IPN May 2025

May 2025 Volume 17  Issue 5 PHARMACYNEWSIRELAND.COM

THE INDEPENDENT VOICE OF PHARMACY

In this issue: NEWS:

Let’s Grow Together

New Guidelines on Pharmacy Pricing Transparency Page 4

FEATURE: Exercise and Asthma Page 14

BUSINESS: Pharmacy Claims Management Page 20

CPD: Age-Related Macular Degeneration Page 43

Benefits of buying from Uniphar Brand Partners • 24/7 access to ordering via our website • Simplify your ordering with 300+ brands available in one place • Access to trending brands • Curated range of Irish brands • Exciting promotions • Strong retailer margins & competitive pricing on leading brands • Dedicated sales, buying, marketing and customer service team

AWARDS: Irish Pharmacy Awards 2025 – Finalists Announced Page 49

TEAM TRAINING: Fungal Foot Infections Page 68

CLINICAL: www.uniphar.ie

linkup@uniphar.ie

This Publication is for Healthcare Professionals Only

@unipharbrandpartners

Understanding Diabetes Page 75

Generic Product Launch

Nasusaf

137 micrograms/50 micrograms per actuation Nasal Spray, Suspension azelastine hydrochloride/ fluticasone propionate

Indications Nasusaf 137 micrograms/50 micrograms per actuation nasal spray, suspension Relief of symptoms of moderate to severe seasonal and perennial allergic rhinitis if monotherapy with either intranasal antihistamine or glucocorticoid is not considered sufficient.

Nasusaf (azelastine hydrochloride and fluticasone propionate) Nasal Spray Abbreviated blurred vision or other visual disturbances, the patient should be considered for referral to an Prescribing Information. ophthalmologist for evaluation of possible causes. If there is any reason to believe that adrenal function is impaired, care must be taken when transferring patients from systemic steroid Presentation: Each ml of suspension contains 1000mcg azelastine hydrochloride and 365mcg treatment to Nasusaf nasal spray. In patients who have tuberculosis, any type of untreated fluticasone propionate. One actuation (0.14g) delivers 137mcg azelastine hydrochloride infection, or have had a recent surgical operation or injury to the nose or mouth, the possible (equivalent to 125mcg azelastine) and 50mcg fluticasone propionate. Indications: Relief of benefits of the treatment with Nasusaf nasal spray should be weighed against possible risk. symptoms of moderate to severe seasonal and perennial allergic rhinitis if monotherapy Infections of the nasal airways should be treated with antibacterial or antimycotical therapy, with either intranasal antihistamine or glucocorticoid is not considered sufficient. Dosage but do not constitute a specific contraindication to treatment with Nasusaf nasal spray. and administration: For nasal use only. Nasusaf nasal spray is suitable for long-term use. Nasusaf nasal spray contains benzalkonium chloride. Long term use may cause oedema of The duration of treatment should correspond to the period of allergenic exposure. Adults the nasal mucosa. Interactions: Ritonavir (a highly potent cytochrome P450 3A4 inhibitor) and Adolescents (12 years and above): One actuation in each nostril twice daily. Children can greatly increase fluticasone propionate plasma concentrations, resulting in markedly (below 12 years of age): Not recommended for use. Elderly: No dose adjustment required. reduced serum cortisol concentrations. During postmarketing use, there have been reports Renal and Hepatic Impairment: No data available. Contraindications: Hypersensitivity to of clinically significant drug interactions in patients receiving intranasal or inhaled fluticasone the active substances or to any of the excipients. Precautions and warnings: During post- propionate and ritonavir, resulting in systemic corticosteroid effects. Co-treatment with other marketing use, there have been reports of clinically significant drug interactions in patients CYP3A4 inhibitors, including cobicistat-containing products is also expected to increase receiving fluticasone propionate and ritonavir, resulting in systemic corticosteroid effects the risk of systemic side-effects. The combination should be avoided unless the benefit including Cushing’s syndrome and adrenal suppression. Therefore, concomitant use of outweighs the increased risk of systemic corticosteroid side-effects. Care should be taken fluticasone propionate and ritonavir should be avoided, unless the potential benefit to the when administering azelastine hydrochloride in patients taking concurrent sedative or central patient outweighs the risk of systemic corticosteroid side-effects. Systemic effects of nasal nervous medications because sedative effect may be enhanced. Alcohol may also enhance this corticosteroids may occur, particularly when prescribed at high doses for prolonged periods. effect. Pregnancy and lactation: Nasusaf nasal spray should be used during pregnancy and These effects are much less likely to occur than with oral corticosteroids and may vary in lactation only if the potential benefit justifies the potential risk to the foetus. Effects on ability individual patients and between different corticosteroid preparations. Nasusaf nasal spray to drive and use machines: Nasusaf nasal spray has minor influence on the ability to drive undergoes extensive first-pass metabolism, therefore the systemic exposure of intranasal and use machines. In isolated cases fatigue, weariness, exhaustion, dizziness or weakness that fluticasone propionate in patients with severe liver disease is likely to be increased. This may may also be caused by the disease itself, may occur when using Nasusaf nasal spray. In these result in a higher frequency of systemic adverse events. Caution is advised when treating cases, the ability to drive and use machines may be impaired. Alcohol may enhance this effect. these patients. Treatment with higher than recommended doses of nasal corticosteroids Adverse reactions: Hypersensitivity including anaphylactic reactions, angioedema. Very may result in clinically significant adrenal suppression. If there is evidence for higher than Common: Epistaxis. Common: Headache, dysgeusia, unpleasant smell. Consult the Summary recommended doses being used, then additional systemic corticosteroid cover should be of Product Characteristics in relation to other side effects. Overdose: With the nasal route of considered during periods of stress or elective surgery. In general the dose of intranasal administration overdose reactions are not anticipated. In the event of overdose after incidental fluticasone formulations should be reduced to the lowest dose at which effective control of oral uptake, disturbances of the central nervous system (including drowsiness, confusion, the symptoms of rhinitis is maintained. Growth retardation has been reported in children coma, tachycardia and hypotension) caused by azelastine hydrochloride are to be expected. receiving nasal corticosteroids at licensed doses. Since growing up is also given in adolescents Treatment of these disorders must be symptomatic. Depending on the amount swallowed, it is recommended that the growth of adolescents receiving prolonged treatment with nasal gastric lavage is recommended. There is no known antidote. Legal category: POM. Marketing corticosteroids is regularly monitored, too. If growth is slowed, therapy should be reviewed Authorisation Number: PA1986/109/001. Marketing Authorisation Holder: Teva B.V., Swensweg with the aim of reducing the dose of nasal corticosteroid if possible, to the lowest dose at 5, 2031GA Haarlem, The Netherlands. Job Code: MED-IE-00086. Date of Preparation: October which effective control of symptoms is maintained. Visual disturbance may be reported 2024. with systemic and topical corticosteroid use. If a patient presents with symptoms such as

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

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

Prescription Only Medicine.

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

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

Date of Preparation: November 2024 | Job Code: GEN-IE-00103 Further information is available on request or in the SmPC. Product Information also available on the HPRA website.

3

Contents

Foreword

Page 5: McCabes Pharmacy rank high in Reputation Index

In one of your lead news stories this month, we detail that the Pharmaceutical Society of Ireland (PSI) – the pharmacy regulator – will develop new guidelines on the transparency of pricing in respect of services provided by pharmacies.

Page 8: Over 1m illegal medicines detained says HPRA

The announcement was made by Minister for Health Jennifer Carroll MacNeill. She said, "I believe patients don’t have clear visibility of the fees they are paying for services such as dispensing services when getting their prescription medicines dispensed. Since becoming Minister for Health, I have engaged with pharmacy stakeholders, pharmacists, and patients on a wide range of issues concerning community pharmacies. Through these engagements I recognise that the fees patients pay for medicines and associated services are not well understood and not as clear as we should expect in 2025.”

Page 12: Transfer of PMI President’s Chain

5

Page 20: Smart Claims Tool helping Pharmacies

Turn to page 4 for the full story.

Page 36: Elevating Care in the Community Setting Page 49: Irish Pharmacy Awards 2025 – The Finalists

6

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

Grainne Power, Director of Compliance with the HPRA, says the 2024 data continues to highlight that individuals are putting their health at risk by attempting to purchase prescription medicines from unauthorised suppliers.

MANAGING DIRECTOR Natalie Maginnis n-maginnis@btconnect.com

The May issue also carries all the details of our Finalists for the 2025 Irish Pharmacy Awards.

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

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SALES MANAGER Amy Evans | amy@ipn.ie 0872799317 CONTRIBUTORS Dr Laura Monoghan Professor Patrick Mitchell Sarah Gilson Joyce Clegg Laura Dowling Dr Maurice O’Farrell Barbara Paldus Maebh Coyle Bernie Carter Dr Orla Killeen Lisa McAnena Ciara O’Byrne Dr Johann Leunbach Dr Shameer Rafee Professor Niall Tubridy Professor Derek O’Keeffe Dr Lyle McVicker Professor Lis Neubeck DESIGN DIRECTOR Ian Stoddart Design PHARMACYNEWSIRELAND.COM @Irish_PharmNews IrishPharmacyNews

In other news, on page 8 we reveal that over one million units of illegal medicines were detained by the Health Products Regulatory Authority (HPRA) in 2024, marking a 14% increase compared to numbers detained in 2023. Announcing its annual enforcement data, the HPRA confirmed that it detained 1,000,984 dosage units of falsified and other illegal medicines in 2024. The data highlights that anabolic steroids, sedatives and erectile dysfunction products are consistently the most detained categories of medicines year on year.

These 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.

They represent a unique and high-profile opportunity to celebrate the outstanding accomplishments of Ireland’s pharmacy professionals and aim to recognise outstanding examples of high standards, best practice, innovation and excellence.

Please turn to page 49 for all the details.

49 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

We look forward to welcoming everyone on Saturday, 24th May.

Regulars CPD: AGE-RELATED MACULAR DEGENERATION

P43

FEATURE: CVD PREVENTION

P48

TEAM TRAINING: FUNGAL FOOT INFECTIONS

P68

FEATURE: UNDERSTANDING DIABETES

P74

CLINICAL PR:

P79

PHARMACYNEWSIRELAND.COM

4

News

Pricing Transparencies in Pharmacy Minister for Health Jennifer Carroll MacNeill has announced that the Pharmaceutical Society of Ireland (PSI) – the pharmacy regulator – will develop new guidelines on the transparency of pricing in respect of services provided by pharmacies.

The Minister for Health Jennifer Carroll MacNeill

delighted to announce that the PSI has agreed to progress a programme of work to develop statutory guidelines aimed at improving patient access to information in respect of services provided by community pharmacies. This is something that has been recommended by the PSI and I am keen to work with them to enable it.

Minister Carroll MacNeill said, "I believe patients don’t have clear visibility of the fees they are paying for services such as dispensing services when getting their prescription medicines dispensed. Since becoming Minister for Health, I have engaged with pharmacy stakeholders, pharmacists, and patients on a wide range of issues concerning community pharmacies. Through these engagements I recognise that the fees patients pay for medicines and associated services are not well understood and not as clear as we should expect in 2025.

"Pharmacists are highly trained, highly competent and trusted professionals who offer expert advice on illness, ensure the safe supply of medicines, and deliver vaccines to the public. They absolutely should charge a service fee for their expertise and for these professional services.

"I want to see pharmacists working at the very top of their expertise,

providing the best of professional services to their community, who place great trust in them. I also want to see pharmacists providing more professional healthcare services to their community, such as diagnosing and prescribing for common conditions such as eye infections, urinary tract infections and others. I look forward to advancing this with pharmacies as the year progresses. This will make it easier for patients to be diagnosed more quickly, more conveniently, and to recover more quickly as we continue to expand GP services for a growing population.

"However, all charges by pharmacies must be more transparent and readily understood by patients. Today, that means dispensing fees - the price a pharmacist charges for their expert handling and preparation of medicine and advice to a patient.

"I recently met with the PSI to progress this issue and I am

Date for your Diary The Pharmaceutical Managers’ Institute will host a Stakeholder Briefing – NCPE Update on May 22nd in the Clayton Hotel, Dublin.

The PMI will host Professor Michael Barry, Clinical Director with the NCPE for the breakfast briefing. During his talk, Professor Barry will discuss Healthcare Cost Effectiveness and will give an outline of the trends and observations in reimbursement across the industry along with policy updates from the NCPE. The briefing will take place from 7.30-9.30am Visit www.thepmi.com for further details.

PHARMACYNEWSIRELAND.COM

"I have huge ambition for the future of pharmacies, and I am committed to supporting the ongoing reform and expansion of pharmacy services.

"The expansion of Community Pharmacy services presents a real and meaningful opportunity for our health service on many fronts. It will significantly empower our pharmacy workforce and the public by increasing access to care in the community. It will also give community pharmacies opportunities to diversify their health service offerings, their business models and their revenue streams."

Welcoming the PSI’s support on this important matter, the Minister stated: "I believe this is a proportionate response to the transparency issue. I hope pharmacies will support their patients, proactively, with clear information on the nature and quantum of charges levied. I will keep an open mind on this matter, and I will subsequently consider other opportunities including legislative intervention, if they are needed, to achieve this important public policy goal."

Meeting on Medicines Tariffs Medicines for Europe and its delegation recently met with President Von der Leyen for a strategic dialogue on how the European Commission can best support the pharmaceutical sector.

The President and the Health Commissioner are committed to helping the industry and patients in Europe who rely on medicines for better health. Medicines for Europe state, “Tariffs are a regressive and counterproductive and would disrupt global supply chains, cause shortages of critical and essential medicines and undermine patient access.

“This is why advanced economies have agreed on World Trade Organisation (WTO) rules to exempt pharmaceuticals from tariffs.”

To support the Commission and protect the unique value of the pharmaceutical industry, Medicines for Europe has developed a 5-step action plan for pharmaceuticals.

1. Continue diplomatic efforts to prevent the imposition of tariffs on EU medicines and active pharmaceutical ingredients. This is critical to avoid shortages and very real harm to patients.

2. Review complex and burdensome legislation that undermine pharmaceutical activities in Europe and negatively affect patient access and security of supply like the Urban Wastewater Treatment Directive and restrictions on substances required for manufacturing.

3. Accelerate industrial policies like the Critical Medicines Act and the Biotech Act as state aid and tax deferments will be necessary to counter the effect of the competitiveness shock caused by potential tariffs.

4. Adopt the EU pharma legislation with balanced regulatory incentives that health care systems can afford and clear rules to allow day-1 competition after patent expiry and accelerate the digital transformation of regulation and of the sector.

5. Build EU action on strategic autonomy, championing EU solidarity over division and most importantly, prioritising the access and security of medicines

News Balancing Stress The HSE has developed a free, easy-to-access online programme called ‘Balancing Stress’ to support people across Ireland in managing everyday stress.

‘Balancing Stress’, was launched by Jennifer Murnane O'Connor TD, Minister of State for Public Health, Wellbeing, and the National Drugs Strategy.

The programme offers six selfdirected online video sessions (each around 35 minutes) covering key topics including managing stress, worry, anxiety, low mood, and relationship stress. It is available free of charge.

Stress is something many people can struggle with from time to time. In today’s fast-paced world, it’s easy to feel overwhelmed. Learning how to manage stress is essential for both our mental and physical wellbeing.

The programme is delivered

by Dr Niamh Clarke, HSE Principal Psychologist, and features expert interviews with Professor Alan Carr, clinical psychology at the UCD School of Psychology, as well as guided exercises across all six sessions.

Participants can watch at their own pace, on their own time, using a phone, tablet or laptop.

Key features of the programme include: • comprehensive curriculum: a series of accessible 35min video sessions which include guided relaxation exercises, case studies and evidencebased strategies to help manage stressors in our lives • 24/7 accessibility: available online, the programme can be accessed at a time and place that is most convenient to the individual • expert guidance: programme is delivered by key experts in the field of clinical and positive psychology The programme was developed

by HSE Health and Wellbeing, together with HSE Psychology.

5

McCabes Ranks High in Reputation McCabes Pharmacy (formerly Lloyds Pharmacy) has ranked 23rd in the Ireland Reputation Index 2025, achieving a strong reputation score of 74.2.

McCabes Pharmacy have ranked 23rd in the Ireland Reputation Index

The Ireland Reputation Index is the largest and longest-running study of reputation in Ireland, based on the views of over 5,000 members of the public. It measures trust, respect, admiration, and esteem for 100 of the most important organisations in the country.

McCabes’ ranking and score reflect the strong connection they continue to build with customers and communities, especially following the rebrand to McCabes Pharmacy earlier this year.

Said Sharon McCabe, “We're incredibly grateful for the continued support and trust as we move forward with a renewed purpose and commitment to care.”

New Appointment for Claire The Irish Pharmacy Union (IPU) is pleased to announce the appointment of Clare Fitzell as its Secretary General. Ms Fitzell will assume the role with immediate effect and will focus on advancing the development of community pharmacy services in a sustainable and patient-centred way.

Clare Fitzell is a qualified pharmacist with over 25 years of experience in communitybased practice. She has been the Head of Strategic Policy at the IPU since September 2019. She recently oversaw the launch of the IPU’s White Paper, “Key Enablers for a Sustainable Pharmacy Model – Pharmaceutical Care at the Heart of Healthier Communities”, which will, in conjunction with the “IPU Vision for Community Pharmacy 2030”, form the basis for the IPU’s continuing engagement with Government.

Announcing Ms Fitzell’s appointment, IPU President Tom Murray said: “Clare is a highly respected pharmacist with a deep understanding of the challenges and opportunities within our profession. Her experience, leadership and unwavering commitment to community pharmacy make her ideally placed to guide the IPU over the next number of years. We are confident she will be a powerful advocate for pharmacists and for the essential role we play in healthcare.”.

The newly appointed Secretary General of the Irish Pharmacy Union, Clare Fitzell said: “I am deeply honoured to take on the role of Secretary General of the Irish Pharmacy Union. Having been involved with the IPU for more than 25 years, both as a member and in a leadership capacity, I am proud to represent the profession I care so passionately about.”

“Pharmacists are medicines experts, and we are uniquely positioned to improve patient care by ensuring the safe, effective and accessible use of medicines.

There is enormous untapped potential within the pharmacy sector to support better health outcomes in every community across Ireland. This potential has been clearly recognised by the Department of Health’s Expert Taskforce and reflected in the Programme for Government.”

Clare Fitzell IPU

“I believe passionately in the value of community pharmacy and in the need to fully integrate pharmacists across our healthcare systems. My priorities will include the sustainable expansion of

pharmacy services, long-overdue reform of funding models, removal of unnecessary administration burdens and supporting pharmacists to deliver even greater impact in patient care.”

PHARMACYNEWSIRELAND.COM

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News

New Vice-Chair of Medicines for Ireland Medicines for Ireland (MFI), the representative body for the suppliers of the majority of medicine in Ireland has announced Mr Donagh O’Leary as its new Vice Chairperson. Mr O’Leary will join MFI Chairperson, Paul Neill in leading the association as it enters a period of strategic significance for the industry and patients.

IV Antibiotics at Home saves Beds A free HSE Mid West service where patients on IV antibiotics are discharged early from hospital and treated at home or in the community has improved patient experience and freed up acute beds for other patients.

Along with the significant annual saving of more than 3,200 bed-days through admission avoidance or reduced length of stay, the region’s Outpatient Parenteral Antimicrobial Therapy (OPAT) service also ensures that patients can safely return home with minimal disruption to their lives.

OPAT, established in the Mid West in 2017, operates 365 days a year and aims to ensure that no patient who is receiving IV antimicrobials and is otherwise fit for discharge remains an inpatient in the hospital due to antimicrobial treatment.

Mr Donagh O’Leary, Managing Director at Clonmel Healthcare Ltd, Vice Chairman, MFI

As Managing Director at Clonmel Healthcare Ltd, Mr O’Leary brings over 25 years of experience in the pharmaceutical sector across Ireland and the UK. During his tenure with Clonmel Healthcare Ltd, he has grown the business to become the largest supplier of consumer healthcare and generic medications in Ireland.

patients. The Directive will lead to severe disruptions, compromising patient access to affordable, essential and critical medicines and undermining efforts to invest in more resilient medicines manufacturing in the context of the Critical Medicines Alliance.

This year, negotiations on a new Framework Agreement on the Pricing and Supply of Medicines will take place with the State. The terms of the new Agreement will be pivotal in addressing the issues facing the supply of medicines for Irish patients that are being challenged due to rising costs and contradictory legislation coming from Europe.

Commenting on his election at a recent MFI AGM, Mr O’Leary said: “I’m honoured to have been appointed by the members as Vice Chair during this pivotal time for our industry. The future of medicine availability for patients is at a critical juncture. There is an urgent need to stop the race to the bottom via complementary rather than contradictory reforms at the EU & national levels.

The European Union’s Urban Waste Water Treatment Directive (UWWTD) will introduce an extended producer responsibility (EPR), which will generate significant additional costs for the industry. MFI argues that this will place disproportionate financial and operational burdens on the generic pharmaceutical industry, hindering the supply of medicines to millions of Irish

“At the core of the solution to addressing shortages is the introduction of flexible pricing mechanisms that allow for the adjustment of medicine prices, in line with inflation and regulatory costs. This would continue to foster competition, thereby ensuring viability for a wider number of manufacturers and better security of supply for patients.”

PHARMACYNEWSIRELAND.COM

Mr O’Leary concluded: “Working with Paul and the wider membership, my goal is to engage with stakeholders across the State to develop and implement reforms to create a sustainable and resilient medicines supply system that protects patient access and ensures the long-term security of essential treatments across Ireland.”

Commenting on Mr O’Leary’s election, Chairperson of MFI, Paul Neill said, “I’m delighted to welcome Donagh as Vice Chairperson of MFI. He brings a wealth of experience and a strong commitment to our mission of improving access to medicines for patients through advocating for policies that ensure a sustainable and stable medicines supply while maintaining affordability for the healthcare system. I look forward to working closely with Donagh during this critical time for the industry. I also want to thank Deirdre Kelly for all of her support during her tenure as Vice Chairperson. I look forward to continuing to work closely with her as she progresses MFI’s work in gaining recognition and support for value-added medicines.”

Since 2017 to the end of 2024, 1,049 patients have been discharged onto the Mid West OPAT service, saving approximately 24,000 bed-days.

Maria Molyneaux, candidate Advanced Nurse Practitioner (cANP), OPAT, explains, “The aim is to review all patients within 24 hours of referral and discharge patients who fit the national OPAT discharge criteria within 48 to 72 hours of review.

“Nationally, patient satisfaction with the service is very high; with 98% of patients agreeing they would use the service again, 92% rating it as excellent and 96% agreeing that the experience was preferable to hospital treatment.”

Patients remain under the care of the primary consultant and infectious diseases (ID) consultant while receiving IV treatment at home, and there is a weekly review in the OPAT clinic with the ID consultant and senior nursing team or with the primary consultant.

Benefits for the patient include equivalent clinical outcomes to hospital care, without the stress of being in hospital.

Promoting admission avoidance and early discharge, the service also promotes antimicrobial stewardship.

Using the latest, cutting-edge technologies to make dispensing to your patients reliable, safe & efficient.

• Now with nursing home & new life features • Integrated tills mean the end of double data entry • Head office management

To learn more or book a demo, get in touch on info@navi.ie or check out our website, navi.ie.

8

News

Over One Million Illegal Medicines Detained Over one million units of illegal medicines were detained by the Health Products Regulatory Authority (HPRA) in 2024, marking a 14% increase compared to numbers detained in 2023. Announcing its annual enforcement data, the HPRA confirmed that it detained 1,000,984 dosage units* of falsified and other illegal medicines in 2024. The data highlights that anabolic steroids, sedatives and erectile dysfunction products are consistently the most detained categories of medicines year on year.

Grainne Power, Director of Compliance with the HPRA

The HPRA continues to encourage consumers to make informed and safe choices by purchasing prescription medicines only from authorised sources, ensuring their safety and quality.

When prescription medicines are bought on-line in Ireland there is no way of knowing for certain if the product is genuine, if it contains the right active ingredient or if it has been tested and approved for human use. The HPRA states that the supply of online prescription medicines into and within Ireland is illegal and that consumers are taking a risk with their health if they seek to buy outside of the regulated pharmacy setting or via the internet.

The HPRA detention figures for 2024 include: • Anabolic steroids - 203,088 units detained (20%) • Sedative medicines - 146,686 units detained (15%) • Erectile dysfunction - 119,289 units detained (12%) • Analgesic medicines - 113,555 units detained (11%) The HPRA also noted an upward trend in detentions of GLP-1 products including, predominantly, semaglutide and liraglutide. While overall numbers remain low, 1,582

units of GLP-1 products were detained in 2024 compared to 568 units in 2023 and just 40 units in 2022.

• 2,553 websites, e-commerce listings and/or social media pages amended or shutdown.

"While purchasing on-line is second nature for many of us, when it comes to prescription medicines, people need to ensure that the product is prescribed by a healthcare professional and sourced from a local pharmacy.

Your pharmacy has sourced medicines from authorised sources for your protection and is an expert in their use. Using these prescription medicines without medical supervision or from an unregulated source leaves people unprotected. The seizure of over one million dosage units of illegal medicines last year highlights the persistent extent of the threats posed by falsified and unauthorised prescription medicines. Our investigations and prosecutions have shown that those profiting from illegally supplied medicines have little or no regard for the health and safety of those who use them. While some websites may appear legitimate, many are simply fronts for unlawful activity, putting consumers at serious risk.

Grainne Power, Director of Compliance with the HPRA, says the 2024 data continues to highlight that individuals are putting their health at risk by attempting to purchase prescription medicines from unauthorised suppliers:

"In addition to our enforcement efforts, which target promotion and supply, it is also essential that we continue our efforts to raise public awareness about the dangers of purchasing prescription medicines from unregulated sources. Increasing awareness of

As part of its enforcement remit, the HPRA conducts ongoing monitoring to identify illegal online activity promoting prescription medicines and other substances to consumers. It routinely intervenes to disrupt online promotions through website closure and social media page removals. The HPRA also initiates prosecution cases where it considers that there is a significant risk to public health or where there are persistent noncompliances. In 2024, the HPRA undertook several significant enforcement actions, including: • Two prosecution cases initiated, one relating to the importation or distribution of anabolic steroids and one relating to the importation or distribution of the weight loss product Saxenda;

PHARMACYNEWSIRELAND.COM

these risks to reduce demand is critically important.

“We understand that there are many reasons why members of the public seek out these illegally supplied products, such as privacy, ease of access, cost, or the belief that their doctor might not deem it appropriate medical use. However, regardless of the reason, it is never worth taking a risk when it comes to your health. We advise anyone who has purchased prescription medicines from unregulated sources to stop using them immediately and to contact their healthcare professional if they have any concerns about their health,” she concluded.

The HPRA works in close cooperation with colleagues from An Garda Síochána and Revenue’s Customs Service. There continues to be significant inter-agency collaboration to combat the illegal supply of health products into and within Ireland. The HPRA also supports prosecutions brought by the Director of Public Prosecutions in relation to the illegal supply of medicines. Additionally, the HPRA co-operates and shares intelligence with other regulatory and law enforcement agencies across Europe and worldwide to prevent the illegal manufacture, importation and distribution of medicines, medical devices, and cosmetics.

NEW Triple blend formulation Magnesium Glycinate, Citrate and Malate 250mg elemental magnesium

Triple blend magnesium drink formulations deliver fast nutrient absorption to support muscle function, energy production and fight fatigue.

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News

Leading the Way in Ostomy & Urology Care: United Drug Sets the Gold Standard in Patient-Centric Services In the evolving landscape of community pharmacy and healthcare support services, United Drug continues to stand tall as Ireland’s number one provider of Ostomy and Urology products and services. With a focus on innovation, clinical excellence, and customer care, United Drug has positioned itself at the heart of improving quality of life for ostomy and urology patients across the country.

At the core of United Drug’s Ostomy & Urology Care offering is its state-of-the-art technology, anchored by two cutting machines that ensure complimentary, tailormade solutions for every patient.

On average, the team cuts and dispatches 10,000 ostomy bags per week demonstrating both scale and commitment to patient needs.

Beyond technology, it’s the human touch that truly differentiates United Drug. A dedicated Customer Care team works closely with pharmacists to provide fast and compassionate support. Their efficiency is unmatched, with a 48hour turnaround time for emergency orders, ensuring that critical needs are met without delay.

In addition, access to experienced Stoma Nurses across Ireland provides a vital clinical bridge, offering personalised care and expert guidance. Through strong supplier partnerships, United Drug also delivers in-store training for pharmacy staff, online learning modules, and one-to-one Quality of Life consultations for patients—equipping pharmacies

Boots Rank Third: Ireland’s Most Reputable Retailer and Pharmacy Chain Boots Ireland are proud to announce that Boots has ranked as Ireland’s Most Reputable Retailer and Pharmacy Chain and placed third overall in the Ireland Reputation Index 2025 study.

This respected study, based on the views of thousands of people across Ireland, measures the trust, respect and admiration the public has for organisations, and the Boots Ireland team were honoured to see their reputation recognised in this way.

Said a spokesperson, “At the heart of this achievement are our incredible team members, whose

care, passion and commitment embody our ‘With you. For Life’ promise - supporting our customers through every moment that matters.

“Thank you to our incredible team for the vital role you play in earning and protecting our reputation, and to the customers and communities who continue to place their trust in us.”

PHARMACYNEWSIRELAND.COM

with the tools to offer informed, empathetic care.

The company’s extensive sourcing capabilities, partnering with 35 leading manufacturers, ensure that pharmacies and patients have access to over 3,000 highquality products, all underpinned by a steadfast commitment to Customer Care, Product Range, Service and Training.

In a healthcare environment where personalisation, responsiveness, and trust are paramount, United Drug continues to lead with confidence. Their Ostomy & Urology Care service is not just about products—it’s about empowering pharmacies, supporting healthcare professionals, and most importantly, making life better for every patient they serve.

United Drug is here to help make it easier for you to support patients in this highly specialised area. For more information, contact your area manager, visit our website www.udw.ie or call our dedicated customer care team on 01 - 4632347.

Ireland’s No.1 leading provider of Ostomy products & services 48-hour turnaround time for emergency orders

Access to stoma nurses across Ireland

Cutting an average of 10,000 bags per week

Over 3000 products available

Dedicated customer care team

Sourcing from over 35 leading manufacturers

Contact us www.udw.ie T: 01 463 2347

United, we do better!

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News

World No Tobacco Day 2025 31 May is World No Tobacco Day (WNTD). In 2025 WHO and public health champions from across the globe will come together for WNTD to raise awareness about the harmful tactics of the tobacco industry. complicate quitting, increasing the risk of addiction and long-term health consequences.

Need for stronger policies in Europe to protect youth

Unmasking the appeal: Exposing industry tactics on tobacco and nicotine products This year’s WNTD campaign aims to reveal the strategies employed by the tobacco and nicotine industries to make their harmful products enticing, particularly to young people. By exposing these tactics, WHO seeks to drive awareness, advocate for stronger policies, including a ban on flavours that make tobacco and nicotine products more appealing, and protect public health.

The importance of addressing industry tactics Despite significant progress in global tobacco control, the tobacco and nicotine industries continue to adapt their strategies

to attract and retain consumers.

These efforts undermine public health and target vulnerable groups, particularly youth.

Common tactics include: • flavouring and additives: enhancing taste and masking the harshness of tobacco to increase its appeal; • targeted marketing: using sleek designs, attractive packaging, and digital media campaigns to glamorise harmful products; and • deceptive product design: creating products that resemble sweets or toys, appealing directly to children and adolescents.

These tactics not only encourage the initiation of use, but also

In 2022, data from the WHO European Region revealed significant gaps in protecting children from electronic cigarettes.

Only 4 countries ban all flavours in e-cigarettes, while another 4 allow or restrict specific flavours.

Just 11 countries prohibit all forms of advertising, promotion, and sponsorship of e-cigarettes, compared to 36 with partial bans, and 6 with no regulations.

These gaps leave young people particularly vulnerable to targeted e-cigarette marketing.

The use of nicotine products like electronic cigarettes and nicotine pouches is growing among youth.

In 2022, an estimated 12.5% of adolescents in the region used e-cigarettes, compared to only 2% of adults. In some countries, e-cigarette use among schoolaged children was 2–3 times higher than cigarette smoking, highlighting a concerning trend that requires urgent action.

WNTD 2025 provides an opportunity to shine a light on the strategies that perpetuate tobacco and nicotine use, and to reinforce the collective commitment to a healthier future.

PMI Transfer of President’s Chain At the Annual Pharmaceutical Managers’ Institute Pharma Summit last month, the official transfer of the President's chain took place from Philip O' Meara to Sharon Rice who is the new PMI President for the next 12 months.

Said the PMI, “Huge thanks to Phil for his guidance, support and input over the last year and welcome to both Sharon Rice our new President and Róisín Flynn who is our new Vice President.

Please join me in thanking Phil and welcoming Sharon and Róisín.”

The next PMI event will be held on May 22nd at the Clayton hotel. The Stakeholder Briefing will feature an NCPE update, hosting Professor Michael Barry, Clinical Director.

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Empowering Women in Pharmacy Education and skills development, mentorship and networking and financial support are among the key strategic recommendations outlined by the International Pharmaceutical Federation (FIP) to member organisations in a new FIP insight board report, on International Girls in ICT Day. The community pharmacy ownership sector has traditionally been male dominated, creating a persistent gap in gender representation among entrepreneurs in the field. While the pharmacy profession has made significant strides toward gender equality—with more women now entering and thriving in various roles within pharmacy—the entrepreneurial subset has not kept pace. The proportion of women owning and operating pharmacies remains comparatively low, suggesting the presence of specific barriers that hinder the transition from professional practice to entrepreneurship for many women.

In 2024, FIP and the FIP Community Pharmacy Section hosted an insight board "Empowering women: Advancing female entrepreneurship in community pharmacy" with the aim of gathering diverse perspectives and expert insights on the challenges and solutions related to advancing female entrepreneurship in this field.

The board aimed to bring together diverse perspectives and expert insights to confront the challenges women face in this field and identify actionable solutions. The goal was to collect critical data to drive initiatives and policies that break down barriers and empower women to take on leadership and ownership roles in community pharmacy.

“Empowering women: Advancing female entrepreneurship in community pharmacy” explores the persistent gender gap in pharmacy ownership, despite the increasing presence of women in the profession. The report identifies cultural, financial, and systemic barriers that hinder women from transitioning into ownership roles and highlights the enablers needed for success—such as business education, community backing, and supportive regulation.

Starts to relieve cravings in * 30 seconds *based on 2 x 1mg spray Nicorette QuickMist 1 mg/spray, oromucosal spray, solution. One spray delivers 1 mg nicotine in 0.07 ml solution. 1 ml solution contains 13.6 mg nicotine. Excipient with known effect: Ethanol (less than 100 mg of ethanol/spray). Propylene glycol, Butylated hydroxytoluene. Pharmaceutical form: Oromucosal spray, solution. A clear to weakly opalescent, colourless to yellow solution. Indications: For the treatment of tobacco dependence in adults by relief of nicotine withdrawal symptoms, including cravings, during a quit attempt (or to cut down smoking before stopping completely.

Permanent cessation of tobacco use is the eventual objective. Nicorette QuickMist should preferably be used in conjunction with a behavioral support program. Dosage: Subjects should stop smoking completely during the course of treatment with Nicorette QuickMist. Adults and Elderly: The following chart lists the recommended usage schedule for the oromucosal spray during full treatment (Step I) and during tapering (Step II and Step III). Up to 4 sprays per hour may be used. Do not exceed 2 sprays per dosing episode and do not exceed 64 sprays (4 sprays per hour, over 16 hours) in any 24-hour period. Step I: Weeks 1-6: Use 1 or 2 sprays when cigarettes normally would have been smoked or if cravings emerge. If after a single spray cravings are not controlled within a few minutes, a second spray should be used. If 2 sprays are required, future doses may be delivered as 2 consecutive sprays. Most smokers will require 1-2 sprays every 30 minutes to 1 hour. Step II: Weeks 7-9: Start reducing the number of sprays per day. By the end of week 9 subjects should be using HALF the average number of sprays per day that was used in Step I. Step III: Weeks 10-12: Continue reducing the number of sprays per day so that subjects are not using more than 4 sprays per day during week 12. When subjects have reduced to 2-4 sprays per day, oromucosal spray use should be discontinued. To help stay smoke free after Step III, subjects may continue to use the oromucosal spray in situations when they are strongly tempted to smoke. One spray may be used in situations where there is an urge to smoke, with a second spray if one spray does not help within a few minutes.

No more than four sprays per day should be used during this period. Regular use of the oromucosal spray beyond 6 months is generally not recommended. Some ex-smokers may need treatment with the oromucosal spray longer to avoid returning to smoking. Any remaining oromucosal spray should be retained to be used in the event of sudden cravings.

Gradual cessation through progressive reduction in smoking: For smokers who are not willing or ready to quit abruptly. The oromucosal spray is used between periods of smoking in order to prolong the smoke-free intervals and with the intention to reduce smoking as much as possible. The patient should be aware that an incorrect use of the spray may enhance adverse effects. A cigarette is replaced with one dose (1-2 sprays) and a quit attempt should be made as soon as the smoker feels ready and no later than 12 weeks after start of treatment. If a reduction in cigarette consumption has not been achieved after 6 weeks of treatment, a healthcare professional should be consulted. After quitting smoking, gradually reduce the number of sprays per day. When subjects have reduced to 2-4 sprays per day, oromucosal spray should be discontinued. Regular use of the oromucosal spray beyond 6 months is not recommended. Some ex-smokers may need treatment with the oromucosal spray longer to avoid returning to smoking. Any remaining oromucosal spray should be retained to be used in the event of sudden cravings. Paediatric population: Do not administer this medicine to persons under 18 years of age. There is no experience of treating adolescents under the age of 18 with this medicine. Method of administration: After priming, point the spray nozzle as close to the open mouth as possible. Press firmly the top of the dispenser and release one spray into the mouth, avoiding the lips. Subjects should not inhale while spraying to avoid getting spray into the respiratory tract. For best results, do not swallow for a few seconds after spraying. Subjects should not eat or drink when administering the oromucosal spray. Behavioural therapy advice and support will normally improve the success rate. Contraindications: Hypersensitivity to nicotine or to any of the excipients. Children under the age of 18 years. Those who have never smoked. Special warnings and precautions for use: This medicine should not be used by non-smokers. The benefits of quitting smoking outweigh any risks associated with correctly administered nicotine replacement therapy (NRT). A risk-benefit assessment should be made by an appropriate healthcare professional for patients with the following conditions: Cardiovascular disease: Dependent smokers with a recent myocardial infarction, unstable or worsening angina including Prinzmetal’s angina, severe cardiac arrhythmias, recent cerebrovascular accident and/or who suffer with uncontrolled hypertension should be encouraged to stop smoking with non-pharmacological interventions (such as counselling). If this fails, the oromucosal spray may be considered but as data on safety in this patient group are limited, initiation should only be under close medical supervision. Diabetes Mellitus. Patients with diabetes mellitus should be advised to monitor their blood sugar levels more closely than usual when smoking is stopped and NRT is initiated as reduction in nicotine induced catecholamine release can affect carbohydrate metabolism. Allergic reactions: Susceptibility to angioedema and urticaria. Renal and hepatic impairment: Use with caution in patients with moderate to severe hepatic impairment and/or severe renal impairment as the clearance of nicotine or its metabolites may be decreased with the potential for increased adverse effects. Phaeochromocytoma and uncontrolled hyperthyroidism: Use with caution in patients with uncontrolled hyperthyroidism or phaeochromocytoma as nicotine causes release of catecholamines. Gastrointestinal Disease: Nicotine may exacerbate symptoms in patients suffering from oesophagitis,

gastric or peptic ulcers and NRT preparations should be used with caution in these conditions. Seizures: Use with caution in subjects taking anti-convulsant therapy or with a history of epilepsy as cases of convulsions have been reported in association with nicotine. Paediatric population: Danger in children: Doses of nicotine tolerated by smokers can produce severe toxicity in children that may be fatal. Products containing nicotine should not be left where they may be handled or ingested by children. Transferred dependence: Transferred dependence can occur but is both less harmful and easier to break than smoking dependence. Stopping smoking: Polycyclic aromatic hydrocarbons in tobacco smoke induce the metabolism of drugs metabolised by CYP 1A2 (and possibly by CYP 1A1). When a smoker stops smoking, this may result in slower metabolism and a consequent rise in blood levels of such drugs. This is of potential clinical importance for products with a narrow therapeutic window, e.g. theophylline, tacrine, clozapine and ropinirole. The plasma concentration of other medicinal products metabolised in part by CYP1A2 e.g. imipramine, olanzapine, clomipramine and fluvoxamine may also increase on cessation of smoking, although data to support this are lacking and the possible clinical significance of this effect for these drugs is unknown. Limited data indicate that the metabolism of flecainide and pentazocine may also be induced by smoking. Excipients: This medicine contains about 7 mg of alcohol (ethanol) in each spray which is equivalent to 97 mg/ml. The amount in one spray of this medicine is equivalent to less than 2 ml beer or 1 ml wine. The small amount of alcohol in this medicine will not have any noticeable effects. This medicinal product contains less than 1 mmol sodium (23 mg) per spray, i.e. essentially ‘sodium- free’. This medicine contains 12 mg propylene glycol in each spray which is equivalent to 157 mg/mL. Due to the presence of butylated hydroxytoluene, Nicorette QuickMist may cause local skin reactions (e.g. contact dermatitis), or irritation to the eyes and mucous membranes. Care should be taken not to spray the eyes whilst administering the oromucosal spray. Undesirable effects: Effects of smoking cessation: Regardless of the means used, a variety of symptoms are known to be associated with quitting habitual tobacco use. These include emotional or cognitive effects such as dysphoria or depressed mood; insomnia; irritability, frustration or anger; anxiety; difficulty concentrating, and restlessness or impatience. There may also be physical effects such as decreased heart rate; increased appetite or weight gain, dizziness or presyncopal symptoms, cough, constipation, gingival bleeding or apthous ulceration, or nasopharyngitis. In addition, and of clinical significance, nicotine cravings may result in profound urges to smoke. This medicine may cause adverse reactions similar to those associated with nicotine given by other means and these are mainly dose-dependent. Allergic reactions such as angioedema, urticaria or anaphylaxis may occur in susceptible individuals. Local adverse effects of administration are similar to those seen with other orally delivered forms.

During the first few days of treatment irritation in the mouth and throat may be experienced, and hiccups are particularly common. Tolerance is normal with continued use. Daily collection of data from trial subjects demonstrated that very commonly occurring adverse events were reported with onset in the first 2-3 weeks of use of the oromucosal spray, and declined thereafter. Adverse reactions with oromucosal nicotine formulations identified from clinical trials and during post-marketing experience are presented below. The frequency category has been estimated from clinical trials for the adverse reactions identified during post-marketing experience. 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); not known (cannot be estimated from the available data). Immune system disorders Common Hypersensitivity Not known Allergic reactions including angioedema and anaphylaxis Psychiatric disorders Uncommon Abnormal dream Nervous system disorders Very common Headache Common Dysgeusia, paraesthesia Not known – Seizures (Cases of seizures have been reported in subjects taking anti-convulsant therapy or with a history of epilepsy). Eye disorders Not known Blurred vision, lacrimation increased Cardiac disorders Uncommon Palpitations, tachycardia Not known Atrial fibrillation Vascular disorders Uncommon Flushing, hypertension Respiratory, thoracic and mediastinal disorders Very common: Hiccups, throat rritation Uncommon Bronchospasm, rhinorrea, dysphonia, dyspnoea, nasal congestion, oropharyngeal pain, sneezing, throat tightness Common: cough Gastrointestinal disorders Very common Nausea Common Abdominal pain, dry mouth, diarrhoea, dyspepsia, flatulence, salivary hypersecretion, stomatitis, vomiting Uncommon Eructation, gingival bleeding, glossitis, oral mucosal blistering and exfoliation, paraesthesia oral Rare Dysphagia, hypoaesthesia oral, retching Not known Dry throat, gastrointestinal discomfort, lip pain Skin and subcutaneous tissue disorders Uncommon Hyperhidrosis, pruritus, rash, urticaria Not known Erythema General disorders and administration site conditions Common Burning sensation, fatigue Uncommon Asthenia, chest discomfort and pain, malaise. MAH: JNTL Consumer Health I (Ireland) Ltd. Block 5, High Street, Tallaght, Dublin 24, Ireland, Ireland. PA Number: PA23490/019/013 Date of revision of text: December 2023. Product not subject to medical prescription. Supply through pharmacy and non-pharmacy outlets. Full prescribing information available upon request.

IE-NIC-2024-76107 | Nov 2024

14

Asthma

Breathing Easy: Exercise and Asthma – Understanding, Managing, and Thriving Written by Dr Laura Monoghan Respiratory SpR and Prof. Patrick D. Mitchell, Consultant Respiratory Physician Tallaght University Hospital and School of Medicine, Trinity College Dublin Prof. Patrick D. Mitchell

Asthma, a chronic respiratory condition characterised by inflammation and narrowing of the airways, affects over 400 million people worldwide.

It leads to symptoms such as wheezing, breathlessness, and coughing. Asthma can limit physical activity both through its direct physiological effects and through psychological barriers stemming from fear of triggering symptoms. For many, the idea of exercise with asthma might seem daunting, conjuring fears of triggering an attack or worsening symptoms. However, the reality is far more empowering: with proper management, exercise is not only safe but also a vital component of asthma care. Regular physical activity offers a wide array of health, lifestyle, and wellness benefits, helping individuals with asthma not just manage their condition but truly thrive. It opens up all sorts of avenues from the local gym, sports club and beyond.

Let’s explore how exercise can transform the lives of those with asthma, with a particular focus on understanding and managing exercise-induced asthma (EIA), also known as exercise-induced bronchoconstriction (EIB) whilst also focusing on the importance of asthma control at a person’s baseline. Research over decades has demonstrated that lung expansion, as prompted by aerobic exercise, has positive effects

on lung health. As such, current guidelines strongly recommend that all patients with chronic diseases, including asthma, participate in regular physical activity for overall health benefits.

Despite this recommendation, patients with asthma are significantly less physically active than gender matched controls.

Describing the risks and benefits of physical activity in asthma patients is necessary to improve and implement recommendations regarding this lifestyle intervention.

Patients with asthma need both robust assurance of the positive benefits of exercise and tailored management plans to enable them thrive in an exercise environment. Long-term asthma control is determined both by adherence to an appropriate pharmacologic regimen and by lifestyle contributors. Aerobic exercise is a prominent example of how healthy lifestyle choices can affect the disease course of asthma. Patients with asthma who consistently engage in physical activity have improved disease control, quality of life, and lung function parameters. On the other hand, low levels of physical activity in asthma are associated with increased health care utilization and associated costs.

Most asthma providers recognise the positive effects of physical activity and recommend that their patients engage in it but this

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could be improved upon. It is also important to stress that individuals with difficult to control asthma (compliance with medications, access to appropriate medication, severe asthma and other confounding factors) should not feel stigmatized by being unable to exercise but rather encouraged.

Exercise-induced bronchoconstriction (EIB) refers to the temporary narrowing of the airways triggered by physical activity, a phenomenon that affects 80–90% of individuals with persistent asthma and 5–20% of those without a formal asthma diagnosis. Among elite athletes, particularly those in endurance or cold-weather sports like cross-country skiing, prevalence can soar as high as 50%. Symptoms typically emerge during or shortly after exercise, within 5–20 minutes, and include shortness of breath, chest tightness, wheezing, coughing, fatigue, and reduced exercise performance. These symptoms, which usually resolve within an hour, can be distressing, often leading individuals to shy away from physical activity altogether.

An effective management plan can be developed with these individuals that can include taking their rescue inhaler 15-45 minutes prior to exercising as well as – if needed – adhering to a maintenance regimen.

But why does exercise trigger asthma? Minute ventilation, the volume of air inhaled or exhaled from a person's lungs per minute, rising with exercise. EIB probably results from changes in airway physiology triggered by the large volume of relatively cool, dry air inhaled during vigorous activity. This is supported by several studies finding that EIB is attenuated when the inspired gas is more fully humidified and closer to body temperature. The effect of large-volume dry air inhalation on airway surface osmolality may be the primary stimulus responsible for bronchoconstriction. This is also to be borne in mind when advising patients on management strategies (i.e. a scarf covering the mouth and nose on cold days).

Certain factors heighten the risk of EIB. These including having allergic rhinitis, exercising in cold, dry air, exposure to pollutants such as ozone, high levels of triggering allergens, high-intensity aerobic activities like running or cycling, and even swimming in heavily chlorinated pools, where increased levels of trichloramine can irritate airways. Trichloramine is responsible for the distinctive 'chlorine smell' associated with swimming pools, where the compound is readily formed as a product from hypochlorous acid (in swimming pools) reacting with ammonia and other nitrogenous substances in the water, such as sweat and urea from urine (hence one the main the reason for showering before swimming).

Recent respiratory infections also increase susceptibility.

Recognising these risk factors is the first step toward effective management, ensuring that individuals with asthma can engage in exercise safely and are equipped with the knowledge to make informed decisions on exercising.

Accurate diagnosis of EIB is crucial to distinguish it from other causes of exertional breathlessness, such as poor fitness, vocal cord dysfunction, or cardiovascular issues so it is important to keep these differentials in mind.

Diagnosis typically begins with a detailed clinical history, focusing on symptom onset, patterns, and response to bronchodilators. Objective tests, although not usually needed, such as spirometry before and after exercise or bronchoprovocation testing (e.g., eucapnic voluntary hyperventilation), can confirm the diagnosis, providing clarity for tailored management.

Managing EIB involves a combination of pharmacological and non-pharmacological strategies. On the pharmacological front, short-acting beta-agonists (SABAs) like salbutamol, taken 15–30 minutes before exercise, are the commonest used cornerstone of prevention, offering protection for up to four hours. However there has been a move toward using a combination reliver including

Generic Product Launch

Fluticasone Furoate Teva 27.5 micrograms/spray Nasal Spray, Suspension fluticasone furoate

Indications Fluticasone Furoate Teva 27.5 micrograms/spray, Nasal Spray, Suspension Fluticasone Furoate Teva is indicated in adults, adolescents and children (6 years and over).

Fluticasone Furoate Teva is indicated for the treatment of the symptoms of allergic rhinitis.

Fluticasone Furoate Teva Nasal Spray Abbreviated Prescribing Information.

Presentation: Each spray actuation delivers 27.5mcg of fluticasone furoate. One actuation delivers 8.25mcg of benzalkonium chloride. Indications: Indicated in adults, adolescents and children (6 years and older) for the treatment of the symptoms of allergic rhinitis. Dosage and administration: Intranasal route only. Adults, Adolescents (12 years and over): The recommended starting dose is two spray actuations (27.5mcg of fluticasone furoate per spray actuation) in each nostril once daily (total daily dose, 110mcg). Children (6 to 11 years): The recommended starting dose is one spray actuation (27.5mcg of fluticasone furoate per spray actuation) in each nostril once daily (total daily dose, 55mcg). Children (under 6 years of age): Not recommended for use. Elderly: No dose adjustment required. Renal and Hepatic Impairment: No dose adjustment required. Contraindications: Hypersensitivity to the active substance or to any of the excipients. Precautions and warnings: Systemic effects of nasal corticosteroid may occur, particularly at high doses prescribed for prolonged periods. These effects are much less likely to occur than with oral corticosteroids and may vary in individual patients and between different corticosteroid preparations. Potential systemic effects may include Cushing’s syndrome, Cushingoid features, adrenal suppression, growth retardation in children and adolescents, cataract, glaucoma and more rarely, a range of psychological or behavioural effects including psychomotor hyperactivity, sleep disorders, anxiety, depression or aggression (particularly in children). Treatment with higher than recommended doses of nasal corticosteroids may result in clinically significant adrenal suppression. If there is evidence for higher than recommended doses being used, then additional systemic corticosteroid cover should be considered during periods of stress or elective surgery. As with all intranasal corticosteroids, the total systemic burden of corticosteroids should be considered whenever other forms of corticosteroid treatment are prescribed concurrently. If there is any reason to believe that adrenal function is impaired, care must be taken when transferring patients from systemic steroid treatment to fluticasone furoate. Visual disturbance may be reported with systemic and topical corticosteroid use. If a patient presents with symptoms such as blurred vision or other visual disturbances, the patient should be considered for referral to an ophthalmologist for evaluation of possible causes which may include

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

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

Prescription Only Medicine.

cataract, glaucoma or rare diseases such as central serous chorioretinopathy (CSCR) which have been reported after use of systemic and topical corticosteroids. Growth retardation has been reported in children receiving nasal corticosteroids at licensed doses. A reduction in growth velocity has been observed in children treated with fluticasone furoate 110mcg/day for one year. Therefore, children should be maintained on the lowest possible efficacious dose which delivers adequate symptom control. It is recommended that the growth of children receiving prolonged treatment with nasal corticosteroids is regularly monitored. Concomitant administration with ritonavir is not recommended because of the risk of increased systemic exposure of fluticasone furoate.

Interactions: Fluticasone furoate is rapidly cleared by extensive first pass metabolism mediated by the cytochrome P450 3A4. Based on data with another glucocorticoid (fluticasone propionate), that is metabolised by CYP3A4, co-administration with ritonavir is not recommended because of the risk of increased systemic exposure of fluticasone furoate. Caution is recommended when co-administering fluticasone furoate with potent CYP3A inhibitors including cobicistat-containing products as an increase in the risk of systemic side effects is expected. Co-administration should be avoided unless the benefit outweighs the increased risk of systemic corticosteroid side effects, in which case patients should be monitored for systemic corticosteroid side effects. Pregnancy and lactation: Fluticasone furoate should be used in pregnancy only if the benefits to the mother outweigh the potential risks to the foetus or child.

Administration of fluticasone furoate to patients who are breast-feeding should only be considered if the expected benefit to the patient is greater than any possible risk to the child. Effects on ability to drive and use machines: no or negligible influence on the ability to drive and use machines. Adverse reactions: Hypersensitivity reactions including anaphylaxis, angioedema. Very Common: Epistaxis. Common: Headache, nasal ulceration, dyspnoea. Consult the Summary of Product Characteristics in relation to other side effects. Overdose: In a bioavailability study, intranasal doses of up to 2640mcg/day were administered over three days with no adverse systemic reactions observed. Acute overdose is unlikely to require any therapy other than observation.

Legal category: POM. Marketing Authorisation Number: PA1986/126/001. Marketing Authorisation Holder: Teva B.V., Swensweg 5, 2031GA Haarlem, Netherlands. Job Code: MED-IE-00087. Date of Preparation: October 2024.

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

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

Date of Preparation: January 2025 | Job Code: GEN-IE-00109 Further information is available on request or in the SmPC. Product Information also available on the HPRA website.

16

Asthma of obesity—a significant concern for asthma patients, particularly children. The provided text highlights that children with poorly controlled asthma often avoid exercise, leading to decreased fitness and a higher risk of obesity, which can exacerbate asthma through inflammatory pathways.

A 2023 cohort study in American Journal of Respiratory and Critical Care Medicine found that asthmatic children engaging in regular physical activity (150 minutes per week) had a 30% lower obesity incidence over five years compared to sedentary peers. By breaking this cycle, exercise not only improves asthma control but also lowers the risk of comorbidities like diabetes and hypertension.

and inhaled corticosteroid and beta agonist 30 minutes before execising. The ICS component is antiinflammation and targeting inflammation is essential in most patients with asthma. For those with persistent asthma, inhaled corticosteroids (ICS), often combined with long-acting beta-agonists (LABAs), helps reduce airway hyperresponsiveness over time, improving overall asthma control.

Non-pharmacological approaches are equally important. A progressive 10–15-minute warm-up can induce a refractory period, making airways less reactive during exercise. Breathing techniques, such as nasal breathing to warm and humidify air or pursed-lip breathing for post-exercise recovery, can also help. Environmental adjustments are key: exercising in warm, humid environments, avoiding high-pollution or pollen days, and using face masks or scarves in cold weather can minimize triggers. Choosing sports with intermittent exertion, like volleyball or baseball, rather than continuous high-intensity activities like long-distance running, can reduce symptom risk. However – patients should be encouraged to pursue their sport of choice.

Additionally, maintaining hydration and gradually improving physical conditioning through aerobic exercise can further decrease the severity of EIB over time.

The Transformative Power of Exercise in Asthma Far from being a limitation, exercise should be viewed as a cornerstone of asthma management, offering a multitude of benefits that extend well beyond the lungs. Physiologically, regular physical activity enhances aerobic capacity, strengthens respiratory muscles, and improves breathing efficiency, leading to better asthma symptom control and reduced reliance on rescue medications. A 2021 metaanalysis in Thorax found that moderate aerobic exercise (e.g., 30 minutes, three times a week) improved forced expiratory volume in 1 second (FEV1) by 5–10% in asthma patients over 12 weeks, demonstrating its direct impact on lung function.

The psychological benefits are equally compelling. Exercise is a proven mood enhancer, reducing anxiety and depression—common challenges for those with asthma, who often face stress related to their condition. A 2023 study showed that children with asthma who participated in a six-month exercise program reported a 20% reduction in anxiety scores, alongside improved self-esteem and body image. These mental health gains translate to better adherence to asthma management plans, empowering individuals to take control of their health.

Metabolically, exercise helps manage weight, reducing the risk

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Exercise also bolsters the immune system, reducing the frequency of respiratory infections—a common asthma trigger. A 2021 study in Allergy found that asthmatic patients who exercised regularly had a 20% lower incidence of upper respiratory infections over one year, highlighting the protective role of physical activity.

This is particularly crucial for children, whose asthma control is often assessed by activity limitations, school absenteeism, and social engagement, as noted in the text.

Exercise, Sleep, and Overall Wellness One often-overlooked benefit of exercise in asthma management is its impact on sleep. Many individuals with asthma experience nocturnal symptoms that disrupt sleep, leading to fatigue and reduced quality of life. Regular physical activity helps people fall asleep faster by lowering body temperature post-exercise and reducing arousal and anxiety.

It also increases time spent in restorative deep sleep, reduces nighttime awakenings, and improves overall sleep efficiency.

These effects are invaluable for asthma patients, as better sleep enhances daytime energy, mood, and resilience to symptom triggers.

Empowering Children with Asthma For children with asthma, the stakes of exercise avoidance are particularly high. As the text emphasizes, evaluating asthma control in children involves assessing not just symptoms and medication use but also limitations in daily activities, including sports, play, and social life. Children with poorly controlled asthma may avoid strenuous exercise to prevent symptoms, leading to

decreased fitness, weight gain, and a misleading impression of disease control. This can result in social isolation, reduced school attendance, and long-term health consequences like obesity.

Clinicians must actively explore these impacts and support safe engagement in physical activity, ensuring children can enjoy the physical, social, and emotional benefits of an active lifestyle.

The Asthma Society is Encouraging People to ‘Get Active for Asthma’ This World Asthma Day The Asthma Society of Ireland is leading the charge this World Asthma Day (7 May) with an inspiring new campaign: Get Active for Asthma. Running throughout Asthma Awareness Week (5-9 May), this initiative aims to encourage people with asthma to embrace physical activity as a vital component of asthma management, with support from the charity’s expert nurses and physiotherapist.

The Asthma Society’s e-referral system allows health professionals to connect patients with the Asthma Adviceline, where they can access specialist advice on managing symptoms, medication use, and the benefits of an active lifestyle. The e-referral form can be found on asthma.ie.

This World Asthma Day let’s work together to break down the barriers to physical activity for people with asthma. Join the movement and help spread the message: asthma should never hold anyone back.

Get involved, stay informed, and get #ActiveForAsthma!

Final Thoughts: Thriving with Asthma Exercise-induced asthma, while common, is highly manageable with the right strategies. Through accurate diagnosis, personalized treatment plans, and lifestyle adjustments, individuals with asthma can lead active, healthy lives. Rather than viewing asthma as a barrier, we should see it as an opportunity to harness the transformative power of exercise.

From improving lung function and mental health to reducing obesity risk and enhancing sleep, the benefits of physical activity for asthma patients are profound and far-reaching. With the right approach, asthma need not limit one’s ability to enjoy sports, achieve fitness goals, or live fully.

Exercise should be a considered cornerstone in the management of asthma.

Let’s Grow Together Uniphar Brand Partner: Evolving to Drive Smarter Brand Growth Formerly known as Uniphar Link Up, we are proud to introduce our new identity: Uniphar Brand Partners. This rebrand represents more than just a name change—it reflects our ongoing commitment to building deeper, more strategic partnerships with both brands and retailers.

Our inhouse team is made up of the buying, sales, retail and marketing experts who understand what it takes to not just get listed on shelf but what it take from a brand and a retail plan to stay there. We are the distributor that partners for long term investment in both the brand and retail partners – It not the first order we are just here for it’s the one after that and the one after that again – working with both the brands vison of what they believe their retail landscape should be while ensuring their retail partners have all they need to drives sales and entice and delight customers and keep they buying in pharmacy channels We don’t just distribute; we collaborate. From tailored commercial strategy and sales support to training and full brand delivery, our role is to unlock real, measurable growth. As specialists in the pharmacy channel, we understand the nuances of this unique retail environment. That’s why our support goes far beyond logistics—think premium retail execution, innovative category development, and impactful in-store activations.

Pharmacy is evolving, and so are the brands within it. Today’s leading beauty, skincare, and supplement ranges go beyond surface solutions. They align with a growing consumer demand for purpose-led, wellness-infused products. We are proud to partner with brands that share this ethos—delivering “inside-out” beauty solutions that resonate with modern shoppers and fit perfectly into the trusted pharmacy space.

At Uniphar Brand Partners, we help brands navigate this shift, offering a full suite of services including point-of-sale, social and influencer campaigns, experiential events, and front-of-shop excellence that keeps pharmacy retail ahead of traditional grocery competitors.

From growth-focused commercial strategies to first-in-class retail presence, Uniphar Brand Partners is here to build the future of consumer health, wellness, and beauty—together.

www.uniphar.ie

linkup@uniphar.ie

@unipharbrandpartners

To learn more about our exciting LinkUp Gold offerin get in touch with our team today!

Derek McHugh – National Sales Manager – 085-8773771

Derek has worked with pharmacy owners and suppliers to ensure the bes in the market is available to Link Up Gold members. Derek has worked in patient facing roles along with business development roles supporting ow ensure product availability.

Sales Representatives Darragh Browne West of Ireland 085 880 1769 dabrowne@uniphar.ie Celine O’Reilly North Dublin/North Leinster 085 851 5104 ceoreilly@uniphar.ie Tom Ryan South Dublin/South Leinster 085 219 1333 tryan@uniphar.ie Peter Bennett Munster 085 219 9018 pbennett@uniphar.ie

Billy Reidy – Account Manager – South - 087-1316984 To learn more about our exciting LinkUp Gold offerin Billy has worked for Link Up Gold and has been the face of Uniphar whole South.

Prior to joining Uniphar he worked in Pharmacy on the consumer s get in touch with team today!

Commercial Salesour Manager

Billy prides himself on exceptional customer service, having excellent mark He also has keen eye for driving profitability in pharmacy.

Derek Derek McHugh McHugh – National Sales Manager – 085-8773771 dmchugh@uniphar.ie Derek has worked with pharmacy owners and suppliers to ensure the bes Ian – Account – West -Derek 085-8773792 in theMcDonald market is available to LinkManager Up Gold members. has worked in

Ian is the Territory forbusiness the West/North of Ireland, has extensive patient facing rolesManager along with development roleshesupporting ow involvedproduct in the community ensure availability. pharmacy industry for 30 years. He has been w has formed exceptional relationships with his members. Ian values the per owners and growing their business in strong, sustainable way

Key Account Manager

Billy Reidy – Account Manager – South - 087-1316984

Billy has worked for Link Up Gold and has been the face of Uniphar whole

Jacqui Leonard– Account Manager – East – 085-8723036 JacquiPrior Leonard South. to joining Uniphar he worked in Pharmacy on the consumer s 085 872 Jacqui is a3036 qualified Pharmacy Technician with over 20 yearsexcellent in communit Billy prides himself on exceptional customer service, having mark jleonard@uniphar.ie Uniphar since 2019. an Account Manager for Link Up Gold, she ensu He also has keen eyeNow for driving profitability in pharmacy.

exceptional service, and long-term growth. Leveraging her deep understa market trends, Jacqui drives increased revenue and strengthens your pha

Ian McDonald – Account Manager – West - 085-8773792 Skincare BDM

Ian is the Territory Manager for the West/North of Ireland, he has extensive involved in the community pharmacy industry for 30 years. He has been w Hayley Grimes has formed exceptional relationships with his members. Ian values the per 085 800 3084 owners and growing their business in strong, sustainable way

hgrimes@uniphar.ie

Jacqui Leonard – Account Manager – East – 085-8723036

Jacqui is a qualified Pharmacy Technician with over 20 years in communit Uniphar since 2019. Now an Account Manager for Link Up Gold, she ensu exceptional service, and long-term growth. Leveraging her deep understa market trends, Jacqui drives increased revenue and strengthens your pha

20

Pharmacy Claims

ARC: The Smart Claims Tool Helping Pharmacies Take Control of Rejections and Revenue In today’s pharmacy environment, every claim counts. With growing prescription volumes, increasing complexity in reimbursement rules and staff constantly balancing clinical and administrative duties, there’s little room for inefficiency — especially when it comes to claims management.

Written by Sarah Gilson, Dispensary Support Manager, Adrian Dunne Pharmacies

such as resubmission or contact with the HSE—can be logged using ARC’s built-in notes feature.

This gives pharmacies full visibility into where they are losing money — and how to get it back.

That’s why ARC, a relatively new but rapidly growing pharmacy claims tool, is changing how pharmacies across Ireland handle claims, reclaims and rejections — all in real time, with minimal disruption to workflow.

When I was asked if I would write an article for the IPN, Arc was the obvious choice for me.

With more than 25 years in pharmacy in Ireland, I have seen the administrative burden grow so much and I am delighted to recommend Arc to help prune it back to a far more manageable size.

When I was first shown Arc, it was kept exclusively for a buying group; I saw enough to know that I did not want to know more unless I could have it.

A year on, I happened to sit next to Alan from ARC in an IPU meeting and discovered it was now accessible outside the buying group. With Alan’s help and senior management on board, we rolled this out to our stores. Feedback has been wonderful and it’s only likely to get better.

Live Claims Support Right at the Point of Dispensing At its core, ARC is claims intelligence software that quietly sits alongside your dispensing system. It monitors prescription

entries as they happen and raises alerts when an issue is likely to trigger a rejection from PCRS. It identifies and assesses each claim with pinpoint accuracy and alerts using the PMR (Patient Medical Record) file number to adhere to GDPR demands.

From identifying second supplies of items like Dexcom sensors, to flagging 777 coded or prior approval only items, ARC proactively reduces the risk of costly claim rejections.

These alerts allow pharmacy staff to make corrections before the claim is submitted — a gamechanger in reducing unnecessary rejections. Better still, if an alert isn’t relevant or concerning, it can be dismissed. When a patient record is corrected the alert resolves automatically.

Not only does this save time on backtracking and reprocessing claims, but also serves as an excellent training tool for newer technicians — essentially training while dispensing.

Digging into the Past: Smarter Rejection Management ARC goes beyond the current claim. It also helps pharmacies take control of historical claims and payment issues by pulling in data from payment books and meticulously crosschecking GMS and DPS payment reports against submitted claims — line-by-line, item by item.

Any rejected or unpaid claims are flagged; the reason for rejection is provided, and any action taken—

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Pharmacy teams can easily review past claims for the same patient or item to check payment history, which reduces duplicate effort and provides valuable context for handling repeat rejections. If a claim is eligible for resubmission— either online or manually—ARC automatically reconciles it once payment comes through. Where no recourse is possible, pharmacy staff can reconcile the rejection manually or create a new claim as necessary.

For unrecoverable rejections, ARC allows for manual reconciliation or the creation of a new claim for proper coverage. Even methadone dispensing is included: the system pulls in methadone book data and flags any rejects for reclaim.

Reducing Workload, Increasing Clarity ARC is designed with simplicity and efficiency in mind. Beyond claims and reclaims, it handles time-consuming admin tasks that can burden busy pharmacy teams.

The platform keeps track of Hardship Scheme claims and payments, enabling easy crossreferencing and reducing time spent chasing down payment confirmation. It also compiles a list of patients eligible for High Tech patient care fee-only claims, ready for processing at the end of each month, streamlining one more administrative task that would otherwise take up valuable hours.

All of this helps cut down on spreadsheet report checks, duplication of work, and paper trails — freeing up your team to focus on patients, not paperwork.

Powerful Oversight at the Group Level For pharmacy groups, like us, ARC offers even more. It is real-time claim and reclaim tracking at the branch level gives head office a clear view of what is happening on the ground.

Head office teams can view claims and reclaims in real time, complete with reject and reconciliation notes regarding follow-up and branch level performance trends.

This kind of oversight not only helps with auditing and compliance but also makes it easy to spot trends, identify recurring issues and provide targeted support to specific branches, enabling faster decisions and more coordinated follow-up.

This enhanced visibility ARC provides actual financial values of rejections and reclaims, enabling more accurate forecasting and financial planning.

A Proven Impact: The ARC Experience We adopted ARC across our 13 branches — and the impact has been significant.

We have seen a clear reduction in rejections across the group.

ARC has made it easier for our teams to spot issues before they become problems. Following up on outstanding claims is now faster, easier and more structured.

We no longer rely on PCRS percentages to understand store performance — we can now put financial value on both rejected claims and reclaims.

In a sector where margins are under constant pressure that kind of clarity and control is invaluable.

The Team It’s not just a game changing product.

The team behind ARC are huge support, with training, guidance and problem solving just the tip of their iceberg of talents.

They can also put up with me and my teams endless suggestions.

Conclusion: Taking the Stress Out of Claims Management Whether independent or part of a group, ARC offers a smarter, simpler way to manage claims, reduce rejections, and regain control of lost revenue. It’s more than just a claims tool — it’s a complete claims strategy, built for the realities of today’s pharmacy.

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 reported adverse reactions it is unlikely that fexofenadine hydrochloride tablets wil produce an effect on the ability to drive or use machines. In ALLERGIES ALLERGIES objective tests, Fexo Allergy Relief has been shown to have no significant effects on central nervous system function. This means that patients TAKING TAKING OVER may YOUR drYOUR ive or perform tasks tLIFE? hat 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 system diOne-A-Day sOne-A-Day orders: Common: headache, drowsiness, dizNon-Drowsy iness. Gastrointestinal disorders: Common: naus24hr e24hr a. General dicontrol scontrol orders 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

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Abbreviatedprescribing prescribinginformation information Abbreviated ProductName: Name:Fexo FexoAllergy AllergyRelief Relief120 120mg mgFilm-coated Film-coated tablets tablets Product Composition:Each Eachtablet tabletcontains contains120 120mg mgof offexofenadine fexofenadine hydrochloride hydrochloride equivalent to 112 Composition: 112 mg mg of of fexofenadine. fexofenadine.Description: Description:Peach Peachcoloured coloured 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 oblong, plain on on both both sides. sides. Indication(s): Indication(s):Adults Adultsand andchildren children12 12years 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: Relief of symptoms associated with seasonal allergic Adults and children aged 12 years and over: One tablet (120mg) oncedaily dailytaken takenbefore beforeaameal. meal.Children Children under under 12 12 years: years: Efficacy Efficacy and safety of fexofenadine once fexofenadine hydrochloride hydrochloride 120 120 mg mg has has not notbeen beenstudied studiedinin childrenunder under12.

12.Children Children from from 66 to to 11 11 years years of of age: age: Administer Administer fexofenadine hydrochloride children hydrochloride 30 30 mg. mg. Special Specialpopulations: populations:No Noneed needtotoadjust adjust thedose doseconfirmed confirmedby bystudies studies inin special special risk risk groups groups (older (older people, renally or hepatically the hepatically impaired impairedpatients). patients). Contraindications: Contraindications: Hypersensitivitytotothe theactive activesubstance substanceor orto toany any of of the the excipients. excipients. Warnings Warnings and Hypersensitivity and Precautions Precautions for for Use: Use: Limited Limited data data inin the theelderly elderlyand andrenally renally hepaticallyimpaired impaired patients. patients. Administer Administer with with care care in in these these special special groups. groups. Warn ororhepatically Warn patients patients with with aa history historyof ofor orongoing ongoingcardiovascular cardiovascular diseasethat, that,antihistamines antihistamineshave havebeen beenassociated associated with with the the adverse adverse reactions, reactions, tachycardia disease tachycardia and and palpitations. palpitations. Interactions: Interactions:Fexofenadine Fexofenadinedoes doesnot not undergo hepatic biotransformation and therefore will not interact with other medicinal products through hepatic mechanisms.

Fexofenadine undergo hepatic biotransformation and therefore will not interact with other medicinal products through hepatic mechanisms. Fexofenadineisisa a P-glycoprotein(P-gp) (P-gp)and and organic-anion-transporting organic-anion-transporting polypeptide polypeptide (OATP) (OATP) substrate. substrate. Concomitant P-glycoprotein Concomitant use usewith withP-gp P-gpinhibitors inhibitorsor orinducers inducerscan canaffect affect the exposure to fexofenadine.

Co-administration with P-gp inhibitors erythromycin or ketoconazole resulted in 2-3 times increase in the the exposure to fexofenadine. Co-administration with P-gp inhibitors erythromycin or ketoconazole resulted in 2-3 times increase in thelevel levelofof fexofenadineininplasma. plasma.The Thechanges changeswere werenot not accompanied accompanied by by any any effects effects on fexofenadine on the the QT QT interval interval and and were werenot notassociated associatedwith withany anyincrease increaseinin adversereactions reactionscompared comparedto tothe the medicinal medicinalproducts products given given singly. singly. A A clinical clinical drug-drug adverse drug-drug interaction interaction study studyshowed showedthat thatco-administration co-administrationofof apalutamide(a(aweak weakinducer inducerof ofP-gp) P-gp)and andaasingle single oral oral dose dose of of 30 30 mg mg fexofenadine fexofenadine resulted apalutamide resulted in in aa 30 30 % % decrease decrease ininAUC AUCofoffexofenadine. fexofenadine.No No interaction with omeprazole.

Administration of an antacid containing aluminium and magnesium hydroxide gels 15 minutes interaction with omeprazole. Administration of an antacid containing aluminium and magnesium hydroxide gels 15 minutesprior priortotofexofenadine fexofenadine hydrochloridecaused causedaareduction reductionininbioavailability, bioavailability, most most likely likely due due to to binding binding in hydrochloride in the the gastrointestinal gastrointestinal tract. tract.ItItisisadvisable advisableto toleave leave22hours hoursbetween between administration of fexofenadine hydrochloride and aluminium and magnesium hydroxide containing antacids.

Pregnancy and Lactation: administration of fexofenadine hydrochloride and aluminium and magnesium hydroxide containing antacids. Pregnancy and Lactation: Pregnancy:Do Donot notuse useunless unless clearly clearly necessary. necessary. No No adequate adequate data data from from the Pregnancy: the use use of of fexofenadine fexofenadine hydrochloride hydrochloride inin pregnant pregnant women. women.

Limited animal studies do not indicate direct or indirect harmful effects with respect to effects on pregnancy, embryonal/foetal Limited animal studies do not indicate direct or indirect harmful effects with respect to effects on pregnancy, embryonal/foetal development, parturition or postnatal development. Breast-feeding: Not recommended. No data on the content of human milk after development, parturition or postnatal development. Breast-feeding: Not recommended. No data on the content of human milk after administering fexofenadine hydrochloride. However, when terfenadine was administered to nursing mothers’ fexofenadine was found to administering fexofenadine hydrochloride. However, when terfenadine was administered to nursing mothers’ fexofenadine was found to cross into human breast milk. Fertility: No human data available. Ability to Drive and Use Machinery: Based on the pharmacodynamic profile and cross into human breast milk. Fertility: No human data available. Ability to Drive and Use Machinery: Based on the pharmacodynamic profile 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 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 medicinal products, it is advisable to check the individual response before driving or performing complicated tasks. Undesirable Effects: Nervous 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 system disorders: Common: headache, drowsiness, dizziness. Gastrointestinal disorders: Common: nausea. General disorders and administration site conditions: Uncommon: fatigue. Refer to the SPC for other undesirable effects. Marketing Authorisation Holder: Rowa Pharmaceuticals 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: Limited., Newtown, Co.Freephone: Cork. Marketing Authorisation Number: PA0074/096/001 Further information and SPC are available from: Rowex Ltd., Bantry,Bantry, Co. Cork.

1800 304 400 Fax: 027 50417 E-mail: rowex@rowa-pharma.ie 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 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 emailing Rowex pv@rowa-pharma.ie

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

Supply status: Supply through pharmacies only

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

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

22

Allergies

Allergy Contact Dermatitis, Contact dermatitis is a common skin condition characterised by redness, itching, and inflammation of the skin. It occurs when the skin comes in contact with an allergen or irritant, triggering an immune response.

At The Allergy Clinic we use Allergy patch testing as diagnostic tool used to identify the specific allergens responsible for contact dermatitis. In this article, we will explore the process of allergy patch testing, its applications, and its importance in diagnosing work-related allergies, cosmetics allergies, and metal allergies in orthopaedic surgery.

Written by Joyce Clegg, The Allergy Clinic Ireland

• Reduced risk of complications: By identifying metal allergies, healthcare providers can take steps to minimise the risk of adverse reactions.

• Improved patient safety: Patch testing can help ensure patient safety by identifying potential allergens before surgery. This can lead to reduced need for second surgery to remove the implant.

Metal allergy to orthopaedic prosthetics can present in various ways post-surgery. Here are some possible signs and symptoms: Common Symptoms: • Pain: Persistent or worsening pain at the implant site.

What is Allergy Patch Testing?

Allergy patch testing involves applying small amounts of potential allergens to the skin, usually to the patients back, using adhesive patches. Patch testing is a type IV hypersensitivity test carried out over 5days.

The patient must attend The Allergy Clinic Mon/Wed/Friday of the same week with each appointment lasting 30 minutes.

patch testing can help identify these allergens, such as: • Fragrances: Commonly found in perfumes, soaps, and other scented products.

• Preservatives: Used to extend the shelf life of cosmetics and personal care products.

• Dyes: Used in hair dyes, makeup, and other products.

Work-Related Allergies

Metal Allergies in Orthopaedic Surgery

Occupational contact dermatitis is a common problem affecting workers in various industries, including healthcare, construction, and manufacturing. Allergy patch testing can help identify work-related allergens, such as:

Metal allergies are a growing concern in orthopaedic surgery, particularly with the increasing use of implants and prosthetics. Metal allergy testing via patch testing is crucial for patients

• Latex: Commonly found in gloves, medical equipment, and other products.

• Nickel: Found in some metal alloys, jewellery, and industrial equipment.

• Chromium: Used in leather tanning, cement, and some metal alloys.

• Formaldehyde: Used in some industrial processes, cosmetics, and personal care products.

undergoing orthopaedic surgery, particularly those receiving implants or prosthetics. Allergy patch testing can help identify metal allergies, such as: • Nickel: Found in some metal alloys used in implants and prosthetics.

• Cobalt & Titanium: Used in some metal alloys and implants.

• Chromium: Used in some metal alloys and implants.

Cosmetic Allergies

Benefits of Preoperative Patch Testing

Cosmetics and personal care products can contain allergens that trigger contact dermatitis. Allergy

• Informed decision-making: Patch testing provides valuable information for surgeons and

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patients, enabling informed decisions about implant selection. The surgeon can choose either Cobalt or Titanium implant for the patient.

• Swelling: Swelling, redness, or inflammation around the implant site.

Allergy Patch Testing

Blocked nose from hayfever?

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Use in the Elderly: There havefrom: been no specific studies any o long lasting of this medicine in the elderly. Experience has indicated that normal adult dosage is appropriate. Hepatic Dysfunction: Caution should be exercised when administering this medicine to patients with severe hepatic impairment. RenalFast, Dysfunction: Caution should be pregn As wi exercised when administering this medicine to patients with mild to moderate renal impairment. Contra-Indications: This medicine is contra-indicated in individuals with known hypersensitivity to pseudoephedrine or any of the excipients. This medicine is contra- nose. indicated in individuals who are taking or have taken monoamine oxidase inhibitors (MAOIs) within the preceding two weeks. The concomitant use of pseudoephedrine and this type of product may cause a rise in blood pressure and/or hypertensive crisis This medicine breat of the is contra-indicated in individuals with cardiovascular disease including hypertension, and in those who are taking beta blockers. This medicine is contraindicated in individuals who have diabetes mellitus, phaeochromocytoma, hyperthyroidism, closed angle glaucoma, the fl p or severe acute or chronic kidney disease / renal failure impairment. This medicine is contra-indicated in individuals at risk of developing respiratory failure. This medicine is contraindicated in individuals who are currently taking other sympathomimetic decongestants. the nozzl This medicine is contra-indicated in children under 12 years of age. Special Warnings and Special Precautions for Use: Although pseudoephedrine has virtually no pressor effects in normotensive patients, this medicine should be used with caution in patients Remo 53 do taking antihypertensive agents, tricyclic antidepressants, or other sympathomimetic agents (such as appetite suppressants and amphetamine-like psychostimulants) The effects of a single dose on the blood pressure of these patients should be observed before Each b recommending repeated or unsupervised treatment. The physician or pharmacist should check that sympathomimetic containing preparations are not simultaneously administered by several routes i.e. orally and topically (nasal, aural and eye preparations). If any of the recom following occur, this medicine should be stopped: Hallucinations, Restlessness, Sleep disturbances. Severe Skin reactions: Severe skin reactions such as acute generalized exanthematous pustulosis (AGEP) may occur with pseudoephedrine-containing products. This Child medic acute pustular eruption may occur within the first 2 days of treatment, with fever, and numerous, small, mostly non-follicular pustules arising on a widespread oedematous erythema and mainly localized on the skin folds, trunk, and upper extremities. Patients should with o be carefully monitored. If signs and symptoms such as pyrexia, erythema, or many small pustules are observed, administration of this medicine should be discontinued and appropriate measures taken if needed. Ischaemic colitis: Some cases of ischaemic colitis have 3 dos excee been reported with pseudoephedrine. Pseudoephedrine should be discontinued and medical advice sought if sudden abdominal pain, rectal bleeding or other symptoms of ischaemic colitis develop. Ischaemic optic neuropathy: Cases of ischaemic optic neuropathy your d have been reported with pseudoephedrine. Pseudoephedrine should be discontinued if sudden loss of vision or decreased visual acuity such as scotoma occurs. Posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome than 5 6-12 (RCVS). Cases of PRES and RCVS have been reported with the use of pseudoephedrine-containing products. The risk is increased in patients with severe or uncontrolled hypertension, or with severe acute or chronic kidney disease/renal failure. Pseudoephedrine should docto be discontinued and immediate medical assistance sought if the following symptoms occur: sudden severe headache or thunderclap headache, nausea, vomiting, confusion, seizures and/or visual disturbances. Most reported cases of PRES and RCVS Client resolved following relief. have discontinuation and appropriate treatment. There have been no specific studies of this medicine in patients with hepatic and/or renal dysfunction. Caution should be exercised when using the product in the presence of severe hepatic impairment or mild to moderate Use o F309038 ETUI/CARTON 34 x 33 x 112 mm V6.0 J&J renal impairment. Patients with difficulty in urination and/or enlargement of the prostate should be advised to consult a physician before using this product. Patients with thyroid disease who are receiving thyroid hormones should not take pseudoephedrine unless For ch 24 ho directed by a physician. Use with caution in occlusive vascular disease. This product may act as a cerebral stimulant giving rise to hyperpyrexia, tremor and epileptiform convulsions. Care should be taken when used in epileptic patients. Pseudoephedrine may induce Do no ETU008 Effects: 3 tim N° 25or glucose-galactose malabsorption EAN positive results in certain anti-doping tests. This product contains lactose. Tablets: Patients with rare hereditary problems of galactose intolerance, the Lapp LÆTUS lactose deficiency should not take this medicine Undesirable over: Immune System Disorders Not known Hypersensitivity – cross sensitivity may occur with other sympathomimetics Psychiatric Disorders Common Insomnia, Nervousness Rare Hallucination Not known Agitation, Anxiety, Delusion, Euphoric mood, Hallucination, visual, Adult Irritability, Restlessness, Sleep disorder Nervous System Disorders Very common Headache Common Dizziness Not known Cerebrovascular accident (stroke without known pre-existing risk factors), Paraesthesia, Posterior reversible encephalopathy syndrome (PRES) Read

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Sudafed 0.1% w/v Nasal Spray Solution. Composition: Contains 0.1% w/v Xylometazoline Hydrochloride. Each metered spray (0.14 ml) delivers 140 micrograms of xylometazoline hydrocholoride. Indications: Sudafed Nasal Spray is indicated for the symptomatic PMS Cool Grey relief of nasal congestion associated with the common cold, influenza, sinusitis, allergic and non-allergic rhinitis, and other upper respiratory tract allergies. Dosage: Adults and children 12 years and over: Nasal. One spray to be expressed into each nostril 2-3 times daily, as necessary. Maximum daily dose: 3 Sprays per nostril. Do not exceed the stated dose. Use for more than seven consecutive days is not recommended. Children aged 6 to 12 years: Nasal. One spray to be expressed into each nostril 2-3 times daily, as necessary.

Maximum daily dose: 3 Sprays per nostril. Do not exceed the stated dose. Consult a doctor or pharmacist before use. Use only when simple measures have failed to bring adequate relief. Use for more than five consecutive days is not recommended. Children under 6 years: Do not give SUDAFED decongestant Nasal Spray to children under 6 years of age The Elderly: Experience has indicated that normal adult dosage is appropriate. Hepatic/renal dysfunction: Normal adult dosage is appropriate. Contraindications: Sudafed Nasal Spray is contra-indicated in individuals with known hypersensitivity to the product or any of its constituents. Sudafed Nasal Spray is contraindicated in individuals who are taking or have taken, monoamine oxidase inhibitors within the preceding two weeks.

Sudafed Nasal Spray is contraindicated in individuals with hypophysectomy or surgery exposing dura mater. Sudafed Nasal Spray is contraindicated for use in children under the age of 6 years. Special warnings and precautions for use: Patients with long QT syndrome treated with xylometazoline may be at increased risk of serious ventricular arrhythmias. There is minimal systemic absorption with topically applied imidazoline sympathomimetics such as xylometazoline, however, Sudafed Nasal Spray should be used with LASeffect AN vmay /wlead %1to.0nasal caution in patients suffering coronary artery disease, hypertension, hyperthyroidism or diabetes mellitus. This medicine is intended for short-term use only. Prolonged treatment may lead to reactive hyperemia of the nasal mucosa. This rebound OITforUaLO S Ytime.

ARPSorbitol S congestion or nasal obstruction during continued use or after discontinuation, resulting in repeated or even continuous use of the medicine by the patient. Benzalkonium chloride may cause irritation or swelling inside the nose, especially if N used long edirolhcordyh enilozatemolyX E420 – Patients with rare hereditary problems of fructose intolerance should not take this medicine. Children aged 6 to 12 years: Consult a doctor or pharmacist before using this product. Do not use with other cough and cold medicines. Undesirable Effects: Nervous TOLNot System Disorders Not known Burning sensation mucosal Respiratory, Thoracic and Mediastinal Disorders Uncommon Epistaxis Not known Nasal discomfort, Nasal dryness, Nasal pruritus, Rhinalgia, Sneezing General Disorders and Administration Site Conditions STAMPING AREA known Rebound effect. MA holder: JNTL Consumer Health I (Ireland) Ltd. Block 5, Hight Street, Tallaght, Dublin 24, Ireland. PA number: PA23490/012/001. Product not subject to prescription. Full prescribing information available upon request. Supply through PXE pharmacies only. Date of revision of text: May 2024.

IE-SUD-2025-128200

24

Allergies Timing of Symptoms: • Early onset: Symptoms can occur shortly after surgery, within weeks or months.

• Delayed onset: Symptoms can also develop months or years after surgery.

• Rash: A skin rash or eczema-like reaction near the implant site.

• Itching: Itching or pruritus around the implant site.

• Loosening: Implant loosening or instability.

• Impending sense of doom, depression.

Other Possible Symptoms: • Effusion: Joint effusion or fluid accumulation around the implant.

• Inflammation: Chronic inflammation or tissue damage around the implant.

• Allergic contact dermatitis: A skin reaction that can spread beyond the implant site.

Metal allergy testing via patch testing is an essential step in the preoperative evaluation of patients undergoing orthopaedic surgery.

By identifying metal allergies, healthcare providers can make informed decisions about implant selection, reduce the risk of complications, and improve patient outcomes. If you're scheduled for orthopaedic surgery, contact The Allergy Clinic to discuss metal allergy testing to determine if it's right for you.

The Importance of Allergy Patch Testing Allergy patch testing is a valuable diagnostic tool for identifying contact dermatitis allergens. It can help:

• Diagnose: Identify the specific allergen responsible for contact dermatitis.

• Prevent: Avoid exposure to identified allergens. Particularly useful in preventing second surgeries in hip or knee replacement. Allergy patch testing is recommended before orthopaedic surgery.

• Treat: Develop a treatment plan to manage symptoms and prevent future reactions.

Conclusion Allergy patch testing is a crucial diagnostic tool for identifying contact dermatitis allergens. It can help diagnose work-related allergies, cosmetics allergies, metal allergies in orthopaedic surgery and more. By understanding the process and applications of allergy patch testing, The Allergy Clinic can provide effective treatment and prevention strategies for patients with contact dermatitis. The fee for allergy patch testing with The Allergy Clinic is ¤250. www.theallergyclinic.ie

News

Speak to your Pharmacist: Before Damage is Done Marty Morrissey has urged people to have the ‘silent killer’ of blood pressure checked having lost his father and grandfather to heart attacks. The legendary GAA commentator said their deaths fuelled his acute awareness of cardiac health as he backed the Irish Heart Foundation’s ‘Before Damage is Done’ campaign.

Janis Morrissey, Director of Health Information and Training with the Irish Heart Foundation and Marty Morrissey

still of working age, so it can have devastating consequences not only for someone’s health, but also on their quality of life and financial independence if they are forced to stop working.”

In addition, the data shows public knowledge has fallen in relation to how untreated blood pressure can lead to dementia or kidney disease, as well as damaging your heart and other organs.

Blood pressure checks are a vital tool in measuring how effectively the heart pumps blood around the body.

Worryingly, 29% of people believe the signs of high blood pressure are obvious, yet high blood pressure is a silent killer.

Mr Morrissey, from Quilty, Co. Clare whose dad Martin died of a sudden heart attack in 2004, was speaking as new research by the national stroke and heart charity showed a drop in understanding of the risk of stroke and heart disease from untreated high blood pressure.

Last month’s online survey of 1,000 people, conducted by Core

Research, reveals just 49% had their blood pressure checked in the last six months, compared to 57% in November 2023.

Only 67% believe untreated blood pressure creates a high risk of stroke (down from 78% in 2023), while 64% believe there is a high risk of heart disease (down from 72% in 2023).

PHARMACYNEWSIRELAND.COM

“The research shows an unfortunate fall off in the level of understanding of the serious consequences of hypertension or high blood pressure,” said Janis Morrissey, Director of Health Promotion, Information and Training with the Irish Heart Foundation.

“High blood pressure is among the leading risk factors for heart disease or stroke and premature death worldwide.”

“A quarter of people having strokes are under age 65 and are

Dr David McConaghy, ICGP/HSE Integrated Care Lead for Prevention said: “The Irish College of General Practitioners supports this campaign to raise awareness about blood pressure and encourages people to attend their GP practice for a cardiovascular review.”

Susan O’Dwyer, Head of Governance and Pharmacy Services with the Irish Pharmacy Union said “We support this important campaign to encourage people to get their blood pressure checked with the aim of detecting high blood pressure before damage is done. Pharmacies nationwide offer blood pressure testing and many also offer 24hour blood pressure monitoring.

Speak to your local pharmacist to learn more.”

Hair Care

25

More Than Skin Deep: The Rise of Hair and Nail Wellness Author Bio - Laura Dowling is a pharmacist, founder, and advocate for women’s health. With over 20 years' experience in Irish community pharmacy, she is passionate about empowering patients with honest, accessible advice to support real wellness at every stage of life.

Written by Laura Dowling, Pharmacist and Women's Health Advocate

Hair loss, dandruff, and the booming self-care movement reshaping pharmacy shelves When it comes to personal care, hair and nail health is an area that has truly come into its own in recent years. Once seen as simply cosmetic, these categories are now increasingly recognised as indicators of overall wellbeing – and consumer demand is reflecting that.

In pharmacies across Ireland, we are witnessing a shift: more and more people are actively seeking advice and products that support healthy hair and nails, not just for aesthetics, but for confidence, vitality, and health.

Growth in the Category: Driven

by Health and Wellness The hair and nail care category is growing steadily, underpinned by rising consumer interest in holistic health. Shoppers are no longer just looking for a quick-fix shampoo or a strong-hold nail polish; they want nourishing solutions that address the root cause of concerns like hair thinning, brittle nails, and scalp health.

Price-wise, we have seen some upward pressure. Raw material costs for high-quality ingredients like marine collagen, hyaluronic acid, and patented actives have increased globally, and this is reflected in retail prices. Despite this, consumers are willing to pay a premium for products that deliver visible and lasting results.

Products enriched with vitamins, botanicals, functional mushrooms, collagen, and targeted supplements have exploded onto the shelves. Pharmacy customers are asking informed questions — “Is this sulfate-free?”, “Does this contain keratin?”, “Is this clinically studied?” — showing that they are investing more thought, time, and money into their choices.

Shopper Trends: Education, Trust, and Multi-Solution Products

I’ve seen this shift firsthand in my own work too. In my own supplement range, my Skin Hair Nails Glow product is the second best-seller. Consumers reach out daily, asking questions, sharing updates, and wanting to know exactly how it works. Their passion and engagement around hair health mirrors the way skin health became a major focus about ten years ago. It really feels like hair is now having its “health moment” — and customers are keen to invest in looking after it properly.

Educated buying is a major trend.

Shoppers want to understand what they are buying and why. In a world saturated with marketing promises, trusted advice from pharmacy staff is more important than ever.

Another key trend is multi-solution products — supplements that support skin, hair, and nails together, or shampoos that address both dandruff and hair thinning. Convenience is king, and anything that offers a holistic benefit in one simple step is winning customer loyalty.

Eco-conscious buying is also emerging strongly. Consumers are scrutinising labels for sustainability claims, cruelty-free certifications, and recyclable packaging. Brands that embrace

clean beauty and transparency are gaining market share.

Spotlight on Conditions: Hair Loss

Innovation: Supplements, Scalp Care, and Hair Loss Treatments

Hair loss is one of the most emotionally charged topics we encounter in pharmacy practice. It can be devastating to self-esteem, and it affects both men and women.

Innovation is vibrant in this space.

Supplements are becoming more sophisticated, blending vitamins, minerals, adaptogens, and amino acids to support hair strength and growth.

Scalp health is finally getting the spotlight it deserves, with a surge in pre-shampoos, scalp scrubs, and serums designed to create the perfect environment for healthy hair to flourish.

Causes of hair loss can include stress, hormonal changes (especially around menopause or after pregnancy), nutritional deficiencies, thyroid disorders, certain medications, and genetic predisposition.

For those experiencing hair thinning or loss, a combined approach often works best:

Hair loss treatments have evolved too. Minoxidil remains a pharmacy staple, but it's now joined by an array of supplement options containing zinc, selenium, marine collagen, and vitamin D, offering a supportive, less medicalised route for those at the beginning of their hair loss journey.

• Topical treatments like minoxidil

There’s also been significant expansion into dermatologically tested ranges for sensitive scalps — catering to those managing conditions like seborrheic dermatitis, psoriasis, and chronic dandruff.

• Medical evaluation where appropriate to rule out underlying conditions

• Nutritional support with supplements containing zinc, collagen, vitamin D, and iron (if deficient) • Stress management and lifestyle changes

It’s crucial to have compassionate conversations, provide reassurance, and recommend professional referral if needed.

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Quick Overview of Treatments for Hair Loss and 26 Hair Care Dandruff Pharmacy Advice Focus - Topical minoxidilHolistic advice; Zinc, Selenium, Vitamin D, Supplements- Stress emotional support; Hair Loss Marine Collagen, Amino Acids check for underlying management- Medical Iron (if deficient) referral if needed medical issues Normalise the - Medicated shampooscondition; recommend Ketoconazole, Selenium Dandruff Scalp treatments- Gentle consistent treatment; Sulfide, Zinc Pyrithione haircare routine reassure on hygiene Condition Treatment Options

Spotlight on Conditions: Dandruff Dandruff is another common concern, and while it may seem minor, it can be distressing and persistent.

Dandruff occurs when the scalp sheds excess skin cells, often due to an overgrowth of yeast

Key Ingredients/Supports

(Malassezia) or increased oil production. Stress, cold weather, and hormonal changes can exacerbate it.

Treatment typically includes: • Medicated shampoos containing ketoconazole, selenium sulfide, or zinc pyrithione

Quick Overview of Treatments for Hair Loss and Dandruff

Conclusion: A Category that Reflects Holistic Health Hair and nail care is no longer a luxury category – it’s a health category. Customers are more empowered, educated, and willing to invest in products and advice that genuinely support their wellbeing.

• Regular washing to reduce oil build-up

We’ve seen this pattern before with skin health — once considered purely cosmetic, now recognised as an essential pillar of selfcare. Hair is following the same trajectory. It is having its “health moment,” and pharmacies are perfectly placed to lead the way.

It’s important to remind customers that dandruff is a scalp condition, not a sign of poor hygiene, and that with the right treatments, it can be very manageable.

With trusted advice, high-quality products, and empathetic listening, we can support our customers not just to look better — but to feel better.

• Soothing scalp treatments to reduce itchiness and inflammation

News PHX Ireland Announces Charity Partnership with HUGG, Ireland’s National Suicide Bereavement Charity PHX Ireland, Ireland's leading fully integrated healthcare provider, recently announced a two-year charity partnership with HUGG, the national suicide bereavement charity.

Hillary Collins, Fiona Tuomey and Paul Reilly at the HUGG Launch

Postvention refers to activities that reduce risk and promote healing for those impacted by suicide.

By supporting people who have lost a loved one to suicide, HUGG plays a vital role in reducing the increased risk of suicidal ideation among the bereaved -estimated to be ten times higher than in the general population.

This partnership aligns with PHX Ireland purpose, to make a real, lasting difference to our customers and communities and will extend across PHX Ireland's subsidiaries: United Drug, Ireland's leading pharmaceutical wholesaler and distributor; McCabes Pharmacy, Ireland's largest pharmacy retail brand with 110 pharmacies nationwide; and TCP Homecare, innovators in clinical home nursing services and direct-to-patient delivery solutions.

Founded in 2017 by Fiona Tuomey after the devastating death by suicide of her 11-yearold daughter Milly, HUGG was created to ensure that no one bereaved by suicide would have to face their grief alone. With around 500 suicides recorded in Ireland each year—and research showing that every suicide can impact up to 135 people — more than 60,000 individuals may be affected annually and in need of postvention support.

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Speaking about the partnership CEO of PHX Ireland Paul Reilly said "We are delighted to announce our partnership with HUGG for the next two years. PHX Ireland prioritises the health and wellbeing of communities making the partnership a natural collaboration.

Together with HUGG, we look forward to fostering positive change and providing essential resources to those in need. We are very excited to develop this partnership, creating opportunities

for our teammates, colleagues and customers to support a very deserving charity.”

HUGG’s services include a telephone support line, suicide bereavement support groups, information on grief after suicide, and ongoing research and advocacy. HUGG also hosts public events and webinars including its annual remembrance event, Say Their Name and Finding Hope & Healing After Suicide. These events provide compassionate support and connection. A new initiative from HUGG is the rollout of Suicide Bereavement Pop-up Cafés, beginning in Kerry and Waterford in April.

PHX employees will have the opportunity to participate in a Salary Donation Scheme, allowing them to contribute any amount from their payroll to HUGG. These donations will then be matched

by PHX Ireland, showcasing the company’s strong commitment to supporting impactful causes.

Further information on HUGG and the support they provide can be found at www.HUGG.ie

28

GLP1

The GLP1 Revolution Scientific development tends to progress incrementally. But every few decades the relative equilibrium in a particular area will be punctuated by rapid advancement before settling down again. The development of antibiotics, anti-hypertensives and statins are such examples. The fundamental problem is finding a therapeutic target to treat a given condition. This eluded medicine for the disease of obesity until recently.

The discovery of the therapeutic targets – the receptors for incretins such as GLP1 and GIP is the revolution in this field. But the magnitude of this particular development is like nothing seen since the development of antibiotics for one simple reason – every organ in the body is affected by the disease of obesity and by treating obesity you treat every organ. It is this connection that underpins the enormous versatility of the anti-obesity medication (AOM). Coupled with this there appears to be reward pathways the brain that are common to satiety and the effects of alcohol, smoking, gambling and even compulsive shopping. More research is needed in these areas to elaborate on the anecdotal reports and small studies that are accumulating.

Written by Dr Maurice O’Farrell, The Medication Weight Loss Clinic

own clinic on the effects of GLP-1 agonists and alcohol intake.

In this article I briefly describe my own clinical experience with AOM and the discovery that could create a new treatment paradigm for alcohol use disorder.

I will describe the potential versatility of the medication and finally provide some advice for pharmacists involved in dispensing the medication. The information provided here is for general purposes only, specific advice should always be sought in respect of specific patients.

Alcohol Use Disorder My early clinical experience with GLP1 agonists was working on endocrinology in the Mater Hospital where they were used to treat type 2 diabetes. I first started prescribing GLP1 agonists to treat the disease of obesity in 2021 and then set up my own weight management clinic The Medication Weight Loss Clinic in 2022.

Before developing an interest in the disease of obesity I had focused on addiction medicine.

This background in addiction medication gave me a context to appreciate the patient feedback on alcohol intake which prompted me to start gathering data in my

When I started prescribing the GLP-1 agonists for the disease of obesity the very first problem I ran into with my first patient was that of severe hangovers. I noticed this was something of a pattern with many more patients along with feedback that they felt unwell while drinking. I would advice patients about this in advance of starting the medication. But then I came to realise that this could be presented as a positive health benefit given the deleterious nature of alcohol.

As I followed up patients thought 2022 I realised there was a lot more going on with the medication then just exacerbating hangovers.

Patients explained that they were too full after their evening meal to drink. When they did drink, they reached satiety very fast and had a very low threshold for nausea. They were drinking at a slower pace which affects the rate of alcohol absorption. The absorption is further reduced by delayed gastric emptying. The slower absorption changes the pharmacokinetics of alcohol and the proportion of acetaldehyde which reduces the pleasurable effects resulting in patients not enjoying the experience as much.

Interestingly this is completely the opposite to what happens after gastric bypass surgery where alcohol is absorbed much faster thereby making it more pleasurable and addictive. Clearly there was a negative feedback

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loop developing with the patients on AOM which appeared to be compounded by a reduction in cravings that may be attributable to the common reward pathways in the pleasure centres of the brain.

Overall, patients were simply losing interest in alcohol. I knew from my work with patients suffering from alcohol use disorder that this was remarkable given that there is no pharmacological treatment that I ever found effective for helping them. My research published with Professor Carel Le Roux and Dr Faisal Almohaileb in Diabetes, Obesity and Metabolism found that patients reduced their alcohol intake from an average of 12 to 4 units a week. However, the heavier drinkers reduced from 23 units to 8 units per week, a two thirds reduction. This compared with the 61% reduction reported in clinical trials for nalmefene - a medication approved by the European Medicines Agency for reduction of alcohol consumption.

Two points stood out about this – the first was that the medication was giving people control over their drinking which is something every heavy drinker wants rather been told that they have to stop drinking completely. The second point was compliance – a once weekly medication is enormously more effective for a condition like alcohol use disorder because the cravings come in waves which compromises the patient’s commitment to a medication regime. The potential of this medication as an adjunct to treatment for alcohol use disorder is yet to be fully established and will require radomised control trails that will provide a much higher level of evidence. It should not be used for this purpose until there is sufficient evidence to support relevant guidelines.

Future Applications There are many other conditions that may be treated by AOM as set out below.

Obstructive sleep apnoea – AOM is now commonly used to treat this condition which responds well to weight reduction.

PCOS – a 10% weight reduction is sufficient for clinical improvement in PCOS symptoms including increased fertility.

Cardiovascular disease – ESC 2024 guidelines recommend semaglutide for patients that are overweight with chronic coronary syndrome Hypertension responds extremely well to weight reduction. Even in the absence of weight reduction there are cardiovascular benefits probably attributable to the reduction in inflammation.

Other conditions may include liver disease, previously known as NASH – now metabolic dysfunction-associated steatohepatitis (MASH), chronic kidney disease – which can be caused by visceral adiposity in a manner similar to MASH and osteoarthritis – due to reduced physical pressure on joints and reduced inflammation.

There are also neurological conditions being examined. It is thought that the benefits accrue from reduced inflammation, reduced deposition of beta amyloid and enhanced brain metabolism.

Researchers in Denmark are examining if semaglutide could be used as a treatment of idiopathic intracranial hypertension. Novo Nordisk has a trial testing semaglutide in patients with early Alzheimers disease. Researchers in France are examining the use of lixisenatide for Parkinsons disease.

FAST, PROVEN HYDRATION

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T (044) 939 6188 E info@pharmed.ie

SPORTS & EXERCISE

HANGOVER HYDRATION

EVERYDAY WELLNESS

TRAVEL HYDRATION

HOT WEATHER

FOR ADULTS & KIDS

30

GLP1

Advice for pharmacists The pharmacist has a central role in supporting patients on AOM. Patients with a history of cholelithiasis or pancreatitis need to be cautioned on the signs and symptoms of these conditions because of the risk associated with AOM. Patients should be asked about any history of gastroparesis or ileus as AOM has been associated with these conditions. These conditions would justify a slower titration and close monitoring.

The pharmacist should check any other medication that the patient is on before dispensing the AOM. Patients on insulin or a sulphonylurea are at risk of hypoglycemia. These patients should have a slower titration schedule and consider reducing the sulfonylurea or insulin while monitoring the blood sugars more often. A continuous blood glucose monitor would be particularly helpful during initiation and uptitration.

Female patients of child bearing age should be counselled about contraception because of how AOM reduces gastric emptying and can reduce the efficacy of oral contraception on initiation and uptitration. A second form of contraception should be used in conjunction with oral contraception for 4 weeks after starting and after each dose

increase. Patients should stop the mediation at least 2 months before a planned pregnancy.

Constipation should be treated before starting an AOM because of how the medication slows down bowel movements. This can be done with diet adjustments such as increasing citric fruits and avoiding white bread and pasta.

If diet is not sufficient then a nonstimulative laxative can be used.

The stimulative laxatives should be kept in reserve for acute episodes of constipation.

Nausea is a very common side effect when starting AOM however a minority of patients are very sensitive to AOM and even the starting dose can result in them having severe nausea and difficulty eating anything or even drinking water, risking dehydration and kidney injury. It is extremely important that patients starting AOM understand that while mild nausea is common, vomiting is never normal. Antiemetic medication can be used to counter the nausea if it is severe or there is vomiting but antiemetic medication should only be used if necessary and should not be used on a continual basis. If there is severe nausea or vomiting the dose is too high and needs to be reduced. If this happens the patient should be referred back to their prescribing doctor to have the dose reduced.

Lifestyle advice should include

regular exercise, a high fibre diet, good hydration and an OTC multivitamin to prevent micronutrient malnutrition.

It’s very important that the patient knows how to use the dispensing pen. Many pharmacists are comfortable showing patients how to count the clicks to dispense a dose other than the assigned dose of the pen. This is an off-license use of the device but is now reasonably common practice and considered safe. It is necessary to know how many clicks make up the assigned dose for that particular pen and then use a proportionate number of clicks for the desired dose. Patients will need extra needles to do this.

Many patients living with the disease of obesity have an unhealthy relationship with the scales. Sensitivity should be paramount when questioning a patient about their weight. A visual inspection is often sufficient to establish that a patient has an elevated BMI. In the event that a visual inspection raises suspicion of a patient being underweight then further questioning is justified.

If a patient’s weight is to be checked it should be done with their expressed consent and in a part of the premises that is private.

Repeat Prescriptions When a patient is returning for a repeat prescription there are

important questions to ask.

Firstly, that the bowels are moving regularly and that any constipation is mild. As previously mentioned, diet can be used to mitigate constipation, exercise after eating aides gut mobility and adequate hydration helps. A regular bulking agent can used added if necessary.

Diarrhoea is usually transient on initiation or dose increase and is rarely an ongoing problem.

The risk of treating it is rebound constipation. An oral electrolyte replacement can be used but if loperamide is used the patient will have to be referred back to the prescribing doctor for dose adjustment because the risk of constipation which is a more serious problem.

As previously mentioned nausea is common but vomiting is not acceptable. Nausea can be mitigated by eating more slowly, eating regular smaller meals, avoiding spicy, fried or greasy foods and drinking cold water.

Importantly the patient should not increase the dose of their medication as scheduled if there is any significant nausea, diarrhoea or constipation.

Acid reflux can improve when on AOM due to smaller meals and not eating at night but it can get worse due to delayed gastric emptying.

It can be mitigated by avoiding alcohol, smoking, spicy foods, eating late at night and identifying triggers by keeping a food diary.

If conservative measures are insufficient then any of the OTC medications can be used such as a PPI. Sulphur burps are a related side effect which are more difficult to treat but they rarely persist.

Treatment options include trying a pro-biotic and peppermint tea or extract. Avoiding sulphur rich foods and ensuring good hydration can also help.

Finally, it’s important to be aware that many patients have had very bad experiences previously with healthcare professionals and may be sensitized to any perceived judgement or stigma. It’s vitally important to display a nonjudgemental supportive approach.

Conflict of Interest Dr Maurice O’Farrell provides obesity clinical care in The Medication Weight Loss Clinic and is the owner of this clinic. He has served on advisory boards for Novo Nordisk and Johnson & Johnson, both positions unremunerated.

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32

Eczema

Plant-Biotech alternatives to corticosteroids Novel oral-topical approach to improving symptoms of mild to moderate atopic dermatitis (eczema) Atopic dermatitis, or eczema, is a chronic skin condition wherein the skin barrier is disrupted leading to a cycle of inflammation, redness, pruritus, and scratching. These symptoms further weaken the skin barrier increasing trans-epidermal water loss (TEWL) and triggering de-hydration and inflammation.

Written by Barbara Paldus, CEO, Codex Labs Corp

was included to meet USA FDA OTC Monograph M016.

The plant-biotech stem cells selected to repair and fortify the skin barrier include: • Calendula officinalis: antioxidant, anti-inflammatory and wound healing benefits2 • Symphytum officinale: allantoin promotes desquamation; rosmarinic acid increases ceramide formation3 and inhibits itch-causing S. aureus The researchers explore Conventional AD treatments include topical corticosteroids alongside skincare routines with emollients/moisturizers and gentle cleansers. Integrative dermatology considers the role of the skin-gut axis in AD: in addition to topicals, it also addresses gut dysbiosis and systemic inflammation.

Eczema Skin-Gut Axis Increased intestinal permeability (IP) is also known as leaky gut.

Eczema is often correlated with leaky gut, and gut inflammation like irritable bowel syndrome (IBS) or Crohn’s-like symptoms.

Studies have found that children with AD have increased IP, and one study reported a correlation between a marker of increased IP and the Scoring Atopic Dermatitis (SCORAD) index.1 Novel Biotech topical treatment for AD The topical regimen discussed here consists of Bia™ unscented soap and Bia eczema relief lotion, made with the patented biotech BiaComplex 2.0.

The soap is cold processed to yield excess glycerin, so it does not strip moisture, sebum, or the microbiome from the skin. This is essential in maintaining skin barrier integrity and supporting the native skin microbiome to prevent S. aureus infections.

BiaComplex 2.0 is comprised of plant stem cell extracts as well as hyaluronic acid and NP ceramides. 1% colloidal oatmeal

• Haberlea rhodopensis: myconoside stimulates extracellular matrix synthesis4 • Padina pavonica thallus: laminarins and alginic acids moisturize and support wound healing.5 The use of sunflower oil as a carrier enables the bioactive compounds to penetrate skin without synthetic penetration enhancers. Its high concentration of linoleic acid (>60%) helps maintain skin barrier integrity, serves as an emollient, and reduces TEWL. It is safe for those with tree nut allergies, which are common in AD. Treatment of Pruritus Inflammatory skin disorders such as AD are also characterised by intense pruritus, leading to significant discomfort and distress. Particularly in children, interleukin-13 (IL-13), a cytokine that regulates immune responses and inflammation, can promote intense itch. Research has shown that elevated levels of IL-13 are present in the skin of individuals with AD.6 Gene expression studies of the BiaComplex 2.0 applied to epidermal tissues demonstrated downregulation of IL-4 cytokine genes that can activate IL-13, thereby reducing itching.7 Novel Anti-Inflammatory Oral Treatment for AD L-histidine, an amino acid, supports skin barrier integrity through filaggrin formation and has

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been found to significantly reduce AD severity and flare-ups: children taking 0.8 grams of L-histidine daily for 12 weeks experienced 49% reduced AD severity;8 adults taking 4 grams of L-histidine daily for 8 weeks experienced 34% reduced AD severity.9 The Antü Skin Barrier Support supplement combines 4 g of L-histidine and three antioxidant, gut barrier supporting plants (M3Complex): • Matico (Buddleja globosa): stigmasterol helps protect gut mucosa and reduces gut inflammation10 • Maqui (Aristotelia chilensis): anthocyanins and flavonoids help neutralize free radicals • Murta (Ugni molinae): gallic acid, quercetin, and kaempferol enable strong antioxidant activity against lipid peroxidation.

The M3Complex antioxidant activity was compared to ascorbic acid (vitamin C), curcumin, black tea and green tea EGCG. In four laboratory methods, M3Complex showed comparable if not superior antioxidant capacity. It also showed the highest quercetic and phenolic equivalents.

M3Complex is an effective option for reducing gut and systemic inflammation in AD. Clinical Test Results Two clinical trials were performed at Eurofins in Poland. The results are comparable to corticosteroids (e.g. triamcinolone

or betamethasone) and have been submitted for publication.

The first study used only the soap and lotion on 34 subjects with mild AD (average SCORAD 29.8).

By day 56, in 100% of subjects, SCORAD decreased by 99% (p < 0.0001) and pruritus decreased by 93% (p < 0.0001) compared to day 0 baseline. All skin parameters improved by day 56: 78% hydration increase, 40% TEWL decrease, and 65% desquamation index decrease.

The second study used the soap and lotion as well as the oral supplement on 35 subjects with moderate AD (average SCORAD 34.6). By day 56, in 100% of subjects, SCORAD decreased by 93% (p < 0.0001) and pruritus decreased by 97% (p < 0.0001) compared to day 0 baseline. All skin parameters improved by day 56: 117% hydration increase, 29% TEWL decrease, and 83% desquamation index decrease.

The test subject feedback fully supported the measured data with 100% reporting their skin condition improved and felt soothed, while 97% reported less itch and less dryness.

This initial data demonstrates conclusively that it is possible to leverage plant-biotech actives to achieve comparable performance in AD severity and pruritus reduction to traditional corticosteroids, but without the known side effects, allowing longterm use.

References available on request

34

Arthritis

Raising Awareness of Arthritis Written by Maebh Coyle, Arthritis Ireland Each year, Arthritis Ireland strives to raise awareness of the challenges facing those living with arthritis, in addition to sharing and promoting self-management techniques. The theme of this year’s National Arthritis Week (held during the first week of April) was ‘Empowering Lives with Lifestyle Medicine’. The goal of this week was to highlight the latest evidence-based, best practice guidelines for the management of all forms of arthritis. than solely on the longer-term outcomes. These benefits have been shown to foster greater self-esteem, self-efficacy and a sense of empowerment in people living with a chronic condition.

Putting it all together

The six pillars of lifestyle medicine Our education campaign highlighted six key pillars of lifestyle medicine which are known to have a big impact in the management of symptoms of arthritis (and possibly also playing a role in preventing it from occurring in the first place).

• Diet and Nutrition: Promoting the importance of a balanced diet, such as the Mediterranean diet, which is high in fibre and helps lower inflammation.

• Exercise and Movement: Encouraging regular exercise like swimming, aqua-aerobics, walking, cycling, Pilates, and yoga to improve joint flexibility and reduce stiffness.

• Sleep and Rest: Emphasising good sleep hygiene practices to manage pain and fatigue.

• Managing Stress: Providing techniques such as mindfulness, meditation, and deep breathing exercises to reduce stress.

• Smoking and Substance Misuse: Educating on the benefits of reducing or eliminating smoking and excessive alcohol consumption.

• Relationships and Connections: Highlighting the importance of supportive relationships and community involvement for emotional well-being.

How we reached our audience During National Arthritis Week, Arthritis Ireland launched a

dynamic campaign featuring graphic resources and content that highlighted the transformative benefits of lifestyle medicine.

Through a series of lifestyle medicine webinars, dedicated landing pages and social media posts, the campaign demonstrated how simple changes can lead to significant improvements in symptoms and overall health. In addition to raising awareness, these assets also succeeded in driving more visitors to the Arthritis Ireland website, social channels, self-management programmes, helpline and fundraising activities.

Informative webinars The webinars were given by a number of health psychologists and lifestyle medicine physicians from RCSCI (including Dr Lisa Mellon, Dr Kate McCann, Dr Alan Maddock and Dr Maria Pertl).

Topics covered included an introduction to Lifestyle Medicine, including where to begin and how to incorporate the six pillars into daily life, as well as focus on social connections, sleep, stress reduction and mindfulness.

Motivating patients It is generally understood that behavioural change is hard, but it is a very worthwhile goal given the convincing evidence that these lifestyle changes are likely to have a significant impact on public health. One key aspect involved in behavioural change (and motivation) is to focus on the sense of wellbeing that lifestyle changes can offer to individuals almost immediately, rather

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Individuals are encouraged to reflect on their goals, design an action plan, track progress, and access resources for ongoing support. Goal-setting is vital to help focus efforts and energy towards clear objectives, which can help sustain motivation through the change journey. Some important questions to ask patients when setting goals include; • How do you want to feel?

• What do you want to focus on?

• Where to you want to go with this?

As an individual progresses, it is helpful to not only focus on the end goal, but also the benefits and changes experienced along the way. To help you discuss these aspects of behaviour change with your patients, please download and disseminate this lifestyle medicine booklet, Living your Best Life. https://www.arthritisireland. ie/Handlers/Download. ashx?IDMF=ff6482e1-1110-4c00 91e6-d1171c47d9ac Additional resources The Arthritis Ireland helpline is open Monday to Friday, 10am-4pm (0818 252 846) or via email at: helpline@arthritisireland.ie – offering a confidential service that can provide support on a whole range of issues relating to arthritis, from work related concerns to emotional wellbeing or medications advice.

For anyone recently diagnosed with arthritis, please refer them to our Steps Programme. STEPS is a unique programme that helps people understand their diagnosis, adjust their behaviour and lifestyle, and embrace supported selfmanagement of their disease.

It is a unique way to introduce people to the supports and services available from Arthritis Ireland by offering personallytailored information to support them, no matter where they are on their arthritis journey. Use this referral form to refer your patients to Arthritis Ireland’s STEPS programme (www.arthritisireland. ie/forms/steps-programme): or access on the Arthritis Ireland website (arthritisireland.ie). Below we outline the process: Step 1 – Healthcare professional gets consent to pass details to Arthritis Ireland Step 2 – Within 3-5 working days, a fully trained peer arranges suitable call time with individual Step 3 – The peer completes a screening form during initial conversation Step 4 – Based on the screening form, a personalised pack of information is posted Step 5 – After 8 weeks a follow-up call & screening form is completed Step 6 – Comparisons are made and data from calls assessed *Crucially, this service does not interfere with, nor replace, treatment with your rheumatology clinic or by any other medical professional. Rather it emphasises supported self-management – whereby the individual patient is in control of their condition but is supported by Arthritis Ireland throughout their journey.

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News

Elevating Care in the Community Setting Since its launch in 2020, the HSE Chronic Disease Management (CDM) Treatment Programme in General Practice has helped over 400,000 patients. 91% of these patients now receive routine chronic disease care within the community, closer to their home.

Dr Shane McKeogh, ICGP, HSE GP Integrated Care Lead for Adult Respiratory Disease

Figures published today demonstrate the positive impact of the programme, transforming people’s health journeys and improving the quality of life of people living with chronic diseases across Ireland.

The CDM Treatment Programme is an essential element of the HSE Enhanced Community Care Programme, linking General Practice and community services, and delivering care to patients in the right place at the right time.

Clinical Lead for the Chronic Disease Treatment Programme

in General Practice, Dr Orlaith O’Reilly said, “We are incredibly proud of the transformative impact the Chronic Disease Management Programme is having on patient care across Ireland. As part of the Enhanced Community Care Programme, the programme fosters early detection and proactive management of chronic diseases within community settings. We are significantly reducing the need for hospital-based interventions and empowering patients to take charge of their health. This programme exemplifies our commitment to delivering high-quality, accessible care that improves outcomes and quality of life for individuals with chronic conditions.

Since its inception, the programme has reached over 400,000 patients, with 91% now receiving routine care in community settings, reducing their reliance on hospitals. Participants have experienced 30% fewer ED attendances, 26% fewer hospital

admissions, and 33% fewer GP out-of-hours visits.”

Among the 270,000 patients participating in the programme reviewed by their GPs in the first half of 2024, only 7.6% had visited an Emergency Department (ED) in the preceding six months. This is a notable reduction compared to the 16% ED attendance rate reported in the general population by the Healthy Ireland survey in 2023, especially considering the higher age and multimorbidity of the patients in the programme.

This is further supported by an audit by the Irish College of General Practice (ICGP) which revealed that patients enrolled in the CDM Treatment Programme experienced:  30% fewer ED attendances  26% fewer hospital admissions, and  33% fewer GP out-of-hours attendances compared to their pre-enrolment rates.

Dr Shane McKeogh, ICGP/HSE GP Integrated Care Lead for Adult Respiratory Disease added: “The new Chronic Disease Management Programme in General Practice, now in its 5th year, has been a

game changer for eligible patients (patients with medical cards or doctor visit cards) living with Type 2 Diabetes, COPD, Asthma and cardiovascular illness in Ireland.

Supported by 97% of GPs, and providing structured reviews twice yearly when patients are well as opposed to unwell, it represents a giant step forward for the provision of care outside the hospitals. It also demonstrates the power of General Practice to deliver whole country large population health impacts when appropriately resourced.”

Decreased Unscheduled Admissions In the first half of 2024, only 8% of the 270,000 patients attending scheduled GP reviews were admitted to hospitals in the prior six months. This compares favourably with the Healthy Ireland 2023 data indicating a 12% annual admission rate among the general population.

These results highlight the CDM Treatment Programme's success in delivering proactive, communitybased healthcare, reducing hospital dependency, and promoting early disease detection, ultimately enhancing the health and wellbeing of Ireland's population.

Increasing Awareness of Ovarian Cancer World Ovarian Cancer Day (#WOCD2025) was held on May 8th, when the World Ovarian Cancer Coalition and its 200 partner organizations from around the globe raised their collective voices to increase awareness of ovarian cancer and advocate for the global health community to recognise ovarian cancer as a health priority and boost crucial awareness efforts in order to save lives.

• Pelvic/abdominal pain • Urinary changes

World Ovarian Cancer Coalition Global Ambassador and bestselling novelist, Deborah Harkness says, “If your body is telling you something isn’t right, LISTEN TO IT. I urge women to know the signs of ovarian cancer, make sure that you take this list of symptoms to your doctor to advocate for the right testing and the right follow-through care. Women and their doctors must be better informed about the symptoms of ovarian cancer so

that they can take action. If we do this, we will truly leave no woman behind in the challenge of facing ovarian cancer.”

What women should know: The five most common symptoms of ovarian cancer: • Persistent bloating • Difficulty eating • Feeling full quickly

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The World Ovarian Cancer Coalition Every Woman Study™: Low-and Middle-Income Edition, which documented the experiences of over 2400 women living with ovarian cancer in 22 low- and middle-income countries (LMIC), found that just one in four women (26.1%) said they had heard of ovarian cancer and knew something about it prior to their own diagnosis. This varied by country from as low as 3.3% (Nepal) to 63.2% (Uzbekistan).

This stark lack of awareness is not just the case for LMICs. According to our first Every Woman Study in 2018, over two-thirds of women in high-income countries had not heard of ovarian cancer or

knew anything about it prior to their own diagnosis. There is a direct link between awareness and diagnosis. The 2018 study revealed that women with more knowledge of ovarian cancer were more likely to visit their doctor within three months.

The theme this #WOCD2025 is once again “No Woman Left Behind” World Ovarian Cancer Coalition CEO, Clara MacKay says, “No matter where she lives, every woman with ovarian cancer deserves the earliest possible diagnosis and the best possible care. Accelerating diagnosis efforts and radically boosting awareness is not just a global health and economic imperative – it’s a matter of equality and justice.”

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Skin Cancer

Skin cancer and Melanoma Skin cancer is the most common cancer in Ireland. More than 11,000 cases are diagnosed annually accounting for over one-third of all cancers diagnosed, yet most skin cancers could be prevented.

Written by Bernie Carter, Assistant Director of Nursing Services, Marie Keating Foundation

C – Colour – has your mole changed colour over time or does it contain several different colours?

D – Diameter – is the circumference of your mole larger than the top of a rubber on a pencil (larger than 6mm – the size of a pencil rubber), although melanomas can sometimes be smaller than this.

There are 2 main types of skin cancer: Non-melanoma skin cancer and melanoma skin cancer.

Non-melanoma skin cancer includes: • Basal cell skin cancer this is also called Basal Cell Carcinoma (BCC) • Squamous cell skin cancer this is also called Squamous Cell Carcinoma (SCC) This is much more common but less aggressive than melanoma skin cancer. It slowly progresses over months or years.

Melanoma Skin Cancer: Melanoma is a less common but more aggressive type of skin cancer. The most common sign is the appearance of a new mole or change in an existing mole. It is more likely to spread to other parts of the body if not caught and treated early. Commonly affected areas are the trunk (chest and back) in men and the legs in women. It has a high 5-year survival rate of 93% if caught in time.

E – Evolving – has your mole changes in height, appearance or are you experiencing any changes within or around your mole (e.g. itching, bleeding, crusting)

Having lots of Moles:

What are the risk factors?

Ultraviolet (UV) radiation:

Birthmarks:

Exposure to UV radiation is the main risk factor responsible for skin cancers. It is emitted naturally from the sun and from artificial sources such as sunbeds and sun lamps.

Most birthmarks, carry no risk of developing into a cancer. A very rare type, called a giant congenital melanocytic nevus, can develop into a melanoma if it is larger than 20cm. Check all birthmarks regularly for any signs of change.

It is important to know what is normal for you and what your normal skin looks like. If you are concerned about a change in your skin, or any of the above symptoms, see your GP.

It’s important to remember that skin damage doesn’t just happen on holiday or in hot, sunny places.

The sun is often strong enough to cause damage in the Ireland, even on a cloudy day.

Sunbed usage:

A – Asymmetry – if you draw a line down the centre of your mole, is it larger on one side?

B – Border – are the borders of your mole uneven, jagged or notched?

Several studies suggest that sunbed use adds a specific risk of melanoma independently

What changes to look out for:

Skin Type: Fairer skinned people with lots of freckles and moles are more at risk. However, if you have skin, you can get skin cancer so we all need to protect our skin and observe our skin for any new changes.

The more moles you have on your body, the higher your risk of melanoma, meaning you should be very careful about exposing yourself to the sun and keep an eye on all your moles particularly new moles. It is important also to know that nearly 70% of skin melanomas appear on normal skin where there was no existing mole. https://www.mskcc.org/news/fivesurprising-facts-about-melanoma

Research shows that the type of ultraviolet light used in sunbeds (UVA) can cause all types of skin cancer. The International Agency for Research into Cancer (IARC) has classified using sunbeds as a cause of melanoma. Just one session can increase your risk of developing cancer by 20%. The risk is highest for people who use a sunbed before age 35. Sunbed use by under-18s is banned in Ireland and hopefully sunbeds will be banned for all age groups in the future in Ireland given how sunbed use greatly increases the risk of skin cancer, primarily melanoma.

It is important for everyone to familiarise themselves with all the moles on their skin and not only look for changes in existing moles, but also any new spots that may appear.

from individual susceptibility and behaviour in the sun. That means that people with darker skin tones, who tan easily and do not burn in the sun, can also be at risk of developing melanoma from sunbeds. https://health.ec.europa. eu/scientific-committees/ easy-read-summaries-scientificopinions/5-cancers-linked-usesunbeds_en

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Age: The risk of melanoma increases with age. However, compared to most other cancer types, melanoma is also quite common in younger people.

Family history: Your risk of melanoma is higher if you have a close relative who has had melanoma.

Genetic risk for Melanoma: Some families tend to have large numbers of moles, or moles that are unusual (atypical moles).

The atypical moles tend to be an irregular shape or colour and may be larger than usual. An inherited condition called familial atypical multiple mole melanoma syndrome (FAMMM) increases your risk of melanoma.

The SunSmart Code: Five steps we can take to help protect skin from the harmful effects of the sun while outdoors.

1. Seek Shade if outdoors from 11am to 3pm, when the sun is at its strongest. Always use a sunshade on a child’s buggy 2. Slip on some Clothes made from close woven material that covers skin.

3. Slap on a wide brimmed hat to protect exposed skin such as face, neck, and ears from harmful rays 4. Slide on sunglasses with UV protection to shield your eyes from UV rays and protect yourself from cancer and chronic conditions such as cataracts.

5. Slop on sunscreen with an SPF of 30+ for adults and 50+ for children, with high UVA protection and water resistant.

Apply regularly and thoroughly throughout the day.

Visit www.mariekeating.ie for more information and support.

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Onset JIA

Systemic onset JIA and Macrophage Activation Syndrome Written by Dr Orla Killeen, Consultant Paediatric Rheumatologist and Dr Davina Henderson, Paediatric Specialist Registrar, Department of Rheumatology, Children’s Health Ireland at Crumlin Dr Davina Henderson

includes corticosteroids and other immunosuppressive medications, which may be detrimental to other conditions such as malignancies. A diagnosis of systemic JIA may only be confirmed once other causes have been excluded.

The differential is broad and includes malignancies (such as acute leukaemia, lymphoma and neuroblastoma) bacterial and viral infections (Lyme’s disease, EBV, CMV, Adenovirus, Tuberculosis), other inflammatory conditions (Kawasaki Disease, SLE, vasculitis, Inflammatory bowel disease) connective tissue disorders and periodic fever syndromes.

Introduction

Pathogenesis

Juvenile Idiopathic Arthritis (JIA) is a chronic arthritis that persists for at least six weeks and starts before the age of sixteen. The International League Against Rheumatism (ILAR) classifies JIA into seven subtypes, one of which is systemic JIA.1 Systemic JIA, or Still’s Disease, occurs in 10% of children with JIA, with a prevalence of 1 in 32,000 patients. Systemic JIA affects males and females equally, with onset typically between the ages of 3-5, but it can occur at any age.2 It is the childhood continuum of adultonset Still disease (AOSD).

There is growing consensus that systemic JIA is an autoinflammatory condition, distinct from other JIA subtypes.

Whilst this complex disorder is not fully understood, inflammation is predominately driven by abnormalities in the innate immune system, with IL-1, IL-6, IL-18, neutrophils and macrophages playing a significant role in the disease phenotype. Genome studies have linked HLA-DRB1*11 and systemic JIA.3 A biphasic model of immunopathogenesis in systemic JIA includes an early innate autoinflammatory phase, followed by a chronic adaptive immune response. This would explain the phenotype of initial hyperinflammatory presentation followed by a more chronic arthritic presentation.

Systemic JIA differs from other JIA subtypes by presenting with a multisystem hyperinflammatory phenotype. The ILAR Classification criteria define systemic JIA as arthritis in 1 or more joints with or preceded by a fever of at least two-week duration, documented daily for at least three days, accompanied by one or more of: • Evanescent erythematous rash • Generalised lymphadenopathy • Hepatomegaly and or splenomegaly • Serositis Children usually require hospitalisation for investigation and diagnostic workup, as a fever of unknown origin is often the initial presenting symptom.

Investigations often include a bone marrow sample, echocardiogram, abdominal ultrasound, urinary catecholamines, extensive infectious serology and monitoring of inflammatory markers.

Given the diagnostic challenges, careful history-taking and thorough examination are essential. It is important to note that in some children, arthritis may not be a feature at first presentation. Initially, the child may present with arthralgias, and

arthritis subsequently presents with a median of one month post diagnosis.

The fever is daily and described as quotidian, meaning it is daily, and typically rises above 39 C and falls between fever peaks at least once a day, for at least three consecutive days over two weeks.

The evanescent ‘salmon pink’ macular rash may become more prominent during the febrile period, and may fade significantly or completely between temperature spikes. It is often limited to the trunk and extremities and typically can be found on areas where pressure is applied such as the buttocks if sitting or lying down. It can also be urticarial in appearance as well as occasionally being pruritic.

Any joint may be affected, including small and large joints. Joint involvement is often symmetrical and may be oligo-articular or more likely polyarticular in nature.

Children may not consistently localise to the involved joint.

Therefore, a full MSK examination is required, looking for subtle swelling or joint involvement.

Image 1. Typical macular evanescent rash associated with Systemic JIA

Differential Diagnosis and Investigations Systemic JIA is a diagnosis of exclusion. It is a heterogenous disease with no single specific defining clinical feature or laboratory marker. This can present diagnostic challenges for clinicians. Often children have been admitted to hospital with a pyrexia of unknown origin, and have undergone an extensive workup prior to reaching their diagnosis.

Careful attention is required when attributing symptoms to systemic JIA, as treatment

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Image 1. Typical macular evanescent rash associated with Syste

Image 1. Typical macular evanescent rash associated with Systemic JIA

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Image 2. Fever chart of a childof with a child with Systemic JIA chart 2. Fever Image Systemic JIA

Management of Systemic JIA

for early treatment initiation in the management of children with Macrophage activation order to reduce corticosteroid syndrome refractory systemic JIA and for toxicity and disease complications, those who develop interstitial lung Macrophage activation syndrome aiming to positively influence longdisease. Haematopoietic stem (MAS) is a potentially lifeterm disease course. Agents such cell transplants were previously threatening complication of as Anakinra (recombinant IL-1 used as a treatment option, Systemic JIA. Fulminant MAS receptor inhibitors), Canakinumab they are now rarely used and occurs in 10% of patients with (anti-IL-1beta antibody) and reserved for children with severe, systemic JIA, while up to 30-40% Tocilizumab (IL-6 inhibitor) have refractory disease. may have subclinical MAS. MAS, been developed for use. There is driven by a dysfunctional immune Clinical inactive disease is defined increasing evidence to support system and resultant cytokine as the absence of symptoms and the use of Anakinra as a first line storm, carries a high morbidity and monotherapy agent in children with normal inflammatory markers. systemic JIA, avoiding the use of Remission is defined as six months mortality rate, quoted at between 8-20% in some studies.6 some or any corticosteroids. Early of clinically inactive disease. and prompt initiation of Anakinra Systemic JIA is characterised by Features of MAS include a sepsishas been shown to yield a highly relapsing and remitting flares. For like syndrome with sustained favourable clinical response with most children the fever and rash fever, hepatosplenomegaly, rapid and sustained achievement Treatment aims to remove the inducing stimuli suppress theand hyperinflammatory state. features abate andand subsequently neurological sequelae. of clinical disease remission.5 ainitiation relapsing polyarticular arthritic Neurological symptoms include Early recognition and treatment is key, as late diagnosis is associated with poorer However, due to its relatively remains. Therefore, headache,care irritability, outcomes children.

Children presentation often require admission to the intensive unit and for short half-life,for daily subcutaneous management must be dynamic coma. Laboratory markers injections are management required. aggressive and close monitoring. in response to the patient’s reveal hyperferritinaemia, presentation—stepped up and hypertriglyceridaemia, DMARD agent Methotrexate may down according to their disease coagulopathy, cytopenias and as be used in addition to treat active The mainstay of treatment includes high-dose intravenous corticosteroids and drugs such activity. The ultimate goal of falling inflammatory markers. arthritis. Janus Kinase Inhibitors Anakinra and Ciclosporin, are carefully titrated dependingObtaining on the clinical response. a bone marrow sample may be a promising agent for whichtreatment is drug-free remission.

Management of Systemic JIA

As with other types of JIA, the multidisciplinary team is crucial for patient management. A Paediatric Rheumatologist should manage all patients with systemic JIA. Support from psychology and social work is key for families on their diagnostic journey.

Clinical nurse specialists play a fundamental role in supporting and educating the family on their condition. Physiotherapy and Occupational therapy facilitate early joint mobilisation, rehabilitation and optimisation of musculoskeletal function.

Unlike other forms of JIA, uveitis is less common in systemic JIA, occurring in approximately 2%.4 Children should still undergo routine slit lamp eye examinations and screening.

As with other types of JIA, the multidisciplinary team is crucial for patient management. A Paediatric Rheumatologist should manage all patients with systemic JIA. Support from psychology and social work is key for families on their diagnostic journey. Clinical nurse specialists play a fundamental role in supporting and educating the family on their condition.

Physiotherapy and Occupational therapy facilitate early joint mobilisation, rehabilitation and optimisation of musculoskeletal function. Unlike other forms of JIA, uveitis is less common in systemic JIA, occurring in approximately 2%.(4) Children should still undergo routine slit lamp eye examinations and screening.

The goal of treatment is rapid control of symptoms to prevent disease complications. Initial treatment with glucocorticoid steroids is often required to rapidly turn off the systemic The goal of treatment is rapid and therefore most will require a pulse treatment of inflammatory control of symptoms to process prevent disease complications. Initial will likely this, children Following corticosteroids. rather methylprednisolone Serialthan ferritinoral monitoring is helpful to monitor disease activity and response. treatment with glucocorticoid steroids is often required to rapidly turn off the systemic inflammatory process and therefore most will require a pulse treatment of methylprednisolone rather than oral corticosteroids. Following this, children will likely require a tapering course of oral steroids to establish disease control whilst bridging onto more long-term steroid-sparing biologic and Disease Modifying Antirheumatic Drug (DMARD) agents. The arsenal of treatment options has expanded over the last two decades, as we continue to further understand this systemic condition's pathophysiology. There is a described ‘window of opportunity’

Figure 3. 2016 ACR/EULAR classification criteria for macrophage activation syndrome

Figure 3. 2016 ACR/EULAR classification criteria for macrophage activation syndrome PHARMACYNEWSIRELAND.COM

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Onset JIA

is helpful for diagnostic purposes.

The cytokine storm inhibits bone marrow haematopoiesis and ultimately leads to multi-organ dysfunction. The 2016 ACR/ EULAR diagnostic criteria are described below in Figure 3.(6) Treatment aims to remove the inducing stimuli and suppress the hyperinflammatory state.

Early recognition and treatment initiation is key, as late diagnosis is associated with poorer outcomes for children. Children often require admission to the intensive care unit for aggressive management and close monitoring.

The mainstay of treatment includes high-dose intravenous corticosteroids and drugs such as Anakinra and Ciclosporin, which are carefully titrated depending on the clinical response. Serial ferritin monitoring is helpful to monitor disease activity and response.

Children with systemic JIA may also develop a rare complication known as systemic JIA-associated interstitial lung disease, which carries a high mortality rate.

This is a newly recognised condition and the consensus on its definition, pathogenesis and increasing incidence is not yet fully understood. Reports of lung disease associated with systemic JIA were exceptionally

rare prior 2013, with a sustained increase in cases described in the literature since. Some reports have suggested a temporal association to more widespread use and hypersensitivity response to biologics such as anti-IL-6 agents.7 Typically, children who develop this complication have a history of severe, difficultto-control disease requiring multiple immunosuppressive agents. A complete history and examination for signs and symptoms such as nail bed clubbing is essential at clinical reviews to aid early detection.

Clinical Course The disease course and outcomes of systemic JIA are highly variable, making it challenging to counsel families at diagnosis. However, the majority of children achieve disease remission in the first one to five years.8 Children usually fall into three distinct disease categories.

The first is a monophasic course, in which, following initial presentation, the disease becomes completely quiescent and does not reoccur. Some patients have a polycyclic relapsing remitting presentation with multiple disease reoccurrences with periods of disease inactivity. Despite advances in therapies, some children develop a severe refractory chronic disease course and may

develop destructive arthritis and secondary complications.

JIA is a complex, multifactorial disease, and as research into its immunopathogenesis advances, more targeted therapies are emerging. In the future, novel biomarkers may become available to aid prompt diagnosis. Early recognition of systemic JIA and treatment initiation is key to preventing long-term diseaserelated morbidity.

References 1. Martini A, Ravelli A, Avcin T, Beresford MW, Burgos-Vargas R, Cuttica R, et al. Toward New Classification Criteria for Juvenile Idiopathic Arthritis: First Steps, Pediatric Rheumatology International Trials Organization International Consensus. J Rheumatol. 2019;46(2):190-7.

2. Vastert SJ, Kuis W, Grom AA. Systemic JIA: new developments in the understanding of the pathophysiology and therapy.

Best Pract Res Clin Rheumatol.

2009;23(5):655-64.

3. Foley CM, McKenna D, Gallagher K, McLellan K, Alkhdher H, Lacassagne S, et al. Systemic juvenile idiopathic arthritis: The Great Ormond Street Hospital experience (2005-2021). Front Pediatr.

2023;11:1218312.

4. Heiligenhaus A, Minden K, Föll D, Pleyer U. Uveitis in juvenile idiopathic arthritis. Dtsch Arztebl Int. 2015;112(6):92-100, i.

5. Mastrolia MV, Sarah A-R, Ilaria M, Valerio M, Edoardo M, Ilaria P, et al. Anakinra as first-line monotherapy for new-onset steroid-naïve sJIA patients.

Expert Review of Clinical Immunology. 2024;20(11):1293-5.

6. Ravelli A, Minoia F, Davì S, Horne A, Bovis F, Pistorio A, et al. 2016 Classification Criteria for Macrophage Activation Syndrome Complicating Systemic Juvenile Idiopathic Arthritis: A European League Against Rheumatism/American College of Rheumatology/ Paediatric Rheumatology International Trials Organisation Collaborative Initiative. Arthritis Rheumatol. 2016;68(3):566-76.

7. Schulert GS, Yasin S, Carey B, Chalk C, Do T, Schapiro AH, et al. Systemic Juvenile Idiopathic Arthritis-Associated Lung Disease: Characterization and Risk Factors. Arthritis Rheumatol.

2019;71(11):1943-54.

8. Ter Haar NM, van Dijkhuizen EHP, Swart JF, van RoyenKerkhof A, El Idrissi A, Leek AP, et al. Treatment to Target Using Recombinant Interleukin-1 Receptor Antagonist as First-Line

News

HSE takes next Step to improve Services for Cardiac Rehabilitation Patients Cardiac rehabilitation significantly improves outcomes for patients with established cardiovascular disease, reducing hospital admissions and increasing quality of life.

The HSE Enhanced Community Care Programme has provided significant additional resources to support existing hospital-based cardiac rehabilitation services.

However, a HSE report published today shows further work is needed to continue the progress made so far in improving cardiac patient outcomes and ensure timely access to standardised cardiac rehabilitation services for all patients who need it.

The report ‘Overview of Cardiac Rehabilitation Services in Ireland,’ outlines current services, and identifies areas where additional resources are needed to enhance access to cardiac rehabilitation.

To support the ongoing development of cardiac

rehabilitation services, the report makes several recommendations, including the need: • to prioritise regional cardiac rehabilitation posts across community and hospital services • for dietetic and psychology resources to ensure a highquality, person-centred service • to develop a national, accredited cardiac rehabilitation programme that can be delivered in-person, online, or in a hybrid format to improve accessibility for all eligible patients.

Welcoming the report, Dr Sarah O’Brien, HSE National Clinical Advisor and Group Lead for Chronic Disease, said: “This

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is a significant step forward in advancing cardiac rehabilitation services in Ireland. The report highlights where we need to improve in the design and delivery of cardiac rehabilitation services for both patients and staff. The report makes clear recommendations on the steps that need to be taken to ensure that every patient requiring cardiac rehabilitation will have access to and receive a timely, high quality, person-centred and evidence-based programme, no matter where they live in Ireland.”

Prof J William McEvoy, Chair of the Prevention Sub-Group of the HSE National Heart Programme and Director of the National Institute for Prevention and Cardiovascular

Health, said: “The Overview of Cardiac Rehabilitation Services in Ireland has been developed and refined by a wide range of stakeholders within the Irish healthcare system, and particularly by cardiac rehabilitation staff on the ground who have first-hand knowledge of the challenges involved in delivering cardiac rehabilitation. This report outlines challenges and highlights the gaps which need to be addressed in order to implement the Model of Care and advance integrated cardiac rehabilitation services. I hope this publication will advance improvements in timely access to and consistency of care for patients who require cardiac rehabilitation across the country.”

CPD: AMD Continuing Professional Development

CPD

Written by Lisa McAnena, Ophthalmology Consultant and Ciara O’Byrne, Trainee Mater Hospital, Dublin

Lisa McAnena

60 Second Summary Age-related macular degeneration is one of the leading causes of vision loss in adults, particularly in Europe and other ageing populations, and is reported to affect one in eight people over the age of 60 years. It is estimated to affect 200 million worldwide with this figure predicted to rise closer to 300 million by 2040.

Dry age-related macular degeneration is the most prevalent form. The pathogenesis is multifactorial, involving genetic predispositions, environmental factors, and oxidative stress. It is characterised by a gradual breakdown of the outer retinal layers and retinal pigment epithelium cells.

The wet form of age-related macular degeneration is less common but more severe. It is one of the commonest causes of blindness. It involves choroidal neovascularisation (CNV), where new blood vessels grow from the choroid and penetrate through Bruch’s membrane, often accompanied by a low-grade inflammatory response.

Health professionals can play an important role in the community in supporting these patients. While there is no cure for dry agerelated macular degeneration, certain lifestyle modifications can be made. Smoking cessation is of critical importance in patients with age-related macular degeneration.

At present, there is no definitive treatment to restore vision lost from dry age-related macular degeneration. As discussed, conservative options are critical in the management of these patients such as quitting smoking, healthy diets and specific nutritional supplements.

Pharmacists in Ireland can play a key role in Orbis’ mission to prevent blindness by participating in pharmacy-led donation drives and supporting corporate social responsibility initiatives like the Eye Care for All campaign, which raises funds and awareness for Orbis’ eye care projects in rural Ethiopia.

43

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

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

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

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

3. PLAN - If I have identified a

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

Ciara O’Byrne

4 previous steps, log and record your findings.

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

Age-related Macular Degeneration A review on the condition, its current treatment options and pipeline developments Age-related macular degeneration is one of the leading causes of vision loss in adults, particularly in Europe and other ageing populations, and is reported to affect one in eight people over the age of 60 years. It is estimated to affect 200 million worldwide with this figure predicted to rise closer to 300 million by 2040. At present, there is no cure for age-related macular degeneration and the disease has a massive impact both on individual quality of life but also on healthcare systems worldwide as services attempt to provide the considerable ongoing care that is required. For this reason, age-related macular degeneration represents a major public health concern, and all healthcare professionals should be aware of the symptoms as well as the management recommendations for the disease. Age-related macular degeneration affects the macula, the central part of the retina, which is responsible for sharp and detailed vision. Due to its high metabolic activity, the macula is constantly in need of oxygen and nutrients. As people age, various factors, including genetic predisposition, environmental and lifestyle factors, can lead to age-related macular degeneration.

There are two types of agerelated macular degeneration known as dry and wet. The hallmark symptom of age-related macular degeneration is the loss of central vision, which is crucial for activities such as reading, driving, and recognising faces.

This vision loss can range from mild to severe, depending on the stage of the disease. Blurriness and distortion of straight lines can occur which make everyday tasks challenging. Patients with age-related macular degeneration find it increasingly difficult to see in low-light conditions or at night due to degeneration of the photoreceptors in the retina. In addition to the specific symptoms, patients become more dependent on others for support with daily activities as their vision decreases.

This can lead to significant psychological challenges. The emotional burden is compounded by the fear of complete vision loss, which is a common concern among those diagnosed with agerelated macular degeneration.

Dry age-related macular degeneration Dry age-related macular degeneration is the most prevalent form. The pathogenesis is

multifactorial, involving genetic predispositions, environmental factors, and oxidative stress. It is characterised by a gradual breakdown of the outer retinal layers and retinal pigment epithelium cells. Deposits composed of lipids, proteins and other cellular debris known as drusen accumulate in the space between the retina and the underlying choroid.

Drusen can be seen in early disease but are not necessarily associated with vision loss.

Inflammation plays a significant role, with evidence pointing to the involvement of immune and inflammatory responses in the disease’s progression, Key inflammatory mediators, such as immunoglobulins, complement proteins, and cytokines, have been identified in the retinal pigment epithelium and drusen.

The complement cascade, a part of the innate immune system, is particularly implicated in the development and progression of dry age-related macular degeneration, with several complement proteins being potential therapeutic targets.

The symptoms of dry agerelated macular degeneration develop slowly and often go

44

CPD: AMD

unnoticed in the early stages. These patients may experience mild blurring or distortion of central vision, difficulty adjusting to low-light conditions, and the gradual loss of the ability to recognise fine details. The disease typically progresses over several years, with vision deterioration occurring at different rates in different individuals. A particularly debilitating feature is the development of central scotomas which are blind spots in the centre of vision.

These visual deficits can make activities such as reading or recognising faces difficult.

Wet age-related macular degeneration The wet form of age-related macular degeneration is less common but more severe. It is one of the commonest causes of blindness. It involves choroidal neovascularisation (CNV), where new blood vessels grow from the choroid and penetrate through Bruch’s membrane, often accompanied by a low-grade inflammatory response. These vessels can then proliferate between Bruch’s membrane and the RPE or in the subretinal area. Vascular endothelial growth factor accumulates which, in turn, promotes angiogenesis which further leads to increased vascular permeability. The new blood vessels are fragile and can haemorrhage. They also can leak fluid, proteins and lipids disrupting the normal structure of the retina. There is proliferation of fibrous tissue which can ultimately lead to fibrovascular scar formation with irreversible damage to the neurosensory

retina ultimately leading to rapid and severe vision loss if left untreated.

Community interventions for age-related macular degeneration Health professionals can play an important role in the community in supporting these patients. While there is no cure for dry agerelated macular degeneration, certain lifestyle modifications can be made. Smoking cessation is of critical importance in patients with agerelated macular degeneration. Encouraging patients to quit smoking can help to reduce the risk and severity of disease ultimately prolonging visual function and improving quality of life. Smoking is associated with a higher risk of both early and late stages of age-related macular degeneration with smoking linked to both atrophic and wet types. The risk is particularly high for those with a long history of smoking, measured in pack-years. Individuals with more than 40 pack-years have significantly higher odds of developing age-related macular degeneration compared to non-smokers. It is postulated that smoking may cause damage to the retinal pigment epithelium, leading to mitochondrial DNA damage and increased degradative processes, which contribute to age-related development. A healthy diet rich in fruits and vegetables, particularly leafy green vegetables is important. Certain nutritional supplements have also been examined. The Age-Related Eye Disease Study (AREDS) demonstrated that

certain nutritional supplements, including high doses of antioxidants (vitamin C, vitamin E, and beta-carotene) and zinc, can reduce the risk of progression from intermediate to advanced age-related macular degeneration. Its subsequent follow-up study (AREDS2) showed that the addition of lutein and zeaxanthin, two carotenoids found in the retina, was shown to further reduce the risk of progression, although the strength of evidence in this study was less robust. The impact of moderate and advanced age-related macular degeneration on patients is profound, affecting their quality of life significantly. Community health professionals can inform themselves on local support groups for age-related macular degeneration and direct patients towards them if appropriate.

Patients should also be educated on the importance of regular eye checks and advised to attend for urgent review should they experience any new visual symptoms.

Current treatment options for dry agerelated macular degeneration At present, there is no definitive treatment to restore vision lost from dry age-related macular degeneration. As discussed, conservative options are critical in the management of these patients such as quitting smoking, healthy diets and specific nutritional supplements.

These patients should also be provided with an Amsler grid which is a simple square of horizontal and vertical lines containing a dot in the middle. It is an easy self-monitoring tool to

45 identify changes in the vision, particularly visual distortion or blurred patches. It must be noted, however, that patients should be cautioned that they are not a substitute to regular eye checks and advised to contact their local Eye department urgently should they experience any new vision changes even if this is not reflected on the Amsler grid.

New and emerging treatment options for dry age-related macular degeneration Although there is no current treatment on the market, there are several therapeutic avenues currently under investigation. The complement pathway is implicated in the pathogenesis of age-related macular degeneration.

Therefore, one area of research is in the use of complement pathway inhibitors targeting components of this pathway, such as C1q, C3, and C5. Intravitreal anti-complement factors such as pegcetacoplan and avacincaptad pegol have demonstrated promising results in reducing the growth of geographic atrophy in phase 3 clinical trials. They are reported to slow the development of atrophy by 20% but do not improve functional vision. In addition, there are several side effects to these drugs at present which explains why they have not been further approved for use. Neuroprotective agents and visual cycle modulators are in early phases of research but aim to protect retinal cells from degeneration and modulate the visual cycle to reduce toxic byproducts.

It is proposed that gene and stem cell-based therapy may offer a solution towards repairing or replacing damaged retinal cells, thus providing a more longer-term treatment option.

Laser and surgical options have looked at using implantable devices to alter the retinal environment or provide new structural support to the retina. Photobiomodulation is a novel approach which may be utilised to improve functional outcomes in dry age-related macular degeneration patients by improving visual acuity and contrast sensitivity.

Treatment options for wet age-related macular degeneration The introduction of VEGF inhibitors has revolutionised the treatment of wet agerelated macular degeneration. These drugs work by targeting VEGF to reduce neovascularisation and subsequent macular oedema. The breakthrough in understanding VEGF originated in oncology research, where scientists discovered that tumours rely on VEGF to develop their own blood supply.

The realisation that the same mechanism occurs in the retina led to the development of anti-VEGF treatments, transforming the lives for many patients with age-related macular degeneration.

Prior to the introduction of anti-VEGF treatment, laser photocoagulation was used in the treatment of wet age-related macular degeneration. Laser photocoagulation uses a high-energy laser to destroy abnormal

blood vessels in the retina. It has now been largely replaced by anti-VEGF treatment due to the lower risk of side effects and greater efficacy. Nonetheless, laser photocoagulation treatment may be considered in specific cases if anti-VEGF agents are not an option.

Similarly, photodynamic therapy was previously utilised in the management of wet age-related macular degeneration but is now typically only reserved for specific cases where anti-VEGF therapy is not effective or appropriate. This involves the use of a photosensitive drug, usually verteporfin, which is injected into the bloodstream. The drug circulates through the body and accumulates in the abnormal blood vessels in the eye. A laser is then used to activate the drug, which causes it to destroy the abnormal blood vessels.

Ranibizumab and aflibercept are two common anti-VEGF agents approved for ophthalmic use and have shown comparable clinical efficacy.

Bevacizumab is another anti-VEGF used

commonly in the treatment of wet age-related macular degeneration. It is an off-label drug but is less expensive than the previous two.

The need for frequent intravitreal injections poses a significant treatment burden and financial cost which must be considered when the anti-VEGF agents have similar efficacies.

Patients receiving this treatment typically require regular injections which can follow different regiments, depending on the drug and individual response to treatment, with the treat-and-extend approach showing promising results. In addition to regular injections, these patients also require close follow-up with an ophthalmologist to assess the ongoing effectiveness of the therapy.

New and emerging treatment options for wet age-related macular degeneration While the current treatments for wet agerelated macular degeneration have improved outcomes for many patients, current treatment

46

CPD: AMD

regimens place a significant burden on both the patient and healthcare systems, requiring regular attendances for both injections and reviews. In addition, no treatment at present offers a definitive cure or disease reversal.

Therefore, ongoing research is focused on finding even more effective therapies with several promising areas of investigation. Novel anti-VEGF agents and formulations are being developed to provide more durable effects and reduce the frequency of injections. These include extended-release formulations and gene therapies that aim to sustain drug delivery over longer periods. A new higher-dose version of the anti-VEGF Eylea (Eylea HD) is proposed to last up to 3-4 months compared to the current standard dose. Faricimab (Vabysmo) is an agent that targets both VEGF and the protein angiopoietin-2. This dual action aims to provide a more durable treatment effect by reducing vascular leakage and inflammation, potentially extending the interval between treatments. Clinical trials, such as the TENAYA and LUCERNE studies, have demonstrated that faricimab can maintain efficacy with extended dosing intervals of up to 16 weeks, comparable to aflibercept doses every 8 weeks, while maintaining a good safety profile.

Tyrosine kinase inhibitors prevent tyrosine kinase phosphorylation which are associated with VEGF receptors in the downstream signalling cascade. An agent which combines two different drugs is currently being explored within clinical trials called Sozinibercept. This drug inhibits VEGF-C and VEGF-D which are both mediators of angioegenesis which is observed in age-related macular degeneration.

New delivery systems, such as hydrogels, are being developed to provide sustained release of anti-VEGF agents, potentially reducing the need for frequent injections and minimising side effects. As discussed in relation to dry age-related macular degeneration, the potential of stem cell therapy is being explored for the regeneration of damaged retinal cells with restoration of lost vision. Stem cell therapies, such as human embryonic stem cell-derived retinal pigment epithelium transplants, have shown promise in early trials, providing some functional improvement without adverse effects. Gene therapy involves delivering genes into the retina to correct or replace defective genes or to produce proteins that can help prevent the growth of abnormal blood vessels.

One such approach aims to deliver genes that suppress VEGF production, thereby reducing the formation of new blood vessels. Two phase 3 studies, ATMOSPHERE and ASCENT, are investigating ranibizumab-like proteins via a viral vector as a subretinal injection in comparison to monthly ranibizumab and bimonthly aflibercept with promising results thus far. Suprachoroidal delivery approach is also being evaluated with stable anatomical and visual endpoints at the interim 6-month trial results with a significant reduction in burden of injections. RemeGen provides dual inhibition of VEGF and fibroblast growth factor 2 which due to enter phase 3 trial. The results

so far have shown good tolerability with a favourable safety profile. The authors have reported improvements in visual acuity and anatomical parameters. Tivozanib is a topical anti-VEGF therapy that is currently in a phase 2 trial. It is being compared against aflibercept with the primary outcome reported to be an improvement in best corrected visual acuity by week 44. There are no preliminary results reported to date although it will be interesting to observe the effects of a topical approach.

Reducing treatment burden on both the patient and services remains a major challenge in the management of age-related macular degeneration. The rising prevalence of the condition is placing healthcare systems worldwide under immense pressure to meet the continuous demand. It is hopeful that new extended release strategies and formulations of treatment may help address this issue.

Nonetheless, ensuring the safety and efficacy of new treatments is crucial. While some therapies have shown promise in clinical trials, ongoing research is needed to confirm their long-term benefits and potential side effects, particularly considering many patients will require these agents for long periods of time.

Orbis and Age-Related Macular Degeneration Orbis is a global non-profit dedicated to eliminating avoidable blindness, focusing on the world’s most poverty-stricken regions.

As one of the few international charities specialising in retina care and training, Orbis provides cutting-edge education and support for eye health professionals worldwide.

Through Cybersight, an online training and mentorship platform, Orbis equips eye care professionals—particularly in low-resource areas—with the latest knowledge on AMD and diabetic retinopathy. Cybersight offers: • 1,000+ surgical videos, quizzes, textbooks, and simulation materials in multiple languages.

• 50% of courses available in languages other than English.

• Expert mentorship, connecting professionals with specialists for real-time case consultations.

• 100,000+ registered users (as of 2024), spanning 190+ countries.

Orbis is also at the forefront of AI-driven ophthalmology. Its in-house AI system detects retinal diseases such as AMD and diabetic retinopathy, delivering instant diagnoses within 30 seconds—even in rural areas without ophthalmologists. This technology has received regulatory approval and is enabling earlier interventions worldwide.

Beyond technology, Orbis invests in longterm capacity building, empowering local healthcare providers through retina screening programmes and specialised surgical training.

By bridging knowledge gaps and improving access to early intervention, Orbis is helping to prevent blindness and transform lives in underserved communities.

Conclusion Age-related macular degeneration is a significant cause of visual impairment and blindness. As the global population ages, the prevalence of age-related macular degeneration is predicted to rise, making is a critical public health concern. The pathogenesis of age-related macular degeneration involves a complex interplay of genetic, environmental, and lifestyle factors. The past three decades have witnessed remarkable advancements in ophthalmology, from improved diagnostics using optical coherence tomography to revolutionary treatments such as anti-VEGF injections and gene therapy research.

Research is actively underway to explore and develop new therapies, including regenerative treatments, novel pharmacological agents and potential options for dry age-related macular degeneration. Orbis continues to drive innovation, ensuring that life-changing treatments reach those who need them most, regardless of location or economic status. For patients, annual eye exams remain essential for early detection. For healthcare professionals, staying informed about these breakthroughs ensures that patients receive the best possible care. And for society as a whole, the continued investment in vision research is proving to be one of the most impactful ways to prevent avoidable blindness worldwide.

In conclusion, age-related macular degeneration is a complex, multifactorial disease with significant implications for public health as the global population ages.

While treatments for wet age-related macular degeneration have advanced, the lack of effective therapies for dry age-related macular degeneration and the disease’s overall burden underscore the need for continued research and innovation. Future efforts should focus on personalised medicine, prevention strategies, and improving patient care to mitigate the impact of age-related macular degeneration on individuals and society.

Pharmacists’ Role in Supporting Global Eye Health through Orbis Pharmacists in Ireland can play a key role in Orbis’ mission to prevent blindness by participating in pharmacy-led donation drives and supporting corporate social responsibility initiatives like the Eye Care for All campaign, which raises funds and awareness for Orbis’ eye care projects in rural Ethiopia. They can also contribute by sponsoring training programmes for healthcare workers in underserved areas, advocating for stronger eye health policies, and promoting public awareness about preventable blindness. By leveraging their expertise and community reach, pharmacists can help expand access to essential eye care globally.

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Digital Health

Digital Health for CVD prevention Introduction - The rapid evolution of digital health technologies is revolutionising the management of cardiovascular disease (CVD), providing innovative solutions for primary and secondary prevention of CVD. From telemedicine and wearable devices to artificial intelligence (AI) and big data, digital health is reshaping patient care, enabling early detection, personalised treatment, and improved outcomes.

Written by Professor Lis Neubeck, Head of the Centre for Cardiovascular Health, School of Health and Social Care, Edinburgh Napier University

Understanding Digital Health Digital health encompasses a broad spectrum of technologies designed to enhance healthcare delivery. Key components include telemedicine, remote monitoring, wearable technology, AI, big data analytics, and electronic health records (EHRs).1 These tools facilitate continuous patient engagement, data-driven decision-making, and improved accessibility to care. Wearable devices, such as smartwatches and fitness trackers, have become pivotal in monitoring heart rate, physical activity, and other vital parameters.2 AI-driven models offer predictive insights, improving risk stratification and early disease detection.3 Meanwhile, electronic health records enhance data management, ensuring seamless communication between healthcare providers and with patients.4 CVD Prevention CVD prevention has significantly benefited from digital technologies.

AI-powered risk prediction models help identify individuals at high risk of developing heart disease, allowing for early intervention.3 Wearable devices and mobile health applications can encourage lifestyle modifications by tracking physical activity, dietary habits, and stress levels.5 Persuasive technology can also play a crucial role in behaviour change by employing convincing and effective communication strategies.6 Smartwatches and wearables equipped with photoplethysmography can detect

irregular heart rhythms. prompting users to seek medical attention.

Smartphone cameras7, 8 and voice analysis applications have also emerged as novel diagnostic tools.9 AI-powered algorithms enhance the accuracy of detecting conditions such as atrial fibrillation (AF) by analysing vast amounts of data from wearable devices.10 The widespread adoption of mobile health applications has demonstrated that behaviour change is most effective when applications are user-friendly, engaging, and integrated into daily life.11 Early and accurate diagnosis is critical in managing CVD. AI-assisted interpretation of electrocardiograms (ECGs) and echocardiograms enables clinicians to detect abnormalities with greater accuracy. Machine learning algorithms improve the early detection of arrhythmias, such as AF,12 facilitating timely intervention and reducing the risk of complications. Blood pressure monitors and other smart health tools also contribute to comprehensive cardiovascular assessment.13 Digital health technologies have also improved the management of heart failure through teleconsultations, remote rehabilitation programs, and wearable monitoring devices.14 Patients with heart failure benefit from remote haemodynamic monitoring, which enables early detection of fluid retention and other warning signs.14 Digital scales, wearable sensors, and teleyoga programs contribute to

PHARMACYNEWSIRELAND.COM

holistic disease management, promoting physical activity and overall well-being.15 The integration of AI enhances predictive analytics, allowing clinicians to personalise treatment plans and optimise patient care.3 Telemedicine enables remote consultations, reducing the need for in-person visits while ensuring continuity of care.16 AI-driven decision support systems assist clinicians in making informed treatment decisions based on real-time patient data. Implantable devices, such as implantable cardioverter-defibrillators (ICDs) and pacemakers, are now equipped with remote monitoring capabilities.17 These devices allow healthcare providers to track patient status, adjust therapies as needed, and promptly address any complications. Telemedicine also plays a crucial role in medication adherence, supporting patients in maintaining their prescribed treatment regimens.16 Benefits of Digital Health in CVD The implementation of digital health technologies offers numerous advantages in cardiovascular care. Equitable access to care is one of the most significant benefits, as telemedicine and remote monitoring bridge geographical barriers, ensuring patients in remote areas receive timely medical attention.18 Digital tools empower patients to take an active role in their health, fostering adherence to treatment plans and lifestyle modifications.

Remote monitoring minimises hospital visits and readmissions, resulting in cost savings for healthcare systems. AI-powered predictive models facilitate early diagnosis, reducing the burden of advanced-stage disease and associated complications.

Challenges and Barriers Despite the significant benefits, digital health adoption in CVD management is not without challenges. One of the primary concerns is the increased burden on healthcare providers, as the influx of digital health data requires additional resources for analysis and interpretation.18 The sheer volume of data generated by wearables and remote monitoring devices can overwhelm healthcare

professionals, necessitating efficient data management strategies. The rapid evolution of digital health may result in a more reactive approach rather than proactive prevention efforts.

Questions regarding data storage, ownership, and access remain critical concerns. Ensuring data security and patient confidentiality is paramount, requiring stringent regulatory frameworks.19 Future Recommendations To maximise the potential of digital health in CVD management, several recommendations should be considered. Adopting a patient-centred approach is crucial, as digital health solutions should prioritise patient needs, preferences, and accessibility. Ensuring digital inclusion is essential to bridge the digital divide, making certain that all patients, regardless of socioeconomic status, can benefit from digital health innovations.

Investment in AI-powered decision support should be encouraged to enhance clinical decisionmaking, improving accuracy and efficiency. Strengthening data protection regulations is necessary to safeguard patient data and address privacy concerns.

Encouraging collaboration between healthcare providers, technology developers, and academia will drive innovation and improve healthcare delivery.

Conclusion Digital health is transforming the landscape of cardiovascular disease prevention, diagnosis, and management. From AIdriven risk prediction models to wearable monitoring devices and telemedicine, technological advancements are enhancing patient care, improving accessibility, and reducing healthcare costs.

However, challenges such as data management, privacy concerns, and healthcare provider burden must be addressed to ensure the successful integration of digital health into clinical practice. By adopting a patientcentred approach, fostering collaboration, and investing in AI-powered solutions, the future of cardiovascular care will be more efficient, equitable, and impactful.

References available on request

Awards The Irish Pharmacy

Finalists

2025

Perrigo Superintendent Pharmacist of the Year Award 2025 Stephanie Slevin, Chemist Warehouse, Dublin

Stephanie has always demonstrated exceptional leadership as Superintendent Pharmacist of Chemist Warehouse. Stephanie has fostered a culture of excellence amongst the team at the pharmacy.

She has implemented a comprehensive training programme that not only enhances the skills of the pharmacy team but also promotes a customer-centred approach that reflects their strive for excellence at Chemist Warehouse.

Stephanie has been an exemplary role model in demonstrating an ongoing commitment to learning and professional development. She has encouraged and supported all staff to pursue further training across all members of the pharmacy team from over-the-counter assistants to pharmacists. This engagement in continuous improvement in staff training has resulted in the production of a highly skilled and knowledgeable workforce that can deal with the needs of each and every one of their patients walking through the door.

Michael Maher, Mahers totalhealth Pharmacy, Drogheda 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.

Bernie McLaughlin, Allcare Campile Pharmacy, New Ross Bernie plays a critical role in the overall success of Campile Allcare Pharmacy by demonstrating exceptional leadership and governance skills. She leads by example in ensuring high standards of patient care, regulatory compliance, financial sustainability and operation effectiveness.

She is constantly developing and empowering the team and takes an active role in mentoring the staff. She fosters a learning environment where team members feel supported and encouraged to advance their knowledge and skills and gives opportunities for professional growth. Pharmacy is an essential component of healthcare. It relies on individuals who are not only highly skilled in medication management but also exhibit leadership, vision, and commitment to improving the wellbeing of patients. Bernie, as Superintendent Pharmacist at Campile Allcare Pharmacy is responsible for ensuring the safe and effective use of medications across an entire community of patients.

PHARMACYNEWSIRELAND.COM | 49

Awards The Irish Pharmacy

2025

Finalists

OTC Counter Assistant of the Year Award 2025

Ellen Hardiman, Leo Walsh Pharmacy,Tornog Ellen exemplifies the highest standards of community pharmacy care through her exceptional communication skills, warmth, and dedication to patients. She consistently goes above and beyond her role—seeking feedback, expanding her knowledge, and streamlining pharmacy processes to enhance patient safety and team efficiency.

Whether summarising consultations for pharmacists or offering thoughtful touches like paper and colours for children, Ellen brings compassion, initiative, and professionalism to everything she does.

Her commitment to trust, teamwork, and continuous improvement truly embodies the spirit of community pharmacy.

Margaret O’Neill, Mahers totalhealth Pharmacy, Drogheda Margaret stands out for her personalised, patient-first approach to care. She takes the time to truly listen, ensuring customers understand their medications, feel supported, and are confident in their health decisions. Her follow-ups, thoughtful advice, and knowledgesharing go beyond expectations, creating a welcoming and informed environment.

Remembering customer preferences and offering tailored guidance, Margaret consistently makes people feel valued, empowered, and cared for—making her an exceptional asset to her pharmacy and community.

50 | PHARMACYNEWSIRELAND.COM

Charlotte Carroll, Raheny’s McCartans Pharmacy, Raheny 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 toward 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.

Ashley Gough, McMeels Pharmacy, Skerries With 24 years of public service experience and 8 years in the pharmacy, including 4 as Manager, this nominee brings a wealth of empathy, resilience, and leadership to the role. Her strong foundation in customer care—especially during challenging interactions—is complemented by formal qualifications, including the IPU OTC and Managers courses, and regular skincare training with leading brands. She fosters a collaborative team environment by assigning clear responsibilities, holding monthly meetings for shared input, and leading by example with her own designated area. Known for her open-door policy and commitment to a positive workplace culture, she ensures both operational efficiency and team morale remain high.

Linda Nevin, McCormacks Pharmacy. Dundalk Linda Nevin, General Manager and Principal Counter Assistant at McCormack’s Pharmacy, has dedicated over 11 years to her role, bringing with her a rich background in beauty and fashion sales. She is described as the heart of the pharmacy, known for her unwavering energy, empathy, and commitment to exceptional customer service. Linda treats every customer with kindness and respect, adapting her approach to suit individual needs while staying calm and compassionate, even in challenging situations. Her creative flair shines through in her vibrant seasonal displays, and her remarkable memory fosters deep, personal connections with customers. A highly respected figure in the community, Linda consistently elevates both the pharmacy environment and patient experience.

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Awards The Irish Pharmacy

MGK9299 Haleon Trade Ads.pdf

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10/08/2022

2025

14:58

Finalists

Introducing...

Haleon Self-Care Award 2025 McCabes Pharmacy, Kenmare

McCabes Pharmacy Kenmare are proud to champion self-care and community well-being through meaningful, culturally sensitive, and highly accessible health promotion initiatives.

Nestled in a rural corner of Ireland, serving Kenmare and its surrounding communities, their approach to healthcare is grounded in personal connection, trust, and empowerment. The team firmly believe that pharmacy services should meet people where they are physically, emotionally, and culturally. The core of their mission is simple: to empower individuals to take proactive control of their health.

Haleon, formerly part of GSK

Millmount Pharmacy, Drogheda This pharmacy goes beyond dispensing medication—actively promoting physical, mental, and emotional well-being through community events, provide personalised in-store services, and their team are continually educating themselves in any relevant aspect of the industry that they feel is needed. They are really at the heart of every initiative, building trust with patients and delivering care that truly makes a difference. Since Millmount Pharmacy opened its doors in 2017, it has grown from strength to strength, continually evolving to meet the needs of the community. What started out as a traditional dispensing pharmacy has now grown to offer a full range of health services, including vaccinations, health screenings, and personalised consultations.

Spooners CarePlus Pharmacy,Templelogue 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 self-care 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.

Village Pharmacy, Carlingford Healthcare in Ireland has an increasing and aging population, a growing rate of chronic diseases, and increasing public expectations in the service. This, together with facing financial challenges from the State in healthcare expenditure, the team at Village Pharmacy feel that guidance to their patients, regarding self-care advice and services, are more important now than ever before.

With this in mind, the team at Village Pharmacy place a strong emphasis on promoting their dedicated sports section, alongside the vitamins and well-being departments. Perfectly aligning with the pharmacy’s mission, "It’s All About You," they have launched numerous successful healthcare campaigns centered around their theme in this area "Healthy Body, Healthy Mind.”

52 | PHARMACYNEWSIRELAND.COM

Awards The Irish Pharmacy

Finalists

2025

Excellence in Technology Award 2025 Brogans totalhealth Pharmacy 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.

Adrian Dunne Pharmacy Adrian Dunne Pharmacy Group has embraced digital transformation to meet the needs of today’s fast-paced world, launching a 24/7 online prescription ordering service and introducing real-time patient notifications. These innovations have significantly reduced phone calls and manual handling, allowing staff to focus more on patient care. With further rollout of automated dispensing and SMS updates across the Group, the initiative is driving greater efficiency and improving the overall patient experience.

McCabes Pharmacy Faced with rising locum costs, this pharmacy introduced a streamlined rostering system by integrating an ideal shift pattern with a new scheduling platform. The result was a unified solution that reduced manual planning, freed up team time, and enabled central operations to allocate staff more efficiently. This strategic approach has delivered significant operational efficiencies and substantial payroll savings.

Sarah Kenny, Retail Operations Manager, McCabes Pharmacy

Navi Group Navi Group proudly presents DispenSense, the latest breakthrough in pharmacy technology, designed to revolutionise and simplify the dispensing process and workflow. Emerging from the legacy of the Axium Buying Group that began in 2009, Navi Group has consistently led the charge in introducing innovative IT solutions to the pharmacy market. With DispenSense, the core focus is squarely on simplifying and enhancing the dispensing experience.

The incorporation of state-of-the-art technologies ensures that DispenSense is not just a software solution; it’s a catalyst for positive change and digital transformation within the pharmacy landscape.

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Awards The Irish Pharmacy

2025

Finalists

BOI Payment Acceptance (BOIPA) Innovation & Service Development (Chain) Award 2025 Navi Group DispenSense fits into the current market as a best-in-class PMR system that eliminates the bugbears pharmacies have had with previous dispensary software systems and adds helpful features to make daily life in the pharmacy easier.

DispenSense is the first fully-cloud based PMR product to be launched in the Irish pharmacy market, using the latest software technologies which are future-proofed to address the challenges facing a pharmacist today and into the future, while also offering great flexibility and efficiencies.

It has been designed by pharmacists and technicians with the sole goal of meeting the needs of the current pharmacy industry while also showing real progression in a stagnant market. Setting DispenSense apart is its adeptness at embracing the hybrid nature of modern pharmacy practices, seamlessly handling both Healthmail (the software offers unique Healthmail integration with AI patient matching) and paper prescriptions.

McCabes Pharmacy This project has likely been the largest and most comprehensive rebrand in the history of pharmacy in Ireland and its success is driven by being customer-led and needs based – doing the right thing for the end patient.

Through collaboration across Pharmacy teams, support office, senior leaderships and suppliers McCabes Pharmacy teams have collated and reviewed feedback to deliver a unified and consistent Pharmacy experience that champions best customer service, listening and supporting patients, going the extra mile, treating each customer like a member of their family and the complete solutions to their communities and patients health needs.

Through enthusiasm, dedication and resilience, two pharmacy brands, many pharmacy teams and two support office functions have merged in less than 10 months, identified and launched the best processes and solutions to care for their patients.

Collectively as one team, these entrants have understood their customer needs, reviewed market trends and merged the best of systems, processes as well as investing in new ones so that they could deliver a best-in-class customer experience across all customer touchpoints- both in store and online, and via one single app.

Brogans totalhealth Pharmacy Brogans totalhealth Pharmacy believe innovation is about making real, human-centred improvements that impact patients' lives. In May 2024, they implemented the Yuyama Robot system, a revolutionary step forward for our pharmacy's blister packing service and overall patient care model.

While the technology itself was cutting-edge, what made this project innovative was how they redesigned their service delivery around it. Jack, the late supervising pharmacist and tech visionary, had researched and chosen this solution, understanding it would transform not only workflow but patient outcomes.

The robot allowed the team to personalise medication timings for patients with complex regimes, such as Parkinson's patients requiring six doses a day. This bespoke packaging, complete with specific times on every pouch, restored independence and confidence to the most vulnerable patients.

From left to right, Patricia Sanchez, pharmacist, Amber Staunton, owner, Diana O'Connor, OTC assistant, Lisa Jackson, Supervising pharmacist

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Internally, the innovation transformed our daily operations: blister pack production was consolidated to two days a week, freeing up staff to engage in wider patient services. Stock control improved through software integration, ensuring efficient inventory management and minimizing waste.

Awards The Irish Pharmacy

Finalists

2025

Uniphar LinkUp Consumer Training & Development Award 2025

A DIVISION OF

Adrian Dunne Pharmacy, Rush 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.

Boots Ireland School of Boots Since opening in 2023, Pharmacist Meadhbh Honohan has established Boots Harold’s Cross as a standout centre for learning and development. Through hands-on training, structured mentorship, and personalised coaching, she has supported the growth of 13 Healthcare Assistants and four pharmacists, directly leading to career progression and enhanced clinical skills. Her commitment to lifelong learning—reflected in her own postgraduate studies—feeds into regular knowledge-sharing sessions that elevate team performance. Meadhbh’s leadership has also driven innovation, notably in launching a highimpact flu vaccination programme. The result is a high-performing, motivated team with strong retention and a reputation for excellence in patient care.

Meadhbh Honohan, Boots Pharmacy, Harold’s Cross

Uniphar Learning & Development Rooted in a "patient first" ethos, this pharmacy has built a comprehensive learning ecosystem that enhances colleague skills and drives better patient outcomes. A standout feature is the structured 13-module OTC course, delivered over six months to support gradual, practical learning. Coupled with a redesigned onboarding programme and clear SOP frameworks, the training ensures new and existing staff are equipped to perform with confidence and consistency. With a focus on real-world application, ongoing development, and tailored pathways for specialist roles like technicians, the pharmacy fosters a culture of continuous improvement and professional growth.

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Awards The Irish Pharmacy

2025

Finalists

United Drug Business Development (Independent) Award 2025 Millmount Pharmacy, Drogheda 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.

Reidy’s Pharmacy, Rathcoole Rooted in a strong family tradition of healthcare, this pharmacy has built its success on empathy, adaptability, and a deep commitment to supporting patients at every life stage. Their multigenerational perspective allows them to offer compassionate, tailored care to all— from infants to the elderly. Their ability to evolve with changing times, particularly during the COVID-19 pandemic, highlighted their resilience and dedication, with pharmacists providing round-the-clock support, advice, and vital human connection. This family-led, patient-first ethos continues to drive meaningful growth and enduring community trust.

Ballylinan Pharmacy, Ballylinan Ballylinan Pharmacy, established by Claire Duggan and Fadi Almasri, is a newly launched healthcare facility located in the heart of Ballylinan town. Recognising a critical gap in local health services, Claire and Fadi joined forces to bring accessible, community-focused pharmaceutical care to the residents of Ballylinan and its surrounding areas.

With over 20 years of experience in community pharmacy, Claire—originally from Durrow and now based in Emo—has spent the past five years serving in Stradbally. During this time, she encountered many Ballylinan residents who faced significant travel just to access pharmacy services. Her professional insight and passion for community health, combined with Fadi’s entrepreneurial background, inspired the creation of Ballylinan Pharmacy.

Fadi, a Syrian native living in Portlaoise for the past decade, is also the successful owner of a well-established pharmacy in Ballon, Co. Carlow. He has long seen the need for a pharmacy in Ballylinan and collaborated with Claire to turn this vision into a reality.

Together, they have transformed an existing premises into a modern, welcoming pharmacy complete with a consulting room to facilitate private and clinical services.

Ballylinan Pharmacy represents not just a new business, but a vital addition to the town’s infrastructure—one built on community need, professional dedication, and a shared mission to improve local healthcare access.

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Awards The Irish Pharmacy

Finalists

2025

Clonmel Healthcare Customer Service (3+ Pharmacies) Award 2025

CarePlus Pharmacy Led by Eugene and Roisín Daly, this network of pharmacies redefines customer service through a shared commitment to empathy, innovation, and consistent excellence. Serving communities across Limerick and Tipperary, their patientcentred approach focuses on delivering a gold-standard experience at every touchpoint. By empowering teams with training and support, and embedding a culture of continuous improvement, they go beyond expectations—transforming routine healthcare interactions into personalised, reassuring moments. Their unified vision and measurable impact make them standout.

Allcare Pharmacy 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.

McCauley Pharmacy McCauley stands out through its structured, training-driven approach to consistently high service standards. With quarterly product training, the WHAMM customer engagement framework, and in-store safety reminders, McCauley ensures staff are well-prepared to deliver safe, personalised care. Their unwavering commitment to professionalism, accountability, and adaptability across all locations underpins a strong culture of customer-first service, reflecting the excellence their brand is known for.

Hickeys Pharmacy A consistent leader in customer care, Hickey’s Pharmacy displays excellence in customer service through exceptional service across its network. Achieving a remarkable 90.54% in recent mystery shopping assessments—15 stores scoring 100%—and securing Top 10 positions in the CXi Survey for three consecutive years, Hickey’s demonstrates unwavering dedication to customer experience.

This success is underpinned by robust employee training and a culture deeply rooted in customer-centric values. With a strong focus on empathy, expertise, and continuous improvement, Hickey’s Pharmacy sets a benchmark for excellence in the pharmacy sector.

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Awards The Irish Pharmacy

2025

Finalists

Originalis & Pluripharm Community Pharmacy Technician of the Year Award 2025 Aoibheann Smith, Blackglen Pharmacy, Sandyford

As well as being an exceptional Pharmacy Technician, Aoibheann has become integral to the management of the pharmacy store, presenting to the supervising pharmacist all industry updates and HSE changes. Aoibheann is described as a professional who isn’t just filling time in the pharmacy, but who is building relationships with all patients and customers. The customers of Blackglen Pharmacy trust her with their health and with the health of their families, which speaks volumes in itself.

Anita Waldron, Adrian Dunne Pharmacy, Ashford Anita exemplifies what it means to be an outstanding Pharmacy Technician, particularly as the role has evolved to meet the growing clinical demands of community pharmacy. Adrian Dunne Pharmacy in Ashford offers a range of health services such as vaccinations, health checks, blood pressure monitoring, and the provision of emergency contraception, Anita has been at the forefront of these developments.

She is a true driver of service innovation, constantly seeking out new training opportunities to better serve our community and takes the initiative to share her knowledge with colleagues and consistently promotes health awareness among patients.

Luz Santos, McGreals Pharmacy, Blessington Luz has consistently demonstrated excellence in her role as a Pharmacy Technician. Luz participates in ongoing professional development opportunities, including annual CPR courses, ensuring she remains current with life-saving techniques and adheres to the latest guidelines.

Her commitment to continuous learning and adherence to best practices significantly contribute to the high standards of care provided in McGreals Pharmacy. Luz also plays a pivotal role in mentoring new staff members, sharing her extensive knowledge and experience to help them integrate seamlessly into the team.

Michalina Biskupska, McCabes Pharmacy, Swords Michalina exemplifies everything the community Pharmacy Technician represents: unwavering dedication to patient care, a proactive approach to professional development, outstanding teamwork, and a lasting impact on both pharmacy operations and the wider community.

At the heart of her work is a genuine passion for helping people. Whether working behind the counter or assisting with medication counselling under the pharmacist’s supervision, she consistently demonstrates empathy, patience, and cultural sensitivity; going beyond simply dispensing medications—she ensures that every patient leaves the pharmacy feeling confident, cared for, and supported.

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Ina Marin, Spooners CarePlus Pharmacy,Templelogue Ina Marin is a truly exceptional individual. A highly educated person from Moldova, she came to Ireland with her family and undertook a series of training and development courses to get to the role she’s in today. She is constantly learning and building on her knowledge.

It’s clear that Ina enjoys interacting with customers and sharing her knowledge. Customer in Spooner’s are constantly asking to speak with her at the counter as they know they will get thoughtful, considerate and up to date information on the products offered in the pharmacy. Ina conducts thorough research on produces new to the pharmacy and engages with representatives and online training to ensure she can speak to the benefits of the products. She tailors her advice to individual customer need and they feel heard and cared for.

Ashley Burgess, McCartans Pharmacy, Donaghmede In everything Ash does, she puts patient safety first all the time. In order to maximise safety, me and Ash work very closely to put systems in place which always simplify processes to enable the whole team to succeed with greater accuracy and better information.

Ash has been instrumental in moving the pharmacy to single pack dispensing. She has spent multiple hours taking patients through the journey from 30 packs towards packs in their original state. She will always come at this through the patient safety angle, and always explains the true benefits to the patient and reassures them that we will never compromise their supply, by working closely with the prescribers on the patient’s behalf.

Janet Corish, Allcare Campile Pharmacy, New Ross Janet Corish 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.

Angela Costello, Gleneaston Pharmacy, Leixlip Angela is the longest-serving pharmacy colleague in the Gleneaston Pharmacy team. She is a Leixlip girl and is the fulcrum around which the pharmacy operates. It is a very busy pharmacy and Angela maintains the highest standards every day without exception, leading by example and treating every patient with the care and diligence they deserve. Even when busy, Angela calmly ensures everyone is looked after whether it be a colleague or a patient. She's the person that makes everybody else's day better.

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Awards The Irish Pharmacy

2025

Finalists

McLernons Independent Pharmacy of the Year Award 2025 Reidy’s Pharmacy, Rathcoole Reidy’s Pharmacy Ltd, led by husband and wife team Farouk and Hawwa Kara, has been a pillar of the Rathcoole community since 2001. Originally from South Africa, the couple brought their passion for inclusive, high-quality healthcare to Ireland, building a pharmacy renowned for its personal touch and commitment to community well-being. Their dedication extends beyond dispensing medicine—they actively support local charities such as the Irish Cancer Society and Pieta House through fundraising efforts. With the successful introduction of services like flu vaccinations, Reidy’s Pharmacy has become a trusted, accessible healthcare hub known for going above and beyond for every patient.

Campile Allcare Pharmacy, New Ross Campile Allcare Pharmacy exemplifies outstanding pharmacy practice through its unwavering commitment to patient-centred care. Blending professional expertise with a personal, community-focused approach, the pharmacy delivers tailored healthcare solutions that improve outcomes and quality of life. Services extend beyond dispensing to include holistic consultations, multidisciplinary medication reviews, and a unique integration of pharmaceutical and nutritional care. With a broad range of health services—from vaccinations and smoking cessation to blood pressure monitoring and lifestyle advice—Campile Allcare Pharmacy stands as a model of innovation, compassion, and excellence in community pharmacy.

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North Road Pharmacy, Drogheda 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, patient-focused healthcare provider.

Spooners CarePlus Pharmacy,Templelogue Spooner’s CarePlus Pharmacy, a family-owned business led by Cormac and Eleanor Spooner, delivers a pharmacist-led, patient-first service supported by a highly skilled and adaptable team. With customer care at the core of its mission, the pharmacy is known for its outstanding service, accessibility to expert advice, and commitment to clinical excellence. The team goes above and beyond through proactive advocacy—liaising with GPs, public health services, and consultants to ensure patients receive personalised, optimal care. Trusted deeply by their community, Spooner’s Pharmacy exemplifies what it means to champion patients' health with compassion, professionalism, and dedication.

Leo Walsh Pharmacy,Tornog Since opening its doors in 2020, Leo Walsh Pharmacy in Tornog has steadily established itself as a cornerstone of the local community. Central to this growth and impact is the exceptional contribution of the pharmacy staff, all of whom wear many hats. As an independent pharmacy, the team has worked tirelessly to provide not only essential healthcare services, but also a warm, patient-focused environment where every individual feels genuinely cared for. Despite the modest size, the team functions with remarkable cohesion, flexibility, and mutual support—handling everything from patient consultations and stock management to dispensary support and community outreach.

The team’s shared commitment to continuous learning, collaboration, and community care drives everything they do. Every member supports one another and shares responsibility in delivering a high-quality, safe, and empathetic service. This close-knit approach ensures that patients don’t just receive treatment—they receive trust, consistency, and kindness.

Leo Walsh Pharmacy represents the very best of independent pharmacy: a passionate team, working together with integrity and heart, to serve their community every single day.

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Awards The Irish Pharmacy

2025

Finalists

PKF Brenson Lawlor Young Community Pharmacist of the Year 2025

Natasha Benjamin-Payne, McCabes Pharmacy, Kinsale Natasha has made a remarkable impact early in her career through her dedication to patients, leadership within the team, and commitment to community health. She consistently takes time to ensure patients understand their medications, putting even the most anxious individuals at ease — especially older patients and families with sick children.

She’s improved the pharmacy’s workflow by reorganizing the dispensary on her day off, showing initiative and care for her team. Natasha also mentors trainee technicians and supports her colleagues with calm professionalism, no matter how busy the day.

Beyond the pharmacy, she volunteers to administer vaccines in local schools, reflecting her passion for public health. Natasha’s compassion, leadership, and maturity have made her an invaluable member of the team and a trusted figure in the community.

Grace Hegarty, Chemist Warehouse, Dublin Despite being in the early stages of her career, Grace has made a significant and lasting impact in her role as a pharmacist. From the day she registered as a pharmacist, she demonstrated not only capabilities beyond her years, but also a natural ability to lead, connect and drive positive change within the field. One of her most notable contributions was helping to establish and grow a brand-new pharmacy store – Chemist Warehouse Talbot Street and train a whole new team of staff – an impressive achievement for someone newly qualified. Grace has been instrumental in driving meaningful improvements to the services provided in the Pharmacy.

Michaela Donovan, McCauley Pharmacy, Midleton Michaela is a highly dedicated and skilled young pharmacist who has already made significant contributions to her community and profession. Her patient-centric approach and enthusiasm for expanding the role of community pharmacists are admirable qualities.

Her commitment to ongoing learning and development, as well as her willingness to share her experiences and support the next generation of pharmacists, are further indications of her leadership potential.

Michaela has already demonstrated strong leadership skills, particularly in her ability to develop and execute plans.

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Meadhbh Honohan, Boots Pharmacy, Harold’s Cross 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.

Joe White, Park CarePlus Pharmacy, Cabinteely Joe White has made a remarkable impact early in his career as a pharmacist, distinguishing himself through his dedication to his patients, his innovative contributions to pharmacy services, and his drive to improve healthcare delivery. His leadership, compassion, and forward-thinking approach have allowed him to influence patient outcomes. From the outset of his career, Joe demonstrated a strong commitment to enhancing patient care.

Beyond direct patient care, Joe expanded the scope of pharmacy services at Park CarePlus Pharmacy, Cabinteely. He was instrumental in the development and launch of a pharmacist-led vaccination clinic. Understanding the critical need for accessible immunisation services. Under his leadership, the pharmacy provided flu, COVID-19, and shingles vaccines.

Conor Sweeney, Adrian Dunne Pharmacy,Trim Conor has had a hugely positive impact since joining the team back 2023. Adrian Dunne, Trim is a busy rural community pharmacy, where many of the customers are loyal, so change is a big deal to them. Conor quickly connected and forged relationships with them all. From young to old, male and female, Conor has a talent in dealing with people. He makes them feel at ease and he makes them feel like they are listened to and he genuinely cares. He also excels with his management skills. Every morning he provides his team with clear goals and expectations of the day. He is calm, methodical and very approachable by all, which is really important in community pharmacy, as his role is very demanding.

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Awards The Irish Pharmacy

2025

Finalists

Reckitt Community Pharmacist of the Year Award 2025 Dan Whelan, 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.

Gillian Robinson, Hickeys Pharmacy, Gorey Gillian Robinson is a dedicated and highly skilled pharmacist whose expertise in women’s health, vaccination, and education sets her apart as a leader in the field. With a wealth of knowledge in women’s health, Gillian has been a trusted resource for patients, providing essential guidance on medications, reproductive health, and overall well-being. Her commitment to patient education ensures that individuals feel informed and empowered in their healthcare decisions.

Beyond her direct patient care, Gillian is also an exceptional teacher and mentor. Whether training pharmacy students, guiding colleagues, or conducting educational sessions, she consistently shares her knowledge and passion for the profession.

Tomás Conefrey, Conefrey’s CarePlus Pharmacy, Dublin Tomás has significantly broadened the range of services at Conefrey’s CarePlus Pharmacy to meet the evolving needs of his customers while incorporating sustainable practices. The introduction of advanced services like vaccinations, 24-hour blood pressure monitoring, and online emergency contraception reflects his commitment to professional growth. Additionally, Tomás emphasises sustainability by sourcing environmentally friendly products and encouraging customers to adopt greener health and wellness choices.

Tomás unwavering connection to the Pearse Street and docklands community highlights his dedication to professional excellence and sustainability. Although he resides in Bray, Tomás remains deeply involved in the local area where his family has been a trusted presence for generations. The pharmacy serves as a vital resource for the community, fostering long-term relationships with customers and contributing to the community's overall well-being, in some cases, Tomás has treated four generations of a family in the pharmacy.

Kevin McDonnell, Allcare Pharmacy,Tonglee Kevin has demonstrated outstanding leadership and innovation in enhancing pharmacy services and patient care. Recognising the evolving needs of the community, Kevin has implemented digital medication management system that integrates with patients' mobile devices. This platform not only sends automated reminders for medication adherence but also allows two-way communication for queries, and prescription reorders This has significantly reduced waiting times in the pharmacy setting – having bigger Prescriptions ready in advance saving patient time and also improving accuracy.

What truly sets this pharmacist apart is their dedication to holistic community health. Beyond technology, Kevin uses supports in place to help with , smoking cessation, and lifestyle diseases.

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Dearbhla Walsh, Allcare Campile Pharmacy, New Ross As a pharmacist with 15 years community experience, Dearbhla has always strived to go above and beyond for her patients. One particular patient was a young girl diagnosed with breast cancer. She was in early 30’s and her mum had passed away from the same cancer a year before. Having all the staff of the pharmacy aware of the situation meant everyone could give her the best care. If that meant spending a little more time listening to her concerns and counselling her, they did.

Being a leader is an important skill to develop as a pharmacist. Dearbhla’s role extends beyond just dispensing medications, in the community setting it involves influencing patient outcomes. She advises patients on a daily based about how to take their medicines for example. Dearbhla believes it is also important for pharmacists to use their leadership and collaboration skills reach out to the wider community to improve patient outcomes

Ana Romero, Adrian Dunne Pharmacy, Balbriggan Ana has gone above and beyond in her role as a community pharmacist, consistently demonstrating leadership, compassion, and an unwavering commitment to patient care. Ana joined Adrian Dunne Pharmacy Group 7 years ago and during this time her work exemplifies the evolution of the pharmacy profession into a cornerstone of accessible healthcare within the community. Ana’s dedication was truly life-saving when, in December, a gentleman suffered a heart attack at the post office next door. Without hesitation, Ana sprang into action, using a defibrillator to deliver life-saving treatment. Two local men assisted with chest compressions until paramedics arrived. Thanks to their quick intervention, the gentleman made a remarkable recovery—and recently returned to the pharmacy to personally thank Ana for saving his life. This act of bravery is a testament to Ana’s skill, composure, and commitment to her community. Ana also fosters strong, personal connections with her patients and the broader community.

Mark Beddis, McCartans Pharmacy, Donaghmede Mark, with over 30 years of experience in community pharmacy, exemplifies what it means to go above and beyond in patient care. He is driven by a deeply held belief: “A good pharmacist is a knowledgeable pharmacist, thinking fast and considering every alternative—but a great pharmacist is somebody who truly cares about the patient.” And Mark lives this philosophy every single day.

In McCartan’s Pharmacy Donaghmede—a large and busy pharmacy—Mark is a cornerstone. He never stands still. Whether it’s obvious or not, there’s always something to be done, and he’s the first to step in and do it. He constantly scans for ways to improve the pharmacy’s flow, anticipate patients’ needs, and create a calm, welcoming space for those who enter.

Mark goes further than anyone for his patients—following up with GPs to resolve queries, ensuring the pharmacy is stocked during nationwide shortages, and personally reassuring patients that if they can’t find something in elsewhere Dublin, it’s likely to be available at McCartan’s because he’s already thought ahead. This commitment has earned the trust of the entire community.

Laura Gilmartin, North Road Pharmacy, Drogheda As a highly respected pharmacist, Laura’s success stems from her patient-centred and initiative-taking approach. She has found a critical gap in local healthcare access and successfully introduced 24-hour blood pressure monitoring across all stores. With GP waiting times often exceeding three months, Laura’s initiative has enabled us to provide this service from just 48 hours, improving access and convenience for patients.

Laura prides herself in delivering and ensuring best practice in pharmacy by prioritising patient welfare.

Patient safety is the number one priority, and she has implemented changes along the way in the dispensing process to ensure that mistakes and errors are minimised. Her structured approach to all work practices ensure adherence to all standard operating procedures.

Laura’s professionalism and ongoing awareness of changes in pharmacy, including changing legislation, code of conduct, drug shortages, price changes and upcoming de-regulation of drugs is unparalleled.

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Awards The Irish Pharmacy

2025

Finalists

Athlone Pharmaceuticals Community Pharmacy Team of the Year Award 2025 Adrian Dunne Pharmacy,Trim 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.

Mahers totalhealth Pharmacy, Drogheda Led by Superintendent Pharmacist Michael Maher, Manager Margaret O’Neill, and Pharmaceutical Assistant Caroline O'Donnell, this team exemplifies collaboration, innovation, and a steadfast commitment to patient-centred care. Through regular team meetings, shared problem-solving, and open communication, they ensure seamless, high-quality service across all touchpoints—from personalised consultations to robotic dispensing and HealthMail efficiency. Their integrated approach to care includes community outreach, clinic-based services, and proactive medication management. Built on mutual respect, trust, and a passion for excellence, this cohesive team consistently goes above and beyond to exceed patient expectations.

North Road Pharmacy, Drogheda The North Road Pharmacy team, made up of 9 dedicated individuals, exemplifies collaboration, innovation, and community impact. Operating both in-store and through their website youpharmacy.com, the team works seamlessly across departments to deliver outstanding care and customer service. Their "Healthy Body, Healthy Mind" initiative and the creation of North Sports reflect a proactive approach to health and wellness. Through regular brainstorming and exceptional teamwork, they've introduced new services, hosted community events, and secured premium brand partnerships like Clarins. Their unity, creativity, and commitment to staying current make them a standout, deserving Team of the Year.

Bhagwans Pharmacy at Meaghers, Dublin Bhagwans Pharmacy stands out for its uniquely collaborative team structure, where traditional boundaries between dispensary, front-of-shop, pharmacists, and technicians are intentionally blurred. This integrated approach fosters versatility, mutual respect, and shared responsibility, allowing staff to support one another and adapt quickly to challenges like staff shortages. By encouraging all team members to engage in a variety of tasks, the pharmacy ensures continuity, enhances customer service, and creates a dynamic, inclusive work environment. Their model promotes both operational efficiency and a stronger connection with customers, making them a standout team.

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Kelly’s Pharmacy, Clondalkin The team at Kelly’s Pharmacy exemplifies compassionate, collaborative care rooted in a deep understanding of each patient’s needs. Led by pharmacist Louise, the team combines expert clinical support with outstanding front-of-store service, ensuring a warm and professional environment for all. With open communication, regular team meetings, and a strong focus on continuous professional development, they deliver patient-centred care across all services—from complex prescriptions to vaccinations. United by a shared passion for community health, Kelly’s Pharmacy stands out as a trusted healthcare partner.

Ryans Pharmacy, Edenderry This pharmacy team has successfully redefined its identity as a destination gift and beauty store while preserving its exceptional standard of care. Their commitment goes beyond dispensing—it’s about fostering lasting relationships, offering expert advice, and creating a welcoming environment. Through strong community involvement, standout customer service, and deep product knowledge, the team continues to make a meaningful impact on patient health and local engagement, making them a worthy finalist for the Athlone Pharmaceuticals Community Pharmacy Team of the Year Award 2025.

Hickeys Pharmacy, Finglass Finglas Main Street Pharmacy is a small but high-performing team known for its unique culture, collaborative mindset, and patient-first approach.

With a blend of energy types and cross-trained staff, the team works synergistically to deliver exceptional service, where every member supports one another and steps up when needed. Daily goal-setting meetings and constant, clear communication ensure smooth operations and minimal errors. By embracing technology such as the Ready to Collect system and investing in both internal and external training, the team continuously evolves to meet patient needs. Their dedication was recognised in 2022 with the Uniphar Customer Experience Award, highlighting their excellence in community pharmacy care.

Boots Pharmacy, Waterford The Boots Waterford team, led by Supervising Pharmacist Emmet, delivers outstanding, patient-centred care through seamless collaboration and a strong focus on development. With a blend of experience—like Maria’s long-standing service since 1999—and emerging talent, the team fosters a culture of continuous learning and adaptability. Their holistic approach extends beyond the counter, highlighted by a highly successful vaccination campaign and proactive patient outreach. With a foundation of mutual support, skill-sharing, and open communication, the team consistently earns high praise and trust from their community, exemplifying excellence in pharmacy practice.

PHARMACYNEWSIRELAND.COM | 67

Topic Team Training – Fungal Foot Infections 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. resulting in a portal for infection that can escalate to cellulitis. In warm weather, feet tend to sweat more, and such conditions as tinea pedis can be exacerbated.

Symptoms of Athlete’s foot include: • An itchy, red rash, which often starts in between the 4th and 5th toes, before spreading to the other toes.

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 Funga Infections.

Fungal nail and skin infections can present with various symptoms.

Athlete’s foot, a common fungal infection that usually develops between the toes, most commonly affects teenagers and young adults. The infection usually clears up within days or weeks with antifungal treatment. Customers can choose between fungicidal products that kill the fungus e.g.

Lamisil, and fungistatic products, which slow down its growth until it stops. Fungicidal products generally require shorter treatment times compared to fungistatics.

Athlete’s foot is highly infectious, as the fungi multiply quickly in warm and humid environments, such as swimming pools, showers and changing rooms. Good foot hygiene can help to reduce the spread of an infection and involves drying the feet thoroughly, particularly between the toes, wearing clean cotton socks, rotating footwear and avoiding walking barefoot in changing rooms.

Tines pedis can present with red, sweaty, hot, and itchy feet. It is very common during the warmer months and can be accompanied by small red pustules on certain areas of the foot. It can be seen interdigitally and underneath the arch profile on the plantar aspect of the foot. The risk of leaving tinea pedis untreated is that small tears in the skin epidermis form,

• Scaling or cracking of the skin may occur.

• Blisters can occur. If these burst, they can cause pain & swelling.

Unfortunately, fungal toenails are notoriously common, and the patients coming in to see pharmacists are getting younger.

Fungal nail infections can make the nail: • thicker • change colour • brittle • painful Fungal nail infections sometimes start at the edges of the nail.

The infection often spreads to the middle of the nail. The nail becomes yellow and can lift off.

The nail may become brittle and pieces can break off. It sometimes causes pain and swelling around the nail.

Often the infection is just in one nail but several may be affected.

It is usually painless. The most common symptoms are: • Thickened nail.

• Discoloured nail (often a yellowish colour).

Commonly, this is all that occurs and fungal nail infections often cause no other symptoms. The main reason people see their doctor is because the appearance is unsightly.

Sometimes the infection becomes worse and additional symptoms occur. These include:

Consider: Those most likely to suffer from athlete’s foot and fungal foot infections  Conditions which may lead to fungal infections  The signs and symptoms of athlete’s foot and fungal foot infections  Any follow-up actions that may be required

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• The nail becoming soft and crumbling.

• White or yellow patches appearing where the nail has come away from the skin.

• The skin next to the nail becoming inflamed or scaly.

Sometimes the whole nail comes away. If left untreated, the infection may eventually destroy the nail and the nail bed, and may become painful. Walking may become uncomfortable if a toenail is affected.

Between 3 and 8 out of 100 people will develop a fungal nail infection (Onychomycosis) at some stage of their lives. Toenails are more commonly affected than fingernails. It is more common in people aged over 60 and in younger people who share communal showers, such as swimmers or athletes.

What causes fungal nail infections?

• Spread from a fungal skin infection. For example, athlete's foot (tinea pedis) is a fungal skin infection of the toes. This may spread to the toenails if the skin infection is not treated early.

• Fingernail infection may occur after a toenail infection has become established. The fungus may spread to a finger after scratching itchy toes and toenails.

• Fingernail infections are also more likely to occur in someone who washes their hands frequently or has them in water a lot, for example, cooks or cleaners. Constant washing may damage the protective skin at the base of the nail. This may allow fungi to enter.

Key Points: Check your pharmacy team are aware and understand the following key points:  Are able to recognise the signs and symptoms of athlete’s foot and fungal nail infections

• A nail that has recently been damaged is also more likely to become infected.

• There is an increased risk of developing a fungal nail infection with various other conditions for example: o Diabetes. o Psoriasis. o Poor circulation. o A weakened immune system (for example, if you have AIDS or are on chemotherapy). o A general poor state of health such as heavy alcohol consumption.

• Nail infections are more common in people who live in hot or humid climates.

• Smoking also increases the risk of developing a nail infection.

• In some cases there is no apparent reason. Fungal germs are common and an infection can occur 'out of the blue'.

Fungal nail infection diagnosis Other nail conditions can sometimes look like a fungal infection (typically "trauma" to the nails from shoes). Therefore, to confirm the diagnosis, a doctor will usually request that a nail clipping is sent to the laboratory for testing.

Actions:  Ensure efficient sign posting to discreet consultation areas within the pharmacy for further help and advice  Educate staff on being able to identify the presenting features of some common fungal infections of the feet  Ensure that I know the recommendations for OTC treatments  Educate the team to advise patients on the use of these treatments  Ensure pharmacy staff are able to explain management options and possible complications

 Be aware of the OTC treatment options available

 Be familiar with when to not treat fungal infections OTC

 Know when to refer and spot red flags

 Train the team to meet all the above considerations

Treat Athlete’s Foot with just one application

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Enhances Terbinafine penetration by 2.5 times***

To maximise treatment outcome remind your customers to: Apply LAMISIL ONCE to both feet Spread evenly on toes, sole and sides of feet

13 Days

Creates a reservoir that prolongs the fungicidal effect of Terbinafine for up to 13 days**

Do not massage or rub Do not wash feet for 24 hours

Helps to kill the fungus* Helps soothe symptoms* Helps prevent recurrence* Lamisil is a medicine containing Terbinafine Hydrochloride. Always recommend reading the individual product leaflet before use. Lamisil ONCE is suitable for 18+ years. *Ortonne, J P et al. “Efficacy and safety of a new single-dose terbinafine 1% formulation in patients with tinea pedis (athlete's foot): a randomized, double-blind, placebo-controlled study.” Journal of the European Academy of Dermatology and Venereology : JEADV vol. 20,10 (2006): 1307-13. doi:10.1111/j.1468-3083.2006.01807. Epub 2007 Apr 27. PMID: 17559730. **Kienzler, J-L et al. “Stratum corneum pharmacokinetics of the anti-fungal drug, terbinafine, in a novel topical formulation, for single-dose application in dermatophytoses.”

Current medical research and opinion vol. 23,6 (2007): 1293-302. Doi:10.1185/030079907X199664. *** Compared to Lamisil cream.

Lamisil® OnceTM 1% cutaneous solution is a pharmacy only product. Marketing Authorisation Number: PL 50567/0016. Distributed in Ireland by Ocean Healthcare. Date of preparation: April 2025. For more information visit www.lamisil.ie

01 296 8080 orders@oceanhealthcare.ie www.oceanhealthcare.ie

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Stroke

Young Stroke Mechanisms Written by Dr Johann Leunbach, Dr Shameer Rafee and Professor Niall Tubridy Dr Johann Leunbach

Strokes are a major cause of disability. “Young strokes” (strokes in people under the age of 50) have been increasing worldwide. Stroke and TIA (transient ischaemic attack) symptoms can be variable; any individual presenting with sudden onset focal neurological deficit(s) should be evaluated for a neurovascular cause.

Young strokes were thought to be due to rare aetiologies, but classic risk factors such as atherosclerosis, hypertension and diabetes mellitus, remain important. All strokes should be assessed with a similar methodical approach, although there are some differences in young stroke mechanisms that clinicians should bear in mind. The TOAST criteria provide a useful classification system of stroke mechanisms (Table 1). Targeted investigations and management can illuminate underlying causes and reduce risk of recurrence.

TOAST criteria Large vessel occlusion (LVO) Small vessel occlusion (SVO) Cardioembolic (CE) Stroke of determined source (SDS) Cryptogenic stroke (CS) TABLE 1- TOAST criteria.

TOAST= Trial of ORG 10172 in Acute Stroke Treatment

LVO is largely a reflection of accumulated cardiovascular risk factors over time and includes intracranial and extracranial stenoses. It accounts for 1020% of all strokes; a figure that is probably higher in certain ethnicities (e.g., Asian/ black cohorts). Prevalences in young strokes are variable. One study, which included patients up to the age of 55 years, suggested that up to 18% of ischaemic strokes/ TIAs are due to LVO. However, this was mostly confined to patients over 45 years. Vascular imaging with CT/MR angiography is an important part of stroke workup.

Carotid doppler ultrasound is frequently used, particularly in patients who do not meet criteria for thrombolysis or thrombectomy.

Carotid doppler will not capture intracranial LVO but may be sufficient in some clinical contexts.

SVO leading to stroke is rare in the younger cohort with prevalence increasing from the age of 40. This stroke mechanism is strongly linked to traditional cardiovascular risk factors. Lacunar strokes (small, subcortical infarcts), due to occlusion of penetrating arteries, define strokes from SVO. Certain stroke patterns are associated with lacunar infarcts including pure motor or sensory deficits, ataxic hemiparesis or mixed sensorimotor symptoms.

CE stroke accounts for upwards of 45% of young strokes. CE strokes can occur due to atrial fibrillation (most common), cardiomyopathy, valvular disease, cardiac thrombus and infective endocarditis causing septic emboli. Patent foramen ovale (PFO) is a common cardiac malformation and an important consideration in patients labelled as cryptogenic. All stroke patients should have an ECG. Telemetry is recommended to assess for paroxysmal arrhythmias.

In some cases, prolonged cardiac monitoring, with a Holter monitor or a loop recorder, may be necessary to identify atrial fibrillation. Cardiac imaging is also required- transthoracic echocardiograms are usually readily available and, with bubble studies, may be able to

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detect PFOs. The presence of a PFO does not indicate that it’s causative, as PFOs can be seen in up to 25% of the general population. Transoesophageal echocardiograms provide a more detailed assessment of PFO size and information on high-risk features e.g., aneurysmal/mobile septum and volume of bubbles being shunted. As PFOs are so common, it is crucial to carefully evaluate its role in stroke before considering interventions such as closure. Tools such as the RoPE (Risk of Paradoxical Embolism) score can help clinicians assess the likelihood of a PFO being the underlying cause.

SDS account for 20-30% of young strokes. Cervical artery dissection (CAD) involving carotid or vertebral arteries is the most common.

Presentation can be variable.

Historical and examination clues like neck trauma or manipulation, headache, tinnitus and presence of Horner’s syndrome can suggest CAD. CAD can be asymptomatic and an incidental finding on imaging. Strokes from CAD can occur many days after the initial injury. CT or MR angiography are first line investigations when dissection is suspected.

Connective tissue disorders can predispose to CAD but patients typically present with other features like poor wound healing or recurrent joint dislocations.

Antiphospholipid syndrome and other hypercoagulable states (e.g., active malignancy), inflammatory syndromes, iatrogenic injuries, drug use, hypoperfusion and genetic conditions all fall under SDS. Genetic conditions that predispose to small vessel disease are still classified as SDS e.g., CADASIL (cerebral autosomal arteriopathy with subcortical infarcts and leukoencephalopathy) and CARASIL (cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy).

CS accounts for 25% of all young strokes. CS is a diagnosis of exclusion, and a detailed series of investigations are warranted.

Risks of recurrence are variable, but some studies suggest that early recurrence could be as high as 6%. An important factor in CS is the advanced methodology for investigating potential causes: high definition MRI and angiography,

TOE and laboratory investigations for autoimmune and inflammatory causes for stroke. A significant proportion of CS are thought to be cardioembolic in origin and these patients should be considered for long term implanted rhythm monitoring (loop recorder). These patients may show evidence of intracranial atherosclerosis. Even mildly stenotic vessels can harbour unstable plaques, although identifying and treating these can be challenging. Transitory causes of CS exist that can be difficult to diagnose e.g., dissected vessels can heal quickly and appear normal on vessel imaging, despite being causative for stroke.

Cancer is an important cause of coagulopathy and patients with CS can have occult malignancies.

Appropriately, a very high threshold is needed for diagnosis of CS. Stroke in the young person is associated with significant long-term morbidity and increased mortality. It also has an outsized economic impact, as it disables victims during their most productive years.

Preventing stroke in both primary and secondary settings should focus on modifiable risk factors such as smoking, hypertension, diabetes and obesity. While initial assessment of the stroke victim remains the same whether young or old, the treating clinician should bear in mind that stroke mechanisms differ and treatments should reflect this. Tailoring further investigations and treatment may identify pathology that would otherwise have been missed.

References 1. Smajlović D. Strokes in young adults: epidemiology and prevention. Vasc Health Risk Manag. 2015 Feb 24;11:157-64. doi: 10.2147/VHRM.S53203.

2. Putaala J, Martinez-Majander N, Saeed S, et al. Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Triggers, Causes, and Outcome (SECRETO): Rationale and design. Eur Stroke J. 2017 Jun;2(2):116-125. doi: 10.1177/2396987317703210.

3. Kim J. Griffin, MD, William S. Harmsen, MS, Jay Mandrekar, et al. AHA Journals. 2014 Jan https://doi.org/10.1161/ STROKEAHA.123.043647

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News

Ocean Healthcare Empowers Pharmacies As part of their nationwide Skincare Campaign, Ocean Healthcare has been actively supporting pharmacies throughout the Republic of Ireland, delivering in-depth training sessions focused on two of their most trusted skincare brands: E45 and Bio-Oil. These interactive sessions, led by experienced Sales Representatives, offered pharmacy teams expert knowledge on product usage, skincare best practices, and tailored advice for addressing specific patient concerns.

The initiative not only deepened product understanding but also reinforced the vital role pharmacy staff play in frontline skincare support. Teams responded with enthusiasm, highlighting the relevance and practical value of the content. To recognise this commitment, Ocean Healthcare awarded certificates of completion to all participants, celebrating their dedication to patient care and continued professional development.

Running through March and April, the campaign successfully empowered pharmacy staff to offer confident, informed skincare recommendations, ultimately enhancing patient trust and outcomes. Ocean Healthcare remains committed to supporting pharmacy teams with ongoing education and resources that elevate everyday care.

Pharmacy staff featured from (clockwise) McCabes Pharmacy, Baltinglass Kelly's Pharmacy Carlow

For more information about Ocean Healthcare’s brands and resources, please contact info@oceanhealthcare.ie or call 01 296 8080

Walsh’s Pharmacy, Oranmore Lavelle’s Pharmacy, Belmullet

New Findings by RCSI on Bleeding Disorders New research by RCSI University of Medicine and Health Sciences has identified a previously unrecognised subgroup of patients with von Willebrand disease, the most common inherited bleeding disorder. These findings challenge current diagnostic practices and highlight a need to adapt clinical guidelines to ensure patient safety.

Von Willebrand disease affects as many as 1-in-1000 individuals and is caused by a deficiency or dysfunction of von Willebrand factor (VWF), a protein that helps form blood clots. Patients are usually diagnosed based on reduced levels of VWF or severe functional defects of VWF in the blood.

However, this study demonstrated how a subset of patients had normal quantities of VWF in the blood but still exhibited bleeding symptoms due to mild functional defects in the protein.

“Our results demonstrated that nearly half of patients with

‘low VWF’ in reality had mild functional defects of VWF instead of reductions in the amount of VWF. These patients would have been missed if functional VWF assays were not performed,” said Professor James O’Donnell, Professor of Vascular Biology at RCSI’s School of Pharmacy and Biomolecular Sciences and Director of the Irish Centre for Vascular Biology at RCSI. “By acknowledging these patients as a distinct clinical subgroup, we can improve their quality of life and ensure they receive appropriate care,” he added.

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Official recognition of this subgroup within international guidelines and hospitals, as recommended by the researchers, would enable better management of bleeding symptoms and efforts to prevent bleeding during highrisk situations, such as during surgery and childbirth.

“This discovery adds to the growing understanding that von Willebrand disease encompasses a spectrum of defects of VWF,” said Opens in new windowDr Ferdows Atiq, Senior Research Fellow, RCSI School of Pharmacy

and Biomolecular Sciences and lead author of the study. “Since we have found that the mild functional defects in VWF were not explained by genetic changes, future research is required to investigate the biological mechanisms of this phenomenon.”

The study examined over 400 patients from both Irish and Dutch cohorts. It was carried out by RCSI in collaboration with the National Coagulation Centre in St James’s Hospital, Dublin and Erasmus University Medical Centre, Rotterdam, The Netherlands.

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Diabetes

Understanding Diabetes: Type 1 vs Type 2 Diagnosis and Treatment Written by Professor Derek O’Keeffe, Consultant Physician/ Professor of Medical Device Technology, University Hospital Galway, Ireland/Digital Health Principal Investigator, CURAM Research Ireland Centre for Medical Devices, Ireland, National Clinical Lead Diabetes, HSE. Dr Lyle McVicker, University Hospital Galway, Endocrinology SPR, Research Physician, University Hospital Galway - As endocrinologists, we frequently encounter diagnostic challenges when differentiating between diabetes types. While both Type 1 and Type 2 diabetes share hyperglycaemia as their hallmark, their underlying pathophysiology, management approaches, and progression significantly differ. This article aims to provide hospital practitioners with practical knowledge on diagnosing diabetes, distinguishing between its main types and effectively managing them. within the diabetic range. When discordant results occur between tests, repeating the abnormal test is recommended, with careful consideration of factors that might affect glucose or A1C measurements.

Diabetes. But, what type?

The distinction between diabetes types is crucial for implementing appropriate treatment strategies.

Type 1 diabetes generally requires insulin replacement from diagnosis, while type 2 may initially respond to non-insulin therapies. Figure 1 shows a simple breakdown of the classic clinical features of each type.

Professor Derek O’Keeffe

Dr Lyle McVicker

Diagnosing Diabetes

For asymptomatic patients, diagnosis should never rely on a single abnormal test result.

Confirmation requires a second test, either of the same type or a different one, showing values

The American Diabetes Association (ADA) and World Health Organization (WHO) have established clear diagnostic criteria for diabetes. A definitive diagnosis requires meeting one of these threshold values: • Haemoglobin A1C ≥48 mmol/ mol • Fasting plasma glucose ≥7.0 mmol/L (following at least 8 hours without caloric intake) • 2-hour plasma glucose ≥11.1 mmol/L during an oral glucose tolerance test (OGTT) • Random plasma glucose ≥11.1 mmol/L in patients exhibiting classic hyperglycaemic symptoms Clinicians should consider testing for diabetes when patients present with classic symptoms including polyuria (frequent urination), polydipsia (increased thirst), unexplained weight loss, recurrent infections, delayed wound healing, blurred vision, or fatigue.

Feature

As is true of the old adage, ‘’patients don’t always read the textbooks’’ and as such we are often left scratching our head as to the type of diabetes a patient may have. When clinical features don't clearly point to a specific diabetes type, biomarker testing provides valuable insights:

Type 1 Diabetes

Islet autoantibody testing is most informative when conducted within three years of diagnosis. Clinicians should test for multiple antibodies including GAD, IA2, and ZnT8, as the presence of multiple positive antibodies strongly supports a type 1 diagnosis. It's important to note that higher false positive rates occur in older adults, which often necessitates confirmation with C-peptide testing for accurate classification.

C-peptide testing becomes particularly useful when evaluating patients with long-duration diabetes. Very low C-peptide levels (<0.24 ng/mL) strongly indicate type 1 diabetes, while intermediate values (0.6–1.8 ng/mL) require

Figure 1. Characteristic features of Type 1 and Type 2 Diabetes

Type 2 Diabetes

Age of Onset Usually <35 years but can

occur at any age

Typically >40 years but increasingly common in younger individuals

Body Mass Index Often normal or underweight (BMI)

Overweight or obese (BMI ≥25 kg/m2)

Symptoms Acute onset, polyuria, polydipsia,

weight loss, ketosis

Insidious onset, often asymptomatic, may present with complications

Family History

Strong family history of diabetes

Less common, associated with autoimmune diseases

Autoimmune Markers Present (GAD, IA-2, ZnT8 autoantibodies)

Absent

Insulin Dependence Required at diagnosis

Not initially required, but may be needed over time

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75 careful clinical correlation as they could represent type 1 diabetes, MODY, or insulin-treated type 2 diabetes. Measurements should be paired with a serum glucose level to aid interpretation.

When interpreting biomarker results, clinicians should consider the complete clinical picture. A patient with negative autoantibodies but persistently low C-peptide levels might still have type 1 diabetes, particularly if the testing was performed many years after diagnosis when autoantibodies may have disappeared. Conversely, a patient with weakly positive single autoantibody but robust C-peptide production likely has type 2 diabetes with a false positive antibody result. This integrated approach to biomarker interpretation helps resolve diagnostic dilemmas in clinically ambiguous presentations.

Generally speaking, if in doubt regarding the underlying cause of diabetes it is safest to err on the side of caution and treat in a way that most reduces potential harm i.e. diabetic ketoacidosis (DKA).

In practice this means oftentimes starting insulin on a patient newly diagnosed with diabetes where uncertainty exists between a diagnosis of type 1 of type 2. This is sometimes done while awaiting antibody results and continued until a short interval clinic appointment following hospital discharge. If after several weeks, antibodies have returned negative and the clinical picture more resembles one of type 2 diabetes the insulin can be carefully tapered off or stopped outright and oral medications instituted.

Challenging Clinical Presentations of Diabetes Type 1 diabetes in older adults presents unique diagnostic challenges. Despite classic presentations with DKA, type 2 diabetes remains significantly more common in older age groups. Negative autoantibody testing in older adults makes type 1 diabetes much less likely, and routine autoantibody screening isn't necessary if typical type 1 features are absent. For cases with uncertain classification, C-peptide measurement provides valuable confirmation, helping to distinguish late-onset type 1 from insulin-requiring type 2 diabetes, thus guiding appropriate therapeutic approaches.

Indeed, early insulin requirement serves as an important predictive factor for misdiagnosed type 1 diabetes. Patients initially classified as having type 2 diabetes who

require insulin therapy within three years of diagnosis likely have slowly progressive type 1 diabetes. These patients should undergo comprehensive biomarker testing, including autoantibody and C-peptide assessment, to confirm the correct diagnosis. Early recognition of misclassified type 1 diabetes helps prevent dangerous gaps in insulin therapy and inappropriate treatment with agents that may have limited efficacy.

Pancreatic cancer should be considered in the differential diagnosis of new-onset diabetes, particularly in specific high-risk scenarios. Clinicians should maintain heightened vigilance when diabetes presents in patients over 50 years old without typical metabolic syndrome features, especially when accompanied by unexplained weight loss, abdominal pain, or jaundice.

The relationship works both ways - new-onset diabetes can sometimes be the first detectable sign of pancreatic cancer, presenting months before the cancer becomes clinically apparent through other symptoms. Early imaging studies should be considered for patients with suspicious presentations, particularly when multiple risk factors are present.

Maturity-Onset Diabetes of the Young (MODY) represents several monogenic forms of diabetes that should be considered when patients present with atypical features. These typically include relatively mild hyperglycaemia (A1C <58 mmol/mol at diagnosis), strong multigenerational family history of diabetes, absence of typical autoimmune or insulin resistance markers, and onset at a young age (typically before 25-30 years). Patients with MODY may also display distinctive clinical features suggesting specific genetic variants, such as renal cysts, lipodystrophy, or characteristic patterns of glycemic control such as persistently elevated fasting glucose with normal post-prandial values.

Genetic testing provides definitive diagnosis and guides targeted treatment approaches for these patients. Awareness is critical as a MODY diagnosis can dramatically change treatment regimens and reduce burden on patients.

Latent Autoimmune Diabetes in Adults (LADA) presents a particular diagnostic challenge as it initially resembles type 2 diabetes but has an autoimmune pathophysiology similar to type 1. These patients typically appear to have type 2 diabetes but experience a more rapid progression to insulin

dependence. GAD autoantibody testing aids identification, and early recognition allows for appropriate treatment planning that accounts for the progressive β -cell failure these patients will experience. Recognizing LADA helps clinicians anticipate the eventual need for insulin therapy rather than persisting with combination oral agents that may prove insufficient.

Modern Diabetes Management: A Practical Guide for Hospital Clinicians Effective diabetes management requires personalization based on the patient's age, comorbidities, preferences, and social circumstances. While HbA1c targets of ≤53 mmol/mol suit most adults, consider lower targets for selected patients who can achieve them safely, and more relaxed goals (58-69 mmol/mol) for frail elderly patients.

Type 2 Diabetes Management Most recent international joint consensus guidelines from the ADA and European Association for the Study of Diabetes (EASD) now emphasise the consideration of cardiorenal protection and weight management alongside glycemic control when devising a medication regimen in type 2 Diabetes.

• Metformin: Remains the first-line pharmacological therapy for most patients with type 2 Diabetes due to its proven efficacy, safety profile, low cost, and extensive clinical experience. Metformin has demonstrated modest cardiovascular benefits, is weight neutral or may promote slight weight loss, and has a low risk of hypoglycaemia.

Contraindications include severe renal impairment (eGFR <30 mL/min/1.73m2), and dose adjustment is recommended for moderate renal impairment.

• SGLT2 inhibitors: Consider for patients with established cardiovascular disease (CVD), heart failure, or chronic kidney disease regardless of HbA1c.

These reduce heart failure hospitalizations and slow CKD progression, particularly in patients with albuminuria.

• GLP-1 receptor agonists: Offer significant cardiovascular benefits for patients with atherosclerotic disease while providing excellent glycemic control and weight reduction.

Tirzepatide (dual GIP/GLP-1 agonist) shows superior efficacy for both glucose management and weight loss compared to earlier GLP-1 RAs. It is now

available in Ireland though it's not yet covered by the long-term illness scheme.

• DPP-4 inhibitors: Provide modest glycemic improvements with minimal hypoglycaemia risk and weight neutrality, making them suitable for elderly patients.

• Traditional agents: Sulfonylureas and insulin remain effective for glucose control but carry increased hypoglycaemia risk and weight gain concerns.

Weight management is crucial—5-10% weight loss improves multiple metabolic parameters, while ≥15% loss can induce diabetes remission in some patients. The availability of GLP-1 RAs have revolutionized pharmacological weight management though recent supply shortages have truncated some patients' courses and stopped others from accessing the most potent agents. For patients with BMI ≥35 kg/m2 and suboptimal control despite medication, metabolic surgery should be considered though access to this via both the public and private system in Ireland remains difficult and waiting lists are long.

Despite pharmaceutical advances, lifestyle modifications remain fundamental. Recommend individualized nutrition therapy (Mediterranean, plant-based, or moderate low-carbohydrate approaches) and physical activity (≥150 minutes weekly of moderateintensity activity, resistance training, and reduced sedentary time).

Type 1 Diabetes Management Person-centred care is essential for type 1 diabetes. Diabetes self-management education and support (DSMES) remains the cornerstone intervention at diagnosis and throughout the patient's life. The DAFNE (Dose Adjustment For Normal Eating) programme, ideally implemented within 6-12 months of diagnosis, equips patients with carbohydrate counting skills and insulin adjustment strategies.

Continuous glucose monitors (CGMs) represent the preferred monitoring approach, focusing on Time in Range (TIR).

Recommend patients aim for >70% of time within 3.9–10.0 mmol/L, while minimizing time below 3.9 mmol/L (<4%, ideally <1% below 3.0 mmol/L).

Insulin therapy options include: • Multiple daily injections (MDI) with basal-bolus regimens (standard approach)

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Diabetes

• Continuous subcutaneous insulin infusion (insulin pump therapy) • Hybrid closed-loop systems (insulin pumps linked to CGM with a software algorithm controlling insulin delivery), which improve outcomes and reduce hypoglycaemia • Connected insulin pens as intermediate technology, providing dose tracking and decision support Comprehensive Care Considerations for All Diabetes Types Beyond glycemic control, address cardiovascular and kidney risk: • Blood pressure targets: <140/90 mmHg generally, <130/80 mmHg in high-risk patients • Lipid management: statin therapy for patients >40 years or with additional CVD risk factors.

Risk level can be assessed

through use of the American College of Cardiology ASCVD risk calculator (Risk Estimator Plus).

• Annual kidney function screening: albuminuria and eGFR • Regular retinal screening: The National Diabetic Retinal Screening Programme in Ireland facilitates free screening and onward referral to ophthalmology if required.

• Comprehensive foot care: Annual foot examinations to assess skin integrity, vascular status, and neuropathy using monofilament testing and vibration sensation.

The psychological burden of diabetes requires regular screening for diabetes distress, depression, anxiety, and eating disorders. Pay particular attention during care transitions to prevent treatment gaps. Optimal diabetes management requires a multidisciplinary team including

endocrinologists, diabetes specialist nurses, dietitians, and psychologists to address the complex biological, technological, and psychosocial aspects of diabetes care.

Key Takeaways for HospitalBased Clinicians 1. Individualise treatment plans considering the whole person, not just their HbA1c 2. For type 2 diabetes, select medications based on cardiorenal benefits and weight impacts 3. For type 1 diabetes, prioritise education, CGM, and appropriate insulin delivery methods 4. Address cardiovascular and kidney risk factors in all patients 5. Screen regularly for psychological complications 6. Collaborate with a multidisciplinary team for comprehensive care

Guidance taken from: 1. Department of Health (2024), V2. NCEC National Clinical Guideline No. 17 Adult type 1 diabetes mellitus. Available at: http://health.gov.ie/nationalpatient-safety-office/ncec/ 2. Management of Hyperglycaemia in type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 1 November 2022; 45 (11): 2753–2786. https://doi. org/10.2337/dci22-0034 3. The Management of type 1 Diabetes in Adults. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD).

Diabetes Care 1 November 2021; 44 (11): 2589–2625. https://doi.org/10.2337/ dci21-0043

News

Urgent Need to Improve Diabetes Services Representatives from the Donegal Branch of Diabetes Ireland met with Minister for Health, Ms Jennifer Carroll MacNeill TD, on her recent visit to Donegal to highlight the severe under-resourcing of adult diabetes services in Letterkenny University Hospital (LUH) which is impacting on the level of care that is being provided to the local diabetes community.

Chairperson Mr Paul Gillespie highlighted their long-time efforts to have these issues addressed with a number of the Minister’s predecessors but informed the Minister that very little had been done to deliver the extra staffing resources needed and type 1 diabetes care for adults had further declined.

At present, there are two consultant endocrinologists posts vacant in LUH and the HSE, despite several recruitment attempts to fill the posts, have failed to fill the posts. “We outlined to the Minister that we believe the difficulties in recruiting and retaining endocrinologists is partly due to the fact that LUH has never been awarded the two Advanced Nurse Practitioner (ANP) posts so badly needed for the service” said Paul.

At a recent meeting, LUH Hospital Management confirmed that an ANP post for the adult Type

1 diabetes service was their main priority but were awaiting agreement from the HSE to provide funding for the post.

The group pressed the Minister to provide the funding for this post and highlighted that when her predecessor Minister James O’Reilly sanctioned an ANP post for the hospital’s paediatric type 1 diabetes service, it transformed the service and the care provided to our children living with Type 1 diabetes and their families. “In our view, a similar commitment for the adult service to support a new consultant endocrinologist due to start next month would transform the level of type 1 diabetes care for our community” added Paul.

Representatives also highlighted the fact that a paediatric diabetes centre of excellence for the North West region, which was part of the HSE model of care guidance over 10 years ago has never been fully implemented. A centre of

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excellence needs a paediatric consultant endocrinologist based in LUH, due to size of population, along with a second paediatric endocrinologist based in SUH for shared cover.

“The Minister was very attentive and we believe had a good understanding of the challenges

of living with type 1 diabetes.

She committed to find out why the Type 1 Adult ANP positions had never been sanctioned and would revert to the delegation in a timely manner. The minister also committed to pursuing the other resources needed to give proper equity of care for everyone in our community” concluded Paul.

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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News

Ireland: Lowest Rate of Access to Cancer Medicines 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.

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

Annual SunSmart Campaign New research shows parents protect their children’s skin from the sun and set a good example for their children when it comes to sun protection To mark the launch of the annual SunSmart campaign, the HSE’s National Cancer Control Programme (NCCP) and Healthy Ireland are reminding parents of the importance of protecting children’s skin from overexposure to the sun’s ultraviolet (UV) rays to reduce their risk of sunburn.

Research shows that most parents set a good SunSmart example for their children. Most are vigilant regarding children’s sun protection but more likely to be so when abroad rather than here in Ireland.*

The survey of 36 European countries, including 27 in the European Union, covers the full four years between 2020 and 2023 analysing 173 innovative medicines authorised for use by the European Medicines Agency (EMA). Key points this year are: • 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,

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“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”.

A child’s skin is very sensitive to UV rays from the sun, and sunburn during childhood increases the risk of developing skin cancer as an adult.

Overexposure to the sun’s ultraviolet (UV) rays, even in April, increases the risk of sunburn.

According to Dr Aoife Lally, Consultant Dermatologist, St Vincent’s University Hospital, “It is important to remember that, in Ireland, the sun’s UV rays are strong and damaging from April to September with UV levels of 3 or above. Whenever the UV level is 3 or above, your child should always be protected from the sun (with clothing, hats, sunglasses and shade) and wear sunscreen.”

The new research carried out by the HSE’s NCCP found that: • The vast majority of parents (82%) report being more concerned about their child’s sun protection than their own.

• Nearly half (45%) of parents surveyed reported that their child experienced sunburn last year (2024) and 63% of parents reported experiencing sunburn themselves.

• While there is evidence of consistent use of sun protection measures by parents and guardians, the research suggests that they are more vigilant about protecting their children’s skin when abroad than at home in Ireland.

Clinical Profiles "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.

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 everyday. 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.

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 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.”

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 check-ups. 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!

MATER PRIVATE NETWORK CORK OFFICIALLY OPENS ITS HEART CENTRE Mater Private Network Cork has announced the official opening of its Cork Heart Centre, marking a significant milestone in the development of cardiac care services in the Munster region. The ¤12 million investment includes the expansion and extended opening hours of Urgent Cardiac Care services, and the introduction of a new ICU and Cardiothoracic Surgical service.

The Cork Heart Centre focuses on delivering excellence by enhancing the capacity to diagnose and treat both routine and complex cardiac conditions. This reflects Mater Private Network’s commitment to providing specialist, patientcentred care in a state-of-the-art environment.

John Hurley, CEO, Mater Private Network Group said: "The launch of the Cork Heart Centre is a landmark moment not only for Mater Private Cork, but for cardiac care across Munster.

Our investment in this facility ensures that patients have access to the highest standard of cardiac diagnostics and treatment, delivered by an expert multidisciplinary team in a centre of excellence.

“For over 40 years, Mater Private Network has led the way in delivering complex cardiac care in Dublin. We are proud to bring this depth of expertise to the Munster region. We are confident that patients treated at the Heart Centre in Cork will benefit from the same clinical excellence, patientfocused care, and outcomes that have made us a national leader in cardiac services.”

The Heart Centre is led by Dr. John P. Foran, with Cardiothoracic Surgery directed by Dr. Niamh Keenan. Both are committed to advancing cardiac care and driving transformative change in heart health across Ireland.

In addition to expanding the scale of cardiac-focused facilities, the Heart Centre brings together an expert team of cardiologists and surgeons with subspecialty expertise under one roof, improving access to specialists, speeding up diagnosis, and providing expert treatment to optimise patient outcomes. This integration reflects Mater Private Network’s strategy to deliver excellence through operational simplicity.

Dr John P. Foran, Clinical Lead and Head of the Department of Cardiology at Mater Private Cork, said: “The opening of the

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Cork Heart Centre is a major step forward for cardiac care in the region. Having these facilities available locally means that patients in Munster can now access the highest level of cardiac diagnostics and treatment without the need to travel further afield.

This investment will allow us to treat more patients, more quickly, and deliver life-saving interventions closer to home.”

The launch of the Cork Heart Centre was marked by a panel discussion held today at Mater Private Network Cork, focusing on the future of cardiovascular health in the Munster region. Experts from the Mater Private Network Heart & Vascular team, the first patient to undergo Cardiothoracic Surgery at MPC Mr. John Daly, and special guest Sonia O’Sullivan discussed the importance of lifelong health and cardiac awareness.

The event highlighted the Heart Centre’s new capabilities, including advanced Cardiothoracic Surgery and expanded urgent care services, reinforcing its commitment to innovation and excellence in cardiac care, and bringing the expertise of Mater Private National Tertiary Cardiac Centre to Cork.

The Cork Heart Centre is part of Mater Private Network’s broader programme of investment and digital transformation aimed at advancing healthcare delivery nationwide.

Members of the Mater Private Network Heart & Vascular team, along with Mr. John Daly, the first patient to undergo Cardiothoracic Surgery at the centre

As part of this development, the new Cardiothoracic Surgery service offers local access to advanced procedures, supported by a multidisciplinary team and a new intensive care unit.

This complements the Centre’s comprehensive cardiac care pathway — including diagnostics, surgery, and rehabilitation — ensuring high-quality treatment and recovery for patients, close to home.

Patients also benefit from the established Cardiac Rehabilitation Programme, designed to support long-term heart health through education, exercise, and lifestyle management, ultimately improving both patient experience and clinical outcomes.

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CANCER TRIALS IRELAND URGES PATIENTS “DON’T BE SHY – JUST ASK!”

• Approximately one in five (18%) either know of someone who has taken part in a clinical trial, or have taken part themselves, while three in five (62%) would be willing to take part in one

Ahead of International Clinical Trials Day on May 20, Cancer Trials Ireland is mounting a “Just Ask” campaign urging people with cancer undergoing treatment to “just ask” their doctors of the clinical trial options open to them.

• Seven in ten (70%) would take part in a trial to potentially help others get better treatment for their health issues in the future, while almost four in ten (38%) would do it to have a longer life, and approximately one-third would sign up to access a new treatment before it’s widely available (32%), or to cure their disease (30%)

With over 24,000 people newly diagnosed with cancer each year in Ireland1, Cancer Trials Ireland is dedicated to finding new ways to prevent, find and treat cancer. It currently has over 110 trials open and recruiting new patients.

The charity is hosting an information webinar on Tuesday May 20 from 2.30-3.30pm offering an overview of trials here, how they work and how to access them. The session will feature the perspectives of both cancer researchers and patients, with contributions from Prof. Gerry Hanna, Vice Clinical Lead, Cancer Trials Ireland, Dr Claire Kilty, Head of Research at the Irish Cancer Society, and patient advocate Jed van de Poll. Broadcaster and former GP, Ciara Kelly, will host the webinar which is free of charge to members of the public—to register, visit www.cancertrials.ie/JustAsk. For Prof. Gerry Hanna, Vice Clinical Lead at Cancer Trials Ireland, the ambition is to achieve an up to 75 per cent five-year survival rate for people diagnosed with cancer within the next decade: “We're seeking to constantly improve outcomes for people with cancer and we've gone from 25 per cent of people being alive five years after a cancer diagnosis 30 years ago, to now over 50 per cent. We want to get that figure up to 75 per cent in the next ten

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Prof. Gerry Hanna, Vice Clinical Lead, Cancer Trials Ireland

years and one of the ways that we can do this is through clinical trials in finding the next generation of treatments that will improve outcomes for people with cancer.

The intention with a prospective trial treatment received by patients is that it should be at least as good as the standard of care and hopefully better.

“We also know that in hospitals that run clinical trials, the outcomes are generally better even for those patients who are not taking part in the trial, as the quality of clinical care improves for everyone. With this campaign, I would encourage any person going through cancer treatment to ‘just ask’ their doctor if there is a cancer trial currently available that would be suitable for them.”

Public Attitudes When it comes to the latest attitudes of members of the public to clinical trials, a survey conducted by Cancer Trials Ireland in July last year yielded some very interesting findings:

• Over half (53%) would get involved in a trial to improve their health and well-being, with two in five to have a more active role in their healthcare if ill (44%), or to access medical care and more frequent health checks as part of treatment (40%) Interestingly, three in four of those surveyed (77%) know someone who has had cancer, or have had cancer themselves.

BALVERSA® (ERDAFITINIB) APPROVED FOR REIMBURSEMENT IN IRELAND FOR THE TREATMENT OF ADULT PATIENTS WITH UNRESECTABLE OR METASTATIC UROTHELIAL CARCINOMA WITH SUSCEPTIBLE FGFR3 GENETIC ALTERATIONS Johnson & Johnson Innovative Medicine have announced that BALVERSA® (erdafitinib), a once-daily oral monotherapy for the treatment of adult patients with unresectable or metastatic urothelial carcinoma (UC), harbouring susceptible FGFR3 genetic alterations who have previously received at least one line of therapy containing a PD-1 or PD-L1 inhibitor in the unresectable or metastatic treatment setting, has been approved for reimbursement in Ireland. Erdafitinib is the first pan FGFR kinase inhibitor to be approved by the European Commission based on positive results from Cohort 1 of the Phase 3 THOR study which showed 36 percent reduction in risk of death with erdafitinib versus chemotherapy.

Bladder cancer is diagnosed in approximately 540 people in Ireland per year and is the 14th most common cancer in Ireland. The most common form of bladder cancer is UC,4 and up to 20 percent of patients with metastatic UC (mUC) have FGFR alterations. Unfortunately, prognoses remain poor for patients with mUC, with only eight percent of people diagnosed at a

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late metastatic stage surviving for five years or more.

Prof Ray McDermott, Consultant Medical Oncologist at St. Vincent’s Hospital said: “The need for novel, targeted therapies for people living with unresectable or metastatic urothelial carcinoma with susceptible FGFR3 genetic alterations remains high. With erdafitinib now available for this patient cohort, there is potential to improve outcomes and progression-free survival rates or patients with FGFR3 alterations who, until now, have had limited options available.

The reimbursement of erdafitinib marks a major step towards ensuring that Irish patients have access to the most innovative treatments available.”

Michaela Hagenhofer, General Manager, Commercial Operations at Johnson & Johnson Innovative Medicine said: “At Johnson & Johnson, we are dedicated to getting in front of cancer and advancing cutting-edge, precision treatments in oncology. The reimbursement of erdafitinib marks an important milestone as the first therapy targeting FGFR3 alterations in patients with metastatic urothelial carcinoma, to be approved for reimbursement in Ireland. It also highlights the importance of FGFR testing for all patients with metastatic urothelial cancer, and the need for a multi-disciplinary team approach to optimise outcomes for each patient.”

Erdafitinib received EC approval in 2024 based on results from Cohort 1 of the randomised, controlled, open-label multicentre Phase 3 THOR study (NCT03390504),8 evaluating the efficacy and safety of erdafitinib (n=136) versus chemotherapy (n=130) in patients with advanced or mUC with select FGFR alterations who have progressed on or after one or two prior treatments, at least one of which includes an antiPD-(L) 1 agent.9 In June 2023, based on the recommendation of the independent data safety monitoring committee, the THOR study was stopped at the interim analysis for efficacy and all patients randomised to chemotherapy (docetaxel or vinflunine) were offered the opportunity to cross over to erdafitinib. The results demonstrate median overall survival (OS) of over one year at the data cut-off, marking a significant increase as compared to those in the chemotherapy arm (12.1 months vs. 7.8 months; hazard ratio [HR], 0.64; 95 percent confidence interval [CI], 0.44 to 0.93; P=0.0050). Treatment with erdafitinib also showed

81 an improvement in median progression-free survival [PFS] compared to chemotherapy of 5.6 months versus 2.7 months (HR 0.58; 95 percent CI, 0.41 to 0.82; P=0.0002) and overall response rate [ORR] of 35.3 percent versus 8.5 percent.

Serious treatment-related adverse events (TRAEs) were observed in 13.3 percent of patients who received erdafitinib and 24.1 percent of patients randomised to chemotherapy.2 Grade 3 or higher adverse events were observed in 45.9 percent of patients on erdafitinib and 46.4 percent on chemotherapy. Amongst patients who received erdafitinib, 8.1 percent had TRAEs that led to discontinuation of therapy, versus 13.4 percent of patients who received chemotherapy. TRAEs leading to death were reported in one patient who received erdafitinib and six patients who received chemotherapy.

MAGIC-I STUDY TO REVOLUTIONISE CHILDHOOD CANCER CARE IN IRELAND Leaders from Ireland’s health service, children’s hospitals, Irish and global cancer research community and industry recently gathered to launch MAGIC-I, the country’s first clinical study of genomics approaches in cancer care.

MAGIC-I is a five-year clinical study that harnesses the power of genetics, genomics and big data to optimise treatments in childhood cancers. Genomics is the study of an individual’s complete genetic make-up, using cutting edge computational modelling and data science methods to analyse their genes.

activities at Children’s Health Ireland (CHI) hospitals with computational modelling and data science at Systems Biology Ireland (SBI) research centre based at UCD. It was developed in close collaboration between SBI and CHI, in partnership with Precision Oncology Ireland, and industry collaborators including global biotechnology company Illumina which supports the study with its Dragen™ software and sequencing reagents.

Director of SBI, who co-led the data analytics and infrastructure work stream in the national genomics strategy, and a MAGIC-I investigator, Professor Walter Kolch said: “I cannot emphasize enough how big of a signal this is for the Irish healthcare system and likely also beyond it.

Importantly, it steps up to a global ambition in its seamless amalgamation of clinical research with advanced computational modelling. It is a trailblazer in incorporating new concepts for personalized medicine, such as digital twins, and for handin-glove cooperation between clinical research and cutting-edge computational modelling, which is still very unique.”

Principal Investigator in MAGIC-I and SBI, Professor of Child, Adolescent and Young Adult Oncology at Trinity College Dublin, and Consultant Paediatric

Haematologist at CHI, Crumlin, Professor Owen Smith said: “In the past decade, genome sequencing has not only enabled critical advances in our understanding of how leukaemia develops but also why some patients fail to respond to initial treatment, relapse later, or experience severe toxicities leading to injury, secondary illnesses and secondary cancers.

The rollout of MAGIC-I will allow the clinical implementation of sequence-based approaches for more precise diagnosis and management of cancers that will ultimately translate into better outcomes for patients. It will allow us to develop personalised treatments for Irish children who develop cancer.”

Also speaking at the launch, Noreen Doyle is a mum-of-four who has been through cancer diagnoses with two of her children and has been a spokesperson and advocate for the advancement of childhood cancer care. She said: “'Your two-year old son has Leukaemia' are words that will forever ring in my ears. If I could have swapped places with my son in that moment, I would have in a heartbeat. In that moment when you get the diagnosis, you hear more words; 'life threatening illness', 'chemotherapy', 'complications from medicines'.

The thoughts of what was ahead of my little boy just terrified me - it's every parent's biggest fear. This

is why it is so important to advance Precision and Personalised approaches to cancer diagnosis and treatment, so the day that diagnosis comes, families have the comfort of knowing their child will get not only the most effective care but also treatment that minimises the side effects and risks."

Mark Robinson, VP and General Manager for UK and Ireland, and Northern Europe, said: “Illumina is proud to be supporting MAGIC-I in this close collaborative effort to introduce whole genome and transcriptome sequencing analysis to help researchers improve in the diagnosis and treatment of childhood cancers.

Using our comprehensive suite of DRAGENTM software tools, and Illumina sequencing reagents, will help get the study off to the best possible start.”

IRELAND’S SECOND EVER NATIONAL MATERNITY EXPERIENCE SURVEY GETS UNDERWAY The second ever National Maternity Experience Survey commenced last month, spanning all maternity services, to include five maternity hospitals, 14 maternity units, and the National Home Births Service. The survey invites women who have recently given birth to share their experiences of Ireland’s maternity services, with the goal

The project will put in place the processes to carry out deep genomic analysis for all children and adolescents with cancer in Ireland, including those who have experienced a relapse of their disease.

Speaking at the launch, Dr Colm Henry, Chief Clinical Officer of Ireland’s Health Service Executive (HSE), said: “This launch is a significant milestone in Irish cancer care. It is a great example of the translation of new knowledge and advances in technology into improved patient outcomes. This shares the vision of the ‘National Strategy for Accelerating Genetic and Genomic Medicine in Ireland,’ which was developed by the HSE to integrate genetics and genomics into clinical practice at all stages of the patient pathway.”

MAGIC-I was initially funded through a philanthropic donation to University College Dublin (UCD) aimed at bridging clinical

Prof Mary Horgan, Chief Medical Officer, Department of Health; Noreen Doyle, Patient Advocate; Prof Owen Smith, Professor of Child, Adolescent and Young Adult Oncology, Trinity College Dublin, and Principal Investigator on MAGIC-I; Prof Walter Kolch, Director of Systems Biology Ireland, UCD, and Principal Investigator on MAGIC-I; Triona McCormack, Vice-President for Strategy and External Engagement, UCD; Prof Susa Bensler, Chief Academic Officer, Children’s Health Ireland; Prof Risteard O'Laoide, Director, National Cancer Control Programme

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of improving the quality and safety of care provided to women and their babies.

This initiative, part of the National Care Experience Programme, is a collaboration between the Health Information and Quality Authority (HIQA), the Health Service Executive (HSE), and the Department of Health.

The survey includes 64 questions covering every stage of the maternity journey: antenatal care, labour and birth, and postnatal care in the community.

Women aged 16 and over who gave birth in February or March 2025 will be invited to participate.

Participants will receive an invitation by text message to take the survey approximately three months after giving birth, from 1 May 2025 to 30 June 2025. They will be provided with details about the survey and a link to complete it online.

Minister for Health, Jennifer Carroll McNeill said: “The voices of mothers, especially new mothers are crucial in the development of better health services, and I would ask everyone eligible to participate in the National Maternity Experience Survey. This is an opportunity to place patients, their experiences, and their views at the heart of a health service striving for continuous improvements in delivering quality care.

In the last National Maternity Experience Survey in 2020, women identified a need for greater postnatal support. We responded to this by establishing five pilot Postnatal Hubs in the community, offering services including birth reflections, physiotherapy, mental health and wellbeing supports, and dietetics. This network is now expanding to a total of 13 hubs.

We now have an opportunity to build on this work and it is really important that we hear the voices of the women in Ireland who are eligible to have their say in shaping the future enhancement and improvement of maternity services.”

HIQA CEO Angela Fitzgerald stated: “Our maternity services need to meet the needs of women at one of the most significant times in their lives. Each year, thousands of women in Ireland give birth, each with a unique story to tell.

The feedback from this survey will provide crucial insights into the quality of maternity care in Ireland.

This information will allow us to identify what works well

and address areas that need improvement, ensuring that maternity services remain safe, responsive, and centered on the needs of women and their babies.”

HSE Chief Executive Officer Bernard Gloster said: ‘‘Improving our health service and people’s health experiences are key priorities for us. The National Maternity Experience Survey offers eligible women who have recently given birth the opportunity to share their experiences of Ireland’s maternity services — from antenatal to postnatal care, to help us improve maternity services around the country. I strongly encourage women to share their views. It is only by listening and learning from lived experiences that we can bring about effective and sustainable improvements.

This is the second time that a national survey will be carried out of women’s experiences of maternity services. The valuable feedback guides and drives important actions aimed at continuously improving maternity services into the future.’’

The inaugural survey in 2020 saw over 3,200 women share their experiences, resulting in meaningful changes across maternity services.

All survey responses will be anonymised, analysed, and compiled into a national report detailing the quality of maternity care. The findings will guide improvements at both local and national levels. The final report will be published in late 2025 and made available to the public on www.yourexperience.ie.

VERTEX RECEIVES CHMP POSITIVE OPINION FOR ALYFTREK®, A NEW ONCEDAILY CFTR MODULATOR FOR THE TREATMENT OF CYSTIC FIBROSIS Vertex Pharmaceuticals (Nasdaq: VRTX) has announced that the European Medicines Agency’s (EMA) Committee for Medicinal Products for Human Use (CHMP) adopted a positive opinion for ALYFTREK® (deutivacaftor/ tezacaftor/vanzacaftor) for the treatment of people with cystic fibrosis (CF) ages 6 years and older who have at least one non-class I mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene.

“Our goal has always been to serially innovate to help people with cystic fibrosis live healthier and longer lives. If approved, this new medicine would be indicated for people with CF ages 6 years and older with at least one nonclass I mutation, meaning more patients would be eligible for a

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medicine that gets them closer to normal levels of sweat chloride,” said Carmen Bozic, M.D., Executive Vice President, Global Medicines Development and Medical Affairs, and Chief Medical Officer, Vertex.

“CFTR modulators have already revolutionized the way we treat CF and I am encouraged that, if approved, this medicine could advance CF treatment even further,” said Professor Marcus A. Mall, M.D., Professor and Chair of the Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine and Cystic Fibrosis Center at Charité - Universitätsmedizin Berlin.

“The results we saw from the two deutivacaftor/tezacaftor/ vanzacaftor Phase 3 clinical trials were motivating as they showed non-inferiority in ppFEV1 and superior improvement of sweat chloride levels compared to ivacaftor/tezacaftor/elexacaftor in combination with ivacaftor.”

ALYFTREK® is currently licensed in the U.S. and UK and is under regulatory review in Canada, Switzerland, Australia and New Zealand.

About Cystic Fibrosis Cystic fibrosis (CF) is a rare, life-shortening genetic disease affecting more than 109,000 people, including 94,000 people in North America, Europe and Australia. CF is a progressive, multi-organ disease that affects the lungs, liver, pancreas, GI tract, sinuses, sweat glands and reproductive tract. CF is caused by a defective and/or missing CFTR protein resulting from certain mutations in the CFTR gene.

Children must inherit two defective CFTR genes — one from each parent — to have CF, and these mutations can be identified by a genetic test. While there are many different types of CFTR mutations that can cause the disease, the vast majority of people with CF have at least one F508del mutation. CFTR mutations lead to CF by causing CFTR protein to be defective or by leading to a shortage or absence of CFTR protein at the cell surface. The defective function and/or absence of CFTR protein results in poor flow of salt and water into and out of the cells in a number of organs.

In the lungs, this leads to the buildup of abnormally thick, sticky mucus, chronic lung infections and progressive lung damage that eventually leads to death for many patients. The median age of death is in the 30s, but with treatment, projected survival is improving.

Today Vertex CF medicines are treating over 68,000 people with CF across more than 60 countries on

six continents. This represents 2/3 of the diagnosed people with CF eligible for CFTR modulator therapy.

Diagnosis of CF is often made by genetic testing and is confirmed by testing sweat chloride (SwCl), which measures CFTR protein dysfunction. The diagnostic threshold for CF is SwCl ≥60 mmol/L, while levels between 30-59 indicate CF is possible and more testing may be needed to make the diagnosis of CF. A SwCl level of <30 mmol/L is seen in people who carry one copy of a CFTR gene mutation but do not have any manifestation of disease (carriers). At a population level, higher levels of SwCl are associated with more severe disease. Restoring CFTR function leads to lower levels of SwCl. SwCl levels below 60 mmol/L are associated with improved outcomes such as better and more stable lung function, fewer pulmonary exacerbations, better quality of life and improved survival. Restoring SwCl levels below 30 mmol/L has long been the ultimate treatment goal for Vertex, as levels below 30 mmol/L are considered normal and are typical of CF carriers who do not have disease.

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

83 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).8 Data from the study were previously presented at the 2024 International Myeloma Society (IMS) Annual Meeting.9 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).8 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.8 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.9 The most common (>10 percent) 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.

TEVA LAUNCHES NASUSAF (AZELASTINE HYDROCHLORIDE/ FLUTICASONE PROPIONATE) Teva Pharmaceuticals is pleased to announce the launch of Nasusaf (Azelastine hydrochloride/ Fluticasone propionate) 137 micrograms/50 micrograms per actuation, Nasal Spray, Suspension.

This product is indicated for the relief of symptoms of moderate to severe seasonal and perennial

moving — through fun, sociable, and structured group sessions delivered by trained leaders in local athletics clubs. Whether walking or running, participants build endurance at their own pace, with expert guidance and encouragement throughout.

To mark the launch of the McCabes Pharmacy Fit for Life Programme, a launch was held bringing together Irish Olympians Thomas Barr, a 400m hurdles finalist at the Rio 2016 Games, and Kate O’Connor, Ireland’s first-ever female European Championships medallist in the heptathlon.

They were joined by members of Athletics Ireland, passionate team members from McCabes Pharmacy who can advise participants on their fitness journey and McCabes Pharmacy Fit for Life participants from clubs around the country.

allergic rhinitis if monotherapy with either intranasal antihistamine or glucocorticoid is not considered sufficient.

For any queries or further information, please contact your local Teva representative or contact Teva on 1800 201 700.

Further product information is available upon request or from the SmPC available at hpra.ie.

Adverse events should be reported. Reporting forms and information can be found at hpra. ie. Adverse events should also be reported to Teva UK Limited on +44 (0) 207 540 7117 or medinfo@ tevauk.com.

Date of preparation: March 2025 Job code: GEN-IE-NP-00143 MCCABES PHARMACY EXCLUSIVE PHARMACY PARTNER TO ATHLETICS IRELAND McCabes Pharmacy, Ireland’s largest and most patient-centric pharmacy brand, has been named the exclusive pharmacy partner of Athletics Ireland. As the first major initiative under this new partnership, McCabes Pharmacy will serve as title sponsor of Athletics Ireland’s community fitness programme, now rebranded as the McCabes Pharmacy Fit for Life Programme. The collaboration reflects McCabes Pharmacy’s goal of championing the health and wellness of patients, to help them improve their quality of life.

Designed to support people of all fitness levels, McCabes Pharmacy Fit for Life programme encourages communities across Ireland to get

Brian O’Keeffe, Chief Operating Officer of McCabes Pharmacy, said, “At McCabes Pharmacy, we believe health isn’t one-sizefits-all. This programme allows us to meet people where they are in their fitness journey, providing personalised health support in a community setting — from injury recovery to everyday wellbeing. It’s a powerful expression of our mission: better health for every body.”

As part of the rollout participants will benefit from practical healthcare support, including BMI and blood pressure checks, delivered through local club activations from Donore Harriers in Dublin to Limerick AC and beyond.

In addition, monthly McCabes Pharmacy Fit for Life Roadshows will take place in selected regions, offering expert-led health and fitness guidance, digital resources, and advice on recovery, prevention, and holistic wellness.

Hamish Adams, CEO of Athletics Ireland, said, “We’re delighted to welcome McCabes Pharmacy as our exclusive pharmacy partner and title sponsor of Fit for Life.

Their dedication to accessible, personalised healthcare aligns seamlessly with our goal of making fitness enjoyable and achievable for everyone, no matter where they’re starting from.”

The McCabes Pharmacy Fit for Life programme will raise awareness across Irish communities of the benefits of proactively managing one’s health including being active, and aligns with the brand’s purpose of providing better health for every body. It’s about more than fitness; it’s about building healthier habits for life.

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