loratadine. An initial dose of 10 mg every other day is recommended for adults and children weighing more than 30 kg. Contraindications: Hypersensitivity to loratadine or to any of the excipients.Warnings and Precautions: Clarityn should be administered with caution in patients with severe liver impairment. Contains lactose; patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine. Administration of Clarityn should be discontinued at least 48 hours before skin tests since antihistamines may prevent or reduce otherwise positive reactions to dermal reactivity index. Interactions with other medicinal products: Clarityn has no potentiating effects when administered concomitantly with alcohol. Potential interaction may occur with all known inhibitors of CYP3A4 or CYP2D6 resulting in elevated levels of loratadine, which may cause an increase in adverse events. Increase in plasma concentrations of loratadine has been reported after concomitant use with ketoconazole, erythromycin, and cimetidine in controlled trials, but without clinically significant changes (including electrocardiographic). Interaction studies have only been performed in adults. Fertility, pregnancy and lactation: There are no data available on male and female fertility. It is preferable to avoid the use of Clarityn during pregnancy. Clarityn should not be used during breast-feeding. Effects on ability to drive and use machines: Clarityn has no or negligible influence on the ability to drive and use machines. However, patients should be informed that very rarely some people experience drowsiness, which may affect their ability to drive or use machines. Undesirable effects: Very rare: hypersensitivity reactions (including angioedema and anaphylaxis, dizziness, convulsion, tachycardia, palpitation, nausea, dry mouth, gastritis, abnormal hepatic function, rash, alopecia, fatigue. In clinical trials in children aged 2 to 12 years, somnolence, headache, nervousness and fatigue were commonly reported and headache, increased appetite and insomnia were reported uncommonly. Classification for sale or supply: pharmacy-only. MA numbers: PA1410/75/1 Further information available from the Marketing Authorisation Holder: Bayer Ltd., The Atrium, Blackthorn Road, Dublin 18. Tel: 01 2999313. Date of Preparation: November 2015
Reference: 1. Internal calculations derived from QuintilesIMS OTC Global Analysis database, MAT 6/2016.
Contents Page 5: Pharmacists take part in CarePlus Frontline Cycle
Page 10: Medicines for Ireland issue calls for reform
Page 14: Conference report – Drop in HPV vaccine uptakes
Page 34: Clinical Trials Ireland calls for doubling of cancer patient participation
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This month in IPN we start our showcase with one of our winners from the Irish Pharmacy Awards. Featured this month is the HPN Respiratory Team of the Year, Chemco Pharmacy in Bandon. On page 8, we detail how, from the start of next month (July) the cost to the State of 780 medicines, most of which are supplied by member companies of the Irish Pharmaceutical Healthcare Association (IPHA), will fall. The reductions, which will result in additional savings to the State of an estimated ¤15million are in accordance with Clause 5.2 of the 2016 Framework Agreement on the Supply and Pricing of Medicines between IPHA, the Department of Health, the Department of Public Expenditure and reform and the HSE. “IPHA member companies continue to deliver savings. The purpose of the Agreement was to create budget headroom for new medicines. We have played our part," says IPHA CEO Oliver O'Connor.
Page 24: HSE losing millions due to lack of National Obesity Policy
In other news, the Irish Pharmacy Union (IPU) has criticised the Sláintecare Health report issued by the Joint Committee on the Future of Healthcare, regarding the future of Irish Healthcare, as ‘too GP-centric’ and not having enough emphasis on utilising the skills and expertise of Community Pharmacists. “The report provides many useful proposals, particularly on treating patients locally, but is undermined by the lack of recognition of the contribution of pharmacists whose contribution to primary care solutions has been recognised internationally,” Daragh Connolly, the IPU said. The IPU also noted that while it welcomed ‘certain aspects’ of the report, ‘it is lacking in substance’ and is ‘largely aspirational’ – turn to page four for details. Meanwhile Pharmacists are finding reimbursement from the Health Service difficult and time-consuming due to the number of schemes that patients can currently claim drugs under, as well as the amount of paperwork that is required to be filled out to be reimbursed. Currently, patients can claim drugs for free under their Medical Card, The Hardship Scheme, as well as the Long-Term Illness Scheme, all of which present a pharmacist with a large amount of paperwork. Read about it on page five. On page 26, Thomas McDonald FCA Of Brenson Lawlor provides some financial tips for Pharmacists, while our features for this month include Extemperanious Medicines, Head Lice, Hangover Prevention Tips, and Infant Feeding. Finally, this month’s CPD section is Hypertension.
Feature: Specials Feature: Infant Feeding
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News news brief ALL IRELAND OBESITY SEMINAR The use of negative imagery and language in communications contributes to weight-related stigma, an expert seminar in Belfast heard recently. Delegates at the All Island Obesity Action Forum heard how stigmatization can have a negative effect on those who need help the most when it comes to their weight. Speakers also highlighted what is known from evidence regarding stigma in mental health. At the seminar, safefood announced plans for a workshop with media to explore the role of communications in weight stigma. Dr Grace O’Malley, Chair of the Association for the Study of Obesity on the island of Ireland (ASOI) commented, “In clinical settings, we witness the effects of obesity on the physical and psycho-emotional health of children and adults. All too often, individuals are stigmatized due to their shape or weight in school, in healthcare, in work, online or just walking around their neighbourhood. We each have a role to play in tackling this issue; promoting and modelling a healthier lifestyle, enabling a healthier environment and improving access to treatment for patients.”
Minor Ailment Scheme ‘would work easily’ in Republic As Community Pharmacists in Ireland await a report from the Department of Health regarding the practicalities of the implementation of a Minor Ailments Scheme, Northern Irish Pharmacists, who are currently using the scheme, have noted it’s benefits. in the window to show that they’re providers of this service. Patients would go into the consultation area and have a chat with their pharmacists,” said Independent Prescriber Judith Dowey, Andersons pharmacy, Portodown, speaking to Irish Pharmacy News.
Currently, Community Pharmacists in Northern Ireland can treat Minor Ailments, such as Coldsores, ear wax, mouth ulscers, oral thrush athletes foots, head lice, diarrhoea, vaginal thrush, saving patients a trip to their GP. The Irish Pharmacy Union (IPU) have called for a nationwide Minor Ailment Scheme to be rolled out in the Republic of Ireland. “At the minute pharmacies who provide the service present a cross
The All island Obesity Action Forum was hosted by safefood in collaboration with the Association for the Study of Obesity on the Island of Ireland (ASOI) and the Northern Ireland Regional Group, of the Association for the Study of Obesity (ASO, UK).
Pharmacies in NI also have the benefit of a Medicine Use Review system, which empowers and engages them the healthcare needs of patients. Community Pharmacists in the Republic also
“Diabetic patients are very engaged and quite open to discussion about their conditions”, Dowey continued, discussing the MUR. “Inhaler technique, to make sure they’re using the right technique, that’s another big part of the scheme that you end up doing.” However, Dowey notes that she would like to see more products made available over the counter. “I’ like to see a provision to provide a neurochamber, which attaches to an inhaler for the purposes of assisting hand-eye coordination” she said. “At the moment, a patient needs a prescription to get one.”
Pharmacists to help improve COPD quality of life COPD Awareness Week took place in June, and the Irish Pharmacy Union and COPD Support Ireland have launched a campaign to offer advice and support to the half a million Irish people living with COPD and to raise awareness to help people spot the symptoms and seek early treatment. increasing and many patients are not yet diagnosed. It is the fourth most common cause of death in Ireland after lung cancer, heart disease and stroke.
Delegates heard leading experts present the latest research findings in the area of weight stigma, its negative effects on physical and mental health, and the strategies being used to combat weight stigma. Dr Cliodhna Foley-Nolan, Director, Human Health & Nutrition, safefood continued, “Much in the same way as we’ve moved the conversation from ‘mental illness’ to ‘mental health’, so we need to do the same with weight issues and obesity on the island of Ireland.”
“If they’re suitable we’d them write a voucher, and keep a record of the consultation. We get a prescription pad, and on the right hand is the minor ailments consultation side, so it’s very straightforward. We also have a laptop in the consultation room that allows me to print it out, which saves us a lot of time.”
await its implementation, and have called for further empowerment in this regard.
Damien Peelo, Executive Director of COPD Support Ireland
COPD (Chronic Obstructive Pulmonary Disease) is a collective name for two main lung conditions (emphysema and chronic bronchitis) that make it hard for sufferers to breathe due to obstruction in the air passages of their lung. COPD is the most common cause of emergency admissions in Ireland, with 15,000 patients admitted annually. Numbers with the disease are
Speaking at the launch of the campaign Daragh Connolly, community pharmacist and IPU President said, “At present there is no cure for COPD. However, there are things you can do to make it easier to live with COPD and to slow down the progress of the disease. Pharmacists have a vital role to play in this regard and are important in identifying undiagnosed COPD in a patient. People who are regularly looking for over-the-counter cough remedies should be advised to seek further investigation. “We also know that the earlier you seek help, the more effective the treatments will be. Most importantly, if you think you have some of the symptoms of COPD and you smoke, you must try to stop immediately.” Mr Connolly also advised people with COPD to become aware of what triggers make their condition worse. “Your pharmacist can help
you to better understand your disease and manage it so that you can avoid hospitalisation.” Damien Peelo, Executive Director of COPD Support Ireland, added, “COPD Support Ireland is delighted to be working in collaboration with the Irish Pharmacy Union on COPD Awareness Week. COPD continues to be a major health issue in Ireland with an estimated 200,000 people diagnosed with COPD. Already, we have the highest rate of hospitalisation for COPD in a survey of 31 countries in the OECD. There are many more undiagnosed people, up to 300,000 in the community, who also need appropriate treatment and care. We should be managing this illness much better in primary care. The local pharmacy plays a vital role in the management of COPD and could potentially have an even greater role in identifying those who have the symptoms of COPD but are as yet undiagnosed. The pharmacist provides a trusted source of information and based in the heart of our communities they provide a very accessible service to people living with COPD.”
News Bureaucracy of reimbursement presses Pharmacists Pharmacists are finding reimbursement from the Health Service difficult and time-consuming due to the number of schemes that patients can currently claim drugs under, as well as the amount of paperwork that is required to be filled out to be reimbursed. Last month, Irish pharmacy News reported that the paperwork involved, and timely nature of applying for reimbursement under the Hardship Scheme, mean that some pharmacists were being left out of pocket if certain drugs were not approved.
Currently, patients can claim drugs for free under their Medical Card, The Hardship Scheme, as well as the Long-Term Illness Scheme, all of which present a pharmacist with a large amount of paperwork. Applying for reimbursement, particularly under the Hardship Scheme is a very time-consuming endeavour. “To be honest, it’s a full-time job just keeping up with the paperwork” said pharmacist
Tomas Conefrey, speaking to Irish Pharmacy News. “There’s a lot of bureaucracy involved, and it can be very difficult to get money back, particularly under certain schemes. “It doesn’t help when schemes like the Hardship Shceme, for instance, come into play. Take this morning, when I had to fill out about 15 forms, arrange to get them signed by a GP, and a patient, before I can send them off and get reimbursed.”
Often, under the scheme, patients who present and wish to claim are in need of their products immediately, and simply cannot wait for two to three weeks for a product to be approved.
Pharmacists are the first stop for people suffering from hay fever, and most of the time OTC products will suffice for the treatment of allergies.
As a result, many pharmacists opt to take a calculated risk, in the hope of later being reimbursed, but also ensuring that patients receive the items they need.
The CarePlus Frontline Cycle will see up to 70 pharmacists from all across Ireland get on their bikes and cycle more than 230km - from Dublin to Galway (via Athlone) over July 21st and 22nd. The cycle starts in Dublin on Friday 21st July, stops Friday night in Mullingar and finishes in Galway on Saturday July 22nd.
In 2011, the Frontline Cycle raised more than ¤9,000 for the Irish Cancer Society’s Action Prostate charity. More than ¤12,000 was raised for the same charity in 2013 as pharmacists again got on their bikes, this time to raise awareness of Ovarian Cancer. In 2015 more
Eamonn Brady MPSI (Whelehans Pharmacies Mullingar), Bernie McHugh (LARCC), Robert Keane MPSI (Careplus Pharmacies Mullingar and Enfield) than ¤15000 was raised for First Fortnight and Good to Talk in Mullingar. The CarePlus Frontline Cycle is organised by Mullingar-based pharmacists Eamonn Brady, John Keane and Robert Keane. Eamonn Brady MPSI from Whelehans Pharmacies
The majority of people, or 84 percent, do not know what products will help with their allergies, a new study has revealed.
An application is assessed both on the patient’s financial circumstances and on how important the items requested are to the patient’s treatment.
Pharmacists across Ireland are set to do their part to raise funds in aid of Family Carers, Cancer Support LARCC, and The pharmacy Benevolent Fund.
This year organisers have chosen to fundraise for Family Carers, Cancer Support LARCC and The Pharmacy Benevolent Fund.
MIS-INFORMATION FOR ALLERGY SUFFERERS
The research, commissioned by Scope-Healthcare and conducted by Ignite research among 1,000 Irish people, found that one in five allergy sufferers have missed work and, of these, one in three have missed four days or more.
Pharmacists to take part in the CarePlus frontline cycle this july
Now in its fourth year, the CarePlus Frontline Cycle is a fundraising event that encourages pharmacists to fundraise on behalf of a nominated charity each year.
Mullingar, said, “it is a fun way for pharmacists to meet up in an informal environment and raise funds for great charities. There are still places left for any pharmacist or non- pharmacist interested in taking part in all or part of the cycle. Email robert. firstname.lastname@example.org to register your interest.”
The study also found that allergies are increasingly a key factor in workplace absenteeism, with one in five people in Ireland taking sick days as a result. The research found that 40% of Irish adults suffer from allergies. Hay fever (21%) is the most common allergy reported, followed by dust (13%), food (9%) and animal dander (5%). Scope Healthcare, Ireland’s leading medical distributor headquartered in Dublin commissioned the research to highlight the prevalence of allergies in Ireland was conducted as part of the national ‘Smiling not Sneezing, Seeing not Streaming’ campaign that encourages sufferers to take positive steps to manage, control and prevent allergy symptoms. Alarmingly, two percent have taken long-term leave of more than 20 days while the majority of those who miss work due to allergies (64%) are under 35s. 50% of those with allergies class their symptoms as moderate, while one in ten say they experience severe symptoms. Despite severe symptoms and missing days from work, most people with allergies are suffering in silence. One in four do not take any medication to treat their allergies.
Slaintecare Health Report ‘Too GP-Centric’ The Irish Pharmacy Union (IPU) has criticised the Sláintecare Health report issued by the Joint Committee on the Future of Healthcare, regarding the future of Irish Healthcare, as ‘too GP-centric’ and not having enough emphasis on utilising the skills and expertise of Community Pharmacists. “The report provides many useful proposals, particularly on treating patients locally, but is undermined by the lack of recognition of the contribution of pharmacists whose contribution to primary care solutions has been recognised internationally,” Daragh Connolly, President of the IPU said. Pharmacists are empowered to a greater extent in parts of mainland Europe, and the UK, with Minor Ailments Schemes and Medicine Use Review Systems in place allowing Pharmacists to contribute more to their healthcare systems. Last year, the Pharmaceutical Society of Ireland (PSI), called for further empowerment of community pharmacists in its ‘Future in Pharmacy’ report. The IPU also noted that while it welcomed ‘certain aspects’ of the report, ‘it is lacking in substance’ and is ‘largely aspirational’. Welcoming the proposed reductions in the GMS prescription levy and the Drugs Payment Scheme charge, the IPU called for these reductions to be implemented immediately to benefit hardpressed patients, particularly those in vulnerable circumstances. Free GP care for all The committee worked on the plan for just under one year, hearing over 160 different submissions from health experts from home and abroad. The plan also aims to reduce waiting times to a maximum of 12 weeks for inpatient procedures, 10 weeks for outpatient appointments and ten days for a diagnostic test. The report has recommended free GP for all, a phasing out of private healthcare within public hospitals and also aims to cut the cost of medication for patients. In addition, the plan also calls for the introduction of a new health card, which will be known as a Cárta Sláinte. It will also see the HSE transformed into “a more strategic “national centre” carrying out national level functions” while regional bodies are established to ensure timely access to integrated care. The IPU however, does not think the current plan is practical, or feasible.
The Irish Pharmacy Union has slammed the Healthcare Report for being too ‘GP focused’
There is no way a totally GP-centric primary care system can work without innovative use of community Pharmacy and an expanded role for the Pharmacy profession “It does not provide a clear or implementable blueprint for future primary care services in Ireland,” a spokesperson said. “We have a chronic and worsening shortage of GPs. There is no way a totally GP-centric primary care system can work without innovative use of community pharmacy and an expanded role for the pharmacy profession,”. The Minister for Health Simon Harris said he hoped that the new plan will end "political tinkering" with the health service, also noting that it could potentially provide direction for the future of health care in Ireland. "I think the Irish health service has really suffered from constant political tinkering with the health service," he said. "We need once and for all to have a plan for the next decade. I would like now to take time to consider the report,
I think it deserves that; it deserves a number of weeks of consideration." "I expect there will be quite a substantive debate in the Dáil - I presume next month - and I look forward to participating in that." Health service investment The state has estimated that the cost of providing the required package of care at community and hospital level will be around ¤2.8bn over a ten-year period. The report was produced by the cross-party Oireachtas Committee on the Future of Healthcare which was chaired by Social Democrat co-leader Róisín Shortall TD. Deputy Shortall said, “Too many people’s lives have been damaged by a lack of adequate health care. And too many people have been impoverished because they have
had to bear the costs of services that should be available free to all. Sláintecare is a fully costed plan to build a modern universal healthcare system to meet the needs of all people based on their medical needs, not on their economic status. “Under the Sláintecare proposals, people will be able to get at least 70 per cent of their healthcare in their community, rather than having to travel to the nearest acute hospital. This includes free GP care, access to therapies like speech and language and physiotheraphy, treatment for chronic illnesses, minor surgery and diagnostic services. “This shift away from hospital care will require additional funding to provide universal benefits, to build and equip primary health centres, to offer community diagnostic testing and to recruit and train more medical professionals. We are confident that our proposals will deliver an improved and costeffective healthcare system that works for staff and patients alike.” The second package of investment will go towards a special transition fund to address the chronic underinvestment in health care over the austerity years – and will cost ¤3bn over six years.
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News news brief
Prices of 780 medicines to fall says IPHA From 1 July next the cost to the State of 780 medicines, most of which are supplied by member companies of the Irish Pharmaceutical Healthcare Association (IPHA), will fall.
EMERGENCY CONTRACEPTION FOR MEDICAL CARD HOLDERS
Despite this, the HSE now has no budget available for new medicines. This is unacceptable. Despite very large savings to the State, medicines that are routinely available in other EU member states are not available to patients in Ireland
Minister for Health, Simon Harris, has last month, signed a statutory instrument changing access to emergency hormonal contraception (EHC) for medical card holders. Minister Harris said, “From next month medical card holders will be able to obtain EHC directly from a pharmacy, free of charge, without having to go to their GP for a prescription first. EHC is an over the counter treatment. However, medical card holders currently need a GP’s prescription to get EHC through the medical card scheme. “From 1st July, medical card holders will be able to obtain EHC directly from their pharmacist, following a consultation, without a prescription from their GP. This is an important public health measure and will remove any barrier to medical card patients getting timely treatment from their local pharmacy. This is about equity of access for all our citizens.” EHC is classified by the Health Products Regulatory Authority as an over the counter treatment. Anyone can go to a Pharmacy and buy it, without needing a prescription. There are currently three EHC products available in Ireland. In dispensing EHC, pharmacies are required to comply with the Pharmaceutical Society of Ireland (PSI) professional practice guidelines on dispensing over the counter EHC and on advising patients. EHC is available free to medical card holders on the General Medical Services (GMS) Scheme, provided the patient has a doctor’s prescription. A medical card holder can also purchase EHC without a prescription. From 1 July medical card holders will be able to get EHC free from their pharmacy without a prescription, however they will still be able to go to their GP for a prescription if they wish.
IPHA CEO Oliver O'Connor
The reductions, which will result in additional savings to the State of an estimated ¤15million are in accordance with Clause 5.2 of the 2016 Framework Agreement on the Supply and Pricing of Medicines between IPHA, the Department of Health, the Department of Public Expenditure and reform and the HSE. IPHA CEO Oliver O’Connor said, “IPHA member companies continue to deliver savings. The purpose of the Agreement was to create budget headroom for new medicines. We have played our part. Despite this, the HSE now has no budget available for new medicines. This is unacceptable. Despite very large savings to the State, medicines that are routinely available in other EU member states are not available to patients in Ireland.” A central element of the Framework Agreement IPHA negotiated with the State a year ago was an annual realignment of prices to the average of 14 European reference countries. On 1 July, this takes place with approximately ¤15 million in savings to the State for the next year. These savings will be in addition to approximately ¤140 million already made under the Agreement in its first 12 months, which includes over ¤15m from the first savings on biologic medicine. The HSE budget for the Primary Care Reimbursement Service was set this year with minimal growth of ¤5m on a ¤2.556bn base – 0.2%. The HSE is now routinely sending medicines it has agreed and wants to fund for patients to the Department of Health for approval because there is now no
more budget available for new medicines. This is entirely unacceptable. The reimbursement process is also much slower in Ireland compared to other European countries, according to O’Connor. “Other European countries have systems in place which enable new medicines to become available to patients within six months. The process in Ireland is clogged up, pushing us behind our European counterparts. A European survey of medicines over 2012-15 has showed Ireland as 16th out of 26 countries in terms of the number of newly-authorised medicines being made available to patients. This situation is most likely worse in 2017. Now there are 10 critical new medicines currently badly delayed for patients who need them– but they are reimbursed in the health services in nearly all our 14 reference countries already. Some are already available in 18 or more countries. Despite the fact that the Agreement states that it ‘will ensure that Ireland remains at the forefront of its European peers
in terms of early access,’ our approval process is simply not working well. It now takes an average of 348 days post authorisation for medicines to be reimbursed for patients and sometimes it can take several years. Other countries manage their approval process and budget to get medicines to patients much faster. Ireland should be able to achieve this too for patients. ” ”IPHA member companies are delivering on their side of the Agreement and providing savings which will total ¤785 million by 2020. It is not pricing or expenditure that prevents Ireland from being among the top European countries in providing new medicines to patients, it is the slow process and inadequate budgeting. This must be addressed now or Ireland will continue to fall behind in providing new medicines to patients”, he added.  Portugal, Spain, Slovenia, Belgium, France, Finland, Italy, Switzerland, Norway, Sweden, Germany, Netherlands, Austria, Denmark, UK are all ahead of Ireland.
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Calls for reform of medicine procurement - supply increasingly at risk A new national healthcare organisation, Medicines for Ireland, has launched last month, calling for a fundamental reform of medicine policy in Ireland.
Time is running out for Irish policy makers to combat rising costs of biological medicines. Irish people have far less access to certain medicines that many of our European neighbours Sandra Gannon, Joint Chairperson of Medicines for Ireland and General Manager of Teva Pharmaceuticals Ireland
Jeffrey Walsh Joint Chairperson of Medicines of Ireland and Commercial Manager
The group has warned that without critical reforms and a long-term strategy for medicine procurement Irish patients will face increasing difficulty in accessing and affording life-saving medicines.
Introducing measures to urgently tackle the growing problem of medicine shortages (with currently over 140 medicines unavailable);
Medicines for Ireland is a grouping of key medicine suppliers including some of the largest suppliers of medicines to the HSE. The new organisation is a coming together of the memberships of Healthcare Enterprise Alliance and the Irish Generic Manufacturers Association. Its members include Accord Healthcare, Consilient Healthcare, Clonmel Healthcare, Fannin Healthcare, Mylan, Pinewood Healthcare, Rowa Pharmaceuticals and Teva Pharmaceuticals. Medicines for Ireland’s membership was to the fore in driving and implementing generic substitution in 2013. This policy change resulted in Ireland’s traditional low levels of generic medicine usage being dramatically reversed. Usage of generic medicines has grown from 11% to 53% over the last four years, with the State achieving hundreds of million in savings as a result. The new organisation is committed to continuing this reform momentum. Over the period ahead, Medicine for Ireland’s focus will include: Developing a longer-term vision for medicine procurement;
Proactive initiatives to create greater competition in the medicines market, particularly hospital medicines where spend has grown from ¤315 million in 2009 to over ¤600 million in 2016; and The roll-out of a National Biosimilars Policy which expands the usage of biosimilar medicines, to counterbalance the unsustainable cost of biologic medicines. Medicines for Ireland is currently finalising a comprehensive policy document which will examine the critical issues facing medicine supply in Ireland and will publish its proposals in the coming weeks. Sandra Gannon, Joint Chairperson of Medicines for Ireland and General Manager of Teva Pharmaceuticals Ireland commenting on the launch of the group noted, “Medicines for Ireland’s launch is a significant development. It marks the coming together of the leading players in the supply of medicines in Ireland. We are driven by and share the common objective of improving the supply, accessibility and affordability of medicines for Irish patients. To do so, we need significant reform.
“Medicines now play a key part in helping Irish people live better and for much longer than ever before. With the growing importance of medicines, the issue of ensuring that Irish patients can access the treatments they need and the State can continue to pay for these medicines is crucial. “Recent experience has shown such access is no longer guaranteed. Medicine shortages are becoming a worsening problem and increasingly our ability to pay for them is also at risk. “Several factors are threatening the supply of medicines to Irish patients. These include the spiralling cost of the High-Tech Medicines Scheme which has grown by almost ¤300 million in just seven years (¤315 million in 2009 to over ¤600 million in 2016); increasing medicine shortages with over 140 medicines currently out of stock and the failure to embrace more affordable medicines such as biosimilars.” Jeffrey Walsh, Joint Chairperson of Medicines for Ireland and Commercial Manager, Pinewood
Healthcare, added, “We believe that without fundamental reforms at Government, hospital and community levels in how we procure and supply medicines then the existing problems will accelerate. We need reforms across a range of areas including in our national pricing agreements, hospital pharmacy, the extent to which full competition in the market is fostered and in our resistance to adopt newer, more affordable medicines such as biosimilars.” Noting Ireland’s underdeveloped approach to biosimilars and the failure of the promised public consultation on biosimilars to materialise, Owen McKeon, Board Member, Medicines for Ireland and Country Manager of Mylan Ireland commenting on the launch of the group said, “Time is running out for Irish policy makers to combat rising costs of biological medicines. Irish people have far less access to certain medicines that many of our European neighbours. It’s time for all stakeholders to come together to examine Medicines for Ireland’s proposals.”
Owen McKeon, Board Member, Medicines for Ireland and Country Manager of Mylan Ireland
Abbreviated Prescribing Information Abbreviated Prescribing Information Nurofen Express 200mg Tablets Nurofen Express 200mg Tablets Nurofen Express Maximum Strength 400mgTablets Tablets Nurofen Express Maximum Strength 400mg Refer Summary Product Characteristicsfor forfull fullinformation information Refer toto Summary ofof Product Characteristics Active ingredient: Ibuprofen sodiumdihydrate). dihydrate).Pharmaceutical PharmaceuticalForm: Form:Coated Coatedtablet tablet - whiteto tooff-white, off-white,bioconvex, bioconvex, round, round, sugar sugar coated tablet with an identifying logo black and red (for Active ingredient: Ibuprofen (as(as sodium identifying logo in in400mg black(for (for200mg 200mgtablet) tablet) redface. (for400mg 400mgtablet) tablet)on onone oneface. face. hite to off-white, bioconvex, round, sugar coated tablet with an- white identifying logo in black (for 200mg tablet) and red (for tablet) on and one Indications: anti-inflammatory, analgesicand andantipyretic antipyreticfor forshort-term short-termmanagement managementofofmild mildto tomoderate moderatepain painsuch suchas as isis associated associated with headache, dental pain, period pain, muscular strain, and for the of the of head colds and influenza. Dosage & Indications: anti-inflammatory, analgesic pain, fever, fever,and period pain, muscular strain,backache, backache, forsymptoms themanagement management thesymptoms symptoms head colds and influenza. Dosage d to moderate pain such as is associated with headache, dental pain, fever, period pain, muscular strain, backache, for the management ofand the ofofhead colds of and influenza. Dosage && Administration: oral administration.Short Shortterm termuse use only.Adults Adultsand andchildren childrenover over12 12years: years: Nurofen NurofenExpress Express200mg 200mgTablets: Tablets: 1-2 1-2 tablets every four hours with aa maximum in maximum dose 1200mg a a2424hour Nurofen Express Maximum Strength ForFor oral administration. withmaximum maximumof of6dose 6tablets tabletsof ina1200mg a24 24hours, hours,i.e. i.e. doseofof 1200mginin hourperiod. period. Nurofen Express Maximum Strength ars:Administration: Nurofen Express 200mg Tablets: 1-2only. tablets every four hours with a maximum of 6 tablets in a 24 hours, i.e. inmaximum a 24 hour period. Nurofen Express Maximum Strength 400mg Tablets; ONLY 1 TABLET PER DOSE.1 1tablet tabletevery everyfour fourhours hourswith withaamaximum maximumofof33tablets tabletsininaa24 24hours, hours,i.e. i.e.maximum maximum dose dose of 1200mg in a 24 hour period. Max duration of treatment 33days. IfIfthe symptoms worsen you should consult a adoctor. If Ifinin adolescents this medicinal product 400mg Tablets; ONLY 1 TABLET PER DOSE. period. Max duration of treatment days. the symptoms worsen you should consult doctor. adolescents this medicinal product blets in a 24 hours, i.e. maximum dose of 1200mg in a 24 hour period. Max duration of treatment 3 days. If the symptoms worsen you should consult a doctor. If in adolescents this medicinal product is required for more than 3 days symptomsworsen worsen adoctor doctorshould shouldbe beconsulted. consulted.Not Notsuitable suitablefor forchildren childrenunder under 12 12 years years of of age age without medical advice. Use NSAIDs with in elderly and the dose period due totohigher ofof adverse drug reactions (ADRs). is required more than 3 days oror if ifsymptoms NSAIDs withcaution caution inthe the andatatperiod thelowest lowestdue doseof ofshortest shortest period higherrisk risk adverse drug reactions (ADRs). uitable for for children under 12 years of agea without medical advice. Use NSAIDs with caution in the elderly and Use at the lowest dose of elderly shortest to higher riskdue of adverse drug reactions (ADRs). Discontinue if no benefit is seen intoleranceoccurs. occurs. Contraindications:History Historyofofgastrointestinal gastrointestinalbleeding bleedingor or perforation related related to to previous previous NSAIDs NSAIDs therapy. Active peptic ulcer/haemorrhage (two distinct episodes ofofproven ulceration oror bleeding) or Discontinue if no benefit seen oror intolerance Active or or history historyof ofrecurrent recurrent peptic ulcer/haemorrhage (twoorormore more episodes proven ulceration bleeding) ntestinal bleeding oris perforation relatedContraindications: to previous NSAIDs therapy. Active or perforation history of recurrent peptic therapy. ulcer/haemorrhage (two or more distinct episodes of distinct proven ulceration or bleeding) or or other gastrointestinal disorder. Patientswith witha aknown knownhistory historyofofhypersensitivity hypersensitivityreactions reactions(e.g. (e.g.asthma, asthma,bronchospasm, bronchospasm, rhinitis, rhinitis, angioedema angioedema or or urticaria) urticaria) in response to ibuprofen (the active substance) or any ofofthe excipients, acetylsalicylic acid (aspirin) oror other non-steroidal other gastrointestinal disorder. Patients in response to ibuprofen (the active substance) or any the excipients, acetylsalicylic acid (aspirin) other non-steroidal e.g. asthma, bronchospasm, rhinitis, angioedema or urticaria) in response to ibuprofen (the active substance) or any of the excipients, acetylsalicylic acid (aspirin) or other non-steroidal anti-inflammatory drugs (NSAIDs). Useininchildren childrenunder under1212years yearsofofage. age.Patients Patientswith withsevere severehepatic hepaticfailure, failure, severerenal renal failure failure or or severe severe heart heart failure. failure. Patients with problems glucose-galactose malabsorption insufficiency should anti-inflammatory drugs (NSAIDs). Use Patientsintolerance, with rare rare hereditary hereditary problemsof offructose fructoseintolerance, intolerance, glucose-galactose malabsorptionororsucrase-isomaltase sucrase-isomaltase insufficiency should re hepatic failure, severe renal failure or severe heart failure. Patients with raresevere hereditary problems of fructose glucose-galactose malabsorption or sucrase-isomaltase insufficiency should take this medicine. During the lasttrimester trimesterofofpregnancy. pregnancy. Warningsand andPrecautions: Precautions:Undesirable Undesirableeffects effectsmay maybe be minimised minimised by using using the the minimum minimum effective dose for duration totocontrol symptoms. The ananincreased frequency ofof adverse reactions to notnot take this medicine. During the last effective for the theshortest shortest durationnecessary necessary control symptoms. Theelderly elderlyhave have increased reactions ndesirable effects may be minimised by usingWarnings the minimum effective dose for the shortestbyduration necessary todose control symptoms. The elderly have an increased frequency offrequency adverse adverse reactions toto NSAIDs especially gastrointestinal bleedingand andperforation perforationwhich whichmay maybe be fatal.Prolonged Prolongeduse useof ofNSAIDs NSAIDsin inthe theelderly elderly isis not not recommended. recommended. Use Use with NSAIDs, including selective inhibitors, should Increased risk ofof aseptic meningitis with especially gastrointestinal bleeding with concomitant concomitant NSAIDs,inhibitors, includingcyclooxygenase-2 cyclooxygenase-2 inhibitors, shouldbe beavoided. avoided. aseptic meningitis useNSAIDs of NSAIDs in the elderly is not recommended. Usefatal. with concomitant NSAIDs, including cyclooxygenase-2 selective should beselective avoided. Increased risk of Increased asepticrisk meningitis with with Systemic lupus erythematosus and mixedconnective connectivetissue tissuedisease. disease.NSAIDs NSAIDsshould shouldbe begiven givenwith withcare careto topatients patientswith with aa history history of of gastrointestinal gastrointestinal disease (ulcerative Crohn’s disease) may GIGIbleeding, ulceration perforation, which can bebe fatal, hashas Systemic lupus and mixed disease (ulcerative colitis, colitis, disease)as astheir theircondition condition maybe beexacerbated. exacerbated. bleeding, ulcerationoror perforation, which can fatal, n with care toerythematosus patients with a history of gastrointestinal disease (ulcerative colitis, Crohn’s disease) as their condition mayCrohn’s be exacerbated. GI bleeding, ulceration or perforation, which can be fatal, has been reported with NSAIDs anytime timeduring duringtreatment, treatment,with withororwithout withoutany anywarning warningsymptoms symptomsor oraaprevious previoushistory history of of serious GI GI events. events. The The risk ulceration isishigher increasing doses, ininpatients with a ahistory ofof ulcer, particularly if complicated been reported allall NSAIDs atat any risk of of GI GI bleeding, bleeding, ulcerationor orperforation perforation higherwith with increasingNSAID NSAID patients history ulcer, particularly if complicated ymptoms or awith previous history of serious GI events. The risk of GI bleeding, ulceration orserious perforation is higher with increasing NSAID doses, in patients withdoses, a history of with ulcer, particularly if complicated with haemorrhage perforation, andininthe theelderly. elderly.These Thesepatients patientsshould shouldcommence commencetreatment treatmenton onthe thelowest lowestdose dose available. available. Combination Combination therapy with agents (e.g. or pump should be for and also forfor patients requiring with haemorrhage oror perforation, with protective protective (e.g.misoprostol misoprostol orproton proton pumpinhibitors) inhibitors) should beconsidered considered forthese thesepatients, patients, and also patients requiring tment on the lowest dose and available. Combination therapy with protective agents (e.g. misoprostol therapy or proton pumpagents inhibitors) should be considered for these patients, and also for patients requiring concomitant low dose aspirin, otherdrugs drugslikely likelytotoincrease increase gastrointestinalrisk. risk.Patients Patientswith withaahistory historyof ofGI GItoxicity, toxicity, particularly particularly when elderly, elderly, should report abdominal (especially GIGIbleeding) particularly ininthe initial When GIGI bleeding or concomitant low dose aspirin, oror other should report any any unusual unusual abdominalsymptoms symptoms (especially bleeding) initialstages stagesofoftreatment. treatment. bleeding with a history of GI toxicity, particularly whengastrointestinal elderly, should report any unusual abdominalwhen symptoms (especially GI bleeding) particularly in the initialparticularly stages ofthe treatment. When GI When bleeding or or ulceration occurs patients receivingNurofen NurofenExpress ExpressTablets, Tablets,the thetreatment treatmentshould shouldbe bewithdrawn. withdrawn.Caution Cautionshould shouldbe be advised advised in patients patients receiving receiving concomitant medications which increase ofofulceration or bleeding, anticoagulants such asas ulceration occurs in in patients receiving concomitant whichcould could increasethe therisk risk ulceration bleeding,such suchasasoral oralcorticosteroids, corticosteroids, anticoagulants such hdrawn. Caution should be advised in patients receiving concomitant medications whichincould increase the risk medications of ulceration or bleeding, such as oralorcorticosteroids, anticoagulants such as warfarin, selective serotonin reuptake inhibitors or anti-platelet agents such as aspirin. Caution (discussion with doctor or pharmacist) is required prior to treatment in patients with a history of controlled or uncontrolled hypertension, congestive heart failure, cardiac oedema, established selective serotonin reuptakeor inhibitors or anti-platelet agents suchprior as aspirin. (discussion with doctor or pharmacist) is required prior to treatment patients with a history of controlled or uncontrolled hypertension, congestive heart failure, cardiac oedema, established ionwarfarin, (discussion with doctor pharmacist) is required to Caution treatment in patients with a history of controlled or in uncontrolled hypertension, congestive heart failure, cardiac oedema, established ischaemic heart disease, peripheral arterialdisease disease and/orcerebrovascular cerebrovasculardisease. disease.Similar Similarconsideration considerationshould shouldbe bemade made before before initiating longer-term longer-term treatment with factors for events hyperlipidaemia, diabetes mellitus and smoking). ischaemic heart disease, peripheral arterial treatment of of patients patients withrisk risk factors forcardiovascular cardiovascularhyperlipidaemia, events(e.g. (e.g.hypertension, hypertension, hyperlipidaemia, diabetes mellitus and smoking). consideration should be made before and/or initiating longer-term treatment of patients with riskinitiating factors for cardiovascular events (e.g. hypertension, diabetes mellitus and smoking). Prolonged use any type painkillerforforheadaches headachescan canmake makethem themworse. worse.IfIfthis thissituation situationisisexperienced experiencedor orsuspected, suspected, medical medical advice should should be be obtained and treatment be The ofof'Medication Overuse should suspected inin patients who have use ofof any ofof painkiller obtained treatment should should bediscontinued. discontinued. Thediagnosis diagnosis 'Medication OveruseHeadache Headache shouldbebe suspected patients have n is Prolonged experienced ortype suspected, medical advice should be obtained and treatment should be advice discontinued. The and diagnosis of 'Medication Overuse Headache should be suspected in patients who who have frequent or daily headaches despite (or because of ) the regular use of headache medications. Clinical trial and epidemiological data suggest that use of ibuprofen, particularly at high doses (2400mg daily) and in long term treatment may be associated with a small increased risk of of arterial frequent ortrial daily headaches despite (or because of ) the regular use ofthat headache Clinical particularly trial and epidemiological data suggest(2400mg that use of ibuprofen, particularly at high dosestreatment (2400mg daily)may and in be longassociated term treatment with may beaassociated with a small increased arterial ns. Clinical and epidemiological data suggest usemedications. of ibuprofen, at high doses daily) and in long term small increased risk ofrisk arterial thrombotic events (for example myocardialinfarction infarctionororstroke). stroke).Overall, Overall,epidemiological epidemiologicalstudies studiesdo donot notsuggest suggestthat that low low dose dose ibuprofen ibuprofen (e.g. (e.g. < < 1200mg 1200mg daily) is associated with an increased risk of myocardial infarction. Serious skin reactions, some ofofthem fatal, including Exfoliative thrombotic events (for example myocardial daily) is associated with an increased risk of myocardial infarction. Serious skin reactions, some them fatal, including Exfoliative tudies do not suggest that low dose ibuprofen (e.g. < 1200mg daily) is associated with an increased risk of myocardial infarction. Serious skin reactions, some of them fatal, including Exfoliative Dermatitis, Stevens-Johnson syndromeand andToxic ToxicEpidermal EpidermalNecrolysis, Necrolysis,have havebeen beenreported reported veryrarely rarelyin inassociation association with the the use of of NSAIDs. NSAIDs. Patients Patients appear to be at risk these reactions early ofoftherapy, the ofofthe occurring inin the majority of of cases Dermatitis, syndrome at highest highest riskof of reactionsthe earlyin inthe thecourse course therapy, theonset onset thereaction reaction occurring the majority cases very rarelyStevens-Johnson in association with the use of NSAIDs. Patients appearvery to be at highest with risk ofuse these reactions appear earlytoinbethe course ofthese therapy, onset of the reaction occurring in the majority of cases within the first month of treatment. Nurofen Express Tablets should be discontinued at the first appearance of skin rash, mucosal lesions, or any other sign of hypersensitivity. Renal impairment as renal function may deteriorate. Hepatic dysfunction. Patients with bronchospasm or SLE within the first monthof ofskin treatment. Nurofen Expresslesions, Tablets should be discontinued at the appearance of skin rash, mucosal lesions, or any other sign of hypersensitivity. Renal impairment as renal functiondysfunction. may deteriorate. Hepatic dysfunction. Patients with bronchospasm or SLE first appearance rash, mucosal or any other sign offirst hypersensitivity. Renal impairment as renal function may deteriorate. Hepatic Patients with bronchospasm or SLE should consult their doctor before taking this medicine. Bronchospasm may be precipitated in patients suffering from or with a previous history of bronchial asthma or allergic disease. There is some evidence that drugs which inhibit cyclo-oxygenase/prostaglandin synthesis may cause consultsuffering their doctor before this medicine. Bronchospasm may precipitated in patients suffering from ordisease. with a previous history bronchial asthma or allergic disease. There is some evidence that drugs which inhibit cyclo-oxygenase/prostaglandin may cause d inshould patients fromtaking or with a previous history ofbebronchial asthma or allergic There is of some evidence that drugs which inhibit cyclo-oxygenase/prostaglandin synthesissynthesis may cause impairment of female fertility by an effect on ovulation. This is reversible on withdrawal of treatment. As NSAIDs can interfere with platelet function, they should be used with caution in patients with intracranial haemorrhage and bleeding diathesis. If you are pregnant, elderly or have impairmentAs of female fertility by an effect on ovulation. This is reversible on withdrawal of treatment. NSAIDswith can interfere with in platelet function,with they should be used with caution in patientsand with intracranial haemorrhage andIfbleeding diathesis. If you areelderly pregnant, or elderly or have reatment. NSAIDs can interfere with platelet function, they should beAsused caution patients intracranial haemorrhage bleeding diathesis. you are pregnant, have asthma or are receiving regular medical treatment please consult your doctor before taking this medication. Each tablet contains an average of 24.6mg (200mg) or 49.2mg (400mg) of sodium. This should be considered in patients whose overall intake of sodium must be markedly restricted. asthma or are receiving regular medicalcontains treatment please consult your doctor before (200mg) taking this medication. Each (400mg) tablet contains average of This 24.6mgshould (200mg) or 49.2mg (400mg) of sodium. This should be considered in patients overall intake of sodium must be markedly restricted. this medication. Each tablet an average of 24.6mg or 49.2mg ofansodium. be considered in patients whose overall intakewhose of sodium must be markedly restricted. There is a risk of renal impairment in dehydrated adolescents. Interaction with other medicinal products and other forms of interaction: known to interact with the following (please see SPC for full details): Corticosteroids, Anti-coagulants, Anti-platelet agents and SSRIs , Anti-hypertensive is a risk ofand renalother impairment in dehydrated adolescents.known Interactionto with other medicinal and other forms of interaction: known interact with theCorticosteroids, following (please see SPC for full details): Corticosteroids, Anti-coagulants, Anti-platelet agents, and SSRIs , Anti-hypertensive nalThere products forms of interaction: interact withproducts the following (please see SPC fortofull details): Anti-coagulants, Anti-platelet agents and SSRIs Anti-hypertensive (ACE inhibitors and Angiotensin II Antagonists) , Diuretics, Cardiac glycosides, Lithium, Methotrexate, Ciclosporin, Other NSAIDs including cyclooxygenase-2 selective inhibitors, Aminoglycosides, Probenecid, Oral hypoglycaemic agents, Zidovudine, Mifepristone, Tacrolimus, Quinolone hotrexate, Ciclosporin, Other NSAIDs including cyclooxygenase-2 selective inhibitors, Aminoglycosides, Probenecid, Oral hypoglycaemic agents,Oral Zidovudine, Quinolone (ACE inhibitors and Angiotensin II Antagonists) , Diuretics, Cardiac glycosides, Lithium, Methotrexate, Ciclosporin, Other NSAIDs including cyclooxygenase-2 selective inhibitors, Aminoglycosides, Probenecid, hypoglycaemicMifepristone, agents, Zidovudine,Tacrolimus, Mifepristone, Tacrolimus, Quinolone antibiotics and low dose aspirin. Fertility, Pregnancy and Lactation: Ibuprofen is not recommended during the first six months of pregnancy and is contraindicated in the last trimester of pregnancy. Ibuprofen and its metabolites can pass in very small concentrations into the breast milk. No mended during months of pregnancy and is contraindicated in the last of pregnancy. Ibuprofen its metabolites pass initsvery small concentrations into the breast milk. No antibiotics and lowthe dose first aspirin.six Fertility, Pregnancy and Lactation: Ibuprofen is not recommended during the first sixtrimester months of pregnancy and is contraindicated in theand last trimester of pregnancy. can Ibuprofen and metabolites can pass in very small concentrations into the breast milk. No harmful effects to infants are known, so it is not necessary to interrupt breast-feeding for short-term treatment with the recommended dose for mild to moderate pain and fever. Side Effects: Haematopoietic disorders (anaemia, leucopenia, thrombocytopenia, pancytopenia, ort-term treatment the so recommended for mild to moderate and fever. Side Effects: Haematopoietic (anaemia, leucopenia, thrombocytopenia, pancytopenia, harmful effects to infantswith are known, it is not necessary to dose interrupt breast-feeding for short-term pain treatment with the recommended dose for mild to moderate paindisorders and fever. Side Effects: Haematopoietic disorders (anaemia, leucopenia, thrombocytopenia, pancytopenia, agranulocytosis) are very rare - first signs are fever, sore throat, superficial mouth ulcers, flu-like symptoms, severe exhaustion, nose and skin bleeding, and bruising. Hypersensitivity reactions consisting of urticaria and pruritus (uncommon), severe hypersensitivity reactions including likeagranulocytosis) symptoms,are severe nose bleeding, andflu-like bruising. Hypersensitivity reactions consisting of urticaria and reactions pruritus (uncommon), severe reactions reactions including very rareexhaustion, - first signs are fever, soreand throat,skin superficial mouth ulcers, symptoms, severe exhaustion, nose and skin bleeding, and bruising. Hypersensitivity consisting of urticaria and pruritus hypersensitivity (uncommon), severe hypersensitivity including tongue and laryngeal swelling, dyspnoea, tachycardia, hypotension (anaphylaxis, angioedema or severe shock) are very rare. Aggravated asthma, bronchospasm. Respiratory tract reactivity comprising asthma or dyspnoea. Headache, dizziness. Aseptic meningitis (very rare). Impaired matongue or severe shock) are very rare. Aggravated asthma, bronchospasm. Respiratory tract reactivity comprising asthma or dyspnoea. Headache, dizziness. Aseptic (very rare). Impaired and laryngeal swelling, dyspnoea, tachycardia, hypotension (anaphylaxis, angioedema or severe shock) are very rare. Aggravated asthma, bronchospasm. Respiratory tract reactivity comprising asthma or dyspnoea. Headache,meningitis dizziness. Aseptic meningitis (very rare). Impaired hearing (uncommon). Cardiac failure, oedema, hypertension (very rare). Abdominal pain, nausea and dyspepsia (uncommon) Diarrhoea, flatulence, constipation and vomiting (rare). Peptic ulcers, perforation or gastrointestinal haemorrhage, malaena, haematemesis, sometimes fatal, ausea and dyspepsia (uncommon) flatulence, constipation and vomiting (rare). Pepticflatulence, ulcers,constipation perforation or gastrointestinal malaena, haematemesis, sometimes fatal,fatal, hearing (uncommon). Cardiac failure, oedema,Diarrhoea, hypertension (very rare). Abdominal pain, nausea and dyspepsia (uncommon) Diarrhoea, and vomiting (rare). Peptic ulcers,haemorrhage, perforation or gastrointestinal haemorrhage, malaena, haematemesis, sometimes particularly in the elderly, ulcerative stomatitis, gastritis, exacerbation of colitis and Crohn’s disease (very rare). Liver disorders, especially in long-term treatment (very rare). Severe forms of skin reactions such as bullous reactions including Stevens-Johnson Syndrome, erythema multiforme disease (very rare). Liver disorders, especially in long-term treatment (very rare). Severe forms ofinskin reactions such as bullous reactions including Stevens-Johnson Syndrome, erythema multiforme particularly in the elderly, ulcerative stomatitis, gastritis, exacerbation of colitis and Crohn’s disease (very rare). Liver disorders, especially long-term treatment (very rare). Severe forms of skin reactions such as bullous reactions including Stevens-Johnson Syndrome, erythema multiforme and toxic epidermal necrolysis can occur (very rare). Acute renal failure, papillary necrosis, especially in long-term use associated with increased serum urea and oedema (very rare), decreased haemoglobin levels and decreased urea clearance (very rare). Name and Address of Marketing specially long-term use associated with increased serum urea especially and oedema (very rare), decreased levels and urea clearance (very rare). Name and Address Marketing and toxicin epidermal necrolysis occur (very rare). renal failure,campus, papillary necrosis, long-term associated increasedhaemoglobin serum urea and oedema (very rare),decreased decreased haemoglobin levels and decreased urea clearance (very rare). Name andof Address of Marketing Authorisation Holder: Reckittcan Benckiser Ireland Ltd,Acute Citywest Business Dublin 24, Ireland. PAinNumber: PA use 979/32/10 and with PA 979/32/11 eland. PA Number: PA 979/32/10 and PA 979/32/11 Authorisation Holder: Reckitt Benckiser Ireland Ltd, Citywest Business campus, Dublin 24, Ireland. PA Number: PA 979/32/10 and PA 979/32/11 For full prescribing information, please consult the SPC which is available on www.medicines.ie. For product queries, please call (01) 630 5429 or contact the MAH above. es.ie. For productinformation, queries,please please call (01) 630 is 5429 or on contact the MAH above. ForLegal full prescribing consult the SPCDate which available www.medicines.ie. For product queries, please call (01) 630 5429 or contact the MAH above. Category: Retail Sales through Pharmacy only. of preparation: May 2016. Legal Category: Retail Sales through Pharmacy only. Date of preparation: May 2016.
1.Steiner TJ, et al. J Headache Pain. 2007;8: S3-47 1.Steiner TJ, et al. J Headache Pain. 2007;8: S3-47 2.Cathcart S, et al. Cephalagia. 2010; 30(10): 1250-1267 2.Cathcart S, et al. Cephalagia. 2010; 30(10): 1250-1267 3.RB market research, survey, 2013, Headache Awareness Week, 1-33, 1010 participants. 3.RB market research, survey, 2013, Headache Awareness Week, 1-33, 1010 participants. 4.Moore A, et al. Pain. 2014. 155(1):14–21 4.Moore A, et al. Pain. 2014. 155(1):14–21 5.Nurofen Express 400mg Maximum Strength Tablet SPC. Accessed 22/02/2017 http://www.medicines.ie/medicine/15024/SPC/Nurofen+Express+Maximum+Strength+400mg+Tablets/ SPC/Nurofen+Express+Maximum+Strength+400mg+Tablets/ 5.Nurofen Express 400mg Maximum Strength Tablet SPC. Accessed 22/02/2017 http://www.medicines.ie/medicine/15024/SPC/Nurofen+Express+Maximum+Strength+400mg+Tablets/
ALWAYS READ THE LABEL. Date of preparation: Mar 2017 IRL/N/0317/0017 ALWAYS READ THE LABEL. Date of preparation: Mar 2017 IRL/N/0317/0017
News Launch of Clinical Leadership in news brief Pharmacy ‘exceptionally well received’ ¤1.3M INVESTMENT IN PHARMACEUTICAL MANUFACTURING RESEARCH New research projects being carried out at a leading national technology centre is to help biopharmaceutical companies in Ireland improve their manufacturing processes and increase competitiveness. Enterprise Ireland has awarded ¤1.3 million worth of funding to the Pharmaceutical Manufacturing Technology Centre (PMTC), hosted at University of Limerick, for economically important Innovation Partnership Projects involving multiple industry partners. This funding will primarily focus research towards improving cleaning processes in the industry and contributing to network competitiveness in areas such as product-toproduct changeover. The research effort will lead to increased efficiencies, cost savings and will ensure improved effectiveness in the biopharmaceutical industry helping to secure jobs. The PMTC is part of the Enterprise Ireland IDA Technology Centre Program and works with industry partners to provide advanced technology solutions for the biopharmaceutical sector in Ireland. The centre currently assists more than 30 companies on pharmaceutical manufacturing projects. According to Dr Chris Edlin, Centre Director of PMTC, “Our primary focus in PMTC is to advance cutting-edge innovation; bringing forward novel technologies to advance Irish-based biopharmaceutical companies. These additional funds from Enterprise Ireland will help strengthen our capabilities and expand our services to more partners. Furthermore, this investment will deliver highly-skilled postgraduate jobs, driving enterprise and employment growth in the region”. Pfizer is the lead industrial collaborator on the multi-partner EI Innovation Programme.
The recent launch of the Clinical Leadership in Pharmacy Across Ireland (CLIP) programme, which got under way at the Ballymascanlon Hotel, just outside Dundalk in late May was widely praised by participants, and later described as ‘exceptionally well received.” The course is a comprehensive leadership series aiming to unlock the potential of Ireland’s future pharmacy leaders. By embedding collective leadership behaviours within the pharmacy sector, this programme hopes to support our future leaders in maximising the opportunities created by health and social care integration and novel models of care. Pharmacy leaders, both now and in the future, are likely to encounter increasing challenges to the profession amidst an evolving leadership culture and climate, and the programme was designed to include members of Pharmaceutical Industry as participants. The programme includes a broad suite of leadership training events aimed at transforming delegates’ leadership capabilities, through the development of appropriate skills and behaviours. The launch saw a detailed and interesting outline of the challenges and changes within Pharmacy in Northern Ireland
from Cathy Harrison, the Northern Ireland Senior Principal Pharmaceutical Officer, who also highlighted the support of the Department of Health for the CLIP Programme. Next up, two of the recent participants in the Scottish equivalent pilot programme that ran in 2016/17, highlighted their personal experiences of attending the course, and how it helped them to develop their leadership, decision making and time management skills. Mandy Mackintosh, Acute Prescribing Support Pharmacist at NHS Dumfries and Galloway told the group of 30 plus pharmacy professionals how the course had helped her develop the confidence to take decisions and to push issues which she feels have merit. “In particular, I found the introduction to flexible leadership very useful, how to deal with different personalities and how to lead with impact. The networking opportunities were excellent, and I will undoubtedly have better prospects as a result of
my attendance at the course. I found the time management elements very useful and I would unequivocally say that attending the CLIP programme has been invaluable to me and to my career,” she said. Another previous participant of the CLIP Scotland course, Millie Galvin of Aberdeen Royal Infirmary gave a similarly glowing outline of her time spent on the CLIP programme. “I wanted to go for my personal career development, as I’d never done anything as comprehensive before. The shared learning aspects of the course appealed to me and I genuinely found the course both challenging and exciting. I initially found the delegate list quite intimidating but by the end of the first day Tom Philips, the programme leader had made sure that everyone had settled in. I’m a more effective team member for having attended the course and it has certainty made me more confident to push projects and to develop ideas of my own.”
Registration open for 8th All Ireland Pharmacy Conference The 8th All Ireland Pharmacy Conference will take place in the Ballymascanlon House Hotel, Dundalk on 17th October 2017. This cross-border conference aims to bring together people with an interest in pharmacy practice from all Ireland to allow networking and the exchange of ideas. The conference aim is to share good practice across the primary and secondary care sectors. The conference focuses on providing a forum to share insights from pharmacy practice research across the island of Ireland, it is open to pharmacists, technicians and pharmaceutical assistants, and will be of particular interest to individuals with an interest in pharmacy practice. Individuals interested in attending the conference can register through the IIOP website (www. iiop.ie/8thAIPC2017). A delegate fee of ¤45, which can be paid online, also includes attendance at a conference dinner on Monday 16th October 2017.
Ballymascanlon House Hotel, Dundalk The keynote address, entitled Building Capacity in Healthcare, will be given by Professor RoseMarie Parr (Chief Pharmaceutical Officer, Scotland). The parallel sessions will cover topics including: Research and Policy into Practice, Medicines Optimisation, Empowering Patients and Developing the Pharmacy Workforce.
The main conference proceedings will start at 9.30am on Tuesday 17th October 2017 and finish at 5:00pm approximately. Overnight accommodation (¤85 single and ¤75 sharing) can be organised directly with the Ballymascanlon House Hotel (www.ballymascanlon.com, +353 (0) 42 935 8200).
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For more information visit www.lyclear.ie Please use sufficient product and comb thoroughly to remove all eggs. In case of re-infection or abnormal infestation, treatment may need to be repeated. *IMS MAT volume sales April 2017. Ask your pharmacist for advice. Data on file. Lyclear Sensitive, Shampoo & Spray are medical devices. †Lyclear Repellent: Data on file. Use insect repellents safely. Always read the label and product information before use.
News news brief WHO AWARD FOR HSE
Drop in HPV vaccine uptake, conference hears Addressing the HSE National HPV Conference recently, Mr Robb Butler, Head of Vaccine Preventable Diseases and Immunisation at the World Health Organisation (WHO)/Europe, acknowledged that provisional HSE data shows a stabilisation in the drop in HPV vaccine uptake rates in Ireland. done to date by the HSE and Dept of Health who are investing time and effort to encourage and help parents understand the real facts and make an informed choice.
The World Health Organisation (WHO) has awarded the Department of Health a prestigious 2017 World No Tobacco Day Award for its achievements in the area of tobacco control. Ireland is a world leader in tobacco control, and the team at the Department of Health has led the implementation of many of the measures that the WHO calls for today. This year on World No Tobacco Day, the WHO is highlighting how tobacco threatens the development of nations worldwide, and is calling on governments to implement strong tobacco control measures, including banning marketing and advertising of tobacco, promoting plain packaging of tobacco products, raising excise taxes, and making indoor public places and workplaces smoke-free. Speaking today, Minister Marcella Corcoran Kennedy TD said, “We can be proud of the progress we have made in Ireland, and that this progress has been rewarded not only in the improved health of Irish people, but in this recognition from the WHO for the work the Department has undertaken. Ireland ranks second out of 34 European Countries in relation to tobacco control initiatives. Recent measures, like the commencement of legislation for the standardised packaging of tobacco, to come into force in September 2017, have kept Ireland to the fore in this area. “I want to thank all the stakeholders involved, including the HSE and the many charities, advocacy groups and individuals who have supported this work over many years.” The Minister warned, however, that complacency shouldn’t be allowed to set in. “Approximately 6,000 people die from diseases caused by tobacco use each year. I and the rest of Government are committed to continuing to implement the Tobacco Free Ireland policy, with a view to reducing the number of smokers and reducing the numbers who start smoking.”
Mr Robb Butler, Head of Vaccine Preventable Diseases and Immunisation at the World Health Organisation However, Mr Butler also expressed concern at the steep decline in the rates noting that “it is particularly alarming given Ireland boasted the world’s most successful HPV vaccination programmes globally, just a few years ago.” “We in the WHO stand with the many health bodies and agencies in Ireland in their ongoing efforts to see this worrisome trend reversed and the campaign of misinformation ceased,” he said. “The victims of the decisions made today will be those whose families are affected by cervical cancer that could have been prevented. We applaud the substantial work
“Ireland was recently commended by the Regional Verification Commission for Measles and Rubella Elimination for interrupting transmission of measles and entirely eliminating rubella. This was achieved largely through the efforts and commitment of the health authorities and the public’s understanding that vaccines offer the most effective way to consign disease to history.” Addressing the conference, Dr Brenda Corcoran Head of the HSE National Immunisation Office, confirmed that initial data from March/April shows that the drop in uptake has stabilised. “Although this information is provisional, and we remain very concerned at the current rates, it does tell us that more parents would seem to be hearing the message that this vaccine is safe and effective – it offers their daughters a life without cervical cancer. We do understand the concerns of parents and encourage them to talk directly to us and our fellow healthcare professionals across the country,” she said.
Dr Angela O’Leary, Principal Medical Officer, told the conference of the experience of the school vaccination teams in Cork and Kerry, sharing the frontline reality of addressing much of the misinformation that is facing parents and teenage girls. Globally, it has been estimated by the WHO that based on 80% of the world’s 12 year old female population receiving the vaccine, 420,000 deaths from cervical cancer could be prevented. Researchers compared the cervical screening and vaccination records of women born in 1995, who had been vaccinated as teenagers, with those from unvaccinated women born between 1989 and 1990. They found just 0.5% of women from the 1995 group tested positive for the virus, compared with 21.4% of women born before 1990. The study also showed evidence that the vaccine protected against three other highrisk HPV genotypes involved in the development of cervical cancer. Over 200,000 girls in Ireland have safely received the HPV vaccine, along with 100 million people worldwide in countries like the United States, Canada, Australia and New Zealand.
TouchStore and Clarity Locums Improve Efficiency in Pharmacies Clarity Locums is delighted to announce its collaboration with TouchStore. From last month, TouchStore Rx users will be able to link up directly with Clarity Locums from the TouchStore Rx system and book locums with the Clarity agency. Speaking at the launch at the Irish Pharmacy Union Conference, TouchStore's CEO John Cassidy said, "This is a great step forward for TouchStore. A major focus for TouchStore is to continuously add functionality that removes hassle from our client's lives. Providing functionally that enables clients to book locums from our system is part of that focus.” The interface will deliver TouchStore Rx users directly to the Clarity Locums site where they can book locums in a matter of seconds. This isn't the first time Clarity and TouchStore have teamed up, back in 2015 they opened Ireland's first locum training centre which has gone on to see hundreds of locums trained on TouchStore Rx. Clarity and TouchStore will continue to work closely together over the coming months.
John Cassidy, TouchStore, Eamonn Hynes, Clarity Locums and Anthony O'Neill, Clarity Locums
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INCREDIBLE TIME for your customer to QUIT MAH: McNeil Healthcare (Ireland) Ltd., Airton Road, Tallaght, Dublin 24. Full prescribing information available upon request. Products not subject to medical prescription.
News Assistance to Pharmacy in diagnosis malignant melanoma A new study carried out in Ireland has identified the most effective clinical prediction rules (CPRs) that aim to assist health professionals in the diagnosis of malignant melanoma. This systematic review of 24 unique CPRs (identified from 51 individual studies) used to assist in distinguishing malignant melanoma from benign pigmented skin lesions aimed to quantify the diagnostic accuracy of CPRs in primary care and specialist outpatient settings. CPRs may be for use in clinical (i.e. naked eye) examinations, or in conjunction with dermoscopy (the examination of pigmented skin lesions using surface microscopy). The research showed that the ABCD rule for dermoscopy was the best performing CPR in a primary care setting to assist General
Practitioners (GPs) in differentiating patients with clinically significant lesions requiring referral to specialist care from those who can be treated and monitored in primary care. The ABCD rule reaches 85% sensitivity and 72% specificity, which is reasonably effective at ruling out melanoma. This CPR involves a GP checking a pigmented skin lesion for, Asymmetry, irregular Borders, more than one or an uneven distribution of Colour, or a large (greater than 6 mm) Diameter. Melanoma is the most serious form of skin cancer, is one of the most common cancers in Ireland and
is a condition that is increasing its incidence rapidly amongst the Irish population, with 984 cases diagnosed in 2013 alone. The research was by the RCSI (Royal College of Surgeons in Ireland) Department of General Practice and the HRB (Health Research Board) Centre for Primary Care Research and published in the BMJ Open. The methodology of the study involved a literature search on a range of scientific databases, including PubMed, EMBASE, SCOPUS, PROSPERO and the Cochrane Library.
systematic review, Professor Tom Fahey, Principal Investigator of the study and Professor & Head of the Department of General Practice at RCSI said, "Early detection of malignant melanoma improves prognosis for patients. Differentiating between a benign and malignant lesion can be a difficult task, particularly at an early stage of presentation in primary care settings. Being able to categorise patients with a skin lesion into the probability of having melanoma is helpful in ensuring only those patients who require further investigation and specialist care receive it."
Speaking on the findings from the
Pharmacists continue to support the Benevolent Fund Pharmacists have continued to support the Pharmacy Benevolent Fund, which was established to help pharmacists and other industry professionals in times of need.
Pictured left to right: Christy Canavan, Consumer Director, United Drug, Ann Walsh, Marketing Manager Retail, United Drug, Johnny Murphy, Head of Consumer Health, A.Menarini Consumer Health, Rachel Gubbins, President Pictured left to right.Benevolent Fund and David Keyes, of The Pharmacy Distribution and Consumer Hospital Director, Christy Canavan, Director,United UnitedDrug Drug Ann Marketingof Manager Retail, United Drug out how they can apply to figure TheWalsh, main objective the
Pharmacy Benevolent Fund is Health,asA.Menarini well.” Johnny Murphy, Head of Consumer Consumer Health “the relief of poverty by giving
Assistance may also be provided “to any other individuals in Ireland in need who are or have been who may beDrug considered to be in David Keyes, Distribution and Hospital Director, United engaged in or associated with the need of financial assistance”. pharmaceutical profession and to Pharmacy companies are typically the spouses, widows, widowers, generous in donations, with A. children and other dependents of Menorini recently pledging to such persons who themselves are donate 1000 to the fund. Funds in need”. from the upcoming Careplus Cycle “Well, typically, we would be will also be donated to the cause. assisting between 20 to 23 people The fund support individuals and at any given time,” said Mary families in many ways such as: Dowd, speaking to Irish Pharmacy Providing regular monthly grants; News. “They could be in ill health, giving extra financial assistance have some kind of issue meaning at certain times of the year like that they can’t work. Recently, Christmas or help with large bills, we’ve started to get applications for example, heating, medical from some students, which we never had before, so we’re trying expenses and house repairs; Rachel Gubbins, President of The Pharmacy Benevolent Fund financial assistance to persons
helping individuals to avail of their full social welfare entitlements. The Charity also assists with arrangements for home help, nursing homes and organising
financial affairs; refers people to specialist services if needed; and offers the hand of friendship to those who are lonely and need more than financial help.
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freephone: 1800 816 005 email: firstname.lastname@example.org visit: www.scopehealthcare.ie or www.scopeophthalmics.ie SCOPEUK0079
It’s all about HIM
Pharmacy show support in Men’s Health
Men’s Health Week (MHW), which ran from Monday 12th until Sunday 18th June saw pharmacies up and down the country have been embracing this year’s theme: ‘It’s all about HIM’ and recognising that men’s health needs deserve our undivided attention. The Men’s Health Forum, who organise MHW explain why they chose the theme ‘It’s all about HIM’ for 2017: “Not too long ago, we were unaware of the full extent of men’s poor health status and the specific health issues that they face. However, this is no longer the case. In recent years, a broad range of research has highlighted the health challenges which face men in Ireland and further afield.” Local men die, on average, four and a half years younger than women do. Males have higher death rates than women for all the leading causes of death. Poor lifestyles are responsible for a high proportion of chronic diseases. Late presentation to health services leads to many problems becoming untreatable. Physiological differences, however, cannot adequately explain the extent of the life-expectancy gap, or why men have a higher mortality rate for virtually all comparable causes of death, so sociological and lifestyle differences between men and women must certainly be a factor. It must also be noted that men are much less willing to access healthcare services than women. Many men are reluctant to visit the pharmacy as they don’t see it as an environment that is particularly open to them. The enormous gap between male and female Pharmacy attendance illustrates just how much more could be done to encourage male customers, for example posters to promote male specific products. Pharmacies should also make efforts to tie their promotion to prominent national campaigns exploit social media as a promotional tool when possible, and stock products related to sports and fitness, which are increasingly popular purchases for men. “We know from our own experience that men are reluctant to talk about their health. But, by opening up more about how they feel and any symptoms they are experiencing, men are more likely to identify health issues early, maximising the chance of a problem being resolved before it becomes untreatable,” said community pharmacist and
President of the Irish Pharmacy Union, Daragh Connolly. Prostate cancer As it is mostly found in men over the age of 65, prostate cancer is only going to increase in prevalence as our population ages. Presently, over 3,300 men in Ireland are diagnosed with the condition every year. It accounts for one fifth of all male cases of cancer, with the Irish Cancer Society noting that 1 in 7 Irish men will suffer from the condition at some point in their lives. It is in lifestyle promotion that pharmacists can have the most impact when it comes to prevention and management of prostate issues, as outside of family history and age, the key risk factors for developing prostate cancer are a bad diet and an inactive lifestyle. The European Prospective Investigation of Cancer (EPIC) recommends a diet that is high in fibre and low in saturated fat, endorses cutting down on red and processed meats, and encourages eating fruit and vegetables. Benign Prostatic Hyperplasia (BPH) It is normal for a man’s prostate to enlarge as he ages, with half of all men presenting evidence for BPH by age 50, and 90% by age 90. While usually harmless, an enlarged prostate can obstruct the flow of urine by pressing against the urethra, sometimes leading to chronic or acute retention. It can also cause other complications such as bladder stones and cystitis. If the customer’s symptoms are mild to moderate, the pharmacist should recommend a period of watchful waiting. If the condition worsens, then they should see their GP. Erectile Dysfunction Cancers are not the only condition with a strong link to tobacco consumption. Smokers, for instance, are twice as likely to develop erectile dysfunction (ED) as non-smokers. Other causes for erection problems include obesity, high blood pressure, high cholesterol and diabetes. In such cases,
pharmacists should promote lifestyle changes such as improving the patient’s diet, increasing their exercise and reducing their alcohol intake. Increasingly, pharmacies are beginning to offer free ED assessments or run erectile dysfunction clinics so that customers can have private consultations. These sessions may result in the patient being prescribed medication such as Sildenafil. If the issue is psychological, therapy might also be recommended for the patient. Hair Loss Hair loss can begin to occur at any age in adult males, and treatment has recently become less taboo, although the anxiety around hair loss remains for many men. There are a range of treatments available from basic shampoos, right up to surgery, and there are many products in the pharmacy which can ebb the tide of hair loss. There can be many causes of hair loss, but the majority of hair loss in males occurs from hereditary androgenetic alopecia, which is known normally as “male pattern baldness”. For this to occur, the hormone DHT must be present in the system. Minoxidil is available as a topical ointment for the scalp. It is available from pharmacies
without a prescription. The medication contains either 5% or 2% minoxidil, with evidence suggesting that the stronger version (5%) is more effective. Minoxidil is available under the brand name Regaine. There are some natural alternatives available, with one, Bioxsine, available in irish pharmacies. Bioxine is clinically proven to stop hair loss and to create new hair growth, it natural herbal formula containing the active ingredient Biocomplex B11 which strengthens hair follicles and helps create new hair growth. Mental Health Over 75% of men will not seek help for a mental health problem, so it is much less probable that they will end up taking antidepressants, see a therapist or develop a coping strategy. Symptoms that are more common among depressed men than depressed women include irritability, aggressive behaviour and a proclivity towards risktaking. It is also much more prevalent among shy men. A pharmacist is in an ideal position to help identify the signs, lend an ear and provide a safe place for a man to express their feelings, providing general direction and encouraging them to pursue further help.
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Pharmacists get ready for head lice season! The summer time, and the hot weather means head lice season: every year, tiny, wingless insects set upon children (and some adults!), sucking blood from their scalps, living in their hair, and causing great difficulty to parents, who want to keep their children free of bugs and parasites. The bugs present a particularly common problem, and are most likely to present in kids aged 4 to 11. Each year, more than 33% of children in Ireland will suffer from headlice. At any given time, it is estimated that 1 in 10 children suffer from headlice. How lice Spread A female head louse lays eggs which cement to hairs (often close to the root), where they are kept warm by the scalp. Headlice spread by direct contact from person-to-person. Once the headlice have made their way to a scalp, a female will begin to lay her eggs, gluing them to hairs, where the scalp will keep them warm. These eggs – which are incredibly difficult to see – will hatch roughly a week later, giving life to a new batch of baby headlice, who will then mature, and begin the cycle anew. After about a week, headlice are fully grown, transfer from scalp to scalp, spreading even further. The remaining eggs are known as nits. As more and more headlice begin to hatch on the scalp, these nits accumulate and become increasingly noticeable. Symptoms of head lice A rash may appear on the back of the neck, caused by a reaction to lice droppings. Untreated infestation can result in general malaise, headache, lethargy. Small white egg cases attached to the hair. Black powdery deposits on pillows and clothing. Live lice may be seen on the individual’s head. In many cases, head lice cause the scalp to itch. Itching is not due to lice biting the scalp, but by an allergy to the lice.
Not everyone is allergic to head lice, so you or your child may not have itching. Itching can take up to three months to develop. Treatment options Head lice treatment falls into two main categories: Pesticide treatments, and non-pesticide treatments. Pesticide treatments These are medications that involve chemicals which are toxic to insects. a substance used for destroying insects or other organisms harmful to cultivated plants or to animals. There are two main OTC treatments that pharmacists can suggest to patients with headlice, or parents seeking treatment for a child with headlice. Malathion An unlicensed product, Prioderm lotion, is available in Ireland for the treatment of headlice. It is rubbed into dry hair, and left for 10 hours. Afterwards, parents and patients can shampoo it out. Pharmacists should tell patients that the medication is not safe for use in pregnancy, and also not appropriate for asthmatics, as it can cause wheezing. It’s primary ingredient, Malathion is of low toxicity; however, absorption or ingestion into the human body readily results in its metabolism to malaoxon, which is substantially more toxic. Permethrin Ermetherin is sold under the brand name Nix, in a topical or lotion form, and can be used to treat both scabies and lice. This medication can also be used a preventative measure, and pharmacists should advise patients and customers that the medication can be sprayed on mosquito nets and clothing. There are however, some side-
effects which pharmacists need to make their patients aware of: the medication can cause a rash, and skin irritation after use. The medication appears to be safe to use during pregnancy. Non-pesticide treatments These do not contain the chemicals that are harmful to insects, and instead act in different ways to kill headlice. They are generally accepted as being more effective as lice are less likely to become resistant to them Lyclear Lyclear is an insecticide treatment containing dimethicone 4 per cent lotion or spray, which dehydrates and suffocates the headlice. It is typically applied to the scalp and left for eight hours, then washed out. Vamousse Lice Treatment This is clinically proven to kill lice and eggs with one treatment. Unlike some other pesticidebased treatments, which require a follow-up regimen to kill lice after they have hatched because they have low or no ovicidal (egg) activity, Vamousse does not.
Vamousse Lice Treatment works by physical mode of action, killing lice and eggs by dehydration and avoiding pesticide resistance issues. Vamousse Lice Defense gentle daily shampoo is also a good product for preventing headlice being caught in the first place, and is non-toxic and pesticide free. Hedrin ONCE This also contains dimethicone 4 per cent spray gel and an extra ingredient, penetrol, which boosts the egg kill rate and shortens the time that headlice are killed to about 15 minutes. It works by physically soothing the lice and also contains Penetrol which helps the product to penetrate louse eggs in order to kill them. The gel can safely be used as often as required without lice developing resistance. Two other products in the Hedrin range are: Hedrin Treat and Go which is a water based treatment which rinses out of hair easily, without any greasy residue and when dry, remains on the child’s hair while they play, go to school or sleep. Requiring just two applications (for eight hours or
Feature first line treatment as they are effective and suitable for asthmatics. They do not lead to resistance.
take the following steps to avoid their children contracting headlice, or contributing to a headlice outbreak.
Picking the right product
1. Check children’s hair for lice regularly, ideally once a week. Use a wet comb made for the purpose. Combing through wet hair makes the process easier. Good light is important.
As many products for the treatment of head lice can exacerbate the symptoms of asthma, pharmacists are advised to exercise extreme caution when recommending them to patients – in particular with regard to recommending malathion, permethrin, or phenothrin. Patients must ensure that they use each regime more than once, if they are to successfully rid themselves of lice. Insecticides should be used for an entire week, in order to kill any eggs that survived the first use. overnight) seven days apart, Hedrin Treat and Go is available in spray and mousse Hedrin Protect and Go is clinically proven to give protection when the threat of head lice appears and is designed for regular long term use. It is gentle with a mild detangling formula that protects and conditions and is simplied apply after every hair wash (or at least twice a week).
Full Marks Solution This product contains isopropyl myristate and cyclomethicone solution which is applied to the scalp and left for 10 minutes. This solution has a physical action on the lice causing them to dehydrate (lose water) and die. They can then be removed along with any eggs using the Full Marks Removal Comb supplied. These products are a better
Lice products can be used on children who are older than six months, however, Full Marks solution can be used on children who are over two years old. Pregnant and breastfeeding women should avoid insecticides as they can be potentially harmful to them. Head Lice – Advice for pharmacists to give to patients According to the Irish Pharmacy Union, pharmacists should advise patients to
2. Itching and scratching are common signs of head lice. As well as live lice, which crawl around the head, look out for nits which are tiny eggs that may look like dandruff but cannot be flicked off the hair. 3. Check close to the scalp, behind the ears, around the nape of the neck, top of the head and under the fringe. 4. Treat the hair only if live lice or unhatched eggs are present. Treat the child and other family members as soon as possible. 5. Inform the school, contacts and friends when your child has head lice. The school can then inform other parents that there is an outbreak, so everyone can check and treat their own children. 6. Always follow the instructions on the treatment pack. Products used to treat head lice do not prevent the infestation from occurring and should never be used “just in case”.
News IACPT welcomes new members to board The Irish Association of Community Pharmacy Technicians has welcomed new members to its board. The President is Elaine Lorigan Mcsweeney, of Pharmacy Wizard, Vice president & treasurer is now Noelle Liston, while Secretary is Noeleen Boyce. “Community pharmacy technicians are an integral part of any pharmacy, but they are often underrepresented, and underpaid” said President Elain Lorigan McSweeney, speaking to Irish Pharmacy News, “we’re encouraging any community pharmacy technician out there to get involved in our organisation.” The IACPT is the leadership and advisory body for Community
Pharmacy Technicians in Ireland. Their mission is to help attain recognition and regulation of pharmacy technician’s in conjunction with other professional and regulatory bodies. This goal is to achieve this through communication with and support of our members by establishing networks with other healthcare professions both at home and abroad. Those who wish to get involved can contact them via their website, http://www.iacpt.ie/, or via Facebook.
Secretary Noeleen Boyce, Vice president & treasurer Noelle Liston, President Elaine Lorigan McSweeney Pharmacy Wizard
¤56m lost by not implementing national obesity treatment policy Obesity experts are calling on the government to implement a national obesity treatment programme to reduce the financial and societal burden from obesity-related diseases like type 2 diabetes, heart disease, sleep apnoea, cancer and fertility issues. from indirect costs including productivity losses from absenteeism. Mortality associated with obesity are treatable with a 10% loss in body weight.
Professor Francis Finucane, Consultant in Obesity and Endocrinology, Galway University Hospital By recognising obesity as a disease of the brain and treating people with personalised treatment programmes, including diet, exercise, weight loss medicine, cognitive behavioural therapy, and surgery the HSE could have saved millions. For example, doing a minimum of 400 operations per year on patients with obesity and difficult to control diabetes would have saved ¤56 million over a 10-year period from a reduction in diabetes medication costs alone. * This call to action is supported by The Royal College of Physicians in Ireland (RCPI) and The European Association for the Study of Obesity (EASO). Ireland has one of the highest obesity rates in Europe and it affects more than one million people here: one in four adults are obese and one in four children are overweight or obese making them highly likely to become obese adults. Every year in Ireland approximately 2,000 deaths are attributable to obesity. According to the WHO, 65% of the diabetes burden, 23% of the heart disease burden and between 7% and 41% of certain cancer burdens are attributable to overweight and obesity. The current cost of treating obesity-related diseases here is approximately ¤1.16 billion per annum: 35% of this cost is allocated to hospital care and medication costs and 65% is
In Ireland, approximately one in 20 adults have an obesity-related disease such as type 2 diabetes, heart disease, sleep apnoea or subfertility which will improve if they can lose and sustain 10% reduction in their body weight. Treatment of obesity is now relatively straightforward as a result of several evidence based and effective treatments that work alongside diet and exercise programmes. "Failing to accept obesity as a disease contributes to stigma, shame, stress and ultimately the worsening health of patients. Complications from obesity are common, they are costly to manage and have severe effects on a person's wellbeing", says Professor Francis Finucane, Consultant in Obesity and Endocrinology, Galway University Hospital. "I have seen the benefits of dedicated obesity treatment programmes in my clinic – these programmes provide a personalised holistic approach that help patients lose 10% or more body weight, remain compliant with their weight loss regime and lower their risk of death from heart disease and stroke. By taking this personalised approach, we can greatly reduce the costs of obesity-related diseases in Ireland and drastically improve people's quality of life". Obesity surgery offers the most successful and cost effective treatment option for the treatment of severe obesity, with more than 90% of patients who seek the procedure (and for whom it was felt to be a suitable therapeutic option) achieving significantly more than 10% weight loss. Research shows that up to 40% of patients with type 2 diabetes who undergo obesity surgery can achieve remission from their disease. Additionally, there is a mortality benefit and a two to three-year return on investment for the healthcare provider.
Yet, in Ireland, less than 0.1% of patients for whom it would be effective over the longer term have access to obesity surgery. Treatments for obesity in general are severely under-resourced in Ireland at the two publicly funded regional obesity centres in Galway and Dublin. Key recommendations: 1. Gain recognition that obesity is a primary disease The Department of Health in Ireland, World Health Organization (WHO), American Medical Association (AMA) and Food & Drug Administration (FDA) have all acknowledged that obesity is a disease. This is an important action to focus attention on the obesity problem and help improve services for the management of obesity 2. Implement existing government policy that obesity is a disease that requires treatment · Provide treatment interventions that can help people with obesity lose at least 10% of their body weight to enable them to reduce their mortality and improve their quality of life · Provide access to treatments within the HSE to provide maximum benefit to the largest number of people that will obtain value while still being cost effective for the HSE 3. Establish a national obesity treatment programme · Establish a national obesity programme in Ireland that delivers regional specialist weight management services as part of an integrated model across primary, secondary and community care · Ensure access to specialist diet and exercise programmes, weight loss medication, cognitive behavioural therapy and obesity surgery for people who will have significant health benefit from a 10% loss in body weight. Centres should have well-integrated pathway from primary care services to secondary care and back
· Develop care pathways that complement existing preventative care and community based interventions · Broaden the expertise of the obesity multidisciplinary teams so integrated services can deliver intensive diet and exercise programmes, medication or obesity surgery to at least 400 patients per year while being geographically located in such a way as to optimise access nationally · Establish obesity treatment centres in each of the six hospital groups alongside one national paediatric obesity centre, with full multidisciplinary teams and access to associated assessment clinics within each of the HSE Hospital Groups · Multidisciplinary teams need to be fit for purpose and could include upper gastrointestinal surgeons, an obesity physicians, dietitians, a specialist nurses, a clinical psychologists or psychiatrists and physiotherapists or exercise physiologists 4. Education of healthcare professionals · Educate healthcare professionals that a) obesity is a disease, b) obesity can benefit from treatment. Healthcare professional-initiated discussions can motivate patients to lose weight and change behaviour. As patients are less likely to start the dialogue about their weight it is important that healthcare professionals are educated as to how they can take the initiative to discuss obesity as a disease 5. Public awareness and education · Empower individuals to take responsibility for their weight by educating the public that obesity is a disease and that treatments range from diet and exercise to medications and surgery · Provide clear and accessible nutritional health information to the public, through our education system, community and primary care centres and through targeted media campaigns
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Abbreviated SPC Nolpacid 20 mg gastro-resistant tablets,contains 20 mg of pantoprazole as pantoprazole sodium sesquihydrate. Indicated for short-term treatment of reflux symptoms (e.g. heartburn, acid regurgitation) in adults. No dose adjustment is necessary in elderly patients or in those with impaired renal or liver function. Nolpacid is not recommended for use in children and adolescents below 18 years of age due to insufficient data on safety and efficacy. Precautions: Nolpacid 20 mg gastro-resistant tablets should not be chewed or crushed, and should be swallowed whole with liquid before a meal. Patients with long-term recurrent symptoms of indigestion or heartburn should see their doctor at regular intervals. Especially, patients over 55 years taking any non-prescription indigestion or heartburn remedy on a daily basis should inform their pharmacist or doctor. Patients should not take another proton pump inhibitor or H2 antagonist concomitantly. Patients should consult their doctor before taking this medicinal product if they are due to have an endoscopy or urea breath test. Patients should be advised that the tablets are not intended to provide immediate relief. Patients may start to experience symptomatic relief after approximately one day of treatment with pantoprazole, but it might be necessary to take it for 7 days to achieve complete heartburn control. Patients should not take pantoprazole as a preventive medicinal product. Contraindications: Hypersensitivity to the active substance or to any of the excipients listed in section 6.1. Co-administration with atazanavir (see section 4.5). Adverse reactions: Sleep disorders, headache, dizziness, diarrhoea, nausea / vomiting, abdominal distension and bloating, constipation, dry mouth, abdominal pain and discomfort, liver enzymes increased (transaminases,-GT), rash / exanthema / eruption, pruritus, asthenia, fatigue and malaise, agranulocytosis, hypersensitivity, hyperlipidaemias and lipid increases, weight changes, depression, taste disorders, disturbances in vision / blurred vision, bilirubin increased, urticaria, angioedema, arthralgia, myalgia, gynaecomastia, body temperature increased, oedema peripheral, thrombocytopenia, leucopenia, pancytopenia, disorientation, hyponatraemia, hypomagnesaemia, hallucination, confusion, hepatocellular injury, jaundice, hepatocellular failure, Stevens-Johnson syndrome, Lyell syndrome, erythema multiforme, photosensitivity, subacute cutaneous lupus erythematosus (see section 4.4), interstitial nephritis. Shelf Life: 5 Years. Legal Category: Medicinal product not subject to medical prescription. Marketing Authorisation Number: PA1347/032/001. Marketing Authorisation Holder: Krka, d. d., Novo Mesto, Šmarjeska cesta 6, 8501 Novo mesto, Slovenia. SPC: http://www.hpra.ie/homepage/medicines/medicines-information/find-a-medicine/results/item?pano=PA1347/032/001&t=NOLPACID Date of Preparation: 26/04/2017. Additional information is available on request from KRKA Pharma Dublin Ltd. Unit 4A, Leopardstown Business Centre, Ballyogan Road, Leopardstown, Dublin 18. D18 KX88– Tel: 01 293 9180. Reference number: 01-06-2017.
Finance How could the same property cost ¤833,000 or ¤350,000? By Thomas McDonald FCA Partner with JPA Brenson Lawlor, Chartered Accountants and Business Advisors For those that are fortunate enough to have some surplus cash in their business, be it a pharmacy business or any other type of business, the question arises – what do I do with the money? The default option is to leave surplus cash in the safety of a bank. There are significant advantages associated with this, principally the fact that you generally have ready access to funds and, of course, for many pharmacy owners there is great comfort in having the financial security that comes with having reserves of cash in the bank. very hard to accumulate what you have don’t blow it! I have my own holistic checklist that I use to consider the pharmacy owner’s overall circumstances. I chat to the owner about the circumstances of the business and its future level of maintainable profitability, their own personal assets and liabilities including their family home and the mortgage thereon, the level of savings for the future, in particular pension provision and other factors.
Thomas McDonald FCA However, against this there is effectively no interest available from the banks on deposit. Additionally, the value of other asset classes is increasing. And though inflation seems tame today, some of us are old enough to remember inflation rates of 15% per annum. Big inflation could always come back. In these circumstances, the relative value of bank deposits is decreasing. In essence money in the bank is not working for the business owner and that is a bad thing. When I meet a business owner in these circumstances I generally advise him or her along the following lines – you have worked
Taking consideration of all of the above I may recommend some or all of the following – take an increased level of personal remuneration from the business (in most instances this will involve taxation); start a pension/ make increased payments to the existing pensions structure; make some investments in a corporate structure or leave surplus funds on deposit. Some pharmacy owners also opt to reinvest in the sector via the acquisition of a new pharmacy, something I’ve seen some increased activity in recently. Property has always been a popular investment proposition for Irish business owners. That’s despite all the difficulties associated with property acquisitions made in the period 2004 to 2008. Numerous clients have already invested in property and others are asking about the opportunity to invest in property and with all the economic forecasts suggesting very solid demand for housing over the next five years it is certainly worth looking at. Similar forecasts for economic growth would suggest that commercial property is also worth considering.
Let’s consider a notional example, the notional acquisition of a notional apartment in Dublin for ¤400,000. This apartment will be acquired without any third party funding/bank debt. The funding will all come from the existing pharmacy business: 1. Personal ownership – it would be ideal to own a property, unencumbered, in a personal capacity. In order to acquire a property asset in a personal capacity you will need to have the personal funds to do so. Typically this is a stumbling block. While it is not unusual for a business owner to have surplus funds, these are usually held in the business owner’s company. In order to generate ¤400,000 to acquire a property, the business owner will have to declare a bonus of ¤833,333 and pay income tax of ¤433,333 on the distribution. In these circumstances it is usually not feasible to acquire an investment in a personal capacity. Additionally personal income tax rates, to include PRSI and USC, at 52% are prohibitively high reducing the overall investment return available to a buyer. 2. Company ownership – typically pharmacies are operated through limited liability companies. In these circumstances the surplus funds available for investment are usually held in these companies. In order to acquire a property through a company there is no withdrawal of funds from the company and consequently no income tax hit as outlined above in the personal ownership option.
The tax rate in a company on rental income is 25%. There is an additional surcharge which could bring this rate to an effective rate of 40% however the surcharge can be avoided (in certain circumstances). 3. Pension ownership – in some pension structures, particularly self-administered structures, it is possible to acquire property investments. In these circumstances it will be necessary to transfer funds to the business owner’s personal pension, this lump sum contribution should be tax deductible against the pharmacy profits (at 12.50%). A ¤400,000 lump sum contribution to a pension structure will typically give rise to corporation tax savings of ¤50,000 reducing the net cost to the investment to the company to ¤350,000. Thereafter the rental income from the apartment is tax free within the pension. So in one case the apartment could cost ¤833,000 while in another scenario it might cost only ¤350,000. But of course it’s not that straight forward. There are pros and cons with each of these structures and depending on an individual’s personal circumstances one option will be preferable to another. That’s why you need to talk to your professional adviser before you make such a move. Your adviser should sit down with you and work through that checklist. From that he or she should compile a report in order that he or she will be able to understand their options and make the best decision that is appropriate to their circumstances.
Clinical Pharmacy Course: Applications are invited for a two-year (part-time) distance learning Master’s Degree offered by the School of Pharmacy, University College Cork course, commencing in September 2017. The programme has won Postgraduate Course of the Year in the Health Sciences category at the gradireland Higher Education Awards (2017). The course is structured to provide specialist training to enable pharmacists working in hospital and community pharmacies, extend their professional role within the evolving clinical healthcare system. Applicants must hold a primary pharmacy degree and ideally, should have a minimum of one to two years’ practical experience. Applicants must apply online at www.pac.ie/ucc .
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Doublebase Emollient Gel Therapeutic ingredients: Isopropyl myristate 15% w/w, liquid paraffin 15% w/w. Presentation: White opaque gel. Uses: Highly moisturising and protective hydrating gel for regular and frequent use in the management of dry skin conditions such as eczema, psoriasis or ichthyosis. Directions: Adults, the elderly, infants and children: Apply directly to dry skin as often as needed. It may also be applied before washing, showering or bathing to prevent further drying of the skin. Contra-indications, warnings, side effects etc: Do not use if sensitive to any of the ingredients. In the rare event of a reaction stop treatment. Ingredients: Isopropyl myristate, liquid paraffin, glycerol, carbomer, sorbitan laurate, trolamine, phenoxyethanol,
Not your average emollient... purified water. Pack sizes: 100g tube and 250g pump pack. Legal category: Class I medical device. Further information is available from the manufacturer: Dermal Laboratories, Tatmore Place, Gosmore, Hitchin, Herts, SG4 7QR, UK. Date of preparation: May 2017. ‘Doublebase’ is a trademark.
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Perrigo Seminars take to the Road Pharmacists receive expert guidance on best practice in pain management Perrigo took its award-winning seminar programme back out on the road during June, making stops in Galway, Cork and Dublin. Focused on the subject of pain, Sarah Whitehead, Training Consultant, steered over 300 pharmacists through the latest in best practice advice on pain management in the pharmacy. With approximately 13 per cent of the population affected by pain almost daily1, it has a major impact on quality of life and highlights the key role pharmacists can have on their customers’ health outcomes. According to Fiona Clancy, Senior Brand Manager, Perrigo: “As leader in the pain category in pharmacy, we are committed to supporting pharmacists in their management of the often-challenging area of pain management.
Our workshops are designed to educate in the latest best thinking and practice as well as to equip with the latest knowledge so that pharmacists can provide excellent advice, in line with the latest clinical evidence and guidelines, which is an important part of the pharmacist’s role.”
people perceive pain; the pain pathway and when to recommend products to customers; and being confident in recommending the Solpadeine range. For more information on best practice in pain management or Perrigo’s seminar programme, please contact your Perrigo Business Manager.
Key modules explored with expert guidance during the hour-long workshop included understanding the psychology of pain and how
Members of the Perrigo team: Shane Tyrell, Anne Marie O’Neill, Fiona Clancy, Alan Bennett, Jennifer Valentine, Paul Hatton, Sarah Whitehead (Training Consultant), Ollie Higgins, Lynette Roberts (training manager), Amanda Quinn, Rob Faulkner and Martina Byrne
Emi Wong, Philip Arnold, Christine Doyle, Palmerstown Pharmacy
Emily Carroll, Health Express, Scotch Hall, Drogheda, Fiona Leyden, Chapelizod Pharmacy
Aoife McGuire, Stacks, Skerries and Milada Campion, McCaffreys, Dun Laoghaire
Margaret and John Boles, A.C. Boles, Dolphins Barn
Sarah Gilson, Claire White, Rebecca Clarke, Susan Donoghue, Adrian Dunne Pharmacy, Balinteer
Sinéad Ryan, pharmacist, Angela Fabian, Boots Roselawn, Dublin 15
Karina Guinan, Allcare Balbriggan; Fionnuala Johnstone, Cromcastle Pharmacy (C&D Medical Group), Coolock
Mark Beddis, Thom’s Pharmacy Kimmage and José Puertas, Lloyds Pharmacy, Knocklyon
Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment. European Journal of Pain 10 (2006) 287-333
Kayla O’Connor, Vicki Lucey, Madge O’Dwyer, Trish Minihan, Ruth Shanahan, Niamh Creedon, Minihans Pharmacy, Oliver St. Plunkett Street, Cork with Brendan O’Keeffe, Perrigo
Gillian Crowley, Sinead O’Neil, Claire Farrell, Boots Bandon, Brendan O’Keeffe, Perrigo
Ellen Crowe, Catherine Kane, Crowleys Allcare Mahon with Brendan O’Keeffe, Perrigo
Shauna Devlin, Orla Sylvester, Suzanne Meaney, Nicki Quill, Owennacurra Pharmacy, Midleton, Brendan O’Keeffe, Perrigo
Michael Daly, Mary Bourke, Fitzgibbons Mitchelstown, Brendan O’Keeffe, Perrigo
Mary O’Mahoney, Mary Cussen, Pat Dalton, Valerie Hanlon, Janice Dewale, Daltons Pharmacy North Main Street, Cork, Brendan O’Keeffe, Perrigo
Paula O’Regan, Regina Dunne, Sinead Neville, Weedle Pharmacy, Brendan O’Keeffe, Perrigo
Printha Griffen, Abbey Healthcare, Sean O’Hagan, O’Sheas Pharmacy, Geraldine Kelleher, Pharmacy First, Douglas, Brendan O’Keeffe, Perrigo
Una French, Tim Doody, Doody Pharmacy Mitchelstown, Brendan O’Keeffe, Perrigo
Aishling Caldwell, Denise Grady, Bernie Lenihan, McSharry’s Pharmacy, Terryland, Galway
Olive Bradley, Richard Farnan, Norrie O’Grady, Moughans Pharmacy, Cookes Corner, Galway
Andrea Barnicle and Tina Hosty, Flanagan’s Total Health, Shop St., Galway with Ollie Higgins, Perrigo
Serena Sorbello and Michelangelo Mallia, Scanlons Late Night Express, Dock Road, Limerick
Pauline Murphy and Ilona Prokosa, McSharry’s Pharmacy, Westside, Galway
David Lohan and Lorraine Ward, Lohan’s Pharmacy, Prospect Hill, Galway
Paul Hatton, Perrigo, Ellen Rose Lyons, Haven Pharmacy, Barna, Co. Galway
Mary O Connor, Reena Hynes, Michelle Kelly, Marguerite Howley, Debbie McInerney, Daly’s Pharmacy, Gort, Co. Galway
John Feely, Feely’s Total Health, Tuam, Co. Galway and Ollie Higgins, Perrigo
Extemporaneously Prepared Products (Special)s in the Pharmacy ‘Specials’, or extemporaneously prepared products, are unlicensed medicinal products manufactured for human use which have been specially prepared to meet a prescription ordered for individual patients without the need for the manufacturer to hold a marketing authorisation for the medicinal product concerned. Scheme, and will give them the drug in the hope that they will be reimbursed. Sometimes, it transpires that the patient cannot get the drug on the Medical Card, and a pharmacist can be left out of pocket.
In Ireland, under the Medicinal Products (Control of Placing on the Market) Regulations 2007, pharmacists are permitted to manufacture extemporaneously prepared medicinal products limited circumstances, although they must exercise extreme caution when doing so. The conditions in which a pharmacist may distribute such drugs include: in response to a bona fide unsolicited order of a practitioner (i.e. on foot of a prescription); where the medicinal product is for an individual patient under the prescribing practitioner’s care; in response to a request from a patient where the extemporaneously produced medicinal product is not subject to prescription-only control and is produced in the pharmacy in accordance with the specifications of the Pharmacopeia. Specials, Reimbursement and Community Pharmacy Irish Pharmacy News spoke with Tomas Conefrey, of Conefrey’s Careplus Pharmacy about specials, and some of the issues community pharmacists who dispense specials, sometimes known as extemporaneously prepared products, or ‘extemps’ face.
“The thing about specials, is” he said, speaking to Irish Pharmacy News, “it’s a product that for whatever reason is not available in Ireland. It could cost too much money for them to apply for a product license, to market it, and so on, but it’s still available in certain circumstances because patients still need the drug. So, ever so often, prescribers are giving them out to people.” Sometimes, when a patient is getting a prescribed ‘special’ and has a medical card, they can apply to have them covered under the discretionary Hardship Scheme if it is not covered. The requires a pharmacist apply on their behalf, however this is a very timely process. Specials and the Hardship Scheme While the drugs are highly effective and specialised to the needs of patients with ailments, there have been a number of issues for pharmacists who wish to seek reimbursement for certain specials. As patients will often need the medication immediately, a pharmacist will not be able to tell them to wait while they apply for reimbursement under the Hardship
“The problem comes up when you want to get reimbursed – don’t always have a GMS code. To get paid for them is quite difficult,” Tomas continues. “The problem comes up when there are things that don’t have a code. Here you have two options: The patient can pay for it, which if it’s cheap really doesn’t pose very many issues at all, however these drugs are often specialised and expensive; or, a pharmacist applies for the Hardship Scheme for the patient. This issue arises when the drug is not approved on the hardship scheme, but thankfully, most of the drugs are.” Asked if there is a solution, Tomas called for the HSE to give all of the products their own individual code, as it would make things much easier for community pharmacists. “The simple solution would be for the HSE to give everything a medical card code. There’s frequent thing that people are getting in the hardship scheme. In my own pharmacy, this can happen maybe once or twice a month.” Tomas notes that some of the confusion around specials is a result of the differences between a hospital pharmacy setting, and a community pharmacy setting. “It usually happens with stuff that comes from a hospital,” he continues, “by the time a doctor has approved of it…we have to go searching for the product, we have to go and make it. The hospital pharmacists are excellent in talking to the doctors, that’s a bit of a problem. Maybe the prescribers are not aware of what’s available and not available in a community pharmacy setting.”
The Monograph and PSI Guidelines around extemporaneously prepared products In Ireland only the European Pharmacopeia and British Pharmacopeia are official and as such are the only pharmacopoeias that are relevant for this purpose. The European Pharmacopoeia Monograph on Pharmaceutical Preparations was enforced on April 1, 2013. The Monograph explains the official guidelines for the preparation and professional ethical considerations when supplying patients with extemporaneously prepared products, otherwise known as ‘extemps’. The monograph was established to ensure quality assurance for patient safety. The Monograph underlines the fact that all healthcare professionals involved in the preparation of extemps have a duty of care towards the patient for whom the extemp has been prescribed. Meanwhile, the Pharmaceutical Society of Ireland (PSI) has stated that the Monograph has been issued to ensure pharmacists use their own professional judgement and expertise when receiving prescriptions for an extemporaneously prepared product. Pharmacists should ask themselves whether there is an alternative preparation available or an authorised product that already exists and, if there is something else that could be prescribed instead. Keeping a record If there is not, pharmacists must then decide whether the pharmacy is appropriately equipped to meet all the standards, as outlined in the European Pharmacopoeia Monograph for the preparation of Extemporaneous Preparations.
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Specials Good Manufacturing Practice (GMP) and assessing risk Indeed, there will always be a certain degree of risk involved when extemporaneously preparing a product, and Pharmacists should take things into account such as: Calculation errors; Validity of the formulation; Microbial contamination; Inappropriate starting materials; Labelling errors; Poor patient acceptability of the finished product; Unknown stability and shelf life of the finished product; Health and safety of staff members involved in the preparation of the product The Good Manufacturing Practice (GMP) guide should be used as a reference to determine what level of risk a preparation may be.
Each label should include the following when appropriate: name and address of the preparing pharmacy; name of the pharmacy preparation, if applicable; full qualitative composition and the quantity of the active substance; batch number, if applicable; expiry date or information about limits for use; special storage conditions or handling precautions; directions for use, warnings and precautions; route of administration. This record should be maintained for at least two years on the pharmacy premises and be available for inspection. The record sheet should facilitate a checking mechanism at each stage of the procedure and provide a clear audit trail of the ingredients used and process followed.
Whilst legislation does not prohibit batch manufacture to maintain a limited stock of a particular product, caution should be exercised in view of the short shelf life of such products. Pharmacists must always be satisfied that any product they prepare is safe and fit for purpose at the time of preparation, at the time of supply to the patient and throughout the expected shelf life (see also Section 3.6 Expiry Dates). Please note that a pharmacy cannot legally wholesale an extemporaneously prepared medicine to another pharmacy unless they have the appropriate licence from the HPRA. Where an extemporaneously
prepared medicinal product is prepared in the pharmacy the pharmacist must always make a written record as to its preparation. This should include the precautions taken to ensure that the product is of the character required and a record of any conversations with the prescribing doctor or patient that led to the decision to extemporaneously prepare the medicinal product. In all cases, the pharmacist must be satisfied that the medicinal product concerned is not the subject of an advertisement and that no other authorised medicinal product of appropriate composition is available for use in the particular circumstances.
Again, the risk assessment should consider the complexity of the preparation process, the equipment required, the nature of the product and the availability of clean areas with the required air classification. When it comes to Labelling, the Monograph outlines the importance of (specific) labelling for patient safety. The PSI suggest that, “The product should be clearly and appropriately labelled to comply with regulatory provisions in place. Clear and legible directions should indicate precautionary warnings and directions for use. “As directed” is not appropriate and should not be used. Labelling must include an expiry date for the product and any special storage instructions. Regular assessment of the procedures used for extemporaneous dispensing should be carried out.”
Pain making holiday travel difficult: Research announced by the ‘mypainfeelslike…’ campaign has found that 49% of people living with persistent or chronic pain in Ireland find travelling or going on holiday difficult because of their pain. Just over half discuss their pain with a healthcare professional once a year or more, but almost one in five claim to never discuss their pain with a healthcare professional. To aid people when visiting their GPs, the ‘mypainfeelslike…’ campaign has created an animation with Ivan Yates on how to get the most from your visit – especially before going on holidays this summer https://youtu.be/q-Hf8JlBNp8. The campaign is a collaboration between Grünenthal Pharma Ltd and Chronic Pain Ireland and supported by Multiple Sclerosis Ireland and The Parkinson’s Association of Ireland. Persistent or chronic pain is any type of pain that lasts more than three months. Persistent pain lasts longer than acute pain and often does not indicate ongoing damage, even though it may feel like it. According to this new research, headaches (55%) and lower back pain (51%) are the most common types of pain, with over half of those with persistent pain having experienced either condition. The research also revealed that 52% of people living with persistent pain always take their medicine as instructed, while a third take their medication, but then stop when the pain eases. “Persistent pain has a serious impact on people’s lives and wellbeing. It requires an ongoing and evolving treatment plan that help people move away from a persistent pain cycle – allowing them to enjoy things like travelling and holidays”, says Dr Paul Murphy, Consultant in Pain Medicine in St Vincent’s Hospital, Dublin. “Engaging in an active management plan can help patients reduce pain symptoms, improve mood and increase function. It is also crucial that people comply with any treatment prescribed by their care team to help manage their pain – be it medication, exercises or other treatment options like mindfulness and relaxation practices.”
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Clinical Trial Report Calls to double cancer clinical trial participation To mark International Clinical Trials Day (20th May), Cancer Trials Ireland rolled out its Just Ask Your Doctor! Campaign, in Dublin on May 20th, which encourages patients to get involved in clinical trials. • Head and neck cancer x 1
Increasing incidences of Cancer
• Paediatric x 24
The incidence of cancer continues to rise in Ireland, increasing steadily from 15,393 cases in 2003 to 20,362 cases in 2013. It is the second largest cause of death in the EU. During this time, mortality has decreased with five-year survival data showing an increase from 53.3% survival to 59.9% in the period 2008 – 2012. The decrease in mortality is partly because of the development of new and improved medications which can only be made available due to cancer trials. The European Commission’s target is to reduce cancer incidence by 15% by 2020.
• Central Nervous System x 2 • Gastrointestinal cancer x 11 • Gynaecology cancer x 5 • Haematology and lymphoma x 13 • Translational (Lab bench to bedside) x 3
Eibhlin Mulroe, CEO, Cancer Trials Ireland There are currently almost 100 cancer trials recruiting patients in Ireland. A further 50 trials are under way but have completed their recruitment phase. Around 650 people with cancer join a cancer drug trial each year and Cancer Trials Ireland says it wants to double this to 1300 each year. Speakers on the day included Eibhlin Mulroe, CEO, Cancer Trials Ireland, and Emily Hourican, author, journalist and cancer survivor. Speaking to Irish Pharmacy News, Doctor Robert O’Connor, Head of Research for the Irish Cancer Society, who was present at the event, said, “It’s about trying to help people recognise that there’s incredible cancer research work being done in this country - and people need to know that. They need to have confidence in their researchers and their doctors. But they also need to be able to inform themselves and take part. “More than 40,000 people will be diagnosed with cancer this year. But we’re doing very well with research. More than half of patients today will be cured of their disease. But we can’t be happy with that. We have to bring new treatments, new advances and new approaches, and that only happens if people take part in research. So, we’re encouraging people to take that step, to ask
their doctor or their healthcare provider about research and how they can take part.” Ongoing Trials Cancer Trials Ireland is the leading clinical trials organisation in Ireland, carrying out more trials than all other organisations combined. Its trials are carried out through an independent network of 14 cancer trials research units in hospitals across the country, and has called on the Government to support a doubling of the number of people with cancer participating in cancer drug trials from the current rate of 3% to 6%. Cancer trials can provide people with cancer with free access to new promising treatments which in some cases can only be accessed through a trial. These treatments have the potential to enhance and extend their lives as well as supporting the development of new treatments for future generations. Currently, there are trials ongoing in the following areas: • Breast cancer x 17 • Melanoma x 2 • Lung cancer x 6 • Genitourinary cancer x 11
The numbers of clinical trials covering all therapeutic areas open in Ireland, and consequently the number of opportunities for patients, lags behind our European counterparts. Denmark, which has a similar population size, conducts over four times as many clinical trials as Ireland. Norway also has a similar population and carries out twice as many clinical trials. Speaking at the launch of the campaign, Eibhlin Mulroe, CEO, Cancer Trials Ireland, said that Ireland had huge growth potential in cancer trials, “Cancer Trials Ireland works with the foremost oncologists and research specialists across the country who are highly experienced and skilled in trials research. Combined with the commitment of those participating in our trials, and Brexit, we have a tremendous opportunity to step up our cancer trials capability and make a greater contribution to the global pursuit of the answers to cancer.” She also noted the opportunities that can potentially gleaned from patients volunteering to take part in research, adding, ““There is a huge opportunity for us to attract many more trials from other parts of the world which can open up new treatment options for people with cancer that are currently not available, and at a relatively low cost. This International Clinical Trials Day, we are encouraging all who are living with cancer to Just Ask Their Doctor about cancer trials and whether there is one that is suitable for them and to visit cancertrials.ie to access a full listing of trials that are currently underway in Ireland. Participation is hugely important.”
Speaking to Irish Pharmacy News, Muirish O’Connor, head of R&D at the Department of Health, said, “The Department of Health is very much committed to the promotion of research and innovation and analytics, which are a core component of health service delivery. Days like today promote patient involvement in clinical trials, which is really good for vibrant research and. It’s departmental policy, and national policy to try to ensure that service provision is informed and infused by research and cutting-edge knowledge. And there are a number of measures that have been put in place in recent years to sort of give effect to that. “We have reorganised the department around information under my division. An R&D and health analytics division was established, bringing together the research services, the stats and analytics and the e-health and IT and the enterprise engagement, academic engagement and international engagement. So that really brings together all the functions around information, analytics and research into one place to mutually support and develop policy. Then out in the system, we work through the HRB to fund clinical trials and I know they generate a lot of philanthropic investment as well, and we’re very encouraged by the vibrancy of the clinical trials eco-system in Ireland.” Laoise Daly, Country Director for Janssen in Ireland, added,
10mg Film-Coated Tablets (Cetirizine Dihydrochloride).
IRELAND’S NO. 1 ALLERGY RELIEF1 Cetrine Allergy 10mg Film-Coated Tablets (Cetirizine Dihydrochloride).
• • • •
NO. 1 IN PHARMACIES1 RELIEF OF ALLERGIES* ONE TABLET PER DAY AVAILABLE IN A 7 & 30 PACK SIZE
* Adults, elderly and children aged 12 years and over. Medicinal product not subject to medical prescription. Further information is available from the Marketing Authorisation Holder: Rowex Ltd., Bantry, Co. Cork. Ireland. Freephone: 1890 304 400. Fax: 027-50417. PA: 711/75/2, Date of preparation (02-17) CCF No: 19421. Always read the leaflet. Consult your doctor or pharmacist if symptoms persist. Ref 1: IMS Data.
Rowa Pharmaceuticals Ltd., manufacturing in Bantry, Co. Cork.
Clinical Trial Report Pictured at the launch are: (Back row L-R): John McCormack, Chief Executive, Irish Cancer Society; Liz O’Donnell, Director of Policy, Government Affairs and Communications, MSD; Michelle Gartland, Therapeutic Area Manager Oncology, Bayer HealthCare; Dr Linda Coate, Consultant Oncologist, University Hospital Limerick; Dr. Jerome Coffey, Director of the National Cancer Control Programme, HSE; Leisha Daly, Country Director at Janssen; Evelyn O’Rourke, journalist and cancer survivor; Dr. Jonathan Westrup, Programme Director of the IMI Diploma in Strategy and Innovation and of the IMI Diploma in Regulatory Management; Janet Culbert, Country Brand Leader Pain/CNS, Pfizer Healthcare Ireland. (Front row L-R): Eibhlin Mulroe, CEO Cancer Trials Ireland; Blánaid O'Connell, Medical Science Liaison, Merck Group and Dr Robert O'Connor, Head of Research, Irish Cancer Society. “I’m a member of the board of clinical trials Ireland, so I’m here in that capacity. But also as country director for Janssen. I’m supporting the Just Ask initiative which we think is really important for patients, obviously as a pharmaceutical company, and Jansen is part of J&J, and the patient is very much core to everything we do. This type of partnership, in which we
encourage patients into more clinical trials is very important for Jansen. Internally, pharma companies should be promoting trials for drugs, and also doing what they can to spread awareness.” Speaking at the launch, Professor Bryan Hennessy, Clinical Lead with Cancer Trials Ireland and Consultant Oncologist at
Beaumont Hospital said that cancer trial participation is a no-brainer. “Cancer trials find treatments that stop people dying from cancer, they enable patients to get treatments not available by other means and they save the HSE more than ¤6 million annually in cancer medication costs. “With a more stable economic outlook and one in three of us
affected by cancer in Ireland, it is time for the Government to increase its commitment in Budget 2018 to cancer trials research by at least ¤2.5 million annually. We also want the Government to mainstream cancer trials as one of an array of treatment options for all who have been diagnosed with cancer. Cancer trials must not be seen as an outlier in the treatment of cancer.”
News Renewed Pharmacy Memorandum of Understanding The School of Pharmacy at RCSI (Royal College of Surgeons in Ireland) and the Pharmacy Department of Saint John of God Hospital, one of the leading providers of mental health treatment and care services in Ireland, have announced the continued partnership with the signing of an extension of a Memorandum of Understanding. The original agreement was signed in 2013. Over the past four years, Saint John of God Hospital and the RCSI School of Pharmacy at have experienced many great successes relating to work-based educational initiatives between the two organisations. Clinical work placements and structured site visits have enhanced the experience of pharmacy students, giving them insight into the Hospital's multi-faceted approach to the treatment of mental health difficulties and person-centred care. The agreement is also facilitating collaborative research between the two organisations. According to Dolores Keating, Head of Pharmacy at Saint John
of God Hospital and Honorary Senior Lecturer at RCSI, the Memorandum continues to be an important step forward for the Hospital, "As a teaching hospital, education is a core part of the ethos and mission of the organisation. Pharmacists have an important role to play in the delivery of high quality mental health services. We have received very positive feedback from pharmacy students who reported that they now feel better able to support people experiencing mental health problems on their recovery journey, which is very encouraging to hear. Through this collaboration and co-operation, the Pharmacy Department at Saint
John of God Hospital and the School of Pharmacy in RCSI are mutually committed to the ongoing development and promotion of a person-centred model of care for optimal mental health and well-being in accordance with best practice." Speaking at the hospital to mark the announcement, Professor Hannah Mc Gee, Dean of the Faculty of Medicine and Health Sciences, RCSI added, "This partnership gives our students access to clinical patient care scenarios and provides some unique opportunities for research, with the main beneficiary from our work together being the patient.
The patients who take part in these scenarios are vitally important to the teaching, learning and assessing of our students and help to shape RCSI pharmacy graduates' role as care-givers in healthcare. I thank Dolores Keating and Professor Paul Gallagher (Head of the RCSI School of Pharmacy) for their roles in leading this important partnership between both our organisations.” The Memorandum has been extended for a period of indefinite duration, with annual reviews to take place with both parties.
Almost 1 in 4 babies 1 experience colic Cow & Gate comfort Clinically proven to significantly reduce colic and constipation2,3
ROI HCP Careline
1800 371 371 For the dietary management of colic and constipation
Important Notice: Cow & Gate comfort is a food for special medical purposes for the dietary management of colic and constipation after full consideration of feeding options, including breastfeeding. Only to be used under medical supervision. For enteral use only.
NI HCP Careline
0800 977 5656
References: 1. Garrison MM and Christakis DA Pediatrics. 2000;106(1 Pt 2):184-90. 2. Savino F et al., Acta Paediatr Suppl. 2003; 91(441):86-90. 3. Schmelzle H. et al. J Pediatr Gastro Nutr 2003;36:343-351.
Baby formulas and nutrition Ensuring that a child receives the proper nourishment is essential for new parents, and feeding a child can be quite a daunting task. Often new parents will present to a pharmacy needing help with regard to their child’s nutritional needs. Cow & Gate Nutriprem 2 and SMA PRO Goldprem 2 are also good to recommended for pre term infants.
Anti-Reflux, Enphamil AR are reliable anti-reflux products for parents whose children are having trouble with acid reflux.
What’s important for pharmacists to note here is that AR products often require different methods for reconstitution, so the directions of the box must be followed very carefully by parents.
This kind of milk is designed for babies which a difficulty digesting normal milk, which can be quite common. Typically, these milks are used for bottlefed babies for the dietary management of frequent colic and constipation. The comfort formulas have a bit less lactose in them and have slightly, partially broken-down whey protein which can help to reduce colic and constipation in babies. Aptamil Comfort, SMA Comfort, and Cow & Gate Comfort also provide excellent products in this regard. Babies with Allergies
In these cases, it is important that pharmacists be aware of the various products available, and give the best advice with regard to properly feeding a child to parents. It is important that pharmacists recommend that parents don’t “stretch” their budget by watering down infant formula or breast milk. Not only will the baby get too few nutrients, but there’s also the small but serious risk of “water intoxication.” This over-consumption of water can disturb baby’s electrolyte balance, resulting in seizures or brain damage. It is also important not give cow’s milk to a baby younger than one year old. The proteins in cow’s milk infant formulas have been cooked or processed, making them much easier for babies to digest than regular cow’s milk.
Formulas Although Pharmacists should recommend that breast feeding is the best and most nourishing way to feed a child, it is also important to acknowledge that doing so does not necessarily suit every new mother. Many will opt instead to use a formula. It is important that a pharmacist recommend a formula which is nutritionally complete, so that a baby is receiving all the vitamins and nutrients it requires to remain healthy. Aptamil’s Profutura range is a breast milk substitute, which is suitable from birth, and provides a Nutritionally complete formulation if a baby is combination feeding or not being breastfed. SMA milk is another reliable brand, and nutritionally complete formula for nursing children. Teat size for formulas is typically medium.
While feeding a new-born is itself difficult, it can be made all-the-trickier when a child has an allergy or particular dietary requirements. Hydrolysed cow’s milk protein contain protein that has already been broken down so the babies don’t have to do it. Nutramigen Lipil and Aptamil Pepti are reliable and recommended brands for this. Likewise, some babies may be completely lactose intolerant, in which case a pharmacist can recommend an amino acid based formula. A lactose free formula, SMA lactose fee, ensamil o-lac, Aptamil Lactose Free. These contain zero cow’s milk protein. Nutramigen pure amino, and NeoCate are decent brands available, and can be recommended. Babies with Reflux This can vary from gastro problems to an immature or underdeveloped gut, which are very common in small children. Aptamil anti-reflux, SMA PRO
Some products may also require greater teat sizes - SMA anti-reflux, for instance, is actually thin but thickens in the stomach. Parents should be aware of the importance of reading the labels correctly. For feeding a baby with reflux, a large teat is usually needed. Breast Pumps Sometimes nursing mothers will opt to use a pump to get their breastmilk for convenience. There are two types of pump available – manual, and electric. Pharmacists should recommend the type of pump in accordance with the lifestyle of the mum. As sometimes electric pumps can be a little bit noisy, a manual pump should be used if a new mum wants to be discrete. AMEDA lactaline double electric is a good pump to recommend, as are the Medela electric pumps line. Vitamins for babies A nutritionally complete formula should afford a child almost all of the nutrients and vitamins it needs, however it is also recommended that parents give their baby a vitamin D supplement. ChildLife and NordicNaturals are good vitamin D supplements to recommend for a child.
The new baby bottle for a more familiar feeling. Breastfeeding is and remains the best way to feed a baby. For over 60 years, NUK has been helping to support this with highquality products. However, depending on the situation, every now and then, mothers cannot breastfeed. This is when a good baby bottle is needed with which both breast milk and other foodstuffs can be fed and which lets bottle and breastfeeding be an optimal combination too. So, for this, the stronger a sense of nature such a bottle has, the more familiar the feeling for babies and the better they feel too.
he development of the NUK Nature Sense is based primarily on the scientific finding that the number of openings in a lactating breast are unique to each mother. So, according to the recent study from Münster University,
More needs, more flexibility. NUK Nature Sense Teats come with a varying number of tiny openings – for breast milk and other thicker liquids too. And as the baby grows, the teat can be Several tiny milk ducts
would recommend the new NUK Nature Sense to others.
confirm a more natural drinking experience.
of babies accept the new teat.
Recommended by paediatricians and midwives:
confirm a liquid flow similar to a breast.
confirm the softness and a feeling almost like at a mother’s breast.
EX E FL
T XI RA BL E
A CO N T I LI C
The features of the NUK Nature Sense at a glance.
breastfeeding mothers have, on average, 7.6 active milk ducts with cases of even up to 16 active milk ducts and the number of active milk ducts increases with every additional birth. These
Tested by mothers:
SEVERAL TINY OPENINGS
EX E FL
findings provide the basis for the qualities of our new NUK Nature Sense, with its several tiny openings. These are modelled on the milk ducts in a mother’s breast and make it the baby bottle that lets babies enjoy a familiar feeling when drinking and, above all, a natural flow.
T XI RA BL E
The several tiny openings are modelled on the milk ducts in a mother‘s breast and ensure a smooth and natural flow. The extra-soft tip of the teat is particularly flexible and adapts itself to the mouth in a way similar to a nipple.
The wide, flexible lip rest gives a familiar feeling as if at a mother’s breast.
changed to a size for babies from 0–6 and 6–18 months. The flexible silicone teats are particularly heat and age-resistant, with a neutral smell and taste. The high-quality, polypropylene (PP) bottle is BPA-free and particularly hardwearing. Naturally, convincing – naturally, recommended too. The new NUK Nature Sense was developed in close collaboration with midwives and paediatricians and, before the market launch, was tested by mothers and babies. Asked for their opinion of the new bottle, the experts confirmed, in particular, that the NUK
The innovative NUK Anti-Colic Vent allows the liquid to flow constantly and helps prevent air being swallowed and causing discomfort.
Nature Sense has the most important properties of a good baby bottle and that they would recommend the bottle to mothers who do not want or cannot breastfeed, as well as to mothers who want to both bottle and breastfeed. See for yourself and test the new baby bottle. For more information, go to www.nuk.com
* Independent Research in Germany, 2016
Available to order from your local Intrapharma Sales representative: For Munster contact Maura Cronin 086 - 813 6540 | For Leinster Orla Smith 087 - 052 4507 For Connaught Mervyn Connaughton 086 - 819 8271 | For Northern Ireland Norma Beggs +44 77 205 77747
As an adjunct to diet and exercise for appropriate patients with type 2 diabetes
SUPPORT YOUR PATIENTS WITH
INCLUDING EVIDENCE FROM
TEC S TRIAL EVALUATING CARDIOVASCULAR
O U T C O M E S W I T H S I TA G L I P T I N
NOW EVEN MORE REASONS TO CHOOSE JANUVIA® FIRST AS A PARTNER TO METFORMIN1 Januvia or Janumet. For Januvia only– Renal Impairment: Lower dosages are recommended in patients with moderate and severe renal impairment, as well as in ESRD patients requiring haemodialysis or peritoneal dialysis- see Dosage. For Janumet only - Lactic acidosis and renal function: a very rare, but serious, metabolic complication can occur due to metformin accumulation. Cases in patients on metformin have occurred primarily in diabetic patients with significant renal failure. Reduce incidence by assessing other associated risk factors. If suspected, discontinue treatment and hospitalise patient immediately. Determine serum creatinine concentrations regularly, i.e. at least once a year in patients with normal renal function and at least two to four times a year in patients with serum creatinine levels at or above the upper limit of normal and in elderly patients. Decreased renal function in elderly patients is frequent and asymptomatic. Exercise special caution where renal function may become impaired, e.g. when initiating antihypertensive or diuretic therapy or when starting treatment with a non-steroidal anti-inflammatory drug (NSAID). Surgery: due to metformin hydrochloride content of Janumet, discontinue treatment 48 hours before elective surgery with general, spinal or epidural anaesthesia. Do not resume earlier than 48 hours afterwards and only after renal function is normal. INTERACTIONS For Janumet only - Alcohol: avoid alcohol and medicinal products containing alcohol due to risk of lactic acidosis. Cationic agents that are eliminated by renal tubular secretion (e.g., cimetidine): these may interact with metformin by competing for common renal tubular transport systems. Consider close monitoring of glycaemic control, dose adjustment within the recommended posology and changes in diabetic treatment when these agents are co-administered. Iodinated contrast agents in radiological studies: intravascular administration of these agents may lead to renal failure, resulting in metformin accumulation and a risk of lactic acidosis. Discontinue Janumet prior to, or at the time of the test and do not reinstitute until 48 hours afterwards, and only after renal function is found to be normal. Combination requiring precautions for use: glucocorticoids (given by systemic and local routes) beta-2-agonists, and diuretics have intrinsic hyperglycaemic activity. Inform the patient and perform more frequent blood glucose monitoring, especially at the beginning of treatment. If necessary, adjust dose of the anti-hyperglycaemic medicine during therapy with, or on discontinuation of the other medicine. ACE-inhibitors: as these may decrease the blood glucose levels, if necessary, adjust dose of the antihyperglycaemic during therapy with, or on discontinuation of the other medicine. PREGNANCY AND LACTATION: Do not use during pregnancy or breast-feeding. Animal data do not suggest an effect of treatment with sitagliptin on male and female fertility. Human data are lacking. SIDE EFFECTS Refer to SmPC for complete information on side effects There have been no therapeutic clinical trials conducted with Janumet tablets however Janumet is bioequivalent to co-administered sitagliptin and metformin. Sitagliptin: Serious adverse reactions including pancreatitis and hypersensitivity reactions have been reported. Hypoglycaemia has been reported in combination with sulphonylurea and insulin. The following adverse reactions were reported from both clinical trials and post-marketing experience: Sitagliptin only: Common: hypoglycaemia, headache, Uncommon: dizziness, constipation and pruritus. Sitagliptin with metformin: Common: hypoglycaemia, nausea, flatulence and vomiting; Uncommon: somnolence; upper abdominal pain, diarrhoea, constipation and pruritus. For Januvia and Janumet: Post-marketing experience additional side effects have been reported (frequency not known): hypersensitivity reactions, including anaphylaxis, angioedema, rash, urticaria, cutaneous vasculitis, exfoliative skin conditions including Stevens-Johnson syndrome (see precautions), and bullous pemphigoid; acute pancreatitis, including fatal and non-fatal haemorrhagic and necrotising pancreatitis (see precautions); impaired renal function, including acute renal failure (sometimes requiring dialysis); vomiting; pain in extremity, arthralgia, myalgia, back pain and arthropathy; interstitial lung disease. Januvia: Description of selected adverse reactions Adverse experiences reported regardless of causal relationship to medication and occurring more commonly in patients treated with sitagliptin included upper respiratory tract infection, nasopharyngitis, osteoarthritis and pain in extremity. In the Trial Evaluating Cardiovascular Outcomes with sitagliptin (TECOS), after a median follow up of 3 years, sitagliptin, when added to usual care, did not increase the risk of major adverse cardiovascular events, or the risk of hospitalisation for heart failure compared to usual care without sitagliptin in patients with type 2 diabetes and established cardiovascular disease. PACKAGE QUANTITIES Januvia 25 mg, 50 mg and 100 mg film-coated tablets 28 tablets Janumet 50mg/850mg and 50mg/1000mg film-coated tablets 56 tablets Legal Category: POM. Marketing Authorisation Numbers Januvia 25 mg: EU/1/07/383/002 Janumet 50 mg/850 mg: EU/1/08/455/003 Januvia 50 mg: EU/1/07/383/008 Janumet 50 mg/1000 mg: EU/1/08/455/010 Januvia 100mg: EU/1/07/383/014 Marketing Authorisation Holder Merck Sharp & Dohme Limited, Hertford Road, Hoddesdon, Hertfordshire EN11 9BU, UK Date of revision: January 2016 © Merck Sharp & Dohme Ireland (Human Health) Limited, 2016. All rights reserved. Further information is available on request from: MSD, Red Oak North, South County Business Park, Leopardstown, Dublin 18 or from www.medicines.ie. Date of preparation: October 2016. Adverse events should be reported. Reporting forms and information can be found at www.hpra.ie Adverse events should also be reported to MSD (Tel: 01-299 8700)
Reference: 1. Green JB, Bethel MA, Armstrong PW, et al. Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2015;373(3):232–242.
Red Oak North, South County Business Park, Leopardstown, Dublin D18 X5K7 Ireland
JANUVIA® (Sitagliptin) JANUMET® (Sitagliptin/metformin hydrochloride) ABRIDGED PRESCRIBING INFORMATION Refer to Summary of Product Characteristics (SmPC) before prescribing. PRESENTATION Januvia® 25 mg, 50 mg and 100 mg film-coated tablet each containing 25 mg, 50 mg or 100 mg of sitagliptin respectively. Janumet® 50 mg/850 mg and 50 mg/1000 mg tablets each containing 50 mg sitagliptin and 850 mg or 1000 mg metformin hydrochloride. INDICATIONS For adult patients with type 2 diabetes mellitus Januvia is indicated to improve glycaemic control: as monotherapy • in patients inadequately controlled by diet and exercise alone and for whom metformin is inappropriate due to contraindications or intolerance as dual oral therapy in combination with • metformin when diet and exercise plus metformin alone do not provide adequate glycaemic control • a sulphonylurea when diet and exercise plus maximal tolerated dose of a sulphonylurea alone do not provide adequate glycaemic control and when metformin is inappropriate due to contra-indications or intolerance • a PPARγ agonist (i.e. a thiazolidinedione) when use of a PPARγ agonist is appropriate and when diet and exercise plus the PPARγ agonist alone do not provide adequate glycaemic control as triple oral therapy in combination with • a sulphonylurea and metformin when diet and exercise plus dual therapy with these medicinal products do not provide adequate glycaemic control. • a PPARγ agonist and metformin when use of a PPARγ agonist is appropriate and when diet and exercise plus dual therapy with these medicinal products do not provide adequate glycaemic control. Januvia is also indicated as add on to insulin (with or without metformin) when diet and exercise plus stable dosage of insulin do not provide adequate glycaemic control. Janumet: as an adjunct to diet and exercise to improve glycaemic control in patients inadequately controlled on their maximal tolerated dose of metformin alone or those already being treated with the combination of sitagliptin and metformin. • in combination with a sulphonylurea (i.e., triple combination therapy) as an adjunct to diet and exercise in patients inadequately controlled on their maximal tolerated dose of metformin and a sulphonylurea. • as triple combination therapy with a PPARγ agonist (i.e., a thiazolidinedione) as an adjunct to diet and exercise in patients inadequately controlled on their maximal tolerated dose of metformin and a PPARγ agonist. • as add on to insulin (i.e., triple combination therapy) as an adjunct to diet and exercise to improve glycaemic control in patients when stable dosage of insulin and metformin alone do not provide adequate glycaemic control. DOSAGE AND ADMINISTRATION Januvia - One 100 mg sitagliptin tablet once daily, with or without food. Janumet - The dose of antihyperglycaemic therapy with Janumet should be individualised on the basis of the patient’s current regimen, effectiveness, and tolerability while not exceeding the maximum recommended daily dose of 100 mg sitagliptin. For patients not adequately controlled on metformin alone, the usual starting dose should provide sitagliptin dosed as 50 mg twice daily (100 mg total daily dose) plus the dose of metformin already being taken. For patients switching from co-administration of sitagliptin and metformin, Janumet should be initiated at the dose of sitagliptin and metformin already being taken. For patients inadequately controlled on dual combination therapy with the maximal tolerated dose of metformin and a sulphonylurea or with maximal tolerated dose of metformin and a PPARγ agonist or with maximal tolerated dose of metformin and insulin, the dose should provide sitagliptin dosed as 50 mg twice daily (100 mg total daily dose) and a dose of metformin similar to the dose already being taken. All patients should continue their recommended diet with an adequate distribution of carbohydrate intake during the day. Januvia and Janumet - In combination with a sulphonylurea or with insulin, consider a lower dose of sulphonylurea or insulin, to reduce risk of hypoglycaemia. Renal impairment: For Januvia only: When considering sitagliptin with another anti-diabetic product, its use in patients with renal impairment should be checked. Moderate impairment (CrCl ≥30 to <50 mL/min), the dose is 50 mg once daily. Severe impairment (CrCl <30 mL/min) or with end-stage renal disease (ESRD), the dose is 25 mg once daily. Mild impairment, no dose adjustment. Assessment of renal function is recommended prior to initiation of Januvia and periodically thereafter. For Janumet only: Should not be used in patients with moderate or severe renal impairment (creatinine clearance < 60 ml/min). Hepatic impairment: For Januvia only - no dosage adjustment necessary for patients with mild to moderate hepatic impairment. Januvia has not been studied in patients with severe hepatic impairment and care should be exercised. However, because sitagliptin is primarily renally eliminated, severe hepatic impairment is not expected to affect the dose of sitagliptin. For Janumet only – do not use. Elderly < 75 years: For Januvia only - no dosage adjustment necessary. For Janumet only - use with caution as age increases. Monitoring of renal function is necessary to aid prevention of metformin-associated lactic acidosis. Children: no data available. CONTRAINDICATIONS For Januvia - Hypersensitivity to active substance or excipients. For Janumet - Hypersensitivity. Diabetic ketoacidosis and diabetic pre-coma. Moderate and severe renal impairment (creatinine clearance < 60 ml/min). Acute conditions with the potential to alter renal function such as dehydration, severe infection, shock. Intravascular administration of iodinated contrast agents. Acute or chronic disease which may cause tissue hypoxia such as cardiac or respiratory failure, recent myocardial infarction, shock. Hepatic impairment. Acute alcohol intoxication, alcoholism. Lactation. PRECAUTIONS AND WARNINGS For Januvia and Janumet - General: do not use in patients with type 1 diabetes or for diabetic ketoacidosis. Acute pancreatitis: Use of DPP 4 inhibitors has been associated with a risk of developing acute pancreatitis Inform patients of the symptom of acute pancreatitis: persistent, severe abdominal pain. Resolution of pancreatitis has been observed after discontinuation of sitagliptin, but very rare cases of necrotising or haemorrhagic pancreatitis and/or death have been reported. If pancreatitis is suspected, Januvia or Janumet and other potentially suspect medicinal products should be discontinued; if acute pancreatitis is confirmed, Januvia or Janumet should not be restarted. Caution should be exercised in patients with a history of pancreatitis. Hypoglycaemia when used with other anti-hyperglycaemic medicinal products: Rates of hypoglycaemia reported with sitagliptin were generally similar to rates in patients taking placebo. Hypoglcaemia has been observed when sitagliptin was used in combination with insulin or a sulphonylurea (see side effects). Therefore consider a lower dose of sulphonylurea or insulin to reduce the risk of hypoglycaemia when administering Janumet or Januvia. Hypersensitivity reactions: Serious hypersensitivity reactions have been reported, including anaphylaxis, angioedema, and exfoliative skin conditions including Stevens-Johnson syndrome. Onset occurred within the first 3 months after initiation of treatment with some reports occurring after the first dose. If suspected, discontinue
CPD 80: HYPERTENSION Biography - Amy Louise Oates. I qualified from the Robert Gordon University Aberdeen with a Master in Phamacy in 2011. I then undertook my pre-registration year with Gordons Chemists in Edinburgh. After registration I moved back home, where I am now working for Johnstons Pharmacy in Longford Town, Lanesborough and Ballygar, Co. Galway. I also recently completed a Cardiology in Clinical Pharmacy Practice module with Trinity College Dublin.
1. REFLECT - Before reading this module, consider the following: Will this clinical area be relevant to my practice. 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. 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 has my practise changed as a result? Have I identified further learning needs?
Hypertension is one of the most common worldwide diseases and is a major risk factor for stroke, myocardial infarction, vascular disease, and chronic kidney disease. Hypertension is one of the most important preventable causes of premature death worldwide. It contributes to approximately half of all cardiovascular diseases and is the single most important risk factor for stroke. Prevalence of hypertension is strongly influenced by age – and increasing age is associated with a rise in systolic blood pressure (as a result of progressive stiffening and loss of compliance of larger arteries), while diastolic blood pressure increases up to about the age of 60 years, plateaus and then falls . Blood pressure is determined both by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. Blood Pressure (BP) is the product of the Cardiac Output (CO) and the Peripheral Vascular Resistance (PVR)
BP = x PVR Cardiac output (CO) = volume of blood pumped by the left ventricle to the aorta per minute Peripheral resistance (PVR) = viscosity of
Disclaimer: All material published in CPD and the Pharmacy is copyright and no part of this can be used within any other publication without the permission of the publishers and author.
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.
Pharmacy Management of Hypertension INTRODUCTION
Published by IPN. Copies can be downloaded from www.irishpharmacytraining.ie
blood and the width and elasticity of the peripheral arteries. Blood pressure is a continuous haemodynamic variable and can be affected by many different things (e.g. time of day, posture and acute changes in temperature). Given these variables, diagnosis of hypertension on individual clinic measurements can be problematical. A diagnosis of primary hypertension should be confirmed using 24-hour ambulatory blood pressure monitoring (ABPM) as gold standard. This also eliminates the phenomenon of ‘white coat’ hypertension. STAGE 1 HYPERTENSION: Clinic blood pressure (BP) is 140/90 mmHg or higher and ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM) average is 135/85 mmHg or higher. STAGE 2 HYPERTENSION: Clinic BP 160/100 mmHg is or higher and ABPM or HBPM daytime average is 150/95 mmHg or higher. SEVERE HYPERTENSION: Clinic BP is 180 mmHg or higher or Clinic diastolic BP is 110 mmHg or higher. Although genetics appears to contribute to hypertension, the exact mechanisms underlying essential hypertension have not been established. Many factors modulate the blood pressure such as humoral mediators, vascular reactivity, circulating blood volume, vascular calibre and blood viscosity. Other factors such as genetic predisposition,
60 Second Summary Hypertension is one of the main causes of cardiovascular mortality and morbidity. Hypertension contributes to about half of all cardiovascular events and is one of the most important risk factors for stroke. On diagnosis, management of the elevated blood pressure is important and also to determine the degree of CV risk and any target organ damage. A step by step approach is used to achieve optimum blood pressure control, as well as patient education and lifestyle advice. The “AC” algorithm in the NICE CG127 is followed for determining the course of antihypertensive drug therapy. Drug treatment includes the use of ACE inhibitors, Angiotensin II receptor blockers, diuretics, calcium channel blockers, beta blockers and alpha blockers. It is important that all patients are offered education and advice on lifestyle activities, such as diet and exercise, weight loss, stopping smoking and alcohol consumption.
CPD 80: HYPERTENSION
Abbreviations A = ACE inhibitor (consider angiotensin-II receptor antagonist if ACE intolerant)
Younger than 55 years
55 years or older or black patients of any age
C = calcium-channel blocker A
D = thiazide-type diurectic
Black patients are those of African or Caribbean descent and not mixed race, Asian or Chinese patients
C or D
A + C or A + D
Add • further diuretic therapy or • alpha-blocker or • beta-blocker Consider seeking specialist advice excess dietary salt intake, and adrenergic tone, may also interact resulting in hypertension. RISK FACTORS • Elderly patients • Diabetes Mellitus • Obesity • Diet • Gender – men are more likely that women to get hypertension • Family history DIAGNOSIS Diagnosis involves establishing the blood pressure, identifying any secondary causes
of hypertension and evaluating the overall CV risk. A diagnosis of primary hypertension is made after excluding known causes that comprise what is called secondary hypertension. Primary hypertension accounts for 90-95% of diagnosed hypertension. A single cause of the elevated blood pressure cannot be identified, although a number of contributory factors are recognized such as age, genetics, environment (stress, sodium and alcohol), weight, ethnicity and smoking. Secondary hypertension accounts for less than 5% of all cases. It occurs secondary to diseases such as renal disease, aortic narrowing and endocrine disorders. It can also occur in pregnancy or be a result of certain medications such as corticosteroids, combined oral contraceptives and non-steroidal anti-inflammatory drugs.
Unfortunately removing the cause may not result in a reduction in BP due to irreversible organ damage. SYMPTOMS Patients are usually asymptomatic until end organ damage occurs. However the following symptoms can sometimes be present: • Headache: classically present in morning • Epistaxis: moderate to severe HTN • Nocturia: frequently reported • Impotence: common, not spontaneously mentioned by patients Signs of organ damage should be assessed at the time of diagnosis of hypertension. Damage can be present in the heart, kidneys
CPD 80: HYPERTENSION
or arteries. Damage in the following organs can lead to many disease states. Central Nervous System / Brain: Cerebrovascular accident, transient ischaemic attack (TIA), dementia, Stroke Kidney: Chronic renal impairment, proteinuria Heart: Myocardial infarction, Ischaemic heart disease, Left ventricular hypertrophy, Peripheral vascular disease, Coronary artery disease Monitoring and assessing for organ damage should include ECG, urinalysis for evidence of microalbuminuria, and a physical examination. TREATMENT Non-pharmacological management involved lifestyle modifications and changes. Patient should be educated on the importance of diet and exercise. Salt and caffeine intake should be reduced, alcohol consumption should be within recommended limits, and physical activity should be increased. Advice on weigh reduction and stopping smoking should be given where necessary. It is essential that lifestyle medications are monitored and on-going support is offered to ensure continued compliance. NICE guidelines recommended antihypertensive drug treatment to people of any age with stage 2 hypertension – a clinic blood pressure reading of 160/100mmGh or higher. In patients with stage 1 hypertension, hypertensive drug treatment is recommened in those aged under 80y ears with one or more of the following: • Target organ damage • Established cardiovascular disease • Renal disease • Diabetes • A 10 year cardiovascular risk equivalent to 20% or greater according to the Join British Societies Cardiovascular Risk Assessment Charts. The “AC” algorithm in the NICE CG127 is followed for determining the course of antihypertensive drug therapy. Step 1: Depending on age, patients under 55 years commence on ACE inhibitor or Angiotensin II receptor blocker. People under 55 years should be offered an angiotensin converting enzyme (ACE) inhibitor or a low-cost angiotensin receptor blocker. If an ACE inhibitor is prescribed but not tolerated (e.g. because of cough), offer a low-cost angiotensin receptor blocker. People aged over 55 years and black people of African or Caribbean family origin of any age should
be offered a calcium channel blocker. If a calcium channel blocker is not suitable (e.g. because of oedema or intolerance), or if there is evidence of heart failure or a high risk of heart failure, offer a thiazide-like diuretic.
Step 2: Calcium channel blocker is added. If a calcium channel blocker is not suitable for step 2 treatment or if there is evidence of heart failure or a high risk of heart failure, offer a thiazide-like diuretic.
For black people of African or Caribbean family origin, consider an angiotensin receptor blocker in preference to an ACE inhibitor, in combination with a calcium channel blocker.
• Renovascular disease - can reduce or abolish glomerular filtration and can cause severe renal failyre
Step 3: If treatment with three drugs is required, the combination of ACE inhibitor or angiotensin receptor blocker, calcium channel blocker and thiazide-like diuretic should be used.
E.g: Ramipril, Perindopril, Enalapril
Step 4: For resistant hypertension consider adding a futher diuretic or alpha-blocker or beta-blocker to Step 3 therapy. Low-dose spironolactone (25mg once daily) should be considered initially if the blood potassium level is 4.5mmol/L or lower. Amiloride is a well-tolerated alternative to spironolactone if it is not suitable. BLOOD PRESSURE TARGETS Clinic Blood Pressure Measurement should be used to monitor the response to treatment, however for patients identified as having a “white-coat effect” , ambulatory or home monitoring should be considered. For patients aged under 80, a target BP of lower that 140/90mmHg, and for those aged over 80 years lower that 150/90mmHg. Targets for ABPM and HBPM should be less than 135/85mmHg for those ages under 80 years, and less than 145/85mmHg for those aged over 80 years. ANGIOTENSIN-CONVERTING ENZYME INHIBITORS (ACEi) ACE inhibitors block the conversion of angiotensin I to angiotensin II. In hypertension, ACE inhibitors are the most appropriate initial drug in younger Caucasian patients, Afro-Caribbean patients and in those aged over 55 years. ACE inhibitors are very beneficial in patients with diabetes with nephropathy as the slow renal disease progression, and are also good in patients with Left Ventricular dysfunction as they improve survival. Careful monitoring is required in patients receiving multiple or high dose diuretic (more than 80mg of furosemide or its equivalent), and also in patients treated with concomitant ARB or aliskiren. A persistent dry cough, especially in elderly and female patients can stop continued treatment with ACE inhibitors.
• Play a role in the management of diabetic nephropathy. • A role in preventing cardiovascular events
• Concomitant diuretic therapy – can cause a very rapid fall in BP in volume-depleted patients
• Concomitant use of NSAIDS and potassium-sparing diuretics.
ANGIOTENSIN II RECEPTOR ANTAGONISTS (ARBs) ARBs have many similar properties to ACE inhibitors; however they do not inhibit the breakdown of bradykinin so are less likely to cause the persistent dry cough that is common with ACE inhibitors. ARBs act on the specific receptor for angiotensin II which results in decreased pulmonary vascular resistance (PVR). The BP lowering effect of ARBs is similar to that of ACE inhibitors, with no effect on lipids or fasting glucose. E.g: Valsartan, Losartan, Candesartan CALCIUM CHANNEL BLOCKERS (CCBs) There are two different classes of CCBs: • Dihydropyridine CCBs – amlodipine, felodipine, lercanidipine, nifedapine • Rate- limiting CCBS – verapamil and diltiazem CCB selectively block the slow inward calcium channels of vascular smooth muscle walls and reduce BP by arteriolar dilatation. Dihydropyridine CCBS primarily reduce pulmonary vascular resistance (PVR) , they have some initial diuretic effects also. These CCBS are metabolised in liver so caution with cirrhosis The use of rate limiting CCBs is limited to patients with few other choices. They should generally be avoided in heart failure as the can further depress cardiac function. Verapamil is used in the treatment of angina, hypertension and arrhythmias. It has a very negative inotropic effect and reduces cardiac output, slows the heart rate and can impair atrioventricular conduction. Verapamil should not be used with beta-blockers. Diltiazem is effective in all forms of angina, and the long-acting preparations are used for the treatment of hypertension. Diltiazem can be used in patients in whom beta-blockers are contra-indicated or ineffective.
CPD 80: HYPERTENSION
LIFESTYLE ADVICE Lifestyle advice is vital in the management of Hypertension. A healthy diet and regular exercise may reduce or remove the need for antihypertensive therapy in some patients. Advice should be provided on diet and nutrition, alcohol consumption, smoking status, physical activity and weight management. Pharmacists are ideally placed in the community to provide education and advice to promote healthier lifestyles. • Physical Activity People should aim to be active every day, doing at least 150 minutes of moderate intensity activity a week in bouts of at least 10 minutes (i.e. activity that makes a person feel out of breath, such as heavy housework, brisk walking, dancing or swimming)
BETA-BLOCKERS Beta-adrenoceptor drugs (beta blockers) block the beta-adrenoceptors in the heart, peripheral vasculature, bronchi, pancreas and liver. They have a relatively short duration of action and have to be give twothree times daily, or as modified release preparations. The mechanism of action of beta-blockers in hypertension is not quite understood; however they do reduce cardiac output and block peripheral adrenoceptors. They are effective for reducing blood pressure, but other anti-hypertensives are more beneficial for reducing the incidence of stroke, myocardial infarction and cardiovascular mortality. Beta-blockers can be used in Step 1 in patients in whom ACEi and ARBs are contra-indicated or not tolerated. Beta-blockers are longer preferred as a routine initial therapy for hypertension or as monotherapy. Caution is advised in respiratory disease and labile diabetes. If a patient taking Beta blockers requires a second drug to control hypertension, a Calcium channel blocker rather than a diuretic should be used to reduce the risk of developing diabetes .
& peripheral flow. Diuretics basically act via the loss of sodium – they cause a reactive increase in circulating renin that results in angiotensin-mediated vasoconstriction to offset the hypotensive effect. They therefore combine well with Beta blockers which inhibit renin and also ACEI/ARB which inhibit angiotensin II. CCBs also work well as they directly oppose diuretic induced vasoconstriction. E.g: Bendroflumethaizide, Hydrochlorothiazide, Indapamide ALPHA BLOCKERS Alpha blockers cause post synaptic α blockade which results in vasodilation and a reduction in blood pressure. Alpha-blockers such can be used as an add-on drug in patients with resistant hypertension or where other drugs are poorly tolerated. However, they are most likely to cause postural hypotension and the first dose can cause syncope. Common side effects of alpha blockers include syncope, dizziness, headache, lethargy
E.g: Atenolol, Bisoprolol, Metoprolol
E.g: Doxazosin, Indoramin
Thiazide diuretics work by inhibiting Sodium reabsorption at distal tubule by blocking the Na/Cl co-transporter. These functions to reduce circulating volume, reduce cardiac output and reduce blood pressure
Aliskiren is a renin inhibitor, inhibiting renin directly and so blocking the conversion of angiotensinogen to angiotensin I. A reduction in blood pressure can be seen if used alone or in combination with ARBs.
• Reduce Alcohol Intake The low risk weekly guidelines for adults are up to 11 standard drinks in a week for women, and up to 17 standard drinks in a week for men. Drinks should be spaced out over the week, with two to three alcohol free days per week. A structured alcohol reduction programme can reduce blood pressure by 3-4mmHg • Encourage a healthy diet A healthy low calorie diet can produce a 5-6mmHg reduction in blood pressure. Five portions fruit/vegetables is recommended a day. Reduce salt intake - no more than 6g a day (2.4g sodium) or use a salt substitute. Ensure adequate fluid intake – approximately six to eight glasses of water a day. • Smoking Cessation Offer people who smoke advice and help to stop smoking because, although it will have no effect on blood pressure, it will reduce CVD risk. • Weight Management Patients who are overweight should be educated on the importance of weight management. Patients should aim to reach a normal BMI of 20-25. (overweight: BMI 25-29.9; obese: BMI over 30) Hypertension is one of the main causes of cardiovascular mortality and morbidity. On diagnosis, management of the elevated blood pressure is important and also to determine the degree of CV risk and any target organ damage. A step by step approach is used to achieve optimum blood pressure control, as well as patient education and lifestyle advice.
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HPN Respiratory Award 2017
Chemco Driving Compassion within Cork Managing Pharmacist Tomás Deasy of Chemco Pharmacy Bandon, winner of the HPN Respiratory Team of the Year at the Irish Pharmacy Awards, speaks to Niamh Cahill about the pharmacy’s sterling work in raising asthma awareness.
RoseAnne Walsh, Kathleen Barry, Ciara O'Leary and Tomas Deasy
The team at Chemco Pharmacy has worked hard to established itself as an integral part of the community in the large West Cork town of Bandon since opening there four years ago. Indeed it is so well thought of among the community, that a customer, who to this day remains anonymous, nominated the team for the Respiratory Team of the Year award at the Irish Pharmacy Awards. Speaking to IPN following the win, Mr Deasy explained that the unknown customer nominated the
team following a unique, innovative Asthma in the Pharmacy Day for local customers that involved the entire Pharmacy team and an Asthma Society of Ireland Nurse.
our team can do for patients at a local level.”
Mr Deasy said he is truly honoured to collect the award, the first ever received by the Pharmacy, on behalf of all the team.
“It truly is an honour to have received this award. This award highlights our role as care givers in the local community by raising awareness of asthma related conditions. I would like to thank the IPN awards for recognising the extraordinary talent and hard work of all community pharmacies in Ireland.
“It will give our team huge motivation to continue to provide exemplary customer care to all our customers and to continue to focus on best practice,” Mr Deasy noted.
“The IPN plays an integral role in inspiring creative thinking and excellence in Pharmacy. The IPN awards has given Chemco Bandon a fantastic platform to showcase compassionately what exactly
Around 60 per cent of Irish patients have uncontrolled asthma and around one person dies every week from asthma. Furthermore, some 90 per cent of asthma deaths are preventable.
Ireland has the fourth highest prevalence of asthma in the world, with around 470,000 Irish adults and children suffering from the chronic condition which causes inflammation and narrowing of the airways.
Matthew, RoseAnne Walsh and Tomas Deasy with Sheila Finn, Asthma Nurse Specialist It is startling statistics like these that spurred on the team at Chemco Pharmacy Bandon to raise much needed awareness about asthma among the local community.
Prescription Collection Bags to generate conversations at tills,” Mr Deasy recounted. “This was aimed to be a holistic approach to the care of all our customers who had an asthma
related condition. The idea was for our Pharmacy to raise awareness of asthma in Bandon for all our customers. “This asthma day was special because it was organised in a way
that the customer would benefit from the advice of two different healthcare professionals in the one event. The idea was that that the Asthma Nurse would refer customers out to the pharmacist,
Mr Deasy related that the condition affects all ages and that asthma is the most common chronic disease in Ireland. “Our Pharmacy want to make a difference in the local community. To tackle this issue on a daily basis we try to make a connection with each asthma customer taking the time to go through their medicines and going through inhaler technique step by step where appropriate. Chemco Bandon is a family Pharmacy always there to discuss any worries parents may about their child’s asthma condition,” Mr Deasy said. The Asthma in the Pharmacy Day was held last February to add to these efforts and aimed to boost customers’ understanding of their medicines, answer any questions they may have and improve communication between customers and pharmacists. “Leading up to the event, we put a note [about the event] on
Local customer Ann Fitzgerald with Tomas
HPN Respiratory Award 2017 difference to their quality of life and surprisingly many asthmatics are not using their inhalers in the correct and most effective way. This is one of the reasons why an event such as this and ongoing efforts to engage with each customer about their inhaler techniques are so important for asthma sufferers and their families. The Asthma Society of Ireland website, www.asthma.ie, has videos on inhaler technique and how to use devices correctly. According to Mr Deasy, the event has helped to develop strong links with GP practices in the local area and the Asthma Society of Ireland.
Leroy Onyeonoro showing his inhaler technique to Chemco Pharmacist Tomas to give further Pharmacy advice in relation to their asthma needs and to show them OTC [over the counter] products/services (food intolerance testing) that we have in store. All patients who had scheduled appointments with the nurse were advised to bring in their inhalers with them. We received very positive feedback on this event.” Mr Deasy went on to explain that on the day he was available to answer questions from walk in customers without a scheduled appointment and that an information stand was also set up for customers. “Our team set up asthma stands
in the style of information stations covering a range of Pharmacy topics in store including asthma in adults and children, allergies, inhaler technique, smoking cessation and food intolerance. One of these asthma stands was set up in the centre of the Pharmacy with placebo devices, asthma literature and health promotion, which enhanced our conversations with customers.” There is a strong link between asthma and allergies according to research, which is why the team made sure to highlight information on allergies and asthma. For asthmatics, improving their inhaler technique can make a huge
Mr Deasy plans to hold similar events in the future following the positive feedback generated from the Asthma in the Pharmacy Day. In another move to generate awareness, a video about managing asthma, delivered by Mr Deasy at the Pharmacy, is located on the Pharmacy’s Facebook page and is aimed at helping patients to manage their condition effectively and to increase education around asthma. “I think there is a fantastic appetite amongst our community for holding creative events that raise awareness of asthma. An event like this can really help a person’s understanding of asthma attacks, know how to manage them and focus on good asthma control,” Mr Deasy advised. There is no cure for asthma,
but effective mangement can dramatically reduce the number of attacks a person suffers and their symptoms, according to the Asthma Society of Ireland. Furthermore, the cause of asthma is unknown but it is known that a number of factors can trigger the condition such as allergens, tobacco smoke, outdoor and indoor air pollution, and diet. Efforts are ongoing within the HSE’s National Asthma Programme to improve the quality of care provided to asthma sufferers and in 2015 the Cycle of Care for Asthma in General Practice was rolled out to the under-sixes. The scheme was welcomed by healthcare professionals as the first step towards a more inclusive model of care for patients and along with initiatives by enthusiastic Pharmacy’s like Chemco Pharmacy, has helped to improve asthma care in Ireland. It is understood that around 22,000 children under the age of six are currently receiving care from over 1,500 GPs under the scheme. “The local community Pharmacy can be a highly reliable contact point for free asthma related advice. At the coalface pharmacists can educate patients, help solve compliance issues by demonstrating the proper use of inhalation devices and spacer devices, and give advice on OTC medicines unsafe in asthma,” Mr Deasy advised. “Preparing for an asthma awareness event can be a learning experience for all the Pharmacy team. As pharmacists, we strive to make appropriate interventions and positive clinical outcomes and to work as part of a team with local GP surgeries.” Chemco Pharmacy is an Irishowned independent Pharmacy chain, consisting of eight branches nationwide with the head office and warehouse located in Kilkenny City. Chemco Bandon is located in New Road, Bandon. It is a large, bright and spacious Pharmacy, which opened in 2013. The team consists of Mr Deasy as Managing Pharmacist, a relief pharmacist, a fully qualified technician and three retail sales assistants.
RoseAnne and Tomas planning and setting up an Asthma Stand
“Our Pharmacy are committed to providing the highest standards of customer service in delivering our Pharmacy services, whilst offering our ‘value for money’ ethos to our customers,” Mr Deasy said.
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Awards The Irish Pharmacy
Irish Pharmacy Awards 2017 – Red Carpet Over 650 professionals from Community Pharmacy across Ireland attended the Clayton Hotel, Burlington Road Dublin for the sixth annual Irish Pharmacy Awards. Hosted by Irish actress and comedienne Deirdre O’Kane, guests witnessed seventeen awards presented on the night as they helped celebrate innovation and excellence within their sector. Pictured are some of those who attended.
7 1) Ann Butler, Higgin’s Pharmacy, Sligo, Mary Louise Irwin, Lombard Pharmacy, Dublin and Ken Higgins, Higgin’s Pharmacy Sligo 2) Jean and Philip Dalton, Unilever 3) Lisa and Anthony Malone, Castletown Pharmacy 4) Sharon Tynan and Nuala Carey, Glengariff Pharmacy 5) Stephen O’Donoghue, United Drug and Alan Downey, GSK 6) Gillian Fitzgerald, Fiona Reidy, Leon Diggins and Alison O’Brien, Sam McCauley Chemists, Tralee 7) Laura Swarbrigg, Orla Cahill, Lorraine Hales and Sarah McKeown, Whelehan’s Pharmacy, Mullingar
8) Uniphar Retail Services Team
18 9) Philip Little and Don Cronin, RB Ireland 10) David and Geraldine McFadden, McFaddens Pharmacy, Dublin 11) Caitiona McGovern and Darren Meehan, McCabes Pharmacy 12) Keith and Anna Ryan, Idis 13) Lorraine and Cormac Tobin, Celesio 14) David Collins and Dearbhla Mulvhill, Marron's Pharmacy 15) Matthew and Gemma Farrelly, MSL Healthcare 16) John Arnold, Claire Arnold and Paula Gallagher, Totalhealth Pharmacy Group 17) Sian Feeny, Natalie Kalo and Aine Tierney, Boots Ireland 18) James Cloney, Tomas Deasy and Chris O’Grady, Chemco Pharmacy, Bandon
19) Paolo Iacovelli, Aishling Quinlan, Brian O’Connell and Laura Romero, PharmaConex
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Hangover With summer upon us, we see an increase in alcohol consumption peaking at its biannual period, along with Christmas. Holidays, barbeques, weddings and work parties are on the increase with your customer base and he you have a serious increase in those seeking help enduring a busy period. Painkillers: Can help with headaches and muscle cramps, however some painkillers should be avoided given the strain they can put on the liver, given the organ is already under strain from the alcohol. Sugary foods may reduce trembles, though in some cases, an antacid may be needed to settle your stomach first.
Many, if not all are familiar with the effects of a hangover: splitting headaches, sickness, dizziness, dehydration: anyone who's ever drunk too much knows the consequences. Tips to avoid a hangover Of course, the only sure-fire way to avoid a hangover is abstinence which isn’t always an option, given particularly commitments around work or weddings, but there are certain things that you can do for your customers with regard to easing their hangovers, and making things at least somewhat more comfortable. Below is some helpful advice pharmacists can give to customers as to how to make hangovers less painful. Hydration: Alcohol will make you urinate more, which can lead to dehydration, and with the height of the summer upon us your primary resource for dealing with a hangover is water, and lots of it. It is important to drink water in-between alcoholic drinks, and in hot environments this can make the massive difference in avoiding a serious case of dehydration. Dehydration is what causes many of the symptoms of a hangover, and can be particularly prevalent
in the warmer months. It is helpful when someone is drinking that they always have some water by their bedside to sip when they wake in the night. Food: Always advise for your customers not to drink on an empty stomach. It is important before they go out to have a meal that includes carbohydrates, such as pasta, rice, or bread. Eating food with a high Fat Content is also an option, as each of these types of food will help slow down the body's absorption of alcohol.
binds with toxins in the stomach and helps them to be eliminated, rather than being absorbed and causing harm. The difference between regular charcoal and activated charcoal is in the activation, which creates many more internal pores, increasing the surface area to trap substances in the gut by hundreds of times. It can trap drugs, many poisons, environmental toxins, and components of food. Hangover treatment
Avoid Darker Drinks/Spirits: Always advise not to drink darkcoloured drinks, particularly if your customer has noticed that they are sensitive to them. They contain natural chemicals called congeners, which irritate blood vessels and tissue in the brain and can make a hangover worse.
If the person drinking does happen to wake up the next morning feeling terrible, it may be because they haven’t followed any of the above, but it also may mean that they simply went to excess. There are options which can make enduring the following morning a little easier for your customers, however.
Activated Charcoal: Activated charcoal can help relieve digestive distress, prevent hangovers, and even treat poisoning. Activated charcoal is a popular natural remedy for gas, bloating, detoxification, and hangover prevention, but it can also save a life as a first-aid treatment for poisoning. Activated charcoal
Hydration: Dealing with a hangover involves rehydrating the body to help it deal with the painful symptoms. The best time to rehydrate is before going to sleep after a drinking session, as mentioned, thought the very next best time is as soon as possible the next morning.
Because alcohol is a diuretic, the body loses a lot of vitamins and nutrients during a night on the town. The most important of which are vitamins B and C. Many people that use a vitamin B complex — a pill that includes B1 (thiamine), B2 (riboflavin), folic acid, B6 and B12, among others — to combat hangovers see a marked improvement on their symptoms. One of the most heralded is B12 (also called cobalamin), which performs a key role in the functioning of the brain and nervous system. There are certain things you should look out for when discussing hangover with your customers "Hair of the dog" – drinking more alcohol – does not help. Drinking in the morning is a risky habit, and they may simply be delaying the appearance of symptoms until the alcohol wears off again, this is a common misconception by the general public. Know your units. According to DrinkAware.ie, which is a helpful resource to point your customers towards, Men are advised not to drink more than 17 units a week on a regular basis, and for women just 11 units. Spreading drinking over three or more days can help for those who consume 17 units a week if you want to cut down, try to have several drink-free days each week 17 units is equivalent to 8 pints. Of average-strength beer or 12 small glasses of low-strength wine.
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Summer Beauty Weight management and wellbeing Ireland is set to become the most obese nation in Europe by 2030 according to the World Health Organisation. According to Euromonitor, the weight management and wellbeing category has grown by 2% in the last year. As a result, there are several government assistant campaigns, for example, through organisations such as Safe Food, and also through the Irish media to help increase awareness of the issue. Television shows such as Operation Transformation, which ran for two seasons in 2016, is one of the biggest drivers for increasing awareness of obesity in Ireland. The show offers diet and exercise advice to five participants and also encourages community involvement to help tackle obesity. This awareness has been recognised by consumers who are taking note and are now seeking ways to help reduce their waistlines. The weight management and wellbeing category is set to increase to reach ¤12m in 2021. Irish consumers are expected to continue struggling with their weight as obesity issues become more talked about amongst consumers and via the media. Meal replacement products are anticipated to drive this growth as consumers look to quickly lose weight for occasions such as weddings and holidays.
Consumer trends Bord Bia’s report on consumer lifestyle trends states that food and drink remain key health and wellness strategies. Consumers continue to watch out for ‘nasties’ and scrutinise what goes into their mouths; ‘natural’ is an ever more important shortcut for ‘good for me’. On the other hand, people are becoming more aware of how the social context in which they eat and drink contributes to holistic wellbeing. Brands that can celebrate social meaning around food have an opportunity to build a real emotional connection with consumers. In Ireland, consumers are keenly embracing technology as a way to improve their health; the Deliciously Ella vegan and gluten-free cooking app was the third most downloaded last year, while Couch Potato to 5k fitness training was fifth. Consumers are more inclined to feel stressed than they have been in recent years, although rekindled Irish optimism has brought about communal ways to achieve balance day-to-day. Weight management, either in the form of a structured weight loss programme or general healthy living advice, is a key component of community Pharmacy’s public health role.
Raising the Issue of Weight with Adults The Weight Management Interest Group of the Irish Nutrition and Dietetic Institute have developed a resource to assist healthcare professionals in raising the issue of weight with their patients. (See www.indi.ie) The advice is to begin the conversation with “I haven’t checked your weight and height in a while, I can check it today if that’s ok?”. After checking, calculate the persons BMI, to determine if they are overweight. A BMI of between 25-29.9 is categorised as overweight and over 30 is obese. Linking weight to an existing medical condition is a good way of explaining why excess weight could be a problem. “did you know that losing weight could help lower your blood pressure?”. Advise that gaining further weight could put their health at even greater risk. The next step is to advise the benefits of a modest weight loss of between 5% and 10% - “losing a small amount of weight at a slow rate (0.5 – 1kg per week) over the next few weeks will improve your health.” Advising the patient to keep a food and exercise diary is very beneficial. In the food diary, they should be advised to aim for 3 regular meals per day, 5 portions of fruit and vegetables per day and low-fat varieties of foods, for example, skimmed milk, low fat cheese etc. For the exercise section, set a target of at least 30 minutes of exercise on 5 or more days of the week. They should aim for some strenuous exercise – that increases breathing rate and causes some perspiration but not to become out of breath. Joining a gym or walking/running club is also a good suggestion. Weight management, either in the form of a structured weight loss programme or general healthy living advice, is a key component of community Pharmacy’s public health role. The front of shop team can play a vital role in identifying customers who may be appropriate for a weight management programme, but training is crucial especially when raising a sensitive issue like weight.
Brand Focus Miss Fit Skinny Tea is an expertly formulated blend of 10 natural, super ingredients that traditionally have been used to assist with weight reduction, increasing energy and improving skin. Ingredients include, Hibiscus Jasmine, Lotus Leaf, Chamomile, Pu’Erh Leaf, Sencha Green Tea, Lemongrass, Rhubarb Root, Fennel, Garcinia, and Cambogia Extract. XLS-Medical is Ireland #1 weight loss aid**. Last year they launched XLS-Medical Max Strength, for customers who want to lose weight faster†. Now Introducing Mas Strength New DIRECT Sachet- Perfect for on the go. Benefits: Reduces calorie intake from carbohydrates, sugar and fat. Stabilises blood glucose and insulin levels, which helps in curbing food cravings and with blood glucose management. XLS Max strength contains Clavitanol TM, which is a natural ingredient that works by blocking some of the activity of digestive enzymes alpha amylase alpha glucosidase and lipase. This results in decreased ability of these enzymes to break down dietary carbohydrates, sugar and fat. As a result, they are left undigested as they are too large to be absorbed in the intestine and are naturally passed through your system. † Grube et al. (2015). Vs.XLS-MEDICAL Fat Binder, vs. dieting alone. ** IMS MAT VOLUME SALES MAY 2017.
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Summer Beauty Targeting the Tanning Market In recent years, sales of fake tan have rocketed for a number of reasons in Ireland. Organisations such as the Irish Cancer Society have worked hard on their ‘sun safe’ campaigns to disseminate the message that there is actually no such thing as a ‘healthy glow’ – whether from a sun bed or from the sun’s rays.
Consumer trends Tan fans feel that bronzed limbs make them look slimmer and more toned. Women in Ireland are the biggest users of fake tan in the world. As a result, the Irish market laps up any new developments in this sector and demands more from its sunless tanning products. There are many different tanning products now available from odourless formulations to those for sensitive skin. Odourless preparations are popular, which bronze the skin without leaving the tell-tale ‘biscuit’ smell of some of the traditional products. In addition, consumers are seeking out organic tanning products that use fewer chemicals, which act immediately. Body and face moisturisers which promise ‘a hint of a tint’ of tan have also been embraced by Irish women and men alike. The current trend for the highlighted look means that brands offering tans in the form of oils are growing in popularity, to achieve that all-important sheen, as well as colour. The tanning market also includes subsidiary products ranging from body scrubs, fake-tan removers, exfoliators and body moisturisers. SPF sun-care products should always be used in conjunction with sunless-tanning products because fake tan does not give any protection from the sun. It is a good idea to have all these products shelved together, creating a 'tanning category' area of the pharmacy. This in turn will provide customers with convenience in their shopping experience.
Top Tanning Tips Exfoliate, exfoliate exfoliate! This will remove dead skin cells and create a smooth and uniform surface on the skin for the tan to be applied to, which will in turn result in an even golden colour. Steer clear of exfoliators that contain oils, as these will only act as a film on the skin and while wonderful for locking in moisture, aren’t ideal for tanning. Any hair removal should be carried out 24 hours prior to tanning, to ensure the skin has calmed and any cuts have healed. On the day of a tan application, be it at-home or in a salon, don’t moisturise the body or wear deodorant or perfume. To avoid odd orange stains or streaks, wash hands every five minutes when applying any tanner (and don't forget in between the fingers and fingernails). Alternatively, buy some inexpensive plastic gloves to wear to avoid orange hands and/or fingernails all together when applying the application. Tan might look streaky as it dries. Don't panic until it’s been given it about three hours to dry and time for the colour to develop completely.
Applying the Perfect Fake Tan Step 1 – Shoulders and Arms – Starting from the shoulders apply the fake tan to both shoulders and arms using the same circular and then vertical movements as above. Avoid the elbows and stop at the wrists. Step 2 – Legs and Bum - Working from the bottom down, glide the fake tan over the bottom and legs. Again, take time with the circular and vertical strokes in order to cover the area evenly. Miss out the knees and stop just above the ankles. Step 3 – Tricky Bits – THE ELBOWS Pop a small amount of moisturiser and an even smaller amount of fake tan onto the mitt and spread lightly over the elbow area and work gently into the surrounding area too. THE KNEES Apply fake tan and moisturiser in the exact same way as with the elbows. THE FEETS AND ANKLES Apply the lotion/moisturiser mix onto the feet and ankles working it carefully around the Achilles heel as this is a streak hot spot! THE HANDS AND WRISTS Take the gloves or mitt off. Place a blob of moisturiser with a little fake tan on the back of one of your hands. Place the backs of your hands against each other to gently rub the fake tan into the webs of your fingers and down the sides.
Brand Focus Sunkiss - “The latest tanning product to hit the high street is SUNKISS, a streak-free, beautifully scented selftan which fades naturally without any patchy, uneven fading. Launching with a medium to dark shade in both a mousse and a mist, SUNKISS has been developed by Irish entrepreneur Janice O’ Sullivan specifically for the Irish Skin tone. SUNKISS Instant Self-Tanning Mist & Mousse are your easy step to an instant healthy glow, without any orange overtones. SUNKISS’ unique responsive formulation means adapts to every individual skin tone. Easy application and a lovely fresh scent were key to the final product design which Irish consumers can now enjoy. RRP: ¤12.99 - Available in Pharmacies Nationwide” bBold set to have their biggest and best launch to date this July! With the cosmetics market on the rise, bBold have developed their very own ‘Face and Body Contour Kit’. To differentiate from current colour cosmetic products currently in the market, bBold have listened to consumers and developed a contour, bronze and highlight solution that is paraben free, vegan friendly and free from animal cruelty. Using only ultra-fine pigmented powder to manipulate shadow and light this simple and easy to use kit helps to define and sculpt face and body. With 82% of women now believing social media drives trends (Sena, 2017), bBold have largely invested in pro-active PR campaign to create content that inspires trust, creates credibility, and builds brand awareness. Prepare to see bBold take social media platforms by storm this July.
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*When compared to standard concentrates. +EPA and DHA contribute to maintenance of normal brain and heart function and normal vision, beneficial effect is obtained with a daily intake of 250mg of DHA. Food supplements should not be used instead of a varied balanced diet and a healthy lifestyle. SolgarÂŽ is a registered trademark.
Summer Beauty Teeth Whitening More and more Irish people are turning to cosmetic dentistry to get that Hollywood smile — and the cheapest and most effective way of achieving it is by teeth whitening. In Britain, cosmetic procedures such as whitening accounted for a 20% rise in dentists’ incomes since 2010. Celebrities have been open about having undergone teeth bleaching or straightening procedures, and the public is following suit. There are no figures available for Ireland but the British industry is estimated to be worth £1bn annually. In 2012 the EU ruled that only dentists or dental health professionals working to a dentist’s prescription can carry out whitening procedures.
Oral care category According to Euromonitor the Oral care category grew by 3% in current value terms in 2016 to reach ¤124 million. Oral care is a category that was never impacted upon by the economic downturn as it is seen as an essential daily activity for consumers. Demand for perfect teeth remained important for both male and female consumers and while many try to avoid visiting the dentist, they still like to maintain their own oral hygiene to the best that they can. Colgate-Palmolive Ireland Ltd led oral care in 2016 with a value share of 29%. The company maintained its share in oral care despite seeing fewer innovations in 2016, with several of its product launches from 2015 continuing to perform strongly, including Colgate Max Expert White. The company has a very wide product portfolio with several products designed to meet specific consumer needs including whitening, sensitivity and children’s products. Sales in Oral care are expected to reach 138 million in 2021. Growth will likely remain relatively robust, particularly within tooth whiteners and dental floss.
Top tips for keeping teeth bright and healthy A whitening toothpaste is good for is removing extrinsic staining. These are the stains that build up over time with the food we eat, breathing with our mouths open, and not flossing and brushing properly. To remove extrinsic staining, recommend an electric toothbrush with a special head, along with a whitening toothpaste for polishing. Most of us breathe through our mouths at night while asleep. This dries out the mouth, letting the biofilm (and extrinsic stains) build up on the teeth. If you don’t eat a lot of staining foods but still have teeth staining, you’re probably mouth breathing. Get more frequent teeth cleanings: A hygienist polishes with a professional strength paste, so they can do an even better job removing stains. Brush after every staining food or drink: Coffee, red wine, blueberries, grapefruit, and coffee all cause teeth staining. Keep a toothbrush in your bag or car for on-the-go dry brushing to break down the build-up between meals and snacks. Snack on fibrous foods such as apples, celery, carrots, spinach and broccoli, as they naturally exfoliate the surface of your teeth to help remove stains. When drinking anything sugary, use a straw. Don’t forget to floss. This often-forgotten oral hygiene step really does make a difference. Drink water after a meal - Drinking water after eating will clear out the mouth and wash away any stray foody bits and sugar that may linger on the teeth causing cavities. Alcohol-free mouthwash – Many mouthwashes contain too much alcohol which can dry out the tissues in the mouth, making them more susceptible to bacteria. Clean your teeth properly at home - Clean in-between each tooth and around the mouth and work from one corner of the mouth to the other, brushing all areas. Make sure you brush for at least two minutes every time. Make the investment and buy an electric toothbrush (recommended by nearly all dentists) and use the built-in timer to sure you are brushing for the recommended time. A whitening toothpaste can keep teeth looking tip top and sparkling, without spending a fortune on chemical whitening treatments. Eating foods such as cauliflower, apples, celery, and carrots can all help you get whiter teeth. These natural food choices are great for maintaining a healthy smile because they contain a type of acid which removes surface stains from teeth and whitens the enamel.
Brand Focus Vitis whitening toothpaste and mouthwash effectively whitens and prevent dental sensitivity. Vitis whitening is the first toothpaste and mouthwash formulated with the innovative DENTAID technology nanorepair®: containing nanoparticles of hydroxyapatite (natural element in teeth) which restore the natural whiteness of teeth after 10 days of use, without harming enamel (low abrasion level) and prevent tooth sensitivity. Vitis delivers 5 combined actions to ensure better efficacy - Removes and prevents stains - Prevents calculus - Polishing action - Anti-caries action - Repairing and Whitening action Dentaid Nanorepair technology repairs tooth enamel, making the surface smoother and brighter Available from Uniphar.
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Eye care in the Pharmacy Eye conditions, and eye discomfort or irritation are quite common for patients to present to the pharmacy with. Most of the time, a pharmacist will not have to refer a patient to a doctor, and can safely and effectively treat whatever symptoms a patient has using OTC products. Here, Irish Pharmacy News looks at some common eye conditions that patients suffer from, and outlines some of the treatments available for pharmacists to give them. Dry eyes Keratoconjunctivitis sicca, is a medical condition in which eyes do not make enough tears. A common condition, patients regularly present to pharmacies looking for some kind of relief from dry eyes. Dry eyes can be caused by, environmental factors, hot or windy climates, certain medications, or hormonal changes, and occur when there is a breakdown in the lacrimal functional unit of the eye. However, sometimes the cause of dry eyes cannot be identified. In certain cases where the patient is elderly, the symptoms of dry eye can be caused by drooping of the lower eyelid. This is known as Ectropion. Dry eyes are typically caused by breakdown in the lacrimal unit of the eye. The lacrimal functional unit is the system of different parts of the body that work together to regulate the production of tears. It comprises of the following: The lacrimal gland, which produces the liquid which tears are comprised of; The eyelid, which spreads tears across the eyes, preventing them from becoming dry and itchy and uncomfortable; The meibomian glands, which produce a fatty liquid that protects the other film of the eye; The cornea, which is the clear layer at the front of your eye that contains smaller glands, which also produce some of the liquid that makes up your tears. If the lacrimal functional unit is effected, there are two results. In one outcome, the quality of tears being produced by the eye is effected, and in the other
they are not produced quickly enough, resulting in a dry, itchy, and uncomfortable eye. Symptoms of dry eyes include: stinging or burning of the eye; a sandy or gritty feeling as if something is in the eye; episodes of excess tears following very dry eye periods; a stringy discharge from the eye; pain and redness of the eye; episodes of blurred vision; heavy eyelids. There are several treatments that a pharmacist can recommend to a patient suffering from dry eyes (Thealoz Duo® eye drops), however they should be sent to their GP if symptoms are particularly severe. However, in most cases, an OTC treatment will suffice, and provide the patient with the relief they require.
Drops, ointments and gels are available without prescription at the pharmacy and are designed replicate the role of natural tears, and should be given to patients whose symptoms are not severe enough to be sent to a doctor or optometrist.
eye that is worse upon waking.
These can be drops or ointments, and provide relief for patients from the symptoms of dry eyes. Thealoz Duo, Hylo forte and Optrex are all reliable eye drop brands for relief from dry eyes.
Pharmacists should advise patients to wash the eyelids with specialised blepharitis lotions/gels (e.g. Blephasol®) or eyelid scrub wipes (e.g. Blephaclean® wipes).
Blepharitis Blepharitis another very common eye condition that patients present to a pharmacy with. It is a chronic inflammation of the eyelids, causing red, watery eyes, and a discharge around the lashes. Patients complain of a gritty, itchy, uncomfortable red
It is one of the most common eye problems. The oil glands in the eyelid may become blocked or infected (Meibomian Gland Dysfunction) which can give rise to similar symptoms.
Ocular lubricants can also be helpful to relieve the symptoms of associated dry eye. Episcleritis The episclera (the layer of the eye under the conjunctiva) can sometimes become inflamed as a result of dialation of blood vessels.
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1. Pinto-Bonilla, J.C et al. Ther. Clin Risk Manag (2015); 11: 595-603 2. Dews, Ocul Surf 2007; 5: 75-92
Feature Bacterial conjunctivitis Bacterial conjunctivitis is usually a self-limiting condition with a rapid onset of redness and discharge. Although it will clear up without treatment, pharmacists can give treatment to relieve symptoms, which can be quite uncomfortable. Typically, a sticky discharge sticks eyes together, and crusts over, also making the eyes swell and appear puffy. It is recommended that pharmacists give a patient anti-infective eyedrops to deal with this condition, such as Goldeneye.
This is divided into two types: a) Sectorial episcleritis is where one part of the eye is affected. b) Diffuse episcleritis is when the entire eye is affected and inflamed. While episcleritis is typically and will resolve itself without treatment in three weeks, pharmacists can recommend eye drops to sooth pain and irritation. Sometimes, although not very often, consistent bouts of epsicleritis are associated with system disease such as rheumatoid arthritis. Topical steroids and topical NSAIDs can be prescribed for severe cases. Corneal Ulcer A corneal ulcer can appear as a white/greyish opacity on the surface of the cornea accompanied with a red eye appearance (hyperaemia), which often is caused by overusing contact lenses. The ailment can also be caused by sleeping while leaving contact lenses in. As this condition is potentially sight-threatening, it is important that pharmacists refer a patient who presents to a pharmacy with a corneal ulcer to a doctor immediately. Red eye and Conjunctivitis Some form of conjunctivitis is present in the majority of
patients presenting to the pharmacist with red eye. The conjunctiva - the membrane covering the eye (except for the cornea) and the inner surface of the eyelids â€“ when infected can be put into three different categories: viral, bacterial, or allergic. Conjunctivitis can result from either an infection (viral or bacterial) or an allergen. Conjunctivitis is subdivided into three types- bacterial, viral and allergic conjunctivitis. The adenovirus is most commonly implicated in causing isolated viral conjunctivitis. Pollen is the usual cause of seasonal allergic conjunctivitis, while non-allergic conjunctival irritation can result from foreign bodies - wind, dust, smoke, fumes, chemical vapours and other types of air pollution. Each of the three types of conjunctivitis presents with the three main symptoms of redness, discharge and discomfort. Allergic conjunctivitis Allergic conjunctivitis is typically cause by pollen or allergens. Symptoms include red eyes, itching, and a burning sensation. As the condition is associated with allergens, roughly 70% of patients who present to a pharmacy with allergic conjunctivitis will also have hayfever or asthma or eczema.
Cold compresses and tear substitutes are useful in relieving burning and dry eyes in patients with a mild allergy. While first and second generation oral antihistamines are effective in treating allergic conjunctivitis, topical ophthalmic products are superior in treating the ocular symptoms and reduce systemic side effects. Products containing Sodium Cromoglicate 2% (e.g. Opticrom) can be used prophylactically throughout hay-fever season in adults and children. Xylometazoline 0.5% and Antazoline sulphate 0.5% can be used in adults and children over 12 years to reduce symptoms. If OTC medications do not provide effective relief within 7 days or the condition worsens patients should be referred for further investigation. Chlamydial Conjunctivitis Chlamydial conjunctivitis is more prevalent in younger adults and frequently presents in patients with systemic chlamydial infection. The eye appears red, the discharge can vary from a watery to mucopurulent and in some cases the eyelids are swollen. It can present in neonates, born to mothers with active chlamydial infection. It is estimated that 50 per cent of babies acquire the infection if the mother has an active infection at the time of birth. Patients with suspect chlamydial conjunctivitis should be referred.
If this course of action does not resolve the symptoms then the patient should be referred for a course of topical antibiotics with a typical course of treatment lasting a week. In general, the use of topical steroids is only prescribed by a consultant ophthalmologist due to their associated side effects. Herpes Simplex Keratitis Primary infections with herpes simplex usually occur, early in life, between the ages of six months and five years. Typical symptoms are similar to those of a viral illness: - Swollen lymph glands - Malaise, - Sore throat - Blurred vision and discomfort in the eyes There may be accompanying herpetic vesicles on the eyelid or periocular skin. Patients presenting with signs of Herpes Simplex keratitis should be referred to a GP. HSV virus typically affects the eyelids, conjunctiva and cornea. On optical examination, the infection typically presents as a central ocular ulcer (dendritic lesion). The patient needs to be referred immediately if they have this ailment.
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News International heart failure patient initiatives news brief launched in Ireland NEW CARERS RESOURCE LAUNCHED Within the Republic of Ireland 10% of all adults, are unpaid family carers. Over 30,000 people die in Ireland each year, and as more and more people spend the last part of their lives at home, families are often the primary caregivers. To support them in this role the All Ireland Institute of Hospice and Palliative Care (AIIHPC) has launched new resources as part of National Carers Week which ran from June 12th to 18th. Caring for Carers is a new website dedicated to carers and family caring providing core information for family members or friends who are providing support to a person who needs palliative care. The website has eight sections and contains videos, downloads, links and information that has been created by a group of experts, including carers, from across the island of Ireland. Caring for Carers was created by a team led by Professor Peter Hudson from Queen’s University Belfast in collaboration with AIIHPC and a working group made up of family carers and former carers, carer organisations, health and social care professionals and charities. The site is hosted on www.thepalliativehub.com an all-island gateway to palliative care information. Professor Hudson stated, “One of the most important things people confronting the end of their lives want is to be assured that their family will be well supported. Family caregivers need to know how to access support services and where to obtain key information to assist them manage the role of supporting their relative or friend. This new resource ‘Caring for Carers’ meets these needs by offering an evidenced based, reliable and easily accessible resource for family caregivers of people with life limiting conditions.”
International delegates gathered this month at the third annual Heart Failure Patient Organisation Capacity Building Academy, which took place at the Croí Heart and Stroke Centre in Galway. The two-day Academy, organised by Croí, and supported by Novartis, provides heart failure patient group leaders from 17 countries around the world with the opportunity to network and discuss issues affecting those living with heart failure – a condition that about 90,000 people live with in Ireland[i], with 10,000 new cases diagnosed each year. The 2017 Academy saw the establishment of a new European Network of Heart Failure Patient Organisations and the European branch of the International Heart Hub (iHHub). The two-day event focused on the need to build strategic alliances between international patient groups and explore how organisations can work together to raise awareness for heart failure and ensure it is prioritised on the health policy agenda. Speaker highlights from the series of talks included: Denis Costello, EURORDIS Rare Diseases Europe, Spain who discussed ‘The networked patient group: Using social media to increase reach and influence’. Donna Walsh, Executive Director, European Federation of Neurological Associations (EFNA), Ireland who discussed ‘Alliance Building - the road to more sustainable and effective patient advocacy’. Liam O’Sullivan, Executive Director, Care Alliance Ireland who discussed ‘Caring for carers: Challenges and solutions’. Speaking at the Academy Neil Johnson, Chief Executive, Croí
Delegates and speakers pictured at the third annual Heart Failure Patient Organisation Capacity Building Academy at the Croí Heart and Stroke Centre in Galway said, “One in five people can expect to develop heart failure in their lifetime and it is a leading cause of hospitalisation and high admission and re-admission rates here in Ireland. Yet, awareness is low and person-centred approaches to care are not being adopted. By hosting this global network, we want to learn how to prioritise heart failure on the national policy agenda, share experiences and discuss common challenges for patients and their carers. We hope the establishment of the European Network of Heart Failure Patient Organisations will help us prioritise heart failure at a European and at a national level.” “Now in year three, this Heart Failure Academy has placed Ireland at the forefront of advancing the heart failure patients’ voice on the international stage. However, despite notable improvements in heart failure treatment approximately 1 in 3 people admitted to hospital with heart failure in Ireland will die within one year. It is vital that we learn from our international counterparts and provide support
and access to treatments for people affected by heart failure”, commented Loretto Callaghan, Managing Director, Novartis Ireland. “Novartis is committed to supporting initiatives like the Heart Failure Patient Organisation Capacity Building Academy and ensuring that all patients with heart failure have access to the right support and treatments for this debilitating condition.” The European Network of Heart Failure Patient Organisations will provide a platform for groups to work together at a European level to increase awareness of heart failure and help improve outcomes for those living with the condition. The European branch of the International Heart Hub (iHHub) is the first global non-profit organisation to support patient groups from every country in the world to raise awareness of heart disease and improve lives. The European hub aims to provide heart failure patient groups across Europe with access to up to date information, treatment guidelines, best practices and patient support.
Masters (MSc) in Human Factors in Patient Safety RCSI is now accepting applications for the Masters (MSc) in Human Factors in Patient Safety. This programme will be of particular interest to Senior Clinicians and allied Health Care Professionals who desire to understand more about patient safety, risk and error in healthcare and who wish to develop their skills as influencers and change agents.
The course is open to all healthcare professionals involved in the care of surgical patients. Candidates must have a bachelor’s degree or equivalent in a health sciences field with a qualification achieved at the level of 2.2 honours, plus four years work experience in acute hospital care.
Further information on the programme can be found by clicking on the following link: http://rcsi.ie/pghumanfactors Or contact Emer Pyke Tel: +353 4022701 Email: email@example.com The closing date for applications is Friday 31 August 2017.
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Event Gallery The Cosmetic Association 2017 Trade Fair The 2017 Trade Fair for The Cosmetic Association was the most successful trade fair to date, being held in Dublin’s RDS from May 21st to May 23rd inclusive. Jo Somerville, Managing Director said, “Both exhibitor and visitor numbers were increased with almost 1,500 buyers attending over the course of the event. We had the largest number of exhibitors to date and the widest ranges of products ever. “The exhibitors pulled out all the stops with regards to dressing their stands and the compliments from the buyers were very encouraging. New members brought excitement to the show and they were very happy with their experience. “The word on the street is; most Buyers are saying that they will spend two days at the event in future, to allow them get around all the lovely stands. “We are looking forward to preparing for next year already! The Cosmetic Association is very happy to see an increase in the number of pharmacy buyers who travel from Northern Ireland to the RDS where we arrange the largest event, under one roof, for the pharmacy sector in both jurisdictions. We hope you will continue to support us in future years.”
Eloise Shilliday, Rymer Distribution, Kay Breslin, Ferns Pharmacy, Michelle Hamilton and Bernie Donoghue, Ferns Pharmacy
Marie Therese McSorley, McSorley’s Pharmacy, Mark McGarvey, DLK Photo and Roisin Austin, McSorley’s Pharmacy
Simon O’Connor and Aoife McCarthy, Life’s 2 Good
Maurice Byrne, Paul Benson, John Tooher and Tim Andrews, Pemberton / United Drug
Paul O’Neill, Easilocks, Miriam Killeen and Maxine Maher, MacNamara Pharmacy
Rachel O’Mahony, Niamh Canavan and Nicola Hourigan, Cosmetic Alliance
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Practical efﬁcacy Relvar® Ellipta® (fluticasone furoate/vilanterol [as trifenatate]) Prescribing information (Please consult the full Summary of Product Characteristics (SmPC) before prescribing) Relvar® Ellipta® (fluticasone furoate/vilanterol [as trifenatate]) inhalation powder. Each single inhalation of fluticasone furoate (FF) 100 micrograms (mcg) and vilanterol (VI) 25mcg provides a delivered dose of 92mcg FF and 22mcg VI. Each single inhalation of FF 200mcg and VI 25mcg provides a delivered dose of 184mcg of FF and 22mcg of VI. Indications: Asthma: Regular treatment of asthma in patients ≥12 years and older not adequately controlled on inhaled corticosteroids and ‘’as needed” shortacting inhaled 2-agonists, where a long-acting 2-agonist and inhaled corticosteroid combination is appropriate. COPD (Relvar 92/22mcg only): Symptomatic treatment of adults with COPD with a FEV1<70% predicted normal (post-bronchodilator) and an exacerbation history despite regular bronchodilator therapy). Dosage and administration: Inhalation only. Asthma: Adults and adolescents ≥12 years: one inhalation once daily of: Relvar 92/22mcg for patients who require a low to mid dose of inhaled corticosteroid in combination with a long-acting beta2-agonist. If patients are inadequately controlled then the dose can be increased to one inhalation once daily Relvar 184/22mcg. Relvar 184/22mcg can also be Relvar® Ellipta® was developed considered for patients who require a higher dose of in collaboration with inhaled corticosteroid in combination with a longacting beta2-agonist. Regularly review patients and reduce dose to lowest that maintains effective symptom control. COPD: one inhalation once daily of Relvar 92/22mcg. Contraindications: Hypersensitivity to the active substances or to any of the excipients (lactose monohydrate & magnesium stearate). Precautions: Pulmonary tuberculosis, severe cardiovascular disorders, heart rhythm abnormalities, thyrotoxicosis, uncorrected
hypokalaemia or patients predisposed to low levels of serum potassium. chronic or untreated infections, diabetes mellitus. Paradoxical bronchospasm – substitute alternative therapy if necessary. In patients with hepatic with moderate to severe impairment 92/22mcg dose should be used. Acute symptoms: Not for acute symptoms, use short-acting inhaled bronchodilator. Warn patients to seek medical advice if shortacting inhaled bronchodilator use increases. Therapy should not be abruptly stopped without physician supervision due to risk of symptom recurrence. Asthma-related adverse events and exacerbations may occur during treatment. Patients should continue treatment but seek medical advice if asthma symptoms remain uncontrolled or worsen after initiation of Relvar. Systemic effects: Systemic effects of inhaled corticosteroids may occur, particularly at high doses for long periods, but much less likely than with oral corticosteroids. Possible Systemic effects include: Cushing’s syndrome, Cushingoid features, adrenal suppression, decrease in bone mineral density, growth retardation in children and adolescents, cataract, glaucoma. More rarely, a range of psychological or behavioural effects including psychomotor hyperactivity, sleep disorders, anxiety, depression or aggression (particularly in children). Increased incidence of pneumonia, including pneumonia requiring hospitalisation, has been observed in patients with COPD receiving inhaled corticosteroids. Physicians should remain vigilant for the possible development of pneumonia in patients with COPD as the clinical features of such infections overlap with the symptoms of COPD exacerbations. Risk factors for pneumonia include: current smoking, older age, low body mass index and severe COPD. The incidence of pneumonia in patients with asthma was common at the higher dose of Relvar (184/22mcg). Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take Relvar. Interactions with other medicinal products: Interaction studies have only been performed in adults. Avoid -blockers. Caution is
advised when co-administering with strong CYP 3A4 inhibitors (e.g. ketoconazole, ritonavir). Concomitant administration of other sympathomimetic medicinal products may potentiate the adverse reactions of FF/VI. Relvar should not be used in conjunction with other long-acting 2-adrenergic agonists or medicinal products containing longacting 2-adrenergic agonists. Pregnancy and breast-feeding: Experience limited. Balance risks against benefits. Side effects: Very Common (≥1/10): Headache, nasopharyngitis. Common (≥1/100 to <1/10): Candidiasis of the mouth and throat, pneumonia, bronchitis, upper respiratory tract infection, influenza, oropharyngeal pain, sinusitis, pharyngitis, rhinitis, cough, dysphonia, abdominal pain, arthralgia, back pain, muscle spasms, fractures, pyrexia. Uncommon (≥1/1,000 to <1/100): Extrasystoles. Rare (≥1/10,000 to <1/1,000): Hypersensitivity reactions including anaphylaxis, angioedema, rash, urticaria, palpitations, and tachycardia. Tremor, Anxiety. Marketing authorisation (MA) Holder: Glaxo Group Ltd, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK. MA Nrs: 92/22mcg 1x30 doses [EU/1/13/886/002]; 184/22mcg 1x30 doses [EU/1/13/886/005]. Legal category: POM B. Last date of revision: November 2016. Job Ref: IE/FFT/0046/15 (3). Further information available on request from GlaxoSmithKline, 12 Riverwalk, Citywest Business Campus, Dublin 24. Tel: 01-4955000.
Adverse events should be reported to the Health Products Regulatory Authority (HPRA) using an Adverse Reaction Report Form obtained either from the HPRA or electronically via the website at www.hpra.ie. Adverse reactions can also be reported to the HPRA by calling: (01) 6764971. Adverse events should also be reported to GlaxoSmithKline on 1800 244 255. References: 1. Relvar Ellipta Summary of Product Characteristics. GlaxoSmithKline; 2016. IE/FFT/0015/17(1) Date of preparation: April 2017
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BIOXSINE Bioxsine is scientifically tested for thinning hair in men and women, for male pattern baldness and for temporary hair loss in women. Clinical tests have proven that hair loss, hair growth and thicker hair result from regular use of Bioxsine Shampoos, Serum and Spray. The Bioxsine range contains the unique ingredient Biocomplex B11 which is clinically proven to help with hair loss and to stimulate hair growth. For more information on Bioxsine please contact Ocean Healthcare on 01-2968080
New Distributor in Ireland for Promin Firstplay dietary foods Firstplay Dietary Foods have appointed Biofact as their new distributor in Ireland for Promin Foods. As of now pharmacists can order our Promin low protein products from Biofact. Biofact will stock all the GMS reimbursable products and a number of the non-reimbursable foods. Firstplay Dietary Foods, has been in PKU low-protein dietary food manufacture since 1984 and continues to develop low protein meal solutions, available under the Promin low protein brand. Continual research and development ensures that there is much more to come from Firstplay Dietary Foods. Biofact have been a registered HPRA Wholesaler since 2011 and operate from their premises in Celbridge Co. Kildare. Biofact - Tel: 01 6012544 / email@example.com
Rosanna Davison backs Irish Tanning Brand The nutritional therapist, model and former Miss World has become a brand ambassador for the natural organic self- tanning brand, developed in Ireland. The announcement of Rosanna Davison’s support for the Irish beauty brand also coincides with the launch of the latest new TanOrganic Self-Tan Mousse formula, which is a lightweight and ultra-moisturising application that simply glides over the skin and dries instantly. The Irish developed range now sells worldwide and boasts a Self-Tan Oil, Self-Tan Lotion, and the new lightweight Mousse format, as well as a Moisturising Facial Tan Oil. The full range of eco-certified self-tanning products, made wholly from natural organic ingredients, is available in pharmacies across Ireland and online at www.tanorganic.com.
L’Oréal’s newest sensitive skin expert brand Mixa, has just launched exclusively in pharmacies in Ireland nationwide The Mixa philosophy brings a traditional apothecary approach to the world of sensitive skincare, whilst incorporating a fresh aptitude for listening to modern skin needs. BORN IN 1924, IN A FRENCH PHARMACY Dermatological expertise for the most sensitive skin TESTED UNDER DERMATOLOGICAL CONTROL ENRICHED WITH APOTHECARY INGREDIENTS. MIXA IS DEVOTED TO IMPROVING THE COMFORT OF SENSITIVE SKIN. INSPIRED BY AN APOTHECARY HERITAGE, MIXA HAS CREATED TAILOR MADE, HIGH PERFORMING BODY CARE SOLUTIONS WITH A COMMITMENT TO STRICT FORMULATION PRINCIPALS.
Clinical Profiles ASIA-PACIFIC ASTHMA MARKET WILL HIT $6 BILLION BY 2023 AS MANUFACTURERS LOOK TO ADDRESS UNMET NEEDS, SAYS GBI RESEARCH The Asia-Pacific (APAC) asthma therapeutics market, which covers India, China, Australia, South Korea and Japan, is expected to grow significantly from $4.1 billion in 2016 to around $6 billion by 2023, representing a compound annual growth rate of 5.4%, according to business intelligence provider GBI Research. The company’s latest report states that this strong growth will be driven by an expanding aging population, increases in air pollution, a promising product pipeline and the launch of first-inclass molecules. Gautam Arora, Analyst for GBI Research, explains: “There are a number of therapies currently in development for asthma designed to address unmet needs in the market that will, depending on clinician uptake, drive the annual cost of therapy associated with the disease. The most prominent examples are interleukin-targeting monoclonal antibodies (mAbs), including reslizumab, dupilumab, tralokinumab, and benralizumab. “Mepolizumab and omalizumab represent a clear shift towards personalized medicine for the treatment of asthma. The high price of these biologics, which is due to the costliness of manufacturing a biologic agent, as well as the potential first-tomarket status for severe asthma, will contribute to the high sales figures.” A rise in biologic development in the asthma market is possibly attributable to the success of Xolair (omalizumab), one of the currently marketed mAbs, which reached blockbuster status in 2014. The drug was approved in 2003 in India, Australia, Japan, and South Korea, as an add-on therapy for those aged 12 and over with moderate-to-severe allergic asthmas and symptoms not adequately controlled with inhaled corticosteroids. It was the first biologic to reach the APAC asthma market, and its launch addressed a significant unmet need for personalized therapy in asthma. Arora continues: “Drug developers are now looking to follow the example of Xolair, which is widely prescribed in Japan, Australia, and South Korea, by developing highly targeted biologics and mAbs aimed at specific patient subtypes, with the hope of benefiting
previously underserved patients and generating strong revenues.
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“The level of innovation in asthma drug development is greater than that seen historically, which is a cause for optimism. The current pipeline molecules may be able to address unmet patient needs, and could provide additional alternative treatment options for patients with severe asthma that is uncontrolled with standard treatment.”
SelectMDx service testing remains available through distribution partners and laboratories that are not equipped to use the IVD PCR kit. Samples are processed at MDxHealth's state-of-the-art ISO-certified diagnostic facilities in Nijmegen, the Netherlands and Irvine, California, US.
MDXHEALTH LAUNCHES CE-MARKED SELECTMDX IVD PCR KIT AND URNCOLLECT DEVICE IRVINE, CA, and HERSTAL, BELGIUM - 07:00 CEST, June 08, 2017 - MDxHealth SA (Euronext: MDXH.BR) today announced the launch in Europe and other markets* of the SelectMDx® for Prostate Cancer in vitro diagnostic (IVD) PCR kit with CE-marked components and CE-marked UrNCollect(TM) device. The IVD PCR kit will enable diagnostic laboratories with manual and automated RNA extraction and PCR platforms to perform the SelectMDx liquid biopsy test in their own facility. The CE-marked UrNCollect device is a unique, user-friendly and compact collection tool that complements the IVD kit by enabling easy and efficient sample collection. Robustness, reproducibility and interlaboratory performance of SelectMDx was recently published in a technical validation study in Translational Medicine Communications. Urine samples from men scheduled for prostate biopsies due to elevated PSA levels and/or an abnormal digital rectal exam (DRE) or family history of prostate cancer, were tested with SelectMDx. There was less than a two percent difference between the sites' test results for finding high-grade prostate cancer upon biopsy and samples could be successfully evaluated even after being stored for a year. Prior studies have validated that SelectMDx predicts the presence of high-grade prostate cancer and helps stratify patients to receive MRI scans or biopsies. "Many of our current customers are eager to start using the IVD PCR kit so they can run the SelectMDx for Prostate Cancer test in their own labs," said Dr. Jan Groen, CEO of MDxHealth. "It's well-timed that our UrNCollect device is launching as a complement to the SelectMDx IVD PCR kit because pilot studies demonstrated that patients and physicians found the device
VENOUS THROMBOEMBOLISM (VTE) MARKET WILL SEE STRONG GROWTH TO 2026, HITTING $2.85 BILLION, SAYS GLOBALDATA The venous thromboembolism (VTE) space across the seven major markets of the US, France, Germany, Italy, Spain, the UK, and Japan, is set to rise from $1.95 billion in 2016 to around $2.85 billion by 2026, representing a strong compound annual growth rate (CAGR) of 3.87%, according to research and consulting firm GlobalData. The company’s latest report states that major drivers of the rise in market value include an increase in patient uptake of novel oral anticoagulants (NOACs), the launch of betrixaban for extendedduration prophylaxis in acute medically ill patients, and an increase in the global prevalence of VTE. GlobalData believes that the most prominent wave of VTE sales increases will come from the NOAC class, which is expected to peak at $1.04 billion in global sales by 2022, reflecting a 10-year CAGR of 3.91% by 2026, despite the generic erosion of several key players. Although the NOACs will contribute to a major growth burst in the VTE forecast, the genericization of major NOAC players in the VTE treatment and total knee replacement and total hip replacement segments will result in decreasing sales within these NOAC treated VTE patient segments. Conversely, sales in the acute medically ill space will be given a boost through the launch of Portola Pharmaceuticals’ pipeline contender, betrixaban, which is projected to reach peak sales of $577 million by 2026, as well as Xarelto’s expected label expansion to treat this patient population. Jesus Cuaron, Ph.D., Managing Healthcare Analyst for GlobalData, explains: “The VTE prophylaxis segment dominates the VTE space due to the much higher number
of patients in need of prophylaxis compared to the number of patients in need of VTE treatment. This is especially true for the acute medically ill segment, which accounted for approximately 85% of the entire VTE population in 2016. “More specifically, acute medically ill treatment in the prophylaxis setting is the single most important contributor to VTE development over the forecast period. Acute medically ill sales brought in $1.32 billion in 2016, a figure that is anticipated to extensively increase to $2.07 billion in 2026 at a CAGR of 4.65%.”
XBIOTECH ANNOUNCES DISCONTINUATION OF PHASE III STUDY FOR COLORECTAL CANCER BASED ON SECOND INTERIM ANALYSIS AUSTIN, Texas, June 09, 2017 (GLOBE NEWSWIRE) -- XBiotech Inc. (NASDAQ:XBIT) announced today that an Independent Data Monitoring Committee (IDMC) has performed its second prospectively planned, unblinded analysis of the Phase 3 XCITE study for the Company's novel candidate antibody therapy for the treatment of colorectal cancer. The IDMC had no safety concerns from the unblinded analysis. However, the committee recommended the early termination of the study since the findings were not sufficient to meet efficacy or the threshold for continuation, which involved a prospectively defined acceptance boundary for the interim analysis of less than or equal to p = 0.08. John Simard, XBiotech President & CEO stated, "We are obviously disappointed with these findings. In the coming weeks, the Company plans to analyze the data extensively to further understand the primary and secondary endpoint data, as well as to identify populations that may have benefited from the therapy. These findings today will not affect our efforts to pursue approval of the therapy based on the successful completion of the European study, which demonstrated control of debilitating symptoms in colorectal cancer." Patients enrolled in the XCITE study were randomized 2:1 to receive Xilonix or placebo plus, in each case, best supportive care. Advanced colorectal cancer patients were required to have previous failed regimens that included flouropyrimidines, oxaliplatin, irinotecan, and Cetuximab (or Panitumumab for patients with KRAS mutation).
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Product Information: Please consult the summary of product characteristics for full product information. Panadol Extra 500mg/65mg Soluble Effervescent Tablets, paracetamol, caffeine. Indications: Relief of mild to moderate pain such as that associated with rheumatism, neuralgia, headache, musculoskeletal disorders, menstrual pain, toothache, fever, symptoms of colds and flu. Dosage: Adults and children 12 years and over: 2 tablets up to 4 times a day. Max 8 tablets in 24 hours. Do not give to children under 12 years. Minimum dosing interval: 4 hours. Contraindications: Hypersensitivity to paracetamol, caffeine or any of the other ingredients. Precautions: Diagnosed liver or kidney impairment, hereditary sugar intolerance, pregnancy, concurrent use of other paracetamol-containing products, excessive caffeine intake, low sodium diet. Do not exceed the stated dose. Prolonged use except under medical supervision may be harmful. Side effects: All very rare: Hypersensitivity reactions including anaphylaxis and skin rash, thrombocytopenia, angiodema, Stevens-Johnson syndrome, bronchospasm, hepatic dysfunction. Frequency unknown: Nervousness, dizziness. Overdose: Immediate medical advice should be sought in the event of an overdose, even if symptoms of overdose are not present. Combined with dietary intake, higher doses of caffeine can cause: insomnia, restlessness, anxiety, irritability, headaches, GI disturbances and palpitations. Legal Category: Pharmacy Only. MA Number: PA 678/39/10. MA Holder: GlaxoSmithKline Consumer Healthcare (Ireland) Limited, Riverwalk, CityWest Business Campus, Dublin 24. Text prepared: July 2016. Further information available on request. Panadol is a registered trade mark of the GSK group of companies. Contains Paracetamol. Always read the label/leaflet.