PAI Diary 2018

PAI

PHARMACY ASSIST IRELAND 2018

E D U C AT I O N T R A I N I N G G U I D E

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The Irish Pharmacy

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Fitzgerald Power would like to thank all our clients and partners in the Irish community pharmacy sector for your support over the last 35 years.

We were honoured to receive the advisory team of the year award for our work in the community pharmacy sector at this year’s Irish Accountancy Awards.

Dublin: +353 1 6794772

|

www.fitzgeraldpower.ie

Waterford: +353 51 870152

|

Carlow: +353 59 9141100

contents

5

Training guide content by page number and sources of further information

Abdominal Cramps 9 Allergies

11

Analgesics

13

Bone Health

15

BV/Thrush

17

Cow’s Milk Allergy in Infants 29 Diarrhoea

31

Dry Eye

33

Dysphagia

35

Headaches

49

Sleep Disruption

69

Indigestion

51

Infantile Colic

53

Slimming and Nutrition

71

Migraine

55

Smoking Cessation

73

Nappy Rash

57

Sore Throat

75 77

Eczema in children

37

Nasal Congestion

59

Sports Injury

Oral Health

61

Topical Analgesics 79

Childrens Analgesics

19

Fatigue

39

Cold Sores

21

Fertility

41

Colds

23

Fungal Nail

Constipation

25

Coughs

27

URTIs

81

63

VMS

83

Pain Relief

65

Winter Health

85

Skincare

67

43

Pain and Fever in Children

Hay Fever

45

Head Lice

47

PUBLISHER IPN Communications Ireland Ltd. Clifton House, Lower Fitzwilliam Street Dublin 2 00353 (01) 6690562 COMMERCIAL MANAGER - Barry Maguire (00353)87 399 1969 | barry@ipnirishpharmacynews.ie ADVERTISING MANAGER - Nicola McGarvey 0044 7450 211751 | nicola@ipnirishpharmacynews.ie www.pharmacynewsireland.com

The views and opinions expressed within this Pharmacy Assist directory are those of the authors and it is provided to you only as guidance. All the information is published in good faith and for general information purpose only. Please share with your supervising pharmacist for his/ her review in order to tailor it to the specific needs and practices of your individual pharmacy.

All rights reserved by IPN Communications Ltd. All material published in Pharmacy Assist is copyright and no part of this document may be reproduced, stored in a retrieval system or transmitted in any form without prior written permission. IPN Communications Ltd have taken every care in compiling Pharmacy Assist 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.

A GREAT HEALTHCARE FAMILY

MAH: McNeil Healthcare (Ireland) Ltd. Airton Road, Tallaght, Dublin 24, Ireland.

Products not subject to medical prescription. Full prescribing information available from Johnson & Johnson (Ireland) Ltd. Airton Road, Tallaght, Dublin 24, Ireland.

IRE/JPM/17-2522

Our Pharmacy

7

No two pharmacies are the same. Whether you are working within a pharmacy chain or in a smaller, independent pharmacy; staff, opening hours, protocols and allied healthcare professionals will differ.

It is important therefore that you are knowledgeable as to your pharmacy's business and services provided. In addition, you should be educated in knowing the roles and remits of your colleagues.

Pharmacy name: Pharmacy address:

Pharmacy telephone number: Pharmacy fax number: Pharmacy email address:

Pharmacy website: Pharmacy opening hours:

Mon-Fri:

Sat: Christmas & New Year:

Pharmacy Holiday closures: Easter: Bank Holidays: Doctor Localities Local Health Centre: Address:

Telephone number:

Email:

Dentist Localities Local dentist surgery: Address:

Telephone number: Locum Contacts: 1 2 3 Lead Pharmacist: Pharmacy Manager: Pharmacy Technician: Accredited Checking Technician: Dispensing Assistant: Medicines Counter Assistant: Locum Pharmacist: Other:

Email:

Sun:

World’s No1 antispasmodic range

1

Effective relief from the pain and discomfort of abdominal cramps and IBS Targets the source Fast acting relief Gentle on the stomach Well tolerated Pharmacy only Contains hyoscine butylbromide. Always read the label.

Buscopan® 10mg Coated Tablets Product Information Presentation: Tablets containing hyoscine butylbromide 10mg. Indications: Relief of spasm of the gastrointestinal tract and for the symptomatic relief of Irritable Bowel Syndrome. Dosage and administration: For spasm of the gastrointestinal tract: adults and children over 12 years: 2 tablets four times daily. For Irritable Bowel Syndrome: initially 1 tablet three times daily, increasing if necessary to 2 tablets four times a day. Contraindications: Myasthenia gravis, megacolon, narrow angle glaucoma, known hypersensitivity to any component. Warnings and precautions: Should not be taken for extended periods without investigating the cause of abdominal pain. Use with caution in conditions characterised by tachycardia; those susceptible to intestinal or urinary outlet obstruction; pyrexia. Warn patients to seek medical advice if they develop a painful red eye with loss of vision whilst or after taking Buscopan 10mg Coated Tablets. Patients with rare hereditary problems of fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency should not take Buscopan 10mg Coated Tablets since the tablet coat contains sucrose. Advise patients to consult their doctor before taking if: this is the first time they have symptoms of IBS, age over 40 years and some time since the last attack of IBS or the symptoms are different; recent rectal bleeding; severe constipation; nausea or vomiting; loss of appetite or weight; difficulty or pain passing urine; fever; recent travel abroad. Advise patients to consult their doctor if they develop new symptoms, or if symptoms worsen, or if they do not improve after 2 weeks of treatment. Interactions: The anticholinergic effect of drugs, e.g. tri- and tetracyclic antidepressants, antihistamines, quinidine, amantadine, antipsychotics (e.g. butyrophenones, phenothiazines), disopyramide and other anticholinergics (e.g. tiotropium, ipratropium, atropine-like compounds) may be intensified by Buscopan 10mg Coated Tablets. Co-administration with a dopamine antagonist may diminish the effect of both medicines. The tachycardic effects of beta-adrenergic agents may be enhanced by Buscopan 10mg Coated Tablets. Pregnancy and lactation: Use during pregnancy and breastfeeding is not recommended. Side effects: Uncommon: dry mouth, tachycardia, skin reactions (e.g. urticaria, pruritus), dyshidrosis, constipation. Rare: urinary retention. Not known: anaphylactic shock, anaphylactic reactions, dyspnoea, rash, erythema, other hypersensitivity, visual accommodation disturbances. Pack sizes: 20 and 40. Legal category: Retail sale through pharmacies. Product authorisation number: PA 540/181/2. Product authorisation holder: Sanofi Ireland Ltd., Citywest Business Campus, Dublin 24, Ireland. Tel 01403 5600, email: IEmedinfo@sanofi.com. For further information please see Summary of Product Characteristics. Date of revision: August 2017.

1: IMS data - July 2017

SAIE.BUSC.17.11.0234 November 2017

Abdominal Cramps

9

ABDOMINAL CRAMPS Abdominal cramps, pain and discomfort are commonly reported as a gastrointestinal (GI) complaint. While many cases can be attributed to functional GI disorders such as Irritable Bowel Syndrome (IBS), not all sufferers fall within this definition. A significant proportion of people who experience abdominal cramps, pain and discomfort do not have an IBS diagnosis and there are other triggers that can cause abdominal cramps.

It is estimated that around 50% of the Irish adult population suffer from abdominal cramps.

Episodes can be frequent, with around 63% of abdominal cramps sufferers experiencing episodes once a month or more and 24% every week. Abdominal cramps can affect adults of all ages although it is more prevalent in people aged 25-45.

Causes Abdominal cramps relate to muscle spasm in the GI tract resulting in sharp cramp-like pains. The organs of the abdomen are very sensitive to internal and external influences and the abdomen reacts to both physical and psychological states and conditions. Anxiety and tension can often cause spasms in the muscles of the stomach, intestines or colon resulting in abdominal cramps pain and discomfort.

The most common triggers for abdominal cramps include: • Stress • Changes in diet or lifestyle (alcohol, fizzy drinks, processed foods and fried or fatty foods can be common causes).

• Food allergies or intolerances • Symptom of an underlying condition such as Irritable Bowel Syndrome  Irritable Bowel Syndrome (IBS) - IBS is a chronic condition that results in bouts of abdominal pain, bloating, diarrhoea/ constipation. Defined as a functional GI disorder, the actual cause of IBS is not clearly understood, although many experts believe modern lifestyles play some part in triggering it. The medical diagnosis of IBS is made by exclusion – ruling out other possible causes for the symptoms. It is estimated that IBS affects 1 in 3 people in Ireland and is more prevalent amongst women, although 30% of sufferers are men. Frequency of IBS is higher than with non-specific abdominal cramps, with 40% of IBS sufferers experiencing flareups every 2 weeks.

Symptoms There is plenty of confusion and a general lack of awareness amongst sufferers as to what is happening when a patient has abdominal cramps.

Often described as a sharp, stabbing, tight, or intense pain in the lower abdominal region. Some patients may refer to their as an upset stomach.

In addition to the symptoms of abdominal

cramps and pain, nearly two thirds of sufferers experience excess gas or wind with more than half also experiencing a bloated or gurgling stomach. 37% of people also experience diarrhoea, with a third of suffers experiencing constipation when they have an abdominal cramps episode.

Abdominal cramps share similar symptoms with a variety of other conditions and diseases. This is why it is important to differentiate abdominal cramps, IBS and other similar conditions from diseases and conditions like Crohn’s disease, ulcerative colitis, coeliac disease, ovarian cancer and other infections of the gut.

Treatments There are a number of effective ways to reduce or eliminate abdominal cramp, pain and discomfort. Prevention is often seen as the best remedy and patients are often encouraged to avoid foods and drinks that will trigger symptoms and try to relax, which will help reduce the effects of stress on the abdomen.

There are also a wide range of treatments in pharmacy that are used to alleviate abdominal cramps and other GI associated symptoms.

OTC medicines such as Antispasmodics (antimuscarinics and direct smooth muscle relaxants) help restore normal peristalsis to alleviate abdominal cramps and also other IBS symptoms. They are helpful in treating both abdominal pain and IBS symptoms, as they suppress the contractile response of GI muscles in response to stimulants such as stress or food and include ingredients like mebeverine, alverine citrate and peppermint oil, hyoscine butylbromide and dicycloverine.

Other treatments and preventative measures These include lifestyle and dietary changes, which also work as preventative methods. While no treatment is likely to remove all symptoms for good, the correct treatment can work to ease symptoms, improving a sufferer’s quality of life.

• Lifestyle changes There are a number of lifestyle changes that can be recommended to sufferers to help alleviate the symptoms of abdominal cramps. Such as:

W W H A M

 Regular exercise  Reducing stress levels and other emotional upset - If a person feels they are struggling with stress or anxiety, it is recommended that they speak to a doctor or GP.  Quit smoking • Dietary changes Sufferers are often advised to make specific changes to their diet in an attempt to reduce symptoms. Generally, sufferers of abdominal cramps and other GI-related symptoms are advised to:  Eat regular meals,  Eat at a leisurely pace and avoid long periods between eating  Drink non-caffeinated drinks regularly – at least eight cups of water per day  Restricting the consumption of fizzy drinks and alcohol.  Intaking enough fibre  Cut down on the amount of fat consumed • Psychological treatments Many other psychological factors can cause symptoms of abdominal cramps. If a person has suffered with moderate or severe symptoms and other treatments have failed, they may be advised to undertake specific treatments such as cognitive behavioural therapy, hypnotherapy or psychological therapy. These treatments are often advised if it is clear a sufferer’s symptoms are being caused by stress or other psychological issues.

Who? Anyone – More prevalence in people aged 25-45 What are the symptoms? Sharp, stabbing, tight, or intense pain in the lower abdominal region How long have they had the symptoms? Sufferers experience episodes which can be frequent Action already taken? Patients may need advice on self-selected products Medication? Avoiding antispasmodic medicines if possible is usually recommended for pregnant and breast-feeding women

10

How often should I use Stérimar?

We recommend using Stérimar Isotonic and Stérimar Baby two to six times a day (or more) in each nostril for as long as you need it or as long as and as often as your doctor recommends.

Stérimar Hypertonic is recommended for a short period. Use two to four times a day in each nostril for light congestion and up to six times a day for severe congestion.

Can Stérimar be used with other medication?

Yes. Stérimar is drug-free and doesn’t contain preservatives so there is no known risk of interaction with any other medication. However, in all cases it is best to check with your doctor.

Am I likely to experience any irritation from using Stérimar?

Stérimar Isotonic and Stérimar Baby are purified sea water solutions with the same concentration of salts as the cells in the human body. As such, irritation is highly unlikely. Stérimar Hypertonic has a higher salt content than Stérimar Isotonic but the solution is still less salty than sea water. A sensation of dryness may occur and should disappear within a few days.

Always follow instructions and/or doctor’s recommendations.

Can I use Stérimar if I am pregnant, diabetic or suffer from high blood pressure?

Yes, Stérimar is completely safe to use with these conditions, but it is always a good idea to check with your doctor.

Can I use Stérimar for my three year old?

Yes, Stérimar Isotonic is suitable for the whole of the family, even babies from 3 months old. Stérimar Hypertonic is suitable for all adults and children over three years of age and Stérimar Baby is a new part of the range and can be used with babies from birth to 3 years old.

Is the nozzle safe to use?

Yes. The Stérimar nozzle has been specifically designed to fit any shape and size of nostrils.

Stérimar Baby has a specific nozzle with a protective flange. The nozzle cannot be pushed too far into the nose to avoid any risks of injury.

How long will Stérimar keep?

Stérimar products can be kept for a maximum of three years after manufacture or until all solution has been used. The expiry date can be found at the bottom of the can and carton. Each dose of Stérimar delivered is aseptic.

Please contact your Intrapharma Rep to place your order on 01 4632424

The valve on top of the can prevents air from entering. Also, because the solution is kept in a sterilised pouch it never comes into contact with either the aluminium can or the non-flammable nitrogen gas within.

Why is it important to clean the nozzle after each use?

You must clean the nozzle in soapy water to remove any microorganisms left after use to help avoid any crosscontamination.

What does micro-diffusion mean?

The unique Stérimar micro-diffusion system produces a fine spray of sea water. As the droplets produced by Stérimar are microfine, they remain in contact with the walls of the nasal passages for longer, making Stérimar even more effective.

Why are the copper and manganese in Stérimar Hypertonic important?

Copper and manganese are found in very small amounts in the human body.

They stimulate the body’s self defense mechanisms and help keep it healthy.

Allergies

11

ALLERGIES Unlike seasonal allergies such as hay fever, indoor allergies can last all year long.

Allergy symptoms can actually be worse in the winter when the windows are closed and people are shut in with the allergens.

Indoor allergies tend to be at their worst in the late summer, when dust mites are at most prevalent. Sensitivity to indoor allergens is very common and occurs at every age. It is less common in children younger than 5 years.

Common causes of indoor allergies House Dust Although many allergens in the environment can trigger allergic symptoms, house dust is the main culprit in indoor allergies. House dust is an airborne mixture that might contain fine particles of soil and plant material from indoors or outdoors, particles of human and animal skin dander and hair, fabric fibres, mould spores, dust mites, fragments of insects that have died and their waste, food particles, and other debris. Some dust is present in every home, regardless of how often or how thoroughly the house is cleaned.

Dust mites Often, when people believe they are sensitive to dust, they are in fact sensitive to the dust mites and their waste particles that are found in household dust. Dust mites can be found in most homes, usually in beds and bed covers, upholstered furniture and fabrics. Preventative measures include: using a dehumidifier or air conditioner, washing bedding on a hot cycle (non-washable bedding can be frozen overnight to kill dust mites), replacing wool or feathered bedding with synthetic materials or allergen-proof bedding, using a vacuum cleaner with a HEPA filter and avoiding the vacuumed area for 20 minutes to allow any dust and allergens to settle.

Pet dander The allergic reaction to an animal is not caused by the animal’s hair. It is caused by substances in the animal’s saliva, urine, and especially dander (dead skin flakes that become loosened from the animal’s skin). The allergens become crusted on the animal’s fur and skin from urination or the animal licking or scratching itself; once dry, the allergens are released into the air, where they join the other components of house dust. Cats and dogs are most likely to cause allergic reactions.

Moulds Moulds generally live outdoors but can normally be found in almost any indoor environment.

They easily pass through open doors and windows and settle indoors, especially where there is excess heat and humidity. They grow and produce mildew which thrives in places like shower cubicles. Non-visible moulds can grow in unseen areas of the house, such as under flooring materials and behind walls. To grow, mould requires water; for example, from a leaking pipe or roof, or condensation. As it grows, mould releases more spores, many of which become part of house dust. While moulds can trigger allergic symptoms, like any other allergen, they rarely cause serious health

problems, except in people who are seriously immunocompromised or on chemotherapy.

Symptoms of Indoor Allergies • Itchy, congested nose • Clear nasal discharge • Itchy, watery, swollen or red eyes • Sneezing • Tickly, swollen throat • Coughing or wheezing • Tightness in the chest • Reactions to animal allergens may be very mild or quite severe. Symptoms may occur immediately after exposure to the allergen, or they may build gradually for 8-12 hours after exposure or become persistent.

W W H A M

Self-Care Treatment Options First-generation antihistamines are more likely to cause drowsiness. Depending on the product, the duration of action is often shorter than newer antihistamines and may necessitate taking the drug 3-4 times each day. Secondgeneration antihistamines can be taken over the long term with minimal side effects and are unlikely to cause sleepiness. The non-sedating antihistamines are convenient to take since they are taken once or twice daily.

Saline nasal rinses reduce the symptoms of nasal allergies and can offer relief in conjunction with conventional treatment. Maintaining clear and nasal pages is important - the tiny hairs (cilia) inside the nasal passage work to carry dust, pollution and allergens to the back of the throat where they are swallowed and destroyed, before they can multiply and cause harm. If the nasal passages are dry or blocked, they become less efficient.

Who is the patient? Sensitivity to indoor allergens is very common and occurs at every age What are the Symptoms? Itchy, congested nose, clear nasal discharge, irritated eyes, sneezing, tickly throat, coughing or wheezing How long have the symptoms been present? Indoor allergies tend to be at their worst in the late summer, when dust mites are at most prevalent Action already taken? Patients may have tried antihistamines but not be aware of the benefits of nasal hygiene Medication? Saline nasal rinses and sprays are drug free and do not contain preservatives, so will not interact with other medication

Analgesics

13

ANALGESICS Oral analgesics are commonly used for relieving pains such as headaches, menstrual pain, toothache, back pain and arthritis. Some analgesics work on the body’s peripheral and central nervous systems to block or decrease sensitivity to pain. Other analgesics act by inhibiting the formation of certain chemicals in the body that mediate pain. Analgesics come in various oral forms such as tablets, capsules, syrups, suspensions and powders. By 2022, the analgesics market is expected to reach $26.4 Billion (¤22.3 billion) globally.

Categories Analgesics fall into two categories: Non-opioid: Non-opioid analgesics include paracetamol and non-steroid anti-inflammatory drugs (NSAIDs) such as Aspirin and Ibuprofen.

Non-opioid analgesics are the first choice analgesics for treating mild to moderate pain and are also used in moderate to severe pain to potentiate the effects of opioids.

Opioid: Opioid analgesics block or decrease sensitivity to pain in the body’s peripheral and central nervous systems. Most of the opioid analgesics are prescription-only medicines and are suitable for moderate to severe pain. Opioids can be further classified into two categories: mild and potent. Mild opioid analgesics include codeine and tramadol.

Strong opioid analgesics include morphine and methadone.

Advice when taking Oral Analgesics • Always follow the dosage instructions on the packaging or as instructed by a doctor or pharmacist. Do not take more than the recommended dose as this will increase the risk of serious side effects.

• Painkillers should not be shared with anyone else, as different people may experience pain with different cause and severity.

• Avoid taking alcohol when taking analgesics as it may increase the risk and severity of side effects of the medicines.

Types OF Analgesics Ibuprofen: Ibuprofen works as a painkiller by affecting chemicals in the body known as prostaglandins. Prostaglandins are substances released in response to illness or injury, these cause pain and inflammation (swelling).

Prostaglandins that are released in your brain can also cause a high temperature (fever or pyrexia). The painkilling effect of ibuprofen begins soon after dose is taken.

Paracetamol: Paracetamol blocks the production of prostaglandins, making the body less aware of the pain or injury. Paracetamol reduces temperature by acting on the area of the brain that is responsible for controlling temperature.

Using Analgesics with Caution Paracetamol: Taking excessive amounts can cause Liver damage and less frequently kidney damage following overdoses. It should be used with caution for patients with impaired kidney or liver function, alcohol dependence, chronic malnutrition or dehydration Ibuprofen: Ibuprofen can sometimes cause side effects such as ulceration. It is advised that patients over the age of 65 or anyone who has a history of gut problems should take Ibuprofen with caution.

Managing Pain with Oral Analgesics Oral Pain Many common conditions cause oral pain or discomfort, such as cold sores (see separate entry), toothaches; tooth sensitivity; teething; minor oral mucosal injury or irritation; oral mucosal disorders, such as recurrent aphthous stomatitis ([RAS]; and xerostomia (dry mouth). There are a number of OTC products available for the self-treatment of oral pain and discomfort, including topical analgesics/

W W H A M

anaesthetics, toothpastes formulated for sensitive teeth, artificial saliva products for dry mouth, and oral mucosal protectants, as well as products that provide treatment of and relief from pain due to cold sores.

Patients should be assessed for the appropriateness of therapy and educated on the proper use of these products.

Pharmacists should advise patients to seek medical attention if their conditions worsen or show signs of infection.

In an effort to self-medicate, some patients may try using analgesics to ward off pain caused by more serious health conditions and pharmacists are in an ideal position to look for signs of a patient who is doing so.

Dental Pain Toothache is pain in and around the teeth and jaws that is most often caused by tooth decay.

The pain usually starts suddenly and it can vary from mild discomfort to a severe throbbing, which is often worse at night. The area of the jaw close to the infected tooth may also be sore and tender to the touch.

Toothache can either come and go or be constant. Eating or drinking (Both hot and cold) can make the pain worse. Painkillers such as paracetamol and ibuprofen may help reduce pain and discomfort.

Who: Those suffering from pain including dental pain and headaches What are the symptoms? Pain anywhere in the body How long have they had symptoms? Symptoms will usually clear up within 7 days of treatment Action already taken? Sufferers who may already have tried analgesics.

If the pain persists longer than 2 weeks, the patient should be referred to a GP Medication: check for underlying conditions before suggesting a specific pain relief

Your body is designed to move Solgar® 7: The Next Generation In Joint Comfort, Mobility & Flexibility Solgar® 7 brings together seven bio-active nutrients that work together to balance the release of joint enzymes, and structurally support collagen building blocks and sensitive joint cartilage.

This unique formulation including a specialised form of collagen (UC-II®), boswellia, turmeric root, and vitamin C:

. Targets multiple pathways

. Provides support for joint stressors brought on by exercise, sports or physical activity

. Helps the body’s range of motion, mobility and flexibility.

1

The Science Behind UC-II® and Boswellia Clinical trials indicate undenatured collagen (UC-II®) as more effective than glucosamine and chondroitin, resulting in significant support for daily activities and quality of life.2 Studies also show UC-II® is effective in supporting joint mobility, flexibility and comfort during strenuous exercise in healthy subjects and has been shown to support longer periods of exercise before experiencing joint discomfort.3 A 2011 clinical study showed a compound of Boswellia (Aflapin) effectively supports joint function.4 For more information contact your Solgar® Territory Account Manager or call 01442 890 355

solgar.co.uk/solgar-7

1. The vitamin C in this product helps collagen formation for the normal function of cartilage and bones. It also helps to protect cells from oxidative damage (stress). 2. D. C. Crowley et al. Safety and efficacy of undenatured type II collagen in the treatment of osteoarthritis of the knee: a clinical trial.

Int. J. Med. Sci. 2009, 6. 3. J.P. Lugo et al. Undenatured type II collagen (UC-II®) for joint support: a randomized, double-blind, placebo-controlled study in healthy volunteers. Journal of the International Society of Sports Nutrition 2013, 10:48. 4. A. Vishal et al. A Double Blind, Randomized, Placebo Controlled Clinical Study Evaluates the Early Efficacy of Aflapin® in Subjects with Osteoarthritis of Knee. Int. J. Med. Sci. 2011, 8. Food supplements should not be used instead of a varied balanced diet and a healthy lifestyle. Solgar® is a registered trademark. UC-II® is a registered trademark of InterHealth N.I.

Bone Health

15

BONE HEALTH Bone health is about staying fit and well as we get older so we can continue to do the things we enjoy.

Taking care of our bones is a lifelong investment that will pay dividends by helping us all to stay fit and independent later in life. As people are now living longer, more and more will become vulnerable to weak bones (osteoporosis) and breaking bones from falls.

Older people and fractures About one in three people over 65, and half of people over 80, fall each year. One in two women, and one in five men over 50, will break a bone, typically in the wrist, hip and spine, because of osteoporosis. A fall later in life can be life-changing, leading to distress, pain, injury, loss of confidence, loss of independence and even death. Half of older people never regain their former level of function after a hip fracture and one in five dies within three months.

Osteoporosis and falls are not an inevitable part of ageing and much can be done to prevent them. Preventing osteoporosis starts in childhood, if not earlier, when our bones are growing, and continues throughout life. Lifelong strong bones can be built by: • a healthy balanced diet that includes calcium • vitamin D, from sunlight, food and supplements • regular exercise • avoiding smoking, too much alcohol and other risk factors The same lifestyle advice applies to women during the menopause, osteoporosis or who are at risk of fracture as it will help reduce the rate of bone loss and their risk of falling.

Preventing falls People with osteoporosis have weak bones, but it’s falls that break bones. While it is impossible to prevent all falls, there are lifestyle and practical measures that can reduce their occurrence. The most effective measures to prevent falls among people considered at risk involve: • strength and balance exercises • checking the home for trip and other hazards • checking eyesight • reviewing medication, which may affect balance

Activity for healthy bones Activity levels tend to drop as people get older. Older people may feel they don’t have the energy to exercise or that they may harm themselves in some way. Physical problems like stiff, painful joints can also make people

less inclined to be active. Being inactive makes the muscles and bones lose strength. This increases the risk of osteoporosis, falls and fractures. By staying active, older people can significantly lower their risk of breaking a bone.

For optimum health, the recommendation is that people over 65 get 150 minutes of moderate-intensity exercise, in bouts of 10 minutes or more, every week, for example golf, bowls, gardening, or walking.

Muscle strength is vital for improving balance and staying independent and mobile in later years. It is recommended that people over the age of 65 do activities to improve muscle strength at least twice a week. This could include dancing, carrying groceries, going up and down stairs, or exercising to music.

Activities to improve balance and co-ordination can also reduce the risk of falling, such as yoga or tai chi. These types of activity can also ease stiffness and unsteadiness associated with painful joints. People over 65s should also avoid sitting around for long periods. As well as reducing muscle and bone strength, this can make joints feel stiffer and so increase the risk of falls. Physical problems, such as painful joints, needn’t prevent older people from being active. Classes are available for people who are older or who have underlying health conditions, such as heart disease or arthritis.

Eating for healthy bones over 65 Some people find their appetite starts to drop as they get older. Eating less can make it more difficult to get the nutrients needed to keep muscles and bones strong and healthy.

Staying active will help to keep the appetite up. Older people often don’t feel like eating much some days, but it’s still important to try

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and maintain a balanced diet with fruit and veg, dairy, carbohydrates and protein. Healthy muscles and bones especially need calcium, vitamin D and protein. Protein, meanwhile, is important for muscle strength. Another reason to eat a balanced diet is that it will help to maintain a healthy body weight.

Being underweight is linked to a higher risk of fractures. Some medicines can affect the appetite.

Vitamin D Vitamin D is important for both strong muscles and healthy bones. Our bodies make vitamin D from the action of the summer sunlight (from late March/April to the end of September) on our skin.

People who are not often exposed to the sun should take a daily vitamin D supplement.

These include people: • who are not often outdoors, such as those who are frail or housebound • who are in a care home or other institution • who usually wear clothes that cover up most their skin when outdoors • People with dark skin such as those of African, African-Caribbean and South Asian origin might not get enough vitamin D from sunlight so they should consider taking a supplement throughout the year.

Some foods contain vitamin D. These include oily fish such as mackerel and salmon, eggs, foods fortified with vitamin D such as fat spreads and some breakfast cereals. However, it’s difficult to get enough vitamin D from food alone so all adults should be advised to consider taking a daily vitamin D supplement, particularly during the winter.

Who? People over 65 are more likely to suffer from bone weakness What are the symptoms? Although a fracture is the first sign of osteoporosis, some older people develop the characteristic stooped posture How long have they had the symptoms? Women lose bone rapidly in the first few years after the menopause. Women are more at risk of osteoporosis than men, particularly if the menopause begins before the age of 45 Action already taken? People may be trying to eat a balanced diet but not be aware of the benefits of taking supplements Medication? Some medication can affect the balance, such as antidepressants, antihistamines, blood pressure and other heart medication

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Bacterial Vaginosis

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BACTERIAL VAGINOSIS Many women don’t know that vaginal infections are most commonly caused by bacteria rather than yeast (in the case of thrush) and trichomoniasis (a sexually transmitted infection).

BV is the most common cause of vaginal infections in women of childbearing age and is caused by certain bacteria leading to a pH imbalance in the vagina.

Most people experience symptoms such as: • Fishy or unpleasant odour • Watery discharge • Greyish white looking discharge • Worsening of the above after sex or during your period Everyone is different, so some women who have BV may not suffer from any symptoms.

BV is not a sexually transmitted infection and it should not cause any soreness or irritation.

Thrush or BV? Many women mistake BV for thrush, but they are two different infections with different symptoms. Because BV treatment is different to thrush treatment, it’s important to know which infection it is, so that the right product can be recommended.

Self-test kits are available so that women can quickly and reliably determine if they have thrush or BV from the comfort of their own home.

The Vagina The vagina is normally acidic, which helps prevent bad bacteria from growing and maintains the level of good bacteria called lactobacillus. If the pH balance becomes less acidic however, this can affect the health of the vagina. Different factors can affect the pH balance of the vagina, including menstruation, taking antibiotics, over-washing, using an IUD and semen if you sex has taken place without a condom. The imbalance of pH can be accompanied by overgrowth of anaerobic organisms that replace normal lactobacilli, causing BV. The vagina contains a natural balance of microorganisms which help keep the physiological environment in the vagina. This balance of microorganisms is known as vaginal flora. Lactobacilli make up the majority of vaginal flora.

Many factors can disrupt the level of lactobacilli in the vagina including antibiotics, hormonal changes and lifestyle factors (e.g. tight clothing, synthetic underwear or washing with harsh soaps and shower gels in the intimate area) which can cause vaginal infections.

Maintaining an optimal level of lactobacilli in the vagina is important to help protect against

vaginal infections as lactobacilli create a protective barrier over the walls of the vagina, and help to maintain an optimal pH.

Pregnancy and BV Pregnancy can cause an increase of bad bacteria and lead to problems like a BV infection. Pregnant women should visit their GP to discuss management of BV. It’s best to get checked out as BV can cause complications such as: • Pelvic inflammatory disease • Increased risk of miscarriage • Increased risk of premature labour

Treating BV Once a woman has been diagnosed with BV, either by self testing or by their doctor, it can usually be successfully treated using a short course of antibiotic tablets or a gel to be applied inside the vagina, which works by helping to regulate the pH balance.

Antibiotics Metronidazole is the most common antibiotic treatment for BV. It is available as tablets to be taken twice a day for five to seven days, a single larger-dose tablet, or a gel to apply inside the vagina once a day for five days Side effects - Metronidazole can cause nausea, vomiting and a slight metallic taste in the mouth.

It is best taken after after eating. Women should be advised not to drink alcohol while taking metronidazole and for at least 48 hours after finishing the course of antibiotics. Drinking alcohol while taking this medicine can cause more severe side effects.

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For some women, the first course of antibiotic treatment doesn’t treat BV effectively.

Vaginal pH correction treatments Vaginal pH correction treatments are a relatively new way of treating BV. These usually involve applying a pessary or gel to the inside of the vagina that changes the acid balance, making it a less hospitable environment for harmful bacteria. Some BV gels also relieve the unpleasant odour and abnormal discharge and come in applicator tubes for ease of use.

The recurrence rate of BV with antibiotics can be high. BV gels can provide an effective alternative to antibiotics for treatment and prevention.

Preventing BV It is common for BV to return. More than half of women successfully treated with BV find their symptoms return.

Women should be advised to: • avoid using deodorants or perfumed products in and around the vaginal area • Avoid over-washing • Avoid using strong detergent to wash underwear • Change their tampons or pads frequently • Ensure they wipe from front to back after going to the toilet • Dry their vaginal area after washing, swimming or exercise • Change their underwear after swimming or exercise

Who? Women of childbearing age, particularly those who are sexually active What are the symptoms? Fishy or unpleasant smelling vaginal discharge, sometimes greyish or watery. Remember that around half of women with bacterial vaginosis have no symptoms How long have they had the symptoms? Women who have frequent episodes of BV should be advised to see their GP Action already taken? Women may have tried washing the area, to remove the odour, but over-washing can make the problem worse Medication? BV is more common in women who use a IUD for contraception

Infant Analgesics

INFANT ANALGESICS

tolerated. It can be taken for pain and fever in children of three months and over who weigh more than 5kg (11lbs). Ibuprofen is not recommended for children who suffer with asthma, reflux, tummy, kidney, liver or heart problems. Ibuprofen takes effect in 1 to 2 hours, and can last up to 8 hours. Ibuprofen should be taken with milk or food to reduce the risk of gastrointestinal side effects.

Guidelines for Safe Use

Many OTC analgesic medications are not suitable for use by infants and children.

Some can be dangerous as children’s organs such as their liver and kidneys are still developing and are unable to break down medicines as efficiently as adults.

The most commonly used analgesics for infants and children for the treatment of pain and fever today are Paracetamol and Ibuprofen. Both analgesics are safe and effective for common childhood illnesses.

OTC analgesics are available in drops or syrups for babies and young children.

Parents should always read labels carefully to minimize the risk of overdose.

Identifying Pain in Babies and Toddlers Babies may be crying to communicate many things which may be mistaken for pain, such as: hunger, trapped wind, soiled nappy, tiredness or overheating. It is important to rule out any of these causes before administering pain relief.

Toddlers may be able to communicate using words, or they might hold or rub the part of the body that is causing them pain, for example they may poke or pull their ears if they may have an earache.

Causes of Pain Colic: may start within weeks of birth and symptoms peak around two to three months of age. Parents can be reassured that it should resolve by three to four months. Babies may have periods of intense crying, often in the early evening, pull up their legs and arch their backs.

They should still feed and gain weight.

Teething: first teeth can start appearing in babies around six to nine months of age.

Symptoms may appear from as early as three months, before teeth are visible. Teething causes pain and discomfort around the gums, swollen gums, excessive saliva production and an increased tendency to chew on objects for relief. The child may also have red, hot cheeks.

Colds and flu: caused by many different viruses, colds are normally mild and resolve within a couple of weeks. Symptoms include sneezing, sore throat, runny nose, mild fever and a cough. Flu symptoms may come on more quickly, and make the child feel more poorly.

They may complain of aching muscles.

Ear infections: children are more susceptible to ear infections and these often follow a cold.

Symptoms include ear pain, fever, vomiting, hearing loss and lethargy. Children may pull or tug at their ear and have a cough or runny nose. Ear infections should resolve within a few days.

Sore throat: often caused by a viral illness, a sore throat can be alleviated with pain relief.

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Given the high risk for overdose, parents should: • Only use analgesics for clearly defined symptoms of illness • Not give more than one type of analgesic to their baby • Give liquid medicine using a special spoon or liquid medicine measure. Never use a kitchen teaspoon, as they vary in size.

Paracetamol and ibuprofen for babies and children Paracetamol and ibuprofen are safe for treating pain and fever in babies and children.

Both are available as liquid medicines for young children. A sugar-free version should be recommended as medicines that contain sugar can a child’s teeth.

Paracetamol is safe to use for babies over 2 months onwards. Paracetamol works by blocking pain messages - the source of the pain is still present, it’s just not noticed as much. It can be taken on an empty stomach or with food or milk, and takes approximately 30-60 mins to work fully. Its effect lasts up to 4 hours.

Ibuprofen can be given to children who are aged three months or older and who weigh more than 5kg (11lbs). Ibuprofen has a similar effect to aspirin, but is more potent and better

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• Not give more than the recommended dose.

• Not give baby analgesics for longer than 24 hours.

• Check labels carefully. Caution needs to be taken with the wide variety of different strengths of oral preparations available.

• Monitor the effectiveness of the treatment.

Medicines to avoid Aspirin is no longer recommended for use by babies and children due to the risk of Reye’s Syndrome, which is a rare but dangerous disease (most cases have occurred in children and young adults recovering from a viral infection and they had taken aspirin to treat their symptoms). Other analgesics containing opioids and medications containing narcotic drugs can have potentially serious effects for babies and children because they produce a sedative effect that may impair breathing function.

Who? Paracetamol can be given to children aged two months or older for pain or fever. Ibuprofen can be given to children who are aged three months or older and who weigh more than 5kg (11lbs) What are the symptoms? Complaining of pain, soreness and crying. It is important to rule out other causes of distress in babies before administering pain relief How long have they had the symptoms? Babies should not be given analgesics for more than 24 hours Action already taken? Parents may have tried pain relief. They should not give the child paracetamol and ibuprofen at the same time, unless advised to by a healthcare professional Medication? If the child has asthma, get advice from a GP before giving them ibuprofen

Cold Sores

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COLD SORES Cold sores, also known as fever blisters, are caused by the HSV-1 virus and are common and easy to recognize. Usually appearing as red bumps or blisters around the lips and mouth, those affected can seek a number of treatments from pharmacists that reduce the duration of cold sores when used at first sign of a break out.

Causes Cold sores are caused by a form of the herpes simplex virus. Once infected, the virus never leaves the body. The virus is usually first contracted in early childhood where it may not appear as a visible cold sore.

The herpes simplex virus has two distinct types: HSV-1 and HSV-2. Both types can cause sores around the mouth (herpes labialis) and on the genitals (genital herpes).

Up to 80% of the global population has the HSV-1 virus because it’s so contagious.

Damaging the skin as it reproduces itself and creating cold sores, the virus enters the body initially through a break in the skin around or inside the mouth.

HSV invades the cells of the epidermis, the outer layer of the skin, causing fluid-filled blisters to appear. The virus travels from the epidermis along the nerve paths to the roots of the nerves where it becomes inactive.

The virus is extremely contagious, and spreads when a person has interaction a cold sore. They can also spread when a person has interaction with infected fluid such as saliva. Examples of way that the virus can spread in this way include through the sharing eating utensils or razors or kissing an infected person.

Cold sores can also be spread to other areas of the body such as the nose or chin. There are other triggers for people who get cold sores such as sunlight, fever, stress and menstruation.

Most people will have come into contact with the virus at an early age (between the ages of three and five) but will often not show any symptoms until after puberty.

Around 1 in 3 people will experience recurrent infections. The HSV-1 virus ‘wakes up’, infects the cells in or around the lip or mouth and causes a visible and contagious sore.

Symptoms Symptoms of cold sores usually occur after something has triggered the virus, like a rundown immune system or cold, dry weather leading to dry, chapped lips.

Prior to a breakout, there are certain sign to look out for such as: • Tingling lips • Sore mouth that makes eating, and drinking uncomfortable • Fever • Sore throat • Swollen lymph nodes in the neck

At break out of a cold sore, the skin around the blister is often red, swollen, and sore. Blisters usually open, leak a clear fluid, and scab over after a few days. Without treatment, these cold sores can heal themselves within 10 days.

Treatment Nothing can prevent an outbreak, however there are a number of treatments that work to reduce the duration of cold sore symptoms such as: • OTC antiviral creams can speed up the healing process.

• Cold sore patches containing hydrocolloid gel that ordinarily treats skin wounds. The patch is placed over the cold sore while it heals.

• In severe cases, the patient should be referred to their GP so that antiviral tablets may be prescribed.

General Advice on Management • Avoid triggers such as stress and colds.

• Avoid too much direct exposure to sunlight as it can cause cold sores to flare.

• Drink plenty of fluids to avoid dehydration • Try to avoid acidic or salty foods and eat cool, soft foods.

• If brushing teeth the is painful, use an antiseptic mouthwash.

• Dab creams on to sores – avoid rubbing them.

• Wash hands regularly using soap and water before and after applying cold sore creams.

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Possible Complications • Cold sores can become infected by bacteria.

• Dehydration can occur if the lesions are so painful as to discourage drinking.

Young children in particular may be at risk of dehydration.

• Herpetic whitlow (whitlow finger). Should the cold sore virus spread to another part of the body it may cause a secondary infection. The whitlow finger is such an infection, when the virus has come into contact with a graze or cut on the skin.

• If the condition spreads to the eyes, a secondary infection of the cold sore virus (herpetic keratoconjunctivitis) can occur. It is easily treated, but if left untreated it can damage vision.

• In patients who suffer from atopic dermatitis, cold sores can, in rare cases, spread to larger parts of the body.

• Larger cold sores can be a sign that another disease, such as pneumonia or HIV as the body’s defences are weakened due to the virus.

• Encephalitis (an infection or inflammation of the brain from any source). Very rarely, the cold sore virus can be responsible for Encephalitis, which if left untreated, could lead to brain damage or even death.

Encephalitis is treated with intravenous antiviral medication, such as aciclovir .

Who? Anyone infected with the herpes simplex virus, but predominantly HSV1 What are the symptoms? Tingling, swollen lip, pain, blisters How long have they had the symptoms? Cold sores should clear within 2 weeks, but patient may need referred to a GP if symptoms persist Action already taken? Customers may already have purchased cream to speed up the healing process Medication: Caution should be taken with patients who have existing skin conditions and are applying creams or treatments to skin

Colds

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COLDS The common cold is a mild, viral infectious disease of the upper respiratory tract that primarily affects the nose. The throat, sinuses, and larynx can also be affected. Signs and symptoms may begin less than two days following exposure.

People usually recover in seven to ten days, but some symptoms may last up to three weeks. For most, the symptoms can be easily managed at home with OTC medication. Colds do not respond to antibiotics because they are caused by a virus. The common cold is the most frequent infectious disease in humans; the average adult gets two to four colds a year, while the average child may get six to eight. Colds occur more commonly during the Winter.

The main symptoms of a cold • Sore throat • Blocked or runny nose • Sneezing • A cough More severe symptoms, including a high temperature (fever), headache and aching muscles can also occur, although these tend to be associated more with flu.

How do colds spread?

• Using decongestant sprays or tablets to relieve a blocked nose.

• Medicated lozenges can provide relief from sore throats.

When to Refer for Further Advice People whose symptoms persist for more than three weeks or have symptoms which get suddenly worse should see their GP. People with respiratory problems and breathing difficulties should also seek advice.

High fever – A high temperature above 39°C that does not come down when treated with ibuprofen and/or paracetamol.

Signs that may suggest a more serious condition People purchasing OTC medication for colds should be advised of the following warning signs:

In general, a person becomes contagious from a few days before their symptoms begin until all their symptoms have gone. This means most people will be infectious for around two weeks.

• Effect on day to day life - they are confused or disorientated.

The virus from an infectious person by:

• If they are experiencing difficulty breathing.

• Touching an object or surface contaminated by infected droplets and then touching the mouth, nose or eyes.

• Cough up blood-stained phlegm.

• Touching the skin of someone who has the infected droplets on their skin and then touching the mouth, nose or eyes.

• Inhaling tiny droplets of fluid that contain the cold virus – these are launched into the air when an infected person coughs or sneezes.

Colds spread most easily among groups of people in constant close contact, such as families and children in school or day care facilities. They’re also more frequent during the winter, although it’s not clear exactly why.

Several different viruses can cause a cold, so it’s possible to have several colds one after the other, as each one may be caused by a different virus.

Treating a cold There’s no cure for a cold, but most people can look after themselves at home by: • Resting, drinking plenty of fluids and eating healthily.

• Taking OTC painkillers, such as paracetamol or ibuprofen, to reduce any fever or discomfort.

• If they notice a sharp pain in the chest.

• If they notice a swelling of the glands in the neck and/or armpits.

• Their symptoms last longer than 3 weeks.

People should be advised to consult their GP if they notice any of these warning signs, which may suggest that their symptoms could possibly be caused by a more serious underlying condition or may require medical attention.

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Preventing the spread of a cold • Wash your hands regularly, particularly before touching your nose or mouth and before handling food.

• always sneeze and cough into tissues – this will help prevent the virus-containing droplets from your nose and mouth entering the air, where they can infect others; you should throw away used tissues immediately and wash your hands.

• clean surfaces regularly to keep them free of germs.

• use your own cup, plates, cutlery and kitchen utensils.

• don’t share towels or toys with someone who has a cold.

• It’s been suggested that vitamin C, zinc and garlic supplements may help reduce your risk of getting a cold, but there’s currently not enough strong evidence to support this.

Common Cold Myths Feed a cold, starve a fever – Cold symptoms supress the appetite and force-feeding won’t help. It is more important to stay hydrated and get enough calories.

You’ll get sick if don’t wear a coat - Colds and flu are caused by viruses. They do circulate during cold weather, but are more likely to be picked inside than out. Going outside and getting more physical activity, not just during cold and flu season is actually more likely to help prevent sickness.

A wet head can make you catch a cold – Apart from feeling physically cold as a result of going outside with wet hair, it will not cause a person to catch a cold. Again, this is because colds are caused by a virus.

Who: Anyone, more commonly in Autumn and Winter What are the symptoms? Runny nose, headache, sinus pain affecting the forehead, cheeks, and nose, nasal discharge, nasal congestion, fever, scratchy or sore throat How long have they had symptoms? If the onset is immediate it is more likely to be flu Action already taken? The customer may have already purchased OTC products Medication: It is important not to take various medications simultaneously as it could lead to overdose. Antibiotics have no effect against viral infections or against the viruses that cause the common cold

The first self-selection laxative on the Irish Market containing Macrogol 4000, a NEW ingredient in the Dulco range A great option for a wide range of customers, including: • those treating constipation for the first time, • those looking for a gentle laxative with a pronounced stool softening effect, or • pregnant and breastfeeding women and children between 2-8 years when advised by a doctor.

SAIE.DULC1.17.06.0139 July 2017

Constipation

CONSTIPATION Constipation occurs when a person’s digestive system, for one reason or another, does not function properly.

Referring to instances where bowel movements are difficult or happen less often than normal, almost anyone at any age can be affected by constipation at some point in their life.

Complications from Constipation

Symptoms Each person can experience constipation differently. While constipation symptoms are not the same for everyone, there tend to be some common signs and symptoms such as: • Feeling bloated

Usually not a serious condition, constipation can be painful however learning to identify and understand its symptoms and causes can help a person interpret their body’s messages more clearly to help them find the right type of relief.

Causes Constipation can be caused by certain diet and lifestyle choices as well as physiological changes and certain medications.

Sometimes it is not always easy to anticipate what will cause constipation; and it is not always predictable. Causes of constipation include: • Changes to diet or level of activity (high fat and refined sugar, low in fiber) • Dehydration • Stress • Large intake of dairy products • IBS • Eating Disorders • Change to daily routine • Not using bathroom when having the urge to go • Inactivity/Lack of exercise • Pregnancy - Approximately 40% of pregnant women experience constipation during their pregnancy.

More serious causes of constipation include: • Colon cancer • Neurological conditions such as MS or Parkinson’s disease Constipation may also be a side effect of a medicine a person may be taking.

Common types of medication that can cause constipation include:

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• Feeling Nauseous • Stomach Aches and Cramps • Loss of appetites • Having painful difficult bowel movements (excessive straining while going) • Having dry, hard stools • Having the feeling of incomplete evacuation after a bowel movement

Constipation rarely causes any complications or long-term health problems however in some cases of chronic (long-term) constipation, a patient can be more at risk of experiencing complications such as: • Haemorrhoids - More commonly known as piles haemorrhoids are swollen blood vessels that form in the lower rectum and anus.

• Faecal impaction - worsens constipation because it makes it harder for stools and waste products to pass out of your anus as the path is obstructed.

• Psychological effects - Faecal incontinence can be very upsetting and embarrassing talking openly and honestly about the constipation can help create a better understanding the condition.

Facts and Myths

Treatment

There are a number of facts and myths surrounding constipation such as:

There are a variety of over-the-counter treatment options available to relieve constipation. Such as:

Myth: It’s abnormal if you do not have a bowel movement a day.

• Stimulant Tablet (Taken by mouth)

Fact: Less than 50% of people have one bowel movement a day.

• Stimulant Suppository (Inserted rectally) • Stool Softener • Osmotic • Bulk-forming • Lubricant *Laxcitives should not be used for two weeks without informing your GP as laxative overuse can worsen symptoms.

More lifestyle orientated treatment suggestions include: • Drinking two to four extra glasses of water • Trying warm liquids, especially in the morning • Adding fruits and vegetables to your diet • Eating high fibre foods such as bran and prunes Treatment for constipation is effective but it may take a while for a regular bowl pattern to return.

If constipation lasts longer than 1 week, or a sudden change in bowel habits is noticed, it is important to consult a doctor.

Myth: Chronic constipation is recognised as fewer than five or six bowel movements a week.

Fact: 95% of adults have bowel movements between three and 21 times per week.

Myth: If bowel movements are infrequent, toxins accumulate in the intestine.

Fact: There is absolutely no scientific evidence that “toxins” accumulate when bowel movements are infrequent. It has not been proven that constipation leads to diseases such as cancer however a case of constipation lasting longer than a week should be referred to a doctor.

Myth: Not being active enough causes constipation Fact: While being inactive can accompany other issues, inactivity alone does not cause constipation.

Myth: If you eat well, drink plenty of fluids, and exercise you should never suffer from chronic constipation.

Fact: There are various reasons for constipation

• Aluminum antacids (medicine to treat indigestion) • Antidepressants • Antiepileptics (medicine to treat epilepsy) • Antipsychotics (medicine to treat schizophrenia and other mental health conditions) • Calcium supplements • Diuretics (water tablets) • Iron supplements If constipation is caused by medication, the condition usually eases once the medication is stopped being taken. However, a GP should be consulted before stopping any medication.

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Who: Anyone can be affected What are the symptoms? Is this a mild or chronic case?

How long have they had symptoms? Is this a recent or ongoing problem?

Action already taken? Customers may already have purchased laxatives Medication: Antacid medications containing calcium or aluminium can cause constipation, check if the patient is taking those before suggesting anything else

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Buttercup Bronchostop Cough Syrup contains thyme herb extract and marshmallow root extract. A traditional herbal medicinal product for the relief of coughs, such as chesty, dry, tickly, irritating coughs and catarrh, exclusively based upon long-standing use. Adults and children over 12 years: 15ml every 4 hours. Max dose 90ml per day. Not recommended for children under 12 years. Seek medical advice if symptoms persist after 7 days or if dyspnoea, fever or purulent sputum occurs. Contraindications: Known hypersensitivity to ingredients, rare hereditary intolerance to some sugars. Caution: Not recommended for use in Pregnancy and lactation. Contains methyl parahydroxybenzoate and propyl parahydroxybenzoate, which may cause allergic reactions. Side effects: Stomach disorders. TR 2006/1/1. TR Holder: Kwizda Pharma GmbH, Effingergasse 21, A-1160 Vienna, Austria. RRP (ex.VAT) 120ml €6.99, 200ml €9.99, 290ml €12.99 SPC: www.medicines.ie/medicine/16380/SPC/ Buttercup+Bronchostop+Cough+Sy rup Buttercup Bronchostop Berry Flavour Cough Pastilles contain thyme herb extract. A traditional herbal medicinal product for the relief of coughs, such as chesty, dry, tickly, irritating coughs and catarrh, exclusively based upon long-standing use. Adults and children over 12 years: 1 - 2 pastilles every 4 hours. Max dose 12 pastilles per day. Not recommended for children under 12 years. Seek medical advice if symptoms persist after 7 days or if dyspnoea, fever or purulent sputum occurs. Contraindications: Known hypersensitivity to ingredients, rare hereditary intolerance to some sugars. Caution: Not recommended for use in Pregnancy and lactation. Contains 0.6 g fructose per 2 pastille dose – to be taken into consideration in those with diabetes mellitus. Side effects: Stomach disorders. TR 2006/1/2. TR Holder: Kwizda Pharma GmbH, Effingergasse 21, A-1160 Vienna, Austria. RRP (ex. VAT) 10s €3.99 20s €5.99 SPC: www.medicines.ie/medicine/16381/SPC/ Buttercup+Bronchostop+Berry+Flavour+Cough+Pastilles/

Coughs

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COUGHS A cough (a reflex action to clear your airways of mucus and irritants such as dust or smoke) can be classified in two categories, non-productive and productive coughs. Within these categories, coughs can also be classified by how long they last.

• Acute cough lasts for less than three weeks • Subacute cough gets better over a three-to-eight-week period • Chronic (persistent) cough lasts for longer than eight weeks

Non-productive Cough A non-productive cough is one that does not bring up any mucous. It’s also known as a dry cough.

Non-productive coughs tend to be caused by irritation in the throat or swelling in the airways caused by other conditions such as asthma or bronchitis. Non-productive coughs can occur when you a person has a cold, the flu or any other upper respiratory illness. These illnesses can also cause a productive cough as well.

Productive Cough A productive cough causes the formation of mucus or phlegm in the lung. Also known as a chesty cough, this type of cough causes the cough reflex to be triggered to help raise phlegm in order to clear the lungs. These types of coughs can occur along-side a build-up of catarrh in the nasal passage.

Mucus or phlegm can vary in appearance and be either: • Green • Yellow • White and creamy • Clear • Blood-tinged • Dark red blood • Bright red blood Coughs occur when there an upper respiratory infection (or cold) is present. This cause, usually resolves within a few days- however some symptoms can get in the way of work and other activities so treatment is recommended.

Much more serious illnesses can also cause productive coughs so it is important to check how long the symptoms of the cough have been present, and if there are other symptoms a patient may be experiencing. If the cough is productive and lasts longer than a week or two, a referral to a doctor or GP is recommended.

Immediate medical attention from a doctor should be sought should a patient produce pink, frothy secretions or blood when coughing. This can be a sign of a lifethreatening condition. This can be a sign of a life-threatening condition. You should contact your health care provider right away if you are coughing up blood also.

Recommendations Coughing is irritating no matter which category it falls under (productive or non-productive), and often patients will seek to have them resolved quickly.

Establishing and eliminating whether a cough requires a trip to the doctor, is the first step to being able to recommend the correct relief for a patient.

Whilst recommending medication, there are steps that a patient should be encouraged to take in order to aid relief, such as drinking plenty of water to stay hydrated and running a humidifier when sleeping at night.

Treatments There are several types of treatments available such as: • Cough suppressants - Suppressants do their job by blocking the cough reflex.

Dextromethorphan is the most common ingredient for this. This ingredient will be listed as DM on the medication packaging.

• Expectorants – help loosen and thin mucus and help bring up phlegm so that coughing is easier. They include compounds such as

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guaiphenesin, ammonium chloride, squill, sodium citrate and ipecacuanha which are found in small quantities of cough mixtures so they are unlikely to have any side effects or interact with any other medicines.

• Topical Ointments - Camphor and menthol are types of natural treatments. They usually come in an ointment which can be rubbed on the throat and chest. Their strong-smelling vapors can ease a cough and open up stuffy sinuses.

• Combination Medicine - Many over-thecounter treatments mix both a suppressant and expectorant with medicines for other symptoms. These could include an antihistamine, a decongestant, and a pain reliever. A mixture of medications in one can be effective if a person has a range of cold symptoms, such as: body aches, coughs, and congestion. However, some medications may cause drowsiness, alcohol, and may not be suitable for children.

• Herbal medication - has been in used for the treatment of coughs and colds for many years, often used ingredients in treatments include: herbs like thyme which has antiseptic properties, marshmallow extract which is an anti-inflammatory, and menthol as it has decongestant properties. Herbal medicines also tend to be free from alcohol and sugar.

Who? Anyone can be affected What are the symptoms? Depending on type of cough to suggest if it is allergic or viral How long has the patient had the symptoms? Coughs should clear after 3 weeks, is it short or persistent?

Action already taken? Customers who may already have purchased cough medicines Medication? Some of the ingredients in cough medicines should not be given to children such as opioids. Antacids may interfere with other medicines

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Find out more at: aptamilhcp.ie Call our freephone: 1800 22 12 34 References: 1. Høst A et al. Arch Dis Child 1999; 81(1):80-4. 2. Verwimp JJ et al. Eur J Clin Nutr. 1995; 49 Suppl 1:S39-48. 3. Giampietro PG et al. Pediatr Allergy Immunol. 2001; 12(2):83-6. 4. Mabin DC et al. Arch Dis Child 1995; 73(3): 208-10.

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Cow’s Milk Allergy 29

COW’S MILK ALLERGY From stomach cramps to sickness and diarrhoea, there are many similarities between milk intolerance and milk allergy symptoms. The names of these conditions are often used interchangeably and not always correctly. Knowing how to recognise them can help get a quicker diagnosis for the baby, and lead to an effective dietary management programme, either through the mum’s own diet if they are breastfeeding, or with a specialised allergy formula milk if bottle-feeding.

Exclusive breastfeeding is recommended by the World Health Organisation up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond.

Allergy or intolerance?

Feeding and milk allergies

Babies can either be allergic or intolerant to milk. Because some of the symptoms of milk allergy and milk intolerance are similar, they are difficult to diagnose.

Managing a cows’ milk allergy involves removing all cows’ milk from the baby’s diet, so parents should always read ingredients on food labels. Common allergens, like milk, must be declared on pre-packaged foods.

A milk allergy involves an immune reaction to one or more of the proteins present in milk, whereas an intolerance does not involve the immune system. An intolerance is caused by an inability to deal with certain substances in milk, such as lactose. Lactose intolerance is when some individuals don’t produce any or enough of the enzyme lactase which breaks down lactose. Undigested lactose causes symptoms like diarrhoea, bloating and wind.

Recognising milk allergy If a baby is allergic to milk, they will react to infant formula which is based on cows’ milk and sometimes, but very rarely, to breast milk the mother recently consumed dairy products. Symptoms include stomach cramps, vomiting, diarrhoea, rashes, hives, eczema, and difficulty breathing. Individual symptoms can sometimes be related to a bug, but if the baby is affected in two separate areas of the body – for example, the stomach (vomiting) and skin (hives), parents should ask their health visitor or Doctor for advice.

It’s common for babies who are allergic to cows’ milk to be allergic to goats’ milk and sheep’s milk too, as they contain similar proteins. Unfortunately, there is no single diagnostic test for cows’ milk allergy and a combination of tests and a series of elimination and reintroduction diets are often necessary.

Giving the Doctor as much detail about the baby’s symptoms as possible can help speed up the diagnosis process. By keeping a diary of their symptoms, including when they occur and how long they last for, can help the doctor identify or rule out cows’ milk allergy. Taking photos of any skin reactions, such as a rash, can be helpful too. They should advise the Doctor if is a history of allergy in the family.

If a baby is being formula fed and has been diagnosed with cows’ milk allergy, The Doctor may prescribe an extensively hydrolysed formula. The protein in these formulae has been broken down into smaller pieces so that the baby’s immune system does not recognise it as an allergen – a process which does not affect the nutritional value of the formula.

Soya formulae are not recommended before 6 months as they contain phytoestrogens (plant-based compounds with oestrogen-like properties), and infants who react to cows’ milk-based formulae often also react to soyabased formulae.

In rare cases, the baby may be reacting to the milk proteins passing from the mothers’ diet into breast milk. If a breastfeeding mothers’ baby is diagnosed with cows’ milk allergy, she may have to change her diet but this is quite rare.

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Identifying Lactose Intolerance A baby with a lactose intolerance usually experiences less severe reactions than one with an allergy. As with a milk allergy, symptoms of lactose intolerance can include diarrhoea, vomiting, and stomach cramps but not usually hives or breathing difficulties. Another difference is that a lactose intolerance will not show up in a blood or skin-prick test. However, the baby’s reaction will be noticeable, if not as severe as that of an allergy.

There are two main types of lactose intolerance: The first is primary lactose intolerance, and is caused by a deficiency in the enzyme lactase. It normally affects Hispanic, Asian and American Indian populations, but is uncommon in Europeans. Primary lactose intolerance doesn’t mean that lactose must be removed from the diet entirely: depending on the individual, those with primary lactose intolerance can often tolerate a certain amount of lactose.

Secondary lactose intolerance is usually caused by damage to the gut, after a severe stomach bug, for example. But this form of the condition is usually temporary, until the gut heals. In very severe cases, lactose may need to be removed from the diet for a few weeks.

Who? Babies and infants What are the symptoms? Stomach cramps, vomiting, diarrhoea, rashes, hives, eczema, and difficulty breathing How long has the patient had the symptoms? Only around 2–7.5% of babies under 1 year old are allergic to cows’ milk. By the age of three most children will have grown out of cows’ milk allergies Action already taken? If a baby is being formula fed and has been diagnosed with cows’ milk allergy, The Doctor may have prescribed an extensively hydrolysed formula Medication? Parents may be using creams or emollients to treat the symptoms affecting their baby’s skin

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PRESCRIBING INFORMATION DIORALYTE™ NATURAL, BLACKCURRANT AND CITRUS, POWDER FOR ORAL SOLUTION Presentation: Sachet containing the active ingredients Sodium Chloride 0.47g, Potassium Chloride 0.30g, Glucose 3.56g and Disodium Hydrogen Citrate 0.53g. Indications: Oral correction of fluid and electrolyte loss and the management of watery diarrhoea in infants, children and adults. Dosage and Administration: Each sachet should be reconstituted in 200ml (approximately 7 fluid ounces) of fresh drinking water. For infants where fresh drinking water is unavailable the water should be freshly boiled and cooled. The solution should be made up immediately before use. If refrigerated, the solution may be stored for up to 24 hours, otherwise any solution remaining an hour after reconstitution should be discarded. The solution must not be boiled after reconstitution. Daily intake may be based on a volume of 150ml/kg body weight for infants and 20-40 mg/kg body weight for adults and children. A reasonable approximation is: Infants – One to one and a half times the usual feed volume. For infants under 12 months, use only under medical advice. Children – One sachet after every loose motion. Adults (including elderly) – One or two sachets after every loose motion. More may be required initially to ensure early and full volume repletion. Contraindications: None known. Warnings and Precautions: The solution must not be reconstituted except with water at the volume stated. Solutions of greater concentration may result in hypernatraemia. Those of greater dilution may result in inadequate replacement. If there is no improvement within 24-36 hours, consult the physician.

If nausea and vomiting are present with the diarrhoea, small but frequent amounts of dioralyte should be drunk at first. No specific precautions are necessary in the elderly. However, caution is required in cases of severe renal or hepatic impairment or other conditions where the normal electrolyte balance may be disturbed. Pregnancy and Lactation: Dioralyte is not contra-

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indicated in pregnancy or lactation. Interactions and Adverse Effects: None stated. Overdose: In the event of significant overdose, serum electrolytes should be evaluated as soon as possible, correct any abnormalities and monitor levels until return to normal, especially in the very young and in cases of severe hepatic or renal failure. Precautions for Storage: Do not store above 25°C. The reconstituted solution should be used immediately but may be stored for up to 24 hours in a refrigerator at 2-8°C. Marketing Authorisation Holder: Sanofi Ireland Ltd., Citywest Business Campus, Dublin 24. Marketing Authorisation No. PA 540/98/1 (Blackcurrant), PA 540/98/2 (Citrus), PA 540/99/1 (Natural) Legal Category: P Further information: Available from Sanofi Ireland Ltd., Citywest Business Campus, Dublin 24 or contact IEmedinfo@sanofi. com. Please refer to Summary of Product Characteristics which can be found on IPHA at http://www.medicines.ie/ before prescribing. Date of Preparation: January 2016 Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via HPRA Pharmacovigilance, Earlsfort Terrace, IRL - Dublin 2; Tel: +353 1 6764971; Fax: +353 1 6762517. Website: www.hpra.ie; E-mail: medsafety@hpra.ie.

Suspected adverse events can also be reported to Sanofi Ireland Ltd. directly by emailing IEPharmacovigilance@Sanofi.com or calling 01 403 5600.

Date of Preparation: March 2017 SAIE.DIO.17.01.0010b

Diarrhoea

DIARRHOEA Diarrhoea is passing loose or watery faeces more than three times a day. A common cause in both children and adults is gastroenteritis. Bouts of diarrhoea in adults may also be brought on by anxiety or drinking too much coffee or alcohol. Diarrhoea may also be a side effect of a medication. In adults, diarrhoea caused by gastroenteritis will usually clear up in two to four days when the infection has cleared.

The symptoms of travellers’ diarrhoea usually start within two to three days of travelling abroad. Over 90% of cases occur within the first two weeks of a holiday. The symptoms usually get better without medical treatment within three to five days. In around 5-10% of travellers, the diarrhoea can last for two weeks or longer. For 1-3% of travellers, the diarrhoea can last longer than a month.

Persistent Diarrhoea Diarrhoea in adults that lasts for more than a few weeks may be a sign of a more serious condition, such as Crohn’s disease, or Irritable Bowel Syndrome. It should always be investigated by a GP - especially if a person is seeing blood or pus in their faeces.

A person should see their GP if: • They have recently been treated in hospital, or with antibiotics.

• They have diarrhoea that has blood in it, or are bleeding from the rectum.

• They have diarrhoea and persistent vomiting.

• Experiencing unexplained weight loss.

• They have passed large volumes of very watery diarrhoea, as they may be at risk of dehydration.

• Their symptoms at night that are disturbing their sleep.

• The diarrhoea lasts longer than a week.

• A baby has had six or more episodes of diarrhoea in the past 24 hours.

Dehydration Symptoms of dehydration in children include: • appearing to get more unwell • being irritable or drowsy • passing urine infrequently • pale or mottled skin • cold hands and feet Symptoms of dehydration in adults include:

• sunken eyes • muscle cramps • rapid heartbeat • Nausea • Vomiting

Treating Dehydration Oral rehydration therapy may be recommended particularly for at-risk groups, to reduce the risks of dehydration. An oral syringe may be helpful for administering fluids slowly to children. Home-made salt or sugar drinks should be avoided.

Oral rehydration products must be mixed with 200ml of fresh drinking water according to the manufacturer’s instructions. For infants where drinking water is unavailable the water should be freshly boiled and cooled. The solution should be made up immediately before use. If refrigerated, the solution may be stored for up to 24 hours, otherwise any solution remaining an hour after reconstitution should be discarded. The solution must not be boiled after reconstitution.

Daily intake may be based on a volume of 150ml/kg body weight for infants and 20-40 mg/kg body weight for adults and children. A reasonable approximation is: Infants - One to one and a half times the usual feed volume.

For infants under 12 months, use only under medical advice. Children - One sachet after every loose motion. Adults including elderlyOne or two sachets after every loose motion.

More may be required initially to ensure early and full volume repletion.

The solution can be given as 5-10ml as every 5 minutes, gradually increased until the child is able to drink normally. It is recommended not to eat in the early stages of diarrhoea. Bottle and other infant feeds should also be stopped initially, however breastfeeding can continue as normal.

Advice on Eating Expert opinion is divided over when and what a person should eat if they have diarrhoea, but most agree that eating solid food as soon as they feel able to is advisable. They should eat small, light meals and avoid fatty, spicy or heavy foods. If a person feels they cannot eat, it should not do them any harm, but they should make sure that they continue drinking fluids, and eat as soon as they can.

If a child is dehydrated, parents should be advised not to give them any solid food until

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• lacking energy or feeling tired • loss of appetite • nausea • feeling light-headed • dizziness, especially when standing up • dry tongue

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they have drunk enough fluids. Once they have stopped showing signs of dehydration, they can start eating their normal diet. If the child is not dehydrated, they can be offered their normal foods. If a child refuses to eat, parents should continue to offer drinks and wait until their appetite returns.

Antidiarrhoeal Medicine Antidiarrhoeal medicines may reduce the diarrhoea and shorten how long it lasts by around 24 hours. However, they are not usually necessary unless shortening the duration of a person’s diarrhoea helps them to get back to their essential activities sooner.

Loperamide is the preferred antidiarrhoeal medicine because it causes fewer side effects and there is more evidence of its effectiveness.

Loperamide slows down muscle movements in the gut, which leads to more water being absorbed from faeces. The faeces then become firmer and are passed less frequently.

Antidiarrhoeal medicines should not be taken by anyone who has blood or mucus in their stools or if they have a high temperature. Children should not be given antidiarrhoeal medicines.

Who? Anyone What are the symptoms? Loose stools, cramps How long has the patient had the symptoms? Usually gone after a few days, if symptoms persist refer to GP Action already taken? Patients may be taking pain relief medication Medication? Children should not be given antidiarrhoeal medicines.

Oral rehydration therapy may be recommended particularly for at-risk groups, to reduce the risks of dehydration

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Dry Eye

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DRY EYE Dry eye syndrome, or dry eye disease, is a common condition that occurs when the eyes don’t make enough tears, or the tears evaporate too quickly. This leads to the eyes drying out and becoming red, swollen and irritated. Dry eye syndrome is also known as keratoconjunctivitis sicca, or simply “dry eyes”.

Symptoms of dry eye syndrome The symptoms of dry eye syndrome are mild for most people, although more severe cases can be painful and lead to complications.

Symptoms usually affect both eyes and often include: • feelings of dryness, grittiness or soreness that get worse throughout the day • burning and red eyes • eyelids that stick together when waking up • temporarily blurred vision, which usually improves when blinking • Some people may also have episodes of watering eyes, which can occur if the eye tries to relieve the irritation by producing more tears.

Causes of dry eye syndrome Dry eye syndrome can occur when the complex tear production process is disrupted in some way. There are many different reasons why this can happen, although a single identifiable cause often can’t be found.

Although the condition may affect people of any age, the chances of developing dry eye syndrome increase as we grow older. It’s estimated up to one in every three people over the age of 65 experiences problems with dry eyes. Dry eye syndrome is more common in women than men.

Hormonal changes - Hormones and the nervous system play an important part in tear production. Hormones stimulate the production of tears. Changes in hormone levels in women can increase their risk of dry eye syndrome. For example: during pregnancy, the menopause and while using the contraceptive pill.

Ageing - Dry eye syndrome is more common in older people. This may be because we produce fewer tears as we get older, and the eyelids become less effective at spreading tears over the surface of the eyes.

Environmental factors can have a drying effect on the eyes, causing your tears to evaporate. These include: sun, wind, dry climate, hot blowing air, high altitude.

Certain activities can also contribute to dry eye syndrome, such as: reading, writing, working with a computer - People tend to blink less frequently during activities that require visual concentration. This means the tear film evaporates or drains away more quickly than it’s replenished.

Certain medications Several medicines are thought to cause dry eye syndrome as a side effect in some people, including: antihistamines, antidepressants, betablockers, diuretics, Laser eye surgery - Some people who have had certain types of laser eye surgery find they have dry eye syndrome in the weeks after surgery.

Contact lenses Sometimes contact lenses irritate the eye and cause dry eye syndrome.

Changing to a different type of lens or limiting contact lens use usually helps resolve the symptoms, as can changing cleaning solutions or using preservative-free lubricant eye drops.

Medical conditions There are a number of medical conditions that increase the risk of developing dry eye syndrome.

Blepharitis - Many people with dry eye syndrome also have blepharitis or meibomian gland dysfunction (MGD). This is where the eyelid margins become inflamed, which can block the glands that produce oils for the tear film. Blepharitis can occur at any age and in otherwise healthy people, although it sometimes occurs as the result of a bacterial infection or other conditions, such as rosacea.

Allergic conjunctivitis inflammation of the transparent layer of cells that covers the white part of the eyeball and the inner surfaces of the eyelids (conjunctiva) caused by an allergy, usually to pollen and dust mites Contact dermatitis is a type of eczema that causes inflammation of the skin because of a substance the person is sensitive to.

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Sjögren’s syndrome is a condition that can cause excessive dryness of the eyes, mouth and vagina, which is also associated with fatigue and arthritis Rheumatoid arthritis causes pain, swelling and inflammation in the joints that can affect any part of the body, including the glands around the eyes and inflammation of the white of the eye (scleritis)

Treatments Dry eye syndrome isn’t usually a serious condition. Treatments are available to help relieve the symptoms, which include: • eye drops to lubricate the eyes • medications to reduce any inflammation • if necessary, surgery to prevent tears from draining away easily If dry eye syndrome is caused by an underlying condition, treating this condition usually helps to relieve the symptoms.

Self-care for eyes As well as medical treatments, there are some things which can be done to help prevent dry eye syndrome or reduce the symptoms: • keeping the eyes and eyelids clean and protecting them from dusty, smoky, windy and dry environments • using computers or laptops correctly to avoid eye strain • using a humidifier to moisten the air • eating a healthy diet that includes omega-3 and omega-7 fats

Who? One in every three people over the age of 65 experiences problems with dry eyes. Dry eye syndrome is more common in women than men What are the symptoms? feelings of dryness, grittiness or soreness that get worse throughout the day, burning and red eyes How long have they had the symptoms? People with persistent but mild symptoms of dry eye syndrome should speak with an optometrist Action already taken? People may already be using lubricating eye-drops, but the above self-care steps can also relieve symptoms Medication? Antihistamines, antidepressants, beta-blockers, diuretics can all cause dry eye as a side effect

Dysphagia

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DYSPHAGIA Dysphagia is the medical term to describe difficulty swallowing. Clinically dysphagia can be classified into two categories, oropharyngeal and oesophageal dysphagia.

• Oropharyngeal dysphagia – Is the inability to initiate the act of swallowing and is a transfer problem due to the impaired ability to transfer food from the mouth to the upper oesophagus.

• Oesophageal dysphagia - is a ‘transport problem’ and is defined as the sensation of difficult passage of solids from the mouth to the stomach.

Although dysphagia can happen to anyone, it is most common in older-adults, babies, and people who have problems of the brain or nervous system. This problem can extend to taking medication, which can be very problematic when a child or elderly person is ill.

Causes If a patient has a hard time swallowing once or twice, they are unlikely to have a medical problem. However, if a patient has trouble swallowing on a regular basis they have a more serious problem that requires treatment.

Various rare conditions that cause inflammation or reduced function of the oesophagus; can cause dysphagia including infections of the oesophagus or throat, cancer of the stomach or throat and swallowing large objects that get stuck (more common in children).

Symptoms Symptoms of dysphagia can be mild or severe and can get worse over time. These include: • Have problems getting food and liquids to go down on the first try.

• Gagging, choking, or coughing when swallowing.

• Having food or liquids come back up through your throat, mouth, or nose after swallowing.

• Feeling like foods or liquids are stuck in some part of your throat or chest.

considered safe and appropriate by healthcare professionals. Thickened food and fluids are easier to control in the mouth and can be more safely swallowed by the patient.

Medications With regard to difficulties swallowing medication, many issues can be put down to the medicine itself. Tablets and lozenges are sometimes rough and can come in large shapes and capsules. This can be a problem, particularly if the medication has to be taken on a regular basis or if numerous medicines have to be taken at the same time.

Opening up capsules or crushing tablets in order to take them should be avoided. It can lead to a change in stability and efficacy of medication and could lead to severe side-effects and can be dangerous.

Chewing tablets can often leave a horrible taste in the mouth, which is why not everyone can just easily swallow their medicines with a glass of water.

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• Experiencing pain when swallowing.

• Having pain or pressure in the chest or having heartburn.

• Losing weight because there is not enough intake of food or liquid.

Treatment There are a number of treatments available to patients suffering with dysphagia. if dysphagia is causing dietary problems, food supplements can be taken. These products normally contain a high number of calories, protein, or vitamins; in some cases, all three to aid the nutrition in the person with dysphagia, and to ensure they are reaching their nutritional targets.

A way to manage swallowing difficulties is to thicken food and fluids to a consistency

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Oral solutions are available in the form of specially made medications but these are often costly to a patient and hard to access.

OTC products such as medication lubricants which make the intake of oral tablets and medication easier are available to patients suffering from Dysphagia. A universal aid which can be clear and flavoured medication lubricants work by moistening the mucous membranes in the mouth and throat cavity and allowing the tablets to pass smoothly via the oesophagus to the stomach and can be used to take multiple tablets at the same time.

Often made from food based ingredients these lubricants have no known interactions with other medications and almost immediately break down when they reach the acidic environment of the stomach, meaning they have minimal impact on the absorption of medication. These lubricants can be used by anyone who can swallow autonomously over the age of 2.

Who? Elderly people have the highest tendency to be affected by dysphagia, however young children can be affected by this also, and anyone who has suffered a medical condition such as a stroke or another neurological condition may be affected What are the symptoms? Patients will complain of being unable to, or to have difficulty swallowing?

How long has the patient had the symptoms? If this is a recent condition it may be that the patient is simply suffering with a sore throat or similar ailment. The length occurring, and the condition’s frequency should be noted Action already taken? It is important to note that the patient should not tamper with their current medication, and advice should be given as to the reasons for this Medication? Food supplements, Food and drink thickeners and medication lubricants (swallowing gel)

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Eczema in Children

ECZEMA IN CHILDREN Healthy skin contains fats and oils which help to maintain moisture by creating a protective layer. In eczema prone skin, the cells don’t produce as many fats and oils and so retain less water. This leads to the protective layer being weaker, allowing irritants and allergens to enter the skin leading to irritation. Eczema is an extremely common condition affecting around one in five children in Ireland. 8 out of 10 cases occur before the child turns 5 years of age. Eczema can cause the skin to become itchy, red, dry and cracked.

In severe cases there may be weeping, crusting and bleeding.

Recognising Eczema Eczema usually occurs in areas where the skin folds, such as: Behind the knees, inside the elbows, the sides of the neck and also around the eyes and ears.

The major symptom of atopic eczema is an intense itch. Scratching only provides temporary relief, and leads to more itching and scratching.

This is often referred to as the itch scratch cycle, where itch leads to scratching and scratching makes the skin itchy. Scratching worsens eczema, and can make the skin more vulnerable to infection.

be diluted before use. Two tablespoons of emollient should be taken out of the container using a clean spoon, NOT fingers (to prevent contamination), and transferred into a jug.

Hot water should be added and the solution whisked with a fork for five minutes before adding to the bath. A bath additive solution can simply be poured into the bath.

Applying Emollients to the Skin Emollients should be applied several times every day and are an essential part of a longterm skincare regime, even when the skin is clear.

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Tips for protecting Eczema prone skin • Make sure the skin is moisturised using an oil-based moisturiser.

• Protect children from the harsh winter weather, by wrapping up in warm clothes.

• Use a gentle bath wash such as a bath additive. After washing use an emollient cream.

• Changes in temperature can aggravate the skin.

• When drying after a bath, pat the skin gently instead of rubbing the skin dry.

• Soak the child in the bath water for 10-20 minutes - keeping them in bath longer may dry out the skin.

• Use cotton sheets that have been washed with a sensitive skin detergent.

• Emollients should be applied in a smooth, downward motion, in the direction of hair growth, after a bath and before going to bed.

• Apply an emollient cream about 20 minutes before bedtime to allow it to soak in to the skin.

• Emollients come as lotions, creams and ointments. However, ointments work better when the skin is very dry. Sometimes, more than one product may need to be used, for example an ointment at night and cream or lotion during the day.

• Try to keep the child’s nails short so any scratching that does occur does minimal damage.

During a ‘flare up’, when eczema is very active, symptoms such as redness, dryness and itch worsen, while at other times, symptoms settle.

A flare may be triggered by environmental irritants such as soap or detergents, changes in temperature, or allergens like animal dander, but sometimes no cause can be identified. Although there is no cure yet, treatments are available to manage the condition.

Treatments The most common method of treatment is the use of emollients. Emollients are an essential treatment in eczema and dry skin conditions to moisturise the skin by soothing and softening.

Emollients are moisturisers which are used in two ways - applied directly to the skin as a leave-on moisturiser, and as a soap substitute instead of soap and shower gel.

Emollient Wash Products

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Emollient wash products work as soap substitutes. Ordinary soaps and bubble baths dry out the skin by stripping away its natural oils. Emollient wash products should be used when hand washing, bathing or showering to leave the skin coated with a protective film afterwards. These products cleanse but do not lather like ordinary soap.

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Parents of children with eczema should try to bathe their child in an emollient wash product once a day. Emollient creams should also be used frequently; the weekly recommended amount for children is 250 g per week. On a day to day basis, it is recommended to apply an emollient cream at least 3 to 4 times a day.

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Bath emollients which come in tubs need to

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Who? It can start at any time of life but is most common in childhood, affecting approximately one in five children. It affects males and females equally What are the symptoms? Eczema is almost always itchy. The rash most commonly appears on the face, back of the knees, wrists, hands, or feet How long has the patient had the symptoms? 8 out of 10 cases occur before the child turns 5 years of age Action already taken? Finding the right emollient may be a matter of trial and error Medication? Normal soap and bubble baths should be avoided

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Fatigue

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FATIGUE

Lacking energy not only makes a person feel sluggish and lazy but it can also have a negative impact on a person’s emotions.

There can be several causes of a feeling of lack energy. At any given time, one in five people feels unusually tired, and one in 10 have prolonged fatigue. Psychological tiredness is far more common than tiredness caused by a physical problem.

One key reason is anxiety, which can cause insomnia and, in turn, lead to persistent fatigue. Nearly a third of the population are severely sleep-deprived, often because of job and money worries.

Getting enough sleep Sleep plays a vital role in good health and well-being. Getting enough good-quality sleep can help protect mental health, physical health, quality of life and relationships. Sleep also plays an essential role in maintaining energy levels, with one of its proposed main functions being to preserve energy. Energy expenditure is lower during sleep versus wakefulness to reduce a person’s total daily energy needs.

Tips for getting a good night’s sleep include: • Try having a warm bath before bed.

• Try a cup of camomile tea or a cup of hot milk.

• Get into bed an hour or two earlier whenever possible.

• Switch off all distractions e.g. TV, social media, instead swap these for a book.

Eating right Food is our body’s fuel. Therefore, not eating enough can result in a lack of energy and fatigue. All the cells in the body run off glucose; the simplest form of carbohydrate. If a person doesn’t eat enough or leaves it too long between meals, their glucose levels will become too low. This will result in the body’s cells not being able to function properly and feeling run-down. Concentrate also drops too, as the brain cells use twice as much energy as other cells. People should eat three balanced meals a day, leaving 4-6 hours between each meal.

Fruit or nuts are good for snacking when hungry between meals. Some carbohydrates should be included with every meal - wholegrains are best.

Too much sugar Today sugar is abundant in our diet, with several types of sugar derived from various sources. The over consumption of sugar has led to an increase in the occurrence of obesity, diabetes, cardiovascular disease, dementia, and tooth decay. Although the consumption of sugar appears to initially raise energy levels in proportion to the amount consumed, large enough amounts can result in a burst of energy known as a sugar high that ends in a sharp drop in energy levels, termed a “crash.”

The Effects of stress Stress can affect all aspects of life, including the emotions, behaviour, thinking ability, and

physical health. No part of the body is immune, but, because people handle stress differently, symptoms of stress can vary. One physical symptom of stress is low energy levels, as the stress response mobilizes the body’s energy stores in order to respond to a threatening situation.

Tips for beating stress • Try adding some gentle exercise into your daily routine.

• Be kind to yourself and make sure you do something you enjoy each day.

• Put an hour aside each day to relax e.g. watch favourite TV programme, read a book, take a bath.

• Focus on the positives of each day rather than any negatives.

• Simple changes in your lifestyle can make a big change to your life.

Physical causes of tiredness There are several health complaints that can make us feel tired. Not just the well-recognised ones like anaemia and thyroid problems, but also, diabetes, food intolerances and sleep apnoea.

Being overweight or underweight can cause tiredness, because the body has to work

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harder than normal to do everyday activities.

Underweight people have less muscle strength, and may feel tired more quickly. Pregnancy, especially in the first 12 weeks, can also sap a woman’s energy.

Some health conditions that are known to cause fatigue are: Coeliac disease, Anaemia, Chronic fatigue, Hypothyroidism, Diabetes, Glandular fever and Restless Leg syndrome.

Psychological causes of tiredness Depression makes people feel drained of energy. It can cause sleep disturbances, which lead to further feelings of tiredness during the day. Many people have constant uncontrollable feelings of anxiety, which are so strong they affect their daily life. As well as feeling worried and irritable, people with anxiety often feel tired.

Lifestyle causes of tiredness Tiredness can often be attributed to lifestyle factors, such as drinking too much alcohol, or having an inadequate diet. Drinking alcohol in the evening can cause waking in the middle of the night. For many people, their lifestyle means they have a disturbed sleep pattern – for instance, working night shifts, or looking after young children.

Who? Anyone - one in 10 people can have prolonged fatigue What are the symptoms? Feelings of exhaustion and lack of energy How long has the patient had the symptoms? Some health conditions are known to cause fatigue Action already taken? People may have been taking sleeping tablets Medication? Many prescription and non-prescription drugs can cause weakness and fatigue, for example antianxiety medicines and antidepressants

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Fertility

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FERTILITY Becoming pregnant is not always straightforward. There are many factors that can impact the fertility of men and women. With couples choosing to have children in later life, patients are seeking information and help more frequently. If a couple have been trying regularly for a period of six months to conceive, they should be referred to their GP so that sperm can be tested, and ovulation can be confirmed.

Factors Affecting Fertility Age: When women reach 35, the quantity and the quality of their eggs begins to decline as the rate of follicle loss accelerates. This makes conception more challenging as follicle loss results in fewer and poorer quality eggs.

Women over 35 are also at a higher risk of having babies with chromosomal abnormalities, or miscarrying.

Weight: If the female patient is overweight or significantly underweight, it may prevent normal ovulation. Having a healthy BMI has been proven to increase the frequency of ovulation and result in pregnancy. If the male is overweight, his fertility will be lower than normal.

Smoking: Smoking increases the risk of miscarriage and ectopic pregnancy. It can also damage the cervix and fallopian tubes. Smoking cessation is recommended before even trying for a child.

Sexual history: Chlamydia and gonorrhea can cause fallopian tube damage, so patients who have had regular unprotected sex with multiple partners should get an STI check before trying for a baby.

Alcohol: Heavy drinking is associated with an increased risk of ovulation disorders and endometriosis.

Positive steps to aid becoming pregnant: • Eat a healthy balanced diet: If the BMI of both partners is between 20-25, they have a better chance of becoming pregnant.

• Avoid alcohol: drinking alcohol in the first three months of pregnancy can increase the risk of miscarriage; the quality of sperm is also affected if a man drinks more than 3-4 unit of alcohol a day.

• Take folic acid supplements when trying for a baby and through the pregnancy. These reduce the risk of neural tube defects, such as spina bifida.

• Have sex when ovulating: Women are at their most fertile when ovulating, so when trying for a baby, it’s the best time of the month to have sex.

Ovulation Tests A woman’s body runs on cycles with fertile windows. An ovulation predictor kit can help to identify the two days of the month when she is most likely to conceive.

There are changes in the body right before ovulation. An ovulation test works by detecting

one of these changes, specifically the increase of luteinizing hormone (LH) levels in urine. The LH surge, as it is commonly called, precedes ovulation by 24 to 36 hours. Predicting the LH surge with an ovulation test, enables her to identify the most fertile time of her cycle — the two days beginning with the surge.

Pregnancy tests work by detecting hCG levels in urine. When a woman’s urine comes in contact with the specially treated strip on a pregnancy test stick, results appear within minutes, indicating whether or not hCG, the pregnancy hormone, has been detected.

Couples can maximize their chances of becoming pregnant if they have intercourse within 24 to 36 hours after detecting the LH surge. Timing is one of the most important factors when trying to get pregnant.

• Using a test first thing in the morning is thought to deliver the best results, because urine is the most concentrated at that time.

How Pregnancy Tests Work From the earliest moments of conception, the body is already starting to undergo monumental changes. One of the very first is production of the pregnancy hormone, hCG (human Chorionic Gonadotropin), which can be detected in the blood and urine. hCG increases rapidly, doubling every 36 to 48 hours as the pregnancy progresses, reaching its peak at eight to ten weeks.

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Tips for using pregnancy tests:

• Read the instructions carefully, and make sure to follow them, step by step • Use a clock or a timer when taking the test Advice for after taking the test: If a woman gets a positive result, they should schedule a GP appointment.

If the result is negative, or inconclusive, and her period is not yet late, she should test again a few days later. If a woman has missed her period by a week or more and she is still getting a negative result, she should call her GP.

Who? Adult, women over the age of 45 are at a greater risk of infertility What are the symptoms? Being unable to conceive How long have they had the symptoms? Couples trying for longer than 6 months and who do not have risk factors should refer to a GP Action already taken? Couples may already be taking prenatal supplements Medication? aspirin, ibuprofen or naproxen during pregnancy or just before may increase the risk of miscarriage

Email: info@pamex.ie Email: Email: info@pamex.ie Email: info@pamex.ie info@pamex.ie Phone: 094– 902 4000 Phone:Phone: 094– Phone: 902 094– 4000 094– 902 902 40004000 Website: www.pamex.com Website: Website: www.pamex.com Website: www.pamex.com www.pamex.com

Fungal Nail Infection

FUNGAL NAIL INFECTION

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Preventing fungal nail infections

Most people develop a fungal nail infection (onychomycosis) at some point in their life. It is not usually serious, but can be unpleasant and difficult to treat. The infection develops slowly and causes the nail to become discoloured, thickened and distorted. The toenails are more frequently affected than the fingernails.

• antifungal tablets – tablets taken once or twice a day for several months

Fungal nail infections can be spread to other people, so steps should be taken to avoid this (see below) by people who have an infection.

• antifungal nail paints – special paints applied directly to the nail over several months

• keeping the hands and feet clean and dry.

Symptoms of a fungal nail infection

The treatment of fungal nails can generally be divided into two categories:

A fungal nail infection may not cause any obvious symptoms at first. As it progresses, the infection can cause: • discolouration of the nail – it may turn white, black, yellow or green • thickening and distortion of the nail – it may become an unusual shape or texture and be difficult to trim • pain or discomfort – particularly when using or placing pressure on the affected toe or finger • brittle or crumbly nails – pieces may break off and come away completely • Sometimes the skin nearby may also become infected and be itchy and cracked or red and swollen.

Causes of fungal nail infections

• nail softening kits – where a paste is used to soften infected parts of the nail, before they’re removed with a scraping device

Topical treatment for mild to moderate cases - Existing topical treatments are mainly based on an intensive treatment with nail polish.

Some are available on prescription and others can be bought over the counter. Most topical substances have to be used for a longer period of time during which the nail polish has to be removed and applied again. There are products on the market, which use technologies that enable the active substances to penetrate deeper into the nail. Due to this, the fungus is treated locally.

Oral treatments Oral treatment for severe cases - Oral treatments can only be obtained on prescription and are used only for treatment of severe cases in which the nail matrix is affected.

• wearing well-fitting shoes made of natural materials and clean cotton socks – these will allow the feet to “breathe”.

• clipping nails to keep them short – don’t share clippers or scissors with other people.

• not sharing towels and socks with other people, and ensuring towels are washed regularly.

• not walking around barefoot in public pools, showers, and locker rooms – use the special shower shoes provided in gyms and sports centres.

• replacing old footwear that could be contaminated with fungi.

• treating athlete’s foot as soon as possible to avoid the infection spreading to the nails.

• Nail salon equipment can sometimes be the source of fungal nail infections. If the person with the infection regularly visits a salon, they can ask to make sure any equipment used is properly sterilised between uses.

It is important to continue treatment until the nail looks perfectly clean and healthy again. Fungal nails often return after treatment because not all the fungus is completely cleared. Nails grow slowly and therefore it takes a long time until the affected part has completely grown out of the nail.

Most fungal nail infections occur as a result of the fungi that cause athlete’s foot infecting the nails.

These fungi often live harmlessly on the skin, but they can sometimes multiply and lead to infections. The fungi prefer warm, dark and moist places like the feet.

People are more likely to develop a fungal nail infection if they: • don’t keep their feet clean and dry.

• wear shoes that cause their feet to get hot and sweaty.

• walk around barefoot in places where fungal infections can spread easily, such as communal showers, changing rooms and gyms.

• have damaged their nails.

• have a weakened immune system.

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• have certain other health conditions, such as diabetes, psoriasis or peripheral arterial disease.

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Treatments for fungal nail infections A fungal nail will not cure without help; and you should always recommend treatment. There is an increased risk that the fungus spreads to other parts of the nails and feet, and as it is very contagious, it can even spread to other people.

Various OTC treatments are available:

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Who? Fungal nail infections are common as they are can be spread from person to person What are the symptoms? The nail has become discoloured, thickened and distorted How long have they had the symptoms? A fungal nail infection may not cause any obvious symptoms at first Action already taken? People may have tried OTC treatments but not continued the treatment until the nail is completely healthy again Medication – People should always read the label of OTC medicines to ensure they are not allergic to any pf the ingredients

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hay fever

HAY FEVER What is Hay Fever? Hay fever is a type of allergic rhinitis caused by pollen or spores.

The allergen causes the inside of the nose to become inflamed. Hay fever affects the nose, sinuses, throat and eyes and causes sneezing, a runny nose, and itchy eyes.

The symptoms of hay fever occur when the immune system overreacts to a normally harmless substance, in this case pollen. When the body comes into contact with pollen, cells in the lining of the nose, mouth and eyes release histamine, which triggers the symptoms of an allergic reaction.

Hay fever usually occurs in spring and summer, when there is more pollen in the air.

Trees, grass and plants release pollen as part of their reproductive process. Mould and fungi also release tiny reproductive particles, called spores.

People with hay fever can experience their symptoms at different times of the year, depending on which pollens or spores they are allergic to.

Hay fever is estimated to affect around 20% of people. Hay fever is more likely if there is a family history of allergies, particularly asthma or eczema. In Ireland, most people with hay fever are allergic to grass pollen. However, trees, mould spores and weeds can also cause hay fever. Research suggests that pollution, such as cigarette smoke or car exhaust fumes, can make allergies worse.

Treatments Hay fever cannot be cured completely, but there are a number of treatments available to relieve the symptoms.

duration of action also enables a more patient-friendly dosing regimen which increases patient compliance.

Types of second generation antihistamines • Loratadine • Cetirizine • Fexofenadine

Ocular antihistamines OTC Eye drops treat the hay fever symptoms that affect the eyes, such as redness, itchiness and watering (allergic conjunctivitis). These drops contain antihistamine to reduce the inflammation in the eyes, which will relieve the symptoms.

Eye drops containing the active ingredient sodium cromoglicate are the most widely used. Some may cause side effects, such as a stinging or burning feeling in the eyes.

Corticosteroids If symptoms are frequent or persistent and individuals have nasal blockages or nasal polyps, a nasal spray or drops containing corticosteroids should be recommended.

Corticosteroids help to reduce inflammation.

They take longer to work than antihistamines but their effects last longer. Side effects from inhaled corticosteroids are rare but can include nasal dryness and irritation, and nosebleeds.

Nasal decongestants

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for more than five to seven days. Using them for longer can worsen congestion. They are not recommended for those taking a type of antidepressant known as a monoamine oxidase inhibitor (MAOI).

Non-pharmacological Treatment Non-pharmacologic management may provide symptomatic relief and reduce the need for medications in patients, particularly those who are affected seasonally.

Guidelines developed in collaboration with the World Health Organisation recommend: • The identification and avoidance of allergens when practical. However, the evidence does not suggest that any one intervention alone will lead to substantial symptom reduction.

• Recommendations have included the minimisation of exposure to pollen or mould, which are major allergens for patients with seasonal rhinitis, by keeping windows and doors closed during pollen season.

• Outdoor activities should also be minimised on sunny days with low humidity and high winds, as pollen counts tend to increase on those types of days.

• For patients with indoor allergies, such as sensitivity to dust mites, methods to reduce exposure include reducing the use of carpets, maintaining a level of humidity between 35% to 50%, washing the bedding in hot water, avoiding stuffed toys and upholstered furniture, and placing mattresses and pillows in allergy-proof coverings.

Decongestants can be taken as tablets, capsules, nasal sprays or liquids. They should not be used to treat allergic rhinitis

Oral Antihistamines Two types of OTC antihistamines are available: first-generation and second-generation antihistamines. Both types can be useful for allergies. First-generation antihistamines are also sometimes used in OTC cold medicines First-generation antihistamines work in the part of the brain that controls nausea and vomiting. They can also help prevent motion sickness and are sometimes used to help insomnia. The most common side effect of firstgeneration antihistamines is feeling sleepy. They may also cause symptoms such as dry mouth, urinary retention and confusion in the elderly.

Types of first-Generation OTC Antihistamines: • Brompheniramine

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• Chlorpheniramine • Dimenhydrinate • Diphenhydramine • Doxylamine Second-generation or non-sedating antihistamines are newer drugs. They offer the advantages of a lack of side effects such as sedation and dry mouth, which are commonly seen in first-generation antihistamines. Secondgeneration antihistamines are less likely to interact with other medicines. Their longer

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Who: A global health problem affecting 20% of the population What are the symptoms? Runny nose, watery eyes, sneezing, itching How long have they had symptoms? Symptoms may last for weeks or months Action already taken? Sufferers may already be implementing lifestyle changes or have tried OTC treatments Medication: Refer to a GP for first-generation antihistamines if the person is also suffering from: glaucoma, enlarged prostate, breathing problems, thyroid disease, heart disease, high blood pressure or being prescribed sedatives or muscle relaxants. Patients with kidney or liver disease should see their GP before taking second generation antihistamines

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Head Lice

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HEAD LICE There is much myth and misinformation surrounding head lice causes and treatment. Parents are often concerned that their child could be ostracized because of lice, and it is important that their fears are allayed, and they do not try to use various treatments simultaneously.

Pharmacy teams are essential in delivering accurate and helpful advice to patients.

The Facts • Infestations of head lice mostly affect children aged between 4-11.

• Head lice are tiny grey-brown wingless insects. When hatched, they are the size of a pinhead and 3mm long when fully grown.

• They cannot fly, jump or swim, but are spread by head-to-head contact when mature lice climb from the hair of the infected person to the head of another person.

• Head lice feed by biting the scalp and sucking blood through it.

• Eggs are cemented to hairs close to the root by female louse where they are kept warm by the scalp. 7 to 10 days later, after the lice have hatched, the empty eggshells (nits) remain. They become more noticeable as hair grows and the shiny white shells are carried away from the scalp.

• As female lice can reproduce again after 7 days, all lice need to be removed from the head before the sixth day after hatching to break the cycle.

• Head Lice cannot be prevented, but weekly detection combing is the only way of finding lice quickly.

Diagnosing Head Lice An active head lice infestation must be diagnosed before using any medicated treatment. Given their colour and size, head lice can be hard to see. The most accurate method to confirm an active head lice infestation is detection combing using a head lice comb: • Use a special fine-toothed head lice comb with a tooth spacing of 0.2-0.3mm; this comb can trap even the smallest lice. It is most effective on wet hair but can also be used on dry hair.

• Wash hair using ordinary shampoo, then apply a lot of conditioner and leave it in.

Untangle the hair first using a wide-toothed comb. Once the comb moves freely through the hair, switch to the detection comb.

• Make sure the teeth of the comb start at the root of the hair with the bevel-edge of the teeth lightly touching the scalp to detect nits at the root.

• Draw the comb down to the ends of the hair with every stroke, and check the comb for lice. If lice are detected, remove them by rinsing the comb.

• Comb the whole head of hair section by section then rinse out the conditioner and repeat the combing procedure.

Treatment Options Treatment should only be applied if an active louse one that is living and moving is found.

NEVER as a preventative measure. Only one medicated treatment should be used at a time and the manufacturer’s instructions should always be followed.

Head Lice are treated predominantly in three ways: • Pesticide treatments: There are various pesticide treatments available, and these work by poisoning the lice. The pesticide treatments available, Malathion and Permethrin, work by poisoning the lice.

However, lice are becoming increasingly resistant to these pesticides in part because of inappropriate and overuse of these agents over a long period.

• Non-pesticide treatments: These are still insecticides, but physical ones and are seen as more scalp friendly. They work by using Dimeticone, which immoblises the lice to prevent spreading.

• Alternative Treatments: Like detection combing, wet combing needs to be performed every three days. It may not be

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as effective as the other treatments, and it will take longer for the infestation to clear.

Electronic nit combs are also available.

After Treatment Whatever treatment is used, detection combing two or three days after will show if it has been successful. If nits are found, it doesn’t necessarily mean that the treatment hasn’t worked – they may just be empty egg cases. If live lice are found, the treatment may not have been successful. The treatment will need to be repeated on your whole household.

Prevention If someone suspects there is a case in the family, they should check for lice immediately and make sure that whoever has them cannot have the opportunity to spread them to someone else. Touching heads, sharing hats and combs are just some ways that head lice can be transferred. Children’s hair should be checked regularly with a lice comb and children should be made aware of the ways that they can spread.

Who? Generally, children aged 4-11 What are the symptoms? An itchy scalp. Lice may already have been found How long have they had the symptoms? Crucial to assessing which product to use. Size of lice, are there eggs only?

Action already taken? Customers may have already tried a shampoo, or combing the nits out Medication: Anyone with psoriasis, sensitive skin, or asthma should use non-pesticide remedies

Headaches

HEADACHES Headaches are one of the most common health complaints, but most are easily treated. Most headaches aren’t serious and can be treated with pharmacy remedies and lifestyle changes, such as getting more rest and drinking enough fluids. Nearly all of us have suffered from a headache at some point. However the headache a person experiences may not be the same as someone else’s. Headaches are usually classified as either primary or secondary headaches. Secondary headaches are usually the result of an underlying illness.

Most headaches experienced are usually primary headaches. The three most common types of primary headache are tension, migraine and cluster headaches.

Each type of headache has its own pattern of pain and cause.

Tension headache Tension headaches are the most common, affecting as many as 8 out of 10 people from time to time and are what most people think of as normal everyday headaches.

They feel like a dull ache with constant pressure around the front, top and sides of the head as if a rubber band has been stretched around it.

Stress is one cause, but there are lots of others, including drinking too much alcohol, not getting enough sleep, depression, skipping meals and becoming dehydrated.

One source of tension headaches is tender muscles in the head and neck. When someone is stressed or tired, the muscles in their head and neck become sore and tender. When these muscles become tense, the pain travels up to the head where it is felt as a headache.

Cluster headaches Cluster headaches are the third type of primary headache. Cluster headaches are rare, excruciatingly painful headaches cause an intense pain around one eye. Cluster headaches get their name because the attacks come in groups (one to three headaches every day, for several weeks or months) and often with little warning. The attacks are usually sudden and the pain felt is generally severe and felt behind the eye or sometimes on one side of the head.

OTC medications don’t ease the symptoms of a cluster headache, but a doctor can prescribe specific treatments to ease the pain.

It’s not known what causes cluster headaches but it’s thought’ the hypothalamus (the brain’s ‘biological clock) is believed to play a role by releasing chemicals which are responsible for cluster headaches.

Some people have their cluster headaches triggered by certain factors, for example an extreme increase in temperature or strongsmelling substances.

Secondary headaches Secondary headaches have a separate cause, such as illness, and include headaches that come on after drinking too much alcohol or after a head injury or concussion.

Some headaches are a side effect of taking a particular medication, and sometimes people get headaches when they’re unwell. People may get a headache when they have had a cold, sinusitis, flu or an allergic reaction, for example. Frequent headaches can also be caused by taking too many painkillers.

Headaches in women are often caused by hormones, and many women notice a link with their periods. The Pill, the menopause and pregnancy are also potential triggers.

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If someone has been getting really bad headaches it’s natural for them to have wondered if there’s something seriously wrong, like a brain tumour. This is extremely rare and the cause is almost always something else.

When to refer for further help It’s very rare that headaches are a sign of something serious like a brain tumour. However, it’s best to advise people to see their doctor if: • They feel unwell between their headaches • Their headaches aren’t relieved by pharmacy treatments • They are experiencing headaches which are so painful that they are limiting the persons’ ability to get on with life or are causing them to miss work • Their headache is the result of a head injury • They develop problems with their vision such as blurriness • Their Headache is accompanied by other symptoms such as fever, vomiting weakness, slurred speech or confusion.

Pain Relief There are lots of ways to help customers relieve headache pain. Reducing stress and avoiding common headache triggers can help ease a headache. You can also suggest an over the counter pain killer which contains ibuprofen, which blocks an enzyme in the body called cyclooxygenase (COX), which then blocks the production of prostaglandins. Prostaglandins are important molecules involved in such processes as pain, inflammation, and temperature control.

There are a range of triggers for tension type headaches, such as; stress, poor posture, bright lights and loud noises.

Migraine Headache Migraines are less common. If a headache is recurrent and disabling to the point of stopping someone from carrying on with daily life, it’s usually a migraine.

People describe migraines as an especially sharp and throbbing pain on one or both sides of the head. People may also experience nausea and sensitivity to light, and even get visual problems such as flashing lights or zigzag lines.

It’s not fully understood what causes a migraine, but temporary changes in blood vessels and chemicals in the brain may be a factor. Genetics may also play a role as some migraine sufferers also have a close relative with the condition.

Migraines can be caused by a range of triggers like stress, tiredness, they can also be brought on by environmental factors such as bright lights, certain foods and hormone changes.

Most people treat their migraines successfully with over-the-counter medication. If they’re severe, however, they may need stronger migraine-specific medication that is only available on prescription from a doctor.

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Who? Tension headaches affect as many as 8 out of 10 people from time to time What are the symptoms? Different types of headache have different symptoms – ask the patient to describe the pain How long have they had they symptoms? Has the headache been triggered by drinking too much alcohol or a head injury or concussion?

Action already taken? If the persons’ headaches aren’t relieved by pharmacy treatments, they should see their GP Medication? Ibuprofen can cause irritation of the stomach or intestinal lining. This risk increases with older age, longer duration, smoking or alcohol use, and being on other medications like blood thinners (warfarin) or corticosteroids (prednisone). While taking ibuprofen, some patients may notice an increase in their blood pressure, so those being treated for hypertension should be especially careful

Indigestion

INDIGESTION Indigestion, also known as dyspepsia, is pain or discomfort in the upper abdomen. People with indigestion may experience a number of symptoms, including: heartburn, regurgitation, bloating, nausea and vomiting.

Is it indigestion?

It’s important to understand the difference between heartburn and indigestion and know how they can be treated and prevented. There are differences between the symptoms; Heartburn, also known as acid reflux, is the hot, burning pain felt when acid from the stomach refluxes into the oesophagus.

Unlike the stomach lining, however, the lining in the oesophagus isn’t designed to protect against stomach acid. So, if acid gets into the oesophagus, it can cause pain.

Sufferers often described the feeling as: • A hot pain or burning sensation • A tight feeling • An acidic taste (with or without the feeling of sickness) The affected area usually is centered around the chest, often behind the breast bone (sternum) and the back of the throat can feel hoarse, accompanied by a bitter taste. The feeling may last for a minute or two, several minutes, or even several hours with severe episodes.

Indigestion can involve several symptoms, which are all associated with digestive processes - the symptoms are usually experienced after eating or drinking. Food and drink can stimulate the stomach to produce excess acid which, in the case of indigestion, begins to break down the protective stomach lining. This is the innermost layer of the stomach that’s directly in contact with its contents including stomach acid. As a result, people can experience:

• Drinking caffeinated drinks, alcohol, very hot drinks or citrus juices • Pregnancy - hormonal changes and/or the pressure put on the stomach and digestive tract by a growing baby • Various medicines • Carrying a little too much weight • Wearing tight clothes • Smoking • Stress

Preventing and treating indigestion A good way to discover triggers is to start a food diary. Using this, people will be able to determine which foods induce it more, and tailor their actions appropriately. These actions may include eating smaller amounts or cutting down on spicy foods. Or it may occur due to changing circumstances, such as becoming pregnant or taking on a particularly stressful new job. Therefore, it can vary from person to person and at different stages of their lives.

Indigestion in Pregnancy Most people are affected by indigestion from time to time, but women are often affected by it while they are pregnant. As many as 8 out of 10 women experience indigestion at some point during their pregnancy. Indigestion tends to become more common as the baby develops.

Indigestion during pregnancy is mainly due to changes that occur in the body, such as rising levels of hormones and increased pressure on the abdomen.

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These changes can often result in acid reflux, the most common cause of indigestion. Acid reflux occurs when stomach acid flows back up from the stomach into the oesophagus and irritates the lining.

A number of lifestyle changes may help improve the symptoms of indigestion, such as eating smaller meals or cutting out certain foods.

There are also medicines, such as antacids, that can be taken safely during pregnancy to treat indigestion.

Some women may find that their indigestion gets worse as their pregnancy progresses.

However, in most cases, after giving birth, the symptoms disappear. Indigestion during pregnancy rarely causes complications.

Pregnant women can be more likely to get indigestion during pregnancy if: • She experienced indigestion before she became pregnant • She has been pregnant before • She is in the latter stages of pregnancy

When to refer Women should be advised to see their GP or midwife if they are pregnant and experience severe or recurring indigestion. Their GP will usually be able to diagnose indigestion from their symptoms and by asking them a number of questions. For example, they may ask: • how the symptoms are affecting her day-to-day life • what her usual eating habits are • if she has tried any treatments already • if she experienced indigestion or any other stomach conditions before she was pregnant

• Pain in the lower chest, abdomen or top of the stomach • Feeling bloated • Gas build up - needing to burp or pass wind • Nausea or vomiting

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• A loss of appetite

Indigestion and heartburn causes The two conditions are closely associated, since stomach acid is involved in both. In fact, 73% of people can experience indigestion and heartburn interchangeably. They can have the same causes too, and almost anyone can suffer, even people with a generally healthy lifestyle.

Causes include: • Eating big meals, irregular meals or eating on the run • Eating fatty foods, spicy foods, chocolate, mint or tomato products

W H

A M

Who? 73% of people can experience indigestion and heartburn interchangeably. As many as 8 out of 10 women experience indigestion at some point during their pregnancy What are the symptoms? Pain in the lower chest, abdomen or top of the stomach, feeling bloated, needing to burp or pass wind, Nausea or vomiting and loss of appetite How long have they had the symptoms? The symptoms are usually experienced after eating or drinking, but there can sometimes be a delay between eating a meal and developing indigestion. Women may experience indigestion at any point during their pregnancy. Symptoms may be more frequent and severe during the third trimester Action already taken? People may have taken antacids but not be aware how to eliminate triggers until they start to keep a food diary Medication? Antacids can be taken safely during pregnancy to treat indigestion

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CHILD HEALTH CONSULATATION: PHARMACY ASSISTANTS Q & A SESSION ON INFANTILE COLIC Infantile Colic is a common ailment which can affect the whole family.

The intense crying that defines the condition makes it highly distressing for both baby and parents and can have a major impact on family life.

The aim of this training guide is to provide information and reassurance about the condition and offer practical advice on a non-medicinal solution.

Explain what Colic is Colic is the name given to excessive, frequent crying in a baby who appears to be otherwise healthy. It’s a common problem with almost half of babies in the UK developing Colic*.

Colic is very distressing for both baby and parent!

Reassure parents as to what the signs and symptoms of Colic are Colic is defined by: • Intense crying bouts • Crying in the late afternoon or evening that lasts at least 3 hours a day, 3 days per week.

• Baby’s face may become red and flushed when they cry • Baby will tend to clench their fists, draw their knees up to their tummy, and arch their back while crying Caring for a baby with colic can be very difficult for parents, particularly first-time parents.

Explain the common causes of Infantile Colic 1) 78% of Healthcare Professionals agree that the most common cause of colic in young babies is caused by digestive or feeding problems, including swallowing air and trapped wind* 2) Temporary gut sensitivity to certain proteins and sugars found in breast milk and formula milk, such as Lactose Intolerance.

3) Gastro-Oesophageal Reflux Disease (GORD)

• Gently rock baby over your shoulder • Bath baby in a warm bath

Reassure parents that Colic will not harm baby?

• Gently massaging baby’s tummy

Explain that a baby suffering from colic may appear to be in pain but the condition is not harmful to baby’s health in the long term, as long as baby continue to feed and gain weight normally.

Product Options: There is a natural solution – suggest to parents to change their baby bottle to Dr Brown’s Options bottles or recommend they use Dr Brown’s from day one as prevention is better than cure!

Practical Advice for Parents?

Preventing baby from swallowing air is extremely important in helping to avoid wind related colic and choosing the right baby bottle can help.

Traditional and restrictive vented bottles tend to develop vacuums because babies have to suck progressively harder on the one hole in the bottle to obtain the liquid.

This causes teat collapse and baby has to stop feeding. Air enters the bottle when the teat reinflates; the air is ingested which can cause the colic symptoms.

There are also a number of techniques you can advise parents to try that can help alleviate the symptoms of windy colic: • Burp baby after feeds

Dr Brown’s Options™ Baby Bottles feature a unique system with a removable green vent designed to create a “vacuum free” environment. Dr Brown’s is clinically proven to help reduce wind related colic by removing the air bubbles in the feed*.

As baby becomes more developed and no longer experiences feeding issues parents now have the convenient option to remove the vent. Without the vent Dr Brown’s Options™ provides a feeding experience similar to most teat-vented bottles. The teat venting creates a controlled flow,

Dr Brown’s Options bottles offer the complete feeding system that grows with baby and helps alleviate symptoms of windy colic.

53 Other useful information sources you can offer to parents.

Cry-sis - the only UK charity offering help and support to parents with babies who cry excessively or have sleeping problems - https://www.cry-sis.org.uk/ NCT - https://www.nct.org.uk/parenting/ coping-colic NHS - https://www.nhs.uk/conditions/ colic/ Article sponsored by:

offering babies and easy and convenient way to feed at their own pace.

Parents can see a fully animated explanation on www.drbrowns.co.uk Dr Brown’s is the most recommended baby bottle for the relief of wind related colic*.

When can parents expect their baby to stop suffering from Colic?

Thankfully babies tend to grow out of Colic between four and six months, as baby’s feeding become more developed.

Explanation as to how a Dr Brown’s Options™ bottle works?

Dr Brown’s availability: Dr Brown’s Options bottles and feeding accessories are available for pharmacies to purchase from http://www.murrayshealthandbeauty.com/ References: Results from a HCP Colic Survey carried out by Consumer Analysis – May 2010 and research conducted by Mustard Research Ltd amongst a sample of 200 UK Health Care Professionals during May 2017.

Aspirin 250mg, Paracetamol 250mg, Caffeine 65mg film-coated Tablets

UNIQUE TRIPLE ACTION COMBINATION

Starts relieving Migraine Pain & Symptoms in 30 minutes1

CONTAINS PARACETAMOL. ALWAYS READ THE LABEL / LEAFLET Product Information: Please consult the summary of product characteristics for full Product Information.

Excedrin 250 mg/250 mg/65 mg film coated tablets (acetylsalicyclic acid, paracetamol, caffeine). Indications: Acute treatment of headache and of migraine attacks with or without aura. Dosage: Maximum 6 tablets in 24 hours. Drink a full glass of water with each dose. Must not be used for a longer period or at a higher dosage without first consulting a doctor. Not for use in those under 18 years.

Exercise caution in the elderly. Headache: 1 tablet; if needed an additional tablet can be taken. In case of more intense pain, 2 tablets. If needed, an additional 2 tablets can be taken. Allow 4 to 6 hours between doses. For episodic use, up to 4 days. Migraine: 2 tablets when symptoms appear. If needed, an additional 2 tablets can be taken, with 4 to 6 hours between doses. For episodic use, up to 3 days.

Contraindications: Hypersensitivity to ingredients. Patients in whom attacks of asthma, urticaria, or acute rhinitis are precipitated by aspirin or other NSAIDs, e.g. diclofenac or ibuprofen. Active gastric or intestinal ulcer, gastrointestinal bleeding or perforation and in patients with a history of peptic ulceration. Haemophilia or other haemorrhagic disorders. Severe cardiac, hepatic or renal failure. Intake of >15 mg methotrexate per week. Third trimester of pregnancy. Warnings and precautions: Not to be taken with other products containing aspirin or paracetamol. Not to be used if vomiting occurs with >20% or bedrest is needed with >50% of migraine attacks. Seek medical advice if no migraine relief from first 2-tablet dose. Not to be used on >10 days per month for >3 months. Discontinue use in actual or suspected medication overuse headache; gastrointestinal bleeds or ulceration. Risk of bleeding could be enhanced by alcohol, NSAIDs and corticosteroids. Caution in undiagnosed migraineurs, or those with atypical symptoms, exclude other neurological conditions; patients with dehydration, gout, impaired renal or hepatic function, uncontrolled hypertension, diabetes mellitus, severe glucose 6-phosphate dehydrogenase deficiency, alcohol dependence, hyperthyroidism, arrhythmia, bronchial asthma, seasonal allergic rhinitis, nasal polyps, chronic obstructive pulmonary disease, chronic infection of the respiratory tract, patients showing allergic reactions to other substances (e.g. cutaneous reactions, urticaria). May mask signs and symptoms of infection, increase bleeding tendency during/after surgery.

Not to be taken with anticoagulant or other medicines that inhibit platelet aggregation unless under doctor supervision. Monitor in patients with defects of haemostasis. Caution in case of metrorrhagia or menorrhagia. May interfere with thyroid function tests. Caution in those taking liver enzyme inducers or potentially hepatotoxic medicines, or alcohol. Limit intake of caffeine-containing products.

Pregnancy and lactation: Contraindicated in third trimester. Caution in 1st and 2nd trimester. Not recommended during breastfeeding. Side effects: Common: Nervousness, dizziness, nausea, abdominal discomfort. Uncommon: Insomnia, tremor, paraesthesia, headache, tinnitus, arrhythmia, dry mouth, diarrhoea, vomiting, fatigue, feeling jittery. Rare: Pharyngitis, decreased appetite, anxiety, euphoric mood, tension, dysgeusia, disturbance in attention, amnesia, coordination abnormal, hyperaesthesia, sinus headache, eye pain, visual disturbance, flushing, peripheral vascular disorder, epistaxis, hypoventilation, rhinorrhoea, eructation, flatulence, dysphagia, paraesthesia oral, salivary hypersecretion, hyperhidrosis, pruritus, urticaria, musculoskeletal stiffness, neck and back pain, muscle spasms, asthenia, chest discomfort. Not known: Hypersensitivity, anaphylactic reaction, Stevens Johnson syndrome, toxic epidermal necrolysis, restlessness, migraine, somnolence, palpitations, hypotension, dyspnoea, asthma, abdominal pain, dyspepsia, GI haemorrhage, GI ulcer, hepatic failure, hepatic enzyme increased, erythema, rash, angioedema, malaise, feeling abnormal. See SPC for full details. Legal category: Pharmacy only. MA number: PA 678/122/1. MA holder: GlaxoSmithKline Consumer Healthcare (Ireland) Limited. 12 Riverwalk, Citywest Business Campus, Dublin 24, Ireland. Text revised: September 2017. Further information available on request.

Reference 1: Lipton R et al. Efficacy and safety of acetaminophen, aspirin, and caffeine in alleviating migraine headache pain: three double blind, randomized, placebo-controlled trials. Arch Neurol.

1998;55:210-217.

CHGBI/CHXCDRN/0001/17

Date of Preparation: September 2017.

Migraines

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MIGRAINES Nausea is one of the most common symptoms of a migraine, but it’s not the only one. Experts have yet to definitively pinpoint the medical cause of migraines, but knowing the most common symptoms can help you properly diagnose a migraine and determine the best course of migraine treatment.

Major Migraine Symptoms Aside from the severe head pain that generally has throbbing or pulsating peaks, often on one side of the head, the most common symptom migraine sufferers are hit with is nausea and vomiting. Nausea tends to impact about 80 percent of people who experience migraines, while about half succumb to vomiting — both generally towards the latter end of the migraine attack. Other migraine symptoms include a sensitivity to light or sound called photophobia and phonophobia, respectively, as well as clamminess and light-headedness.

Other Migraine Symptoms Other symptoms suffered less frequently during a migraine include numbness, weakness or pain on one side of the body. One’s speech or ability to think and communicate clearly can also become limited during a migraine. If a person describes experiencing these symptoms, they should be advised to see their GP to ensure the problem isn’t more serious than a migraine.

Aura Migraines In the minutes leading up to a migraine, some sufferers experience “aura” — visual symptoms like geometric patterns, flashing lights or possibly a shimmering effect (kind of like heat waves) that indicate a migraine’s about to strike.

Less than one quarter of migraine patients ever will experience aura, but those who do often start experiencing this visual impairment anywhere from five to 20 minutes before a migraine strikes.

Most commonly, aura is experienced in both “positive” and “negative” forms. The negative leaves the person with blind or white spots along with tunnel vision, reducing their field of vision. “Positive” means that sufferers will see something added to their field of vision, often a shimmering border or a band of absent vision.

Those who experience this type of positive symptom will often see the vision enlarge as time goes on, and will sometimes hallucinate other visions during the lead-up to the migraine headache.

The second-most common aura experienced before a headache is paraesthesia, or the feeling of numbness, tingling or a prickly feeling in one’s skin. Nearly 40 percent of all aura migraine sufferers report paraesthesia as a part of their migraine experience, and numbness or a prickly feeling can often originate in the hands or limbs and then migrate towards the face.

Other aura symptoms can include sensory symptoms like heavy-feeling or weak limbs, and those who experience sensory issues often also report language or speech impairment during this same time.

Warning Signs Many migraine sufferers report experiencing prodrome — early symptoms that can serve as a warning sign of an impending migraine.

These premonitory symptoms can take place anywhere from days to hours prior to a migraine, and their frequency and severity can vary depending on many different variables.

People may experience irritability, restlessness, depression or a combination of these feelings right before a migraine begins.

Sensitivity to light, sounds and smells – which becomes even more heightened during the migraine – is a common premonitory symptom, while others are impacted by things like excessive thirst, lethargy and constipation or diarrhoea. Some migraine sufferers experience vision impairment or temporary loss (most commonly in aura migraines).

W W H A M

The Aftermath The duration of a migraine can be excruciating, but even once the worst of the attack has passed, there’s often after-effects to deal with for up to 24 hours later. Following the headache, sufferers often feel depleted of energy and can face a shift in mood (irritability is frequently reported), though for some the opposite happens and they get a surge of energy afterwards. Muscle weakness accompanied by tiredness is also a common post-migraine complaint, with many sufferers needing to sleep following an attack.

In the hopes of helping to prevent future migraines, keeping track of potential triggers and pre-headache symptoms is recommended – as each individual person might experience a different set. People can track any triggers and possible patterns in their migraines by keeping a migraine headache diary. Understanding each individual’s own personal migraine patterns and symptoms will be key to controlling them.

Who? Anyone - There are half a million migraine sufferers in Ireland What are the symptoms? Severe head pain that generally has throbbing or pulsating peaks, often on one side of the head, nausea and vomiting How long have they had the symptoms? Migraines are best controlled as soon as the warning signs appear. After-effects can last up to 24 hours Action already taken? Paracetamol, aspirin or ibuprofen can be effective for patients with mild-moderate migraine although the data suggests that their efficacy is limited to about 1/3 of patients Medication? Codeine is a major cause of rebound headache

CaldeSpray from the makers of Caldesene.

Contains Zinc Oxide. ALWAYS READ THE LABEL. For cutaneous use only.

Date prepared: July 2017. 2017/ADV/CAL/033

Nappy Rash

NAPPY RASH Ireland now has the highest birth rate in Europe and this market for the retail baby category has shown positive growth.

Pharmacies have significant advantages over supermarkets, mainly because pharmacy staff can offer advice and expertise that the supermarkets do not offer. Reassure the parent that nappy rash is very common, and at some stage of parenthood, they will be confronted with it. Also make clear that this can occur whether the parent uses washable or disposable nappies. The key here is to clear the nappy rash as soon as possible, and help explain preventative measures to avoid this recurring.

Causes and Symptoms There are various causes of a nappy rash.

Listen (and look if possible) at the rash and explain what type it is, and how to treat it most effectively. There are three types: Nappy Rash When a baby soils or wets itself and the nappy is left on for a longer time than usual, the urine and faeces can encourage the production of the chemical ammonia, which can irritate the baby’s skin, causing it to become sore and inflamed.

This is when nappy rash occurs. Where there has been close contact with the nappy, the baby’s skin will look red and inflamed. Most affected will be the genitals, the outer skin on the folds of her thighs, and the bottom. The affected areas can appear either dry or moist, and look shiny or pimply.

• The best way to treat this is to keep the bottom as clean and dry as possible and change nappies often. It’s also a good idea to apply a barrier ointment/cream or medicated powder after every change.

Fungal Nappy Rash Fungal nappy rash is often a complication of initial nappy rash, and looks different. If the baby’s skin is warm and damp for long periods of time, it can cause the fungus ‘candida’, to grow. Like ammonia, candida can irritate the baby’s skin. The area of skin will be inflamed, with spots around the edges. The infection will be bright red and also present in the folds of the skin.

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To treat a fungal infection, the parent should apply a barrier cream every time the baby’s nappy is changed. Zinc cream, zinc oxide ointment and petroleum jelly are all suitable barrier creams.

• Zinc Oxide works by providing a skin barrier to prevent and help heal skin irritation.

• Matricaria Chamomilla (chamomile) is effective in that it is both a demulcent and antibacterial.

• Dexpanthenol (pro-vitamin B5) is an advantageous ingredient in baby care products as it encourages the regeneration of the skin, is a demulcent, activates the lipid synthesis and strengthens the skin’s protective barrier.

Severe Nappy Rash If a patient’s baby has sever or reoccurring nappy rash, they should be advised to visit their GP as it will usually require prescribed medication. Nappy rash should clear up within a few days of over the counter treatment.

There are a number of treatments for severe nappy rash.

• Corticosteroids help to reduce the inflammation of the skin and relieve any itching and redness.

• Hydrocortisone cream, which should only be applied once a day should not be used for more than seven days • An anticandidal medicine helps to treat any fungal infection that may cause a rash.

Some commonly prescribed anticandidal medicines include: Clotrimazole, econazole, ketoconazole, miconazole and nystatin.

Prevention Ultimately, prevention is key and, in order to avoid painful nappy rashes, pharmacists should advise parents to follow the same steps involved in treating a mild nappy rash.

This involves: • Leaving the nappy off for as long as possible.

• Changing the nappy regularly.

• Using only water to wash the baby’s bottom.

• Applying a barrier cream after each nappy change.

W W H A M

• Tight-fitting plastic pants over nappies should not be used.

• Standard talcum powder should not be used when changing nappies.

Promoting Brands With women in Ireland bearing an average of 2.1 children each, baby care represents a growing market.

In general, product price is not as important within baby care and child-specific products as in other beauty and personal care categories because mothers are prepared to spend more on their babies – they want products that are of the highest quality.

The positioning of this category is a vital focus.

There are several factors to keep in mind when positioning the baby category; shoppers may often require advice when selecting products therefore endeavour to position the category close to the OTC counter to facilitate this, if it is established that this category is a core category for many of your shoppers ensure that the fixture is clearly visible along the natural path of browsing customers with clear category signage to draw shoppers to the fixture.

Consider that young families will need room to browse the fixture if they are shopping with buggies or with small children. Lastly, consider the adjacent categories when positioning baby in order to maximise the opportunity for cross purchase by shoppers.

Who? Predominantly newborn babies up to age 1 year What are the symptoms? Nappy rash can affect the genitals, the outer skin on the folds of the thighs and the buttocks. The affected areas can appear either dry or moist and may sometimes look shiny or pimply How long has the patient had the symptoms? Severe nappy rash or recurring nappy rash should be referred Action already taken? Parents may already be following self-care tips such as leaving baby’s appy off and changing regularly Medication? If baby’s rash is caused by thrush, don’t use a barrier cream or ointment, as this can make the rash worse

www.septanazal.ie

Unblocks the nose and heals.

NEW

Septanazal® nasal spray with dexpanthenol not only unblocks the nose, but also heals and protects dry and irritated nasal mucosa.

10/2017, Ireland, 1388-2017, RB/KS.

Next generation nasal spray with dexpanthenol

www.krka.ie

+ Acts within 5–10 minutes + Lasts up to 11 hours* + Contains no preservatives Septanazal:The nasal spray solution contains xylometazoline hydrochloride and dexpanthenol. Indicated for adults and children over the age of 6 for reducing swelling of the nasal mucosa in rhinitis and as supportive treatment for healing the mucous membrane lesions, for the relief in vasomotor rhinitis and for the treatment of nasal respiratory obstruction after nasal surgery. Adults and children over 6 years of age: The usual dose of Septanazal for adults and children aged 6 years or over is one spray into each nostril up to 3 times a day. Regarding the duration of treatment in children, a doctor should always be consulted. Precautions: This medicinal product may be used only after a careful assessment of the risks and benefits in cases of: patients being treated with the monoamine oxidase inhibitors (MAOIS) and other drugs which potentially increase blood pressure, increased intraocular pressure, especially narrow-angle glaucoma, serious heart and circulatory diseases (e.g., coronary heart disease, hypertension), phaeochromocytoma, metabolic disorders (e.g., hyperthyroidism), porphyria and prostate hyperplasia. In chronic rhinitis it may be used only under medical supervision owing to the danger of the atrophy of the nasal mucosa. The prolonged use and overdose of decongestant sympathomimetics in particular may lead to reactive hyperaemia of the nasal mucosa. This rebound effect causes narrowing of the airways and, consequently, the patient uses the medicinal product repeatedly until its use becomes permanent. The consequences are chronic swelling (rhinitis medicamentosa) or even atrophy of the nasal mucosa. In less severe cases consideration can be given to discontinuing the use of the sympathomimetic in one nostril initially and, after the symptoms have abated, changing to the other side in order to maintain at least part of the nasal respiration. Direct contact of the medicinal product with the eyes should be avoided. In case of misuse or use of excessive amounts of the spray, the absorption of xylometazoline can cause systemic adverse effects, particularly in children (cardiovascular and neurological adverse effects) (see sections 4.8 and 4.9). Concomitant use of the product with medicinal products for local or systemic treatment of the flu and sympathomimetics contained in cough-and-cold medicines (e.g.: pseudoephedrine, ephedrine, phenylephrine, oxymetazoline, xylometazoline, tramazoline, naphazoline, tuaminoheptane) is not recommended in order to avoid an increased risk of possible cardiovascular and neurological adverse effects (see section 4.5). Contraindications: Hypersensitivity to the active substances or to any of the excipients listed in section 6.1 of the SPC, dry inflammation of the nasal mucosa, history of transsphenoidal hypophysectomy or other surgical interventions which expose dura mater. Septanazal for adults is contraindicated in children under 6 years of age. Fertility, pregnancy and lactation: Septanazal should not be used during pregnancy, as there is not sufficient data available concerning the use of xylometazoline hydrochloride by pregnant women. Septanazal should not be used during the lactation period, since it is not known whether xylometazoline hydrochloride is excreted in the breast milk. There is no data on the influence of Septanazal on fertility. Adverse reactions: Uncommon: hypersensitivity. Rare: palpitations, tachycardia, hypertension. Very rare: restlessness, insomnia, fatigue, headache, hallucinations, rebound congestion, nosebleed, convulsions. Not known: burning and dryness of nasal mucosa, sneezing. Shelf life: 2 years. Legal category: Medicinal product not subject to medical prescription. Marketing authorisation number: PA1347/058/002.

Marketing authorisation holder: Krka, d. d., Novo mesto, Šmarješka cesta 6, 8501 Novo mesto, Slovenia. http://www.hpra.ie/img/uploaded/swedocuments/LicenseSPC_PA1347-058-002_19012017142039.pdf Date of Preparation: October 2017.

Additional information is available on request from Krka Pharma Dublin Ltd. Unit 4A, Leopardstown Business Centre, Ballyogan Road, Leopardstown, Dublin 18. D18 KX88. Reference number: 01-11-2017. * Passàli D, Salerni L, Passàli GC et al. Nasal decongestants in the treatment of chronic nasal obstruction: efficacy and safety of use. Expert Opinion on Drug Safety 2006; 5(6): 783–90.

Nasal Congestion

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NASAL CONGESTION Catarrh is an excessive build-up of mucus in one of the airways or cavities of the body. It is usually found inside the nose, but it can also occur in the throat, ears, or chest. Catarrh is not a condition in itself, but a symptom of a condition such as: the common cold or another infection, hay fever or other type of allergic rhinitis, non-allergic rhinitis (sensitivity to environmental triggers), or nasal polyps (fleshy swellings inside the nose).

Most cases of nasal catarrh are acute, passing within a few days once the body fights off the underlying infection. However, some people have chronic (persistent) catarrh, either due to an allergy or because there is an abnormality inside their nose, such as nasal polyps.

The symptoms of acute catarrh can usually be relieved by taking a short-term course of decongestants. Treatment for chronic catarrh will depend on the underlying causes.

The symptoms often associated with catarrh include: • a blocked and stuffy nose • a runny nose or mucus running down the back of the throat • an irritating, persistent cough caused by excess mucus at the back of the throat • headache • facial pain caused by a blocked nose and blocked sinuses • a loss of smell and taste • temporary partial hearing loss and a crackling sensation in the middle ear • tiredness Catarrh is caused by the immune system reacting to an infection or irritation in one of the cavities of your body, such as inside the nose.

The immune system will send infection-fighting white blood cells to the source of the infection or irritation. The white blood cells cause the linings of your cavity to swell and produce mucus. This swelling also narrows the cavity, which causes decongestion.

The most common triggers of catarrh are: • infections, such as the common cold • allergic reactions, for example, reactions to pollen or dust mites (allergic rhinitis) Less commonly it can be caused by nonallergic rhinitis or nasal polyps.

Non-allergic rhinitis is caused by abnormally sensitive blood vessels that react to environmental triggers, such as cigarette smoke and pollution. This sensitivity causes the blood vessels to expand much like they do in response to an infection or allergic reaction.

This swelling leads to congestion and catarrh.

Triggers of non-allergic rhinitis include chemical irritants, such as smoke, perfumes or paint fumes, changes in the weather, such as a drop in temperature, alcohol, spicy food or being stressed.

Nasal polyps are non-cancerous, fleshy swellings that grow from the lining of the nose or sinuses. They can prevent mucus from properly draining out of the sinuses, leading to congestion and catarrh.

Decongestants In most cases of acute catarrh, the underlying infection should pass quickly without the need for treatment. A blocked nose can be relieved by using OTC decongestants, which help to relieve a blocked nose by reducing the swelling of the blood vessels in the nose.

The inside of the nose is lined with many tiny blood vessels. When these blood vessels are irritated by something, such as an infection or an allergy, more blood flows to them as part of the body’s immune response. This extra blood makes your blood vessels swell up so they block the nasal airway, making it difficult to breathe normally through the nose.

Decongestant medicines do not often cause side effects. Any that may be experienced are likely to be mild. Possible side effects of decongestant nasal sprays may include: • irritation to the lining of your nose • headaches • nausea

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Steam inhalation Inhaling steam from a bowl of hot (but not boiling) water may help to soften and loosen the build-up of mucus in the nose. Adding menthol or eucalyptus oil to the water eases the blocked nose and catarrh. Steam inhalation is not recommended as a treatment for children because of the risk of scalding.

Saline sprays Saline (salt water) sprays or drops can also soften and loosen the mucus and help relieve symptoms.

Chronic catarrh The recommended treatment for chronic catarrh will depend on the underlying cause.

For example, rhinitis can usually be managed by avoiding the environmental triggers or allergens that cause catarrh. Symptoms can sometimes be relieved by using a nasal spray that contains corticosteroids. Small nasal polyps can often be shrunk using a nasal spray that contains steroids. Larger polyps may need to be removed with surgery.

Who? Anyone – Nasal congestion is not a condition, but a symptom of a condition such as the common cold or another infection, hay fever, or other allergy What are the symptoms? a blocked and stuffy nose, not being able to breathe normally thorough the nose How long have they had the symptoms? Decongestants should not be used for more than five to seven days at a time. This is because they only provide short-term relief, and using them for any longer can make symptoms worse Action already taken? People may have tried steam inhalation and saline spray Medication? Decongestants should not be given to people who are prescribed monoamine oxidase inhibitor antidepressants, as this can cause a dangerous rise in blood pressure

WHEN YOUR PATIENTS NEED INTENSIVE TREATMENT FOR GINGIVITIS. ACTS IN 30 SECONDS, LASTS FOR UP TO 12 HOURS1,2

Corsodyl 0.2% w/v Mint Mouthwash Chlorhexidine Digluconate

Recommend Corsodyl treatment mouthwash to treat gum problems: BLEEDING GUMS

IRRITATED GUMS

MOUTH ULCERS

Product Information: Please consult the summary of product characteristics for full product information.

Indications: Plaque inhibition; gingivitis; maintenance of oral hygiene; post periodontal surgery or treatment; aphthous ulceration; oral candida. Dosage & Administration: Adults and children 12 years and over: 10 ml rinse for 1 minute twice daily or pre-surgery. Soak dentures for 15 minutes twice daily. Treatment length: gingivitis 1 month. Ulcers, oral candida: continue treatment 48 hours after clinical resolution. Children under 12: on healthcare professional advice only. Contraindications: Hypersensitivity to Chlorhexidine or any of the excipients.

Precautions: Keep out of the eyes and ears, do not swallow. Separate use from conventional dentifrices (e.g. rinse mouth between applications). In case or soreness, swelling or irritation of the mouth cease use of the product. Macrogolglycerol Hydroxystearate may cause skin reactions. Aniseed Mouthwash: Azo dye Ponceau 4R (E124) may cause allergic reactions. Side effects: Superficial discolouration of tongue, teeth and tooth coloured restorations, usually reversible; transient taste disturbances and burning sensation of tongue on initial use; irritative skin reactions; extremely rare, generalised allergic reactions, hypersensitivity and anaphylaxis, oral desquamation and parotid swelling. Overdose: Due to alcohol content (7%) ingestion of large amounts by children requires medical attention. Legal Classification: GSL. Product Authorisation Numbers: PA 678/2/2 & PA 678/2/4. Product Authorisation Holder: GlaxoSmithKline Consumer Healthcare (Ireland) Limited, 12 Riverwalk, CityWest Business Campus, Dublin 24. Date of Preparation: May 2016. Further information is available on request. References. 1. Jones CG. Periodontology 2000. 1997; 15: 55-62. 2. Gomes BP et al. Int Endod J 2001; 34(6): 42-48.

Corsodyl is a registered trade mark of the GSK group of companies. Contains chlorhexidine digluconate. Always read the label/leaflet. CHGBI/CHCSYL/0083/17.

oral health

61

ORAL HEALTH Patients are in need of more than just toothpaste to maintain good oral health. Maintaining and improving oral hygiene is important and can prevent many illnesses from emerging. In addition to what products can be recommend, it is good to also provide trips on general oral hygiene such as: • Regularly (twice daily) brush teeth and gums using a fluoride toothpaste • Floss between teeth using dental floss, dental tape, or interdental brushes • Keeping the tongue clean (Gently brush the tongue a couple of times to remove bacteria and freshen breath when brushing teeth) In addition to those seeking good oral health, there will be patients who have already developed illnesses related to poor oral hygiene.

The most common are Gingivitis and Halitosis.

Gingivitis (Gum disease)

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Gingivitis is a form of periodontal disease. Periodontal disease is the inflammation and infection that destroys the tissues, such as the gums, ligaments and the tooth sockets, which support the teeth. This is caused by a build-up of plaque over periods of time and is caused by poor dental hygiene, undiagnosed diabetes or a poor diet.

Gum disease affects at least 50% of adults. It can cause bad breath and red, swollen and bleeding gums. If left untreated it can lead to receding gums and eventually tooth loss. The disease can often remain silent for many years and will only present itself when the gums become swollen or bleed. Gum disease can result in teeth loss. Patients who smoke or suffer from diabetes are at a higher risk of developing the disease.

If a patient presents with symptoms of gingivitis, they should have their teeth professionally cleaned and they should also be advised to practice good oral hygiene. In order to prevent a build-up of plaque, toothbrushes or water irrigation devices can be advised, along with anti-bacterial mouthwashes and anti-plaque or anti-tartar toothpastes.

Soft bristle brushes should be used and the recommended time for cleaning the teeth is two minutes.

Halitosis Halitosis or bad breath can be caused by excessive amounts of volatile sulphur compounds (VSCs) being produced by bacteria in the mouth. This can be influenced by any number of factors, such as eating, drinking, oral hygiene, sleeping and the effect that these activities have on saliva flow. Mouthwashes will reduce halitosis, due to the anti-microbial influences of the products.

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Who: Adults are more likely to present to the pharmacy with gingivitis, especially smokers, those with a poor diet and some experts believe women on some of the contraceptive pills may be extra-susceptible What are the symptoms? Swollen or bleeding gums How long have they had symptoms? Gingivitis can be present for years without the patient knowing Action already taken? Patients may have already attended their dentist and are looking for pharmacy over-the-counter solutions Medication: Customers who express concern about sensitive teeth should choose a product formulated to reduce this

Who: People, who have poor oral hygiene. The problem can affect anyone of any age What are the symptoms? Bad breath How long have they had symptoms? If the patient has persistent bad breath that cannot be resolved, it may be a symptom of another condition Action already taken? A referral should be made to a doctor, dentist or health hygienist Medication: Customers who express concern about sensitive teeth should choose a product formulated to reduce this

Mouth Ulcers Mouth ulcers are painful sores inside the mouth that are not related to poor oral hygiene. They may occur on the tongue, the lining of the cheeks, the gums, the inside of the lips, or the soft palate on the back of the roof of your mouth.

Common symptoms of mouth ulcers include the following: • A burning, tingling, or prickling sensation, up to 24 hours before the sore appears.

• Crater-like ulcers that are white, grey, or yellow in colour, with a red border.

• Sores are usually painful.

• Difficulty speaking, eating, or swallowing Over-the-counter pain medications such as ibuprofen, acetaminophen, or naproxen can be used to help with discomfort from mouth ulcers. Zinc lozenges or vitamins B and C may also help relieve symptoms. In addition, oral antiseptic rinses may aid in the healing of lesions. Sufferers should be advised to seek care from their GP if symptoms worsen, show no signs of improvement after 7 days of selftreatment, or do not heal in 14 days.

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Who: Those suffering from mouth ulcers What are the symptoms? Ranging from burning and tingling before sores appear, pain in the mouth How long have they had symptoms? Symptoms will usually clear up within 7 days of treatment Action already taken? Sufferers may already be aware of tell-tale signs Medication: If using Ibuprofen avoid smoking or drinking large amounts of alcohol

Pain and Fever in Children

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PAIN AND FEVER IN CHILDREN Pain is the body’s way of telling us that something somewhere needs some attention. When a child is ill or hurt, nerve fibres detect the tissue damage and send pain signals to their brain to let them know that something isn’t right. These pain signals work the same way in adults too, however unlike adults, children can’t always express the cause of their pain clearly, especially when they are very young, which is why it is important to be aware of the different signs that a child may be suffering from pain.

How to tell if a child is in pain Every person has their own individual pain threshold; some will have a high tolerance whilst others won’t. The pain threshold of each child will vary according to the emotions they are feeling at the time and if they are a little older, experiences with pain that they have had in their past will also affect how they react to it.

Since every child experiences and reacts to pain differently, being able to identify pain in a baby or toddler is not always straightforward.

Babies For babies who haven’t started talking yet, crying is the only way to communicate that they need something but because there are many different reasons they could be crying it isn’t always easy to know what they need.

That being said, there are some basic reasons why all babies cry and these should be checked first: • Is it time for a feed? They could be hungry.

• Have they been fed but are still crying? They could have trapped air in their stomach and need burping.

• Is their nappy wet or dirty? They could need changing.

• Are they irritated and disinterested in playing?

They could be tired and need to sleep.

• Is their face flushed and are they sweaty?

They could be too hot and need some layers of clothing removed.

If the cries seem unusual and the baby is inconsolable then they may be in pain or suffering from illness. Check for any visible sources of pain or discomfort and check their temperature to see if they have a fever.

Toddlers With toddlers it is easier to tell if they are in pain because by this age they can talk and even if they can’t explain in detail the exact cause of the pain they will be able to tell if something is wrong. If a toddler is in pain, it is common for them to also clutch the part of the body that is causing them pain. E.g. if they are hitting or holding their head then they may have a headache.

High Temperature A high temperature is one of the natural ways a child’s immune system defends against infections by making it difficult for bacteria and viruses that cause infections to survive. When a child has a high temperature, it is a sign that they are suffering from an underlying illness such as a cold, flu, ear infection, sore throat or urinary tract infection. Children’s temperatures can also rise during teething, after vaccination or if they overheat because of excess bedding or clothing.

The normal temperature of the body is between 36 and 36.8 C (96.8 and 98.24°F). This can vary slightly by individual. In children, any temperature of 38°C (100.4°F) or above is considered high and is classed as a fever.

The most accurate way to measure a child’s temperature is to use a digital thermometer and hold under the child’s armpit.

Parents should be encouraged to continue monitoring their child’s temperature closely to keep track on how the fever is developing and to also know if the high temperature is a result of having too many layers of clothing.

Symptoms of Fever Symptoms of fever can vary according to the underlying cause, but you can generally tell that a child has a fever if they: • Appear hot and flushed all over.

• Look pale with cool hands and feet but have a hot forehead, tummy and back.

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• Are irritable, crying and lethargic.

• Start to shiver uncontrollably.

• Act restless, particularly during the night.

• Lose their appetite.

Relieving a Fever Most fevers in children resulting from minor ailments are not serious and tend to go away on their own once the illness or infection clears up. In the meantime, there are some things that parents can do to help make their child more comfortable while trying to bring the fever down: • Offer fluids regularly: During a fever the child will lose fluids through sweating or a runny nose. Because fluids help the body tackle infection it’s important to replace as much fluid as possible. Parents should offer the child plenty of water to drink and if possible some clear soup to replace the lost fluids.

• Ensure rest: Rest helps the child’s body focus its energy on getting better.

• Ensure your child is dressed comfortably: When a child has a high temperature, they will feel uncomfortable in layers of heavy clothing.

• Parents can place a humidifier in the child’s room can keep the air moist and reduce any nasal and chest congestion.

• Offer some medicine: If the child is distressed, giving a pain relief medicine will help reduce fever.

Who? Children and Babies What are the symptoms? The child may appear hot and flushed all over, or lethargic How long have they had the symptoms? A child temperature should be monitored closely Action already taken? Parents may have tried investigating the source of the child’s discomfort and found no obvious cause, such as wet nappy etc.

Medication – Aspirin is not suitable for children

Product Information: Please consult the summary of product characteristics for full product information. Panadol Extra 500mg/65mg Soluble Effervescent Tablets, paracetamol, caffeine. Indications: Relief of mild to moderate pain such as that associated with rheumatism, neuralgia, headache, musculoskeletal disorders, menstrual pain, toothache, fever, symptoms of colds and flu. Dosage: Adults and children 12 years and over: 2 tablets up to 4 times a day. Max 8 tablets in 24 hours. Do not give to children under 12 years. Minimum dosing interval: 4 hours. The lowest dose necessary to achieve efficacy should be used. Contraindications: Hypersensitivity to paracetamol, caffeine or any of the other ingredients. Precautions: Do not use with any other paracetamol-containing products. The concomitant use with other products containing paracetamol may lead to an overdose. Paracetamol overdose may cause liver failure which can lead to liver transplant or death. Patients with depleted glutathione levels / glutathione depleted states. Diagnosed liver or kidney impairment, hereditary sugar intolerance, pregnancy, excessive caffeine intake, low sodium diet. Do not exceed the stated dose. Prolonged use except under medical supervision may be harmful. Side effects: Very rare cases of serious skin reactions have been reported. All very rare: Hypersensitivity reactions including anaphylaxis and skin rash, thrombocytopenia, angiodema, Stevens-Johnson syndrome, bronchospasm, hepatic dysfunction. Frequency unknown: Nervousness. dizziness. Legal Category: Pharmacy Only. MA Number: PA 678/39/10. MA Holder: GlaxoSmithKline Consumer Healthcare (Ireland) Limited, 12 Riverwalk, CityWest Business Campus, Dublin 24. Text prepared: July 2017. Further information available on request. Panadol is a registered trade mark of the GSK group of companies. Contains Paracetamol. Always read the label/leaflet.

CHGBI/CHPAN/0090/17

Pain: Acute vs Chronic

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PAIN: ACUTE VS CHRONIC While pain can be debilitating, a lot of customers are reluctant to see someone about it and may well be suffering in silence. If someone does come to the pharmacy to purchase pain relief, it is important to assess if their pain is acute or chronic so as to assess if a GP visit should be recommended for an underlying condition.

Acute Pain Causes Acute pain begins suddenly and is usually sharp in quality. It serves as a warning of disease or a threat to the body. Acute pain might be caused by many events or circumstances, including: • Burns or cuts • Broken bones • Dental work • Labour and childbirth • Surgery Acute pain can be mild and fleeting, or it might be severe and last for weeks or months. In most cases, acute pain does not last longer than six months, and it disappears when the underlying cause of pain has been treated or has healed. Unrelieved acute pain, however, might lead to chronic pain.

Chronic Pain Causes People with persistent pain often think of themselves as suffering from a specific ailment, whether it’s arthritis, back pain, migraines, or something else. But anyone who has experienced pain for several months or longer with little relief is suffering from chronic pain.

Despite decades of research, chronic pain remains poorly understood and notoriously hard to control. There are various conditions that are thought to cause chronic pain:

Pain Treatment Depending upon its severity, pain can be treated in a number of ways. Symptomatic options for the treatment of pain might include one or more of the following:

• Opioids (such as morphine or codeine) • Localized anaesthetic (a shot of a pain killer medicine into the area of the pain) • Nerve blocks (the blocking of a group of nerves with local anaesthetics)

• Non-steroidal anti-inflammatory drugs (NSAIDs)

• Acupuncture

• Lower back pain

• Acetaminophen

• Arthritis, especially osteoarthritis

• Physical therapy

In cases of Chronic Pain:

• Headache

• Surgery

• Antidepressants. Several drugs approved to treat depression are also prescribed by doctors to help relieve chronic pain. These include tricyclic antidepressants such as amitriptyline, imipramine, clomipramine, desipramine, doxepin, and nortriptyline. The pain-relieving effect of tricyclics appears to be distinct from the mood-boosting effect, so these drugs can be helpful even in chronic pain patients who are not depressed.

• Psychotherapy (talk therapy)

• Multiple sclerosis • Fibromyalgia • Shingles • Nerve damage (neuropathy) Treating the underlying condition is, of course, vitally important. But often that does not resolve chronic pain. Increasingly, doctors consider chronic pain a condition of its own, requiring pain treatment that addresses the patient’s physical and psychological health. At a fundamental level, chronic pain is a matter of biology: Errant nerve impulses keep alerting the brain about tissue damage that no longer exists, if it ever did. But complex social and psychological factors are also at play, and they seem to help determine who fares well despite even severe chronic pain -- and whose lives quickly unravel. Negative emotions, including sadness and anxiety, seem to aggravate chronic pain. For example, people who dwell on their discomfort tend to be more disabled by chronic pain than people who try to take their pain in stride.

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• Electrical stimulation

• Relaxation techniques such as deep breathing • Biofeedback (treatment technique in which people are trained to improve their health by using signals from their own bodies) • Behaviour modification

Who? Anyone What are the symptoms? Pain in one or more sites in the body How long has the patient had the symptoms? If the pain lasts longer than three months it is considered chronic Action already taken? The patient may have already used OTC pain relief Medication? Opioids to be used sparingly due to addictive properties

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The thermal water’s unique composition enables it to strengthen the skin barrier. Thanks to its high concentration in mineral salts, similar to the skin’s natural moisturizing factors, it offers unique moisturizing benefits as well as restoring the cutaneous barrier. It soothes sensitive skin due to the high level of calcium and magnesium salts while silicon strengthens the skin’s hydrolipidic film.

Uriage Thermal Water has 7 properties, and clinical studies to prove their effectiveness: Isotonic, only thermal water that can be sprayed in the eyes, due to its

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Specially formulated to provide the skin with the ideal amount of water it needs to restore its natural balance.

Designed especially for acne and oily skin prone to imperfection. They combine the performance of active ingredients with the pleasure of daily use.

ROSÉLIANE An anti-redness care that treats flushes, blotchiness, rosacea and skin subject to redness.

This range is extremely effective for skin that is subject to redness as it has a gentle action, and will restore comfort for sensitive skin.

BARIÉDERM Uriage Bariéderm is a range for isolating and repairing skin, specially designed to meet the needs of specific problems such as chapped and cracked skin.

Other ranges include Keratosane 30 for Psoriasis, Xémose for atopic-prone skin, D.S. for flaky, irritated skin, Bariésun for sun care, Isoliss, Isofill & Isodense for anti-aging, GYN for intimate hygiene, a Daily Care range and the 1st Care range for babies and children.

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skincare

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SKINCARE Pharmacies can provide advice as well as treatment for those suffering from dry skin.

Customers will welcome expert advice on skin conditions from dry skin and eczema to acne, psoriasis and sensitive skin.

The local pharmacy is the most easily accessible place for customers to get on-the-spot advice on medical skin conditions, as well as general skincare tips for all the family.

It is important to recognise this as you can offer a point of difference and help increase customer loyalty with good advice.

The average skincare category accounts for 5 per cent of total OTC shelf space. It is important this space works hard for you and the range stocked provides maximum return in terms of profitability as well as offering customers the right range of specialist skincare treatments to meet their needs.

Moisturisers People suffering from dry skin, shouldn’t use harsh, alcohol-based products as these can irritate skin and dry it out. People who have oily skin should avoid oil-based products and choose water-based ones instead. A good moisturiser is not necessarily an expensive one. Deciding what is best for skin depends on ingredients. There are various ingredients that provide different functions including: • Ceramides. Ceramides help the skin hold water and soothe dry skin. Synthetic ceramides may mimic the natural substances in the outermost layer of skin that help keep moisture in.

• Dimethicone and glycerin. These draw water to the skin and keep it there.

• Hyaluronic acid. Like ceramides, hyaluronic acid helps skin hold water.

• Lanolin, mineral oil, and petroleum jelly (petrolatum). These help skin hold on to water absorbed during bathing.

Washing Dry Skin In addition to moisturising, dry skin needs to be washed appropriately. This includes: • Skipping long, hot showers: hot water strips oils from the skin faster than warm water.

Long showers or baths actually dry out the skin. Anyone suffering from dry skin should limit themselves to a single 5- or 10-minute warm shower or bath a day.

• Using a gentle cleanser or shower gel with moisturizer. Instead of harsh cleansers, suggest unscented, soap-free, or mild soap cleansers.

• Moisturising while skin is still moist. Patting skin with a towel after a shower or washing the face or hands, leaving it damp. Apply a moisturiser within three to five minutes of washing to lock moisture in.

Relieving Dry Skin Dry skin can be particularly uncomfortable during the winter months. There are various

Skincare tips

strategies that those affected by dry skin can try to relieve symptoms. These include: • Plugging in a humidifier at home to help keep skin hydrated during winter months when indoor air is dry.

• Avoid washing face with soap. It has a high alkaline pH level and can damage the skin’s barrier layer, leading to dryness.

• Wearing cotton and other natural fibres.

Wool, synthetics, or other fabrics can be scratchy and irritating.

• Cleanse and moisturise morning and evening – advise that it may take a month before customers see results.

• Drinking plenty of water.

• Apply a serum under their usual moisturiser.

• Eating omega-3 foods. Essential fatty acids can help fortify the skin’s natural oil-retaining barriers. Foods rich in omega-3 include coldwater fish (salmon, halibut, sardines), flax, walnuts, and sunflower oil.

• If the skin is red or inflamed, apply a cool compress or an over-the-counter hydrocortisone cream on the area for a week.

If these don’t provide relief, the patient should be referred to a doctor.

• Use a body moisturiser after bathing/showering.

• Even people with oily skin need a moisturiser.

Recommend an oil-free one.

• Exfoliate facial and body skin once weekly to prevent dry, flaky patches and improve radiance.

Applying moisturiser

People who work in jobs where they frequently have to put their hands in water or come into contact with certain chemicals can sometimes experience inflammation and itchiness on their hands. This is not merely dry skin, but is known as contact dermatitis or contact eczema. The patient should be referred to a GP who can advise on treatment, which usually includes topical creams.

• Apply a 50p piece-sized amount of moisturiser to the face and neck, from the chest upwards.

Even medical creams and lotions contain preservatives and can sting sensitive skin. Ointments are preservative-free, so recommend these to customers with sensitive skin who complain of stinging/burning when using emollients.

• Advise customers not to apply face cream to the eye area, as this requires a specific eye cream. Many moisturisers may be too rich in oils for the eye area and cause puffiness, or contain high levels of hydroxy acids, which may cause irritation.

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• Application should be even, across the whole area, especially when using a day cream with in-built sun protection. Moisturisers can be applied immediately after a serum or, if not using a serum, directly after cleansing, to help trap essential moisture inside the skin.

Who? Anyone What are the symptoms? Red and inflamed skin How long has the patient had the symptoms? Dry skin is particularly prevalent in the winter months Action already taken? Patients may already be using moisturisers Medication: If the patient has other skin conditions refer them to a GP so they can provide the appropriate treatment

Sleep Disruption

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SLEEP DISRUPTION Disruption to sleep can be caused by many different things, for example fever, the aches and pains associated with colds and flu, headaches, backache, rheumatic pains and muscle pains, period pains and toothache.

Headaches A tension headache will affect most of us at some time in our lives. In fact, even children get tension headaches. Although these headaches are more common in women than men, the symptoms are much the same in everybody: • pain that feels like a tight, squeezing band all over the head • pain that is mild to moderate, not severe • pain that lasts from 30 minutes to several days Many people who have tension headaches experience one or two every month. The pain symptoms can be easily managed with OTC painkillers. Some prevention advice may also be useful: • regular exercise – tension headaches are more common in people who don’t do a lot of exercise. Fitting some exercise into day-today life could help.

• relaxing and managing stress – massaging the shoulders and neck, applying a hot washcloth to the forehead or neck, yoga and even having a warm bath can help with relaxation. Specific relaxation exercises may also help.

• avoiding triggers – these can include certain foods, poor posture, stress or anxiety, eye strain and even feeling hungry.

Toothache Toothache occurs when the pulp inside the tooth gets inflamed (known as pulpitis). This is often caused by dental decay that results from poor oral hygiene, or it is sometimes caused by infection.

Toothache often starts suddenly, and the pain can vary from mild discomfort to severe. People with toothache may have a throbbing pain in the head, jaw and ear that is constant or that comes and goes. The pain can be worse when eating or drinking, particularly if the food or drink is hot or cold.

The jaw in the area of the tooth may be sore and tender to the touch. The pain can also get worse when laying down, because more pressure is put on the tooth.

Typical symptoms of toothache include: • increased pain when chewing • sensitivity to hot or cold food • bleeding around the tooth or gums • swelling around the tooth • swelling of the jaw If a customer is seeking pain relief for toothache, it is important that you encourage

them to see their dentist as soon as possible as treatment depends on what is causing the problem.

Menstrual Pain During the time that the lining of the womb is being shed, women experience cramping pain in the lower stomach, lower back and at the top of the legs – this is menstrual pain. The pain is caused by the womb contracting to remove the lining that it no longer needs. It’s thought that pain-causing chemicals, called prostaglandins, are involved in helping the womb contract.

For some women and girls their menstrual pain can be mild, but in others the pain can be more severe. No one really knows why, but it could be that some women who have more severe pain may have too many prostaglandins or be more sensitive to them. This can make the womb squeeze especially hard, briefly cutting off blood supply to your womb and causing even more pain. Around 10% can suffer from severe pain that stops them from going to school or work.

Up to 90% of girls and women have pain around the time of their period. Women may find the following tips helpful to ease menstrual pain: • Heat on the stomach can help ease menstrual pain - Apply a heat patch or putting a hot water bottle on the stomach.

• There’s some evidence to suggest that exercise may reduce menstrual pain. This could be any form of exercise.

• Try massaging the painful area of the stomach with gentle, circular motions.

Getting better sleep Unfortunately, as beneficial as sleep is for keeping colds and sickness at bay, many of us struggle to get enough of it. In addition to leaving us vulnerable to colds and flu, lack of sleep also affects work performance, leisure activities, relationships, the ability to think clearly, and mental and emotional well-being.

Small changes can help ensure sufficient, quality sleep: • Keeping a consistent sleep schedule. That means going to bed and waking up at the same time every day – including weekends!

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• Limiting food and beverage consumption at least two hours before bedtime to prevent heartburn and to keep from getting up for trips to the bathroom.

• Avoiding caffeine, nicotine and alcohol before bed. These substances are known to interfere with sleep.

• Creating a pro-sleep bedroom environment.

That means low lighting, a comfortable temperature and a noise level. It’s also important to have a comfortable mattress and pillow to prevent tossing and turning.

• Taking time to wind down before bed. Ease the transition from the hectic day to restful sleep by engaging in relaxing activities before bed. Take a warm bath, listen to soft music, or read a book.

• Exercise regularly. In general, exercising regularly makes it easier to fall asleep and contributes to sounder sleep. Finish exercise at least 3 hours before bedtime.

• Keep prescription sleeping pills to a minimum. Sleeping pills are effective but can have side-effects, so they should be used sparingly and for the shortest amount of time possible.

• If someone’s sleep is disrupted on a regular basis, they could have a sleep disorder. Their doctor can help to identify and treat the cause of the sleeping problems if they cannot be manged through self-care.

Who? Anyone – sleep disruption can have many causes What are the symptoms? Will depend on the cause of sleep disruption How long have they had the symptoms? Regular sleep disruption could be the sign of a sleep disorder Action already taken? Sleeping pills are effective but can have side-effects and should only be used sparingly Medication? Pain relief medicines should always be checked for contraindications if the patient is taking prescription medicine for any condition

Slimming and Nutrition

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SLIMMING AND NUTRITION For women, a waist size of over 32” can potentially lead to serious health problems. Whilst 32” doesn’t seem like much, if most of a woman’s fat is around her waist rather than at her hips, she can be at a higher risk for heart disease, stroke and type 2 diabetes.

Almost half of adults underestimate how large their waists can get before it can have an impact on their health. Sometimes what’s going on inside the body can be concealed and that is why diet and nutrition is vital for optimum health.

Reasons people can struggle to lose weight Successful weight loss is not complex. Quite simply, it is a matter of eating less calories than you burn in a day. But it won’t happen overnight. If you consume 500 less calories than you burn per day, it will take you a week to lose 1lb. It’s basic maths.

• They don’t see almost instant progress, so they quit.

• They see some success on a fad diet, get the results they want, then revert back to their old lifestyle, gaining back everything they lost and often additional weight on top.

• Complicated diets often have people obsessively measuring their food, taking pills and eating foods they hate. The result is that they get bored and frustrated, because they think they’re doing everything right. They quit when it is not successful.

• With some weight loss programmes, where people restrict themselves to repetitive meal and exercise people can very easily become bored and unable to sustain the plan. The best eating and training plan is one that the individual will enjoy, and be able to stick to long term.

• For many who are new to training, they find the muscular pain when they work hard in the gym or pool etc., too much to handle.

• Sometimes it’s difficult to eat healthily when a person feels that they are missing out on the foods that their partner or friends stull enjoy.

Losing weight naturally Many natural ingredients have powerful benefits for people losing weight: Sencha green tea: Sencha is a Japanese tea that packs powerful health benefits. It’s full of antioxidants, is fantastic for your skin and revs up that slacking metabolism. It’s great for fat burning and reducing cholesterol, and fights inflammation, acne and helps regenerate damaged cells.

Lotus leaf: Lotus leaf is fantastic in aiding high blood pressure. It originated in India and its calming properties alleviate restlessness, heart palpitations and insomnia. It is good for gut health as it soothes away gas, cramps, bloating and is an effective anti-inflammatory too. It’s a great source of B & C vitamins and for helping detox the body.

Pu’Erh leaf: Pu’Erh has long been valued in Chinese Herbalism for its vast benefits which include weight loss, cardiovascular benefits and reduction in cholesterol. It’s a gentle cleansing leaf which cleans up gathered toxins in the body. It can help alleviate bloating or digestion problems. Studies have also shown that pu-erh significantly suppresses fatty acid synthesis.

Lemon Grass: This citrusy leaf as the name suggests has the fragrance of lemon, but is milder and sweeter in taste. It has been used as an ancient remedy for all stomach problems in Chinese medicine such as bloating, constipation and indigestion. Again, it’s a leaf that is packed with antioxidants and fantastic for detoxing. It’s a natural fat burner and builds up the immune system, helping beat those colds and flus a lot quicker.

Garcinia cambogia extract: The name Garcinia Cambogia has become well known in recent years for its health benefits, including its ability to aid weight loss, reduce stress, fight depression, lower cholesterol, regulate blood sugar, increase metabolism and boost energy levels to name but a few. It’s also a great natural appetite suppressant, so really is a staple ingredient in the recipe for sustainable weight loss.

Rhubarb root: Rhubarb is packed with minerals, vitamins, organic compounds and

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other nutrients that make it ideal for keeping the body healthy. It’s a massive source of vitamin K, which supports healthy bone growth and can limit neuronal damage in the brain. It is good for bloating, skin care and as it’s a huge source of fibre, is great for aiding weight loss too.

Hibiscus leaf: A natural rich antioxidant, hibiscus gently cleanses the body from harmful and unwanted toxins. It also has anti-inflammatory properties which again are great for acne and other skin conditions. It can also be beneficial for women who suffer from PMS, or for a boost of energy.

Fennel: relaxes the digestive tract which eases uncomfortable symptoms. It’s also a natural blood cleanser and is known for reducing cellulite and regulating appetite.

It’s also beneficial for the heart health and balancing hormones.

Chamomile: properties include soothing upset stomachs, helping with sleep, boosting immunity, skin care and much more. It can lower blood sugar levels which in turn protects the pancreas. The health of the pancreas is extremely important as it produces insulin, the hormone responsible for removing sugar from the blood.

Jasmine: The antioxidants in jasmine tea can help protect the body against damage from free radicals. It’s great for those who suffer with a sweet tooth while trying to achieve weight loss goals as it’s naturally sweet flavour satisfies most cravings for sweet foods. It also reduces fat and cholesterol absorption and is great for calming nerves.

Who? Many woman and men alike will want lose weight. For women a wait measurement of over 32” means she should consider losing weight What are the symptoms? Bloating, lack of energy, digestive problems How long have they had the symptoms? Many women find it hard to lose weight after having a baby Action already taken – Many have given up on restrictive or repetitive diets through boredom or lack of results Medication – Diets pills are not suitable for many, for example those with hypertension

An

*

NEW

Patch for 24 hour craving control

Hit cravings with great flavour†

from *Provides significant improvement in quit rates vs. patch alone. †216 person sensory study.

NiQuitin Fresh Mint 2/4 mg Medicated Chewing Gum is to be used for the treatment of tobacco dependence by relief of nicotine withdrawal symptoms and cravings. Indicated in adults (18 years and over). NiQuitin Fresh Mint Medicated Chewing Gum 2 mg is suitable for who smoke who smoke 20 cigarettes or less. NiQuitin Fresh Mint Medicated Chewing Gum 4 mg is suitable for smokers who smoke 20 cigarettes or more. Gums should be chewed as directed whenever there is an urge to smoke, to maintain complete abstinence from smoking. Maximum 15 per day. In general, the use of the medicated chewing gum is 2-3 months then the use of gums may be reduced gradually. When daily use is 1-2 gums, use should be stopped. Abrupt cessation: Use a lozenges whenever there is an urge to smoke, maximum of 15 lozenges a day. Continue for up to 6 weeks, then gradually reduce lozenge use.

Adolescents (12-17 years): only with advice from a healthcare professional. Contraindications: hypersensitivity to nicotine or any of the excipients and children under the age of 12 years. Precaution: Supervise use if recent MI, unstable or worsening angina, severe CA, uncontrolled hypertension or recent cerebrovascular accident, diabetes, renal/hepatic imapairment, phaeochromocytoma, uncontrolled hyperthyroidism, GI disease. Side effects: Allergic reactions, anaphylactic reactions, insomnia, irritability, dizziness, headache, lightheadedness, tremor, palpitation, tachycardia, atrial fibrillation, hiccups, sore throat, pharyngitis, cough, pharyngolaryngeal pain, dyspnoea, nausea, GI discomfort, sore mouth, vomiting, indigestion, mouth irritation, mouth ulceration, dyspepsia, abdominal upper pain, diarrhoea, dry mouth, constipation, flatulence, oral discomfort, stomatitis, erythema, urticaria, increased sweating, jaw pain, chest pain, arthralgia, myalgia, malaise, parageusia, metallic taste, taste perversion. Legal classification: GSL: PA 1186/19/1 & PA 1186/19/2 MAH: Chefaro Ireland DAC, Treasury Building, Lower Grand Canal Street, Dublin 2, Ireland. RRP (ex. VAT): 30’s €9.99 100’s €24.99. SPCs: http://www.medicines.ie/medicine/17205/SPC/NiQuitin+Fresh+Mint+2mg+Medicated+Chewing+Gum/ NiQuitin 21 mg/24 hrs transdermal patches is indicated for the relief of nicotine withdrawal symptoms including cravings as an aid to smoking cessation. Indicated in adults and adolescents aged 12 years and over. NiQuitin patches should be applied once a day, at the same time each day and preferably soon after waking and worn continuously for 24 hours. Therapy should usually begin with NiQuitin 21 mg/24 hrs. Therapy schedule: Step1 NiQuitin 21 mg/24 hrs transdermal patches for 6 weeks, Step 2 NiQuitin 14 mg/24 hrs transdermal patches for 2 weeks, Step 3 NiQuitin 7 mg/24 hrs transdermal patches for final 2 weeks. Light smokers (e.g. those who smoke less than 10 cigarettes per day) are recommended to start at Step 2 (14 mg) for 6 weeks and decrease the dose to NiQuitin 7 mg/24 hrs for the final 2 weeks. Apply a patch to non-hairy clean dry skin surface, a new skin site should be used every day. Contraindications: non-smokers, children under 12 years and occasional smokers. Precaution: Supervise use if hospitalised for MI, severe dysrhythmia or CVA, If haemodynamically unstable, susceptible to angioedema, urticara, discontinue if severe persistent skin rash. Renal/hepatic impairment, hyperthyroidism, diabetic, phaeochromocytoma, current/previous epilepsy. Pregnancy and lactation: oral formats preferable to patches unless nauseous. Remove patches at bedtime. Side effects: Transient rash, itching, burning, tingling, numbness, swelling, pain urticaria, heaviness, hypersensitivity reactions. Headache, dizziness, tremor, seizures, sleep disorders, nervousness, palpitations, tachycardia, dyspnoea, pharyngitis, cough, GI disturbance, dry mouth, sweating, arthralgia, myalgia, asthenia, malaise, influenza-type illness, fatigue and anaphylaxis. Legal classification: GSL: PA 1186/18/1, PA 1186/18/2 and PA 1186/18/3. MAH: Chefaro Ireland DAC, Treasury Building, Lower Grand Canal Street, Dublin 2, Ireland. RRP (ex. VAT): 14 Day €37.73, 7 Day €20.94. SPCs: http://www.medicines.ie/medicine/6829/SPC/NiQuitin+7mg+24hrs+transdermal+patch es/, http://www.medicines.ie/medicine/4308/SPC/NiQuitin+14+mg+24hrs+transdermal+patches/, http://www.medicines.ie/medicine/4311/SPC/NiQuitin++21mg+24hrs+transdermal+patches/

Smoking Cessation

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SMOKING CESSATION Smoking is the leading cause of preventable death in Ireland. Each year at least 5,200 people die from diseases caused by tobacco use. This represents almost one in five of all deaths. Smoking related deaths are mainly due to cancers, chronic obstructive pulmonary diseases (COPD) and heart disease. Cigarettes contain over 4000 toxic chemicals, many of which are proven to cause cancer.

Smoking’s impact on public health is huge. In Ireland in 2008, smoking was responsible for 36,000 hospital admissions costing ¤280m.

Advice Access to services to promote smoking cessation should be readily available to patients. If a patient indicates a desire to quit, the information provided is key to the patient quitting smoking. According to findings from the Irish Cancer Society (ICS), just 15% of smokers have raised the topic with their GP, while only 4% have spoken to a Pharmacist. Just 3% have spoken to both their GP and Pharmacist.

Providing them with the benefits of their decision should always be the first port of call.

These include: • It saves money: the average smoker has 13 cigarettes a day, which works out as 364 cigarettes a month. That is ¤127 a month, and ¤1533 a year • Breathing and fitness improve dramatically • Food becomes mor e enjoyable as a sense of taste returns to maximum functionality • Skin and teeth appearance improve • Fertility levels improve, along with the chances of having a healthy pregnancy and baby

OTC Treatments Nicotine replacement therapy (NRT) increases the chance of quitting smoking. But, the level of smoker and previous attempts at quitting should always be considered to suggest the right product. The choice of therapy depends on patient’s preference; previous treatment should also be taken into account. Combination therapy may benefit some people who have a high level of nicotine dependence or who have tried previously to quit and failed. Gum For patients who smoke less than 20 cigarettes per day should use one piece of the 2mg strength gum when they get the urge to smoke. The gum should be chewed until the taste becomes strong and then placed between the cheek and gum, one piece generally lasts about 30 minutes. For people smoking more than 20 cigarettes per day or those who require more than 15 pieces of the 2mg gum should use the 4mg strength.

Inhalation Cartridges These can be used when the urge to smoke occurs and are generally ideal for patients who feel that they would miss the hand to mouth action of smoking. No more than 12 of the

10mg or 6 of the 15mg inhalators should be used per day. An inhalation cartridge last 40 minutes of intense use.

Lozenges A lower strength lozenge should be used in patients who smoke less than 20 cigarettes per day, and the higher strength lozenge should be used in those who smoke more than 20 cigarettes per day. One lozenge can be used every 1 to 2 hours when the urge occurs.

while using one form of NRT, or for those who have not been able to quit altogether using one form of NRT alone. The usual combination therapy is the nicotine patch combined with oral nicotine replacement products.

It is suitable for those smokers who are still experiencing significant cravings and nicotine withdrawal symptoms while using one form of NRT, or for those who have not been able to quit altogether using one form of NRT alone. It is suitable if your customer: • is a Heavy Smoker

Patches

• has failed to quit using NRT previously

Nicotine patches are a prolonged release formulation that can be applied for 24 or 16 hours. Patients who experience cravings on waking should use a 24 hour patch. For those who smoke more than 10 cigarettes per day a high strength patch can be advised to be applied per day for 6 to 8 weeks, followed by a medium strength patch for two weeks and then a low strength patch for 2 weeks. In those who smoke less than 10 cigarettes per day can start on a medium strength patch for 6 to 8 weeks and then a low strength patch for 2 to 4 weeks.

Including combination therapy in a quit a smoking strategy means you can offer a patient a nicotine patch throughout the day but also provide an oral NRT product for use during the day when patients may find craving for cigarettes difficult to manage. For example, sometimes a craving can be hard to manage early in the morning, before a nicotine patch has time to work. This is a situation where oral NRT can be very helpful. Some people may have concerns that they may get too much nicotine with combination therapy. Research shows that, for a smoker who is suited to this kind of therapy, there is no increased risk of side effects from combination therapy. The amount of nicotine in all NRT products is typically lower than the amount a person receives from regular smoking.

Combination Therapy Combination therapy is suitable for those smokers who are still experiencing significant cravings and nicotine withdrawal symptoms

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• Experiences acute breakthrough cravings

Who? Any adults What? N/A How long have they had the symptoms? The length of time they have smoked and the volume is essential to determining what NRT to recommend Action already taken? Sufferers may already be trying to cut down or stop smoking all together Medication: No more than 15 of the higher strength NRT lozenges should be used per day. Inhalators should be used in caution with patients with COPD or chronic throat disease

Your throat is your strength.

www.septabene.ie

L-ROUND L A

TR

E AT M E N T

NEW A new sore-throat medicine with a unique formula for all-round treatment: • Analgesic: quickly relieves pain • Anti-Inflammatory: reduces inflammation • Antiseptic: eliminates causes of infection • SUITABLE FOR DIABETICS • SUITABLE FOR COELIACS

Septabene lozenges and spray: The spray solution and lozenges contain benzydamine hydrochloride and cetylpyridinium chloride. Septabene spray: Indicated for adults and children aged 6 years and over for anti-inflammatory, analgesic and antiseptic treatment of irritations in the throat, mouth and gums, in gingivitis, pharyngitis, laryngitis and before and after tooth extractions. Septabene lozenges: Indicated for anti-inflammatory, analgesic and antiseptic treatment of symptoms of sore throat associated with upper respiratory infections including pharyngitis, laryngitis and tonsilitis. Children from 6 to 12 years of age: The recommended dosage is 3 lozenges a day. The lozenge should be slowly dissolved in the mouth every 3-6 hours. For a single dose of the spray, press the spray head once. This may be repeated every 2 hours 3-5 times a day. Adults, elderly and children over 12 years of age: The recommended dosage is 3-4 lozenges a day. The lozenge should be slowly dissolved in the mouth every 3–6 hours. For a single dose of the spray, press the spray head once to twice. This may be repeated every 2 hours 3-5 times a day. Precautions: Septabene should not be used for more than 7 days. If there is no improvement after 3 days, the patient should consult a doctor. The use of topical preparations, especially over a long period of time, may lead to sensitization, in which case the treatment must be discontinued and doctor consulted to set up a suitable therapy. Septabene must not be used in combination with anionic compounds, such as those present in toothpastes, therefore it is not recommended to use the product immediately before or after cleaning teeth. Benzydamine use is not advisable in patients with hypersensitivity to salicylates (e.g. acetylsalicylic acid and salicylic acid) or other NSAIDs. Bronchospasm may be precipitated in patients suffering from or with a previous history of bronchial asthma. Caution should be exercised in these patients. Septabene should not be used in patients with open wounds or ulcerations in the mouth or throat. Septabene contains isomalt (E953). Patients with rare hereditary problems of fructose intolerance should not take this medicine. Direct contact of Septabene spray solution with eyes should be avoided. Septabene spray contains small amounts of ethanol. Contraindications: Septabene lozenges and spray: Hypersensitivity to the active substances or to any of the excipients listed in section 6.1 of the SPC. Children aged under 6 years: The pharmaceutical form is not appropriate for this age group. Fertility, pregnancy and lactation: There are no or limited amount of data from the use of benzydamine hydrochloride and cetylpyridinium chloride in pregnant women. Septabene is not recommended during pregnancy. It is unknown whether benzydamine hydrochloride (metabolites) are excreted in human milk. A risk to the newborns and infants cannot be excluded. A decision must be made whether to discontinue breast-feeding or to discontinue (abstain from) Septabene therapy taking into account the benefit of breast feeding for the child and the benefit of therapy for the woman. Adverse reactions: Septabene lozenges and spray: Rare: Hypersensitivity reaction, bronchospasm, urticaria, photosensitivity. Very rare: Oral mucosal irritation, burning oral sensation. Not known: Burning mucosa, anaesthesia of oral mucosa. Shelf life: 2 years. Legal category: Medicinal product not subject to medical prescription. Marketing authorisation number: Septabene spray PA1347/049/001, Septabene lozenges PA1347/063/001. Marketing authorisation holder: Krka, d. d., Novo mesto, Šmarješka cesta 6, 8501 Novo mesto, Slovenia. SPC: http://www.hpra.ie/homepage/medicines/medicines-information/find-a-medicine/results?query=septabene&field= Date of preparation: June 2017. Additional information is available on request from Krka Pharma Dublin Ltd. Unit 4A, Leopardstown Business Centre, Ballyogan Road, Leopardstown, Dublin 18. D18 KX88. Reference number: 02-11-2017.

Sore Throat

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SORE THROAT A sore throat is a painful, dry, or scratchy feeling in the throat. Most sore throats are caused by infections, or by environmental factors like dry air. Although a sore throat can be uncomfortable, it’ll usually go away on its own. Sore throats are very common and usually nothing to worry about. They normally get better within a week. Most are caused by minor illnesses such as colds or flu and can be treated at home.

Sore throats are divided into types, based on the part of the throat they affect: Pharyngitis affects the area right behind the mouth.

Tonsillitis is swelling and redness of the tonsils, the soft tissue in the back of the mouth.

Laryngitis is swelling and redness of the voice box, or larynx.

Symptoms • swollen tonsils • enlarged and tender glands in the neck • a painful, tender feeling at the back of the throat • discomfort when swallowing

Causes of a sore throat The cause of a sore throat isn’t always obvious.

But in most cases it’s a symptom of a viral or bacterial infection.

Common causes A sore throat is often a symptom of: Colds or Flu – they may also have a blocked or runny nose, a cough, a high temperature (fever), a headache and general aches Llaryngitis – they may also have a hoarse voice, a dry cough and a constant need to clear their throat Tonsillitis – they may also have red or spotty tonsils, discomfort when swallowing and a fever Strep Throat (bacterial throat infection) – they may also have swollen glands in the neck, discomfort when swallowing and tonsillitis

Glandular Fever – they may also feel very tired and have a fever and swollen glands in the neck It may also be caused by something irritating the throat, such as smoke, gastro-oesophageal reflux disease (where acid leaks up from the stomach) and allergies.

Less common causes Less often, a sore throat can be a sign of: quinsy (a painful collection of pus at the back of the throat) – the pain may be severe, and they may also have difficulty opening their mouth or difficulty swallowing epiglottitis (inflammation of the flap of tissue at the back of the throat) – the pain may be severe, and they may have difficulty breathing and difficulty swallowing

• They have a weak immune system - for example, if they have HIV, are having chemotherapy, or are taking medication that suppresses the immune system

Helping soothe a sore throat • Recommend ibuprofen or paracetamol – paracetamol is better for children and for people who can’t take ibuprofen (note that children under 16 should never take aspirin) • drink plenty of cool or warm fluids, and avoid very hot drinks • eat cool, soft foods • avoid smoking and smoky places

These conditions are more serious and should be seen by a doctor as soon as possible.

• adults can try gargling with a homemade mouthwash of warm, salty water (not recommended for children)

When to refer

• suck lozenges, hard sweets, ice cubes or ice lollies – but don’t give young children anything small and hard to suck because of the risk of choking

• Their symptoms are severe • They have persistent symptoms that haven’t started to improve after a week • They experience severe sore throats frequently

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• medicated lozenges and sprays • Antibiotics aren’t usually prescribed for a sore throat, even if it’s caused by a bacterial infection

Who? Sore throats are common. Most people have at least two or three every year. They are more common among children and teenagers What are the symptoms? a painful, tender feeling at the back of the throat, discomfort when swallowing How long have they had the symptoms? A clinical diagnosis of the condition is usually not required, unless the symptoms do not improve after two weeks Action already taken? People may have taken painkillers for their sore throat Medication? Always check the label of pain relief or medicated throat sprays for contraindications

Sports Injuries – Treating with hold and Cold therapy

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SPORTS INJURIES - TREATING WITH HOLD AND COLD THERAPY With people increasingly continuing to play sport in their adult lives and be active, sports injuries are on the increase.

Pharmacies are usually the first port of call particularly for men who are less likely to attend their GP. It is important therefore to be thorough in identifying the cause of the injury and providing appropriate and helpful care.

Sports injuries can be caused by many things including: • an accident • insufficient warm-up/ no warm-up • using poor technique or inappropriate equipment • pushing oneself too hard

Treating Sports Injuries Sport injuries can affect almost any part of the body, including the muscles, bones, joints and connective tissues (tendons and ligaments).

Every athlete is different whether it is a tennis player or a swimmer, using different muscle groups, different equipment and different strategies. As such, the pharmacy can see a multitude of ailments including strains and strains, possible broken bones, head injuries, joint inflammation, heel pain, back pain, knee and ligament issues, skin conditions, and hamstring injuries.

Topical Analgesics Topical pain relief products are applied externally to the skin where they exert an analgesic effect.

• GPs and Physiotherapists may recommend topical analgesics as first line treatment for muscular aches, pain and injuries.

• Not all topical analgesics are the same – some can offer additional benefits, such as hot and cold therapy, which assist with healing and recovery.

• Topical products are associated with fewer gastric side effects than oral pain relief.

• Creams, gels and patches can provide alternative pain relief to customers who cannot take oral pain relief.

Heat Therapy Heat increases blood flow to the affected area providing oxygen and nutrients to aid the healing process and help restore movement.

Heat should be applied the affected area where pain is felt. It can be used before exercise as part of a warm up where previous injury has occurred.

Heat therapy is suitable for: • Stiff, aching muscles • Muscular back pain

• Sharp, shooting muscle pain

• Before exercise (for muscular aches and pains)

• Muscular back pain during pregnancy

When heat is applied to the body, it activates receptors in the skin which then send signals to the brain which dilute the pain.

• Fast pain relief

• Comforting, warming pain relief

• Alternative to oral pain killers

• Can help soft tissue recovery after injury

• Helps minimise soft tissue damage

• Alternative to taking oral painkillers

Preparation and caring for your muscles before taking part in any exercise is equally as important to cooling down and stretching out after exercise.

Cold Therapy When cold is applied it causes the blood vessels to constrict. This can help minimise damage and thereby reduce the amount of repair needed.

When recommending any of the products on offer for the treatment of sports injuries, several precautions should be communicated to the patient.

Cold should be applied to the affected area as soon as possible after injury when pain is felt.

Treatments should continue until all swelling has subsided (can take up to 72 hours)

These analgesics should not be used in patients under the age of five years. Nor should they be used if symptoms persist for more than seven days, or clear up but recur within a few days. They should only be used three to four times daily and discontinued if the condition worsens. The area should not be bandaged, and the products should not be applied to wounds or broken skin. They should never be used with any source of external heat, such as a heating pad.

Cold therapy is suitable for:

• Some people are concerned about taking pills and topical products can offer an alternative.

• They can provide pain relief directly at the point of pain without having to take pills.

The benefits of cold treatments are;

The benefits of heat treatment are:

External analgesics (counter-irritants) are widely used choices for care of sports injuries that result in pain, swelling, bruising and tenderness around a joint or in a muscle. Applied topically, they provide a sensation of heat, such as methyl salicylate or coolness, such as menthol.

Why recommend a topical product?

When cold is applied to the body, it activates receptors in the skin which then send signals to the brain which dilute the pain.

• Sprains, strains, after injury

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Using heat therapy before exercise, for muscular aches and pains, as part of a warm up can increase blood flow which helps increase the flexibility of muscles and joints to help prevent injury.

It is important to advise not to use heat therapy immediately after strenuous exercise or immediately after injury as it increases circulation. When there is any injury, cooling therapy should be used for this at the same time.

Who? Those who are partaking in sport What are the symptoms? Dependent upon the site of injury How long have they had the symptoms? Refer anyone with long-term pain resulting from sports injuries where OTC treatments are not having an impact Action already taken? Sufferers may already have self-selected OTC medication Medication: Consult GP if prescription medications are being used

Topical Analgesics

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TOPICAL ANALGESICS Over-the-counter analgesics are a class of medicines that relieve pain, and depending on the dosage form, some analgesics may also help to reduce things like fever.

There are two different categories of analgesics: internal and external.

• Internal analgesics are pain relievers and fever reducers. These medicines are intended for internal use and are either taken by mouth in the form of pills and liquids, or inserted into the rectum in suppository form.

• External analgesics are topical pain relievers and are not intended to reduce fever. These medicines are for external use only and are applied directly to the outer body surface in lotions, sprays, and other forms.

Before selecting an OTC analgesic medicine, the type of symptoms a customer is experiencing helps determine the best treatment suited to them.

The Market Analgesics make up a large proportion of the total self medication market in Ireland, the market worth ¤273 million is estimated in total. Patients often use OTC topical analgesics for the treatment and management of musculoskeletal injuries and disorders.

Following the introduction of the codeine regulations, pharmacists now encourage the use of acetaminophen as first in line choice of pain relief, followed by ibuprofen, before codeine-based analgesics. In addition, patients must be made aware of how to use the medication properly and must be informed by pharmacists of the possible side effects that can occur when a product is used after the recommended period of three days.

Products may have local analgesic, anaesthetic, antipruritic, and/or counterirritant effects. Topical pain killers, or analgesics, are sprayed on or rubbed into the skin over painful muscles or joints. Although all are designed to relieve pain, different products are made up different ingredients.

Counterirritants are approved for the topical treatment of minor aches and pains of muscles and joints. They are often employed for the treatment of acute musculoskeletal injuries and as an adjunct therapy in the treatment of chronic musculoskeletal disorders.

Counterirritants differ from other external analgesics in that pain relief results more from nerve stimulation than depression.

Topical analgesics for musculoskeletal pain can be used alone or in conjunction with oral analgesics when appropriate and warranted.

External analgesic products may contain or more of the following ingredients: methyl salicylate, camphor, menthol, methyl nicotinate, capsicum, and trolamine salicylate.

Salicylates: These same ingredients that give aspirin its pain-relieving quality are found in some creams. When absorbed into the skin, they may help with pain, particularly in joints close to the skin, such as the fingers, knees, and elbows.

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Capsaicin: The main ingredient of hot chili peppers, capsaicin is also one of the most effective ingredients for topical pain relief. When first applied, capsaicin creams cause a warm tingling or burning sensation. This gets better over time. Users may need to apply these creams for a few days up to a couple of weeks before they will notice relief from pain.

Topical analgesic products are available in a variety of formulations, including gels, ointments, creams, lotions, and patches in single-entity or combination formulations.

Topical heat therapy patches are also available in various sizes for treating joint and muscle pain and provide 8 to 12 hours of continual, portable heat therapy.

OTC topical analgesics are intended to be used for mild to-moderate pain for no longer than 7 days. The factors that a pharmacist may consider when recommending a topical analgesic include dosage form, cost, ease of use of product, as well as the patient’s medical history, including possible allergies.

Who? Anyone suffering from pain, musculoskeletal problems or fever What are the symptoms? Dependent on the condition suffered How long has the patient had the symptoms? Dependent on the condition suffered Action already taken? Pain relief Medication? Apply topical products only to intact skin. Areas treated with counterirritants should not be covered with tight bandages or occlusive dressings. Patients on anticoagulation therapy should be advised not to use topical products that contain salicylates, because concomitant use has been associated with prolonged prothrombin time

Otrivine® Adult Mucus Relief Menthol 0.1%w/v Nasal Spray is for relief of nasal congestion.

CHGBI/CHOTRI/0017/17

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Product Information: Please refer to Summary of Product Characteristics for full prescribing information.

Otrivine Adult 0.1%w/v Nasal Drops, solution; Otrivine Adult 0.1%w/v Nasal Spray, solution; Otrivine Adult Measured Dose Sinusitis 0.1%w/v Nasal Spray, solution; Otrivine Adult Mucus Relief 0.1%w/v Nasal Spray, solution (xylometazoline hydrochloride 0.1% w/v). Uses: Nasal decongestant for relief of symptoms of acute rhinitis in allergic or upper respiratory tract infections, including the common cold or influenza and relief of sinusitis. Dosage and method of use: Adults, elderly and children over 12 years: Adult Drops: Two to four drops in each nostril, up to 3 times daily as needed. Spray: One to two sprays into each nostril, up to 3 times daily as needed. Measured Dose Sinusitis Spray: One application in each nostril, up to 3 times daily as needed. Mucus Relief Menthol Spray: One application in each nostril, 3 times daily as needed. Children under 12 years: Do not use. Contraindications: Hypersensitivity to ingredients. Concomitant use with MAOIs or ceased treatment within the last 2 weeks. Recent trans-nasal surgery, acute coronary disease, hyperthyroidism, narrow angle glaucoma, rhinitis sicca and atrophic rhinitis. Precautions: Do not exceed the recommended dose or use for more than 7 consecutive days as excessive or prolonged use may cause rebound congestion and drug induced rhinitis. Use with caution in those showing a strong reaction to adrenergic agents, or with cardiovascular disease, hypertension, prostatic enlargement or diabetes, pregnancy and breast feeding. Otrivine Menthol: Extra caution is advised in patients with hyperthyroidism. All of the products contain: benzalkonium chloride which can cause irritation or bronchospasm. Otrivine Menthol also contains: polyoxl hydrogenated castor oil, which may cause skin reactions. To prevent cross infection, each pack should be used by one person only.

Side Effects: Common: headache, nasal dryness or nasal discomfort, burning sensation, nausea, application site burning; Very rare: Hypersensitivity reaction (angioedema, rash, pruritus), visual impairment/disturbance, heart rate irregular and heart rate increased. Legal Category: Pharmacy only. Product Authorisation Number: Otrivine Adult Nasal Drops: PA 0678/120/001; Otrivine Adult Nasal Spray: PA 0678/120/002; Otrivine Adult Measured Dose Sinusitis Spray: PA 0678/120/003; Otrivine Adult Mucus Relief Menthol Nasal Spray PA0678/120/005 PA Holder: GlaxoSmithKline Consumer Healthcare (Ireland) Limited, 12 Riverwalk, Citywest Business Campus, Dublin 24, Ireland. Date of last revision: 02 June 2017. Further information is available on request.

Upper Respiratory Tract Infections

81

UPPER RESPIRATORY TRACT INFECTIONS Respiratory tract infections (RTIs) are any infection of the sinuses, throat, airways or lungs. They’re usually caused by viruses, but can be caused by bacteria. RTIs are one of the main reasons why people visit the Pharmacy. The common cold is the most widespread RTI. There is a distinction between the two types: • upper respiratory tract infections – which affect the nose, sinuses and throat • lower respiratory tract infections – which affect the airways and lungs Children tend to get more upper RTIs than adults because they haven’t built up immunity to the many viruses that can cause these infections.

How respiratory infections spread RTIs can spread in several ways. When a person has an infection such as a cold, tiny droplets of fluid containing the cold virus are launched into the air whenever they sneeze or cough. If these are breathed in by someone else, they may also become infected.

Infections can also be spread through indirect contact. For example, if someone has a cold and they touch their nose or eyes before touching an object or surface, the virus may be passed to someone else when they touch that object or surface.

The best way to prevent spreading infections is to practise good hygiene, such as regularly washing their hands with soap and warm water.

Upper respiratory tract infections Common upper respiratory tract infections include: • the common cold • tonsillitis • sinusitis • laryngitis

As with upper RTIs, the main symptom of a lower RTI is a cough. However, it’s usually more severe and phlegm and mucus may be brought up. Other possible symptoms are a tight feeling in the chest, an increased rate of breathing, breathlessness and wheezing.

Self-Care for Symptoms

• They have a condition that affects the nervous system, such as multiple sclerosis • They have cystic fibrosis or bronchiectasis • They have a weakened immune system • They have a cough which has persisted for more than three weeks • They are losing weight, • They have chest pain

Most RTIs pass without the need for treatment and won’t usually need to be seen by a GP. You can encourage people to treat their symptoms at home by taking over-the-counter painkillers such as paracetamol or ibuprofen, drinking plenty of fluids and resting. In most cases, antibiotics aren’t recommended because they’re only effective if the infection is caused by bacteria. The symptoms of an upper RTI usually pass within one to two weeks.

• If there are any lumps in their neck

When to Refer

• They have a history of heart failure

• The symptoms suggest they may have pneumonia – for example, if they are coughing up bloody mucus and phlegm

It’s also recommended that people visit their GP if they are over 65 years of age and they have a cough and two or more of the factors listed below, or they are over 80 years of age and have a cough and one of the following factors: • Have been admitted to hospital at some point during the past year • They have type 1 diabetes or type 2 diabetes • They are currently taking a type of steroid medication known as oral glucocorticoids – for example, prednisolone.

• They have a pre-existing heart, lung, liver or kidney condition • They have a long-term lung condition, such as chronic obstructive pulmonary disease (COPD) or asthma

• flu A cough is the most common symptom of an upper RTI. Other symptoms include headaches, a stuffy or runny nose, a sore throat, sneezing and muscle aches.

Lower respiratory tract infections

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Common lower RTIs include: • flu – which can affect either the upper or lower respiratory tract

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• bronchitis • pneumonia • bronchiolitis • tuberculosis

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Who? Anyone - Children tend to get more upper RTIs than adults What are the symptoms? A cough is the most common symptom of an upper RTI. Other symptoms include headaches, a stuffy or runny nose, a sore throat, sneezing and muscle aches How long have they had they symptoms? The symptoms of an upper RTI usually pass within one to two weeks Action already taken? People may have tried to manage their symptoms at home by taking OTC painkillers such as paracetamol or ibuprofen, drinking plenty of fluids and resting Medication? Elderly people who are taking oral glucocorticoids – for example, prednisolone, should be referred to their GP

Irish Pharmacy News

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VMS

83

VMS Vitamins and minerals are essential nutrients that your body needs in small amounts to work properly.

Most people should be able to get all the nutrients they need by eating a varied and balanced diet. If you choose to take vitamin and mineral supplements, be aware that taking too much or taking them for too long can cause harmful effects.

Vitamins There are two types of vitamins: fat-soluble and water-soluble.

Fat Soluble Fat-soluble vitamins are found mainly in fatty foods such as animal fats including butter and lard, vegetable oils, dairy foods, liver and oily fish.

While the body needs these vitamins every day to work properly, a person does not need to eat foods containing them every day. This is because, the body does not need these vitamins immediately, it stores them in the liver and fatty tissues for future use. These stores can build up so they are there whenever they are needed. However, too much fat-soluble vitamins can be harmful.

Fat-soluble vitamins are: • Vitamin A - Also known as retinol. It has several important functions, such as: strengthening immunity against infections, helping vision in dim light and keeping skin and the linings of some parts of the body, such as the nose, healthy. The recommended intake of vitamin A is 0.7mg a day for men and 0.6mg a day for women.

• Vitamin D - Vitamin D has several important functions. It helps regulate the amount of calcium and phosphate in the body.

These substances are needed to keep bones and teeth healthy. Vitamin D is not needed in your diet every day, because any of the vitamin your body does not need immediately is stored for future use.

However, it is recommended that all babies 0 to 12 months should receive a vitamin D supplement. Vitamin D3 is the preferred form of the supplement for infants. Products which contain other vitamins as well as vitamin D should not be used.

• Vitamin E- Vitamin E has several important functions. It helps protect cell membranes. The amount of vitamin E recommended is 4mg a day for men and 3mg a day for women.

• Vitamin K - Vitamin K has several important functions. It is needed for blood clotting, which means it helps wounds heal properly and there is increasing evidence that vitamin K is also needed to help build strong bones. It is recommended that adults need approximately 0.001mg a day of vitamin K for each kilogram of their body weight.

Water-Soluable Vitamins Water-soluble vitamins are not stored in the body, so they are needed more frequently.

If there are more than you needed the body gets rid of the extra vitamins when a person urinates. As the body does not store watersoluble vitamins, these vitamins are generally not harmful.

Water-soluble vitamins are found in fruit, vegetables and grains. Unlike fat-soluble vitamins, they can be destroyed by heat or by being exposed to the air. They can also be lost in water used for cooking.

Water-soluble vitamins are vitamin C, the B vitamins and folic acid.

• Vitamin C - Vitamin C is also known as ascorbic acid. It has several important functions. It helps protect cells and keeps them healthy and is necessary for the maintenance of healthy connective tissue, which gives support and structure for other tissue and organs. A lack of vitamin C can lead to scurvy. It is recommended that adults get 40mg of vitamin C a day.

• B Vitamins - Vitamin B6 is also known as pyridoxine. It has several important functions, including allowing the body to use and store energy from protein and carbohydrates in food and helping form haemoglobin, the substance that carries oxygen around the body. The recommended amount of vitamin

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B6 is 1.4mg a day for men and 1.2mg a day for women.

• B12 - Vitamin B12 has several important functions and is involved in making red blood cells and keeping the nervous system healthy, releasing energy from the food we eat and processing folic acid. Adults need approximately 0.0015mg a day of vitamin B12.

• B3 - Otherwise known as Niacin, B3 has several important functions including helping produce energy from the foods we eat and helping keep the nervous and digestive systems healthy. The recommended amount of niacin you needed is 17mg a day for men and 13mg a day for women.

Minerals Minerals are necessary for three main reasons: • building strong bones and teeth • controlling body fluids inside and outside cells • turning the food you eat into energy Minerals are needed in the form they are found in food. Essential minerals include calcium and iron.

Who? Anyone should consider taking a supplement of Vitamin D daily, particularly in winter What are the symptoms? People feeling fatigued, for example after an illness, can benefit from multivitamin supplements How long have they had the symptoms? Feelings of fatigue can last as long as six months after illness Action already taken? People may have taken steps to improve the balance of their diet Medication? Some supplements could prevent prescribed drugs from working as intended, or result in additional side effects. Always check the label

Cold and Flu Film-Coated Tablets contain:

Professionally recommended for: Colds and Flu Runny Nose

Pain Relief Congestion

A triple combination of antihistamine, analgesic and stimulant

Does not contain Pseudoephedrine

Caffeine strengthens the analgesic and antipyretic effects of Paracetamol*

An optional adjuvant therapy for the management of the symptoms of upper respiratory tract infections

Product Code: 5903 Product: Cold and Flu Film-Coated Tablet Unit Barcode: 5013837204072 Size: 20 P PA Holder : Seven Seas Limited, Bedfont Cross, Stanwell Road, Feltham, TW14 8NX, United Kingdom PA 417/18/1 Seven Seas Limited is a member of the Merck Group *Summary of Product Characteristics, Ilvico Cold and Flu-film coated tablets, CRN 2167729: Date Printed December 2015

Further information is available on request from Brandshapers on 053 915 5950

Winter Ailments

85

WINTER AILMENTS Winter is that time of year when it is dark in the mornings and it can be a struggle to get out of bed. Many of us may suffer from colds, coughs and sore throats and if we are unluckier may even contract a dose of the winter flu. Unfortunately, it’s not always possible to prevent these common winter ailments from crossing our path.

The Common Cold Colds are one of the most frequently dealt with complaints in the pharmacy. They are highly contagious airborne conditions and are passed on by sneezing, coughing and hand to hand contact. They are caused by a virus and not bacteria and therefore should not be treated with antibiotics. The winter flu is often mistaken for a cold but although both conditions are caused by viruses there are a number of differences between them. Whereas as symptoms of a cold generally only last a few days, flu symptoms can make people feel very unwell often leaving them unable to leave the house or go to work.

Congestion A stuffy head can be very annoying and can often be accompanied by sinus pain across the forehead, through the nose and under the eyes.

Decongestants are the mainstay treatment for treating congestion as they decrease the swelling in the lining of the nose, unblocking it which can help reduce the headaches associated with a cold.

Advice: Recommend to people suffering from a cold to take a hot shower before bed, or sit in the bathroom with the hot shower running.

The steam will help open the sinus. It’ll also help drain the mucus, so they can breathe easier through their nose.

Sore Throat Sore throats also tend to be caused by viruses and again are often best treated with an OTC product. Occasionally a severe sore throat is accompanied by swollen glands and a high temperature which can indicate a bacterial infection and hence a referral to a doctor may be necessary. The two main treatments for sore throats include lozenges and throat sprays.

These usually contain a local anaesthetic which numbs the area and this relieves pain.

Antibacterial and anti-inflammatories are also commonly used to reduce the chance of infection and inflammation.

Advice: A good mouthwash is recommended to in order to maintain good oral hygiene especially if a sore throat keeps recurring.

Coughs People may develop a cough when suffering from a cold. This cough may be chesty which can be best treated with an expectorant, which works by loosening phlegm allowing it to be expelled, or a mucolytic that works by liquefying mucus. In certain circumstances a cough can develop and lead to infection. If a person

is coughing up discoloured, thick mucus, a bacterial infection may be present and they should consult their GP. For poeple suffering from a dry cough, a cough suppressant can be useful.

Advice: Lozenges are a good way to help relieve a dry irritating cough.

The Winter Flu The flu is not as easy to treat and can leave people bed bound for up to a week, with severe aches, pains and a high temperature. The key is prevention rather than cure - the flu injection is a highly effective at preventing the flu and the dangerous complications that can accompany it especially in the elderly or people who fall into the “at risk” category: • Persons aged 65 and over • Those with a long-term medical condition such as diabetes, heart or lung disease • People whose immune system is impaired due to disease or treatment • Persons with Down Syndrome • Persons with a body mass index (BMI) over 40 • Pregnant women (can be given at any stage of pregnancy).

• Residents of nursing homes and other long stay institutions • Healthcare workers • Carers

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• People with regular close contact with poultry, water fowl or pigs • Cancer patients

Winter wellness Supplements Vitamin C – Whilst it may not prevent a cold, it can certainly lessen the effects by a day or two.

It is a powerful anti-oxidant and also supports tissue growth, healthy blood vessels and storing bones and teeth.

Iron – A lack of iron can make us sluggish.

Boosting iron intake can rev up energy levels and encourage healthy fresh blood oxygen levels to the lungs, spleen and other organs.

Vitamin D – As there is much less sunshine in the winter due to shorter days, we all get a lot less vitamin D from the sun. Without vitamin D the body cannot absorb calcium and also cannot stimulate an adequate response to colds and flu.

Calcium – Calcium helps keeps bones strong and therefore protects against bone breaks in the case of a fall especially in the elderly.

Omega-3 fatty acids – Many people can suffer from seasonal affective disorder in the winter months due to shorter days. These fatty acids can help boost mood, increase mental focus and ward off sniffles.

Probiotics – Probiotics are good bacteria which have been proven to improve gut health which in turn can help reduce the incidence, severity and duration of colds and flu by helping fight infection.

Who? Anyone – The young and elderly are more susceptible to winter illness What are the symptoms? Cold, congestion, sore throat and cough How long have they had the symptoms? symptoms of a cold generally only last a few days, flu symptoms can make people feel very unwell often leaving them unable to leave the house or go to work Action already taken? People may have tried pain relief – but may not be aware of combination products, for example ones containing combination of antihistamine, analgesic and stimulant Medication? Pseudoephedrine is contraindicated in patients with diabetes mellitus, cardiovascular disease, severe or uncontrolled hypertension, severe coronary artery disease, prostatic hypertrophy, hyperthyroidism, closed angle glaucoma, and pregnant women

January 2018 Week 1

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December 2017 4 11 18 25 M 5 12 19 26 T 6 13 20 27 W 7 14 21 28 T F 1 8 15 22 29 S 2 9 16 23 30 S 3 10 17 24 31

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December 2017 4 11 18 25 M 5 12 19 26 T 6 13 20 27 W 7 14 21 28 T F 1 8 15 22 29 S 2 9 16 23 30 S 3 10 17 24 31

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January 2018 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 31 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

February 2018 5 12 19 26 M 6 13 20 27 T 7 14 21 28 W T 1 8 15 22 F 2 9 16 23 S 3 10 17 24 S 4 11 18 25

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June 2018 M 4 11 18 25 T 5 12 19 26 W 6 13 20 27 T 7 14 21 28 F 1 8 15 22 29 S 2 9 16 23 30 S 3 10 17 24

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June 2018 M 4 11 18 25 T 5 12 19 26 W 6 13 20 27 T 7 14 21 28 F 1 8 15 22 29 S 2 9 16 23 30 S 3 10 17 24

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June 2018 M 4 11 18 25 T 5 12 19 26 W 6 13 20 27 T 7 14 21 28 F 1 8 15 22 29 S 2 9 16 23 30 S 3 10 17 24

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June 2018 M 4 11 18 25 T 5 12 19 26 W 6 13 20 27 T 7 14 21 28 F 1 8 15 22 29 S 2 9 16 23 30 S 3 10 17 24

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June 2018 M 4 11 18 25 T 5 12 19 26 W 6 13 20 27 T 7 14 21 28 F 1 8 15 22 29 S 2 9 16 23 30 S 3 10 17 24

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May 2018 7 14 21 28 M T 1 8 15 22 29 W 2 9 16 23 30 T 3 10 17 24 31 F 4 11 18 25 S 5 12 19 26 S 6 13 20 27

June 2018 M 4 11 18 25 T 5 12 19 26 W 6 13 20 27 T 7 14 21 28 F 1 8 15 22 29 S 2 9 16 23 30 S 3 10 17 24

21 Thursday

July 2018 2 M 3 T 4 W 5 T 6 F 7 S S 1 8

9 16 23 30 10 17 24 31 11 18 25 12 19 26 13 20 27 14 21 28 15 22 29

22 Friday

June 2018

23 Saturday

24 Sunday

June 2018 Week 26

25 Monday

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27 Wednesday

May 2018 7 14 21 28 M T 1 8 15 22 29 W 2 9 16 23 30 T 3 10 17 24 31 F 4 11 18 25 S 5 12 19 26 S 6 13 20 27

June 2018 M 4 11 18 25 T 5 12 19 26 W 6 13 20 27 T 7 14 21 28 F 1 8 15 22 29 S 2 9 16 23 30 S 3 10 17 24

28 Thursday

July 2018 2 M 3 T 4 W 5 T 6 F 7 S S 1 8

9 16 23 30 10 17 24 31 11 18 25 12 19 26 13 20 27 14 21 28 15 22 29

29 Friday

June/ July 2018

30 Saturday

1 Sunday

July 2018 Week 27

2 Monday

3 Tuesday

4 Wednesday

June 2018 M 4 11 18 25 T 5 12 19 26 W 6 13 20 27 T 7 14 21 28 F 1 8 15 22 29 S 2 9 16 23 30 S 3 10 17 24

5 Thursday

July 2018 2 M 3 T 4 W 5 T 6 F 7 S S 1 8

9 16 23 30 10 17 24 31 11 18 25 12 19 26 13 20 27 14 21 28 15 22 29

August 2018 6 13 20 27 M 7 14 21 28 T W 1 8 15 22 29 T 2 9 16 23 30 F 3 10 17 24 31 S 4 11 18 25 S 5 12 19 26

6 Friday

July 2018

7 Saturday

8 Sunday

July 2018 Week 28

9 Monday

10 Tuesday

11 Wednesday

June 2018 M 4 11 18 25 T 5 12 19 26 W 6 13 20 27 T 7 14 21 28 F 1 8 15 22 29 S 2 9 16 23 30 S 3 10 17 24

July 2018 2 M 3 T 4 W 5 T 6 F 7 S S 1 8

12 Thursday

9 16 23 30 10 17 24 31 11 18 25 12 19 26 13 20 27 14 21 28 15 22 29

August 2018 6 13 20 27 M 7 14 21 28 T W 1 8 15 22 29 T 2 9 16 23 30 F 3 10 17 24 31 S 4 11 18 25 S 5 12 19 26

13 Friday

July 2018

14 Saturday

15 Sunday

July 2018 Week 29

16 Monday

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18 Wednesday

June 2018 M 4 11 18 25 T 5 12 19 26 W 6 13 20 27 T 7 14 21 28 F 1 8 15 22 29 S 2 9 16 23 30 S 3 10 17 24

July 2018 2 M 3 T 4 W 5 T 6 F 7 S S 1 8

19 Thursday

9 16 23 30 10 17 24 31 11 18 25 12 19 26 13 20 27 14 21 28 15 22 29

August 2018 6 13 20 27 M 7 14 21 28 T W 1 8 15 22 29 T 2 9 16 23 30 F 3 10 17 24 31 S 4 11 18 25 S 5 12 19 26

20 Friday

July 2018

21 Saturday

22 Sunday

July 2018 Week 30

23 Monday

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25 Wednesday

June 2018 M 4 11 18 25 T 5 12 19 26 W 6 13 20 27 T 7 14 21 28 F 1 8 15 22 29 S 2 9 16 23 30 S 3 10 17 24

July 2018 2 M 3 T 4 W 5 T 6 F 7 S S 1 8

26 Thursday

9 16 23 30 10 17 24 31 11 18 25 12 19 26 13 20 27 14 21 28 15 22 29

August 2018 6 13 20 27 M 7 14 21 28 T W 1 8 15 22 29 T 2 9 16 23 30 F 3 10 17 24 31 S 4 11 18 25 S 5 12 19 26

27 Friday

July 2018

28 Saturday

29 Sunday

July/ August 2018 Week 31

30 Monday

31 Tuesday

1 Wednesday

July 2018 M 2 3 T 4 W 5 T 6 F 7 S S 1 8

9 16 23 30 10 17 24 31 11 18 25 12 19 26 13 20 27 14 21 28 15 22 29

2 Thursday

August 2018 6 13 20 27 M 7 14 21 28 T W 1 8 15 22 29 T 2 9 16 23 30 F 3 10 17 24 31 S 4 11 18 25 S 5 12 19 26

September 2018 3 10 17 24 M 4 11 18 25 T 5 12 19 26 W 6 13 20 27 T 7 14 21 28 F S 1 8 15 22 29 S 2 9 16 23 30

3 Friday

August 2018

4 Saturday

5 Sunday

August 2018 Week 32

6 Monday

7 Tuesday

8 Wednesday

July 2018 M 2 3 T 4 W 5 T 6 F 7 S S 1 8

9 16 23 30 10 17 24 31 11 18 25 12 19 26 13 20 27 14 21 28 15 22 29

9 Thursday

August 2018 6 13 20 27 M 7 14 21 28 T W 1 8 15 22 29 T 2 9 16 23 30 F 3 10 17 24 31 S 4 11 18 25 S 5 12 19 26

September 2018 3 10 17 24 M 4 11 18 25 T 5 12 19 26 W 6 13 20 27 T 7 14 21 28 F S 1 8 15 22 29 S 2 9 16 23 30

10 Friday

August 2018

11 Saturday

12 Sunday

August 2018 Week 33

13 Monday

14 Tuesday

15 Wednesday

July 2018 M 2 3 T 4 W 5 T 6 F 7 S S 1 8

9 16 23 30 10 17 24 31 11 18 25 12 19 26 13 20 27 14 21 28 15 22 29

16 Thursday

August 2018 6 13 20 27 M 7 14 21 28 T W 1 8 15 22 29 T 2 9 16 23 30 F 3 10 17 24 31 S 4 11 18 25 S 5 12 19 26

September 2018 3 10 17 24 M 4 11 18 25 T 5 12 19 26 W 6 13 20 27 T 7 14 21 28 F S 1 8 15 22 29 S 2 9 16 23 30

17 Friday

August 2018

18 Saturday

19 Sunday

August 2018 Week 34

20 Monday

21 Tuesday

22 Wednesday

July 2018 M 2 3 T 4 W 5 T 6 F 7 S S 1 8

9 16 23 30 10 17 24 31 11 18 25 12 19 26 13 20 27 14 21 28 15 22 29

23 Thursday

August 2018 6 13 20 27 M 7 14 21 28 T W 1 8 15 22 29 T 2 9 16 23 30 F 3 10 17 24 31 S 4 11 18 25 S 5 12 19 26

September 2018 3 10 17 24 M 4 11 18 25 T 5 12 19 26 W 6 13 20 27 T 7 14 21 28 F S 1 8 15 22 29 S 2 9 16 23 30

24 Friday

August 2018

25 Saturday

26 Sunday

August 2018 Week 35

27 Monday

28 Tuesday

29 Wednesday

July 2018 M 2 3 T 4 W 5 T 6 F 7 S S 1 8

9 16 23 30 10 17 24 31 11 18 25 12 19 26 13 20 27 14 21 28 15 22 29

30 Thursday

August 2018 6 13 20 27 M 7 14 21 28 T W 1 8 15 22 29 T 2 9 16 23 30 F 3 10 17 24 31 S 4 11 18 25 S 5 12 19 26

September 2018 3 10 17 24 M 4 11 18 25 T 5 12 19 26 W 6 13 20 27 T 7 14 21 28 F S 1 8 15 22 29 S 2 9 16 23 30

31 Friday

August/ Sept 2018

1 Saturday

2 Sunday

September 2018 Week 36

3 Monday

4 Tuesday

5 Wednesday

August 2018 6 13 20 27 M 7 14 21 28 T W 1 8 15 22 29 T 2 9 16 23 30 F 3 10 17 24 31 S 4 11 18 25 S 5 12 19 26

6 Thursday

September 2018 3 10 17 24 M 4 11 18 25 T 5 12 19 26 W 6 13 20 27 T 7 14 21 28 F S 1 8 15 22 29 S 2 9 16 23 30

October 2018 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 31 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

7 Friday

September 2018

8 Saturday

9 Sunday

September 2018 Week 37

10 Monday

11 Tuesday

12 Wednesday

August 2018 6 13 20 27 M 7 14 21 28 T W 1 8 15 22 29 T 2 9 16 23 30 F 3 10 17 24 31 S 4 11 18 25 S 5 12 19 26

September 2018 3 10 17 24 M 4 11 18 25 T 5 12 19 26 W 6 13 20 27 T 7 14 21 28 F S 1 8 15 22 29 S 2 9 16 23 30

13 Thursday

October 2018 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 31 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

14 Friday

September 2018

15 Saturday

16 Sunday

September 2018 Week 38

17 Monday

18 Tuesday

19 Wednesday

August 2018 6 13 20 27 M 7 14 21 28 T W 1 8 15 22 29 T 2 9 16 23 30 F 3 10 17 24 31 S 4 11 18 25 S 5 12 19 26

September 2018 3 10 17 24 M 4 11 18 25 T 5 12 19 26 W 6 13 20 27 T 7 14 21 28 F S 1 8 15 22 29 S 2 9 16 23 30

20 Thursday

October 2018 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 31 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

21 Friday

September 2018

22 Saturday

23 Sunday

September 2018 Week 39

24 Monday

25 Tuesday

26 Wednesday

August 2018 6 13 20 27 M 7 14 21 28 T W 1 8 15 22 29 T 2 9 16 23 30 F 3 10 17 24 31 S 4 11 18 25 S 5 12 19 26

September 2018 3 10 17 24 M 4 11 18 25 T 5 12 19 26 W 6 13 20 27 T 7 14 21 28 F S 1 8 15 22 29 S 2 9 16 23 30

27 Thursday

October 2018 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 31 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

28 Friday

September 2018

29 Saturday

30 Sunday

October 2018 Week 40

1 Monday

2 Tuesday

3 Wednesday

September 2018 3 10 17 24 M 4 11 18 25 T 5 12 19 26 W 6 13 20 27 T 7 14 21 28 F S 1 8 15 22 29 S 2 9 16 23 30

4 Thursday

October 2018 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 31 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

November 2018 5 12 19 26 M 6 13 20 27 T 7 14 21 28 W T 1 8 15 22 29 F 2 9 16 23 30 S 3 10 17 24 S 4 11 18 25

5 Friday

October 2018

6 Saturday

7 Sunday

October 2018 Week 41

8 Monday

9 Tuesday

10 Wednesday

September 2018 3 10 17 24 M 4 11 18 25 T 5 12 19 26 W 6 13 20 27 T 7 14 21 28 F S 1 8 15 22 29 S 2 9 16 23 30

October 2018 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 31 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

11 Thursday

November 2018 5 12 19 26 M 6 13 20 27 T 7 14 21 28 W T 1 8 15 22 29 F 2 9 16 23 30 S 3 10 17 24 S 4 11 18 25

12 Friday

October 2018

13 Saturday

14 Sunday

October 2018 Week 42

15 Monday

16 Tuesday

17 Wednesday

September 2018 3 10 17 24 M 4 11 18 25 T 5 12 19 26 W 6 13 20 27 T 7 14 21 28 F S 1 8 15 22 29 S 2 9 16 23 30

October 2018 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 31 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

18 Thursday

November 2018 5 12 19 26 M 6 13 20 27 T 7 14 21 28 W T 1 8 15 22 29 F 2 9 16 23 30 S 3 10 17 24 S 4 11 18 25

19 Friday

October 2018

20 Saturday

21 Sunday

October 2018 Week 43

22 Monday

23 Tuesday

24 Wednesday

September 2018 3 10 17 24 M 4 11 18 25 T 5 12 19 26 W 6 13 20 27 T 7 14 21 28 F S 1 8 15 22 29 S 2 9 16 23 30

October 2018 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 31 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

25 Thursday

November 2018 5 12 19 26 M 6 13 20 27 T 7 14 21 28 W T 1 8 15 22 29 F 2 9 16 23 30 S 3 10 17 24 S 4 11 18 25

26 Friday

October 2018

27 Saturday

28 Sunday

October 2018 Week 44

29 Monday

30 Tuesday

31 Wednesday

October 2018 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 31 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

1 Thursday

November 2018 5 12 19 26 M 6 13 20 27 T 7 14 21 28 W T 1 8 15 22 29 F 2 9 16 23 30 S 3 10 17 24 S 4 11 18 25

December 2018 3 10 17 24 31 M 4 11 18 25 T 5 12 19 26 W 6 13 20 27 T 7 14 21 28 F S 1 8 15 22 29 S 2 9 16 23 30

2 Friday

November 2018

3 Saturday

4 Sunday

November 2018 Week 45

5 Monday

6 Tuesday

7

October 2018 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 31 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

8 Thursday

November 2018 5 12 19 26 M 6 13 20 27 T 7 14 21 28 W T 1 8 15 22 29 F 2 9 16 23 30 S 3 10 17 24 S 4 11 18 25

December 2018 3 10 17 24 31 M 4 11 18 25 T 5 12 19 26 W 6 13 20 27 T 7 14 21 28 F S 1 8 15 22 29 S 2 9 16 23 30

9 Friday

November 2018

10 Saturday

11 Sunday

November 2018 Week 46

12 Monday

13 Tuesday

14 Wednesday

October 2018 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 31 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

November 2018 5 12 19 26 M 6 13 20 27 T 7 14 21 28 W T 1 8 15 22 29 F 2 9 16 23 30 S 3 10 17 24 S 4 11 18 25

15 Thursday

December 2018 3 10 17 24 31 M 4 11 18 25 T 5 12 19 26 W 6 13 20 27 T 7 14 21 28 F S 1 8 15 22 29 S 2 9 16 23 30

16 Friday

November 2018

17 Saturday

18 Sunday

November 2018 Week 47

19 Monday

20 Tuesday

21 Wednesday

October 2018 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 31 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

November 2018 5 12 19 26 M 6 13 20 27 T 7 14 21 28 W T 1 8 15 22 29 F 2 9 16 23 30 S 3 10 17 24 S 4 11 18 25

22 Thursday

December 2018 3 10 17 24 31 M 4 11 18 25 T 5 12 19 26 W 6 13 20 27 T 7 14 21 28 F S 1 8 15 22 29 S 2 9 16 23 30

23 Friday

November 2018

24 Saturday

25 Sunday

November 2018 Week 48

26 Monday

27 Tuesday

28 Wednesday

November 2018 5 12 19 26 M 6 13 20 27 T 7 14 21 28 W T 1 8 15 22 29 F 2 9 16 23 30 S 3 10 17 24 S 4 11 18 25

December 2018 3 10 17 24 31 M 4 11 18 25 T 5 12 19 26 W 6 13 20 27 T 7 14 21 28 F S 1 8 15 22 29 S 2 9 16 23 30

29 Thursday

January 2019 7 14 21 28 M T 1 8 15 22 29 W 2 9 16 23 30 T 3 10 17 24 31 F 4 11 18 25 S 5 12 19 26 S 6 13 20 27

30 Friday

November/ Dec 2018

1 Saturday

2 Sunday

December 2018 Week 49

3 Monday

4 Tuesday

5 Wednesday

November 2018 5 12 19 26 M 6 13 20 27 T 7 14 21 28 W T 1 8 15 22 29 F 2 9 16 23 30 S 3 10 17 24 S 4 11 18 25

6 Thursday

December 2018 3 10 17 24 31 M 4 11 18 25 T 5 12 19 26 W 6 13 20 27 T 7 14 21 28 F S 1 8 15 22 29 S 2 9 16 23 30

January 2019 7 14 21 28 M T 1 8 15 22 29 W 2 9 16 23 30 T 3 10 17 24 31 F 4 11 18 25 S 5 12 19 26 S 6 13 20 27

7 Friday

December 2018

8 Saturday

9 Sunday

December 2018 Week 50

10 Monday

11 Tuesday

12 Wednesday

November 2018 5 12 19 26 M 6 13 20 27 T 7 14 21 28 W T 1 8 15 22 29 F 2 9 16 23 30 S 3 10 17 24 S 4 11 18 25

December 2018 3 10 17 24 31 M 4 11 18 25 T 5 12 19 26 W 6 13 20 27 T 7 14 21 28 F S 1 8 15 22 29 S 2 9 16 23 30

13 Thursday

January 2019 7 14 21 28 M T 1 8 15 22 29 W 2 9 16 23 30 T 3 10 17 24 31 F 4 11 18 25 S 5 12 19 26 S 6 13 20 27

14 Friday

December 2018

15 Saturday

16 Sunday

December 2018 Week 51

17 Monday

18 Tuesday

19 Wednesday

November 2018 5 12 19 26 M 6 13 20 27 T 7 14 21 28 W T 1 8 15 22 29 F 2 9 16 23 30 S 3 10 17 24 S 4 11 18 25

December 2018 3 10 17 24 31 M 4 11 18 25 T 5 12 19 26 W 6 13 20 27 T 7 14 21 28 F S 1 8 15 22 29 S 2 9 16 23 30

20 Thursday

January 2019 7 14 21 28 M T 1 8 15 22 29 W 2 9 16 23 30 T 3 10 17 24 31 F 4 11 18 25 S 5 12 19 26 S 6 13 20 27

21 Friday

December 2018

22 Saturday

23 Sunday

December 2018 Week 52

24 Monday

25 Tuesday

26 Wednesday

November 2018 5 12 19 26 M 6 13 20 27 T 7 14 21 28 W T 1 8 15 22 29 F 2 9 16 23 30 S 3 10 17 24 S 4 11 18 25

December 2018 3 10 17 24 31 M 4 11 18 25 T 5 12 19 26 W 6 13 20 27 T 7 14 21 28 F S 1 8 15 22 29 S 2 9 16 23 30

27 Thursday

January 2019 7 14 21 28 M T 1 8 15 22 29 W 2 9 16 23 30 T 3 10 17 24 31 F 4 11 18 25 S 5 12 19 26 S 6 13 20 27

28 Friday

December 2018

29 Saturday

30 Sunday

Dec 2018/ Jan 2019 Week 53

31 Monday

1 Tuesday

2 Wednesday

December 2018 3 10 17 24 31 M 4 11 18 25 T 5 12 19 26 W 6 13 20 27 T 7 14 21 28 F S 1 8 15 22 29 S 2 9 16 23 30

3 Thursday

January 2019 7 14 21 28 M T 1 8 15 22 29 W 2 9 16 23 30 T 3 10 17 24 31 F 4 11 18 25 S 5 12 19 26 S 6 13 20 27

February 2019 4 11 18 25 M 5 12 19 26 T 6 13 20 27 W 7 14 21 28 T F 1 8 15 22 S 2 9 16 23 S 3 10 17 24

4 Friday

January 2019

5 Saturday

6 Sunday

192

Company Listings

Aptamil

Aptamil Anti Reflux* (from birth)- for the dietary management of reflux and regurgitation.

Aptamil Lactose Free* (from birth) – for the dietary management of lactose intolerance

Block 1, Deansgrange Business Park, Deansgrange, Co. Dublin, Ireland Type of company: Infant Nutrition Website: Website for parents: www.aptaclub.ie Website for Health Care Professionals: www.aptamilhcp.ie Helpline for parents: 1800 22 12 34

Aptamil Pepti 1* (from birth) – for the dietary management of cows milk allergy from birth Aptamil Pepti 2* (from 6 months) – for the dietary management of cows milk allergy from 6 months Aptamil Pepti-Junior* For the dietary management of malabsorption and multiple food intolerances. GMS Listed

Bayer Ltd Consumer Health

Helpline for healthcare professionals: 1800 22 12 34 Products A range of booklets/ Information leaflets covering pregnancy through to toddler years Standard Range: Aptamil – First Milk (from birth to 12 months) Aptamil Profutura – First milk (from birth to 12 months) Aptamil – Hungry milk (for hungrier infants) Aptamil 2 - Follow on Milk (from 6 months+) Aptamil Profutura 2 - Follow on Milk (from 6 months+) Aptamil 3 – Growing up Milk (1-2 years) Aptamil Profutura 3 – Growing up milk (1 year +) Aptamil 4 - Growing up Milk (from 2 year+) Specials Range: Aptamil Comfort* (from birth) - for the dietary management of colic and constipation

Consumer Health Products: Aspirin, Alka-Seltzer, Bepanthen, Bepantiseptic, Berocca, Canesten, Canespro, Canestest, Canesbalance, Clarityn, Cystopurin, Diprobase, Feminax, Kwells, Losec Control, Redoxon, Rennie, Scheriproct Suppositries & Ointment, UItraproct Ointment, Skineron Gel 15’s and Travacort Cream

Local Contacts: Liam Dooley, Commercial Manager liamdooley@brandshapers.ie

Local contacts: Commercial Lead: Hayley Claassen, Pharmacy Channel Manager: Patricia Lawrence

Clonmel Healthcare Ltd

Animal Health Products: Advantage, Advantix, Advocate, Bayticol, Baytril, Baytril Max, Baycox 5%, Baycox Bovis, Byemite, Drontal Plus Flavours, Drontal Cat, Profender, Veraflox, Seresto Local contact: Veterinary Business Managers: Carol Griffin RVN and Melanie O’Donoghue RVN

Brandshapers Ltd The Atrium, Blackthorn Road, Sandyford, Dublin 18

Ballytramon Business Park, Ardcavan, Castlebridge, Co Wexford Y35 Y19A

Bayer is a global life science company managed by 3 divisions; Pharmaceuticals, Consumer Health and Crop Science. In all

Type of company: Wholesale Distribution

Areas of our business, we invent, develop and market new molecules which influence the biochemical processes in living organisms.

Tel: +353 53 9179007

Pharmaceuticals: The Pharmaceuticals Division focuses on prescription drugs for the therapeutic areas of cardiology, ophthalmology, oncology, women’s health, haematology and neurology.

The division also comprises Radiology.

Local contact: Managing Director Itziar Canamasas

Any other info: customerservice@ brandshapers.ie

Unit 20A, Second Floor, Beckett Way, Park West Business Park, Nangor Road, Dublin 12 Website: www.clonmel-health.ie Tel: 353 1 620 4000 Help Line: 353 1 620 4000 Order Line: 1800 26 26 26

Type of company: Life Science Website: www.bayer.ie Tel: 01 2999313

Jenni Fenlon Brand Manager jennifenlon@brandshapers.ie

Website: www.brandshapers.ie

Fax Number: +353 53 9159494 Help Line Number: +353 53 9179007 Order Line: +353 53 9179007 Products: Isa Dora, Real Techniques, TanTastic, Beverly Hills Formula, OGX, Seven Seas, LifeLine Hangover Defence, Profusion, Just For Men, Vagisil, Nakd, Trek

Services: Distributors of Medicines and OTC Products direct to Pharmacies, Hospitals and via Wholesalers Ethical Products: Aceomel; Amidex; Amitriptyline; Amlotan; Amoxicillin Clonmel, Anxicalm; Apo-Go; Aspirin; Atenomel; Atorvastatin Clonmel, Axid; Azithromycin Clonmel; Binosto; Bisoprolol; Calvepen; Candist; Candist Plus; Casomide; Caspofungin; Cimeldine; Ciprotan; Clavamel; Clavamel Forte; Cleo Infusion Sets; Clonactil; Clonocid; Clopidogrel TAD; Cozatan; Cozatan Comp; Crystapen; Denzapine; Donesyn; Doxatan; Doxatan XL; Duloxetine; Efestad; Etalopro; Flucloxacillin; Folic Acid; Fungasil; Fungasil Cream; Furosemide; Grastofil; Ibandronic Acid; Imatinib; Irbesartan Clonmel; Isomel SR; Keflex; Lercanidipine Clonmel; Letrozole; Levetiracetam Clonmel; Linezolide; Losamel; Maxilief; Melfen; Memantine; Memantine Drops, Meroponia; Miramel; Montelair; Mycophenolate mofetil Clonmel; Nebimel;

193 Nepramel; Nytamel; Olanzapine; Olanzapine ODT; Olmesartan; Olmesartan HCT; Osteomel; Pantium; Paracetamol; Perdamel; Phenobarbital; Pipercin; Pravamel; Prednisolone; Pregabalin; Prindace; Profloxin; Prosentio; Prozamel; Ramitace; Rasagaline Clonmel; Rabeprazole; Rinozal; Risontel; Rosuvastatin; Serimel; Seropia, Seropia XR; Sildenafil Clonmel; Simtan; Tamnic; Tamnexyl XL; Telmisartan; Telmisartan HCT; Temozolomide; Tipuric; Toltertan SR; True Result Diabetes Monitor, True result Twist; Valtan; Valtan Comp; Venex XL; Xymel; Xymel SR; Xymel Comp; Zestan; Zomel; Zopitan; Zolendronic Acid.

OTC Products: Accurate; Acriflex; Anti-Hist Allergy; Caldease; Caldesene; Caldesene Adult; CaldeSpray; Caldesun; CaldeBaby Teething Gel; CaldeKids Travel Pops; Cerumol; Cerumol Olive Oil; Clonfolic; Clonfolic Multicare; Covonia; Desenex; Easofen for children strawberry oral suspension; Easofen; Easofen Max; Eucryl; Flexitol Heel Balm, Flexitol heel Balm Platinum, Flexitol Heel Magic, Flexitol Moisturising Foot Cream, Flexitol Hand Balm; Galfer Caps, Galfer FA Caps, Galfer Syrup; Gastrolief; Gloup Swallowing Gel; Hedrin Treat and Go Lotion Spray, Hedrin Treat and Go Mousse, Hedrin Protect and Go Spray, Hedrin Dual Pack, Hedrin ONCE; Joint Aid; Just a Drop; Maxilief, Nicochew 2mg Gum, Nicochew 4mg Gum; Paralief 500mg Tablets; Paralief Effervescent Tablets; Viralief 2g cream; ViraSoothe Gel, ViraSoothe Spray.

Cow & Gate

Block 1, Deansgrange Business Park, Deansgrange, Co. Dublin, Ireland.

Type of company: Infant Nutrition

Website for parents: www.cowandgate.ie Website for Health Care Professionals: www.cowandgatehcp.ie Tel: Freephone 1800 570 570 Helpline for parents: 1800 570 570 Helpline for healthcare professionals: 1800 371 371 Products: A range of booklets/Information leaflets covering pregnancy through to toddler years Standard Range: Cow and Gate – First Milk (from birth to 12 months) Cow and Gate – Hungrier Milk (for hungrier infants) Cow and Gate 2 - Follow on Milk (from 6 months+)

Cow & Gate nutriprem 2* (suitable as a sole source of nutrition. It can be used up to 6 months corrected age) Cow & Gate Hydrolysed Nutriprem (hospital only product). For the dietary management of preterm and low birth weight babies who require hydrolysed protein.

Cow & Gate Nutriprem Protein Supplement (hospital only product). This is a product for extremely low birth weight preterm babies (<1,000g) who require additional protein.

For the dietary management of preterm and low birthweight babies

Fitzgerald Power, Chartered Accountants & Business Advisors

Cow and Gate 3 – Growing up Milk 1yr+ (from 1 year+) Cow and Gate 4 - Growing up Milk 2yr+ (from 2 year+) Specials Range: Cow and Gate Comfort* (from birth) - for the dietary management of colic and constipation Cow and Gate Anti reflux* (from birth)- for the dietary management of reflux and regurgitation.

Cow & Gate instant carobel* (Suitable for full term babies, children and adults) for Infantile vomiting and posseting. GMS Listed Cow & Gate pepti junior* For the dietary management of malabsorption and multiple food intolerances. GMS Listed Preterm Range: Cow & Gate nutriprem breastmilk fortifier* To supplement expressed breastmilk for preterm and low birthweight babies Cow & Gate Nutriprem 1* (hospital only product) For the dietary management of preterm and low birthweight babies

Head office: Greyfriars, Waterford Offices also in Dublin and Carlow Type of company: Accountancy and business advisory firm Website: www.fitzgeraldpower.ie Tel: 051 870152 Fax: 051 871214 Products: Financial health check; Pharmacy valuations; Pharmacy sale brokerage; VAT investigations; Pharmacy specific online management accounts; Year-end statutory accounts production; Outsourced bookkeeping, payroll and company secretarial services; Business advisory; Tax planning and compliance.

Local Contacts: Dublin – John O’Sullivan, 01 6794772, josullivan@fitzgeraldpower.ie Waterford – Stuart Fitzgerald, 051 870152, sfitzgerald@fitzgeraldpower.ie Carlow – John McHugh, 059 9141100, jmchugh@fitzgeraldpower.ie

KRKA

KRKA Pharma Dublin Ltd. Unit 4A, Leopardstown Business Centre, Ballyogan Road, Leopardstown, Dublin 18. D18 YW 52 Type of company: Pharmaceutical Supplier of OTC brands and Generic Ethical Medication Websites: www.krka.ie www.septabene.ie www.septanazal.ie Tel: 01-293-9180 Help Line Number: 01-293-9180 Order Line: 01-293-9180 Ethical Products: Amoxicillin Clavulanic Acid Krka, Amlodipine Krka, Aspirin Krka,Atorvastatin Krka,Aripiprazole Focus, Azithromycin Krka, Bisoprolol Krka, Candesartan Krka, Candesartan HCTZ Krka, Ecansya, Carvedilol Krka, Celecoxib Krka, Ciprofloxacin Krka, Clopidogrel Krka, Dasselta, Diacronal MR, Donepezil Krka, Duloxetine Krka, Enalapril/Lercanidipine Krka, Escitalopram Krka, Esomeprazole Krka, Etoricoxib, Galsya SR, Imatinib Krka , Icorvida SR, Ifirmasta, Kamiren SR, Levocetirizine Krka, Lansoprazole Krka ,Levofloxacin Krka, Linezolid Krka,Losartan Krka, Losartan HCTZ Krka, Loxentia, Marixino, Montelukast Krka, Nimvastid, Nolpaza, Olmesartan Krka, Olmesartan HCTZ Krka, Oprymea, Oprymea SR, Perindopril Krka, Pregabalin Krka, Quetiapine Krka, Quentiax SR Rabeprazole, Ramipril Krka, Rasagiline HCS, Rolpryna SR, Rosuvastatin Krka, Sertraline Krka, Simvastatin Krka, Tadalafil Krka, Tramadol/Paracetamol Krka, Tolura, Tolucombi HCTZ, Valsartan Krka,Valsartan HCTZ Krka, Venlafex XL, Vizarsin, Zalasta,

194

Company Listings

OTC products: Nolpacid, Septabene Spray, Septabene Lozenges, Septanazal Local Contacts: Daniel Byers Country Manager 012939180 Roisin Kelly Product Manager 012939180 Paul Nash Key Account Manager 0872909218 Ben Tighe Medical Representative Leinster 0872361952 Judi Duggan Medical Representative Munster 0876327437 John Clancy Medical Representative Connacht 0877020070 Alannah Maloney Hospital Representative 0879206604

Miss Fit Enterprises Ltd

Unit 14, Block P, Greenogue Business Park, Rathcoole, Co. Dublin Website: www.missfitsupplements.com Tel: 01 4016887 Products: Miss Fit Skinny Tea The D Crave Local contacts: Clark Hetherington, Ruth Hetherington

Murrays Health & Beauty

School Lane, Chandlers Ford, Hampshire SO53 4YN

Type of company: Health and Beauty Accessories Websites: www.murrayshealthandbeauty.com www.drbrownsbaby.ie Tel: +44 (0) 23 8046 0600 Fax: +44 (0) 23 8046 0601 Help line: +44 (0) 80 8168 6716 Order line: +44 (0) 23 8046 0600 Products: Dr Brown’s Anti-Colic Baby Bottles & Accessories.

AXimed Medicine soothers.

Dreamgenii Pregnancy Support and Feeding Pillows.

Local Contacts: Stuart Lambert (General Sales Manager, Ireland) 00 353 8777 00889 Trevor Fletcher (Rep for Ireland East) Monaghan, Kildare, Dublin, Meath, Westmeath, Cavan, Louth, Offaly, Laois, Wicklow, Longford, Wexford, Carlow, Kilkenny 00 353 8797 92698 Martin Crowe (Rep for Ireland West) Roscommon, Mayo, Galway, Clare, Leitrim, Donegal, Sligo, Tipperary, Waterford, Limerick, Cork, Kerry 00 353 8791

Nova Laboratories Ltd.

range of pharmaceutical and biotechnology companies.

Nova is a UK leading independent supplier of both ‘Specials’ and clinical trial medicines to healthcare professionals. Our state-of-theart facilities allow us to provide virtually any pharmaceutical dosage form, including nonsterile cytotoxic formulations.

Our highly skilled team of formulation pharmacists continue to develop and produce new formulations, with >10,000 available.

Website: www.novalabs.co.uk Tel: +44 (0) 116 223 0100 Help Line: (Customer Care Pharmacist) +44 (0) 116 223 0100 Order Line: +44 (0) 116 223 0100 Email: sales@novalabs.co.uk Products: We have over 10,000 formulations available which include: Solutions; Suspensions; Creams; Ointments; Lotions; Capsules; Sachets; Suppositories; Enemas; Ear Drops; Nasal Drops; Cytotoxic Products; Pre-Filled Syringes; Mini Bags; Injectables Local Contact: Karen Cole, Group Sales & Marketing Manager Specials: 07944 450987 Dr Mike Edge - Head of Non-Sterile Manufacturing Tel: +44 (0) 116 223 0100

PAMEX Martin House, Gloucester Crescent, Wigston, Leicester LE18 4YL Type of company: Full Line Specials Manufacturer

Moneen Business Park, Castlebar, Co. Mayo

Nova Laboratories Limited was established in 1994 and has since gained a global reputation for manufacturing complex and innovative experimental medicines and delivery devices, for a wide

Type of company: Pharma Distribution Website: www.pamex.com Tel: 094 9024000

Products: Alflorex, Thea Pharmaceuticals, Kin Dental Products, Bioxtra, Skin Republic, Carmex, Total Shaving Solution, Dermatonics Once Heel Balm, Mycosan Local Contacts: Diarmuid Gavin 086 2205864 Gerard Murphy 087 7015701 Any other info: Pamex Limited is a successful marketing company, specialising in the promotion of prescription pharmaceutical medicines and personal healthcare products to Irish consumers.

The personnel at Pamex Limited have many years’ experience in dealing with pharmacists and members of the medical and pharmaceutical professions, along with the key influencers and decision makers in the market.

Perrigo

Treasury Building, Lower Grand Canal Street, Dublin 2, Ireland, D02 XN96.

Tel: +353 1 709 4000 Type of Business: Sales and Marketing of OTC Healthcare products.

Products: OTC Confined: Abidec Multivitamin Drops, Beconase Hayfever Spray, Lyclear Crème Rinse, Metatone Tonic, NiQuitin Patches, NiQuitin Fresh Mint Gum, NiQuitin Mini Mint Lozenges, Prevallergy Tablets, SolpaExtra, Solpadeine Capsules, Solpadeine Soluble, Solpadeine Tablets, Solpa-Sinus.

Non-Confined: Abidec Advanced Multivitamin Syrup, Abidec Vitamin D3 Drops, Buttercup Cough Syrup, Bronchostop Cough Syrup, Bronchostop Cough Pastilles, Hedex, Jungle Formula Insect Repellent, Lyclear Repellent,

195 Lyclear Sensitive, Lyclear Shampoo, Lyclear Spray, Milk of Magnesia, Poligrip Wernets, Prevalin Allergy, TCP Liquid, Tiger Balm Red, Tiger Balm White, Urostemol Men, Urostemol Femina, Wartner Wart & Verruca remover, Wartner Wart and Verruca Pen, XLS- Medical Appetite Reducer, XLS-Medical Fat Direct Fat Binder Sachets, XLS-Medical Max Strength Tabs/Sachets, XLS- Medical Tablets, Zantac.

Distribution: Via Wholesalers.

Management: Mr John Sheehy Country Manager Mr Niall Faul National Pharmacy Sales Controller Mr Paul Hatton National Pharmacy Field Sales Controller Sales Force: Alan Harnett 086 818 9846 North Leinster Jennifer Valentine 086 467 9113 Midlands

Website: www.rb.com Tel: 01 4689200 Fax: 01 4689299 Help Line: Healthcare 01 6305429 Consumer (Household) 01 667318 Order Line: 01 4689200 Products: Bonjela, Dettol, Disprin, Durex, E45, Full Marks, Fybogel, Gaviscon, KY, Lemsip, Mega Red, Nurofen, Optrex, Scholl, Senokot Strepsils, Veet Local Contacts: Adrian McCourt, Senior National Account Manager Pharmacy

Rowex Ltd

Newtown, Bantry, Co Cork.

Type of company: Pharmaceutical Marketing of Ethical Medicines and OTC Products Website: www.rowex.ie

Amanda Quinn 086 601 1643 Greater Dublin

Tel: 00 353 27 50077

Anne Marie O’Neill 086 174 9626 South Leinster

Freephone: 1800 304 400

Ollie Higgins 087 953 3161 West of Ireland Brendan O’Keeffe 086 818 9843 South of Ireland

RB Ireland

Unit 7, Riverwalk, Citywest Business Campus, Dublin 24 Type of company: Consumer Health

Fax: 00 353 27 50417

Order Line: 1800 304 400 Ethical Products: Alfu, Alopur, Amoclav, Amoclav Suspension, Amlode, Anastrazole, Atecor, AtecorCT, Atorvas, Beta-Prograne andf Half Beta –Prograne, Biluta, Bisop, Bonefurbit, Capecitabine Sandoz, Captor, Captor-HCT, Catasart, Catasart Plus, Ceftal, Cetrine, Cifox, Citrol, Clorom, Clorom XL, Clodel, Co-Vatan, Dancex SR, Deslor, Dexketoprofen Rowex, Diclac, Diltam, Domerid, Doxane XL, Dozept, Emazole, Enap,Eplerenone Rowex, Esciprex, Fental Matrix, Fintrid, Flucol, Fluzac, Gabin, Irbesan, Isomonit Retard, Lanzol, Lanafine, Larig, Latop, Latop-Comp, Letzo, Leuprex 3,

Leonore, Levocetirizine, Lispril, Lispril-Hydrochlorothiazide, Lorat, Lotanos, Lotanos Comp, Mefac, Melcam, Metocor, Methadone Hydrochloride, Memantine LEK, Metophage, Minox, Mirap, Mirap Distab, Mometasone, Montelukast Paediatric, Montelukast, Mycolat, Nebol, Ondansetron,Pantup, Parox, Pendrex, Pendrex Plus, Pravitin, Quetex, Quetex XR, Ramilo, Ranitic, Razole, Rispone, Ridate, Rivastigmine Sandoz, Rolyprexa, Rolyprexa Distab, Romax Once weekly, Romep, Rosuva, Salbul, Serlan, Sidena, Sivatin, Sumatran, Tamox, Tamsu, Telmisartan Rowex, Ternaf, Tolusitol, Tradol, Valotix, Vatan, Vedixal, Vedixal XL, Vensir XL, Verap, Zoledronic Acid Sandoz, ZolnodAirFluSal, Aripiprazole Sandoz, Celecoxib Rowex, Macrolief, Metidate XL, Metformin Aurobindo, Pregabalin Sandoz, Telmisartan HCT, Vertigon OTC Products: Acic Cold Sore, Calciup D3 Forte, Cetrine Allergy, Diclac Relief Gel, Domerid Relief, Lactulose Fresenius, Lanafine AFR, Ketozol, Lorat, Pantup Relief, Ranitic 75mg. Brupro, Brupro Max, Carbosan Gel, Decavit Plus, Magnesium Verla, Olive Oil BP Local Contact: Mr Tom Egan Munster 087-289 6738 Mr Martin Rowe Leinster 087- 982 1463 Mr Rodney McCullough Leinster 087-260 6016 Mr Chris Thompson Leinster 087- 820 9011 Mr Peter Hughes Connacht 087 -687 1407 Mr Pearse Timothy Connacht 087- 289 3350

Sam McLernon Dublin Ltd

Fox & Geese House Naas Road, Dublin 22.

Type of company: Leading Provider of Packaging Solutions to the Pharmaceutical, Healthcare and Medicines Industry in Ireland for over three quarters of a century.

Website: www.sammclernon.ie Tel: 01 450 4121 Fax: 01 456 9217 Email: sales@sammclernon.ie Manufacturers of: Tablet Vials & Tablet Bottles Plastic Bottles, Dispensing & Advisory Labels, Overprinted Carrier Bags in small lots Suppliers of: Full range of Compliance Cards & Blisters in paper or plastic, Full range of care home packaging available, De Blister Machines, Full range of giftwrapping and gift packaging for pharmacy, Anti-Fatigue matting for pharmacy, Full range of compliance packaging for Pharmacy ‘New Openings’.

Distribution: Direct Local Contacts: Management: Ivan Powell Managing Director Annette Norton Commercial Director Sales Force: Joe O’Malley Based Limerick Geraldine Kerrigan Based Cork Olwen Fahy Based Dublin Annette Norton Based Dublin

Notes

Notes

THE INDEPENDENT VOICE OF PHARMACY

In this issue: THE INDEPENDENT VOICE OF COMMUNITY PHARMACY: Bringing you the latest industry news and views that matter

12 ISSUES PER YEAR: Ireland’s biggest pharmacy magazine

WHAT’S INSIDE: The latest news, exclusive interviews, industry profiles, debates, educational and clinical articles, features and more

UNRIVALLED CIRCULATION: Readership of over 9000 Circulation of 2800+

AUDIENCE: Pharmacists, Pharmacy owners, Buyers, Decision makers, Buying Groups, Academia and other industry experts

W E N

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