PAI Diary 2019

PAI

PHARMACY ASSIST IRELAND 2019

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

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With dedicated Business Partners, we specialise in supporting affiliated professionals across a range of sectors including financial, legal, medical and pharmacy.

To experience a new way to bank for business, call our Business Support Team Call 1800 804 414 Visit www.kbc.ie/business

KBC Bank Ireland plc is regulated by the Central Bank of Ireland.

2019 year Planner

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CONTENTS

Training guide content by page number and sources of further information

Page 13 Page 29 Abdominal Cramps Diarrhoea

Page 47 IBS

Page 15 Adult Incontinence

Page 31 Dry Eyes

Page 49 Indigestion

Page 17 Allergies

Page 33 Dysphagia

Page 19 Analgesics

Page 35 Foot Care

Page 51 Infantile Colic and Constipation

Page 21 Cold Sores

Page 37 Haemorrhoids

Page 23 Colds Page 25 Cows’ Milk Allergies Page 27 Clearing Congestion in Children

Page 39 Hair Loss

Page 53 Iron Supplementation Page 55 Migraine

Page 63 Pain and fever in children Page 65 Pain Relief in Infants Page 67 Sexual Health and Wellbeing Page 69 Skin Beauty Page 71 Smoking Cessation Page 73 Topical Analgesics

Page 41 Hay Fever

Page 57 Mild to Moderate Pain

Page 43 Headaches

Page 59 Nappy Rash

Page 77 VMS

Page 45 Herbal Remedies

Page 61 Osteoarthritis

Page 79 Winter Ailments

Page 75 Vaginal Dryness

5

PUBLISHER IPN Communications Ireland Ltd. Clifton House, Lower Fitzwilliam Street Dublin 2 00353 (01) 6690562 ADVERTISING DIRECTOR - Debbie Graham 00353 (87) 288 2371 | debbie@ipn.ie ADVERTISING SALES - Louie French 00353 (1) 6690562 | louie@ipn.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 of the information is published in good faith and for general information purposes 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. It can be shared with counter staff at your discretion for training purposes.

All rights reserved by IPN Communication 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 print, however the publishers assume no responsibility for any effects from omissions or errors.

BUILDING GREAT HEALTHCARE BRANDS

MAH: McNeil Healthcare (Ireland) Ltd. & Johnson & Johnson (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/MC/18-3471

OUR PHARMACY 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:

7

8

IMPORTANT DATES

IMPORTANT DATES

2019 Tuesday 1st January New Year’s Day

Friday 19th of April Good Friday

Monday 3rd of June June Bank Holiday

Wednesday 30th of January World Leprosy Day 2019

Sunday 21st of April Easter Sunday

Saturday 8th of June World Brain Tumour Day 2019

Monday 4th of February World Cancer Day 2019

Monday 22nd of April Easter Monday

Friday 14th of June World Blood Donor Day 2019

Saturday 9th of February Toothache Day 2019

Thursday 25th of April DNA Day 2019

Tuesday 18th of June Autistic Pride Day 2019

Thursday 25th of April World Malaria Day 2019

Friday 21st of June June Solstice

Tuesday 5th of March Multiple Personality Day 2019

Sunday 28th of April World Day for Safety and Health at Work 2019

Tuesday 25th of June World Vitiligo Day 2019

Thursday 14th of March World Kidney Day 2019

Monday 6th of May May Day

Sunday 17th of March St. Patricks Day 2019

Wednesday 26th of June International Day against Drug Abuse and Illicit Trafficking 2019

Tuesday 7th of May World Asthma Day 2019

Sunday 28th of July World Hepatitis Day 2019

Wednesday 20th of March March Equinox

Wednesday 8th of May World Red Cross and Red Crescent Day 2019

Monday 5th of August - August Bank Holiday

Thursday 28th of February Rare Disease Day 2019

Thursday 21st of March World Down Syndrome Day 2019 Sunday 24th of March World Tuberculosis Day 2019 Tuesday 2nd of April World Autism Awareness Day 2019 Sunday 7th of April World Health Day 2019 Wednesday 17th of April World Haemophilia Day 2019

Sunday 12th of May International Nurses Day and Chronic Fatigue Syndrome Day 2019 Saturday 18th of May World AIDS Vaccine Day 2019 Friday 31st of May World No Tobacco Day 2019 Sunday 2nd of June National Cancer Survivors Day 2019

Tuesday 10th of September World Suicide Prevention Day 2019 Monday 23rd of September September Equinox Saturday 28th of September World Rabies Day 2019 Thursday 3rd of October Virus Appreciation Day 2019 Monday 7th of October Child Health Day 2019

9 Thursday 10th of October World Mental Health Day 2019 Tuesday 15th of October Global handwashing Day 2019 Wednesday 16th of October World Food Day 2019

Thursday 14th of November World Diabetes Day 2019

Sunday 20th of October World Osteoporosis Day 2019

Sunday 17th of November World Prematurity Day 2019

Tuesday 22nd of October International Stuttering Awareness Day 2019

Sunday 1st of December World AIDS Day 2019

Tuesday 24th of December Christmas Eve Wednesday 25th of December Christmas Day

Monday 28th of October October Bank Holiday

Tuesday 3rd of December International Day of People with Disability 2019

Tuesday 12th of November World Pneumonia Day 2019

Sunday 22nd of December December Solstice

Buscopan Advert 297x207_NOV v2 PRINT.pdf

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07/11/2017

Thursday 26th of December St. Stephen’s Day Tuesday 31st of December New Year’s Eve

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World’s No1 antispasmodic range

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for the effective management of cows’ milk allergy

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cows’ milk allergy symptoms1 with 97% efficacy2

Just 3 Sprays helps relieve pain for up to 6 hours

Effective relief from the pain and discomfort of abdominal cramps and IBS

REDUCE

incidence of atopic dermatitis up to five years3

Strepsils Intensive 8.75mg/dose Oromucosal Spray

NOW PROVEN4

is indicated for the symptomatic relief of throat infections including acute sore throat. Strepsils 15ml Spray contains Flurbiprofen which is a non-steroidal anti-inflammatory drug which has potent analgesic, and anti-inflammatory properties.

Targets the source Fast acting relief

REASSURE

with Ireland’s most palatable extensively hydrolysed formula4

Gentle on the stomach Well tolerated

Republic of Ireland: www.aptamilhcp.ie Northern Ireland: www.eln.nutricia.co.uk

Pharmacy only Always Discreet has a super absorbent core that quickly turns liquid to gel, to keep you feeling dry, and really comfortable.

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

References: 1. Verwimp JJ et al. Eur J Clin Nutr. 1995;49 (Suppl1):S39-S48. 2. Giampietro PG et al. Pediatr Allergy Immunol. 2001;12:83-86. 3. Arslanoglu S et al. J Biol Regul Homeost Agents.

2012;26:49-59. 4. O’ Carroll, E, Redmond, M et al. (2018), A blinded palatability study comparing two extensively hydrolysed infant formula used for the dietary management of Cows’ Milk Allergy in Ireland. The Nutrition Society Advancing Nutritional Science Spring Conference OC18.

IMPORTANT NOTICE: Aptamil Pepti 1 & 2 are foods for special medical purposes for the dietary management of cows’ milk allergy. They should only be used under medical supervision, after full consideration of the feeding options available including breastfeeding. Aptamil Pepti 1 is suitable for use as the sole source of nutrition for infants from birth, and/or as part of a balanced diet from 6-12 months. Aptamil Pepti 2 is suitable for babies over 6 months as part of a mixed diet.

Always Discreet. For sensitive bladder.

FOR HEALTHCARE PROFESSIONAL USE ONLY. *Always Discreet Long Pads vs. leader brand Extra Pads

© 2018 P&G

17-026 / March 2018

Strepsils Intensive 8.75mg per dose Oromucosal Spray contains Flurbiprofen for relief of acute Sore Throat. Over 18s only.

Max duration of use three days. ALWAYS READ THE LABEL. Date of prep Nov 2018, IRL/CC/1118/0020

SAIE.BUSC.17.11.0234 November 2017

10594_Aptamil_Pepti_Ad_A4_Updates_JUL18_01.indd 1

Clear Little-Kids Advert A4 FA.pdf

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21/09/2018

The The nation’s nation’s favourite favourite treatment treatment * range range for for piles piles*..

T R E H A L O S E 3 % , S O D I U M H YA L U R O N AT E 0 . 1 5 %

FOR ALL PATIENTS WITH DRY EYES

No.1 Selling Rehydration Treatment*1

Rehydrate right with

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ABAK® SYSTEM The most widely used preservative free bottle in the world

Are your customers suffering from diarrhoea?

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Trusted by Pharmacists for over 30 years Meets ESPGHAN2 and NICE3 (Natural and Citrus) guidelines for oral rehydration Suitable for children** Available to stock in a convenient CDU

Dehydration is a common side effect of diarrhoea and can be more serious in young children and the elderly. can help your customers to rehydrate right and recover faster than with water alone.

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** For infants under 24 months, use only under medical advice.

* Based on sales data.

References: 1. Data on File March 2018. 2. ESPGAN Working Group. J Pediatr Gastroenterol Nutr 1993;14:113-115.

3. NICE, Diarrhoea and vomiting caused by gastroenteritis in under 5s: diagnosis and management. Clinical guideline [CG84]. Published date: April 2009 (excludes Citrus)

• Uniquely protects, hydrates and lubricates

TO PLACE AN ORDER WITH YOUR SANOFI REPRESENTATIVE CALL: Padhraic Speight Tel: 086 0456 817 Munster

Colm Moran Tel: 086 0470 989 Midlands, North West

DIORALYTE® NATURAL, BLACKCURRANT AND CITRUS, POWDER FOR ORAL SOLUTION PRODUCT INFORMATION 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 up to the age of 24 months and 20-40 ml/kg body weight for adults and children. A reasonable approximation is: Infants under 24 months – Use only under medical advice. One to one and a half times the usual 24 hour feed volume. Children over 24 months – 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: Hypersensitivity to the active substances or to any of the excipients. Warnings and precautions: Dioralyte should not be used for treatment in infants below the age of 24 months without medical supervision. Dioralyte should not be used for self-treatment by patients with: chronic or persistent diarrhoea, liver or kidney disease, diabetes, on low potassium or sodium diets, intestinal obstruction. The use of Dioralyte in

Laurence O’Carroll Tel: 086 0456 816 East Coast

• Preservative free: Essential for dry eye management2 • Safe for contact lens wearers

patients with these conditions should be supervised by a doctor. The solution must not be reconstituted except with water at the volume stated. A weaker solution than recommended will not contain the optimal glucose and electrolyte concentration and a stronger solution than recommended may give rise to electrolyte imbalance. 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: Medical supervision is recommended for use during pregnancy and lactation. Interactions and side effects: None stated. Pack sizes: 6 and 20 sachets.

Legal category: P. Product authorisation number: PA 540/98/1 (Blackcurrant), PA 540/98/2 (Citrus), PA 540/99/1 (Natural). Product authorisation holder: Sanofi, 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 2018.

Adverse events should be reported. Reporting forms and information can be found at www.hpra.ie. Adverse events should also be reported to Sanofi on 01403 5600 or email IEPharmacovigilance@Sanofi.com

Haemorrhoid solutions that are proven to shrink Haemorrhoid solutions that are proven shrink piles, reduce inflammation, soothe itchingto and relieve piles, reduce soothe andfavourite relieve *. discomfort?

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For more information please contact your Pemberton Rep or Customer Service on 01-4632424

Pamex Ltd.

PRESERVATIVE FREE

Date of Preparation: September 2018 SAIE.DIO.17.01.0010c(1)

Dioralyte Ireland Trade Ad 2018 Irish Pharmacy News 210x297mm new PI Print.indd 1

14 Moneen Business Park, Castlebar, Co. Mayo 094 – 902 4000 info@pamex.ie www.pamex.com

Anusol Cream, Ointment & Suppositories Product Information: Presentation: Cream, Ointment and Suppositories. Cream: Each 100g contains Bismuth oxide 2.14g, Balsam Peru 1.8g, Zinc oxide 10.75g. Ointment: Each 100g contains Bismuth subgallate 2.25g, Bismuth oxide 0.875g, Balsam Peru 1.875g, Zinc oxide 10.75g. Suppositories: Each suppository contains: Bismuth subgallate 59mg, Bismuth oxide 24mg, Balsam Peru 49mg, ZincOintment oxide 296mg.

Uses: Symptomatic of internal and externalCream, (creamOintment and ointment only) haemorrhoids conditions.

Apply1.8g, cream ointment or Ointment: insert one Anusol Cream, & Suppositories Productrelief Information: Presentation: and Suppositories.

Cream: and Eachother 100g related containsano-rectal Bismuth oxide 2.14g,Dosage: Balsam Peru Zincoroxide 10.75g. suppository to the affected area at night,2.25g, in the Bismuth morning oxide and after eachBalsam evacuation the condition controlled.

Not recommended for children.

Contraindications: Hypersensitivity to the active or Each 100g contains Bismuth subgallate 0.875g, Peruuntil 1.875g, Zinc oxideis10.75g.

Suppositories: Each suppository contains: Bismuth subgallate 59mg, Bismuth oxide substance(s) 24mg, Balsam to any49mg, of theZinc excipients.

Precautions: Patients withrelief rectalofbleeding blood in the(cream stool should talk to only) their doctor before using this product these conditions may be the Apply symptom of aormore serious Peru oxide 296mg.

Uses: Symptomatic internal or and external and ointment haemorrhoids and other related as ano-rectal conditions.

Dosage: cream ointment or underlying insert one disorder. Pregnancy and Lactation: Should used during pregnancy and lactation the potential benefit ofNot treatment to the mother outweighs the possible risk to the developing foetus or nursing infant. suppository to the affected area at night, in not the be morning and after each evacuation untilunless the condition is controlled. recommended for children.

Contraindications: Hypersensitivity to the active substance(s) or Side Zinc Oxide:Patients Rare: Hypersensitivity; Not known: reaction Burn, before Erythema, Irritation, Pruritus, Rash, andsymptom Urticaria).ofOther (attributed directly to to anyeffects: of the Identified excipients.with Precautions: with rectal bleeding or bloodApplication in the stoolsite should talk(including to their doctor usingExfoliation, this product as thesePain, conditions may be the a more serious underlying Balsam Peru): Skin sensitisation reactions andnot systemic contact dermatitis.

RRP (exlactation VAT): Cream: 23gthe €5.65; Ointment: €5.65; Suppositories: €5.98;outweighs 24s €10.53.

Status: Supply through general sales: PA Holder: disorder.

Pregnancy and Lactation: Should be used during pregnancy and unless potential benefit of treatment to the12s mother theSupply possible risk to the developing foetus or nursing infant.

Church & Dwight UK Ltd.,with Folkestone, KentRare: CT19 Hypersensitivity; 4RJ, UK. PA No: Cream 2190/001/001 & Ointment 2190/001/002.

Supply Supply throughIrritation, PharmacyPain, OnlyPruritus, (Dispensing Status not subject to medical prescription) Side effects: Identified Zinc Oxide: Not known: Application site reaction (including Burn,Status: Erythema, Exfoliation, Rash, and –Urticaria).

Other (attributed directly to Suppositories 2190/001/003 Date €5.65; of prep: May 2018 12s €5.98; 24s €10.53. Supply Status: Supply through general sales: PA Holder: Balsam Peru): Skin sensitisation reactions and systemic contact dermatitis. RRP (ex VAT): Cream: 23g €5.65; Ointment: Suppositories: Church & Dwight UK Ltd., Folkestone, Kent CT19 4RJ, UK. PA No: Cream 2190/001/001 & Ointment 2190/001/002. Supply Status: Supply through Pharmacy Only (Dispensing Status – not subject to medical prescription) Suppositories 2190/001/003 Date of prep: May 2018

1. Pinto-Bonilla, J.C et al. Ther. Clin Risk Manag (2015); 11: 595-603 2. Dews, Ocul Surf 2007; 5: 75-92

13/09/2018 14:36

13328_THEA_DUO_TRADE_AD_PAMEX.indd 1

15/06/2017 13:47

HAYFEVER MEETS ITS

Our supplements feed the root from within

Available from your local Pharmacy

• Clinically proven

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MATCH

25 years of research in the science of hair

More allergy sufferers use Zirtek Allergy Relief in Ireland than any other brand.

That’s because it’s a trusted, non-drowsy way to ease the symptoms of hayfever and other allergy symptoms, 24-hours-a-day.1,2

Supported by 10 clinical trials

With Zirtek Allergy Relief, you’ll also get: High-profile marketing support, including a new website, national television campaign, online advertising and social media Your own point-of-sale material A range of products suitable for all the family3 A heritage and reputation based on reliability and dependability, supported by extensive knowledge and research

The Bio-kult range is a scientifically developed advanced multi-strain formula for the entire family.

Round-the-clock, max strength treatment, available in extra-value packs of 30

To place your order please contact your local Pemberton rep or customer service on:

Proven to survive the high acidity of the stomach, Bio-kult is gluten free and suitable for vegetarians. It can be swallowed whole, sprinkled over food or mixed in a drink and it doesn’t need to be refrigerated.

Tel: 01-463 2424 Email: cs.pemberton@united-drug.com www.zirtek.ie

ZirtekIE

Zirtek IE

Ask your wholesaler for more information

Zirtek Usage and Attitude in the ROI report.

Does not cause drowsiness in the majority of people.

3 Zirtek is available in liquid formula for ages 2 and upwards, and in tablets suitable for ages 6 and upwards.

Zirtek D is suitable for adults and adolescents from 12 years of age and upwards.

1 2

Gets to Work Instantly

Please consult the Summary of Product Characteristics before prescribing, information about this product can be found at www.medicines.ie Further information is available on request from UCB Pharma Ireland Ltd, United Drug House, Magna Drive, Citywest Road, Dublin 24 MA Numbers:

Zirtek 1 mg/ml oral solution: PA 891/8/3, Zirtek Plus Decongestant 5/120mg Prolonged Release Tablets PA 891/8/1, Zirtek Tablets PA0891/008/005

Product licence holder:

UCB Pharma Ireland Ltd

Classification:

Zirtek tablets & oral solution: Cetirizine dihydrochloride Zirtek Plus Decongestant prolonged release tablets: Cetirizine dihydrochloride, Pseudoephedrine hydrochloride

Legal Category: OTC

Adverse events should be reported to the Health Products Authority at www.hpra.ie or via email to medsafety@hpra.ie Adverse events should also be reported to UCB Pharma Ireland Ltd via email UCBCares.IE@ucb.com

For further information please contact your Pemberton representative or call customer services on 01 463 2424

97324.003 Trade Advertising A4_Pemberton_aw2.indd 2

Irish Pharmacy Advert A4 Full Page Ad_FA_OL.pdf

@ScopeGroup1 p 1800 816 005

e info@scopehealthcare.ie w www.scopehealthcare.ie

July 2018 UK/18ZI0009(1)

Gaviscon Extra chewable tablets. Gaviscon Extra oral suspension. For the relief of Heartburn & Indigestion. For the use in adults and children 12 years and over. ALWAYS READ THE LABEL. Date of Preparation: November 2018, IRL/G-OTC/1118/0033

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FOR HEALTHCARE PROFESSIONAL USE ONLY

ts

Could it be Colic?

Inconsolable crying

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3. Partially hydrolysed whey protein - For easy digestion 4. Reduced lactose - In cases of lactose maldigestion, can help to reduce flatulence 6

Rowex Ltd. is pleased to announce the first ever OTC Sumatriptan in Ireland

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*Sumatran Relief is a non-prescription migraine treatment, containing sumatriptan. Sales must be referred to the pharmacist. Please use your consultation aid.

Medicinal product not subject to medical prescription. Further information and SPC are available from: Rowex Ltd., Bantry, Co. Cork, P75 V009.

Freephone: 1800 304 400 Fax: 027 50417 E-mail: rowex@rowa-pharma.ie. Date of preparation (09-18) CCF No:21373

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swallowed air during feeding6

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Important notice: Cow & Gate comfort is a food for special medical purposes for the dietary management of colic and constipation after full consideration of feeding options, including breastfeeding.

Only to be used under medical supervision. For enteral use only. © 2018 Danone Nutricia Early Life Nutrition, [17-089]

References: 1. Merry A, et al. AFT-MX-1, a prospective parallel group, double-blind comparison of the analgesic effect of a combination inhibiting drug, an anti-inflammatory drug and thiazide diuretic at the same time increases the risk of renal impairment. Blood of paracetamol and ibuprofen, paracetamol alone, or ibuprofen alone in patients with post-operative pain. Department of Anaesthesiology, dyscrasias have been rarely reported. Patients on long-term therapy with ibuprofen should have regular haematological monitoring.

University of Auckland, New Zealand 2008. *compared with the same daily dose of standard paracetamol or ibuprofen alone.

Like other NSAIDs, ibuprofen can inhibit platelet aggregation. GI bleeding, ulceration or perforation, which can be fatal, has been reported with all NSAIDs at anytime during treatment. Combination therapy with protective agents (e.g. misoprostol or proton pump Easolief Duo 500 mg/150 mg film-coated tablets Each tablet contains paracetamol 500 mg and ibuprofen 150 mg. inhibitors) should be considered. Use with concomitant NSAIDs including cyclooxygenase-2 selective inhibitors should be avoided.

Presentation: A White, capsule shaped tablet with breakline on one side and plain on the other side. Indications: Short-term NSAIDs may lead to onset of new hypertension or worsening of pre-existing hypertension and patients taking antihypertensive symptomatic treatment of mild to moderate pain. Dosage: Adults/elderly: The usual dosage is one to two tablets taken every medicines with NSAIDs may have an impaired anti-hypertensive response. Fluid retention and oedema have been observed in six hours up to a maximum of six tablets in 24 hours. Children: Easolief Duo is contraindicated in children under 18 years. some patients taking NSAIDs. NSAIDs may very rarely cause serious cutaneous adverse events such as exfoliative dermatitis, toxic Contraindications: Severe heart failure, known hypersensitivity to paracetamol, ibuprofen, other NSAIDs or to any of the epidermal necrolysis and Stevens-Johnson syndrome. Products containing ibuprofen should not be administered to patients with excipients, active alcoholism, asthma, urticaria, or allergic-type reactions after taking acetylsalicylic acid or other NSAIDs, history acetylsalicylic acid sensitive asthma and should be used with caution in patients with pre-existing asthma. Adverse ophthalmological of gastrointestinal bleeding or perforation related to previous NSAID therapy, active or history of recurrent peptic ulceration/ effects have been observed with NSAIDs. For products containing ibuprofen aseptic meningitis has been reported only rarely. NSAIDs haemorrhage, severe hepatic failure or severe renal failure, cerebrovascular or other active bleeding, blood-formation disturbances, may mask symptoms of infection and fever. Interactions: Warfarin, medicines to treat epilepsy, chloramphenicol, probenecid, during the third trimester of pregnancy. Warnings and precautions: This medicine is for short term use and is not recommended zidovudine, medicines used to treat tuberculosis such as isoniazid, acetylsalicylic acid, other NSAIDs, medicines to treat high blood for use beyond 3 days. Clinical studies suggest that use of ibuprofen, particularly at a high dose may be associated with a small pressure or other heart conditions, diuretics, lithium, methotrexate, corticosteroids. Refer to summary of product charachteristics increased risk of arterial thrombotic events. Patients with uncontrolled hypertension, congestive heart failure, established ischaemic for other interactions. Fertility, pregnancy and lactation: Easolief Duo is contraindicated during the third trimester of pregnancy. heart disease, peripheral arterial disease and/or cerebrovascular disease should only be treated with ibuprofen after careful Driving and operation of machinery: Dizziness, drowsiness, fatigue and visual disturbances are possible after taking NSAIDs. consideration and high doses should be avoided. Careful consideration should be exercised before initiating long-term treatment If affected patients should not drive or operate machinery. Undesirable effects: Dizziness, headache, nervousness, tinnitus, of patients with risk factors for cardiovascular events. The use of paracetamol at higher than recommended doses can lead to oedema, fluid retention, abdominal pain, diarrhoea, dyspepsia, nausea, stomach discomfort, vomiting, flatulence, constipation, slight hepatotoxicity, hepatic failure and death. Patients with impaired liver function or a history of liver disease or who are on long term gastrointestinal blood loss, rash, pruritus, alanine aminotransferase increased, gamma-glutamyltransferase increased, abnormal liver ibuprofen or paracetamol therapy should have hepatic function monitored at regular intervals. Severe hepatic reactions, including function tests, blood creatinine increased and blood urea increased. Refer to Summary of Product Characteristics for other adverse jaundice and cases of fatal hepatitis, though rare, have been reported with ibuprofen. Paracetamol can be used in patients with effects. Pack size: 24 tablets. Marketing authorisation holder: Clonmel Healthcare Ltd., Clonmel, Co. Tipperary. Marketing chronic renal disease without dosage adjustment. There is minimal risk of paracetamol toxicity in patients with moderate to severe authorisation number: PA0126/294/1. Medicinal product not subject to medical prescription. For retail sale through pharmacy only. renal failure. Caution should be used when initiating treatment with ibuprofen in patients with dehydration. The use of an ACE A copy of the summary of product charachteristics is available upon request. Date prepared: March 2018. 2018/ADV/EAS/008H.

CaldeSpray from the makers of Caldesene.

Products for supply through general sales. A copy of the SmPC for Caldesene and Caldease is available on request.Clonmel Healthcare Ltd., Clonmel, Co. Tipperary.

For topical use only. Cleanse and dry the area before applying. ALWAYS READ THE LABEL. Caldespray contains Zinc oxide 10%, 100ml pack size.

The active ingredient in Caldesene Medicated Powder is Calcium Undecylenate 10% w/w 20g, 55g, 100g pack size.

The active ingredient in Caldease Medicated Ointment is Zinc oxide 15% w/w 30g pack size. Date prepared: August 2017. 2017/ADV/CAL/038

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regularly in patients who use sumatriptan intermittently, over the longer term. Sumatriptan is effective for migraine occurring during menstruation, but women with migraine who are taking the combined oral contraceptive have an increased risk of stroke and should seek advice from their doctor if migraine attacks started recently (within the last 3 months), migraine symptoms have worsened, or they have migraine with aura. Not to be given to patients (especially postmenopausal women and males over 40 years of age) with risk factors for ischaemic heart disease, including those patients who are heavy smokers or users of nicotine substitution therapies, without prior cardiovascular evaluation. Risk factors for heart disease include hypercholesterolaemia, regular smoking, marked obesity, diabetes or a family history of early heart disease (father/brother developed heart disease before the age of 55, mother/sister developed heart disease before the age of 65). The diagnosis of medication overuse headache (MOH) should be suspected in patients who have frequent or daily headaches despite (or because of) the regular use of headache medications (e.g. triptans, opioids, ergotamine or combination of these drugs for 10 days or more per month). Patients with headache present on more than or 15 days per month for three months whose headache has developed or markedly worsened during medication overuse should be referred to their doctor for further management. Contains lactose monohydrate. Interactions: There have been rare post-marketing reports describing patients with serotonin syndrome (including altered mental status, autonomic instability and neuromuscular abnormalities) following the use of SSRIs and sumatriptan.

Serotonin syndrome has also been reported following concomitant treatment with triptans and SNRIs and is also a risk with concomitant use with lithium. Undesirable effects may be more common during concomitant use with herbal preparations containing St John’s Wort (Hypericum perforatum). Pregnancy and Lactation: Not to be used during pregnancy or breast-feeding unless on the advice of their doctor. Ability to Drive and Use Machinery: Drowsiness, dizziness and weakness may occur as a result of migraine or its treatment with sumatriptan. This may influence the ability to drive and to operate machinery. Undesirable Effects: Common: Dizziness, drowsiness, sensory disturbance including paraesthesia and hypoaesthesia. Transient increases in blood pressure arising soon after treatment, flushing. Dyspnoea. Nausea and vomiting occurred in some patients, but it is unclear if this is related to sumatriptan or the underlying condition. Sensations of heaviness (usually transient and may be intense and can affect any part of the body including the chest and throat), myalgia. Pain, sensations of heat or cold, pressure or tightness (these events are usually transient and may be intense and can affect any part of the body including the chest and throat); feelings of weakness, fatigue (both events are mostly mild to moderate in intensity and transient). Marketing Authorisation Holder: Rowex Ltd., Bantry, Co. Cork. Marketing Authorisation Number: PA 711/272/1. Further information and SPC are available from: Rowex Ltd., Bantry, Co. Cork. Freephone: 1800 304 400 Fax: 027 50417 E-mail rowex@rowa-pharma.ie Legal Category: Not Subject to medical prescription. Date of Preparation: April 2018

GP R

The greatest improvement in symptoms has been shown after 2 weeks of using Cow & Gate’s Comfort milk6,8

Republic of Ireland: www.cowandgatehcp.ie Northern Ireland: www.eln.nutricia.co.uk References: 1. Knol J et al. J Paediatr Gastroenterol Nutr 2005;40:36-42. 2. Moro G et al. J Paediatr Gastroenterol Nutr 2002;34:291-5. 3. Schmelzle H et al. J Paediatr Gastroenterol Nutr 2003;36:343-351.

4. Kennedy K et al. Am J Clin Nutr 1999;70:920-7. 5. Carnielli VP et al. J Paediatr Gastroenterol Nutr 1996;23(5):553-60. 6. Savino F et al. Acta Paediatr Suppl. 2003;441:86-90. 7. Kanabar D et al. J Hum Nutr Dietet 2001;14:359-63. 8. Savino F et al. Eur J Clin Nutr 2006;60:1304–10.

ABBREVIATED PRESCRIBING INFORMATION Product Name: Sumatran Relief 50 mg Tablets. Composition: Each tablet contains 50 mg sumatriptan (as sumatriptan succinate). Description: Pink, biconvex, oblong tablet with a break-line on both sides. Indication(s): The acute treatment of migraine attacks with or without aura. Only to be used where there is a clear diagnosis of migraine. Dosage: Only in Adults aged 18 to 65 years: Recommended adult dose is a single 50 mg tablet.

If a patient responds to the first dose of sumatriptan, but the symptoms recur a second dose may be taken for the same attack but no sooner than 2 hours after the first tablet was taken. If a patient does not respond to the first dose, a second dose should not be taken for the same attack (in these cases the attack can be treated with paracetamol, acetylsalicylic acid, or non-steroidal anti-inflammatory drugs). No more than 100 mg (2 tablets) should be taken in 24 hrs. The recommended dose should not be exceeded. Contraindications: Hypersensitivity to the active substance or to any of the excipients or sulphonamides; Should not be used prophylactically; A history of myocardial infarction, ischaemic heart disease or coronary vasospasm (Prinzmetal’s angina;) Peripheral vascular disease; Symptoms or signs consistent with ischaemic heart disease; A history of stroke (cerebrovascular accident (CVA)) or transient ischaemic attack (TIA) or cardiac arrhythmia; Renal or hepatic impairment; Hypertension or a history of hypertension; History of seizures or other risk factors which lower the threshold; Concomitant administration of preparations containing ergotamine or ergotamine derivatives (including methysergide) or any triptan/5-hydroxytryptamine 1 (5-HT1) receptor agonist; Concomitant use of monoamine oxidase inhibitors and the use of sumatriptan within 2 weeks after discontinuation of therapy with monoamine oxidase inhibitors; Management of basilar, hemiplegic or ophthalmoplegic migraine. Warnings and Precautions for Use: Only for use where a clear diagnosis of “migraine” has been made by a doctor initally. For pharmacy supply, patients should have an established pattern of migraine (a history of five or more migraine attacks occurring over a period of at least 1 year). Migraineurs whose typical headaches persist for longer than 24 hours, who experience four or more migraine attacks per month, or in whom the pattern of symptoms has changed or whose attacks have become more frequent, more persistant, or more severe, or who do not recover completely between attacks, should seek advice from their doctor. Following administration, sumatriptan can be associated with transient symptoms including chest pain and tightness, which may be intense and involve the throat. Where such symptoms are thought to indicate ischaemic heart disease, no further doses of sumatriptan should be given. A medical evaluation should be obtained immediately.

Note that migraineurs may be at increased risk of certain cerebrovascular events (e.g. CVA, TIA). Medication should be stopped if they experience atypical symptoms (i.e. unilateral motor weakness, double vision, ataxia etc.) and they should seek medical advice. Not to be used in migraineurs without a prior cardiac risk assessment by a doctor or pharmacist. As migraine is a chronic condition, cardiovascular risk should be evaluated

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WWHAM

11

WWHAM As a member of the pharmacy team, counter and pharmacy assistants will deal with many different situations which call for effective communication. These will always include responding to OTC requests for information, and counselling patients on their medications.

WWHAM is one of the many mnemonics that allow you to do that effectively and it is included in every article within this booklet.

It is the most basic method of questioning used by Pharmacy teams, but it is direct, and asks most of the necessary questions.

It is used as follows:

WWHAM • Who is the presenting complaint about? (patient or other) • What are the symptoms present?

• How long have the symptoms been present?

• Action already taken?

• Medication being taken?

In order for WWHAM to work effectively, the pharmacy team do need to work on the communication process between health professionals and patients.

In the first instance, it establishes the ongoing relationship between the provider and the patient. This is not something that is simply “nice to do”. All professional activities between the pharmacy team and a patient take place in the context of the relationship they establish. An effective relationship forms the base that allows a patient to meet professional responsibilities in patient care.

In addition to creating an atmosphere of trust, it further facilitates the exchange of information necessary to assess the patient’s health condition, implement treatment of medical problems and evaluate the effects of treatment on a patient’s quality of life.

Effective communication allows for WWHAM to work in that it is also involves a number of basic processes which include: • Initiating a conversation: In many situations patients can be uneasy, concerned or embarrassed when they come to speak to the pharmacy team.

When beginning the conversation it is important to focus on the patient in front of you, greet the customer and introduce yourself and be conscious of

how the patient may be feeling. Similarly, establish immediately who the patient is: are they there for themselves or for someone else?

• Obtaining information: Obtaining information is a complex process including the acts of listening, questioning, checking your understanding and reading non-verbal signals. Stop talking and allow the patient to explain why they are here.

Look at the other person to help you concentrate and show the other person that you are indeed listening. Similarly, react to ideas, not to the person. It is crucial to focus on what is being said and not on whether you like the person.

This will allow you to pick up on changes in speech or tone as well as non-verbal cues • Action already taken: Any action taken by the patient should be established, including the use of any medication to treat the symptoms. About 50% of patients will have tried at least one remedy before seeking a pharmacist’s advice. Treatment may have consisted of OTC medicines bought from a pharmacy or elsewhere, other medicines prescribed by a doctor on this or a previous occasion, or medicines ‘borrowed’ from a friend or neighbour or ‘found’ in the medicine cabinet. Homoeopathic or herbal remedies may have been used.

The cultural traditions of people from different ethnic backgrounds include the use of various remedies that may not be considered as ‘medicines’.

• The identity of any medicines taken regularly by the patient is important for two reasons: possible interactions and potential adverse reactions.

Such medicines will usually be those prescribed by the doctor, but may also include OTC products. Pharmacies have an increasingly important role in detecting adverse drug reactions and consideration should be given to the possibility that the patient’s symptoms might be an adverse effect caused by medication. Where you suspect an adverse drug reaction to a prescribed medicine, you should discuss with the doctor what action should be taken.

It is also vital after having used WWHAM to suggest treatment that the patient fully understands the information that you give to them.

Often it is assumed that the patient will interpret information given accurately and it can be common to fail to realise that different people may assign different meanings to different words or phrases that are used.

Verifying the fact that the patient interpreted the intended meaning of a message accurately takes additional time and is sometimes awkward.

However, it is an important part of the communication process.

CLINICAL DECISION-MAKING AND THE WWHAM APPROACH The pharmacy is a focal point of any community when it comes to identifying, managing and treating minor ailments and health complaints. An increase in the number of medicines has meant an increased need for the further training of counter assistants.

There are associated risks with regards to the public having a wider variety of over-thecounter medicines and it is the job of the pharmacy staff to ensure the safe, -effective and evidence-based supply of these medicines. Inappropriate supply can have many implications, including misdiagnosis and delayed access to treatments.

Counter assistants now play a key role in being a central interface between customer and pharmacist and, thus, it is essential they are educated and knowledgeable.

The Pharmacy Assist Directory has been designed with counter assistants in mind, using the poplar WWHAM acronym.

It is also important that counter assistants and pharmacy staff employ clinical reasoning when helping customers with a diagnosis and over the counter medicines available.

World’s No1 antispasmodic range

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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

13

ABDOMINAL CRAMPS A stomach ache is a term often used to refer to cramps or a dull ache in the tummy (abdomen).

It’s usually short-lived and is often not serious.

Stomach cramps with bloating are often caused by trapped wind. This is a very common problem that can be embarrassing but is easily dealt with. You will be able to recommend a product such as buscopan or mebeverine, which can be bought over the counter to treat the problem.

If stomach cramps have started recently and the patient also has diarrhoea, the cause may be a tummy bug (gastroenteritis). If the patient has repeated bouts of stomach cramps and diarrhoea, they may have a long-term condition, such as irritable bowel syndrome (IBS).

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 such as 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 one in three 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 flare-ups every two 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 this 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.

Almost four in 10 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

• 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 red uce 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

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.

• Drink non-caffeinated drinks regularly – at least eight cups of water per day

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.

Psychological treatments

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

• Restricting the consumption of fizzy drinks and alcohol • Intake enough fibre • Cut down on the amount of fat consumed 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 prevalent in people aged 25-45.

What are the symptoms? Sharp, stabbing, tight, or intense pain in the lower abdominal region.

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.

How long have they had the symptoms?

Sufferers experience episodes which can be frequent.

Lifestyle changes

Medication? Avoiding antispasmodic medicines if possible is usually recommended for pregnant and breastfeeding women.

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

Action already taken? Patients may need advice on self-selected products.

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ADULT INCONTINENCE

15

ADULT INCONTINENCE Urinary incontinence is loss of control of the bladder. It can affect anyone, regardless of age. It is a condition which ranges from mild to uncontrollable and embarrassing wetting.

Incontinence can often be caused by an illness, such as a urinary tract infection, and often when the infection gets better the incontinence improves.

Bladder control problems have a significant effect on the quality of life of sufferers on a physical, emotional and social level. Continence is a necessity for comfortable social adjustment and conversely, urinary incontinence frequently causes profound psychological and social consequences and restricts social activities.

Types of incontinence Stress incontinence - happens when a person wets themself during exercise, coughing, sneezing, laughing or other movements that put pressure on the bladder.

It is the most common type of incontinence and usually affects women, however, men can also develop stress incontinence after a prostate operation.

Urgency/urge incontinence - occurs when a person cannot hold on long enough to reach a toilet. This may be caused by an over-active bladder, infection, medication or poor mobility.

In men, it may be sign of an enlarged prostate.

Overflow incontinence - happens when the bladder does not empty completely. Urine builds up and then may overflow, often as frequent dribbling. This type of incontinence is more common in men and may be due to an enlarged prostate gland, but constipation may also be a cause.

Reflex incontinence - is where the bladder empties when it is full and the person is usually unaware of this. The cause is a break in the signals between the brain and bladder, which may be caused by a stroke or spinal injury.

Incontinence products While incontinence products aren’t a treatment for urinary incontinence, they are useful for managing the condition while a person is waiting to be assessed or for treatment to take effect.

Incontinence products include • absorbent products, such as incontinence pants or pads. Liners, pads, disposable underwear, and reusable underwear absorb moisture. Products made for incontinence control catch the leaks and pull moisture away from the skin. That allows sufferers to go longer between changes. Many disposable pads, liners, and undergarments have a waterproof backing. This helps prevent overflow from reaching clothes.

The waterproof systems use a “breathable” plastic film that helps reduce skin irritation.

There’s also a range of disposable undergarments with built-in protection - not just in the crotch, but throughout the entire garment. Styles range from pull-ons with

elasticised legs and waists resembling a traditional cloth underwear to underwear that slips on with Velcro or adhesive tabs for a customised fit. There are also open-sided “thong style” pants held together by straps in the front and back that rest on top of the hip bone. Incontinence bed sheets are also available.

may refer a patient to a specialist to start a programme of pelvic floor muscle training.

The specialist will assess whether the person is able to squeeze (contract) their pelvic floor muscles and by how much. If they can contract their pelvic floor muscles, they’ll be given an individual exercise programme based on their assessment.

• handheld urinals

Bladder training

• a catheter, a thin tube that is inserted into the bladder to drain urine

When diagnosed with urge incontinence, one of the first treatments offered is bladder training. Bladder training may also be combined with pelvic floor muscle training if a person is suffering from mixed urinary incontinence. It involves learning techniques to increase the length of time between feeling the need to urinate and passing urine. The course will usually last for at least six weeks.

• devices that are placed into the vagina or urethra to prevent urine leakage – for example, during exercise Treatments The treatment a medical professional will recommend for urinary incontinence will depend on the type of incontinence a patient has and the severity of their symptoms. If the incontinence is caused by an underlying condition, they may receive treatment for this alongside incontinence treatment.

Conservative treatments, which don’t involve medication or surgery, can be recommended first. These include: Lifestyle changes • reducing caffeine intake – caffeine is found in tea, coffee and cola, and can increase the amount of urine the body produces • altering how much fluid is drunk a day – drinking too much or too little can make incontinence worse • losing weight Pelvic floor muscle training (Kegel exercises) The pelvic floor muscles are the muscles used to control the flow of urine as the body urinates.

They surround the bladder and urethra, the tube that carries urine from the bladder outside the body. Weak or damaged pelvic floor muscles can cause urinary incontinence, so exercising these muscles is often recommended. A GP

Surgery Mid-urethral slings are minimally invasive procedures developed in Europe in the 1990s to treat female stress urinary incontinence.

These slings are narrow, polypropylene (a commonly used suture material) tapes that are surgically placed beneath the middle part of the urethra (water pipe) to provide dynamic support to stop leakage from the bladder. They have been shown to be as effective as more invasive traditional surgery with major advantages of shorter operating and admission times, and a quicker return to normal activities together with lower rates of complications Who? Anyone, regardless of age.

Women are more prone to stress incontinence than men.

What are the symptoms? Depends on the type of incontinence, but generally wetting oneself or dribbling.

How long have they had the symptoms?

Medical advice should be sought when symptoms present.

Action already taken? Lifestyle changes or pelvic exercises may help.

Medication? A range of products to manage the condition are available.

16

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

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ALLERGIES An allergy is a reaction the body has to a particular food or substance. Allergies are very common. They’re thought to affect more than one in four people at some point in their lives.

They are particularly common in children.

Some allergies go away as a child gets older, although many are lifelong. Adults can develop allergies to things they weren’t previously allergic to.

Having an allergy can be a nuisance and affect your everyday activities, but most allergic reactions are mild and can be largely kept under control. Severe reactions can occasionally occur, but these are uncommon.

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 immune-compromised or on chemotherapy.

Symptoms of indoor allergies

Second generation 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.

• Itchy, congested nose • Clear nasal discharge • Itchy, watery, swollen or red eyes • Sneezing • Tickly, swollen throat

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.

• 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 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 three to four times each day.

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

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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.

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/ 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 seven days of treatment Action already taken? Sufferers who may already have tried analgesics.

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

COLD SORES

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COLD SORES Cold sores are small blisters that develop on the lips or around the mouth. They’re caused by the herpes simplex virus and usually clear up without treatment within seven to 10 days.

Sufferers may not have any symptoms when they first become infected with the herpes simplex virus. An outbreak of cold sores may happen some time later.

Cold sores often start with a tingling, itching or burning sensation around the mouth. Small fluid-filled sores then appear, usually on the edges of your lower lip. 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 one in three 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 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 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 of 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 acyclovir 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 two weeks, but a 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.

6hrs Just 3 Sprays helps relieve pain for up to 6 hours Strepsils Intensive 8.75mg/dose Oromucosal Spray is indicated for the symptomatic relief of throat infections including acute sore throat. Strepsils 15ml Spray contains Flurbiprofen which is a non-steroidal anti-inflammatory drug which has potent analgesic, and anti-inflammatory properties.

Strepsils Intensive 8.75mg per dose Oromucosal Spray contains Flurbiprofen for relief of acute Sore Throat. Over 18s only.

Max duration of use three days. ALWAYS READ THE LABEL. Date of prep Nov 2018, IRL/CC/1118/0020

COLDS

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COLDS A cold is a mild viral infection of the nose, throat, sinuses and upper airways. It’s very common and usually clears up on its own within a week or two.

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?

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.

The virus from an infectious person by: • Touching an object or surface contaminated by infected droplets and then touching the mouth, nose or eyes • 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

• Medicated lozenges can provide relief from sore throats

• Clean surfaces regularly to keep them free of germs

When to refer for further advice

• Use your own cup, plates, cutlery and kitchen utensils

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: • Effect on day to day life - they are confused or disorientated • If they notice a sharp pain in the chest • If they are experiencing difficulty breathing

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.

• Cough up blood-stained phlegm

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.

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.

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.

• Using decongestant sprays or tablets to relieve a blocked nose

• If they notice a swelling of the glands in the neck and/or armpits • Their symptoms last longer than three weeks.

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

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

Aptamil Pepti for the effective management of cows’ milk allergy

RELIEVE

cows’ milk allergy symptoms1 with 97% efficacy2

REDUCE

incidence of atopic dermatitis up to five years3 NOW PROVEN4

REASSURE

with Ireland’s most palatable extensively hydrolysed formula4

Republic of Ireland: www.aptamilhcp.ie Northern Ireland: www.eln.nutricia.co.uk References: 1. Verwimp JJ et al. Eur J Clin Nutr. 1995;49 (Suppl1):S39-S48. 2. Giampietro PG et al. Pediatr Allergy Immunol. 2001;12:83-86. 3. Arslanoglu S et al. J Biol Regul Homeost Agents.

2012;26:49-59. 4. O’ Carroll, E, Redmond, M et al. (2018), A blinded palatability study comparing two extensively hydrolysed infant formula used for the dietary management of Cows’ Milk Allergy in Ireland. The Nutrition Society Advancing Nutritional Science Spring Conference OC18.

IMPORTANT NOTICE: Aptamil Pepti 1 & 2 are foods for special medical purposes for the dietary management of cows’ milk allergy. They should only be used under medical supervision, after full consideration of the feeding options available including breastfeeding. Aptamil Pepti 1 is suitable for use as the sole source of nutrition for infants from birth, and/or as part of a balanced diet from 6-12 months. Aptamil Pepti 2 is suitable for babies over 6 months as part of a mixed diet.

FOR HEALTHCARE PROFESSIONAL USE ONLY.

17-026 / March 2018

COWS’ MILK ALLERGY

25

COWS’ MILK ALLERGY Cows’ milk allergy (CMA), also called cows’ milk protein allergy, is one of the most common childhood food allergies. It is estimated to affect between 2% and 7.5% of babies under one, though most children grow out of it by the age of five.

CMA typically develops when cows’ milk is first introduced into a baby’s diet either in formula or when a baby starts eating solids.

More rarely, it can affect babies who are exclusively breastfed because of cows’ milk from the mother’s diet passing to the baby through breast milk.

There are two main types of CMA: • immediate CMA – where symptoms typically begin within minutes of having cows’ milk • delayed CMA – where symptoms typically begin several hours, or even days, after having cows’ milk Allergy or intolerance?

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. 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 if 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 sheeps’ 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 there is a history of allergy in the family.

Another difference is that 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.

Feeding and milk allergies

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.

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.

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 six 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.

Identifying Lactose Intolerance A baby with 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.

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 one 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.

CLEARING CONGESTION IN CHILDREN

27

CLEARING CONGESTION IN CHILDREN Clearing congestion in a small child can be a challenge. For starters, it’s not always obvious what’s causing a stuffy nose. Infants and toddlers often catch colds because they are just starting to build up their immunity to common viruses. But there are many other potential causes of congestion.

If a child has a stuffy nose, breathing in steam with added essential oils, such as eucalyptus or rosemary, may help to relieve it. For babies, placing a few drops of saline (salt water) just inside their nose, before they feed, will help to relieve a blocked nose. Saline drops are available.

Cold medicines for relief of older children and adults are not recommended for infants and toddlers. Fortunately, there are plenty of safe and effective treatments.

Symptoms Nasal congestion happens when blood vessels and tissue in the nasal cavity fill up with too much fluid. It can make it hard to sleep and lead to problems like a sinus infection (sinusitis). A baby may also have trouble feeding if he or she is congested. There are some tell-tale signs that can help you tell the difference between viral and bacterial infections.

For example, if a child has a runny nose, the colour of the discharge is an important clue.

Clear and watery discharge at first usually come from a virus, though the mucus may turn white, green, or yellow for a few days before it turns clear again.

Blocked noses can be caused by a mild infection, like the cold or flu, but it’s worth checking if a child has accidentally blocked a nostril themselves.

A gentle option is to wash away the mucus that’s causing the blockage, so the child can breathe more easily. A natural treatment like a nasal spray of saline drops can help to do this.

Safe Treatments One of the safest and most effective ways to help clear a baby’s congestion is with a saline (salt water) spray or natural nose drops. These products are available without a prescription and are preservative free.

The drops or spray work to maintain daily nasal hygiene by gently cleansing “nasally” nostrils and preserving the natural balance of the nasal mucosa of the infant/child.

They can improve the evacuation of mucus, which ultimately prevents colds and limits the occurrence of allergic symptoms like hay fever. By clearing the child’s nose and allowing

them to breathe more freely, this also results in improved sleeping and feeding.

If advising the use of drops, tell the parent to place two drops in each nostril to loosen the mucus inside. A suction bulb can be used to withdraw the saline and mucus.

Tips for using a nasal spray • Get the timing right. It’s hard to use a nasal spray when a baby’s feeling wriggly, so try dosing them when they are nice and relaxed, like after a bath or a feed.

If a child’s under 2: 1. Lay the child down and turn their head to one side.

2. It’s sometimes helpful to lay them on a pillow, so you can tilt their head back slightly.

3. Put the nozzle into a nostril and press the spray head once.

4. Then repeat in the other nostril.

If they’re over 2: 1. Put the nozzle into one nostril, holding the bottle vertically.

2. Press the other nostril closed.

3. Press the spray head once and spray deeply, asking your child to breathe in at the same time.

4. Then repeat in the other nostril.

• Don’t worry about misfires If a little spray gets in their eye, don’t panic. It may surprise them a little but saline solution is very gentle and shouldn’t cause any harm.

• If it is tricky to use a nasal spray with a young baby, try using nasal drops instead, as some people find these easier.

Other tips Moisture and warmth can help too. Try advising a parent to take the child into the bathroom while they run a steamy shower or bath.

Advise the parent to make sure their little one gets plenty of restful sleep – this will really help give them the strength they need to recover.

If the child is older than one, advise the parent to prop up the child’s pillow. It can help the child breathe more easily while they sleep.

A range of plug-in products which release vaporised oils into the child’s room or vapour rubs are also available for young children.

Who? All children are prone to congestion and colds.

What are the symptoms?

Stuffy nose, irritability.

How long have they had the symptoms?

An infant will have difficulty communicating their symptoms.

Action already taken?

Steam, moisture and warmth can help to alleviate symptoms.

Medication?

Decongestants for adults or older children should not be used on young children.

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DIORALYTE® NATURAL, BLACKCURRANT AND CITRUS, POWDER FOR ORAL SOLUTION PRODUCT INFORMATION 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 up to the age of 24 months and 20-40 ml/kg body weight for adults and children. A reasonable approximation is: Infants under 24 months – Use only under medical advice. One to one and a half times the usual 24 hour feed volume. Children over 24 months – 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: Hypersensitivity to the active substances or to any of the excipients. Warnings and precautions: Dioralyte should not be used for treatment in infants below the age of 24 months without medical supervision. Dioralyte should not be used for self-treatment by patients with: chronic or persistent diarrhoea, liver or kidney disease, diabetes, on low potassium or sodium diets, intestinal obstruction. The use of Dioralyte in

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patients with these conditions should be supervised by a doctor. The solution must not be reconstituted except with water at the volume stated. A weaker solution than recommended will not contain the optimal glucose and electrolyte concentration and a stronger solution than recommended may give rise to electrolyte imbalance. 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: Medical supervision is recommended for use during pregnancy and lactation. Interactions and side effects: None stated. Pack sizes: 6 and 20 sachets.

Legal category: P. Product authorisation number: PA 540/98/1 (Blackcurrant), PA 540/98/2 (Citrus), PA 540/99/1 (Natural). Product authorisation holder: Sanofi, 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 2018.

Adverse events should be reported. Reporting forms and information can be found at www.hpra.ie. Adverse events should also be reported to Sanofi on 01403 5600 or email IEPharmacovigilance@Sanofi.com Date of Preparation: September 2018 SAIE.DIO.17.01.0010c(1)

DIARRHOEA

29

DIARRHOEA Diarrhoea is passing looser or more frequent stools than is normal. It affects most people from time to time and is usually nothing to worry about. However, it can be distressing and unpleasant until it passes, which normally takes a few days to a week.

There are many different causes of diarrhoea, but a bowel infection (gastroenteritis) is a common cause in both adults and children.

Gastroenteritis can be caused by: • a virus – such as norovirus or rotavirus • bacteria – such as campylobacter and Escherichia coli (E. coli), which are often picked up from contaminated food • a parasite – such as the parasite that causes giardiasis, which is spread in contaminated water These infections can sometimes be caught during travel abroad, particularly to areas with poor standards of public hygiene. This is known as travellers’ diarrhoea. Diarrhoea can also be the result of anxiety, a food allergy, medication, or a long-term condition, such as irritable bowel syndrome (IBS).

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 (IBS). 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: • lacking energy or feeling tired.

• loss of appetite.

• nausea.

• feeling light-headed.

• dizziness, especially when standing up.

• dry tongue.

• 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 elderly one 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 five 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 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.

Antidiarrheal Medicine Antidiarrheal 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 antidiarrheal 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.

Antidiarrheal 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 antidiarrheal 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 antidiarrheal medicines.

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

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DRY EYE

31

DRY EYE 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.

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.

visual concentration. This means the tear film evaporates or drains away more quickly than it is replenished.

Other factors Several medicines are thought to cause dry eye syndrome as a side effect in some people, including: antihistamines, antidepressants, betablockers, diuretics and 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.

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.

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 experience problems with dry eyes. Dry eye syndrome is more common in women than men.

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.

What are the symptoms? Feelings of dryness, grittiness or soreness that get worse throughout the day, burning and red eyes.

Contact dermatitis - a type of eczema that causes inflammation of the skin because of a substance the person is sensitive to.

How long have they had the symptoms?

People with persistent but mild symptoms of dry eye syndrome should speak with an optometrist.

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

Sjögren’s syndrome - a condition that can cause excessive dryness of the eyes, mouth and vagina, which is also associated with fatigue and arthritis.

Action already taken? People may already be using lubricating eye-drops, but the above self-care steps can also relieve symptoms.

Visual concentration - this can also contribute to dry eye syndrome, and can occur when involved in activities such as reading, writing or working with a computer. People tend to blink less frequently during activities that require

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)

Medication? Antihistamines, antidepressants, beta-blockers and diuretics can all cause dry eye as a side effect.

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.

DYSPHAGIA

33

DYSPHAGIA Dysphagia is the medical term to describe difficulty swallowing. Some people with dysphagia have problems swallowing certain foods, while others can’t swallow at all. 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.

• 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 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 sideeffects 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.

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 flavoured swallowing gel is available which works by moistening the mucous membranes in the mouth and throat cavity and allowing the

tablets to pass smoothly via the oesophagus to the stomach. It can also be used to take multiple tablets at the same time.

Often made from food-based ingredients this lubricant has no known interactions with other medications and almost immediately breaks down when it reaches the acidic environment of the stomach, meaning it have minimal impact on the absorption of medication. This lubricant can be used by anyone who can swallow autonomously over the age of two.

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).

FOOT CARE

35

FOOT CARE Everyday feet are abused and bruised, which is why so many experience heel pain, blisters, corns and calluses. But, despite a high prevalence of foot care conditions, few people actually treat.

A major part of the problem surrounding reluctance to treat is confusion. With over 15 different ailments in foot care, this is a category that spans a hugely diverse number of consumer needs. There are also issues with daily foot comfort and posture.

An overarching lack of awareness about available solutions is the key reason why people are not doing enough about general discomfort.

Common problems and treatments Corns and calluses- are a build-up of hard dead skin caused by pressure when bony parts of the feet rub against the shoes.

Wearing shoes that fit better or using special pads may solve the problem. If corns or calluses become painful, patients should be advised to visit the chiropodist or doctor.

Over-the-counter treatments for corns, such as corn plasters, are available. Corn plasters may not be suitable for certain people, such as those with diabetes, circulation problems, or fragile skin.

Bunions - develop when the joints of the big toe no longer fit together. This causes a painful swelling which makes walking difficult.

Wearing shoes made of soft leather or fabric uppers, or bunion shields may help to ease the discomfort. A chiropodist or doctor will advise on how to treat the condition.

Athlete’s Foot - is a fungal infection and is very contagious. It causes dry skin, an itchy rash, splitting of the skin between the toes and blisters on the skin under the toes. To prevent infection advise patient to keep feet – especially the area between toes – clean and dry. Change shoes, socks, tights or stockings often. Over-the-counter antifungal creams are sufficient for treating most cases of athlete’s foot. If the condition does not get better within two weeks, advise a visit to chiropodist or GP. In-growing toenails - can be very painful and are usually caused by cutting the toenail too short or by wearing shoes that are too tight. A chiropodist or GP will advise on how to treat the condition. OTC soaks are available to help relieve pain or swelling and pain-relieving medication can also be recommended.

Veruucas - Most verrucas, which develop on the soles of the feet, are harmless. They don’t cause any pain, unless they are on a

weight-bearing part of the foot. The affected skin is usually white and may have a black spot in the centre.

Verrucas are highly contagious and spread easily through contact with contaminated changing room floors or swimming pool areas. They usually disappear on their own, but this can take up to two years. Several treatment options are available OTC, including salicylic acid gels, creams, plasters and paints, and cryotherapy products.

Cracked heels - often caused by openbacked shoes, such as sandals or flip-flops rubbing the skin. Applying a moisturising cream or specially formulated foot cream, twice daily, will keep feet smooth and soft.

Any hard skin can be removed with a pumice stone or non-metal foot file; these are most effective when used during a bath or shower.

Blisters - can be painful and are more likely to occur in hot weather, when sandals or flipflops rub against the skin. Anti-blister sticks and blister plasters can provide instant relief and prevent further damage. Customers should be advised not to pop blisters, as this increases the risk of infections – instead, they should cover them with a protective gel dressing.

Fungal nail infections - commonest in people who wear shoes in hot sweaty weather, regularly damage their nail or skin, or have certain health conditions such as diabetes or psoriasis. The infection usually develops slowly and causes the nail to become thickened and discoloured. The nail may turn white, black, yellow or green, but isn’t usually painful.

Mild fungal nail infections usually clear up on their own, although a GP may check for any underlying conditions. Antifungal nail paint may be effective if only the end of the nail is

infected, but this needs to be used for up to six months or even a year.

Antifungal tablets are up to 80 per cent effective, but again need to be taken for several months. Most treatment failure occurs because people stop using the medicines too early. In severe or painful cases, the nail may be removed with surgery.

Feet odours - teenagers and pregnant women are particularly prone to sweaty feet, because hormonal changes make them sweat more often. Ideally, customers should wash their feet every morning and night with warm soapy water and change their socks at least once a day. An antibacterial wash, followed by a wipe with cotton wool soaked in surgical spirit, can help to combat any odour. Medicated insoles and ‘feet fresh’ socks have a deodorising effect.

Who? Everyone is prone to foot problems, particularly those who are on their feet for most of the day.

What are the symptoms?

There are a wide range of common foot problems with a wide range of symptoms.

How long has the patient had the symptoms?

Many patients are confused about the range of foot ailments so do not tackle discomfort early.

Action already taken?

Using appropriate footwear for the conditions can alleviate or prevent many foot ailments.

Medication?

A wide range of OTC products are available.

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Cream: and Eachother 100g related containsano-rectal Bismuth oxide 2.14g,Dosage: Balsam Peru Zincoroxide 10.75g. suppository to the affected area at night,2.25g, in the Bismuth morning oxide and after eachBalsam evacuation the condition controlled.

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Contraindications: Hypersensitivity to the active or Each 100g contains Bismuth subgallate 0.875g, Peruuntil 1.875g, Zinc oxideis10.75g.

Suppositories: Each suppository contains: Bismuth subgallate 59mg, Bismuth oxide substance(s) 24mg, Balsam to any49mg, of theZinc excipients.

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Dosage: cream ointment or underlying insert one disorder.

Pregnancy and Lactation: Should not be used during pregnancy and lactation unless the potential benefit of treatment to the mother outweighs the possible risk to the developing foetus or nursing infant. suppository to the affected area at night, in the morning and after each evacuation until the condition is controlled. Not recommended for children. Contraindications: Hypersensitivity to the active substance(s) or Side Zinc Oxide:Patients Rare: Hypersensitivity; Not known: reaction Burn, before Erythema, Irritation, Pruritus, Rash, andsymptom Urticaria).ofOther (attributed directly to to anyeffects: of the Identified excipients.with Precautions: with rectal bleeding or bloodApplication in the stoolsite should talk(including to their doctor usingExfoliation, this product as thesePain, conditions may be the a more serious underlying Balsam Skin sensitisation reactions andnot systemic contact dermatitis.

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Church & Dwight UK Ltd.,with Folkestone, KentRare: CT19 Hypersensitivity; 4RJ, UK. PA No: Cream 2190/001/001 & Ointment 2190/001/002.

Supply Supply throughIrritation, PharmacyPain, OnlyPruritus, (Dispensing Status not subject to medical prescription) Side effects: Identified Zinc Oxide: Not known: Application site reaction (including Burn,Status: Erythema, Exfoliation, Rash, and –Urticaria).

Other (attributed directly to Suppositories 2190/001/003 Date €5.65; of prep: May 2018 12s €5.98; 24s €10.53. Supply Status: Supply through general sales: PA Holder: Balsam Peru): Skin sensitisation reactions and systemic contact dermatitis. RRP (ex VAT): Cream: 23g €5.65; Ointment: Suppositories: Church & Dwight UK Ltd., Folkestone, Kent CT19 4RJ, UK. PA No: Cream 2190/001/001 & Ointment 2190/001/002. Supply Status: Supply through Pharmacy Only (Dispensing Status – not subject to medical prescription) Suppositories 2190/001/003 Date of prep: May 2018

HAEMORRHOIDS

37

HAEMORRHOIDS Haemorrhoids, also known as piles, are swellings containing enlarged blood vessels that are found inside or around the bottom (the rectum and anus).

In many cases, haemorrhoids don’t cause symptoms, and some people don’t even realise they have them. However, when symptoms do occur, they may include: • bleeding after passing a stool (the blood is usually bright red) • itchy bottom • a lump hanging down outside of the anus, which may need to be pushed back in after passing a stool • a mucus discharge after passing a stool • soreness, redness and swelling around your anus Haemorrhoids aren’t usually painful, unless their blood supply slows down or is interrupted.

What causes haemorrhoids?

The exact cause of haemorrhoids is unclear, but they’re associated with increased pressure in the blood vessels in and around the anus. This pressure can cause the blood vessels in the back passage to become swollen and inflamed.

Many cases are thought to be caused by too much straining on the toilet, due to prolonged constipation – this is often due to a lack of fibre in a person’s diet. Chronic (long-term) diarrhoea can also make sufferers more vulnerable to getting haemorrhoids.

Other factors that might increase the risk of developing haemorrhoids include: • being overweight or obese • age – as a person get older, the body’s supporting tissues get weaker, increasing the risk of haemorrhoids • being pregnant – which can place increased pressure on your pelvic blood vessels, causing them to enlarge • having a family history of haemorrhoids • regularly lifting heavy objects • a persistent cough or repeated vomiting • sitting down for long periods of time Preventing and treating haemorrhoids Haemorrhoid symptoms often settle down after a few days, without needing treatment.

Haemorrhoids that occur during pregnancy often get better after giving birth.

However, making lifestyle changes to reduce the strain on the blood vessels in and around the anus is often recommended. These can include:

• gradually increasing the amount of fibre in a diet – good sources of fibre include fruit, vegetables, wholegrain rice, wholewheat pasta and bread, pulses and beans, seeds, nuts and oats • drinking plenty of fluid, particularly water, but avoiding or cutting down on caffeine and alcohol • not delaying going to the toilet, ignoring the urge to empty your bowels can make your stools harder and drier, which can lead to straining when you do go to the toilet • avoiding medication that causes constipation, such as painkillers that contain codeine • losing weight (if the person is overweight) • exercising regularly can help prevent constipation, reduce blood pressure and help lose weight These measures can also reduce the risk of haemorrhoids returning, or even developing in the first place.

Medication and treatments OTC treatments - various creams, ointments and suppositories are available from pharmacies without a prescription. They can be used to relieve any swelling and discomfort. These medicines should only be used for five to seven days at a time. They may irritate the sensitive skin around your anus if you use them longer than this.

Any medication should be combined with the diet and self-care advice discussed above.

Pharmacists can advise about which product is most suitable.

Corticosteroid cream - a GP may prescribe corticosteroid cream, which contains steroids, if there is severe inflammation in and around the back passage.

Painkillers - common painkilling medication, such as paracetamol, can help relieve the pain of haemorrhoids. But if a sufferer has excessive bleeding, they should avoid using non-steroid anti-inflammatory drugs (NSAIDs), such as ibuprofen, as they can make rectal bleeding

worse. They should also avoid using codeine painkillers as they can cause constipation.

Banding - carried out as a day procedure, this involves placing a very tight elastic band around the base of the haemorrhoids to cut off their blood supply. The haemorrhoids should then fall off within about a week of having the treatment.

Banding is usually a day procedure that doesn’t need an anaesthetic, and most people can get back to their normal activities the next day.

Sclerotherapy - may be used as an alternative to banding. During sclerotherapy, a chemical solution is injected into the blood vessels in the back passage. This relieves pain by numbing the nerve endings at the site of the injection. It also hardens the tissue of the haemorrhoid so a scar is formed. After about four to six weeks, the haemorrhoid should decrease in size or shrivel up.

Surgery - although most haemorrhoids can be treated using the methods described above, around one in every 10 people will eventually need surgery. Surgery is particularly useful for haemorrhoids that have developed below the dentate line – unlike non-surgical treatments, anaesthetic is used to ensure sufferers don’t feel any pain.

Who? The risk of haemorrhoids increases as a person gets older.

What are the symptoms? Pain or discomfort, especially when sitting, pain during bowel movements, itching or irritation around the anal region, bright red blood on stools, swelling around the anus.

How long have they had the symptoms?

If OTC products have not helped the symptoms within a week they sufferer should be referred to a doctor.

Action already taken? Sufferer can be advised of a number of lifestyle changes which can lessen the symptoms or reduce the risk of haemorrhoids returning.

Medication? A number of OTC treatments are available. Sufferers should avoid ibuprofen and codeine.

Our supplements feed the root from within

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HAIR LOSS

39

HAIR LOSS Losing hair isn’t usually anything to be worried about but it can be upsetting.

Treatment may help with some types of hair loss. It’s normal to lose hair. Most people can lose between 50 and 100 hairs a day, often without noticing. Occasionally it can be a sign of a medical condition.

Some types of hair loss are permanent, like male and female pattern baldness. This type of hair loss usually runs in the family. Other types of hair loss may be temporary. They can be caused by an illness, stress, cancer treatment, weight loss, iron deficiency.

Which vitamins may help thinning hair?

The quality of hair growth can be influenced by diet, so supplements that include minerals needed to stimulate hair growth are often advised for thinning hair and hair loss. The quality of diet can be reflected in the quality of hair so it pays to eat a balanced diet and include foods such as oily fish, spinach and eggs.

The most common supplements advised for hair growth are: Iron: People who are anaemic, can start to see hair loss. If you believe that a patient may be anaemic, they should be referred to a GP. Zinc: It’s thought that this mineral is useful for hair growth because people who are deficient in it due to other medical conditions can often have dry, brittle hair.

Zinc is a vital mineral for healthy hair, skin and nails. A zinc supplement for hair loss will supply a good amount of the mineral, as well as other key hair nutrients such as biotin, vitamin C and iron.

Some experts believe that zinc deficiency actually can lead to deterioration of the protein structure that makes up the hair follicle. This weakening of follicles can in turn cause hair shedding and hair loss. Zinc is also believed to play a crucial role in DNA and RNA production.

This is required for the normal division of hair follicle cells, leading to healthier hair growth.

Zinc also may help keep hormone levels balanced. As a bonus, zinc for hair growth may help eliminate dandruff on the scalp as well.

Biotin: A B vitamin often recommended for hair health. Since biotin deficiency can lead to thinning of the hair, proponents claim that taking biotin supplements (in pill or tablet form) or using biotin-enriched shampoo and hair products can thicken hair and stimulate hair and nail growth.

Hair loss is a symptom of biotin deficiency, so biotin supplementation is thought to benefit people with hair loss or thinning hair who have a biotin deficiency.

Male pattern baldness Androgenetic alopecia, commonly known as male-pattern baldness, is the most common form of hair loss for both men and women.

It can be caused by either hormonal or hereditary factors.

Androgenetic alopecia is an androgendependent hereditary disorder in which dihydrotestosterone is a significant contributing factor. The condition affects Caucasian men more than men of other ethnicities. It can start at any age, but approximately 30% of men will experience some hair loss by the age of 30 years, 50% by the age of 50 years, and 80% by the age of 70 years.

In addition, up to 13% of premenopausal women experience some degree of androgenetic alopecia, and the incidence may increase significantly after menopause. By the age of 70 years, approximately 40% to 50% of women experience hair loss.

Alopecia areata is another type of hair loss, involving patches of baldness that may come and go. It can occur at any age, but mostly affects teenagers and young adults. Six of 10 people who are affected develop their first bald patch before they are 20 years old.

Causes: Hair loss, in the form of male pattern baldness is often a genetic disorder.

Male pattern baldness occurs when hair follicles convert testosterone into another hormone called dihydrotestosterone (DHT).

Affected hair follicles (typically at the sides and the top of the head) become more sensitive to DHT, which causes the hair follicles to shrink, weaken, and eventually die. This slows down hair production and can stop hair growth altogether.

Treatments: Minoxidil is available as a lotion that you rub on your scalp every day.

It is available from pharmacies without a prescription. It is not clear how minoxidil works, but evidence suggests that it can cause hair regrowth in some men.

Minoxidil usually needs to be used for at least four months before any effect is seen. The balding process will usually resume if treatment with minoxidil is stopped. Any new hair that regrows will fall out two months after treatment is stopped. Side effects are uncommon.

Finasteride is a medicine that is used in the UK for treating male pattern baldness. It is also used for treating Benign Prostatic Hypertrophy (BPH). It is only licensed in Ireland for BPH. Who? Both men and women can be affected by thinning hair due to a number of factors. Androgenetic alopecia will affect 30% of men will by the age of 30 years, 50% by the age of 50 years, and 80% by the age of 70 years. In addition, up to 13% of premenopausal women experience some degree of androgenetic alopecia.

What are the symptoms? Most people will lose some hair every day. Patients with androgenetic alopecia experience hair loss with no signs of inflammation or scarring.

How long has the patient had the symptoms? If a patient develops sudden hair loss they should be referred to a GP. Action already taken? Eating a balanced diet can aid hair health.

Medications? Finasteride is only licensed in Ireland for BPH.

HAYFEVER MEETS ITS

MATCH More allergy sufferers use Zirtek Allergy Relief in Ireland than any other brand.

That’s because it’s a trusted, non-drowsy way to ease the symptoms of hayfever and other allergy symptoms, 24-hours-a-day.1,2 With Zirtek Allergy Relief, you’ll also get: High-profile marketing support, including a new website, national television campaign, online advertising and social media Your own point-of-sale material A range of products suitable for all the family3 A heritage and reputation based on reliability and dependability, supported by extensive knowledge and research Round-the-clock, max strength treatment, available in extra-value packs of 30

To place your order please contact your local Pemberton rep or customer service on: Tel: 01-463 2424 Email: cs.pemberton@united-drug.com www.zirtek.ie

ZirtekIE

Zirtek IE

Zirtek Usage and Attitude in the ROI report.

Does not cause drowsiness in the majority of people.

3 Zirtek is available in liquid formula for ages 2 and upwards, and in tablets suitable for ages 6 and upwards.

Zirtek D is suitable for adults and adolescents from 12 years of age and upwards.

1 2

Please consult the Summary of Product Characteristics before prescribing, information about this product can be found at www.medicines.ie Further information is available on request from UCB Pharma Ireland Ltd, United Drug House, Magna Drive, Citywest Road, Dublin 24 MA Numbers:

Zirtek 1 mg/ml oral solution: PA 891/8/3, Zirtek Plus Decongestant 5/120mg Prolonged Release Tablets PA 891/8/1, Zirtek Tablets PA0891/008/005

Product licence holder:

UCB Pharma Ireland Ltd

Classification:

Zirtek tablets & oral solution: Cetirizine dihydrochloride Zirtek Plus Decongestant prolonged release tablets: Cetirizine dihydrochloride, Pseudoephedrine hydrochloride

Legal Category: OTC

Adverse events should be reported to the Health Products Authority at www.hpra.ie or via email to medsafety@hpra.ie Adverse events should also be reported to UCB Pharma Ireland Ltd via email UCBCares.IE@ucb.com

July 2018 UK/18ZI0009(1)

HAY FEVER

41

HAY FEVER Hay fever is a common allergic condition that affects up to one in five people at some point in their life. Symptoms of hay fever include sneezing, a runny nose and itchy eyes. Sufferers will experience hay fever symptoms if they have an allergic reaction to pollen.

Pollen is a fine powder released by plants as part of their reproductive cycle. It contains proteins that can cause the nose, eyes, throat and sinuses (small air-filled cavities behind cheekbones and forehead) to become swollen, irritated and inflamed.

Sufferers can have an allergy to tree pollen, released during spring, grass pollen, released during the end of spring and beginning of summer or weed pollen, released late autumn.

Many people find their symptoms improve as they get older. Around half of people report some improvement in symptoms after several years. Symptoms disappear completely in around 10-20% of people.

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

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 first generation 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

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.

• Chlorpheniramine

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.

• Dimenhydrinate

Nasal decongestants

• Diphenhydramine

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

• Brompheniramine

• 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. Second generation antihistamines are less likely to interact with other medicines.

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

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.

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 firstgeneration 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.

HEADACHES

43

HEADACHES Headaches are one of the most common health complaints. But most aren’t serious and are easily treated. In many cases they can be treated at home with over-the-counter painkillers and lifestyle changes, such as getting more rest and drinking enough fluids.

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

Migraine 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) plays 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 strong smelling substances.

Secondary headaches

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.

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 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.

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.

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.

When to refer for further help

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.

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 painkiller 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.

Who? Tension headaches affect as many as eight 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 person’s 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.

HERBAL REMEDIES

45

HERBAL REMEDIES Herbal remedies have been the foundation of healthcare throughout history, and many modern drugs are derived from plants.

Herbal medicines have become popular for self-medication in the treatment of minor medical conditions. The growing public demand for herbal medicines and the associated increase in their use is evident.

Herbal medicines are those with active ingredients made from plant parts, such as leaves, roots or flowers. Just like conventional medicines, herbal medicines will have an effect on the body, and should therefore be used with the same care and respect as conventional medicines.

Herbal medicines sold in the European Union (EU) are required to be approved prior to being placed on the market. This is to ensure that herbal medicines are of acceptable safety and quality.

Within the group of herbal medicinal products, some have a long tradition of use. European Union legislation classifies as traditional herbal medicinal products those herbal medicinal products that have been used for at least 30 years, including at least 15 years within the EU, and are intended to be used without the supervision of a medical practitioner and are not administered by injection.

The role of pharmacists The most obvious involvement for pharmacists is through the sale of products such as dietary supplements, herbal medicines, homoeopathic remedies and aromatherapy oils. However, as in other areas of pharmacy practice, pharmacists’ role could extend beyond products. Pharmacists can be involved in: • Providing information on the appropriate use of herbal remedies. This should include not only those products sold in the pharmacy but also those products and therapies received by patients outside of the pharmacy.

• Asking customers questions about their use of herbal medicine.

• Being aware of potential adverse reactions and interactions with conventional medicines.

it can be used as a muscle rub to relieve the pain in muscles and joints.

Black Cohosh - this well-known herb is said to relieve menopausal symptoms such as hot flushes and night sweats. Can also be used for relieving the mood swings that often accompany the menopause.

Devil’s Claw - used for joint & muscular pain, backache, joint pain, muscular pain and rheumatic pain Devil’s Claw is a plant found in the Kalahari desert and the root is used to produce a herbal remedy.

Echinacea - mainly used for colds and flu to relieve symptoms such as sore throat and runny nose and to strengthen the immune system This is one of the most well-known herbs.

Milk Thistle - used to relieve symptoms of overindulgence with food and drink. Many users take the herb particularly at Christmas time because it has a longstanding reputation for protecting the liver.

Pelargonium - used to keep the symptoms of a cold at bay Passion flower - used for relieving stress and anxiety and has a calming effect on mood.

Rhodiola rosea - used for relieving stress and boosting energy

Some popular herbal remedies Agnus Castus - used to relieve many premenstrual symptoms such a s mood swings, cramps, bloating and breast tenderness.

Arnica - used for muscle aches and pains, stiff neck and shoulders, knee pain and sprains and strains. Arnica is commonly used to relieve the symptoms of bruising – however,

Rhubarb root - the root and underground stem of rhubarb (rhizome) are used to make medicine. Rhubarb is used primarily for digestive complaints including constipation, diarrhoea, heartburn, stomach pain, gastrointestinal (GI) bleeding, and preparation for certain GI diagnostic procedures. Some people use rhubarb so they have to strain less during bowel movements; this reduces pain from hemorrhoids or anal fissures.

St. John’s Wort - often used for low mood, including feelings of unhappiness and anxiety.

St. John’s Wort is also known as Hypericum and is another well-known herb.

Sage - used for symptoms of the menopause such as hot flushes, excessive sweating and night sweats. This is the same herb that used in cooking.

Saw Palmetto - often used for men with a confirmed diagnosis of an enlarged prostate, a condition which causes the need to urinate frequently and having to get up at night to go to the toilet.

Senna - mostly used for constipation and to clear the bowels prior to surgery. Senna is regarded as more potent than another natural laxative, cascara sagrada.

Valerian - it is valerian root that is used for herbal remedies. It works to relax your nervous system and can be used to relieve mild anxiety and also to help you when you experience disturbed sleep.

Who? Available to everyone.

Symptoms? Herbal remedies may provide relief for a wide range of symptoms. The extracts of various plants are used for a wide range of complaints.

How long have they had the symptoms? N/A Action already taken? Herbal remedies are often taken as part of self-medication.

Medication? Should always be used appropriately and with awareness of interactions with conventional medicines.

The Bio-kult range is a scientifically developed advanced multi-strain formula for the entire family.

Proven to survive the high acidity of the stomach, Bio-kult is gluten free and suitable for vegetarians. It can be swallowed whole, sprinkled over food or mixed in a drink and it doesn’t need to be refrigerated.

Ask your wholesaler for more information

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e info@scopehealthcare.ie w www.scopehealthcare.ie

IRRITABLE BOWEL SYNDROME

47

IRRITABLE BOWEL SYNDROME Irritable bowel syndrome (IBS) is a common, long-term condition of the digestive system. It can cause bouts of stomach cramps, bloating, diarrhoea and/or constipation. IBS is thought to affect up to one in five people at some point in their life, and it usually first develops when a person is between 20 and 30 years of age.

Around twice as many women are affected as men.

The condition is often lifelong, although it may improve over several years.

IBS symptoms The symptoms of IBS vary between individuals and affect some people more severely than others. They tend to come and go in periods lasting a few days to a few months at a time, often during times of stress or after eating certain foods.

A person may find some of the symptoms of IBS ease after going to the toilet and opening their bowels.

The most common symptoms of IBS are: • abdominal (stomach) pain and cramping, which may be relieved by passing stools • a change in bowel habits – such as diarrhoea, constipation or sometimes both • bloating and swelling of the stomach • excessive wind (flatulence) • occasionally experiencing an urgent need to go to the toilet • a feeling that the person hasn’t fully emptied their bowels after going to the toilet • passing mucus from the bottom What causes IBS? The exact cause of IBS is unknown, but most experts think that it’s related to increased sensitivity of the gut and problems digesting food. These problems may mean that a sufferer is more sensitive to pain coming from their gut, and they may become constipated or have diarrhoea because food passes through the gut either too slowly or too quickly.

Psychological factors such as stress may also play a part in IBS. IBS triggers Certain foods and drinks can trigger the symptoms of IBS. Triggers vary from person to person, but common ones include: • alcohol • fizzy drinks

• chocolate • drinks that contain caffeine – such as tea, coffee or cola • processed snacks – such as crisps and biscuits • fatty or fried food Advising a patient to keep a food diary may be a useful way of identifying possible triggers in their diet. Stress is another common trigger of IBS symptoms. Therefore, finding ways to manage stressful situations is an important part of treating the condition.

Treatment IBS-friendly diet - changing diet will play an important part in controlling symptoms of IBS. However, there is no “one size fits all” diet for people with the condition. The diet that works best for an individual will depend on their symptoms and how they react to different foods. People with IBS are often advised to modify the amount of fibre in their diet.

Probiotics - these are dietary supplements that may help improve digestive health. They contain so-called “friendly bacteria” that can supposedly restore the natural balance of your gut bacteria when it has been disrupted. Some people find taking probiotics regularly helps to relieve the symptoms of IBS. Antispasmodics - these work by helping to relax the muscles in the digestive system.

Examples of antispasmodic medicines include mebeverine and therapeutic peppermint oil.

Side effects associated with antispasmodics are rare. However, people taking peppermint oil may have occasional heartburn and irritation on the skin around their bottom.

Laxatives - usually recommended for people with IBS-related constipation. They make the stools softer, which means they are easier to pass. It’s important to drink plenty of fluids while using a bulk-forming laxative. This will help prevent the laxative from causing an obstruction in your digestive system.

Start a patient on a low dose and then, if necessary, increase it every few days until one or two soft stools are produced every one or two days. Side effects associated with taking laxatives can include bloating and wind.

However, if the dose is increased gradually, the patient should have few, if any, side effects.

Antimotility medicines - the antimotility medicine loperamide is usually recommended for IBS-related diarrhoea. Loperamide works by slowing contractions of muscles in the bowel, which slows down the speed at which food passes through the digestive system.

This allows more time forstools to harden and solidify. Side effects of loperamide can include stomach cramps and bloating, dizziness, drowsiness and rashes.

Psychological treatments - if IBS symptoms are still causing problems after 12 months of treatment, a GP may refer a patient for a type of therapy known as a psychological intervention. There are several different types of psychological therapy. They all involve teaching techniques to help control the condition better, and there is good evidence to suggest they may help some people with IBS. Who? Thought to effect up to one in five people.

What are the symptoms? Can vary but often include abdominal (stomach) pain and cramping, which may be relieved by passing stools, a change in bowel habits – such as diarrhoea, constipation or sometimes both, bloating and swelling of the stomach, excessive wind (flatulence).

How long have they had the symptoms? Symptoms can come and go but people with persistent symptoms should be referred to a GP. Action already taken? Keeping a food diary is a good way of monitoring triggers of IBS. Medications? A range of treatments are available to help relieve symptoms.

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Gaviscon Extra chewable tablets. Gaviscon Extra oral suspension. For the relief of Heartburn & Indigestion. For Gaviscon Extra chewable tablets.

Gaviscon ExtraALWAYS oral suspension. the relief For the use in adults and children 12 years and over.

READ THEFor LABEL. DateofofHeartburn Preparation:& Indigestion.

November 2018, the use in adults and children 12 years and over. ALWAYS READ THE LABEL. Date of Preparation: November 2018, IRL/G-OTC/1118/0033 IRL/G-OTC/1118/0033

INDIGESTION

49

INDIGESTION Indigestion can be pain or discomfort in the upper abdomen (dyspepsia) or burning pain behind the breastbone (heartburn). Dyspepsia and heartburn may occur together or on their own. Symptoms usually appear soon after eating or drinking.

Common associated symptoms include: • feeling full or bloated • feeling sick (nausea) • belching • bringing up (regurgitating) fluid or food into the gullet (oesophagus) Indigestion is a common problem that affects many people, but in most cases it’s mild and only occurs occasionally.

Why it happens Indigestion may be caused by stomach acid coming into contact with the sensitive, protective lining of the digestive system (mucosa). The stomach acid breaks down the lining, leading to irritation and inflammation, which can be painful.

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.

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:

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

• Eating big meals, irregular meals or eating on the run

Pregnant women can be more likely to get indigestion during pregnancy if:

• Eating fatty foods, spicy foods, chocolate, mint or tomato products

• She experienced indigestion before she became pregnant

• Drinking caffeinated drinks, alcohol, very hot drinks or citrus juices

• She has been pregnant before

• 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

Sufferers often described the feeling as:

• Stress

• A hot pain or burning sensation

Preventing and treating indigestion

• A tight feeling

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.

• An acidic taste (with or without the feeling of sickness) The affected area usually is centred 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: • 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 • A loss of appetite Indigestion and heartburn causes The two conditions are closely associated, since stomach acid is involved in both. In fact,

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

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 eight 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.

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

• 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-today 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 Who? 73% of people can experience indigestion and heartburn interchangeably. As many as eight 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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FOR HEALTHCARE PROFESSIONAL USE ONLY

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Could it be Colic?

Inconsolable crying

Flushed face

Drawing knees up to the chest

Prolonged periods of irritability

Difficulty sleeping

Nutritionally tailored in 5 ways to help support babies with colic and constipation.

Cow & Gate Comfort helps you offer a broad dietary management option for formula-fed infants with colic or constipation, as an alternative to medicine:

1.

Unique blend of prebiotics (GOS/FOS) - Shown to increase the number of bifidobacteria in the gut and promote a softer stool1-3

2. Structured vegetable oil - To help produce softer stools and aid the absorption of fat and calcium3-6

3. Partially hydrolysed whey protein - For easy digestion 4. Reduced lactose - In cases of lactose maldigestion, can help to reduce flatulence 6

and abdominal discomfort6,7

The greatest improvement in symptoms has been shown after 2 weeks of using Cow & Gate’s Comfort milk6,8

5. Contains starch - Thickens the formula in order to help reduce swallowed air during feeding6

Let us help you manage colic.

Republic of Ireland: www.cowandgatehcp.ie Northern Ireland: www.eln.nutricia.co.uk References: 1. Knol J et al. J Paediatr Gastroenterol Nutr 2005;40:36-42. 2. Moro G et al. J Paediatr Gastroenterol Nutr 2002;34:291-5. 3. Schmelzle H et al. J Paediatr Gastroenterol Nutr 2003;36:343-351.

4. Kennedy K et al. Am J Clin Nutr 1999;70:920-7. 5. Carnielli VP et al. J Paediatr Gastroenterol Nutr 1996;23(5):553-60. 6. Savino F et al. Acta Paediatr Suppl. 2003;441:86-90. 7. Kanabar D et al. J Hum Nutr Dietet 2001;14:359-63. 8. Savino F et al. Eur J Clin Nutr 2006;60:1304–10.

Important notice: Cow & Gate comfort is a food for special medical purposes for the dietary management of colic and constipation after full consideration of feeding options, including breastfeeding.

Only to be used under medical supervision. For enteral use only. © 2018 Danone Nutricia Early Life Nutrition, [17-089]

INFANTILE COLIC AND CONSTIPATION

51

INFANTILE COLIC AND CONSTIPATION Colic is when a baby cries a lot but there’s no obvious cause. All babies cry, but they may have colic if they cry more than three hours a day, three days a week for at least one week.

They may cry more often in the afternoon and evening. The exact cause of colic is not known, which can be frustrating for parents.

Constipation usually involves a baby passing abnormally delayed, infrequent, hard or dry stools, accompanied by pain and straining.

Parents may also notice they have a poor appetite and a lack of energy.

Colic in newborns Colic is one of the most common feedingrelated problems, equally amongst breast and bottle-fed babies. It often starts at two or three weeks of age. Signs of colic include: • A baby is less than five months of age when the symptoms start and stop.

Breastfed babies have several helpful types of bacteria in their large intestine that are capable of breaking down some of the otherwise indigestible carbohydrates, proteins and fats in milk. As a result, their stools are softer, making bowel movements easier.

• They have repeated and prolonged bouts of crying, fussing or irritability, without any obvious cause.

Breast milk also contains a hormone called motilin that increases the movement of the baby’s bowels, helping them to empty.

• A baby is otherwise well and is growing at a healthy rate.

Other causes

How to help relieve a baby’s colic Experts believe there are a variety of causes including immaturity of the digestive system, trapped wind, lactose intolerance and the balance of gut bacteria. Mothers who smoke also appear to play a role. Parents who suspect colic can be advised to try the following: • Sit a baby upright during feeds to prevent them from swallowing more air.

• Burp them regularly, gently rubbing their back or tummy.

• Try holding them in different positions to relieve wind.

• Gentle swaying, rocking or even a trip in the car can help.

• Try gentle baby massage for colic to help soothe a baby.

Food (ie type of milk and then the particular foods given after weaning) is usually the cause of baby constipation. However dehydration, especially in hot weather, can be an important contributory factor.

But in some cases, constipation can be a symptom of a more serious underlying disease.

If a baby isn’t gaining weight or shows any other unusual symptoms, advice the parent to seek the advice of a doctor.

The bottlefed baby Bottlefed babies frequently suffer from constipation because formula milk is harder for a baby to digest and the baby has a limited supply of fluid (ie what is given to them in the bottle).

A baby who receives only formula milk will typically have fewer bowel movements than a breastfed child. Their stools will be thicker and have a different, more greenish colour.

If a parent is breastfeeding, certain foods such as caffeine, spicy food or garlic in your diet may contribute to a baby’s colic. You can advise a parent to note down what they’re eating when their baby’s symptoms occur.

How to help a constipated baby

What causes constipation?

• Gently move their legs in a bicycle motion or massage their tummy.

The breastfed baby - A breastfed baby will very rarely get constipation because breast milk is more easily digested.

• If a baby is constipated, you can advise a parent to give them a little boiled and cooled water between feeds.

• If parents are bottle-feeding, make sure they always follow the preparation instructions on

the label. Too much powder or too little water can make a baby constipated.

• Some medication can cause constipation.

Always advice the parent to read the label carefully and, if in doubt, speak to a healthcare professional.

Treatments Pharmacists will be able to recommend a number of options for parents to relieve the symptoms of colic and constipation.

Anti-colic bottles - these specially-designed bottles have internal vent which is supposed to eliminate the vacuum and air bubbles in a milk feed, thus helping to reduce burping, wind and digestive discomfort.

Colic relief drops - the main ingredient is simeticone which is an anti-flatulent. It is administered using a dropper or syringe before a feed and works as an anti-foaming agent, joining the small bubbles of gas in the stomach to form larger bubbles.

Comfort milk - nutritionally tailored milk with less lactose than standard milks, to reduce gas and other intestinal discomfort.

Who? Newborn babies and infants.

What are the symptoms? Persistent crying, abnormal difficulty passing stools.

How long have they had the symptoms?

If a child cries for more than three hours in a row on three or more days of the week they may be considered colicky.

Action already taken? Parents may have already considered a number of home actions to soothe symptoms.

Medication? Medications can be considered under medical advice as part of a controlled diet.

IRON SUPPLEMENTATION

53

IRON SUPPLEMENTATION Iron deficiency anaemia occurs when there is a reduced number of red blood cells because the body does not have enough iron to produce them. The main symptoms are tiredness and lethargy (lack of energy).

An estimated 20% of all women, 50% of pregnant women, and 3% of men do not have a sufficient amount of iron in their bodies.

Iron is an essential mineral because it is an integral component of haemoglobin (Hb), which enables oxygen to be bound, stored and carried around the body in the blood. Reduced iron in the body therefore results in less oxygen being delivered to tissues and organs.

This lack of iron can be caused by either reduced iron intake or an increased loss of iron from the body. Non-anaemic iron deficiency or latent iron deficiency is a condition in which there is iron deficiency but Hb levels are normal and symptoms often include fatigue, hair loss, lack of concentration and irritability.

Iron is found in meat, dried fruit and some vegetables. It is used by the body to make haemoglobin, which helps store and carry oxygen in red blood cells. Haemoglobin transports oxygen from the lungs to the rest of the body. If there is a lack of iron in the blood, the organs and tissues will not get as much oxygen as they usually do.

How common is iron deficiency anaemia?

Iron deficiency anaemia affects up to one in 20 men and one in 20 post-menopausal women (after a woman’s menstrual periods have stopped). Iron deficiency anaemia is more common in women who are still menstruating (having periods). This is because menstruation and pregnancy can cause iron deficiency.

Outlook Treatment for iron deficiency anaemia involves increasing dietary iron intake or taking iron supplements to replace the missing iron in the body. This is usually very effective and the condition rarely causes any serious complications.

Patients with iron deficiency anaemia may need to be monitored to check that the treatment is working and that your iron levels have returned to normal.

In some cases, further tests may be necessary to determine the underlying cause of iron deficiency anaemia. Apart from menstrual loss, the most common cause is bleeding in the gastrointestinal tract (the stomach and intestines), which may require separate treatment.

Causes Gastrointestinal blood loss The gastrointestinal tract is the part of the body responsible for digesting food. It is made up of the:

Bleeding in the stomach and intestines is the most common cause of iron deficiency anaemia in men and in women who have been through the menopause (when a woman’s monthly periods stop).

• trauma: a serious accident, such as a car accident, may cause you to lose a lot of blood

Causes in women

• haematuria (blood in your urine): this is also rare and may be the symptom of another condition

In women who are still menstruating (having monthly periods), the most common causes of iron deficiency anaemia are: • menstruation (monthly periods) • pregnancy Menstruation Usually, only women with particularly heavy periods develop iron deficiency anaemia. If you have heavy bleeding over several consecutive menstrual cycles, it is known as menorrhagia.

Pregnancy It is very common for women to develop iron deficiency during pregnancy. This is because their body needs extra iron so that your baby has a sufficient blood supply and receives all of the necessary oxygen and nutrients. Many pregnant women require an iron supplement, particularly from the 20th week of pregnancy.

Other causes Other conditions or situations that cause blood loss and may lead to iron deficiency anaemia include: • inflammatory bowel disease: a condition that causes inflammation (redness and swelling) in the digestive system, such as Crohn’s disease and ulcerative colitis • oesophagitis: inflammation of the gullet (oesophagus) that is caused by stomach acid leaking up it

• stomach, a sac-like organ that helps digest food by churning it and mixing it with acids to break it down into smaller pieces

• schistosomiasis: an infection that is caused by parasites and is mainly found in subSaharan Africa

• intestines, which digest and absorb food and liquid

• blood donation: donating a large amount of blood may lead to anaemia

• nosebleeds: if you have a lot of nosebleeds, this may lead to anaemia, although it is rare

Malabsorption Malabsorption (when your body cannot absorb the iron from your food) is another possible cause of iron deficiency anaemia. This may occur if you have: • coeliac disease, a condition that damages the lining of the intestines • a gastrectomy, a medical procedure to surgically remove your stomach, for example to treat stomach cancer Diet Unless you are pregnant, it is very rare for iron deficiency anaemia to be caused solely by a lack of iron in your diet.

Pregnant women may have to increase the amount of iron-rich food that they consume during their pregnancy to help avoid iron deficiency anaemia.

Who? Anyone, but women, and particularly pregnant women are more likely to suffer.

What are the symptoms? The main symptoms are tiredness and lack of energy.

How long have they had the symptoms?

Best controlled as soon as the symptoms are diagnosed.

Action already taken? Treatment for iron deficiency anaemia involves increasing dietary iron intake or taking iron supplements to replace the missing iron in the body.

Medication? Prescribed medication may lead some people to get side effects such as constipation or diarrhoea, tummy pain or a feeling of sickness.

Rowex Ltd. DON’T GET DON’T GET DON’T GET is pleased FLATTENED FLATTENED FLATTENED to announce BY Migraine BY BYtheMigraine Migraine first ever OTC Sumatriptan Rowex Ltd. Rowex Ltd. is Rowex Ltd. inistopleased Ireland is pleased announce pleased

EXCLUSIVE OTC PRODUCT EFOXRCLPHARMACI USIVE OTCEPSRONLODUYC*T to announce theannounce first to the first ever OTC the first ever OTC Sumatriptan ever OTC Sumatriptan in Ireland Sumatriptan in Ireland in Ireland

FEXCLUSIOR PHAVREMOTCACIEPRODUCT S ONLY*

*Sumatran Relief is a non-prescription migraine treatment, containing sumatriptan. Sales must be refer ed to the pharmacist. Please use your consultation aid.

MediPRODUCT cinal product not subject to medical prescription. Further information and SPC are available from: Rowex Ltd., Bantry, Co. Cork, P75 V009.

EXCLUSIVE OTC EXCLUSIVE OTC PRODUCT EXCLUSIVE OTC PRODUCT FOR PHARMACIES Fr e 1800 304 400 Fax: 027 50417 E-mail: rowex@rowa-pharma.ie. Date of preparation (09-18) CCF No:21373 FOR PHARMACIESephone:ONLY* ONLY* FOR PHARMACIES ONLY*

*Sumatran Relief is a non-prescription migraine treatment, containing sumatriptan. Sales must be referred to the pharmacist. Please use your consultation aid.

Medicinal product subject to medical prescription.

Further information and SPC Sales are available Rowex Ltd.,pharmacist.

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Freephone:product 1800 304 400 Fax: 027 50417 E-mail: rowex@rowa-pharma.ie.

Date preparation CCF No:21373 Medicinal subject to medical prescription.

Further information and of SPC are available Rowex Ltd.,pharmacist.

Bantry, Co.Please Cork, P75 *Sumatran Relief isnot a non-prescription migraine treatment, containing sumatriptan.

Sales must(09-18) befrom: referred to the useV009. your consultation aid.

Freephone:product 1800 304 Fax: 027 50417 E-mail: rowex@rowa-pharma.ie. preparation (09-18) No:21373 Medicinal not400 subject to medical prescription.

Further informationDate and of SPC are available from:CCF Rowex Ltd., Bantry, Co. Cork, P75 V009.

Freephone: 1800 304 400 Fax: 027 50417 E-mail: rowex@rowa-pharma.ie. Date of preparation (09-18) CCF No:21373

FOR PHARMACI*ESumSatraONLY* n Relief is a non-prescription migraine treatment,containing sumatriptan.Sales must be refer ed to the pharmacist.Please use your consultation aid.

ABBREVIATED PRESCRIBING INFORMATION Product Name:PRESCRIBING Sumatran Relief 50 mg Tablets. Composition: Each tablet contains 50 mg sumatriptan (as sumatriptan succinate). Description: ABBREVIATED INFORMATION Pink, biconvex, tabletRelief with 50 a break-line on Composition: both sides. Indication(s): acute 50 treatment of migraine(asattacks with orsuccinate). without aura.

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but women migraine whosumatriptan are taking the combined oral haveSumatriptan an increasedisrisk of stroke shouldoccurring seek advice frommenstruation, their doctor regularly in with patients who use intermittently, overcontraceptive the longer term. effective for and migraine during ifbutmigraine attacks startedwho recently (withinthe thecombined last 3 months), migraine symptoms have worsened, they and haveshould migraine aura.from Not their to bedoctor given women with migraine are taking oral contraceptive haveSumatriptan an increased oforstroke seekwith advice regularly in(especially patients who use sumatriptan intermittently, over the longerofterm. isrisk effective for migraine occurring during those menstruation, to patients postmenopausal women and males over 40 years age) with risk factors for ischaemic heart disease, including patients ifbutmigraine attacks startedwho recently (withinthe thecombined last 3 months), migraine symptoms have worsened, orstroke they and haveshould migraine with aura.from Not their to be given women with migraine are taking oral contraceptive have an increased risk of seek advice doctor who are heavy smokers or users of nicotine substitution therapies, without prior Risk factors forincluding heart disease include to patients (especially postmenopausal women and3males over 40 years of age) withcardiovascular risk factors forevaluation. ischaemic heart disease, those patients if migraine attacks started recently (within the last months), migraine symptoms have ordisease they have migraine with aura. Not to be given hypercholesterolaemia, regular smoking, marked obesity, diabetes orwithout a family history of worsened, early heartevaluation. (father/brother developed heart disease who are heavy smokers or users of nicotine substitution therapies, prior cardiovascular Risk factors for heart disease include to patients (especially postmenopausal womenheart and males overbefore 40 years of age) withThe riskdiagnosis factors forofischaemic heart disease, including thoseshould patients developed disease thea family age of history 65). medication overuse headache (MOH) be before the age of 55, mother/sister hypercholesterolaemia, regular smoking, marked obesity, diabetes or of early heart disease (father/brother developed heart disease who are heavy smokers usersfrequent of nicotine substitution therapies, without priorof)cardiovascular evaluation.

Riskmedications factors for heart disease opioids, include suspected in patients whoorhave or daily headaches despitethe (or age because thediagnosis regular use of headache (e.g. triptans, heart disease before of history 65). The medication overuse headache (MOH) should be before the age of 55, mother/sister developed hypercholesterolaemia, regular smoking, marked obesity, diabetes ormonth). a family of early heartofdisease (father/brother developed heartmonth disease ergotamine or combination of these drugs for 10 days or more per Patients with headache present on more than or 15 days per for suspected in patients who have frequent or daily headaches despitethe (or age because of)The thediagnosis regular use of headacheoveruse medications (e.g. triptans, opioids, heart disease before of 65). of medication headache (MOH)for should be beforemonths the age of 55, mother/sister three whose headache hasdeveloped developed markedly worsened during medication overuse should on bemore referred doctor further ergotamine combination of these drugs 10orheadaches days or more per month).

Patients withregular headache thantoortheir 15 days per month for suspected inorpatients wholactose have frequent orfordaily despite (or because of) the use present of headache medications (e.g. triptans, opioids, describing patients with serotonin management.

Contains monohydrate.

Interactions: There have been rare post-marketing reports three monthsor whose headache hasdrugs developed ordays markedly worsened during medication overusepresent should on bemore referred toortheir doctor for further ergotamine combination of these for 10 or more per month).

Patients with headache than 15 days per month for syndrome (including altered mental status, autonomic instability andhave neuromuscular abnormalities) following the use of patients SSRIs andwith sumatriptan. serotonin management.

Contains lactose monohydrate.

Interactions: There beenmedication rare post-marketing reports describing three months whose headache has developed or markedly worsened during overuse referred to their doctor for further Serotonin syndrome has alsomental been reported following concomitant treatment with triptans and SNRIsshould and isbe alsothe a use risk of with concomitant use with syndrome (including altered status, autonomic instability and neuromuscular abnormalities) following SSRIs andwith sumatriptan. patients serotonin management.

Contains lactose monohydrate.

Interactions: There have been rare post-marketing reports describing lithium. Undesirable effects may be more following common concomitant during concomitant usewith with herbalandpreparations containing Stwith John’s Wort (Hypericum Serotonin syndrome has also been reported treatment triptans SNRIs and is also a risk concomitant use with syndrome (including altered mental status, autonomic instability and neuromuscular abnormalities) following the use doctor. of SSRIs and tosumatriptan. perforatum).

Pregnancy and Lactation: Not to be used during pregnancy or breast-feeding unless on the advice of their Ability Drive and lithium. Undesirable effects be more following common concomitant during concomitant usewith with herbalandpreparations John’s Wort (Hypericum Serotonin syndrome has also may been reported triptans SNRIs andwith iscontaining also a riskStwith concomitant use with Use Machinery: Drowsiness, dizziness and may astreatment a result of migraine or its treatment sumatriptan.

This may to influence the perforatum).

Pregnancy and Lactation: Not weakness tocommon be usedduring duringoccur pregnancy or use breast-feeding on the advice of theirStdoctor.

Ability Drive and lithium.toUndesirable effects may be more concomitant with drowsiness, herbalunless preparations containing John’s Wort (Hypericum ability drive and to operate machinery.

Undesirable Effects: Common: Dizziness, sensory disturbance including paraesthesia and Use Machinery: Drowsiness, dizziness and weakness may occur as a result of migraine orunless its treatment with sumatriptan.

This may to influence the perforatum).

Pregnancy and Lactation: Not to be used during pregnancy or breast-feeding on the advice of their doctor.

Ability Drive and hypoaesthesia.

Transient increases in blood pressure arising soon after treatment, flushing.

Dyspnoea.

Nausea and vomiting occurred in some ability to drive and to operate machinery.

Undesirable Effects: Common: Dizziness, drowsiness, sensorywith disturbance including paraesthesia and Use Machinery: Drowsiness, and weakness may occur as a result of migraine or its treatment sumatriptan.

Thisand may influence the patients, but it isTransient unclear ifincreases thisdizziness is related to sumatriptan or the underlying condition.

Sensations of heaviness (usually transient may beinintense hypoaesthesia. in blood pressure arising soon after treatment, flushing.

Dyspnoea.

Nausea and vomiting occurred some abilitycantoaffect drive any and part to operate machinery.

Undesirable Effects: Common: Dizziness, drowsiness, sensory including paraesthesia and and ofifthe body including the chest and throat), myalgia.condition.

Pain, sensations of heat or cold,disturbance pressure or tightness (these events are patients, but it is unclear this is related to sumatriptan or the underlying Sensations of heaviness (usually transient and may be intense hypoaesthesia.

Transient increases inand blood pressure arising afterincluding treatment, Dyspnoea.

Nauseaofand vomitingfatigue occurred inevents some usually and be intense canthe affect anyand partthroat), ofsoon themyalgia. body theflushing. chest and throat); feelings weakness, (both and cantransient affect partmay ofifthe body including chest Pain, sensations of heat or cold, pressure or tightness events are patients, butmild it any istounclear this isintensity related to sumatriptan or the underlying condition.

Sensations ofLtd., heaviness (usually transient and(these may be intense are mostly moderate inintense and transient).

Marketing Authorisation Holder: Rowex Bantry, Co.ofCork.

Marketing Authorisation usually transient and may be and can affect any part of the body including the chest and throat); feelings weakness, fatigue (both events and can affect any part ofFurther the body including the chest andavailable throat), myalgia.

Pain, sensations ofCo. heatCork. or cold, pressure1800 or tightness (these events are Number: PA 711/272/1. information and SPC are from: Rowex Ltd., Bantry, Freephone: 304 400 Fax: 027 50417 are mostly mild toand moderate intensity and Marketing Authorisation Ltd., Bantry, Co.ofCork.

Marketing usually transient may be inintense and cantransient). affect any part ofto the body prescription. including Holder: theDate chestRowex throat); feelings weakness, fatigueAuthorisation (both events ofand Preparation: April 2018 E-mail rowex@rowa-pharma.ie Legal Category: medical Number: 711/272/1.

Further information and Not SPCSubject are available from: Rowex Ltd., Bantry, Co. Cork.

Freephone: 1800Marketing 304 400 Fax: 027 50417 are mostlyPAmild to moderate in intensity and transient).

Marketing Authorisation Holder: Rowex Ltd., Bantry, Co. Cork.

Authorisation April 2018 E-mail rowex@rowa-pharma.ie Category: to medical of Preparation: Number: PA 711/272/1. FurtherLegal information and Not SPCSubject are available from:prescription.

Rowex Ltd.,Date Bantry, Co. Cork. Freephone: 1800 304 400 Fax: 027 50417

without a prior cardiac risk assessment by a doctor or pharmacist. As migraine is a chronic condition, cardiovascular risk should be evaluated

E-mail rowex@rowa-pharma.ie Legal Category: Not Subject to medical prescription. Date of Preparation: April 2018

regularly in patients who use sumatriptan intermittently, over the longer term. Sumatriptan is effective for migraine occurring during menstruation,

ABBREVIATED PRESCRIBING INFORMATION regularly in patients who use sumatriptan intermit ently, over the longer term. Sumatriptan is ef ective for migraine oc ur ing during menstruation, *Sumatran Relief is a non-prescription migraine treatment, containing sumatriptan. Sales must be referred to the pharmacist. Please use your consultation aid.

Product Name: Sumatran Relief 50 mg Tablets. CompositionMedi : Each ctaibnlealt cproduct ontains 50 mgnotsusubjmatripetactn (toas smediumatricptalanprescri suc inatep).tiDeosn.criFurther ption: informati but womoennwiandth migSPCrainearewho aavaire taklainblg tehefrom: combineRowex d oral conLtd.tracep,tBantry, ive have anCo.increCork, ased risP75k of stV009. roke and should se k advice from their doctor Pink, biconvex, oblong tablet with a break-line on both sides.InFreephone: dication(s): The 1800 acute tre304atme400nt of miFax:grain027e at ac50417 ks with oE-mai r withoult:arowex@rowa-pharma. ura. Only to be if migrainee. aDatet acks ofstarpreparati ted recently (wointhi(n0t9-18) he last 3CCFmontNo:hs), mi21373 graine symptoms have worsened, or they have migraine with aura. Not to be given used where there is a clear diagnosis of migraine. Dosage: Only in Adults aged 18 to 65 years: Recommended adult dose is a single 50 mg tablet. to patients (especial y postmenopausal women and males over 40 years of age) with risk factors for ischaemic heart disease, including those patients If a patient responds to the first dose of sumatriptan, but he symptoms recur a second dose may be taken for the same at ack but no so ner than 2 whregulo aarrelyhineapatvyiesmntoskwhoers ouser ussumaters ofrnipictaontininetesrumbisttieunttiloy,novertherathpeielso,ngerwithtoeurtmp.rSumatior carrdipiotvaansicsueflarfeectviavleuafotironmi. Rigrsakinfeacoccurtors rfoinrghdurearitndgismenstease rinucatluiodn,e ABBREVIATED PRESCRIBING INFORMATION hours afteName:r the firSumatst tablreatnwaRels iteafke50n.mgIf a pTablatieentst.dComposi oes not retisopn:onEachd to thtaeblfiersttcontdosaei,nass50ecomgnd dsumatose srhioputaldn n(aost bsumate takerniptfaonr tsuccihe sanmateea).tDescriack (inptthioesn:e hbutypewomenrcholeswitertohlamiemgriaai,nreegwhoulararsme otakkiinngg, mathercombiked obneedsityor, adliacontbeterasceptor aivfaemhaveily hianstoirnycroefasedearlyrhisekaofrt dstisroekeaseand(fatshoulher/bdroseekther dadvievecloepferodmhetahreitrddoctiseasoer Product cPiansk,esbithconvex,e at ackoblcaonngbteabltreeattwiedthwiathbrpeaak-lracienteamonolbot, achesitydlses.alicInydiliccaatciido,n(osr)n:oThen-stacuteroiedatrleaatntmi-entinflaofmmimagtroariynedratugtascks). Nowimoth rore withathnout10aurmga. Onl(2 tyabtolebets) bifemiforgeratihneeaatgteacksof 5st,amortetdherer/centsistelyr (dweivtheilnoptehde hlaestar3t dmontiseashes)b,emifogreratihnee asymptge ofo6ms5).haveThe dworiagnsoened,sis oformethdeyicahavetion omivegrruasineehwieatdhaaurchea(.MNotOH)tosbehougildvenbe

Medicinal product not subject o medical prescription.Further information and SPC are available from:Rowex Ltd.,Bantry,Co.Cork,P75V0 9.

Fre phone:180 304 40 Fax:027 50417 E-mail:rowex@rowa-pharma.ie.Date of preparation (09-18) C F No:21373

MIGRAINE

55

MIGRAINE A migraine is usually a moderate or severe headache felt as a throbbing pain on one side of the head. Many people also have symptoms such as nausea, vomiting and increased sensitivity to light or sound.

Migraine is a common health condition, affecting around one in every five women and around one in every 15 men. They usually begin in early adulthood.

There are several types of migraine, including: • migraine with aura – where there are specific warning signs just before the migraine begins, such as seeing flashing lights • migraine without aura – the most common type, where the migraine occurs without the specific warning signs • migraine aura without headache, also known as silent migraine – where an aura or other migraine symptoms are experienced, but a headache doesn’t develop Some people have migraines frequently, up to several times a week. Other people only have a migraine occasionally. It’s possible for years to pass between migraine attacks.

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 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 see 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).

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. Aftereffects 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 one third of patients.

Medication? Codeine is a major cause of rebound headache.

NEW

DUAL ACTION

IN ONE TABLET A new analgesic brand that is clinically proven to provide 30% more effective pain relief1*

NOW AVAILABLE TO ORDER Call our freephone order line on 1800 26 26 26

References: 1. Merry A, et al. AFT-MX-1, a prospective parallel group, double-blind comparison of the analgesic effect of a combination inhibiting drug, an anti-inflammatory drug and thiazide diuretic at the same time increases the risk of renal impairment. Blood of paracetamol and ibuprofen, paracetamol alone, or ibuprofen alone in patients with post-operative pain. Department of Anaesthesiology, dyscrasias have been rarely reported. Patients on long-term therapy with ibuprofen should have regular haematological monitoring.

University of Auckland, New Zealand 2008. *compared with the same daily dose of standard paracetamol or ibuprofen alone.

Like other NSAIDs, ibuprofen can inhibit platelet aggregation. GI bleeding, ulceration or perforation, which can be fatal, has been reported with all NSAIDs at anytime during treatment. Combination therapy with protective agents (e.g. misoprostol or proton pump Easolief Duo 500 mg/150 mg film-coated tablets Each tablet contains paracetamol 500 mg and ibuprofen 150 mg. inhibitors) should be considered. Use with concomitant NSAIDs including cyclooxygenase-2 selective inhibitors should be avoided.

Presentation: A White, capsule shaped tablet with breakline on one side and plain on the other side. Indications: Short-term NSAIDs may lead to onset of new hypertension or worsening of pre-existing hypertension and patients taking antihypertensive symptomatic treatment of mild to moderate pain. Dosage: Adults/elderly: The usual dosage is one to two tablets taken every medicines with NSAIDs may have an impaired anti-hypertensive response. Fluid retention and oedema have been observed in six hours up to a maximum of six tablets in 24 hours. Children: Easolief Duo is contraindicated in children under 18 years. some patients taking NSAIDs. NSAIDs may very rarely cause serious cutaneous adverse events such as exfoliative dermatitis, toxic Contraindications: Severe heart failure, known hypersensitivity to paracetamol, ibuprofen, other NSAIDs or to any of the epidermal necrolysis and Stevens-Johnson syndrome. Products containing ibuprofen should not be administered to patients with excipients, active alcoholism, asthma, urticaria, or allergic-type reactions after taking acetylsalicylic acid or other NSAIDs, history acetylsalicylic acid sensitive asthma and should be used with caution in patients with pre-existing asthma. Adverse ophthalmological of gastrointestinal bleeding or perforation related to previous NSAID therapy, active or history of recurrent peptic ulceration/ effects have been observed with NSAIDs. For products containing ibuprofen aseptic meningitis has been reported only rarely. NSAIDs haemorrhage, severe hepatic failure or severe renal failure, cerebrovascular or other active bleeding, blood-formation disturbances, may mask symptoms of infection and fever. Interactions: Warfarin, medicines to treat epilepsy, chloramphenicol, probenecid, during the third trimester of pregnancy. Warnings and precautions: This medicine is for short term use and is not recommended zidovudine, medicines used to treat tuberculosis such as isoniazid, acetylsalicylic acid, other NSAIDs, medicines to treat high blood for use beyond 3 days. Clinical studies suggest that use of ibuprofen, particularly at a high dose may be associated with a small pressure or other heart conditions, diuretics, lithium, methotrexate, corticosteroids. Refer to summary of product charachteristics increased risk of arterial thrombotic events. Patients with uncontrolled hypertension, congestive heart failure, established ischaemic for other interactions. Fertility, pregnancy and lactation: Easolief Duo is contraindicated during the third trimester of pregnancy. heart disease, peripheral arterial disease and/or cerebrovascular disease should only be treated with ibuprofen after careful Driving and operation of machinery: Dizziness, drowsiness, fatigue and visual disturbances are possible after taking NSAIDs. consideration and high doses should be avoided. Careful consideration should be exercised before initiating long-term treatment If affected patients should not drive or operate machinery. Undesirable effects: Dizziness, headache, nervousness, tinnitus, of patients with risk factors for cardiovascular events. The use of paracetamol at higher than recommended doses can lead to oedema, fluid retention, abdominal pain, diarrhoea, dyspepsia, nausea, stomach discomfort, vomiting, flatulence, constipation, slight hepatotoxicity, hepatic failure and death. Patients with impaired liver function or a history of liver disease or who are on long term gastrointestinal blood loss, rash, pruritus, alanine aminotransferase increased, gamma-glutamyltransferase increased, abnormal liver ibuprofen or paracetamol therapy should have hepatic function monitored at regular intervals. Severe hepatic reactions, including function tests, blood creatinine increased and blood urea increased. Refer to Summary of Product Characteristics for other adverse jaundice and cases of fatal hepatitis, though rare, have been reported with ibuprofen. Paracetamol can be used in patients with effects. Pack size: 24 tablets. Marketing authorisation holder: Clonmel Healthcare Ltd., Clonmel, Co. Tipperary. Marketing chronic renal disease without dosage adjustment. There is minimal risk of paracetamol toxicity in patients with moderate to severe authorisation number: PA0126/294/1. Medicinal product not subject to medical prescription. For retail sale through pharmacy only. renal failure. Caution should be used when initiating treatment with ibuprofen in patients with dehydration. The use of an ACE A copy of the summary of product charachteristics is available upon request. Date prepared: March 2018. 2018/ADV/EAS/008H.

MILD TO MODERATE PAIN

57

MILD TO MODERATE PAIN Pain is one of the most common symptoms presented to pharmacists and its presence is almost ubiquitous in all diseases and injuries.

Pain can be mild, moderate or severe. It can be treated using different strengths of painkiller, depending on the level of pain. A pharmacist can assess a patient’s pain before prescribing the best painkillers to help control it.

Mild to moderate pain is often treated with non-opioid drugs and anti-inflammatory drugs. Sometimes opioids are used to treat mild pain. A patient’s description of pain should be considered the most reliable indicator of suffering.

On the whole, pains encountered in community pharmacies will be mild to moderate and self-limiting (less than one week), and will generally respond to any one of the wide range of over-the-counter analgesic products available. Typical conditions presented include toothache, headache, dysmenorrhoea and musculoskeletal injuries.

Non-opiod drugs Mild pain is often successfully treated with painkillers such as paracetamol and antiinflammatory drugs.

Paracetamol can be used for most types of mild pain. It can be bought it from a pharmacy or supermarket. It has few side effects, but it is very important not to take more than the recommended dose. Higher doses can damage the liver. Paracetamol does not reduce inflammation.

Anti-inflammatory drugs such as ibuprofen help reduce inflammation and swelling. They are good for treating pain in the skin, muscle or bone. These can be bought from a pharmacy or supermarket. Other anti-inflammatory medicines need to be prescribed by a doctor.

Advice should be given by a medical professional before these types of medicines are taken. They do not always work for everyone and may not mix well with other medicines you’re taking.

Anti-inflammatory drugs can cause indigestion and may irritate the lining of the stomach, so it’s important to take them after a meal or snack.

A doctor may prescribe another medicine to help protect the stomach. If a patient has had problems with stomach ulcers before, a doctor may suggest they don’t take anti-inflammatory drugs at all. Or they may suggest they use an anti-inflammatory gel, which you can rub onto the skin.

When taking these drugs, always check the recommended dose on the packet and never take a higher dose.

Other medicines or tablets that are sold from a pharmacy or supermarket, such as cold and flu remedies, may also contain paracetamol or anti-inflammatory drugs. If a person is taking painkillers, they should be careful which other medicines they take, so that they don’t take more than the recommended doses.

A pharmacist can give advice about over-the-counter medicines.

Compound analgesics

Topical OTC treatments

Compound analgesics are made from a combination of two different drugs. New combination painkillers combining full strength paracetamol and ibuprofen are available and suitable for the treatment of mild to moderate pain.

Topical OTC treatments broadly divide into those with active ingredients and those that are drug-free.

Compound analgesics containing low doses of codeine are available over the counter from pharmacists, but stronger ones are only available on prescription. They can be used for moderate pain.

Other ways to manage pain A number of other methods can be recommended for managing pain • Applying heat to the skin can help some types of pain. Use compresses or products such as sprays, creams, ointments, gels and patches to help swelling and inflammation.

• Support from bandages or compression hosiery can help with sprains and strains.

• Acupuncture or Transcutaneous Electrical Nerve • Stimulation (TENS) are alternatives to medication for pain control • Rest • Exercise (if the patient is able to) What kinds of pain can be helped by OTC medicines?

• Headache, migraine • Toothache • Period pain • Minor injuries, strains and sprains • Backache, muscle aches, joint pains

Formats available include gels, creams, ointments, sprays, patches and wraps. Patients will often use OTC topical analgesics for the treatment and management of musculoskeletal injuries and disorders.

These products may have local analgesic, anesthetic, antipruritic, and/or counterirritant effects.

Topical analgesics for musculoskeletal pain can be used alone or in conjunction with oral analgesics when appropriate and warranted.

External analgesic products may contain one or more of the following ingredients: methyl salicylate, camphor, menthol, methyl nicotinate, capsicum, and trolamine salicylate.

Who? Anyone suffering mild to moderate pain.

What are the symptoms? Persistent and nagging pain.

How long have they had the symptoms?

If the symptoms persist after taking OTC medication further advice should be offered.

Action already taken? Rest and exercise can help with managing mild to moderate pain.

Medication? A number of painkillers are available OTC. Stronger painkillers are available with prescription.

it f o r p g Drivin ourrofit yp Driviinnsgtooruerrofit yp Driviinnsgtooruer in y store

CaldeSpray from the makers of Caldesene.

Products for supply through general sales. A copy of the SmPC for Caldesene and Caldease is available on request.Clonmel Healthcare Ltd., Clonmel, Co. Tipperary.

For topical use only. Cleanse and dry the area before applying. ALWAYS READ THE LABEL. Caldespray contains Zinc oxide 10%, 100ml pack size.

CaldeSpray from the makers of Powder Caldesene.

The active ingredient in Caldesene Medicated is Calcium Undecylenate 10% w/w 20g, 55g, 100g pack size.

Products supply through general sales. A Ointment copy of the for Caldesene available on request.Clonmel Healthcare Ltd., Clonmel, Co. Tipperary.

The activeforingredient in Caldease Medicated is SmPC Zinc oxide 15% w/wand 30gCaldease pack size.isDate prepared: August 2017. 2017/ADV/CAL/038 For topical use only. Cleanse and dry the area before applying. ALWAYS READ THE LABEL. Caldespray contains Zinc oxide 10%, 100ml pack size.

CaldeSpray from the makers of Powder Caldesene.

The active ingredient in Caldesene Medicated is Calcium Undecylenate 10% w/w 20g, 55g, 100g pack size.

Products supply through general sales. A Ointment copy of the for Caldesene available on request.Clonmel Healthcare Ltd., Clonmel, Co. Tipperary.

The activeforingredient in Caldease Medicated is SmPC Zinc oxide 15% w/wand 30gCaldease pack size.isDate prepared: August 2017. 2017/ADV/CAL/038 For topical use only. Cleanse and dry the area before applying. ALWAYS READ THE LABEL. Caldespray contains Zinc oxide 10%, 100ml pack size.

The active ingredient in Caldesene Medicated Powder is Calcium Undecylenate 10% w/w 20g, 55g, 100g pack size.

The active ingredient in Caldease Medicated Ointment is Zinc oxide 15% w/w 30g pack size. Date prepared: August 2017. 2017/ADV/CAL/038

NAPPY RASH

59

NAPPY RASH Ireland has one of the highest birth rates in the European Union 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.

Examine the rash and explain what type it is, and how to treat it most effectively.

Nappy rash can occur if 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.

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 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.

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

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If a patient’s baby has severe 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.

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.

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.

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

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

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 one year of age.

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 nappy 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.

OSTEOARTHRITIS

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OSTEOARTHRITIS Osteoarthritis is a condition that causes the joints to become painful and stiff. It is the most common type of arthritis. The severity of osteoarthritis symptoms can vary greatly from person to person, and between different affected joints. For some people, the symptoms may be mild and may come and go, whereas others can experience more continuous and severe problems.

Almost any joint can be affected by osteoarthritis, but the condition most often causes problems in the knees, hips, and small joints of the hands. The pain and stiffness in the joints can make carrying out everyday activities difficult for some people with the condition.

Osteoarthritis is more common and often more severe in women, especially in the knees and hands. It often starts after the menopause.

What causes osteoarthritis?

Osteoarthritis occurs when there is damage in and around the joints that the body cannot fully repair. It’s not clear exactly why this happens in some people, although the chances of developing the condition can be influenced by a number of factors, such as age and weight.

Osteoarthritis usually develops in people over 45 years of age, although younger people can also be affected. It is commonly thought that osteoarthritis is an inevitable part of getting older, but this is not quite true.

People may in fact be able to reduce their chances of developing the condition by doing regular, gentle exercises and maintaining a healthy weight.

Symptoms The main symptoms of osteoarthritis are pain and stiffness in the joints, which can make it difficult to move the affected joints and do certain activities. The symptoms may come and go in episodes, which can be related to things such as activity levels and even the weather.

In more severe cases, the symptoms can be continuous.

Other symptoms can include: • joint tenderness • increased pain and stiffness when a person has not moved their joints for a while • joints appearing slightly larger or more ‘knobbly’ than usual • a grating or crackling sound or sensation in the joints • limited range of movement in the joints • weakness and muscle wasting (loss of muscle bulk) Osteoarthritis can affect any joint in the body, but the most common areas affected are the knees, hips, and small joints in the hands.

Often, a person will only experience symptoms in one joint or a few joints at any one time.

Treatments There’s no cure for osteoarthritis, but the condition doesn’t necessarily get any worse over time and a number of treatments are

available to help relieve the symptoms. One of the main treatments for osteoarthritis is changes to lifestyle – such as maintaining a healthy weight and exercising regularly.

Topical biolubricating gel - pharmacists will be able to advise on the use of topically applied gel to ease joint pain associated with osteoarthritis. Gels work by delivering lubricating ingredients directly into joints that have become damaged due to osteoarthritis.

By improving lubrication within the joints they can relieve pain and reduce joint stiffness. They can be used safely with other medicines.

Painkillers - the type of painkiller (analgesic) you may recommend will depend on the severity of the pain and other conditions or health problems the patient has. Paracetamol is often used in the first instance and sufferers can be advised to take it regularly rather than waiting until the pain becomes unbearable.

Opioids, such as codeine, are another type of painkiller that may ease pain if paracetamol does not work. Opioids can help relieve severe pain, but can also cause side effects such as drowsiness, nausea and constipation.

In some circumstances a non-steroidal anti-inflammatory drug (NSAID) may be prescribed as a painkiller by a GP. NSAIDs are painkillers that work by reducing inflammation.

Some NSAIDs are available as creams (topical NSAIDs) that you apply directly to the affected joints. Some topical NSAIDs are available without a prescription.

Topical Anti-inflammatories - are available as gels, gel patches, sprays, or foams. They contain an anti-inflammatory (Non-Steroidal Anti-inflammatory) medicine such as ibuprofen or diclofenac. While they are the most popular choice of painkiller, they don’t come without their restrictions and health warnings.

Capsaicin cream - a GP may prescribe capsaicin cream if a patient has osteoarthritis in the hands or knees and topical NSAIDs haven’t been effective in easing the pain. Capsaicin cream works by blocking the nerves that send pain messages in the treated area. The patient may have to use it for a while before it has an effect.

Steroid injections - steroids are a type of medication that contain manmade versions of the hormone cortisol, and are sometimes used to treat particularly painful musculoskeletal problems. Some people with osteoarthritis may be offered steroid injections when other treatments haven’t worked.

Who? Osteoarthritis usually develops over the age of 45. It is more common and severe in women than men.

What are the symptoms? Pain and stiffness in the joints, joint tenderness, increased pain and stiffness when a person has not moved their joints for a while, joints appearing slightly larger or more ‘knobbly’ than usual, a grating or crackling sound or sensation in the joints, limited range of movement in the joints.

How long have they had the symptoms?

Medical help should be sought if a patient has persistent symptoms.

Action already taken? Lifestyle changes, such as exercise and losing weight, can help to relieve symptoms.

Medication? There’s no cure for osteoarthritis, but the condition doesn’t necessarily get any worse over time and a number of treatments are available to help relieve the symptoms.

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

Relieving a Fever

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.

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.

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.

• Are irritable, crying and lethargic.

• Start to shiver uncontrollably.

• Act restless, particularly during the night.

• Lose their appetite.

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’s 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.

PAIN RELIEF - INFANTS

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PAIN RELIEF - INFANTS Medicines aren’t always needed for minor illnesses like coughs and colds in children. But if a child does need a medicine, it’s important they have one that’s right for their age and it is given to them safely.

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.

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 clear up within a few days.

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

Paracetamol and ibuprofen for babies and children

• Not give baby analgesics for longer than 24 hours.

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 damage a child’s teeth.

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

Paracetamol is safe to use for babies over two months old. 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 four 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 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 one to two hours, and can last up to eight hours. Ibuprofen should be taken with milk or food to reduce the risk of gastrointestinal side effects.

Guidelines for safe use 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.

• Not give more than the recommended dose.

• Monitor the effectiveness of the treatment.

Medicines to avoid Aspirin is not 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.

SEXUAL HEALTH

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SEXUAL HEALTH Sexual health is an important part of overall health. It means the absence of disease and infections but also covers well-being, the ability to control fertility and to have children and the ability to enjoy fulfilling relationships free from discrimination.

Pharmacists will offer discreet, confidential advice on sexual health and wellbeing. Some people find it difficult to talk about their sexual health but pharmacies have a private consultation room where concerns can be raised and advice given in complete confidence.

General topics will include concerns over unprotected sex and sexually transmitted infections, sexual health services, including emergency hormonal contraception, chlamydia screening and condoms.

Sexually Transmitted Infections (STIs) Many people do not notice symptoms when they have an STI, including most women with chlamydia. If it’s left untreated, chlamydia can affect your ability to get pregnant. Gonorrhoea can also affect fertility. Around 50% of women and 10% of men with gonorrhoea do not have symptoms.

Left untreated, STIs can affect a person’s health. If a patient has any of the symptoms listed below, they should be recommended for testing. Many pharmacies will offer tests for a range of sexually transmitted infections including chlamydia, gonorrhoea, trichomonas, syphilis and HIV and treatment for chlamydia, genital herpes and warts.

In women and men: • pain when passing urine.

• itching, burning or tingling around the genitals.

Pharmacies will offer an online and/or in-store contraception service with a wide variety of contraceptive pills, as well as detailed information available on the different methods and effects of each pill. Women will be checked to ensure that they are clinically appropriate for the pill and receive a quick and free blood pressure, height and weight check in a private consultation room.

• Oil-based products, such as moisturiser, lotion and Vaseline, can damage latex and polyisoprene condoms, but they are safe to use with polyurethane condoms.

The morning after pill

• Condoms need to be stored in places that aren’t too hot or cold, and away from sharp or rough surfaces that could tear them or wear them away.

The morning after pill is a form of emergency contraception which is available without prescription, it can prevent pregnancy after a woman has had unprotected sex or if a method of contraception has not worked. It prevents or delays an egg being released during ovulation.

• blisters, sores, spots or lumps around the genitals or anus.

In-store emergency contraception service

• black powder or tiny white dots in your underwear – this could be droppings or eggs from pubic lice.

Pharmacists will provide advice and information on the emergency contraception available.

This will be a private consultation and can be anonymous.

In women: • yellow or green vaginal discharge.

• discharge that smells.

• bleeding between periods or after sex.

• pain during sex.

• lower abdominal pain.

In men: • discharge from the penis.

• irritation of the urethra (the tube urine comes out of).

The use of condoms is recommended to protect against catching or passing an STI. The contraceptive pill There are multiple versions of the oral contraceptive pill, also commonly referred to as “the pill”. They are available via prescription.

The pill contains artificial versions of female hormones, which can help to: prevent the release of an egg during ovulation; create difficulty for an egg to be implanted in the lining of the womb; and also make it harder for sperm to reach the egg.

Sexual health home-testing kits Pharmacies will offer sexual health home-testing kits online; from HIV test kits for both men and women, to Chlamydia and vagina infection tests and treatments for women. Customers can test themselvs privately in your own home with accurate and easy-to-use kits. The results will provide the necessary incentive to take further action when it comes to managing your sexual health.

Condoms Condoms are a barrier method to provide protection against pregnancy and against sexually transmitted infections (STIs). There are two types of condoms: male condoms, worn on the penis; and female condoms, worn inside the vagina. Male condoms are made from very thin latex (rubber), polyisoprene or polyurethane and are designed to stop a man’s semen from coming into contact with his sexual partner.

• When used correctly every time during sex, male condoms are 98% effective. This means two out of 100 women will become pregnant in one year when male condoms are used as contraception.

• Water-based lubricant is safe to use with all condoms.

• It’s possible for a condom to slip off during sex.

• Putting on a condom can be an enjoyable part of sex and doesn’t have to feel like an interruption.

• If a person is sensitive to latex, they can use polyurethane or polyisoprene condoms instead.

• A condom must not be used more than once. Use a new one each time for sex.

• Condoms have a use-by date on the packaging. Don’t use out-of-date condoms.

• Always use condoms that have the BSI kite mark and the CE mark on the packet.

This means they’ve been tested to high safety standards.

Who? Anyone who is sexually active.

What are the symptoms? Depends upon the condition, but for STIs can include pain when you pass urine, itching, burning or tingling around the genitals blisters, sores, spots or lumps around the genitals or anus, black powder or tiny white dots in your underwear – this could be droppings or eggs from pubic lice.

How long have they had the symptoms?

Medical advice should be given as soon as symptoms present.

Action already taken? Practising good sexual health, including use of condoms or other contraception.

Medication? A number of forms of contraceptive pill are available.

AS SEEN V ON T

The Gold Standard for beauty . Premium, unique complex designed to help build collagen, a major component of skin, to support skin structure and elasticity1

. Contains essential beauty nutrients including zinc, copper and vitamin C

. Protects against free radical damage . Suitable for vegan, vegetarian, Kosher and Halal diets Solgar® is your perfect supplement to good health – 98% of Solgar® consumers recommend the brand2

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1. Zinc contributes to the maintenance of normal hair, skin and nails. 2. *Global Praxis online shopper survey 2017, which included 3,882 VMS consumers. Food supplements should not be used instead of a varied balanced diet and a healthy lifestyle. Solgar® is a registered trademark.

SKIN BEAUTY

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SKIN BEAUTY While a healthy, balanced diet, which includes plenty of essential vitamins and minerals, is required for healthy skin, more and more people are using beauty supplements – sometimes known as nutraceuticals - to help add further benefit.

Some nutraceuticals contain vitamins such as A, C, B2, B3 and B7, and minerals like iodine and zinc, all of which are known to contribute to healthy skin, nails and hair.

Those who take nutraceuticals should always be advised that they should be taken to boost, rather than as a substitute for, diet. It is useful to provide customers with clear guidance on a variety of different products, what they are for and their various benefits, including natural healthcare options.

Women and older people Women are more likely to take supplements for healthy skin, nails and hair than men.

As people age, the most important proteins in their skin, collagen and elastin begin to break down. Making matters worse, the body doesn’t produce these proteins as easily as a person grows older. While different supplements work in slightly different ways, the overall effects are similar. Skin supportive supplements are designed to help revitalise and rejuvenate skin by improving the health of skin cells and helping to produce more crucial proteins like collagen.

Popular supplements Fish oil - supplements are loaded with Omega-3 fatty acids. These fatty acids have a number of proven health benefits. They support collagen growth and promote skin moisture, both of which help to keep skin healthy.

Fern extract - sometimes referred to as Polypodium Leucotomos Extract, or PLE extract, as that chemical compound is the primary active ingredient. Designed to offer protection from the sun. The sun’s harmful UV rays are a leading cause of collagen degradation, so extra protection does a lot to keep skin healthy.

GLA oils - also known as gamma-Linolenic acid oils, GLA oils are Omega-6 fatty acids.

Like their cousin, the Omega-3 fatty acids, Omega-6s are also intended to keep skin healthy. While they’re important for healthy skin, the body doesn’t produce them. GLA oils are found in vegetable oils. The most common GLA supplements are evening primrose oil (EPO), borage oil, and black currant seed oil. All these varieties of GLA oil can be found in tablet form.

Zinc and calcium - both are necessary for health in general, but they’re also critical for the health of skin. Zinc is essential for cell structure and tissue strength, which helps

fight wrinkles and keep skin tight. Meanwhile, calcium helps with cell regeneration and cell growth, thus keeping your skin youthful and healthy.

Vitamins (A, C& E) - it’s widely known that vitamins are good for general health. But it’s worth stressing how important these Vitamins A, C, and E are for skin health.

• Vitamin A increases cell reproduction and stimulates collagen production.

• Vitamin C helps prevent damage to cells, thus facilitating the production of elastin and collagen.

• Vitamin E is an antioxidant that protects skin cells and helps maintain moisture.

Phytonutrients - these are antioxidants found in fruits, veggies, and nuts. There are a number of different phytonutrients, including Lycopene, Ellagic Acid, and Resveratrol, among others. Phytonutrients are useful supplements for healthy skin because they expel toxins and harmful chemicals from skin cells. This allows for healthy cell regeneration and maximum collagen production.

Coenzyme Q10 - commonly referred to as CoQ10, this antioxidant helps get rid of free radicals and other toxins in the body. Thus, it has the effect of promoting healthy skin and allowing the body to make as much collagen as possible.

Biotin - an essential B vitamin, also known as vitamin B7, that helps promote healthy skin, as well as healthy nails and hair. Researchers also think that Biotin works to reduce the death of skin cells. Biotin is found in foods like cheese, beans, eggs, and leafy greens. People can add more of these foods to their diet to ensure they’re getting plenty of Biotin, or can take a tablet as a supplement.

Hyaluronic acid - also known as sodium hyaluronate, has strong moisture-retaining properties, which benefits healthy skin. While this compound is an ingredient in many creams and serums, there’s little evidence to suggest hyaluronic acid is effective when applied topically. It’s best to ingest an oral tablet to receive maximum benefits from this skin supplement.

Curcumin - is not produced by the body, but it does occur naturally in turmeric, the bright yellow spice often used in Indian food.

Curcumin acts as an antioxidant and has been shown to have a number of health benefits.

Available as a supplement tablet.

Copper - Copper is an essential trace mineral necessary for survival. It is found in all body tissues and plays a role in making red blood cells and maintaining nerve cells and the immune system. It also helps the body form collagen and absorb iron, and plays a role in energy production. Most copper in the body is found in the liver, brain, heart, kidneys, and skeletal muscle.

Who? Available to everyone, but women and older people purchase more supplements.

Symptoms? As a person ages the collagen and elastin in their skin begins to break down.

How long have they had the symptoms? Part of the natural ageing process.

Action already taken. A balanced diet is recommended to achieve necessary vitamins and minerals.

Medication? N/A

SMOKING CESSATION

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SMOKING CESSATION Research shows that 70% of smokers want to quit. 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 step.

are generally ideal for patients who feel that they would miss the hand to mouth action of smoking. No more than six of the 15mg inhalators should be used per day. An inhalation cartridge last 40 minutes of intense use.

These include:

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 one to two hours when the urge occurs.

• 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 more 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

Lozenges

Patches 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 six to eight weeks, followed by a medium strength patch for two weeks and then a low strength patch for two weeks.

In those who smoke less than 10 cigarettes per day can start on a medium strength patch for six to eight weeks and then a low strength patch for two to four weeks.

Mouth Spray Nicotine mouth spray is a nicotine replacement therapy (NRT) product that looks a bit like breath freshener. It helps a smoker to quit by replacing some of the nicotine they would normally get from a cigarette. They may still get cravings but the nicotine mouth spray takes the edge off. Using the mouth spray can help to reduce nicotine withdrawal symptoms after quitting, such as cravings, difficulty concentrating, frustration, restlessness and anxiety.

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 • Has failed to quit using NRT previously • Experiences acute breakthrough cravings 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.

Who? Any adults who smoke 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

Combination Therapy

Action already taken? Sufferers may already be trying to cut down or stop smoking all together.

Combination therapy 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.

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.

TOPICAL ANALGESICS

73

TOPICAL ANALGESICS When patients experience muscle and joint pain, pharmacists can recommend topical analgesics (rubs, creams and sprays) to help provide relief for their symptoms.

Patients will often use OTC topical analgesics for the treatment and management of musculoskeletal injuries and disorders. These products may have local analgesic, anaesthetic, antipruritic, and/or counterirritant effects.

Topical analgesics for musculoskeletal pain can be used alone or in conjunction with oral analgesics when appropriate and warranted. External analgesic products may contain one or more of the following ingredients: methyl salicylate, camphor, menthol, methyl nicotinate, capsicum and trolamine salicylate.

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 is worth an estimated ¤273 million 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.

Capsaicin: The main ingredient of hot chilli 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 eight 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 seven 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.

U

GP R *GPrXdata – from July 2014 to June 2015 – UK coverage

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VAGINAL DRYNESS

75

VAGINAL DRYNESS Normally, the walls of the vagina stay lubricated with a thin layer of clear fluid. The hormone estrogen helps maintain that fluid and keeps the lining of your vagina healthy, thick, and elastic. A drop in estrogen levels reduces the amount of moisture available and can lead to vaginal dryness.

It is a common but treatable problem that many women experience at some point in their lives. It can be a problem at any age, but is a particular issue for women who are going through or have experienced the menopause.

Sufferers will often feel embarrassed about seeking help but can be advised that there are a number of treatments that can help.

Symptoms Some women only have symptoms of vaginal dryness at certain times, such as during sex, while others have them all the time. Problems associated with having a dry vagina include: • vaginal irritation, discomfort, itchiness or a burning sensation

Vaginal dryness is also sometimes caused by an underlying condition such as diabetes or Sjögren’s syndrome, where the immune attacks the glands in the body that produce fluid.

Self-help

• a reduced sex drive

Sufferers of vaginal dryness can be advised that it’s worth trying self-help options first. It can help to:

• difficulty getting aroused and reaching orgasm

• try using a lubricant or vaginal moisturiser, these can be bought without a prescription

• the surface of the vagina looks pale and thin • narrowing or shortening of the vagina

• give yourself enough time to become aroused before having sex, read more about female arousal and get good sex tips

• needing to pass urine more often than usual

Treatments

• repeated urinary tract infections (UTIs)

The most common treatment for vaginal dryness due to low estrogen levels is topical estrogen therapy. These replace some of the hormone the body is no longer making. That helps relieve vaginal symptoms, but it doesn’t put as much estrogen in the bloodstream as the hormone therapy in pills.

• discomfort during sex

Causes Causes of a dry vagina include: • the menopause - decreased levels of the hormone oestrogen during the menopause can cause persistent vaginal dryness (also known as vaginal atrophy or atrophic vaginitis) • breastfeeding or childbirth - oestrogen levels can temporarily decrease after giving birth and make the vagina feel drier than usual • not being aroused before sex - if a woman doesn’t feel aroused before having sex, her vagina may not produce natural lubricant and sex may be uncomfortable • some types of contraception the combined contraceptive pill and contraceptive injection can occasionally cause vaginal dryness, although this is uncommon • cancer treatment - radiotherapy to the pelvic area, hormonal cancer treatments, and sometimes chemotherapy can cause vaginal dryness

Lubricants - liquids or gels that are applied to the vulva, vagina or the partner’s penis just before having sex to keep the vagina moist.

They offer immediate but short-term relief from vaginal dryness. Several different brands of lubricant are available to buy from pharmacies without a prescription.

Vaginal moisturisers - creams that are applied inside the vagina to keep it moist. They may be better than lubricants if the dryness isn’t just causing problems during sex, as they tend to have a longer-lasting effect. They usually need to be applied every few days.

Vaginal oestrogen - a GP may prescribe vaginal oestrogen if the dryness is caused by the menopause. This works by increasing the level of oestrogen that declines during and after the menopause.

Vaginal oestrogen is available as pills that are placed in the vagina (pessaries), vaginal creams and vaginal rings. Oestrogen

treatment can be more effective than lubricants and moisturisers for menopausal women, and it generally causes few side effects.

However, it can take a few weeks to start working, so the patient may want to use a lubricant or moisturiser as well to begin with.

Treatment usually needs to be continued indefinitely, as the dryness tends to return if treatment stops.

Hormone replacement therapy - HRT is a treatment that involves taking medication to replace the hormones that start to decline during the menopause.

It’s available on prescription from a GP either as tablets, a skin patch, an implant under the skin, or a gel that’s applied to the skin.

HRT has a wider effect on the body than vaginal oestrogen, so may be best if the person has other menopause symptoms, such as hot flushes. However, it also has more side effects.

Who? All women, but more prevalent during the menopause.

What are the symptoms? Vaginal irritation, discomfort, itchiness or a burning sensation, discomfort during sex, a reduced sex drive, difficulty getting aroused and reaching orgasm, the surface of the vagina looks pale and thin, narrowing or shortening of the vagina, needing to pass urine more often than usual, repeated urinary tract infections (UTIs).

How long has the patient had the symptoms? Many women will delay seeking medical advise because they may be embarrassed about the symptoms.

Action already taken? A number of self-care treatments may already have been used by the sufferer.

Medication? Topical estrogen therapies replace some of the hormone the body is no longer making.

76

Vitamins, Minerals & Supplements Chart

VMS Vitamin / Mineral

Source

Indication

Efficacy

Vitamin A Retinol Men: 3 000 IU Women: 2 700 IU

Liver, fortified Milk (Retinol form – see below for Carotene sources.)

Eyes ( Night Vision), Skin, Hair, Bones, Teeth, Immune System, Liver, Reproductive Organs, Pregnancy & Lactation

Deficiency: Night blindness; reduced Assists body in hair growth in children; loss of apetite; ridding environmental dry, rough skin; lowered resistance to pollutants infection; dry eyes.

Overdose: Headaches; blurred vision; fatigue; diarrhea; irregular periods; joint and bone pain; dry, cracked skin; rashes; loss of hair; vomiting, liver damage

Beta Carotene (Pro-Vitamin A) (See Vitamin A)

Alfalfa sprouts, Avocado, Bannana, Bee pollen, Brocolli, Cayenne pepper, Carrots Yellow orange fruit, Garlic, Squash, Broccoli, Green & Yellow Vegetables

Antioxidant. Converted to Vitamin A in the body. (See Vitamin A)

The antioxidant properties of this nutrient may be a factor in reducing the risk of certain forms of cancer.

Vitamin D Men: 100 IU Women: 100 IU

Egg Yolk, Milk, Exposure to sun enables body to make its own Vitamin D., Cod liver Oil, Salmon, seeds, lemongrass, dandelion root, alfalfa sprouts, avocado, garlic, greens leafy

Teeth & Bones - Immunity - Enhances calcium & phosphorus absorption - Regulates mineral absorption Stabilizes nervous system & heart Normal blood clotting

Deficiency: Rickets in children; bone softening in adults; osteoporosis Overdose: Calcium deposits in organs; fragile bones; renal and cardiovascular damage.

Vitamin E Men: 9-10 mg Women: 6-7 mg

Corn or Cottonseed Oil, Butter, Brown Rice, Soybean Oil, Vegetable oils such as Corn, Cottonseed or Soybean, Nuts Wheat Germ.

Antioxidant. Helps form red blood cells, muscles and other tissues. Preserves fatty acids. - Reproduction - Lacation RBC protection - Wounds - Prevention blood clots

Deficiency: Rare, seen primarily in premature or low birth weight babies or children who do not absorb fat properly.

Causes nerve abnormalities.

Overdose: Unknown.

Vitamin K None established.

Estimated at 0.03 mcg/kg

Green Vegetables, Liver, also made by intestinal bacteria.

Needed for normal blood clotting.

Deficiency: Defective blood coagulation.

Overdose: Jaundice in infants.

Thiamine Vitamin B1 Men: 0.8 – 1.3 mg Women: 0.8 mg

Sunflower Seeds, Pork, whole and enriched Grains, dried Beans., kelp, dates, garlic, parsley, wild rice, watercress, wheatgrass

Carbohydrate metabolism - Muscle coordination. - Proper nerve function.

- VIP consistent growth in children Helps with Stress - Stabilizes appetite by improving digestion and assimilation of nutrients - Fertility & Lactation Provides Energy - Mental attitude , focus & concentration

Deficiency: Anxiety; hysteria; depression; muscle cramps; loss of appetite; in extreme cases beriberi (mostly in alcoholics).Overdose: Unknown, although excess of one B vitamin may cause deficiency of others.

Riboflavin Vitamin B2 Men: 1.3 – 1.6 mg Women: 1.1 mg

Liver, Milk, Spinach, enriched Noodles, Mushrooms., alfalfa sprouts, apple , apricot, avocado, dates, figs, garlic, kelp, parsley, wild rice rosehips, seeds

Needed for metabolism of all foods and Deficiency: Cracks and sores around the the release of energy to cells. Essential mouth and nose; visual problems.

Overdose: See Vitamin B1 to the functioning of Vitamin B6 and Niacin. - RBCs & antibodies - Vision Skin, nails , hair - Stress

Mushrooms, Bran, Tuna, Chicken, Beef, Peanuts, enriched Grains., rice brown, wild , alfalfa, almonds, apricots, chamomile, figs, garlic, nuts

Needed in many enzymes that convert food to energy. Helps maintain a healthy digestive tract and nervous system. In very large doses, lower cholesterol (large doses should only be taken under the advice of a physician)

Deficiency: In extreme cases, pellagra, a disease characterized by dermatitis, diarrhea and mouth sores. Overdose: Hot flashes; ulcers; liver disorders; high blood sugar and uric acid; cardiac arrythmias

Niacin Vitamin B3 Men: 16-23 mg Women: 14-16 mg Niacin is converted to niacinamide in the body.

Pantothenic Acid Vitamin B5 Men: 2.5 mg Women: 2.5 mg

Abundant in animal tissues, whole grain cereals and legumes., alfalfa, almonds, avocado, broccoli, honey faw, oats, oranges, peas, seeds, soybeans, walnuts

Converts food to molecular forms.

Needed to manufacture adrenal hormones and chemicals that regulate nerve function. - Wounds - Adrenals Produced in the body by the beneficial bacteria in the intestines

Deficiency: Unclear in humans.

Overdose: See Vitamin B

Vitamin B6 Pyridoxine Men: 1.8 mg Women: 1.5 m

Animal protein foods, Spinach, Broccoli, Bananas, alfalfa, bell pepper, beets, cantaloupe, greens, lemon, nuts,peas, sprouts, veggies green

Protein metabolism and absorption - Carbohydrate metabolism. - Helps form red blood cells. - Promotes nerve and brain function. - Skin , Teeth, muscles , nerves - Antibodies, RBCs - Balance of Sodium & Phosphorus, Balance of Sodium & Potassium

Deficiency: Anemia, irritability, patches of itchy, scaling skin; convulsions.Overdose: Nerve damage.

Claims

The antioxidant properties of this nutrient may be a factor in reducing the risk of certain forms of cancer

77 Vitamin / Mineral

Source

Indication

Efficacy

Vitamin B12 Cyanocobalamin Men: 2 mcg Women: 2 mcg

Found almost exclusively in animal products, alfalfa, beans, dulse, garlic, Korean, Siberian ginseng, klep, nuts, seeds,

Builds genetic material. Helps form red blood cells. - Growth - Energy - RBC s - Concentration, memory , balance

Deficiency: Pernicious anemia; nerve damage. (Note: Deficiency rare except in strict vegetarians, the elderly or people with malabsorption disorders.)

Overdose: See Vitamin B1.

Biotin 60 mcg

Cheese, Egg, Yolk, Cauliflower, Peanut Butter, alfalfa sprouts, banana , beans, fruits, grains, nuts ,brown rice, seeds, soybeans

Needed for metabolism of glucose and formation of certain fatty acids.

Essential for proper body chemistry.

- Formation RNA & DNA - Food into energy - Prevent exhaustion - Muscle pain - Helps prevent baldness

Deficiency:Seborrhic dermatitis in infants.

Rare in adults, but can be induced by consuming large amounts of egg whites – anorexia, nausea, vomiting, dry scaly skin. Overdose: See Vitamin B1

Folic Acid (Folacin) Men: 180-220 mg Women: 160-190 mg

Green, leafy vegetables, Orange Juice, organ Meats, Sprouts

Essential for the manufacture of genetic material as well as protein metabolism and red blood cell formation - Brain Function - RBCs - Circulation

Deficiency: Impaired cell division; anemia; diarrhea; gastrointestinal upsets.

Overdose: Convulsions in epileptics. May mask pernicious anemia (see Vitamin B12 deficiency).

Adequate amounts of this nutrient in the first stage of pregnancy may reduce the risks of neural tube birth defects.

Vitamin C Ascorbic Acid Men: 40 mg Women: 30 mg

Citrus Fruits, Strawberries, Broccoli, Green Peppers

Antioxidant. Helps bind cells together and strengthens blood vessel walls.

Helps maintain healthy gums. Aids in the absorption of iron. - Collagen, Connective Tissue - Bones, Teeth, - Natural laxative - Formation of adrenalin

Deficiency: Muscle weakness, bleeding gums; easy bruising. In extreme cases, scurvy. Overdose: Loose bowls

The antioxidant properties of this nutrient may be a factor in reducing the risk of certain forms of cancer. May reduce the effects of the common cold.

Calcium Men: 800 – 1000 m Women: 700-800 mg

Milk, Yogurt, Cheese, Sardines, Broccoli, Turnip Greens

Bones & Teeth - Muscle & Nerve Function - Blood Clotting - Activates enzymes needed to convert food to energy

Deficiency: Muscle cramps, Brain function, Rickets in children; osteomalacia (soft bones) and osteoporosis in adults. Overdose: Constipation, Kidney Stones, calcium deposits in body tissues. Hinders absorption of iron and other minerals.

Chromium

Beets, cardamom, cloves, dulse, garlic, kelp, mushrooms, wheatgrass, onions

Glucose to Energy - Metabolism of amino acids ( building blocks of proteins) and fats

Deficiency: Glucose intolerance or insulin resistance hyperglycemia Raised serum lipids & weight changes Overdose: Hinders body’s absorption of calcium.

Liver and other organ Meats, Seafoods, Nuts and Seeds., pomegranates, prunes, green veggies , parslety , peas, raisins, grains, almonds , avocado

Proteins involved in growth - Nerve function - Energy release - Enzymes for Iron metabolism ( ceruplasmin ( ferroxidase I) and ferroxidase II Antioxidant - Regulation of gene expression. Component of several enzymes, including on needed to make skin, hair and other pigments.

Stimulates iron absorption. - Needed to make red blood cells, connective tissue and nerve fibres.

Iron (Elemental) Men: 8-10 mg Women: 8-13 mg

Liver, lean Meats, Kidney beans, enriched Bread, Raisins., alfalfa sprouts, almonds, apricot, asparagus, beets, cherries, dates, figs, grains, grteens, lentils , parsley, peacans, pistachio nuts, seeds, swiss chard, walnut Note: Oxalic acid in spinach hinders iron absorption.

Essential for making hemoglobin, the red substance in blood that carries oxygen to body cells - Most iron is stored in bone marrow that makes blood cells - If there is not enough in the body , it goes to the bone marrow reserves. If this iron stored in the bone marrow is low, RBCs don’t form properly, they are smaller than usual (microcytosis) and fewer

Deficiency: Skin pallor; weakness; fatigue; headaches; shortness of breath, difficulty concentrating, brittle nails, cracked lips Overdose: Constipation Type II diabetes ( J of A Medical Assn) Toxic buildup in liver and in rare instances the heart

Magnesium Men: 230 – 250 mg Women: 200 – 210 mg

Spinach, Beef Greens, Broccoli, Tofu, Popcorn, Cashews, Wheat Bran,

Activates enzymes needed to release energy in body. Needed by cells for genetic material and bone growth. Low calcium - Low serum potassium - Retention of sodium - Low circulating levels of parathyroid hormone Muscular tremors, spasms - Loss of appetite, nausea, vomiting, personality changes - Alkalinity - Lung & Brain Function - Aids digestion

Nausea, irritability, muscle weakness; twitching; cramps, cardiac arrhythmias.

Overdose: Nausea, vomiting, low blood pressure, nervous system disorders.

Warning: Overdose can be fatal to people with kidney disease.

Manganese 2-5 mg

Tea, whole Grains and Cereal products are the richest dietary sources. Adequate amounts are found in Fruits and Vegetables. coconut, dates, figs, beets, avocado, honey raw,

Antioxidant. Interacts with Vitamin E to prevent breakdown of fats and body chemicals -

Deficiency: Impaired growth, Antioxidant reproduction, skeletal system, glucose tolerance, altered carbohydrate and lipid metabolism Overdose: Caution may be toxic at high doses Generally results from inhalation of manganese containing dust or fumes, not dietary ingestion.

Acid neutralizer - Proper fx of muscles and nerves - Prevents clotting Enhances digestion

Deficiency: Maybe related to low blood pressure Overdose: May elevate blood pressure

Copper 2-3 mg

Sodium

Claims

Deficiency: Anemia that is unresponsive to iron therapy but corrected by copper - Low WBC’s thus lower immunity Rare in adults. Infants may develop a type of anemia marked by abnormal development of bones, nerve tissue and lungs. Overdose: Liver disease; vomiting; diarrhea

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 91 79007 or customerservice@brandshapers.ie

WINTER AILMENTS

79

WINTER AILMENTS Many people feel tired and sluggish during winter. This is due to the lack of sunlight, which disrupts sleep and waking cycles.

Most will suffer from colds, coughs and sore throats and may even contract the winter flu.

Unfortunately, it’s not always possible to prevent these common winter ailments from crossing our path.

The common cold Colds are 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.

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 people 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:

Iron - a lack of iron can make us sluggish.

Boosting iron intake can increase 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 colds.

• Those with a long-term medical condition such as diabetes, heart or lung disease

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.

• People whose immune system is impaired due to disease or treatment

Who? Anyone – the young and elderly are more susceptible to winter illness.

• People with Down Syndrome

What are the symptoms? Cold, congestion, sore throat and cough.

• People aged 65 and over

• People 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 • People with regular close contact with poultry, water fowl or pigs • Cancer patients

Coughs

Winter wellness supplements

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

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.

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 combinations 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.

Dec 2018/ Jan 2019 Week 1

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 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 S 2 9 16 23 S 3 10 17 24

4 Friday

January 2019

5 Saturday

6 Sunday

January 2019 Week 2

7 Monday

8 Tuesday

9 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

10 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 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 S 2 9 16 23 S 3 10 17 24

11 Friday

January 2019

12 Saturday

13 Sunday

January 2019 Week 3

14 Monday

15 Tuesday

16 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

17 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 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 S 2 9 16 23 S 3 10 17 24

18 Friday

January 2019

19 Saturday

20 Sunday

January 2019 Week 4

21 Monday

22 Tuesday

23 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

24 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 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 S 2 9 16 23 S 3 10 17 24

25 Friday

January 2019

26 Saturday

27 Sunday

January 2019 Week 5

28 Monday

29 Tuesday

30 Wednesday

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

31 Thursday

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

March 2019 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 31

1 Friday

Jan/ February 2019

2 Saturday

3 Sunday

February 2019 Week 6

4 Monday

5 Tuesday

6 Wednesday

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 Thursday

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

March 2019 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 31

8 Friday

February 2019

9 Saturday

10 Sunday

February 2019 Week 7

11 Monday

12 Tuesday

13 Wednesday

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 Thursday

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

March 2019 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 31

15 Friday

February 2019

16 Saturday

17 Sunday

February 2019 Week 8

18 Monday

19 Tuesday

20 Wednesday

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 Thursday

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

March 2019 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 31

22 Friday

February 2019

23 Saturday

24 Sunday

February 2019 Week 9

25 Monday

26 Tuesday

27 Wednesday

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

March 2019 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 31

28 Thursday

April 2019 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

1 Friday

Feb/ March 2019

2 Saturday

3 Sunday

March 2019 Week 10

4 Monday

5 Tuesday

6 Wednesday

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

7 Thursday

March 2019 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 31

April 2019 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

8 Friday

March 2019

9 Saturday

10 Sunday

March 2019 Week 11

11 Monday

12 Tuesday

13 Wednesday

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

March 2019 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 31

14 Thursday

April 2019 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

15 Friday

March 2019

16 Saturday

17 Sunday

March 2019 Week 12

18 Monday

19 Tuesday

20 Wednesday

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

March 2019 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 31

21 Thursday

April 2019 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

22 Friday

March 2019

23 Saturday

24 Sunday

March 2019 Week 13

25 Monday

26 Tuesday

27 Wednesday

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

March 2019 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 31

28 Thursday

April 2019 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

29 Friday

March 2019

30 Saturday

31 Sunday

April 2019 Week 14

1 Monday

2 Tuesday

3 Wednesday

March 2019 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 31

4 Thursday

April 2019 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

May 2019 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

5 Friday

April 2019

6 Saturday

7 Sunday

April 2019 Week 15

8 Monday

9 Tuesday

10 Wednesday

March 2019 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 31

April 2019 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

11 Thursday

May 2019 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

12 Friday

April 2019

13 Saturday

14 Sunday

April 2019 Week 16

15 Monday

16 Tuesday

17 Wednesday

March 2019 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 31

April 2019 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

18 Thursday

May 2019 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

19 Friday

April 2019

20 Saturday

21 Sunday

April 2019 Week 17

22 Monday

23 Tuesday

24 Wednesday

March 2019 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 31

April 2019 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

25 Thursday

May 2019 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

26 Friday

April 2019

27 Saturday

28 Sunday

April/ May 2019 Week 18

29 Monday

30 Tuesday

1 Wednesday

April 2019 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

2 Thursday

May 2019 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

June 2019 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

May 2019

4 Saturday

5 Sunday

May 2019 Week 19

6 Monday

7 Tuesday

8 Wednesday

April 2019 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

9 Thursday

May 2019 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

June 2019 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

May 2019

11 Saturday

12 Sunday

May 2019 Week 20

13 Monday

14 Tuesday

15 Wednesday

April 2019 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

May 2019 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

16 Thursday

June 2019 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

May 2019

18 Saturday

19 Sunday

May 2019 Week 21

20 Monday

21 Tuesday

22 Wednesday

April 2019 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

May 2019 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

23 Thursday

June 2019 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

May 2019

25 Saturday

26 Sunday

May 2019 Week 22

27 Monday

28 Tuesday

29 Wednesday

May 2019 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

June 2019 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

30 Thursday

July 2019 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

31 Friday

May/ June 2019

1 Saturday

2 Sunday

June 2019 Week 23

3 Monday

4 Tuesday

5 Wednesday

May 2019 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

June 2019 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

July 2019 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

June 2019

8 Saturday

9 Sunday

June 2019 Week 24

10 Monday

11 Tuesday

12 Wednesday

May 2019 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

June 2019 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

July 2019 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

June 2019

15 Saturday

16 Sunday

June 2019 Week 25

17 Monday

18 Tuesday

19 Wednesday

May 2019 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

June 2019 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

July 2019 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

June 2019

22 Saturday

23 Sunday

June 2019 Week 26

24 Monday

25 Tuesday

26 Wednesday

May 2019 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

June 2019 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

July 2019 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

June 2019

29 Saturday

30 Sunday

July 2019 Week 27

1 Monday

2 Tuesday

3 Wednesday

June 2019 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

July 2019 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

August 2019 M 5 12 19 26 T 6 13 20 27 W 7 14 21 28 T 1 8 15 22 29 F 2 9 16 23 30 S 3 10 17 24 31 S 4 11 18 25

5 Friday

July 2019

6 Saturday

7 Sunday

July 2019 Week 28

8 Monday

9 Tuesday

10 Wednesday

June 2019 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

July 2019 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

August 2019 M 5 12 19 26 T 6 13 20 27 W 7 14 21 28 T 1 8 15 22 29 F 2 9 16 23 30 S 3 10 17 24 31 S 4 11 18 25

12 Friday

July 2019

13 Saturday

14 Sunday

July 2019 Week 29

15 Monday

16 Tuesday

17 Wednesday

June 2019 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

July 2019 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

August 2019 M 5 12 19 26 T 6 13 20 27 W 7 14 21 28 T 1 8 15 22 29 F 2 9 16 23 30 S 3 10 17 24 31 S 4 11 18 25

19 Friday

July 2019

20 Saturday

21 Sunday

July 2019 Week 30

22 Monday

23 Tuesday

24 Wednesday

June 2019 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

July 2019 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

August 2019 M 5 12 19 26 T 6 13 20 27 W 7 14 21 28 T 1 8 15 22 29 F 2 9 16 23 30 S 3 10 17 24 31 S 4 11 18 25

26 Friday

July 2019

27 Saturday

28 Sunday

July 2019 Week 31

29 Monday

30 Tuesday

31 Wednesday

July 2019 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

August 2019 M 5 12 19 26 T 6 13 20 27 W 7 14 21 28 T 1 8 15 22 29 F 2 9 16 23 30 S 3 10 17 24 31 S 4 11 18 25

September 2019 2 9 16 23 30 M 3 10 17 24 T 4 11 18 25 W 5 12 19 26 T 6 13 20 27 F 7 14 21 28 S S 1 8 15 22 29

2 Friday

August 2019

3 Saturday

4 Sunday

August 2019 Week 32

5 Monday

6 Tuesday

7 Wednesday

July 2019 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

August 2019 M 5 12 19 26 T 6 13 20 27 W 7 14 21 28 T 1 8 15 22 29 F 2 9 16 23 30 S 3 10 17 24 31 S 4 11 18 25

September 2019 2 9 16 23 30 M 3 10 17 24 T 4 11 18 25 W 5 12 19 26 T 6 13 20 27 F 7 14 21 28 S S 1 8 15 22 29

9 Friday

August 2019

10 Saturday

11 Sunday

August 2019 Week 33

12 Monday

13 Tuesday

14 Wednesday

July 2019 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

August 2019 M 5 12 19 26 T 6 13 20 27 W 7 14 21 28 T 1 8 15 22 29 F 2 9 16 23 30 S 3 10 17 24 31 S 4 11 18 25

15 Thursday

September 2019 2 9 16 23 30 M 3 10 17 24 T 4 11 18 25 W 5 12 19 26 T 6 13 20 27 F 7 14 21 28 S S 1 8 15 22 29

16 Friday

August 2019

17 Saturday

18 Sunday

August 2019 Week 34

19 Monday

20 Tuesday

21 Wednesday

July 2019 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

August 2019 M 5 12 19 26 T 6 13 20 27 W 7 14 21 28 T 1 8 15 22 29 F 2 9 16 23 30 S 3 10 17 24 31 S 4 11 18 25

22 Thursday

September 2019 2 9 16 23 30 M 3 10 17 24 T 4 11 18 25 W 5 12 19 26 T 6 13 20 27 F 7 14 21 28 S S 1 8 15 22 29

23 Friday

August 2019

24 Saturday

25 Sunday

August 2019 Week 35

26 Monday

27 Tuesday

28 Wednesday

August 2019 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 31 S 4 11 18 25

September 2019 2 9 16 23 30 M 3 10 17 24 T 4 11 18 25 W 5 12 19 26 T 6 13 20 27 F 7 14 21 28 S S 1 8 15 22 29

29 Thursday

October 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

Aug/ September 2019

31 Saturday

1 Sunday

September 2019 Week 36

2 Monday

3 Tuesday

4 Wednesday

August 2019 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 31 S 4 11 18 25

5 Thursday

September 2019 2 9 16 23 30 M 3 10 17 24 T 4 11 18 25 W 5 12 19 26 T 6 13 20 27 F 7 14 21 28 S S 1 8 15 22 29

October 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

6 Friday

September 2019

7 Saturday

8 Sunday

September 2019 Week 37

9 Monday

10 Tuesday

11 Wednesday

August 2019 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 31 S 4 11 18 25

September 2019 2 9 16 23 30 M 3 10 17 24 T 4 11 18 25 W 5 12 19 26 T 6 13 20 27 F 7 14 21 28 S S 1 8 15 22 29

12 Thursday

October 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

13 Friday

September 2019

14 Saturday

15 Sunday

September 2019 Week 38

16 Monday

17 Tuesday

18 Wednesday

August 2019 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 31 S 4 11 18 25

September 2019 2 9 16 23 30 M 3 10 17 24 T 4 11 18 25 W 5 12 19 26 T 6 13 20 27 F 7 14 21 28 S S 1 8 15 22 29

19 Thursday

October 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

20 Friday

September 2019

21 Saturday

22 Sunday

September 2019 Week 39

23 Monday

24 Tuesday

25 Wednesday

August 2019 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 31 S 4 11 18 25

September 2019 2 9 16 23 30 M 3 10 17 24 T 4 11 18 25 W 5 12 19 26 T 6 13 20 27 F 7 14 21 28 S S 1 8 15 22 29

26 Thursday

October 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

27 Friday

September 2019

28 Saturday

29 Sunday

Sept/ October 2019 Week 40

30 Monday

1 Tuesday

2 Wednesday

September 2019 M 2 9 16 23 30 3 10 17 24 T 4 11 18 25 W 5 12 19 26 T 6 13 20 27 F 7 14 21 28 S S 1 8 15 22 29

3 Thursday

October 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

November 2019 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

4 Friday

October 2019

5 Saturday

6 Sunday

October 2019 Week 41

7 Monday

8 Tuesday

9 Wednesday

September 2019 M 2 9 16 23 30 3 10 17 24 T 4 11 18 25 W 5 12 19 26 T 6 13 20 27 F 7 14 21 28 S S 1 8 15 22 29

10 Thursday

October 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

November 2019 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

11 Friday

October 2019

12 Saturday

13 Sunday

October 2019 Week 42

14 Monday

15 Tuesday

16 Wednesday

September 2019 M 2 9 16 23 30 3 10 17 24 T 4 11 18 25 W 5 12 19 26 T 6 13 20 27 F 7 14 21 28 S S 1 8 15 22 29

17 Thursday

October 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

November 2019 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

18 Friday

October 2019

19 Saturday

20 Sunday

October 2019 Week 43

21 Monday

22 Tuesday

23 Wednesday

September 2019 M 2 9 16 23 30 3 10 17 24 T 4 11 18 25 W 5 12 19 26 T 6 13 20 27 F 7 14 21 28 S S 1 8 15 22 29

24 Thursday

October 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

November 2019 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

25 Friday

October 2019

26 Saturday

27 Sunday

October 2019 Week 44

28 Monday

29 Tuesday

30 Wednesday

October 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

November 2019 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

31 Thursday

December 2019 2 9 16 23 30 M 3 10 17 24 31 T 4 11 18 25 W 5 12 19 26 T 6 13 20 27 F 7 14 21 28 S S 1 8 15 22 29

1 Friday

Oct/ November 2019

2 Saturday

3 Sunday

November 2019 Week 45

4 Monday

5 Tuesday

6 Wednesday

October 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 Thursday

November 2019 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

December 2019 2 9 16 23 30 M 3 10 17 24 31 T 4 11 18 25 W 5 12 19 26 T 6 13 20 27 F 7 14 21 28 S S 1 8 15 22 29

8 Friday

November 2019

9 Saturday

10 Sunday

November 2019 Week 46

11 Monday

12 Tuesday

13 Wednesday

October 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

November 2019 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

14 Thursday

December 2019 2 9 16 23 30 M 3 10 17 24 31 T 4 11 18 25 W 5 12 19 26 T 6 13 20 27 F 7 14 21 28 S S 1 8 15 22 29

15 Friday

November 2019

16 Saturday

17 Sunday

November 2019 Week 47

18 Monday

19 Tuesday

20 Wednesday

October 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

November 2019 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

December 2019 2 9 16 23 30 M 3 10 17 24 31 T 4 11 18 25 W 5 12 19 26 T 6 13 20 27 F 7 14 21 28 S S 1 8 15 22 29

22 Friday

November 2019

23 Saturday

24 Sunday

November 2019 Week 48

25 Monday

26 Tuesday

27 Wednesday

November 2019 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

December 2019 2 9 16 23 30 M 3 10 17 24 31 T 4 11 18 25 W 5 12 19 26 T 6 13 20 27 F 7 14 21 28 S S 1 8 15 22 29

28 Thursday

January 2020 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

29 Friday

Nov/ December 2019

30 Saturday

1 Sunday

December 2019 Week 49

2 Monday

3 Tuesday

4 Wednesday

November 2019 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

December 2019 2 9 16 23 30 M 3 10 17 24 31 T 4 11 18 25 W 5 12 19 26 T 6 13 20 27 F 7 14 21 28 S S 1 8 15 22 29

January 2020 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

December 2019

7 Saturday

8 Sunday

December 2019 Week 50

9 Monday

10 Tuesday

11 Wednesday

November 2019 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

December 2019 2 9 16 23 30 M 3 10 17 24 31 T 4 11 18 25 W 5 12 19 26 T 6 13 20 27 F 7 14 21 28 S S 1 8 15 22 29

12 Thursday

January 2020 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

December 2019

14 Saturday

15 Sunday

December 2019 Week 51

16 Monday

17 Tuesday

18 Wednesday

November 2019 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

December 2019 2 9 16 23 30 M 3 10 17 24 31 T 4 11 18 25 W 5 12 19 26 T 6 13 20 27 F 7 14 21 28 S S 1 8 15 22 29

19 Thursday

January 2020 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

December 2019

21 Saturday

22 Sunday

December 2019 Week 52

23 Monday

24 Tuesday

25 Wednesday

November 2019 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

December 2019 2 9 16 23 30 M 3 10 17 24 31 T 4 11 18 25 W 5 12 19 26 T 6 13 20 27 F 7 14 21 28 S S 1 8 15 22 29

26 Thursday

January 2020 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

December 2019

28 Saturday

29 Sunday

Dec 2019/ Jan 2020 Week 53

30 Monday

31 Tuesday

1 Wednesday

December 2019 M 2 9 16 23 30 3 10 17 24 31 T 4 11 18 25 W 5 12 19 26 T 6 13 20 27 F 7 14 21 28 S S 1 8 15 22 29

2 Thursday

January 2020 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

February 2020 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

3 Friday

January 2020

4 Saturday

5 Sunday

186

COMPANY LISTINGS

Aptamil

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

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 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 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

Aptamil Pepti-Junior* For the dietary management of malabsorption and multiple food intolerances. GMS Listed

Bayer Ltd Consumer Health

The Atrium, Blackthorn Road, Sandyford, Dublin 18 Type of company: Life Science Website: www.bayer.ie Tel: 01 2999313 Bayer is a Life Sciences company with a presence in Ireland for over 50 years.

Through our innovative products in the areas of pharmaceuticals; consumer health; crop science and animal health, we contribute to finding solutions to some of the major challenges of our time.

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 Consumer Health Products: Aspirin, Alka-Seltzer, Bepanthen, Bepantiseptic, Berocca, Canesten, Canespro, Canestest, Canesbalance, Clarityn, Cystopurin, Diprobase, Kwells, Losec Control, Redoxon, Rennie, Scheriproct Suppositries & Ointment, UItraproct Ointment, Skineron Gel 15’s and Travacort Cream Local contacts: Commercial Lead: Hayley Claassen,

Pharmacy Channel Manager: Patricia Lawrence Animal Health Products: Advantage, Advantix, Advocate, Bayticol, Baytril, Baytril Max, Baycox Multi, Byemite, Drontal Plus Flavours, Drontal Cat, Profender, Veraflox, Seresto Local contacts: Veterinary Business Managers: Carol Griffin RVN and Melanie O’Donoghue RVN

Tel: +44 (0) 1953 607856 Fax: +44 (0) 1953 713649 For medical enquiries please call +44 (0)1908 363434 or email medinfo@cambridgehealthcare.co.uk Product Portfolio: Anabact, Effercitrate Tablets, GoldenEye, Pylobactell, Xepin

Clonmel Healthcare Ltd

Brandshapers Ltd

Ballytramon Business Park, Ardcavan, Castlebridge, Co Wexford Y35 Y19A Type of company: Wholesale Distribution Website: www.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

Tel: +353 53 9179007

Order Line: 1800 26 26 26

Fax Number: +353 53 9159494

Services: Distributors of Medicines and OTC Products direct to Pharmacies, Hospitals and via Wholesalers

Help Line Number: +353 53 9179007 Order Line: +353 53 9179007 Products: IsaDora, Real Techniques, Seven Seas, Sculpted, TanTastic, Beverly Hills Formula, Just for Men, Vagisil, Bull Dog, Happy Skin, Old Spice, LifeLine Hangover Defence, Human + Kind, Profusion, Nakd, Trek.

Local Contacts: Liam Dooley, Commercial Manager, liamdooley@brandshapers.ie Jenni Fenlon, Brand Manager jennifenlon@brandshapers.ie customerservice@ brandshapers.ie

Cambridge Healthcare Supplies Limited

Unit 1 Chestnut Drive, Wymondham, Norfolk NR18 9SB UK

Ethical: 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; Nepramel; Nytamel; Olanzapine; Olanzapine ODT; Olmesartan; Olmesartan

COMPANY LISTINGS

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: 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.

Cosmetic Alliance

nail care, hand and body wash, nail polish, self-tanning products, gloves, anti-bacterial products, ear-piercing system.

Local Contacts: Pat O’Mahony (Director) 061 496685 Paul O’Neill (Sales Director ) 0877002543

Cow and gate

Block 1, Deansgrange Business Park, Deansgrange, Co. Dublin, Ireland.

Type of company: Infant Nutrition Website: Website for parents: www.candgbabyclub.ie Website for Health Care Professionals: www.cowandgatehcp.ie Help Line Number: 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 & Gate – First Milk (from birth to 12 months) Cow & Gate – Hungrier Milk (for hungrier infants) Cow & Gate 2 - Follow on Milk (from 6 months+) Cow & Gate 3 – Growing up Milk 1yr+ (from 1 year+) Cow & Gate 4 - Growing up Milk 2yr+ (from 2 year+)

Unit 4B, Corcanree Business Park, Dock Road, Co. Limerick V94X070 Type of company: Cosmetic Distribution Website: www.ca.ie Tel: 061 496685 Products: Cosmetics, skincare, fragrance, haircare,

Specials Range: Cow &Gate Comfort* (from birth) - for the dietary management of colic and constipation Cow & 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

Preterm Range: Cow & Gate nutriprem human milk 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 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

Creative Distribution Ltd

Unit 4D, Avonbeg Industrial Estate, The Long Mile Road, Dublin 12 Ireland Sales & Distribution Services CBD Brands / Products Website: www.cd.ie Tel: 00 353 1450 4642 Fax: 00 353 1456 4990 Help Line Number: 00 353 1450 4642 Order Line: 00 353 1450 4642 Products: Fully Approved / Legal CBD Food Supplements & Skin Care Products EXCLUSIVELY available across the Irish market from major international brands, including Canabidol, Love CBD, CBDOne, Natra CBD, Reverse Nature CBD, CARUN, Pharma Hemp, Advance Biotech and CannibiGold.

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Product Portfolio • Oils / Tinctures • Oral Spray • Gel Tabs • Creams / Balms • Confectionery Charlie McKenna Head of Sales & New Business Development Mobile No: 087 395 3104 Office No: 01 450 4642 E-Mail: charlie@cd.ie Kevin Crothers Sales Office Manager Office No: 01 450 4642 E-Mail: kevin@cd.ie

Fitzgerald Power, Chartered Accountants & Business Advisors

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

Flexiseq

Leverton House, 13 Bedford Square, London WC1B 3RA, United Kingdom

188

COMPANY LISTINGS

Email: info@ascension.co.uk Tel: +44 (0) 20 7291 5400

Nova Laboratories Ltd.

Pamex

Pharmaceutical Manufacturer and Distributor of Ethical and OTC Products

Website: www.flexiseq.com Flexiseq is a topical drug-free gel for lubricating the cartilage in joints to relieve pain and stiffness, and improve joint function associated with all stages of osteoarthritis.

KBC Bank Ireland plc

The Bank of You and Your Business Hub We are not a traditional bank.

If you’ve been into one of our Hubs, you’ll know why. It’s set up differently – no counters, just comfy seats and booths.

You can charge your phone while sipping a decent cup of free coffee. You can check your emails with our free Wi-Fi. Focused on your business, we know it’s not always easy to get to the bank in normal working hours. So our Hubs open late and on Saturday mornings to make it easier for you.

Martin House, Gloucester Crescent, Wigston, Leicester LE18 4YL Type of company: Full Line Specials Manufacturer 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 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

Your Business Partner will be available at the end of a mobile or email and keen to help. They will even come out to your office or meet you anywhere that suits you.

Tel: +44 (0) 116 223 0100

Your KBC Business Support team contact details

Order Line: freephone number 0800 975 4840

Tel: 1 800 804 414 Tel: +353 1 664 6180 Business Support Team: 1 800 804 414 +353 1 664 6180 Business Internet Banking Support: 1 800 804 414 +353 1 664 6180 24 hour debit & credit card lost/stolen: 1800 93 62 87

Help Line: (Customer Care Pharmacist) freephone number 0800 975 4840

Moneen Business Park, Castlebar, Co. Mayo 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.

Pinewood Healthcare

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

Web: www.pinewood.ie

Unit 1, M50 Business Park, Ballymount, Dublin 12, Ireland Accounts, Manufacturing and Marketing: Ballymacarbry, Clonmel, Co Tipperary, Ireland Tel: 00353 1 456 9123 (Dublin) 00353 52 61 86000 (Clonmel) Fax: 00353 1 456 9125 (Dublin) 00353 52 61 36311 (Clonmel) Email: customerservicem50@ pinewood.ie

Products: Ethical: Alendronic Acid, Amlodipine, Anastrozole, Aripiprazole, Atorvastatin, Bisopine, Calcium Acetate, Caprin, Cetirizine, Chlorpromazine, Clopidogrel, Co-Danthramer, Citric Acid, Citalopram, Clarithromycin, Co-Tipol Suppositories, Donepezil, Dalmapam, Diflazole, Entacapone, Escitalopram, Flucillin, Grepid, Imatinib, Kopen, Lansoprazole, Levetiracetam, Levothyroxine, Losartan, Metformin, Minosil, Mirtazapine, Memantine, Mobiglan, Nexazole, Olanzapine, Omeprazole, Ondran, Paroser, Pantoprazole, Pinadone, Pinamox, Pregabalin, Pravat, Primacine, Prozit, Ramic, Risedronate, Rosuvastatin, Sereflo Inhaler, Sertraline, Simvastatin, Tipol Suppositories, Tramapine, Venlablue XL, Zileze, Olanzapine Orodispersible.

OTC Confined: Acidex, Aqueous Cream, Calamine Lotion, Cetirizine, Chlorhexidine, Codinex, Cortopin, Dispensing Bottles, Emulsifying Ointment, Fenopine Suspension, Flamozil woundspray, Glycerine Honey & Lemon, Glycerine Suppositories, Laxose, Micolette, Paratabs, Parapaed Junior, Parapaed Six Plus, Pholcodex, Silcocks Base, Surgical Spirits, Tantum Verde Lozenges, Tefin Suppositories, Tipol Granules, Tipol Suppositories, Viscolex.

Devices: Early Bird Pregnancy Test Kits & Ovulation Kit, Salbutamol CFC-Free Inhaler, Vera Temp Thermometer, Distribution: Direct to Pharmacies, Hospital Pharmacies and via Wholesalers Management: Mr Fergal Murphy: Company Director Mr Jurgen Wegner 087 741 1411 Hospital Business Manager

COMPANY LISTINGS

Mr Jeffrey Walsh 087 669 4043 Commercial Development Manager

Rowex Ltd

Mr Peadar Flynn: 087 259 4129 Pharmacy Business Manager Mr Michael O’Halloran 087 117 9979 Pharmacy Business Manager Mr Michael Comerford 087 226 6899 Biosimilar Key Account Manager Pharmacy Sales Representatives: Mr Pat Ahern 087 131 6663 South Mr David Brannigan East Mr Ciaran Clarke 087 770 0086 Dublin / North East Mr Danny Lynskey 087 251 3239 Mid-West Ms Aoife McDonnell 087 624 0817 Dublin / East Mr Tom O’ Brien 087 255 9950 South Hospital Representative Ms Katie Tobin 087 991 4404

RB Ireland

Unit 7, Riverwalk, Citywest Business Campus, Dublin 24 Type of company: Consumer Health 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

Newtown, Bantry, Co Cork.

Type of company: Pharmaceutical Marketing of Ethical Medicines and OTC Products Website: www.rowex.ie Tel: 00 353 27 50077 Fax: 00 353 27 50417 Freephone: 1800 304 400 Order Line: 1800 304 400 Products: ETHICAL - 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

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Rowex, Macrolief, Metidate XL, Metformin Aurobindo, Pregabalin Sandoz, Telmisartan HCT, Vertigon

Floor 1, Wing A, Building 1 Finnabair Business & Technology Park, Dundalk, Co. Louth, Ireland.

OTC: 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

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

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

The Nature’s Bounty Co. Ltd.

Aldbury, Tring, Herts, HP23 5PT United Kingdom Tel: +44 (0) 1442 890 355 Working hours (9:00 am – 5:30 pm) Email: info@naturesbounty.co.uk

United Drug

Sanofi-Aventis Ireland Limited Magna Drive, Magna Business Park, Citywest Road, Dublin 24, D24 XKE5, Ireland.

18 Riverwalk Citywest Business Campus Dublin 24 Tel: + 353 (0)1 403 5600

Solvotrin Therapeutics

Tel: +353 1 463 2300 Fax: +353 1 463 2333 E: Reception.UDW@uniteddrug.com Consumer E: Consumer@united-drug.com Distribution E: Distribution@united-drug.com Wholesale E: Wholesale@united-drug.com

United Drug Wholesale (Ballina) Hoffmann Park, Little Island, Cork, Co. Cork Tel: +353 (021) 4510220 Fax: +353 (021) 4510229 Email: info@solvotrin.com Products: Active Iron and Active Iron & B Complex Plus for Men and Women

Teva Pharmaceuticals

Crossmolina Road, Ballina, Mayo, F26 W6R6, Ireland.

Tel: +353 096 72555 Fax: +353 096 72400

190

COMPANY LISTINGS

United Drug Wholesale (Limerick)

Animal Over-Dominant, Animal Timid. Amina Strath – Feed supplement (combination of yeast & herbs).

Avalon: Organic skin and body care. Shampoos, conditioner, moisturiser, shower gels.

Active Edge: Cherry Juice

Johnsgate House, Old Clare Street, Limerick, V94 E3F1, Ireland.

Tel: +353 061 315411 Fax: +353 061 315012

Wholefoods Wholesale

Aromatherapy Oils: Atlantic Aromatics, Absolute Aromas, Ord River Tea Tree, Puressential.

Bach Original Flower Remedies Bioglan: OAD Super Fish Oil, Red Krill, Stat-Guard, Glucosamine SR1500mg, Promensil.

Biomedical: Cardio-K, Cardio-P, and Cardio-T.

Unit 3 Kylemore Ind Estate, Killeen Road, Dublin 10 Tel: 01 626 2315 Fax: 01 626 1233 Email: info@wholefoods.ie Website: www.wholefoods.ie Types of Business: Agents and distributors of Herbal Remedies, Nutritional Supplements, Homeopathic Remedies, Flower Essences, Natural and Organic Bodycare, Manuka Honey, Sports Nutrition, Natural Hair colouring, Aromatherapy Oils, Gluten free and Dietary foods.

Bio-Strath: Herbal Tonic Celtic Wind: CBD Oil Eskimo Oil: Brainsharp Omega, Eskimo Kids and Eskimo Omega 3.

Gluten Free and Dietary Foods: Nanny Goats Milk, Barkat, Eat Natural, Nak’d Bars, Linwood’s, Panda, RJ’s Licorice, Vita Coco.

Healthy Snacking: Meridian Nut Butters, Protein Bars (Quest, Fulfil, Deliciously Ella, Satisfi).

Herbal Teas: Pukka, Tea Pigs, Heath & Heather and Yogi.

Ethical: A.Vogel Herbal: Gingko Biloba, Hypericum Complex, Hypericum Higher Nature: The Saltpipe, Perforatum, Serotone, St John’s Balance for Nerves, Red Sterol, Wort Kids Range, Teens range, Full Vitamin range.

OTC Confined: A.Vogel Herbal: Prostasan.

Hubner: Gastrointestinal Gel, Non-OTC Confined: A.Vogel Herbal Tinctures: Echinacea for the family, Atrosan, Atrogel, Milk Thistle tincture and tablets, Passiflora, Dormeasan, Cough Spray, Ivy Thyme, Venaforce, Sinuforce, Eye Drops, Bronchosan, Digestisan and Menoforce as well as a full range of other herbal remedies.

A.Vogel Veterinary: Jan De Vries Animal Essences – Animal Separation, Animal Emergency, Animal Highly Strung Essence,

Iron Vital Tonic, Silicea Caps – For Hair, Skin & Nails, Silicea Cold Sore Lip Gel and Silicea Beauty Gel. Jason: Personal and body care range.

Jan De Vries Essences: Night, Craving, Concentration, Emergency, Relaxation, Confidence, Mood.

Kinvara: Hyaluronic Youth Boost, Active Rosehip Day Cream, 24Hr Rosehip Face Serum, Omega Rich Hand

& Nail Cream, Elemental Exfoliating Powder, Eye Wow! Eye Serum.

Tea Tree, Montmorency Cherry Juice, Cranberry Concentrate Juice.

Life Boost: Children’s Honey & Lemon Syrup.

Parasol: Suncare range.

Lifestyle Products: Ecover, Lilly’s, The Saltpipe and Natracare (personal hygiene).

LithoLexal® Marine Plant Extract- Bone Health, Joint Health, Bone Care MAG365: Powder based range of magnesium supplements.

Pernaton Green Lipped Mussel Extract: Pernaton Gel, Pernaton Relaxing Bath Therapy, Pernaton Capsules.

Pre-Conceive: Pre-Conceive preconception supplement Probiotic: Optibac.

Phizz: Rehydration + Vitamins and Minerals.

Mother and Babycare: Earth Friendly Baby, Natural Babycare Nappies, Wipes and Bodycare.

Rescue Remedy: Rescue Remedy, Rescue Night, Rescue Plus.

Natural and Organic Bodycare: Jason, Avalon, Faith in Nature, Natura Siberica.

Sambucol Black Elderberry Extract: Sambucol Original, Sambucol Kids, Sambucol Effervescent.

Natural Henna: Surya Brasil

Sea-Band, Hay-Band: SeaBand Child, Sea-Band Adult, Sea-Band Mama.

Naturtint Hair Colours: Permanent, Reflex (Semi Permanent).

Natura Siberica: Hair and body care range.

Nelsons Homeopathic Remedies: Nelsons Teetha Granules and Gel, Nelsons Arnicare, Nelsons Clikpak, topical and formulated remedies.

Nourkrin Hair Supplements: Nourkrin Maintain, Nourkrin Man, Nourkrin Woman, Nourkrin Post Pregnancy, Nourkrin Active, Nourkrin Radiance, Scalp Lotion, Nourkrin Shampoo & Conditioner

Silicolgel: Oral gel containing colloidal silicic acid for the treatment of gastrointestinal disorders and IBS. Spatone Iron Supplement: Spatone Original and Spatone Vit C. Sports Nutrition: Optimum Nutrition, Maximuscle, Plantforce.

Teetha: Teething granules and gel.

Zerochol: Zerochol plant sterol supplement.

Zincuflex: Curcumin and Ginger food supplement.

Nourella: Active skin support supplement, Active skin rejuvenation cream.

Distribution: Direct to Pharmacies and via wholesalers (specific lines).

Nupo: Balanced meal replacement.

Number of Sales Force: 8

Optibac Probiotics: A natural range of probiotic supplements suitable for the whole family.

Optima: Aloe Vera Gel, Gentle Action Colon Cleanse, Aloe Dent Toothpastes and Mouthwash, Joint Complex, Aloe Pura Juices, Allergenics Skincare, Lecithin, Optima Lifestyle Vitamins, Australian

Territory: Ireland – For details of your local representative please contact the Wholefoods office on 01 6262315.

NOTES

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5

2

4

2

Wed

2

6

3

1

5

3

Thurs

3

7

4

2

6

4

Fri

4

8

5

3

7

5

Sat

5

9

6

4

8

6

Sun

6

10

7

5

9

7

Mon

7

11

8

6

10

8

Tues

8

12

9

7

11

9

Wed

9

13

10

8

12

10

Thurs

10

14

11

9

13

11

Fri

11

15

12

10

14

12

Sat

12

16

13

11

15

13

Sun

13

17

14

12

16

14

Mon

14

18

15

13

17

15

Tues

15

19

16

14

18

16

Wed

16

20

17

15

19

17

Thurs

17

21

18

16

20

18

Fri

18

22

19

17

21

19

Sat

19

23

20

18

22

20

Sun

20

24

21

19

23

21

Mon

21

25

22

20

24

22

Tues

22

26

23

21

25

23

Wed

23

27

24

22

26

24

Thurs

24

28

25

23

27

25

Fri

25

29

26

24

28

26

Sat

26

30

27

25

29

27

Sun

27

31

28

26

30

28

Mon

28

29

27

29

Tues

29

30

28

30

Wed

30

29

31

Thurs

31

30

Fri

31

Sat Sun

Bursting with

delicious

energy

*

• 125 mg of CoQ-10 per serving, with vitamin C • Unique to market gelatin-free chewable adult gummies • Delicious on-the-go energy support* • Convenient alternative to pills or capsules • Suitable for vegetarians & vegans

naturesbounty.co.uk For more information contact your Nature’s Bounty® Territory Account Manager or call 0044 1442 890 355 *Vitamin C contributes to normal energy-yielding metabolism. Food supplements should not be used instead of a varied balanced diet and a healthy lifestyle. Nature’s Bounty® is a registered trademark.