IPN September 2025

September 2025 Volume 17  Issue 9 PHARMACYNEWSIRELAND.COM

THE INDEPENDENT VOICE OF PHARMACY

In this issue: NEWS: Warning issued over Online Medicines Page 4

REPORT: Embracing Lean Principles in Pharmacy Page 14

MARKETING: How AI is Transforming Pharmacy Marketing Page 16

FEATURE: Cold & Flu Season Page 22

CLINICAL: Head and Neck Cancer Page 40

CPD: Emergency Contraception Page 41

TEAM TRAINING: Dehydration Page 77 This Publication is for Healthcare Professionals Only

Kopen Sugar Free 250mg/5ml Powder for Oral Solution Phenoxymethylpenicillin

ed in in oducced pr produ

ND ELA AND IR IREL

produced in Product Authorisation Holder: Athlone Pharmaceuticals Ltd

IRELAND

For further information on this product, please contact your Athlone Pharmaceuticals Key Account Manager or our customer service team.

Athlone Pharmaceuticals Ltd., Connaught House, 1 Burlington Road, Dublin 4, Ireland.

Tel: + 353 (0) 9066 61109 | Fax: +353 (0) 9066 61921 Email: customer.service@kent-athlone.com

Date of preparation: July 2025 Ref: IE2025/003/00

AVAILABLE FROM YOUR PREFERRED WHOLESALER

3

Contents

Foreword

Page 4: Opiod supply pressure hits community pharmacy

Ireland's pharmaceutical industry faces a new challenge following the EU-US trade agreement, which imposes a 15% tariff on pharmaceuticals exported from the EU to the US. This tariff will hit Ireland particularly hard due to the country's high exposure as a major pharmaceutical export hub, though a national security investigation is needed before they are fully implemented.

Pharmaceutical companies will have to adapt to the increased costs and operational challenges, with potential impacts on margins.

Page 8: Double success for United Drug Page 12: Award recognition for Adrian Dunne Pharmacy

4

Page 14: Embracing Lean Principles in Pharmacy

“A lower or zero tariff on generic products and their ingredients, leaving open higher tariffs on innovative medicines, is misguided and does not support investment in innovation and patients’ interests in either the US or the European Union. Moreover, the patent-status of products does not fit into existing trade product categories and will raise further complexities.

Page 16: How AI is transforming Pharmacy Marketing Page 18: Acknowledging World Pharmacists Day

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In other news, the PSI is conducting its fourth annual workforce survey this September and is asking all pharmacists to take part and contribute to this important initiative. The survey is designed to support the regulator’s ongoing efforts to enhance the data and insights available about the pharmacist workforce in Ireland.

Findings will help inform collaborative action by the PSI and other pharmacy stakeholders to help ensure the sustainability of the workforce and its capacity to meet the evolving needs of both the pharmacy sector and wider healthcare system.

Page 38: United Drug Elements – a Trusted Partner

Turn to page 12 for more details.

12

MANAGING DIRECTOR Natalie Maginnis n-maginnis@btconnect.com EDITOR Kelly Jo Eastwood: 00353 (87)737 6308 kelly-jo@ipn.ie SALES MANAGER Amy Evans | amy@ipn.ie 0872799317 CONTRIBUTORS Frank Olden Adam Esa Eamonn Brady Seamus Hussey Eimear O’Reilly Orlaith Kennedy Professor Derek O’Keeffe Dr Lyle McVicker Dr Rosemary Keane DESIGN DIRECTOR Ian Stoddart Design PHARMACYNEWSIRELAND.COM

“IPHA asks the Irish Government to continue to make the case for zero tariffs on innovative medicines with the US Administration, with Ireland as a key and strategically reliable supply chain partner,” they said.

Turn to page 5 for the full story.

Page 22: Time to prepare for Cold and Flu season

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

The Irish Pharmaceutical Association (IPHA) has responded to the joint statement by the US and EU on tariffs, particularly the aspects dealing with pharmaceuticals. In a statement, they said some mitigation of the potentially bad outcomes is set out.

However, there remains considerable uncertainty and problems with tariffs policy.

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

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

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

Also in this issue, we launch the search for the 2025 People’s Pharmacist Award. This unique Award is built entirely around the voice of the public. Anyone can nominate a pharmacist who has shown exceptional dedication, compassion, or innovation.

The aim is simple: to recognise the unwavering support that makes pharmacists one of the most vital members of Ireland’s healthcare family.

From rural towns where the local pharmacist may be the only healthcare professional available, to busy city centres where thousands rely on their expertise each week, the stories that emerge each year are deeply moving. Patients often speak about pharmacists who stayed late to make sure medication was ready, who offered a listening ear when someone was at their lowest, or who guided families through moments of crisis with empathy and professionalism.

Regulars CPD: EMERGENCY CONTRACEPTION

P41

FEATURE: ORAL CARE

P46

TEAM TRAINING: DEHYDRATION

P70

FEATURE: CHRONIC PAIN

P74

CLINICAL PR:

P80

@Irish_PharmNews IrishPharmacyNews

PHARMACYNEWSIRELAND.COM

4

News

Opioid Supply Pressure hits Pharmacy Community pharmacists are facing ongoing challenges in sourcing key opioid analgesics, after a recent debate in the Dáil highlighted the impact of shortages on hospices and pharmacy practice.

Deputy Roderic O’Gorman

The Health Products Regulatory Authority (HPRA) has confirmed a series of shortages in opioid injectables. Mundipharma, the marketing authorisation holder for OxyNorm 10mg/ml solution for injection or infusion, notified the regulator of supply issues with the 1ml presentation in June, with stock expected to return by late July or early August. A further shortage of the 2ml presentation was notified in July, with resupply forecast for September.

Deputy Roderic O’Gorman questioned Minister for Health Jennifer Carroll MacNeill about the availability of pain relief medicines, asking whether regulatory bottlenecks could be eased and whether imports from other EU countries or the UK might be facilitated.

In her response, Minister Carroll MacNeill acknowledged the strain shortages place on both patients and healthcare professionals, and confirmed that several workstreams are underway across the Department of Health and the wider health service to mitigate risks.

Additional shortages were reported in March by AS Kalceks, covering: • Oxycodone hydrochloride 10mg/ml injection/infusion (1ml and 2ml) • Hydromorphone hydrochloride 20mg/ml injection/infusion • Hydromorphone hydrochloride 50mg/ml injection/infusion Resupply of these lines is anticipated from mid to late August.

The HPRA operates Ireland’s National Medicines Shortages Framework, which coordinates a multi-stakeholder response once companies notify potential

shortages. The regulator publishes a live, daily-updated list of shortages on its website and is in constant liaison with suppliers.

According to the Department, opioid shortages are being “closely monitored and prioritised,” with strategies including engagement with suppliers of alternative marketed products and expediting regulatory assessments to speed up resupply.

Where licensed options are unavailable, clinicians may prescribe Exempt Medicinal Products (EMPs). These are medicines not authorised in Ireland but sourced through authorised wholesalers in response to individual prescriptions. EMPs can only be used when no authorised equivalent is available on the Irish market, and wholesalers and manufacturers are required to notify the HPRA of their sourcing activity.

For community pharmacists, these developments underline the importance of maintaining strong communication with prescribers and wholesalers, as well as checking the HPRA shortages list for the latest updates. With resupply timelines still weeks away, contingency planning around alternative analgesics and EMP processes remains critical to ensuring continuity of care for patients with significant pain management needs.

Pharmacy Warning about Online Medicines Pharmacists across Ireland have warned about the rising tide of counterfeit and potentially harmful medicines being sold online. The Irish Pharmacy Union (IPU) is warning the public to think twice before purchasing medicines from unverified websites, as doing so could pose serious risks to an individual’s health.

As more healthcare moves online, concerns are growing. A recent Ipsos-B&A study, commissioned by the IPU, confirmed that 32% of people now look up healthcarerelated information online, a trend that exposes people to growing risks particularly if it involves the purchase of medicines.

Recently published figures from the Health Products Regulatory Authority (HPRA) reveal a 14% increase in the seizure of illegal medicines in the past year, with fake weight loss drugs more than doubling, jumping from 568 units in 2023 to a staggering 1,582 in 2024.

“Commenting, IPU President Tom Murray said, “Online consultations

have improved healthcare access, but purchasing medicines from unregulated websites is a potential disaster waiting to happen. There are no safety checks, no oversight, and no guarantees about what is actually in the medicines.”

appropriate standards, whether they have the correct active ingredients or contain harmful substances. You could be taking something completely ineffective or dangerously toxic,” Mr Murray added. “

“Every medicine dispensed in a pharmacy complies with rigorous quality standards and has also been checked by a pharmacist to ensure it is safe and appropriate for the patient. When you purchase a medication online from an unauthorised source there is no way of identifying if these products are genuine or counterfeit. There is no way of knowing if they meet the

Concluding Mr Murray said “Only healthcare professionals are qualified to prescribe medication and pharmacists are the medicines experts qualified to dispense them safely. The message from pharmacists is clear; if the medicine you purchase is not from a registered pharmacy, do not take it. The potential damage to your health is not worth the risk.

PHARMACYNEWSIRELAND.COM

Collaborative Dementia Network A new investment through the Health Research Board (HRB)’s Collaborative Research Networks Scheme will provide Dementia Research Network Ireland (DRNI) with crucial resources to expand their work, extend their reach and sustain their impact into the future. DRNI works to support and facilitate collaborative and interdisciplinary research in dementia and neurodegeneration. The network seeks to integrate the clinical, basic and social sciences to bring about a demonstrable impact on research, knowledge translation and policy development.

Established in 2012, DRNI aims to facilitate, support and promote interdisciplinary collaboration between academics, policy actors and experts across the island of Ireland and internationally in dementia and neurodegenerative research.

DRNI also supports early career researchers in the area of dementia and neurodegenerative research.

Professor Seán Kennelly, Consultant Physician in Geriatric Medicine, Clinical Senior Lecturer in Medical Gerontology, Trinity College Dublin and Lead-Investigator for HRBfunded research at DRNI,said, “At a time when we are finding better ways to diagnose and manage dementia, we are delighted to receive this support from the Health Research Board for Dementia Research Network Ireland, an all-island collaborative interdisciplinary network that addresses the complex challenges of dementia.

“Through national and international partnerships, DRNI brings together leading clinicians, scientists, policy partners, advocacy groups, and people living with dementia to accelerate innovation, support translation of research into meaningful impact, and improve the lives of those affected by dementia today and into the future.”

The HRB’s Collaborative Research Networks Scheme reinforces an ongoing commitment to collaboration in research, and is designed to advance collaborative and interdisciplinary research, as well as its translation into policy and practice to tackle key health and social care challenges across the island of Ireland.

News Hepatitis C Online Order The HSE is expanding its hepatitis C online order-to-home testing service to include a new, rapid oral swab self-test.

This new oral test makes testing for hepatitis C easier, more accessible and stigma free, delivering results in 20 minutes.

It complements the existing lab-based self-test, offering people a choice of how to check for hepatitis C. The service is fully confidential, and the test arrives in discreet packaging. Anyone who receives a reactive test result will be supported in accessing free hepatitis C confirmation testing and treatment services, ensuring timely and effective care.

Hepatitis C is a virus that affects the liver and, if left untreated, can lead to serious and potentially life-threatening conditions over time. The virus is transmitted through blood-to-blood contact.

Those most at risk include: • people who use or have used drugs • current or former prisoners • people experiencing homelessness • people born in countries where hepatitis C is more common.

Professor Aiden McCormick, Clinical Lead for the HSE National Hepatitis C Treatment Programme, commented, “It’s never been easier to find out if you have hepatitis C. This new self-test is a painless, blood-free oral swab. We urge anyone who could be living with hepatitis C to get checked for peace of mind so that we can connect them to life saving treatment.

This is designed as a convenient way to reach people who might not otherwise get tested for hepatitis C virus (HCV), and therefore go undiagnosed.

To date the National Hepatitis C Treatment Programme has treated over 7,000 people with a 95% cure rate, and is on track to meet the elimination targets set out by the World Health Organisation (WHO).”

5

Ireland Responds to EU and US Tariffs IPHA has noted the joint statement by the US and EU on tariffs, particularly the aspects dealing with pharmaceuticals.

In a statement, the Irish Pharmaceutical and Healthcare Authority said some mitigation of the potentially bad outcomes is set out. However, there remains considerable uncertainty and problems with tariffs policy. A 15% tariff on innovative medicines exports would not be a solution for anything or any country; tariffs on medicines would be a substantial new cost where there was none before and a drag on investment, jobs and innovation.

“A lower or zero tariff on generic products and their ingredients, leaving open higher tariffs on innovative medicines, is misguided and does not support investment in innovation and patients’ interests in either the US or the European Union. Moreover, the patent-status of products does not fit into existing trade product categories and will raise further complexities.

“IPHA asks the Irish Government to continue to make the case for zero tariffs on innovative medicines with the US Administration, with Ireland as a key and strategicallyreliable supply chain partner.”

IPHA would reiterate: • Tariffs on innovative medicines will disrupt global supply chains,

undermine innovation, and ultimately harm patient access to life-enhancing medicines on both sides of the Atlantic.

• Ireland plays a crucial role in supporting manufacturing facilities in the United States by providing many of the essential components and critical segments of the production process needed to bring lifeenhancing medical treatments to the people that need them.

• Tariffs are a blunt instrument that threaten jobs, investment, competitiveness, and supply chain resilience across the US and the EU. Instead, both industry and Government should continue to address the issues raised in the US Administration’s Section 232 investigation and, given the complexities of pharmaceutical supply chains and the risks to patient access, it is critical to establish a zerotariff framework—with a grace period built in for any changes— to safeguard uninterrupted care when it is most needed.

• From a European perspective to secure future pharmaceutical investment and ensure fair, sustainable access to innovative

medicines, we need policy solutions that values innovation and creates an operating environment that can accelerate turning Europe’s great science into new treatments.

• In parallel, Ireland can also urgently address its access to medicines environment to ensure we remain competitive on all fronts. The upcoming IPHA Framework Agreement on Pricing and Supply of medicines, due for renewal at the end of September, is a key opportunity to improve timely patient access to new medicines while maintaining a competitive, innovation-friendly environment.

With the right policy changes and serious commitments to invest in a world class pharmaceutical ecosystem in Europe and Ireland, we can continue to be a global hub for new medicines serving the needs of millions of patients.

The Irish Pharmaceutical Healthcare Association (IPHA) represents 41 providers of innovative medicines in Ireland, with many companies having significant manufacturing and business presence in the country.

Creating Exceptional Pharmacy Experiences McCabes Pharmacy Group are proud to share another important step in their journey to become Ireland’s leading and most patient-centric pharmacy brand.

All 110 McCabes Pharmacies are now equipped with impactful digital screens in windows and dispensary areas — with high-impact LED window displays in their flagship shopping centre locations: Dundrum, Blanchardstown, and Swords Pavilions.

This commercial project headed by Marina Timotijevic in partnership with Focal who supplied and installed the screens.

Benefits include: • Flexibility to create tailored messages that support local shoppers

• Greater impact with dynamic, engaging content • A sustainable solution reducing print and waste

Another big step forward in creating exceptional pharmacy experiences for communities.

PHARMACYNEWSIRELAND.COM

6

News

Marking Pharmacy Heritage Week RCSI has unveiled a newly catalogued and digitised archive collection from one of Ireland’s most significant pharmacy chains, Hayes, Conyngham & Robinson, to mark Heritage Week 2025.

Pictured in the group photograph left to right are: Christopher Shiell, Professor Helena Kelly, Head of RCSI School of Pharmacy & Biomolecular Sciences; Professor Tracy Robinson, Deputy Vice Chancellor for Academic Affairs, RCSI; Michael Shiell, Professor Cathal Kelly, Vice Chancellor, RCSI and Kathryn Smyth, Associate Librarian, RCSI. Christopher and Michael Shiell are the donors of the collection

that this material will now be preserved and made accessible for future generations.”

Founded in 1897, Hayes Conyngham & Robinson began as a family-run business and grew to become one of the largest Irish-owned pharmacy chains in Ireland. Its final shop on Grafton Street, Dublin closed in 1998. The Hayes, Conyngham & Robinson Pharmaceutical Chemists collection is a rich and valuable resource which provides a window into the evolution of pharmacy and medicine in Ireland from the mid-19th century up to the late 20th century.

The archive sheds light on the development and concerns of organisations such as the Pharmaceutical Society of Ireland, the Dublin and Provincial Retail Drug Association and its successor, the Irish Pharmaceutical Union as well as institutions like the Ledwich School of Anatomy and Surgery.

It also offers rich insights into Irish social history, featuring personal papers, artefacts, photographs and memorabilia from those who worked in the Hayes, Conyngham & Robinson Medical Halls. Among the materials are unique accounts of events in modern Irish history, including the 1916 Easter Rising.

“This new acquisition to our Heritage Collections offers students, faculty and researchers an unparallelled opportunity to explore the history, development and impact of pharmaceutical practices over the decades”, said Professor Helena Kelly, Head of the School of Pharmacy and Biomolecular Sciences.

“These records don’t just chart scientific progress; they offer a rich and sometimes quirky glimpse into Irish life and culture through the lens of pharmacy. We’re delighted

The archive was generously donated by Michael and Christopher Sheils, great grandsons of company founder Mr Henry Conyngham. It includes company records, formula books, pharmacopoeias, reference texts, ephemera, photographs and personal papers from members of the Robinson family and those who worked for the pharmacy throughout its 100 years in business.

Hayes, Conyngham & Robinson played a vital role in the everyday health and well-being of communities across Ireland.

Through the medicines they dispensed and the advice they offered, the pharmacy chain was a trusted point of care for generations, reflecting the close connection between pharmaceutical practice and public health.

Improving Diabetes Care A recent audit of a full year of data from nurse-led diabetes clinics across four Integrated Disease (Chronic Care) networks in Limerick has shown promising results for people living with Type 2 Diabetes.

The review of 175 patients, all discharged from the service in 2024, found that most experienced meaningful improvements in their health.

The key highlights of the 2024 audit included: • Better Blood Sugar Control: Nearly 80% of patients saw improvements in their HbA1c levels—a key measure of blood sugar control.

Impressively, 71% had reductions of more than 11 mmol/mol, and 44.6% saw drops greater than 21 mmol/ mol. These changes are linked to lower risks of diabetes complications and fewer hospital visits.

• Medication and Lifestyle Support: 80% of patients audited had their medications adjusted to better manage their condition, while all patients made some form of lifestyle change during their time with the service.

• Safe and Appropriate Discharges: Of the patients discharged, 26% were referred to secondary care, including those on insulin therapy, in line with national guidelines.

This ensures patients receive the right level of care for their needs.

The CNSs provide holistic assessments, support lifestyle changes, and help patients manage their medications effectively. This proactive approach improves health outcomes and helps reduce pressure on hospitals and outpatient services.

The four Limerick networks in the 2024 audit are covered by two Diabetes CNSs. With a third CNS responsible for East Limerick and North Tipperary, Brid Collins and Karen Guico host county outpatient clinics at Newcastle West, Croom and Kilmallock, and in the city and outskirts at Ballynanty, Kings Island, Barrack View and Dooradoyle.

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The end of erectile problems?

Touch wood.

Available over the counter. No prescription required.

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

ABBREVIATED PRESCRIBING INFORMATION Product Name: Sidena 50 mg Tablets.

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

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

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

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

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

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

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

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

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

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

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

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

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

Supply status: Supply through pharmacies only.

8

News

Dual Success for United Drug United Drug Wholesale shortlisted for major healthcare and ecommerce awards United Drug Wholesale is celebrating dual award success this year, with recognition at both the Irish Healthcare Awards and the Irish Ecom Awards.

At the Irish Healthcare Awards, UDW has been shortlisted in the Patient Education Project of the Year – Pharmaceutical category, recognising its innovative approach to supporting both pharmaceutical suppliers and community pharmacies across Ireland. Through targeted supplier campaigns, CPD-accredited webinars, the UD Talks podcast, and data-led insights, the strategy helps to bridge the gap between manufacturers and patientfacing teams. The result is a communications approach that not only supports suppliers but also empowers pharmacists to deliver better patient care.

The shortlisting reflects United Drug’s two-pronged strategy, designed to meet the needs of suppliers while also equipping pharmacists with the resources they need to provide high-quality patient care. By combining education, insights, and communications, the programme strengthens the connection between suppliers and the 1,900-strong pharmacy network United Drug supports nationwide.

Over the past year, the team has delivered tailored supplier campaigns, launched the UD Talks

podcast, hosted CPD-accredited webinars, and produced data-led sales insights, all supported by an integrated social media and email marketing strategy. This mix of channels ensures that important clinical and product information is accessible, relevant, and practical for pharmacists, whether in the dispensary, online, or on the go.

The results speak for themselves.

Supplier campaigns have achieved engagement rates well above industry benchmarks, with banner placements on the UDW.ie homepage generating over 150,000 weekly views. The UD Talks podcast has already reached more than a third of Irish pharmacies, while social media growth has further expanded the reach of key healthcare messages.

Alongside this, United Drug has been named a finalist in the Ecom Awards 2025 for B2B Website of the Year with both its flagship ordering platform UDW.ie and compliance-based buying group platform Pharmax.ie.

UDW.ie serves as a central portal for more than 2,000 pharmacies, providing 24/7 access to over 14,000 products, account management tools,

United Drug Marketing Team (L – R) Adrian Pietrzak, Martin O'Loughlin, Dervila McGarry and Karen Gibney and a dedicated Resource Hub offering pharmacist-only education. Pharmax.ie, meanwhile, is designed to help pharmacies maximise margins by sourcing competitively priced medicines and front-of-shop products, using smart procurement algorithms and seamless integration with dispensary systems.

These nominations highlight United Drug’s continued investment in digital innovation, education,

and supplier collaboration. From strengthening communications in pharmacy practice to transforming procurement, United Drug is committed to supporting the sector with tools and resources that make a real impact on patient care and pharmacy business.

For more information on supplier marketing services and resources contact the marketing team at UDWMarketing@united-drug.com

¤6.5m Horizon Europe Bone Regeneration Project Dr Ciara Murphy, Senior Lecturer from the RCSI Department of Anatomy and Regenerative Medicine, the Research Ireland Centre for Advanced Materials and BioEngineering Research (AMBER) and RCSI Tissue Engineering Research Group, has been named a partner on a prestigious ¤6.5 million Horizon Europe grant.

The funding will support HYDROHEAL, an ambitious research initiative aimed at developing smart, sustainable biomaterials to transform the treatment of bone loss and fractures.

As part of the international HYDROHEAL consortium, Dr Murphy will advance the development of injectable hydrogels made from natural, renewable sources. These hydrogels are designed not only to support bone healing – particularly in the spine and jaw – but also to deliver therapeutics precisely when and where they are needed, activated by external signals.

“What sets HYDROHEAL apart is the integration of intelligent biomaterials with advanced drug delivery systems,” said Dr Murphy. “Our goal is to create eco-friendly, scalable solutions that don’t just support healing – they actively enhance it, improving outcomes for patients with serious skeletal injuries.”

bioengineered hydrogels will incorporate features to support healing, fight bacterial infection, and enable real-time treatment monitoring. They will also be enhanced through machine learning and digital design tools, helping ensure sustainable, cost-effective production at clinical scale.

The project addresses a significant clinical need. Fractures caused by injury, infection, osteoporosis or cancer remain a major global health challenge, and current treatments such as bone grafts and bone cement have limitations in effectiveness and safety. HYDROHEAL’s

In addition to scientific innovation, HYDROHEAL will be informed by public and patient involvement (PPI). Patient groups affected by spinal and jawbone injuries will be directly engaged through focus groups, surveys, and consultation activities. The project aims to collaborate with at least five

PHARMACYNEWSIRELAND.COM

patient associations, ensuring that patient needs and priorities guide the research.

Professor Fergal O’Brien, Deputy Vice Chancellor for Research and Innovation at RCSI, welcomed the award, “This Horizon Europe funding reflects the outstanding calibre of Dr Murphy’s work and the strategic impact of RCSI’s regenerative medicine research.

HYDROHEAL is an excellent example of how scientific innovation, when grounded in clinical need and sustainability, can drive meaningful change in healthcare.”

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10

News

Sharp Increase in Pain Medication Prescribing of pain medications in Ireland has risen significantly over the past decade, with usage rates now outpacing those in England, according to new research from RCSI University of Medicine and Health Sciences.

Professor Frank Moriarty, senior author of the study and Associate Professor at the RCSI School of Pharmacy and Biomolecular Sciences

“While medication can play an important role in treating pain, we must address issues like orthopaedic surgery waiting times and ensure Irish patients also have access to safe, evidencebased alternatives to medications. Access to data is equally vital to track how prescribing patterns evolve across this and other disease areas over time.”

Published in the British Journal of Clinical Pharmacology, the study highlights differences in how pain is treated in primary care in Ireland and raises questions about healthcare access, prescribing practices and the availability of nondrug interventions to address pain.

Researchers examined national prescribing data between 2014 and 2022, focusing on patients in Ireland covered by the General Medical Services (GMS) scheme – people with a medical card, representing about one third of the population – and on data from all general practices in England.

In Ireland, the use of opioids increased by approximately 25% over the study period, while prescriptions for paracetamol rose by 50%. Specific medicines like codeine and stronger opioids like tapentadol and oxycodone increased by even higher percentages. By contrast, England

experienced declining use across most classes of pain medications during the same timeframe.

“These results suggest a growing reliance on prescribing pharmacological treatments for pain in Ireland for the GMS patients we analysed,” said Dr Molly Mattsson, first author of the study and Postdoctoral Fellow at the RCSI School of Pharmacy and Biomolecular Sciences. “The trends raise important questions about healthcare access and the availability of non-drug options to manage pain, particularly for medical card holders who avail of public services.”

The analysis also revealed that prescribing levels in Ireland were substantially higher than in England by 2022: two times higher for opioids, four times higher for anti-inflammatories, and nearly five times higher for paracetamol.

PHARMACYNEWSIRELAND.COM

Some of this disparity can be attributed to the differing populations studied. NHS data covers the entire population of England, while the Irish data reflects prescribing to GMS patients – a group where older adults are overrepresented.

However, the Irish and English health systems also take markedly different approaches to managing pain issues.

In England, broad access to healthcare services including pain clinics and non-pharmacological interventions such as physical therapy through the NHS may help reduce reliance on medication.

In Ireland, such services are less widely available, particularly for medical card holders, which may be contributing to higher medication use.

“Many of these medications carry risks such as dependency which can be worsened by overprescribing,” said Professor Frank Moriarty, senior author of the study and Associate Professor at the RCSI School of Pharmacy and Biomolecular Sciences.

“While medication can play an important role in treating pain, we must address issues like orthopaedic surgery waiting times and ensure Irish patients also have access to safe, evidencebased alternatives to medications.

Access to data is equally vital to track how prescribing patterns evolve across this and other disease areas over time.”

The study was carried out in collaboration with the Health Service Executive (HSE) Quality and Patient Safety Directorate, University of Oxford, University College Cork, and University College Dublin and was funded by the Health Research Board (HRB).

Pharmacy Emergency Response “Pharmacy’s global responses to emergencies and disasters: Country examples” is a new report released by the International Pharmaceutical Federation (FIP) to mark World Humanitarian Day. The report showcases how pharmacists worldwide are supporting communities in times of crisis. Developed under FIP’s Humanitarian programme, the report presents real-world case studies from countries including Cameroon, Japan, Lebanon, New Zealand, South Africa, Spain, Turkey and Ukraine, highlighting pharmacists’ roles in responding to derailments, natural disasters, disease outbreaks, armed conflicts, and other emergencies.

It identifies enablers, challenges, and lessons learnt from these responses, and outlines opportunities for collaboration and FIP support to strengthen emergency preparedness within the profession. By sharing these experiences, FIP aims to inspire action, improve readiness, and advocate for pharmacists as essential actors in humanitarian and disaster response.

FIP President Paul Sinclair said, “Recent events over the past few years have underscored the urgent need for co-ordinated strategic actions to ensure equitable access to healthcare and strengthen the resilience of communities worldwide.

Pharmacists and healthcare professionals have remained steadfast at the forefront of these efforts, often working in the most adverse and perilous conditions to ensure that people continue to receive the care and medicines they so desperately need.

“As a global federation we pledge to stand shoulder to shoulder with these heroes.

FIP has adapted our global campaign to encourage everyone to ‘Think Humanity, Think Pharmacy,’ a message that reflects the vital role of pharmacy in promoting global health through a human-centred lens. This motto underscores the responsibility of pharmacists and the pharmaceutical sector, not only to ensure the safe and effective use of medicines, but also to make a meaningful contribution to the health and wellbeing of individuals and communities around the world.”

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12

News

Retail Excellence for Adrian Dunne Pharmacy Eight Adrian Dunne Pharmacy branches are celebrating having been named among the 2025 Retail Excellence Top 100 Finalists for National Retailer of the Year! A big congratulations to our teams in Ashbourne, Ashford, Baldoyle, Ballinteer, Kilbarrack, Portarlington, Rush & Trim.

The HSE is building on last winter’s very successful RSV immunisation programme which was delivered to new born babies in maternity settings and higher risk babies in the community. The programme significantly reduced infections, serious illness and hospitalisations.

This winter season the HSE will once again offer RSV immunisation in maternity settings to all babies born in Ireland from 1st September 2025 to 28th February 2026 as well as extending the programme to all babies in Ireland born in the six month period from 1st March 2025 to 31st August 2025 across various community sites.

The National Retailer of the Year honours an Irish retail business that has demonstrated exceptional performance, innovation, and leadership. The recipient will have consistently delivered outstanding customer experience, shown a commitment to continuous improvement, and stood out for their ability to adapt and grow in a competitive retail environment.

The winner will represent the highest standard in Irish retail - combining operational excellence with a clear brand vision, strong team culture, and meaningful customer connection. The National Retailer of the Year is selected from the winners of each award category. Award categories are subject to change based on the nature and variety of entries received - these cover all sectors of retail.

Every winter RSV infection causes hospitalisations, including some serious illness, especially among young infants says HSE National Director for Health Protection, Dr Éamonn O’Moore.

The Elavon Retail Excellence Ireland Awards recognise and celebrate the best in Irish retail, with the National Retailer of the Year Award honouring retailers who demonstrate outstanding service, performance and innovation.

Pharmacists PSI workforce Survey The PSI is conducting its fourth annual workforce survey this September and is asking all pharmacists to take part and contribute to this important initiative.

The survey is designed to support the regulator’s ongoing efforts to enhance the data and insights available about the pharmacist workforce in Ireland. Findings will help inform collaborative action by the PSI and other pharmacy stakeholders to help ensure the sustainability of the workforce and its capacity to meet the evolving needs of both the pharmacy sector and wider healthcare system.

To enable monitoring of workforce trends, the survey repeats many of the questions asked in previous years and also seeks views in relation to current practice advancements as well as potential future developments. Supervising pharmacists have the opportunity to provide information about their pharmacy including staffing composition and services provided.

The register of pharmacists in Ireland has been consistently increasing and currently stands at over 7,700. This survey

is applicable to registered pharmacists at all career stages and every area of work, including those who work outside of healthcare/pharmacy, retired or temporarily non-practising. With healthcare continuing to evolve, it is increasingly important to see how and where pharmacists are applying their skills and expertise, and to understand the proportion of those registered who are working in direct patient care.

The PSI conducted its first detailed workforce survey in 2022 and subsequently published the Workforce Intelligence Report in 2023. To advance recommendations of that report, a Pharmacy Workforce Working Group was established in April 2024. Jointly overseen by the PSI and the Department of Health, the group includes representation from the HSE, IPU, Schools of Pharmacy, pharmacists in practice, and others. The annual survey is a key component of the group’s

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HSE Extends RSV Programme

ongoing work to monitor changes in the pharmacy environment.

Previous reports and more information on this area of work can be found on the PSI website (www. psi.ie/information-and-resources/ future-pharmacy-workforce).

All pharmacists registered with the PSI as of 1 September will receive an email with a link to the 2025 workforce survey, which should take less than 10 minutes to complete. The PSI is happy to hear from pharmacists who do not receive access to the survey or who encounter any difficulties with completing it (email professionalstandards@psi.ie).

The PSI is grateful for the continued engagement of pharmacists and encourages strong participation in the workforce survey again this year.

The insights gathered will be shared in the 2025 Workforce Survey Report, to be published in early 2026.

“Before the introduction of the programme, each winter, 4 out of every 100 infants were hospitalised due to RSV, with some infants needing special treatment in intensive care units.

A further 50 out of every 100 infants got RSV and many needed medical care from their GP, or the emergency department of a children’s hospital.

“I would urge parents of all eligible babies to take up the offer when the programme begins in September.”

Parents of babies born from 1st March to 31st August can book an appointment at a local community site from Monday 25th August on the RSV Immunisation page of the HSE website https://www2.hse.ie/ conditions/rsv/immunisation/ Parents of babies born from 1st September to 28th February 2026 will be offered the immunisation before they leave the maternity hospital.

“This year’s programme is a second ‘path-finder’ which will allow us to explore and analyse how best to improve health and to provide information and experience on rolling out any future programmes. It finishes at the end of February 2026.

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14

Lean Pharmacy

Embracing Lean Principles: A Pathway to Efficiency and Enhanced Patient Care in Irish Community Pharmacies The Growing Burden on Community Pharmacies Community pharmacies in Ireland, much like their counterparts globally, are facing an unprecedented escalation in workload. This isn't merely a fleeting challenge but a systemic issue, intricately linked to an aging population with more complex medical needs, the increasing array of patient services offered, and an ever-growing administrative burden that takes valuable time away from direct patient interaction.

This escalating workload has far-reaching consequences, extending beyond just patient access to clinical pharmacy services. It significantly impacts the well-being of our dedicated pharmacists and pharmacy staff, contributing to increased stress, burnout, diminished job satisfaction, and even a higher rate of job turnover.

Written by Frank Olden, Hickey’s Pharmacy, Cork

most common individual rework type (8%), highlighting a critical point of failure in communication or data entry. Other significant issues included incorrect quantities (5.2%), wrong strengths (3.4%), and even instances of the wrong patient or brand on the label. These errors often require a complete relabeling process, consuming time and potentially delaying patient access to their medication.

Within this demanding environment, a pervasive yet often unquantified phenomenon known as 'rework' further exacerbates the pressures on pharmacy operations. Rework, in essence, is any activity during the medication dispensing cycle that necessitates a return to a prior procedural step for correction. It represents an inefficiency, a deviation from the ideal flow, and a significant drain on resources. My recent research, a pioneering observational study into the cause and frequency of prescription rework in community pharmacies, has unveiled the startling reality of its prevalence.

This study, the first of its kind to comprehensively evaluate a wide variety of prescription reworks in this setting, found that on average, at least five instances of prescription rework occur every single day in community pharmacies. This figure, based on self-reported data, is likely a conservative estimate, as many reworks caused by other staff members might not even reach the pharmacist's awareness.

The sheer frequency of rework

undeniably adds considerable complexity and a significant time burden to the already demanding role of providing pharmaceutical care to patients. As a pharmacist and a fervent advocate for lean principles, I firmly believe that adopting these methodologies offers a robust and transformative solution to these challenges, promising to inject much-needed structure, efficiency, and value into the Irish pharmacy business.

Understanding Rework: A Deeper Dive into the Causes To effectively combat rework, we must first understand its multifaceted origins. Our study cataloged 325 reworks across 65 study days, revealing distinct patterns and primary culprits.

The three most common categories of rework identified were: • Labelling Errors (22.8% of all reworks): These were the most frequent category, encompassing a range of inaccuracies that necessitate correction. "Wrong instructions on the label" was the

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• Prepared Prescriptions Requiring Opening and Repackaging (15.1% of all reworks): This category speaks to inefficiencies in the preparation and dispensing process itself. The most frequent individual rework within this category was "an item omitted from bag" (7.4%), followed by "an additional unwanted item in bag" (4.9%). This means that after a prescription has been seemingly completed and bagged, it needs to be unbagged, corrected, and rebagged, a wasteful duplication of effort. My research further highlights the critical role of communication between pharmacy staff and patients in preventing this type of rework.

• Medication Owings to Patients (13.9% of all reworks): This is a particularly frustrating category for both patients and pharmacy staff. The overwhelming majority of these reworks (71.1%) were directly attributed to "insufficient supply of medication on shelf".

This isn't just about a missing item; it triggers a cascade of additional work: amending the patient medication record (PMR), placing an order with the wholesaler, and then reassuring the patient about when their medication will be available.

Once the medication arrives, the PMR must be updated again, a new label generated, and the medication checked and provided to the patient.

This entire sequence illustrates the deep complexity and time consumption that rework can propagate within a community pharmacy setting. While external factors like wholesaler shortages contribute, a significant portion is undoubtedly due to inadequate inventory management systems within pharmacies themselves.

Beyond these top three, other significant contributors to rework include workflow issues, high telephone call volumes and distractions, prescriptions requiring prescriber clarification, and patients failing to collect automatic prescription refills. Our study also highlighted specific examples such as refrigeration errors, incomplete controlled drug requirements, and typographical errors on labels. These findings collectively underscore the diverse array of challenges that interrupt the smooth flow of prescription processing and the urgent need for systemic improvements.

The Philosophy of Lean: Reducing Waste, Enhancing Value My personal journey to understanding and advocating for lean principles took a significant step forward with my visit to Toyota in 2024. The insights gained from observing their renowned production system reinforced my conviction that these principles, though originating in manufacturing, are profoundly applicable and indeed vital for healthcare settings, particularly community pharmacies.

Lean principles are fundamentally about creating maximum value for the patient by systematically reducing waste and variation, leveling workload, and empowering staff to actively participate in process improvement.

15 Within the lean philosophy, 'waste' is defined as any activity that fails to add value or results in redundancy to the next user, impeding quality and flow, and therefore, should be eliminated.

Our study's definition of rework aligns perfectly with two of the seven forms of waste identified in lean principles: 'defects' and 'inappropriate processing'.

When a defect occurs (e.g., a labelling error), or processing is inappropriate (e.g., preparing a prescription that is later uncollected), it inevitably leads to rework – a wasteful activity that consumes time, resources, and often, staff morale.

By embracing lean, pharmacies can move beyond simply reacting to errors to proactively identifying and preventing them. This involves: • Value Stream Mapping: Visually mapping the entire prescription processing workflow to identify every step, distinguishing between value-adding activities and non-value-adding waste. This allows for a clear understanding of where rework typically occurs.

• Standard Work: Developing clear, consistent, and standardized procedures for all tasks to reduce variation and ensure quality. This is particularly relevant for addressing common labelling errors or ensuring complete prescriptions.

• Just-in-Time Inventory: Optimising stock levels to avoid both overstocking (which can lead to expired medications or storage issues) and understocking (which directly causes "owings" rework). My study highlighted insufficient medication on the shelf as a major cause of rework, making robust inventory management a key area for lean intervention.

Firstly, the high prevalence of labelling errors (22.8%) points to the need for rigorous doublechecking mechanisms and potentially automated systems to minimize human error. Currently, comprehensive staff training on accurate data entry and label verification, could significantly reduce this rework category.

Secondly, the frequent rework on prepared prescriptions (15.1%), particularly due to omitted or unwanted items, underscores the importance of final checks before bagging, as well as clear communication with patients regarding their order. Implementing a standardized patient ordering protocol, could be a simple yet effective lean intervention.

Thirdly, the substantial rework caused by medication owings (13.9%) due to insufficient stock highlights a critical area for inventory management improvement. Pharmacies should evaluate their current inventory systems for effectiveness. This could involve implementing robust stock rotation practices, leveraging technology for demand forecasting, and establishing clear communication channels with wholesalers to anticipate and mitigate shortages. While some shortages are external, internal inventory control remains a powerful lever for reducing rework.

Our study also revealed interesting trends related to staffing and workload. We observed that pharmacies with higher levels of dispensary staff (two pharmacists and four or more total dispensary staff) recorded less rework than those with fewer staff. While our small sample size limits generalizability, this finding aligns with previous research indicating that inadequate pharmacist cover can lead to medication errors.

Rework and errors, while distinct,

both represent failures in planned actions. This suggests that appropriate staffing levels are not just about managing volume but are integral to preventing inefficiencies and maintaining quality.

Furthermore, the observation that rework occurred more frequently during peak hours (9 am-12 pm and 3 pm-6 pm) and significantly increased after 6 pm in the sole pharmacy open until 9 pm, hints at the role of fatigue as a contributory factor. Lean principles emphasize leveling the workload to prevent peaks and troughs that contribute to stress and errors. This could involve optimizing scheduling to ensure adequate coverage during busy periods and considering strategies to mitigate fatigue during extended shifts.

Finally, the development of our comprehensive rework list, which successfully captured over 91.7% of all rework instances, is a significant strength of this study.

This list can serve as an invaluable tool for other pharmacy staff to conduct their own internal audits, identify specific training needs, and foster a stronger safety culture. It provides a concrete framework for initiating lean improvement cycles within individual pharmacies.

Conclusion: A Call to Action for a More Efficient Future This study unequivocally demonstrates that prescription rework is not an anomaly but a frequent occurrence in Irish community pharmacies, imposing a substantial burden on both staff and operations. The primary culprits—labelling errors, medication owings (largely due to stock insufficiency), and prepared prescriptions requiring subsequent repackaging—highlight specific areas where targeted interventions can yield significant improvements.

While our study’s limited sample

size prevents definitive conclusions on the impact of pharmacy and pharmacist characteristics on rework frequency, it strongly suggests a correlation that warrants further investigation with larger cohorts.

My journey to Toyota cemented my belief that lean principles are not just theoretical constructs but practical, powerful tools that can fundamentally reshape how we operate. The estimated four hours of pharmacist time spent on rework per week, translating to an astonishing 208 hours per pharmacy per year, represents a colossal amount of wasted potential. By strategically minimizing rework through the application of lean methodologies, we can unlock significant time and cost benefits, enabling us to reallocate precious resources. This means more time for pharmacists to engage in essential clinical pharmacy services, enhance patient safety during prescription processing, and ultimately, better meet the diverse healthcare needs of our communities.

The future of community pharmacy in Ireland hinges on our collective commitment to efficiency and continuous improvement. By embracing lean principles, we can transform challenges into opportunities, reduce unnecessary workload, and cultivate a more structured, resilient, and patientcentric pharmacy business. This research serves as a starting point, generating awareness and providing a framework for action. It is now imperative for pharmacy staff, researchers, and policymakers to collaborate in developing and implementing robust strategies to minimize rework, ensuring that our pharmacists can dedicate their expertise to where it matters most: enhancing patient care.

• Continuous Improvement (Kaizen): Fostering a culture where all staff members are encouraged to identify problems, suggest improvements, and participate in small, incremental changes to optimize processes.

This empowers the front-line staff who are most familiar with daily operations.

• Visual Management: Using visual cues and displays to make the status of work clear and immediately apparent, helping to flag potential issues before they become reworks.

Practical Implications for Irish Pharmacy Practice The findings of our study provide tangible areas where Irish community pharmacies can begin to implement lean principles and address rework.

PHARMACYNEWSIRELAND.COM

16

Pharmacy Marketing

Harnessing the Power of Patient Data: How AI Is Transforming Pharmacy Marketing in Ireland In today’s fast-moving digital world, pharmacies hold a powerful but often underused asset — patient data.

From prescription orders to health product trends, this information can offer deep insights into customer needs, behaviour, and health challenges. With the right technology, pharmacies can unlock this data to build better relationships with patients, create more targeted health campaigns, and ultimately improve public health outcomes. pharmacists or marketing staff can copy and paste this content into their preferred communication channels, saving hours of manual work.

Written by Adam Esa MPSI MPHARM MBA aesa@localpharmacy.ie This means pharmacies can now build highly specific, niche marketing campaigns — whether via SMS, email, or social media — based on key factors like age, gender, health condition, or even the specific medications a patient orders. For example, if a surge in hay fever prescriptions is detected, a pharmacy could automatically send targeted tips, promotions, or health advice to relevant patients.

From Raw Data to Real Campaigns — In Minutes At Taskgo AI, we are proud to be at the forefront of this transformation.

As Ireland’s first AI-driven pharmacy tool, we are pioneering how pharmacies can use artificial intelligence (AI) to turn everyday prescription data into dynamic, real-time marketing strategies.

A Feasibility Study: The Future of Pharmacy Marketing We’re currently carrying out an exciting feasibility study that explores how pharmacies can use AI agents to learn from online patient prescription orders.

These agents don’t just collect data — they learn from it. They understand trends, identify health patterns, and use that information to feed a pharmacy’s Customer Relationship Management (CRM) system in real time.

What makes Taskgo AI truly revolutionary is how we’ve connected these learnings to an intelligent, machine-learned marketing campaign builder. This system not only pulls insights from your patients’ prescription history, but also connects with reliable public sources like the HSE, HSPC, and Met Éireann.

So, if there’s a new flu warning, an allergy season spike, or a change in public health guidelines, the system reacts. It builds a marketing strategy on the spot — choosing the right tone, message, channel, and target audience.

And it doesn’t stop there. The AI then automatically generates ready-to-use content for retail posters, emails, social media, and SMS campaigns. Within minutes,

Saving Time, Cutting Costs, and Boosting Health Outcomes For busy pharmacies, this technology is a game-changer. It removes the guesswork, reduces time spent on planning and design, and eliminates the need for expensive outside marketing teams. At the same time, it ensures that patients receive timely, relevant, and helpful health information — all based on real data and current events.

This feasibility study is just the beginning. As we continue to learn and adapt, Taskgo AI will become an even more powerful partner for pharmacies across Ireland, helping them turn patient data into healthier communities.

To learn more about how Taskgo AI can support your pharmacy’s marketing goals and unlock the full potential of your patient data, visit www.digitalpharmacy.ai. You can request a free demo to see how the platform works in real-time.

It’s never been easier to bring intelligent, time-saving technology into your pharmacy.

By using AI to connect patient insights with public health trends and marketing tools, Taskgo AI empowers pharmacies to act faster, communicate better, and operate smarter.

Leading the Way in Irish AI Innovation We’re proud to say that Taskgo AI is Ireland’s first AI tool built specifically for pharmacies — designed, developed, and tested with the unique needs of the Irish healthcare system in mind. Our goal is to help pharmacies move from reactive to proactive care, using smart technology to make marketing not just easier, but more meaningful. Whats better is that its being pioneered by Irish registered pharmacists working every day on the front line.

About the Author Adam Esa is a superintendent pharmacist in Ireland and the director of Taskgo AI. He has previously founded and exited multiple health tech ventures, including a pharmacy-focused health tech education company within the United Kingdom.

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04/07/2025 14:4

Atorvastatin Teva Pharma replaces Atorvastatin Teva

Same GMS codes apply: 41990 (10 mg), 41991 (20 mg), 41992 (40 mg), 41993 (80 mg) Indications 10 mg, 20 mg, 40 mg and 80 mg film-coated tablets Hypercholesterolaemia Atorvastatin Teva Pharma is indicated as an adjunct to diet for reduction of elevated total cholesterol (total-C), LDLcholesterol (LDL-C), apolipoprotein B, and triglycerides in adults, adolescents and children aged 10 years or older with primary hypercholesterolaemia including familial hypercholesterolaemia (heterozygous variant) or combined (mixed) hyperlipidaemia (corresponding to Types IIa and IIb of the Fredrickson classification) when response to diet and other non-pharmacological measures is inadequate.

Atorvastatin Teva Pharma is also indicated to reduce total-C and LDL-C in adults with homozygous familial hypercholesterolaemia as an adjunct to other lipid-lowering treatments (e.g. LDL apheresis) or if such treatments are unavailable.

Prevention of cardiovascular disease Prevention of cardiovascular events in adult patients estimated to have a high risk for a first cardiovascular event, as an adjunct to correction of other risk factors.

Atorvastatin Teva Pharma Film-Coated Tablets Abbreviated Prescribing Information. Presentation: Each film-coated tablet contains 10mg, 20mg, 40mg and 80mg atorvastatin (as atorvastatin calcium). Indications: Hypercholesterolaemia: Atorvastatin Teva Pharma is indicated as an adjunct to diet for reduction of elevated total cholesterol (total-C), LDL-cholesterol (LDL-C), apolipoprotein B, and triglycerides in adults, adolescents and children aged 10 years or older with primary hypercholesterolaemia including familial hypercholesterolaemia (heterozygous variant) or combined (mixed) hyperlipidaemia when response to diet and other nonpharmacological measures is inadequate. Atorvastatin Teva Pharma is also indicated to reduce total-C and LDL-C in adults with homozygous familial hypercholesterolaemia as an adjunct to other lipid-lowering treatments (e.g.

LDL apheresis) or if such treatments are unavailable. Prevention of cardiovascular disease: Prevention of cardiovascular events in adult patients estimated to have a high risk for a first cardiovascular event, as an adjunct to correction of other risk factors. Dosage and administration: For oral administration. Adults: Usual starting dose is 10mg once a day, with adjustment of dose made at intervals of 4 weeks or more. Maximum dose is 80mg once a day. Primary hypercholesterolaemia and combined (mixed) hyperlipidaemia: Majority of patients are controlled with Atorvastatin Teva Pharma 10mg once a day. A therapeutic response is evident within 2 weeks, and the maximum therapeutic response is usually achieved within 4 weeks.

Heterozygous familial hypercholesterolaemia: Patients should be started with Atorvastatin Teva Pharma 10mg daily. Doses should be individualised and adjusted every 4 weeks to 40mg daily. Thereafter, either the dose may be increased to a maximum of 80mg daily or a bile acid sequestrant may be combined with 40 mg atorvastatin once daily. Homozygous familial hypercholesterolaemia: Limited data available. The dose of atorvastatin in patients with homozygous familial hypercholesterolemia is 10 to 80mg daily.

Atorvastatin should be used as an adjunct to other lipid-lowering treatments (e.g. LDL apheresis) in these patients or if such treatments are unavailable.

Prevention of cardiovascular disease: In the primary prevention trials the dose was 10mg/day. Higher doses may be necessary in order to attain (LDL-) cholesterol levels according to current guidelines. Children aged 10 years and above for Heterozygous Familial Hypercholesterolemia: Recommended starting dose is 10mg per day which may be increased to 80mg daily, according to the response and tolerability. Elderly: Efficacy and safety in patients older than 70 using recommended doses are similar to those seen in the general population. Renal impairment: No dose adjustment required.

Hepatic impairment: Atorvastatin Teva Pharma should be used with caution in patients with hepatic impairment. Atorvastatin Teva Pharma is contraindicated in patients with active liver disease Contraindications: Atorvastatin Teva Pharma is contraindicated in patients with: hypersensitivity to the active substance or to any of the excipients; active liver disease or unexplained persistent elevations of serum transaminases exceeding 3 times the upper limit of normal; during pregnancy, while breast-feeding and in patients of child-bearing potential not using appropriate contraceptive measures; treated with the hepatitis C antivirals glecaprevir/pibrentasvir.

Precautions and warnings: Liver function tests should be performed before the initiation of treatment and periodically thereafter. Patients who develop any signs or symptoms suggestive of liver injury should have liver function tests performed. Atorvastatin Teva Pharma should be used with caution in

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patients who consume substantial quantities of alcohol and/or have a history of liver disease. For patients with prior haemorrhagic stroke or lacunar infarct, the balance of risks and benefits of atorvastatin 80mg is uncertain, and the potential risk of haemorrhagic stroke should be carefully considered before initiating treatment. Atorvastatin may in rare occasions affect the skeletal muscle and cause myalgia, myositis, and myopathy that may progress to rhabdomyolysis, a potentially life-threatening condition characterised by markedly elevated creatine kinase (CK) levels (> 10 times ULN), myoglobinaemia and myoglobinuria which may lead to renal failure. There have been very rare reports of an immune-mediated necrotizing myopathy (IMNM) during or after treatment with some statins. IMNM is clinically characterised by persistent proximal muscle weakness and elevated serum creatine kinase, which persist despite discontinuation of statin treatment, positive anti-HMG CoA reductase antibody and improvement with immunosuppressive agents. In few cases, statins have been reported to induce de novo or aggravate pre-existing myasthenia gravis or ocular myasthenia. This medicinal product should be discontinued in case of aggravation of symptoms. Atorvastatin should be prescribed with caution in patients with pre-disposing factors for rhabdomyolysis. A CK level should be measured before starting statin treatment. The risk of treatment should be considered in relation to possible benefit, and clinical monitoring is recommended. If CK levels are significantly elevated (> 5 times ULN) at baseline, treatment should not be started. Exceptional cases of interstitial lung disease have been reported with some statins, especially with longterm therapy. Presenting features can include dyspnoea, non-productive cough and deterioration in general health (fatigue, weight loss and fever). If it is suspected a patient has developed interstitial lung disease, statin therapy should be discontinued. Some evidence suggests that statins as a class raise blood glucose and in some patients, at high risk of future diabetes, may produce a level of hyperglycaemia where formal diabetes care is appropriate. Patients at risk (fasting glucose 5.6 to 6.9mmol/L, BMI>30kg/ m2, raised triglycerides, hypertension) should be monitored both clinically and biochemically according to national guidelines. Interactions: Please refer to the SmPC for a comprehensive list of drug interactions (including the effect of medicinal products on atorvastatin, and the effect of atorvastatin on other co-administered medicinal products). Risk of rhabdomyolysis is increased when atorvastatin is administered concomitantly with potent inhibitors of CYP3A4 or transport proteins (e.g. ciclosporin, telithromycin, clarithromycin, delavirdine, stiripentol, ketoconazole, voriconazole, itraconazole, posaconazole, letermovir and HIV protease inhibitors including ritonavir, lopinavir, atazanavir, indinavir, darunavir, tipranavir/ritonavir, etc).

The risk of myopathy may also be increased with the concomitant use of gemfibrozil and other fibric acid derivates, antivirals for the treatment of hepatitis C (HCV) (e.g. boceprevir, telaprevir, elbasvir/grazoprevir, ledipasvir/ sofosbuvir), erythromycin, niacin, or ezetimibe. If possible, alternative (noninteracting) therapies should be considered instead of these medicinal products. In cases where co-administration of these medicinal products with atorvastatin is necessary, the benefit and the risk of concurrent treatment should be carefully considered. When patients are receiving medicinal products that increase the plasma concentration of atorvastatin, a lower maximum dose of atorvastatin is recommended. In addition, in the case of potent CYP3A4 inhibitors, a lower starting dose of atorvastatin should be

considered, and appropriate clinical monitoring of these patients is recommended. The risk of myopathy and/or rhabdomyolysis may be increased by concomitant administration of HMG-CoA reductase inhibitors (e.g. atorvastatin) and daptomycin. Consideration should be given to temporarily suspend Atorvastatin Teva Pharma in patients taking daptomycin unless the benefits of concomitant administration outweigh the risk. If co-administration cannot be avoided, CK levels should be measured 2-3 times per week and patients should be closely monitored for any signs or symptoms that might represent myopathy. Atorvastatin must not be coadministered with systemic formulations of fusidic acid or within 7 days of stopping fusidic acid treatment. In patients where the use of systemic fusidic acid is considered essential, statin treatment should be discontinued throughout the duration of fusidic acid treatment. There have been reports of rhabdomyolysis (including some fatalities) in patients receiving fusidic acid and statins in combination. The patient should be advised to seek medical advice immediately if they experience any symptoms of muscle weakness, pain or tenderness. Statin therapy may be re-introduced seven days after the last dose of fusidic acid. In exceptional circumstances, where prolonged systemic fusidic acid is needed, e.g. for the treatment of severe infections, the need for co-administration of Atorvastatin Teva Pharma and fusidic acid should only be considered on a case-by-case basis and under close medical supervision. Pregnancy and lactation: Patients of childbearing potential should use appropriate contraceptive measures during treatment. Atorvastatin Teva Pharma is contraindicated during pregnancy.

Atorvastatin Teva Pharma should not be used in patients who are pregnant, trying to become pregnant or suspect they are pregnant. Treatment with Atorvastatin Teva Pharma should be suspended for the duration of pregnancy or until it has been determined that the patient is not pregnant.

Patients taking Atorvastatin Teva Pharma should not breast-feed their infants. Atorvastatin is contraindicated during breast-feeding. Effects on ability to drive and use machines: Atorvastatin Teva Pharma has negligible influence on the ability to drive and use machines. Adverse reactions: Thrombocytopenia, anaphylaxis, peripheral neuropathy, myasthenia gravis, hearing loss, pancreatitis, hepatitis, hepatic failure, cholestasis, angioneurotic oedema, dermatitis bullous including erythema multiforme, StevensJohnson syndrome and toxic epidermal necrolysis, myopathy, myositis, rhabdomyolysis, muscle rupture, lupus-like syndrome, immune-mediated necrotizing myopathy, gynaecomastia, peripheral oedema. Common: Nasopharyngitis, allergic reactions, hyperglycaemia, headache, pharyngolaryngeal pain, epistaxis, constipation, flatulence, dyspepsia, nausea, diarrhoea, myalgia, arthralgia, pain in extremity, muscle spasms, joint swelling, back pain. Consult the Summary of Product Characteristics in relation to other side effects. Overdose: Specific treatment is not available for atorvastatin overdose. Should an overdose occur, the patient should be treated symptomatically and supportive measures instituted, as required.

Liver function tests should be performed and serum CK levels should be monitored. Due to extensive atorvastatin binding to plasma proteins, haemodialysis is not expected to significantly enhance atorvastatin clearance. Legal category: POM. Marketing Authorisation Number: PA1986/125/001-004. Marketing Authorisation Holder: Teva B.V., Swensweg 5, 2031GA Haarlem, Netherlands. Job Code: MED-IE-00099. Date of Preparation: July 2025

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

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

Date of Preparation: August 2025 | Job Code: GEN-IE-00149 Further information is available on request or in the SmPC. Product Information also available on the HPRA website.

18

News

Think Health, Think Pharmacy: A Profession at a Crossroads Pharmacy has long been the Cinderella of the healthcare professions. Upfront, yet often in the background, pharmacists provide medicines, clarity, advice, and common sense to a grateful public. Rarely in the spotlight, yet indispensable to the functioning of healthcare, pharmacists have been the constant thread holding patient care together.

Written by Richard Collis, MPSI

With World Pharmacists Day approaching, this year’s theme of Think Health, Think Pharmacy feels especially timely. After more than two decades of debate, negotiations with the Department of Health are set to deliver an expanded role for community pharmacy within primary care.

By the time you read this, the outcome of those discussions will be known — a landmark moment that promises to fully utilise the expertise of pharmacists for the public good.

This is an exciting step forward.

But it is also worth pausing to consider pharmacy in a global context — and in particular, the plight of our colleagues in conflict zones.

Pharmacy Under Fire While pharmacists here look forward to expanded services

and recognition, the picture could not be more different in Gaza and the West Bank, the proposed components of a future Palestinian state. There, the healthcare infrastructure — hospitals, clinics, surgeries, and pharmacies — has been devastated. Healthcare workers have been targeted, detained, tortured, and killed.

More than a thousand health professionals have lost their lives, among them pharmacists.

The Channel 4 documentary Doctors in Gaza starkly documents this reality. Under the Geneva Conventions, targeting healthcare workers and facilities constitutes a war crime — and yet, it is happening.

To understand the scale of suffering, one must consider the long shadow of history. In 1922, under the British Mandate, Arabs — both Muslim and Christian — made up 95% of the population of Palestine. Palestinian Jews represented the remaining 5%.

What followed over the next century — mass inward migration,

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World Pharmacists Day is rightly a celebration of our profession — of the expertise, dedication, and quiet constancy that pharmacists bring to healthcare. But it is also a moment for solidarity. displacement in 1948, the creation of millions of refugees — has fuelled a conflict that continues to devastate daily life. For Palestinians, every illness risks becoming a tragedy, every day of survival a blessing. Pharmacies, where they exist, are often unable to replenish stock. The most basic infrastructure we take for granted is absent.

A Tale of Two Realities The contrast is stark. In Ireland, pharmacists may soon step into a new dawn for the profession — better integrated into primary care, with the resources to deliver expanded services for patients.

We can practise in safety, return home each evening to our families, and work within a robust healthcare system.

For colleagues in Palestine and other conflict zones, every day is a struggle in the extreme sense.

Survival, not service expansion, is the priority. Their resilience in the face of adversity should give us pause. It reminds us that while we campaign for professional

recognition, others campaign for the simple right to live, work, and serve their communities without fear.

World Pharmacists Day: More Than Celebration World Pharmacists Day is rightly a celebration of our profession — of the expertise, dedication, and quiet constancy that pharmacists bring to healthcare. But it is also a moment for solidarity. As we embrace the theme Think Health, Think Pharmacy, let us do so not only with optimism for the profession’s future here, but also with awareness of our colleagues who cannot yet share that optimism.

Pharmacy is, at its heart, about service. And service takes many forms: dispensing advice, enabling access, ensuring medicines reach those in need. In Ireland, that future is brightening. In Palestine, it is darkened by conflict. As a profession, we must hold both truths in mind — with gratitude for our opportunities and compassion for those denied them.

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20

Coeliac Disease

Updates in Coeliac Disease Coeliac disease is a long-term autoimmune condition that affects about 0.5% to 1% of people. A new published collaborative report from scientists at Children’s Health Ireland (CHI) , Johnson & Johnson and Trinity College Dublin, created the most detailed map to date of how individual cells behave in the small intestine of people with coeliac disease, using a technique called single-cell RNA sequencing. They looked at over 200,000 individual cells from tissue samples of both people with active coeliac disease and healthy individuals (all anonymised). The report is recently published in the journal Cell Reports.

Seamus Hussey, Consultant in Gastroenterology, Hepatology, Intestinal Failure and Transplant Medicine in CHI at Crumlin

The results showed major differences in the types and activities of cells in the gut lining (epithelium) and the supporting tissue underneath (called the stroma) between people with coeliac disease and those without.

The team created an atlas of cells present in the small intestines of both patient types, allowing them to: • Characterise how these cells are different in disease through identifying which genes are ‘switched on’.

• Find that genes which are ‘switched on’ in diseased tissues (but not in normal tissues) activate pathways which potentially drive the disease.

• The supporting stromal cells also changed, especially a type of cell called fibroblasts, which became more active and more common.

The study found that immune signals, especially from two immune system proteins (IL-1β and IFN-γ), may be encouraging these fibroblasts to support changes in the gut lining. This suggests that communication between immune, stromal, and epithelial cells plays a key role in how the gut reacts to gluten in coeliac disease.

Overall, this research gives new insight into how different types of cells in the gut work together—and change—in response to gluten exposure in celiac disease. The findings allow the team and other researchers to move a step closer towards providing effective therapies for coeliac disease.

The team found that in people with coeliac disease:

Patrick Walsh, Clinical Medicine, School of Medicine, Trinity College Dublin explained, “CHI patients’ involvement has been the pivotal factor in this research, which has allowed us to advance knowledge of how this disease occurs and ultimately assist in efforts to open avenues for the development of new treatment approaches.

• There were more stem cells and secretory cells, but fewer cells that absorb nutrients, which matches known damage like villus atrophy (flattening of the gut lining) and crypt hyperplasia (overgrowth of certain gut structures).

“These findings provide a detailed and comprehensive map of the cellular landscape in the inflamed intestine of young coeliac patients and has the potential to inform future directions for researchers working internationally to tackle this disease.”

• Identify pathways through which different cells can communicate with each other to drive the tissue damage which is characteristic of coeliac disease.

Key findings

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Seamus Hussey, Consultant in Gastroenterology, Hepatology, Intestinal Failure and Transplant Medicine in CHI at Crumlin, added, “Every year, 150-200 children in Ireland are newly diagnosed with coeliac disease, a condition that currently requires a lifelong gluten-free diet. This groundbreaking research stems from existing strong partnerships between researchers in Trinity and Children’s Health Ireland at Crumlin. Illuminating new intricate immune pathways and connections in paediatric coeliac disease marks a pivotal step toward developing novel, immunebased medical treatment options for patients worldwide.“ Darren Ruane, Director of translational science and medicine, immunology, Johnson & Johnson, said, “This exciting collaboration between Johnson & Johnson, Immunology and the research teams at Trinity and CHI, has provided significant impact to the coeliac disease field. These efforts have identified novel pathways related to

coeliac disease pathogenesis and highlighted the previous unknown role of stromal-immune cellular communication in disease.

This research will enable new therapeutic target identification.”

Research funding: This research has been supported by Janssen Research & Development, LLC, a wholly owned subsidiary of Johnson & Johnson. Additional funding was provided by Science Foundation Ireland (SFI) ** (21/ FFP-P/10135) and Children’s Health Foundation (to P.W. and S.H., RSFG-21-ACC07). **Research Ireland is the new national competitive research and innovation funding agency, established through the amalgamation of activities and functions of SFI and the IRC. The paper, published in Cell Reports: ‘Immune signalling mediates stromal changes to support epithelial reprogramming in celiac duodenum’ can be viewed at this link: https://www.cell. com/cell-reports/fulltext/S22111247(25)00810-1

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22

Cold & Flu

Management of Cold & Flu The common cold and flu are both upper respiratory tract illnesses caused by viral infections. They both tend to be acute, self-limiting and may sometimes involve the lower respiratory tract. Both the common cold and flu are contagious respiratory illnesses but are caused by different viruses; flu is caused by different influenza viruses and the common cold can be caused by coronaviruses, rhinoviruses, adenoviruses and parainfluenza viruses. The incidence of the common cold and flu is subject to seasonal variation, with a higher incidence in winter compared to summer. The common cold is the most common illness in the world, with an average of 6-8 episodes per year in children, decreasing to 2-4 episodes per year in adults. It can have a large economic burden due to absenteeism at work and school.

The common cold and flu can share some similarities in symptoms but differences exist between the viruses. The common cold generally has a gradual onset of symptoms, compared to the more sudden onset of flu symptoms, which usually appear within a few hours. Both viruses can be unpredictable, but symptoms generally start to resolve after one week. Symptoms of cold are usually limited to the upper respiratory tract (nose and throat) and flu symptoms generally affect more than just the upper respiratory tract, with symptoms of flu usually much more severe than those of a cold. Symptoms of a cold can include blocked or runny nose, sneezing, cough, sore throat and fever. Symptoms of flu can include fever, fatigue, body aches, headache, difficulty sleeping, loss of appetite, dry cough and nausea.

Runny nose and sore throat are also possible, but less common than with the common cold.

Influenza can be classified into uncomplicated and complicated.

Uncomplicated flu is characterised by the sudden onset of the typical symptoms outlined above, with symptoms generally resolving in less than two weeks. Complicated flu occurs when the viral infection causes a potential wide range of complications that can result in severe disease.

Complications and Warning Signs The common cold and flu are generally self-limiting in healthy individuals and usually will resolve within two weeks. However, flu and complications of flu can lead to serious illness. In children, otitis media (middle ear infection) and respiratory complications including croup and bronchiolitis are most common. Rarer complications in children can include myocarditis, pericarditis, encephalopathy, encephalitis and Reye’s syndrome.

The most common complications of flu in adults are pneumonia and bronchitis, which can lead to respiratory failure, acute

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respiratory distress syndrome, septic shock or multi-organ failure.

Flu can often cause dehydration, which can exacerbate underlying chronic medical conditions.

Patients that are aged 65 years or older, pregnant or have a long-term medical condition are at an increased risk of complications from flu. As patients with asthma, COPD, diabetes and heart failure are at a higher risk of complications, there may be a need to refer to a medical doctor for further treatment.

Pharmacists and pharmacy staff should be aware that patients may need referral to a doctor if their symptoms don’t improve after 7 days or they have a weakened immune system, due to HIV or chemotherapy.

pharmacy staff should recognise when referral is necessary. Some of the more common of these warning signs are outlined in the table below.

In the event of patients experiencing any warning sign symptoms, then they should seek medical attention immediately.

Pharmacies are often the first port of call for patients with symptoms, therefore pharmacists and

Not urinating or dehydration

Warning Signs Coughing up blood Worsening of chronic medical conditions Difficulty breathing or shortness of breath Seizures Pain or pressure in the chest or abdomen Persistent dizziness or confusion

Fever or cough that improves but returns or worsens Bluish lips or face

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Keeping Levels Healthy

Your pregnancy can be an exhilarating but sometimes tiring experience. Keep energy levels up by boosting your iron intake, so you can enjoy the time.

Floradix and Floravital contain iron gluconate, which is a highly absorbable form of iron.

Chapped lips, brittle hair, constant fatigue and palpitations are not on a prospective mum’s wish list. They are, however, some of the tell-tale signs of iron deficiency, which is common amongst pregnant women. Iron is needed to make haemoglobin, the chemical that transports oxygen in the blood. A range of stressful symptoms can indicate a deficiency, but severe cases can lead to anemia, total exhaustion and a weakened immune system. Throughout pregnancy, eating for two also means that your body requires twice the amount of iron to stay healthy.

A healthy, balanced diet with ironrich foods will provide most of the iron you need during pregnancy. This should include lean meats; pulses such as peas, beans and lentils; fruit such as prunes, apricots and raisins; and dark green leafy vegetables such as spinach. However, it can be difficult to absorb enough iron from a balanced diet alone for you and your growing baby, particularly if you have a deficiency as you need to eat a lot of iron-rich foods to correct it.

This is where Floradix can really help.

This high quality liquid supplement contains organic iron gluconate, and its easy absorption into the body is enhanced by vitamins C and B complex, herbal extracts and fruit juice concentrates. This special blend of ingredients mean that it’s easy to digest and the unpleasant side effects of many iron preparations, such as stomach cramps and constipation, are avoided. So it’s no wonder Floradix is recommended by numerous midwives and health care professionals.

What’s more, it’s completely free of chemical preservatives, colourings or flavourings, and is also available in a gluten-free form called Floravital.

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Helping Absorption Vitamin C, animo acids, fructose and glucose all help your body absorb more iron from foods and supplements. Other elements of our diet will decrease absorption, such as calcium, milk proteins, black tea, coffee, fibre, vitamin E and phosphates (found in soft drinks). So to maximise the amount of iron you are getting, take an iron supplement before eating.

Warning signs of iron deficiency • pale skin under eyes and nails • brittle hair • cracked skin around mouth • breathlessness when exercising • heart palpitations • rapid pulse • difficulty concentrating • cold hands and feet • increased frequency of infection

24

Cold & Flu

Community Pharmacy Role in Cold and Flu Community pharmacy is often the first port of call for patients when they have symptoms of cold or flu.

Most symptoms can be effectively treated by using over the counter (OTC) medicines from community pharmacies, which can help reduce the burden on other primary care providers and emergency departments. A systematic approach to each consultation should be implemented to ensure a consistent high-level of care to each patient presenting with cold and flu symptoms. A patientcentred approach should be followed in community pharmacy.

All pharmacy staff should be fully trained and competent in conducting OTC consultations.

There is a great importance in tailoring each consultation to reflect the different role, responsibility and knowledge of the staff members. Pharmacy staff should know when to refer to the pharmacist when carrying out each consultation.

Effective consultations between pharmacy staff and patients are fundamental to ensure appropriate recommendations are made and desired patient outcomes are achieved. Optimal management of these consultations require effective information gathering from the patient, with proper use of a framework essential for retrieving information. Who is the patient, What are the symptoms, How long has the patient had the symptoms, Action to date and other existing Medication being taken (WWHAM) is the most common framework used in information gathering.

Effective communication skills are necessary to counsel each patient and communication style may be required to be tailored to each patient. Pharmacists should oversee consultations to ensure correct treatment options are selected or patients are referred if necessary.

Prevention Prevention is key in reducing the burden of cold and flu in society. Pharmacists are trusted healthcare professionals and therefore can reshape patient perceptions and reinforce the messaging around prevention of infection. Vaccination is an important preventative measure against influenza. Unfortunately, due to many different serotypes of the common cold, it is not possible to vaccinate against this illness. Simple measures including

regular handwashing with soap, avoiding touching the face and cleaning surfaces that people regularly touch can help prevent spread of respiratory viruses.

Covering coughs and sneezes with a tissue and discarding the tissue immediately after use, improving ventilation in buildings and avoiding close contact with other people when symptomatic are all also practical measures that patients can be counselled on to reduce spread of common cold and flu.

Vaccination Vaccination is the best method of protection against flu. Vaccines contain weakened or inactive parts of a pathogen that triggers an immune response in the body, that will produce antibodies and offer protection if exposed to the pathogen later. The flu vaccine should be administered annually as the antibodies reduce over time, as well as the fact that flu strains can change from year to year. The vaccine is generally available from October to April, but it is ideal to get it as early as possible, before the commencement of flu season.

Vaccination generally reduces the risk of getting flu by 40% to 60% and can also reduce intensity and duration of symptoms.

There are usually two vaccines available in Ireland; the quadrivalent influenza vaccine (QIV) which is generally used for over 18 years old and the live attenuated influenza vaccine (LAIV) which is used for those aged 2 to 17 years old. The preferred administration site for the QIV is in the deltoid muscle via intramuscular injection. The LAIV is administered nasally, with half of the dose administered via a spray in both nostrils. Mild side effects are possible and can include fever, fatigue, soreness or swelling at injection site, body aches and headaches. Nasal congestion is also common with nasal administration of the vaccine.

These are generally self-limiting and will resolve within 48 hours.

Taking paracetamol and resting are advised if these side effects are experienced. More serious side effects are rare and should be reported to the HPRA. Pharmacists have been providing a seasonal influenza vaccination service in community pharmacies since 2011. Flu vaccination service in community pharmacies has been reported to improve uptake of the vaccine. Recommendations from healthcare workers have also shown to greatly improve

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vaccination rates. As patients visit their community pharmacy much more often than their primary care physician, pharmacists have a very important role in this.

Pharmacist can counsel patients on the benefits of vaccination, risks of not getting vaccinated and ease patient concerns regarding potential side effects.

Diagnosis The diagnosis of common cold and flu is generally based on symptoms and physical examination. As these illnesses are usually self-limiting, symptoms can be examined by a physician and a diagnosis made without need for further diagnostic tools. Rapid influenza diagnostic tests (RIDTs) can be used to diagnose influenza by detecting antigens that stimulate an immune response. Molecular assays that detect genetic material of influenza can be used and are more accurate than RIDTs. Both tests take less than 20 minutes to perform. Specialised laboratory tests such as polymerase chain reaction (PCR) tests can be used for diagnosing influenza. These tests are usually not required but can be useful in differential diagnosis between common cold, influenza and other respiratory infections including Covid-19.

Reliability can be an issue for all these methods of diagnosing.

Therefore, diagnostic tools are not very useful, and treatment can be initiated if required based on clinical symptoms, patient history and physical examination.

Treatment Treating based on symptoms that a patient exhibits is the mainstay of treating common cold and flu. Getting a full knowledge of clinical symptoms and patient history is important in selecting an appropriate treatment option.

OTC analgesic options including paracetamol and ibuprofen are useful in treating aches and pains, as well as lowering fever associated with the viral infection.

Antihistamines First-generation antihistamines such as brompheniramine and chlorpheniramine have been shown to provide some symptomatic relief. This involves a reduction in symptoms such as sneezing and nasal discharge, as well as a reducing the duration of symptoms. Side effects associated with diphenhydramine include drowsiness, dry mouth and blurred vision. Second-generation antihistamines are ineffective in treating symptoms of cold and flu.

Decongestants Decongestants have been shown to have clinical effectiveness in reducing symptoms of rhinorrhoea, nasal congestion and sneezing. Pseudoephedrine and Phenylephrine are two decongestants that are licensed for OTC use in those aged 12 years and older in Ireland. Potential side effects can include agitation, hypertension, tachycardia, nausea and dysrhythmia. Decongestants can also be used in combination with a first-generation oral antihistamine. Xylometazoline is a decongestant that can be used topically to reduce nasal symptoms. Side effects of nasal decongestants can include irritation of nasal membranes, rebound congestion and nosebleeds.

Non-pharmacological treatment Daily administration of zinc has effectiveness in reducing the number of colds per year, particularly in children. Other supplements such as vitamin C, vitamin D and garlic have mixed results, with studies showing no benefit versus placebo. Natural products including ginseng and echinacea showed no clear evidence of benefit. Homeopathy also does not have a positive effect on preventing or treating the common cold or flu. Honey may be useful in treating nighttime cough in children but should not be used in children under 12 months due to the risk of infant botulism. Bulb suction with saline drops can be useful in relieving nasal symptoms in children. Vapour rub containing ingredients such as eucalyptus, camphor and levomenthol may provide symptomatic relief in children over 2 years old.

Pharmacists and pharmacy staff should carry out a structured approach to each consultation to ensure each patient receives appropriate counselling, treatment and referral if necessary.

Prevention is important in reducing the spread of flu, with vaccination the best approach in preventing and reducing severity of symptoms. Hand hygiene and other measures can also be effective in reducing transmission of respiratory viruses.

The diagnosis of cold and flu is generally based on symptoms and physical examination, with laboratory tests used only if necessary. Antibiotics are not effective in treating cold and flu, and their use can lead to the development of antimicrobial resistance.

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Hydrate Like a Queen Maeve Madden Shares Her Everyday Wellness Routine with O.R.S Hydration Tablets In a world where life often feels like a never-ending to-do list, finding time for health and fitness can be overwhelming. Gyms can be expensive, crowded, or simply too far out of the way. That’s why Irish fitness influencer, entrepreneur, and self-professed Queen of Home Workouts Maeve Madden is on a mission to prove that you don’t need a gym membership to feel strong, confident, and energised.

Hydration for Everyone Maeve’s partnership with O.R.S Hydration Tablets highlights an important truth: hydration isn’t just for gym-goers or athletes — it’s for parents on the school run, professionals at their desks, travellers on the go, and anyone who wants to feel their best. ORS makes hydration easy, affordable, and accessible.

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O.R.S Hydration Tablets makes it easy — just drop, dissolve, and drink. It’s the small daily ritual that makes the biggest difference.”

Everyday Energy, Everyday Confidence Maeve has built a global following by making wellness accessible and enjoyable — and central to her philosophy is the idea that hydration is the ultimate gamechanger. As the proud ambassador for O.R.S Hydration Tablets, Maeve wants to show that hydration isn’t just for elite athletes — it’s for everyone, every day.

Home Workouts, Made Simple For Maeve, the beauty of working out at home is in its freedom and flexibility.

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Maeve’s Top Five Tips for Winning at Home Workouts As part of her partnership with O.R.S Hydration Tablets, Maeve has shared her five golden rules for making the most of every sweat session at home:

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Whether you’re chasing fitness goals, juggling family life, or simply trying to get through a busy day, O.R.S Hydration Tablets deliver hydration that works as hard as you do. And with Maeve Madden leading the way, the message is clear: staying hydrated is the foundation of feeling good — inside and out.

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28

Acne

The Role of the Pharmacist in Acne Management Acne is a disorder of the pilosebaceous unit of the skin and as such, manifests primarily in sites of the body rich in sebaceous glands, such as the face, neck, shoulders and back. Blockage of these glands leads to the characteristic skin lesions associated with acne, namely open and closed comedones, papules, pustules, nodules and cysts.

Acne commonly begins at puberty, when hormonal changes trigger dysfunction of the sebaceous glands, leading to excessive oil production. Bacteria Cutibacterium acnes proliferates in this oily environment, causing the characteristic skin lesions. While most commonly associated with teenagers, acne can persist into adulthood, or develop for the first time later in life. Given that hormones play a large role in the manifestation of acne, it stands to reason that acne can also occur during menstruation, pregnancy, and menopause, when hormonal fluctuations are common.

Open and closed comedones represent non inflammatory acne. If these are the only lesions present, topical retinoids such as apadelene (Differin®) and tretinoin are considered first line treatment.

Patients should be advised to gradually build up to nightly use and to wear SPF daily.

If inflammatory lesions predominate (papules, pustules, nodules and/or cysts) the preferred first line topical agent is Benzoyl Peroxide (BPO-Acnecide®). Again, gradually increase to nightly use and advise caution with application as the product can bleach hair and clothes. Pustule dominant acne typically responds to a combination of topical BPO and Clindamycin (Duac®). Advise patients to store this product in the fridge, build to nightly use and beware of the risk of bleaching.

If both inflammatory and non inflammatory lesions are present, products containing a combination of topical retinoids and BPO (Epiduo®) are the preferred first line option. Azelaic acid (Skinoren®) is second line option for this type of acne.

For moderate acne or mild acne not responding to first line topical treatment, the next step involves addition of an oral antibiotic

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to the treatment regimen. It is important to note that oral and topical antibiotics should not be used in combination as this increases the risk of antibiotic resistance. Therefore, patients who commence oral antibiotic therapy should discontinue Duac if this is the topical treatment they have been using. All patients treated with a course of antibiotics should be reviewed after 12 weeks.

Patients with severe, scarring acne or those who have not responded to two different oral antibiotic courses will be referred to dermatology for treatment with isotretinoin (Roaccutane®), if deemed appropriate.

Advice to those commencing isotretinoin: • Females of child bearing potential requires two forms of contraception to avoid pregnancy for duration of treatment and one month after completion

• Prescriptions are only valid for seven days once written and limited to 30 day supply for female of child bearing potential • Skin and mucous membranes will become very dry while taking isotretinoin. Regularly apply moisturiser to the skin, Vaseline in the inside of the nose, lubricating eye drops to the eyes, and lip balms on the lips • Skin will be more sensitive to sunlight so careful application of SPF advised. Advise caution with sunbathing • Skin will be more fragile so avoid anything that can cause trauma to the skin e.g. piercings, waxing, tattoos, epilation, laser, peels • Take isotretinoin with a fatty meal e.g. full fat milk at breakfast. This aids absorption

E45 knows how to support skin E45 cream is used for treating dry skin conditions such as dry/flaky skin, eczema, dry psoriasis, dermatitis and sunburn. Suitable for the whole family. Apply 2-3 times daily for best results*.

E45 Cream is a medicinal product not subject to medical prescription, containing White Soft Paraffin 14.5% w/w, Light Liquid Paraffin 12.6% w/w and Anhydrous Lanolin 1.0% w/w. Suitable for use from 1 month of age. Always read the leaflet before use. Marketing Authorisation Number: PA 22650/007/001.

Distributed in Ireland by Ocean Healthcare Ltd. Date of preparation: May 2025. *E45 SPC. Available at: https://www.medicines.ie/medicines/e45-cream-31954/spc.

Tel: 01 2968080 orders@oceanhealthcare.ie www.oceanhealthcare.ie

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Acne

• Night vision can be impacted so caution if driving at night.

Acne during pregnancy If pregnant, patients should be advised to avoid retinols and retinoids and certain oral antibiotics like lymecycline and minocycline, as they pose risks to the developing baby. The preferred topical agent in this patient cohort is Azelaic Acid and the preferred oral antibiotic is erythromycin.

Acne triggered by Polycystic Ovary Syndrome (PCOS) One of the hallmark symptoms of PCOS is elevated levels of androgen hormones, which increase oil production and contribute to the development of acne. Spironolactone blocks

the effects of androgens and as such, can be useful in the treatment of this type of acne. Oral Contraceptives regulate hormonal levels and can also be useful in the treatment of this type of acne.

Menopausal Acne Fluctuating hormones during perimenopause and menopause can trigger acne flare-ups, even in women who never had skin problems before. The same oral treatment options used in PCOS acne are effective in the treatment of menopausal acne, as both are caused by high levels of androgens. The choice of topical treatment for this type of acne is different as menopausal skin tends to be thinner and more delicate than teenage skin. While teenage

skin can tolerate treatments such as BPO, menopausal skin can become thinner and drier with the decline in oestrogen, therefore harsher topicals are typically avoided. Retinoids are the preferred topical for the management of this type of acne.

Not only do they tackle the acne skin lesions, they provide antiaging benefits. Patients should be advised to begin with the lowest concentration and gradually build up to nightly use. Patients should also be advised to expect peeling, flaking and dryness when using retinoids as the skin undergoes “retinisation”. This is temporary and the skin adapts after four to six weeks of regular use. Azelaic acid is also used to manage this type of acne as it confers anti-inflammatory

benefits and is considered gentler than other topicals such as antibiotics and BPO. Summary Contrary to common myths, acne is most certainly not a condition that only impacts teenagers with poor hygiene.

Acne is a dermatological condition caused by dysfunction of the sebaceous glands and can persist from teenager years through to adulthood, or manifest for the first time later in life. It also varies in its presentation and severity.

Pharmacists can empower patients to take control of their acne and achieve better results by taking the time to provide clear, practical, evidence based advice.

Periods, Pimples and Puberty Supporting School-Aged Children with Menstrual Acne, Hormonal Changes, and Period Care Menstruation is a natural part of growing up, yet it remains a source of confusion, stigma, and discomfort for many school-aged children. Community pharmacists and their teams are in a unique position to provide guidance, reassurance, and practical support.

Understanding Hormonal Changes and Menstrual Acne Menstrual acne is a common concern for many young people during puberty and the early years of menstruation. Acne flares are typically linked to the hormonal fluctuations that occur throughout the menstrual cycle, particularly the rise and fall of androgens, such as testosterone.

How hormones trigger acne: • In the second half of the menstrual cycle (the luteal phase), progesterone levels rise. This can lead to increased sebum (oil) production, creating an environment where acnecausing bacteria can thrive.

• Androgens stimulate sebaceous glands and can lead to clogged pores, resulting in comedones (blackheads/whiteheads), papules, or pustules.

• Hormonal acne typically appears on the lower face, jawline, and chin, and may worsen just before or during menstruation.

Period Care for School-Aged Children Menstruation often begins between the ages of 9 and 13, though it can start earlier or later

depending on the individual. The early cycles may be irregular and can vary in flow and duration.

For young menstruators, this can be overwhelming and may affect their confidence, self-esteem, and school participation.

Period products and support: Pharmacy teams are ideally placed to provide non-judgmental, accessible information on the wide range of menstrual products available today. Understanding and respecting individual preferences is key.

• Pads (sanitary towels): Still the most commonly used product among first-time menstruators.

Available in various absorbencies and sizes.

• Tampons: Generally not recommended until a child is older, more comfortable with their body, and confident with insertion. Pharmacy teams can support caregivers in discussing these options when appropriate.

Tips for the pharmacy team: • Create a discreet, welcoming environment for young people to ask questions.

• Use inclusive and ageappropriate language: phrases

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like "people who menstruate" or "period care for young people" can be helpful, especially in diverse communities.

The Role of Pharmacists in Hormonal Education While puberty education is covered in schools, young people and their families often seek clarity and guidance from their local pharmacy team.

Pharmacists can be a trusted voice in helping children understand the changes happening in their bodies.

Key messages to convey: • Menstrual cycles are unique and can take time to regulate — reassure young patients that irregular periods are normal in the first year or two.

• Changes in mood, bloating, cramps, and skin concerns are common and can often be managed with simple self-care strategies.

• If periods are excessively painful, heavy, or affecting quality of life, referral to a GP is essential. Conditions such as endometriosis or PCOS can present early.

OTC options for symptom relief: • Paracetamol and ibuprofen can be recommended for menstrual cramps and general discomfort.

Always ensure appropriate dosing for age and weight.

• Heat patches, herbal teas, and reusable hot water bottles can be promoted for natural relief.

• Some pharmacists may wish to discuss nutritional supplements, such as magnesium or vitamin B6, though this should be based on individual need.

Reducing Stigma and Promoting Body Confidence Period stigma and embarrassment still persist, especially among young people. The pharmacy team can contribute to breaking taboos and promoting a culture of openness and support.

Actionable ideas: • Create a discreet display of period care products with educational leaflets.

• Host drop-in clinics or school outreach talks in partnership with local educators.

• Provide staff training to improve confidence when engaging with young people and their caregivers on sensitive topics.

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Advertorial

Novel Approaches in Acne Inflammation Novel gut-skin-microbiome approach to treating the acne inflammasome with plant-biotech, microbiome-supporting topicals and probiotic supplements Integrative dermatology is exploring the role of the gut in acne. Disturbances in mucosal lining, microbiome dysbiosis, overgrowth of bacteria in small intestines, can all appear as rashes, flares, or even the onset of skin diseases such as acne, eczema, or psoriasis. Therefore, in additional to topical management, gut dysbiosis and inflammation must be simultaneously addressed.

Written by Barbara Paldus, CEO, Codex Labs Corp

can increase insulin signaling in the body and trigger the FoxO1 gene that stimulates the mTORC1 complex associated with acne development.4 A high-fat diet can increase the growth of Firmicutes, which increases their ratio to Bacteroidetes, resulting in dysbiosis and alteration of serological cytokine levels that promote inflammation.4 In addition, some acne patients have hyperchlorhydria that enables colonic bacteria to migrate to the distal region of the small intestine, creating dysbiosis and overgrowth.4 Probiotic Solutions for Acne Vulgaris

Acne Gut-Skin-Microbiome Axis Gut-skin axis studies show that acne vulgaris is correlated with an altered gut microbiome.

Gastrointestinal dysfunction and dysbiosis cause excess bacterial growth of pathobionts, leading to competition for nutrients and toxic metabolite production.

This results in local and systemic inflammation affecting the physiology of the skin and hair follicles. Maintaining intestinal integrity is therefore crucial for preventing skin inflammation.

As early as 1930, Stokes and Pillsbury noted the connection between gut, skin, and nervous systems: they were among the first to propose probiotic Lactobacillus acidophilus for acne treatment.1 Gut microbes and oral probiotics can be linked to the skin, and particularly acne severity, by their ability to influence mood, systemic inflammation, oxidative stress, glycemic control, and tissue lipid content.2

To date, studies suggest that the gut microbiota of acne sufferers is different from those without acne. The acneic gut microbiota are less biodiverse, with a lower ratio of Bacteroidetes to Firmicutes (dysbiosis).3 The levels of Lactobacillus, Bifidobacterium, Butyricicoccus, Coprobacillus and Allobaculum in acne sufferers were found to be lower than the control group.3 A significant reduction in commensal Actinobacteria, Bifidobacterium, Butyricicoccus, Coprobacillus, and Lactobacillus, along with increased pathogenic Proteobacteria were observed in acne patients.4 This dysbiosis appears to correlate to skin sebum overproduction, which allows Cutibacterium acnes to grow unchecked and form inflammatory lesions.

The relationship between gut microbiome and skin may also be influenced by diet. A high glycemic load influences acne:5 consumption of copious sugar

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In view of the gut-skin-microbiome axis, probiotics may be key to re-establishing a healthy gut microbiota, managing acne breakouts, and reducing the use of anti-biotics. Recent clinical studies demonstrate that Codex Labs’ Shaant ClearSkinTM probiotic helps reduce acne lesions by 58% within 8 weeks. It combines bacteria known to reduce gut dysbiosis and inflammation with anti-inflammatory Ayurvedic plant medicinals: • Lactobacillus has been found to possess anti-inflammatory properties by increasing levels of IL-10, an anti-inflammatory cytokine.6 • Bifidobacterium (bifidum or lactis) has been shown to reduce pathogenic microorganisms and support the immune system, as well as positively influence inflammation-triggering glucose levels.7 • Bacillus coagulans is a spore-based probiotic with anti-inflammatory and blood lipid lowering activities.

Research also suggests that Bacillus coagulans is a producer of short-chain fatty acids that help maintain intestinal and immune homeostasis.8 • Guggul is an herb that has been shown to help reduce blood lipid levels and lower blood sugar levels. Guggul’s active ingredient, guggulsterones,

have been found to decrease acne lesions in a manner comparable to the commonly used antibiotic tetracycline.9,10 • Epigallocatechin gallate (EGCG) has anti-inflammatory and antioxidant properties, allowing acne patients to experience a significant reduction in acne lesion counts.11 Local topical Management of the Acne Inflammasome The most effective way of topically managing the occurrence of acne is by simultaneously inhibiting sebum overproduction and reducing skin inflammation.

The ShaantComplexTM is clinically proven to reduce sebum overproduction via the successful regulation of endocannabinoid pathways that manage inflammation of the sebaceous glands, inciting desquamation, along with pore diameter reduction. Together these effects prevent clogging of the pores and promote skin homeostasis to maintain epidermal structure and function by balancing skin cell proliferation and apoptosis, all in a microbiome-friendly manner. It is composed of both terrestrial and marine plants: • Ghotu Kola (Centella asiatica) helps reduce redness and supports wound healing • Patchouli (Pogostemon Cablin) soothes and helps enhance skin homeostasis via CB2 receptors • Green Microalgae (Tetraselmis chui) help decrease sebum production • Spiral Wrack (Fucus Spiralis) helps comfort irritated skin with anti-inflammatory polysaccharide fucoidans.

The ShaantComplex™ is supplemented by other Ayurvedic plants. For example, the Codex oil control cream contains Bakuchiol, derived from the babchi plant, that mimics retinol to refine skin texture and even out skin tone.

References available on request

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Corporate Profile

35

enabling staff to spend less time sorting stock and more time with patients. The pharmacy team can trust the system’s high accuracy and expiry controls, which aid regulatory compliance.

Seamus McConville, Healthwise Pharmacy Ballyraine, Letterkenny

„Since Gollmann introduced split-pack handling, there is truly nothing more we could ask for in our day-to-day operations with their robot. The system has proven to be the perfect solution for automated warehousing and dispensing in an Irish pharmacy setting.

We‘ve seen noticeable gains in efficiency, accuracy, space saving and workflow consistency across the dispensary.

It has streamlined our processes, reduced manual handling, and allowed our team to focus more on patient care. Gollmann’s technology has become an integral part of how we operate at Healthwise Pharmacy Ballyraine”

Space Optimisation Irish retail and community pharmacies often operate in older premises with tight layouts.

GOLLMANN’s space saving design lets you reclaim valuable working or counselling space.

Tailored to Your Business Unlike off the shelf robotic systems, GOLLMANN solutions are custom tailored down to dimensions, colour, configuration, and future expandability–giving pharmacies the autonomy to develop their environment over time.

Irish Support, German Engineering With a Dublin based GOLLMANN Ireland operations team, pharmacies get local service and support with rapid response times, backed by German engineering standards of durability and reliability.

In Summary: A Robo Partner, Not a One Size Fits All Machine

For Irish pharmacy owners, adopting GOLLMANN means investing in a partner system: highly efficient, configurable, and intelligent. It stores significantly more, takes up less space, handles complexities like split packs and batch expiry, and can evolve over two decades alongside your business. The voice of existing users underscores its ease of use and operational benefits, not just as

a robot–but as an integrated part of daily pharmacy life.

Final Thought & Invitation

In a time when pharmacies are seeking smarter, safer, and more flexible solutions to serve communities, GOLLMANN delivers a compelling mix of engineering excellence, space saving productivity, and practical adaptability.

And with local support based in Dublin, the promise becomes tangible.

If you‘re considering automation for your pharmacy–or are simply curious about how robotic storage could transform your workflow–GOLLMANN Ireland would welcome the opportunity to show you a tailored solution.

With minimal disruption and high flexibility, it’s a future proof step into smarter pharmacy practice.

Interested in learning how GOLLMANN can work for your premises?

Reach out to the GOLLMANN Ireland team today for a conversation about your needs, an overview of options, or an on site demonstration tailored to your pharmacy.

GOLLMANN ZWICK LTD Mobile: +353 (87) 340 7640 Email: Info.ie@gollmann-zwick.com Website: www.gollmann.ie

Why GOLLMANN Matters to Irish Pharmacies Efficiency Meets Safety With Ireland’s growing workload for pharmacists, GOLLMANN supports safer and faster dispensing,

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Advertorial

Helping Patients Find Their Voice Again: Why GeloRevoice® Belongs in Every Pharmacy Community pharmacies are often the first port of call for patients seeking advice on sore throats, hoarseness, or dry cough. From busy teachers and singers to children with viral infections, or parents worried about safe remedies in pregnancy, pharmacists are asked daily for effective, trustworthy solutions.

• A parent worried about what’s safe for their child’s sore throat.

• A pregnant woman reluctant to use medicated lozenges.

• A singer preparing for a performance who can’t risk hoarseness.

Traditionally, the category has been dominated by antiseptic or anaesthetic lozenges, which offer temporary relief but do little to support the throat’s natural recovery process. Patients frequently return looking for something longer-lasting and more effective.

That is where GeloRevoice® stands out — and why it is increasingly recognised by pharmacists as a product that meets a genuine patient need.

A Growing Patient Demand Throat irritation and hoarseness are among the most common minor complaints brought to pharmacy counters. Contributing factors include seasonal colds and flu, voice strain, allergies, air pollution, and even prolonged exposure to dry indoor heating or air conditioning.

How GeloRevoice® Works

Clinical and Real-World Evidence

Unlike traditional lozenges, GeloRevoice® uses an innovative triple-action principle:

Pharmacists can recommend GeloRevoice® with confidence thanks to published observational studies. Patients reported significant improvements in hoarseness, dryness, and sore throat within just a few days of use, with over 60% experiencing notable symptom reduction. Satisfaction levels were consistently high.

1. Stimulates saliva flow – supporting the throat’s natural moisture balance.

2. Delivers a hydrogel complex (hyaluronic acid, xanthan gum, carbomer) – binding moisture and soothing tissues.

3. Forms a protective film – coating the mucous membranes to relieve irritation and shield from further strain.

This creates a long-lasting, moist protective layer that directly addresses the underlying cause of hoarseness and dryness, rather than simply masking symptoms.

For many patients, especially those who depend on their voices professionally, these issues are more than an inconvenience — they can affect quality of life, confidence, and work performance. Pharmacists, as trusted advisors, are ideally placed to recommend products that go beyond “quick fixes” to deliver lasting relief.

What’s more, GeloRevoice®’s safety profile is excellent. It is sugar-free, lactose-free and gluten-free, making it suitable for patients with dietary restrictions. It can also be used by children over six, as well as during pregnancy and breastfeeding — offering peace of mind for groups often excluded from throat remedies.

Practical Benefits for the Pharmacy For pharmacy teams, GeloRevoice® fills a valuable gap in the throat care category. It: • Differentiates from standard lozenges by offering a medical device solution, not just a confectionery-style product.

• Provides a professional recommendation option when patients want “something that really works” or have not responded to traditional lozenges.

• Increases category value, as patients are willing to invest in a solution that delivers lasting relief and proven results.

• Encourages repeat custom, as satisfied patients return for flavours such as blackcurrant or cherry.

Meeting Real Patient Needs Every day, pharmacy teams meet patients with stories like these: • A teacher losing their voice mid-week, desperate to finish classes.

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In each case, GeloRevoice® offers a clear, evidence-based recommendation that pharmacists can give with confidence.

A Professional Standard in Throat Care In a crowded market, it’s not always easy for patients to distinguish between products on the shelf. GeloRevoice® gives pharmacists the chance to lead that conversation, positioning themselves as knowledgeable advisors offering more than just over-the-counter relief.

By recommending GeloRevoice®, pharmacists can provide a solution that is clinically backed, safe for a wide range of patients, and genuinely effective in protecting and restoring the voice.

Conclusion Community pharmacists play a central role in helping patients manage everyday health concerns.

With GeloRevoice®, they now have a trusted, differentiated option to recommend for hoarseness, sore throat, and dry cough.

By stocking and recommending GeloRevoice®, pharmacies can meet growing patient demand, add value to the throat care category, and — most importantly — help their patients find their voices again.

GeloRevoice® — trusted by pharmacists, loved by patients.

Find out more at www.gelorevoice.ie.

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New CPR Training Programme An Irish hospital has become the first in the country to adopt a new digital cardiopulmonary resuscitation (CPR) training programme – an approach that may hold valuable lessons for community pharmacy teams as first responders in their own settings.

The National Rehabilitation Hospital (NRH) in Dun Laoghaire has rolled out Resuscitation Quality Improvement (RQI), in partnership with the Irish Heart Foundation. The programme uses simulation technology and digital learning to help healthcare staff sustain high-quality CPR skills – a critical factor in improving survival after cardiac arrest.

For decades, healthcare professionals have relied on traditional instructor-led Basic Life Support (BLS) courses, with certification renewed every one to two years. However, research shows CPR skills can deteriorate within just three to six months of training. The RQI model addresses this by offering quarterly, selfdirected refresher sessions using simulation stations, accessible 24/7 within the hospital.

Unlike the traditional four-and-ahalf-hour classroom model, RQI requires shorter, more frequent practice sessions, which help embed competence while reducing disruption to clinical services.

In one evaluation, adult/child compression quality rose from 84% to 96%, and ventilation performance improved from 80% to 95% after repeated practice with real-time feedback.

Attracta Kennedy, Resuscitation Officer at the NRH

While the initiative is being pioneered in a hospital setting, community pharmacy teams are also well placed to consider the benefits of regular, skills-focused CPR training. Pharmacies are often the first point of contact in the community, and many already engage with public health initiatives led by the Irish Heart Foundation, such as blood pressure checks and cardiovascular risk awareness campaigns.

As frontline healthcare providers, pharmacists and their teams may be called upon to respond to medical emergencies in the pharmacy, on the street, or while supporting local health events.

Consistent, high-quality CPR training could provide reassurance to staff and the public alike.

Speaking about the launch, Geraldine Leete, Resuscitation

Quality Improvement Lead at the Irish Heart Foundation, noted, “Research shows that the better the quality of CPR delivered, the greater the impact on survival. The RQI programme raises the bar in how organisations develop and sustain lifesaving competence.”

“The move to digital CPR training is another step forward in our digital transformation journey at the NRH. “We look forward to streamlining and sustaining CPR skills and competence as we transition from instructor led Basic Life Support CPR training to the RQI digital training programme

in collaboration with the Irish Heart Foundation”, said Attracta Kennedy, Resuscitation Officer at the NRH. For community pharmacy, the takeaway is clear: moving away from infrequent, one-off CPR training towards a model of shorter, repeated skills refreshers could strengthen confidence and preparedness across the profession. With digital platforms making training more flexible, the pharmacy sector may have opportunities to adopt similar models to support its vital role in emergency response.

EMA Consultation The European Medicines Agency (EMA) has opened a public consultation on a new guideline providing recommendations for including and retaining pregnant and breastfeeding people in clinical trials.

Many individuals who are pregnant or breastfeeding need medicine to treat or prevent medical conditions. However, pregnant and breastfeeding individuals are often excluded from clinical trials. If someone becomes pregnant during a trial, they are often required to stop taking part.

As a result, medicine leaflets usually lack detail about the benefits and risks of a medicine specifically in pregnancy and breastfeeding. This means that patients and healthcare professionals must make treatment decisions without this essential information.

The new guideline aims to help developers of new medicines collect robust and reliable data about how medicines work in people who are pregnant or breastfeeding. This will support informed, evidence-based decisions when using medicines.

Key points in the guideline The key points from the guideline include: • Considerations for including pregnant and breastfeeding people in clinical trials for all relevant medicines • Scientific, regulatory, and ethical principles to ensure the safety of participants and their fetuses or babies • Recommendations for early planning and proactive engagement between medicine developers and regulatory authorities to ensure the safety and efficacy of treatments during pregnancy and breastfeeding How to take part in the consultation Patients and healthcare professionals are invited to share their views.

Visit the EMA websiteOpens in new window for more information and to take part in the consultation.

The deadline for submission is 15 September 2025.

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News

United Drug Elements: Your Trusted Partner for Exempt Medicine Products At United Drug, we know how important it is for pharmacists to have timely access to medicines that may not be available through regular distribution channels. That is why we created United Drug Elements – a dedicated service for the safe, efficient and reliable supply of Exempt Medicine Products (EMPs).

What is Elements?

United Drug Elements is the specialist sourcing and supply service for unlicensed medicines and pharmaceutical products.

Whether due to shortages, discontinuations or unavailability in Ireland, we ensure pharmacies have access to the medicines their patients need.

Our team manages the sourcing, storage and delivery of EMPs in line with HPRA guidelines, giving pharmacists confidence in both the process and the product. Stocked lines are available for same-day delivery, while emergency products can often be turned around in less than 48 hours.

More than a supplier – a partner Like pharmacists, United Drug puts the patient at the centre of everything we do. That philosophy underpins our work in Elements.

Our dedicated EMP Sourcing Team works closely with pharmacists to locate and supply the right products as quickly as possible.

We know every request matters, so our team is always available to support with sourcing queries, product searches or advice on quality guidelines.

This partnership approach is backed by practical benefits: • Safe and secure sourcing under HPRA regulations • Fast turnaround times, including same-day delivery on stocked lines • Live stock visibility on UDW.ie • Simple ordering of non-stocked lines via email, online or phone • Ongoing investment in technology to make ordering easier

Proactive Sourcing You Can Rely On

• Request non-stocked lines quickly and easily

Our EMP team actively monitors the HPRA shortages list each week. Where a medicine is at risk of shortage or discontinuation, we move quickly to identify and source alternatives. New EMP listings are added to our system each month, with a focus on Irish alternatives where possible to avoid customs delays and reduce lead times.

• View alternative unlicensed options for unavailable licensed stock

This proactive approach ensures patients are not left without essential medication and pharmacists can focus on providing care with peace of mind.

Ordering Through Elements Ordering EMPs has never been simpler. Through UDW.ie, you can: • Access the full list of EMP products with live stock visibility

• Manage invoices and credits directly through the portal Always Here to Help Our Customer Care team is available on a dedicated phone line (01 463 2410) to support with sourcing queries or EMP quality guidelines. With United Drug Elements, you have a trusted partner that understands the urgency, complexity and responsibility of sourcing unlicensed medicines.

At United Drug, we are committed to providing best-in-class service, safe supply and reliable support so that you can continue to deliver the best care to your patients.

National Rare Disease Strategy 2025-2030 Minister for Health, Jennifer Carroll MacNeill TD, has launched the National Rare Disease Strategy 20252030. This landmark strategy sets out a vision to improve the lives of the estimated 300,000 people living with rare diseases in Ireland.

Chair of the National Rare Disease Steering Group Professor Cecily Kelleher The strategy contains 11 recommendations to achieve its vision, including: • Putting people with rare diseases at the centre of service design and delivery • Establishment of an Implementation Oversight Group • Expansion of the National Rare Diseases Office • Establishment of a National Rare Disease Registry, to help improve the planning, coordination, and monitoring of services for people with rare diseases

The Strategy was developed following engagement with a broad range of stakeholders, including patients and families affected by rare diseases.

It outlines a comprehensive framework designed to enhance

diagnosis, treatment, and support for people living with rare diseases, aiming to improve quality of life, promote equitable access to healthcare, and foster innovation in rare disease research and treatment.

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• Increased international cooperation, particularly through the integration of European Reference Networks (ERNs) into the Irish healthcare service • Improved care coordination • Increased education and awareness of rare diseases among health professionals

The Strategy's recommendations also emphasise the importance of developing and enabling earlier diagnosis, integrated care, data and registries, research and innovation, and access to orphan medicines. By addressing these areas, the Strategy aims to create a more inclusive healthcare service that meets the complex needs of people living with rare diseases.

Chair of the National Rare Disease Steering Group Professor Cecily Kelleher said, "This is an evidencebased report which drew on the multi-disciplinary expertise of advocates, patient representatives, clinicians, scientists, researchers and policy makers to conduct its work. We had a particular strength in having a specially established consultative forum co-chaired by two of our Steering Group members, to express the voice of experience throughout.

“Our collective efforts have culminated in eleven recommendations that span the life course for those diagnosed with challenging and difficult conditions.”

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¤5.6m investment in Innovative Cancer Care Technology New radiotherapy technology, TrueBeam LINAC with HyperSight imaging, offers faster, more precise treatment, improving patient outcomes and experience Mater Private Network has announced a €5.6 million investment in Ireland’s first TrueBeam LINACs with HyperSight– an advanced radiotherapy system that uses high-quality imaging to deliver faster, more precise cancer treatment. The new system, now available at its Dublin hospital and soon to be available in its Limerick Radiation Oncology Centre, enables clinicians to target tumours with greater accuracy, improving outcomes, reducing side effects and reducing treatment times for patients.

The recent announcement builds on a series of strategic investments by Mater Private Network, which has invested ¤20 million over the last five years to enhance cancer services across its network. This latest upgrade reflects its ongoing commitment to innovation, clinical excellence, and faster access to care.

Hugh Healy, Director of Cancer, Mater Private Network, said, “Today marks a major milestone for cancer care in Ireland and builds on our ongoing investment in oncology services. This is the first time this technology is available in the country. The TrueBeam LINAC with HyperSight is capable of producing high quality scans in just six seconds, enhancing the precision of tumour targeting while making treatment times quicker for patients. Within our network, we will be able to offer best-in-class stereotacticcapable machines incorporating Varian HyperSight and Brainlab Exactrac Dynamic in both the east and west of the country, as part of the newest fleet of LINAC machines and planning CTs. We’re proud to be the first healthcare network in Ireland to introduce this treatment technology, reaffirming our commitment to ensuring that patients have access to the most advanced treatments available.”

Radiation oncology at Mater Private Network is led by a team of seven sub-specialty

The launch was officially marked with a ribbon-cutting ceremony earlier today at Mater Private Network’s hospital in Dublin

radiation oncologists, dedicated to delivering personalised, patient-centred care. Working closely with the Medical Oncology Department, and the multidisciplinary team at The Mater Hospitals and UCD Cancer Centre and University Hospital Limerick, the team works to optimise individualised treatment pathways and patient outcomes.

Thanks to improved workflows and more efficient technology, patients referred to Mater Private Network for radiotherapy, including for prostate, brain, lung, and other site-specific cancers, can typically be seen within one

Radiation oncology at Mater Private Network is led by a team of seven sub-specialty radiation oncologists, dedicated to delivering personalised, patient-centred care

week and begin treatment within one month of referral, ensuring expedited access to potentially life-saving care.

Professor Daniel Cagney, Clinical Director of Radiation Oncology, Mater Private Network said, “These new capabilities, including the TrueBeam LINAC with HyperSight and Brainlab Exactrac Professor Daniel Cagney, Clinical Director of Radiation Oncology, Mater Private Network and Hugh Healy, Director of Cancer, Mater Private Network

Dynamic, are transforming how we deliver radiotherapy. With clearer imaging and faster scans, we can ensure more precise treatment and personalised care. As the first and only healthcare network currently offering this technology, we’re ensuring more people have access to world-class treatment close to home. Ultimately, it’s about better outcomes and giving patients confidence and peace of mind during a very difficult time.”

The launch was officially marked with a ribbon-cutting ceremony earlier today at Mater Private Network’s hospital in Dublin.

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Oncology

An Overview of Head and Neck Cancer Written by Áine Finn, Community and Online Information Nurse, Marie Keating Foundation

increase our risk.5 The three main cause of head and neck cancers are tobacco and alcohol and the human papillomavirus (HPV).

Tobacco

Introduction: In Ireland we see on average 800 new cases of head and neck cancer diagnosed every year. Men are at a higher risk of the disease,1 with men being more than twice as likely to develop it (4.6%) compared to women (1.8%).1 The risk of head and neck cancers increase as we get older with the majority occurring over the age of 50 years, however they can also develop in people younger.2 Types of Head and Neck Cancers: Head and neck cancer can be used as an umbrella term to describe a number of different cancers that can develop in the soft tissues of the head and neck.

They can include cancers such as:

“The most common type of head and neck cancer is squamous cell carcinoma. About 9 out of 10 head and neck cancers (90%) start in squamous cells.4 Treatment will vary depending on the location of the cancer” - Salivary gland cancer – there are three main salivary glands in the mouth along with 100s of smaller ones in the mouth and throat.

- Throat cancer – cancer developing in any part of the throat.

- Laryngeal cancer – cancer of the larynx or voice box

- Tongue Cancer – cancer at the front or back of the tongue

- Nasopharyngeal cancer – cancer in the area where the nose and back of the throat meet.

- Tonsillar Cancer – cancer occurring in the tonsils of the mouth

- Mouth and Oropharyngeal cancer – area of the mouth including the lips, gums and sides of the mouth and the oropharyngeal area (area of the throat just behind the mouth) - Nasal and Paranasal Sinus cancer – space behind the nose or within the bones close to the nasal cavity.

- Oesophageal cancer – cancer of the oesophagus an area where food is transported from the mouth to the stomach, also known as the gullet or food pipe.

- Ear cancer – cancer developing in any of the three areas of the ear, the inner, middle or outer sections.3 The most common type of head and neck cancer is squamous cell carcinoma. About 9 out of 10 head and neck cancers (90%) start in squamous cells.4 Treatment will vary depending on the location of the cancer.

Risk Factors and Causes: We do not know the cause of most head and neck cancers however there are certain factors that can

PHARMACYNEWSIRELAND.COM

This includes cigarettes, cigars and pipes as well as smokeless or chewable forms of tobacco.

Alcohol No alcohol is best however when consuming alcohol the recommendation is to try not to exceed the weekly recommended guidance.6 The risk of alcohol consumption can be further increased when alcohol and tobacco are used together. This is due to an increased absorption of harmful chemicals from both tobacco and alcohol into the cells in our body when combined.

HPV (Human Papillomavirus) The human papillomavirus is a very common virus which most people will be exposed to at some point in their life. It is spread through close skin to skin contact, usually during sexual activity such as sexual intercourse, anal sex or oral sex. There are over 100 different strains of HPV and they can be classified as low-risk strains and high-risk strains. Our own immune system can play a role in clearing this virus, with the majority of people able to clear it within two years. However, with high-risk strains of this virus, if we are unable to effectively clear the virus ourselves, it can increase the risk of developing some mouth and oropharyngeal cancers.5, 7 Other risk factors: Age: As previously mentioned, the risk of head and neck cancers increases with age with the majority of people diagnosed over 50 years of age.2 Sex: Men are more than twice as likely to develop head and neck cancers compared to women. Head and neck cancers are the 5th most common cancer in men excluding non-melanoma skin cancer.1

UV Exposure: Exposure to harmful ultraviolet (UV) rays from the sun or from sunbeds can increase the risk of cancer of the mouth in particular of the lips. Therefore, it is important to apply sunscreen to protect our lips from harmful UV rays and to avoid sunbed use.2, 7 Signs and symptoms - Hoarseness - Persistent sore throat - Pain to the ear, head or neck - Difficulty swallowing or food getting caught or stuck - A lump to the mouth, throat or head - Numbness or issues with moving the tongue - New changes to your gums, cheeks or tongue such as red or white patches, - Mouth ulcers or blisters that don’t heal - Loose tooth that is unexplained - Droop in the side of your face - Gums that don’t fully heal -after dental work.2, 8 Head and neck cancers can be treated successfully if caught in time. Therefore, it is important that if a person has any one or combination of the above symptoms, especially if they persist for more than three weeks, that they seek medical advice.

People can also help to reduce their risk by regular dental checkups and by self-checks at home on a regular basis.2 Treatment: Treatment is dependent upon a number of factors including the stage and grade of the cancer, the type and location as well as the general health of the person. The main treatment options for head and neck cancers are: - Surgery

Weakened immune system:

- Chemotherapy

When our immune system is weakened, we are at an increased risk for being unable to clear HPV. People who are on immunosuppressant drugs or those with a weakened immune system can be at an increased risk of developing some head and neck cancers.7

- Radiotherapy - Combination of chemotherapy and radiotherapy - Targeted therapies - Immunotherapies9, 10, 11, 12 References available on request

CPD: Emergency Contraception

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Written by Eamonn Brady, MPSI Continuing Professional Development

CPD 60 Second Summary This article provides a comprehensive pharmacistfocused review of emergency hormonal contraception (EHC), covering its clinical use, counselling considerations, and public health context. It outlines the three main methods, namely levonorgestrel, ulipristal acetate, and the copper intrauterine device, highlighting their mechanisms, timing, effectiveness, and side-effect profiles. Particular attention is given to factors influencing choice, including timing in the menstrual cycle, body mass index, breastfeeding, drug interactions, and patient preference. The article stresses that while EHC is safe and effective for occasional use, it should not replace regular contraception due to reduced overall effectiveness and potential for cycle disruption.

Pharmacist counselling is emphasised as central to safe and supportive care.

Key points include timely administration, management of side effects, guidance on ongoing contraception, and reassurance around confidentiality, especially for younger patients. The role of pharmacists in safeguarding under-16s, addressing patient anxieties, and offering STI advice is also discussed.

The article further examines reasons for EHC use in Ireland, such as condom failure and missed pills, and factors behind contraceptive failure. It places EHC within the wider public health landscape, reflecting on cost barriers, the HSE’s free contraception scheme, and strategies to discourage overreliance. Appendices provide practical pharmacy tools including a patient leaflet and consultation questionnaire.

Eamonn is the Supervising Pharmacist and Owner of Whelehan’s Pharmacy’s, Pearse Street and Clonmore, Mullingar

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

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. ellaOne has no editorial oversight of the CPD programmes included in these modules.

Emergency contraception practices in community pharmacy Emergency contraception (EC) remains a crucial area where pharmacists can make a real difference to women’s health.

Despite advances in access, many women still face barriers—ranging from stigma to uncertainty about where to seek reliable information.

With GP appointments no longer required for EC, pharmacists have become the first port of professional consultation for many women, offering both accessibility and trusted expertise. Research shows that 74% of women turn to Google for information about sexual health, highlighting the risk of misinformation and the growing importance of pharmacists as a readily available, evidence-based source of guidance and care.

This CPD module will explore the evolving role of the pharmacist in EC management and provide practical insights to support confident, patientcentred consultations.

Hormonal Contraception 1. Ulipristal acetate Ulipristal acetate (UPA) – E.g. ellaOne® A selective progesterone receptor modulator that can delay ovulation even after the LH surge has begun, offering a wider window of opportunity compared to levonorgestrel-based emergency

contraception. It works by binding to progesterone receptors in the ovary, preventing or postponing the release of an egg and thereby reducing the risk of fertilisation.

Dose and timing 30mg orally, taken as soon as possible after unprotected sexual intercourse (UPSI), and effective for up to 120 hours (5 days) after UPSI. Its ability to delay ovulation even when the luteinising hormone (LH) surge has started makes it a preferred option in later parts of the fertile window.

Effectiveness Maintains consistently high efficacy throughout the entire 5-day window. Demonstrated to be significantly more effective than levonorgestrel (LNG) between 72–120 hours, particularly when UPSI occurs closer to ovulation.

Effectiveness is not reduced by body weight to the same extent as LNG, though some data suggest a modest reduction in women with higher BMI. Side effects Headache, nausea, abdominal discomfort, dizziness, and menstrual changes (including earlier or later onset of bleeding).

Most side effects are mild and self-limiting.

Special considerations Breastfeeding should be avoided for 7 days after use, as tiny amounts can pass into breast milk. Hormonal contraception should be delayed for 5 days after taking UPA to avoid reducing its effectiveness. If vomiting occurs within 3 hours of taking the dose, a replacement dose should be taken.

Not recommended for women with severe asthma controlled by oral glucocorticoids or those with severe liver disease.

2. Levonorgestrel Levonorgestrel (LNG) – NorLevo® Levonorgestrel is a synthetic progestogen that works primarily by inhibiting or delaying ovulation.

It does this by suppressing or postponing the luteinising hormone (LH) surge if taken before ovulation has occurred, thereby preventing the release of an egg and reducing the risk of fertilisation.

It is ineffective once ovulation has already taken place and does not interrupt or harm an existing pregnancy. Levonorgestrel has been widely used for decades as an emergency contraceptive and is available in single-dose formulations, providing a wellestablished safety profile and predictable pharmacological action.

ellaOne® 30 mg film-coated tablet (ulipristal acetate). Refer to the SmPC for further information. INDICATION: Emergency contraception (EC) within 120 hours (5 days) of unprotected sexual intercourse or contraceptive failure. MARKETING AUTHORISATION HOLDER: Laboratoire HRA Pharma, 200 avenue de Paris 92320 Châtillon - France. MARKETED IN IRELAND BY: Chefaro Ireland DAC, The Sharp Building, 10-12 Hogan Place, Dublin 2, D02 TY74, Ireland. MARKETING AUTHORISATION NUMBER(S): EU/1/09/522/003. LEGAL CATEGORY: Medicinal product not subject to medical prescription.

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time Initial cramping or discomfort at insertion is common but typically short-lived. risksdaily include uterine Can for women who cannot use oestrogen or progestogen.

Provides ongoing protectionRare without adherence. perforation, pelvic infection (mainly in the first 20 days after insertion). be removed expulsion, at any timeand if pregnancy is desired.

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Side effects: Quick clinical reference table CPD: Emergency Contraception May cause heavier or more painful periods in the first few months after insertion, which usually improves with Advantages

Dose and timing The recommended dose is 1.5 mg taken orally as a single dose, ideally within twelve hours of unprotected sexual intercourse (UPSI) to maximise effectiveness.

It is licensed for use up to seventy-two hours, or three days, after UPSI, though efficacy decreases with time. If vomiting occurs within three hours of taking the dose, a replacement dose should be taken. It can be taken at any point in the menstrual cycle, provided pregnancy has been reasonably excluded.

Effectiveness Levonorgestrel is approximately eighty-four percent effective overall when taken within the recommended time frame.

Effectiveness is highest when taken within the first twelve hours and declines progressively thereafter. Reduced efficacy is observed in individuals with a body mass index of twenty-six kilograms per square metre or greater, or in those with a body weight above seventy kilograms. In such cases, ulipristal acetate or a copper intrauterine device (Cu-IUD) may be considered more appropriate. It is not effective once ovulation has already occurred.

Side effects

Method Dose Average Possible Side Special Notes time Initial cramping orMechanism discomfort at insertion is&common but typically short-lived.

Rare risks include uterine Offers long-term contraception lasting 5–10 years, depending on device type. Completely hormone-free, suitable Effectiveness Effects without daily adherence. Can perforation, expulsion, infection (mainly in the first 20 days after insertion). for women who cannot and use pelvic oestrogen or Timing progestogen.

Provides ongoing protection Levonorgestrel Delays 1.5 mg PO 84%, reduced Nausea, Avoid with enzymebe removed at any time if pregnancy is desired.

Quick clinical reference table (LNG) ovulation ASAP, within with BMI ≥26 headache, inducing drugs; Quick clinical reference table before LH 72h (best or >70 kg dizziness, repeat if vomit <3h Side effects: Method Mechanism Dose & first fewAverage Possiblewhich Side usually Special Notes surge <12h) May cause heavier or more painful periods in the months aftermenstrual insertion, improves with Timing Effectiveness EffectsRare risks include uterine changes time Initial cramping or discomfort at insertion is common but typically short-lived.

Ulipristal expulsion, 30 mg PO Consistent Headache, Levonorgestrel Delays 1.5 mg PO in the 84%, reduced Nausea, Avoid with enzymeperforation, and pelvic infection (mainly first 20 days after insertion).

Acetate (UPA) across 5 days; nausea, breastfeeding (LNG) ovulation even ASAP, within with BMI ≥26 headache, inducing drugs;7 after LHLH surge 120h(best superior abdominal pain, days: delay before 72h or >70 kgto dizziness, repeat if vomit <3h Quick clinical reference table starts LNG at 72– hormonal surge <12h) menstrual Method Mechanism Dose & Average Possible Side Special Notes 120h contraception 5 changes Effectiveness Headache, Effects days Ulipristal Delays 30 Timing mg PO Consistent Avoid Copper IUD Copper ions Insert >99%reduced Heavier periods, breastfeeding Long-term (5–10 Levonorgestrel Delays 1.5 mg≤5 PO 84%, Nausea, Avoid with enzymeAcetate (UPA) ovulation even ASAP, within across 5 days; nausea, 7 toxic LH to sperm, days postcramps, rare yrs), hormone-free, (LNG) ovulation ASAP, within superior with BMI to ≥26 headache, inducing drugs; after surge 120h abdominal pain, days: delay preventLH UPSI(best or perforation unaffected

by BMI before 72h or >70 dizziness, repeat if vomit <3h starts LNG atkg 72– menstrual hormonal fertilisation & ovulation surge <12h) menstrual 120h changes contraception 5 implantation days changes UlipristalIUD Delays ions 30 mg≤5 PO Consistent Headache, Avoid Copper Copper Insert >99% Heavier periods, Long-term (5–10 Acetate (UPA) ovulation even days ASAP, within across 5 days; cramps, nausea, rare breastfeeding 7 to sperm, postyrs), hormone-free, Repeat use andtoxic safety after LHcycle surge 120h superior toUPA and abdominal pain, not unaffected days: delay UPSI perforation

by BMI for Repeating use in theprevent same is safe butor may disrupt cycles.

LNG should be taken together starts test&if menstrual LNG period at 72– is over menstrual hormonal fertilisation ovulation the same UPSI. Pregnancy cycle (period) 7 days late.

120h changes contraception 5 implantation days Copper IUD Copper Insert ≤5 or up>99% periods, Provides Long-term (5–10 after UPSI to 5 days after Heavier progestogen. ongoing The most effective form of ions Repeat use and safety to cycle sperm, days postcramps, rare yrs), hormone-free, thebut earliest possible date of protection without daily adherence. emergency contraception (>99% Repeating use in thetoxic same is safe may disrupt cycles.

UPA and LNG should not be taken together for UPSI orcycle perforation unaffected

by BMI ovulation.

Can be used at any Can late. be removed at any time if efficacy). worksPregnancy by prevent continuously the sameItUPSI. test if menstrual (period) period is over 7 days ovulation time in the menstrual cycle, pregnancy is desired. releasing copper ionsfertilisation into the & implantation provided pregnancy has been uterus, creating a toxic environment Side effects reasonably excluded. for sperm and eggs, impairing May cause heavier or more sperm motility viability, and Repeat useand and safety Advantages painful periods in the first few preventing If fertilisation Repeating fertilisation. use in the same cycle is safe but may disrupt cycles. UPA and LNG should not be taken together for Offers long-term contraception months after insertion, which has alreadyUPSI. occurred, it can also the same Pregnancy test if menstrual cycle (period) period is over 7 days late. lasting 5–10 years, depending usually improves with time Initial inhibit implantation. on device type. Completely cramping or discomfort at insertion Timing hormone-free, suitable for women is common but typically shortCan be inserted up to 5 days who cannot use oestrogen or lived. Rare risks include uterine

DiagramDiagram 1. Mechanism action of LNG and UPA 1. Mechanismof of action of LNG and UPA

This diagram shows how levonorgestrel (LNG) and ulipristal acetate (UPA) act (created October 20th, 2014)

Most side effects if they occur, This diagram shows how levonorgestrel (LNG) and ulipristal acetate (UPA) act during the follicular and peri-ovulatory during the phases. follicular and peri-ovulatory phases.

Their main effect is delaying or UPA blocking ovulation, are mild, short-lived, and resolve Their main effect is delaying or blocking ovulation, preventing fertilisation. can remain effectivepreventing even very fertilisation.close UPA remain evenoccurs, very close to the LH Once ovulation occurs, these methods without intervention. to can the LH surge. effective Once ovulation these methods aresurge. no longer effective.

are no longer effective.

Common side effects include nausea (taking the tablet with food or at bedtime may help reduce nausea), headache, dizziness, abdominal discomfort, and fatigue. Menstrual changes may also occur, including earlier or later onset of bleeding, heavier or lighter menstrual flow, and spotting between periods. Temporary breast tenderness or fullness can occur (especially with LNG than UPA) but typically subsides within a few days.

Interactions

Enzyme-inducing drugs reduce efficacy; Cu-IUD preferred in such cases. For Levonorgestrel (LNG), enzyme-inducing drugs that can reduce its efficacy include medicines that increase the activity of liver enzymes (particularly CYP3A4), leading to faster breakdown and lower plasma levels of LNG. 3. Copper intrauterine device (Cu-IUD)

ellaOne® 30 mg film-coated tablet (ulipristal acetate). Refer to the SmPC for further information. INDICATION: Emergency contraception (EC) within 120 hours (5 days) of unprotected sexual intercourse or contraceptive failure. MARKETING AUTHORISATION HOLDER: Laboratoire HRA Pharma, 200 avenue de Paris 92320 Châtillon - France. MARKETED IN IRELAND BY: Chefaro Ireland DAC, The Sharp Building, 10-12 Hogan Place, Dublin 2, D02 TY74, Ireland. MARKETING AUTHORISATION NUMBER(S): EU/1/09/522/003. LEGAL CATEGORY: Medicinal product not subject to medical prescription.

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Diagram 2. Hormonal dynamics and EHC action points

This diagram overlays luteinising hormone (LH) and follicle-stimulating hormone (FSH) trends across the menstrual cycle with emergency contraception action points. Levonorgestrel acts before the LH surge, ulipristal can act closer to ovulation, and the intrauterine device (IUD) is effective regardless of cycle stage. Bear in mind misepristone not licensed for EHC in Ireland:

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for use within 72 hours; UPA within 120 hours. Early use increases effectiveness for both medicines.

If the UPSI was more than 5 days ago, refer for copper IUD fitting where possible.

Method selection Pharmacists should discuss factors influencing choice: • Time since UPSI: UPA may be preferred after 72 hours.

• Cycle timing: UPA is more effective closer to ovulation.

• Current contraception: LNG allows immediate continuation; UPA requires a 5-day delay.

• BMI and body weight: LNG efficacy may be reduced in BMI ≥26 kg/m2; UPA is less affected but still consider IUD referral.

Diagram 2. Hormonal dynamics and EHC action points This diagram overlays luteinising hormone (LH) and follicle-stimulating hormone (FSH) trends across the menstrual cycle with emergency contraception action points. Levonorgestrel acts before the LH surge, ulipristal can act closer to ovulation, and the intrauterine device (IUD) is effective regardless of cycle stage. Bear in mind misepristone not licensed for EHC in Ireland.

• Breastfeeding: LNG is safe; UPA requires a 7-day breastfeeding break.

perforation, expulsion, and pelvic

Take one tablet orally with water.

failure. While both are safe and

Impact on regular hormonal

Administration and missed doses

If vomiting occurs within 3 hours, infection (mainly in the first 20 days effective in whenIreland: used appropriately, contraceptionusage statistics Emergency contraception Estimated repeat the dose. Advise patients to after insertion). regular reliance on EHC instead of The table below presents estimated usage statistics for different forms ofUsing emergency contraception in Ireland.

UPA regularly may interfere avoid alcohol or excessive caffeine consistent contraception can lead Repeat use and safety of with the efficacy of ongoing if feeling nauseated, although no These percentages are approximationstobased on international data and local practice patterns can vary, as a range of clinical, practical, and contraception hormonal contraception. After direct interaction exists. official emergency Irish data are limited. psychosocial issues including:

UPA, there must be a 5-day Repeating use in the same cycle Expected side effects Method Estimated Usage % delay before Notes restarting hormonal Reduced overall contraceptive is safe but may disrupt cycles. contraception, during which Levonorgestrel pill (LNG) 65–75% Most common due to OTC access and effectiveness UPA and LNG should not be As detailed above; most get no barrier methods must be used. taken together for the same UPSI. convenience side effects, if they occur, they are EHC is less effective than most Repeated courses can therefore Pregnancy test if menstrual cycle generally mild and very short term Ulipristal acetate 20–30% Used when more time has passed; still OTC regular contraceptive methods. lead to prolonged contraceptive (period) period is over 7 days late. ® (UPA/ellaOne ) LNG reduces pregnancy risk by Contraceptive protection gaps without full contraceptive Factors around1–5% 84% when taken within afterwards Copper IUD affecting choice of Most effective butthus least used;increasing requires clinical protection actually emergency contraceptive 72 hours of UPSI, while UPA insertionchance pregnancy longer term.

• After LNG: continue or start is more effective but still not Overall safety profile of LNG hormonal contraception Psychological and emotional as dependable as long-acting and UPA immediately; use condoms for 7 effects reversible contraception (LARC) or days (9 days for Qlaira® users).

Both LNG and UPA have extensive combined oral contraceptives.

Some patients report feeling safety data supporting their use, • After UPA: delay hormonal anxious, guilty, or judged Menstrual cycle disruption including in adolescents, and contraception for 5 days, then when accessing EHC multiple breastfeeding women (with some use condoms until hormonal Repeated EHC use in a short times. This can impact selfrestrictions for UPA described method has been active for 7 period can cause unpredictable esteem and decision-making. above). Neither is associated days (or 9 days for Qlaira®). menstrual changes including Pharmacists play a key role in with serious long-term adverse shortened or lengthened cycles; non-judgmental support and effects. Studies have shown no • Emphasise that EHC does not reframing consultations towards lighter or heavier bleeding; evidence of teratogenicity if EHC protect against pregnancy for empowerment and choice. intermenstrual spotting. These is inadvertently taken during an further UPSI later in the same are not medically harmful but can early pregnancy. Importantly, cycle.

Pharmacist counselling points cause anxiety and complicate these medicines do not cause for EHC Pregnancy testing and follow-up pregnancy detection. abortion and will not affect an Some of the points below for established pregnancy. They act Advise pregnancy test if: Hormonal side effects counselling are mentioned already before implantation, primarily by but are simply repeated to give delaying ovulation.

• Menstrual cycle (period) is more The side effects discussed already coherent counselling advice in than 7 days late. of occasional EHC use are usually Issues with regular use of EHC one section. mild, but frequent exposure can • The next period is unusually light increase the likelihood of side EHC, primarily levonorgestrel Timing is critical or heavy. effects including side effects (LNG) and ulipristal acetate (UPA) becoming more persistent and EHC should be taken as soon as is designed for occasional, urgent • There are pregnancy symptoms increased intensity the more EHC possible after unprotected sexual use after unprotected sexual (nausea, breast tenderness, intercourse (UPSI) or contraceptive fatigue). is used. intercourse (UPSI). LNG is licensed

ellaOne® 30 mg film-coated tablet (ulipristal acetate). Refer to the SmPC for further information. INDICATION: Emergency contraception (EC) within 120 hours (5 days) of unprotected sexual intercourse or contraceptive failure. MARKETING AUTHORISATION HOLDER: Laboratoire HRA Pharma, 200 avenue de Paris 92320 Châtillon - France. MARKETED IN IRELAND BY: Chefaro Ireland DAC, The Sharp Building, 10-12 Hogan Place, Dublin 2, D02 TY74, Ireland. MARKETING AUTHORISATION NUMBER(S): EU/1/09/522/003. LEGAL CATEGORY: Medicinal product not subject to medical prescription.

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CPD: Emergency Contraception • If the product is unlicensed, it cannot be supplied under the pharmacy OTC EHC arm of the scheme. Instead, EMP rules apply (prescription + consultant initiation).

4) PCRS claiming & 777 Codes • For DPS/LTI/HAA schemes, unlicensed medicines are claimed using 777xx codes with invoice evidence attached.

• 77750 = 0% VAT, 77752 = 23% VAT (confirm exact suffix with PCRS before submission). Oral products have zero VAT. • These codes are not used for standard Free Contraception Scheme supplies of licensed products.

5) Workflow for pharmacy teams

STI awareness and referral • EHC does not protect against sexually transmitted infections (STIs).

• Offer STI screening referral where indicated.

• Encourage condom use for both infection and pregnancy prevention.

Confidentiality and supportive environment • Provide EHC in a private consultation area.

• Use a non-judgmental, supportive tone, especially for younger patients.

• Reassure that access to EHC is legal and confidential.

Long-term contraception advice • Frequent EHC use is less effective and more disruptive than regular contraception (e.g., the pill).

• Discuss options such as oral contraceptives, implants, injections, or IUDs Special circumstances • Enzyme-inducing drugs (e.g., rifampicin, carbamazepine) reduce efficacy – recommend copper IUD or double LNG dose (off-label).

• Postpartum women can use LNG; UPA not advised during breastfeeding without temporary milk cessation.

• Perimenopausal women still require contraception until menopause confirmed.

Supply considerations of emergency hormonal contraception (EHC) in Ireland – shortages and alternatives Guidance for pharmacists on supply considerations, if shortages occur, is outlined below.

1) Current supply issues & expected end dates • The HPRA maintains the official national shortages list. As of August 2025, Ulipristal® acetate (UPA 30 mg) had a shortage earlier in 2025 (Rowa brand only) with Ella One® always available.

Levonorgestrel (LNG 1.5 mg) has not had persistent shortages recently, but both remain subject to intermittent availability issues.

• Always check the HPRA shortages portal and IPU/NHPC updates for real-time information.

2) Use of unlicensed (ULM/EMP) versions • If licensed brands are unavailable, supply of unlicensed emergency contraception is only permitted through the Exempt Medicinal Product (EMP) framework. This requires consultant initiation, patient informed consent, and invoice evidence.

• Claims must be processed under HSE Pharmacy Circular 12/23 (EMPs).

3) Free contraception scheme and coverage • The Free Contraception Scheme covers licensed emergency contraception supplied via pharmacy for eligible patients (17th birthday to the day before 36th birthday).

1. Check HPRA/IPU shortages list and wholesalers for alternative licensed brands.

2. If UPA is unavailable, consider LNG (if ≤72 hours) or refer for copper IUD. 3. If no licensed option is obtainable, request prescriber/ consultant initiation for EMP supply.

4. For EMPs, process claims via 777xx codes with invoices (DPS/ LTI/HAA) or GMS list codes where available.

5. For licensed EHC supplied without prescription under the Free Contraception Scheme, claim usual fee plus ¤11.50 service fee.

6) There was never any ULMs of EHC needed yet in Ireland Despite my description of protocols if ULMs of EHC are required, actually there has never thankfully been a need for a ULM version EHC needed or used in Ireland as there was always an alternative licensed version; both levonorgestrel (Norlevo®) and ulipristal acetate (Ella One®) have an alternative generic version (both Rowa). Rowa generic was temporarily short in 2025, but alternative licensed brand versions were available, unlike HRT where ULMs are often required.

Free emergency hormonal contraception HSE scheme from pharmacies Free emergency hormonal contraception is available anytime from participating pharmacies

for women aged 17 to 35 under the HSE scheme. It is also free outside this age group if patients have a medical card arranged directly in the pharmacy without needing to visit your GP. Patients not within the 17-to-35-year age group or without a medical card are still entitled to EHC via pharmacy but they will have to pay the price of the product (price varies by pharmacy).

All pharmacies have a private consultation room to enable a discreet, confidential, and confidential service. The pharmacist will ask health questions (many pharmacies have a confidential health questionnaire) to ensure it is safe and to choose the right one for the patient based on criteria given already. The process takes only minutes, making it quick, discreet, and effective in preventing unintended pregnancies through timely access.

Providing EHC free of charge at pharmacies removes a major financial barrier. A single course of EHC can cost ¤15–¤35 privately, which may deter some women from seeking it promptly.

Timeliness is critical.

Aged 16 and below Pharmacists should also be aware that the age of sexual consent in Ireland is 17 years. Where appropriate, pharmacists need to assure themselves of the age of the patient. Having regard to the age and circumstances of the individual patient, and any child protection issues arising, pharmacists should consider whether referral to a medical practitioner, other healthcare professional, or other agency or authority is appropriate Pharmacists are legally allowed to supply EHC without parental consent to those aged 16 years and over. Individuals in this age group are considered capable of giving their own consent for medical treatment. There is no strict age limit for the product itself.

Under 16 Years Old If someone is under 16, pharmacists should seek parental or guardian consent before providing EHC or they may decide it is best for the patient to see their GP depending on circumstance and the pharmacist’s professional opinion.

ellaOne® 30 mg film-coated tablet (ulipristal acetate). Refer to the SmPC for further information. INDICATION: Emergency contraception (EC) within 120 hours (5 days) of unprotected sexual intercourse or contraceptive failure. MARKETING AUTHORISATION HOLDER: Laboratoire HRA Pharma, 200 avenue de Paris 92320 Châtillon - France. MARKETED IN IRELAND BY: Chefaro Ireland DAC, The Sharp Building, 10-12 Hogan Place, Dublin 2, D02 TY74, Ireland. MARKETING AUTHORISATION NUMBER(S): EU/1/09/522/003. LEGAL CATEGORY: Medicinal product not subject to medical prescription.

MAT-10894

*Based on IQVIA sales data MAT June 2025. ~ Glasier AF, et al. Lancet. 2010;375(9714):55 5 62. Erratum in Lancet. 2014;384(9953):15 and ellaOne EU SmPC PRODUCT INFORMATION ellaOne® 30 mg film-coated tablet (ulipristal acetate). Refer to the SmPC for further information. INDICATION: Emergency contraception (EC) within 120 hours (5 days) of unprotected sexual intercourse or contraceptive failure. DOSAGE: one 30mg tablet taken orally as soon as possible, but no later than 120 hours (5 days) after unprotected intercourse or contraceptive failure. Another tablet should be taken if vomiting occurs within 3 hours of intake. Can be taken at any time during the menstrual cycle. Not recommended for women with severe hepatic impairment. CONTRAINDICATIONS: Hypersensitivity to the active substance or excipients. SPECIAL WARNINGS AND PRECAUTIONS: Occasional use only. Use reliable barrier method after use until next menstrual period. If next menstrual period is delayed >7 days or is abnormal or suggestive symptoms occur then perform pregnancy test. Consider ectopic pregnancy. If pregnancy confirmed, woman should contact their doctor. Concomitant use with EC containing levonorgestrel not recommended.

Does not contraindicate the continued use of regular hormonal contraception but reliable barrier method should be used until next menstrual period. Not recommended in severe asthma treated by oral corticosteroids. Concomitant use of CYP3A4 inducers [e.g. barbiturates (including primidone and phenobarbital), phenytoin, fosphenytoin, carbamazepine, oxcarbazepine, herbal medicines containing Hypericum perforatum (St. John’s wort), rifampicin, rifabutin, griseofulvin, efavirenz, nevirapine] not recommended (may decrease efficacy of ellaOne). Long term use of ritonavir not recommended. Not recommended for women who have used enzyme-inducing drugs in the past 4 weeks. Non-hormonal emergency contraception (i.e. a copper intrauterine device (Cu-IUD)) should be considered. Contains lactose. Patients with rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption should not take this medicinal product. Contains less than 1 mmol sodium (23 mg) per vial, essentially ‘sodium free’. FERTILITY, PREGNANCY AND LACTATION: Not intended for use during existing or suspected pregnancy. Limited human data does not suggest safety concern. Does not interrupt existing pregnancy. No teratogenic potential was observed; animal data insufficient with regard to reproduction toxicity. Marketing Authorisation Holder maintains a pregnancy registry (www. hra-pregnancy-registry.com) to monitor outcomes of pregnancy in women exposed to ellaOne®. Patients and health care providers are encouraged to report any exposure. Ulipristal acetate is excreted in human breast milk; breastfeeding is not recommended for one week after intake. Breast milk should be expressed and discarded. A rapid return of fertility is likely following ellaOne use; regular contraception should be continued or initiated as soon as possible; subsequent acts of intercourse should be protected by reliable barrier method until next menstrual period. UNDESIRABLE EFFECTS: Always consult the SmPC before prescribing. Only the most common side effects and those which are rare but may be serious are listed below. Most commonly reported adverse reactions: headache, nausea, abdominal pain and dysmenorrhea. Common (≥1/100 to <1/10): mood disorders, dizziness, vomiting, abdominal discomfort, myalgia, back pain, pelvic pain, breast tenderness and fatigue. Rare (≥1/10,000 to <1/1,000): ruptured ovarian cyst. MARKETING AUTHORISATION HOLDER: Laboratoire HRA Pharma, 200 avenue de Paris 92320 Châtillon - France. MARKETED IN IRELAND BY: Chefaro Ireland DAC, The Sharp Building, 10-12 Hogan Place, Dublin 2, D02 TY74, Ireland. MARKETING AUTHORISATION NUMBER(S): EU/1/09/522/003. LEGAL CATEGORY: Medicinal product not subject to medical prescription. Adverse events should be reported. Reporting forms can be found at www.hpra.ie or email: medsafety@hpra.ie Reporting forms can be found at: www.hpra.ie or email: medsafety@hpra.ie Adverse events should also be reported to: Chefaro Ireland DAC on Freephone:+353 (0)1709 4190 or email: UKLOCustomerService@per rigo.com MAT 10672

46

Oral Care

Tooth Decay in Children Tooth decay remains one of the most common health issues affecting children globally. Despite advances in dental care, up to 90% of children worldwide still experience decay, making it the most widespread chronic childhood disease. Beyond causing pain and distress, tooth decay disrupts education and often leads to hospital treatment under general anaesthetic.

The good news? Tooth decay is largely preventable with simple, consistent oral health routines.

The Impact of Tooth Decay

especially if brushing is infrequent.

Every time sugar is consumed, plaque bacteria produce acid for around 30 minutes, slowly eroding tooth enamel.

Each year, thousands of children miss out on school, play, and sleep because of dental pain. In many cases, poor oral health becomes a barrier to normal childhood activities and development.

Establishing healthy dental habits early in life is critical to preventing decay and protecting children’s overall well-being.

Key Oral Health Strategies

How Tooth Decay Happens

• Visit the dentist regularly, starting by age one.

The mouth contains bacteria— some helpful, others harmful. When sugary or acidic food and drinks are consumed frequently, harmful bacteria feed on the sugar and produce acid. This acid attacks the outer layer of the tooth, leading to demineralisation. If not addressed, this process continues and results in cavities (dental caries).

A sticky film called plaque forms on teeth when bacteria accumulate,

Preventing tooth decay starts with three simple but powerful habits: • Limit sugary and acidic foods and drinks, keeping them to mealtimes only.

• Brush teeth at least twice daily using fluoride toothpaste.

When these steps are followed consistently from infancy, the risk of dental disease drops significantly.

Understanding Dental Caries Tooth enamel is made of minerals like calcium and phosphate. In an acidic environment, these minerals leach out (demineralisation), weakening the tooth. However, saliva naturally

neutralises acid and helps replace lost minerals through remineralisation, especially when supported by fluoride.

Fluoride strengthens enamel by speeding up remineralisation and making teeth more resistant to acid attack. Fluoride can be found in toothpaste, mouth rinses, and professionally applied varnishes— each proven to reduce cavities in children.

Oral Health Starts Early By their first birthday, many infants are already at risk of developing dental caries. Early feeding habits play a big role. While breastfeeding up to 12 months offers some protection against decay, prolonged bottle feeding— especially with sugary drinks—can increase risk.

The primary bacteria behind decay, Streptococcus mutans, are usually passed from caregiver to infant.

This makes early education for parents and caregivers essential.

Supporting Children with Special Needs Children with special care needs often face greater oral health challenges, including increased risk of gum disease, cavities, and oral trauma. These children benefit from tailored support and extra vigilance in oral hygiene routines.

Parental Guidance and Home Care Many parents receive little guidance on how to protect their children’s teeth. Yet simple, clear strategies can make a big difference: • Start brushing as soon as the first tooth appears, using a soft-bristled brush and a smear of fluoride toothpaste.

• From ages 3–6, use a pea-sized amount of toothpaste and supervise brushing.

• Brush twice a day, including once before bed, when saliva flow is lower and teeth are more vulnerable to acid.

• Children should be supervised while brushing until at least age 7.

• Transition babies to a free-flow cup by 6 months, and phase out bottles by 12 months.

• Avoid bottles in bed and sugary snacks after teeth are brushed.

Diet and Fluoride: A Crucial Duo Alongside fluoride, diet plays a major role in preventing decay.

Caregivers should limit both the amount and frequency of sugar intake—especially before bed.

Ideally, only breast milk, formula, or water should be offered in bottles.

Supporting exclusive breastfeeding for the first 6 months also reduces cavity risk.

Promising New Tools Emerging solutions, like xylitol wipes, show potential for cleaning babies' gums and new teeth while reducing harmful bacteria. These innovations, while still under evaluation, may become part of early oral care routines in the near future.

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Protects, strengthens and provides a soothing sensation for baby's gums.

Chamomile & Sage Extract Provitamin B5 Pleasant Strawberry Flavour 0% Alcohol No Anaesthetic

Distributed by: Pamex Limited, Moneen Business Park, Castlebar, Co. Mayo. F23 RX24. Ireland Contact: sales@pamex.ie

Date Prepared: August 2025

KIN BABY

48

Oral Care

Labelling Challenges: “No Added Sugar” Despite awareness efforts, many products marketed as “no added sugar” still contain high levels of natural or free sugars, which can damage teeth. Clearer regulation and labelling are needed to help families make informed choices.

Oral Health for Cystic Fibrosis Patients Earlier this year, a new website providing essential information about the oral health of adults and children living with cystic fibrosis (CF) was launched.

The resource, which aims to improve dental care for people with CF, was developed following a Health Research Board funded study which explore the oral health challenges faced by individuals with cystic fibrosis.

The project was conducted at University College Cork in collaboration with Cystic Fibrosis Ireland. It had significant input from CF advocates. Dr Niamh Coffey, Senior Lecturer in RCSI's School of Dentistry, was one of the study leads.

During the project, the researchers conducted several clinical studies, including the largest global study on this topic.

Their research focused on the oral health of people with CF, the attitudes and knowledge of dental professionals, and the experiences of the CF community in accessing dental care.

Key findings from the study reveal that adults with cystic fibrosis experience more dental decay than individuals without CF. They also tend to have more developmental defects in dental enamel, which can affect the appearance of teeth and increase the risk of

dental decay. Additionally, people with CF are more likely to have higher levels of dental plaque and calculus buildup.

The research also identified the potential impact of oral nutritional supplements, with many of these drinks containing high sugar levels. The study recommends that individuals using these supplements alert their dentist, allowing them to recommend additional dental products to prevent damage caused by excessive sugar content.

One particularly important finding concerns patients awaiting organ transplants. The research highlighted the need for individuals to be certified as “dentally fit” by their dentist before being placed on transplant lists, which can present a barrier to accessing timely care if dental diseases such as decay or gum disease are present.

Dr Niamh Coffey, RCSI School of Dentistry, said: “We have developed this online resource to provide practical information about the specific oral health issues experienced by people with CF. Our goal is to empower individuals with cystic fibrosis and their families, as well as dental professionals, with the knowledge they need to better manage and maintain oral health.”

The newly launched website provides comprehensive information including oral health care tips, the relationship between transplants and dental health, the impact of reflux on teeth, inhaled steroids and their effects, and managing candida. The website also includes a special section for parents of children with CF, discussing enamel defects and the role of nutritional supplements in increasing the risk of dental decay.

Oral Health and the Pharmacist – Making Every Contact Count Oral health is vital for talking, eating, smiling and living with confidence. Yet it is also inseparable from general health, with clear links between poor oral health and conditions such as diabetes, cardiovascular disease, cancer and respiratory illness.

Why it matters • Tooth decay is the world’s most common non-communicable disease. Left untreated, it can cause pain, infection and tooth loss, all of which affect speech, eating and quality of life.

• Gum disease not only leads to tooth loss but is closely linked to diabetes control and maternal health during pregnancy.

Written by Orlaith Kennedy, Chief Executive, Dental Health Foundation Ireland Pharmacists, often the most accessible healthcare professionals in the community, are ideally placed to reinforce the importance of good oral care. For many people, the pharmacy is the first stop for dental concerns – whether it’s toothache relief, temporary filling kits or advice on dry mouth. Every one of these interactions is an opportunity to promote oral health.

• are among the most common cancers worldwide. Pharmacists can help by signposting to dentists or GPs when patients present with concerning symptoms lasting more than three weeks.

The pharmacist’s role • Recommending fluoride toothpaste, toothbrushes and interdental aids.

• Advising on sugar-free medicines, especially for children or those on long-term treatment.

• Supporting patients with dry mouth by suggesting saliva

PHARMACYNEWSIRELAND.COM

substitutes or sugar-free chewing gum.

• Encouraging healthy choices – reducing sugary snacks, avoiding smoking and limiting alcohol.

• Promoting regular dental attendance, even for those without their own teeth.

A healthy mouth means more than disease prevention – it supports nutrition, social confidence and healthy ageing. Pharmacists have a unique opportunity to make every contact count by linking oral health advice to wider wellbeing.

Free resources for pharmacists The Dental Health Foundation has supported oral health promotion in Ireland for over 40 years. Our latest publication, Oral Health in Ireland: 3rd Edition, is freely available to download at www.dentalhealth. ie. It contains evidence-based information on all aspects of oral health, and is an invaluable resource for pharmacists who want to empower patients to look after both their oral and general health.

Quick Tips for Pharmacists 1. Promote fluoride Encourage twice-daily brushing with fluoride toothpaste (1000ppm+), and remind patients not to rinse after brushing.

2. Sugar matters Advise on sugar-free medicines, fortified drinks and supplements where possible. Highlight the role of diet in preventing tooth decay and erosion.

3. Manage dry mouth Recommend saliva substitutes or sugar-free chewing gum. Suggest frequent sips of water, especially fluoridated tap water.

4. Spot the signs If a sore, ulcer, lump, or red/white patch in the mouth lasts more than 3 weeks, signpost patients promptly to their dentist or GP. Early detection of oral cancer saves lives.

5. Encourage dental visits Remind patients to attend the dentist at least once a year – even if they have dentures or no natural teeth.

09/2025

50

Advertorial

Redefining Everyday Care Globally, Kenvue is the largest pure-play consumer health company by revenue, touching the lives of more than a billion people across the globe. With a rich heritage and a science-led portfolio of iconic brands, we empower people to take control of their health through effective and accessible everyday care.

In Ireland, under the leadership of Carol Keating, Head of Ireland, Kenvue is a category leader in over-the-counter (OTC) medicines and preventative healthcare.

Our success is built on a deep understanding of consumer needs, strong pharmacy partnerships, and a commitment to science-driven innovation that supports better outcomes across healthcare systems.

Putting Everyday Care in People’s Hands At the heart of Kenvue’s strategy is a belief in the extraordinary power of everyday care. As healthcare systems worldwide face rising demand and limited capacity, we are focused on enabling more people to manage minor health concerns independently. Through trusted brands such as: • CALPOL® - helping parents and caregivers effectively relieve pain and fever symptoms that commonly affect children • NICORETTE® - supporting smoking cessation with proven nicotine replacement therapies • AVEENO® - assisting people in nourishing and preventing dry skin Kenvue equips consumers with the tools to confidently take charge of their health, ensuring that they have the resources and support they need to make informed decisions about their well-being.

Science and Innovation is at the Heart of Everything We Do Built on more than a century of heritage, Kenvue has been

committed to using sciencebacked knowledge to deliver real and impactful solutions to everyday problems for more than 135 years. We invest in continuous research and development (R&D) to develop and improve our existing products and brands and bring new innovations to market.

This science-first approach helps healthcare professionals, including pharmacists, offer more holistic care to their patients in Ireland and around the world.

Pharmacy at the Frontline of Public Health Pharmacists play a pivotal role in Ireland’s primary healthcare landscape, and we see them not just as product distributors, but as partners in education and preventative care.

Through tailored pharmacy engagement and in-store support, Kenvue helps to ensure that pharmacists are equipped with the tools and insights to offer advice and guide consumers toward appropriate self-care solutions.

This is particularly important as the role of pharmacists continues to expand, taking on greater clinical responsibility and helping to relieve pressure on overburdened GP services.

Advocating for Self-Care and Behaviour Change A core challenge across the healthcare sector is underutilisation of self-care, despite its proven potential to improve outcomes and reduce system pressure.

Kenvue is actively working to close that gap by championing public health campaigns, educational

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resources and targeted initiatives that increase awareness and understanding of self-care.

This includes a focus on national health priorities such as smoking cessation. We provide both product solutions and support to help individuals move toward a smoke-free future.

Everyday care in action Kenvue not only cares about the impact its products make on improving consumers’ daily care but also on protecting the environment. Kenvue’s approach to sustainability is designed to effectively manage impacts and risks while also identifying opportunities to accelerate innovation and growth and drive business value for all stakeholders.

The Healthy Lives Mission is our call for everyday care in action and is supported by three pillars: nurture Healthy People, enrich a Healthy Planet and maintain Healthy Practice. Within these three pillars, Kenvue is focused on nine priority areas for which there are established goals and commitments to hold itself accountable.

Through everyday care in action— amplified by approximately 22,000 caring Kenvuers and backed by the resources of a global company— Kenvue’s aim is to build lasting positive change for people, communities and the planet.

Looking Ahead With healthcare expectations evolving rapidly, Kenvue is

positioning itself not just as a product provider, but as a health enabler, partnering with professionals, empowering consumers, and investing in innovation that will shape the future of everyday care in Ireland and beyond.

“Our goal is simple: to make sciencebacked products accessible to more people every day.

Kenvuers in Ireland care fiercely and are passionate about making a difference in consumers’ lives. By working with pharmacy and supporting responsible self-care, we can empower people to take better care of themselves and their loved ones, and help create a more resilient, sustainable healthcare system.” Carol Keating says.

MAH: JNTL Consumer Health I (Ireland) Ltd. Block 5, Hight Street, Tallaght, Dublin 24, Ireland.

Products not subject to medical prescription. Supply through nonpharmacy outlets and pharmacies.

Full prescribing information available upon request.

How to protect your family during Tummy Bug Season Family Use

NEW Berry Flavour Electrolyte for hydration**

Gut-Friendly Bacteria

At certain times of the year, there is an increase in tummy bugs and viruses. While symptoms include nausea, diarrhoea and vomiting, the highly contagious norovirus is one of the most common stomach infections.

Choose MyPro DiaCare MyPro DiaCare’s unique dual chambered sachet allows for two-in-one benefits:

1 There is nothing worse than a vomiting bug or diarrhoea. In some cases, you can have a fever and muscle aches as well.

MyPro DiaCare is a solution, which is suitable for the whole family, from the age of 3 years.

MyPro DiaCare is a unique food supplement for Children and Adults suffering from diarrhoea, fever or other conditions which can cause loss of body fluids.

MyPro DiaCare is a scientifically balanced blend of glucose electrolyte, minerals and and GutFriendly Bacteria (Lactobacillus Rhamnosus GG).

Contains: • Magnesium which contributes to electrolyte balance.

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Contains Electrolytes which tackles the problem of dehydration.

Oral rehydration therapy (ORT) is recommended as first-line therapy for both mildly and moderately dehydration.

MyPro DiaCare contains electrolytes sodium chloride, potassium chloride and magnesium hydroxide.

Restores electrolyte balance during/post diarrhoea.

Effective for dehydration following fluid loss.

2

Contains a Gut-Friendly Bacteria which helps to swiftly restore the gut to normal.

More about our Gut-Friendly Bacteria (Lactobacillus Rhamnosus GG) • Clinical trials show people taking Lactobacillus Rhamnosus GG are protected against bacterial infections.

• Increased adherence of beneficial bacteria results in reduced diarrhoea-causing bacterial numbers in the GI tract. Therefore, Lactobacillus is effective in both the treatment and prevention of diarrhoea.

• Lactobacillus Rhamnosus GG provides immune support in the gastrointestinal tract.

• Repopulates natural gut bacteria.

• Restores normal acidic pH of the stomach.

• The lactic acid facilitates other organic acids and bacteriocins to reduce counts of diarrhoea causing bacteria.

Probiotics act faster than bacteria: effectively colonises the gut within 5-7 days, outnumbers pathogenic species. (National Institutes of Health Office of Dietary Supplements).

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Available in pharmacies nationwide

54

Advertorial

Proceive: Leading the Way in Fertility and Pregnancy Nutrition In the increasingly competitive market for fertility and pregnancy supplements, one brand continues to stand out. Proceive, which first entered the Irish pharmacy landscape with a science-led approach, has firmly established itself as the most advanced range available today.

A pioneer in the category Proceive was the first to introduce clinicallydriven, stage-specific formulations for both fertility and pregnancy. By focusing on precision nutrition rather than generic multivitamins, the brand set a new standard in the category. Its range now spans products tailored for men and women trying to conceive, as well as targeted support for each trimester of pregnancy.

Pharmacists note that this science-backed approach has helped position Proceive as a trusted recommendation for customers seeking evidence-based nutritional support.

Survey highlights strong consumer trust To better understand its impact with end-users, Proceive recently conducted a nationwide customer survey. The results provide compelling evidence of its continued leadership:

PHARMACYNEWSIRELAND.COM

• 92% of respondents reported feeling more confident in their fertility or pregnancy journey when taking Proceive.

• 9 in 10 said they would recommend the brand to a friend or family member.

• 87% said Proceive as more comprehensive and effective than other supplements they had previously tried.

For pharmacies, these findings confirm what many have already observed at store level: Proceive enjoys high levels of repeat purchase and word-of-mouth referral, driving ongoing demand.

Why it matters for pharmacy With more customers actively seeking advanced nutritional support during fertility and pregnancy, pharmacies are under pressure to provide trusted, proven solutions.

Proceive’s strength lies not only in its scientific formulations but also in the loyalty demonstrated by its users.

The brand’s three key differentiators stand out: • Scientific innovation – formulations developed with clinical evidence at their core.

• Comprehensive range – covering the entire journey from conception to birth.

• Proven demand – backed by strong consumer data on trust, satisfaction, and repeat purchase.

Continuing to lead While competitors have entered the category, Proceive continues to set the pace. Its combination of pioneering science, comprehensive product coverage, and robust customer endorsement ensures it remains the benchmark for fertility and pregnancy nutrition.

For pharmacies, the message is clear: Proceive is not only the original leader in this space but also the brand that customers continue to trust and request by name.

It takes nine twelve months to make a baby Before conception, there’s a three month window where both sperm and egg health can be optimised.

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56

HPV

Overcoming HPV Vaccine Hesitancy: Strategies for healthcare professionals Written by Margaret Efua Sackeya, Kathleen Markeya, Annmarie Grealisha, b a

School of Nursing and Midwifery, Health Research Institute, University of Limerick, Limerick, Ireland

b

Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, United Kingdom

Introduction The following outlines key factors contributing to HPV vaccine hesitancy and highlights evidence-based strategies that healthcare professionals can implement to enhance vaccine uptake among adolescents, as identified in recent studies by Sackey et al. (2022; 2025).

In recent years, the human papillomavirus (HPV) vaccine has become a vital tool in preventing cervical cancer and other HPVrelated diseases. Initially welcomed with enthusiasm, uptake fell sharply as misinformation and anxieties spread through social media and communities. More recently, renewed public attention and awareness campaigns have helped boost vaccination rates.

For community pharmacists— often one of the most trusted and accessible sources of healthcare

advice—understanding these trends is crucial. By recognising the challenges healthcare teams face and the strategies that work, pharmacists can play a leading role in rebuilding confidence and improving vaccine uptake.

From Acceptance to Anxiety When the HPV vaccine was first introduced, uptake was high and public confidence was strong.

However, by the mid-2010s, this began to change. Reports of side effects such as chronic fatigue and paralysis—largely unsupported by evidence—circulated widely online.

Parents became anxious, some adolescents refused the vaccine, and uptake dropped significantly.

Social media platforms, from Facebook to WhatsApp groups, amplified these concerns. Stories of infertility, paralysis, or the vaccine being unnecessary for boys were shared as fact,

PHARMACYNEWSIRELAND.COM

despite no scientific backing. In diverse communities, cultural resistance and misconceptions— such as fears that the vaccine encouraged promiscuity—further fuelled hesitancy.

For frontline professionals, these shifts were difficult. What had once been a straightforward conversation about a cancerpreventing vaccine turned into emotionally charged debates. In some cases, parents expressed anger and hostility, leaving health staff feeling as though they were being accused of harming rather than protecting children.

The Tide Turns Again Despite this period of mistrust, the narrative has begun to change. High-profile cervical cancer cases, tragic deaths of well-known individuals, and media coverage highlighting the

dangers of HPV helped turn public opinion back towards acceptance.

Awareness campaigns from health departments, coupled with generational shifts in attitudes, have restored confidence for many families.

Younger parents and adolescents now have easier access to accurate information, and in many communities the vaccine is once again seen as an essential cancer prevention tool rather than a cause for concern.

However, hesitancy remains in some marginalised groups, highlighting the importance of ongoing engagement.

Understanding Persistent Resistance While overall uptake is improving, certain groups remain reluctant.

For families facing social or economic hardship, vaccination may not be a priority. In deprived

Promotional material for Irish HCPs only. Full Prescribing Information and Adverse Events information available at the bottom of the page.

START AN IMPACTFUL CONVERSATION WITH PATIENTS ABOUT HUMAN PAPILLOMAVIRUS (HPV) VACCINATION.

AGE 36 Image for illustration purposes.

Gardasil 9 is indicated for active immunisation of individuals from the age of 9 years against the following HPV diseases: • Premalignant lesions and cancers affecting the cervix, vulva, vagina and anus caused by vaccine HPV types.1 • Genital warts (Condyloma acuminata) caused by specific HPV types.1

HPV infections can occur in most sexually active people Safety statement in their lifetime. Models consistently estimate that at least In Gardasil 9 clinical trials adverse events were mostly 30% of disease-causal infections occurred after age 26.2,3,4,5 mild to moderate. The most common reactions were • GARDASIL 9 is a vaccine for children and adolescents from 9 years of age and adults.1 • GARDASIL 9 has been studied in males 9 to 26 years of age and females 9 to 45 years of age.1 Not all cervical, vulvar, vaginal, and anal cancers are caused by HPV.

injection-site reactions (84.8%) and headache (13.2%).

Only 0.1% discontinued due to adverse events. Safety was consistent across age groups and when co-administered with other vaccines. Post-marketing data confirm the established safety profile.1

As a pharmacist you are a valued source of trust for your patients.6 Talk to your eligible patients about HPV vaccination today. Before prescribing or administering GARDASIL 9, please read the full prescribing information or full Summary of Product Characteristics (SmPC). For most people, HPV clears on its own.

But for those who don’t clear the virus, it can cause certain cancers and diseases.7 the use of potent immunosuppressive therapy, a genetic defect, Human Immunodeficiency Virus (HIV) infection, or other causes, may not respond to Gardasil 9. Long-term follow-up studies are currently ongoing to determine the duration of protection. There are no safety, immunogenicity or efficacy data to support interchangeability of Gardasil 9 with bivalent or quadrivalent HPV vaccines. FERTILITY, PREGNANCY AND LACTATION There are insufficient data to recommend use of Gardasil 9 during pregnancy; therefore vaccination should be postponed until after completion of pregnancy. The vaccine can be given to breastfeeding women. No human data on the effect of Gardasil 9 on fertility are available. SIDE EFFECTS Very common side effects include: erythema, pain and swelling at the injection site and headache. Common side effects include: pruritus and bruising at the injection site, dizziness, nausea, pyrexia and fatigue. The post-marketing safety experience with qHPV vaccine is relevant to Gardasil 9 since the vaccines contain L1 HPV proteins of 4 of the same HPV types. The following adverse experiences have been spontaneously reported during post-approval use of qHPV vaccine: urticaria, bronchospasm, idiopathic thrombocytopenic purpura, acute disseminated encephalomyelitis, Guillain-Barré Syndrome and hypersensitivity reactions, including anaphylactic/anaphylactoid reactions. For a complete list of undesirable effects please refer to the Summary of Product Characteristics. PACKAGE QUANTITIES Single pack containing one 0.5 millilitre dose pre-filled syringe with two separate needles. Legal category: POM Marketing authorisation number: EU/1/15/1007/002 (pre-filled syringe with two separate needles). Marketing Authorisation holder: Merck Sharp & Dohme B.V., Waarderweg 39, 2031 BN Haarlem, The Netherlands. Date of revision: March 2023. © 2023 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. All rights reserved. Further information is available on request from: MSD, Red Oak North, South County Business Park, Leopardstown, Dublin 18 D18 X5K7 or from www.medicines.ie. PSUR PSUSA/00010389/202206 Adverse events should be reported. Reporting forms and information can be found at www.hpra.ie Adverse events should also be reported to MSD (Tel: 01-299 8700) References 1. Gardasil 9 SPC. Accessed August 2025 at: Gardasil 9 suspension for injection in a pre-filled syringe | SPC | medicines.ie 2. Estimating the Age of Disease-causal HPV Infection Based on the Natural History of CIN2+ Among Females in Canada. Cherif A1,, You X1, Hillhouse E2, Stone R2, Murphy B2, Baluni G3, Yadav M3, Gotarkar S3, Reuschenbach M4, Chen YT1, Cook J3, Roberts C1, Franco EL5.

IPVC 2024 3. Estimating the Age of Acquisition of Disease-causing HPV Infection for CIN2+ in England Kayla Engelbrecht1, Xuedan You2, Dionysios Ntais, Olga Ovcinnikova1, Alhaji Cherif2. IPVC 2024 4. Prabhu, V.S., et al., Median Age at HPV Infection Among Women in the United States: A Model-Based Analysis Informed by Real-world Data.

Open Forum Infect Dis, 2021. 8(7): p. ofab111.

5. Burger, E.A., et al., Age of Acquiring Causal Human Papillomavirus (HPV) Infections: Leveraging Simulation Models to Explore the Natural History of HPV- induced Cervical Cancer. Clin Infect Dis, 2017. 65(6): p. 893–899.

6. Ipsos Veracity Index 2024. (2024). Accessed August 2025 at HYPERLINK “https://www.ipsos.com/sites/default/files/ct/news/documents/2024-09/%20Ipsos%20BandA%20%20Veracity%20Index%202024.pdf”https://www.ipsos.com/sites/default/files/ct/news/documents/2024-09/ Ipsos%20BandA%20%20Veracity%20Index%202024.pdf 7. HIQA. NIAC – Chapter 10 Human Papillomavirus. Accessed August 2025 at: https://www.hiqa.ie/sites/default/files/NIAC/Immunisation_Guidelines/Chapter_10_Human_Papillomavirus.pdf

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IE-GSL-00226 Date of preparation: August 2025

GARDASIL® 9 (Human Papillomavirus 9-valent Vaccine (Recombinant, adsorbed)).

ABRIDGED PRODUCT INFORMATION Refer to Summary of Product Characteristics before prescribing. PRESENTATION Gardasil 9 is supplied as a single dose pre-filled syringe containing 0.5 millilitre of suspension. Each dose of vaccine contains highly purified virus-like particles (VLPs) of the major capsid L1 protein of Human Papillomavirus (HPV). These are type 6 (30 μg), type 11 (40 μg), type 16 (60 μg), type 18 (40 μg), type 31 (20 μg), type 33 (20 μg), type 45 (20 μg), type 52 (20 μg) and type 58 (20 μg). INDICATIONS Gardasil 9 is a vaccine for use from the age of 9 years for the prevention of premalignant lesions and cancers affecting the cervix, vulva, vagina and anus caused by vaccine HPV-types and genital warts (condyloma acuminata) caused by specific HPV types. The indication is based on the demonstration of efficacy of Gardasil 9 in males and females 16 to 26 years of age and on the demonstration of immunogenicity of Gardasil 9 in children and adolescents aged 9 to 15 years. The use of Gardasil 9 should be in accordance with official recommendations. DOSAGE AND ADMINISTRATION Individuals 9 to and including 14 years of age at time of first injection: Gardasil 9 can be administered according to a 2-dose schedule. The second dose should be administered between 5 and 13 months after the first dose. If the second vaccine dose is administered earlier than 5 months after the first dose, a third dose should always be administered. Gardasil 9 can be administered according to a 3-dose (0, 2, 6 months) schedule. The second dose should be administered at least one month after the first dose and the third dose should be administered at least 3 months after the second dose. All three doses should be given within a 1-year period. Individuals 15 years of age and older at time of first injection: Gardasil 9 should be administered according to a 3-dose (0, 2, 6 months) schedule. The second dose should be administered at least one month after the first dose and the third dose should be administered at least 3 months after the second dose. All three doses should be given within a 1-year period. It is recommended that individuals who receive a first dose of Gardasil 9 complete the vaccination course with Gardasil 9. The need for a booster dose has not been established. Studies using a mixed regimen (interchangeability) of HPV vaccines were not performed for Gardasil 9. Subjects previously vaccinated with a 3-dose regimen of quadrivalent HPV types 6, 11, 16, and 18 vaccine (Gardasil or Silgard), hereafter referred to as qHPV vaccine, may receive 3 doses of Gardasil 9. The use of Gardasil 9 should be in accordance with official recommendations. Paediatric population (children <9 years of age): The safety and efficacy of Gardasil 9 in children below 9 years of age have not been established. No data are available. The vaccine should be administered by intramuscular injection. The preferred site is the deltoid area of the upper arm or in the higher anterolateral area of the thigh. Gardasil 9 must not be injected intravascularly, subcutaneously or intradermally. The vaccine should not be mixed in the same syringe with any other vaccines and solution. CONTRAINDICATIONS Hypersensitivity to any component of the vaccine including active substances and/or excipients. Individuals with hypersensitivity after previous administration of Gardasil 9 or Gardasil /Silgard should not receive Gardasil 9. PRECAUTIONS AND WARNINGS In order to improve traceability of biological medicinal products, the name and batch number of the administered product should be clearly recorded.

The decision to vaccinate an individual should take into account the risk for previous HPV exposure and potential benefit from vaccination. As with all injectable vaccines, appropriate medical treatment and supervision should always be readily available in case of rare anaphylactic reactions following the administration of the vaccine. The vaccine should be given with caution to individuals with thrombocytopaenia or any coagulation disorder because bleeding may occur following an intramuscular administration in these individuals. Syncope, sometimes associated with falling, can occur before or after vaccination with Gardasil 9 as a psychogenic response to the needle injection. Vaccinees should be observed for approximately 15 minutes after vaccination; procedures should be in place to avoid injury from faints. Vaccination should be postponed in individuals suffering from an acute severe febrile illness. However, the presence of a minor infection, such as a mild upper respiratory tract infection or low-grade fever, is not a contraindication for immunisation. As with any vaccine, vaccination with Gardasil 9 may not result in protection in all vaccine recipients. Gardasil 9 will only protect against diseases that are caused by HPV types targeted by the vaccine. The vaccine is for prophylactic use only and has no effect on active HPV infections or established clinical disease. The vaccine has not been shown to have a therapeutic effect and is not indicated for treatment of cervical, vulvar, vaginal and anal cancer, high-grade cervical, vulvar, vaginal and anal dysplastic lesions or genital warts. It is also not intended to prevent progression of other established HPV-related lesions. Gardasil 9 does not prevent lesions due to a vaccine HPV type in individuals infected with that HPV type at the time of vaccination. Vaccination is not a substitute for routine cervical screening. There are no data on the use of Gardasil 9 in individuals with impaired immune responsiveness. Safety and immunogenicity of a qHPV vaccine have been assessed in individuals aged from 7 to 12 years who are known to be infected with human immunodeficiency virus (HIV). Individuals with impaired immune responsiveness, due to either

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HPV more interactive, face-to-face training. Learning how to hold motivational conversations or engage with adolescents with special needs could improve vaccine confidence.

Pharmacist takeaway: Seek out continuing professional development (CPD) opportunities on vaccine communication. Even informal peer learning—sharing approaches with colleagues—can sharpen skills.

The Role of Social Media One of the strongest forces shaping public opinion on vaccines is social media. Misinformation spreads quickly, with parents often citing viral posts or messages from friends as reasons for refusing vaccination. Stories of supposed side effects, even from unverified sources, can outweigh scientific evidence in the eyes of anxious families.

areas where parents may struggle with unemployment, addiction, or social isolation, preventive healthcare often takes a back seat.

or catch-up days for vaccines can help ensure that a missed appointment doesn’t mean a missed opportunity.

Among some ethnic minority groups, mistrust of authorities also plays a role. Families from countries with histories of government corruption or coercion may be especially suspicious of vaccines promoted by official bodies. Others view HPV vaccination as unnecessary or culturally inappropriate.

2. Clear, Simple Education

Then there are those firmly opposed to vaccination altogether—the so-called “antivaxxers.” For these individuals, no amount of information is likely to change minds. Instead, healthcare teams often focus their energy on families who are hesitant but still open to discussion.

Strategies That Work Despite these challenges, healthcare professionals have developed effective approaches to improve uptake. Community pharmacists can adapt many of these strategies in their own practice.

1. Creating Second Chances Missed vaccination opportunities are common, especially in schools.

“Mop-up clinics”—drop-in sessions at community centres— give families a second chance.

By making access flexible, with no appointment needed, more adolescents complete the vaccine schedule.

Pharmacist takeaway: Offering flexible clinic times, walk-in slots,

Pharmacist takeaway: While pharmacists may not run school programmes, building relationships with local schools—perhaps through talks or parent information evenings—can extend your influence in the community.

Yet social media can also be part of the solution. Campaigns led by trusted voices, including survivors of cervical cancer, have shown positive effects. Influencers, celebrities, and even peers who speak openly about vaccination can help normalise it.

Healthcare professionals face organisational and structural challenges that also affect vaccination rates.

Pharmacist takeaway: Encourage patients to seek information from official health websites. Where possible, signpost social media accounts run by credible health organisations rather than leaving patients to navigate the “dark web” of misinformation.

Staff Shortages and Time Pressure

Looking Ahead: Future Improvements

Pharmacist takeaway: Break down complex information into simple, relatable messages.

Emphasise the vaccine’s role in preventing cancer, not just infection.

Vaccination teams are often overstretched, juggling multiple programmes. With thousands of children to vaccinate, there is little time for one-to-one conversations with hesitant parents.

To continue improving uptake, professionals suggest several strategies that pharmacists can also champion.

3. Personal Stories and Influence

For pharmacists, time is also limited. But even brief interventions—answering a quick question while dispensing medication or offering reassurance during a consultation—can make an impact.

Incorporating HPV education into sex education lessons can help adolescents understand the vaccine’s purpose early. When young people themselves value the vaccine, they are more likely to influence their parents’ decisions.

Administrative Hurdles

2. Cross-Sector Collaboration

Many vaccination programmes still rely on paper-based systems.

Errors, delays, and mismatched records make tracking uptake difficult. Data protection rules (such as GDPR) further complicate matters, limiting access to school class lists and preventing proactive follow-up with families.

Closer working between health and education departments is essential. Schools need to understand their role as partners, not just facilitators. Similarly, GPs and pharmacists can use every patient interaction as an opportunity to raise awareness.

Parents and adolescents often hesitate because they don’t fully understand HPV or the vaccine’s benefits. Providing straightforward explanations—avoiding medical jargon—can make a huge difference. Leaflets, FAQs, and directing families to reliable websites can help them make informed decisions.

Healthcare professionals who share personal experiences—such as treating patients with HPVrelated conditions—help make the vaccine’s benefits real. Hearing conviction from a trusted source builds confidence.

Pharmacist takeaway: Don’t underestimate your influence. A personal, sincere recommendation can be more persuasive than statistics alone.

4. Partnership with Schools Schools remain the most effective setting for mass HPV vaccination. Close working relationships with teachers and administrators are essential to coordinate consent forms, provide accurate information, and ensure vaccination days run smoothly.

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Barriers Beyond the Clinic

1. Education in Schools

Limited Training and Support

3. Creative Awareness Campaigns

Professionals often feel underprepared for the role of vaccine promoters. Online modules exist, but many want

A modern approach means meeting people where they are— on social media, in community groups, and at public events.

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HPV

Genuine influencers, including young people who have had the vaccine, may be more persuasive than official statements.

4. Better Support for Professionals Ongoing training, adequate staffing, and improved digital systems would enable healthcare workers to focus on education and reassurance rather than administration.

Conferences and shared learning opportunities could help professionals share what works and tackle challenges collectively.

Lessons for Community Pharmacists As accessible healthcare providers, pharmacists are ideally placed to support HPV vaccination programmes. Practical steps include: • Be approachable: Encourage parents and adolescents to ask about the vaccine. A short conversation can counter a damaging myth.

• Keep it simple: Focus on key benefits—“this vaccine prevents cancers caused by HPV”— rather than overwhelming families with detail.

• Use every opportunity: Whether during prescription pick-up, a flu vaccination, or a casual enquiry, seize moments to promote vaccine confidence.

• Know your resources: Have leaflets ready and be able to direct families to trusted online sources.

• Work locally: Build links with schools, youth groups, and community centres to extend your influence beyond the pharmacy walls.

• Stay informed: Keep up with training and updates so your advice is confident and current.

Conclusion The story of the HPV vaccine is a reminder of how fragile public confidence in health

interventions can be—and how quickly misinformation can undo years of progress. But it also shows the power of clear communication, trusted voices, and persistent engagement.

For community pharmacists, the message is clear: you are a crucial part of the solution. By providing reassurance, debunking myths, and using your everyday interactions as opportunities for education, you can help ensure more adolescents are protected against HPV and its devastating consequences.

The future of HPV vaccination success will not rest on one campaign or one profession alone—it will depend on collective effort. But with their unique position at the heart of communities, pharmacists are perfectly placed to keep the momentum moving in the right direction.

An overview of ‘Strategies used by healthcare professionals to increase the human papillomavirus vaccine uptake

among adolescents in Ireland: A qualitative study’ Received 4 October 2024, Revised 29 March 2025, Accepted 31 March 2025, Available online 1 April 2025, Version of Record 13 April 2025.

Sackey, M., Markey, K. and Grealish, A., 2025. Strategies used by healthcare professionals to increase the human papillomavirus vaccine uptake among adolescents in Ireland: A qualitative study. University of Limerick Research Repository.

Strategies used by healthcare professionals to increase the human papillomavirus vaccine uptake among adolescents in Ireland: A qualitative study ScienceDirect Healthcare professional's promotional strategies in improving Human papillomavirus (HPV) vaccination uptake in adolescents: A systematic review - PubMed i.e

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¤20 billion Healthcare Cost of Smoking A study by researchers at RCSI University of Medicine and Health Sciences calculates that current smokers in Ireland will lose almost 5 million years of life and 2.5 million years of productivity, leading to healthcare costs of around €20.2 billion.

Conducted at the RCSI School of Population Health, the research is the first of its kind in Ireland and offers a comprehensive analysis of the long-term health and societal impacts of tobacco smoking in Ireland, measured across multiple health outcomes such as life years, years with disease, productivityadjusted life years and associated healthcare costs.

The study also estimates that current smokers will spend a combined 5.9 million years living with smoking-related chronic diseases such as COPD, lung cancer, stroke, and heart disease.

Dr Paul Kavanagh, Honorary Clinical Senior Lecturer, RCSI and Public Health Advisor to the HSE Tobacco Free Ireland Programme

Postdoctoral researcher at Converge: Centre for Chronic Disease and Population Health Research and lead author of the study Dr Gintare Valentelyte said: “This is the first study to provide evidence on the long-term

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outcomes and healthcare costs for the full smoking population in Ireland. At a time when reductions in smoking prevalence have stalled and commitment to achieving the goal of Tobacco Free Ireland is at risk, this study highlights the substantial impact of tobacco smoking on health and productivity among the Irish population.”

In 2023, smoking prevalence in Ireland stalled at 18%, with other EU countries varying from 8% in Sweden to 37% in Bulgaria.

The data used for this analysis was based on Irish populationlevel statistics for 2022, following smokers aged 15 to 85. At an individual level, the greatest burden was estimated for daily smoking males aged 20 years who were expected to lose eight years of life, lose more than eight years of productivity and incur an additional ¤28,000 in healthcare

costs over their lifetime compared to a non-smoker.

Dr Paul Kavanagh, Honorary Clinical Senior Lecturer, RCSI and Public Health Advisor to the HSE Tobacco Free Ireland Programme noted the impact of the findings: “Despite progress, smoking remains the greatest challenge facing population health in Ireland.

This research shows its impact goes beyond health, with 2.5 million years of lost productivity meaning fewer people in work, reduced earnings and a smaller contribution to the economy. With reductions in smoking stalling, there is a need to strengthen proven measures like increasing tobacco taxation, accessible stop smoking support and a new Tobacco Free Ireland plan to end the health, economic and wider social harms of smoking.”

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Do not chew or swallow whole. In heavy smokers, those who have relapsed after NRT, or when one NRT is not enough to control cravings, NiQuitin Minis may be used in combination with NiQuitin patches (refer to the package leaflet for dosing guidance). Abrupt cessation: Use a lozenge whenever there is an urge to smoke, maximum of 15 lozenges a day. Continue for up to 6 weeks, then gradually reduce lozenge use. Gradual cessation Use lozenges whenever there is an urge to smoke in order to reduce the number of cigarettes smoked for up to 6 weeks, followed by abrupt cessation. Adolescents (12-17 years): only with advice from a healthcare professional.

Should not quit with a combination NRT regimen. Contraindications: hypersensitivity to nicotine or any of the excipients, children under the age of 12 years and non-smokers. Precaution: Supervised use in dependent smokers with a recent myocardial infarction, unstable or worsening angina pectoris including Prinzmetal’s angina, severe cardiac arrhythmias, uncontrolled hypertensions or recent cerebrovascular accident. Use with caution in those with; stable cardiovascular diseases, diabetes mellitus, susceptibility to angioedema & urticaria, renal/hepatic impairment, phaeochromocytoma & uncontrolled hyperthyroidism, GI disease & seizures.

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62

Diabetic Technology

Advancements in Diabetes Technology: Optimising Care with CGMs and Insulin Pumps A guide for hospital clinicians on the use of modern diabetes technology within the Irish healthcare system Written by Professor Derek O’Keeffe, Consultant Physician/ Professor of Medical Device Technology, University Hospital Galway, Ireland/Digital Health Principal Investigator, LERO, University of Limerick, Ireland, National Clinical Lead Diabetes, HSE and Dr Lyle McVicker, University Hospital Galway. of 1:10 means one unit of insulin covers 10 grams of carbohydrate.

Correction Factor/Insulin Sensitivity Factor (ISF): The amount (in mmol/L) that one unit of insulin will lower blood glucose.

For example, an ISF of 3.0 means one unit reduces glucose by 3.0 mmol/L. TIR (Time in Range): The percentage of time glucose levels remain within the target range (typically 3.9-10.0 mmol/L). The goal is >70% for most adults.

TAR (Time Above Range): The percentage of time glucose levels are above target range (>10.0 mmol/L).

Professor Derek O'Keeffe

Dr Lyle McVicker

Diabetes technology has undergone a revolutionary transformation in recent years, fundamentally changing how we monitor and manage both Type 1 and Type 2 diabetes. With increasing proportions of people living with diabetes now using these technologies, clinicians of all disciplines are more likely to encounter them in their daily work. Having a familiarity with the commonly used diabetes technologies and how they work is critical to ensuring safe patient care in an increasingly complex hospital system. This article provides practical guidance on continuous glucose monitors (CGMs) and insulin pump therapy, with specific reference to access pathways and implementation within the Irish healthcare system.

of the sensor with a reader or smartphone to obtain glucose readings and trends.

Glossary of Diabetes Technology Terms rtCGM (Real-time Continuous Glucose Monitoring): A system that automatically displays glucose readings every few minutes and provides alarms for high or low glucose levels. Users can view their glucose levels at any time without scanning. isCGM (Intermittently Scanned Continuous Glucose Monitoring): Also known as "flash" monitoring, this requires manual scanning

HCL (Hybrid Closed-Loop): An automated insulin delivery system that links an insulin pump to a CGM with software algorithms that automatically adjust insulin delivery. Sometimes called an "artificial pancreas," though it still requires user input for meals.

Open Loop Therapy: A traditional insulin pump that delivers programmed insulin doses but doesn't automatically adjust based on glucose readings.

All adjustments must be made manually by the user.

Artificial Pancreas: A fully automated insulin delivery system that would require no user intervention. Current systems are "hybrid" as they still require meal announcements and other user inputs.

TBR (Time Below Range): The percentage of time glucose levels are below target range (<3.9 mmol/L). The goal is <4% overall and <1% below 3.0 mmol/L. Understanding Continuous Glucose Monitoring Continuous glucose monitors represent a paradigm shift from traditional fingerstick glucose monitoring. These devices measure glucose levels in interstitial fluid every few minutes, providing real-time data that enables more precise diabetes management. The technology comprises a small sensor attached to the arm or abdomen, paired with either a dedicated reader or smartphone application.

The clinical evidence supporting CGM use is compelling across multiple domains:

Basal Rates: The continuous background insulin delivery programmed into an insulin pump, typically varying throughout the day to match the body's natural insulin requirements.

Glycaemic Control Improvements: The DIAMOND randomised controlled trial demonstrated a 0.6% reduction in HbA1c among adults with Type 1 diabetes using CGM compared to usual care, with participants spending significantly more time in target glucose range and experiencing fewer episodes of hyperglycaemia and hypoglycaemia.

Insulin-to-Carbohydrate Ratio (ICR): The amount of carbohydrate (in grams) that one unit of insulin will cover. For example, a ratio

Hypoglycaemia Reduction: Perhaps more striking is the HypoDE study, which showed CGM use resulted in a 72%

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reduction in hypoglycaemic events among people with Type 1 diabetes and impaired awareness of hypoglycaemia. This technology proved particularly beneficial for nocturnal hypoglycaemia, with over 50% reduction in night-time episodes—a finding with profound implications for patient safety and quality of life.

Early Intervention Benefits: Recently published research demonstrated that initiating CGM within the first year of Type 1 diabetes diagnosis in children and adolescents leads to improved glycaemic control in multi-year follow-up studies compared to those who begin CGM use at later stages, suggesting that early adoption of this technology provides lasting benefits.

Current Guidelines and Recommendations The evidence has influenced international guidelines significantly. The 2025 American Diabetes Association (ADA) Standards of Care guidelines now recommend CGM for all people living with Type 1 diabetes, regardless of their current level of glycaemic control. This represents a major shift from previous recommendations that limited CGM to those with problematic hypoglycaemia or suboptimal control.

The 2024 Irish National Clinical Guideline for management of Type 1 Diabetes aligns with this approach, recommending that adults should be offered a choice between real-time CGM or intermittently scanned CGM based on individual preferences, needs, and device functionality.

The emphasis on shared decisionmaking reflects the recognition that patient engagement and preference significantly influence successful technology adoption.

HSE Coverage and Access Pathways Access to CGMs has improved significantly through The HSE Medicines Management Programme (MMP). The programme currently recommends

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64

Diabetic Technology

Image 1: Dexcom One+ from DexCom, Inc.

Image 3: Medtronic MiniMed 780G from Medtronic

Image 3: Medtronic MiniMed 780G from Medtronic Diabetes Insulin Pump Therapy and Hybrid Closed-Loop Systems Insulin pump represents Pumpfrom TherapyYpsomed Evidence Image 4: therapy mylife YpsomedInsulin Pump another significant advance,

Image 1: Dexcom One+ from DexCom, Inc. two preferred CGM systems for people with diabetes who are not insulin pump users: the FreeStyle Libre 2 and Dexcom One+. They make this distinction because not every CGM allows insulin pump integration.

feature particularly valuable for parents of children with diabetes.

The FreeStyle Libre 2 uses a 14day sensor suitable for ages four and above, worn on the back of the arm. The Dexcom One+ features a 10-day sensor approved from age two, with placement options varying by age group.

particularly when integrated with CGM technology. Modern insulin pumps are small electronic devices worn 24 hours daily, delivering insulin continuously through a tiny subcutaneous tube. The insulin used within the pump is generally rapid acting such as Novorapid or Humalog with a continuous background infusion acting as a basal rate with accompanying boluses delivered via the pump to cover meals or to correct for rising blood glucose levels. Most contemporary pumps integrate with CGM systems, automatically adjusting insulin delivery based on glucose readings via sophisticated algorithms—a technology known as hybrid closed-loop (HCL) systems.

Efficacy Data: A 2008 metaanalysis reported that severe hypoglycaemia was reduced by a ratio of 2.89 in randomised controlled trials and 4.34 for before/after studies when using continuous subcutaneous insulin infusion (CSII). The reduction was greatest in those with initial high rates of hypoglycaemia. The mean HbA1c reduction was 0.21% (2.3 mmol/mol) in RCTs and 0.72% (7.9 mmol/mol) in before/after studies.

Quality of Life: CSII can reduce glycaemic variability and For patients with Type 1 diabetes, improve aspects of quality of life, these CGM systems are available particularly in relation to diet and free of charge where clinically Both systems offer high and low physical activity flexibility. indicated. The diabetes team glucose alerts and integrate with makes the application on the smartphone applications that HCL Benefits: Evidence suggests patient's behalf, with ongoing enable family members or carers to average HbA1c improvements of Image 3: Medtronic MiniMed 780G from Medtronic Diabetes The benefits of pump therapy supplies provided through monitor glucose levels remotely—a approximately 0.5% (5.5 mmol/ Image 2: Freestyle Libre 2 from Abbott Laboratories are substantial. Patients gain community pharmacy under the mol) can be achieved with the greater flexibility with meal Long-Term Illness scheme. addition of CGM to CSII when timing and insulin dosing, often Image 2: Freestyle Libre 2 from the CGM component is in use at achieving more stable blood Abbott Laboratories least 60-70% of the time. HCL glucose levels. The integration systems that stop insulin delivery with CGM technology reduces the when hypoglycaemia occurs or burden of diabetes management is predicted have been shown to while improving outcomes, with significantly reduce the frequency Time in Range (TIR) serving as and severity of hypoglycaemia. the primary metric for success.

Research demonstrates that Available Systems in Ireland each 10% increase in TIR Within the HSE system, several correlates with a 40% reduced insulin pump options are available, risk of microalbuminuria and 64% risk of retinopathy.

Image 4:reduced mylife Ypsomed Pump from Ypsomed including the Tandem t:slim X2, Image 4: mylife Ypsomed Pump from Ypsomed

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Image 5: Tandem t:slim X2 from Tandem Diabetes

65 Image 5: Tandem t:slim X2 from Tandem Diabetes

fibrosis-related diabetes, and hospital settings (including ICU and surgical environments) show promise. CGM devices continue to get smaller and last longer without need for replacement – improving acceptability to patients.

Non-invasive glucose monitoring techniques using optical methods remain under development, potentially eliminating the need for subcutaneous sensors entirely.

Connected insulin smartpens such as the NovoPen represent an intermediate technology gaining traction and can be effective for patients not using a pump. These devices capture insulin delivery Medtronic MiniMed 780G, and Illness scheme. The main barrier While Ireland does not have specific guidelines surrounding the use of insulin pump therapy, data including timing and dosing, Ypsomed YpsoPump. Each system of access to pump therapy is the integrating with CGM platforms to the Diabetes Technology Network Ireland (DTN-IRL) recommends that teams use the Best integrates with specific CGM limited availability of skilled clinical Practice Guide for Insulin Pumps, which is based on the NICE Technology appraisal provide comprehensive diabetes devices: the Medtronic system staff to provide the necessary insights. In simple guidance (2022). This states that pumps therapy should be offered to those with T1DMmanagement who uses Guardian 4 or Simplera training for onboarding new terms, while before you could see struggle with debilitating hypoglycaemia or those who fail to reach glucose targets despite sensors, while the Tandem and pump users and support their only a 24-hour glucose tracing and optimal multiple daily injectable therapies. In reality, many practitioners are more aggressive Ypsomed pumps work with continued care. Waiting lists for rely on the patient’s recollection about getting their patients onto pump therapy such are the possible benefits.

Dexcom sensors (G6 currently, pump therapy can be long in some to inform when insulin was taken, with G7 integration expanding). institutions and not every service a smartpen allows you to see Each pump has specific advantages and disadvantages and the choice of pump should be operates a dedicated pump guided individual characteristics and preferences. For instance, the Ypsomedexactly when insulin was given, Whileby Ireland doespatient not have service as of yet. However, there at what dose and how glucose system offers unique advantages for certain populations.

It's the only pump currently specific guidelines surrounding is a widespread appreciation that levels approved for use during pregnancy, with target thatand can clinical be set sufficiently meet reacted in response to this. the use of insulin pump therapy, theranges demand need for low toWhile not currently reimbursed pregnancy requirements.

The Network pump is controlled via smartphone, allowing screen the Diabetes Technology diabetes technology services will through the HSE, they show magnification for visually impaired users, though this population faces particular challenges Ireland (DTN-IRL) recommends increase massively in future years promise for improving medication with thatPractice the field continues to address. efforts are being thatdiabetes teams technology use the Best and significant adherence and achieving modest Guide for Insulin Pumps, which made to train diabetes staff around improvements in TIR. is based on thepump NICEisTechnology Fortunately, each funded through the HSE at no cost to the patient and consumables the country to provide pump appraisal guidance (2022). required to utilise the pump areThis available under the Long-Term Illness scheme.

The main Essential Hospital Management services. Examples of these efforts statesofthat pumps therapy should barrier access to pump therapy is the limited availability of national skilled clinical staff to provide of Diabetes Technology include running diabetes benecessary offered to thosefor with T1DM new pump the training onboarding users and supportdays their around continued care. technology training Immediate Safety Assessment who struggle Waiting lists for with pumpdebilitating therapy can be long inthe some institutions andestablishment not every service operates country and the or those a hypoglycaemia dedicated pump service as who of yet.fail However, is a widespread appreciation that the ofthere a DTN-IRL. For Insulin Pump Users: to reach demand andglucose clinical targets need fordespite diabetes technology services will increase massively in future optimal multiple daily injectable Future Directions and Emerging • Ensure backup rapid-acting therapies. In reality, many Technologies insulin pens are available— pump failure can cause diabetic practitioners are more aggressive The field continues to evolve ketoacidosis within hours about getting their patients rapidly with pumps becoming onto pump therapy such are the • Check if pump is functioning (no more sophisticated and easier possible benefits. alarms, infusion set connected) to use by patients with each Each pump has specific iteration. Patch pumps such as the • Verify patient can operate their advantages and disadvantages Omnipod, which eliminate tubing device safely – caution in acute and the choice of pump should and offer more discrete insulin confusional states be guided by individual patient delivery, are available in many characteristics and preferences. countries though not yet on offer For CGM Users: For instance, the Ypsomed to the Irish market. The advent of • Remember CGM readings system offers unique advantages HCL systems has led to significant lag blood glucose by several for certain populations. It's the improvements in patients’ abilities minutes only pump currently approved to achieve TIRs >70% however for use during pregnancy, with many still struggle to achieve good • Use fingerstick glucose for target ranges that can be set control and oftentimes this can be rapid changes, hypoglycaemia sufficiently low to meet pregnancy related to issues surrounding meal treatment, or when CGM requirements. The pump is time boluses, when the user has readings don't match clinical controlled via smartphone, to interact with their pump more picture allowing screen magnification directly. The concept of an artificial • Communicate plan for how for visually impaired users, pancreas—fully automated insulin blood glucose will be monitored though this population faces delivery systems which require less and recorded with patient and particular challenges with diabetes user input—moves closer to reality nursing staff technology that the field continues with each technological iteration to address. and represents a major frontier in Managing Pump Problems diabetes technology.

Fortunately, each pump is funded Unexplained hyperglycaemia (>13 through the HSE at no cost to For CGM technology, expansion mmol/L): the patient and consumables beyond Type 1 diabetes appears required to utilise the pump are inevitable. Applications in Type 1. Patient takes correction bolus available under the Long-Term 2 diabetes on insulin, cystic via pump

2. If no improvement in 2 hours: give correction with insulin pen and check ketones 3. Consider pump/infusion set failure—ask patient to perform infusion set change if possible 4. Transition to alternate form of insulin delivery following infusion set change if no improvement and seek specialist advice Never stop or suspend pump therapy without ensuring backup insulin is provided Key Safety Points • Pump users have no long-acting insulin depot—interruptions in insulin delivery are dangerous • Most pump complications relate to infusion set problems (kinking, blockage) • Patients should perform infusion set changes every 2-3 days, ideally early in the day • Both pump and CGM users should have traditional backup supplies available Discharge Planning • Ensure diabetes technology is functioning before discharge • Verify backup insulin supplies are available – these should be prescribed on discharge prescription • Arrange appropriate diabetes team follow-up for any technology issues • If technology has failed, ensure interim management plan until specialist review When in Doubt Default to traditional glucose monitoring and insulin delivery methods while seeking diabetes specialist input—patient safety takes priority over technology convenience.

Understanding these principles enables clinicians to safely manage patients using diabetes technology while maximising the benefits these innovations provide Additional Reading and Resources: • HSE National Clinical Guideline No. 17 Adult Type 1 Diabetes Mellitus v2 • Diabetes Technology Network UK (DTN-UK): https://abcd. care/current/abcd-diabetestechnology-network • YpsoPump Explorer app and t:simulator app available to download from Google Play/Apple store for device familiarisation • HSE Medicines Management Programme guidelines for CGM reimbursement applications

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News

Exceptional Progress and Transformative Health Initiatives Croí Heart and Stroke Charity, has published its 2024 Annual Report, marking a year of exceptional impact, transformation, and community reach in the fight against heart disease and stroke.

Pictured at the launch of the 2024 Croí Heart & Stroke Charity Annual Report is Dr. Lisa Hynes, Head of Health Programmes and Health Psychologist; Mark O’Donnell, Chief Executive; Beatrice Gomez Maestre, Community Stroke Support Specialist; Mark Gantly, Chairman of the Board and Christine Flanagan, Director of Fundraising, Croí Heart & Stroke Charity

In 2024, Croí launched its first multiannual strategy (2024–2027) and delivered major new initiatives, underpinned by a transformative legacy gift from the Joe & Helen O’Toole Charitable Trust (Tuam).

This investment funded the construction of a state-of-the-art Community Stroke Hub in Galway and the creation of a Mobile Health Fleet, dramatically increasing access to life-saving prevention, screening, and recovery services—particularly in rural and underserved communities.

• Supported 1,426 engagements through the Croí Connects nurse helpline and online chat service.

• Delivered a 30% increase in 1:1 stroke recovery sessions and introduced a number of innovative new stroke recovery support programmes.

Over the year, Croí:

• Increased the number and range of exercise classes, providing 562 hours of class activity across the year, with a weekly attendance of close to 300 people.

• Provided 4,724 free health checks at over 105 events, including 1,442 checks via the new Mobile Health Units.

• Enabled 110 family stays, free of charge, at the Croí Courtyard Apartments for loved ones of cardiac and stroke patients.

• Engaged thousands of people through awareness campaigns, educational programmes, and community partnerships, in person, and online with over 304,000 page views on the Croí website.

commend Mark O’Donnell, CEO, and the entire Croi team for an outstanding performance in 2024, detailed in this report. Their work on behalf of the community was supported by that community – through philanthropy, fundraising and volunteering. It is that support which sustains us financially and confirms to us that we are making a real difference. Our particular thanks to the Joe & Helen O’Toole Charitable Trust (Tuam). 2024 was the year when their generous award had its first impact – an impact that has been game changing for the organisation and, into the future, will enable our ambition to transform lives across our region.”

Croí also strengthened its patient advocacy work, launching the Manifesto for Change to call for a national cardiovascular health strategy, as well as developing the Heart & Stroke Voice Ireland network to amplify and foreground the patient voice. The charity also participated in two major EU-level projects—JACARDI and Heartsafe North West Europe—aimed at prevention, rehabilitation, and improving survival rates from sudden cardiac arrest.

Chief Executive Mark O’Donnell praised the dedication of Croí’s staff, volunteers, and supporters, saying, “2024 was a landmark year in our mission to prevent heart disease and stroke, save lives, and support recovery, and represented a step-change in the scale and range of the critical services we provide in communities across the country, with a particular focus on the west. We are profoundly grateful to all of Croí’s supporters and partners for helping us to further develop our activities and increase our impact.”

Chairman of Croí, Mark Gantly spoke at the launch “On behalf of the board of Croí, I want to

The full 2024 Annual Report is available at www.croi.ie/about/ annual-reports/

Improving Healthcare Efficiency Projects on improving access to vaccinations against shingles, preparing older patients for kidney transplants and the avoidance of inappropriate cell testing in laboratory settings have been announced as the winners of the inaugural High Potential Innovation Awards by the Graduate School of Healthcare Management at RCSI University of Medicine and Health Sciences, in partnership with the HSE Spark Innovation Programme.

The awards are a new initiative that supports and advances transformative solutions for healthcare delivery and patient care. The winning projects were chosen from ideas developed by participants of RCSI’s MSc in Leadership and Innovation in Healthcare. Each of the winners will receive funding and support to progress their idea with their associated organisation.

The winning projects are: • Sarah Gleeson – Breaking Barriers: A Nurse-Led Vaccination Model Eliminating Financial Obstacles to Essential

Shingles Protection for Ireland's Most Vulnerable IBD Patients • Dr John Holland – OK POP: Older Kidney Patient Optimisation Pre-transplant • Isabelle Delachapelle – Could the Introduction of a Demand Management System Reduce Inappropriate Testing in our Inmmunophenotyping Service?

“The participants in RCSI’s online MSc in Leadership and Innovation in Healthcare are practising clinicians, doctors, nurses, interdisciplinary health and social care professionals, healthcare managers and administrators,”

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said Dr Gloria Kirwan, Programme Director and Senior Lecturer, RCSI School of Graduate Healthcare Management.

“The High Potential Innovation Awards provide an ideal environment for developing and testing new ideas and initiatives from a broad range of perspectives. Sarah Gleeson’s project has the potential to broaden the delivery of vaccination for patients with irritable bowel disease, and Dr John Holland has developed an assessment pathway for treating older adults with kidney failure awaiting transplant. Both are worthy recipients of RCSI

bursaries, and alongside HSE Spark Innovation Programme bursary recipient Isabelle Delachapelle’s work on laboratory efficiency, they demonstrate programme participants’ widespread appetite and capability for improving healthcare systems and patient outcomes.”

Each of the winners will receive bursaries of ¤3,000, two of which are funded by RCSI and open to all students of the University’s MSc in Leadership and Innovation in Healthcare. The third bursary is funded by HSE Spark for employees of the HSE or a Section 38 organisation in Ireland.

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Finance

Saving and Investing Are Not the Same Thing Many people have never stopped to consider the difference between saving and investing. In fact, some may even disagree with the premise that there is a difference. But if you're serious about achieving your long-term financial goals, understanding this distinction isn’t just helpful — it’s essential.

Written by Kieran Moore Q.F.A, SIA, Director, Moore Wealth Management

Before I explain how you arrive at a plan, we need to discuss risk.

Much like the enemy of our future dreams, inflation, risk must be understood and managed.

There’s No Such Thing as “No Risk” Once you understand the time value of money, it becomes clear.

Even so-called “safe” or “low-risk” savings vehicles like bank deposits carry the high risk of losing real value due to inflation over the long term. On the other hand, investments often labelled as “high risk” such as equities have historically done a far better job of protecting purchasing power over the long haul.

Why Do We Save Money?

A reasonable answer might be: to fund our future goals. Whether it's retirement, a child’s education or financial independence, we put money aside today so that it's available when we need it in the future. But here's the problem, when you factor in the time value of money, our future goal will cost more as the future value of today’s money will be less.

Time Value of Money: Why Future Euros Are Worth Less The time value of money is a fundamental financial principle.

It tells us that a euro today is worth more than a euro tomorrow, primarily because money has earning potential over time. And then there’s inflation, the silent dream killer. Inflation steadily erodes the purchasing power of money. What costs ¤1 today might cost ¤1.50, ¤2, or more by the time you need to spend it.

Your Goals Are Getting More Expensive The truth is that your future goals will likely cost far more than they would today. Unless you have a reliable strategy to keep pace with or ideally outpace inflation, those goals will become harder to reach with each passing year.

This is why as Financial Planners, we advocate for investing, not just saving.

Saving long-term in low interest deposits comes with two clear risks

• You are losing value in real terms each year as described above with the time value of money • You are not considering the “opportunity cost”; any financial decision must be viewed in this context, so what is Opportunity Cost?

Opportunity Cost This refers to the value of the next best alternative foregone when making a choice. Financial decisions don’t happen in a vacuum; there are usually a range of alternatives that can offer a range of other potential outcomes.

It is not an abstract notion, it is a real thing that should be a consideration when planning how you save or invest for the future.

It would be rare to see someone elect to put money in an account for 12 months paying 2.50% if the same bank had another deposit offering paying 3.00% for the same 12 months. It would be very clear to you in this situation that you would have an opportunity cost of 0.50% if you took the first option.

This does not happen in such a basic way of course it’s more complex than that. We are rarely comparing apples with apples in these situations.

So how then with all these factors at play do we make the right decisions for ourselves? The simple answer is you should not.

Expert advice can help and if done properly, it starts with clearly establishing your financial goals and ends with a plan.

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Yes, market volatility is real. It’s a measure of investment risk. But when viewed through a long-term lens, there’s strong historical evidence showing that time in the market can mitigate that risk as can investing regularly or deploying lump sums on a staggered basis.

Unfortunately, short-term volatility often causes savers to freeze when instead, they should be looking ahead.

Investing With a Realistic Perspective When evaluating investment options, it’s crucial to look beyond the nominal return (the headline percentage). What really matters is the real return — the return after adjusting for inflation.

If an investment yields 5% annually, but inflation is 3%, the real return is only 2%. That 2% is your true growth in purchasing power. This inflation-adjusted view helps investors make more informed, grounded decisions and ensures their wealth grows, not just in numbers, but in real value.

Pensions are the Ultimate taxefficient investment vehicle Pensions are a highly efficient tax-free investment options for many compelling reasons.

First, they offer tax relief on contributions, meaning that your company can transfer funds to your pension free of income tax and claim that transfer against corporation tax. In addition

individuals can deduct 40% of their contributions from their taxable income, significantly reducing their tax burden. All investment growth within the pension is taxfree, which allows for compound growth over time, maximizing the investment potential.

Finally, upon retirement, a portion of the pension can often be withdrawn tax-free, providing individuals with a tax-efficient income stream during retirement.

Overall, pensions combine tax advantages, security, and longterm growth potential, making them an attractive choice for retirement planning So, with all that in mind let’s get back to that financial plan.

A plan that’s financial but deeply personal • Step one – Get specific about your future financial goals, quantifying them and their real future cost will give you clarity and perspective • Step two – Analyse where you are right now on your journey to meeting those financial goals, this provides more perspective and deeper clarity on what needs to be done • Step three – Develop a comprehensive investment strategy that targets funding those future goals, be aware of the time value of money, of real returns and of the opportunity cost of ignoring alternatives when making these decisions.

Put risk in context and remember value matters.

• Step four – Invest as tax efficiently as possible, plan for getting all the business-related tax breaks available, tick all boxes to keep as many options open as possible.

• Step Five – Review the process regularly to make sure your plan stays on track; a lifetime cash flow model can certainly help you keep this process focused.

The Bottom Line Understanding the relationship between the time value of money and inflation is key to effective

69 Image for illustrative purposes only.

Investments are not guaranteed, and you may get back less than you invested — which, in real (inflation-adjusted) terms, is also true of a bank account

financial planning. So the next time you ask yourself should I invest you already are.

If you're holding cash in the bank or post office long term, you're looking at a loss because inflation is eating away at your purchasing power every year.

If you're unsure how to invest in a way that's inflation-aware, goalfocused, and evidence-based, talk to someone who can help.

News

New Programme Receives Pharmacy Approval New MPharm Programme at Atlantic Technological University (ATU) receives approval from PSI – The Pharmacy Regulator Atlantic Technological University (ATU) has completed the PSI accreditation process to establish a new Master's of Pharmacy (MPharm) Degree Programme. The Council of the PSI, the pharmacy regulator’s governing board, was pleased to accredit the programme*.

The MPharm to be offered by ATU out of its Sligo campus is the fifth programme available to students wishing to study pharmacy in Ireland. The University will be able to enrol its first students to the new programme commencing this Autumn.

The PSI has been working with universities towards accreditation since the Government announced funding for expanded healthcare places, including the creation of three new MPharm degree programmes. The MPharm provides the qualification necessary for registration to practise as a pharmacist and is a five-year integrated programme that incorporates clinical and other experiential learning placements.

Speaking about the accreditation of the new programme, PSI Registrar and Chief Officer, Joanne Kissane, said: “This is a positive announcement for the northwest of the country and for the Atlantic Technological University. The PSI has been pleased to support the expansion of pharmacy programmes through our accreditation role since first proposed by Government through

the Higher Education Authority (HEA) in 2023.

programme in Sligo, and its students, will bring.”

“The availability of a greater number of student places for pharmacy in Ireland is significant for those interested in this field of study, for the future provision of patient care, and for our evolving healthcare services. Today’s announcement contributes to the work we have ongoing with the Department of Health and other stakeholders in relation to workforce planning for pharmacy. I congratulate all those involved in establishing this new programme at ATU.”

Welcoming the news, ATU President Dr Orla Flynn said: “The accreditation of ATU’s Master of Pharmacy is a milestone achievement for our university and for pharmacy education in Ireland.

It builds on ATU’s long-established strengths in pharmaceutical, biopharmaceutical, and clinical sciences. The programme will provide vital opportunities for students in the Northwest and will help increase the pharmacy workforce, at a time when the pharmacist’s role in healthcare is expanding significantly.”

“Our role as pharmacy regulator is to maintain and support patient safety and public trust in pharmacy.

This includes accrediting and approving educational programmes for pharmacy and for setting the accreditation standards that must be met on an ongoing basis by the approved pharmacy programme providers. Our aim is to ensure that future pharmacists are equipped to meet their professional and clinical obligations, the needs of patients and the health system. The PSI looks forward to the valuable contribution that the new pharmacy

The Head of the Department of Pharmacy at ATU, Marita Kinsella, said “accreditation of a new MPharm programme is a very proud moment for ATU and is the culmination of significant work of staff, including excellent collaboration from pharmacists, other clinicians and health service colleagues. ATU’s vision is to enhance quality of life for all in the Northwest. Offering a new MPharm programme enables ATU to play its part in meeting student demand, strengthening pharmacy services in the Northwest region,

and enhancing patient care through supporting expansion of the pharmacist’s role”.

Commending the availability of the new pharmacy programme, the Minister for Health, Jennifer Carroll McNeill, said: “I'm really pleased that Atlantic Technological University has been successful in securing accreditation for its pharmacy programme. With enrolments starting this Autumn, this marks a major milestone not just for students eager to study pharmacy, but also for the northwest, which will benefit greatly from this development.

A heartfelt thank you to the PSI and everyone at ATU for their dedication and collaboration over the past two years.”

Prospective students for MPharm programmes are encouraged to communicate with the relevant universities directly. The existing offerings, all accredited by the PSI, are provided already at Trinity College Dublin, University College Cork, and the Royal College of Surgeons in Ireland, with a new programme also commencing this September at the University of Galway.

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Topic Team Training – Dehydration 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.

• Older adults: They may drink less to avoid frequent urination and may not experience thirst as strongly due to age-related changes in brain signalling.

• Athletes: High-intensity training and endurance sports increase fluid loss through sweating, which can impact performance and recovery.

• Infants and young children: Diarrhoea and vomiting are the most common causes of dehydration in this group.

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 Dehydration.

Dehydration occurs when the body loses more fluids than it takes in, leading to an imbalance that affects normal bodily functions.

Even mild dehydration can cause headaches, fatigue, and constipation. Given that the human body is approximately 60-75% water, maintaining proper hydration is critical to overall health.

Our bodies have a natural water regulation system, with thirst acting as an indicator to replenish lost fluids. However, dehydration can occur even before thirst sets in, particularly in older adults.

Although drinking fluids generally restores hydration, severe cases require immediate medical attention.

Key Facts About Dehydration • The human body is primarily composed of water, making hydration essential for survival.

• Common causes of dehydration include diarrhoea, vomiting, excessive sweating, and insufficient fluid intake.

• Those at a higher risk include athletes, older adults, and individuals with chronic illnesses.

• Early signs include dry mouth, fatigue, dizziness, and darkcoloured urine, which serves as a key indicator of hydration levels.

Recognising the Symptoms Mild to Moderate Dehydration Symptoms: • Thirst • Dark urine and decreased urine output • Dry mouth • Fatigue and muscle weakness • Headache and dizziness Severe Dehydration Symptoms (Loss of 10-15% of Body Fluid):

• People with chronic conditions: Those with diabetes, kidney disease, adrenal gland disorders, or cystic fibrosis are at a heightened risk.

Effective Treatment for Dehydration The key to treating dehydration is replacing lost fluids and electrolytes appropriately. The best treatment depends on the individual’s age, severity of dehydration, and the underlying cause.

• Use an oral rehydration solution (ORS), available over the counter, which contains the right balance of water, salts, and electrolytes.

• Begin with small amounts (e.g., a teaspoon every few minutes) and increase gradually.

• Lack of sweating • Sunken eyes

For Adults:

• Dry and shrivelled skin

• Increase fluid intake by drinking water, clear broths, or electrolytecontaining beverages.

• High fever • Delirium or unconsciousness

Key Points:

Who Is Most at Risk?

Check your pharmacy team are aware and understand the following key points:

While dehydration can affect anyone, certain groups are more vulnerable, including:

Consider:  The first symptoms of dehydration  How to identify severe dehydration  When to refer someone for further investigation  Those at greatest risk of suffering from dehydration

70 | PHARMACYNEWSIRELAND.COM

• For those exercising in hot or humid weather, sports drinks with electrolytes can be beneficial, but water remains the best choice.

Community pharmacies play a vital role in educating and assisting customers with hydration and dehydration concerns. By fostering a team-based learning environment, pharmacy staff can stay informed, improve patient interactions, and enhance service quality. Encouraging regular training sessions and discussions on health topics ensures that pharmacy teams remain confident and well-equipped to support their communities.

By incorporating hydration education into your CPD strategy, you help ensure that customers receive accurate advice and practical solutions to stay healthy and hydrated.

For Infants and Young Children:

• For older children, dilute sports drinks with equal parts water to avoid excessive sugar intake.

• Low blood pressure and rapid heart rate

• Avoid full-strength fruit juices and soft drinks, as they may worsen diarrhoea.

 The pharmacy team knows to what to advise in older adults drinking less water  The team knows which groups of customers are likely to be at greatest risk of dehydration  My pharmacy assistants can meet the points in this training checklist.

Actions:  Ensure the team can meet the needs of patients who experience dehydration due to everyday nonmedical causes (such as excessive sweating) and those who experience dehydration due to common medical conditions (such as gastroenteritis)  Ensure that I and the team are aware of the treatments for dehydration and appropriate counselling  Do we understand the reasons why some people may be at greater risk of dehydration? What are these?  Are we confident on the appropriate amount of ORS to give in the first 4 hours to children and to adults?  Can we provide good advice on dealing with dehydration?  Train the team to meet all the above considerations

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71

E45 Cream: Trusted Relief for Dry and Sensitive Skin Dry, itchy, and sensitive skin is one of the most common dermatological issues, affecting people of all ages.

In Ireland alone, more than half of the population experiences skin disease annually. For over 70 years, E45 Cream has been a trusted solution, clinically proven to moisturise, soothe, and relieve a wide range of dry skin conditions. and cut the number of nights disrupted by irritation by almost half. By providing relief without harsh ingredients, it reassures both children and parents and supports better quality of life.

Everyday and Preventative Care E45 Cream is not only effective for flare-ups but also valuable as part of a daily skincare routine.

Applying after bathing or showering is especially beneficial, as it helps lock in absorbed moisture. This is particularly important during winter months, when central heating and harsh weather strip the skin of natural oils.

Using E45 Cream regularly can support the prevention of recurring dryness, reduce irritation cycles,

Clinically Proven, Licensed Care E45 Cream is more than an everyday moisturiser—it is an emollient licensed to treat a variety of dry skin conditions, including flaking and chapped skin, traumatic dermatitis, the dry stage of eczema, ichthyosis, sunburn, and certain cases of dry psoriasis.

Formulated with lanolin, light liquid paraffin, and white soft paraffin, E45 Cream works by restoring the skin’s natural moisture balance, softening rough patches, and forming a protective barrier to prevent further dryness. Its nongreasy texture ensures comfort and rapid absorption, leaving skin relieved without residue.

Why Emollients Matter Emollients are recognised as the first-line treatment for dry skin conditions. Regular use— typically two to three times daily—offers benefits beyond simple moisturisation. For patients, this means: • Fewer flare-ups of eczema or dermatitis

and help maintain healthy, resilient skin over time.

Conclusion Dry, flaky, or itchy skin can significantly impact quality of life, but it does not have to be a constant struggle. With its proven efficacy, licensed uses, and reputation built over seven decades, E45 Cream offers a reliable, clinically backed solution for people living with a range of dry skin conditions.

Trusted by healthcare professionals and families alike, E45 Cream combines the science of dermatology with the reassurance of a well-known brand—making it a dependable choice for managing dry skin conditions across all ages.

• Reduced reliance on additional treatments • Improved comfort and sleep quality • Greater confidence in managing their condition This positions E45 Cream not only as a treatment for active symptoms but also as an essential tool in long-term management and prevention.

Suitable for the Whole Family E45 Cream is dermatologically tested, fragrance-free, and gentle enough for sensitive skin. It is suitable for the entire family, including babies from one month old. This makes it a versatile recommendation for parents seeking a single, effective cream that can address multiple skin concerns within the household— from soothing an infant’s dry cheeks to calming an adult’s irritated shins.

Children’s skin can be particularly sensitive, and studies have shown that E45 Cream can reduce symptom severity, ease itching,

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Advertorial

Cold & Flu Season: Practical Tips and Real Experiences from the Pharmacy Frontline Cold and flu season is a familiar part of every weather transition. For communities across Ireland, pharmacies are a trusted point of advice and reassurance. They not only dispense medicines but also guide people on prevention, self-care, and everyday habits that make a difference.

At Fleming Medical, we wanted to explore how pharmacies prepare for this season and what practices are most effective. We spoke with pharmacy managers in Dublin, Cork, Galway, and Limerick. Their experiences highlight how practical steps, paired with the right tools, support both patients and staff throughout the colder months.

5. Make Cleanliness Obvious Across all conversations, pharmacy managers spoke about the importance of keeping the pharmacy space visibly clean. Customers notice counters, payment terminals, and consultation rooms. When these areas are well maintained, it creates a sense of reassurance and professionalism.

1. Make Hand Hygiene Visible

Adding small visible cues, such as a sign stating, “This area is cleaned regularly for your safety,” reinforces that commitment.

Pairing cleaning routines with Hand Sanitiser ensures staff and customers can interact with confidence.

In Dublin, Dunville pharmacy’s store assistant Niamh emphasised that prevention begins with the basics.

“Hand hygiene is one of the easiest habits to encourage, but it makes the biggest difference.

We’ve put sanitiser stands at the entrance and beside the consultation room. People notice and use them, and it reassures them that their safety is being looked after.”

The World Health Organisation estimates that up to 80% of infections spread by hand contact. Visible sanitiser encourages customers and staff to protect themselves and others. The Medicare Hand Sanitiser, with its quick-drying 70% alcohol formula, is a practical way to support this important routine in busy pharmacy environments.

2. Protect Teams During Vaccination Clinics In Dublin 7, Store manager Fionnuala Johnstone from Pelly’s Pharmacy described the rhythm of flu and COVID-19 vaccination clinics.

“During clinics the pace is fast. Gloves are a simple step that keep us protected and give patients confidence. People see you are taking precautions seriously, and that builds trust in your service.”

6. Build Awareness and Engagement

Protection is not only about hygiene but also about confidence. Patients want to see that their pharmacy team is taking every precaution, while staff want to feel supported in delivering care.

The Medicare Gloves Range for Pharmacists provides that balance by offering comfort and reliability during high-volume clinics.

3. Offer Everyday Prevention Advice In Offaly, Store Official Muriel from Ryan’s Pharmacy Edenderry, shared that customers are increasingly proactive about prevention.

“People often ask what they can do before they get sick. Beyond handwashing, we explain how nasal sprays help keep passages hydrated and support natural defences.

People like advice that is practical and easy to fit into their daily routine.”

Pharmacies are uniquely placed to give simple, evidence-based recommendations that empower patients to take ownership of their health. The new Medicare Nasal Spray supports this approach by gently cleansing and hydrating the nasal passages, making prevention part of everyday wellbeing.

4. Improve Indoor Air Quality In Mayo, Maria Butler, Store Manager from Molloy’s Pharmacy Bunree highlighted the impact of the indoor environment.

“When the heating is on during cold weather, the air can feel very dry. Customers do not always connect that with how they are feeling. We talk about humidifiers in terms of comfort and respiratory health, and once people understand the link, they see the benefit immediately.”

Indoor air plays an important role in how people feel during colder months. Dryness in the air can cause discomfort and affect respiratory health. Medicare Humidifiers, including the Cirrus and Nimbus ranges, restore balance and help create healthier indoor spaces for homes, pharmacies, and workplaces.

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Education was another theme that came through strongly. All four managers agreed that when pharmacies share advice, patients engage more deeply and return more often.

Seasonal displays that combine health information with practical products work particularly well.

An example is a “Stay Well This Winter” display that brings together hand sanitiser, nasal spray, and humidifiers alongside simple tips. On social media, pharmacies can share quick and accessible advice such as “Three ways to protect your family from colds and preventing flu.” These touchpoints strengthen the pharmacy’s reputation as a trusted healthcare advisor.

The Fleming Medical Perspective From Dublin to Limerick, one message stands out. Cold and flu season is not defined only by the illnesses themselves, but by how communities respond.

Pharmacies are central to that response. They are protecting their teams, guiding patients, and promoting small actions that together make a significant difference.

At Fleming Medical, we are proud to support pharmacies in this work.

Our products, including the Medicare Hand Sanitiser, Medicare Gloves, the Medicare Nasal Spray, and Medicare Humidifiers, are designed to make best practices easier to deliver. More importantly, our role is to stand alongside pharmacies as partners in community health.

Together, we can ensure that each cold and flu season is approached with confidence, preparation, and care.

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Chronic Pain

Changing the Narrative: Confronting Stigma in Chronic Pain 1. Introduction Up to one in three people in Ireland live with chronic pain, and one in five report pain lasting more than ten years. It is now widely accepted that chronic pain is both a sensory and emotional experience, dynamically shaped by biological, psychological and social factors.

While chronic pain itself is complex and frequently misunderstood, stigma adds a further, often invisible, layer of suffering.

Listening to patients—or even a cursory scan of the literature— reveals the near-ubiquitous presence of stigma in the lives of those living with pain.

“I think the stigma that goes with back injuries is fairly nasty… I don’t tell people I have a back injury.

I’d rather tell them I was dying of something.” - Slade et al. (2009), Pain Medicine

“I was labelled ‘drug-seeking.’ I felt like I had to prove I was really in pain.” - Bean et al. (2022), Pain Reports

2. Stigma is a Clinical Risk Factor: What the Evidence Tells Us

These accounts echo what we hear from patients in Irish pain clinics. They are often loaded with the emotional weight of life-altering pain, compounded by accumulated wounds inflicted by stigma—intentional or otherwise.

A 2024 meta-analysis in Pain found that higher levels of stigma are significantly associated with worse pain intensity, disability, and depression (Hickling et al., 2024).

Stigma is particularly potent in conditions where the pathology is invisible or contested, such as fibromyalgia. People with both fibromyalgia and rheumatoid arthritis reported significantly more stigma and poorer wellbeing than those with rheumatoid arthritis alone (Van Alboom et al., 2021).

Stigma is not always explicit, or obvious. It can manifest as subtle disbelief, avoidance, or the quiet omission of timely referrals.

Understanding how stigma operates is not only a matter of empathy—it is a clinical and systemic necessity.

Stigma can be enacted (e.g. being labelled "drug-seeking," having symptoms dismissed), or internalised, when individuals begin to believe negative assumptions others hold. These processes can erode confidence, suppress help-seeking, and amplify pain.

“I wasn’t listened to or believed.

I felt violated.” - Wallace et al.

(2021), International Journal for Equity in Health

Krishnan and Mathur (2025) describe stigma operating at three levels: Written by Dr Rosemary Keane, Principal Specialist Clinical Psychologist, Pain Team at the Mater Misericordiae University Hospital; Secretary, Pain Psychologists Ireland (PPI)

Krishnan and Mathur (2025) describe stigma operating at three levels:

Dimension

Definition

Examples

Structural

System-level barriers to equitable pain care

Public

Societal attitudes that minimise or “It’s all in your head”; disbelief from invalidate pain family or professionals

Internalised

Self-directed stigma shaped by external judgements

Underfunded services, long waitlists, inadequate staff training

Shame, social withdrawal, reduced helpseeking

These layers often intersect with social determinants of health such as gender, race, or socioeconomic status. Crucially, research shows stigma may amplify pain through overlapping neural pathways between physical pain and social exclusion (e.g., via the anterior cingulate cortex and insula).

In Ireland, a national audit revealed that patients often wait more than 18 months to access public chronic pain services, which remain critically under-resourced (Purcell et al., 2022).

Sheridan et al. (2025) identified four common experiences in Irish pain services: the dominance of biomedical care, fragmentation of support, the desire for more holistic care, and barriers to self-management like short appointments and long waits.

3. Drivers of Stigma Chronic pain challenges the biomedical model, especially when it doesn’t neatly correspond to test results or visible injury. While neuroscience and psychology have made strides in understanding central sensitisation and pain processing, these insights have not fully permeated public or clinical consciousness.

Further contributors include: • Out-group bias: pain expressed by people from marginalised groups is more likely to PHARMACYNEWSIRELAND.COM be discounted • Perceived blame: when pain is viewed as self-inflicted, empathy decreases

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While neuroscience and psychology have made strides in understanding central sensitisation and pain processing, these insights have not fully permeated public or clinical consciousness.

These layers often intersect with social determinants of health such as gender, race, or socioeconomic status. Crucially, research shows stigma may amplify pain through overlapping neural pathways between physical pain and social exclusion (e.g., via the anterior cingulate cortex and insula).

ignored or misread, people often respond by masking symptoms.

This coping mechanism, though understandable, reduces opportunities for validation and increases isolation. Over time, it contributes to a shrinking sense of identity and unmet emotional needs.

In Ireland, a national audit revealed that patients often wait more than 18 months to access public chronic pain services, which remain critically under-resourced (Purcell et al., 2022). Sheridan et al. (2025) identified four common experiences in Irish pain services: the dominance of biomedical care, fragmentation of support, the desire for more holistic care, and barriers to self-management like short appointments and long waits.

5. Breaking the Cycle: Validation

3. Drivers of Stigma Chronic pain challenges the biomedical model, especially when it doesn’t neatly correspond to test results or visible injury.

While neuroscience and psychology have made strides in understanding central sensitisation and pain processing, these insights have not fully permeated public or clinical consciousness.

Further contributors include: • Out-group bias: pain expressed by people from marginalised groups is more likely to be discounted • Perceived blame: when pain is viewed as self-inflicted, empathy decreases • Clinical discomfort: professionals may struggle with uncertainty, especially without training (De Ruddere & Craig, 2016) 4. A Vicious Cycle: Masking, Disconnection, and Identity Loss Pain is not just felt—it’s communicated and interpreted.

But when expressions of pain are

In Abraham Verghese’s Cutting for Stone, a surgeon asks: “Tell us, please, what treatment in an emergency is administered by ear?” The answer—“words of comfort”—reminds us that compassionate presence is a powerful intervention.

These statements reflect not only emotional relief but also potential clinical benefit. As Vowles and Thompson (2011) emphasise, emotionally safe, group-based interventions can reduce shame, increase connection, and promote psychological flexibility—a key mechanism in recovery.

between stigma and health outcomes in people with chronic pain: A meta-analysis. Pain. Advance online publication. https://doi.org/10.1097/j. pain.0000000000003077

Such services rebuild trust and provide a model of stigma-resilient care. Unfortunately, these are the exception rather than the rule across Ireland.

https://doi.org/10.1016/j. copsyc.2024.101980.

7. Breaking the Cycle: Education and Awareness Chronic Pain Ireland’s 2025 Pain Awareness Month focuses on stigma across healthcare, work, and life. Tuning into lived experience is essential. Listening is not passive—it is an active form of care. More at chronicpain.ie 8. Conclusion: What Can We Do Today?

Stigma manifests in subtle and overt ways—from offhand comments to system-level neglect. Yet small shifts in how we speak, listen, and relate can have outsized effects. Begin with a question. Offer space. Choose words with care. Every staff member in the hospital system has the capacity to change the narrative of chronic pain and help to reduce the invisible burden carried by so many.

Scott, W., Buchman, D.Z., Vasiliou, V.S. (2025). The multi-dimensional stigma of chronic pain: A narrative review, Current Opinion in Psychology (62):101980

Purcell, A., Channappa, K., Moore, D. et al. A national survey of publicly funded chronic pain management services in Ireland. Ir J Med Sci 191, 1315–1323 (2022). https://doi. org/10.1007/s11845-021-02673-5 Sheridan, R., Coote, S., et al. (2025).

The lived experience of pain services: A comparison of service users and service providers in the Irish health services. Pain Research and Management, Article ID 4608906. https://doi.org/10.1155/2025/4608906 Slade, S. C., Molloy, E., & Keating, J. L. (2009). Stigma experienced by people with nonspecific chronic low back pain: A qualitative study. Pain Medicine, 10(1), 143–154.1 https://doi.org/10.1111/j.15264637.2008.00540.x Van Alboom, M., De Ruddere, L., Kindt, S., Loeys, T., Van Ryckeghem, D., Bracke, P., Mittinty, M., Goubert, L. (2021) Well-being and Perceived Stigma in Individuals With Rheumatoid Arthritis and Fibromyalgia: A Daily Diary Study. The Clinical Journal of Pain 37(5):p 349-358 https://doi.org/10.1097/

When pain is invisible, language AJP.0000000000000929 though understandable, reducesReferences opportunities for validation and increases isolation. Over and empathy matter. The Verghese, A. (2009). “Cutting for time, it contributes to a shrinking sense identity and unmet emotional needs. strategies below can enhance Stone”. Knopf.

Bean, D. J.,of Johnson, M. H., clinical validation: Kydd, R. R., & Dean, S. (2022).

The determinants and effects of chronic pain stigma: A review and conceptual model. Pain Reports, 7(1), e967. https://doi.org/10.1097/ The Mater Hospital’s eight- Validation 5. Breaking the Cycle: PR9.0000000000000967 week interdisciplinary

6. Breaking the Cycle: Interdisciplinary Pain Care

Vowles, K. E., & Thompson, M. (2011).

The patient-provider relationship in chronic pain. Current Pain and Headache Reports, 15(2), 133–138. https://doi.org/10.1007/s11916-0100170-3

De Ruddere, L., & Craig, K. D. (2016). programme involves psychology, Wallace, C., et al. (2021). "I wasn’t Understanding and chronic physiotherapy, and nursing. Cutting for In Abraham Verghese’s Stone, a stigma surgeon asks: “Tell us, please, what treatment listened to or believed": A qualitativein pain: A state-of-the-art review.

Pain, Patients describe the impact of this analysis of experiences of chronic an emergency is administered by ear?”

The answer—“words of comfort”—reminds us that 157(8), 1607–1610. https://doi. stating; “I especially felt listened pain stigma in healthcare. International org/10.1097/j.pain.0000000000000512 to,”, “Helping us topresence understandis a powerful compassionate intervention.

Journal for Equity in Health, 20, Article pain and move on,”, “Everyone 72. https://doi.org/10.1186/s12939Hickling, L. M., Allani, M., Cella, M., & Scott, W. (2024). The relationship 021-01416-y had a voice.”

When pain is invisible, language and empathy matter. The following strategies can enhance clinical validation: Strategy

Application

Acknowledge the reality of pain

Accept pain as described by the patient. Trust their account.

Listen without rushing to fix

Prioritise understanding before advising.

Validate emotional responses

Normalise fear, frustration, shame, or anger.

Choose language carefully

Avoid stigmatising phrases like “medically unexplained” or “non-compliant.” Clinical notes shape future care.

Recognise coping effort

Acknowledge the unseen work patients do to function day to day.

Offer hope through partnership Encourage autonomy and shared decision-making.

6. Breaking the Cycle: Interdisciplinary Pain Care

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Cholesterol

The role of the dairy matrix in cholesterol management Written by Dr Martina Rooney, Prof Eileen R Gibney and Dr Emma L Feeney.

Food for Health Ireland, Institute for Food and Health, UCD.

Dr Martina Rooney, Research Scientist/Research Progamme and Grants Manager, UCD

Prof Eileen Gibney, Full Professor of Nutrition, UCD

Dr Emma Feeney, Lecturer/Assistant Professor in Nutrition, UCD

Milk, cheese and yogurt are rich sources of nutrients important for health, including protein, fat, calcium, iodine, phosphorus, vitamin D, vitamin B12, riboflavin and other nutritive and bioactive compounds. These nutrients are essential for biological function including bone growth and development, bone health, energy and nutrient metabolism, nervous and immune system function and many others. Dairy products are an important contributor to the intake of these nutrients, on average in the Irish population, dairy provides 39% of calcium, 34.5% of vitamin B12 and 10.5% of magnesium intakes (1).

However, these findings are from 2010 when 99% of the sampled population consumed some form of dairy. The most recent analysis from 2024 indicates 84% of those sampled consumed milk, while 62% ate cheese, with an average population intake of ~1 glass and ~ a cheese portion daily (2).

Delving into these figures further, cheese alone provides 9.1% of calcium, 12.6% of retinol, 3.7% of protein, 3.4% of vitamin B12 and 3.2% of riboflavin intakes (1). The critical role of dairy in nutrition and health is further emphasised by recent global analysis highlighting widespread deficiency several nutrients of concern, particularly B vitamins, iodine and calcium (3). Globally, the triple burden of malnutrition has recently been highlighted with 820 million chronically undernourished people, and greater than 2 billion people suffering from ‘hidden hunger’, i.e. insufficient

micronutrient intake despite consuming enough calories (4).

Given the rich nutritional profile of dairy foods, particularly in ‘nutrients of concern’, such as calcium, iodine and riboflavin, dairy foods can play an important

role in assisting populations to achieve optimal nutritional intakes and health outcomes.

However, dairy also contains saturated fat, high intakes of which are linked with elevated

Figure 1: Effect of dairy fat in different matrices

LDL-cholesterol concentrations, which in turn is associated with increased cardiovascular disease (CVD) risk (5). Globally, nutrientbased dietary guidelines have a blanket recommendation for saturated fat intake, of 10% of total energy intake or less (6-8).

Consequently, those with elevated cholesterol concentrations are often advised to limit dairy intake, particularly cheese, thus this population may be missing out on important nutrients, such as calcium and protein (9). Experts in the field of dairy and health have made recent global calls to challenge these guidelines, given the compelling evidence that the dairy matrix can influence the physiological and health effects of nutrients, including saturated fat (10). The dairy matrix refers to the nutrients and interactions of the proteins, fats and other nutritive and bioactive compounds within the dairy food. Different dairy structures and common processing methods may enhance interactions between nutrients in

Full-fat cheese Reduced-fat cheese and butter Deconstructed cheese ingredients

Change in cholesterol (mmol/L)

0.2 0.1

*

* *

0

*

-0.1 -0.2 -0.3 -0.4 -0.5 -0.6

Total-C

HDL-C

LDL-C

Cholesterol response to full-fat cheese (teal), reduced-fat cheese (green) and ‘deconstructed’ cheese ingredients (blue) in the RCT by Feeney et al., published in the American Journal of Clinical Nutrition (2018). Full-fat cheese, where all dairy fat was contained within the dairy matrix, significantly lowered total and LDL cholesterol concentrations compared to both reduced fat cheese and butter (where some fat was within the dairy matrix, and some outside), and deconstructed cheese ingredients, where all dairy fat was outside the dairy matrix. * indicates significant difference in response between groups.

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77 Figure 2: Effect of cheese form (structure) 0.25

*

Unmelted cheese Melted Cheese

Change in cholesterol (mmol/L)

0.2 Deconstructed cheese ingredients 0.15

0.1

0.05

0

-0.05

Total-C

HDL-C

LDL-C

Cholesterol response to unmelted cheese (teal), melted cheese (purple) and ‘deconstructed’ cheese ingredients (blue) in the RCT by O’Connor et al., published in Food & Function (2024). Here, the dairy matrix was disrupted by applying heat, i.e., melting. Consumption of melted cheese was shown to significantly increase total cholesterol and triglyceride (not shown) concentrations, compared to butter, in middle-aged adults with overweight and obesity. * indicates significant difference in response between groups. the dairy matrix, which may modify the metabolic effects of dairy consumption (11).

Approximately 60% of the fat in dairy is saturated fat, however, the nature of the dairy matrix can mitigate the effects of saturated fat on health. Specifically, when the same amount of fat is eaten in the form of cheese vs in the form of butter, we see that cheese raises cholesterol significantly less than butter. This has been shown independently in a number of trials and summarised in meta-analyses, an approach which combines the results of multiple studies which address the same research question in order to provide a more comprehensive overview.

The most recent meta-analysis (12) considered the effect of cheese vs butter on 264 participants from seven randomised controlled trials (RCTs), with findings indicating that consumption of 135g/day (~4 servings) of cheese for at least two weeks decreased total cholesterol by 0.24 mmol/L and LDL cholesterol by 0.19 mmol/L, compared to 52g butter (~three pats of butter). These findings, from independent research groups in Denmark, Australia, Ireland and America, indicate the beneficial effects of cheese, compared to butter, on cardiometabolic health.

But what are the mechanisms underpinning this relationship?

Several potential pathways have been proposed, each rendering saturated fat less available

for cholesterol synthesis and in turn, lowering cholesterol concentrations. Cheese is a rich source of calcium, which can bind with fat and form calcium soaps, making the fat less digestible and subsequently increasing faecal fat excretion (13, 14). Therefore, when contained within the cheese matrix, it may be that not all of the fat is digested. Within the dairy food category, the foods themselves have different matrices with milk having a liquid matrix, yogurt has a gel matrix and cheese a semi-solid matrix. The disintegration of the matrix is a key factor influencing nutrient release during digestion, with in-vitro studies demonstrating a much slower release of fat from cheese, compared to milk or yogurt, owing to the matrix structure (15). Furthermore, disrupting the physical structure of the matrix by applying heat, i.e., melting, has been shown to increase total cholesterol and triglyceride concentrations in middle-aged adults (16).

Research at Food for Health Ireland (FHI), a dairy technology centre based at University College Dublin, has been investigating this over the past decade and researchers have gained further insight into the dairy matrix effect. In order to investigate the effect of the cheese matrix on cardiometabolic health, the team at FHI disrupted the cheese matrix by deconstructing the ingredients

(17) and the structure, i.e., through melting (16) in a series of human intervention studies. The first study investigated how dairy fat contained within or outside the cheese matrix affected health, in 127 people (17). The test diets comprised of either a full-fat cheddar cheese, a reduced fat cheese and butter intervention or ‘deconstructed’ cheese ingredients (butter, powdered calcium caseinate, and a calcium supplement to match the overall macro and micronutrient profile of cheese). Each of the test diets provided ~40g dairy fat in different matrices and were matched for energy (calories), fat, protein and calcium. This was important so that any effect observed could be attributed to the matrices (structures) and not any nutritional differences between the test diets.

The authors also note the high ‘dose’ of 120g of cheese eaten daily in this study, which was above recommended guidelines of 3 portions of dairy per day.

However, it was important to provide enough of the cheese to demonstrate a difference in cheese vs butter in the relatively short 6-week study time period.

Participants recruited for these studies were healthy adults with overweight or obesity, of middle age, and who were not prescribed any medications for cholesterol or blood pressure management or therapeutic diets. Evidence suggests any benefits from cheese

consumption would be greatest in a slightly older, heavier cohort.

When full-fat cheddar cheese was consumed, i.e., all dairy fat was contained within the cheese matrix, total and LDL cholesterol concentrations decreased by 0.52 mmol/L and 0.45 mmol/L, respectively, after 6-weeks. In response to the reduced-fat cheddar cheese and butter group, i.e., when some dairy fat was within the cheese matrix and some was outside the matrix, reductions of 0.37 mmol/L and 0.27 mmol/L in total and LDL cholesterol concentrations were observed.

Finally, when all the dairy fat was outside the cheese matrix, i.e. the ‘deconstructed’ cheese ingredients, total cholesterol lowered by 0.10 mmol/L and LDL cholesterol by 0.07 mmol/L. As can be seen from the results, a step-wise reduction in cholesterol concentrations was observed, with the greater improvements when more fat was contained within the dairy matrix. This seminal RCT was the first to confirm the role of the dairy matrix in cardiometabolic health, by the investigating the presence of dairy fat within or outside the cheese matrix. While other studies had previously compared cheese to butter, none had nutrient-matched the interventions in this way to test the effect of the matrix structure.

The next step was to test the role of the dairy matrix form, or structure, on cardiometabolic health The second RCT disrupted the dairy matrix by deconstructing the physical structure, by applying heat, i.e., melting (16). Here, two of the test diets were identical to the original study, i.e., full-fat cheddar cheese (participants were advised to eat cheese unmelted, in its natural form) and deconstructed cheese ingredients; however, the novel test arm was a full-fat cheddar cheese that was melted by grilling or micro-waving before consumption. Otherwise, the protocols were identical across both RCTs. Again, on this occasion the dairy matrix effect was demonstrated, as when the matrix was disrupted through melting significant differences in cholesterol response were observed between the melted and unmelted cheese groups (16). There was no change in lipid parameters after consumption of unmelted cheese, however total cholesterol and triglyceride concentrations increased in response to melted cheese. This can be explained by the physical breakdown of the cheese structure when melted, where the fat escapes from the protein structure, and can pool on the surface, known as ‘oiling-off’. It must be noted that in the original study reductions in cholesterol

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Cholesterol

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Figure 3: Effect of dairy fat within males

Full-fat, unmelted cheese Deconstructed cheese ingredients

0.15

Change in cholesterol (mmol/L)

0.1 0.05 0 -0.05 -0.1 -0.15 -0.2 -0.25 -0.3

Total-C

HDL-C

LDL-C

When data from both RCTs was pooled and split by sex, there was no difference in cholesterol response between cheese and butter within males

concentrations in response to cheese vs butter were observed (17) whereas in the second RCT maintenance or an increase in these markers were observed, despite identical recruitment criteria and study protocols between the studies. However, sampling for the second RCT

started in March 2020, just as Ireland entered a Covid-19 related lockdown, which altered diet and lifestyle factors for many people.

CVD is traditionally considered to affect males more than females, with ischaemic heart disease responsible for 159.59 deaths per

100,000 males, and 146.27 deaths per 100,000 females in Western Europe in 2019 (18). In recent years, there has been growing realisation of the difference in presentation and treatment of CVD in males compared to females, with calls for action for sex-specific CVD guidelines (19).

Figure 4: Effect of dairy fat within female 0.15

*

Full-fat, unmelted cheese

Change in cholesterol (mmol/L)

0.1

Deconstructed cheese ingredients

*

0.05 0 -0.05 -0.1 -0.15 -0.2 -0.25 -0.3

Total-C

HDL-C

LDL-C

The dairy matrix effect may be stronger in females.When data from both RCTs was pooled and split by sex, there was a significant difference in response to total and LDL cholesterol after consumption of cheese and butter, within middle-aged females with overweight and obesity. * indicates significant difference in response between groups.

PHARMACYNEWSIRELAND.COM

Female-specific CVD risk factors include age of menarche and menopause, polycystic ovarian syndrome, parity, pregnancy loss, and adverse pregnancy outcomes (20). Furthermore, interest into the effect of sexual dimorphism in nutrition has grown, as males and females often respond differently to dietary intervention (21, 22).

Thus, pooling of data from the abovementioned RCT, allowed further insight into sex differences in the cholesterol lowering effect of cheese compared to butter (23). When data from all those who consumed (a) unmelted, full-fat cheddar cheese or (b) the deconstructed cheese ingredients were combined, LDL cholesterol was shown to be significantly lowered following 6 weeks cheese consumption, compared to butter.

When stratified by sex, there was there was no difference in cholesterol response between cheese and butter within males.

However the ‘dairy matrix effect’ appeared to be particularly strong in females, with a decrease of − 0.19 ± 0.77 mmol/L in total cholesterol in response to the cheese diet and an increase of 0.10 ± 0.73 mmol/L in response to the deconstructed cheese diet (23). These findings are particularly relevant for personalised nutrition, as heavier, middle-aged females are often advised to limit cheese intake for dietary management of cholesterol concentrations, however this group may actually benefit most from cheese, for both lipid management and nutrient intake and health. The rationale behind these observed sex-related differences are unknown, although HDL-mediated cholesterol efflux capacity response to dietary fat has been shown to vary between males and females (24).

Whilst, genetic factors were not considered as part of this analysis, the influence of genes cannot be ruled out. Furthermore, carryover effects from pregnancy-related outcomes and subsequent impact on health may be implicated.

Patients, and medical practitioners, are familiar with the traditional lipid markers of total, LDL and HDL cholesterol concentrations. More recently, however, the field has advanced to develop novel and more sensitive markers of cardiovascular health such as lipoprotein particle concentration and size.

Total, LDL and HDL cholesterol biomarkers consider the amount of cholesterol circulating around the body, whereas lipoprotein particle markers reflect the number and size of the particles carrying the cholesterol (25). In order to understand this marker and health, smaller, more denser LDL particles are more atherogenic than larger,

79 more buoyant LDL particles. In follow-up analysis of the cheese matrix study for more sensitive biomarkers, an increase in LDL particle size and reduction in LDL particle density was observed after consumption of full-fat cheese, compared to the other test diets. These findings indicate when cheese is consumed within its whole or intact food matrix it may lead to improvements in atherogenic lipid profile, compared to the formulated diets where the fat was eaten as butter (26).

Preliminary analysis suggests sex may also play a role in this relationship, with more favourable effects of cheese on lipoprotein particle profiles observed in females compared to males.

Whilst this article has focused mainly on cholesterol concentrations, other markers of cardiometabolic health, such as

anthropometry, glycaemic control and blood pressure, cannot be ignored. In our cheese matrix studies despite providing an additional energy intake, no net change in body weight or body fat percentage was observed. This is in line with other studies, although displacement of other foods in the background diet cannot be ignored. However, it is also worth noting that in an observational analysis of a representative Irish population, higher dairy intake was associated with lower body mass index, percentage body fat, waist circumference and waist-to-hip ratio (27). While the cohorts in the cheese matrix studies were normotensive at baseline, no effect on blood pressure was observed in response to cheese.

Again this is in line with other studies considering cheese and blood pressure, while evidence

suggests that mixed dairy intakes, i.e., including milk, cheese and yogurt in the daily diet (28) may have the greatest blood pressure lowering effects in populations with overweight or obesity (29). These findings highlight the neutral effects of cheese consumption on cardiometabolic health, and thus how cheese, and dairy, can play an important role in nutrition and health.

The evidence for the role of dairy in nutrition and health is compelling.

Milk, cheese and yogurt are a key source of essential nutrients that billions of people worldwide are lacking. On the other hand, evidence suggests cheese has neutral or beneficial effects on cardiometabolic health, despite containing saturated fat. But what does this mean for health professionals and their practice?

Considering the evidence provided

here when offering patientcentred care is a positive next step. If a patient is lacking intake of essential nutrients, it is worth encouraging milk, cheese and yogurt as a digestible, accessible, affordable source of protein and a range of micronutrients.

When offering lifestyle and dietary management of elevated cholesterol concentrations, reassuring cheese-lovers that consuming cheese can be neutral or even beneficial for their cardiometabolic health, particularly if they are middleaged, with overweight/obesity or female, can make dietary advice more acceptable and varied, and therefore effective. Personalised nutrition and positive messaging around dairy and health is a winwin for both the practitioner and the patient.

References available on request

News

¤34m Research Ireland ARC Hub Significant Research Ireland funding has been announced today for the ARC Hub for HealthTech which is led by Professor Garry Duffy, Head of Department of Anatomy and Regenerative Medicine at RCSI and Professor of Health Technology Innovation at University of Galway.

The ARC Hub for HealthTech aims to boost translational research in chronic disease management, focusing specifically on aspects such as decision support and intervention planning, smart implants, advanced wearables, novel sensors, and algorithms and artificial intelligence/machine learning models.

Funded by Research Ireland, along with the European Regional Development Fund (ERDF) and the Government of Ireland, ARC Hub for HealthTech will be implemented across Northern and Western Regions of Ireland. The innovation-led programme will fast track research projects, boosting healthcare access across regional parts of Ireland.

Minister for Further and Higher Education, Research and Innovation James Lawless added: “Enhancing the existing academic-enterprise healthcare and technology ecosystems, the ARC Hub will deliver a suite of impactful, on-the-ground supports, benefitting everyone in the process – researchers, engineers, technologists, manufacturers, clinicians, physicians and, critically, patients. The ARC Hub for HealthTech will play an instrumental role in accelerating the commercialisation of research and getting health solutions to those that need them, faster.”

Pictured (l-r): Director of the ARC Hub for HealthTech Professor Garry Duffy, Head of Department of Anatomy and Regenerative Medicine at RCSI and Professor of Health Technology Innovation at University of Galway; ARC Hub for HealthTech Co-lead Professor Richard Costello, Professor of Respiratory Medicine, RCSI; Dr Aoife Gallagher, Head of Innovation, RCSI; Research Ireland’s Interim CEO, Celine Fitzgerald; and Dr Seamus Browne, Head of Strategic Research Initiatives and Industry Partnerships, RCSI.

Professor Fergal O’Brien, Deputy Vice Chancellor for Academic Affairs at RCSI, commented on RCSI’s involvement, saying: “Supported by RCSI’s Office of Research and Innovation, we are delighted to be play a key role in such an important initiative for translational research. RCSI is dedicated to boosting development and commercialisation in medtech, digital health, and biomaterials and we look forward to advancing our efforts in these areas through our ongoing collaboration with ARC Hub for HealthTech”.

The five RCSI projects funded under the new ARC Hub for HealthTech programme are: • Developing novel biosensor technology to improve heart failure management – Dr Aamir

Hameed, Tissue Engineering Research Group, RCSI. • Developing a novel medical device to improve the accuracy of diagnosis of lung conditions, overcoming current spirometer limitations – Professor Richard Costello, Department of Medicine, RCSI. • Developing an algorithm for early-stage breast cancer prediction and treatment guidance – Professor Darran O’Connor, School of Postgraduate Studies, RCSI.

• Creating a decision support and intervention planning digital obesity treatment platform for adolescents – Dr Grace O’Malley, School of Physiotherapy, RCSI. • Developing a novel device to overcome the major challenges associated with current brain stimulation devices used for deep brain stimulation in epilepsy – Opens in new windowDr Ian Woods and Professor Fergal O’Brien, Tissue Engineering Research Group, RCSI.

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Clinical Profiles

BREAKING THE CYCLE OF WASTEFUL CRISIS SPENDING ALONE and Social Justice Ireland are calling on Government to act in the forthcoming Budget to meet the social care, health and housing needs of an ageing population.

As society faces several major transitions, including demographic shifts, the way we navigate these changes is crucial. We need to break the cycle of waiting for the crisis to happen. Investing while we can in the right policies will benefit all ages. ALONE and Social Justice Ireland believe that all individuals should be supported to age well in the community, and that this should be Government’s overarching policy goal for an ageing population.

Meeting the social care, health and housing needs of an ageing population is a key challenge in achieving this goal. Their joint paper, ‘Policy Options to Support Ageing Well at Home’, highlights the growing challenges facing older people, including disability, chronic illness, loneliness, mental health concerns, and malnutrition.

ALONE is a national organisation that enables older people to age at home. ALONE’s work is for all older people and aims to improve physical, emotional and mental wellbeing. Social Justice Ireland is an independent social justice think tank and advocacy organisation.

Both organisations support a vision of Ireland where older people can age happily and securely at home and are strongly connected to their local communities.

ALONE CEO, Sean Moynihan said, “Last year we supported over 44,000 older people to age at home and our findings have produced these policy asks. Older people today need support with housing, financial and health needs and the demand that we are seeing will only grow. We are calling on Government to start now in building an Ireland where everyone can age at home, equally with comfort and dignity.

Our growing population of older people is to be celebrated, there are many positives to this, but we must invest in the right areas to make ageing at home work for all. This is a call for leadership as much as money because the credit for this investment will come later when services are suitable and sustainable.”

one-fifth of the population. This is a success story that is to be welcomed. It means that people are living longer and healthier lives.

It also means that the housing, health and social care needs of our ageing population is growing.

Meeting these growing needs requires vision and planning for our future, and ambitious investment that looks to the long-term demand on resources and how this might be funded. The investment and planning to ensure that our older people can age happily at home and remain part of their local communities must begin now.”

Together they have outlined costed policy asks including; • Investment in Primary GP Care services.

• Expand community-based rehabilitation beds.

• Expand acute mental healthcare capacity for older adults.

• Invest in falls prevention community exercise programmes.

Both organisations agree that Government must live up to Programme for Government commitments to enhance day care centres, design a statutory home care scheme, and to invest in social programmes and befriending services, but further action is needed if we are to deliver adequate health and social care services for an ageing Ireland.

BOOTS SECURES PRESTIGIOUS BUSINESS WORKING RESPONSIBLY MARK Boots has once again achieved the highly coveted Business Working Responsibly Mark, a powerful testament to its unwavering commitment to ethical and sustainable practices. This marks the fifth consecutive time the retailer has earned the prestigious certification, underscoring over a decade of leadership in responsible business.

Social Justice Ireland CEO, John McGeady commented, “We believe in building a society in which everyone's rights and responsibilities are honoured.

By 2040, it is projected that over 1.3 million people in Ireland will be aged 65 and over, more than

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First awarded the Mark in 2013, Boots Ireland pioneered the way as the country's first retailer to achieve this independently audited standard for Environmental, Social, and Governance (ESG) practices.

More than ten years later, this renewed certification isn't just a badge; it's a clear reflection of the company's continuous, tangible efforts to create a positive impact on its people, the communities it serves, and the planet we all share.

The Business Working Responsibly Mark, awarded by Business in the Community Ireland and rigorously audited by the NSAI, is reserved for companies that consistently go beyond mere compliance, deeply embedding responsibility into every facet of their operations. Boots Ireland's recertification highlights its ongoing, impactful work across critical areas including comprehensive employee wellbeing programs, vibrant community engagement initiatives, robust environmental performance, and exemplary corporate governance.

Stephen Watkins, Managing Director of Boots Ireland, commented: “At Boots, our purpose is deeply rooted in caring for our colleagues, serving our customers, and enriching the communities we are privileged to be a part of. Our simple yet powerful goal is to leave everyone we meet better for the experience. That core value drives every decision we make, and this re-certification is a fantastic affirmation that we are truly on the right path.”

Tomás Sercovich, CEO of Business in the Community Ireland, added: “We wholeheartedly applaud Boots for achieving this Mark for an impressive fifth time. Over the Stephen Watkins, Managing Director of Boots Ireland and Tomás Sercovich, CEO of Business in the Community Ireland with team

years, Boots has consistently demonstrated unparalleled leadership and a profound commitment to all dimensions of sustainability. Their particular focus on the full lifecycle of their products stands out, exemplified by excellent supplier engagement upstream and their innovative 'Recycle at Boots' scheme – a brilliant model for encouraging circular practices. We commend the entire Boots team for this significant achievement and their relentless dedication.”

HIQA TO ESTIMATE THE RISK OF ALCOHOL-RELATED HOSPITAL ADMISSION AND MORTALITY ASSOCIATED WITH DIFFERENT LEVELS OF ALCOHOL CONSUMPTION The Health Information and Quality Authority (HIQA) is undertaking a study to estimate the risk of alcohol-related mortality and hospital admission in Ireland associated with different levels of alcohol consumption. The findings will support an update of Ireland’s low-risk alcohol guidelines, which were revised in 2015 to less than 11 standard drinks for women and less than 17 standard drinks for men per week.

Michelle O’Neill, Deputy Director of Health Technology Assessment, said: “Alcohol consumption is a major risk factor for mortality and disability worldwide. Many adults in Ireland consume alcohol. In order to make informed decisions, they should have access to accurate information about the risks.

“We are conducting this work to inform an update of the national low-risk alcohol guidelines by the Department of Health. These guidelines provide information on the risks associated with alcohol consumption, in addition to providing guidance on drinking levels associated with lower risk, and on situations when drinking is not safe.”

In light of new evidence that has emerged nationally and internationally over the past decade, the Department of Health is planning to update Ireland’s guidelines. To support this update, HIQA will estimate the risks of mortality and hospital admission associated with different levels and patterns of alcohol consumption.

Defined risk thresholds will inform what constitutes lower-risk drinking. The approach used will be similar to those that have been taken in Australia, Canada, and the UK in their most recent updates to their low-risk alcohol guidelines.

The protocol, which sets out the scope of the upcoming study and the approach HIQA will use to estimate the risk of harm, based on how much and how often alcohol

81 is consumed, is available at www. hiqa.ie. The full report is expected to be published in 2026.

EVERY STEP COUNTS: DR. CIARA KELLY STEPS UP FOR LIFE PHARMACY AND JACK AND JILL CHILDREN’S FOUNDATION FUNDRAISING CAMPAIGN Life Pharmacy, part of the Uniphar Group, is proudly stepping up to launch its annual nationwide fundraising campaign in aid of the Jack and Jill Children’s Foundation, and this year, the goal is bolder than ever. Throughout the month of September, Life Pharmacy teams across Ireland will hit the ground walking, each pledging to complete 100km in a bid to raise ¤100,000 to fund vital nursing care for families with children, up to the age of six, with severe learning disabilities often associated with complex medical needs.

From Cavan to Clonakilty, local Life pharmacy teams will lace up and lead the way in a communitypowered challenge aimed at delivering 5,556 hours of nursing care and respite support for Jack and Jill families. The campaign is calling on customers and communities to join the movement by donating, either in-store or online, and be part of something truly life-changing. Every ¤18 donated provides one hour of home nursing care, offering comfort and support to families navigating the toughest of circumstances.

Mairead Reen, Chairperson, Life Pharmacy, said "At Life Pharmacy, we’ve always believed in the strength of community – and this campaign is proof of what we can achieve when we walk together for a common cause.

We’re immensely proud to partner with Jack and Jill once again, and I encourage everyone to get Brady Garry, Dr Ciara Kelly and Louise Garry

involved. Whether it’s one step or one donation, every action matters. Together, we can turn kilometres into care for families who need it most."

Deirdre Walsh, CEO of the Jack and Jill Children’s Foundation said, “We’re so pleased to be partnering once again with our wonderful friends at Life Pharmacy for another inspiring community-driven fundraiser. This month, we’re encouraging all the pharmacies and their customers across the country to register and take part in the ‘Walk 100km in September’ challenge, with the goal of raising ¤100,000 in vital funds for Jack and Jill families nationwide. This support will make a real difference helping to fund 5,556 hours of in-home nursing care for the 451 families currently under our wing. We’re incredibly grateful to Life Pharmacy for their continued commitment, and we can’t wait to see communities coming together in support of local families throughout September."

Dr. Ciara Kelly, Newstalk radio presenter, columnist, and champion of inspiring the nation to walk, commented, "I’ve always believed in the power of walking – it’s free, it’s easy, and it’s for everyone, no matter your age or fitness level. All it takes is a road, a pair of runners, and a bit of fresh Irish air. But now, every step you take can do something even more powerful. By joining this Life Pharmacy ‘Walk 100km Challenge for Jack and Jill’ campaign, your walk can help raise vital funds for Jack and Jill families in your local community. So why not lace up, step out, and turn your walk into a lifeline for a child who needs your support? Let’s get Ireland moving, one meaningful step at a time."

Since its founding in 1997, the Jack and Jill Children’s Foundation has supported 3,180 families across Ireland. In 2024, 538 families benefited from in-home

nursing care and respite support.

Currently the charity supports to 451 families, nationwide with up to 100 hours of care per month – all thanks to community initiatives like this.

PANADOL INTRODUCES LARGER PACK SIZE

ABACUS MEDICINE GROUP ACQUIRES SWISS CARDIO TECHNOLOGIES The Abacus Medicine Group has acquired Swiss Cardio Technologies AG. The company was founded by a group of cardiovascular surgery specialists with origins at the University of Berne, Switzerland, and are the innovators of Cardioplexol® (magnesium sulfate heptahydrate, potassium chloride, xylitol, procaine hydrochloride).

The acquisition includes the global rights for Swiss Cardio Technology’s cardioplegia business. Cardioplegia is a technique used to intentionally and temporarily interrupt cardiac activity to facilitate bypass surgery or other cardiac and aortic repairs that require an immobile heart.

Panadol, the world’s number one pain relief tablet brand*[1], is introducing a larger 24-pack of its Panadol Actifast 500mg Soluble Tablets (paracetamol) into Irish pharmacies this September. This new pack size offers greater value per tablet and supports users looking for trusted, fast-acting pain relief in an easy-to-take format.

Panadol Actifast Soluble Tablets are scientifically proven to provide fast pain relief, starting to work in as little as 15 minutes[2]. This makes them an ideal option for common types of everyday pain, including headache, toothache, period pain, and those associated with cold and flu, and in particular for patients who prefer to avoid swallowing tablets.

Matthew Beattie, Pharmacy Lead at Ireland, stated, “As a pain relief expert, Panadol is committed to providing pharmacy teams and their patients with fast, effective treatments that meet changing needs. Panadol Actifast Soluble Tablets offer quick relief for those who prefer alternatives to tablets, and the larger 24 pack size increases convenience and value.”

As healthcare professionals in Ireland prepare for potential regulatory changes within the pain relief sector, particularly around the ingredient codeine, suitable paracetamol-based alternatives like Panadol Actifast are likely to become increasingly relevant among shoppers.

The Panadol Actifast Soluble Tablets 24-pack will be launching into Irish pharmacies this September for an RRP of: ¤8.50. *excluding US, based on sales data

Swiss Cardio Technologies has extensive, long-term relationships with global opinion leaders in cardiothoracic surgery. By joining forces, the Abacus Medicine Group and Swiss Cardio Technologies, will considerably accelerate the ongoing commercialization and international expansion of the current business.

Flemming Wagner, CEO and founder of the Abacus Medicine Group, says: “Swiss Cardio Technologies exemplifies excellence in healthcare innovation. The opportunities for our two organisations are significant, and I look forward to exploring them together.

This acquisition of our first pharmaceutical asset is a strategic addition to the Group’s business model and our plans for continued profitable growth. It marks the beginning of a new chapter.”

Professor Thierry Carrel from Swiss Cardio Technologies says: “We are deeply rooted in cardiovascular surgery and research, and our aim has always been to connect academia and industry. Today, we have accomplished exactly that. In Abacus Medicine Group we have found the right, dedicated partner to drive the growth of the business.”

NOVO NORDISK TO PRESENT WEGOVY® AND OZEMPIC® DATA Novo Nordisk has announced new data showing the cardiovascular protective benefits of Wegovy® and Ozempic® will be presented at the European Society of Cardiology (ESC) Congress 2025 from 29 August to 1 September in Madrid, Spain. New data will also include perspectives on the role of inflammation in a condition called atherosclerotic cardiovascular disease (ASCVD).

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Clinical Profiles

“For people living with diabetes and obesity, heart disease is one of the biggest threats that could change a person’s life in an instant.

Semaglutide is proven to reduce the risk of cardiovascular events by 20-26%1, meaning fewer hospitalisations, heart attacks, stroke and deaths,” said Ludovic Helfgott, executive vice president and head of Product & Portfolio Strategy at Novo Nordisk.

The key role of cardiovascular inflammation in ASCVD will be discussed in a Novo Nordisk symposium on Saturday, 30 August. ASCVD is a condition where blood vessels that carry blood to your heart cut off the blood flow to other parts of your body, making those vessels stiff and narrow. Additionally, a range of real-world evidence is being presented, providing a thorough analysis of the impact of inflammation in cardiovascular disease on mortality and major cardiovascular events in people with ASCVD. Real-world evidence is data from everyday healthcare settings that show how treatments work in real life, beyond controlled clinical trials.

“At the ESC congress, we are presenting new data substantiating the unique range of benefits semaglutide has on people with heart and kidney disease, as demonstrated in both clinical trials and in the real world,” Ludovic Helfgott said. “Semaglutide is unrivalled in the GLP-1 class with its proven reduction in heart attack, stroke, kidney complications and cardiovascular death.”

CROÍ’S 2024 ANNUAL REPORT SHOWCASES EXCEPTIONAL PROGRESS AND TRANSFORMATIVE HEALTH INITIATIVES.

including 1,442 checks via the new Mobile Health Units.

• Supported 1,426 engagements through the Croí Connects nurse helpline and online chat service.

• Delivered a 30% increase in 1:1 stroke recovery sessions and introduced a number of innovative new stroke recovery support programmes.

• Increased the number and range of exercise classes, providing 562 hours of class activity across the year, with a weekly attendance of close to 300 people.

• Enabled 110 family stays, free of charge, at the Croí Courtyard Apartments for loved ones of cardiac and stroke patients.

• Engaged thousands of people through awareness campaigns, educational programmes, and community partnerships, in person, and online with over 304,000 page views on the Croí website.

Croí also strengthened its patient advocacy work, launching the Manifesto for Change to call for a national cardiovascular health Pictured at the launch of the 2024 Croí Heart & Stroke Charity Annual Report is Dr. Lisa Hynes, Head of Health Programmes and Health Psychologist; Mark O’Donnell, Chief Executive; Beatrice Gomez Maestre, Community Stroke Support Specialist; Mark Gantly, Chairman of the Board and Christine Flanagan, Director of Fundraising, Croí Heart & Stroke Charity.

Croí Heart and Stroke Charity, has published its 2024 Annual Report, marking a year of exceptional impact, transformation, and community reach in the fight against heart disease and stroke.

In 2024, Croí launched its first multiannual strategy (2024–2027) and delivered major new initiatives, underpinned by a transformative legacy gift from the Joe & Helen O’Toole Charitable Trust (Tuam).

This investment funded the construction of a state-of-the-art Community Stroke Hub in Galway and the creation of a Mobile Health Fleet, dramatically increasing access to life-saving prevention, screening, and recovery services—particularly in rural and underserved communities.

Over the year, Croí: • Provided 4,724 free health checks at over 105 events,

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strategy, as well as developing the Heart & Stroke Voice Ireland network to amplify and foreground the patient voice. The charity also participated in two major EU-level projects—JACARDI and Heartsafe North West Europe—aimed at prevention, rehabilitation, and improving survival rates from sudden cardiac arrest.

Chairman of Croí, Mark Gantly spoke at the launch “On behalf of the board of Croí, I want to commend Mark O’Donnell, CEO, and the entire Croi team for an outstanding performance in 2024, detailed in this report. Their work on behalf of the community was supported by that community – through philanthropy, fundraising and volunteering. It is that support which sustains us financially and confirms to us that we are making a real difference. Our particular thanks to the Joe & Helen O’Toole Charitable Trust (Tuam). 2024 was the year when their generous award had its first impact – an impact that has been game changing for the organisation and, into the future, will enable our ambition to transform lives across our region.”

Chief Executive Mark O’Donnell praised the dedication of Croí’s staff, volunteers, and supporters, saying: “2024 was a landmark year in our mission to prevent heart disease and stroke, save lives, and support recovery, and represented a stepchange in the scale and range of the critical services we provide in communities across the country, with a particular focus on the west.

We are profoundly grateful to all of Croí’s supporters and partners for

helping us to further develop our activities and increase our impact.”

The full 2024 Annual Report is available at www.croi.ie/about/ annual-reports/ TIZIANA LIFE SCIENCES DOSES FIRST PATIENT IN PHASE 2A TRIAL OF INTRANASAL FORALUMAB FOR MULTIPLE SYSTEM ATROPHY Tiziana Life Sciences, Ltd. (Nasdaq: TLSA) (“Tiziana” or the “Company”), a biotechnology company developing breakthrough immunomodulation therapies with its lead development candidate, intranasal foralumab, a fully human, anti-CD3 monoclonal antibody, has announced that the first participant has been enrolled and dosed in its Phase 2a clinical trial evaluating intranasal foralumab in patients living with Multiple System Atrophy (MSA) at Brigham and Women’s Hospital in Boston, Massachusetts.

MSA is a rare, rapidly progressive neurodegenerative disorder affecting the body’s movement, balance, and autonomic functions.

Classified as an orphan disease by the FDA, MSA affects an estimated 15,000–50,000 people in the United States. There are no FDAapproved treatments that alter its course, creating a critical need for new therapeutic strategies.

The six-month open-label study (ClinicalTrials.gov Identifier: NCT06868628) will assess the potential of foralumab to reduce harmful neuroinflammation by engaging the body’s regulatory T cells through a novel, non-systemic delivery approach. Participants

83 will receive treatment over eight dosing cycles, with the goal of determining whether this approach can slow disease progression and improve quality of life.

“We are excited to begin dosing nasal foralumab in MSA patients,” Said Dr. Vikram Khurana, MD, PhD, Tracy T. Batchelor Endowed Chair in Neurology, and Division Chief of Movement Disorders and Director of the MSA Center of Excellence at Brigham and Women’s Hospital and Principal Investigator of the MSA trial, commented: “Every patient I meet with MSA faces a reality of mounting symptoms and few options. This trial represents an important opportunity to explore a treatment aimed directly at the immune processes that may drive the disease. The intranasal route allows us to reach the brain’s immune environment in a way that is both targeted and potentially more tolerable for patients.”

Ivor Elrifi, Chief Executive Officer of Tiziana Life Sciences, added: “Our mission is to bring forward therapies that tackle the root causes of neurodegeneration, not just the symptoms. Dosing our first patient in this MSA study marks an important milestone in that mission. We are hopeful that foralumab’s unique mechanism – modulating immune response through the nasal pathway – can open new doors in treating diseases where inflammation and degeneration are intertwined.”

The trial builds on Tiziana’s broader research into foralumab in neuroinflammatory and neurodegenerative diseases, where early studies have suggested benefits in stabilizing or improving function in conditions such as multiple sclerosis.

SANTHERA SECURES AGREEMENT WITH UNIPHAR FOR THE DISTRIBUTION OF AGAMREE® (VAMOROLONE) IN FIVE GCC (GULF COOPERATION COUNCIL) COUNTRIES Santhera Pharmaceuticals (SIX: SANN) has announced the signing of an exclusive agreement with Uniphar to manage the distribution of AGAMREE® (vamorolone) in the United Arab Emirates, the Kingdom of Saudi Arabia, Kuwait, Oman and Bahrain, for the treatment of Duchenne muscular dystrophy (DMD) in patients four years of age and older.

Sales are expected to begin on a named patient basis in Q1 2026, with broader commercial sales anticipated in late 2026 following market authorization and pricing agreement. Santhera will receive a percentage of net sales as payment, consistent with the Company's previous distribution

agreements. This agreement will help ensure that patients across these countries have timely access to this innovative therapy.

as a direct and reliable source for POEM case referrals nationwide, supported by the hospital’s comprehensive infrastructure.

Dario Eklund, Chief Executive Officer of Santhera, said: “We are excited to partner with Uniphar for the distribution of AGAMREE in GCC (Gulf Cooperation Council) countries. Uniphar’s strong regional presence, combined with its proven expertise in early and expanded access programs, will help address the significant unmet need for boys and men living with DMD in these countries.

This agreement represents another important step in our global expansion strategy and demonstrates our unwavering commitment to making effective rare disease treatments accessible to patients worldwide.”

CROÍ WELCOMES CONNACHT HOSPITALITY GROUP’S SUPPORT FOR CROÍ CONNECTS HELPLINE.

Santhera remains committed to the global rollout of AGAMREE, which already includes multiple regions across North America, Europe and Asia, bringing this important therapy to patients with DMD who are in urgent need of treatment.

Brian O’Shaughnessy, Chief Commercial Officer of Uniphar said: “We are proud to collaborate with Santhera to bring AGAMREE to patients in GCC (Gulf Cooperation Council) countries. Our regional knowledge, commercial experience, and dedication to improving access to innovative therapies align perfectly with Santhera’s mission.

Together, we aim to ensure that patients living with DMD receive the treatment they need without delay.”

MERCY UNIVERSITY HOSPITAL COMPLETES ITS FIRST GASTROENTEROLOGY-LED POEM PROCEDURE Mercy University Hospital (MUH) has completed its first Per Oral Endoscopic Myotomy (POEM) procedure, a significant milestone for the Gastroenterology Department in the treatment of achalasia. This endoscopic surgery offers a transformative treatment for the incurable swallowing condition that affects the oesophagus.

Achalasia is an uncommon disorder characterised by the impaired relaxation of the lower oesophageal sphincter (LOS) and a loss of peristalsis in the lower oesophagus. This condition can lead to challenging symptoms such as dysphagia (difficulty swallowing), food impaction, and a considerable impact on an individual's quality of life.

Traditional treatment approaches include Heller myotomy , Botox injection, and endoscopic pneumatic balloon dilation.

Croí Heart & Stroke Charity, is pleased to announce that the Connacht Hospitality Group, as part of their corporate social responsibility programme, will be kindly supporting the Croí Connects Helpline.

Dr. Ciarán McDonald, a Consultant Gastroenterologist and Interventional Endoscopist at Mercy University Hospital

The milestone procedure, performed on a paediatric patient, demonstrated immediate and significant benefits. The individual, who had been experiencing the debilitating effects of achalasia, was discharged the following day, a remarkable improvement compared to the typical four-tofive-day recovery period often associated with more invasive surgical interventions such as Heller's myotomy.

"We are immensely proud to celebrate a Mercy University Hospital first; we have now completed our first gastroenterology-led POEM procedure for the treatment of achalasia," stated Dr. Ciarán McDonald, a Consultant Gastroenterologist and Interventional Endoscopist at Mercy University Hospital. "This marks an important step for those living with achalasia across the country. Our ability to provide an innovative solution that enables individuals to recover and potentially resume their lives much faster, will have a positive impact on quality of life. The successful implementation of this procedure has been greatly supported by our advanced facilities, including our established gastrointestinal physiology laboratory, reinforcing Mercy University Hospital's commitment to leading-edge endoscopic interventions."

Croí Connects is a vital lifeline for people living with, or affected by, heart disease and stroke. This free Croí service offers direct access to a specialist health team, including experienced Cardiac Nurse Specialist, who provide confidential advice, guidance, and support. Whether you need help understanding your diagnosis, advice on lifestyle changes, or reassurance during a challenging time, Croí Connects is here for you.

In addition to the telephone helpline, Croí Connects also hosts weekly online health chats, offering a welcoming space for people to learn more about heart and stroke health, ask questions, and connect with others. These online sessions will resume on Tuesday, 2nd September, and are open to everyone with an interest in cardiovascular health.

"At Connacht Hospitality Group, we believe in supporting initiatives that make a real difference in people’s lives. Our team is committed to giving back, and this partnership with Croí is a meaningful way for us to contribute to the health and wellbeing of those around us." – Brian Lynch, Group director of Finance Connacht Hospitality Group.

The support from Connacht Hospitality Group will help ensure that Croí Connects remains accessible to those who need it most, continuing to make a difference in communities across the region and beyond.

Croí Connects is available weekdays from 9 am – 5:30 pm on 091 544310 or by email at healthteam@croi.ie For more information on upcoming health chats or the support available, visit www.croi.ie

Mercy University Hospital is now the only centre in Ireland performing this highly specialised procedure.

The establishment of this service at MUH leverages the hospital's well-recognised advanced therapeutic endoscopy unit and established gastrointestinal physiology laboratory. This development is expected to serve

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