IPN June 2025

June 2025 Volume 17  Issue 6 PHARMACYNEWSIRELAND.COM

THE INDEPENDENT VOICE OF PHARMACY

In this issue: NEWS: Pharmacy Talks for a New Framework Page 4

MEDICINES: Ireland Remains at Bottom for Access to Treatments Page 12

FEATURE:

Franchise

Independent pharmacy partner

Role of Diet in Acne Vulgaris Page 16

EDUCATIONAL: Landmark Moment as HRT Becomes Free for All Page 28

CPD: Acute Pain Page 41

AWARDS: Protecting independent pharmacy, enhancing margins and enabling operational efficiency

Irish Pharmacy Awards – The 2025 Winners Page 46

TEAM TRAINING: Osteoarthritis Page 71

FINANCE: Property in a Pension Page 74 This Publication is for Healthcare Professionals Only

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3

Contents

Foreword

Page 5: Cross-border Collaboration on Medicines Optimisation

In one of your lead news stories this month, we detail how Minister for Health Jennifer Carroll MacNeill has published a Framework of Engagement to support the commencement of focused talks between the State and Irish Pharmacy Union on the Community Pharmacy Contract and associated services and arrangements, including fees.

Page 8: New Survey Confirms Strong Support for Expanded Pharmacy Role

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Page 10: Fleming Medical “Before Damage is Done” Donation Page 12: Supporting Pharmacies with Tools That Make a Difference

PU President Tom Murray said, “This framework represents the most comprehensive commitment to the future of Irish pharmacy in decades. Pharmacies have immense potential to improve healthcare in communities nationwide.

This framework should enable us to realise that potential, benefiting the healthcare system, the nationwide community pharmacy network, and most importantly, patients.”

Page 20: Closer Look at Men’s Health in Pharmacy

8

Page 28: Free HRT for Women in Ireland

Page 78: ICO Annual Scientific Conference

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

46

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

From playing a vital role during the pandemic, to delivering new models of care, the profession has proven just how indispensable it truly is.

SALES MANAGER Amy Evans | amy@ipn.ie 0872799317

PHARMACYNEWSIRELAND.COM @Irish_PharmNews IrishPharmacyNews

Turn to page 28 for more details and opinion.

This issue also carries all the winners from the recent 2025 Irish Pharmacy Awards. These Awards celebrate the exceptional commitment, innovation, and impact of pharmacy professionals across the country. Pharmacists and their teams are the heartbeat of community healthcare, and their work continues to improve lives every single day.

MANAGING DIRECTOR Natalie Maginnis n-maginnis@btconnect.com

DESIGN DIRECTOR Ian Stoddart Design

Turn to page 4 to read more about this.

In other landmark news, an agreement has been reached on a way forward for the Hormone Replacement Therapy (HRT) initiative to proceed. The HRT arrangement will see the women of Ireland receive HRT medicines/products free of charge at the point of dispensing from 1 June 2025.

This agreed HRT arrangement includes the provision of HRT products, prescribed for the treatment of symptoms associated with all stages of menopause, without any charge, to women who are resident in the State.

Page 46: All the winners from the 2025 Irish Pharmacy Awards

CONTRIBUTORS Desmond J Tobin Eamonn Brady Fatimah Kara Loretta Dignam Liz O’Hagan Faisal I. Almohaileb Carel W. le Roux Colm Moore Professor Dominic A Hegarty

The Framework has been agreed following extensive preliminary engagement between the department, the Health Service Executive (HSE) and the Irish Pharmacy Union. It will guide the contract talks between the parties to agree how the funds allocated in Budget 2025 should be best used to address unmet healthcare needs, improve patient outcomes, and provide for enhancements to pharmacy fees.

78 Irish Pharmacy News is circulated to all independent, multiple Pharmacists and academics in Ireland.

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

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

IRISH PHARMACY NEWS

Turn to page 46 to read all the details.

Regulars CPD: ACUTE PAIN

P41

TEAM TRAINING: OSTEOARTHRITIS

P71

FEATURE: DIABETES

P72

FEATURE: POST-HERPETIC NEURALGIA

P86

CLINICAL PR:

P96

PHARMACYNEWSIRELAND.COM

4

News

Commencement of Pharmacy Talks The Irish Pharmacy Union (IPU) has welcomed commencement of talks under a new framework agreement with the Department of Health and Health Service Executive aimed at securing the sustainable future of pharmacy services.

Tom Murray, President, Irish Pharmacy Union Confirming the IPU’s endorsement of the revised HRT Scheme, Mr. Murray added: “Our main priority with the HRT Scheme has been to ensure women receive the medication they need without cost.

We are endorsing the scheme in good faith, backed by the broader commitments in this framework, including a review of the pharmacy fee structure.”

Approved by Minister for Health Jennifer Carroll MacNeill TD, the agreement includes commitments to review pharmacy fees, reduce administrative burdens, and support digitalisation. It also paves the way for the much-anticipated expansion of pharmacy services, as recommended last year by an Expert Taskforce.

The IPU welcomes the alignment of the framework themes with the IPU “Vision for Community Pharmacy in 2030” launched this year as a blueprint for a more integrated, patientcentric pharmacy system. The IPU’s vision is for pharmacies to play a central role in health promotion, early detection, disease management and convenient access to timely care. The agreement reflects the future, recognising the evolving role of pharmacists, the need

for sustainable funding, and the importance of enabling technologies and systems that empower pharmacists to devote more time to patient care.

IPU President Tom Murray said, “This framework represents the most comprehensive commitment to the future of Irish pharmacy in decades. Pharmacies have immense potential to improve healthcare in communities nationwide. This framework should enable us to realise that potential, benefiting the healthcare system, the nationwide community pharmacy network, and most importantly, patients.”

He continued, “Enhanced services require a sustainably resourced sector, and we welcome the allocation of ¤50m of annual recurring funding and the associated commitment to address the pharmacy fee structure.”

Clare Fitzell, newly appointed Secretary General of the IPU, also welcomed the framework. “We are encouraged by the ambition and scope of this framework and look forward to collaborating with the Department of Health and HSE on its implementation.

However, time is critical.

Pharmacies have highlighted the growing pressures of the current funding model for years, and each month of delay compounds this challenge. It’s imperative that this framework progresses into a fully formed contractual agreement without delay. We therefore acknowledge and welcome the intention for the process to be completed within three months ahead of the busy winter season.”

She concluded: “We thank the Minister for Health for her personal commitment to realising the potential of pharmacists’ professional role, and our wider role in community healthcare delivery. The IPU will remain fully engaged in ensuring its swift and effective conclusion.”

New Masters of Pharmacy The University of Galway has been approved to provide a new Master’s degree in pharmacy (MPharm), subject to some conditions being met. This follows the University’s involvement in an accreditation process undertaken by the PSI over recent months. The Council of the PSI accepted the recommendations of the accreditation team, whose report was considered at the Council meeting on Thursday, 24 April.

Accreditation teams may recommend that accreditation is granted subject to conditions in instances where some of the accreditation standards remain to be met in full for the pharmacy programme but there is confidence that the conditions can be addressed in an agreed timeline. An update on those conditions is expected to be provided to the PSI Council at its meeting in June.

The PSI has been supporting the expansion of pharmacy programmes through our accreditation role, since the Government announced new healthcare places last year, including the potential for three new pharmacy programmes at the Atlantic Technological University (ATU), the South East Technological University (SETU), and the University of Galway.

The PSI is currently engaged in an accreditation process with ATU and SETU. In addition, the PSI is also completing scheduled accreditation reviews with the current Schools of Pharmacy in Trinity College Dublin, University College Cork and the Royal College of Surgeons of Ireland. Accreditation reports are published on this website once approved by the PSI Council.

Prospective students for MPharm programmes are encouraged to communicate with the relevant universities directly.

PHARMACYNEWSIRELAND.COM

Framework of Engagement with Pharmacy The Minister for Health Jennifer Carroll MacNeill has published a Framework of Engagement to support the commencement of focused talks between the State and Irish Pharmacy Union on the Community Pharmacy Contract and associated services and arrangements, including fees.

The Framework has been agreed following extensive preliminary engagement between the department, the Health Service Executive (HSE) and the Irish Pharmacy Union. It will guide the contract talks between the parties to agree how the funds allocated in Budget 2025 should be best used to address unmet healthcare needs, improve patient outcomes, and provide for enhancements to pharmacy fees.

Recognising a shared commitment to conclude talks and reach a timely agreed outcome, these talks will take place over the next three months.

Minister Carroll MacNeill said, “The future of Community Pharmacy is bright, with real and meaningful opportunities for both our health service and pharmacies on many fronts. I hope that this talks process will help to further facilitate this and contribute towards a sustainable model of community pharmacy.

“Government remains committed to supporting community pharmacy services through investment, reform and modernisation. These talks are accompanied by an actual clear budget commitment and a significant funding envelope of ¤50 million in terms of the overall health budget.

“I look forward to working in partnership with community pharmacies to realise a shared ambition for community pharmacy in Ireland.”

There has been ongoing engagements and meetings between the department, HSE and the IPU in various formats over an extended period of time. These engagements have focused on the role of the community pharmacist, the resources in place with regard to current services, the administrative complexities of community pharmacy practice and the expansion of the scope of practice of pharmacists and community pharmacies.

News Role of Pharmacists in Global Health Threats Key discussions and outcomes from the 2025 International Pharmaceutical Federation (FIP) Global Vaccination Summit, held in March, have been published in a new FIP report.

Building on the success of the inaugural summit in 2024, this year’s event brought together FIP member organisations, international stakeholders, and leaders from across the pharmacy profession to advance the role of pharmacists in lifecourse immunisation.

The summit focused on expanding pharmacist-led vaccination services and supporting equitable access to immunisation through pharmacy practice. Structured around four strategic pillars — workforce and education, policy and regulation, service delivery, and public trust and uptake — the report highlights key insights, challenges, and recommended actions that emerged from the event.

In other news, recently FIP highlighted the role of pharmacists in building resilient and integrated health systems during its side event at the 78th World Health Assembly.

Held at the headquarters of the International Federation of Red Cross and Red Crescent Societies in Geneva, Switzerland, the event carried the theme: “Pharmacists and Pharmacy – Evidence-Based Solutions to Global Threats.”

Discussions showcased FIP’s work in pharmacy-based vaccination, antimicrobial resistance, noncommunicable diseases, humanitarian response, digital health, and sustainable pharmacy— underscoring that the future of health includes pharmacy.

Panellists reaffirmed the need for cross-sector collaboration to tackle global health threats.

From advancing partnerships with the International Federation of Red Cross and Red Crescent Societies in emergency response to supporting World Health Organization’s National Health Workforce Accounts, the message was clear: pharmacists are indispensable allies in global health.

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Cross-border Collaboration on Medicines Optimisation Irish Minister of State Alan Dillon TD recently joined Northern Ireland Health Minister Mike Nesbitt at an event to showcase pharmacy practice and medicines optimisation innovation.

Dr Glenda Fleming, MOIC; Professor John R Scott, HIHI; Professor Cathy Harrison, DoH; Minister Alan Dillon; Health Minister Mike Nesbitt; Professor Mike Scott, MOIC; Dr Tanya Mulcahy, HIHI Mr Dillon is Minister of State at the Department of Enterprise, Trade and Employment with special responsibility for Employment, Small Businesses and Retail, and at the Department of the Environment, Climate and Communications with special responsibility for Circular Economy.

The event also explored opportunities for cross-border working to address shared healthcare challenges.

Over the past decade, the Medicines Optimisation Innovation Centre (MOIC) in Northern Ireland has emerged as a beacon of innovation in healthcare, particularly in the realms of medicines optimisation.

Established in 2015 by the Department of Health, MOIC has made significant strides in enhancing health outcomes, reducing inefficiencies and minimising waste in medicine use through research, collaboration and knowledge transfer.

At the event, MOIC and the Health Innovation Hub Ireland (HIHI) in the Republic of Ireland signed a Memorandum of Understanding

(MOU). The MOU will build on existing relationships and allow for further collaboration to benefit the population’s health across the island of Ireland.

Minister Alan Dillon said: “Today marks a significant milestone in healthcare innovation and collaboration across the Island of Ireland. The signing of the MOU underscores our commitment to advancing innovation in healthcare and medicines optimisation through shared expertise and resources.

“This partnership not only enhances our healthcare systems but also strengthens our economies by fostering job creation and supporting indigenous enterprises on this island. Together, we are paving the way for a healthier future and

demonstrating that innovation knows no borders."

Professor Mike Scott, Director, MOIC, stated, “I am thoroughly delighted to have formalised this agreement with HIHI and look forward to the future opportunities that our collaboration will undoubtedly bring.”

Dr Tanya Mulcahy, Director of HIHI, added, “Collaborating across the island of Ireland enables us to harness the full potential of our collective talent, infrastructure, and ideas to deliver real-world impact in healthcare. By working together, North and South, we strengthen our ability to support innovators, improve patient outcomes, and position this island as a global leader in health innovation."

HRT Pharmacy Finder now available on HSE.ie People can now get free HRT if they have been prescribed it. Participating pharmacies can be located via the new Pharmacy Finder available on the HSE website.

Dr Cliona Murphy, National Clinical Director, HSE National Women and Infants Health Programme, said, “Every woman goes through menopause, but for some, the symptoms can be debilitating. The symptoms, which are caused by changes in our hormones, can include hot flushes, night sweats, flushing, which can be distressing for people affected. Hormone replacement therapy (HRT) is a medicine-based treatment which can really improve the quality of life for people experiencing symptoms. HRT helps to balance

and replace the hormones that your body no longer produces in the same way.

“We really welcome the fact that HRT is now free for women who need it, giving people more choice in their healthcare. The decision to take HRT should be made in consultation with your doctor.”

Apply online for a Drugs Payment Scheme Card at HSE.ie To avail of free HRT people will need to register for a Drugs Payment Scheme card.

Apply for the Drugs Payment Scheme (DPS) online on the HSE website. The following information is required: • full name • date of birth • sex • PPS number • contact details For further information on the pharmacy finder, drugs payment card or HRT, see HSE.ie

PHARMACYNEWSIRELAND.COM

6

News

Calls for Continued Momentum in Clinical Trials The Irish Pharmaceutical Healthcare Association (IPHA) welcomes encouraging progress in clinical trials activity in Ireland over the past year, as reported in its latest Clinical Trials Activity Comparison Report launched last month.

Dr. Rebecca Cramp, IPHA’s Director of Code and Regulatory Affairs

efficiency of clinical trials. We are continuing to work hard to remove other barriers, create a better environment for the conduct of clinical trials in Ireland and ensure that patients in Ireland can access key life-changing trials in Ireland.

Dr. Rebecca Cramp, IPHA’s Director of Code and Regulatory Affairs said, “The progress we’ve made in increasing the number of clinical trials and improving time to first patient is welcome, but we must move faster to ensure patients in Ireland gain earlier access to innovative and potentially life-saving treatments.

“IPHA is proposing practical, high-impact reforms that can be implemented quickly with the continued collaboration with all stakeholders. Ireland has the clinical talent, the infrastructure, and the industry investment.

Now we need a clinical research ecosystem that matches our ambition and capabilities.

IPHA also fully supports the implementation of the interim recommendations of the National Clinical Trials Oversight Group to support the expansion of clinical trials and to meet the ambitions set out in the Programme for Government to increase the number of clinical trials.

The IPHA report shows a 34% increase in the number of pharmaceutical industrysponsored clinical trials commenced in Ireland in 2024 compared to 2023 (43 vs 32 respectively). Notably, in another improvement, the average time to recruit the first patient into a trial dropped by 31%, from 67 days in 2023 to 46 days in 2024. These developments mark tangible progress and reflect the collaborative efforts made to improve clinical research infrastructure and processes.

Despite these positive steps, Ireland still lags many of its European peers. In 2024, Ireland ranked 18th out of 27 EU countries in clinical trials per capita. When the data over a two-year period (2023-2024) is compared to

that of Denmark, which has a similar population and economic wealth to Ireland, a total of 75 pharmaceutical industry sponsored clinical trials commenced in Ireland during this period compared to 229 in Denmark – just over three times as many as Ireland.

“IPHA remains committed to working with the Health Service Executive, Department of Health, academic institutions, and hospitals to ensure Ireland becomes a leading destination for clinical trials in Europe—so that patients here are among the first to benefit from medical innovation.”

In 2024 former Minister for Health, Stephen Donnelly TD, stated he would like to see Ireland double its clinical trials activity. If this ambition was matched, it could rise Ireland from 18th to 4th place in Europe for clinical trials per capita. In this regard, IPHA acknowledges the foundational work already underway through the National Clinical Trials Oversight Group and urges continued cross-sector collaboration to build a more predictable and efficient clinical trials environment in Ireland.

To this end, IPHA is recommending five targeted reforms to reduce start-up delays and enhance Ireland’s attractiveness for the conduct of clinical research:

IPHA has been playing its part.

We have collaborated with the State Claims Agency and HSE in the creation of the standard Clinical Trial Indemnity Form and model Clinical Trial Agreement, respectively, which have substantially improved the start-up

4. Appoint at least one permanent clinical research nurse post for each teaching hospital;

PHARMACYNEWSIRELAND.COM

1. Standardise clinical trial start-up requirements (including Data Protection Impact Assessments) and timelines for hospitals; 2. Designate specific clinical trial signatories in each hospital with a standard sign-off process; 3. Measure and track KPIs and embed research into clinical care;

5. Ensure the development of a robust, effective and efficient digital healthcare system to help speed up patient identification.

Tackling Patient Outcomes A new EU-funded research network led by RCSI University of Medicine and Health Sciences will work to advance patient safety in intensive care units (ICUs) across Europe.

The initiative has been awarded funding through the prestigious COST (European Cooperation in Science and Technology) programme, which supports interdisciplinary research collaboration.

The network, titled Patient SAFety Related Outcome Measures in European ICUs (SAFE ICU) will bring together experts from different countries and sectors to develop a standardised approach to measuring three key nursesensitive outcomes in the ICU – pressure ulcers, healthcareassociated infections (HCAIs), and delirium. While all are preventable, they continue to affect critically ill patients due to inconsistencies in how they are tracked and understood across healthcare systems.

Dr Natalie McEvoy, a StAR Research Lecturer in Critical Care Nursing at the RCSI Department of Anaesthesia and Critical Care, serves as Main Proposer of the COST Action and will coordinate the network’s activities.

Over the next four years the network, comprising researchers, clinicians and public and patient representatives, will collaborate to develop robust, culturally adaptable tools to measure these outcomes. By promoting standardisation across countries, the initiative aims to enable clearer comparisons, better communication of results and ultimately, more effective prevention strategies.

“The overarching aim of SAFE ICU is to bring together a team of experts across 21 different countries initially to work towards the reduction of patient safety-related nurse-sensitive outcomes,” said Dr McEvoy.

“This network will not only support research into reducing avoidable harm in ICU settings, but will also ensure that no country is left behind in the sharing of best practices.”

The project also places a strong emphasis on Public and Patient Involvement (PPI). By sharing PPI expertise among participating countries, the network aims to ensure that patient voices are embedded in research processes and care improvement strategies.

administering fexofenadine hydrochloride. However, when terfenadine was administered to nursing mothers’ fexofenadine was found to cros into human breast milk. Fertility: No human data available. Ability to Drive and Use Machinery: Based on the pharmacodynamic profile and reporALLERGIES teALLERGIES d adverse reactions it is unlikely that fexofenadine hydrochloride tablets wil produce an effect on the ability to drive or use machines. In ALLERGIES TAKING OVER TAKING OVER objTAKING ective tests, Fexo Allergy ReliefOVER has been shown to have no significant effects on central nervous system function. This means that patients YOUR LIFE? YOUR LIFE? YOUR may drive or perform tasks thLIFE? at require concentration. However, in order to identify sensitive people who have an unusual reaction to medicinal products, it is advisable to check the individual response before driving or performing complicated tasks. Undesirable Effects: Nervous Non-Drowsy One-A-Day 24hr control Non-Drowsy Non-Drowsy One-A-Day 24hrcontrol One-A-Day 24hr system disorders: Common: headache, drowsiness, diz iness. Gastrointestinal disorders: Common: nausea. General disocontrol rders and administration site conditions: Uncommon: fatigue. Refer to the SPC for other undesirable effects. Marketing Authorisation Holder: Rowa Pharmaceuticals Limited., Newtown, Bantry, Co. Cork. Marketing Authorisation Number: PA0074/096/001 Further information and SPC are available from: Rowex Ltd., Bantry, Co. Cork. Freephone: 1800 304 400 Fax: 027 50417 E-mail: rowex@rowa-pharma.ie Legal Category: Not Subject to medical prescription. Date of Preparation: September 2024 CCF FOR API: 26741 Marketed by Marketed by Marketed by

Always read the leaflet.

Always read the leaflet.

Always read the leaflet.

Abbreviated prescribing information Abbreviatedprescribing prescribinginformation information Abbreviated Product Name: Fexo Allergy Relief 120 mg Film-coated tablets Product Name: Fexo Allergy Relief 120mg mgof Film-coated tablets Product Name:Each Fexo Allergy Relief 120 120 mg Film-coated tablets Composition: tablet contains fexofenadine hydrochloride equivalent to 112 mg of fexofenadine. Description: Peach coloured Composition:Each Eachtablet tabletcontains contains120 120mg mgof offexofenadine fexofenadine hydrochloride hydrochloride equivalent to mg ofoffexofenadine.

Description: Peach coloured Composition: equivalent to112 112 fexofenadine.

Description: Peach coloured oblong, bi-convex film-coated tablet. Dimensions of 14.9-15.3 mm x 6.4-6.8 mm; plain onmg both sides.

Indication(s): Adults and children 12 years oblong,bi-convex bi-convexfilm-coated film-coatedtablet. tablet.Dimensions Dimensions of of 14.9-15.3 14.9-15.3 mm x 6.4-6.8 mm; plain on both sides.

Indication(s): Adults and children 1212 years oblong, 6.4-6.8 mm; plain on both sides.

Indication(s): Adults and children years and older: Relief of symptoms associated with seasonal allergic rhinitis. Dosage: Adults and children aged 12 years and over: One tablet (120mg) and older: Reliefofofsymptoms symptomsassociated associatedwith withseasonal seasonal allergic allergic rhinitis. rhinitis. Dosage: Adults and children aged 1212years and over: One tablet (120mg) and older: Relief Dosage: Adults and children aged years and over: One tablet (120mg) once daily taken before a meal. Children under 12 years: Efficacy and safety of fexofenadine hydrochloride 120 mg has not been studied in once daily takenbefore beforea ameal. meal.Children Children under 12 12 years: Efficacy Efficacy and safety hydrochloride 120 mg studied in in once daily taken and safety of of fexofenadine fexofenadine hydrochloride 120populations: mghas hasnot notbeen children under 12. Children from 6 to 11under years ofyears: age: Administer fexofenadine hydrochloride 30 mg. Special Nobeen needstudied to adjust children under 12.

Children from 6 to 11 years of age: Administer fexofenadine hydrochloride 30 mg.

Special populations: No need to to adjust children 12. Children from to 11 risk yearsgroups of age: Administer hydrochloride 30 patients). mg. SpecialContraindications: populations: No need adjust the doseunder confirmed by studies in 6special (older people,fexofenadine renally or hepatically impaired the dose confirmed by studies in special risk groups (older people, renally or hepatically impaired patients).

Contraindications: the dose confirmed by studies in special risk groups (older people, renally or hepatically impaired patients).

Contraindications: Hypersensitivity the Warnings and and Precautions Precautionsfor forUse: Use:Limited Limiteddata dataininthe the elderly and renally Hypersensitivityto theactive activesubstance substanceor orto toany anyof of the the excipients. excipients. Warnings and renally Hypersensitivity totothe active substance or to any of the excipients.

Warnings andWarn Precautions for Use: Limited data in theelderly elderly and renally or hepatically impaired patients.

Administer with care in these special groups. patients with a history of or ongoing cardiovascular orhepatically hepaticallyimpaired impairedpatients. patients. Administer Administerwith with care care in in these these special groups.

Warn patients with a ahistory ofofororongoing cardiovascular or special groups.

Warn patients with history ongoing cardiovascular disease that, reactions, tachycardia tachycardiaand andpalpitations. palpitations. Interactions: Interactions: Fexofenadine does disease that,antihistamines antihistamineshave havebeen beenassociated associatedwith with the the adverse adverse reactions, Fexofenadine does notnot disease that, antihistamines have been associated with the adverse reactions, tachycardia and palpitations.

Interactions: Fexofenadine does not undergo hepatic with other medicinal medicinal products throughhepatic hepatic mechanisms.

Fexofenadine undergo hepaticbiotransformation biotransformationand andtherefore thereforewill will not not interact interact with other products through mechanisms.

Fexofenadine is ais a undergo hepatic biotransformation and therefore will polypeptide not interact (OATP) with other medicinal products through hepatic mechanisms.

Fexofenadine is a P-glycoprotein (P-gp) and organic-anion-transporting substrate.

Concomitant use with P-gp inhibitors or inducers can affect P-glycoprotein (P-gp) and organic-anion-transporting polypeptide (OATP) substrate. Concomitant use with P-gp inhibitors or inducers can affect P-glycoprotein (P-gp) and organic-anion-transporting polypeptide (OATP) substrate.

Concomitant use with P-gp inhibitors or inducers can affect thethe exposure erythromycinor orketoconazole ketoconazoleresulted resultedinin2-3 2-3times times increase level exposuretotofexofenadine. fexofenadine.Co-administration Co-administrationwith with P-gp P-gp inhibitors inhibitors erythromycin increase in in thethe level of of the exposure to fexofenadine.

Co-administration with P-gp inhibitors erythromycin or interval ketoconazole resulted in 2-3 times increase in the level of fexofenadine in plasma.

The changes were not accompanied by any effects on the QT and were not associated with any increase in fexofenadine in plasma. The changes were not accompanied by any effects on the QT interval and were not associated with any increase in fexofenadine in plasma.

The changes were not accompanied by any effects on the QT interval and were not associated with any increase in adverse reactions A clinical clinicaldrug-drug drug-druginteraction interactionstudy studyshowed showedthat thatco-administration co-administration adverse reactionscompared comparedtotothe the medicinal medicinalproducts products given given singly. singly. A of of adverse reactions compared to the medicinal productsdose given singly. Afexofenadine clinical drug-drug interaction showed that of co-administration of apalutamide (a(aweak resulted 30%%study decrease AUC fexofenadine. apalutamide weakinducer inducerofofP-gp) P-gp)and andaasingle singleoral oral dose of 30 mg fexofenadine resulted ininaa30 decrease ininAUC of fexofenadine.

NoNo apalutamide (a weak inducer of P-gp) and a single oral dose of 30 mg fexofenadine resulted in a 30 % decrease in AUC of fexofenadine.

No interaction with aluminiumand and magnesium magnesiumhydroxide hydroxidegels gels1515minutes minutes prior fexofenadine interaction withomeprazole. omeprazole.Administration Administrationof ofan an antacid antacid containing aluminium prior to to fexofenadine interaction with omeprazole.

Administration of an antacid containing andgastrointestinal magnesium hydroxide 15 minutes prior fexofenadine hydrochloride caused a areduction ininbioavailability, most due toaluminium binding in inthe the gastrointestinal tract.ItItisgels isadvisable advisable leave 2tohours between hydrochloride caused reduction bioavailability, most likely binding tract. toto leave 2 hours between hydrochloride caused a reduction in bioavailability, most likely due to binding in the gastrointestinal tract.

It is advisable to leave 2 hours administration magnesium hydroxide hydroxidecontaining containingantacids. antacids.Pregnancy Pregnancyand andLactation: Lactation: between administrationofoffexofenadine fexofenadinehydrochloride hydrochlorideand and aluminium aluminium and magnesium administration of fexofenadine hydrochloride andNo aluminium and magnesium containing hydrochloride antacids.

Pregnancy and Lactation: Pregnancy:DoDo not useunless unlessclearly clearlynecessary. necessary.

No adequate from use ininpregnant women.

Pregnancy: not use adequate data from the thehydroxide useof offexofenadine fexofenadine hydrochloride pregnant women.

Pregnancy: Do not use unless clearly necessary.

No adequate data from thewith userespect of fexofenadine inembryonal/foetal pregnant women.

Limitedanimal animal studies do not not indicate direct or or indirect indirect effects totoeffects on Limited studies do indicate direct harmful effects with respect effectshydrochloride onpregnancy, pregnancy,embryonal/foetal Limited animalparturition studies do indicate direct or indirect harmful Not effects with respectNo to data effects pregnancy, embryonal/foetal development, parturition postnatal development.

Breast-feeding: recommended. the content human after development, orornot postnatal development.

Breast-feeding: Not recommended.

No dataon onon the contentofof humanmilk milk after development, parturition or postnatal development.

Breast-feeding: Not recommended.

No data on the content of humanwas milk after administeringfexofenadine fexofenadinehydrochloride. hydrochloride. However, However, when when terfenadine terfenadine was found to to administering was administered administeredtotonursing nursingmothers’ mothers’fexofenadine fexofenadine was found administering fexofenadine hydrochloride.

However, when terfenadine was administered to nursing mothers’ fexofenadine was found to cross into humanbreast breastmilk. milk.Fertility: Fertility:No Nohuman humandata data available. available. Ability to profile andand cross into human to Drive Driveand andUse UseMachinery: Machinery:Based Basedononthe thepharmacodynamic pharmacodynamic profile cross into human breast milk.

Fertility: No human data available.

Ability to Drive and Use Machinery: Based on the pharmacodynamic profile reported adverse reactions it is unlikely that fexofenadine hydrochloride tablets will produce an effect on the ability to drive or use machines.

In and reported adverse reactions it is unlikely that fexofenadine hydrochloride tablets will produce an effect on the ability to drive or use machines.

In reported adverse reactions it is unlikely that fexofenadine hydrochloride tablets will produce an effect on the ability to drive or use machines.

In objective tests, Fexo Allergy Relief has been shown to have no significant effects on central nervous system function.

This means that patients objective tests, Fexo Allergy Relief has been shown to have no significant effects on central nervous system function. This means that patients objective tests, Fexo Allergy Relief has been shown to have no significant effects on central nervous system function.

This means that patients may drive or perform tasks that require concentration.

However, in order to identify sensitive people who have an unusual reaction to may drive or perform tasks that require concentration. However, in order to identify sensitive people who have an unusual reaction to may drive products, orproducts, perform that require concentration. in order to or identify sensitive people tasks. who have an unusual reaction to medicinal advisable check theindividual individualHowever, response before driving complicated Effects: Nervous medicinal itittasks isisadvisable totocheck the response before driving orperforming performing complicated tasks.Undesirable Undesirable Effects: Nervous system disorders: Common: headache, drowsiness, dizziness.

Gastrointestinal disorders: Common: nausea.

General disorders and administration medicinal products, it is advisable to check the individual response before driving or performing complicated tasks.

Undesirable Effects: Nervous system disorders: Common: headache, drowsiness, dizziness. Gastrointestinal disorders: Common: nausea. General disorders and administration site conditions: Uncommon: fatigue.Refer Refer tothe theSPC SPC for other otherGastrointestinal undesirable effects.

Marketing Authorisation Holder: Rowa Pharmaceuticals system disorders: Common: headache, drowsiness, dizziness. disorders: Common: nausea. General and administration site conditions: Uncommon: fatigue. to for undesirable effects.

Marketing Authorisation Holder:disorders Rowa Pharmaceuticals Limited., Newtown, Bantry, Co. Cork.

Marketing Authorisation Number: PA0074/096/001 Further information and SPC from: site conditions: Uncommon: fatigue.

Refer to the SPC for other undesirable effects.

Marketing Authorisation Holder: Rowa Pharmaceuticals Limited., Newtown, Bantry, Co. Cork. Marketing Authorisation Number: PA0074/096/001 Further information and SPCare areavailable available from: Rowex Ltd., Bantry,Bantry, Co. Cork.

Freephone: 1800 304 400 Fax: 027 50417 E-mail: rowex@rowa-pharma.ie Limited., Newtown, Co. Cork.

Marketing Authorisation Number: PA0074/096/001 Further information and SPC are available from: Rowex Ltd., Bantry, Co. Cork. Freephone: 1800 304 400 Fax: 027 50417 E-mail: rowex@rowa-pharma.ie LegalLtd., Category: Not Subject to medical prescription.

Date of 027 Preparation: September 2024 CCF FOR API: 26741 Rowex Bantry, Co. Cork.

Freephone: 1800 304 400 Fax: 50417 E-mail: rowex@rowa-pharma.ie Legal Category: Not Subject to medical prescription. Date of Preparation: September 2024 CCF FOR API: 26741 Legal Category: Not Subject to medical prescription. Date of Preparation: September 2024 CCF FOR API: 26741 Adverse events should be reported. Reporting forms and information can be found on the HPRA website (www.hpra.ie) or by Adverse events should be reported. Reporting forms and information can be found on the HPRA website (www.hpra.ie) or by emailing Rowex pv@rowa-pharma.ie Adverse events be reported. Reporting forms and information can be found on the HPRA website (www.hpra.ie) or by emailing Rowexshould pv@rowa-pharma.ie emailing Rowex pv@rowa-pharma.ie

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

Date of preparation: (02/2025) CCF: 26995

Date of preparation: (02/2025) CCF: 26995 Date of preparation: (02/2025) CCF: 26995 Date of preparation: (02/2025) CCF: 26995

Supply status: Supply through pharmacies only

Supply status: Supply through pharmacies only Supply status: Supply through pharmacies only Supply status: Supply through pharmacies only

8

News

New Survey Confirms Strong Support for Expanded Pharmacy Role The Irish Pharmacy Union (IPU) has welcomed new research confirming overwhelming public support for expanding pharmacy services but warns that the profession cannot deliver without action to address a 17-year state fee freeze and severe resourcing challenges.

IPU President Tom Murray 5. 77% of people say GP appointment wait times are increasing, highlighting the urgency of enabling other parts of the health system to step up to build capacity.

The Pharmacy Index 2025 by IPSOS B&A based on a survey of over 2,000 members of the public shows that Irish people not only trust pharmacists but also want them to play a greater role in healthcare delivery. However, despite rising expectations, community pharmacies are still operating under outdated funding models that threaten the sustainability of services.

Speaking at the National Pharmacy Conference, IPU President Tom Murray said, “These survey results reaffirm that patients want more care through their local pharmacy.

Pharmacists are ready and government policy is now moving in the right direction. Our vision is to expand pharmacy care in a way that strengthens the whole health system. We want to deliver more, and we want to deliver it now, with the right support structures in place.”

1. Over half, 51%, of the adult population visited a pharmacy in the past week

“Initiatives like pharmacy prescribing and support for common conditions services can be truly transformational, and to succeed, they must be built on a solid and sustainable foundation that is adequately resourced.

2. 97% trust the advice they receive from pharmacists

Funding Model Needs to be Addressed

3. 95% are happy with the quality of professional service they receive

Mr Murray warned that to realise the full potential of pharmacies and pharmacy services there needs to be a meaningful commitment to addressing the underfunding of pharmacies.

Key Findings

4. 94% support pharmacy prescribing; 92% would avail of health screening in pharmacies; and 95% want pharmacies to support medicine adherence

“A key enabler is the state funding model for pharmacy, which

has not changed in 17 years, despite rising demand, expanded responsibilities, and increasing operational costs. At a time when inflation has significantly increased the cost of delivering healthcare, pharmacies are being asked to do more, deliver a quality service, and shoulder greater responsibility, while effectively being paid less, due to the regressive nature of our fee structure.

“A properly resourced pharmacy network can reduce pressure elsewhere, improve outcomes, and deliver better value for the health service. But right now, too many pharmacies face unsustainable conditions with one in ten pharmacies operating at a loss, and nearly a third are on the brink.

Some have already been forced to reduce hours or scale back services, directly impacting patient access and continuity of care.

“Modernising the funding framework is a strategic investment in the future of primary care,” Mr Murray added. “With the right foundation, pharmacies can do even more for patients, for communities, and for the health system as a whole.”

In conclusion he said, “The IPU welcomes the commitment of the new Minister for Health and ongoing engagement with the profession. Now, we seek clarity and a firm timeline for delivering the two essential enablers of expanded pharmacy care: fair and sustainable funding, and the rollout of new services.”

PMI Stakeholder Briefing The Pharmaceutical Managers’ institute will host a Stakeholder Breakfast Briefing on Thursday 12th June in the Address Hotel, Citywest. This breakfast briefing will explore the increasingly critical topic of obesity and it’s link to other chronic diseases.

Obesity is a highly complex chronic disease, intricately linked to other chronic diseases such as diabetes, cardiovascular issues and endocrine disorders. This breakfast event will bring together a panel of experts from patient advocacy groups, HCPs and key industry stakeholders. It will provide an excellent opportunity to engage with thought leaders at the forefront of healthcare innovation.

This event will feature a brief presentation from each of the speakers who will then form a panel discussion to delve into the subject of obesity as a chronic disease. Speakers include Dr Jean O’Connell, Endocrinologist – St Columcille’s Hospital & St Vincent’s University Hospital and Susie Birney, Executive Director for the Irish Coalition for People Living with Obesity (ICPO).

Visit www.thepmi.com for further information.

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Digital Mental Health Minister for Mental Health, Mary Butler TD, hosted a high-level International roundtable event on digital mental health in Dublin city centre on Monday 12 May 2025.

Organised in collaboration between the Department of Health, the Health Service Executive (HSE), and the eMental Health International Collaborative, the purpose of the event was to engage national and international stakeholders about how best to use digital technology and AI to augment the delivery of Mental Health care services in Ireland.

With a focus on a) digital mental health strategy and implementation and b) the role of artificial intelligence (AI) in mental health, the objectives of the roundtable were: • To develop a shared understanding and awareness of digital health opportunities for Mental Health care, • To ensure a collective commitment to achieving successful outcomes of deployment of digital in Mental Health care, • Examine emerging international best practices in the digital Mental Health domain and examples of implementation by the Irish Government, and service providers, • Examine the role of digital technologies in improving access, easing workforce constraints, and providing early intervention, • Explore potential opportunities for international collaboration to further Ireland’s aims, and • Provide an opportunity for Irish stakeholders to share their existing and emerging work in digital mental health.

Speaking at the event, Minister Butler said, “It's crucial that digital supports don't replace face-to-face interactions, which are vital for providing connection and compassion to those experiencing mental health issues.

“Just as we ensure that evaluation is part of good service and policy implementation to learn from our experiences, we must do the same with our digital mental health services. This way, we can balance the opportunities technology brings with the associated risks.”

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10

News

Fleming Medical “Before Damage is Done” Donation Following the overwhelming success and public engagement of last year’s campaign, Fleming Medical is proud to continue its support for the Irish Heart Foundation’s national blood pressure awareness campaign, ‘Before Damage is Done’.

Mark Fleming, Founder and Owner Fleming Medical hand over the donation cheque to Cliodhna Burke, Irish Heart Foundation

we saw last year with pharmacies stepping up to offer checks and advice was inspiring. We're proud to renew our support for the Irish Heart Foundation and urge even more pharmacies to join us in tackling high blood pressure before damage is done.”

Join the Campaign

stroke, heart disease, and kidney failure if left undetected. Known as the “silent killer,” it affects millions globally—many without their knowledge.

As part of its 2025 commitment, Fleming Medical pledged to donate 9% or 11% to the Irish Heart Foundation on pharmacy’s behalf—helping support lifesaving work across Ireland.

This year, the partnership is back with a renewed focus on raising awareness and promoting early blood pressure checks,

particularly for adults aged over 50, where the risk of hypertension significantly increases.

A Nationwide Movement to Protect Heart Health High blood pressure often presents no symptoms but can lead to serious conditions such as

In 2024, 72 pharmacies across Ireland participated in the ‘Before Damage is Done’ campaign, offering free blood pressure checks and valuable advice to members of their local communities.

Building on that success, Fleming Medical is encouraging even more pharmacies to get involved this year to help empower individuals to take proactive steps in managing their heart health.

“This campaign reflects the incredible power of healthcare providers and community,” said Mia Fleming, Commercial Manager at Fleming Medical. “The impact

Pharmacies interested in taking part in this year’s ‘Before Damage is Done’ campaign are encouraged to contact their Fleming Medical sales representative or call 1800 307777 for further details. All participating locations will receive campaign resources, in-store signage, and training support to help make a lasting difference in public health.

About Fleming Medical Founded over 35 years ago, Fleming Medical is an Irish family-owned business and a trusted provider of diagnostic, wound care, first aid, and sports therapy solutions. With a strong focus on empowering pharmacies and healthcare professionals, Fleming Medical’s Medicare LifeSense range continues to support cardiovascular wellness through high-quality, accessible medical technology.

Celebrating Excellence and Innovation A researcher using virtual reality and other cutting-edge technology to improve men's health, a spin-out company revolutionising how seizures are detected in newborns, and a palaeontologist who uncovered a fossil forgery were among the awardees honoured for their contributions to research and innovation at the 2024 University College Cork (UCC) Research and Innovation Awards.

Researchers were awarded across twenty-two categories, five of which recognise specific achievements in entrepreneurship and innovation.

Joint winners of the Research Career Achievement Award were Professor Caitriona O'Driscoll and Professor Alan Dobson. Professor O’ Driscoll was recognised for her pioneering contributions to non-viral RNA drug delivery, leadership in establishing Ireland’s first School of Pharmacy and regulatory science programmes, and her global impact on advanced therapeutics through

research, mentorship, and policy engagement. Professor Alan Dobson was awarded for his outstanding and sustained contributions to environmental microbiology, research leadership, and science policy at national and international levels, exemplified by his influential roles across academia, government, and major scientific institutions.

Dr Mohamad Saab is the recipient of the Vice President for Research & Innovation Award for Interdisciplinary Research. Based in UCC’s School of Nursing and Midwifery, Dr Saab was awarded

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for his innovative, high-impact research that uses virtual reality and other cutting-edge technology to improve men's health, particularly around the area of testicular cancer. In 2024, he led three key projects, most notably TRANSCEND-XR, a ¤6 million project funded by Horizon Europe.

This initiative aims to improve how adolescent and young adult testicular cancer survivors understand and manage the longterm effects of treatment, using extended reality (XR) technology.

The UCC 180 Professor Adrian Dixon Prize for Postdoctoral

Researcher of the Year was presented to Dr Valentina Rossi from UCC’s School of Biological, Earth, and Environmental Sciences (BEES). As a leader in her field, Dr Rossi is recognised for her outstanding contributions to palaeontology.

The award for Spin-out of the Year was awarded to Neurobell.

Founded by Dr. Mark O’Sullivan, Dr. Alison O’Shea, and Colm Murphy in 2023, Neurobell is a spin-out from UCC and the Irish Centre for Maternal and Child Health Research (INFANT).

Heart Health Awareness Join Fleming Medical in supporting the Irish Heart Foundation’s national blood pressure awareness campaign, ‘Before Damage is Done’.

Encouraging adults, particularly those aged over 50 to get their blood pressure checked in their local pharmacy. Participating pharmacies will receive campaign merchandise, in-store informational resources, and a blood pressure monitoring information session.

Supported by

Contact your local Sales Representative for more information about how to be a participating pharmacy and get involved in supporting the Irish Heart Foundation.

Help us to exceed the 2024 donation of €25,000 to the Irish Heart Foundation* *Based on your offer choice, each pack includes a heartfelt 9% or 11% donation to the Irish Heart Foundation–made on your behalf–helping support life-saving work across Ireland.

For further information on this campaign and to view the Medicare LifeSense® Blood Pressure range, scan our QR Code.

FLEMINGMEDICAL.IE

@Medicarefirstaid

@Medicarefirstaid

@Medicare1staid

Contact us on Freephone: 1800 307777 or Email: pharmacy@flemingmedical.ie

12

News

Access to Medicines: Ireland Remains at Bottom Ireland continues to rank among the bottom of Western European countries when it comes to availability of newly licensed cancer treatments, according to a new report by data analysts IQVIA for EFPIA, the European pharmaceutical body.

The survey of 36 European countries covers the full four years between 2020 and 2023 analysing 173 innovative medicines authorised for use by the European Medicines Agency (EMA). Key points: • Of the 56 oncology medicines which were granted an EMA licence since 2020, only 14 or 25% are currently available in Ireland. Of Western European countries this is the lowest rate of availability for cancer medicines which means treatment options are more limited here.

• Cancer patients in Ireland continue to wait almost two years or 644 days, post EMA authorisation, to access newly licensed medicines. This is 55 days longer than last year and above the EU average of 586 days.

• The overall time to make a medicine routinely available in Ireland has lengthened significantly since 2020 when it took 477 days: in 2024 it was 645 days.

Longer access to medicines timelines in Ireland mean a lower standard of care than could be available for patients. Lower rates of availability for cancer medicines means inferior treatment options for patients and clinicians than is routinely available in the UK and elsewhere in Europe.

The experience of other countries, which in some cases can make medicines available in half the time while still managing budgets and doing value for money assessments, demonstrates that improved partnerships between health authorities and pharmaceutical companies are possible and should become a policy priority in Ireland. Indeed, in the Programme for Government there is a recognition of the delays within the system with a commitment to ensure that patients have access to new medicines ‘as quickly as possible.’

During 2025 there is an opportunity to address the deficiencies within the Irish reimbursement and pricing system via the

Framework Agreement on the Pricing and Supply of Medicines.

The current agreement is due to expire in September. Based on the above figures, it is clear that the reimbursement system needs to be resourced, governed and designed to operate within the legal 180-days timeline for HSE decisions set by the Oireachtas in 2013. IPHA are not calling for a change to the law but rather reform of the system to ensure all parties involved adhere to the legislation and the process delivers what the legislation promises.

Oliver O’Connor, Chief Executive of the Irish Pharmaceutical Healthcare Association, said.

“Earlier this year, IPHA published a position paper making the case for Faster and Fairer Access to Medicines by measuring access timelines against the Health Act 2013, which obliges the HSE to make decisions on applications for reimbursement of new medicines within 180 days. This report analysed IPHA medicines reimbursed in Ireland during the

period 2022-2024 and found that 86% were in excess of the 180 days allowed to the HSE. The figures released by EFPIA today are a further indication of the inefficiencies within the system in Ireland, while patients continue to wait for the care they deserve.

“Patients in Ireland deserve better, and we can do better, if the political and administrative desire is there. Pharmaceutical treatments can represent a lifeline to cancer patients, significantly enhance quality of life and change the prognosis of individual patients.

“IPHA has proposed Five Key Principles of mutual commitments that should be included in the new Framework Agreement. If adopted, these principles will improve patient care in Ireland through quicker access to innovative medicines. We look forward to engaging with the State over the coming months to ensure we reverse the trend of slower access to medicines in Ireland going forward”.

Supporting Pharmacies with Tools That Make a Difference At United Drug Wholesale, we’re always looking for new ways to support our pharmacy partners. That’s why we’ve introduced a new added-value service: Point of Sale (POS) kits designed to help you boost visibility and drive sales in-store.

Each kit contains everything you need to bring your displays to life, with general and seasonal signage covering key campaigns such as Father’s Day, Suncare and Allergy Relief. The materials are easy to use and ready to go, helping your team create eye-catching displays without adding to your workload.

But that’s not all, we’re also supporting your professional development with UD Talks, our podcast series created for busy pharmacy teams. We know how hard it can be to find time for learning, so we’ve made it easier to access expert-led content whenever it suits you, whether that’s on your commute, over lunch or while catching up on admin.

UD Talks offers high-quality, practical insights on important topics like Naloxone and Overdose

Awareness, Sepsis Awareness, Sexual Health, Long Covid and the Future of Pharmacy with Joanne Kissane. It’s a flexible way to stay informed and up to date with the latest in pharmacy care and policy, all while on the go. And there’s more to come with even more interesting and insightful episodes due to be released over the coming months, there’s plenty to look forward to.

Together, these initiatives reflect United Drug Wholesale’s ongoing commitment to providing pharmacies with the tools and resources they need to succeed, both on the shop floor and beyond.

To find out more about the POS Kits or the UD Talks podcast series, contact the Marketing Team at UDWMarketing@united-drug.com

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For more information and to subscribe to UD Talks contact the United Drug Marketing Department on udwmarketing@united-drug.com

Axium Buying Group:

Your one-stop independent pharmacy ordering platform What is Axium?

Axium is an established order management solution that provides speed, convenience and single pack replenishment to pharmacies when ordering dispensary medicines, front-of-shop lines and consumables, from multiple suppliers in the market. Axium customers have the confidence that the products they are ordering are in stock at the time of order, along with receiving the best possible discount. Navi Group maintains the highest industry quality and information security standards with ISO 9001 and ISO 27001, making us a leader in process management and information technology within the sector.

Why choose Axium?

PRICING STRENGTH AND HIGH MARGINS • Axium has the combined buying power of 600+ independent community retail pharmacies • Dedicated to increasing our pharmacy partners' margins and enhancing operational efficiencies in independent pharmacy • For Axium customers, standard and enhanced discounts are displayed at line level on invoice and customers have access to line level reporting in the interest of transparency • Axium has very competitive second and third line generics to ensure margins are being maximised when stock shortages occur • The number of ULMs in Irish pharmacies is growing constantly.

To support lean operations and prevent lost margin, Axium has a range of ULM suppliers on our system • As an Axium customer, you will have access to Axel, our award-winning OTC and front-of-shop ordering system.

This houses a wide range of key pharmacy suppliers in the market, ensuring our pharmacies are achieving the best price across these products

DEDICATED BUSINESS DEVELOPMENT MANAGER • Highly experienced team of BDMs to offer best in industry levels of service and advice to our pharmacy partners • Monthly face-to-face visits to pharmacies • Your Business Development Manager is focused on highlighting margin-enhancing opportunities and ensuring most efficient ordering is taking place • Across our network of 600+ customers, Navi Group have a team of 10 people dedicated to making independent pharmacy more profitable STOCK • Axium have electronic back order and allocation features to ensure our members best access to stock and insight on what their allocation is

SUPPORT • Always-on Customer Service support • Team of pharmacy technicians to answer all queries via phone, e-mail or interactive chat function • In-store and remote training provided for pharmacy teams One stop shop Axium has all lines under one platform, which negates the need to move between multiple ordering sites; this can result in operational errors, negatively impacting store margin. Axium is dedicated to supporting and protecting independent pharmacies and has developed reporting solutions to identify where operational errors are occurring. Our BDMs will provide insights on process improvements and key actions to improve business performance.

Coming soon:

EFFICIENCY

Navi Group are building a user dashboard where we will be able to provide a single sign-on to Navi products and services and provide owners with clear business insights that are actionable in store, such as:

• User-friendly ordering platform helps save time

- Transparency on all discounts achieved through Axium

• Automated pack replacement ordering, eliminating bulk-buying

- Highlight margin-enhancing opportunities

• All discounted lines on one platform

- Items and items’ benchmarks within the industry

• All wholesale lines set up to provide a one-stop ordering system

- Claims scores

• Provide regular customer updates on upcoming manufacturer shortages and recommended alternatives

• Consistency in supply

- Impact of reimbursement prices on pharmacy profitability year on year

Get in touch

Aisling Smith Head of Business Reletionship Management 087 786 4803

Sarah Leadbetter Business Development Manager North Leinster Region, 087 393 7073

Paul Coleman Business Development Manager Munster Region, 087 687 8018

Philip Morrissey National Sales Manager 087 441 6072

Clodagh Maguire Business Development Manager Connacht and Ulster Region, 087 091 2165

Part of Navi Group

Jean Tomkins Business Development Manager Leinster Region, 087 183 7293

16

Acne Vulgaris

The Role of Diet in Acne Vulgaris – How to Separate out Fact from Fiction?

Introduction: Acne is one of the most common skin conditions globally, affecting approximately 85% of teenagers, although acne lesions can persist into adulthood.1-5 Much has been made of the potential associations with our diet, with almost everything coming under scrutiny at some time or other e.g., fruits, vegetables, high-fat foods, saturated fat, eggs, dairy, carbohydrate, fish.6,7 Common acne (Acne vulgaris) is a chronic disease characterised by skin lesions that result from the inflammation of plugged pilosebaceous units (i.e., hair follicles) in the skin.5, 7 Several factors have been shown to be involved in acne development including increased sebum production, increased keratinocyte proliferation, colonisation of hair follicles by Cutibacterium acnes (previously known as Propionibacterium acnes) and complex inflammatory mechanisms.1,5,8 Written by Desmond J. Tobin PhD, FRCPath, FRSB, FIBMS, FRMS, FIoT, MRIA. Charles Institute of Dermatology, School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland T: +353 1 716 6282 E: desmond. tobin@ucd.ie

Several risk factors for acne development have been identified including increasing age during adolescence, a positive family history of acne (reflecting associated inherited genes), and an oily skintype.1, 9 There is some evidence for an association with smoking and increasing body mass index (BMI).3,10 In addition to the genetics of acne-prone families, there also appears to be an increased risk of acne in the West, and lower prevalence in non-western populations.7 While this is likely to reflect different genetic associations at population level, it may also reflect differences in diet, lifestyle, BMI and physical activity. The development of acne in some non-western populations after they adopt a Western diet and lifestyle provides insights into how diet may also play a role.7,11,12 However, even here genetic differences are likely to predominate.12 Diet and Acne: Diet has long been implicated in the development of acne,13 with early research suggesting a role for carbohydrates and chocolate in the

development and severity of acne, albeit with mixed/contradictory results.14 More recently, studies have examined the potential role of glycaemic index diets, milk/dairy, omega-3 fats and other nutrients6.

It is important to understand some of the mechanisms that may be involved in the relationship between diet and acne.

Insulin and Insulin-like Growth Factor 1 (IGF-1) in Acne Vulgaris: Insulin resistance and IGF-1 may play a role in the pathogenesis of acne6. Raised serum levels of IGF-1 have been reported in patients living with acne, including associations with severity of acne.15 It is important to note that IGF-1 levels rise naturally during puberty, stimulating the synthesis of androgens,12 with both hormone types influencing sebum production.13, 15, 16 Increased sebum production facilitates the colonisation of hair follicles by Cutibacterium acnes, the bacteria most closely associated with acne lesions.17 Higher levels of IGF-1 have been observed in women with acne

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than in controls.18 It is important to note that circulating levels of IGF-1 are genetically controlled.

Indeed, some variants of the IGF-1 gene (especially the IGF-1 (CA) 19 polymorphism) may be significantly more common in those with acne19. Moreover, circulating levels of IGF-1 in blood vary by age, gender, BMI, and smoking.7,20

diets. Thus, we can conclude that at least some of the observed effects of a low GI diet may be related to other dietary and body composition factors.27 Still, readers should note that the number of studies overall in low, and that most of these are of the weaker observational type, with few robust intervention studies reported.

Dietary Glycaemic Index (GI) and Acne: The observations that high glycaemic index (GI) diets and milk consumption can increase insulin and IGF-1 have led to an assumption that diet may contribute to acne incidence and its severity.14,15 Adolescents who routinely consume a diet of high GI carbohydrate foods may develop acute hyper-insulinaemia, which in turn results increases IGF-1 levels and acne.15,20 While several studies report an association between insulin resistance, glycaemic load (GL) and acne vulgaris,5,21 not all study have.22,23 For example, in a 12-week study of 43 males with acne who followed either a low GI diet or a standard diet, acne lesion counts decreased significantly in those consuming a low GI diet compared to controls.24 Similarly, a 10-week study of 32 patients with mild to moderate acne reported significant clinical improvement in acne lesions, reduced inflammation, and reduced size of sebaceous glands in those who were randomly assigned to a low glycaemic load diet versus a control diet.25 Importantly, IGF-1 levels fell significantly in those on a low glycaemic diet,20 although the associated weight loss may be a factor in the improved acne scores.

The UK-based NICE guidelines on the management of acne28,29 have remained cautious. While they acknowledge that there may be some evidence that a low-glycaemic load diet may improve acne, because most acne sufferers are young and at an age when eating disorders are most common, they make no recommendations for a low GI or low GL diet in the management of acne. This is likely in part to avoid any perception of encouraging a focus on weight loss or finicky eating in this potentially vulnerable population group.

Low GL diet may lead to changes in the ratio of saturated to monounsaturated fatty acids in sebum that correlate with lower acne lesion counts and reduced sebum outflow,26 indicating that acne development in likely to be multi-factorial. As low GI/GL load diets are typically higher in fibre and lower in fat, participants frequently lose weight on these

Milk and Acne: Milk and dairy products have also been implicated in the etiology of acne.13 While many studies have not found any association between dairy consumption and acne frequency or severity,13 some studies, albeit on the observational type, have. Despite all the internet chatter on this subject, there are unfortunately, no intervention trials examining the effect of dairy and acne.7 Thus, in the absence of robust data, the untested and so unproven assumption of a causal link between diary and acne is likely due to the observation that IGF-1 levels may increase with dairy consumption.7,15 This view however, may not adequately acknowledge the impact of multiple other foods and nutrients on raising circulating IGF-1 levels, including high protein, red meat, fish, seafood and zinc.30,31 While milk itself contains IGF-1, it is unlikely that this IGF-1 protein would be absorbed intact from foodstuffs by most consumers.32

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18

Acne Vulgaris

Weak observational-type studies that have attempted to examine the potential effects of dairy on acne, tend to depend on recall.

This may be recall of usual dietary intakes from over a decade or more,33 including from during a person’s hectic school years or even recalling whether they had ever been formally diagnosed with acne by a clinician. Despite the weaknesses of studies of this type, a stronger acne association appears to be made for skimmed/ low-fat milk rather than for whole milk. This is interesting, given that the food ‘matrix’ of whole milk is substantially altered when deriving these processed low/no-fat milk varieties (e.g., the reduction/ loss of fat-soluble nutrients e.g., Vitamin A). This is because most are generated by centrifuging whole milk to force fat droplets separation. For example, a casecontrol study of 358 acne patients and 205 matched controls found that frequent consumption of total milk and skim milk, but not whole milk or cheese, was positively associated with acne.27 However, a cross-sectional study among 714 adolescents found that while higher BMI was associated with acne, the consumption of semiskimmed milk, cream cheese, low fat cheese, yoghurt and ice cream was not.34 Strikingly, the Danish General Suburban Population Study of 20,416 adults found no link between milk intake and acne.35 While it has been difficult to sort through a literature based mostly on weak observational-type study design (rather than intervention studies), timeline-unrestricted

meta-analyses can be useful. One recent such meta-analysis7 of 34 studies (410 articles examined i.e., with almost 90% failing the inclusion criteria) concluded that while high glycaemic index, increased glycaemic load, and carbohydrate intake have a modest (but significant) effect in acne, any association with increased dairy consumption was much less clear. Included studies reporting an association between dairy and acne had a level of evidence somewhat lower than those studies that did not show an association.

Indeed, some studies showed a negative association. One study conducted in a population not consuming a western diet reported that increased milk consumption decreased the risk of acne scarring. Thus, careful review of the existing literature would suggest that there remains insufficient evidence to recommend milk restriction as a treatment for patients with acne.13 It is a prudent public health message therefore, that we do not recommend children, adolescents and even young adults to curtail their intake of dairy products, given that these are a major source of critical calcium and iodine. It should be noted that table salt in Ireland is not iodized. Calcium and iodine are important elements for bone and brain development during pregnancy and infancy. It has been estimated by the European Food Safety Authority that Irish adolescents need 1,150 mg of calcium per day,36 so removing dairy products from the diets

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of adolescents may negatively affect calcium and iodine intakes.

Acne patients should therefore be referred to a registered dietitian if a milk-/dairy-free diet is ever to be attempted, so as to ensure their crucial calcium, iodine and protein requirements are being met. To highlight the significant public health concerns in this area, the UK-based NICE guidelines on acne has concluded that there is not sufficient evidence to recommend restricting milk or dairy foods as part of the treatment for acne.28 Fish, Omega-3 Fats and Acne: Populations with higher intakes of omega-3 fatty acids and fish consumption are reported to have lower rates of acne.27,37 Moreover, studies also show that patients with acne are significantly more likely to have lower blood levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).30 This is important, as the omega-3 fatty acids (EPA) and (DHA) are well known for their antiinflammatory properties, reducing pro-inflammatory cytokines, eicosanoids, and IGF-137. This suggests that both have the potential to alleviate acne severity, especially when dietary deficits are identified.37-39 Specifically, Gamma linoleic acid (GLA) is reported to have anti-inflammatory effects on human skin epidermis,39 while a randomised controlled trial assessed the value of 2000 mg EPA and DHA dietary supplements versus 400 mg supplement of gamma linoleic acid in 45 patients with acne39 versus a control group. Acne lesions decreased significantly in both the fish oil and

borage oil groups compared to the control group after 10 weeks.

Discussion While the strongest risk factor for acne is a positive family history, several other factors play a role, including body, weight and smoking etc.3,10 Observational studies, albeit not a robust study type, suggest that high GI diets and higher consumption of milk may increase risk and severity of acne. By contrast, more robust intervention-type studies show very mixed results with respect to low GI diets. Unfortunately, there are still no published intervention-type studies examining dairy consumption and acne development or severity.

While omega-3 fats EPA and DHA may play a role in reducing acne incidence and severity, there is limited evidence of the effect of any one specific dietary factor in acne. Advice on healthy eating is important with people living with acne e.g., increasing fibre, fruits, vegetables and wholegrains, fish consumption while reducing the consumption of high-GI foods.

Finally, if dietary treatment for acne is being considered, referral to a dietitian will allow a global review of diet including glycaemic index, dairy, omega-3 fatty acids.

In this way, patients should put be put at risk of key nutrient deficiencies, such as calcium, iodine, and others from restrictive often fad-based diets that are not based on evidence.

References available on request

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20

Men’s Health

Living it UP - Even if You are Down and Talking is Good Mental Health in men: Recognising the Warning Signs Mental health issues affect men of all ages and backgrounds, yet stigma and pride often delay diagnosis. In Ireland, suicide continues to be one of the primary causes of death for Irish men under 45, highlighting a national mental health crisis. Common conditions like depression, anxiety, and substance misuse continue to go underdiagnosed.

Written by Eamonn Brady (Pharmacist). Whelehans Pharmacies, 38 Pearse St and Clonmore, Mullingar.

Tel 04493 34591 (Pearse St) or 04493 10266 (Clonmore), Mullingar. www.whelehans.ie

Men are less likely to present with sadness or emotional distress and more likely to show signs such as irritability, anger, withdrawal, and even physical symptoms like fatigue or chest tightness.

Many only seek help when in crisis. As primary care providers, pharmacists can spot these early signs and signpost discreetly.

For moderate to severe depression or anxiety, medication plays a valuable role alongside talking therapies. SSRIs such as sertraline and escitalopram, along with SNRIs like venlafaxine, are frequently prescribed options.

Mirtazapine is often favoured where sleep disturbance or appetite issues are present. Men must be counselled on side effects, including the potential impact on libido and sexual function, a key factor for adherence. CBT and structured supports, such as SilverCloud or HSE-recommended talking therapies, remain first-line.

Encouraging regular exercise, routine, and social connection is equally important. Initiatives like Men's Sheds and workplace wellness programmes can offer peer support.

Alcohol and Mental Health in men: Masking Pain, Fueling the Fire Alcohol continues to be a double-edged sword for many Irish men; used as a crutch to cope with mental health challenges, yet often worsening the very symptoms it aims to numb. While a pint with friends may offer short-term relief, chronic or binge drinking can lead to serious psychiatric consequences.

Studies suggest that up to onethird of those with mental illness misuse alcohol, and vice versa.

Alcohol disrupts neurotransmitters like serotonin and dopamine, worsening depression, and anxiety.

It impairs sleep, distorts judgment, and interacts dangerously with psychiatric medications. Many men drink to self-soothe feelings of stress, isolation, or low mood— but the long-term result is often a deepening of symptoms, leading to dependency or crisis. A common saying in Alcoholics Anonymous captures this well: “Alcohol often worsens the very challenges it is used to escape.”

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Men are less likely to seek help and more likely to present with anger, withdrawal, or somatic symptoms. Many don’t realise that their drinking may be masking or triggering underlying mental health conditions such as depression, anxiety disorders, or even early signs of bipolar disorder or psychosis.

Treatment options include:

As pharmacists, we have an opportunity to spot red flags which can include frequent purchases of indigestion remedies, poor sleep aids, or signs of dependence.

Simple screening tools and brief conversations can open the door to help. We should never underestimate our role in signposting men toward services like SMART Recovery, local addiction teams, or HSE mental health resources.

• Lifestyle: Avoiding excess alcohol, caffeine, and ensuring good sleep hygiene are vital.

Encouraging abstinence or moderation is not about judgement; it is about helping men reclaim control over their wellbeing. By tackling alcohol use head-on, we can better support the mental health recovery journey of our patients, helping to replace toxic coping mechanisms with healthier, more sustainable strategies.

Anxiety in men: Beyond Normal Worry

• CBT: structured programmes like CBTi and applied relaxation therapy are HSE-endorsed.

• Medication: SSRIs remain first line. Benzodiazepines (e.g., diazepam) are effective shortterm but should be limited due to dependency risk.

Pharmacists play a vital role by offering reassurance, conducting basic assessments, and referring where needed.

Male Grooming: More Than Skin Deep The male grooming sector is thriving, but it is about more than just appearances. Skincare, haircare, beard care, and even cosmetic procedures are now mainstream. Grooming plays a role in self-esteem, confidence, and mental wellbeing.

Common complaints in pharmacies include: • Razor bumps (pseudofolliculitis barbae) • Seborrheic dermatitis • Acne from occlusive products

Anxiety becomes a disorder when it interferes with everyday life (i.e.)

Anxiety: Beyond Normal Worry

Pharmacists should advise on:

Anxiety becomes a disorder when it interferes with everyday life.

Generalised Anxiety Disorder (GAD) is the most common presentation, affecting up to 5% of adults. In men, it often goes unnoticed as they present with physical symptoms like poor sleep, stomach upset, or headaches.

• SPF 30+ daily for skin cancer prevention

Other forms include panic disorder, OCD, PTSD, and social anxiety. Anxiety often coexists with depression or substance misuse and increases the risk of cardiovascular issues and relationship breakdown.

• Use of non-comedogenic moisturisers

• Medicated shampoos for dandruff or scalp psoriasis Counselling on personal care is no longer trivial; it is a valid entry for broader health discussions Erectile Dysfunction A Vascular Red Flag - ED affects up to 50% of men aged 40–70, though younger men are increasingly affected due to stress, porn-induced anxiety, and lifestyle issues.

Legal Category: Not subject to medical prescription. Supply through pharmacies only. Marketing Authorisation Number: PA23055/016/001 Marketing Authorisation Holder: Upjohn EESV, Rivium Westlaan 142, 2909 LD Capelle aan den IJssel, Netherlands. Full prescribing information available on request from: Viatris, Dublin 17. Phone 01 8322250 Date of Revision of Abbreviated Prescribing Information: 01 Feb 2024 Reference Number: IE-AbPI-ViagraConnect-v004

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Reporting of adverse reactions: Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via HPRA Pharmacovigilance, Website: www.hpra.ie. Adverse reactions/events should also be reported to the marketing autorisation holder at the email address: pv.ireland@viatris.com or phone 0044(0)8001218267.

50 mg

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Indications, Dosage and Administration: Indications: For erectile dysfunction in adult men. Dosage and Method of use: Adults: one 50 mg tablet taken with water approx. one hour before sexual activity. The maximum dosing frequency is once per day. The onset of activity may be delayed if taken with food. Patients should be advised that they may need to take Viagra Connect a number of times on different occasions (max of one 50 mg tablet per day), before they can achieve a penile erection satisfactory for sexual activity. If patients are still not able to achieve a sufficient penile erection they should be advised to consult a doctor. Elderly: no dosage adjustments required (≥ 65 years old).

Renal Impairment: No dosage adjustments for patients with mild to moderate renal impairment.

Dosage adjustments required for those with severe renal impairment, see SmPC. Hepatic Impairment: Dosage adjustments required for those with mild-moderate hepatic impairment, see SmPC. Viagra Connect is contraindicated for patients with severe hepatic impairment (see contraindications). Presentation: Film-coated tablets containing sildenafil citrate equivalent to 50 mg of sildenafil. Contraindications: Hypersensitivity to the active substance or to any of the excipients. Co-administration with nitric oxide donors (such as amyl nitrite), nitrates, ritonavir, guanylate cyclase stimulators (such as riociguat) is contraindicated. Agents for the treatment of erectile dysfunction, including sildenafil, should not be used by those men for whom sexual activity may be inadvisable, and these patients should be referred to their doctor. This includes patients with severe cardiovascular disorders such as a recent (6 months) acute myocardial infarction (AMI) or stroke, unstable angina or severe cardiac failure. Sildenafil should not be used in patients with severe hepatic impairment, hypotension (blood pressure < 90/50 mmHg) and known hereditary degenerative retinal disorders such as retinitis pigmentosa (a minority of these patients have genetic disorders of retinal phosphodiesterases). Sildenafil is contraindicated in patients who have loss of vision in one eye because of non-arteritic anterior ischaemic optic neuropathy (NAION), regardless of whether this episode was in connection or not with previous PDE5 inhibitor exposure. Viagra Connect should not be used in patients with anatomical deformation of the penis (such as angulation, cavernosal fibrosis or Peyronie's disease). Viagra Connect is not indicated for use by women. The product is not intended for men without erectile dysfunction. This product is not intended for men under 18 years of age. Warnings and precautions: Erectile dysfunction can be associated with a number of contributing conditions, e.g. hypertension, diabetes mellitus, hypercholesterolaemia or cardiovascular disease. As a result, all men with erectile dysfunction should be advised to consult their doctor within 6 months for a clinical review of potential underlying conditions and risk factors associated with erectile dysfunction (ED). If symptoms of ED have not improved after taking Viagra Connect on several consecutive occasions, or if their erectile dysfunction worsens, the patient should be advised to consult their doctor. Cardiovascular risk factors: Since there is a degree of cardiac risk associated with sexual activity, the cardiovascular status of men should be considered prior to initiation of therapy. Agents for the treatment of erectile dysfunction, including sildenafil, are not recommended to be used by those men who with light or moderate physical activity, such as walking briskly for 20 minutes or climbing 2 flights of stairs, feel very breathless or experience chest pain. For a list of patients who are considered at low cardiovascular risk from sexual activity see SmPC. Patients previously diagnosed with the following must be advised to consult with their doctor before resuming sexual activity: uncontrolled hypertension, moderate to severe valvular disease, left ventricular dysfunction, hypertrophic obstructive and other cardiomyopathies, or significant arrhythmias. Sildenafil has vasodilator properties, resulting in mild and transient decreases in blood pressure. Patients with increased susceptibility to vasodilators include those with left ventricular outflow obstruction (e.g. aortic stenosis), or those with the rare syndrome of multiple system atrophy manifesting as severely impaired autonomic control of blood pressure. Priapism: Patients who have conditions which may predispose them to priapism (such as sickle cell anaemia, multiple myeloma or leukaemia), should consult a doctor before using agents for the treatment of erectile dysfunction, including sildenafil. Prolonged erections and priapism have been occasionally reported with sildenafil in post-marketing experience. In the event of an erection that persists longer than 4 hours, the patient should seek immediate medical assistance. Concomitant use with other treatments for erectile dysfunction is not recommended. Effects on vision: Patients should be advised that in the event of any sudden visual defect, they should stop taking Viagra Connect and consult a physician immediately. Concomitant use with CYP3A4 inhibitors: patients should be advised to consult a doctor before taking Viagra Connect as a 25 mg tablet may be more suitable for them. Concomitant use with alpha-blockers: Caution is advised when sildenafil is administered to patients taking an alpha-blocker, as the co-administration may lead to symptomatic hypotension in a few susceptible individuals. This is most likely to occur within 4 hours post sildenafil dosing. In order to minimise the potential for developing postural hypotension, patients should be hemodynamically stable on alpha-blocker therapy prior to initiating sildenafil treatment. Thus, patients taking alpha blockers should be advised to consult their doctor before taking Viagra Connect. Treatment should be stopped if symptoms of postural hypotension occur, and patients should seek advice from their doctor on what to do. Effect on bleeding: the use of sildenafil is not recommended in those patients with history of bleeding disorders or active peptic ulceration, and should only be administered after consultation with a doctor. Hepatic impairment: Patients with hepatic or renal impairment must be advised to consult their doctor before taking Viagra Connect, since a 25 mg tablet may be more suitable for them. Lactose: The film coating of the tablet contains lactose. Viagra Connect should not be administered to men with rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption. Sodium: This medicinal product contains less than 1 mmol sodium (23 mg) per tablet. Patients on low sodium diets can be informed that this medicinal product is essentially ‘sodium-free’. Use with alcohol: Drinking excessive alcohol can temporarily reduce a man's ability to get an erection. Men should be advised not to drink large amounts of alcohol before sexual activity. Interactions with other medicinal products and other forms of interaction: Individuals receiving concomitant treatment with CYP3A4 inhibitors must be advised to consult their doctor before taking Viagra Connect, dosing adjustments may be required, see SmPC. Patients receiving alpha blocker treatment should be stabilised on therapy prior to initiating sildenafil treatment and must be advised to consult their doctor before taking Viagra Connect as dosing adjustments may be required, see SmPC. Caution when sildenafil is initiated in patients treated with sacubitril/valsartan, see SmPC. Fertility, pregnancy and lactation: There was no effect on sperm motility or morphology after single 100 mg oral doses of sildenafil in healthy volunteers. Viagra Connect is not indicated for use by women. Undesirable effects: Very common (≥1/10): headache.

Common (>1/100, <1/10): dizziness, visual colour distortions, visual disturbance, vison blurred, flushing, hot flush, nasal congestion, nausea, dyspepsia. For details of uncommon, rare and very rarely reported adverse events and those of unknown frequency, see SmPC.

Viagra Connect (sildenafil) 50 mg film-coated tablets

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Viagra Connect (sildenafil) 50 mg film-coated tablets Please refer to Summary of Product Characteristics (SmPC) before prescribing

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References: 1. European Medicines Agency (EMA), 2024. Viagra: European Public Assessment Report. Available at: https://www.ema.europa.eu/en/medicines/human/EPAR/viagra Last Accessed 4 Jun. 2025.

2. European Medicines Agency (EMA), 2005. Viagra: EPAR – Procedural steps taken and scientific information after authorisation. Available at: https://www.ema.europa.eu/en/documents/ procedural-steps/viagra-epar-procedural-steps-taken-authorisation_en.pdf Last Accessed 4 Jun. 2025.

3. MHRA, 2012. Public Assessment Report: Sildenafil 25mg, 50mg, and 100mg Film-coated Tablets (PL 14894/0588-90; UK/H/3026/001-3/DC). Available at: https:// mhraproducts4853.blob.core.windows.net/ docs/3b7b95ab0606d1ae5b7f251c793ca7caf1e71ee5 Last Accessed 4 Jun. 2025.

4. Medicines and Healthcare products Regulatory Agency (MHRA) (2018) Public Assessment Report: Viagra Connect 50 mg film-coated tablets (sildenafil citrate). Available at: https:// mhraproducts4853.blob.core.windows.net/docs/ b79fb57baf087e3f089a4731039635af4187aff2 Last Accessed 4 Jun. 2025.

IE-VIAC-2025-00007. DOP: June 2025 www.viagraconnect.ie

22

Men’s Health

While often viewed as a sexual issue, Erectile dysfunction (ED) can often signal deeper cardiovascular concerns. The Princeton Consensus recommends ED be treated as a marker of heart health, particularly in men over 30.

Lifestyle changes—weight loss, smoking cessation, and reduced alcohol intake—can dramatically improve ED outcomes. In cases where a psychological component is suspected, referral for counselling is key.

• Health Service Executive (HSE. ie) – Mental Health & Sexual Health Resources

• Journal of Sexual Medicine: Prevalence and Risk Factors of ED in Men Under 40

• World Health Organisation (WHO) Mental Health Action Plan

• Irish Medical Journal (IMJ): Mental Health in Irish Male Adults Post-COVID

Common causes include:

Time to Talk

• Vasculogenic: linked to atherosclerosis and diabetes

Men’s health needs an initiativetaking, non-judgmental approach.

Pharmacists can bridge the gap between stigma and support. By encouraging open conversations, offering practical advice, and referring appropriately, we can play a vital role in improving the health and quality of life of Irish men.

• SIGN Guidelines on Erectile Dysfunction (SIGN 127)

• Journal of Affective Disorders: Anxiety and Cardiovascular Risk in Middle-Aged Men

• Neurogenic: e.g., Parkinson's, MS • Hormonal: low testosterone, thyroid imbalance • Psychological: depression, anxiety, trauma

First-line treatment remains PDE5 inhibitors:

Disclaimer: This article is intended for general information purposes only and should not be considered a substitute for detailed clinical information on the topics discussed.

• Sildenafil (Viagra)

References

• Tadalafil (Cialis) – longer acting

• NICE Clinical Knowledge Summaries (Depression, Erectile Dysfunction, Anxiety)

• Medication: antihypertensives, antidepressants, antipsychotics

These require sexual stimulation to be effective. Pharmacists can now supply sildenafil and Tadalafil OTC after appropriate screening.

• British National Formulary (BNF 85, 2023)

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• Public Health England: Guidance on Mental Health Interventions in Primary Care • Health Products Regulatory Authority (HPRA.ie) – Pharmacovigilance Data • Health Research Board (HRB) Clinical Research Facility at St James’s Hospital • HIQA Health Technology Assessment – Male Sexual Health Services • The Lancet Psychiatry: Men’s Mental Health Trends in Europe (2023) • BMJ: SSRI Effectiveness and Side Effects in Male Patients (2022)

• European Urology: Consensus Statement on ED as a Marker of Vascular Health • Health Research Board (Ireland). Alcohol treatment in Ireland: treatment demand and trends 2015 to 2021. Dublin: HRB; 2022.

• Drinkaware.ie. Alcohol and Mental Health.

• Schuckit, M.A., Tipp, J.E., Bucholz, K.K., et al. (1997). The life-time rates of three major mood disorders and four major anxiety disorders in alcoholics and controls. Addiction, 92(10), 1289–1304.

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24

Striae

Role of Pharmacists in Managing Striae: From Prevention to Therapeutics In these times of increasing body positive movements and loving the skin we’re in, there is still the pressure from the celebrity and beauty industry to attain an unrealistic ‘flawless, blemish-free, perfect’ skin and body which will still see customers seeking advice and support on skincare for example stretch marks (striae) which I will be exploring in this article. Although the majority of cases are self-limiting and do not cause any physiological harm to a person’s health, they may be considered unsightly for the customer and cause distress, thus it is important to still be well-equipped to help and advise these customers with empathy and a high standard of knowledge and patient care.

Written by Fatimah Kara, Superintendent Pharmacist, Reidy’s Pharmacy Rathcoole

Progression 1. Early Stage (Striae Rubrae): Stretch marks first appear as slightly raised, pink or reddishpurple lines.

They may be itchy and feel raised to the touch.

This stage is characterized by inflammation and damage to the skin's connective tissues.

They are usually perpendicular to the direction of skin tension.

2. Intermediate Stage: The initial redness and inflammation begin to fade.

The lines become more silvery or white in appearance.

They may still feel slightly raised or depressed.

3. Later Stage (Striae Albae): The stretch marks become more hypopigmented and less noticeable.

They appear as atrophic (thin) and wrinkled lines.

Definition

areas where elastin breaks.

Stretch marks (striae) are discoloured, slightly sunken (depressed), indented streaks and scar-like lines in your skin which are not painful or harmful and appear when your skin rapidly stretches or shrinks.

It is important to remember that stretch marks can affect both men and women due to a variety of reasons, some are listed below:

• puberty

Areas that stretch marks generally appear are abdominal area, thighs, hips, breasts, upper arms, lower back and buttocks.

Treatment options

• sudden or quick weight gain or loss

As previously mentioned, stretch marks do not have any harmful effect on a person’s health, however they may cause distress and self-confidence issues which is why empathetic counselling and consultations are extremely significant to support customers who come to the pharmacy seeking help and advice.

Stretch marks don't require treatment, they often fade over time, with or without treatment, however they may never disappear completely.

Common causes of stretch marks When skin rapidly stretches or shrinks, it causes the elastin and collagen in a person’s skin to break. Elastin’s main role is to allow skin to stretch. Collagen’s main role is to provide structure, strength and support to skin. As skin heals, stretch marks appear in

• pregnancy

• use of steroid creams or tablets long term • genetic family history of stretch marks • muscles getting bigger quickly through bodybuilding or weightlifting.

• growth spurt during adolescence.

• rarely, stretch marks can be due to a condition called Cushing's syndrome which causes a high level of cortisol in the body due to prolonged high doses of prednisolone or hydrocortisone.

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They may have a slightly depressed appearance.

This stage is characterized by a loss of collagen and elastin in the affected skin.

Treatment improves the appearance of stretch marks, but they may not go away completely.

Addressing your stretch marks when they first appear yields the best results. Older, deep stretch marks may be more challenging to treat. Stretch marks will eventually go away or become less noticeable on their own. In general, stretch

marks take between six and 12 months to fade. With treatment, they often fade faster.

The first thing is to reassure the customer that having stretch marks is very normal and natural and there are several treatment options available to explore if they feel the need to pursue them. Creams, gels, lotions, and cosmetic surgery have all been proposed as treatments for stretch marks.

There are several topical options available over-the- counter claiming to reduce or prevent the appearance of stretch marks, however there is little evidence to suggest that they get rid of them completely and totally.

There are also various other treatments available including microdermabrasion or laser treatment but specialist advice about the suitability of these need to be sought.

Topical treatments are preparations containing active ingredients that are applied to the surface of the skin.

Retinol Retinol comes from vitamin A. It’s an ingredient in many OTC antiaging skin care creams because of its ability to improve wrinkles, skin texture and the skin’s hydration levels. Retinol creams may require at least six months of regular use before noticeable results are seen.

Side effects may include dry skin, irritation, discoloration and light sensitivity and medical advice should be sought for use during pregnancy and breastfeeding. Products containing retinol available include ‘Cerave Resurfacing Retinol Serum for Belmish prone skin’ Bio-Oil Bio-Oil has been one of the most popular products on the market for use on uneven skin tone and especially being promoted for reducing stretch marks. It is a specialist oil mixture with vitamins and plant extracts which helps to improve the appearance of

26

Striae • Avoid yo-yo dieting.

• Eat a balanced diet rich in vitamins and minerals.

Consuming a suitable amount of vitamins A and C such as carrots, citrus fruits and milk can help support the skin, as well as the mineral zinc contained in nuts or fish. Rich in protein, such as lentils, beans, broccoli, lean beef and chicken.

• Drink six to eight glasses of water every day.

• Exercise increases circulation and helps your body produce collagen. Increased circulation and collagen help skin stay strong and stretchy.

Referral

stretch marks and also helps improve skin elasticity, thereby reducing the possibility of stretch marks forming. The results of their clinical trial in Hamburg found that ‘Bio‑Oil® Skincare Oil is efficacious in improving the appearance of stretch marks. A statistically significant result was achieved after only 2 weeks (day 15), evident in 95% of the subjects. After 8 weeks (day 57), 100% of subjects showed an improvement, with the extent of the improvement more than double that at 2 weeks. A continuous improvement of POSAS over the duration of the study.’

Palmers Cocoa Butter range Palmers have a specific range of products for stretch marks during pregnancy including massage cream and oil. Their formula with a special combination of Cocoa Butter, Vitamin E, Collagen, and Elastin, with the lotion having the added benefit of Shea Butter.

These non-greasy formulas relieve the dryness associated with stretched skin due to pregnancy and smooth stretch marks due to weight loss. Palmer’s Cocoa Butter Formula Tummy Butter is a highly concentrated formula with Cocoa Butter, Vitamin E, Collagen, Elastin, and soothing Lavender Oil that is widely recommended for stretch marks during and after pregnancy.

The Tummy Butter penetrates as deep as the dryness and helps to restore vital moisture while smoothing marks and toning skin.

Although studies show that they don’t effectively treat or prevent stretch marks, the massaging of creams and oils can be soothing and have a positive effect on customers, and a little TLC should never not be recommended!

Other treatment options

Microneedling

There are types of treatments done by dermatologists or plastic surgeons that can dramatically reduce the appearance of stretch marks which include laser treatment, microdermabrasion and cosmetic surgery.

During microneedling, the skin is poked with thin needles. The tiny punctures stimulate the growth of new collagen and elastin fibres to create firmer skin. Most people require between three and six treatments to see results. Some people see full, complete results within four to six months. But it may take longer. Side effects may include irritation, discoloration, swelling and flaky skin.

Laser skin resurfacing Laser skin resurfacing is a type of surgery where short, concentrated, pulsating beams of light are directed onto stretch marks. The laser removes layers of the skin very precisely, which stimulates the growth of new collagen fibres to create smoother skin.

An immediate difference should be seen after treatment and skin may continue to improve for up to a year, and the improvement may last for several years.

Side effects may include the appearance of small white bumps on the skin (milia), swelling, dark areas of skin (hyperpigmentation) and light areas of skin (hypopigmentation).

Dermabrasion Dermabrasion is another type of surgery where a specialized instrument is used to scrape away the stretch marks. The process improves skin contour and results in smooth new skin.

It usually takes at least two weeks for the skin to heal but full and complete results are seen several weeks or months after the procedure. Side effects may include milia, hyperpigmentation, hypopigmentation, swelling and enlarged pores.

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Making stretch marks less noticeable There are several ways that a person can hide or improve the appearance of stretch marks acutely if needed such as the following: Self-Tanners Sunless self-tanners can help to fill in the colour of the stretch marks and make them appear closer to the same colour as the rest of the skin. However, regular tanning will not help as well because it can negatively affect the health of your skin. Also, stretch marks are less likely to tan.

Make-Up: Using a foundation makeup that matches skin tone can help hide stretch marks.

Clothes with more coverage: Wearing long sleeves or longer pants can cover up areas that are affected by stretch marks.

Prevention: Stretch marks cannot always be prevented. However, the following steps may help to reduce the risk:

It isn’t usually necessary to refer a customer regarding stretch marks. However it’s a good idea to keep in mind especially if stretch marks cover a large area of skin and the person would like to explore more options and also in case certain stretch mark creams or medications may cause bad skin reactions. Another cause for referral may be if the patient is experiencing low mood or a low self-image which is affecting their quality of life to help support them.

The importance of educating the person on the self-limiting nature of stretch marks and their non risk to health is significant and improving body image is key to supporting customers, however it is very important to respect a persons opinion on stretch marks and the effect it’s having on their self-image so we must approach each patient individually and provide as much support to their individual needs as possible. We are in a very good position to do so as community pharmacists and pharmacy teams to ensure everyone feels comfortable in their own skin.

Sources https://my.clevelandclinic.org/ health/diseases/10785-stretchmarks#overview https://www.mayoclinic.org/ diseases-conditions/stretchmarks/symptoms-causes/syc20351139 https://www.healthline.com/ health/do-stretch-marks-goaway#improving-stretch-marks https://uk.palmers.com/ content/21-cocoa-butterformula#:~:text=After%20 a%20few%20weeks%2C%20 skin's,on%20a%20 healthier%2C%20firmer%20look. https://www.bio-oil.com/ie/en/ products/SCO/information

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28

Menopause

Free HRT for Women in Ireland: A Landmark Moment in Menopause Care In a historic shift for women’s health in Ireland, hormone replacement therapy (HRT) became free for all women on 1st June. This is a landmark change driven by grassroots activism, expert advocacy, and bold government policy.

But while the announcement made headlines, the road to implementation has been far from smooth.

Written by Loretta Dignam, Founder & CEO, The Menopause Hub

and most recently, the Women in Pharma Award for Best Education Leadership.

Campaigning for change

As someone who has lived through the confusion and isolation of unmanaged menopause symptoms, I know firsthand how badly change was needed. After years of debilitating symptoms with little guidance or support, I was struck by the lack of understanding and resources available to women during this critical life stage.

In 2018, I founded The Menopause Hub (TMH), Ireland’s first dedicated menopause clinic. My vision was to create a space where women could manage menopause on their own terms, with access to expert care, information, and support.

TMH quickly became both a sanctuary and a springboard for systemic change. With three clinics now across the country and a workplace-focused Menopause Hub Academy, we’ve helped bring menopause out of the shadows and into the national conversation.

My work in menopause advocacy builds on a wider commitment to gender equity and women’s wellbeing. I’ve had the privilege of lecturing at UCD Smurfit Business School, chairing the Abbey Theatre’s Gender Equality Committee, and in recent years, I’ve been honoured with Tatler’s Woman of the Year award for Women’s Health, inclusion on the Forbes 50 Over 50 Global list,

In 2024, I joined forces with The Irish Menopause support group, co-founded by Sallyanne Brady, to launch a national petition calling for the elimination of financial barriers to HRT. For many women, the monthly cost of ¤30 to ¤70 was a serious obstacle.

While 67% of users were partially covered under the Drug Payment Scheme (DPS), and 33% had Medical Cards, thousands of women found themselves in the "squeezed middle", earning just enough to miss out on support, but not enough to afford consistent treatment.

The campaign captured public attention quickly. Women shared personal stories, signed the petition, and demanded action.

Our advocacy efforts reached across political lines, culminating in a major policy breakthrough in October 2024, when then-Minister for Health Stephen Donnelly announced that HRT would be made free for all women as part of Budget 2025, with implementation set for January 1st, 2025.

But by January, implementation was stalled. At the heart of the delay were ongoing negotiations between the Department of Health and the Irish Pharmacy Union (IPU) regarding operational logistics, reimbursement, and funding structures for participating pharmacies. Without a workable agreement, the voluntary optin model initially proposed in April 2025 floundered. Just 100 pharmacies had signed on, raising concerns about whether the rollout would be widespread or equitable.

A Breakthrough in May On Friday, May 17, Minister for Health Jennifer Carroll MacNeill announced a long-awaited breakthrough. A revised scheme was now agreed upon and endorsed by the IPU, making free HRT widely available from June

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1st, 2025. Under the updated arrangement, pharmacies will receive a ¤5 dispensing fee per HRT item and a ¤2,000 once-off grant to support system upgrades and the transition—up from an earlier ¤1,000 offer.

Why Free HRT Matters This policy isn’t just about money. It’s about medical justice.

Menopause symptoms can be life-altering: hot flushes, insomnia, mood swings, anxiety, brain fog, and more. For many of us, HRT isn’t a lifestyle choice, it’s a medical necessity. And yet, for years, treatment was financially out of reach for thousands of Irish women.

The Irish government’s move sets a new global benchmark for gendered healthcare access. By centring menopause in health policy and removing economic gatekeeping, Ireland is leading by example, placing women’s long-term wellbeing at the heart of national health strategy.

Looking Ahead With free HRT now available, Ireland is poised to become a global leader in menopause care— not just in policy, but in practice.

This milestone proves what’s possible when people power drives real change.

But success depends on delivery.

Clear communication, pharmacy readiness, and public awareness are essential to ensure every woman can access HRT— easily, locally, and without cost.

Supply shortages also pose a real risk. Key products like Estradot 50mcg and 75mcg patches are currently out of stock, with availability not expected until the end of 2025, according to the HPRA. Rising demand from the Free HRT programme could worsen these shortages and strain an already pressured system, making it harder for pharmacists and doctors to manage care effectively.

This was never just about medication. It’s about equality, access, and dignity. Menopause is not a niche issue; it’s a national one. Ireland is finally starting to treat it that way, but whether the system can rise to meet the moment remains to be seen.

Agreed Pathway on HRT Initiative The Minister for Health Jennifer Carroll MacNeill announced in May that she had reached an agreement with Irish Pharmacy Union (IPU) on a way forward for the Hormone Replacement Therapy (HRT) initiative to proceed with the support of the IPU and their members.

The HRT arrangement will see the women of Ireland receive HRT medicines/products free of charge at the point of dispensing from 1 June 2025.

This agreed HRT arrangement includes the provision of HRT products, prescribed for the treatment of symptoms associated with all stages of menopause, without any charge, to women who are resident in the State. This is in circumstances where HRT has been deemed clinically appropriate for a woman and is prescribed by her healthcare provider.

The arrangement will include a pharmacy dispensing fee of ¤5 per HRT item, and a ¤2,000 once-off grant to each participating community pharmacy to support transition arrangements including ICT system upgrades.

Minister MacNeill said, “I am delighted that the women of Ireland will be able to receive their HRT medication completely free of charge in participating pharmacies from 1 June 2025.

“With the full support of the IPU for the free HRT scheme, I anticipate that every pharmacy will now sign up, which I warmly welcome.

“I hugely welcome the contribution pharmacists make to women’s health and to our health services. I look forward to continuing to work closely with the sector in the coming weeks and months.”

As part of Budget 2025, the Minister of Health announced a ¤20 million full year cost investment for the introduction of a state supported HRT initiative.

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Menopause usually the primary treatment unless the patient is experiencing broader menopausal symptoms such as hot flushes or night sweats. Pharmacists involved in HRT dispensing should monitor symptom control and provide ongoing support.

Key Considerations for Community Pharmacists 1. Understanding the Patient’s History Pharmacists should consider: • Menopausal status and age • Medical history, particularly hormone-sensitive cancers • Concurrent medications • Lifestyle factors (e.g., smoking, which can exacerbate vaginal atrophy)

Understanding Vaginal Atrophy Vaginal atrophy, also referred to as genitourinary syndrome of menopause (GSM), is a common yet under-recognised condition that affects many women, particularly during and after the menopausal transition.

Characterised by thinning, drying, and inflammation of the vaginal walls due to reduced oestrogen levels, vaginal atrophy can significantly impact quality of life, sexual health, and overall wellbeing. Given the sensitive nature of the symptoms and the stigma still associated with menopausal changes, many women suffer in silence, often without seeking appropriate medical or pharmaceutical advice.

Community pharmacists are uniquely positioned to identify, support, and guide women experiencing vaginal atrophy.

With their accessibility and regular contact with patients, pharmacists can play a key role in improving awareness, encouraging open conversations, and supporting appropriate treatment and management.

Recognising the Symptoms Pharmacists should be familiar with the common signs and symptoms of vaginal atrophy, which include:

• General discomfort in the vaginal area These symptoms often develop gradually and may be mistaken for other conditions, such as infections. Women may describe feeling “dry,” “irritated,” or “uncomfortable” without immediately recognising the hormonal basis of their symptoms.

Opening the Conversation One of the biggest barriers to treatment is a reluctance among patients to discuss intimate health concerns. Community pharmacists should aim to create a discreet and supportive environment that encourages women to raise these issues. Displaying menopauserelated materials, offering private consultation rooms, or including questions about vaginal symptoms in medication reviews for menopausal women can help normalise the conversation.

Suggested openers include: • “Many women going through menopause notice changes like dryness or irritation—have you experienced anything like that?”

• “Some medications or hormonal changes can cause vaginal discomfort. Let me know if that’s something you’d like to talk about.”

• Vaginal dryness, itching, or burning

Being proactive and empathetic in addressing these concerns can lead to meaningful interventions.

• Pain or discomfort during sexual intercourse (dyspareunia)

Treatment and Management Options

• Light bleeding or spotting after intercourse

There are several treatment pathways available for vaginal atrophy, ranging from nonhormonal over-the-counter (OTC) products to prescription hormonebased therapies. Community

• Increased urinary frequency or urgency • Recurrent urinary tract infections

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pharmacists should be aware of the full spectrum of options and be prepared to offer advice or referral when appropriate.

2. Counselling and Education Patient education is critical.

Pharmacists should explain:

1. Non-Hormonal Options (OTC)

• That vaginal atrophy is a common and treatable condition

• Vaginal moisturisers: Used regularly (every few days) to restore moisture and improve elasticity.

• The importance of consistent use of moisturisers and oestrogen therapy for best results

• Vaginal lubricants: Used as needed, typically before sexual activity, to reduce friction and discomfort.

• Hygiene advice: Encourage the use of unscented, gentle soaps and avoidance of douching or perfumed products.

Pharmacists should ensure patients understand the difference between moisturisers (routine use) and lubricants (situational use), and how they can be used together.

2. Local Oestrogen Therapy (Prescription-Only) Local oestrogen treatments are often first-line therapies for moderate to severe symptoms.

These include: • Vaginal creams • Vaginal tablets or pessaries • Vaginal rings • Vaginal gels These products deliver low doses of oestrogen directly to the vaginal tissue, minimising systemic absorption and associated risks.

3. Systemic Hormone Replacement Therapy (HRT) While systemic HRT can also alleviate vaginal atrophy, it is not

• How to apply vaginal treatments correctly and hygienically • The difference between UTIs and atrophic symptoms Educational leaflets or referral to reliable resources can be helpful.

3. Referral and Signposting If symptoms are severe, unresponsive to OTC products, or if the patient is unsure whether symptoms are due to atrophy or another condition (e.g., infection), pharmacists should refer to a GP or specialist menopause clinic. Patients with a history of breast cancer, unexplained bleeding, or pelvic pain should always be referred.

The Role of the Pharmacy Team All members of the pharmacy team—pharmacists, technicians, and support staff—can contribute to awareness and patient support.

Staff training on menopause and related symptoms can help ensure that women are treated with dignity and given accurate advice.

Encouraging women to talk about their symptoms, highlighting treatment options, and normalising the conversation around vaginal health are powerful ways the community pharmacy can support this often-overlooked aspect of women’s healthcare.

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Menopause

Hot Flashes: Support and Guidance for Pharmacy Teams Hot flashes (or flushes) are one of the most common and distressing symptoms experienced during menopause, affecting up to 75% of menopausal women. These sudden feelings of intense heat, often accompanied by sweating, flushing, and sometimes palpitations or anxiety, can significantly impact sleep, quality of life, and emotional wellbeing. Pharmacy teams have a vital role in recognising, educating, and supporting patients experiencing these symptoms. and intensity of hot flashes.

Pharmacists can support patients prescribed Veoza by: o Explaining how the medicine works and what to expect o Monitoring for potential side effects (e.g., liver function should be checked before and during treatment as recommended) o Encouraging adherence for best results, typically seen within a few weeks • SSRIs/SNRIs – Low doses of antidepressants like venlafaxine, paroxetine, or citalopram can reduce hot flash severity and frequency, particularly helpful for women with concurrent low mood or anxiety.

• Gabapentin or Pregabalin – Originally used for nerve pain or epilepsy, these may benefit women with night sweats, especially where sleep disturbance is a major concern.

Hot flashes are caused by fluctuating and declining oestrogen levels, which disrupt the hypothalamus’s regulation of body temperature. They often begin during perimenopause and may persist for several years. Episodes typically last 1–5 minutes and can vary in frequency and intensity, occurring during the day or waking women from sleep (night sweats).

Key Actions for Pharmacy Teams 1. Open the Conversation Pharmacists should create a welcoming space where women feel comfortable discussing menopausal symptoms. Even a simple question such as, “Are you managing any menopause-related symptoms?” can open the door to meaningful dialogue. Pharmacy teams should also be aware of how cultural background, health literacy, and stigma may impact a woman’s comfort in seeking help.

2. Education on Triggers and Lifestyle Support Educate patients about common hot flash triggers such as caffeine, alcohol, spicy foods, smoking, and stress. Encourage lifestyle

modifications like wearing breathable clothing, using cooling fans, staying hydrated, and practising relaxation techniques.

Sleep hygiene, mindfulness, and regular physical activity can also help reduce symptom severity and support overall wellbeing.

3. OTC and Natural Remedies Some women explore OTC supplements like black cohosh, soy isoflavones, or sage. Pharmacy teams should advise on: • The variable evidence base for these products • Potential interactions with other medications (especially in polypharmacy or with anticoagulants) • The importance of purchasing from reputable brands and reporting any adverse effects 4. Discussion of HRT While HRT must be prescribed, pharmacists can play a key role in: • Educating on the risks and benefits in the context of personal and family history

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• Supporting adherence, especially during the initial adjustment phase • Helping manage common side effects such as breast tenderness or breakthrough bleeding • Signposting to menopause clinics or GPs for patients who may benefit from a tailored review 5. Prescription Treatment Options For patients who are unable or unwilling to take HRT, several non-hormonal prescription treatments are now available.

Pharmacy teams should be aware of these alternatives to help inform discussions: • Veoza® (fezolinetant) – A selective neurokinin-3 (NK3) receptor antagonist, Veoza is a once-daily, non-hormonal treatment specifically licensed for moderate to severe vasomotor symptoms (VMS) of menopause. It works by modulating the brain’s thermoregulatory centre, helping to reduce the frequency

• Clonidine – An older treatment option with modest efficacy and more frequent side effects (e.g., dry mouth, drowsiness), making it less commonly used but still an option in select cases.

6. Emotional Support and Signposting Hot flashes can affect confidence, sleep quality, work performance, and social interactions. Pharmacists should listen empathetically, validate the patient’s experience, and reassure them that help is available. Signposting to reliable resources such as the NHS website, Women’s Health Concern, The British Menopause Society, and local menopause services is essential. In-store posters or leaflets can also encourage women to seek advice.

Final Thoughts Pharmacy teams are in a unique position to offer accessible, informed, and compassionate care for women navigating menopause. Staying updated on emerging treatments like Veoza, offering proactive support, and building trust can significantly improve the patient experience during this life stage.

TREAT the HEAT

WITH NON-HORMONAL VEOZA VEOZA (fezolinetant) is indicated for the treatment of moderate to severe vasomotor symptoms (VMS) associated with menopause. 1 VMS are also known as hot flushes and night sweats. 2 First-in-class selective neurokinin 3 (NK3) receptor antagonist to be licensed1,3

Evaluated for safety over 52 weeks1

Statistically significant reductions in VMS frequency & severity at Weeks 4 & 12 vs. placebo.1

Once-daily oral dosing with VEOZA 45 mg 1

Drug-induced liver injury (DILI) has been reported; perform liver function tests (LFTs) before treatment, monthly for the first 3 months, then based on clinical judgement.

Treatment should not be started if ALT or AST is ≥ 2 x ULN or if total bilirubin is elevated (e.g., ≥ 2 x ULN).

Discontinue if ALT/AST > 5 x ULN OR ALT ≥ 3 x ULN with: total bilirubin > 2 x ULN OR symptoms of liver injury.

Contraindications include hypersensitivity to ingredients, concomitant use with moderate/strong CYP1A2 inhibitors, and known or suspected pregnancy.

Common undesirable effects include diarrhoea (3.2%) and insomnia (3.0%). Refer to the SmPC for full prescribing details.1

▼ This medicinal product is subject to additional monitoring. This will allow quick identification of new safety information. Healthcare

professionals are asked to report any suspected adverse reactions. See section 4.8 of the SPC for how to report adverse reactions.

NK3: neurokinin 3, VMS: vasomotor symptoms.

References: 1. VEOZA Summary of Product Characteristics. 2. Thurston RC. Vasomotor symptoms. In: Crandall CJ, et al. eds. Menopause Practice: A Clinician’s Guide. 6th ed. Pepper Pike, OH: The North American Menopause Society. 2019:43–55. 3. Depypere H, et al. Expert Opin Investig Drugs. 2021;30(7):681–694.

ABBREVIATED SUMMARY OF PRODUCT CHARACTERISTICS For full prescribing information refer to the Summary of Product Characteristics (SPC).

▼

This medicinal product is subject to additional monitoring. This will allow quick identification of new safety information. Healthcare professionals are asked to report any suspected adverse reactions. NAME OF THE MEDICINAL PRODUCT: Veoza 45 mg film-coated tablets QUALITATIVE AND QUANTITATIVE COMPOSITION: Each film-coated tablet contains 45 mg of fezolinetant. For the full list of excipients, see section 6.1 of the SPC. PHARMACEUTICAL FORM: Film-coated tablet (tablet). Round, light red tablets (approximately 7 mm diameter × 3 mm thickness), debossed with the company logo and ‘645’ on the same side. CLINICAL PARTICULARS: Therapeutic indications: Veoza is indicated for the treatment of moderate to severe vasomotor symptoms (VMS) associated with menopause (see section 5.1 of the SPC).

Posology and method of administration: The recommended dose is 45 mg once daily. Benefit of long-term treatment should be periodically assessed since the duration of VMS can vary by individual. Missed dose: If a dose of Veoza is missed or not taken at the usual time, the missed dose should be taken as soon as possible, unless there is less than 12 hours before the next scheduled dose. Individuals should return to the regular schedule the following day. Elderly: Fezolinetant has not been studied for safety and efficacy in women initiating Veoza treatment over 65 years of age. No dose recommendation can be made for this population. Hepatic impairment: No dose modification is recommended for individuals with Child-Pugh Class A (mild) chronic hepatic impairment (see section 5.2 of the SPC). Veoza is not recommended for use in individuals with Child-Pugh Class B (moderate) or C (severe) chronic hepatic impairment.

Fezolinetant has not been studied in individuals with Child-Pugh Class C (severe) chronic hepatic impairment (see section 5.2 of the SPC). Renal impairment: No dose modification is recommended for individuals with mild (eGFR 60 to less than 90 ml/min/1.73 m2) or moderate (eGFR 30 to less than 60 ml/min/1.73 m2) renal impairment (see section 5.2 of the SPC). Veoza is not recommended for use in individuals with severe (eGFR less than 30 ml/min/1.73 m2) renal impairment. Fezolinetant has not been studied in individuals with end-stage renal disease (eGFR less than 15 ml/min/1.73 m2) and is not recommended for use in this population (see section 5.2 of the SPC). Paediatric population: There is no relevant use of Veoza in the paediatric population for the indication of moderate to severe VMS associated with menopause. Method of administration: Veoza should be administered orally once daily at about the same time each day with or without food and taken with liquids. Tablets are to be swallowed whole and not broken, crushed, or chewed due to the absence of clinical data under these conditions.

Contraindications: Hypersensitivity to the active substance or to any of the excipients listed in section 6.1 of the SPC. Concomitant use of moderate or strong CYP1A2 inhibitors (see section 4.5 of the SPC). Known or suspected pregnancy (see section 4.6 of the SPC). Special warnings and precautions for use: Medical examination/consultation: Prior to the initiation or reinstitution of Veoza, a careful diagnosis should be made, and complete medical history (including family history) must be taken. During treatment, periodic check-ups must be carried out according to standard clinical practice. Liver disease: Veoza is not recommended for use in individuals with Child-Pugh Class B (moderate) or C (severe) chronic hepatic impairment.

Women with active liver disease or Child-Pugh Class B (moderate) or C (severe) chronic hepatic impairment have not been included in the clinical efficacy and safety studies with fezolinetant (see section 4.2 of the SPC) and this information cannot be reliably extrapolated. The pharmacokinetics of fezolinetant has been studied in women with Child-Pugh Class A (mild) and B (moderate) chronic hepatic impairment (see section 5.2 of the SPC). Drug-induced liver injury (DILI): Elevations in serum alanine aminotransferase (ALT) levels and serum aspartate aminotransferase (AST) at least 3 times the upper limit of normal (ULN) were observed in women treated with fezolinetant, including serious cases with increased total bilirubin and symptoms suggesting liver injury. Elevated liver function tests (LFTs) and symptoms suggestive of liver injury were generally reversible on discontinuation of therapy. LFTs must be performed prior to treatment initiation with fezolinetant. Treatment should not be started if ALT or AST is ≥ 2 x ULN or if total bilirubin is elevated (e.g., ≥ 2 x ULN). LFTs must be performed monthly during the first three months of treatment, then based on clinical judgement. LFTs must also be

performed when symptoms suggestive of liver injury occur. Treatment should be discontinued in the following situations: - Transaminase elevations are ≥ 3 x ULN with: total bilirubin > 2 x ULN OR symptoms of liver injury. - Transaminase elevations > 5 x ULN. Monitoring of liver function should be maintained until they have normalised. Patients should be informed about the signs and symptoms of liver injury and should be advised to contact their doctor immediately once these occur. Known or previous breast cancer or oestrogen-dependent malignancies: Women undergoing oncologic treatment (e.g., chemotherapy, radiation therapy, anti-hormone therapy) for breast cancer or other oestrogen-dependent malignancies have not been included in the clinical studies. Therefore, Veoza is not recommended for use in this population as the safety and efficacy are unknown. Women with previous breast cancer or other oestrogen-dependent malignancies and no longer on any oncologic treatment have not been included in the clinical studies. A decision to treat these women with Veoza should be based on a benefit-risk consideration for the individual. Concomitant use of hormone replacement therapy with oestrogens (local vaginal preparations excluded): Concomitant use of fezolinetant and hormone replacement therapy with oestrogens has not been studied, and therefore concomitant use is not recommended. Seizures or other convulsive disorders: Fezolinetant has not been studied in women with a history of seizures or other convulsive disorders. There were no cases of seizures or convulsive disorders during clinical studies. A decision to treat these women with Veoza should be based on a benefit-risk consideration for the individual.

Interactions: Effect of other medicinal products on fezolinetant: CYP1A2 inhibitors: Fezolinetant is primarily metabolised by CYP1A2 and to a lesser extent by CYP2C9 and CYP2C19.

Concomitant use of fezolinetant with medicinal products that are moderate or strong inhibitors of CYP1A2 (e.g., ethinyl oestradiol containing contraceptives, mexiletine, enoxacin, fluvoxamine) increase the plasma Cmax and AUC of fezolinetant. Concomitant use of moderate or strong CYP1A2 inhibitors with Veoza is contraindicated (see section 4.3 of the SPC). Co-administration with fluvoxamine, a strong CYP1A2 inhibitor, resulted in an overall 1.8-fold increase in fezolinetant Cmax and 9.4-fold increase in AUC; no change in tmax was observed. Given the large effect of a strong CYP1A2 inhibitor and supportive modelling, the increase in fezolinetant concentrations is expected to be of clinical concern also following concomitant use with moderate CYP1A2 inhibitors (see section 4.3 of the SPC). The increase in fezolinetant exposure was however not predicted to be clinically relevant following concomitant use with weak CYP1A2 inhibitors. CYP1A2 inducers: In vivo data: Smoking (moderate inducer of CYP1A2) decreased fezolinetant Cmax to a geometric LS mean ratio of 71.74%, while AUC decreased to a geometric LS mean ratio of 48.29%. The efficacy data did not point to relevant differences between smokers and non-smokers. No dose modification is recommended for smokers.

Transporters: In vitro data: Fezolinetant is not a substrate of P-glycoprotein (P-gp). Major metabolite ES259564 is a substrate of P-gp. Effect of fezolinetant on other medicinal products: Cytochrome P450 (CYP) enzymes: In vitro data: Fezolinetant and ES259564 are not inhibitors of CYP1A2, CYP2B6, CYP2C8, CYP2C9, CYP2C19, CYP2D6, and CYP3A4. Fezolinetant and ES259564 are not inducers of CYP1A2, CYP2B6, and CYP3A4. Transporters: In vitro data: Fezolinetant and ES259564 are not inhibitors of P-gp, BCRP, OATP1B1, OATP1B3, OCT2, MATE1, and MATE2-K (IC50 > 70 µmol/l). Fezolinetant inhibited OAT1 and OAT3 with IC50 values of 18.9 µmol/l (30 × Cmax,u) and 27.5 µmol/l (44 × Cmax,u), respectively. ES259564 does not inhibit OAT1 and OAT3 (IC50 > 70 µmol/l). Undesirable effects: Summary of the safety profile: The most frequent adverse reactions with fezolinetant 45 mg were diarrhoea (3.2%) and insomnia (3.0%).

There were no serious adverse reactions reported at an incidence greater than 1% across the total study population. On fezolinetant 45 mg, four serious adverse reactions were reported.

The most serious adverse reaction was an event of endometrial adenocarcinoma (0.1%). The most frequent adverse reactions leading to dose discontinuation with fezolinetant 45 mg were alanine aminotransferase (ALT) increased (0.3%) and insomnia (0.2%). Tabulated list of adverse reactions: The safety of fezolinetant has been studied in 2203 women with VMS associated with menopause receiving fezolinetant once daily in phase 3 clinical studies. Adverse reactions observed during clinical studies and from spontaneous reporting are listed below by frequency category in each system organ class. Frequency categories are defined as follows: very common (≥ 1/10); common (≥ 1/100 to < 1/10); uncommon (≥ 1/1 000 to < 1/100); rare (≥ 1/10 000 to < 1/1 000); very rare (< 1/10 000); and not known (cannot be estimated from the available data).

Table 1. Adverse reactions for fezolinetant 45 mg MedDRA system organ class (SOC)

Frequency category

Adverse reaction

Psychiatric disorders

Common

Insomnia

Gastrointestinal disorders

Common

Diarrhoea, Abdominal pain

Hepatobiliary disorders

Common

Alanine aminotransferase (ALT) increased, Aspartate aminotransferase (AST) increased*

Not known

Drug-induced liver injury (DILI)*

*see Description of selected adverse reactions Description of selected adverse reactions: ALT increased/AST increased/DILI: In clinical trials, elevations in ALT levels > 3 x ULN occurred in 2.1% of women receiving fezolinetant compared to 0.8% of women receiving placebo. Elevations in AST levels > 3 x ULN occurred in 1.0% of women receiving fezolinetant compared to 0.4% of women receiving placebo. Serious cases with elevations of ALT and/or AST (> 10 x ULN) with concurrent elevations in bilirubin and/or alkaline phosphatase (ALP) were reported post-marketing. In some cases, elevated liver function tests were associated with signs and symptoms suggestive of liver injury such as fatigue, pruritus, jaundice, dark urine, pale faeces, nausea, vomiting, decreased appetite, and/or abdominal pain (see section 4.4 of the SPC). Overdose: Doses of fezolinetant up to 900 mg have been tested in clinical studies in healthy women. At 900 mg, headache, nausea, and paraesthesia were observed. In the case of overdose, the individual should be closely monitored, and supportive treatment should be considered based on signs and symptoms. Reporting of suspected adverse reactions: Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the national reporting system. België/Belgique: Federaal Agentschap voor Geneesmiddelen en Gezondheidsproducten / Agence fédérale des médicaments et des produits de santé; www.fagg.be / www.afmps.be; Afdeling Vigilantie / Division Vigilance: Website/Site internet: www.eenbijwerkingmelden.be / www.notifieruneffetindesirable.be; e-mail: adr@fagg-afmps.be Ireland: HPRA Pharmacovigilance, Website: www.hpra.ie or Astellas Pharma Co. Ltd. Tel: +353 1 467 1555, E-mail: irishdrugsafety@astellas.com. Nederland: Nederlands Bijwerkingen Centrum Lareb; Website: www.lareb.nl Luxembourg/Luxemburg : Centre Régional de Pharmacovigilance de Nancy ou Division de la pharmacie et des médicaments de la Direction de la santé; Site internet : www.guichet.lu/pharmacovigilance MARKETING AUTHORISATION HOLDER: Astellas Pharma Europe B.V. Sylviusweg 62, 2333 BE Leiden, The Netherlands MARKETING AUTHORISATION NUMBERS: EU/1/23/1771/001-004 DATE OF REVISION OF THE TEXT: February 2025 Job Bag Number: MAT-IE-VEO-2025-00015 Detailed information on this medicinal product is available on the website of the European Medicines Agency https://www.ema.europa.eu. Ireland: Astellas Pharma Co. Ltd., Tel.: +353 1 467 1555. SPC may be found at www.medicines.ie. Delivery Status: subject to medical prescription. Astellas Pharma B.V., NL: Sylviusweg 62, 2333BE Leiden, Netherlands BE/LU: Medialaan 50, 1800 Vilvoorde, Belgium IE: Legal classification: POM/S1A.

MAT-IE-VEO-2025-00006.

February 2025.

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Magnesium

Sleep, Self-Care & the Pharmacist: The Restorative Role of Routine and Magnesium Introduction: Sleep is a cornerstone of well-being—essential for emotional resilience, cognitive performance, immune function, and overall quality of life. Yet, many people, including healthcare professionals like pharmacists, struggle to get enough of it. Lying awake with a racing mind and mounting stress can be both frustrating and exhausting.

Written by Liz O’Hagan, Pharmacist & Lifestyle Medicine Expert

bedtime. Avoid heavy meals and sugary snacks late at night.

• Limit caffeine and alcohol in the evening. Both can interfere with sleep quality.

• Switch off screens at least an hour before bed. Recommend reading or journaling instead.

Try charging your phone outside the bedroom, or at least the other side of the room! Another tip for your phone is to switch it to black and white mode in the evenings – you're much less likely to “doom scroll” with this setting on, trust me!

Chronic poor sleep or insomnia is more than just a nightly inconvenience—it poses serious risks to physical health. Over time, inadequate sleep has been linked to an increased risk of conditions such as cardiovascular disease, type 2 diabetes, obesity, hypertension, and weakened immune response.

It can also contribute to hormonal imbalances, inflammation, and impaired metabolic function, reducing long-term quality of life.

As pharmacists, we are uniquely placed to not only improve our own sleep hygiene but also guide patients through simple, evidencebased lifestyle changes. One area gaining traction in sleep and relaxation support is magnesium supplementation. But before we delve into that, let’s explore sleep as a whole-system process that can be supported by sustainable daily habits.

The Science of Sleep: Why Routine Matters The human body operates on a 24-hour cycle known as the circadian rhythm. This internal clock governs sleep-wake patterns, hormone release, and even digestive activity. Disruptions to this rhythm—through irregular schedules, excessive screen exposure, or poor dietary habits— can profoundly affect sleep quality.

Establishing a consistent sleep routine is one of the most powerful ways to regulate the circadian rhythm: • Try to wake up and go to bed at the same time every day, even on weekends.

• Aim for 7–8 hours of sleep per night—adequate for most adults.

• Seek out morning light exposure, ideally for 15–20 minutes, which will have a positive impact on your next night’s sleep. A morning walk or even sitting by a bright window can help recalibrate the body’s sleep-wake cycle. This can be difficult during the winter months, but try to squeeze some natural light exposure into the early part of the day somewhere!

Creating a Wind-Down Ritual: From Overstimulated to Rested Adults, just like children, benefit from a wind-down routine.

Today’s modern lifestyle is rich in stimuli—excess caffeine, digital content, blue light, and stress. As pharmacists, we can promote gentle evening routines to downregulate the nervous system and prepare the body for sleep.

Practical tips to share with patients (and apply ourselves): • Finish eating 2–3 hours before

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• Dim the lights in the evening.

Use lamps instead of overhead lighting to mimic dusk. Beware of bright bathroom lights, which will negatively impact melatonin levels. Try using a floor-level sensor light for any late-night trips to the bathroom!

• Incorporate aromatherapy.

Scents like lavender are shown to reduce anxiety and improve sleep latency. They also help to contribute to a wind-down ritual, engaging the sense of smell.

• Take a warm bath or shower, followed by gentle stretching or a short bedtime yoga session. This helps to wring out tensions from the day and relax the muscles.

• Encourage journaling or gratitude writing to shift focus away from stressors. Focusing on the good things in life helps to train our thoughts to be more positive, which can help to relax the nervous system.

• Teach breathing techniques, like the 4-7-8 breath, to calm the mind and body. (4-7-8breathing exercise: Breathe in through your nose for 4 seconds, hold for 7 seconds, and exhale slowly through your mouth for 8 seconds. Repeat 4 or 5 times. Try this when you are in bed with the lights off…zzzz!!)

• Use soundscapes or calming music, ideally with an autoshutoff timer.

These rituals help condition the body to associate certain cues—like scents, sounds, and activities—with sleep readiness.

Nasal vs. Mouth Breathing: A Silent Influence on Sleep Quality An often-overlooked factor affecting sleep quality is how we breathe—specifically, whether we breathe through the nose or mouth. Nasal breathing is the body’s natural and most efficient pathway, helping to humidify, filter, and regulate airflow. It also supports optimal oxygen exchange by promoting diaphragmatic breathing and activating the parasympathetic nervous system, which aids relaxation. In contrast, mouth breathing during sleep has been associated with dry mouth, snoring, and disrupted sleep, and may exacerbate or indicate conditions like obstructive sleep apnoea (OSA)—a disorder where breathing repeatedly stops and starts, often without the person’s awareness. Pharmacists should be alert to signs of mouth breathing or undiagnosed OSA in patients presenting with fatigue, poor concentration, or nighttime restlessness, and refer them for medical evaluation by their GP when needed.

Encouraging awareness of nasal breathing and promoting good airway health—especially in children and patients with allergies or nasal congestion—can be a valuable part of holistic sleep care.

The Magnesium Connection: Relaxation at a Cellular Level Magnesium plays a crucial role in muscle function, nerve conduction, and stress modulation. Importantly, it also supports GABA (gammaaminobutyric acid) activity—a neurotransmitter involved in calming the nervous system and facilitating sleep.

As pharmacists, we can: • Assess for symptoms of magnesium deficiency, especially in patients with chronic stress, high caffeine intake, poor diets, or gastrointestinal disorders.

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References: 1. NICE CKS. Managing women with menopause, perimenopause, or premature ovarian insufficiency. https://cks.nice.org.uk/topics/menopause/management/management-of-menopause-perimenopauseor-premature-ovarian-insufficiency/. Accessed Feb 25. 2. NHS. About vaginal oestrogen. January 2023. Available at: https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/vaginal-oestrogen/about-vaginaloestrogen Last accessed Feb 25. 3. British Menopause Society. Consensus statement. Urogenital atrophy. 2023–2024.

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36

Magnesium

• Recommend dietary sources of magnesium first: leafy greens, nuts, seeds, whole grains, and dark chocolate (just a square or two after dinner can help with cravings and provide a dose of magnesium).

• Suggest magnesium supplementation where appropriate. Forms like magnesium glycinate or citrate are better absorbed and gentler on the stomach.

• Caution patients about the excessive use of laxative forms like magnesium oxide, which may cause digestive discomfort and diarrhoea.

A Role for Pharmacists in Sleep Hygiene Education With our accessible role in the community, pharmacists are in a strong position to: • Offer advice on nonpharmacological sleep aids before resorting to medication.

• Guide patients in evaluating lifestyle factors, such as screen time, diet, and stress.

• Provide clear information on herbal teas (e.g., valerian, chamomile, lemon balm) and aromatherapy oils that promote relaxation and encourage a wind-down ritual.

• Recognise when to refer patients for sleep disorders such as insomnia, sleep apnoea, or anxiety-related sleep issues.

Conclusion Sleep should be seen as a vital sign—one that reflects physical,

emotional, and neurological health.

Better sleep improves health outcomes and reduces our risk of heart attacks. By prioritizing our own rest and offering sleep education in pharmacy practice, we not only improve our own resilience but also contribute meaningfully to public health.

With the right tools—routine, rituals, and restorative nutrients like magnesium—we can all move a little closer to a better night’s sleep.

Reducing Melanoma Risk

Reduce Your Risk of Melanoma Skin Cancer HOLIDAYING AT HOME OR ABROAD?

Occasional, intense sun exposure and sunburn increases melanoma risk.

The Irish Skin Foundation, in collaboration with the HSE’s National Cancer Control Programme (NCCP) and the National Cancer Registry of Ireland (NCRI) recently launched an updated ‘Reduce your risk of Melanoma Skin Cancer (Holidaying at home or abroad)’ Infographic , targeting the sun-loving public but with a particular focus on those who intend to spend time holidaying in the sun, whether at home or abroad.

The main aim is to raise awareness of the link between personal susceptibility (i.e. skin type), lifestyle behaviours (i.e. sunny holidays frequently associated with sunburn) and the pattern and timing of UV exposure (i.e. occasional, intense sun exposure and sunburn increases melanoma risk, particularly during childhood).

The infographic was first published in 2017 to illustrate the steep rise in incidence of melanoma skin cancer, the risks associated with intermittent, intense UV exposure and sunburn, and how to reduce your risk. It was updated in 2019, and again in 2024 to highlight the upward trend in melanoma incidence and reinforce the SunSmart messaging in the National Skin Cancer Prevention Plans 2019-2022 and 2023-2026.

This resource is available to download from the ISF’s dedicated SunSmart webpage http://www.irishskin.ie/sunsmart , the HSE NCCP’s SunSmart campaign resources for professionals www.hse.ie/skincancerprevention and the NCRI www.ncri.ie

To explore more about the lifestyle health approach I advocate at Meaghers Pharmacy, visit www. meagherspharmacy.ie and discover Pharmacy 360—a holistic framework for well-being. There, you’ll find insights into the seven pillars of lifestyle health: Sleep, Nutrition, Movement, Stress Management, Social Connections & Relationships, Core Values, and Environment. You can also follow me on Instagram @lizohaganpharmacist for more tips and updates.

377

people were diagnosed with melanoma in 1994

RIS ING IN OF MEL CIDEN ANO CE MA

• Discuss topical magnesium (e.g., Epsom salt baths or magnesium oil sprays), which some patients prefer for muscle relaxation.

Enjoy the Sun safely. Be SunSmart:

1,263

people were diagnosed with melanoma in 2021

Know your skin type!

The effects of sunlight are not the same for everyone A person’s natural skin colour influences their sensitivity to ultraviolet radiation (UV) in sunlight and skin cancer* risk, and can be broadly classified on a scale – the Fitzpatrick Skin Type Scale, which ranges from 1 (high risk) to 6 (low risk). It considers skin colour (lightest to darkest), and how the skin reacts to sunlight (whether it burns easily, or tans).

THE FITZPATRICK SKIN TYPE CLASSIFICATION 1

2

3

4

5

6

Most people living in Ireland have pale/light skin – Fitzpatrick skin type 1 or 2. People with these skin types burn easily and tan poorly so are particularly vulnerable to UV damage and, as a result, are at a higher risk of skin cancer.

Reduce your risk:

protect & inspect your skin You can reduce your risk of melanoma by avoiding overexposure to UV from sunlight or artificial sources e.g. sunbeds. If you are concerned about a change or growth on your skin, you should always see your doctor.

Make sun protection part of your daily routine, particularly when the UV index is 3 or above. Even when it is cloudy!

Stay safe by limiting time in the midday sun when UV is strongest, typically between the hours of 11am-3pm.

LOW RISK

MODERATE

HIGH

VERY HIGH EXTREME RISK

UV INDEX Remember the five ‘Ss’ of sun safety: Seek shade to avoid direct sunlight e.g. under cover of a sun umbrella or trees. Use a sunshade on buggies / prams.

Slip on clothing: Cover skin as much as possible e.g. wear long sleeves, collared t-shirts, clothes made from closewoven material that does not allow sunlight through.

Slap on a hat with a wide (7cm+) brim and a UPF† rating of 50: Protect your face, ears and neck.

Slop on broad-spectrum (UVA/UVB) sunscreen with a sun protection factor (SPF) of at least 30+ for adults and 50+ for children, with high UVA protection, and water resistant.

Reapply regularly.

Slide on sunglasses with UV protection: Guard your eyes from harm.

Protect your family: Babies and young children are particularly vulnerable to the harmful effects of overexposure to the sun. Keep babies and children out of direct sunlight.

Remember: Do not deliberately suntan.

Avoid sunbathing/sunburning.

Never ever use a sunbed!

There is no safe limit for exposure to UV from sunbeds.‡

More information at: irishskin.ie/sunsmart, hse.ie/sunsmart and ncri.ie *Skin cancer is the abnormal, uncontrolled growth of skin cells. Of the different types of skin cancer, melanoma is not the most common but raises the greatest concern as if not detected early, it can spread to other parts of the body where it becomes difficult to treat and can be fatal. Early identification and removal of a melanoma gives the best opportunity for cure. † Ultraviolet Protection Factor (UPF) indicates how much of the Sun’s UV rays (both UVA and UVB) the clothing allows to reach the skin; a higher rating indicates better protection e.g. UPF 50 blocks ~ 98% of the Sun’s UVB rays, so significantly reducing UV exposure for the skin covered by that fabric. ‡ Source: SCHEER (Scientific Committee on Health, Environmental and Emerging Risks), Opinion on Biological effects of ultraviolet radiation relevant to health with particular reference to sunbeds for cosmetic purposes, © European Union 2017.

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Published by the Irish Skin Foundation in association with the NCRI and the NCCP. Date of preparation: April 2024. First published April 2017; updated 2019 and 2024. © Irish Skin Foundation 2017-24. All rights reserved. Registered Charity Number: 20078706

38

News

McCabes Pharmacy supports Men’s Health Week This June, McCabes Pharmacy, Ireland’s leading and most patient centric pharmacy brand, is putting men’s health in the spotlight to celebrate Men’s Health Week (9–15 June), bringing awareness to a variety of preventable and treatable health issues and reminding men that “to your loved ones, your health is everything”.

Men in Ireland are less likely than women to seek preventive care or attend regular health screenings*, often resulting in health issues being detected too late for effective treatment*. In keeping with its ethos of “better health for every body,” McCabes Pharmacy is encouraging patients to take proactive steps in managing their wellbeing. Throughout the month, McCabes Pharmacy will help raise awareness in local communities with educational campaigns, convenient health check bundles, and special in-pharmacy offers.

During Men’s Health Week (9-15th June) McCabes Pharmacy is offering their local communities free blood pressure checks across their 110 pharmacies nationwide, bringing awareness to a condition that can lead to heart attacks, stroke and kidney disease. High blood pressure is known as the ‘silent killer’ as often there are no symptoms. Regular blood pressure checks can help prevent potential health issues or treat them before they become life threatening.

During this week, there is also an opportunity to give back. With three out of four suicides involving men*, McCabes Pharmacy is encouraging customers to support its charity partner HUGG, a suicide bereavement charity, through pharmacy donations.

McCabes Pharmacy is also making it easier than ever for men to take charge of their health with two value health check bundles available in pharmacies nationwide.

Speaking about Men’s Health Month, Denis O’Driscoll, Superintendent Pharmacist at McCabes Pharmacy, says, “Men make up almost half of Ireland’s population*, but the reality is we’re seeing men dying younger, and at higher rates, than women*.

The message for this campaign is “to your loved ones, your health is everything” and we want to encourage more men to take action and not become one of the statistics. This campaign is about raising awareness, supporting early action and encouraging men to talk to their GP or pharmacist if they’re concerned about any aspect of their health.

“We are urging all men across Ireland to take charge of their health and visit one of our 110 pharmacies during Men’s Health Week to avail of our free blood pressure check. We want to take the hassle and worry out of looking after your health and make it easier for men to take the first step. Our teams are always here to support and advice you on your health journey.”

Ireland’s next National Action Plan for Antimicrobial Resistance The Department of Health and the Department of Agriculture, Food and the Marine have jointly launched an online survey which provides the public with an opportunity to inform the development of Ireland’s next National Action Plan for Antimicrobial Resistance.

Antimicrobial Resistance (AMR) causes medicines such as antibiotics to become less effective, or even useless, in the treatment of infection. This increases the likelihood of disease spread or severe illness. AMR is recognised as one of the top ten global public health threats by the World Health Organisation (WHO).

To tackle this issue, Ireland has adopted a holistic One Health approach working across human health, animal health, and the environment sectors, using our national action plan as a roadmap.

The survey which is open to the general public, is a key step in the stakeholder consultation process on the new action plan, which will be Ireland’s third action plan on AMR. We are seeking the views of participants on antibiotic use, current policy on AMR, and future actions that Ireland should take to address this important issue.

The survey will remain open until Friday, 13 June 2025.

The Chief Medical Officer for the Department of Health, Professor Mary Horgan, said, "Antimicrobial

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resistance is ranked as is one of the top threats to public health globally. The emergence and spread of resistant microbes threaten our ability to treat common infections and perform lifesaving medical and surgical procedures that allow people to live healthier for longer.

"We have made a lot of important progress over the first two national action plans therefore it is essential for us to build on this work to ensure that we protect access to safe and effective medicines."

The Chief Nursing Officer for the Department of Health, Rachel Kenna, said, "As with our previous national action plans, a guiding principle in the development of this plan will be a focus on people – patients and their families, clinical staff, and all healthcare workers – working together to reduce antibiotic use and prevent infection.

"This survey gives us an opportunity to hear the views of the public on how we should continue to address the challenge that AMR presents."

Call for papers: make your contribution to Irish Pharmacy News  Articles  Research Papers  Reviews  Programme Descriptions  Reports Case Reports  Letters to editor  In-depth review articles critique fundamental concepts, issues, and problems that define a field of research or practice and support advanced practitioners as well as aspiring early-year pharmacists.  Practice reports share innovations on any area of practice, including delivering clinical services, pharmacy administration, or new approaches to inform and engage with patients with the aim to improving pharmacy practice.  Perspective articles focus on a specific field or discipline and discuss current advances or future directions, and may include original data as well as expert insight and opinions.

Contact: Kelly Jo Eastwood at: kelly-jo@ipn.ie or Aoife Hunter at: aoife@ipn.ie

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CPD: Acute Pain Continuing Professional Development

CPD

41

Written by: Eamonn Brady MPSI (Pharmacist).

Whelehans Pharmacies, 38 Pearse St and Clonmore, Mullingar. Tel 04493 34591 (Pearse St) or 04493 10266 (Clonmore). www.whelehans.ie. Email info@whelehans.ie

June 2025

Acute Pain 60 Second Summary Pain is defined by the International Association for the Study of Pain as “an unpleasant sensory and emotional experience, associated with actual or potential tissue damage, or described in terms of such damage”. Pain may also occur in the absence of tissue damage or any identifiable pathophysiological cause. Pain can be considered more than just a symptom of disease and is sometimes classed as a disease state in itself. Pain is universal however pain perception varies and is affected by the likes of cultural backgrounds and genetic differences.

Acute pain starts quickly and lasts a short period of time.

The definition of acute pain is pain that improves within one to three months of onset. Pain that lasts longer than 6 months is considered chronic pain and will require more specialist treatment from a pain expert.

Pain is a sensation experienced through the nervous system (nerves, spinal cord, and brain). Reflexes are the nervous system’s immediate response to acute pain. This is demonstrated by when a hot plate is touched, it takes milliseconds for the nervous system and muscles to coordinate and make the hand move away immediately (i.e.) a reflex reaction.

1. REFLECT - Before reading this

knowledge gap - will this article satisfy

3. PLAN - If I have identified a

use or assessment. Follow the

4 previous steps, log and record

thoseAssociation needs - or will more findings. module, consider the Will this Pain is defined byfollowing: the International forreading the Study ofyour Pain as “an unpleasant be required? clinical area be relevant to my practice?

Published bytissue IPN. sensory and emotional experience, associated with actual or potential damage, or 4. EVALUATE - Did this article Copies can be downloaded from 2. IDENTIFY - If the answer is no, described termsinof may in the absence of tissue damage meet myPain learning needsalso - and occur how www.irishpharmacytraining.ie I may still bein interested thesuch area damage”. has my practise changed a theidentifiable article may not contribute or but any pathophysiological cause.

Painascan be considered more just Disclaimer: All materialthan published is a result? Have I identified further towards my continuing professional copyright, no part of Pain this can be used in any symptom of disease and is sometimes classed as a disease state in itself. is universal learning needs? development (CPD). If the answer is other publication without permission of the however pain perception varies 5.and is affected by the likes of cultural backgrounds and yes, I should identify any knowledge publishers and author.

SOLPA-EXTRA has no WHAT NEXT - At this time you may editorial oversight of the CPD programmes gaps in the clinical area. like to record your learning for future genetic differences. included in these modules.

The 2006 National Disability Survey Ireland (CSO, 2008) stated that pain was one of the most common disability types reported. Almost 50 per cent of individuals reporting pain as the main cause of their disability and of those, with 34 per cent indicating arthritis as being the most common cause of injury or illness. Almost 20 per centopioids stated the pain disability was Pain is defined by the varies and is affected by the and sedation in hospital caused by an accident or injury. likes of cultural backgrounds and settings is outside the scope of International Association

Acute Pain

genetic differences.

for the Study of Pain as “an

this article.

For this article, I will unpleasant sensory and discuss emotionalthe types of acute pain often seen in pharmacy and GP The 2006 National Disability Causes of pain experience, associated with settings.

The management of acute pain from severe trauma (e.g., RTAs) that requires Survey Ireland (CSO, 2008) stated actual or potential tissue damage, The cause of pain is sometimes management with likes of opioids settings is outside the scope of thatand painsedation was one ofin thehospital most or described in terms of such difficult to determine and there are common disability types reported. this article. damage”. Pain may also occur in

often many aspects to consider.

Almost 50 per cent of individuals the absence of tissue damage or Chronic pain can be more difficult reporting pain as the main cause any identifiable pathophysiological of their disability and of those, with to determine the cause; acute cause. Pain can be considered pain more often has a more clearly 34 per cent indicating arthritis as more than just a symptom of identifiable cause (e.g.) muscle being the most common cause disease and is sometimes classed is the many indeterminate nature ofdifficult injury or to illness.

Almost 20 per thereinjury.

The cause of pain is sometimes determine and are Itoften aspects to as a disease state in itself. Pain is that can present the biggest cent stated the pain disability was consider.

Chronic pain can be more difficult to determine the cause; acute pain more often universal however pain perception obstacle to health professionals to caused by an accident or injury. has a more clearly identifiable cause (e.g.) muscle injury. It is the indeterminate natureofthat establishing proper diagnosis For this article, I will discuss the the condition. can present the biggest obstacletypes to health professionals to establishing proper diagnosis of of acute pain often seen in the condition.

The infographic below on pharmacy and GP settings. The ‘Reported Cause of Pain’ from management of acute pain from the PRIME study,NUIG NUIG 2011, severeCause trauma (e.g., RTAs)from that the PRIME Figure 1: ‘Reported below Cause ofon Pain’ The infographic ‘Reported of Pain’ study, 2011, requires management with likes of illustrates the problem further: from the PRIME study

Causes of pain

illustrates the problem further:

Acute pain can be felt in a specific body area such as the neck or back or the patient may have widespread pain with conditions such as a viral illness.

Chronic pain can be defined as pain which lasts longer than what is considered a ‘normal’ healing time, perhaps as part of recovery from illness or injury — generally more than three months.

Figure 1: ‘Reported Cause of Pain’ from the PRIME study AVAILABLE FROM PHARMACY Solpa-Extra 500mg/65mg Soluble Tablets. Further information is available in the SmPC. Product not subject to medical prescription. PA 1186/017/001.

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42

CPD: Acute Pain

General classification of pain (both acute and chronic)

Musculoskeletal

Headache and/ or migraine Cluster headaches

Neurological

Psychological causes

Osteoarthritis

Migraine

Depression,

Rheumatoid arthritis

Trigeminal neuralgia

Osteomyelitis

Giant cell (temporal) arteritis

Diabetic sensorimotor polyneuropathy (up to 25% of diabetics)

Acute Pain Acute pain starts quickly and lasts a short period of time. The definition of acute pain is pain that improves within one to three months of onset. Pain that lasts longer than 6 months is considered chronic pain and will require more specialist treatment from a pain expert. The period between 3 and 6 months is classified as the time of transition from acute pain to chronic pain. Patients require more specialist evaluation and treatment at this stage rather than just taking painkillers to avoid transitioning into chronic pain.

Common examples of acute pain: • Headaches • Sprains and strains • Dental work • Surgery • Broken bones • Burns or cuts • Childbirth Acute pain can be difficult to diagnose and treat, especially when caused by injuries that are not visually evident like a fractured rib, a herniated disc, a pinched nerve. Pain can develop to be more than a physical sensation.

For example, it can develop to become an emotional problem such as fear, or anxiety related to a traumatic event that triggered the pain. For example, a person may avoid driving after suffering severe injuries in a car accident.

Reasons for Acute Pain Most acute pain episodes arise from causes that can be categorised as musculoskeletal conditions.

Pain is a sensation experienced through the nervous system (nerves, spinal cord, and brain).

Reflexes are the nervous system’s immediate response to acute pain. This is demonstrated by when a hot plate is touched, it takes milliseconds for the nervous system and muscles to coordinate and make the hand move away immediately (i.e.) a reflex reaction.

In addition to reflexes, the nervous system has more sophisticated mechanisms for processing pain. The brain releases neurotransmitters that influence pain levels and have an influence

Osteoporosis

Glaucoma

Ankylosing spondylitis

Smoking

Myofascial diseases Polymyalgia rheumatica Fractures

Brachial plexus traction injury

Personality disorders Sleep disturbances

Thoracic outlet syndrome

Alcohol Temporo-mandibular joint dysfunction

Polymyositis

Spinal stenosis

Anxiety,

Post-herpetic neuralgia Multiple sclerosis

Alcoholism Drug or substance overuse or misuse Thyroid disease

Chronic or repetitive overuse

Pernicious anaemia

Carpel tunnel syndrome Muscular strains

Infections (i.e., HIV), polyneuropathies

Faulty posture

Polyradiculopathies

Mechanical low-back pain Table 1: General pain classification on mood which is one of the reasons why depression can occur in response to pain. Pain and depression can create a vicious cycle in which pain worsens the symptoms of depression and then the resulting depression worsens feelings of pain.

Symptoms of Acute Pain Acute pain can be felt in a specific body area such as the neck or back or the patient may have widespread pain with conditions such as a viral illness.

Acute pain may be described as: • Sharp • Dull • Stabbing • Throbbing (sign of inflammation) • Shooting or shock-like (sign of nerve involvement) Diagnosis for Acute Pain The reason for the pain may not be visually obvious. Diagnostic tests are helpful and include: • Blood tests • Imaging studies (x-ray, CT, MRI, nuclear scans) • Local anaesthetic injections • Dye-injection studies such as a diskogram to identify painful disks in the spine or myelogram to identify areas of spinal nerve compression

• Electromyography and nerve conduction studies to identify nerve abnormalities Patient Assessment Effective management of acute pain begins with a comprehensive patient assessment. Pharmacists play a pivotal role in this process.

A structured approach—such as the SOCRATES mnemonic (Site, Onset, Character, Radiation, Associations, Time course, Exacerbating/Relieving factors, Severity)—can aid in gathering relevant information about the nature of the pain.

Equally important is the identification of red flags that may indicate a more serious underlying condition requiring urgent medical intervention. These red flags vary depending on the location and type of pain but may include symptoms such as unexplained weight loss, fever, night sweats, neurological deficits (e.g. numbness, weakness, or loss of bladder/bowel control), or pain that is severe, persistent, or not responding to standard analgesia. For example, back pain accompanied by saddle anaesthesia or urinary retention may suggest cauda equina syndrome, a medical emergency.

Pharmacists should also be alert to red flags suggestive of non-musculoskeletal causes of pain—such as myocardial infarction presenting with atypical chest, jaw, or arm pain—or systemic conditions like infections,

malignancy, or inflammatory arthritis. In elderly patients, or those with multiple comorbidities, a lower threshold for referral is appropriate.

Chronic pain versus Acute pain Chronic pain can be defined as pain which lasts longer than what is considered a ‘normal’ healing time, perhaps as part of recovery from illness or injury — generally more than three months.

Chronic pain may be attributable to an event, such as an accident, developing from acute pain.

Opinion differs as to whether previous acute pain is always the root cause of chronic pain or simply appears, sometimes without an initial cause. In some cases, especially in relation to sports injury in contact sports, the underlying chronic pain may appear sometime after an event.

Pain may also be related to another condition. Surveys show that in Ireland, 35 per cent of reported chronic pain was arthritis related. It may site-specific, i.e., back, knee, and wrist, however 80 per cent of sufferers in Ireland report that their pain relates to more than one site.

Types of chronic pain Pain can be classified either by type of pain, or by body region.

Classes of pain types include: • Nociceptive pain: Aching, boring, worse on movement, anatomically defined, fluctuates in severity

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43 • Neuropathic pain: Burning sensation, sharp stabbing type, tingling, transient limb pain (shooting), associated with allodynia (experience of pain from a non-painful stimulation of the skin, such as light touch), hypersensitivity, or other sensory changes

Common acute pain conditions and the recommended, over-the-counter, evidence-based analgesia

• Mixed nociceptive and neuropathic pain: Combination of symptoms.

• Visceral pain: Dull, non-specific, difficult to pinpoint • Autonomic symptoms: Physiological changes (colour, temperature), sweating

Pain Type

Evidence-based recommended analgesic

Lower back pain

Non-steroidal anti-inflammatory drugs (NSAIDs, e.g., ibuprofen 400mg three times per day) at the lowest possible dose for the shortest possible time. Do not offer paracetamol alone

Tension-type headache

Aspirin (300mg three times per day), paracetamol or NSAID, taking account of patient preference and comorbidities

Migraine (must be medically diagnosed before over-the-counter medication can be recommended)

Combination of triptan (e.g., sumatriptan no more than two 50mg tablets in 24 hours), NSAID or triptan, and paracetamol. If the patient prefers one drug only, consider monotherapy with oral triptan, or NSAID (e.g., ibuprofen) or paracetamol alone, considering comorbidities. Opioids should not be used for the acute treatment of migraine.

Sprains and strains

Paracetamol (500mg to 1g four times per day, with a maximum 4g in 24 hours) or topical NSAID (e.g., ibuprofen or diclofenac gels) are recommended firstline. Consider oral NSAID (e.g., ibuprofen 400mg three times per day) 48 hours after the initial injury if needed.

Period pain

NSAID (e.g., ibuprofen or naproxen) unless contraindicated. Paracetamol can be used if a NSAID is contraindicated or provides insufficient pain relief.

Treatment Aims of treatment are to: • Reduce intensity of the pain • Enhance physical functioning • Improve mood

Reference: National Institute of Health and Care Excellence (UK)

• Promote the return to work or school and/or role within family and society

• Nerve blocks: local anaesthetics to block nerve activity

• Improve quality of life

• Trigger point injections: to treat muscle spasms

• Support pain-management planning decisions • Reduce need for healthcare services

• Acupuncture

• Resting the affected area

Overview of pain medications

• Applying ice or heat

A successful outcome from GP visits should be a pain management plan. It is highly likely that as part of this, some form of pain-relieving medication will be prescribed.

Ideally, advise on promotion of self-help, self-management, and other treatments to help improve their condition and add value to the benefit offered by medication.

• Physiotherapy • Stress reduction • Bioelectric therapy (i.e., local electrical stimulation like a TENs machine for moderate pain) • Opioid medication such as codeine or morphine • Muscle relaxant medications Second line treatment options include • Antidepressants: some tricyclics such as amitriptyline have a role in nerve pain and some antidepressants may be needed for mood and insomnia issues exacerbated by pain • Anticonvulsants: more often used for nerve pain

Given the wide and varied nature of acute and chronic pain, there is a myriad of medication options.

The effectiveness of medication depends on the nature and severity of the pain.

Regarding treatment of acute pain caused by headache (ie, migraine), in addition to standard paracetamol and NSAIDs, triptans are considered the most effective to combat acute attacks if ordinary analgesics do not work.

These include: •

Almotriptan.

•

Frovatriptan.

•

Sumatriptan.

Eletriptan.

•

Naratriptan.

Efficacy of OTC Painkillers

Medication:

• Exercise

Zolmitriptan.

•

All are POM, apart from sumatriptan, which has an OTC version available in Ireland.

• Steroid injections: to reduce tissue inflammation

First line treatment options include:

• Paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, or naproxen

•

Cochrane reviews (39 in total) of randomised controlled trials on effectiveness of OTC analgesics in acute pain found reliable evidence to indicate that simple, inexpensive, and common analgesics give good pain relief to many patients with acute pain, such as headache, toothache, sprains, and strains. Data demonstrated the most efficacious OTC drugs used were ibuprofen/ paracetamol combinations in respective 400mg/1000mg and 200mg/500mg doses.

These formulations gave effective relief in seven out of ten patients.

Fast-acting ibuprofen 200mg and 400mg was effective in at least five out of ten patients.

Paracetamol alone was effective four out of ten patients.

World Health Organization (WHO) analgesic ladder The World Health Organization analgesic ladder was introduced in 1986, initially designed to guide cancer pain treatment and over time has been adapted and applied to various other pain conditions, including acute and

chronic non-cancer pain. Overthe-counter painkillers can be used for mild pain according to this tool, starting with a nonopioid (e.g., paracetamol or aspirin) for mild pain then trialling an opioid plus a non-opioid (e.g., co-codamol) for mild-to-moderate pain. Despite its origin to manage cancer-related pain, the WHO analgesic ladder now acts as a useful guide for pain control in both acute and chronic pain from malignant and non-malignant causes. As pain is a subjective experience, the stepwise approach of the WHO analgesic ladder is not always appropriate for managing intense pain.

Opioid Stewardship Pharmacists play a critical role in promoting opioid stewardship—a patient-centred approach to ensuring opioids are used safely, appropriately, and only when necessary. While short-term opioid use may be appropriate in some cases of acute pain, the risks of dependency, tolerance, and adverse effects require careful oversight.

As accessible healthcare professionals, pharmacists are ideally positioned to review opioid prescriptions, assess ongoing need, and identify signs of inappropriate use. This includes checking for duplications, excessive quantities, high doses, or concurrent prescriptions

AVAILABLE FROM PHARMACY Solpa-Extra 500mg/65mg Soluble Tablets. Further information is available in the SmPC. Product not subject to medical prescription. PA 1186/017/001.

MAH: Chefaro Ireland DAC, The Sharp Building, Hogan Place, Dublin 2, Ireland.

SPC: https://www.medicines.ie/medicines/solpa-extra-soluble-tablets-33783/spc MAT9348

44

CPD: Acute Pain

of other central nervous system depressants such as benzodiazepines. Pharmacists should counsel patients on the risks of opioids, proper usage, storage, and the importance of not sharing medications.

In the context of deprescribing, pharmacists can initiate conversations with patients and prescribers about tapering opioids when they are no longer clinically indicated. This is particularly important for patients whose acute pain has resolved but who continue to use opioids out of habit, misunderstanding, or fear of recurrence. Pharmacists can provide structured tapering plans, reassurance about withdrawal symptoms, and alternatives such as non-opioid analgesics and nonpharmacological strategies.

Multidisciplinary collaboration is key. Pharmacists should liaise with GPs, pain specialists, and addiction services where appropriate, advocating for a co-ordinated, patient-specific approach. By championing opioid stewardship and deprescribing, pharmacists not only reduce harm but also support more sustainable, evidence-based pain management practices.

The patient’s needs will affect treatment choice so pharmacists and pharmacy teams should have available (and understand) a range of guidance and literature to best advise patients about the most effective treatment for them.

Regular review of the continued suitability of all medications used by those with both acute and chronic pain is vital. For many, the pharmacy is becoming the first port of call when a health problem, especially pain-related, arises.

Using some of the ideas regarding questions, pain diary etc will really help in enabling people to make better informed decisions about their own next step. Becoming familiar with local resources like physio’s, support groups, condition specific charities and sign posting these will only add value to a positive perception.

Guidance on musculoskeletal injures The American Academy of Family Physicians (AAFP) and American College of Physicians (ACP) guidelines published in

2020 (after a review of 13 million patients) recommended topical NSAIDs as first-line therapy for patients experiencing pain from musculoskeletal injuries (excluding lower back pain).

The guidelines recommend that clinicians not prescribe opioids except in cases of severe injury or if patients cannot tolerate first-line therapeutic options.

Private hospitals also have pain clinics. For example, the Beacon Hospital operates an acute pain service and a chronic pain service.

Learning problem-solving strategies and stress reduction techniques will help achieve a successful outcome.

Physical therapy

The pharmacist’s role

Physical therapy covers several different treatment types, which can be beneficial for chronic pain, especially pain due to musculoskeletal disorders.

Patient Counselling

The recommendations state that topical NSAIDs were the only intervention that improved all outcomes in patients with acute pain from non-lower back musculoskeletal pain. They found that topical NSAIDs also were among the most effective options for treatment satisfaction, pain reduction, physical function, and symptom relief, and were not associated with a statistically significant increased risk of adverse effects.

• Hot or cold (ice) pack treatment.

Oral NSAIDs were shown to be effective in reducing pain within two hours and one to seven days after treatment and were associated with greater likelihood of symptom relief. However, oral NSAIDs also were associated with an increased risk of gastrointestinal adverse events.

Self-help Pain management programme The Pain Management Programme (PMP) is a psychologically based rehabilitative treatment for people with persistent pain. It is delivered in a group setting by a multidisciplinary team of experienced healthcare professionals working closely with patients. The main aim is to teach a group of patients with similar problems about pain, how best to cope with it, and how to live a more active life. Referral to a Pain Management Programme is usually through the general practitioner to your local pain clinic.

There are public pain management programmes in: • St Vincent’s University Hospital, Dublin.

• The Adelaide and Meath Hospital (Tallaght), Dublin.

• The Mater Misericordiae University Hospital, Dublin.

• Mercy University Hospital, Cork *This list not exhaustive

• Ultrasound.

• Peripheral nerve stimulation/ transdermal electronic nerve stimulation (TENS).

A chartered physiotherapist can help with manual therapy, which helps to increase tissue extensibility and range of movement, thereby decreasing pain. Manual therapy can also help with alignment and joint mechanics issues, which can also help alleviate pain.

Therapeutic exercise - Such as hydrotherapy, can restore joint movement and flexibility and strengthen and condition muscles to help movement, thereby reducing pain.

Patient education - Can support physical therapy in a self-help or home-based manner. Reading and learning about their condition can assist in management of their own pain.

Exercise - Staying active can be the key to improving chronic pain symptoms. Any activity that increases mobility can have not only a positive physical benefit, but also an affirming mental health benefit also.

Cognitive behavioural therapy (CBT) CBT is a proven ‘talk therapy’, the primary aim of which is to how to recognise and manage negative thinking or unhelpful beliefs that lead to increased distress. Generally delivered on a one-to-one basis, the participant is taught techniques and strategies to enable them to challenge their thoughts and change their attitude, leading to a change in future behaviour. Through regular attendance, confidence builds, leading to positive goal setting.

These goals should relate to achieving resumption of activities previously restricted by pain.

Clear and compassionate communication is fundamental to effective counselling in the management of acute pain.

Pharmacists and their teams must create an environment where patients feel heard, respected, and empowered to engage in their own care. Building rapport begins with active listening—demonstrating genuine interest through eye contact, open body language, and minimal interruptions. Reflective listening, where key points are paraphrased back to the patient, helps confirm understanding and shows empathy.

Using plain language is essential, particularly when explaining complex information such as pain mechanisms, medication use, and possible side effects. Avoiding medical jargon ensures the patient fully understands how and when to take their analgesia, what to expect in terms of pain relief, and when to seek further help. The use of teach-back techniques, where the patient repeats the key information in their own words, is highly effective in confirming comprehension and retention.

Non-verbal cues—such as tone, pace of speech, and facial expression—also significantly influence how information is received. Pharmacists should remain alert to signs of anxiety, confusion, or unspoken concerns, and take time to address them.

Open-ended questions like “How is the pain affecting your daily life?” encourage fuller responses and can reveal underlying worries or misconceptions.

When discussing treatment options, a shared decisionmaking approach helps align management plans with the patient’s goals and preferences.

This is particularly important when advising on the use of overthe-counter analgesics or when exploring non-pharmacological strategies such as rest, heat therapy, or movement.

References available on request

AVAILABLE FROM PHARMACY Solpa-Extra 500mg/65mg Soluble Tablets. Further information is available in the SmPC. Product not subject to medical prescription. PA 1186/017/001.

MAH: Chefaro Ireland DAC, The Sharp Building, Hogan Place, Dublin 2, Ireland.

SPC: https://www.medicines.ie/medicines/solpa-extra-soluble-tablets-33783/spc MAT9348

GETS TO WORK

2x FASTER

*

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NP

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2X FASTE R A R A C E TA M O

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AVAILABLE FROM PHARMACY *Based on absorption data when compared to standard paracetamol tablets. To verify contact: verify@perrigo.com Solpa-Extra 500mg/65mg Soluble Tablets contains paracetamol and caffeine. For the treatment of mild to moderate pain. Adults and adolescents over 16 years: 1-2 tablets dissolved in water every 4-6 hours. Max 8 tablets a day. Adolescents aged 12-15 years: 1 tablet dissolved in water every 4-6 hours. Max 4 tablets a day. Not suitable for children under 12 years. Contraindications: Hypersensitivity to the ingredients. Precautions: Particular caution needed under certain circumstances and medical advice sought for renal or hepatic impairment, Gilbert’s Syndrome, chronic alcoholism, glucose-6-phosphatedehydrogenase deficiency, haemolytic anaemia, glutathione deficiency, malnutrition or dehydration, the elderly, patients weighing less than 50kg. Precautions needed in asthmatic patients sensitive to acetylsalicylic acid, patients on a controlled sodium diet and with rare hereditary problems of fructose intolerance. Patients should be advised not to take other paracetamol containing products concurrently. Immediate medical advice should be sought in the event of overdose even if the patient feels well because the risk of irreversible liver damage. Excessive intake of caffeine should be avoided while taking this product. Interactions: warfarin and other coumarin, other medicines following the same metabolic pathway, cholestyramine, probenecid, chloramphenicol, metoclopramide, domperidone, sedatives, tranquilizers, flucloxacillin and some decongestants. Pregnancy and lactation: Not recommended during pregnancy and breastfeeding. Side effects: Rare: allergies. Very rare: thrombocytopenia, anaphylaxis, bronchospasm, hepatic dysfunction, cutaneous hypersensitivity reactions, very serious skin reactions, TEN, drug-induced dermatitis, SJS, AGEP, sterile pyuria. Unknown: nervousness, dizziness, neutropenia, leukopenia. Further information is available in the SmPC. Product not subject to medical prescription. PA 1186/017/001. MAH: Chefaro Ireland DAC, The Sharp Building, Hogan Place, Dublin 2, Ireland. Date of preparation: Feb 2023. SPC: https://www.medicines.ie/medicines/solpa-extra-soluble-tablets-33783/spc MAT9346

Awards The Irish Pharmacy

2025

Innovation Takes Centre Stage On Saturday, 24th May 2025 over 650 of community pharmacy’s leading individuals, teams and pharma representatives gathered at the Clayton Hotel, Dublin for the biggest night in the pharmacy calendar.

The Irish Pharmacy Awards, proudly brought to you by Irish Pharmacy News—Ireland’s leading independent publication for the community pharmacy sector—are all about recognising the people and teams who continue to drive our profession forward.

From playing a vital role during the pandemic, to delivering new models of care, the profession has proven just how indispensable it truly is.

These Awards celebrate the exceptional commitment, innovation, and impact of pharmacy professionals across the country. Pharmacists and their teams are the heartbeat of community healthcare, and their work continues to improve lives every single day.

Natalie Maginnis, Managing Director at IPN Communications said, “It is a privilege to be joined by so many individuals who exemplify excellence.

The calibre of entries this year has been outstanding – and our judges had a very difficult task on their hands.

They are about acknowledging the commitment, creativity, and courage of pharmacists, teams, and organisations who are making real, tangible impacts on healthcare and on lives across the country.

“A huge thank you to them for their time, expertise, and dedication to ensuring this awards process was fair, rigorous, and reflective of the high standards this sector upholds.

Innovation in pharmacy isn’t just about new technologies or services – it’s about problem-solving, patient-first thinking, and rising to the ever-evolving challenges of modern healthcare.

The Irish pharmacy industry has long been a cornerstone of community health – never more so than in recent years.

And it is innovation that ensures you continue to grow, adapt, and thrive.

“We also extend our deepest thanks to our sponsors – key players in the healthcare landscape who understand the importance of supporting progress and celebrating success.

“Their continued partnership helps make nights like this possible, and more importantly, supports the innovation and collaboration we all want to see flourish.”

Funds were raised on the night for the extremely worthwhile Marie Keating Foundation – a fabulous total of over ¤4,500 was raised.

Awards were given out across thirteen categories and you can view all the winners across the next 13 pages.

PHARMACYNEWSIRELAND.COM

PHARMACYNEWSIRELAND.COM | 46

Winner Panadol People’s Pharmacist of the Year Award Chanel is The People’s Pharmacist. Chanel Geohegan of Hickey’s Pharmacy in Clones was honoured on the night with The Panadol People’s Pharmacist Award.

In association with Panadol, Irish Pharmacy News launched the search to find The People’s Pharmacist at the end of last year; giving the Irish public the opportunity to nominate and vote for, their local pharmacist who has gone above and beyond.

The People’s Pharmacist Award seeks nominations from across the country, giving patients the opportunity to recognise and salute their local pharmacist.

Through this Award, we are enabling the public to have a voice in recognising the unwavering support and spirit that makes pharmacists the backbone of our health service in every community across Ireland.

We had eight extremely deserving finalists and after a nationwide voting campaign, Chanel Geohegan of Hickey’s Pharmacy, Clones was awarded this prestigious title.

Chanel was nominated by members of her local community recognising her exceptional dedication and impact as a community pharmacist.

Known for consistently going above and beyond in her role, Chanel is celebrated as a true pillar of her community, offering invaluable support, care, and expertise to those she serves.

This nomination highlights Chanel's commitment to enhancing the health and well-being of her patients and customers, exemplifying the highest standards of service in her field. Her compassionate approach and tireless efforts have made her a trusted and respected figure, embodying the role of a community leader and healthcare advocate.

Chanel Geoghegan, The People’s Pharmacist 2025

Natalie Maginnis, Managing Director, IPN Communications with Chanel Geoghegan, The People’s Pharmacist 2025

Chanel commented on her win, “I was so pleasantly surprised to be recognised by our community for the role we play in pharmacy. Being patient-facing is truly my favourite part of the job—I love being able to help people when they need it most. It’s also important to recognise that this is a team effort. I have a fantastic team behind me, and none of this would be possible without their support.”

She continued, “Helping people through tough times is genuinely fulfilling. Community pharmacists are uniquely positioned to support the most vulnerable, whether they’re local families or patients who’ve lived here their entire lives. Having grown up here myself, I feel deeply connected to the community and understand the needs of both younger and older generations alike.”

PHARMACYNEWSIRELAND.COM | 47

Awards The Irish Pharmacy

MGK9299 Haleon Trade Ads.pdf

1

10/08/2022

2025

14:58

Introducing...

Winner

Haleon Self-Care Award 2025

Spooners CarePlus Pharmacy, Templelogue are the winners of the 2025 Haleon Self-Care Award.

Promoting self-care and empowering patients to take ownership of their health is central to Spooner’s CarePlus Pharmacy’s future goals.

They believe that when patients are equipped with the right knowledge and support, they are more likely to make positive, lasting changes to their well-being. One of the most impactful initiatives they have introduced to support selfcare is their Health Assessment service.

The Health Assessment service at Spooner’s is meticulously designed to offer a thorough snapshot of a patient’s physical well-being.

By bringing multiple essential health checks together, Spooner’s reduces barriers to early detection and supports patients in understanding their complete health profile.

Their goal is to move beyond the reactive model of care, where interventions only happen once symptoms become severe.

Haleon, formerly part of GSK

Mark Byrne, Customer Business Manager, Haleon with Cormac Spooner and the team from Spooners CarePlus Pharmacy, Templelogue and MC Marty Whelan

Cormac Spooner, Spooners CarePlus Pharmacy said after accepting their trophy, “Winning this is very humbling, to have been awarded the title amongst all the fellow nominees who are all incredibly worthy recipients. We are delighted that the services we provide have been recognised and have been of value to our patients.”

Pharmacist Anne Moore added, “We place a great importance on exceptional customer care with a vision to try and treat health poverties before they arise, whether that’s through vaccination or through health assessment and providing customers with the information to help them look after their own health.”

Mark Byrne, Customer Business Manager with Haleon said, “It is once again an honour for Haleon to sponsor the Self-Care Award and recognise the outstanding work done in this area, throughout the retail pharmacy sector.

Mark Byrne, Customer Business Manager, Haleon with Cormac Spooner, Spooners CarePlus Pharmacy – winners of the 2025 Haleon SelfCare Award

48 | PHARMACYNEWSIRELAND.COM

“At Haleon, our purpose is to deliver better everyday health with humanity.

Our brands play a vital role for people right across Ireland in a sector that is growing and more relevant than ever. Health matters and taking care of something as important as our everyday health needs to be simpler and we believe Haleon is well positioned to become a leader in this space.”

Awards The Irish Pharmacy

2025

Winner

Originalis & Pluripharm Community Pharmacy Technician of the Year Award 2025 Janet Corish from Allcare Campile Pharmacy won the Originalis & Pluripharm Community Pharmacy Technician of the Year title for 2025.

Janet is a highly experienced and dedicated Senior Pharmacy Technician at Campile Allcare Pharmacy with over 25 years of service in the pharmacy profession. Known for her exceptional attention to detail and compassionate approach to patient care, Janet has built a reputation for reliability, professionalism, and deep knowledge of pharmacy operations. Janet has consistently demonstrated excellence in her 25 years of pharmacy experience and in her role as a Senior Pharmacy Technician.

Her impact in Campile Allcare Pharmacy over the past five years has been significant. Janet is known for her warm, approachable manner and ability to explain medications clearly to patients. Her empathy and patience help build trust and reassurance, especially for older patients or those managing complex treatment plans.

Accepting her Award, Janet told us, “I was not expecting to win this tonight. This is something I never thought of being able to achieve.

I started my career in pharmacy at a very young age, working on the perfume counter and progressed my way up to my current position.

I couldn’t have imagined being where I am now.

“I love doing what I do, the colleagues I work with and of course my patients. I feel very humbled that I can now inspire those entering the profession with what can be achieved.”

Winner of the Originalis & Pluripharm Community Pharmacy Technician of the Year Award 2025 Janet Corish, Campile Allcare Pharmacy, New Ross and Rory Holohan, Country Manager, Originalis

Rory Holohan, Country Manager with Originalis said, “Originalis entered Ireland a few years ago, we want to be seen as part of the healthcare landscape. Supporting these Awards was a natural step for Originalis, it’s a statement to all pharmacists and pharmacies in Ireland that we are here to support you.

“On behalf of Pluripharm Ireland and Originalis, we extend our warmest congratulations to all the finalists for the Community Pharmacy Technician of the Year Award. Your dedication, professionalism, and vital contributions to patient care exemplify the very best of your profession.”

PHARMACYNEWSIRELAND.COM | 49

Awards The Irish Pharmacy

2025

Winner

United Drug Business Development (Independent) Award 2025

Millmount Pharmacy won the United Drug Business Development (Independent) Award.

Millmount Pharmacy has successfully evolved into a dynamic health and wellness hub, expanding far beyond the traditional pharmacy model. Over the past year, it has introduced a wide range of new services—including health screenings, digital prescription tools, and sensory-friendly supports for neurodivergent patients—cementing its role as a forwardthinking, inclusive healthcare provider.

With significant investment in staff training and community engagement, Millmount Pharmacy promotes preventative care and self-management, aligning with national health initiatives like Healthy Ireland. Through innovation, education, and strategic growth, it has redefined what a modern pharmacy can be.

Donna McDonnell, Pharmacy Manager at Millmount Pharmacy, said, “We feel amazing to bring this back. Everyone in the community has been rooting for us, and there’s a lot of excitement among the team to even be a finalist.

MC Marty Whelan with Orlagh Dunne, National Sales Manager, United Drug as she presents the United Drug Business Development (Independent) Award 2025 to Ciara Whearty, Donna McDonnell, Siobhan Taylor, Kristina Shields and Ciara Whearty, Millmount Pharmacy, Drogheda

“Professionally, it has been incredible to see us grow from strength to strength. We've built a loyal and supportive customer base and have been on a wonderful journey since we opened.

“For us, it’s all about spending time with our customers—supporting them, getting to know them and their families, and understanding their health needs so we can serve them in the best possible way.”

Orlagh Dunne, National Sales Manager with United Drug presented the Award and commented, “At United Drug we are very proud to support pharmacies to celebrate the vital role they play in the community. Recognising them aligns with our mission to enable better health outcomes to our customers.

“It’s very important that we are connected to our pharmacies as we play a vital role in patient care but we can’t do that without our pharmacies enable us to do that. Tonight is a fantastic opportunity to celebrate them and the work they do every day.”

Orlagh Dunne, National Sales Manager, United Drug presents the United Drug Business Development (Independent) Award 2025 to Ciara Whearty and Donna McDonnell, Siobhan Taylor, Kristina Shields and Ciara Whearty Millmount Pharmacy, Drogheda

50 | PHARMACYNEWSIRELAND.COM

Awards The Irish Pharmacy

2025

Winner

Perrigo Superintendent Pharmacist of the Year Award 2025 Michael Maher, Mahers totalhealth Pharmacy, Drogheda is the 2025 Perrigo Superintendent Pharmacist of the Year.

As Superintendent Pharmacist, Michael has created a gold standard of compliance, care, and leadership, setting the benchmark not only within his own pharmacy but across the wider profession. Michael continuously champions a culture of accountability and excellence, where every team member is empowered and supported to uphold the highest standards of safe, ethical practice.

Under his leadership, the pharmacy has evolved into a community health hub, delivering accessible vaccination clinics, chronic disease management programs, and health education initiatives. Michael does not just run our pharmacy; he really transforms lives.

His leadership is visionary, his standards unwavering, and his commitment to patient care unparalleled.

On accepting his Award Michael said, “Receiving this Award feels surreal, I definitely wasn’t expecting it. I am delighted. The atmosphere here is unbelievable, the calibre of all the professionals in the room is inspiring and always enjoyable to be a part of. To have even been nominated for this I feel is real recognition and feedback that I am doing something right. At the end of the day we are a team and it’s what we do together that enables us to achieve what we achieve.”

Anne Marie O’Neill, Field Sales Manager with Perrigo said, “Perrigo is a global leading provider of over the counter (OTC) solutions for health and wellness. With our healthcare landscape facing continual change, consumers are increasingly looking for self-care products that will improve their health and wellbeing and allow them to take proactive steps in making their lives better.

Anne Marie O’Neill, Field Sales Manager, Perrigo and Micheal Maher, Mahers totalhealth Pharmacy – winner of the 2025 Perrigo Superintendent Pharmacist of the Year Award

“We are committed to producing the highest quality products and solutions possible. It’s why our brands are trusted and valued by consumers. Well done to all the finalists and of course Michael on this great achievement.”

PHARMACYNEWSIRELAND.COM | 51

Awards The Irish Pharmacy

2025

Winner

BOI Payment Acceptance (BOIPA) Innovation & Service Development (Chain) Award 2025

Navi Group won the 2025 title for the Bank of Ireland Payment Acceptance (BOIPA) Innovation & Service Development (Chain) Award 2025.

The team behind Navi Group and CarePlus Pharmacy have created DispenSense, a cloud-based pharmacy management solution that is the first of its kind in Ireland.

Designed to enhance the efficiency of pharmacy operations while simultaneously improving patient care, the system's robust architecture ensures that DispenSense is not just a software solution, it is a catalyst for positive change within the pharmacy landscape, setting a new standard for resilience and efficiency in pharmacy management.

This cutting-edge software strives to make dispensing reliable, safe and efficient, empowering teams to overcome everyday challenges.

Accepting the award, Sarah Whelan, Software Product Manager at DispenSense, Navi Group, said: “It’s fantastic to be recognised by our peers in the industry for the work we’re doing to drive progress and innovation in pharmacy. Our goal is to make life easier for pharmacy professionals and to support them as the sector continues to evolve.

Maria Lettice, Sarah Whelan and Susie Morrissey, Navi Group with Barry Gray, Country Manager with BOI Payment Acceptance

Hard work and persistence have been crucial, but equally important has been the support of those who’ve joined us on this journey.

In light of the challenges pharmacy has faced—from the demands of Covid to the ongoing shifts in the industry—our focus has been on developing IT solutions that help professionals bridge those gaps and ease some of the burden they carry.”

Barry Gray, Country Manager at BOI Payment Acceptance, commented: “We’re proud to sponsor the Innovation and Service Development Award. Recognising excellence through peer recognition is essential—it sets a benchmark for others to aspire to.

Barry Gray, Country Manager with BOI Payment Acceptance and Sarah Whelan, Navi Group – winners of the Bank of Ireland Payment Acceptance (BOIPA) Innovation & Service Development (Chain) Award 2025

52 | PHARMACYNEWSIRELAND.COM

“When we see how pharmacies are innovating, it highlights what’s possible and inspires other businesses to explore new approaches. Pharmacy is a vital part of our economy, employing nearly 15,000 people across the sector. As a payments provider serving a significant number of pharmacies in Ireland, we believe it’s important to actively support and stay connected to this essential industry.”

Awards The Irish Pharmacy

2025

PKF Brenson Lawlor Young Community Pharmacist of the Year 2025

Winner

Meadhbh Honohan of Boots Pharmacy in Harold’s Cross won the PKF Brenson Lawlor Young Community Pharmacist of the Year Award 2025.

Meadhbh has made an extraordinary impact as a pharmacist early in her career by establishing Boots Harold’s Cross as a trusted healthcare provider within just 18 months of its opening in February 2023. Her ability to connect with patients and deliver exceptional care has transformed the pharmacy into a vital resource for the local community. Her innovative approach during flu vaccination season is particularly noteworthy. Despite being a new store without an established patient base or prior experience in running vaccination clinics, Meadhbh led her team to deliver an impressive number of vaccinations daily. This achievement not only protected public health but also positioned Boots Harold’s Cross as a leader in community healthcare services.

After accepting her Award Meadhbh stated, “What a feeling to be recognised by my peers and colleagues across the wider profession. I was so honoured to be among the finalists, never mind actually winning the title. I am only three years qualified and to have this under my belt already is a huge driver of my ambition. I really feel now like there is no limit to what I can achieve and I have been so inspired by all the stories of innovation and dedication I have heard here tonight.”

Jason Bradshaw, Partner, PKF Brenson Lawlor said, “PKF Brenson Lawlor provide a range of services from buying and selling pharmacies to advice on overall business strategy.

Over the years, I have had the pleasure of meeting many pharmacists and seeing many of our pharmacy clients develop and grow.

PKF Brenson Lawlor Young Community Pharmacist of the Year for 2025 Meadhbh Honohan, Boots Pharmacy, Harold’s Cross accepts her Award from Jason Bradshaw, Partner, PKF Brenson Lawlor

“Young pharmacists have an ever-growing role, and we have been able to meet many of them while providing business lectures to the pharmacy students at the Royal College of Surgeons (RCSI) and University College Cork (UCC).

PKF Brenson Lawlor provide awards and bursaries for the pharmacy colleges as we believe young pharmacists are the future of pharmacy.”

PHARMACYNEWSIRELAND.COM | 53

Awards The Irish Pharmacy

2025

Winner

Uniphar LinkUp Consumer Training & Development Award 2025

A DIVISION OF

Adrian Dunne Pharmacy, Rush scooped the title for the Uniphar Training & Development Award.

This pharmacy exemplifies a strong commitment to continuous learning as a cornerstone of exceptional patient care.

Through a combination of internal and external training opportunities, both dispensary and OTC teams stay current with industry standards, product knowledge, and customer care techniques. From regular support office training for technicians to in-house programmes like Revive and Fexo for OTC staff, education is tailored to enhance both confidence and service quality. Leadership development is also prioritised, with management training translating into stronger team engagement and workplace culture. This well-rounded, proactive approach ensures the entire team is empowered to deliver informed, personalised, and professional care.

Marty Whelan, Erik Garajkowstii and Clare Rafferty, Adrian Dunne Pharmacy Group with Jacqui Leonard, Business Development Manager, Uniphar

Jacqui Leonard, Business Development Manager with Uniphar presents the Award to Erik Garajkowstii, Adrian Dunne Pharmacy Group

54 | PHARMACYNEWSIRELAND.COM

Accepting the Award on behalf of the team, Erik Garajkowstil commented, ““We’re absolutely honoured to receive this award.

Training and development have always been at the heart of what we do—because when we invest in our team, we invest in better care for our patients. This recognition is a reflection of the hard work, passion, and commitment our entire team brings every day. We’re proud to be building a culture where learning never stops and where every member of staff is empowered to grow and make a difference.”

Jacqui Leonard, Business Development Manager with Uniphar said after presenting the trophy, “Uniphar is proud to support the Training & Development Award, which embodies our dedication to excellence and progress within the pharmacy sector. As a proudly Irish-owned healthcare company with over 50 years of experience, we understand the essential role pharmacy professionals play in communities. This Award allows us to honour the commitment, resilience and continuous investment in training that enhances patient care and rives the future of healthcare. “

Awards The Irish Pharmacy

2025

McLernons Independent Pharmacy of the Year Award 2025

Winner

Picking up the second Award of the night for Bradlon Ltd, North Road Pharmacy won the McLernons Independent Pharmacy of the Year title.

North Road Pharmacy operates on the guiding motto, “It’s all about you,” delivering a consistently warm, courteous, and professional experience to every customer. This patient-first philosophy is powered by a cohesive, motivated team dedicated to both service excellence and continuous improvement. Regular team collaboration ensures innovation and strategic growth, balancing exceptional care with business success. Known for going the extra mile, North Road Pharmacy addresses unmet needs in the community and is set to become the first pharmacy in the Northeast to offer a full blood testing panel clinic—further cementing its role as a forward-thinking, patientfocused healthcare provider.

Suzanne O’Reilly Burke, Store Manager at North Road Pharmacy, said after their win, “We’re speechless and absolutely over the moon. Our customers are incredibly loyal, and as a team, we’re more like a family—we genuinely love working together.

The relationships we have with each other and with our customers are really special.”

Maria Donnelly, Assistant Store Manager, added, “We’ve built a fantastic community around the pharmacy. From the moment we opened our doors, we’ve supported the community, and they’ve supported us. We organise local charity events each year and are proud to raise funds for great causes. Winning this award feels like a real achievement—it recognises the hard work we put into serving our community every day.”

Robin Hanna, Director of Sales with McLernons said, “We have had five fantastic nominees for this category in 2025 but for North Road Pharmacy to come out on top for the second year in a row that has to be a huge ‘Well Done’ to them.

The Pharmacy team of North Road Pharmacy, McLernons independent Pharmacy of the Year with MC Marty Whelan and Robin Hanna, Director of Sales, McLernons

North Road Pharmacy team Maria Donnelly, Robin Hanna, Suzanne O’Reilly Burke and Owner Siobhan Taylor – winners of the McLernons Independent Pharmacy of the Year 2025 with Robin Hanna, Director of Sales, McLernons

“The team at McLernons are delighted to continue our support of excellence in community pharmacy with the sponsorship of the ‘Independent Community Pharmacy of the Year’ award.

“McLernons have been supporting the recognition of excellence in community pharmacy since the inception of these awards because we believe that they shine a spotlight on the hard work, dedication and professionalism of community pharmacies up and down the country.”

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Awards The Irish Pharmacy

2025

Winner

Clonmel Healthcare Customer Service (3+ Pharmacies) Award 2025

This was a new and exciting category for 2025, encompassing a Mystery Shopper evaluation. Out of four finalists, Allcare Pharmacy walked off with the title.

Allcare Pharmacy demonstrates a network-wide commitment to excellence, setting the standard in consistent customer service at an excellent level. With a strong foundation in staff training, including quarterly product education and the WHAMM framework, Allcare ensures personalised, safe care at every touchpoint.

Clear in-store safety protocols and high service standards support this culture, while outstanding mystery shopping results—90.73% overall, with 29 stores scoring 100%— underscore their consistency. Allcare’s blend of education, accountability, and empathy reflects a model of customer service excellence across all locations.

Louise Martin, Retail Director at Uniphar Supply Chain and Retail, said of the win:

Ruth Proctor, Louise Martin and Lynda O’Brien, Allcare Pharmacy Group with Barry Fitzpatrick, Sales Director, Clonmel Healthcare

“I’m incredibly proud tonight—not just of our Allcare teams, but of all our Uniphar retail brands, including Life, McCauley, Hickey’s, and Allcare. To have three of them shortlisted in this category is superb, and I’m so proud of all our colleagues.

Every day, our store teams put in an enormous amount of work, building strong relationships with customers and delivering outstanding service. They truly are amazing at what they do. I’m accepting this award on behalf of my 1,400 colleagues across all our stores.

Tonight, we’re among the very best in pharmacy, and I feel incredibly proud to lead a team that has achieved this recognition. This isn’t our first customer service award— we’ve won several over the years—and that success reflects the dedication of our support office team right through to the shop floor.”

Barry Fitzpatrick, Director of Sales with Clonmel Healthcare said, “Clonmel Healthcare has proudly supported the Irish Pharmacy Awards since their inception. Recognising excellence in community pharmacy is something we’re deeply committed to, as these professionals play a vital role in the healthcare system across Ireland.

“Celebrating success is always important, and these Awards provide a meaningful opportunity to shine a light on the incredible work being done on the ground every day in pharmacies nationwide.

The Allcare Pharmacy team of Lynda O’Brien, Louise Martin and Ruth Proctor pictured with Barry Fitzpatrick, Sales Director, Clonmel Healthcare.

Allcare Pharmacy won the 2025 Clonmel Healthcare Customer Service (3+ Pharmacies) Award

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“All the finalists here tonight have achieved so much to reach this stage. While there can only be one overall winner, in our eyes, everyone here is a winner for the dedication and impact they’ve demonstrated.”

Awards The Irish Pharmacy

2025

Winner

OTC Counter Assistant of the Year Award 2025

Charlotte Carroll, Raheny’s McCartans Pharmacy, Raheny walked off with the Counter Assistant of the Year title for 2025.

Charlotte Carroll has quickly become an invaluable member of the Raheny Pharmacy team since joining in October 2023. Originally starting as a placement student, her dedication, professionalism, and compassion earned her a full-time position, where she continues to excel.

Charlotte consistently goes above and beyond for patients—offering assistance with everything from product advice to filling forms, and always with patience and warmth, especially towards elderly customers. Her proactive learning, attention to detail, and support with vaccine clinics further highlight her reliability and impact.

Charlotte’s presence greatly enhances the pharmacy’s care and operations, making her a very deserving finalist.

Charlotte said, “Winning this award doesn’t feel real—I’m honestly still in shock. I never imagined I’d be taking this title home, especially when I look at the other finalists and everything they’ve accomplished. It was an honour just to be shortlisted alongside them, so I’m surprised but absolutely delighted.

“I genuinely love what I do. Working with people— especially the elderly—is incredibly rewarding. I take great pride in supporting all sections of our community and caring for our customers.

In our pharmacy, it’s so important to treat everyone like family. Asking people who they are, taking the time to listen, and showing that you truly care—that’s what stays with people. That’s what makes a difference.”

Lylah O’Bernie, Marie Keating Foundation and Charlotte Carroll, Raheny’s McCartans Pharmacy

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Awards The Irish Pharmacy

2025

Winner

Lynked Excellence in Technology Award 2025

A new category for 2025, the Lynked Excellence in Technology accolade went to Brogans totalhealth Pharmacy in Loughrea.

This pharmacy implemented a Yuyama Robot system in May 2024 to enhance patient care and streamline its blister packing service — marking its most significant technological upgrade in years. The project was spearheaded by owner Jack, whose innovative vision and meticulous planning ensured the system’s seamless integration.

Although he sadly passed away before seeing it in full operation, his legacy lives on in a solution that has greatly improved workflow efficiency and, most importantly, patient compliance and outcomes.

Scott Flanagan, CEO, Lynked Loyalty, Patricia Amalia Sanchez Vega, Brogans totalhealth Pharmacy and Adnan Ishaq, Head of Sales, Lynked Loyalty

Lisa Jackson accepted the Award saying, “It is a huge honour to accept the Excellence in Technology Award on behalf of the entire team at Brogans totalhealth Pharmacy. I would like to dedicate to this to our boss and Supervising Pharmacist Jack, who sadly passed away just before Christmas. He was instrumental to this change we brought about within the pharmacy.

Jack carried out all the research, he financed it and he really brought it to fruition but died before he was able to see it up and running. He would be deeply honoured and humbled so this really means a lot to us.

“Credit must be given to our Pharmacy Manager and Owner Amber, Jack’s wife who is bringing us all into this new normal and who is an incredible inspiration to the whole team. I know Jack would be so proud and I know we can uphold his legacy and move forward in continuing to provide the best service we possibly can.”

Scott Flanagan, CEO of Lynked Loyalty, said, “We’ve always been inspired by the opportunity to bring real value to customers within the community pharmacy space. Our loyalty technology is used by many pharmacy brands to enhance customer engagement and retention.

“It’s so important to recognise technological achievements in pharmacy, given the tangible benefits they bring—from saving time to driving footfall and boosting revenue.

Scott Flanagan, CEO and Adnan Ishaq, Head of Sales, Lynked with winners of the Lynked Excellence in Technology Award Brogans totalhealth Pharmacy, Loughrea, Marie O’Brien, Lisa Jackson, Amber Staunton and Patricia Amalia Sanchez Vega

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“One key takeaway from tonight’s event is the importance of continued innovation.

It’s innovation that will make the industry more efficient, and ultimately, create better experiences for both staff and customers.”

Awards The Irish Pharmacy

2025

Reckitt Community Pharmacist of the Year Award 2025

Winner

In what was a hotly contested category with 8 finalists, the Reckitt 2025 Community Pharmacist of the Year Award went to Dan Whelan of Meaghers Pharmacy, Ranelagh.

Dan has demonstrated a profound commitment to enhancing patient care and pharmacy services through the introduction of several innovative approaches, each significantly impacting the community's health and well-being.

Dan consistently goes above and beyond to positively impact both his patients and the community. His dedication to creating a welcoming environment allows patients to feel comfortable sharing their concerns, ensuring they feel heard and supported. His leadership within the pharmacy and the wider healthcare community is marked by collaboration, support, and mentorship. He is a trusted figure among his colleagues, often sought for guidance and support.

Dan said, “I’m overwhelmed— completely shocked but absolutely delighted. This recognition means the world to me. It’s not just about being acknowledged as an individual pharmacy professional, but as part of a wider team. I truly wouldn’t have been able to achieve this without the unwavering support of my colleagues and peers.

“One of the biggest lessons I’ve learned in my career is that very little can be achieved alone. Pharmacy is built on teamwork, collaboration, and mutual support—and I’m incredibly lucky to have such a fantastic team and support network around me. This award is as much theirs as it is mine.”

Matt List-Rose, General Manager with Reckitt Ireland commented, “We come together at the Irish Pharmacy Awards once a year and it is an amazing opportunity to celebrate as suppliers, and sponsors of the Community Pharmacist of the Year Award to celebrate and congratulate these pharmacy professionals who are going above and beyond daily.

Matt List–Rose, General Manager with Reckitt Ireland presents the Reckitt Community Pharmacist of the Year Award 2025 to Dan Whelan, Meaghers Pharmacy, Ranelagh

“We are looking forward to working together in the year ahead to drive more positive change in communities nationwide. To all the finalists in the Community Pharmacist of the year category, we congratulate you on your incredible achievements and huge congratulations to Dan.”

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Awards The Irish Pharmacy

2025

Winner

Athlone Pharmaceuticals Community Pharmacy Team of the Year Award 2025

In what was a second win for the Adrian Dunne Pharmacy Group, the pharmacy store in Trim took the title of Athlone Pharmaceuticals Community Pharmacy Team of the Year Award 2025.

Led by passionate managers who value compassion, trust, and collaboration, this pharmacy team stands out as the heart of the business. With 21 dedicated staff—many with over 20 years’ service—they exemplify loyalty, care, and genuine connection with customers. Their exceptional service, rooted in old-fashioned values, builds lasting relationships and sets them apart in a world moving toward automation. Empowered to make decisions and encouraged to innovate, the team continuously improves processes while supporting each other personally and professionally. Their ongoing commitment to learning and development, including mindfulness and soft skills, makes them a truly special and deserving Team of the Year.

Barry Doyle, Head, Athlone Pharmaceuticals with Darlene Reilly, Amy Regan, Conor Sweeney, Phil Cahill, Roz Devine, Suzanne Melia, Linda Boucher and Adrian Dunne, Adrian Dunne Pharmacy Trim – winners of the Athlone Pharmaceuticals Community Pharmacy Team of the Year Award

Darlene Reilly and Amy Regan with Conor Keane, Business Service Co-ordinator, Athlone Pharmaceuticals

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Pharmacist Darlene Reilly stated, “We’re absolutely delighted. Our team has worked together for many years, and people have always been at the heart of our communityfocused ethos. This Award is a reflection of that—it’s about our team, our people, and how we connect with and support our community.

We make it a priority to really know our customers and understand how we can help them on their journey.

“Our team gives 100% every single day— whether it’s an OTC assistant asking a lady how she’s feeling after breast cancer treatment, a pharmacist delivering prescriptions, or simply checking in on an elderly gentleman living alone. Every interaction matters, and that’s what we take pride in. That’s what motivates us. Winning this Award means so much to all of us—it’s a celebration of the care and dedication our entire staff brings to the pharmacy every day.”

Conor Keane, Business Service Co-ordinator at Athlone Pharmaceuticals, congratulated the winners, saying, “At Athlone Pharmaceuticals, we see firsthand the incredible dedication, professionalism, and care that pharmacy professionals bring to their work every day. It means a great deal to us to support them and to see them honoured with the recognition they truly deserve.”

Awards The Irish Pharmacy

Irish Pharmacy Awards The Best of Pharmacy

2025

Over 650 pharmacy and industry professionals were in attendance as winners across 13 categories were announced at the annual Irish Pharmacy Awards.

Each year Irish Pharmacy News, Ireland’s only independent monthly publication for community pharmacy, celebrates and acknowledges the achievements of teams and individuals within the pharmacy profession.

The 14th annual Irish Pharmacy Awards took place on Saturday, May 24th 2025. Hosted by Marty Whelan, the awards ceremony took place in the Clayton Hotel, Burlington Road, Dublin.

The Irish Pharmacy Awards recognise the achievements of individuals and teams working in the community pharmacy sector; their dedication and innovation which positions the profession at the forefront of healthcare, improving the lives of people across the country.

Pictured are some of those who attended.

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1. Emer Keating and Mark Byrne, Haleon 2. Fergus McCauley, Caitlynn Rowne, Nadia Pusto, Rosemary King and Kelly Macardae, all from IQVIA 3. Adrian Dunne, left with the team from Adrian Dunne Pharmacy, Trim 4. The team from the Marie Keating Foundation Ireland 5. Pharmacist Dearbhla Walsh and team from Campile Allcare Pharmacy, New Ross 6. The pharmacy team from Chemist Warehouse

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Awards The Irish Pharmacy

2025

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1. Fergus McCauley, Jennifer Gallagher and Sarah Collier 2. Adrian Dunne Pharmacy, Rush 3. The pharmacy team from Bhagwans at Meaghers Pharmacy 4. Luz and Gerson Santos, McGreals Pharmacy, Blessington 5. Sarah Sarin, Michaelina Biskupska and Catalin Salop, McCabes Pharmacy Swords Pavilions 6. Marie O’Brien, Lisa Jackson, Amber Staunton, Rita Plower, Diana O’Connor, Gearldine Shaughnessy, Sorcha Nevin, Jessica Waldron and Patricia Vega Sanchez, Brogans totalhealth Pharmacy

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1: Kelly McArdle and Grace Grimes, Meaghers Pharmacy 2. Karen Whelan, Susan Sheahan, Suzy Farrell, Gillian Armstrong, Sarah Gannon, Ellen Byrne, Sarah Smith, Hannah Smith, Clare Healy, Anna Carney and Mark Domican, Gleneaston Pharmacy 3. Valeo Healthcare’s Miyra Alabri, Lisa Kelly, Esme Simington, Stephen Moloney, Marie Almond and Isabella Carmo 4. Linda Nevin, Elena Barbieru, Fiona Nevin, Jemma Turnbull and Saorla O’Mara, McCormacks Pharmacy 5. Pictured enjoying the Irish Pharmacy Awards 6. Orlagh Dunne and the team from United Drug

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Awards The Irish Pharmacy

2025

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1. Shauna Lagoyiannis, Sophia O’Reilly, Letitia Proctor and Damien Keane, Stacks Pharmacy, Ballymount 2. The team from PHX Ireland, United Drug and McCabes Pharmacy including Karen Gibney, Dervila McGarry, Denis O’Driscoll, David Ruane, Jenny Howett, Alan Finn, Maura Cronin, Nichola Carr, Natalie Meinert and Orla Doyle 3. Shane Ryan, centre, with the team from Ryans Pharmacy 4. Letitia Proctor, Sophia O’Reilly and Shauna Lagoyiannis, Stacks Pharmacy, Ballymount 5. Meadhbh Honohan and team, Boots Pharmacy Nutgrove 6. The pharmacy team from Allcare Campile Pharmacy New Ross

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1: Bernie Kelly, Catriona Cullen, Luz Santos Deirdre Garry, McGreals Pharmacy Blessington 2. The People’s Pharmacist Chanel Geoghagan and team from Hickey’s Pharmacy 3. The pharmacy team from Kelly’s Staywell Pharmacy, Dundalk 4. Todor Gasharov, Marta Jozefczuk ,Hollie Keogh and Tina Dunne, McCauleys Pharmacy Group 5. Camilla Morgado and Thaís Terencio, The Menopause Hub 6. The pharmacy team from McMeels Pharmacy, Donaghmede

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Awards The Irish Pharmacy

2025

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1. Ciara Malone, Barbara Kelly, Rebecca Caulfield and Nadine McAllister, Excel Recruitment 2. Fathimah Kara, Ruqayya Kara, Tomas Rutkauskas, Hawwa Kara and Farouk Kara, Reidys Pharmacy Rathcoole 3. The pharmacy team from The Rye Pharmacy 4. Helen Sheils, Sinead O’Connor, Nuala-Anne Curley (Pharmed) 5. Dee O’Dwyer, Dmod Consulting and Alison Cahill, Rochfords Pharmacy 6. Sergio Martin, Senior Pharmacist, St Michael’s Hospital and Kasia Martin 7. Dominika Pawlikowska-Glodziak, Fadi Almasri,Patricia Dunne, Hanin Almasri and Lauren Kelly, Ballon Pharmacy

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1: Micheal O’Reilly and Michelle Duff, Park CarePlus Pharmacy, Cabinteely 2. The team from Spooners CarePlus Pharmacy, Templelogue 3. The pharmacy team from North Road Pharmacy was MC Marty Whelan 4. Mark Beddis and Ruth Beddis, McCartans Pharmacy Donaghmede 5. Mairead O’Mahony and Martina Zupova, McCabes Pharmacy 6. Shane Ryan and Jenny Percival, Ryans Pharmacy 7. Conor Walsh and Eva McMullin, APPEL

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Awards The Irish Pharmacy

2025

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1. Maria Lettice, Caolan McGee and Sarah Whelan, Navi Group 2. The team from Athlone Pharmaceuticals, Conor Keane, Chris McKenna, Gavin Butler, Arjum Pathula and Heidi Ashmore 3. Kelly’s Pharmacy, Clondalkin pharmacy team Ollie Kelly, Lorraine Kelly, Louise Mullaney, Corrina Byrne, Suzanne Fairbrother, Sinead Fairbrother, Hannah Larkin Weir and Scott Nolan 4. Rose Finlay, Rose Finlay totalhealth Pharmacy and Brian Battles, Pharmacy Success 5. Karey Coughlin and Gina Donnery, ITL Health 6. The team from Reckitt Ireland, Matt List-Rose, Ciaran Leonard, Niamh Duffy, Graeme McInerney, Oisin Proudfoot, Carlos Oliva, Martin Delaney and Natasha Eccles

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News

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Heart Failure Doesn’t Stop Us In observance of Heart Failure Awareness Week, the Irish Association of Heart Failure Nurses (IAFHN) stand united with individuals living with heart failure, caregivers, healthcare professionals, and the entire community, to raise awareness about this common, yet often overlooked condition.

Throughout Heart Failure Awareness Week, the IAHFN are encouraging the public to learn more about the symptoms of heart failure, including shortness of breath, fatigue, and swelling, and to recognize the importance of seeking early diagnosis and having regular health checkups. Earlier diagnosis results in earlier access to treatments and interventions, which save lives.

From May 5th to May 8th, heart failure nurses will be hosting information stands and educational activities in hospitals across Ireland. Together this Heart Failure Awareness Week, we can foster a greater understanding of heart failure and support those who continue to live with strength and courage. Heart failure may challenge us, but it doesn’t stop us!

More information on heart failure: https://croi.ie/heart/heart-failure/ www.irishheart.ie www.heartfailurematters.org

Heart failure occurs when the heart does not circulate blood around the body as well as it should.

When blood cannot circulate freely, congestion occurs causing fluid retention in the lungs, legs and stomach. Heart Failure can occur for a variety of reasons, as a result of damage caused by heart attack, high blood pressure, valve disease, diseases of the heart muscle and heart rhythm disorders. Heart failure can also occur due to other diseases, which ultimately damage the heart such as diabetes, lung diseases, excess alcohol, certain drugs, and infections.

The European theme of this year’s Heart Failure Awareness Week, “Heart Failure Doesn’t Stop Us”, highlights the resilience, determination, and hope that people living with heart failure embody every day. Heart failure will affect 1 in 5 adults in our lifetime. Despite its challenges, many individuals find ways to live active and fulfilling lives, emphasizing the importance of early diagnosis, proper

management, and a proactive approach to care.

John Ridge from Corrandulla, Co.Galway is not letting his diagnosis hold him back. John was diagnosed with heart failure 18 months ago. He says, “heart failure doesn’t define me, I still live a full and active life. My heart failure team have been there every step of the way. They’ve helped me to feel confident in managing my condition and getting on with my life.” John continues to enjoy an active social life, playing his accordion at social events, visiting neighbours, going to coffee with friends and bowling in his local club. He is also an avid artist, having taken up painting following his retirement.

continue pushing forward. With the support of healthcare providers, lifestyle changes, and innovation in medical science, people with heart failure are leading productive and meaningful lives.”

John Ridge (Heart Failure patient) and Emer Burke (Advanced Nurse Practitioner, Heart Failure at Galway University Hospitals and President of the Irish Association of Heart Failure Nurses)

Emer Burke, President of the Irish Association of Heart Failure Nurses says “Heart failure doesn’t stop us is more than a slogan. It’s a testament to the courage and strength of those facing heart failure, as well as the advancements in treatments and therapies that allow them to

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News

Living with Crohn’s – Latest Research A new report published today reveals that sixty percent of individuals in Ireland living with Crohn’s disease and colitis experience financial difficulties, highlighting the significant financial burden associated with these conditions. Concerningly, because of costs involved with accessing medical treatment, 47% of people have avoided seeking necessary medical care. The ‘Uncovering the Hidden Cost of Crohn’s and Colitis’ report was launched by Crohn’s and Colitis Ireland (CCI), in partnership with Johnson & Johnson Ireland.

Amy Kelly, Chief Operating Officer at Crohn's & Colitis Ireland, Ged Nash, T.D, Michaela Hagenhofer, General Manager of commercial operations, Johnson & Johnson Innovative Medicine, Dr. Orlaith Kelly, Consultant Gastroenterologist, Connolly Hospital and Jonathan Healy who lives with Crohn's Disease. Picture Jason Clarke.

broader support remains a challenge. 39% expressed difficulty in seeing a GP, and qualifying for a medical card or GP visit card is proving to be difficult.

Only 29% of people with Crohn’s disease and colitis have a medical card and only 13% have qualified for a GP visit card, frequently denied due to these conditions not automatically meeting the eligibility criteria. An overwhelming 98% believe Crohn’s disease and colitis should automatically qualify individuals for additional support, underscoring the urgent need for policy reform.

Crohn’s disease and colitis are two types of Inflammatory Bowel Disease (IBD), chronic digestive conditions that affect an estimated 40,000 people in Ireland. While these conditions can be diagnosed at any age, they commonly present in young adults between 15 and 35, with a notable second wave of diagnoses occurring between 50 and 60. Symptoms include diarrhoea, abdominal pain, fatigue, and weight loss, that can significantly impact a person's daily life.

The report provides insight into the challenges faced people living with Crohn’s disease and colitis in Ireland and identifies the key areas of improvement in care. The findings revealed that direct medical costs are the most significant financial challenge.

People living with these uncurable conditions spend approximately ¤3,252 annually to manage their disease, which includes treatment and dietary needs. On average, this cohort spends a minimum of 33 hours a year accessing healthcare

services, including travelling to and attending appointments.

Indirect costs also significantly impact patients' overall financial stability.

• 62% reported that taking time off work due to their condition has negatively affected their financial situation to some or great extent.

• 82% of respondents said that they missed work or lost wages as a result of their condition, while 86% reported they have attended work when they have needed to take time off work.

• Costs associated with attending medical appointments also play a significant role in financial burden with 85% citing mileage and travel costs, 83% citing parking fees, 62% citing overnight stays for medical appointments and 49% citing childcare fees.

Amy Kelly, Chief Operations Officer at Crohn’s and Colitis Ireland said,

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"These findings show the true extent of the challenges faced when diagnosed with Crohn’s disease and colitis including the financial burden inflicted. However, it's not just about medical bills, it's about lost wages, dietary adjustments and the constant struggle to access the care that people desperately need. We urge the government to listen to the needs of the community and to improve access to care in Ireland.

This includes including Crohn’s disease and colitis in the Chronic Disease Management Programme and expanding medical card eligibility, ensuring equitable access to essential medical care.

This inclusion would provide free, structured care, potentially reducing patients' out-of-pocket healthcare expenses through fewer emergency room visits, hospital admissions, and lower medication costs.”

While the majority of people living with Crohn’s disease and colitis have qualified for the drugs payment scheme (74%), accessing

Painting an even more concerning picture is that over a quarter of respondents (26%) reported delaying taking their medication to make it last longer due to the costs involved.

Dr Orlaith Kelly, Consultant Gastroenterologist, Connolly Hospital, Dublin, said, “It's deeply concerning that this report reveals so many people are delaying or skipping essential treatment due to cost, as this negatively impacts how they manage their condition. As a consultant gastroenterologist, I see firsthand the immense challenges people living with Crohn’s disease and colitis face, not only with their health but also with the financial and emotional burden of managing their condition. This research underscores the urgent need for a more comprehensive approach to care in Ireland, one that ensures financial barriers do not prevent patients from receiving the treatment they desperately need to manage their condition effectively.”

For more information, visit https:// crohnscolitis.ie/

Topic Team Training – Osteoarthritis A community pharmacy environment that fosters teamwork ensured high levels of consumer satisfaction.

This series of articles is designed for you to use as guide to assist your team in focusing on meeting ongoing CPD targets and to identify any training needs in order to keep the knowledge and skills of you and your team up to date.

The below information, considerations and checklist provides support to enable you to run a team training session and identify opportunities for learning within the topic of Osteoarthritis (OA).

OA presents with joint pain and loss of function, however, the disease is widely variable and can present from an asymptomatic incidental finding to a permanently disabling disorder.

Osteoarthritis is a heterogeneous disease caused by multiple factors.

Risk factors for developing OA include increasing age, female gender, obesity, anatomical factors, muscle weakness and joint injury, particularly from occupational and sports activities.

The prevalence and incidence of OA increase with age with a majority of individuals over the age of 65 affected.

The occurrence of osteoarthritis is progressively rising due to increased life expectancy and population aging together with a rise in obesity. Excess weight compounds the problem by putting extra strain on damaged joints. Osteoarthritis is more common and often more severe in women, especially in the knees and hands. It often starts after the menopause. Certain occupations can place excessive loads on the joints resulting in OA in later years.

Occupations with repetitive knee bending can result in knee OA, while heavy manual labour may predispose to hip osteoarthritis.

The presentation and progression of osteoarthritis varies greatly from person to person. The triad of symptoms is joint pain, stiffness and locomotor restriction. Patients can also present with muscle weakness and problems with balance.

Pain is usually related to activity and resolves with rest. For patients in whom the disease progresses, pain is more continuous and affects activities of daily living, eventually

causing severe limitations in function. Patients may also experience bony swelling, joint deformity and instability.

Current therapeutic options are aimed at keeping the associated pain, inflammation, and degeneration of synovial joint tissues manageable in order to minimise the structural and symptomatic progression of osteoarthritis. Management of the disease involves both pharmacological and nonpharmacological therapies.

Pharmacotherapy involves oral, topical, and/or intra-articular options. Paracetamol and oral NSAIDs are usually the initial choice of pharmacological treatment. Topical NSAIDs are less effective than their oral counterparts but have fewer gastrointestinal and other systemic side effects. A proton pump inhibitor (PPI) may also be prescribed at the same time as oral NSAIDs to reduce the risk of damage to the stomach lining.

Capsaicin cream may also be prescribed for osteoarthritis of the hands or knees, if topical NSAIDs have not been effective in easing pain. Capsaicin cream works by blocking the nerves that transmit pain in the treated area.

Intra-articular joint injections can be an effective treatment for osteoarthritis. Glucocorticoid injections have a variable response however, and there is ongoing controversy regarding repeated injections. Although corticosteroid injections can ease osteoarthritis symptoms, they have limitations. They cannot repair damaged cartilage or slow the progression of osteoarthritis and relief is only temporary.

Non-pharmacologic therapy includes avoidance of activities that exacerbate pain, exercise to improve strength, weight loss if applicable, wearing suitable footwear and occupational therapy for unloading joints.

Consider:  Those most likely to suffer from Osteoarthritis  The factors which may cause Osteoarthritis  The signs and symptoms  Any follow-up actions that may be required

Not using joints can cause muscles to waste and increase the stiffness caused by osteoarthritis. Manual therapy is a technique where a physiotherapist uses their hands to stretch, mobilise and massage the body tissues to keep a patients joints supple and flexible. Applying hot or cold packs to the affected joints can also help relieve the pain and symptoms of osteoarthritis in some people. Transcutaneous electrical nerve stimulation (TENS), if advised by a doctor or health care professional may help ease the pain caused by osteoarthritis, by numbing the nerve endings in the spinal cord which control pain.

For osteoarthritis in the lower limbs, such as hips, knees or feet, special footwear or insoles for shoes may be helpful. Footwear with shock-absorbing soles can help relieve some of the pressure

Key Points: Check your pharmacy team are aware and understand the following key points:  Are able to recognise the signs and symptoms of Osteoarthritis

on the leg joints when walking, and special insoles may help spread weight more evenly. Leg braces and supports also work in the same way. For osteoarthritis in the hip or knee that affects mobility, the use of a walking aid, such as a stick or cane may be beneficial. Occupational therapists can provide help and advice about using assistive devices in the home or workplace.

Actions:  Ensure pharmacy staff can provide guidance on appropriate use of pain relief options, while considering age and comorbidities  Educate staff being able to advise on lifestyle changes such as weight management, exercise and physical therapy  Ensure that I monitor for adverse effects, particularly from long-term NSAID use or polypharmacy in older adults

 Support a patient to self-manage the symptoms

 Educate the team to be able to advise patients on proper medication use, expected benefits and potential side effects

 Provide appropriate lifestyle advice

 Train the team to meet all the above considerations

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Diabetes

Embarrassment of Riches Written by Faisal I. Almohaileb and Carel W. le Roux, St Vincent’s Healthcare Group, Dublin over 80% of tirzepatide-treated participants lost at least 10% of their body weight, and nearly one in three achieved more than 25% weight loss and one in five reached more than 30% weight loss previously thought possible only with bariatric surgery. For the first time, a pharmacological therapy offers results once limited to the operating room. These categorical weight loss milestones were also achieved by people treated with semaglutide albeit the percentages were two fold lower.

Faisal I. Almohaileb

Carel W. le Roux

"Tirzepatide and semaglutide’s ability to deliver double-digit weight loss, improve cardiometabolic health, and meet patient expectations marks the beginning of a new era."

Obesity is no longer just a future threat; today it is a global emergency. Across continents, millions struggle with the disease of obesity that increases their risk for chronic complications, erodes their quality of life, and burdens health systems. Despite the rising urgency, medical treatments have previously fallen short of matching the magnitude of the challenge.

That may now be changing.

In May 2025, the results of the SURMOUNT-5 trial, published in The New England Journal of Medicine, signaled a potential paradigm shift in obesity treatment.

This 72-week, real-world, reflective clinical trial compared two state of the art obesity pharmacotherapies: semaglutide and tirzepatide.

Both drugs share glucagon like peptide 1 (GLP-1) activity, but tirzepatide also acts on the glucose-dependent insulinotropic

polypeptide (GIP) receptors. The trial showed tirzepatide delivered significantly greater weight loss and waist circumference reduction.

The trial recruited 751 adults with the disease of obesity (BMI ≥30 kg/m2, or ≥27 kg/m2 with obesity related complications) who did not have type 2 diabetes.

Participants were randomized to receive the maximum tolerated dose of either semaglutide (up to 2.4 mg weekly) or tirzepatide (up to 15 mg weekly), with a gradual dose escalation protocol to manage tolerability. Over the course of 72 weeks, tirzepatide led to an average weight loss of 20.2%, compared to 13.7% with semaglutide, meaning patients were shedding approximately 22.8kg versus 15.0kg.

The proportion of patients achieving categorical weightloss milestones showed that

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But weight loss is only one dimension. Central adiposity, abdominal fat, is a key driver of cardiometabolic risk. The trial measured changes in waist circumference, a proxy for visceral fat. Patients on tirzepatide reduced their waistline by an average of 18.4 cm, compared to 13.0 cm with semaglutide. This may be relevant because other studies showed that each 5 cm increase in waist circumference is associated with a 7% (men) to 9% (women) rise in mortality risk.

What makes tirzepatide so effective? It may be its dual mechanism. Semaglutide is a powerful GLP-1 receptor agonist that treats the disease of obesity and during the weight reduction phase reduces appetitive behaviour, slows gastric emptying, and improves glycaemic control.

Tirzepatide builds on this foundation by also activating GIP receptors. GIP plays roles in fat metabolism, energy regulation, and insulin sensitivity.

By engaging both systems, tirzepatide is able to achieve a lower adipocyte mass with energy balance recalibration. It works in the subcortical areas of the brain, but also in the periphery: adipose tissue, pancreas, kidney, and heart. The result is coordination of a full-system approach to manage the disease of obesity.

Of course, safety matters. Both drugs shared similar side-effect profiles, with gastrointestinal events such as nausea, vomiting, and diarrhea being most common, especially during titration.

Only 2.7% of tirzepatide users discontinued treatment due to side effects, compared to 5.6% of semaglutide users. Injection site reactions were more frequent with tirzepatide but were mild and non-disruptive. No major cardiovascular events or deaths occurred in either group.

Beyond clinical endpoints, SURMOUNT-5 reflects a broader cultural shift in the care of obesity. For decades, weight loss drugs delivered limited results, often less than 10%. This led to frustration, low adherence, and disillusionment among patients and clinicians. Now, with drugs like tirzepatide and semaglutide, we can offer hope backed by strong evidence.

Data from the OBSERVE study shows that many people with obesity, especially those with class II and III obesity, set ambitious yet realistic goals of 15– 20% weight loss. Until recently, these aspirations were dismissed as unreachable. Today, they’re not just possible, they’re becoming expected. With tirzepatide and semaglutide, many patients will exceed them.

This evolution reframes our thinking: from how we discuss treatment goals to how we evaluate outcomes. Weight loss is no longer about aesthetics or numbers on a scale. It becomes a tool for disease remission, prevention, and improved quality of life. Already, tirzepatide and semaglutide are being tested for their ability to reverse sleep apnea, prevent type 2 diabetes, and reduce cardiovascular events.

The possibilities are expanding.

Just as important, tirzepatide and semaglutide challenges the stigma around obesity. These results reaffirm that obesity is a chronic, complex, neurohormonal disease, not simply a matter of willpower.

The profound responses seen with effective obesity medicines reveal that biology, not just behaviour, is at the core of the disease. As treatments improve, so must our empathy.

In conclusion, the SURMOUNT-5 trial is more than a comparison of two medications; it’s a turning point. Tirzepatide and semaglutide’s ability to deliver double-digit weight loss, improve cardiometabolic health, and meet patient expectations marks the beginning of a new era. Obesity care is evolving, and with agents like tirzepatide and semaglutide, we now have the tools to treat not just the condition but the person behind it. The future of obesity medicine has started and we expect it to be bright.

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4. Yaron, M. Diabetes Care (2019): https://doi.org/10.2337/dc18-0166. 5. Leelarathna, L. N Engl J Med (2022): https://doi.org/10.1056/NEJMoa2205650. 6. Wright, E. Diabetes Spectr (2021): https://doi.org/10.2337/ds20-0069. ©2025 Abbott. The sensor housing, FreeStyle, Libre, and related brand marks are marks of Abbott. ADC-112069 v1.0 04/25.

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Finance

Property in a Pension In recent years, Irish investors have increasingly explored the idea of purchasing property through Self-administered pensions that allow individuals to hold direct property within their pension structures.

Written by Colm Moore CERTIFIED FINANCIAL PLANNER™ with Moore Wealth Management.

This year will mark 20 years they are advising the pharmacy community.

He can be contacted on 086-860 3953 or colm@mwm.ie.

For more see www.mwm.ie

3) Borrowing is permitted only under strict conditions (limited recourse borrowing) and must comply with Revenue rules. As there is no recourse to the asset for the lender and thus a higher risk the interest rate is higher than the prevailing market rate to reflect this risk. There may also be personal guarantees sought due to this.

4) You cannot flip or quickly develop and sell the property.

This is regarded as trading rather than investment.

Complexity Owning property through a pension introduces a complex set of compliance rules, for example: While the idea of using a pension to invest in property can appear attractive, especially given Ireland’s housing crisis and the perception of property as a "safe" investment this strategy carries a number of drawbacks when compared to other asset classes.

All too often in the sales process a comparison is shown with someone investing in property outside of a pension compared to inside a pension structure. With the tax relief and tax free growth this looks like an opportunity not to be missed. A truer comparison would be to compare a property in a pension against the asset class the generates the highest return over time in the same structure, namely equities. By equities I mean owning and becoming a shareholder of the biggest and best companies in the world like Apple, Nvidia, Microsoft etc.

While Irish residential and commercial property has experienced periods of strong growth, it has also demonstrated high volatility, especially during economic downturns. The property market crash of 2008 left many Irish investors with deeply negative equity and pension funds that took years to recover.

Over the long term, global equity markets have outperformed every other asset class on a risk-adjusted basis. Equities also

offer the benefits of dividends, compounding returns and exposure to global economic growth. With the advent of low-cost index funds, investors can gain diversified exposure to thousands of companies across geographies and sectors, something a single property investment in Dublin or Galway cannot offer.

Liquidity Property is an illiquid asset. Unlike equities, property cannot be quickly sold, partially divested, or easily rebalanced. If an investor holds a single property in their pension, they are significantly exposed to the performance of that specific asset, location, and tenant. This goes against the core principle of diversification, which underpins all long-term pension strategies. Equities have daily and partial liquidity which is a huge advantage. Who wants to get to retirement and have to sell a property, move tenants out etc to get your tax free lump sum.

Moreover, in times of market downturns or urgent liquidity needs (e.g., when approaching retirement age), exiting a property investment can be time-consuming and may require selling at a loss, especially if the market is unfavorable.

Equities offer far greater flexibility when it comes to retirement.

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1) The property must be held at arm's length from the investor (i.e., you cannot live in it or rent it to a relative).

2) All costs associated with the property must be paid from the pension fund which sounds good until you see the process involved in getting some remedial works completed. You would need to go through the following • Obtain a fixed price contract between the pensioneer trustee and the contractors • Any planning permission applications must be in the name of trustee or at a minimum lodged with a consent letter from the trustee.

• Obtain evidence of contractors and tradesmen P.I insurance for trustees • An architects’ certificate for works carried out is required • Make sure you have sufficient funds in the scheme to meet all expenses • Notify insurers of refurbishment period and ensure insurance policy is adequate It is difficult enough to get work done on a property in Ireland at the moment and here you are adding a layer of complexity and compliance that may frankly deter suitably qualified individuals from carrying out the works.

Failure to follow these rules can result in punitive tax consequences . Compared to passive investments such as equity index funds which require minimal oversight the administration burden of property can be significant.

Its important to note that Self Administered Pension schemes are unregulated. While the Central Bank is aware of these schemes, they do not require licensing or authorization from the Central Bank and are not covered by its consumer protection requirements.

Maintenance, Management, and Vacancy Risks Unlike other asset classes that are managed by fund providers or investment managers, direct property ownership brings operational burdens. Tenants need to be managed, properties require upkeep, and unexpected vacancies or repairs can disrupt cash flow. These risks are borne by the pension fund and can significantly impact performance, particularly if the property is highly leveraged.

In contrast, a portfolio of index funds incurs minimal management hassle, with automatic reinvestment of dividends and no direct involvement in day-to-day operations.

Inflexibility Around Retirement Planning When retirement approaches, pension assets typically need to be converted into an Approved Retirement Fund (ARF) or used to purchase an annuity. Liquidating a property to generate retirement income can be impractical, particularly if the timing coincides with a downturn in the property market. Meanwhile, selling

colm@mwm.ie

086 860 39 53

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086 380 18 68

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Finance

equities is straightforward and can be planned gradually to match income needs.

Rental Income When the rental income arrives into your pension you don’t want to leave this in cash so in most cases that we encounter we find the recommendation from the broker is for the investor to put these into the highest returning asset class, equities !

Costs You need to be very clear on how much this is costing you. If this is something you are considering you need to ask the broker for the following 1) Annual Fee: For the scheme including minimum fee which will include VAT 2) Allocation Rate: If you are moving money from one pension to a self administered scheme how much of these funds are going into your new pension.

You should not accept anything less than 100%. Any lower is unwarranted and unjustified.

3) Set Up Cost: How much are you being charged to set up the self administered scheme 4) Ongoing Broker Fee: What is your brokers ongoing fee for administration and reporting on the scheme. This is separate or can be bundled on top of the annual fee but should be clearly shown.

You want all of these costs confirmed on the brokers headed paper. Do note this headed paper should specify that the broker is

not regulated by the Central Bank for this piece of advice.

Conclusion While purchasing property through a pension in Ireland can offer tax advantages and may suit a small minority of investors with specific expertise or intentions, for most people, the drawbacks outweigh the benefits. Illiquidity, poor diversification, administrative

burden, and suboptimal riskadjusted returns make direct property investment less attractive than alternative asset classes such as global equities.

A well-structured pension should prioritise long-term growth, flexibility, and diversification— objectives that are often best met through a mix of liquid, low-cost, and professionally

managed assets rather than a single, high-maintenance, illiquid property investment. Despite Ireland going through a process of supposed pensions simplification the current market is anything but simple. Investing in a property via your pension is bringing layers of complexity you do not need when a simpler solution is readily available. Make sure you compare and contrast all you options.

News Exploring Supplement Use Among Men with Prostate Cancer in Ireland This study, conducted as part of a final-year MSc thesis in Human Nutrition and Dietetics at University College Cork, investigates the use of herbal and vitamin supplements among men diagnosed with prostate cancer in Ireland.

Prostate cancer is the second most common cancer among men in the country, with approximately 4,000 new cases annually and a lifetime risk affecting 1 in 6 men.

While conventional treatments such as surgery, radiotherapy, and androgen deprivation therapy remain standard, there is growing interest in complementary and alternative medicine (CAM), including dietary supplements, to enhance quality of life during and after treatment.

Despite the increasing prevalence of supplement use, limited data exist on the types of supplements being used, the reasons behind their use, and the role of healthcare professionals in guiding these decisions. This study seeks to address these gaps by collecting anonymous survey data directly from men diagnosed with prostate cancer. The research aims to identify trends in supplement use, understand patient motivations, and assess the extent of communication between patients and healthcare providers on this topic.

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Findings from the study will contribute to a better understanding of supplement practices in this patient population and support the development of evidence-based dietetic guidance. The research aligns with the growing emphasis on holistic, patient-centred care in oncology and aims to enhance dialogue around supplement use, particularly in the context of possible interactions with standard cancer treatments.

The study is currently open for participation and welcomes wider community engagement to increase survey reach. It is being promoted in conjunction with Men’s Health Week to highlight the importance of addressing the nutritional and supportive care needs of men with prostate cancer.  Survey Link: https://ucc. qualtrics.com/jfe/form/ SV_6m8YDdKWYwSpUJo  Ethics Approval Reference: ECM 4 (r) 22/04/2025

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78

Conference

Irish Annual Conference 2025 The Irish College of Ophthalmologists (ICO) Annual Scientific Conference was held at the Kilkenny Convention Centre, Lyrath Estate, Co. Kilkenny from Wednesday, 21st May to Friday 23rd May, 2025. Over 250 ophthalmologists gathered for the three-day scientific conference in Kilkenny to hear the latest clinical developments in the specialty from eye experts at home and abroad Key Symposia Key topics discussed at this year's meeting included General Retina and Genetics, Neuroophthalmology, Anterior Segment Surgery and the Development of Emergency Ophthalmology services.

Building upon the discussions from the ICO Winter Meeting in November, the conference featured a session on the Future of Clinical Practice. Additionally, a dedicated session on Sustainability in Eye Care highlighted the College’s ongoing commitment to prioritising this important issue. This session was led by the outgoing ICO

President Mr John Doris, who concluded his two-year term at the 2025 conference.

A 'Top Ten Tips' session featured insights and advice from specialists in their respective areas of clinical expertise, including glaucoma, ocular surface disease, and cataract surgery.

The eye specialists also shared their experiences in running a practice, offering tips on patient management and emphasising the importance of maintaining doctors' general well-being.

During the Annual General Meeting on Friday, 23rd May, Mr. Gerry Fahy, Consultant Ophthalmic

Dr Duncan Rogers (chair), Consultant Ophthalmologist, Mater Misericordiae University Hospital, Dublin, Ms Lisa McAnena, Consultant Ophthalmic Surgeon, Mater Misericordiae University Hospital and Beaumont Hospital, Dublin, Professor Steffen Hamann, Consultant Neuro-ophthalmologist, Department of Ophthalmology, Copenhagen University Hospital, Denmark, Ms Áine NíMhéalóid, Consultant Ophthalmic Surgeon, University Hospital Waterford and Professor Dan Milea, Head, Neuro-Ophthalmology Department, Rothschild Foundation Hospital, Paris.

Mr John Doris, President, Irish College of Ophthalmologists and Consultant Ophthalmic Surgeon, University Hospital Waterford, Ms Niamh Collins, Consultant Ophthalmic Surgeon, Mater Private Hospital, Cork, Mr Richard Comer, Consultant Ophthalmic Surgeon, Bon Secours Hospital, Galway and Mr James O'Reilly, Consultant Ophthalmic Surgeon, UPMC Aut Even Hospital, Kilkenny and Whitfield Hospital, Waterford.

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Surgeon at Blackrock Health, Galway, was formally appointed as the new President of the College and received the chain of office.

Mooney Lecture 2025 Professor Andrew Dick, Duke Elder Chair and Director of Institute of Ophthalmology at University College London and Professor of Ophthalmology, University of Bristol, United Kingdom presented the Annual Mooney Lecture 2025 on Wednesday, 21st May at the ICO Conference.

Professor Dick's lecture entitled ‘Evolution of Treatment Regimens for Uveitis‘ discussed

the basic concepts of the ocular immunity and immune compensatory mechanisms, the immunopathology driving disease that leads us to what we have developed to treat blinding intraocular inflammatory disease.

He discussed the significant advancements made in the field, highlighting the development of targeted disease taxonomies based on cellular and molecular mechanisms. Furthermore, Professor Dick explored future possibilities, including targeted local gene therapy approaches, aiming to induce and maintain remission and achieve a steroidfree life for uveitis patients.

(L-R) Dr Anders Bolmstedt, Chair of Health Care Without Harm Europe, Sweden, Mr John Doris, President, Irish College of Ophthalmologists, Dr Emilie Mahon, RCSI Ophthalmology Tutor, Royal Victoria Eye and Ear Hospital and Mr Tommy Bracken, Strategic Advisor, Royal Victoria Eye and Ear Hospital, Dublin.

Professor Andrew Dick (left), Duke Elder Chair & Director, Institute of Ophthalmology, University College London and Professor of Ophthalmology, University of Bristol, United Kingdom, is pictured with Mr John Doris, President, Irish College of Ophthalmologists and Professor Conor Murphy, Consultant Ophthalmic Surgeon, Royal Victoria Eye and Ear Hospital, Dublin (right) at the ICO Annual Conference which took place at the Kilkenny Convention Centre, 21-23 May, 2025).

Professor Andrew Dick delivered the Mooney Lecture on his chosen topic, 'Evolution of Treatment Regimens for Uveitis‘ on the evening of Wednesday, 21st May during the ICO Annual Conference.

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Conference

(L-R) Mr Paul O'Brien, Consultant Ophthalmic Surgeon, Blackrock Clinic, Dublin; Ms Janice Brady, Consultant Ophthalmic Surgeon, Waterford University Hospital; Ms Nikolina Budimlija, Consultant Ophthalmic Surgeon, Institute of Eye Surgery Clinic, Waterford and Kildare; Miss Yvonne Delaney, Consultant Ophthalmologist, Mater Private Hospital, Dublin, and Mr David Wallace, Consultant Ophthalmic Surgeon, Bon Secours, Kerry.

The session encompassed insights and advice from the specialists in their respective areas of clinical expertise, including glaucoma, ocular surface disease, and cataract surgery. The eye specialists also shared their experiences in running a practice, offering tips on patient management and emphasising the importance of maintaining doctors' general well-being.

(L-r) Dr Jose Pulido, Director of the Henry and Corrine Bower Memorial Laboratories for Translational Medicine in the Vickie and Jack Farber Vision Research Center at Wills Eye Hospital, Philadelphia; Mr Paul Connell, Consultant Ophthalmic Surgeon, Mater Misericordiae University Hospital, Dublin; Mr John Doris, President, ICO; Mr Paul Kenna, Director of the Ocular Genetics Unit, Trinity College Dublin and Clinical Lecturer in Ophthalmic Genetics Research Foundation of the Royal Victoria Eye and Ear Hospital Dublin, and Miss Miriam Minihan, Consultant Ophthalmic Surgeon, Moorfields Eye Hospital NHS Foundation Trust, London.

(L-R) Ms Sarah Moran (left), Consultant Ophthalmic Surgeon, Cork University Hospital & South Infirmary Victoria University Hospital, who presented the European Society of Ophthalmology (SOE) Lecture 2025 is pictured with Mr John Doris, President, Irish College of Ophthalmologists and Ms Janice Brady, Consultant Ophthalmic Surgeon, Waterford University Hospital.

Ms Moran’s lecture entitled Management of Cataracts in Patients with Corneal Pathologies was delivered on Thursday, May 22nd at the ICO Annual Conference at the Kilkenny Convention Centre, Lyrath Estate in Co Kilkenny. Her talk explored cornea issues that are common in cataract patients, and which can have a significant impact on patient outcomes.

(L-R) Christopher Sweeney, School of Medicine, University College Cork, recipient of the Sir William Wilde Medal for the Best Poster presentation at the ICO Annual Conference 2025 is pictured with ICO President, Mr John Doris and Professor Conor Murphy, Chair of the ICO Scientific Committee.

Mr Sweeney was awarded the prize for his poster "The Preparedness of Ophthalmologists to Manage an Anaphylactic Reaction Post Fluorescein Angiography" at the ICO Annual Conference which took place at the Kilkenny Convention Centre, Lyrath Estate, Co Kilkenny from Wednesday 21st May to Friday , 23rd May. (L-R) Professor David Keegan, Clinical Director of Diabetic RetinaScreen, is pictured with Ms Helen Kavanagh, Diabetic RetinaScreen Programme Director and Ms Aoife Doyle, National Clinical Lead for Ophthalmology, at a workshop session to updates ICO members on the latest developments for both programmes which took place on Thursday, 22nd May during the Irish College of Ophthalmologists Annual Conference in Kilkenny (Kilkenny Convention Centre, 21-23 May, 2025).

Irish College of Ophthalmologists Chief Executive, Ms Siobhan Kelly pictured with Mr John Doris, outgoing President, ICO and Consultant Ophthalmic Surgeon, University Hospital Waterford, at the official publication of the ICO Annual Report 2024 at College's Annual Conference in Kilkenny (21-23 May, 2025)

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82

Travel Health

Pharmacist Ticket to Travel Health Around two million Irish people will go on a sun holiday this year, according to the Irish Travel Agents Association Pharmacy has utilised the changes in legislation since 2000 to increase the range and supply function of services such as travel health to travellers. With the number of travellers leaving Ireland and trying new destinations there is an increasing need for more travel health provision.

Rates of international travel are increasing annually, with particular growth observed in travel to Southeast Asia and to emerging economies. While all patients traveling across geographic regions are recommended to receive a pre-travel consultation to consider their individual risks, many do not, or receive care and recommendations that are not consistent with current evidencebased guidelines.

As experts in medicines, and given the largely preventive nature of most travel health recommendations, pharmacists are well suited to help address this need. Pharmacists possess a high degree of knowledge and confidence with more commonly observed travel health topics in community practice such as travellers’ diarrhoea.

Pharmacists providing travel advice are also reminded to consider non-infectious risks

of illness and injury abroad and to advise those presenting in the pharmacy on strategies to minimise these risks in addition to providing drug and vaccine recommendations.

International Travel The United Nations World Tourism Organisation has reported a steady rise in international travel.

In fact, 2016 marked the seventh consecutive year of above-average international arrivals, reaching 1.2 billion. This is expected to continue to increase at a rate of 3.3% annually through 2030.

Survey research suggests that 22–64% of travellers experience some degree of health impairment while traveling.

Travellers’ diarrhoea is most common, affecting 30–80% of travelers, depending on the destination, with malaria and vaccine-preventable infections significantly less common.

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Important information to obtain from those seeking medical travel advice includes the travel destination, reason for travel (such as work, or leisure), duration of travel, itinerary, and any specific health concerns.

Pharmacists may also be instrumental in helping patients locate a travel-medicine clinic.

Common Ailments Diarrhoea is one of the most common symptoms experienced during travel. Travellers’ diarrhoea is defined as passing 3 or more loose/watery bowel motions in 24 hours. It may be accompanied by any of the following symptoms; fever, tummy cramps, urgent need to pass bowel motion, nausea or vomiting.

Most cases occur in the first week of travel and are mild; i.e. diarrhoea is the only symptom and it does not disrupt normal activities. On average, symptoms last for 3-5

days and most cases resolve without any specific treatment.

When travellers’ diarrhoea is associated with additional symptoms and this leads to an interruption of normal activities, it is classed as moderate to severe.

Travellers’ diarrhoea can be caused by many different organisms including bacteria, such as E.coli and Salmonella, parasites such as Giardia, and viruses such as norovirus. All these organisms are spread through eating/drinking contaminated food/water or contact between the mouth and contaminated hands, cups, plates etc.

Loose bowel movements can also result from a change in diet including, for example, spicy or oily foods.

The priority in treatment is preventing dehydration, especially in young children.

• Clear fluids such as diluted fruit juices or oral rehydration solutions (purchased as

83 packeted oral rehydration salts) should be drunk liberally.

• All rehydrating drinks must be prepared with safe water.

Antidiarrhoeal Agents can help, particularly with associated colicky pains.

If > 6 diarrhoea stools are passed in 24 hours and cause incapacitation, or there is blood or mucous in the stool, or marked vomiting, fever, pain, bleeding, medical attention must be sought.

Intravenous fluids may be needed to prevent dehydration.

Malaria is a serious disease that can be life-threatening. It can affect anyone who travels to a region where infected mosquitoes are found.

The burden of malaria is felt most strongly in sub-Saharan Africa, where numerous initiatives are aiming to improve disease prevention or treatment. Despite reductions in the number of people affected by malaria each year, progress is threatened by the rapid spread of resistance to insecticides and antimalarial drugs But malaria shouldn’t ruin anyone’s trip abroad. Mosquito bite prevention is an important way to reduce the risk of getting malaria; however, for many destinations, travellers are also advised to take malaria chemoprophylaxis.

The initial symptoms of malaria resemble flu symptoms, such as vomiting, fever, headache and shivers/chills. Other symptoms, such as diarrhoea, shivering, general malaise, and body aches can also occur. In some cases, flu-like symptoms can be mild or diarrhoea alone may be present – this can make it difficult to diagnose the disease correctly.

Malaria can develop within seven days of being bitten by an infected mosquito. However, P. falciparum malaria can take up to three months to develop, while other types of malaria can lie dormant for up to a year.

A patient with malaria may seek over-the-counter cold or flu remedies. If this occurs within one year (but especially in the first three months) of their return from a malaria-endemic country, then malaria should be considered.

The risk of serious malaria will also be increased for some individuals, for example those who are very young, elderly, pregnant, or who have had a splenectomy.

Each travel consultation by a pharmacist is unique and requires individualised advice.

Effective bite prevention is the first line of defence against malaria.

Stopping bites before they occur also reduces the traveller’s risk of contracting other diseases transmitted via mosquitoes.

Travel thrombosis is now a recognised condition. It can affect all travellers, whether it be by air, sea or road, and seems to be related to long periods of immobility. There is little evidence to suggest that flying is any more dangerous than taking a long sea voyage or traveling by train, bus or car. A pharmacist can assess the risk of travel thrombosis.

These risks clearly relate to increasing age of patients, a past history of deep vein thrombosis of whatever cause, a co-existing medical illness, recent surgery, recent accident and, in particular, immobilisation in a plaster cast.

Any traveller with any of these conditions is clearly at increased risk. Pharmacists can identify those patients who are at no additional risk, those with some risk factors and those with considerable risk factors. The pharmacist is then in a position to provide advice.

All passengers should be aware that sitting down for long periods of time results in the stagnation of blood flow through the legs, which may precipitate thrombus formation. Clots usually start in the small veins in the leg and progress into the larger veins.

The process might start during travel and can then continue, often during the holiday period, with further extension occurring during the return journey. For this reason, travellers are more likely to experience problems on the return journey.

Before traveling passengers should be encouraged to exercise (walking). After sitting for long periods further exercise can be taken, which may involve walking or carrying out active exercises while seated. The avoidance of drinking too much alcohol combined with drinking plenty of water is advisable.

Offering Travel Advice Ann-Marie Horan is a pharmacist at Fortfield Pharmacy, Dublin and a member of the IPU’s Executive committee. Last year, the IPU published a checklist for use by all community pharmacies in helping to advise those travelling.

She says “The days before departing for a holiday can be very hectic. That is why we have published this handy checklist so nothing important gets left behind.”

In terms of offering advice to customers, Ann-Marie suggests the following.

“The most important thing to remember is essential medicines.

Individuals should bring at least enough for the duration of their trip, and always bring a copy of their prescription in case they need something while away. Be aware of the storage conditions of their medications, some will need to be refrigerated. Offer tips on how best to transport and store these medications.

Tips to provide: • Medication: Make sure to bring an adequate supply of prescription medication on holidays. Always carry some medication in hand luggage in case checked-in luggage is delayed or goes missing.

• Sun: In warmer climates, stay out of the sun between 11am and 3pm. Protect with a high sun protection factor (SPF) with UVA protection, along with a hat, sunglasses and t-shirt.

Apply a complete sun block to children and reapply frequently, especially after swimming.

“Depending on where a person is travelling to, and their own language skills, they may find it challenging to communicate with a pharmacy abroad.

That is why we would always recommend bringing a supply of common medicines including antihistamines, pain relievers and treatments for upset stomachs.”

Of course it is not all about medicines, you should also ensure your store is properly category managed with the full range of sun creams and insect repellents, as well as travel sized toiletries.

If a customer comes into the pharmacy asking for insect repellent, this gives pharmacists, and pharmacy staff, the opportunity to ask where they are travelling to and then you can discuss what other items they may need to purchase, such as anti-diarrhoea or oral rehydration treatments.

Depending on their destination, the following items can be useful in a travel health kit: • Sunscreen • After-sun lotion • Oral rehydration sachets

• Sunburn: Those with sunburn should stay out of the sun for a few days until the sunburn dies down. Drink plenty of water. Advise on appropriate creams and painkillers to relieve symptoms and bring down a temperature. Severe cases of sunburn may require special burn cream and burn dressings.

• Anti-diarrhoea tablets

• Mixing Alcohol and the Sun: Be careful when drinking alcohol in hot weather as it can cause dehydration. Those who have taken alcohol should avoid swimming or engaging in sporting activities.

• Painkillers such as paracetamol or ibuprofen

• Insect bites: Bring insect repellent to protect from insect bites. Those who get bitten should be advised to wash the area with soap and water, and apply a cool compress or calamine lotion to help cool down the affected area.

Finally, apply some antiseptic cream to avoid infection.

Business Opportunities Alongside giving the appropriate advice, pharmacies can also capitalise on the business opportunity that the travel health category offers. Staff can help customers assemble a travel health kit that is appropriate for the area they will be visiting.

• Laxatives • Lip balms (with SPF) • Tissues/wet wipes/alcoholbased hand sanitiser • Contraception • Antihistamines • Motion sickness tablets

• Insect repellent and bite cream • Remedies for indigestion or over-indulgence.

Pharmacists should also suggest that customers take a first aid kit, whether it is pre-prepared or comprises individual items.

Again, the recommended contents will depend on the person’s destination.

For example, a basic kit containing antiseptic cream, plasters and antiseptic wipes will often suffice when travelling on a European holiday or to developed countries, but if someone is going on a more adventurous trip, such as trekking through the Amazon, they will need a more comprehensive kit containing items such as sterilised syringes, sutures and clean needles.

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86

Post-Herpetic Neuralgia

Irish Annual Conference 2025 Herpes zoster is a relatively common disease; the estimated incidence of acute herpes infection in the European population varies from 1.2 to 5.2 per 1000 people per year. There is a correlation between the incidence of the disease and age. People younger than 50 years have a low risk of developing herpes zoster which equals approximately 2%. The incidence sharply rises in adults above 50 years; the risk makes up to at least 20% and continues to increase further reaching 35% in people above 80 years[1]. The recent upswing in chickenpox infection and varicella-zoster virus (HZ) in the community has increased the risk of developing post-herpetic neuralgia (PHN).

Written by Professor Dominic A. Hegarty, BSc., BMedSc., MB., MSc. (Pain Management), PhD. FCARSCI, FFPMCAI, FIPP Consultant in Pain Management & Neuromodulation and Clinical Director Mater Private Hospital, Cork Associate Professor of Pain Medicine, UCC, Ireland Honorary Consultant Guy's & St. Thomas' Hospital, London President World Institute Of Pain (WIP) Clinical Director Pain Relief Ireland www.painreliefireland.ie

PHN is an extremely painful condition, that can persist for many years making life miserable for the unfortunate patient. Early recognition is very important and can offset chronicity. For those who are not so lucky there are advanced options to help manage the pain.

Epidemiology In the acute phase of inflammation, the virus reaches the sensory nervous system and remains latent in trigeminal or dorsal root ganglions for a long period of time. Reactivation of the HZ happens with advancing age or immunosuppression can lead to the development of acute herpes zoster. Postherpetic neuralgia occurs in a subset of the population suffering from an episode of acute HZ. Wellestablished risk factors for an acute HZ episode progressing to PHN include age, severe immunosuppression, the presence of a prodromal phase, severe pain during zoster outbreak, allodynia, ophthalmic involvement, and diabetes mellitus.

A meta-analysis of the risk factors for the development of PHN published in 2016 noted that approximately 13% of patients older than or equal to 50 years of age with HZ would develop PHN. The association between increasing age and PHN is significant. According to some

studies, at age 60, around 60% of patients with shingles develop postherpetic neuralgia, and at age 70, this percentage rises to 75%.

One month after the onset of shingles, 9 to 14.3% of patients develop postherpetic neuralgia, and at three months, this percentage becomes 5%. At one year, 3% of patients continue to have severe pain.

Family history has also been considered a risk factor for herpes zoster. In a case-control study

by Hicks et al., comprising 504 patients and 523 controls, it was observed that the blood relatives of patients were more likely to have herpes zoster than the control group (39% vs. 11%, p< .001).

Moreover, this risk was more significant in patients with multiple blood relatives having herpes zoster than those with a single blood relative having herpes zoster.

There is no sex predilection for postherpetic neuralgia.

COVID-19 are 15% more likely to develop HZ within 6 months compared to those who have not been infected by coronavirus.

The risk was 21% greater in older people who were hospitalized by with COVID19. (Bhavsar et al.

Open forum Infectious Diseases).

Predictors The predictors of PHN development include advanced age, acute pain, severe rash, prodromal pain, presence of the virus in peripheral blood, and adverse psychosocial factors. The associated pain with concomitant allodynia is traditionally attributed to the decrease in the activation threshold of pain-associated neuron clusters. Recently some researchers have shown that TRVP1 receptor activation may also be implicated. This receptor may be a promising target for future analgesic drug development.

The DRG suffers the most damage during PHN. Firstly, the reactivated varicella-zoster virus in the DRG proliferates and destroys axons, causing demyelination and ion channel dysfunction.

The damaged sensory nerves can generate abnormal electrical Pathophysiology impulses that are transmitted to the spinal cord transmitting The exact physiology that pain and pain hypersensitivity. A separates a self-limited zoster significant number of inflammatory outbreak from postherpetic cells are shown to invading into neuralgia is not fully understood.

DRG of patients with PHN. Then, Histological examinations of the inflammatory mediators that Johnson RW, Rice AS. Clinical practice.

Postherpetic neuralgia.

N Engl J Med. 2014 Oct 16;371(16):1526-33. [PubMed: relevant peripheral and central follow promote increase pain 25317872] nervous tissue from sufferers pathway activity and causes of PHN reveal myelin and axon central sensitization. deficiency and atrophy of the dorsal horn in certain instances.

Diagnosis Figure 1 Herpes Zoster acute blister formation One study compared the difference

in epidermal axon densities

COVID 19 and PHN. In a retrospective cohort study of over 2 million people it was highlighted that adults over 50 years of age who had mild

Figure 1 Herpes Zoster acute blister formation Figure 2 Viral load in effected nerve fibers

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between patients who suffered from PHN and those who had a self-limited occurrence of HZ. Those afflicted with PHN had, in most instances, far fewer axons in the relevant dermatomes than non-sufferers. Therefore, an anatomical derangement is likely at least partially responsible for the development of PHN. Some suggest that an unchecked inflammatory response at the neuronal level is the main culprit of the eventual development of PHN, specifically via the reduction of centrally-mediated inhibition of nociceptive input and the promotion of peripheral sensitization via damaged nociceptors.

The diagnosis of postherpetic neuralgia is relatively

2) Early Recognition. Early recognition and treatment of an acute HZ infection, may reduce the chance

developing PHN. The benefit of rapid treatment has been shown to be very useful. If a combination

87

agents can be commenced with 72 hours of first symptoms this will lower the chance of compilations straightforward and not one of exclusion. An episode of herpes zoster is a prerequisite for PHN. Therefore, a history of rash with blisters in a dermatomal pattern would be expected.

Rarely the characteristic rash will not be found. Persistent (more than or equal to 3 months) lancinating/burning pain, allodynia, paraesthesia’s, pruritus, dysesthesias, and/or hyperalgesia at or near the area of the rash is characteristic of PHN. Herpes zoster can reactivate sub clinically with no rash. This condition is called zoster sine herpete and is more complicated. It affects the central nervous system at multiple levels and causes cranial neuropathies, myelitis, polyneuritis, or aseptic meningitis.

Physical examination of a patient with postherpetic neuralgia may reveal the following: • Evidence of cutaneous scarring on an area of previous herpes zoster • Altered sensation in the affected areas, either hypersensitivity or hypoesthesia • Pain is produced by nonnoxious stimuli, such as a light touch, known as allodynia • Autonomic dysfunction, such as excessive sweating over the involved area Investigations Postherpetic neuralgia is almost universally diagnosed based on the history and physical examination.

However, laboratory tests and some targeted imaging may provide a degree of utility. These are of greater value in atypical presentations of PHN, such as zoster sine herpete or herpes zoster of the larynx. Serological testing for VZV IgG and IgM titers is possible, although the sensitivity and specificity are less than ideal. A four-fold rise has been used to diagnose subclinical HZ (zoster sine herpete). However, this rising titer may or may not be secondary to viral exposure or reactivation. Comparatively, immunofluorescence of vesicle scrapings detects VZV antigens in a highly specific and sensitive manner. Similarly, PCR is exquisitely sensitive for the detection of VZV DNA. Results of cerebrospinal fluid (CSF) analysis are abnormal in 61% of patients. Pleocytosis, elevated protein, and varicella-zoster virus (VZV) DNA are usually seen. Viral culture or immunofluorescent staining helps distinguish herpes simplex from herpes zoster.

Small-scale studies suggest that magnetic resonance imaging (MRI)

may hold promise for diagnosing challenging PHN cases and differentiating between PHN and HZ. A study by Haanpaa et al. reported that MRI revealed lesions attributable to HZ in the cervical cord and the brain stem in 9 patients (56%). At three months after the onset of HZ, PHN developed in 5 patients (56%) who had an abnormal MRI. On MRI, seven patients with no HZ lesions did not develop residual pain.

Table 1 Suggested Agents to consider in the early management plan • Acyclovir (Sitavig, Zovirax) Antivirals • Famciclovir (Famvir) • Valacyclovir (Valtrex) Simple Analgesics

• • •

Acetaminophen Ibuprofen Naproxen

Neuropathic Pain Management

• • •

Pregabalin Gabapentin Amitriptyline

Topical

• • •

Lidocaine patches Capsaicin cream Ice packs

Management Options Three fundamental treatment approaches may be considered for postherpetic neuralgia.

1) Prevention. This focuses on identifying populations at risk for contracting HZ and administering a vaccine. At present there are two licenced regarding what constitutes of these methods is mixed but HZ vaccines in Ireland 3) ( MIMS PHN management appropriate use and also rapidly evolving, and certain May 2023) – Shingrix and approaches appear to be more renewed governmental interest Zostavax. This should be in their administration given the successful than others. considered in thoseInover 50 the situation where PHN develops the symptom management of PHN is best considered using multimo epidemic of abuse, addiction, years and in those in the higher Complete resolution of the and mortality.the Theefficacy above of three risk groups. It is not necessaryregimens symptoms medication and interventional The evidence regarding these methods is rare. procedures.

A 2014 study medical societies recommend to determine whether patients concluded that less than half as either first or mixed but and certain approaches appear to be opioids more successful than others. have a history of varicella or rapidly evolving, of patients with PHN achieve second-line treatments, zoster prior to vaccination significant symptom reduction. which underscores the painbecause weaning antibodies The age of the patient population reducing capability in those previouslyComplete exposed resolution of the symptoms is rare.

A 2014 study concluded that less than of halfthis of patients with PH increases the risk side effect medication class. may lead to negative results profiles of interventions. Relevant despite past infection A large achieve significant symptom The age of the patientc)population Lidocaineincreases Patchesthe risk side effect profiles studiesreduction. comparing treatments (n = 38,000) double-blind study and their outcomes are often interventions. studies comparing treatments and their outcomes often have suboptimal designed. published in the NEJM in 2005 Relevant Multiple are studies confirmed suboptimal designed. showed that vaccination in the the short and long-term efficacy elderly reduced the incidence of There is no one superior of the lidocaine 5% patch. This HZ by 51% and PHN by is 66%. treatment patch also hasthat the multimodal additional therapy is lik There no one superior treatmentregimen; regimen;however, however, expert consensus suggests Moreover, even among those benefit of a small side effect expert consensus suggests that the best approach. Lastly, many of therapy the advocated approaches treatprofile chronic neuropathic in general and are who developed PHN, the burden that is mostlypain limited multimodal is likely the of illness was reduced by to application site reactions. best approach. Lastly, many of specific to be PHN. approximately 61%.

It must Application is required for 12 the advocated approaches noted that the immune-boosting hours at a time and should be treat chronic neuropathic pain effect of the vaccination is used over prolonged period (4-8 in general and are not specific a) Traditional non-invasive treatments include oral and topical The American Academy not long-lasting, and interval weeksmedications. initially) to PHN. re-vaccination is necessary to d) Capsaicin Traditional non-invasive Neurologya)(AAN), Special Interest Group on Neuropathic Pain (NeuPSIG), and European Federation maintain its efficacy. treatments include oral preparations(TCA), in the pregabalin, a Unfortunately, these vaccines Neurologicaland Societies (EFNS) all recommend an oralCapsaicin tricyclic antidepressant topical medications. patch and cream formulations are not part of the national The American Academy of are also available but not as 5% patch as(AAN), first-line therapies. The anticholinergic, antihistaminergic, and alpha recept immunisation program so the lidocaine Neurology Special well-studied as the lidocaine patients need to discuss this Interest Group on Neuropathic patch. The leading cause option with their GP and selfPain (NeuPSIG), and European of discontinuing capsaicin fund the vaccine.

Federation of Neurological treatment is pain and irritation Societies (EFNS) all recommend 2) Early Recognition. Early at the application site, an oral tricyclic antidepressant recognition and treatment of an suffered by almost all users (TCA), pregabalin, and the acute HZ infection, may reduce in proportion to the capsaicin lidocaine 5% patch as first-line the chance of developing PHN. concentration. The cream has a therapies. The anticholinergic, The benefit of rapid treatment low concentration of capsaicin, antihistaminergic, and alpha has been shown to be very requiring multiple applications receptor-blocking side useful. If a combination of to achieve a therapeutic effect effects of TCAs must be agents can be commenced throughout the day. Conversely, considered, as the elderly with 72 hours of first symptoms the capsaicin patch is available are more susceptible.

As a this will lower the chance in an 8% formulation, delivering result, it is commonplace to of compilations a therapeutic dose in just initially prescribe and titrate a one application. The higher gabapentinoid, keeping in mind 3) PHN management concentration patch should only that patients with reduced renal be provided by those trained in In the situation where PHN function should be started at a the application and monitoring develops the symptom lower dose and up-titrated of outcome. Nevertheless, management of PHN is best more slowly. encouraging case reports considered using multimodal b) The use of opioids to combat and other literature suggest medication regimens and the intervention warrants PHN is controversial because interventional procedures. The of the changing landscape consideration and further study. evidence regarding the efficacy

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Post-Herpetic Neuralgia Figure 2 Viral load in effected nerve fibers

is complex, and sometimes an individualized non-traditional approach may prove beneficial for a particular patient. f) Invasive Therapies.

https://www.webmd.com/skin-problems-and-treatments/shingles/ss/slideshow-shinglespictures https://www.webmd.com/skin-problems-and-treatments/shingles/ss/slideshow-shingles-pictures

https://www.webmd.com/skin-problems-and-treatments/shingles/ss/slideshow-shinglespictures

e) Non-TCA antidepressants and NMDA antagonists.

There is limited evidence to supports their usefulness. For example, larger studies involving SNRIs (serotonin-norepinephrine reuptake inhibitors) and SSRIs (selective serotonin reuptake inhibitors) have not shown better outcomes than TCAs, and both classes possess concerning side effect profile, though typically less severe than TCAs.

The use of ketamine infusion and related studies for treating a wide range of ailments, from neuropathic pain to depression, has also resulted in renewed interest in the role of NMDA antagonism in treating PHN. There are anecdotal reports that ketamine may prove beneficial, and a few small studies support this finding, but long-term data and large-scale studies are non-existent. Lidocaine

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infusions have also been considered. One double-blind study in 1999 showed that an intravenous lidocaine infusion provided clinically significant short-term pain reduction in patients with PHN. In general, small studies and case reports have established that novel 11 therapies may be useful in certain PHN sufferers when combined with other adjuncts.

The pathophysiology of PHN

Often when an individual presents to a chronic pain clinic they will have tried a number agents so interventional options need to be considered. If the pain persists in a specific dermatomal or nerve distribution then a simple effective option is to use a peripheral nerve block or pulsed denervation the dorsal root ganglion Pulsed radiofrequency (PRF) is a minimally invasive technique that applies pulsed current (300–500 kHz) to the target nerve. The current is delivered in a pulse of 20 ms (45 V’ voltage) followed by a silent period of 480 ms to avoid heat lesions.

Recent studies have confirmed the beneficial effects of PRF against post-operative pain, peripheral neuropathic pain, and postherpetic neuralgia. The thoracic nerves (T1-12) are the most commonly affected by PHN with an incidence of up to 50% cases. Studies have shown that both DRG and intercoastal nerve treated with PRF treatments are effective in the treatment of thoracic postherpetic neuralgia. Targeting the dorsal root ganglion gas shown to have a better outcome in pain intensity and other quality of life domains (SF-36).

Other invasive therapies include botulinum toxin injections, sympathetic blockade with local anaesthetics, and epidural/ intrathecal injections have a limited side effect profile.

However, more studies need to be conducted to evaluate their efficacy. The other invasive therapies mentioned carry the potential for significant peri-procedural risk and/or side effects. g) Future therapy options

11Neuromodulation offers the

possibility of long-term drug-free pain therapy inn a wide range of neuropathic pain conditions.

The development of the dorsal root ganglion stimulator to treat focal dermatomal neuropathic pain conditions is theoretically promising for PHN. Traditional

89 spinal cord stimulation programming option can now target painful area with greater accuracy. We need to extend studies to consider the role of technology to advance our options.

Long-term Enhancement of Healthcare Team Outcomes Considering that postherpetic neuralgia is difficult to treat and outcomes are variable, prevention is of paramount importance.

Therefore, primary care physicians and geriatricians are tasked with administering vaccinations to at-risk populations. The ever growing aging population means that demands on this service will continue to increase. Inclusion of the vaccines on the national immunisation program by the Department of Health needs to be considered as a priority if we are to protect our venerable senior citizens. When preventative measures fail or are never instituted, experts in the field of pain management who have experience with the condition and multimodal treatment techniques should be consulted. Interventional pain management can offer solutions. An interprofessional approach to managing patients with postherpetic neuralgia is the best way forward.

References Isagulyan E, Tkachenko V et al. The Effectiveness of Various Types of Electrical Stimulation of the Spinal Cord for Chronic Pain in Patients with Postherpetic Neuralgia: A Literature Review; Pain Research and Management Volume 2023, Article ID 6015680, 8 pages Huang et al. Efficacy and safety of pulsed radiofrequency modulation of thoracic dorsal root ganglion or intercostal nerve on postherpetic neuralgia in aged patients: a retrospective study BMC Neurol (2021) 21:233 https://doi. org/10.1186/s12883-021-02286-6 Forstenpointner J, Rice ASC, Finnerup NB, Baron R. Update on Clinical Management of Postherpetic Neuralgia and Mechanism-Based Treatment: New Options in Therapy. J Infect Dis. 2018 Sep 22;218(suppl_2):S120-S126.

[PubMed: 30247597] Lu WH, Lin CW, Wang CY, Chen LK, Hsiao FY. Epidemiology and long-term disease burden of herpes zoster and postherpetic neuralgia in Taiwan: a population- based, propensity score-matched cohort study. BMC Public Health. 2018 Mar 20;18(1):369. [PMC free article: PMC5859733] [PubMed: 29554872]

Gabutti G, Valente N, Kuhdari P, Lupi S, Stefanati A. Prevention of herpes zoster and its complications: from the clinic to the real-life experience with the vaccine. J Med Microbiol. 2016 Dec;65(12):1363-1369. [PubMed: 27902409] Zorzoli E, Pica F, Masetti G, Franco E, Volpi A, Gabutti G. Herpes zoster in frail elderly patients: prevalence, impact, management, and preventive strategies. Aging Clin Exp Res. 2018 Jul;30(7):693702. [PubMed: 29721782] Schutzer-Weissmann J, FarquharSmith P. Post-herpetic neuralgia - a review of current management and future directions. Expert Opin Pharmacother. 2017 Nov;18(16):1739-1750. [PubMed: 29025327] Delaney A, Colvin LA, Fallon MT, Dalziel RG, Mitchell R, FleetwoodWalker SM. Postherpetic neuralgia: from preclinical models to the clinic. Neurotherapeutics.

2009 Oct;6(4):630-7. [PMC free article: PMC5084285] [PubMed: 19789068] Hicks LD, Cook-Norris RH, Mendoza N, Madkan V, Arora A, Tyring SK. Family history as a risk factor for herpes zoster: a case-control study. Arch Dermatol.

2008 May;144(5):603-8. [PubMed: 18490586] Helgason S, Petursson G, Gudmundsson S, Sigurdsson JA. Prevalence of postherpetic neuralgia after a first episode of herpes zoster: prospective study with long term follow up. BMJ. 2000 Sep 30;321(7264):794-6.

[PMC free article: PMC27491] [PubMed: 11009518] Chen F, Chen F, Shang Z, Shui Y, Wu G, Liu C, Lin Z, Lin Y, Yu L, Kang D, Tao W, Li Y. White matter microstructure degenerates in patients with postherpetic neuralgia. Neurosci Lett. 2017 Aug 24;656:152-157. [PubMed: 28729077] Watson CPN, Deck JH, Morshead C, Van der Kooy D, Evans RJ. Post-herpetic neuralgia: further post-mortem studies of cases with and without pain. Pain. 1991 Feb;44(2):105-117. [PubMed: 1711192] Werner RN, Nikkels AF, Marinović B, Schäfer M, Czarnecka-Operacz M, Agius AM, Bata-Csörgő Z, Breuer J, Girolomoni G, Gross GE, Langan S, Lapid-Gortzak R, Lesser TH, Pleyer U, Sellner J, Verjans GM, Wutzler P, Dressler C, Erdmann R, Rosumeck S, Nast A. European consensus-based (S2k) Guideline on the Management of Herpes Zoster - guided by the European Dermatology

Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV), Part 1: Diagnosis. J Eur Acad Dermatol Venereol.

2017 Jan;31(1):9-19. [PubMed: 27804172] Koshy E, Mengting L, Kumar H, Jianbo W. Epidemiology, treatment and prevention of herpes zoster: A comprehensive review. Indian J Dermatol Venereol Leprol. 2018 May-Jun;84(3):251-262. [PubMed: 29516900] Gilden D, Nagel MA, Mahalingam R, Mueller NH, Brazeau EA, Pugazhenthi S, Cohrs RJ. Clinical and molecular aspects of varicella zoster virus infection. Future Neurol. 2009 Jan 01;4(1):103-117.

[PMC free article: PMC2782836] [PubMed: 19946620] Spiegel R, Miron D, Lumelsky D, Horovitz Y. Severe meningoencephalitis due to late reactivation of Varicella-Zoster virus in an immunocompetent child. J Child Neurol. 2010 Jan;25(1):87-90. [PubMed: 19494359] Harbecke R, Oxman MN, Arnold BA, Ip C, Johnson GR, Levin MJ, Gelb LD, Schmader KE, Straus SE, Wang H, Wright PF, Pachucki CT, Gershon AA, Arbeit RD, Davis LE, Simberkoff MS, Weinberg A, Williams HM, Cheney C, Petrukhin L, Abraham KG, Shaw A, Manoff S, Antonello JM, Green T, Wang Y, Tan C, Keller PM., Shingles Prevention Study Group. A real-time PCR assay to identify and discriminate among wild-type and vaccine strains of varicella-zoster virus and herpes simplex virus in clinical specimens, and comparison with the clinical diagnoses. J Med Virol. 2009 Jul;81(7):1310-22. [PMC free article: PMC4217208] [PubMed: 19475609] Haanpää M, Dastidar P, Weinberg A, Levin M, Miettinen A, Lapinlampi A, Laippala P, Nurmikko T. CSF and MRI findings in patients with acute herpes zoster. Neurology.

1998 Nov;51(5):1405-11. [PubMed: 9818869] Lang PO, Ferahta N. [Recommendations for treatment and prevention of herpes zoster and associated pain in aged adults]. Rev Med Interne. 2016 Jan;37(1):35-42. [PubMed: 26383768] Kim SR, Khan F, Ramirez-Fort MK, Downing C, Tyring SK. Varicella zoster: an update on current treatment options and future perspectives. Expert Opin Pharmacother. 2014 Jan;15(1):6171. [PubMed: 24289750]

Argoff CE. Review of current guidelines on the care of postherpetic neuralgia. Postgrad Med. 2011 Sep;123(5):134-42.

[PubMed: 21904096] Raja SN, Haythornthwaite JA, Pappagallo M, Clark MR, Travison TG, Sabeen S, Royall RM, Max MB. Opioids versus antidepressants in postherpetic neuralgia: a randomized, placebocontrolled trial. Neurology. 2002 Oct 08;59(7):1015-21. [PubMed: 12370455] Shrestha M, Chen A. Modalities in managing postherpetic neuralgia. Korean J Pain. 2018 Oct;31(4):235-243. [PMC free article: PMC6177534] [PubMed: 30310548] Baron R, Allegri M, Correa-Illanes G, Hans G, Serpell M, Mick G, Mayoral V. The 5% LidocaineMedicated Plaster: Its Inclusion in International Treatment Guidelines for Treating Localized Neuropathic Pain, and Clinical Evidence Supporting its Use. Pain Ther.

2016 Dec;5(2):149-169. [PMC free article: PMC5130910] [PubMed: 27822619] Derry S, Rice AS, Cole P, Tan T, Moore RA. Topical capsaicin (high concentration) for chronic neuropathic pain in adults.

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[PMC free article: PMC6464756] [PubMed: 28085183] Goncalves D, Rebelo V, Barbosa P, Gomes A. 8% Capsaicin Patch in Treatment of Peripheral Neuropathic Pain. Pain Physician.

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[PubMed: 32967405] Kim YH, Lee PB, Oh TK. Is magnesium sulfate effective for pain in chronic postherpetic neuralgia patients comparing with ketamine infusion therapy? J Clin Anesth. 2015 Jun;27(4):296-300.

[PubMed: 25792176] Baranowski AP, De Courcey J, Bonello E. A trial of intravenous lidocaine on the pain and allodynia of postherpetic neuralgia. J Pain Symptom Manage. 1999 Jun;17(6):429-33. [PubMed: 10388248] Apalla Z, Sotiriou E, Lallas A, Lazaridou E, Ioannides D. Botulinum toxin A in postherpetic neuralgia: a parallel, randomized, double-blind, single-dose, placebo-controlled trial. Clin J Pain. 2013 Oct;29(10):857-64.

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90

Orthopaedics

"What You Knee-d to Know" Debunk Myths About Knee Replacement Surgery Research shows people who have undertaken a knee replacement surgery are surprised by speed of recovery as Blackrock health empowers people to reclaim active lives.

Mr. Philip Brady, Consultant Orthopaedic Surgeon at Blackrock Health

significantly in recent years. While individual experiences vary, many return to normal daily activities within one month. We typically look at recovery in three phases: the initial six weeks post-operatively, a return to driving within 4-5 weeks, and a gradual return to full functionality over the subsequent 6 weeks to three months. Patients can generally expect to achieve maximal benefit approximately 18 months post-surgery.”

Q: I've heard knee replacements don't last very long. Should I wait until I’m older to get the surgery?

average age for knee replacement surgery in Ireland is 67.

Blackrock Health has launched a new campaign titled "What You Knee-d to Know" aimed at educating the public about knee replacement surgery, dispelling common myths, and empowering individuals living with chronic knee pain to consider this potentially life-changing procedure.

Community pharmacists can use this information to support patient education, particularly for those managing osteoarthritis or chronic knee issues. Research from Blackrock Health found that many patients are surprised by how quickly they recover postsurgery—55% of respondents reported returning to normal activities such as work, exercise, and household tasks within one month.

To help address misconceptions and inform patient discussions, Mr. Philip Brady, Consultant Orthopaedic Surgeon at Blackrock Health, offers expert insights to separate fact from fiction.

According to Mr Brady “It is a common misconception that joint replacement surgery is only for older people. While age is a factor in the development of knee osteoarthritis, we are seeing an increasing number of patients in the 50-65 age range – representing over one quarter of knee replacement recipients worldwide – who are excellent candidates for this procedure. The decision is based on the patient's overall health, the severity of their symptoms, and the impact of knee pain on their functional capacity.

Indeed, younger patients often demonstrate superior rehabilitation potential compared to their elderly counterparts. Delaying surgery can result in restriction on movement, resulting in psychological and emotional impact, so it’s important to seek help if you are experiencing pain” Q: I'm worried about the recovery. Will I be bedridden for months?

Q: Is it true that knee replacement surgery is only for older people?

Research carried out by Blackrock Health found that one in two people who have undergone a hip or knee replacement were discharged from hospital within 48 hours, with 92% of all people surveyed spending less than five days in hospital overall.

Statistics from the National Office of Clinical Audit (NOCA) show that the

Mr Brady said: “Post-operative recovery has advanced

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According to Mr Brady, contemporary knee implants are designed for longevity. “Current data indicates that 82% of knee replacements remain functional for over 25 years. Furthermore, ongoing advancements in implant materials and surgical techniques continue to improve long-term outcomes. While factors such as patient age, weight, and activity level can influence implant lifespan, the vast majority of patients can anticipate many years of pain-free mobility.”

Q: I'm managing my knee pain with medication. Why should I consider surgery?

“While pharmacologic management can provide symptomatic relief, it does not address the underlying pathology of knee osteoarthritis. If nonsurgical interventions, such as physical therapy and intra-articular injections, have been exhausted and the patient's quality of life remains significantly compromised, knee replacement surgery represents a definitive treatment option. This procedure can provide lasting pain relief, improve joint function, and enable patients to return to activities they previously found difficult or impossible.”

Q: What are some of the biggest fears patients have before surgery, and how do you address them?

Research amongst people who had a hip or knee replacement found that found that prior to surgery, 56% of people cited concerns about the recovery

period such as having to change their routine, recovery at home, the wait before returning to normal activity or post-surgical pain.

However, in many cases these fears were unfounded with 42% of people stating they were surprised at how quickly they started to see progress and 25% of people felt they were able to maintain their independence with little support.

“Patients frequently express anxiety regarding the surgical procedure itself and the subsequent recovery period. We address these concerns through comprehensive pre-operative education, detailed explanations of the surgical technique, and realistic expectations regarding post-operative rehabilitation. We also emphasise the importance of proactive pain management strategies.” Mr Brady commented.

Q: What can patients do to ensure a smooth recovery?

“Having a strong support system of family and friends in place and not being afraid to ask questions of the healthcare team are key. Our research also shows that almost a third of patients manage feelings of anxiety, depression, or isolation during recovery by asking friends or family for help.” Mr Brady advises. “At Blackrock Health, we provide ongoing support and guidance throughout the recovery process, and we encourage patients to reach out to their support network for assistance.”

Q: What is the key takeaway for people experiencing persistent knee pain?

“If you have exhausted all nonsurgical options for managing your knee pain, you should consult with your general practitioner, physiotherapist or a qualified orthopaedic specialist to explore the potential benefits of knee replacement surgery. At Blackrock Health, we are dedicated to restoring mobility and enhancing the quality of life for our patients.”

To learn more about knee replacement surgery at Blackrock Health, visit: https://www. blackrockhealth.com/treatmentsprocedures/knee-treatmentsprocedures

Migraine

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Breaking the Cycle: Advances in Migraine Treatment for Healthcare Professionals: Introduction: Migraine is a primary headache disorder, typically, characterised by frequent bouts of severe headaches accompanied by autonomic and neurological symptoms. It is a common disorder effecting 1012% of the population and has a predilection for women in a ratio of 3:1 with the peak prevalence occurring in women between the ages of 35-50 years. Migraine is a leading cause of disability in which the Global Burden of Disease (2019) ranked migraine as the 2nd leading cause worldwide and the highest amongst women aged 15-49 years. The pathophysiology of migraine and the trigemino-vascular theory has elucidated the underlying mechanisms of migraine resulting in the evolution and development of migraine specific acute and preventative therapies. The triptans 5HT1B/1D receptor agonists were the first to emerge in the 1990’s for the acute With Typical Aura: molecule 1.2.1 attack and in recent years the arrival of CGRP monoclonalMigraine antibodies and the small ‘’gepants” have At least 2 attacks fulfillingthe B and C historical brought us to a transformational era where in clinical practice we are now able to address many Aura of visual, sensory and /or speech /language unmet needs of migraine patients.

Diagnosis: The ICHD (International Classification of Headache Disorders) first published its clinical diagnostic guidelines for migraine and other headache disorders in 1988. Since then there have been 3 updated versions and its 4th revision is a work in progress. These guidelines have a global reach enabling physicians to use consistent, accurate and reproducible criteria for the diagnosis of migraine, which transends borders, cultures and continents. It further assists high quality research in the areas of epidemiology, scientific research, clinical trials and drug development of migraine specific acute and preventative therapies.

The diagnostic criteria for the main forms of migraine are outlined in fig 1,2 and 3.

Pathophysiology of Migraine: Trigemino-Vascular Theory: Painful afferent nocioceptive information from the head and neck is transmitted via the first division of the trigeminal nerve

Written by Dr Edward O’Sullivan, Director, Migraine Clinic, Cork University Hospital

(ophthalmic branch) and the upper cervical nerves (C2 and C3). The painful structures, integral to migraine pathophysiolology, are the meninges, meningeal arteries, large intracranial arteries and the dural venous sinuses. The cell bodies of the trigeminal nerve are located in the trigeminal ganglion. One arm of the nerve projects peripherally to innervate the dura mater and blood vessels and the other arm projects centrally to the mid-brain (pons) synapsing with the trigeminal nucleus and upper segments of the cervical cord to form the trigemino-cervical complex. 2nd order neurones relay nociceptive information to the thalamus and other brain stem nuclei and finally 3rd order neurones relay information to the higher centres in the cerebral cortex.

Migraine With Typical Aura: 1.2.1 At least 2 attacks fulfilling B and C Aura of visual, sensory and /or speech /language symptoms, each fully reversible, but no motor, brainstem or retinal symptoms. > 2 of the following 4 characteristics aura symptom spreads gradually over 5 minutes and /or > 2 symptoms occur in succession.

2. Each individual aura symptom lasts 5-60 minutes 3. > 1 aura symptom is unilateral 4. Aura accompanied by or followed in < 60 minutes by headache D. Not better accounted for by another ICHD-3 diagnosis, and TIA excluded.

Migraine Without Aura: 1.1 At least 5 attacks fulfilling criteria B-D

symptoms, each fully reversible, but no motor, brainstem o retinal symptoms. > 2 of the following 4 characteristics aura symptom spreads gradually over 5 minutes and /or > 2 symptoms occur in succession.

2. Each individual aura symptom lasts 5-60 minutes 3. > 1 aura symptom is unilateral 4. Aura accompanied by or followed in < 60 minutes by headache D. Not better accounted for by another ICHD-3 diagnosis, and TIA excluded.

Migraine Without Aura: 1.1 At least 5 attacks fulfilling criteria B-D Headache attacks lasting 4-72 hours (untreated or unsuccessfully treated) Headache has > 2 of the following characteristics 1. Unilateral Location 2. Pulsating Quality 3. Moderate or severe pain intensity 4.Aggravated by or causing avoidance of routine physical activity.

D. During Headache > 1 of the following.

1. Nausea and or vomiting 2. Photophobia and Phonophobia 2 E. Not better accounted for by another ICHD-3 diagnosis

Fig.2

Fig: 2 Na+, K+ and Mg+ channels.

Cortical spreading depression (CSD) is theorised to be 1.3 the In susceptible individuals, with Chronic Migraine: initiating event in migraine. (TTH-like a genetic it on >15 Headache and /orpredisposition, Migraine-like This is a depolarisation wave accounts for the migraine aura d/mo for > 3 month and fulfilling criteria B and C. propagated across the cerebral symptoms : the visual, sensory, In in a the patient who hasmotor hadand > 5dysphasia. attacks of fulfilling cortex, beginning occipital Through cortex, at acriteria rate of 2-3 mm per unknown mechanisms downward B-D second leading to oligaemia communication to brainstem For 1.1 Migraine Without Aura and /or criteria B and C and neuronal dysfunction via nuclei leads to activation of for 1.2 Migraine With Aura the trigemino-vascular system On > 8 d/month for resulting > 3 month any of the in thefulfilling peripheral release Fig:1 following: of neuropeptides: C.G.R.P. Fig: 1 (calcitonin gene related peptide,Aura Criteria C and D for Migraine Without

Criteria B and C for Migraine With Aura Believed by the patient to be migraine at PHARMACYNEWSIRELAND.COM

1. Nausea and or vomiting 2. Photophobia and Phonophobia E. Not better accounted for by another ICHD-3 diagnosis

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Migraine

demonstrate good efficacy and approxima Fig.2

Chronic Migraine: 1.3 Headache (TTH-like and /or Migraine-like on >15 d/mo for > 3 month and fulfilling criteria B and C. In a patient who has had > 5 attacks of fulfilling criteria B-D For 1.1 Migraine Without Aura and /or criteria B and C for 1.2 Migraine With Aura On > 8 d/month for > 3 month fulfilling any of the following: Criteria C and D for Migraine Without Aura Criteria B and C for Migraine With Aura Believed by the patient to be migraine at

5.

Acute Therapy “gepants”: Rimegepant 75mg Ubrogepant 50mg (not available in Ireland) Zavegepant (not available in Ireland) Fig.3

Fig: 5

Fig: 3

Pathophysiology of Migraine: Trigemino-Vascular Theory:

neurokinin and substance P) at the meningeal nerve terminals.

The neuropeptide release causes an inflammatory reaction and neurogenic inflammation in the meninges and blood vessels (meningeal artery) which in turn stimulates a painful afferent pathway, propagated via the trigeminal nerve and terminates in the brainstem pons in the trigeminoneucleus caudalis. 2nd order neurons relay information to other brainstem nuclei and the thalamus whilst 3rd order neurons further relay afferent information to the higher centres.

The trigeminovascular theory and the study of neuropeptide release lead to the development of therapeutic targets which include the triptans, CGRP antagonists, 5HT1F antagonists and Onabotulinum toxin A. Management of Migraine: In clinical practice, as migraine is a recurrent headache disorder, patients are asked to keep headache diaries. This facilitates the accurate recording of the frequency, severity and duration of attacks. It helps to identify trigger factors and monitors the efficacy and tolerability of acute and preventative therapies. In addition patient reported outcome measurements is a new tool evaluating disability and quality of life of the individual. These observations record subtle improvements and are particularly useful in the evaluation of the CGRP antagonists for migraine prevention.

Acute Treatment of Migraine: Many acute therapies are widely used in the treatment of the acute migraine and these range from

Fig: 4

OTC analgesics (soluble aspirin, paracetamol, and ibuprofen) and opioids (paracetamol / codeine), to prescribed NSAIDs (naproxyn, diclofenac) and anti-migraine specific acute therapies (triptans, gepants and 5HT1F receptor agonist). Most patients will have self-medicated, prior to consultation with their doctor, and in this cohort, soluble aspirin in high dose (900-1000mg) is considered first line and the most evidence based.

Two pivotal publications were published in the past 12 months which conducted a systemic review and metanalysis of acute migraine therapies. These papers concluded and recommended that Triptans (5HT1B/1D), fig 4, should be prescribed first line in the treatment of the acute attack.

In clinical practice, however, it was observed that the triptans were underused despite their proven efficacy and safety. They been available for decades and were first introduced in the 1990’s. In Europe their usage ranged from 3.4% to 22.5% whilst in the US it ranged from 16.8% to 22.7%.

in a metanalysis of the triptans, eletriptan 40mg, was the most favoured in comparative data, although there are no head-tohead studies. The triptans are licenced for those aged 18-65 years and patients should limit their use to 10 doses per month due to the risk of medicationoveruse-headache. If a patient fails to respond to one triptan, then she / he should be prescribed an alternative and it is only when an individual fails to respond to 3 different triptans are they considered a non-responder to the class.

2. Pain Relief at 2 hours 3. Sustained Pain Relief between 2-24 hours In clinical practice, up to recently, 4. Pain Relief at 4 hours there had been no clear guidelines on choosing an acute therapy and The triptans are contraindicated in 5. Relief of most bothersome symptoms to which was first line. The clinical established coronary artery disease The triptans were the first end-points now used to evaluate and uncontrolled hypertension. targeted 6.

Tolerability and side effect efficacy are: They should also be used with specific migraine acute therapies caution in patients on SSRI’s and 1. Pain free at 2 hours and they havewere a high affinity for psychotropic agents due to drugTwo pivotal publications published in the past 12 mo the 1B/1D receptor located on the drug interactions and the risk of 2. Pain Relief at 2 hours peripheral nerve endings of the serotoninergic syndrome. review and metanalysis migraine therapies. These 3.

Sustained Pain Relief between trigmeninal of nerveacute (1D receptor) Small molecule C.G.R.P and the meningeal blood vessels 2-24 hours antagonists: “gepants”: 1B/1D), fig 4 , should be pre (1BTriptans receptor). The triptans block recommended that (5HT 4. Pain Relief at 4 hours the release of neuropeptides at the Calcitonin Gene Related Peptide receptor and vasoconstrict the is a however, potent vasodilator and 5.

Relief of most bothersome ofsymptoms the acute attack.1D In clinical practice, itiswas obs blood vessels at the 1B receptor. widely distributed in the peripheral 70% of patients get and central nervous systems. underused despiteApproximately their proven efficacy and 6.

Tolerability and side effect good pain relief within 2 hours and In migraine it is safety. released from They b the trigeminal nerve endings were first introduced in the 1990’s. Ininnervating Europe theirandusage r the meninges intracranial arteries causing a cascade of changes resulting in in the US it ranged from 16.8% to 22.7%. a sterile neurogenic inflammation Triptans (5HT1B/1D) receptor agonists Sumatriptan 50mg or 100mg Zolmitriptan 2.5mg Eletriptan 40mg Frovatriptan 2.5mg Almotriptan 12.5mg Naratriptan 2.5mg Rizatripan 10mg

The triptans were the first targeted

and pain transmission.

The ‘’gepants’’ block the effects of C.G.R.P. by binding to the C.G.R.P. receptor and are licenced and approved both as acute and preventative therapies. As an acute therapy they demonstrate good efficacy and approximately 30% of patients are pain free after 2 hours. Fig 5.

Fig.4

Rimegepant 75mg is the only “gepant” approved in Ireland as an acute therapy, however it is neither reimbursed on the GMS nor the drug payment schemes, therefore patients have to pay out of pocket for the medication. Rimegepant is indicated for those patients who

specific migraine acute therapies and they have a high affin located on the peripheral nerve endings of the trigmeninal

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Galcanezumab 200mg loading s.c dose and 100mg

therapies include anti-hypertensives (propranolol, candesartan), anti-depressants monthly thereafter.

100mgand i.v infusion every 3 months. flunar (amitriptyline, venlafaxine), anti-epilepticsEptinezumab (topiramate) others (pizotifen, 93

Fig6.

Fig.7

Conventional Preventative Therapies: B-blockers: propranolol, metoprolol,atenolol ARB inhibitors: Candesartan Anti-Depressants: amitriptyline, venlafaxine Anti-epileptics: topiramate Others: pizotifen, flunarizine

Small molecule CGRP receptor Antagonists: Rimegepant 75mg alteranate days Atogepant 60mg daily Fig: 8

Fig. 8

The mode of action of the C.G.R.P. monoclonal ant and eptinezumab) is by blockage of the actions of th Fig.6 small molecule gepants are achieving a > 50% reduction the trigememinal periphereal end ofinthe nerve, whist er approved for prescribing, only frequency and severity of attacks receptor on see thea reduction nerve terminals.

The monoclonal an within neurology departments. and many patients Fig: 6 Eligible patients need to have within the first week. Real world the blood brain barrier.

Infailed clinical trials they co previously 3 or more data patient reported outcomes Evidence is lacking in regards the efficacycross ofandthese therapies (except Topamax), as th conventional preventative indicated that these medications efficacy with > 50% of patients achieving 50% re therapies. evidencea > had are even more impressive in clinical never had to go undergo the rigors of clinical trials which the newerWritten therapies to of these failures needs to be practice than in clinical trials. The attacks and many patients see a reduction within th are non-responder to the triptans factors for progression are: high from their pharmacist and half-life of these agents ranges from obtained order tothegain Nevertheless working hypotheses is that 50% of patients and for whom triptans approval. are baseline frequency of episodic the 26-32 submitted with their application for days and are administered patient reported outcomes indicated that these me contraindicated. migraine, increasing age, obesity, by monthly subcutaneous injections a choosen C.G.R.P. antagonist to a 50% reduction in the frequency of attacks and this is the benchmark inThe which all ne anxiety states, medication-overuse gain reimbursement approval. or 3 monthly when administered clinical practice than in clinical trials. half-life of Migraine Preventative Therapies: and females. The underlying intravenously (eptinezumab Onabotulinum Toxin A: mechanism is thought to be therapies measured against. Patientsand areare recommended commence on a low Migraine preventionare is indicated 100mg).

They are well tolerated andbyto administered monthly subcutaneous injed due to periphereal and central when patients experience 4 or Onabotulinum Toxin A is a licenced reported side effects include: local sensitization of the trigmeminal more days per month therapy100mg). for Chronic Migraine.

It isshould intravenously (eptinezumab They are well t reaction at injection site, flu like andheadache titrate upwards depending on efficacy and tolerability.

Individual patients afferent pathways which lowers and also in those who poorly administered in accordance with symptoms, constipation, fatigue threshold for headache, is self- include: respond to acute therapies. reaction atthe injection site,on fluits like symp Preempt protocol (Phase 3 benefi and rarely Raynauds phenonemon. remain on a chosen the agent for 3 months before alocal determination is made perpetuating, and ultimately leads Conventional preventative Research Evaluating Migraine If a patient fails to respond to to increased headache frequency Raynauds phenonemon.

If a patient fails therapies include antiProphylactic Therapy) into to 31 respond one monoclonal antibody it is the cohort of patients withmigraine. chronic migraine most patients discontinue their treatme and chronic hypertensives (propranolol, sites intramuscularly into the recommended they switch to an recommended they switch alternative candesartan), anti-depressants headto andan neck every 12 weeks. or a ‘’ge alternative or a ‘’gepant’’.

Migraine is arates particularly within months with Chronic adherence of 26%-29% after 6 months, dropping to 17%-22 (amitriptyline, venlafaxine), antiIt is theorised that it acts by challenging condition to treat.

Gepants: aremolecule small molecule C.G.R.P. antag Gepants: are small epileptics (topiramate) and others inhibition of trigeminalreceptor sensory However, since the arrival of the C.G.R.P. receptor antagonists. (pizotifen, flunarizine). Fig 6.

12 months. afferents which innervate the C.G.R.P. antagonists (monoclonal aRimegepant preventative therapy Episodic Migraine (> 4 m 75mg is licenced as a for intracrainial muscles, blocking Evidence is lacking in regards antibodies and gepants), Fig. 7,8 preventative therapy for Episodic the release of acetyl choline Chronic Migraine and migraine prevention: on alternate days, Atogepant 60mg is licence the efficacy of these therapies we are entering a ground breaking Migraine (> 4 migraine attackswhilst per and neuropeptides, and thereby (except Topamax), as they have and transformational era in month) and is given on alternate modulates the sensitization Migraine and Migraine and is given Chronic headache onAtogepant > 15Chronic days month, with atof daily. least Th 8 never had to go migraine undergo the rigorsis a migraine management.which occurs days, whilst 60mg is per central neurons which is causative of clinical trials which the newer The mode of action of the licenced for prevention for both in the chronification of migraine. medications have then 50%for responder rat therapies had to in the order tocharacteristics gain C.G.R.P. monoclonal antibodies retaining of episodic migraine and hasa greater been > 3month Episodic Migraine and Chronic Afterpresent 2 treatment cycles (24 approval. Nevertheless the working (fremanezumab, galcanezumab Migraine and is given daily. They days. weeks), in studies, 71% patients of monthly migraine They are well tolerated a hypotheses is that 50% of patients from and eptinezumab) is by blockage frequently evolves episodic migraine has prevalence of 1.4%-2.2% haveand a half-life of 11ahours. had achieved a > 50% reductionof in the achieve a 50% reduction in the of the actions of the cgrp peptide Both medications have a greater skin headache days. fatigue, constipation, rashes and also rarely Ray frequency of attacks and this is released from the periphereal

then 50% responder rate and population. Risk factors for progression are: high baseline frequency of episodic migr There is also clinical evidence end of the trigememinal nerve, significantly reduced the number supporting the combination of whist erenumab is an antagonist of monthly migraine days. They are and females. The underly increasing age, obesity, anxiety medication-overuse C.G.R.P. monoclonal antibodies at the cgrp receptor onstates, the well tolerated and are safe. Side with Onabotulinum Toxin A nerve terminals. The monoclonal effects include: nausea, fatigue, as the combination is thought mechanism is thought to be due to periphereal central antibodies are large molecules constipation, and skin rashes and also sensitization of the trigm to synergistically enhance and do not cross the blood brain rarely Raynauds phenonemon. theirself-perpetuating, efficacy and give further barrier. In clinical trials they afferent pathways which lowers the threshold for headache, is and reductions in the number of In Ireland both the CGRP consistently demonstrate excellent headache days per month. efficacy with > 50% of patients monoclonal antibodies the ultimately leads to increased headache frequency andandchronic migraine.

Conclusions: Chronic Migraine is a particularly challenging condition to treat.

However, since the a A new era in migraine management has emerged in recent years of the C.G.R.P. antagonists (monoclonal antibodies and gepants), Fig.7,8 weof are enteri Fig: 7 following the approval targeted specific acute and preventative ground breaking and transformational era in migraine management. migraine therapies. These C.G.R.P. Monoclonal Antibodies:

the benchmark in which all newer therapies are measured against.

Patients are recommended to commence on a low dose and titrate upwards depending on efficacy and tolerability. Individual patients should remain on a chosen agent for 3 months before a determination is made on its benefits. In the cohort of patients with chronic migraine most patients discontinue their treatment within months with adherence rates of 26%-29% after 6 months, dropping to 17%-22% after 12 months.

Chronic Migraine and migraine prevention:

Chronic migraine is a headache which occurs on > 15 days per month, with at least 8 days retaining the characteristics of episodic migraine and has been present for > 3months. It frequently evolves from episodic migraine and has a prevalence of 1.4%-2.2% of the population. Risk

Erenumab 70mg or 140mg monthly s.c injections Fremanezumab 225mg monthly or 675mg 3 monthly s.c. injection Galcanezumab 200mg loading s.c dose and 100mg monthly thereafter.

Eptinezumab 100mg i.v infusion every 3 months.

breakthroughs have improved the quality of life and reduced the disability associated with migraine.

Individualised care continues to be the cornerstone of good management and patients are urged to keep diaries to facilitate decision making and optimise their treatments.

Fig.7 Small molecule CGRP receptor Antagonists: Rimegepant 75mg alteranate days

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Congratulations to all the Winners and Finalists of the 2025 Irish Pharmacy Awards.

Thanks to all of our Sponsors.

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Thank You IPN Communications would like to take this opportunity to thank all the companies below who have given their support to the 2025 Irish Pharmacy Awards through the donation of gifts and samples to our Awards Goody Bags at each of your place settings.

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96

Clinical Profiles

CHI AT CONNOLLY CELEBRATES TREATING OVER 100,000 CHILDREN AND YOUNG PEOPLE Staff in Children’s Health Ireland (CHI) at Connolly are proud to announce that they have now seen and treated over 100,000 patients since opening in 2019 — a major milestone in delivering childcentred care to communities in Dublin and surrounding areas.

CHI at Connolly staff treat children with minor injuries and illnesses (by appointment) that are not lifethreatening and do not require a visit to the Emergency Department (ED). A triage system is used to ensure that the patients with the most urgent needs are treated first.

Outpatient Clinics are also held in CHI at Connolly.

The 100,000th patient to attend at CHI at Connolly was 12-year-old Olivia Muphy, who came to the Urgent Care Centre after injuring her arm at gymnastics. Olivia received excellent care and is thankfully doing really well.

To mark this achievement, CHI at Connolly hosted a celebration on Wednesday, 14th May with fun for all ages — including an ice cream truck, garden games, face painting, and more. Staff, patients, and families joined together to celebrate the success and growth of the service.

In 2024, CHI at Connolly recorded: • 24,284 attendances at the Urgent Care Centre • 9,956 outpatient appointments.

These attendances include • 10,818 Injury - burns, fractures, sprains and superficial • 864 Eye and ear problems • 4,123 Respiratory The 100000th patient, Olivia Murphy, joined the staff in CHI at Connolly to celebrate the milestone

The Urgent Care Centre uses a flexible and responsive model of care, which was introduced in February 2023. This model allows staff to adapt services based on acuity, patient needs, and staff availability, ensuring timely and appropriate care for all patients.

Dr Turlough Bolger, Site Clinical Lead CHI at Connolly and CHI at Tallaght, said, “This milestone is a testament to our incredible staff and their commitment to delivering flexible, high-quality care. Reaching 100,000 patients in just a few years shows the real impact CHI at Connolly is having on children, young people, and families.”

HIQA LAUNCHES PUBLIC CONSULTATION The Health Information and Quality Authority (HIQA) has launched a public consultation on its draft health technology assessment (HTA) of providing an alternative national phone line specifically for people with acute but non-urgent medical care needs. This would complement the 112/999 phone line which is intended for use by people with acute urgent medical care needs.

HIQA undertook this assessment at the request of the Health Service Executive (HSE). The final assessment will provide advice to the Minister for Health and the HSE to inform a decision on whether to introduce a new telephone pathway in Ireland.

Currently in Ireland, a range of options exist for individuals to access publicly-funded healthcare, including attending a general practitioner (GP) during office hours, calling GP out-of-hours services, calling 112/999 emergency ambulance services, and self-presenting at an Emergency Department or Injury Unit. Members of the public may also visit a community pharmacy where they can obtain advice or, if

necessary, be redirected to other healthcare providers.

A variety of similar telephone services which offer advice or triage, targeted for use by people with acute, but non-urgent medical care needs have been implemented in other countries including the UK, Denmark, Sweden, Australia, and Canada.

Dr Conor Teljeur, HIQA’s Chief Scientist, said: “Our scoping review of international practice showed that non-urgent telephone pathway services can, and do, positively assist callers to access timely assistance and appropriate care.”

Dr Teljeur continued: “There are numerous ways to access non-urgent care, and it can be challenging for members of the public to know which is the best option in their situation. With a new telephone pathway for non-urgent care, call handlers can support individuals with acute but nonurgent issues to access the right care at the right time, in the most appropriate setting.”

Implementing an alternative telephone pathway in Ireland would require a substantial investment. Depending on demand for the service, the estimated five-year costs range from ¤80 million with low demand to ¤250 million with high demand.

HIQA has published its draft findings to give members of the public an opportunity to provide feedback on the content. An online survey and details of how to take part in the consultation are available on HIQA’s website. The consultation will remain open until 5pm on Wednesday, 18 June 2025.

Following the public consultation, the report will be updated as necessary and a finalised report will be submitted as advice to the Minister for Health and the HSE, and published on the HIQA website.

Read the draft report and take part in the consultation at www.hiqa.ie.

MERCY UNIVERSITY HOSPITAL CORK LAUNCHES AMBITIOUS 2025-2030 STRATEGIC PLAN Mercy University Hospital (MUH) Cork has launched its strategic plan for 2025-2030, "Maintaining and Improving the Health and Wellbeing of those we Serve," outlining a comprehensive vision for the future of healthcare delivery within the hospital and the community it serves. The strategy was officially launched today, May 23rd, by Dr Colm Henry, Chief Clinical Officer of the Health Service Executive (HSE).

Rooted in the core values of Compassion, Excellence, Justice, Respect, and Team Spirit, the

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plan details MUH’s commitment to enhancing patient care, modernising facilities, reinforcing community engagement, and embracing digital transformation.

Key initiatives will be implemented across four strategic areas: People, Continuous Operational Improvement, Sustainability, and Technology & Partnership.

"Our new strategic plan reflects Mercy University Hospital’s unwavering commitment to putting patients first and striving for excellence in everything we do," said Margaret McKiernan, Chief Executive Officer of Mercy University Hospital. "We have carefully considered our role in healthcare provision to the city and wider region, collaborating with our regional partners to continue to advocate for our patients through the delivery of exceptional evidencebased patient care, and also supporting the development of the next generation of healthcare professionals in Ireland."

The 2025-2030 strategy is grounded in six strategic pillars: Mission, Quality, Stewardship, Digital, Sustainability, and Research. These pillars have enabled the identification of four "Big Moves" that will drive progress over the next five years: • People: Developing a partnership approach to foster team spirit and enhance job satisfaction for staff, recognising them as the hospital's most important asset.

• Continuous Operational Improvement: Maintaining high standards of quality, excellence, and performance in all aspects of the organisation's services.

• Sustainability: Assuming ecological responsibility through practices that promote respect and care for the environment, working towards the 2050 Net Zero targets.

• Technology & Partnership: Implementing necessary improvement plans based on best practice, innovative technology, knowledge, and skill, including a "Hospital without Walls" approach.

The plan also addresses key capital developments, including a new extension comprising 72 beds, an increase in the number of ICU/HDU beds, co-location of urgent and emergency care, and centralisation of an expanded theatre complex. MUH is also committed to delivering better digital services, including the introduction of Electronic Prescribing and the adoption of the Electronic Healthcare Record, in line with national policy.

97 Mercy University Hospital serves a diverse and growing population and is committed to providing a sustainable, socially relevant service in line with national and international evidence-based practice. The hospital's mission is to provide excellent patient services to maintain and improve the health and wellbeing of those they serve, especially those who are most vulnerable and marginalised.

WELLFEST TAKES PLACE IN DUBLIN Dublin’s IMMA at the Royal Hospital Kilmainham was transformed recently into Europe’s largest annual outdoor health and wellness festival, WellFest. Now in its ninth year, thousands of fitness fans and wellness enthusiasts descended into Dublin to take part in the two day festival, enjoying 21 hours of high-energy fitness classes, inspirational talks, expertled discussions, cooking demos and so much more from over 150 international and Irish experts across 15 areas and stages.

Saturday standout moments include an inspirational fireside chat on resilience and the transformative power of self-love and confidence with motivational speaker and TV presenter, Katie Piper; one of the world’s largest resistance bands workouts with the Kardashian’s longtime personal trainer DB DONAMATRIX; tantra yoga with holistic sex educator Jenny Keane; wellness reimagined with bestselling author and Deliciously Ella founder Ella Mills; celebrity-favourite, high-intensity bootcamp workout known as ‘the best in the world,’ led by global Co-CEO at Barry’s, Joey Gonzalez; an electrifying Pure Ride indoor cycling class led by Kevin Twomey of I’m Grand Mam podcast fame; and a day full of friends and fitness communities coming together to take part in classes and workouts from HYROX, Zumba, pilates, yoga, dance, HIIT, strength training,spin classes and so much more. For the first time, WellFest

also extended its Saturday hours into the evening, with programming until 9pm including alcohol-free dance parties and DJ sets with Ecstatic Dance, friend speed dating, sauna sessions at WellEnergy and a closing ceremony led by wellness coach Lorraine Hogan.

Sunday marked the exciting debut of WellFest’s Run Club, hosted by Irish 800m Olympic athlete Nadia Power and Aoibhinn Raleigh, founder of Dublin’s beginner-friendly running group Sole Mates. Sunday’s main stage lineup included mental health activist and trainer Get Better with Chris guiding festival-goers through warm-up techniques for running; vinyasa flow yoga with Nike trainer Dr Rebekah Jade; techno yoga with Yoga Le Naoise; and Coppers The Workout, inspired by the legendary Dublin nightclub, alongside an array of power-packed fitness classes from Zumba to rockout workout POUND. Across WellFest’s 15 festival areas, the Sunday schedule features founder of Sober Girl Society Millie Gooch; bestselling author and nutritionist Em the Nutritionist; a womenin-sport panel with Paralympic gold medalist Ellen Keane and Olympian Nadia Power; prominent Irish nutritionist Sophie Morris; Dr Sumi Dunne, the GP expert on RTÉ's former show Operation Transformation, and over a 100 fitness classes, talks, discussions and food demonstrations from dumpling-making masterclasses to bagel baking. Children under 12 can attend WellFest free of charge, accompanied by an adult ticket holder, and enjoy WellKids activities such as gymnastics, family line dances, and even baby raves.

Katie Ryan, co-founder of WellFest shares: “WellFest isn’t just a festival—it’s a celebration of movement, mindfulness, and community. This weekend, IMMA at the Royal Hospital Kilmainham became Europe’s largest and most exciting gathering place for fitness, wellness, and personal

growth, bringing together leading international and Irish experts, trainers and qualified health professionals with thousands of fitness fans and festival-goers from across Ireland and beyond.

From adrenaline-fueled workouts to inspiring discussions, delicious cooking demos, and immersive wellness experiences, WellFest was thrilled to introduce new additions to this year’s festival including extended Saturday evening hours and our first-ever Run Club on Sunday morning.”

Katie Ryan co-founded WellFest alongside her sister Helena Ryan, Fionnualla Cleary, and Anthony Kelly, and the festival is now coowned by the founders and one of Ireland’s leading experience and entertainment companies FUEL since 2022.

UNIPHAR KICKS OFF FIFTH ANNUAL UNITY FOR HOPE CAMPAIGN, RAISING FUNDS FOR PIETA Uniphar, the international diversified healthcare services business and pharmacy group behind Allcare Pharmacy, Hickey’s Pharmacy, and McCauley, has officially launched its 2025 ‘Unity for Hope’ campaign, once again partnering with mental health charity Pieta to support suicide prevention and mental health services across Ireland.

Now in its fifth year, the Unity for Hope campaign has raised over ¤1 million for 17 charitable causes since it began in 2021.

This year, Uniphar’s retail division has committed to raising ¤35,000 for Pieta, building on the group’s

Stephanie Manahan, CEO of Pieta, and Donna Burke, Corporate Partnerships, Trusts & Foundations and Major Donors Officer, attended the campaign’s internal launch alongside Uniphar colleagues

strong legacy of communityfocused fundraising.

The campaign kicked off with an impressive start, as Uniphar colleagues raised more than ¤12,000 during Pieta’s annual flagship fundraising event, Darkness into Light.

Stephanie Manahan, CEO of Pieta, and Donna Burke, Corporate Partnerships, Trusts & Foundations and Major Donors Officer, attended the campaign’s internal launch alongside Uniphar colleagues.

Speaking at the event, Louise Martin, Retail Lead at Uniphar, said: “It’s incredibly moving to see the dedication of our pharmacy teams across the country as we enter our fifth year of Unity for Hope. The ¤10,000 raised for Darkness into Light is just the beginning. Over the coming months, our colleagues will be organising fundraisers in our pharmacies to raise much needed funds for Pieta. We’re proud to once again support Pieta and to continue making a real impact in the communities we serve.”

Stephanie Manahan, CEO of Pieta, added: “Uniphar’s continued support means so much to us and most importantly, to the people who rely on our services every day.

The support from their teams and customers not only helps fund vital services but also sends a powerful message of hope to those who need it most.”

Fundraising events will take place throughout the year across Uniphar’s nationwide pharmacy network, including Allcare Pharmacy, McCauley and Hickey’s Pharmacy. All proceeds will go directly to Pieta to support their lifesaving work in crisis intervention, counselling, and suicide prevention.

For more information about Unity for Hope and how to support the campaign, visit https://www. idonate.ie/event/pietaunity

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Clinical Profiles

EUROPEAN COMMISSION APPROVES JOHNSON & JOHNSON’S SUBCUTANEOUS DARZALEX® (DARATUMUMAB)BASED QUADRUPLET REGIMEN FOR THE TREATMENT OF PATIENTS WITH NEWLY DIAGNOSED MULTIPLE MYELOMA, REGARDLESS OF TRANSPLANT ELIGIBILITY Johnson & Johnson Innovative Medicine has announced that the European Commission (EC) has approved an indication extension of DARZALEX® (daratumumab) subcutaneous (SC) formulation in the frontline setting. The approval is for daratumumab SC in combination with bortezomib, lenalidomide, and dexamethasone (daratumumab-VRd) for the treatment of adult patients with newly diagnosed multiple myeloma (NDMM).

Multiple myeloma remains an incurable blood cancer, with nearly all patients relapsing and requiring subsequent therapy.

Approximately, 380 people are diagnosed with multiple myeloma each year in Ireland and over 2,000 people are currently living with this type of cancer.

“Multiple myeloma is a complex and evolving disease. Starting with more effective regimens in the frontline setting offers patients the best chance of sustained long-term outcomes by preventing disease resistance and relapse,” said Professor Katja Weisel, University Medical Centre Hamburg-Eppendorf. “The subcutaneous daratumumabVRd regimen delivers an effective and convenient new standard of care for patients with newly diagnosed multiple myeloma, regardless of transplant eligibility, with responses that are deep and durable, and translate into significantly reduced risk of disease progression or death.”

Michaela Hagenhofer, General Manager, Commercial Operations at Johnson & Johnson Innovative Medicine said “At Johnson & Johnson Innovative Medicine, we have been dedicated to advancing multiple myeloma research for over 20 years, with a continued focus on getting ahead of cancer and pioneering innovative treatments. This approval marks a significant milestone in those efforts, offering broader access to daratumumab, the only anti-CD38 antibody approved for all newly diagnosed patients in the frontline setting, regardless of transplant eligibility. It underscores our unwavering commitment to improving outcomes for those affected by this disease, and to ultimately finding a cure for multiple myeloma.”

Daratumumab is now approved in nine indications for multiple myeloma, five of which are in the frontline setting, including as part of treatment regimens for newly diagnosed patients who are eligible or ineligible for autologous stem-cell transplant (ASCT). Today’s approval follows the indication extension approval for daratumumab-VRd in October 2024, for the treatment of newly diagnosed patients with multiple myeloma who are eligible for ASCT, based on the results from the Phase 3 PERSEUS study. The study evaluated this daratumumab SC-based quadruplet regimen for induction and consolidation therapy, followed by daratumumab SC and lenalidomide maintenance.

"The Phase 3 CEPHEUS (NCT03652064) study evaluated the efficacy and safety of daratumumab-VRd (n=197) compared to VRd (n=198) for patients with NDMM who are transplant ineligible or for whom ASCT was not planned as initial therapy (transplant ineligible or deferred). Data from the study were previously presented at the 2024 International Myeloma Society (IMS) Annual Meeting. At a median follow-up of 59 months, the primary endpoint was met, with an overall minimal residual disease (MRD)-negativity rate at a sensitivity of 10-5 (no cancer cells detected within 100,000 bone marrow cells) of 60.9 percent for patients receiving daratumumabVRd and 39.4 percent for VRd (Odds ratio [OR], 2.37; 95 percent confidence interval [CI], 1.583.55; p<0.0001).8 Similarly, the proportion of patients achieving sustained MRD-negativity of ≥ 12 months almost doubled with daratumumab-VRd vs VRd (48.7 percent vs 26.3 percent; OR, 2.63; 95 percent CI, 1.73-4.00; p<0.0001). The daratumumab SC-based quadruplet regimen, compared to VRd, also significantly increased the depth of response with higher rates of complete response (CR) or better.8 The CR or better rate was 81.2 percent with daratumumab-VRd vs 61.6 percent with VRd (OR 2.73; 95 percent CI, 1.71-4.34; p<0.0001).

The study also demonstrated that daratumumab-VRd significantly reduced the risk of progression or death by 43 percent (Hazard ratio [HR], 0.57; 95 percent CI, 0.41-0.79; p<0.0005) vs VRd. The median progression-free survival was not reached for daratumumab-VRd vs 52.6 months for VRd. Overall survival data were not yet mature.

The overall safety profile of daratumumab-VRd was consistent with the known safety profiles for daratumumab SC and VRd. The most common (>10 percent)

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Grade 3/4 haematologic and nonhaematologic adverse events with daratumumab-VRd vs VRd were neutropenia (44.2 percent vs 29.7 percent), thrombocytopenia (28.4 percent vs 20.0 percent), anaemia (13.2 percent vs 11.8 percent), peripheral neuropathies (8.1 percent vs 8.2 percent), diarrhoea (12.2 percent vs 9.2 percent), and COVID-19 (11.2 percent vs 4.6 percent).

Johnson & Johnson also submitted a supplemental Biologics License Application to the U.S. Food and Drug Administration seeking approval of a new indication for daratumumab SC in combination with VRd for the treatment of adult patients with NDMM for whom ASCT is deferred or who are ineligible for ASCT, on 30 September 2024.

THE HEART OF THE MATTER – SIBLINGS UNDERGO SAME LIFE-SAVING HEART PROCEDURE University Hospital Galway (UHG) achieved a significant milestone in cardiac care last October by becoming the first hospital in Ireland and the UK to implant the Avalus Ultra biological aortic valve, a major advancement in the field of valvular heart surgery.

The ground-breaking procedure was first performed on Noel O’Brien from County Galway, marking the hospital’s inaugural use of the innovative valve. In a remarkable turn of events, Noel’s brother, Michael, underwent the same life-changing procedure, becoming the eighth patient to receive the implant last month.

Both surgeries were successfully carried out by Professor Alan Soo and his team at UHG.

Noel and Michael O’Brien from Tynagh in County Galway with Professor Alan Soo, Consultant Cardiothoracic Surgeon, University Hospital Galway

Both Noel and Michael O’Brien had experienced symptoms commonly associated with aortic valve disease, a condition where the valve narrows or leaks, forcing the heart to work harder to pump blood. If untreated, the condition can lead to heart failure and other serious complications.

Patients with aortic valve disease, either stenosis (blocked) or regurgitant (leaky), often require valve replacement The Avalus Ultra valve is a next-generation aortic valve replacement that offers improved durability, enhanced surgical handling, and easier placement.

Its introduction places UHG at the forefront of cardiac surgical innovation in Ireland.

Professor Alan Soo, Consultant Cardiothoracic Surgeon praised the development, stating, “The introduction of the Avalus Ultra valve represents a new chapter in heart valve surgery. We are proud to lead the way in offering our patients the very latest in cardiac technology, ensuring better outcomes and improved quality of life.”

The successful adoption of this advanced valve system underscores UHG’s commitment to pioneering treatments and delivering world-class cardiac care to patients across Ireland.

HSE FALLS PREVENTION FRAMEWORK LAUNCH A new falls prevention framework has been launched by HSE West and North West. The framework document presents the best available national and international evidence to help us prevent falls - the main cause of major trauma to our older population. The document has been developed by dedicated healthcare professionals across the region, working in community, residential and acute settings.

Falls are the second largest cause of unintentional injury-related

99 deaths worldwide Falls are more common among older adults, with 30-40% of those over 65 falling each year. 82% of major trauma in older adults in Ireland are attributable to low falls, and 70% of these accidents occur in the home.

A history of falls significantly increases the risk of future falls; for older adults, a fall, whether or not it results in serious injury, may represent a life-changing event that carries implications for their perceived health and behaviour. Fear of falling leads to reduced physical activity, both indoors and outdoors, which contributes to declining physical function, increased frailty, and a higher likelihood of fractures and institutional care.

Recognising the multifactorial nature of falls prevention, a steering group and six working groups were established in late 2022. The six working groups reviewed the research in relation to: Bone Health, Strength & Exercise; Medication Review; Residential Services & Continence; Environment & Structural Issues; Education & Awareness and Equipment & Technology.

Each specialist working group developed key findings and recommendations in relation to promoting healthy aging; preventing falls; managing falls and supporting people after a fall. All of the findings and recommendations from these working groups are now presented in the framework document which will be an indispensable resource for clinicians, not just locally, but all across Ireland and beyond.

Findings from the Falls Prevention framework show that: • Home was the main location for major trauma injury for older adults, with almost double the proportion (70%) of accidents happening in the home compared to those aged under-65 years (36%) (25).

• Care home residents are three times more likely to fall than older adults living in their own homes and therefore all residents should be considered at high risk of falls.

• Many falls can be prevented.

Fall and injury prevention needs multidisciplinary team effort that requires leadership support.

• Regular physical activity can help older persons improve physical function and balance, thereby preventing harmful falls and fall-related injuries (45).

Specifically, multi-component exercise (that includes balance, functional and resistance

exercise) has been proven to reduce the rate of falls by 35%.

• The cost of treating falls in our acute hospitals in the north west was an estimated ¤40.5 to ¤46.9 million in 2023. This does not capture the economic burden associated with falls in the community setting that do not require hospital admission. The cost of fall related injuries in older persons in Ireland is expected to reach over ¤2 billion by 2030.

• Falls prevention knowledge and strategies helps people to live well and independently at home by increasing their knowledge and thereby reducing the risks associated with falls such as reduced muscle strength, poor balance and safety hazards in the home.

The framework document can be accessed on the following link. https://www.hse.ie/eng/services/ publications/falls-preventionframework.pdf STANDING SHOULDER TO SHOULDER FOR MEN’S HEALTH American investor and philanthropist Warren Buffett famously once said: “it takes twenty years to build a reputation and five minutes to ruin it. If you think about that, you’ll do things differently.” For the past twenty years, a diverse range of organisations from across the island of Ireland have been voluntarily coming together to 'do things differently' in the field of men's health. Their work has seen the celebration of Men's Health Week on the island grow from a small number of people handing out a few posters in 2005, to almost 100 groups working together to plan and shape this week on an all-island basis today - running hundreds of events, engaging tens of thousands of men, and distributing over one hundred thousand resources.

This research shows that men on the island of Ireland experience a disproportionate burden of ill-health...

• Men continue to die, on average, younger than women do.

• Some groups of men have much worse health than other men.

• Poor lifestyles (including smoking, drinking, diet and lack of exercise) are responsible for a high proportion of chronic diseases.

• Males have higher death rates than women for almost all of the leading causes of death, and at all ages.

• Men’s mental health needs are often not recognised or met.

• Late presentation to health services can lead to a large number of problems becoming untreatable.

The theme for Men’s Health Week this year is 'Shoulder to Shoulder Connecting for Health'. It focuses upon the importance of connectivity and helping each other - reminding everyone about the importance of not going it alone, that there are supports available, that men’s health is a team effort and that it is important to take small, simple and realistic actions within a supportive environment.

BRINGING MS TO THE BIG SCREEN: A NATIONWIDE CINEMA CAMPAIGN LAUNCHES FOR WORLD MS DAY This World MS Day (May 30th), a powerful new campaign is set to

light up cinema screens across Ireland, bringing vital awareness of multiple sclerosis (MS) to a wider audience. MS Ireland plan to launch this nationwide initiative, featuring a compelling thirty second advert designed to highlight the journey to diagnosis for people living with MS. The campaign will run for six weeks, reaching audiences in major cinema chains including Odeon, IMC, and Omniplex, as well as independent cinemas, covering a total of 83 locations nationwide.

The advert offers a portrayal of the everyday realities of living with MS, aiming to promote understanding and connection.

The campaign also shines a light on the personal experiences of individuals living with MS, sharing their stories to offer an authentic perspective on the condition.

Viewers are encouraged to visit the MS Ireland website at www. ms-society.ie/ to learn more about MS and how they can support the MS community.

This campaign was funded by a sponsorship from Novartis Ireland who had no input to the content or design.

Pictured at the unveiling of the advert in the Odeon, Point Square are Lisa Bashorum, Aoife Kirwan, Aaron Cunningham, Ava Battles and campaign team members

International Men's Health Week (MHW) always begins on the Monday before Father's Day and ends on Father's Day itself. During 2025, it will run from Monday 9th until Sunday 15th June. It is celebrated in many European countries, as well as in the USA, Australia, New Zealand, Canada and a number of other places worldwide.

Back in 2005, we were unaware of the full extent of men’s poor health status and the specific health issues that they are contending with. However, this is no longer the case. In recent years, a broad range of research has highlighted the health challenges which face men on the island of Ireland and further afield.

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