PAI Diary 2026

PAI

PHARMACY ASSIST IRELAND 2026

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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CONTENTS

Page 9 Acne Page 11 Adult Cough Page 13 Adult Incontinence Page 15 Age-Related Macular Degeneration Page 17 Athlete’s Foot Page 19 Bacterial Vaginosis Page 21 Blisters Page 23 Bone Health Page 25 Children’s Cough Page 27 Cognitive Function

Page 29 Congestion in Children Page 31 Decongestants Page 33 Digestion in Children Page 35 Dry Eye Disease Page 37 Ectoparasites Page 39 Emergency Contraception Page 41 Erectile Dysfunction Page 43 Fatigue Page 45 Heartburn

Page 53 Iron Deficiency

Page 75 Shaving Care

Page 55 Menopause

Page 77 Sleep Disorders

Page 57 Multivitamins in Children

Page 79 Smoking Cessation

Page 59 Nail Infections

Page 81 Sore Throat

Page 61 Nappy Rash

Page 83 Stress

Page 63 Nutrition in the Elderly

Page 85 Stretch Marks

Page 65 Oral Analgesics Page 67 Oral Health Page 69 Pain

Page 49 Heart Health

Page 71 Pregnancy and Fertility

Page 51 Immunity

Page 73 Sensitive Skin

HOSPITAL PROFESSIONAL NEWS IRELAND THE INDEPENDENT VOICE OF PHARMACY

Ireland’s Dedicated Hospital Professional Publication

Page 87 Thrush Page 89 Topical Analgesics Page 91 Vaginal Dryness Page 93 Warts

PAI

PHARMACY ASSIST IRELAND 2026

WWHAM

3

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.

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 is essential to the success of WWHAM, as the approach relies on several basic communication processes.

These 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.

• 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.

Notes to the counter assistant: 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 this 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.

PUBLISHER IPN Communications Ireland Ltd. Clifton House, Lower Fitzwilliam Street, Dublin 2 - 00353 (01) 6690562 ADVERTISING SALES: Charne Blume +353 (01) 2339121 - charne@ipn.ie or Debbie Graham +353 8727 99317 - debbiegraham@ipn.ie www.pharmacynewsireland.com

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.

6

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 website: .............................................. Pharmacy email address: .....................................................................

Pharmacy Social Media Streams Instagram: ...........................................................................................................................................................................

Facebook: ...........................................................................................................................................................................

Twitter: ................................................................................................................................................................................

LinkedIn: .............................................................................................................................................................................

Pharmacy opening hours Mon-Fri: ..................................... Sat: ..................................... Sun: .....................................

Pharmacy Holiday closures: .................................................... Christmas & New Year: ....................................................

Easter: ................................................................................................................................................................................

Bank Holidays: ....................................................................................................................................................................

Doctor Localities Local Health Centre: ...........................................................................................................................................................

Address: ............................................................................................................................................................................. ............................................................................................................................................................................................

Telephone number: ....................................................... Email: ..........................................................................................

HOSPITAL PROFESSIONAL NEWS IRELAND THE INDEPENDENT VOICE OF PHARMACY

Ireland’s Dedicated Hospital Professional Publication

PAI

PHARMACY ASSIST IRELAND 2026

7 Dentist Localities Local dentist surgery: ..........................................................................................................................................................

Address: ............................................................................................................................................................................. ............................................................................................................................................................................................

Telephone number: ....................................................... Email: ..........................................................................................

Out-of-Hours Localities: ..................................................................................................................................................

Telephone: ...........................................................................................................................................................................

Address: ..............................................................................................................................................................................

Email: ..................................................................................................................................................................................

Locum Contacts 1: .............................................................................................................................................................

2: .............................................................................................................................................................

3: .............................................................................................................................................................

Lead Pharmacist: ................................................................................................................................................................

Pharmacy Manager: ............................................................................................................................................................

Pharmacy Technician: .........................................................................................................................................................

Accredited Checking Technician: ........................................................................................................................................

Dispensing Assistant: ..........................................................................................................................................................

Medicines Counter Assistant: ..............................................................................................................................................

Locum Pharmacist: .............................................................................................................................................................

Other: .................................................................................................................................................................................

HOSPITAL PROFESSIONAL NEWS IRELAND THE INDEPENDENT VOICE OF PHARMACY

Ireland’s Dedicated Hospital Professional Publication

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PHARMACY ASSIST IRELAND 2026

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ACNE

11

ACNE Acne is one of the most common skin conditions encountered in Irish community pharmacies — affecting more than 80% of teenagers and up to 40% of adults. While it’s often associated with adolescence, adult-onset acne is increasingly common, particularly in women. Acne can have a real impact on self-confidence and emotional wellbeing, and pharmacy teams are frequently the first point of contact for customers seeking advice and effective treatment.

By understanding how acne develops and what over-the-counter (OTC) treatments are appropriate, pharmacy assistants can help patients find safe, evidence-based solutions and know when to refer for further support.

UNDERSTANDING ACNE Acne is a chronic inflammatory skin condition affecting the pilosebaceous (oil) glands.

Hormonal changes — particularly during puberty or in adult women around their menstrual cycle — cause increased oil (sebum) production. When excess oil mixes with dead skin cells, pores can become blocked, forming blackheads (open comedones) and whiteheads (closed comedones).

These ingredients are commonly found in cleansers, toners, and leave-on treatments.

Customers should be advised to start slowly (e.g., using every other day) to minimise dryness or irritation.

BENZOYL PEROXIDE – THE GOLD STANDARD IN OTC ACNE CARE Benzoyl peroxide, the active ingredient in Acnecide, is a first-line OTC treatment for mild to moderate acne. It works by reducing acne-causing bacteria on the skin and helping to clear blocked pores, without the risk of antibiotic resistance.

Acnecide is available in 2.5% and 5% strengths and can be used up to twice daily, morning and evening. Customers should apply a thin layer to affected areas after cleansing.  Mild stinging, dryness, or redness may occur initially — reassure customers this is normal and usually settles within a week or two.  Recommend a light, non-comedogenic moisturiser alongside treatment to protect the skin barrier.

Bacteria such as Cutibacterium acnes thrive in this oily environment, leading to inflammation and red, painful spots. Acne most commonly appears on the face, back, chest, and shoulders — areas with the highest concentration of oil glands.

 Some patients find it easier to start on alternate nights to build tolerance.

ASSESSING SEVERITY AND WHEN TO REFER

PRESCRIPTION AND COMPLEMENTARY TREATMENTS

When a customer presents with acne, the first step is to assess its severity.  Mild acne usually consists of small blackheads, whiteheads, and occasional spots with little redness.

Some customers may already be using prescription treatments such as topical retinoids, oral antibiotics, or hormonal therapies. Assistants should be familiar with these options to provide supportive advice and ensure safe product combinations.

 Moderate to severe acne involves widespread inflammation, deeper cysts or nodules, and carries a higher risk of scarring.

 Retinoids (like adapalene) promote skin turnover but can cause dryness or irritation; these can often be used alongside benzoyl peroxide under medical supervision.

Customers with deep, painful spots, visible scarring, or significant emotional distress should always be referred to the pharmacist and possibly onward to their GP. Similarly, pregnant or breastfeeding women should be assessed carefully, as many treatments are not suitable in these cases.

 Hormonal treatments such as the combined oral contraceptive or spironolactone can be helpful in women with hormonal acne.

OTC TREATMENT OPTIONS AND ACTIVE INGREDIENTS For mild to moderate acne, several effective over-the-counter treatments are available.

Understanding the key ingredients helps pharmacy assistants make informed recommendations.

KERATOLYTIC AGENTS Ingredients such as salicylic acid, glycolic acid, and lactic acid help to exfoliate the skin gently and unblock pores.  Salicylic acid (BHA) penetrates into the pores, reducing oil and helping prevent new spots.  Glycolic and lactic acids (AHAs) smooth the skin’s surface and improve overall texture.

Benzoyl peroxide can bleach fabrics, so customers should wash hands thoroughly and avoid contact with towels or pillowcases.

The key message for all acne management is consistency — most treatments take 8–12 weeks to show improvement, and stopping early is one of the main reasons for poor results.

SKINCARE AND SELF-CARE ADVICE Encourage a simple, consistent skincare routine:  Use a gentle, soap-free cleanser twice daily.  Avoid harsh scrubs or over-washing, which can irritate the skin.  Apply a targeted treatment such as Acnecide or another benzoyl peroxide product twice daily.  Follow with a light, oil-free moisturiser to keep the skin balanced.  Always use sun protection during the day — acne treatments can make skin more sensitive to sunlight.

For those on drying treatments (like isotretinoin), recommend bland emollients, lip balms, and fragrance-free products to maintain comfort.

WHEN TO REFER Pharmacy assistants should refer to the pharmacist or GP if:  There are deep nodules or cysts  There are signs of early scarring  Acne causes psychological distress or affects self-esteem  The patient is pregnant, breastfeeding, or has sensitive skin conditions  There is no improvement after 8–12 weeks of consistent OTC treatment

WWHAM Who? Most common in teenagers, but also affects 20–40% of adults.

What are the symptoms? Blackheads, whiteheads, inflamed papules, pustules, and sometimes deeper nodules. Areas usually affected include the face, chest, upper back and shoulders.

How long has it been present? Acne may persist for 5–10 years. Ask about previous treatments tried.

Action already taken? Diet changes, over-the-counter washes, exfoliants, or lifestyle changes.

Medication? Check for topical acids (salicylic, glycolic, lactic), benzoyl peroxide, prescription retinoids, antibiotics, hormonal treatments.

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ADULT COUGH

13

ADULT COUGH Cough is one of the most common reasons adults seek advice in community pharmacy.

Although often harmless, cough can disrupt sleep, affect work, and cause frustration when it lingers. Pharmacy assistants need to recognise the different types of cough, offer evidence-based product advice, and know when referral is essential.

UNDERSTANDING THE ADULT COUGH A cough is a protective reflex designed to clear the airways of mucus, irritants, or foreign particles. In most adults, cough is linked to viral upper respiratory infections, but many other triggers can contribute, including allergies, smoking, environmental pollutants, heartburn, and certain medications.

Adult coughs are generally classified as:  Dry (non-productive) – triggered by irritation or inflammation, producing no phlegm.

Often linked to viral infections, allergies, acid reflux, or some medicines such as ACE inhibitors.  Chesty (productive) – producing mucus or phlegm, commonly associated with infections or smoking.

Advise adults to:  drink plenty of fluids  avoid smoking  use steam inhalation if helpful 2. Mucolytics

decongestants are not suitable for patients with hypertension, hyperthyroidism, diabetes, or heart disease.

NON-MEDICATED OPTIONS  Honey in warm water (not suitable for children under 1 year)

Ingredients such as carbocisteine help break down thick, sticky mucus. These are often suitable for persistent chesty coughs.

 Saline sprays for post-nasal drip

Correct classification helps guide product recommendation and assess whether the patient may need further medical review.

3. Cough Suppressants (for dry coughs)

 Smoking cessation support

Dry cough mixtures often contain:

 Avoiding known irritants

COMMON CAUSES OF COUGH IN ADULTS

 Dextromethorphan

 Acute (lasts <3 weeks), sub-acute (3–8 weeks), or chronic (8+ weeks).

 Viral colds and flu  Post-viral cough, which can last weeks after infection

 Pholcodine (withdrawn in some markets; check current availability)  Codeine-containing suppressants (pharmacist-only; used with caution)

 Gastro-oesophageal reflux (GORD)

These help reduce the cough reflex and may be useful at night to improve sleep. They should not be used in productive coughs.

Some formulations are sedating.

 Post-nasal drip

4. Soothing agents

 Smoking or vaping

Honey & lemon syrups, glycerine-based products, and demulcent lozenges can be effective for mild throat irritation.

 Allergic rhinitis or hay fever

 Environmental triggers such as dust or pollution  Medication-related cough, especially ACE inhibitors

 Humidifiers

WHEN TO REFER Pharmacy assistants should refer to the pharmacist if the patient has:  a cough lasting more than 3 weeks  fever, breathlessness, chest pain, wheezing  coughing up blood  unintentional weight loss  recurrent night-time cough (possible asthma)  history of heart or lung disease

5. Products combining decongestants

 suspected pneumonia

Combination products may relieve cough linked to nasal congestion. However,

 sudden onset cough in someone taking ACE inhibitors

 Asthma or COPD (requires referral)

TREATMENT OPTIONS AVAILABLE OTC In Ireland, adult cough products are widely available, but correct selection depends on the nature of the cough and the patient’s medical history.

WWHAM Who? Adults of any age—check for pregnancy, chronic illness, smoking status.

What are the symptoms? Dry, chesty, phlegm colour, breathlessness, fever.

How long have they had symptoms? Acute (<3 weeks) vs persistent.

1. Expectorants (for chesty coughs)

Action already taken? Home remedies, previous medicines, hydration.

Expectorants such as guaifenesin help thin mucus, making phlegm easier to clear. These are most appropriate when the cough is productive.

Medication? Check for ACE inhibitors, decongestant cautions, sedating suppressants.

ADULT INCONTINENCE

15

ADULT INCONTINENCE Adult incontinence is a common yet often misunderstood condition that affects millions of individuals across all age groups, with prevalence increasing significantly in older adults. For many customers, seeking assistance for incontinence can be a sensitive and emotionally charged experience.

As a pharmacy assistant, your ability to respond with professionalism, empathy, and product knowledge is essential to delivering high-quality care. This article provides a foundational overview of adult incontinence and outlines practical approaches for supporting customers effectively in the pharmacy setting.

Adult incontinence refers to the involuntary loss of urine (urinary incontinence) or stool (faecal incontinence). While often associated with ageing, it can also occur due to medical conditions, surgery, pregnancy and childbirth, neurological disorders, mobility limitations, or medication effects.

There are several common types of urinary incontinence: Stress incontinence: Leakage triggered by actions such as coughing, sneezing, lifting, or exercising. This occurs when pelvic floor muscles are weakened.

Urge incontinence: Sudden, strong urges to urinate accompanied by an inability to reach the bathroom in time. This is frequently linked to overactive bladder.

Overflow incontinence: Frequent dribbling caused by the bladder not emptying fully.

Functional incontinence: Inability to reach or use the bathroom due to physical or cognitive limitations rather than bladder dysfunction itself.

MAINTAINING A PROFESSIONAL, SUPPORTIVE APPROACH Because incontinence can be emotionally sensitive, your interpersonal skills are as important as your product knowledge.

Consider the following best practices: Provide privacy whenever possible. If a discrete conversation is needed, offer to step aside to a quieter area.

Use neutral, respectful language. Terms like “continence management products” or “protective underwear” are preferable to informal or potentially stigmatising terms.

Listen actively. Allow customers to describe their needs without rushing or interrupting.

Avoid assumptions. Incontinence affects people of all genders, ages, and lifestyles.

Know when to refer to the pharmacist.

Customers reporting sudden onset, pain, signs of infection, skin breakdown, or medication concerns should be directed to the pharmacist for further guidance.

PRODUCT CATEGORIES AND KEY CONSIDERATIONS Pharmacy assistants must be familiar with the wide range of continence-care products available. The most common categories include the following: Pads and liners: Designed for light to moderate urinary leakage. They vary in

absorbency, length, and shape. Many are gender-specific to improve comfort and performance.

Pull-up pants: Suitable for moderate to heavy incontinence. These resemble standard underwear and offer higher absorbency along with discretion and ease of use.

All-in-one briefs (tab-fastened): Designed for heavy urinary or faecal incontinence, as well as for customers with limited mobility or those receiving caregiver support.

Booster pads and bed pads: Used to enhance protection for overnight or extended wear.

Skin protection and hygiene products: Customers may benefit from pH-balanced cleansers, barrier creams, and moisturisers to maintain skin integrity. Recurrent moisture exposure can lead to irritation, so proactive skin care is particularly important.

When assisting customers in product selection, consider the following criteria:  Absorbency level based on leakage severity and timing (day vs night)  Fit and sizing to ensure comfort and prevent leakage

 Mobility and dexterity of the user  Preferences regarding product appearance, discretion, and texture  Cost considerations and pack sizes

PROVIDING GUIDANCE ON USE AND MANAGEMENT While you cannot provide medical advice, you can offer general guidance on product usage and care:  Recommend regular changing to maintain hygiene and comfort.  Suggest appropriate disposal methods (products should not be flushed unless clearly labelled as flushable).  Highlight the importance of proper skin care routines to prevent irritation.  Encourage customers experiencing persistent or worsening symptoms to speak with the pharmacist or their healthcare provider.

Some pharmacies also carry reusable products. If asked, be clear about laundering requirements and differences in absorbency and longevity.

WWHAM Who? Older adults, post-partum individuals, people with chronic illness, mobility limitations, cognitive impairment, or those recently hospitalised or recovering from surgery.

What are the symptoms? Leakage of urine or stool, urgency, frequency, nightWWHAM time wetting, dribbling, or difficulty reaching the toilet in time. Note any skin Who is theodour, patient?

Sensitivity to indoor allergens is very common and occurs irritation, or sudden change in continence. at every age.

How long have they had the symptoms? New or rapidly worsening symptoms require pharmacist involvement.

Persistent symptoms a few weeks may What are the Symptoms?

Itchy, congested nose, clearbeyond nasal discharge, need further assessment and appropriate continence management products. irritated eyes, sneezing, tickly throat, coughing or wheezing.

Action already Customer may have tried pads, liners, pull-ups, toileting How long have taken? the symptoms been present?

Indoor allergies tend to be at routines, or skin-care products.

Identify what has worked, what hasn’t, their worst in the late summer, when dust mites are at most prevalent. and whether sizing or absorbency was appropriate.

Action already taken? Patients may have tried antihistamines but not be aware Medication? Check for medicines affecting bladder function (e.g., diuretics, of the benefits of nasal hygiene. sedatives, anticholinergics) or new prescriptions linked to symptom changes.

Always involve pharmacist if medicines or medical Medication?

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AMD

17

AGE RELATED MACULAR DEGENERATION Age-related macular degeneration (AMD) is the leading cause of sight loss in people over 50 in Ireland, affecting an estimated 7% of the population in this age group. As the number of older adults increases, community pharmacies will see more customers seeking information, reassurance and products to support eye health. Although AMD cannot be cured, early detection, lifestyle modification and appropriate referral can significantly slow progression and improve quality of life. Pharmacy assistants therefore play a valuable role in recognising symptoms, offering evidence-based advice and ensuring timely referral to the pharmacist or an eye-care professional.

UNDERSTANDING AMD AND ITS IMPACT AMD is a chronic, progressive condition that affects the macula—the part of the retina responsible for sharp, central vision used for reading, recognising faces and driving. When the macula becomes damaged, patients may notice blurred central vision, distortion or dark patches. Peripheral (side) vision usually remains intact, meaning that AMD rarely causes total blindness. However, even mild central vision loss can severely impact daily functioning.

Patients often first discuss visual changes with the pharmacy team, making it essential to understand how AMD presents and when urgent referral is required.

TYPES OF AMD Dry AMD - This is the more common form, affecting about 90% of individuals with AMD. It has a slower, more gradual onset.

Patients may report needing brighter light to read, colours appearing faded, or difficulty recognising faces. There is currently no cure, but progression can be slowed through healthy lifestyle choices and, in some cases, nutritional supplements.

Wet AMD - Wet AMD accounts for around 10% of cases but is responsible for most severe vision loss. Abnormal blood vessels form beneath the retina and leak fluid, causing rapid distortion and central vision decline. Symptoms often occur suddenly—for example, straight lines appearing wavy or a sudden dark patch in central vision. Wet AMD requires urgent treatment, usually anti-VEGF injections administered by a specialist.

SYMPTOMS CUSTOMERS MAY REPORT  Distorted or “wavy” straight lines (metamorphopsia)  A dark smudge or blank spot in central vision (scotoma)  Blurred or faded colours  Difficulty reading or recognising faces  Greater sensitivity to bright light  Words disappearing on the page

These symptoms may be subtle at first.

Customers often notice them only when covering one eye at a time.

RISK FACTORS While the exact cause of AMD remains unclear, several factors increase risk:

 Stop smoking (strongest modifiable risk factor)  Engage in regular physical activity  Eat a balanced diet rich in leafy greens, eggs, orange/yellow fruit, oily fish and nuts  Protect eyes from UV light with sunglasses

 Age over 50

2. Nutritional Supplements

 Family history

AREDS2-type supplements containing vitamins C and E, zinc, copper, lutein and zeaxanthin may slow progression from early to late AMD. These supplements do not prevent AMD from developing but may help those already diagnosed. Pharmacy assistants should clarify that they are not a cure and not suitable for everyone (e.g., smokers should avoid beta-carotene-containing formulas).

 High blood pressure  Smoking  Excess body weight  Low dietary intake of leafy greens, antioxidants or omega-3 fats  Prolonged sunlight/UV exposure Pharmacy teams should understand these risks when advising customers on prevention and lifestyle modification.

3. Recognising When to Refer Immediate referral to the pharmacist is required when customers report:

DIAGNOSIS AND MONITORING

 Sudden distortion or “wavy” lines

AMD must be diagnosed by an optometrist or ophthalmologist. Regular eye examinations are essential for customers over 50, particularly those at higher risk.

 New dark spots or sudden central blur

The Amsler Grid is a simple tool that some customers may use at home to check for new distortion, but it does not replace a professional eye exam. If a customer notices sudden distortion or dark patches on an Amsler test, urgent referral is needed.

These may indicate wet AMD—a medical urgency.

ROLE OF THE PHARMACY TEAM 1. Education and Lifestyle Advice Healthy lifestyle choices can significantly reduce progression of AMD:

 Rapid change in reading ability  Difficulty recognising faces

4. Treatment Awareness While pharmacies cannot treat AMD directly, understanding treatment supports better patient discussions.

Wet AMD is managed with anti-VEGF injections, which help stabilise or improve vision. Early treatment offers the best chance of preserving sight.

WWHAM Who? Mainly adults over 50; confirm age and if symptoms affect one or both eyes.

What are the symptoms? Distortion, blurred central vision, dark patches, faded colours, difficulty reading.

How long have they had the symptoms? Sudden changes require urgent referral; gradual changes still require optometrist review.

Action already taken? Eye tests, Amsler Grid use, supplements, lighting adjustments.

Medication? Check for existing eye conditions, hypertension medicines, or supplement use.

Treat Athlete’s Foot

with just one application*

Helps to kill the fungus* Helps soothe symptoms* Helps prevent recurrence* Lamisil is a medicine containing Terbinafine Hydrochloride. Lamisil Once is suitable for 18+ years. Lamisil Once 1% cutaneous Solution is a pharmacy only product. Use as directed by a healthcare professional. Always read the individual product leaflet before use. *Ortonne, J P et al. “Ecacy and safety of a new single-dose terbinafine 1% formulation in patients with tinea pedis (athlete's foot): a randomized, double-blind, placebo-controlled study.” Journal of the European Academy of Dermatology and Venereology : JEADV vol. 20,10 (2006): 1307-13. doi:10.1111/j.1468-3083.2006.01807. Epub 2007 Apr 27. PMID: 17559730. Marketing Authorisation Number: PL 50567/0016.

Distributed in Ireland by Lake Healthcare. Date of preparation: April 2025. For more information visit www.lamisil.ie

ATHLETE’S FOOT

19

ATHLETE’S FOOT Athlete’s foot is one of the most common fungal skin infections encountered in community pharmacy, affecting up to 15–25% of the population at any one time. Although often associated with sports and gym environments, it can affect anyone, regardless of age or activity level. Pharmacy assistants frequently support customers seeking advice for red, itchy, or peeling skin on the feet, making a sound understanding of symptoms, causes, treatment options, and when to refer essential in daily practice.

Athlete’s foot is caused by dermatophyte fungi that thrive in warm, moist environments such as sweaty socks, tight footwear, public showers, swimming pools, and locker rooms.

The infection typically begins between the toes but may spread to the soles, sides of the feet, or toenails. Customers often present with a mixture of irritation, burning sensations, odour, cracking skin, or persistent itchiness, and may feel embarrassed or frustrated if symptoms keep recurring.

treatments. Products are available as creams, sprays, powders, gels, and solutions. The key active ingredients include:  Clotrimazole (azoles)  Miconazole

RECOGNISING ATHLETE’S FOOT

 Terbinafine (allylamine)

Symptoms vary depending on the type of tinea pedis but commonly include:

 Tolnaftate

 Itching, burning, or stinging between the toes  Redness, flaking, or peeling skin  Soft, white, macerated skin between the toes  Cracking or fissures  Dry, rough, “moccasin-type” scaling on the soles  Odour caused by secondary bacterial involvement Many cases start subtly and worsen over time, especially in people who regularly wear tight or non-breathable footwear. Pharmacy assistants should be confident distinguishing athlete’s foot from other conditions such as eczema, psoriasis, or contact dermatitis, which can appear similar.

CAUSES AND RISK FACTORS The fungi responsible for athlete’s foot spread easily through direct skin contact or indirectly via contaminated floors, towels, footwear, and communal surfaces.

Contributing factors include:

 Hydrocortisone + antifungal combinations (only when inflammation is severe — pharmacist referral required)

IMPORTANT POINTS FOR CUSTOMER COUNSELLING

 Wash and dry feet thoroughly, especially between the toes.  Use a separate towel for feet and wash it regularly.  Change socks daily—preferably cotton or moisture-wicking fibres.  Avoid walking barefoot in communal areas.  Rotate footwear and allow shoes to air between uses.  Use antifungal powders in shoes to reduce moisture.  Avoid sharing footwear or socks.

 Treatment must continue for the full recommended course, even if symptoms improve quickly.

Customers experiencing repeated infections may benefit from discussing footwear choice or potential underlying risk factors with the pharmacist.

 Terbinafine generally clears infection faster (typically 1–2 weeks), whereas azole antifungals may require 2–4 weeks.

WHEN TO REFER

 Combination hydrocortisone products should only be used for acute inflammation and for no more than 7 days unless directed by a pharmacist.

 The infection is severe, widespread, or persistent.

 Powders and sprays are beneficial for preventing reinfection and keeping shoes dry.

SELF-CARE AND PREVENTION ADVICE Effective treatment depends not only on antifungal medicines but also on good foot hygiene. Assistants should reinforce advice such as:

Pharmacy assistants should refer to the pharmacist when:

 There is uncertainty about diagnosis.  There are signs of secondary bacterial infection (swelling, pus, severe odour).  The nails are affected — may require antifungal nail treatment or GP referral.  The customer has diabetes, circulatory problems, or immunosuppression.  Hydrocortisone combination treatment is being considered.

 Sweaty feet or hyperhidrosis  Occlusive footwear

WWHAM

 Poor foot hygiene

Who? Common in adults and adolescents; higher risk in those who use communal sports facilities or wear tight footwear.

 Sharing towels or sports equipment  Diabetes or weakened immune systems  Wearing the same shoes daily without airing them Customers with repeated episodes may need more structured advice or referral to ensure the correct diagnosis.

TREATMENT OPTIONS AVAILABLE IN THE PHARMACY Pharmacy assistants play an important role in guiding customers to effective antifungal

What are the symptoms? Itching, redness, peeling, burning between toes or on soles; possible odour or cracking skin.

How long have they had the symptoms? Short-term cases can be self-treated; long-standing or recurrent cases may require referral.

Action already taken? Ask if they have tried antifungals, changed footwear, or used powders; this helps guide next steps.

Medication? Check for antifungal products previously used, any steroid creams applied, and any relevant medical conditions such as diabetes.

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Email: ask@pamex.ie | Phone: 094 902400 *CFU = colony forming units | †Ingredients suitable for vegetarians and vegans 1. Graziottin A et al. Womens Health (Lond). 2024;20: 17455057231223716. 2. Chen X et al. Front Cell Infect Microbiol. 2021;11: 631972. 3. Coudray MS and Madhivanan P. EJOG. 2020;245: 143-48. 4. Lev-Sagie A et al. JLGTD. 2022;26(1): 79-8. 5. Laue C et al. Benef Microbes. 2018. 9(1): 35–50. 6. Anoshina TM. Perinatologiya i pediatriya. 2016.4(68): 22-25.

7. Hilton E et al. Ann Intern Med. 1992;116(5): 353–57. 8. Mollazadeh-Narestan Z et al. Probiotics Antimicro. 2022;15: 1436-46. 9. EFSA Panel. EFSA Journal. 2009;7(9): 1209.

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BACTERIAL VAGINOSIS

21

BACTERIAL VAGINOSIS Bacterial vaginosis (BV) is the most common cause of abnormal vaginal discharge in women of reproductive age. It results from an imbalance in the normal vaginal flora, where protective lactobacilli decrease and are replaced by higher levels of anaerobic bacteria. This shift disrupts the acidic environment of the vagina and triggers symptoms such as unusual discharge and an unpleasant odour.

BV is not considered a sexually transmitted infection (STI), but sexual activity can influence its development, and recurrence is common. Many women feel embarrassed when seeking advice, making the pharmacy team’s approach—confidential, supportive and non-judgemental—essential to their care experience.

Community pharmacies in Ireland increasingly supply over-the-counter treatments for BV, meaning pharmacy assistants should be confident in recognising symptoms, understanding when referral is required and advising on appropriate selfcare and prevention.

WHAT IS BACTERIAL VAGINOSIS? Under normal conditions, the vagina contains a predominance of lactobacilli which produce lactic acid and hydrogen peroxide. This maintains a low vaginal pH and protects against infection.

In BV, lactobacilli levels fall and other bacteria— such as Gardnerella vaginalis—overgrow. This causes the vaginal pH to rise above 4.5 and leads to characteristic symptoms.

BV can affect women at any age but is most common in:  Sexually active women aged 18–45  Women with recent antibiotic use  Women who use vaginal washes, douches or scented products  Individuals with new or multiple sexual partners BV does not cause inflammation, so itching and soreness are uncommon. This can help differentiate BV from thrush.

SYMPTOMS CUSTOMERS MAY REPORT Pharmacy teams should be familiar with the core symptoms of BV. These include:  Thin, white or grey discharge, often described as “milky”

These symptoms suggest thrush or another infection and require referral.

COMPLICATIONS AND WHEN TO REFER BV itself is not dangerous, but unmanaged infection can cause complications, especially in pregnancy. Pharmacy assistants should refer to the pharmacist or encourage GP review if the customer reports:  Pregnancy  Fever, pelvic pain or bleeding

2. Probiotics (Vaginal or Oral) Some products contain lactobacilli strains designed to restore natural flora.

Evidence varies, but many women find them beneficial for recurrence prevention.

3. Prescription Treatments (Pharmacist Referral Only) If symptoms are moderate to severe, recurrent, or persistent despite OTC treatment, customers may require prescribed therapy such as:

 Recurring BV (more than twice in six months)

 Metronidazole oral tablets

 Symptoms after miscarriage, abortion or gynaecological procedures

 Clindamycin cream

 Failure of OTC treatment  Uncertain diagnosis or mixed symptoms Pharmacists should also consider referral for STI screening if the woman has multiple partners or additional symptoms.

 Metronidazole vaginal gel

BV often recurs despite treatment, so education on prevention is essential.

LIFESTYLE AND SELF-CARE ADVICE To reduce risk and recurrence:

PHARMACY TREATMENT OPTIONS

 Avoid douching, vaginal deodorants or scented washes

Several treatments are available OTC in Ireland, mainly focusing on restoring the vaginal pH and supporting lactobacilli regrowth.

 Use mild, unperfumed soap on the external area only

1. Lactic Acid Gels

 Wear breathable cotton underwear  Avoid tight clothing

These work by lowering the vaginal pH to discourage growth of anaerobic bacteria.

 Use condoms if BV is recurrent after sex

 Useful for first-time BV or mild symptoms

 Limit use of bubble baths or perfumed shower gels

 Can be used as a preventative treatment in recurrent BV  Generally well tolerated

Customers should also be reassured that BV is common, treatable and not linked to poor hygiene.

 Strong, fishy odour, especially after sex

WWHAM

 Increased discharge volume

Who? Women of reproductive age; confirm if the customer is pregnant.

 High vaginal pH (if tested) Symptoms of BV tend to fluctuate and may temporarily improve during menstruation.

Many women report recurrent episodes, making long-term advice important.

Symptoms NOT typical for BV include:  Significant itching  Cottage-cheese-like discharge  Vaginal redness or swelling

What are the symptoms? Thin grey/white discharge, fishy odour, no itching.

How long have they had the symptoms? First episode versus recurrence; persistent symptoms require referral.

Action already taken? Previous treatments, use of probiotics, any change in personal hygiene products.

Medication? Check for recent antibiotics, pregnancy, contraceptive use, or conditions requiring GP oversight.

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3. Moisture-enriched hydrogel offers a slight cooling and soothing effect that can provide instant pain relief, while also promoting optimal healing conditions by absorbing exudate and maintaining moisture in superficial wounds.

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5. Hydrogel is known for their ability to promote optimal healing conditions by absorbing exudate and providing moisture to superficial wounds.

6. Cushions and protects the area to provide instant pain relief.

7. Absorbs small amounts of fluid to help promote an optimal environment for skin / blisters to heal.

BLISTERS

BLISTERS

23

Blisters are one of the most common minor skin problems seen in pharmacies, and while usually harmless, they can cause pain, discomfort, and inconvenience. Pharmacy assistants play a key role in advising customers on how to treat blisters safely, prevent infection, and avoid future problems — especially for people who walk or stand for long periods, take part in sports, or wear ill-fitting footwear.

WHAT ARE BLISTERS? A blister is a small pocket of fluid (usually clear serum) that forms between layers of skin, typically as a result of friction, heat, or irritation. The fluid cushions the damaged tissue underneath and protects it as it heals.

Most blisters heal naturally within a few days.

Blisters can vary in appearance:  Clear fluid blisters – the most common type, caused by friction.  Blood blisters – when deeper skin layers are damaged.  Infected blisters – containing yellow or green pus, red skin, or warmth.

COMMON CAUSES OF BLISTERS Blisters most commonly occur due to friction, which happens when the skin is repeatedly rubbed or irritated. This frequently affects people wearing new or tight shoes, those taking part in long walks or running, and anyone involved in repetitive manual tasks such as gardening or using hand tools. Burns and scalds, including sunburn, can also cause blisters by damaging the upper layers of the skin.

Blisters may also develop as part of certain medical or skin conditions. These include eczema, chickenpox, hand, foot and mouth disease, and contact dermatitis, where the skin reacts to an irritant. Some viral infections, such as cold sores caused by the herpes simplex virus, can also lead to blistering. In other cases, allergic reactions to chemicals, adhesives, or topical skincare products can trigger the formation of blisters, especially in those with already sensitive or reactive skin.

WHEN TO RECOMMEND SELFCARE Most mild blisters can be treated safely at home with simple steps. When advising customers, pharmacy assistants should explain that, wherever possible, the blister should be left intact, as the outer layer of skin acts as a natural barrier and protects against infection. The area should be kept clean and covered or cushioned with a dressing or blister plaster to reduce friction and prevent further irritation.

Advise:  Cushioned blister plasters  Hydrocolloid dressings  Soft padding or gauze  Applying petroleum jelly to reduce friction

KEEP IT CLEAN

 Wearing properly fitting shoes

Wash gently with mild soap and water. Avoid alcohol or antiseptic creams unless infection is suspected.

 Breaking in new footwear slowly  Using socks designed to reduce friction

PAIN RELIEF

 Applying blister prevention tape or padding before long walks

Paracetamol or ibuprofen can be recommended for discomfort if appropriate.

 Keeping feet dry — moisture increases friction

If a blister is large, very painful, or likely to burst anyway, a pharmacist may advise controlled drainage

 Using talcum or anti-chafing powders

SIGNS OF INFECTION (REFER TO THE PHARMACIST) Blisters may become infected if the skin breaks. Look for:  Redness or swelling  Increasing pain  Pus or cloudy fluid  Warm skin around the blister  A foul smell  Fever or feeling unwell If infection is suspected, referral is essential.

Antibiotics may be required.

For sports use, hydrocolloid blister plasters can both protect existing blisters and prevent new ones forming.

PRODUCT RECOMMENDATIONS Pharmacy assistants can confidently suggest:  Hydrocolloid blister plasters  Adhesive dressings or cushioned pads  Antiseptic cream (if broken skin is present)  Non-perfumed emollients to reduce friction  Pain relief if needed Avoid recommending:  Strong steroid creams

PREVENTION ADVICE

 Harsh antiseptics (may delay healing)

Pharmacy teams can help customers prevent future blisters by discussing:

 Products containing allergens or fragrances for sensitive skin

WWHAM Who is affected? Consider age, underlying health (especially diabetes or circulation problems).

What are the symptoms? Blister size, number, location, presence of pain, redness or pus.

How long have they had it? Recent blisters usually heal quickly; older or worsening ones may need referral.

Action already taken? Ask if they’ve burst it, applied creams, or covered it.

Medication? Check for diabetes, immune-suppressants, steroids, or anticoagulants — refer to pharmacist if needed.

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BONE HEALTH

25

BONE HEALTH Healthy bones are essential for strength, mobility, and independence throughout life.

Bones continually renew themselves, but with age or certain health conditions, this process can slow down, leading to reduced bone density and a higher risk of fractures.

Pharmacy teams are ideally placed to provide advice on preventing bone loss, recognising risk factors, and supporting patients prescribed bone-health treatments.

UNDERSTANDING BONE HEALTH Bones are living tissue made up of a hard outer layer and a spongy inner structure.

They store calcium and other minerals that give them strength and flexibility. The body constantly breaks down and rebuilds bone — a process called remodelling.

For many adults, especially those who are housebound or over 65, a vitamin D supplement (10 µg daily) is recommended year-round.

In young adults, bone formation and breakdown are balanced. However, as people age, bone loss can occur faster than it is replaced, leading to conditions such as osteopenia (mild bone loss) and osteoporosis (significant weakening of the bones).

Adequate protein is also vital because muscles support bone strength. A healthy diet with plenty of fruit and vegetables provides additional minerals such as magnesium and zinc.

Osteoporosis makes bones more brittle and prone to fractures, particularly in the hip, spine, and wrist. It is sometimes called the “silent disease” because it often develops without symptoms until a break occurs.

Weight-bearing and resistance exercises help maintain bone density. Encourage walking, dancing, climbing stairs, or light strength training. Even short, regular sessions can make a difference.

RISK FACTORS FOR POOR BONE HEALTH

Lifestyle Habits

Some risks cannot be changed, but many are preventable or manageable.

Non-modifiable Risk Factors  Age (risk increases after 50)  Female gender (especially post-menopause)  Family history of osteoporosis or fractures  Ethnicity (Caucasian and Asian populations have higher risk) Modifiable Risk Factors  Low calcium or vitamin D intake  Lack of weight-bearing exercise  Smoking  Excess alcohol intake  Low body weight or poor nutrition

Exercise

 Stop smoking: Smoking reduces bone mass and increases fracture risk.  Limit alcohol: Keep below 14 units per week, with alcohol-free days.  Prevent falls: Good footwear, vision checks, and home safety measures can reduce fracture risk.

PHARMACY’S ROLE IN BONE HEALTH Pharmacy teams can provide practical advice, signposting, and medication support:  Screening and awareness: Encourage customers, particularly post-menopausal women, to discuss bone-density scans (DEXA) with their GP if they are at risk.  Vitamin D and calcium advice: Help customers select appropriate supplements and understand correct dosing.

 Medication adherence: Support patients taking osteoporosis medicines and explain how to use them safely.  Referral: Report red-flag symptoms such as severe back pain, height loss, or unexplained fractures to the pharmacist for GP referral.

COMMON MEDICATIONS FOR BONE HEALTH Pharmacy assistants may encounter customers prescribed the following treatments:  Bisphosphonates (e.g., alendronic acid, risedronate): slow bone loss and reduce fracture risk. They must be taken on an empty stomach with a full glass of water, and the patient should remain upright for 30 minutes afterwards.  Denosumab: an injection given every six months in clinic to strengthen bone.  Selective oestrogen receptor modulators (SERMs) (e.g., raloxifene): used in post-menopausal women to mimic the protective effects of oestrogen on bone.  Hormone replacement therapy (HRT): may help preserve bone density in post-menopausal women.  Calcium and vitamin D supplements: maintain adequate mineral levels to support bone strength.

Pharmacy assistants can reinforce proper use and remind customers that treatment often takes several months to show benefits but must be taken regularly to prevent fractures.

 Long-term use of corticosteroids or certain medications (e.g., PPIs, anticonvulsants)

WWHAM

Pharmacy assistants should be aware of these risks when advising customers, particularly older adults and women after menopause.

Who? Mainly post-menopausal women, older adults, long-term steroid users, or anyone with a family history of osteoporosis or frequent fractures.

PROMOTING HEALTHY BONES Nutrition Encourage customers to eat a balanced diet rich in calcium and vitamin D.  Calcium sources: milk, yoghurt, cheese, leafy greens, fortified plant milks, and tinned fish with bones.  Vitamin D sources: oily fish, eggs, fortified cereals, and safe sun exposure (about 10–15 minutes daily in summer).

What are the symptoms? Often none until a fracture occurs. Possible warning signs include back pain, loss of height, or a stooped posture.

How long have they had the symptoms? Recent or sudden fractures or persistent pain should be referred immediately to the pharmacist or GP. Action already taken? Ask if the person is taking supplements, prescribed medication, or has had a bone-density scan.

Medication? Check for current use of bisphosphonates, calcium/vitamin D, or long-term corticosteroids. Refer to the pharmacist before recommending additional supplements to avoid duplication or interactions.

IRELANDS

N1 o

CHILDREN’S

COUGH * BRAND

STRAWBERRY FLAVOUR *Based on IQVIA Sales Data MAT July 2024. Broncho Junior is a medical device according to Directive 93/42/EEC, used to relieve any cough (dry & chesty) associated with a cold for children from 1 year. Children under 3 years of age should consult with a doctor to exclude more serious diseases being present. Use in children under 1 year of age is not recommended. Children aged 1 year and above: 5ml up to 3 times daily. Children 2 to 3 years: 5ml up to 4 times daily. Children 4 to 5 years: 7.5ml up to 4 times daily. Children 6 to 11 years: 15 ml up to 4 times daily. Always read the Instructions for Use. Date of preparation: 05/2024 MAT-5543

CHILDREN’S COUGH

27

CHILDREN’S COUGH Cough is extremely common in babies and children, especially during autumn and winter.

Parents frequently seek reassurance and advice from the pharmacy. It is important for pharmacy assistants to understand what treatments are safe, suitable, and effective— and what should be avoided.

UNDERSTANDING CHILDREN’S COUGH In most cases, a cough in a child is caused by a viral upper respiratory infection. The cough acts as a natural reflex to clear mucus. These coughs can last up to 3–4 weeks, especially after colds.

Types of cough in children include:  Dry cough – often viral or linked to irritation  Chesty cough – mucus-producing, associated with infections  Barking cough – may indicate croup  Whooping cough – requires medical review  Night-time cough – may be due to postnasal drip or asthma Important Safety Note: OTC Cough Medicines for Children.

Irish and EU guidelines state:

5. Humidified air

 barking cough (possible croup)

 Children under 6 should NOT be given OTC cough suppressants, expectorants, decongestants, or antihistamine-based cough mixtures.

Cool-mist humidifiers or steamy bathroom air can help ease cough and loosen mucus.

 suspected whooping cough

 For children 6–12, some cough medicines may be used with caution, but pharmacist assessment is required.  Honey must not be given to children under 1 year.

Pharmacy assistants must be confident explaining this to parents.

SAFE AND EFFECTIVE OPTIONS FOR CHILDREN 1. Fluids and Hydration Hydration helps thin mucus and soothes irritation.

6. Soothing syrups (non-medicinal) Glycerine-based syrups or simple honey & lemon (age appropriate) can provide comfort without active drug ingredients.

7. Vapour rubs Only use age-appropriate formulations.

Mentholated rubs may not be suitable for infants.

WHEN TO REFER In children, red flags include:  difficulty breathing, ribs pulling in, fast breathing

 drowsiness, dehydration, poor feeding  persistent vomiting  rash with fever  babies under 3 months with any cough

SUPPORTING PARENTS Parents often worry when their child is coughing, especially at night. Reassure them that:  coughs commonly last several weeks  most cases resolve without medicine  sleep may be disrupted temporarily

 very high temperature or persistent fever

 antibiotics are rarely needed

2. Honey (ages 1+)

 cough >3 weeks

A teaspoon of honey can reduce coughing at night and is well supported by evidence.

 wheezing or history of asthma

The most helpful support is good explanation, symptom management strategies and clear advice on when to return or seek further care.

3. Non-pharmacological cough remedies such as medical device-based or demulcent preparations, indicated from one year of age, may also be considered. They provide gentle relief for cough and throat irritation and can be used alongside other comfort measures such as honey and warm fluids. Pharmacy assistants should remind parents to follow the age guidance carefully and check with the pharmacist if unsure.

4. Saline nasal drops or spray Ideal for babies and toddlers with congestion contributing to cough.

WWHAM Who? Child’s exact age is essential.

What are the symptoms? Nature of cough, fever, breathing difficulty, feeding.

How long? Viral coughs can last 2–4 weeks.

Action already taken? Saline, honey (if age appropriate), humidifier, fluids.

Medication? Confirm no OTC cough mixture given under age 6; check for asthma meds.

COGNITIVE FUNCTION

29

COGNITIVE FUNCTION Cognitive function refers to a wide range of mental processes, including memory, attention, reasoning, problem-solving, and the ability to perform daily tasks. Many customers who seek help in the pharmacy may be concerned about memory lapses, difficulty concentrating, unusual confusion, or changes in their ability to organise or complete routine activities. These issues can arise due to ageing, medication effects, stress, sleep disruption, nutritional deficiencies, or underlying medical conditions. Pharmacy assistants play an important role in identifying when support, reassurance, or referral to the pharmacist is needed. This article provides essential guidance for managing cognitivefunction enquiries safely and professionally.

UNDERSTANDING COGNITIVE CHANGES AND THEIR CAUSES

 Avoid interrupting or finishing sentences for the customer.  If a carer is present, include them respectfully while still acknowledging the person affected.  Maintain privacy whenever possible.

Your objective is to gather relevant information, offer appropriate general advice, and involve the pharmacist where necessary.

PRODUCT KNOWLEDGE AND PRACTICAL SUPPORT Pharmacies often offer products and resources that may support cognitive health or help manage contributing factors.

Pharmacy assistants should be familiar with these categories so they can guide customers effectively:

Not all cognitive changes indicate a serious condition. Many are mild, temporary, and reversible. However, some warrant prompt assessment by a pharmacist or healthcare provider. Customers may report symptoms such as forgetfulness, misplacing items, reduced attention span, slower processing, difficulty following conversations, or uncertainty performing familiar tasks. They may also describe behavioural changes such as increased irritability, withdrawal, or unusual mood shifts.

 Vitamin and mineral supplements, particularly B vitamins and omega-3 fatty acids

Common contributors to cognitive changes include:

 Educational materials on lifestyle factors affecting cognitive wellbeing

 Stress, anxiety, or depression

Assistants should make recommendations only within their scope and avoid suggesting that any product can diagnose, treat, or cure cognitive impairment. Any questions related to cognitive supplements, dosing, interactions, or suitability must be referred to the pharmacist.

 Poor sleep quality or disrupted sleep cycles  Dehydration or inadequate nutrition  Vitamin B12 or folate deficiency  Medication side effects  Recent illness or hospitalisation  Decreased sensory input (e.g., hearing or vision problems)  Age-related cognitive decline More serious causes may include infections, head injury, metabolic disorders, or progressive neurological conditions. Pharmacy assistants are not expected to differentiate among these causes but should be able to recognise when symptoms require escalation.

 Hydration and nutrition support products  Sleep aids and sleep-hygiene advice  Hearing and vision-support items, where sensory deficits may be contributing  Medication management aids such as pill organisers and reminder devices

RECOGNISING RED FLAGS AND ENSURING SAFE REFERRAL Certain presentations require immediate escalation to the pharmacist:  Sudden confusion, disorientation, or significant change from baseline  Memory loss interfering with daily safety  Behavioural changes that are unusual or concerning

 Signs of infection, dehydration, or acute illness  Concerns raised by a carer about rapid decline  Any cognitive symptoms occurring alongside medication changes or newly prescribed drugs Timely referral ensures that customers receive appropriate clinical assessment and prevents delays in identifying serious underlying conditions.

SUPPORTING CUSTOMERS AND CARERS THROUGH EFFECTIVE GUIDANCE Cognitive concerns affect not only the individual but often their family or carers.

Pharmacy assistants can contribute to a supportive environment by:  Reassuring customers that many cognitive changes have reversible causes  Encouraging hydration, balanced nutrition, regular physical activity, and consistent sleep routines  Suggesting practical tools to support memory and routine tasks  Escalating promptly to the pharmacist when concerns fall outside the assistant’s scope By offering clear communication and knowledgeable guidance, pharmacy assistants help customers navigate cognitive concerns more confidently. The pharmacy is often the first point of contact for these issues, and the quality of that interaction can positively influence the customer’s wellbeing, safety, and access to appropriate care.

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WWHAM

Conversations about cognitive changes can be sensitive. Customers may feel embarrassed, frustrated, or worried about the implications of their symptoms. They may fear being judged or may minimise what they are experiencing. A calm, respectful, and structured approach helps build trust and ensures that the customer receives appropriate support.

What are the symptoms? Forgetfulness, confusion, difficulty concentrating, slowed thinking, mood changes, problems performing routine tasks, or reduced ability to follow conversations.

When discussing cognitive concerns:  Use clear, neutral language without labels or assumptions.  Speak at a comfortable pace and allow extra time for responses.

Who? Older adults, individuals recently ill or hospitalised, those with chronic conditions, people under significant stress.

How long have they had the symptoms? Sudden or rapidly worsening symptoms require immediate pharmacist involvement.

Action already taken? Customer may have tried improving sleep, hydration, diet, using reminder tools, or adjusting routine.

Medication? Check for medicines that may affect cognition, including sedatives, pain medicines, anticholinergics, or recent dose changes.

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CONGESTION IN CHILDREN

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CONGESTION IN CHILDREN Nasal congestion is extremely common in babies and young children, especially during the winter months when colds and viral infections circulate widely. Because infants and toddlers cannot blow their noses effectively and have narrower nasal passages, even mild swelling can make breathing difficult. This can disrupt feeding, sleeping and general comfort, making congestion a major source of worry for parents. Community pharmacies are often the first place parents seek help, so pharmacy assistants need a clear understanding of what is safe, appropriate and effective for children.

Unlike adults, children under 6 years of age should not be given oral or topical decongestants. The HSE and HPRA advise that over-the-counter “cold and flu” products containing decongestant ingredients such as pseudoephedrine or phenylephrine are unsuitable for young children due to safety concerns, potential side effects and lack of evidence of benefit. Pharmacy assistants must therefore feel confident explaining safe alternatives and reassuring parents that supportive care is usually sufficient.

The most important and effective treatment for congestion in young children is saline (salt water) nasal drops or sprays. These products are safe, preservative-free and suitable from birth. Saline works by loosening thick mucus, helping to clear the nasal passages so the child can feed, sleep and breathe more comfortably. Pharmacy assistants should explain how to use saline correctly: placing a few drops into each nostril, waiting briefly to allow the solution to soften mucus, and then gently wiping or aspirating the nostrils with a suction bulb if needed. This is especially helpful before feeds or bedtime, when breathing may be most difficult.

For older children, saline sprays and childfriendly nasal rinses can help maintain nasal hygiene and prevent mucus build-up. Regular use during colds can reduce discomfort and help avoid complications such as ear infections or sinus issues.

Another non-medicinal option is humidified air, which can ease congestion by adding moisture to dry indoor environments. Parents can sit with the child in a steamy bathroom for a few minutes, or use a cool-mist humidifier in the child’s bedroom. Pharmacy assistants should caution against adding essential oils to humidifiers or using vapour rubs directly on the chest of young babies.

Products containing menthol, eucalyptus or camphor are generally unsuitable for infants under 2 years old unless specifically labelled safe for that age.

Parents often come to the pharmacy expecting a “cold medicine” similar to adult products. It is important to explain gently that cough and cold products have not been shown to be effective in small children and can cause harm. Many over-the-counter medicines designed for older children or adults contain multiple active ingredients—

including decongestants—which are not appropriate for young children. Instead, the focus should be on comfort measures, hydration and monitoring symptoms.

For children aged 6 years and over, some paediatric decongestant products may be appropriate, but these still require careful assessment and referral to the pharmacist.

Even older children may experience side effects such as difficulty sleeping, irritability or increased heart rate. A WWHAM consultation should always be completed before recommending any medicated nasal spray or oral decongestant for this age group.

Knowing when to refer is essential. Babies under 3 months with congestion should be referred to the pharmacist immediately, as breathing difficulties at this age can be more serious. Referral is also necessary when a child has a fever lasting more than 48 hours, is feeding poorly, has ear pain, develops a

rash, shows signs of dehydration or seems unusually drowsy or irritable. Green or foulsmelling mucus, symptoms lasting longer than two weeks, or a parent expressing strong concern are also indications for pharmacist review.

The most valuable support a pharmacy assistant can offer is reassurance. Colds are extremely common in children—many will experience 6–10 each year—and congestion is a normal part of the illness. Parents often feel anxious when their child is uncomfortable, and clear, confident advice about safe treatments such as saline drops, hydration and rest can make a significant difference.

By understanding the limitations of decongestant medicines in children and focusing on safe, evidence-based alternatives, pharmacy assistants can provide high-quality support while ensuring the child’s wellbeing is prioritised.

WWHAM Who? Always confirm the child’s exact age and general health.

What are the symptoms? Blocked nose, noisy breathing, trouble feeding or sleeping.

How long have they had the symptoms? Most congestion from viral colds lasts 7–10 days; longer may need referral.

Action already taken? Saline drops, suction bulb, humidifier use, feeding adjustments.

Medication? Check for any OTC or prescribed medicines; highlight that decongestants are unsuitable for under-6s.

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DECONGESTANTS

33

DECONGESTANTS Decongestants are one of the most frequently requested product categories in Irish community pharmacies, especially during winter when colds, flu and sinus infections surge. Nasal congestion is a particularly frustrating symptom for many people because it impacts breathing, sleep quality, concentration and overall comfort. As a result, pharmacy assistants play an important role in helping customers understand which decongestant products are suitable for them, how to use them safely, and when symptoms may require pharmacist intervention.

Nasal congestion occurs when the blood vessels in the nasal passages and sinuses become inflamed and swollen. This swelling reduces airflow, creates pressure in the face and head, and often leads to difficulty sleeping. Decongestants work by constricting these blood vessels, reducing swelling and helping to reopen the airways. Because of this mechanism, they can provide quick relief from blocked noses, sinus pressure and associated discomfort.

Decongestants are available in a variety of formulations including tablets, capsules, syrups, hot-drink powders, nasal sprays and nasal drops. Oral products—such as those containing pseudoephedrine or phenylephrine—tend to provide longerlasting relief throughout the body. They can be helpful when congestion is accompanied by tiredness, sinus pain or ear pressure.

However, oral decongestants also have a higher risk of side effects and are unsuitable for many customers. Meanwhile, topical nasal decongestants in spray or drop form work directly on the nasal tissues and offer rapid relief within minutes. These are often preferred when quick, targeted opening of the airways is needed.

Allergy sufferers often rely on antihistamines as their main treatment, but during severe flare-ups they may still need a decongestant to relieve blocked sinuses. Many people assume that antihistamines alone will resolve congestion; however, this is not always the case. Understanding the difference allows pharmacy assistants to explain why adding a short course of a decongestant can help break the cycle of blocked sinuses and facial pressure.

Topical nasal decongestant sprays can be extremely effective, but it is essential that customers understand they must not use these products for more than three consecutive days. Extended use can lead to rebound congestion, where the nasal tissues become dependent on the medication and swelling worsens once the spray is stopped. Customers often make the mistake of continuing to use sprays throughout the entire duration of a cold, believing more is better. Pharmacy assistants should therefore explain clearly how to use these sprays safely: short bursts for immediate relief, followed by alternative management such as saline sprays, steam inhalation or steroid nasal sprays (depending on suitability).

Oral decongestants require even greater care. Pseudoephedrine, in particular, can raise blood pressure, increase heart rate and worsen symptoms in customers with

certain medical conditions. It is not suitable for people with hypertension, heart disease, hyperthyroidism, diabetes or for men with benign prostatic enlargement. It can also interact with medicines such as certain antidepressants (e.g., MAOIs) and bloodpressure treatments. Because of this, any request for an oral decongestant should be referred to the pharmacist so that a proper assessment can take place. Pharmacy assistants should gather key WWHAM information first, then hand the case over to the pharmacist.

Knowledge of the legal restrictions around pseudoephedrine and ephedrine is also essential. In Ireland, these medicines are controlled substances due to the risk of misuse. It is unlawful to supply more than 720 mg pseudoephedrine or 180 mg ephedrine in a single transaction without a prescription.

It is also illegal to supply a pseudoephedrine product and an ephedrine product in the same sale. All supplies must be made either by the pharmacist or by staff trained in the legal requirements. Even when a customer requests a permitted quantity, the pharmacist may refuse the sale if there are reasonable grounds to suspect misuse or diversion.

Assistants should therefore remain alert to unusual buying patterns, repeated requests, reluctance to engage in WWHAM questions or inconsistent explanations.

Many customers also arrive at the pharmacy unsure whether a decongestant is appropriate at all. For example, congestion can often persist after other cold symptoms have resolved, and some people confuse sinus

pressure with headaches or allergies.

Pharmacy assistants can help by explaining the difference between viral congestion, allergic congestion and sinusitis, and by advising when medical review may be necessary. Warning signs that require referral include symptoms lasting longer than two weeks, severe facial pain, fever, green or foul-smelling nasal discharge, or repeated episodes of sinusitis.

By understanding how decongestants work, the risks associated with them, and the legal framework that governs their supply, pharmacy assistants can confidently guide customers towards safe and effective options while recognising when pharmacist assessment is required.

PHARMACY SAFETY AND LEGAL REQUIREMENTS  It is unlawful to supply more than 720 mg pseudoephedrine or 180 mg ephedrine in a single transaction without a prescription.  It is illegal to supply a pseudoephedrine product together with an ephedrine product.  All supplies must be made either by the pharmacist or by trained staff who understand the legal controls and know when to refer.  Even when the request is within the legal limit, the pharmacist may refuse the sale if there is reason to suspect misuse or diversion.

WWHAM Who? Adults and older children commonly experience nasal congestion.

Always confirm the age of the person needing treatment.

What are the symptoms? Blocked nose, sinus pressure, headache, difficulty breathing through the nose.

How long have they had the symptoms? Persistent congestion lasting more than two weeks, or recurring frequently, may require pharmacist review.

Action already taken? Steam inhalation, saline sprays, rest, hydration or previous OTC products.

Medication? Ask about prescription medicines, blood pressure treatments, antidepressants, or any previous decongestant use. Refer to the pharmacist if unsure.

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DIGESTION IN CHILDREN

35

DIGESTION IN CHILDREN Digestive discomfort is extremely common in babies and young children, and it is one of the most frequent reasons parents come to the community pharmacy for advice.

Because an infant’s digestive system is still developing, issues such as colic, wind, reflux, constipation and mild diarrhoea are widespread and almost always temporary.

Parents, particularly first-time carers, often feel anxious when their child is unsettled, so pharmacy assistants play an important role in offering reassurance, explaining what is normal, and supporting families with practical suggestions and safe treatment options.

Understanding the reasons behind common digestive issues helps the pharmacy team give confident and effective guidance.

In early infancy, colic and wind are among the most common concerns. Babies may cry for prolonged periods, pull their legs toward their tummy or appear uncomfortable after feeds. Although distressing, colic is not harmful and generally resolves by three to four months. Much of the discomfort relates to swallowing air, immature digestion and sensitivity to feeding routines. Parents often need reassurance that they are not doing anything wrong. Simple guidance on winding techniques, feeding pace, and bottle choice can make a significant difference.

Encouraging them to try slower-flow teats, holding the baby upright after feeds and burping more frequently can help reduce wind and discomfort.

Reflux and mild regurgitation are also very common, particularly in the first months of life. Because the muscle separating the stomach and oesophagus is still developing, milk may come back up easily. Babies may spit up small amounts of milk, arch their backs during feeds or experience bouts of hiccups. Most cases improve naturally as the baby grows, sits up and begins to take solids. Advising parents to give smaller, more frequent feeds or keep the baby upright after feeding can be helpful. Pharmacy assistants should always involve the pharmacist before recommending thickened formulas or specialised feeding products.

Constipation is another frequent complaint and may occur during weaning, toilet training or times of emotional stress. Parents may describe hard pellet-like stools, straining, discomfort or changes in appetite. Dietary adjustments are usually the first step—extra fluids, vegetables, fruit and fibre-rich cereals can soften the stool gradually. Parents sometimes need guidance on realistic timeframes, as constipation can take several days to resolve. If symptoms persist or the child is in significant discomfort, the pharmacist may recommend a suitable OTC product such as lactulose, but referral is important if constipation is severe or recurrent.

Conversely, diarrhoea in young children is often caused by viral infections and usually settles within a few days. The primary concern is dehydration, particularly in infants. Pharmacy assistants should look for signs such as reduced wet nappies, dry mouth or tiredness. Oral rehydration solutions are essential whenever a child has diarrhoea or vomiting, as they replace fluids

and electrolytes. Parents may need clear instructions on preparing ORS and offering small, frequent sips. If the child is under three months, has blood in the stool, a persistent fever or diarrhoea lasting more than 72 hours, referral to a GP is necessary.

When discussing OTC options, pharmacy assistants must ensure they are appropriate for the child’s age and symptoms. Simeticone drops are often used to relieve wind or colic by helping air bubbles combine more easily.

Some parents use colic powders or herbal preparations, and while these may provide comfort, reassurance and feeding guidance remain the foundation of care. ORS is the only recommended treatment for diarrhoea, and no anti-diarrhoeal medicines should be used in young children. Any decision regarding thickened formulas or mild laxatives requires pharmacist involvement.

Communication with parents is vital. Many feel overwhelmed or guilty when their child is distressed. Listening carefully, showing empathy and offering simple, practical advice can boost their confidence and reduce anxiety. Reminding them that most digestive issues improve with time, growth and routine helps them manage expectations.

Encouraging them to return if symptoms worsen or do not improve reinforces the pharmacy’s supportive role and ensures children are referred appropriately if warning signs appear.

Red-flag symptoms include persistent vomiting, forceful projectile vomiting, blood or mucus in stools, signs of dehydration, prolonged diarrhoea, fever, severe abdominal pain, or concerns about weight loss or feeding. Any baby who appears listless, unusually drowsy or in significant pain should be referred immediately.

WWHAM Who? Infant or child; confirm age, as treatment options depend heavily on this.

What are the symptoms? Wind, colic, reflux, constipation, diarrhoea, feeding issues, irritability.

How long have they had the symptoms? Short-term or persistent; worsening symptoms need referral.

Action already taken? Feeding changes, OTC products, formula switches, hydration measures.

Medication? Check for prescribed medicines, special formulas, allergies and underlying conditions.

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DRY EYE DISEASE

37

DRY EYE DISEASE Dry Eye Disease (DED) is one of the most common eye conditions encountered in community pharmacy. It affects an estimated 10–30% of adults over 40, with rates rising sharply with age. In Ireland, as in other countries, dry eye is more prevalent in people over 60 and is significantly more common in women, particularly due to hormonal factors such as menopause, pregnancy and oral contraceptive use. Studies also indicate that up to one-third of adults aged 65 and over experience some degree of dry eye symptoms, making it a key condition for pharmacy teams to recognise and manage.

DED—also referred to as dry eye syndrome or keratoconjunctivitis sicca—is a multifactorial condition involving the tear film and ocular surface. It is characterised by a combination of discomfort, visual disturbance and tear film instability, which may lead to inflammation and potential damage to the front of the eye. DED can be temporary, such as after environmental exposure, or chronic, particularly when associated with systemic health conditions.

A range of medical disorders increase the risk of DED. These include autoimmune conditions such as rheumatoid arthritis, Sjögren syndrome, and lupus, as well as thyroid eye disease, diabetes, and structural eyelid problems.

Medications are also a major contributor.

Pharmacological agents with anticholinergic effects—including antihistamines, decongestants, antidepressants, beta-blockers, and diuretics—can all reduce tear production.

Contact lens wear, smoking, vitamin A deficiency, prolonged screen use and exposure to air conditioning or dry windy environments further increase risk.

RECOGNISING SYMPTOMS IN THE PHARMACY Dry eye symptoms typically affect both eyes and can include:  dryness, grittiness, burning or soreness  redness  watery or reflex tearing (especially outdoors)  sticky eyelids on waking  intermittent blurred vision  worsening discomfort throughout the day These symptoms often flare in environments with low humidity, smoke, central heating or prolonged screen time. Because early symptoms can resemble allergic conjunctivitis or infective conjunctivitis, it is important to take a careful history to support correct triage.

A consultation should cover:  the duration and nature of symptoms  any aggravating factors, such as screen use or environmental exposure  current medications  whether the patient wears contact lenses  any underlying systemic or dermatological disease If symptoms include severe pain, significant redness, vision loss, photophobia or symptoms in only one eye, referral to the

pharmacist—and potentially urgent GP or ophthalmology review—is warranted.

MANAGING DRY EYE IN COMMUNITY PHARMACY DED is typically a chronic condition with no permanent cure, but symptoms can be well controlled with proper management.

The primary objective is to restore tear film stability and improve comfort.

Artificial tears remain the first-line treatment and are available in multiple formulations, including drops, gels, ointments and sprays.

Preservative-free preparations are preferred, especially for frequent use or for contact-lens wearers, as preservatives can worsen irritation.

Thicker gels or ointments can be applied at night for prolonged relief, particularly in people who experience significant morning dryness.

Environmental and lifestyle modifications are equally important. Assist patients by recommending:  the 20-20-20 rule for screen use (look 20 feet away for 20 seconds every 20 minutes)  humidifiers in dry indoor environments  wraparound glasses to reduce tear evaporation when outdoors

 avoiding smoke and strong air flow  taking regular breaks during visually demanding tasks Patients who wear contact lenses may benefit from reduced wearing time, switching to daily disposables or using rewetting drops specifically formulated for lens wear.

More severe or persistent DED may warrant prescription therapy such as ciclosporin or corticosteroid eye drops under specialist care.

In rare, refractory cases, ophthalmology may recommend punctal plugs or other surgical options to retain tears.

ROLE OF THE PHARMACY ASSISTANT Pharmacy assistants play a crucial role in identifying dry eye symptoms early, offering advice on product selection and helping patients understand how to use artificial tears correctly. Many people underuse drops or discontinue them too soon. Remind patients that regular use—often several times daily—is needed for sustained relief.

Assistants should also be alert to medicationrelated causes and refer the patient to the pharmacist when necessary so that medicinerelated dryness can be appropriately reviewed.

WWHAM Who? More common in women and adults over 60, but can affect all age groups.

What are the symptoms? Dryness, grittiness, soreness, redness, watering, sticky eyelids.

How long have they had the symptoms? Symptom duration helps distinguish temporary irritation from chronic DED. Action already taken? Eye drops, reducing screen time, avoiding triggers, environmental changes.

Medication? Artificial tears, ocular lubricants, antihistamines or other medicines that may worsen dryness.

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ECTOPARASITES

39

ECTOPARASITES Ectoparasites are parasites that live on the surface of the human body and feed on blood or skin debris. While not usually medically dangerous, they cause significant discomfort, itching, irritation, and embarrassment for customers. Community pharmacy teams play a crucial role in recognising symptoms, offering evidence-based treatment options, providing reassurance, and knowing when referral is required.

SYMPTOMS

HEAD LICE (PEDICULUS HUMANUS CAPITIS)

Topical Insecticides

Head lice are extremely common, particularly among school-aged children. They spread through direct head-to-head contact and do not reflect poor hygiene. Pharmacy assistants must provide accurate information to reduce stigma and promote adherence to treatment.

SYMPTOMS  Persistent itching (though not always present)  Live lice seen moving close to scalp  Nits (eggs) attached firmly to hair shafts  Irritated scalp from scratching

 Intense itching, especially at night  Small blue spots or specks of blood on skin  Visible lice or eggs attached to hair  Irritation or inflammation from scratching

TREATMENT OPTIONS  Permethrin or malathion lotions  Applied to affected areas and washed off after recommended time  Treatment should be repeated after 7 days

KEY COUNSELLING POINTS

First-line: Permethrin 5% Dermal Cream

 Wash clothing and bedding used within previous 48 hours at 50°C

 Apply thoroughly from the neck down (include under nails)

 Avoid sexual contact until treatment is completed

 Leave on for 8–12 hours

 Eyelash infestation requires referral for specialist care

Alternative: Malathion Lotion

TREATMENT OPTIONS

SCABIES (SARCOPTES SCABIEI)

Head lice are treated with:

Scabies is caused by mites burrowing under the skin. It spreads through prolonged skin-toskin contact and is common within households and care homes. Pharmacy teams must recognise symptoms promptly as the condition will not resolve without treatment.

1. Insecticidal Treatments  Contain permethrin or malathion  Kill lice but may have reduced effectiveness in areas with resistance 2. Non-Insecticidal (Physical) Treatments  Contain dimeticone or isopropyl myristate  Kill lice by physically occluding or dehydrating them  Effective regardless of resistance patterns 3. Wet Combing (Bug Busting)

TREATMENT OPTIONS

 Treat sexual partners

SYMPTOMS  Intense itch, worse at night  Fine, curved burrows in skin  Rash in webbing of fingers, wrists, waist, groin, or abdomen  Itch can persist for weeks even after successful treatment

 Repeat after 7 days Used when permethrin is unsuitable.

WHEN TO REFER TO THE PHARMACIST OR GP  Uncertain diagnosis  Infected or broken skin  People with eczema, psoriasis, or atopic skin  Very young children or infants  Pregnant or breastfeeding individuals needing reassurance on safe treatments  Evidence of secondary bacterial infection  Treatment failure despite correct use  Scabies affecting vulnerable groups (elderly, immunocompromised)

 Systematic combing of wet, conditioned hair with a detection comb  Must be performed every 3–4 days for 2 weeks  Suitable when chemical treatments cannot be used

WWHAM

 Treat only if live lice are seen, not just nits

Who? Children with suspected head lice, adults with itching or visible lice, individuals with close-contact exposure, or households where multiple members show symptoms.

 Treat all affected household members at the same time

What are the symptoms? Itching, visible lice, nits in hair, burrows in skin, rashes, bites, irritation, or persistent night-time itching.

 Repeat treatment after 7 days if required

How long have they had the symptoms? Long-standing itch or rash may indicate scabies or secondary infection; recent signs may indicate initial infestation.

KEY COUNSELLING POINTS

 Check hair again after the treatment course  Clean brushes and combs; washing linens is optional but not essential

PUBIC LICE (PTHIRUS PUBIS) Pubic lice (crabs) typically infest coarse hair in the pubic area but may also affect chest, armpits, or eyelashes. They spread through close bodily contact, including sexual contact.

Action already taken? Previous lice treatments, wet combing, home remedies, laundering, or antihistamines. Check if treatments were applied correctly.

Medication? Identify any conditions or medicines affecting suitability (e.g., pregnancy, infants, asthma, skin conditions). Ensure safe selection of permethrin, malathion, or physical treatments. Refer if uncertain.

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

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

EMERGENCY CONTRACEPTION

41

EMERGENCY CONTRACEPTION Emergency contraception (EC) is a safe and effective way to prevent pregnancy after unprotected sex, contraceptive failure, or sexual assault. It does not cause an abortion and cannot interrupt an existing pregnancy. When taken promptly, emergency contraception significantly reduces the chance of pregnancy, and community pharmacy continues to be one of the most accessible places for people to obtain advice and treatment.

It is important to remember that emergency contraception does not protect against sexually transmitted infections (STIs).

Customers who may be at risk should be signposted to testing options, whether via the pharmacy’s home-test kits, HSE free home STI testing services (where available) or local sexual-health clinics.

SUPPORTING CUSTOMERS IN A SENSITIVE, RESPECTFUL WAY Many people find it difficult or embarrassing to discuss sexual health. Pharmacy assistants should therefore create a reassuring environment, avoid judgemental language, and offer the consultation room wherever possible. Not everyone who asks about emergency contraception is sexually active— some may be seeking information for future use or may need clarity on how contraception works. Providing clear explanations in stages, using straightforward language, helps ensure the customer can ask questions comfortably and understand their options.

It is essential not to make assumptions about age, relationship status or sexual behaviour.

Treat every request with professionalism, empathy and confidentiality. Young people under 17 can legally receive emergency contraception without parental consent if they demonstrate understanding of the treatment and its implications.

CURRENT EMERGENCY CONTRACEPTION OPTIONS IN IRELAND

A third option—the copper IUD—is the most effective form of emergency contraception and can be fitted through GP or specialist services.

Pharmacy staff should be aware of this option and signpost appropriately, especially when oral EC is not suitable or when the customer prefers the most effective method.

FREE CONTRACEPTION SCHEME (IRELAND) The HSE Free Contraception Scheme, introduced in 2022, now covers women and people with a uterus aged 17–36 (expanding further over time). This scheme aims to reduce barriers to regular contraception and improve reproductive health access. Pharmacy teams should be familiar with the scheme’s inclusion criteria and referral process, as many customers seeking EC may benefit from transitioning to ongoing contraception.

The scheme covers:  the cost of prescription contraception  consultations with GPs/clinicians  fitting and removal of long-acting reversible contraception (LARC)  contraceptive injections and checks  training for additional clinicians to fit/remove LARC Pharmacy staff can help customers understand how to access these services following an EC consultation.

COMMUNICATING ABOUT EC EFFECTIVELY When speaking to customers:  Reassure them that seeking emergency contraception is responsible and appropriate.  Use familiar terms such as “morning-after pill” if it helps the conversation.  Offer privacy wherever possible.

 Provide clear guidance on when to take the medication, side effects, what to expect from their next period, and when to seek medical advice.  Encourage discussion about ongoing contraception to prevent future need for EC.

PHARMACY CONSIDERATIONS  Are we confident discussing the differences between LNG and UPA?  Do we understand the latest PSI/ HSE guidance on supplying EC and safeguarding minors?  Are we able to recognise when referral to the pharmacist or GP is required (e.g., heavy bleeding, sexual assault, repeat use within the same cycle)?  Do we know how to signpost customers to STI testing services and the HSE Free Contraception Scheme?  Do we maintain a supportive, confidential environment for all sexual-health conversations?

Pharmacies in Ireland can supply two oral EC options without prescription: 1. Levonorgestrel (LNG) 1.5 mg  Most effective when taken within 72 hours of unprotected intercourse.  Works primarily by delaying ovulation.  Can be used during breastfeeding.  Less effective if ovulation has already occurred or in individuals with higher body weight.

2. Ulipristal acetate (UPA) 30 mg (ellaOne)  Effective up to 120 hours (5 days) after unprotected intercourse.  More effective than LNG if ovulation is near.  Not suitable if already taking hormonal contraception unless restarting method correctly afterwards.  Breastfeeding advice must be clarified (avoid for one week).

WWHAM Who? Sexually active individuals seeking emergency contraception, regardless of age (including under-17s if competent to consent).

What are the symptoms? Unprotected sex, condom breakage, missed pills, failure of contraception, need for STI advice.

How long have they had the symptoms? Time since unprotected intercourse is crucial: LNG effective up to 72 hours | UPA effective up to 120 hours | Copper IUD effective up to 5 days (or 5 days after ovulation) Action already taken? Have they taken EC already this cycle? Have they spoken to GP or used routine contraception?

Medication? Consider suitability of LNG vs UPA, interactions with hormonal contraceptives, breastfeeding status, and signpost STI testing or ongoing contraception.

The end of erectile problems?

Touch wood.

Available over the counter. No prescription required.

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

ABBREVIATED PRESCRIBING INFORMATION Product Name: Sidena 50 mg Tablets.

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

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

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

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

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

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

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

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

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

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

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

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

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

Supply status: Supply through pharmacies only.

ERECTILE DYSFUNCTION

43

ERECTILE DYSFUNCTION Erectile dysfunction (ED) is a common and often distressing condition that affects men of all ages, although it is most prevalent in those over 40. Global estimates suggest that more than 150 million men experience ED, yet the true numbers are likely much higher due to underreporting. Many men feel uncomfortable discussing sexual health, and some clinicians may not routinely ask about it. This makes the community pharmacy an important access point for support, information, and signposting to medical care.

ED is defined as the consistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance. While occasional episodes are normal, persistent symptoms can significantly affect emotional wellbeing, confidence, and intimate relationships. Pharmacy staff therefore play an essential role in reducing stigma, providing accurate information, and ensuring patients feel comfortable discussing concerns.

 Cimetidine and ketoconazole  Some antihypertensives A full medication history should always be reviewed by the pharmacist, as dose changes or alternative treatments may be appropriate.

ASSESSMENT AND THE ROLE OF THE PHARMACY Pharmacy staff do not diagnose ED, but they can identify when referral is necessary, provide lifestyle advice, and support patients who may be embarrassed or unsure where to begin. Staff should respond with empathy, professionalism, and privacy.

Offering the consultation room can make a significant difference.

A pharmacist will assess:  Duration and severity of symptoms  Onset pattern (sudden vs. gradual)

UNDERSTANDING THE CAUSES

 Medication use and medical history

Erectile dysfunction is typically multifactorial.

Physical, psychological, and lifestyle influences often interact, meaning each case may require different support or referral.

 Risk of underlying cardiovascular disease or diabetes

Common physical causes include:  Cardiovascular disease  Diabetes mellitus (men with diabetes are four times more likely to develop ED)

The pharmacist may use structured questions to ensure the patient is safe to receive treatment when appropriate (e.g., PDE5 inhibitors for eligible patients following assessment). Pharmacy assistants must always refer ED enquiries to the pharmacist.

Healthy lifestyle changes can significantly improve erectile function and overall cardiovascular health.

WHEN TO REFER URGENTLY Immediate referral is required if the patient describes:  Chest pain or exertional symptoms

 Hyperlipidaemia and hypertension

LIFESTYLE & SUPPORTIVE ADVICE

 Obesity and metabolic syndrome

Key advice includes:

 Peyronie’s disease (curvature or pain)

 Neurological disease

 Smoking cessation

 Neurological symptoms

 Hormonal issues such as low testosterone

 Weight management

 Benign prostatic hyperplasia (BPH) with lower urinary tract symptoms

 Reducing alcohol consumption

 Suspected low testosterone with systemic symptoms

Because ED can be an early indicator of cardiovascular disease, continued or worsening symptoms should always be taken seriously.

Lifestyle factors such as smoking, excessive alcohol intake, drug use, poor diet, and inactivity can also contribute.

Psychological causes—including anxiety, depression, relationship difficulties, stress, and performance anxiety—are especially common in younger men. Features that may suggest a psychological origin include:  Sudden onset  Good erections during masturbation  Morning erections still present  Situational symptoms (e.g., only with one partner)

MEDICATION-RELATED ED Many medications list ED or reduced libido as a side effect. Pharmacy teams should be aware of common culprits, including:  SSRIs (e.g., fluoxetine, paroxetine, sertraline)  Thiazide diuretics  Some beta-blockers  Spironolactone

 Increasing physical activity  Managing stress and promoting mental health  Reviewing medicines with the pharmacist or GP

 Severe lower urinary tract symptoms

 ED after trauma  Young men with sudden severe ED without clear psychological cause Regular GP follow-up is advised for all ongoing ED cases, given its strong association with cardiovascular disease.

WWHAM Who? Adult males experiencing difficulty achieving or maintaining an erection.

Always involve the pharmacist immediately—ED enquiries should not be managed independently by assistants.

What are the symptoms? Difficulty achieving or sustaining an erection, reduced sexual performance, loss of libido, or situational performance difficulty. Ask sensitively.

How long have they had the symptoms? Symptoms lasting longer than several weeks, suddenly worsening, or occurring frequently should be assessed by the pharmacist and may require GP referral. Action already taken?

Has the patient tried lifestyle changes, spoken to a GP, discontinued any medication, or tried any treatments? Has the issue occurred with all partners and situations?

Medication? Check whether the patient is taking medications associated with ED (e.g., SSRIs, antihypertensives). PDE5 inhibitors must only be supplied after pharmacist assessment to ensure safety (e.g., cannot be used with nitrates).

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FATIGUE

45

FATIGUE Fatigue is one of the most common symptoms presented in community pharmacy.

It affects individuals of all ages and can range from mild tiredness to debilitating exhaustion that significantly impacts daily functioning. Unlike simple sleepiness, fatigue is a persistent lack of physical and/or mental energy that is not relieved by rest. Because fatigue can arise from numerous physical, psychological, or lifestyle-related causes, pharmacy assistants must recognise when to offer supportive advice and when to refer to the pharmacist or a GP for further evaluation.

Fatigue can be acute and short-lived—for example, following a period of stress, illness, or disrupted sleep—or it can be chronic, lasting longer than three months. Chronic fatigue often affects concentration, memory, mood, and motivation, and may be associated with underlying medical conditions.

 Bereavement  Stress and burnout  Chronic worry or insomnia Customers may not always recognise the emotional component, so gentle, open-ended questions can be helpful.

MEDICATION-RELATED FATIGUE Fatigue and drowsiness are common side effects of many medicines. Examples include:  Antihistamines  Benzodiazepines  Antidepressants  Antipsychotics  Beta-blockers

COMMON CAUSES OF FATIGUE

 Muscle relaxants

Fatigue can have a single cause or may result from multiple overlapping factors.

Understanding these helps pharmacy teams support customers effectively.

 Opioid analgesics

LIFESTYLE FACTORS Many customers presenting with fatigue may have contributing lifestyle issues such as:

If medication is suspected, a pharmacist review is essential.

ASSESSMENT IN THE PHARMACY

MANAGEMENT & SUPPORTIVE ADVICE For individuals experiencing simple tiredness due to lifestyle factors, pharmacy teams can suggest:  Improving sleep hygiene (consistent bedtime, limiting screen time before bed, creating a dark and cool sleep environment)  Regular physical activity  Balanced nutrition with adequate iron and B vitamins  Hydration  Limiting alcohol and caffeine  Stress reduction strategies such as mindfulness, breathing exercises, or short walks

 Excessive alcohol consumption

Pharmacy assistants should engage customers in a non-judgemental, supportive manner. A tired or overwhelmed person may be embarrassed or unsure about discussing their symptoms. Using WWHAM principles helps guide conversations and ensures appropriate information is gathered before referring to the pharmacist.

 Poor diet or inadequate hydration

Always consider:

WHEN TO REFER

 Overexertion or excessive physical training

 Duration and severity of symptoms

These causes may be improved with supportive advice and behaviour changes.

 Presence of red flags (e.g., chest pain, severe breathlessness, weight loss)

Urgent referral to a GP or emergency services is required if fatigue is accompanied by:

MEDICAL CONDITIONS

 Possible infection

 Palpitations or dizziness

Fatigue can be a symptom of a wide range of health conditions, including:

 Lifestyle context

 Unexplained weight loss

 Concurrent medication

 Severe abdominal pain

Assistants must not attempt to diagnose.

Instead, the goal is to understand the situation well enough to support appropriate referral and offer general wellbeing advice.

 Persistent fever

 Poor or irregular sleep patterns v High levels of stress or anxiety  Sedentary lifestyle

 Viral or bacterial infections (e.g., influenza, COVID-19, mononucleosis)  Anaemia, particularly iron deficiency  Thyroid disorders (hypothyroidism or hyperthyroidism)  Diabetes  Chronic fatigue syndrome (CFS/ME)  Sleep apnoea  Menopause and perimenopause  Heart, liver, or kidney disease  Autoimmune disorders Pharmacy assistants should be aware that persistent or severe fatigue warrants medical investigation.

MENTAL HEALTH CONTRIBUTORS Fatigue is strongly linked with emotional wellbeing. Common contributors include:  Depression  Anxiety

 Reviewing work–life balance Over-the-counter supplements may help certain individuals, such as those with low dietary intake of iron, vitamin D, or B-complex vitamins, but should only be recommended following pharmacist consultation.

 Chest pain or shortness of breath

 Fainting or collapse  Suspected severe infection

WWHAM Who? Fatigue can affect anyone. Identify the customer’s age and any relevant health conditions to guide referral to the pharmacist.

What are the symptoms? Persistent tiredness, low energy, difficulty concentrating, unrefreshing sleep, slowed thinking, or reduced motivation.

Ask whether symptoms are new, worsening, or longstanding.

How long have they had the symptoms? Fatigue lasting more than a few weeks should be reviewed by the pharmacist and may require GP investigation.

Action already taken? Ask about sleep habits, hydration, diet, exercise, stress levels, and any steps taken to improve symptoms. The customer may already have tried lifestyle changes or OTC supplements.

Medication? Check whether the customer is taking any medicines that can cause drowsiness or fatigue. Always involve the pharmacist to assess potential drug-related causes.

THE POWER OF NEXIUM CONTROL FOR HEARTBURN RELIEF Frequent heartburn (i.e. that occurs more than once a week)1 can significantly impact a patient’s quality of life. 2 Proton Pump Inhibitors (PPIs) treat heartburn by targeting the source of excess stomach acid, 3 and are recommended by NICE guidelines as a first-line treatment for frequent heartburn.4

Proton Pump Inhibitors

Alginates

Antacids

ANTACIDS

Suitable for

People suffering from frequent heartburn (ie. more than once per week1)

People experiencing occasional heartburn

People experiencing occasional heartburn

Affects acid production Mode of action

Targets acid at the source Forms a surface or ‘raft’ by blocking proton over stomach contents to pumps in parietal cells to stop reflux5 reduce acid production3

Once in contact with acid produces salt and water, neutralising contents6

Dosing

One a day for 24-hour protection

As required after meals and at bedtime for shortacting relief

As required throughout the day for short-acting relief

Sodium alginate

Calcium carbonate

Active Esomeprazole, ingredients incl. Omeprazole

TARGET

DISCOVER THE SCIENCE OF NEXIUM CONTROL

References: 1. Farup C, et al. Arch Intern Med. 2001 Jan 8;161(1):45-52. 2. Kulig M et al. Aliment Pharmacol Ther. 2003;18:767-76.

3. Shin JM, Sachs G. Pharmacology of proton pump inhibitors. Curr Gastroenterol Rep. 2008 Dec;10(6):528-34. 4. NICE guidelines CG184 Sept 2014. 5. Mandel KG, et al.

Aliment Pharmacol Ther. 2000 Jun;14(6):669-90. 6. Maton PN, Burton ME. Drugs. 1999 Jun;57(6):855-70.

Nexium Control 20 mg gastro-resistant tablets (contain esomeprazole). Always read the label/leaflet. PM-IE-NEC-25-00003

HEARTBURN

47

HEARTBURN Heartburn is one of the most frequent gastrointestinal complaints seen in community pharmacy. It presents typically as a burning sensation behind the breastbone, often rising toward the throat. Symptoms usually occur after eating, when lying down, after exercise, or during the night. The discomfort is caused by acid reflux, where stomach acid travels into the oesophagus because the lower oesophageal sphincter becomes weakened or temporarily relaxes, allowing gastric contents to move upwards.

Although most people experience occasional heartburn, frequent or persistent symptoms can significantly affect daily life. Many people self-treat, and for mild to moderate cases the pharmacy is often the first point of contact.

As a result, pharmacy assistants need to understand common triggers, when OTC treatments are appropriate, and when referral to the pharmacist or GP is essential.

WHO IS AT RISK AND WHAT CAUSES IT? Heartburn can affect anyone, but certain groups are more prone. Individuals over 55—especially those who are overweight or experiencing high stress—have higher rates of reflux symptoms. Poor dietary habits, smoking, excessive alcohol intake, overeating or eating late at night, and regularly consuming trigger foods such as citrus, tomatoes, chocolate, caffeine, spicy dishes or fatty meals can all contribute.

Exercise, particularly high-impact activity, may worsen symptoms. Pregnancy is also a major risk factor as hormonal changes and increased abdominal pressure promote reflux.

Some medications, including NSAIDs, aspirin, bisphosphonates, oral steroids, calcium channel blockers and certain supplements, can irritate the stomach or relax the oesophageal sphincter, leading to dyspepsia or heartburn.

When symptoms occur more than three times per week, patients may be experiencing gastro-oesophageal reflux disease (GORD).

This longer-lasting form of reflux can cause additional complications and should prompt medical review.

ASSESSING THE PATIENT IN THE PHARMACY Pharmacy staff should explore symptoms with open-ended questions. Ask about:

TREATMENT OPTIONS AVAILABLE IN THE PHARMACY

include headache, abdominal pain, nausea, constipation or diarrhoea.

Three main OTC treatment groups are used for heartburn and dyspepsia:

LIFESTYLE ADVICE AND NONMEDICINAL APPROACHES

1. Antacids and Antacid–Alginate Combinations

Lifestyle modification is crucial for long-term management. Pharmacy assistants can guide patients to:

Antacids neutralise stomach acid, providing fast but short-lasting relief. They can be useful for mild, occasional discomfort. Many formulations contain combinations of antacid salts alongside alginates, which form a protective “raft” that sits on top of stomach contents and reduces acid reflux into the oesophagus. Alginate-antacid products have been shown to provide better relief than antacids alone.

 reduce or avoid known trigger foods  eat smaller meals and avoid eating late at night  maintain a healthy weight  stop smoking  limit alcohol intake

These products must be taken several times a day, ideally between meals and at bedtime.

 raise the head of the bed to reduce nighttime reflux

2. H2-Receptor Antagonists

 keep a food and symptom diary to identify triggers

Famotidine (Pepcid AC) is the only H2antagonist available OTC in Ireland. It works by reducing acid production and is licensed for short-term relief and prevention of heartburn and indigestion, especially around mealtimes. It can be taken 15 minutes before eating to prevent symptoms, or at symptom onset. The maximum OTC dose is 20 mg for up to 14 days, and it is unsuitable for patients with severe renal impairment.

3. Proton Pump Inhibitors (PPIs) PPIs such as pantoprazole or omeprazole reduce acid secretion more effectively than H2-antagonists and are used for more frequent symptoms. They may take a few days to build full effect, but relief can be long lasting. PPIs are licensed for 14 days of OTC use; if symptoms persist beyond this period, referral is required. Common side effects

For pregnant women, antacids are generally considered safe, but the pharmacist must always confirm suitability.

WHEN TO REFER Immediate referral to the pharmacist is needed if:  symptoms occur regularly (more than three times weekly)  symptoms worsen or do not respond to OTC treatment  the patient is over 55 with persistent/new symptoms  there is difficulty swallowing, persistent vomiting, gastrointestinal bleeding, or unexplained weight loss

 the pattern and frequency of symptoms  known dietary triggers

WWHAM

 alcohol, smoking and stress levels

Who? Heartburn can affect anyone; common in adults and pregnant women.

 medications that may contribute to symptoms

What are the symptoms? Burning chest sensation, bloating, nausea, wind, loss of appetite.

 red-flag symptoms (listed below) It is essential to refer to the pharmacist when a patient presents with difficulty swallowing, unexplained weight loss, vomiting blood, black or tarry stools, severe abdominal pain, recurrent symptoms in older patients, or symptoms that persist despite OTC treatment.

How long have they had the symptoms? Typically after meals, but may occur later or at night; pregnancy symptoms vary.

Action already taken? Antacids, dietary changes, reducing triggers, food diary.

Medication? Antacids, alginate products, famotidine, PPIs (short-term).

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HEART HEALTH

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HEART HEALTH Heart disease remains one of the leading causes of illness and death in Ireland and the UK, but with the right lifestyle advice and medication support, pharmacy teams can make a huge difference to prevention and long-term management. As pharmacy assistants are often the first point of contact for customers seeking advice, having a good understanding of heart health, risk factors, and available treatments is essential.

UNDERSTANDING HEART HEALTH The heart is a muscular organ that pumps blood around the body, supplying oxygen and nutrients to vital organs. Cardiovascular disease (CVD) refers to conditions affecting the heart and blood vessels. The most common include:  Coronary heart disease (CHD): Narrowing or blockage of the coronary arteries by fatty deposits (atherosclerosis).  Angina: Chest pain caused by reduced blood flow to the heart.

For those unable to do vigorous exercise, even light daily movement is beneficial.

Smoking and Alcohol Advise customers that smoking doubles the risk of heart attack and stroke. Offer information on the pharmacy’s smoking cessation services and nicotine replacement options.

Alcohol should be limited to no more than 14 units per week, spread evenly over several days with alcohol-free days each week.

Weight and Stress Management Maintaining a healthy weight and managing stress can help control blood pressure and cholesterol. Relaxation techniques, mindfulness, and adequate sleep are all important for cardiovascular health.

PHARMACY’S ROLE IN HEART HEALTH Pharmacy teams are well-placed to provide screening, support, and referral:

 Heart attack (myocardial infarction): Occurs when a blood clot completely blocks a coronary artery.

 Blood Pressure Checks: Many pharmacies now offer walk-in blood pressure testing. Early detection of hypertension can prevent long-term complications.

 Heart failure: When the heart cannot pump blood effectively.

 Cholesterol Testing: Point-of-care testing can identify customers needing GP review.

 Hypertension (high blood pressure): Increases strain on the heart and arteries, often symptomless.

 Smoking Cessation Services: Encourage participation and monitor progress.

RISK FACTORS

 Medication Advice: Support customers prescribed treatments for hypertension, cholesterol, or heart failure, helping them understand their regimen and avoid side effects.

Understanding risk factors helps pharmacy staff identify customers who may need extra support or referral.

COMMON MEDICATIONS FOR HEART HEALTH

These conditions are closely linked, and many share the same underlying causes.

Modifiable Risk Factors These can be reduced through lifestyle and medical management:  Smoking  High blood pressure  High cholesterol  Poor diet (particularly high salt, saturated fat, and sugar intake) Non-Modifiable Risk Factors  Age (risk increases with age)  Family history of heart disease  Gender (men are generally at higher risk earlier in life)  Ethnicity (some ethnic groups have a higher risk of hypertension or diabetes) Encouraging customers to understand these factors empowers them to make positive choices.

Exercise Regular physical activity strengthens the heart and lowers blood pressure. Encourage at least 150 minutes of moderate exercise per week (e.g., brisk walking, swimming, cycling).

Pharmacy assistants should be familiar with the main classes of medicines prescribed for cardiovascular conditions:  Statins (e.g., atorvastatin, simvastatin): Lower cholesterol levels and reduce risk of heart attack or stroke.

 Antihypertensives: Includes ACE inhibitors (ramipril), beta-blockers (bisoprolol), calcium channel blockers (amlodipine), and diuretics (bendroflumethiazide). These control blood pressure and reduce strain on the heart.  Antiplatelets (aspirin, clopidogrel): Prevent blood clots in patients with CHD or after heart attack.  Anticoagulants (warfarin, apixaban): Used in patients with irregular heartbeat (atrial fibrillation) to prevent stroke.  Nitrates (glyceryl trinitrate spray): Relieve chest pain in angina by relaxing blood vessels.

When customers collect these medicines, assistants can reinforce key messages such as:  Take medication at the same time daily.  Continue even if feeling well — heart medicines are preventive.  Report dizziness, swelling, or unusual bleeding to the pharmacist or GP.

PHARMACIST-LED ADVICE AND REFERRAL Pharmacists can identify when referral is needed — for example, unexplained chest pain, shortness of breath, palpitations, ankle swelling, or severe fatigue. Pharmacy assistants should always seek pharmacist advice if these symptoms are mentioned.

Encouraging routine check-ups, adherence to prescribed medicines, and attendance at cardiac rehabilitation programmes supports long-term recovery and wellbeing.

WWHAM Who? Adults at risk of, or living with, heart disease — particularly those with high blood pressure, high cholesterol, diabetes, or a family history of CVD. What are the symptoms? Chest pain, shortness of breath, palpitations, ankle swelling, fatigue, or dizziness. However, hypertension often causes no symptoms, so screening is key.

How long have they had the symptoms? New or worsening symptoms may suggest acute heart problems and require immediate referral to the pharmacist or GP. Sudden severe chest pain or collapse needs emergency medical attention (999).

Action already taken? Check if the customer is using any prescribed medication, lifestyle measures, or home monitoring (e.g., blood pressure readings).

Medication? Ask about prescribed medicines (statins, antihypertensives, anticoagulants) and any over-the-counter remedies. Always refer to the pharmacist before recommending additional medicines to avoid interactions.

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IMMUNITY

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IMMUNITY A significant number of customers seek advice on ways to strengthen their immune system, improve energy levels, or reduce their susceptibility to common infections. Modern lifestyles, busy schedules, and inconsistent dietary habits mean that many individuals struggle to meet daily nutritional requirements through food alone. As a result, interest in vitamins, minerals, and nutritional supplements has increased substantially, with pharmacies becoming a primary destination for product guidance. Pharmacy assistants play a critical role in helping customers navigate this category safely and confidently.

UNDERSTANDING IMMUNITY AND NUTRITIONAL SUPPORT The immune system relies on adequate intake of essential nutrients, particularly vitamins and minerals that support cellular repair, energy metabolism, and normal immune responses.

When customers are not consuming a balanced diet—whether due to appetite issues, restricted eating patterns, illness, or lifestyle choices— they may report low immunity, tiredness, more frequent colds, or difficulty recovering from minor infections.

It is important for pharmacy staff to understand that vitamins and minerals serve different functions: vitamins participate in biochemical processes, while minerals often act as cofactors that enable vitamins to work effectively. Both are required for robust immune function.

Customers often take supplements with the belief that doing so will boost health, slow ageing, enhance vitality, or reduce their risk of chronic illnesses. Many also turn to supplements when they feel run down or at the onset of a cold. While supplements can be beneficial in specific circumstances, pharmacy assistants should stay informed about the evidence, limitations, and appropriate use of these products, and refer to the pharmacist whenever clinical advice is required.

GROWING CONSUMER DEMAND AND NAVIGATING SUPPLEMENT CHOICE The supplement market has grown dramatically, with products now widely accessible well beyond traditional health food stores. The result is a broad and often confusing range of formulations, strengths, and combinations for customers to choose from. Pharmacy staff must be familiar with commonly used vitamins and minerals, recommended daily allowances, and the populations who may benefit most.

Buyer behaviour varies across demographic groups. Women tend to purchase supplements more frequently than men, and usage increases with age or chronic health concerns. Children account for a substantial share of supplement use, with many receiving multivitamins or mineral support routinely.

The EU Recommended Daily Allowances (RDAs) provide a benchmark for safe and adequate nutrient intake. Customers should be guided toward products that align with these standards unless otherwise directed by a healthcare professional.

KEY VITAMINS AND MINERALS RELEVANT TO IMMUNITY Vitamin D: Essential for immune function, bone health, and muscle strength. Recommended for pregnant and breastfeeding women, older adults, and children from six months to five years. Many adults have insufficient vitamin D due to limited sun exposure, making supplementation common.

Combination and Multivitamin Products: Combination supplements—including multivitamins, immune-support blends, and products combining fish oils or herbal ingredients—are increasingly popular. Fish oils, containing omega-3 fatty acids, remain among the most purchased supplements. Assistants should guide customers toward evidenceinformed choices and avoid recommending products solely on the basis of promotions.

Vitamin B9 (Folic Acid): Critical for cell division and neurological development in pregnancy.

Recommended for all women trying to conceive and during the first 12 weeks of pregnancy.

Standard supplementation is 400 mcg daily for low-risk women and 5 mg for high-risk individuals, under clinical supervision.

COMMUNICATING EFFECTIVELY AND ENSURING SAFE USE

Vitamin C: One of the most widely used supplements for immune support. Customers often take it during colds, alongside zinc or herbal products such as echinacea. While Vitamin C has demonstrated antiviral properties in laboratory settings, its clinical effectiveness varies. Importantly, Vitamin C is not appropriate for everyone—individuals with diabetes or haemochromatosis require pharmacist review before use. High doses can cause gastrointestinal discomfort.

 Asking clear, structured questions to understand the customer’s needs

Zinc: A trace mineral vital for normal immune function and growth. Zinc is frequently recommended for early cold symptoms.

Customers must follow recommended dosages, as excessive intake can lead to nausea, vomiting, diarrhoea, or abdominal pain.

Pharmacy assistants should ensure customers feel that supplement recommendations are personalised, appropriate, and safe. Key considerations include:

 Identifying potential nutrient gaps or lifestyle factors contributing to low immunity  Explaining the purpose, benefits, and limitations of suggested products  Checking for potential interactions with medications or health conditions  Referring any clinical concerns, chronic illness, pregnancy, or complex supplementation questions to the pharmacist A careful, informed conversation improves customer confidence and reduces the risk of inappropriate or excessive supplement use.

WWHAM Who? Adults feeling run down, older adults, children, pregnant women, or individuals recovering from illness or with poor dietary patterns.

What are the symptoms? Frequent colds, slow recovery, low energy, poor appetite, stress, disrupted sleep, or difficulty maintaining a balanced diet.

How long have they had the symptoms? Symptoms lasting several weeks, worsening fatigue, or persistent low immunity should be escalated to the pharmacist. Sudden changes with fever or acute illness require immediate referral.

Action already taken? Customer may have tried multivitamins, Vitamin C, zinc, lifestyle changes, or dietary improvements. Identify what has helped and what has not.

Medication? Check for medicines that may alter nutrient absorption or affect immune function. Refer to the pharmacist if the customer has chronic illness, is pregnant, or is taking multiple medications.

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IRON DEFICIENCY

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IRON DEFICIENCY Iron deficiency is one of the most common nutritional deficiencies encountered in community pharmacy. It happens when the body doesn’t have enough iron to make healthy red blood cells, which carry oxygen throughout the body.

Without enough iron, a person may begin to feel tired, weak, or short of breath. If the deficiency continues, it can lead to iron deficiency anaemia — a condition that can affect mood, concentration, and overall wellbeing.

Pharmacy assistants are often the first point of contact for people who feel constantly tired or run down. Recognising possible signs of iron deficiency and knowing how to handle these conversations safely are important skills that help patients get the right care at the right time.

UNDERSTANDING IRON DEFICIENCY Iron deficiency can develop for several reasons.

Some people may not eat enough iron-rich foods, while others may lose iron through heavy menstrual bleeding, injury, or gastrointestinal bleeding. Certain life stages also increase the body’s need for iron, such as pregnancy, childhood, and adolescence. Medical conditions like coeliac disease or inflammatory bowel disease can also reduce how well iron is absorbed from food.

The symptoms of iron deficiency can vary from person to person. Common complaints include fatigue, pale skin, dizziness, headaches, brittle nails, or cold hands and feet. Some people experience shortness of breath even with mild activity or find it difficult to concentrate. Because these symptoms can also be caused by other conditions, it’s important that pharmacy staff encourage patients with ongoing or severe symptoms to see their GP for a blood test.

WHEN TO REFER Not all cases of tiredness can be treated with supplements, and it’s essential to recognise when referral is appropriate. Patients who describe persistent or worsening fatigue, unexplained weight loss, or visible signs of blood loss should always be referred. Pregnant women, children, and older adults should also be directed to their GP for assessment before starting iron supplements.

If a patient has already tried over-the-counter iron but feels no improvement, this too warrants referral — there may be an underlying cause that needs medical attention. It’s safer to overrefer than to miss a potential case of anaemia or another health concern.

ADVICE AND SELF-CARE For many people, improving dietary intake can make a significant difference. Encourage patients to include both haem and non-haem iron sources in their diet. Haem iron, found in red meat, poultry, and fish, is absorbed more efficiently by the body. Non-haem iron comes from plant sources such as beans, lentils, dark leafy greens, and fortified cereals. Combining these foods with a source of vitamin C — like fruit, peppers, or tomatoes — helps the body absorb iron more effectively.

It’s also useful to remind patients that certain foods and drinks can reduce absorption.

Tea, coffee, and dairy products are best taken separately from meals or supplements containing iron.

If dietary changes alone aren’t enough, iron supplements can be considered, but this decision should be made in consultation with the pharmacist. Some products contain gentle iron formulations that are easier on the stomach, while others provide higher doses for those with confirmed deficiency. Common side effects include constipation, nausea, and dark stools, which are usually harmless but can be surprising for patients. Always remind customers to take supplements with food and to store them safely away from children.

COMMUNICATION IN PRACTICE Good communication builds trust and helps ensure patient safety. When discussing symptoms of tiredness or low iron, take the time to listen carefully and show empathy. People experiencing fatigue often feel frustrated or worried, so a calm and understanding approach goes a long way.

Avoid using medical jargon — instead of saying “anaemia,” you could explain that “iron helps your body make healthy blood cells, and low levels can make you feel tired or weak.”

Never attempt to diagnose iron deficiency yourself. Only a GP can confirm it through a blood test. If you’re ever unsure about what advice to give or whether a patient should be referred, always check with the pharmacist before recommending any product.

WWHAM Who? Anyone experiencing unexplained tiredness, weakness, pale skin, dizziness, shortness of breath, or difficulty concentrating. Pay special attention to pregnant women, children, older adults, and customers with chronic illnesses such as kidney or bowel disease.

What are the symptoms? Tiredness or fatigue that doesn’t improve with rest, pale complexion, brittle nails, hair loss, cold hands and feet, or breathlessness.

How long have they had the symptoms? Fatigue lasting several weeks or longer should be discussed with the pharmacist or referred to the GP for a blood test. Short-term tiredness may be related to stress or lifestyle, but persistent or worsening symptoms suggest iron deficiency or another medical cause.

Action already taken? Ask if they have used any supplements or multivitamins and whether these helped. Some may have tried dietary changes or “energy tonics.”

Medication? Check for any current medicines or medical conditions. Iron can interact with thyroid medication, certain antibiotics, and calcium supplements.

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MENOPAUSE

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MENOPAUSE The menopause—often referred to as “the change of life”—marks the natural end of menstruation. For most women, this transition does not occur suddenly. Periods typically become irregular, lighter or heavier, or more widely spaced before stopping completely.

A woman is considered to have reached menopause once she has had no period for 12 consecutive months, after which she is described as post-menopausal. In Ireland, the average age of menopause is around 52 years.

For some women, menopause occurs earlier than expected. When it takes place before age 45, it is termed early or premature menopause, and when it occurs before age 40, it affects around 1% of women. Early menopause can have significant physical and emotional impacts and often requires additional clinical support.

Up to 80% of women experience symptoms in the years leading up to menopause (perimenopause), and almost half report symptoms that significantly affect daily life.

These changes are caused by declining levels of oestrogen and progesterone, which influence many systems within the body.

Without treatment, symptoms often settle naturally within two to five years, although for some they persist much longer.

RECOGNISING MENOPAUSAL SYMPTOMS Menopausal symptoms vary widely between individuals, making it essential for pharmacy teams to listen carefully and show sensitivity.

Common symptoms include hot flushes, night sweats, sleep disturbance, vaginal dryness, itching or discomfort, recurrent urinary tract infections, low mood, irritability, and difficulties with concentration or memory. Changes to bleeding patterns—irregular or more frequent periods—are often the earliest sign.

MENOPAUSE AND SLEEP Sleep problems are among the most disruptive symptoms of menopause, affecting up to 60% of women. Falling hormone levels can lead to insomnia, restless sleep, early waking, and daytime fatigue. Night sweats, overheating, bladder urgency, anxiety and musculoskeletal aches can further interrupt sleep. The impact on cognitive function, mood, energy and quality of life can be significant. If appropriate, Hormone Replacement Therapy (HRT) can restore hormone levels and reduce many of these symptoms, often improving sleep quality.

are key components of cardiovascular protection. For some women, HRT—when appropriate—may also support long-term heart health.

Menopause can be a sensitive topic, so creating a welcoming atmosphere and using open-ended questions can make a significant difference.

THE ROLE OF THE PHARMACY TEAM

PHARMACY CONSIDERATIONS

Community pharmacy staff play a central role in supporting women through menopause.

Many customers may be unsure whether their symptoms are menopausal, worried about the safety of HRT, or unaware of lifestyle measures that can help. Pharmacy assistants should be confident in recognising symptoms, understanding general treatment options, and knowing when to refer to the pharmacist or GP.

 Are we confident discussing menopause sensitively and respectfully?

Support may include:  signposting patients to reliable information  discussing over-the-counter options for managing symptoms  reinforcing lifestyle advice  helping women prepare for a conversation with their GP about HRT  offering empathy, reassurance, and a nonjudgemental environment

 Am I and my team familiar with the full range of menopausal symptoms—not just hot flushes?

 Do we understand lifestyle measures that support symptom control (e.g., exercise, sleep routine, cooling strategies, avoiding triggers)?  Are we aware of the different forms of HRT and able to explain them at a basic level?  Do we feel prepared to respond to concerns about breast-cancer risk using up-to-date guidance?  Is further CPD or team training required to strengthen confidence in menopause conversations?

WWHAM Who? Women typically experience menopause between ages 45–55, with the average at 52.

MENOPAUSE AND HEART HEALTH

What are the symptoms? Hot flushes, night sweats, sleep difficulties, vaginal dryness or discomfort, low mood, recurrent UTIs, irregular bleeding.

Oestrogen plays a protective role in cardiovascular health. Before menopause, women have significantly lower rates of heart disease than men, but this advantage decreases once oestrogen levels fall. Women who experience premature menopause or surgical removal of the ovaries have a higher risk of heart disease, making early assessment and lifestyle advice essential.

How long have they had the symptoms? Symptoms can last 2–5 years, sometimes longer.

A healthy diet, regular physical activity, smoking cessation and weight management

Action already taken? Lifestyle changes such as staying cool at night, avoiding caffeine/alcohol, relaxation techniques, or trying lubricants or moisturisers for vaginal dryness.

Medication? Possibilities include Hormone Replacement Therapy (HRT), local vaginal oestrogen, low-dose antidepressants for vasomotor symptoms, or medicines for osteoporosis prevention (when appropriate).

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MULTIVITAMINS IN CHILDREN

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MULTIVITAMINS IN CHILDREN Ensuring that children receive adequate nutrition is a common concern for parents, particularly when eating habits are unpredictable or when a child is selective with food. Although many children meet their nutritional needs through a balanced diet, vitamins A, C, and D are frequently below recommended levels—especially in young children who may not consume sufficient fruits, vegetables, or fortified foods.

Pharmacy teams therefore play an important role in advising parents on evidence-based supplementation and providing reassurance in a supportive, non-judgemental manner.

Growing children require a range of vitamins and minerals to support healthy development, immunity, and overall wellbeing.

National guidelines recommend routine supplementation with vitamins A, C, and D for most children between 6 months and 5 years, unless they consume more than 500 ml of infant formula daily, which already contains these nutrients.

Parents may feel uncertain about their child’s dietary intake or worry that they are “not eating enough of the right foods.”

Pharmacy assistants should be prepared to offer clear guidance, reduce anxiety, and help parents make informed decisions about supplementation.

KEY VITAMINS IN CHILDREN’S HEALTH

It is difficult to obtain adequate vitamin D from food alone. Limited sunlight exposure, weather patterns, and indoor lifestyles contribute to widespread deficiency. For this reason, vitamin D supplementation is strongly recommended for babies, toddlers, and young children.

ADDITIONAL CONSIDERATIONS: PROBIOTICS AND GUT HEALTH Probiotics have seen a substantial rise in popularity among parents, particularly for children recovering from antibiotic therapy or those prone to digestive discomfort.

While evidence varies between strains and formulations, many parents view probiotics as a supportive measure for gut health.

Pharmacy assistants should be familiar with common products and refer any clinical questions or concerns to the pharmacist.

PROVIDING DIETARY ADVICE WITH SENSITIVITY

 Supports immune function

Eating behaviours in children can be a source of great worry for parents. It is essential that pharmacy teams provide guidance in a way that is non-judgemental, empathetic, and supportive. Building trusting relationships with families encourages ongoing conversations and better health outcomes.

 Assists with vision in low light

Useful conversation openers include:

 Helps maintain healthy skin

 “How do you think your little one is doing with getting their five a day? It can be difficult at this age.”

Vitamin A Vitamin A plays several essential roles:

Good dietary sources include dairy products, fortified fat spreads, carrots, sweet potatoes, mangoes, and green leafy vegetables such as spinach, cabbage, and broccoli. However, many young children do not consume sufficient quantities routinely, making supplementation beneficial.

Vitamin C Vitamin C supports:  Immune health  Iron absorption  General tissue repair and wound healing Foods rich in vitamin C include oranges, kiwi fruit, strawberries, tomatoes, peppers, and broccoli. Despite wide availability in the diet, intake may be inconsistent, particularly in selective eaters.

 “There’s so much information out there— would you like us to go through what foods are recommended and look at suitable supplements together?”  “If you’d like, we can check what’s considered a healthy weight for your child’s age and help monitor it.”

These open-ended, supportive questions help parents feel understood rather than judged.

SUPPORTING FAMILIES WITH SPECIAL DIETS Children following vegetarian or vegan diets may be at risk of specific nutritional deficiencies. Pharmacy assistants should highlight potential gaps—such as vitamin B12, iron, omega-3 fatty acids, and vitamin D—while focusing on solutions rather than criticism.

Having signposting information for community dietitians or nutritionists is beneficial when families require additional guidance.

THE ROLE OF THE PHARMACY TEAM Pharmacies are one of the most accessible points of healthcare for parents seeking advice on infant and child nutrition. To provide highquality support, pharmacy assistants should:  Stay up to date with national guidelines on childhood supplementation  Understand recommended daily allowances for children at different ages  Recognise when referral to the pharmacist is needed  Offer advice in a sensitive, non-judgemental manner  Be familiar with the product ranges stocked in their pharmacy  Understand when supplements are unnecessary—for example, infants consuming more than 500 ml of formula per day Parents value practical, clear recommendations. A well-informed pharmacy team increases confidence and encourages families to return for advice throughout their child’s development.

WWHAM Who? Growing children from 6months; Certain vitamins are recommended for specific age groups.

What are the symptoms? Ensure to speak to the parent/caregiver about the child’s food intake and habits to direct them customer to the most appropriate vitamin/ supplement

Vitamin D

How long have they had the symptoms? N/A

Vitamin D is vital for:

Action already taken? Parents and caregivers may already be incorporating foods into a child’s diet with high levels of vitamins such as A, C and D

 Bone growth  Calcium absorption  Overall immune function

Medication: Supplements including certain vitamins and those containing multivitamins

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NAIL INFECTIONS

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NAIL INFECTIONS Nail infections are common conditions that can affect both fingernails and toenails. They may be caused by fungi, yeast, or bacteria and can significantly impact comfort, appearance, and confidence. Although most nail infections are not medically serious, they can be persistent and require appropriate treatment and adherence to good nail hygiene. Pharmacy assistants play an important frontline role in recognising symptoms, advising on suitable over-the-counter (OTC) treatments, and identifying when referral to the pharmacist or a GP is necessary.

TREATMENT OPTIONS

FUNGAL NAIL INFECTIONS (ONYCHOMYCOSIS)

Treatment requires consistent, long-term use, often for 6–12 months for toenails due to slow nail growth.

Caused by dermatophytes, yeasts, or moulds.

More common in toenails than fingernails due to warm, moist environments and slower nail growth. They tend to develop gradually.

BACTERIAL NAIL INFECTIONS (PARONYCHIA) Often associated with broken skin around the nail from biting, picking, or trauma. Bacterial infections tend to be painful, swollen, and can appear rapidly.

RECOGNISING SYMPTOMS Pharmacy assistants should be familiar with the visible signs of nail infection so they can support customers effectively.

Common symptoms of fungal nail infections:  Thickened, brittle, or crumbly nails  Yellow, white, or brown discolouration  Changes in nail shape or distortion  Nail lifting from the nail bed (onycholysis)  Mild discomfort, especially in shoes Symptoms of bacterial nail infection (paronychia):  Redness, swelling, and pain around the nail fold  Warmth and tenderness  Pus formation in more severe cases

Topical Antifungal Treatments Suitable for mild to moderate fungal nail infections affecting <50% of the nail and not involving the nail matrix (base). Products may include:  Amorolfine nail lacquer  Urea-based softening creams  Antifungal solutions containing ingredients such as terbinafine or clotrimazole

FOR BACTERIAL NAIL INFECTIONS Over-the-counter management often includes:  Warm salt-water soaks  Antiseptic creams  Avoidance of trauma and keeping the area dry If symptoms worsen, if pus is present, or if the customer has diabetes, pharmacist or GP referral is needed.

WHEN TO REFER FOR PRESCRIPTION TREATMENT

Oral antifungal tablets may be required for more complex fungal infections, but these require a GP consultation due to liver monitoring and potential interactions.

SELF-CARE AND PREVENTATIVE ADVICE Effective counselling includes educating customers on nail hygiene and lifestyle adjustments:  Keep nails trimmed, clean, and dry  Wear breathable footwear and moisturewicking socks  Change socks daily  Avoid sharing nail tools  Wear protective sandals in communal areas

ROLE OF THE PHARMACY ASSISTANT Pharmacy assistants should:

 Infection affecting the nail matrix

 Identify symptoms accurately

 Severe or widespread infection

 Recommend appropriate OTC treatments for mild infections

 Multiple nails involved  Lack of improvement after several months of correct use  Diabetic customers with any foot or nail changes

 Provide guidance on product selection and duration of use  Offer self-care and hygienic advice  Recognise when referral is necessary

 Suspected psoriasis or eczema-related nail changes

 Approach the conversation sensitively, as customers may feel embarrassed

 Significant pain or suspected bacterial abscess

Consistent, clear instruction improves adherence and outcomes.

 Rapid onset compared to fungal infections

WWHAM

If a customer presents with pain, acute swelling, or signs of pus, pharmacist involvement is essential.

Who? Anyone with nail discolouration, thickening, pain, swelling, or nail changes. Pay particular attention to customers with diabetes or circulation issues.

Understanding contributing factors helps pharmacy assistants tailor advice:

What are the symptoms? Thick, brittle, discoloured nails; nail lifting; redness or swelling around the nail; pain; pus; rapid onset (suggesting bacterial infection).

 Frequent exposure to moisture (e.g., cleaning, swimming)  Sweaty feet or occlusive footwear  Nail trauma from cutting nails too short or injury  Poor foot hygiene  Sharing nail clippers or walking barefoot in communal areas  Nail-biting or picking  Some chronic conditions (diabetes, circulatory issues, immune disorders)

How long have they had the symptoms? Fungal infections develop slowly; bacterial infections often appear quickly. Long-standing symptoms may require pharmacist or GP referral.

Action already taken? Ask whether the customer has used antifungal creams, lacquers, antiseptics, or home remedies. Determine whether symptoms improved or worsened.

Medication? Check for conditions requiring referral (e.g., diabetes, immune compromise), and identify if the customer takes medicines that increase infection risk. Ensure suitability of antifungal treatments and refer to the pharmacist if oral medication may be needed.

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NAPPY RASH

63

NAPPY RASH Nappy rash is one of the most common skin conditions seen in infants, and it is a frequent reason parents seek advice in community pharmacy. Although usually mild and easy to manage, nappy rash can cause significant discomfort for the baby and stress for parents.

Pharmacy assistants play an important role in identifying the type of rash, offering practical treatment advice, and knowing when to refer to the pharmacist for further assessment.

UNDERSTANDING NAPPY RASH Nappy rash occurs when the skin around the nappy area becomes inflamed, red and sore. It affects babies of all ages but is most common between 9 and 12 months, when nappies are worn continuously and the skin is exposed to prolonged moisture. The irritation typically develops as a result of several combined factors:  Prolonged contact with urine and stools, which breaks down the skin barrier  Chafing or friction from a wet or tight nappy  Residual detergent from nappies or wipes irritating the skin

 Using warm water or gentle wipes designed for sensitive skin  Avoiding harsh soaps or fragranced products

be used without pharmacist or GP advice, especially in infants. Hydrocortisone 1% may be used short-term under medical direction if inflammation is severe, but inappropriate use can thin the skin.

 Allowing nappy-free time each day to let the skin breathe

WHEN TO REFER

 Using a barrier cream at each change to protect the skin

Pharmacy assistants should involve the pharmacist when:

Barrier creams containing zinc oxide or petroleum jelly create a protective layer between the skin and moisture. These are suitable for everyday use and help maintain the skin’s natural barrier.

 The rash is severe, weeping, blistered or bleeding

 Teething, when changes in stool acidity can worsen irritation

TREATMENT OPTIONS IN THE PHARMACY

 Diarrhoea or frequent stools, which increases exposure to digestive enzymes

Most cases of nappy rash respond well to simple measures combined with effective barrier protection. Pharmacy assistants can advise on:

Healthy infant skin is naturally delicate and has a higher pH than adult skin. When exposed to moisture and friction, the skin barrier can break down quickly, allowing inflammation to develop.

RECOGNISING COMMON TYPES OF NAPPY RASH Most nappy rashes are simple irritant rashes—pink or red patches, sometimes slightly shiny, that affect the skin in contact with the nappy. However, pharmacy teams should also recognise:

1. Barrier Creams - These are the first-line treatment. Thick, protective creams can be applied at each nappy change to soothe and shield the skin. Zinc oxide-based creams are particularly effective for irritated skin.

2. Emollients - If the skin is dry or flaky, emollients help to restore moisture and repair the skin barrier. They are safe for regular use and can work alongside other treatments.

 Candidal (yeast) nappy rash: bright red, shiny patches with well-defined edges and “satellite spots”. This type does not usually improve with standard barrier creams and requires antifungal treatment.

3. Antifungal Creams - If a candidal infection is suspected—such as with bright red rash and satellite lesions—an antifungal cream like clotrimazole may be needed.

These should be recommended by the pharmacist following assessment.

 Bacterial rash: painful, spreading rash, sometimes with yellow crusts. This requires referral.

4. Avoiding Hydrocortisone Without Referral - Topical steroid creams should not

 Allergic contact dermatitis: may occur following the introduction of a new wipe, nappy brand or cream.

WWHAM

Correct identification helps ensure parents receive the most appropriate treatment and avoid unnecessary worry.

 The rash is not improving after 2–3 days of appropriate treatment  Candida infection is suspected  The baby has fever, lethargy, or appears unwell  The rash spreads beyond the nappy area  The baby is under 1 month old Early referral prevents complications and reassures anxious parents.

SUPPORTING PARENTS IN THE PHARMACY Nappy rash can be upsetting, and many parents feel guilty or embarrassed. A calm, reassuring approach is essential. Pharmacy assistants should explain that nappy rash is extremely common, often unavoidable, and usually easily treated. Demonstrating how to apply barrier creams correctly, offering product comparisons, and advising on nappy hygiene can significantly improve outcomes.

Community pharmacies are in a strong position to support new parents by providing evidencebased advice, identifying when specialist treatment is needed, and helping to prevent recurrence through good skincare routines.

Who? Most common in infants aged 0–18 months.

What are the symptoms? Redness, soreness, irritation; possible spots, shiny patches, or satellite lesions.

PREVENTION: THE FOUNDATION OF MANAGEMENT

How long have they had the symptoms? Helps distinguish simple irritation from candida or more severe rash.

Prevention is the key message pharmacy assistants should reinforce. Effective strategies include:

Action already taken? Nappy-free time, wipes, barrier creams, switching nappies.

 Frequent nappy changes—keeping the area clean and dry

Medication? Barrier creams, emollients, antifungal creams (if required).

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NUTRITION IN THE ELDERLY

NUTRITION IN ylnELDERLY o eht si knirD lack 2.3 ®nibuserF THE negalloc a niatnoc ot SNO nietorp hgih Good nutrition is a cornerstone of healthy ageing, yet older adults are particularly 1 vulnerable to nutritional deficiencies, weight loss, frailty, and dehydration. As people age, changes in physical health, appetite, mobility, medication use, and social circumstances can all impact their dietary intake.

65

COMMON NUTRITIONAL CONCERNS IN OLDER ADULTS

dnelb nietorp klim dna etasylordyh Unintentional Weight Loss: A major red flag. Significant weight loss over weeks or months requires pharmacist review and often GP referral.

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Malnutrition is more common than many realise. It is estimated that up to one in three older adults are at risk of undernutrition, 2 alone, recently especially those living discharged from hospital, or living with chronic illness. Poor nutritional status increases the risk of falls, infections, delayed wound healing, muscle loss (sarcopenia), cognitive decline, and reduced quality of life.

Pharmacy assistants therefore play a key role in identifying concerns and encouraging intervention as early as possible.

Dehydration: Older adults often have a reduced sense of thirst. Dehydration can lead to confusion, dizziness, constipation, and falls.

Protein Deficiency: Adequate protein is essential to maintain muscle mass, repair tissue, and support immune function.

Low intake contributes to frailty, loss of independence, and impaired wound healing.

PHYSIOLOGICAL CHANGES  Reduced appetite (anorexia of ageing)  Altered taste and smell  Reduced saliva production, leading to dry mouth and difficulty chewing  Changes in digestion, including constipation or slow gastric emptying  Loss of muscle mass and strength (sarcopenia)

MEDICAL CONDITIONS Common conditions affecting nutritional intake include:

fo egnar lluf a sniatnoC gnidulcni stneirtunorcim  Depression or loneliness enStroke inigr(affecting a dna swallowing) D nimativ ,cniz  Dementia or cognitive impairment

PRACTICAL ADVICE

Skin Integrity and Pressure Ulcers: Maintaining healthy skin integrity is a vital part of elderly nutrition. As skin becomes thinner and less elastic with age, the risk of pressure ulcers (bedsores) increases — particularly in those who are immobile, undernourished, or recovering from illness. It is estimated that up to 10% of hospitalised patients and up to 20% of residents in long-term care may develop pressure ulcers at some stage.

 Encourage small, frequent meals rather than three large ones.

Adequate nutrition: Particularly sufficient protein, calories, vitamins, and minerals — plays a crucial role in maintaining skin strength and preventing breakdown. High-protein diets help preserve muscle mass and promote tissue repair, while nutrients such as vitamin C, zinc, and collagen hydrolysate support collagen synthesis and wound healing.

 Promote hydration through water, milk, soups, and decaffeinated drinks.

Where appropriate, pharmacy teams can highlight the importance of protein-rich meals or oral nutritional supplements in supporting both general health and skin integrity.

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Difficulty Chewing or Swallowing: Dental problems, dry mouth, or dysphagia can severely limit food choices and nutrient intake.

 Parkinson’s disease  Diabetes  Heart failure  Gastrointestinal disorders Many of these conditions make meal more difficult.

MEDICATION-RELATED ISSUES

 Recommend foods that are easy to chew and swallow if needed.  Highlight the benefits of social eating to stimulate appetite and improve enjoyment of food.

Pharmacies often stock high-calorie, highprotein drinks and powders, which can be beneficial after pharmacist evaluation, particularly for:  Those recovering from illness or surgery

When older customers or their carers mention tiredness, reduced appetite, unintentional weight changes, or difficulties with eating, pharmacy assistants should explore these concerns sensitively.

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 For those at risk of pressure ulcers or poor wound healing, stress the importance of high-protein intake and consider discussing collagen hydrolysate supplements where appropriate.

 Frail or underweight older adults

SUPPORTING CUSTOMERS IN THE PHARMACY

 Respiratory disease

 Suggest protein-rich foods such as eggs, dairy, fish, poultry, beans, or nut butters.

 People with chronically poor appetites or pressure ulcer risk Supplements should complement, not lm /lacadvised k 2.3by a replace, meals unless healthcare professional.

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WWHAM

Several medicines commonly prescribed to older adults may:

Who? Older adults, particularly those over 65, those living alone, recently hospitalised, or those with chronic illness.

 Reduce appetite

 Cause nausea, constipation, or reflux

What are the symptoms? Loss of appetite, weight loss, low energy, difficulty chewing or swallowing, low mood, poor hydration, or reduced ability to cook or shop.

 Increase drowsiness, reducing motivation to eat

How long have they had the symptoms? Longer than two to three weeks is concerning. Sudden or rapid decline requires urgent pharmacist involvement.

SOCIAL & PRACTICAL BARRIERS

Action already taken? Customer may have tried eating more, using supplements, soft diets, or adjusting meal times. Identify what has or hasn’t helped.

 Alter taste (metallic tastes, reduced taste perception)

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 Living alone

 Bereavement

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Medication? Check for medicines that may affect appetite, digestion, or taste, or that cause nausea or drowsiness. Always involve the pharmacist.

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Panadol 500mg Film Coated Tablets (paracetamol), Panadol Actifast Tablets 500mg, Panadol Actifast 500mg Soluble Tablets, (paracetamol), Panadol Extra Filmcoated Tablets Paracetamol 500mg Caffeine 65mg, Panadol Extra 500mg/65mg Soluble Effervescent Tablets (paracetamol, caffeine), Panadol Night Film-coated Tablets (paracetamol, diphenhydramine hydrochloride). Indications 500mg Film Coated, Actifast, Tablets, Actifast Soluble Tablets & Extra Soluble Effervescent Tablets: Short-term management of headaches, musculoskeletal disorders, menstrual pains, toothache, symptoms of colds and flu. 500mg Film Coated, Actifast Soluble Tablets: mild to moderate osteoarthritis pain diagnosed by a doctor. Night: Short-term treatment of bedtime symptoms of cold and flu pain, rheumatic and muscle pain, backache, toothache, headache, menstrual pain. Dosage Minimum dosing interval between paracetamol containing products is 4 hours. The lowest dose necessary to achieve efficacy should be used. 500mg Film Coated Tablets: Adults and children 16 years and over: 1-2 tablets, up to 4 times daily as required. Children aged 10-15 years of age: 1 tablet, up to 4 times daily as required. Max 4 doses in 24 hours. Do not give to children for more than 3 days without consulting a doctor. Do not give to children under 10 years. Actifast Tablets: Adults and children 16 years and over: 1-2 tablets up to 4 times daily as required. Children aged 12-15 years: 1 tablet up to 4 times daily as required. Max 4 doses in 24 hours. Do not give to children for more than 3 days without consulting a doctor. Do not give to children under 12 years. Actifast Soluble Tablets: Adults and children 16 years and over: 1-2 tablets dissolved in water up to 4 times daily as required. Children aged 10-15 years: 1 tablet dissolved in water up to 4 times daily as required. Max 4 doses in 24 hours. Do not give to children for more than 3 days without consulting a doctor. Do not give to children under 10 years. Extra Film-Coated Tablets and Extra Soluble Effervescent Tablets: Adults and children 16 years and over: 2 tablets up to 4 times a day. Children aged 12-15 years: 1 tablet up to 4 times a day. Do not exceed 4 doses in 24 hours. Do not give to children under 12 years. Night: Adults and children 16 years and over: 2 tablets, 20 minutes before bed.

Children aged 12-15 years: 1 tablet, 20 minutes before bed. Other products containing paracetamol may be taken during the day but the total daily dose of paracetamol must not exceed 4000mg for adults and 2000mg for children aged 12-15 years. Do not give to children under 12 years except on medical advice. Do not use for more than 7 consecutive nights without medical advice. Contraindications All: Hypersensitivity to paracetamol or any of the other ingredients. Night: Closed angle glaucoma, porphyria. Precautions All: Do not use with any other paracetamol-containing products. Those with underlying liver or kidney impairment should seek advice before using. Caution, regarding paracetamol, if used at therapeutic doses for a prolonged period or administered concomitantly with flucloxacillin due to increased risk of high anion gap metabolic acidosis (HAGMA), particularly in patients with severe renal impairment, sepsis, malnutrition and other sources of glutathione deficiency (e.g. chronic alcoholism). If suspected, discontinue use promptly and monitor closely, including measurement of urinary 5-oxoproline. Actifast Soluble Tablets and Extra film-coated Tablets: Use in caution in patients with one or more risk factors for hepatotoxicity including low body weight (<50kg), renal and hepatic impairment, chronic alcoholism, concomitant use of hepatotoxic drugs, sepsis and in acute and chronic malnutrition (low reserves of hepatic glutathione). 500mg Film Coated Tablets, Actifast Tablets, Extra Soluble Effervescent Tablets and Night: Cases of hepatic dysfunction/failure have been reported in patients with depleted glutathione levels / glutathione depleted states, chronic alcoholism, sepsis or who are severely malnourished, anorexic, low body mass index. Do not exceed the stated dose. Prolonged use except under medical supervision may be harmful. Actifast Tablets: Contains 352 mg sodium per 2 tablet dose, use with caution in those on a low sodium diet. Actifast Soluble Tablets: Contains 854mg sodium and 100mg sorbitol powder (E420) per 2 tablet dose. Use in caution in those on a low sodium diet and patients with hereditary fructose intolerance should not take this medicine. Extra Film coated Tablets and Extra Soluble Effervescent Tablets: Avoid excessive caffeine intake. Extra Film coated Tablets: Consult a doctor high fever, or signs of secondary infection occur, or if symptoms persist for longer than 3 days. Contain sodium methyl parahydroxybenzoate (E219), Sodium ethyl parahydroxybenzoate (E215) and Sodium propyl parahydroxybenzoate (E217) which may cause allergic reactions (possibly delayed). Extra Soluble Effervescent Tablets: Caution in those with hereditary sugar intolerance or on a low sodium diet. Night: Avoid use with alcohol. Use with caution in the elderly and avoid use in elderly patients with confusion. Avoid concurrent use with sedatives (including hypnotics and anxiolytics), antimuscarinics and other antihistamines. Caution in those with epilepsy or seizure disorders, myasthenia gravis, narrow angle glaucoma, prostatic hypertrophy, urinary retention, asthma, bronchitis, COPD or with any form of glucose-galactose malabsorption or lactase deficiency. Avoid use of MAOIs within 2 weeks. Side Effects For a full list of side effects please refer to the relevant SPC. All: (Paracetamol) Very rare: Thrombocytopenia, anaphylaxis, cutaneous hypersensitivity reactions including skin rash, angioedema, Stevens-Johnson syndrome, Toxic Epidermal Necrolysis, serious skin reactions, bronchospasm, hepatic dysfunction. Not Known: High anion metabolic acidosis. Extra Film-coated Tablets and Extra Soluble Effervescent Tablets: (Caffeine) Not known: nervousness, dizziness, palpitation, insomnia, restlessness, anxiety, irritability, gastrointestinal disturbances. Night: (Diphenhydramine) Common: Fatigue, sedation, attention disturbance, dizziness, unsteadiness, dry mouth.

Legal Category: – 500 mg Film Coated: 12s GSL; 24s Pharmacy Only.

– Actifast Tablets: 10s GSL; 20s Pharmacy Only.

– Actifast Soluble Tablets: GSL. Extra Film-coated Tablets: 12s GSL; 24s Pharmacy Only.

– Extra Soluble Effervescent Tablets & Night: Pharmacy Only.

MA Number: 500 mg Film coated Tablets: PA 678/107/1; Actifast Tablets: PA 678/39/12; Actifast Soluble Tablets: PA 678/39/14 Extra Film-coated Tablets: PA 678/27/1 Extra Soluble Effervescent Tablets: PA 678/39/10; Night: PA 678/39/8. MA Holder: Haleon Ireland Limited, Clocherane, Youghal Road, Dungarvan, Co. Waterford, X35 Y983, Ireland. Text prepared: June 2025. Further information available on request.

Trade marks are owned by or licensed to the Haleon group of companies. PM-IE-PAN-25-00040

ORAL ANALGESICS

67

ORAL ANALGESICS Oral analgesics remain one of the most frequently requested categories in community pharmacies. Adults commonly seek relief for headaches, dental pain, back pain, menstrual pain, colds and flu symptoms, and general musculoskeletal discomfort. Many customers self-select, but pharmacy teams play a crucial role in ensuring correct product choice, safe use, and awareness of red-flag symptoms.

Pain can be acute or chronic, mild or severe, and can arise from a wide range of causes.

Understanding the different types of oral analgesics and their suitability helps ensure effective and safe customer care.

TYPES OF ORAL ANALGESICS Oral analgesics are broadly divided into nonopioid and opioid medicines. Most products available without prescription fall into the non-opioid group, though some combination products may include low-dose codeine requiring pharmacist intervention.

NON-OPIOID ANALGESICS These are the first-line treatments for mild to moderate pain and include: 1. Paracetamol A well-tolerated analgesic and antipyretic frequently used for headache, dental pain, and general aches.  Safe when used correctly  Suitable for most adults  Can be taken with food or on an empty stomach

GENERAL SAFETY ADVICE FOR CUSTOMERS Pharmacy teams should remind customers to:  Follow dosage instructions strictly – exceeding the maximum dose can cause serious harm.  Avoid sharing pain medicines – different people may have different health risks.  Avoid alcohol with any analgesic, particularly paracetamol, NSAIDs, or opioidcontaining products.  Use the lowest effective dose for the shortest period.  Avoid duplication – e.g., taking cold/flu remedies that already contain paracetamol or ibuprofen.

WARNINGS AND KEY CAUTIONS Paracetamol  Overdose can cause severe liver damage.  Extra caution for customers with alcohol dependence, liver disease, malnutrition, or dehydration.  Ensure patients are not taking multiple products containing paracetamol.

NSAIDs (Ibuprofen, Aspirin, Naproxen)  Always take with food or milk to reduce gastric irritation.

ORAL PAIN AND DENTAL PAIN Dental pain is one of the most common reasons customers seek oral analgesics.

Toothache often arises from decay, infection or gum disease, and symptoms can range from mild sensitivity to severe throbbing, often worsening at night.

Pharmacy teams can advise:  Paracetamol or ibuprofen for temporary relief  Avoiding very hot or cold foods  Using desensitising toothpaste for mild sensitivity However, all dental pain requires assessment by a dentist, and analgesics should only be used as short-term relief until treatment is arranged.

Refer urgently if:  swelling is present  fever occurs  pain persists longer than a few days  the customer is immunocompromised

WHEN TO REFER TO THE PHARMACIST OR GP

2. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

 Can cause stomach ulcers or bleeding; refer immediately if the customer reports black stools or vomiting blood.

Pharmacy assistants should refer customers if they report:

Examples include ibuprofen, naproxen, and aspirin.

 Use with caution or avoid in people with:

 Pain lasting more than 7–10 days

 Severe pain unexplained by a minor injury

o stomach ulcers

 Recurrent headaches

o heart disease

 Suspected nerve pain

 period pain

o kidney disease

 Dental pain lasting more than 48–72 hours

 back pain

o asthma sensitive to NSAIDs

 Stomach pain when taking NSAIDs

o hypertension

 Any signs of overdose

These relieve pain and reduce inflammation, making them useful for:

 muscular injury  dental pain  inflammatory conditions NSAIDs are not suitable for everyone and require careful questioning (see cautions below).

OPIOID ANALGESICS These work directly on the central nervous system to reduce the perception of pain.  Only mild opioids such as codeine or dihydrocodeine may appear in pharmacyonly combination products (e.g., codeine + paracetamol).

 Not suitable in pregnancy (particularly 3rd trimester) unless advised by a clinician.

 Regular use of analgesics (potential medication overuse headache)

WWHAM Who? Age, pregnancy status, underlying medical conditions, alcohol intake.

What are the symptoms? Nature, severity and location of pain; dental, muscular, headache, period pain, etc.

How long have they had the symptoms? Most minor pain resolves in days; persistent or worsening symptoms require referral.

 Strong opioids (e.g., morphine, oxycodone) are prescription-only.

Action already taken? Which analgesics already used? Any relief?

Any adverse effects?

 OTC opioid combinations should be used short-term only and never for chronic pain without medical review.

Medication? Check for regular medicines (warfarin, antihypertensives, steroids), allergies, and duplicate paracetamol/NSAID-containing products.

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ORAL HEALTH

69

ORAL HEALTH Good oral health is essential for overall wellbeing, yet dental and mouth-related problems remain among the most common reasons patients seek advice in the community pharmacy. Issues such as mouth ulcers, oral thrush, tooth sensitivity, gum irritation and dry mouth can affect eating, speaking, sleeping and quality of life. For many customers, the pharmacy is the first point of contact before they can access a dentist, making pharmacy teams uniquely positioned to offer support, provide treatment, and identify when urgent referral is needed.

Oral health problems can arise due to many causes—including poor oral hygiene, diet, medication effects, smoking, stress, hormonal changes, or underlying medical conditions.

Understanding these contributors helps pharmacy assistants ask appropriate questions and recommend suitable OTC products.

UNDERSTANDING COMMON ORAL HEALTH CONDITIONS Mouth Ulcers - Minor aphthous ulcers are extremely common and can be triggered by stress, injury from sharp foods, vitamin deficiencies, or hormonal changes. They usually heal within 1–2 weeks. Pharmacy treatment focuses on relieving pain, reducing inflammation, and protecting the ulcer. Protective gels, mouthwashes and anaesthetic sprays can provide temporary comfort. Customers with unusually large, persistent, or recurrent ulcers should be referred to the pharmacist.

PAIN AND INFECTION RED FLAGS Not all oral pain can be managed with OTC medicines. Customers with severe toothache, facial swelling, fever, difficulty opening the mouth, or pain that disturbs sleep require urgent dental assessment. Pharmacy assistants should not attempt to diagnose dental infections but should recognise when escalation is required.

SUPPORTING ORAL HYGIENE IN THE PHARMACY Pharmacy teams play an important role in reinforcing daily oral care habits:  Brush teeth twice daily with fluoride toothpaste  Use interdental brushes or floss to remove plaque  Change toothbrushes every three months  Reduce sugary snacks and drinks  Stop smoking and limit alcohol intake The pharmacy environment is also an opportunity to educate customers about the link between oral health and general health. Poor oral hygiene has associations with cardiovascular disease, diabetes control and respiratory conditions, underscoring the importance of good habits at every age.

Cold Sores - Cold sores (herpes simplex virus type 1) present as tingling, blistering patches around the lips. Early treatment with antiviral creams at the first tingling sensation is important for reducing severity. Customers with frequent outbreaks, sores lasting longer than 10 days, or lesions near the eyes must be referred.

OTC TREATMENT OPTIONS

Dry Mouth (Xerostomia) - Dry mouth may be caused by medications (antidepressants, antihypertensives, antihistamines), dehydration, diabetes, Sjögren’s syndrome, or anxiety.

Symptoms include difficulty swallowing dry foods, cracked lips, bad breath and increased plaque. Management includes saliva substitutes, oral moisturising gels, sugar-free chewing gum and good hydration. Persistent symptoms require medical or dental referral.

 Antifungal oral gels (for thrush—adult use only unless pharmacist advises)

Oral Thrush - Thrush presents as white patches in the mouth that can be wiped off, often leaving red tissue underneath. It is more common in denture wearers, people using inhaled corticosteroids, diabetics, and those on antibiotics. OTC antifungal treatments may be suitable for adults, but infants, immunocompromised patients, and recurrent cases must be referred immediately.

Tooth Sensitivity - Sensitivity often results from enamel erosion, gum recession, or aggressive brushing. Customers may describe sharp, sudden pain when eating hot, cold or sweet foods. Pharmacy teams can recommend desensitising toothpaste or mouthwash and advise gentle brushing. Any severe, persistent or worsening pain should prompt dental referral.

Common categories include:  Topical anaesthetic gels and mouthwashes (for ulcers, minor irritation)  Antiviral creams (for cold sores)

 Desensitising toothpastes (for sensitivity)  Fluoride rinses (strengthen enamel, reduce decay risk)  Saliva substitutes (for dry mouth)

 Anti-inflammatory mouthwashes (for gum irritation) Pharmacy assistants must always check suitability, age restrictions, pregnancy status and potential interactions before recommending.

WHEN TO REFER TO THE PHARMACIST  Severe or persistent gum swelling  Toothache lasting more than 48 hours  Children under 12 with suspected thrush or oral pain  Cold sores near the eyes  Recurrent ulcers or lesions lasting more than 3 weeks  Customers with medical conditions affecting the immune system  Signs of dehydration, fever, or systemic infection

WWHAM Who? Check the age of the patient—treatments differ for children, adults and older people.

What are the symptoms? Ulcers, pain, swelling, dryness, burning, white patches, bleeding gums, cold sore tingle, sensitivity.

How long have they had the symptoms? Persistent, frequent, or worsening symptoms require referral.

Action already taken? Has the customer tried saltwater rinses, topical gels, toothpaste changes, antiviral creams or oral hygiene adjustments?

Medication? Check for medicines causing dry mouth, recent antibiotics, inhalers, diabetes medicines or steroid use.

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

PAIN

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PAIN Pain is one of the most common reasons people seek advice in community pharmacies, and its management places a considerable burden on the Irish healthcare system. As Ireland’s population ages, the number of people living with chronic pain continues to rise. Pharmacy teams play a vital role in helping customers choose safe and effective options, providing reassurance, and recognising when referral is needed.

Pain can present in many forms and is not always straightforward. Customers may describe discomfort in the lower back, hips, knees, shoulders, abdomen, or in specific sites such as the jaw or ankle. Understanding the type of pain, its duration, and its underlying cause is essential to choosing the appropriate OTC option—or determining when further medical assessment is required.

TYPES OF PAIN Acute pain appears suddenly and usually has a clear cause, such as a burn, minor injury, dental issue or strain. Although unpleasant, acute pain serves a protective purpose, prompting action to prevent further injury. It typically resolves within days once the underlying cause is treated.

Recurrent or intermittent pain comes and goes.

Toothache, menstrual pain, sinus pain and some gastrointestinal discomfort fall into this category. These episodes may require regular short-term management but are not constant.

Chronic pain is persistent, lasting longer than three months, and may stem from long-term conditions such as osteoarthritis, fibromyalgia, or chronic back pain. Chronic pain can severely impact mobility, sleep, concentration, mood, and overall quality of life. Patients living with chronic pain often adapt their behaviour in ways that can affect emotional wellbeing, making pharmacy support and signposting especially valuable.

APPROACHES TO PAIN MANAGEMENT The World Health Organization’s analgesic ladder remains a useful framework:  Step 1 – Mild pain: non-opioids (paracetamol, aspirin, NSAIDs).  Step 2 – Moderate pain: weak opioids (codeine combinations), with or without step-1 medicines.  Step 3 – Severe pain: strong opioids (prescription-only), with or without other agents.

When pain improves, customers should return to the lowest effective step.

OTC codeine- and dihydrocodeine-containing analgesics must only be used short-term—no longer than three days—to limit dependence and addiction risk. Any patient requesting frequent supplies should be referred to the pharmacist for discussion and possible GP review.

OTC TREATMENT OPTIONS Oral Analgesics - Oral analgesics remain the most common self-care option. Choice should be guided by the type and severity of pain, underlying conditions and previous response.

 Fast Relief - Fast relief and onset of action are important for customers seeking immediate comfort from acute pain such as headache, toothache, or muscular strain.

Soluble or effervescent formulations are designed to be absorbed more quickly than standard tablets, providing faster onset of pain relief. Pharmacy assistants should remind customers that while these products offer rapid relief, they must still be used within recommended dosage and duration limits.

Topical NSAIDs provide relief with minimal systemic absorption, making them a safer option for some customers who cannot tolerate oral NSAIDs.

 Paracetamol is a first-line agent for mild to moderate pain and is suitable for most customers when used as directed.

PAIN AND ORAL HEALTH ISSUES

 NSAIDs, such as ibuprofen or aspirin, are effective for inflammatory pain but must always be taken with food. They may not be appropriate for customers with stomach ulcers, cardiovascular disease, kidney issues, asthma or pregnancy.  Combination analgesics containing codeine are licensed for short-term moderate pain but must be used cautiously to avoid dependence.

TOPICAL ANALGESICS Topical treatments are ideal for localised musculoskeletal pain and may improve adherence when discomfort affects a small or easily targeted area.

Options include:  NSAID gels, creams and sprays (diclofenac, ibuprofen)  Counterirritants (menthol, methyl salicylate, camphor)  Heat rubs and creams  Topical anaesthetics

Counterirritants work differently—they stimulate sensory receptors, creating warmth or cooling sensations that help mask or alter the perception of pain. These are commonly used for acute strains, sprains, and simple backache, as well as chronic issues like osteoarthritis.

Pain may also originate in the mouth—such as dental pain, ulcers, cold sores, or injury.

Pharmacy teams must take care to distinguish minor causes from those requiring urgent dental assessment. Mild discomfort may be managed with oral analgesics, topical gels, or protective pastes, but any severe, persistent or infectionrelated pain warrants referral.

WHEN TO REFER Pharmacy assistants must involve the pharmacist when:  Pain persists longer than two weeks  OTC medicines are ineffective  Pain is severe, worsening or unexplained  Red-flag symptoms are described (e.g., chest pain, facial swelling, sudden severe headache, limb weakness, or suspected infection)  A customer requests codeine-based products  The customer is pregnant, has complex medical conditions, or takes multiple medicines

WWHAM Who? Adults, children, older people—pain affects all age groups. Always check age before recommending treatment.

What are the symptoms? Location, type (sharp, burning, throbbing, dull), severity and associated symptoms.

How long have they had the symptoms? Short-term? Recurrent? Chronic?

Duration helps determine treatment and referral.

Action already taken? Has the customer tried analgesics, hot/cold therapy, rest, or topical products?

Medication? Check for current medicines, particularly anticoagulants, antihypertensives, steroids, antidepressants, or a history of stomach or kidney issues before recommending NSAIDs or codeine-containing products.

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More than just folic acid Most trusted by mums2 Most recommended by midwives 2,3 Helping to keep mums and babies healthy for over 30 years, Pregnacare® provides the recommended level of folic acid4 and vitamin D which is advised by the Department of Health.5 It also provides a range of micronutrients, and is supported by unique clinical research with mums-to-be.6,7

BEFORE

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Valeo Healthcare, Merrywell Industrial Estate, Ballymount, Dublin 12. For general queries: 01 405 1500. Email: valeohealthcare@valeofoods.ie. 1. Journal of the American College of Nutrition, Vol.18, No.5, 487-489 (1999). 2. For more information on this research, please visit www.pregnacare.com/mostrecommended. 3. Based on a survey of 1000 midwives. 4. Folic acid contributes to maternal tissue growth during pregnancy. Pregnacare® has always contained 400mcg folic acid, the level recommended for all women from the start of trying to conceive until the 12th week of pregnancy. 5. The Department of Health recommends that all adults, including pregnant and breastfeeding women, should consider taking a daily supplement containing 10μg of vitamin D between September and March. (Source: www.NHS.uk). 6. Agrawal, R. et al. Prospective randomised trial of multiple micronutrients in women undergoing ovulation induction, Reproductive BioMedicine Online December 2011. 7. L Brough et al. Effect of multiple-micronutrient supplementation on maternal nutrient status, infant birth weight and gestational age at birth in a low-income, multi-ethnic population. British Journal of Nutrition (2010), 104, 437-445.

For more information on the Vitabiotics range, contact your Valeo Healthcare Territory Manger Lisa Kelly Mike Peters Gary Considine Chris Ferncombe

086 206 1449 086 856 2077 087 933 4227 086 033 8162

Lisa.Kelly@valeofoods.ie Mike.Peters@valeofoods.ie Gary.Considine@valeofoods.ie Chris.Ferncombe@valeofoods.ie

PREGNANCY & FERTILITY

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PREGNANCY & FERTILITY Community pharmacy teams occupy a uniquely accessible position in the healthcare system and are often the first point of contact for individuals planning a pregnancy, actively trying to conceive, or managing early pregnancy symptoms. Pharmacy staff can support customers by promoting preconception health, identifying risks, advising on lifestyle and supplement use, and helping manage common early-pregnancy discomforts. This guide outlines key areas where pharmacy teams can offer safe, evidence-based advice.

FERTILITY CARE AND PRECONCEPTION SUPPORT Up to half of pregnancies are unplanned, and many individuals seek pharmacy support before consulting a GP. Pharmacy teams can help optimise preconception health by advising on:

LIFESTYLE SCREENING AND RISK FACTORS  Smoking and alcohol use: Offer support, cessation advice, and signposting.

should provide safe information and refer to the pharmacist when medication questions arise.

HEARTBURN AND INDIGESTION Up to 75% of pregnant women experience heartburn due to: 1. Progesterone-related relaxation of the lower oesophageal sphincter 2. Physical pressure on the stomach in later pregnancy Advice to offer:  Eat small, frequent meals  Avoid lying down soon after eating  Sleep propped up  Reduce trigger foods (spicy, fatty, acidic)  Ask the pharmacist about suitable antacids or alginates Heartburn is uncomfortable but harmless to the baby.

MORNING SICKNESS

 Weight management: Discuss healthy BMI targets where appropriate.

Nausea affects more than 80% of pregnant individuals and can occur at any time of day.

 Nutrition: Encourage a balanced diet rich in folate, iron, and vitamin D.

Useful self-care strategies include:

 Medication review: Identify medicines that may impair fertility or pose pregnancy risks and refer to the pharmacist for assessment.

PRECONCEPTION SUPPLEMENTS National guidelines recommend:  Folic acid 400 mcg daily from before conception until the end of the first trimester (5mg for high-risk groups under GP/consultant guidance).  Vitamin D 10mcg daily when trying to conceive, throughout pregnancy, and while breastfeeding.

These supplements reduce the risk of neural tube defects and support healthy fetal bone development. Customers should be reassured that expensive multivitamin formulations are not necessary unless clinically indicated.

SUPPORTIVE TOOLS Customers trying to conceive may ask about:  Ovulation predictor kits  Fertility-friendly lubricants  Basal body temperature tracking Pharmacy teams can explain correct use and manage expectations around time-to-pregnancy while recommending GP review after 6–12 months depending on age and risk factors.

COMMON PREGNANCYRELATED CONCERNS Once pregnancy is established, customers frequently come to the pharmacy for support in managing symptoms. Pharmacy assistants

Advice to share:  Warm compresses for muscle relaxation  Cold compresses for inflammation  Use of pregnancy pillows between the legs  Gentle strengthening (pelvic tilts, Kegels)  Appropriate posture and supportive footwear Pain that is intense or accompanied by neurological symptoms should be referred.

MEDICATION USE IN PREGNANCY

 Avoiding high-sugar and high-fat foods

Customers often present after discovering they are pregnant while already taking medicines. Pharmacy teams must respond with reassurance, sensitivity, and accurate information.

 Limiting exposure to trigger smells

Key principles:

 Including ginger products

 Do not automatically discontinue a medicine without assessing risk/benefit.

 Eating small, frequent meals

 Trying acupressure wristbands If vomiting is severe, persistent, or causing dehydration, referral is essential to rule out hyperemesis gravidarum.

SCIATICA AND MUSCULAR BACK PAIN Up to 98% of pregnant women experience back pain due to weight changes and softening of ligaments.

 The safety of medicines varies by trimester.  Pharmacists should integrate available safety data with the clinical picture before referral.  Supplements such as folic acid and vitamin D remain essential.

Encourage customers to consult their GP or midwife about ongoing medication needs and to avoid unnecessary polypharmacy.

WWHAM Who? Sexually active individuals or couples trying to conceive; people who may be in early pregnancy; women seeking support for common pregnancy symptoms.

What are the symptoms? Difficulty conceiving, irregular cycles, uncertainty about ovulation, early-pregnancy symptoms such as nausea, fatigue, indigestion, or concerns about medicine use.

How long have they had the symptoms? For fertility concerns: difficulty conceiving after 6 months (over age 35) or 12 months (under age 35) warrants referral. For pregnancy symptoms: assess onset, severity, and progression.

Action already taken? Ovulation kits, fertility lubricants, lifestyle changes, or use of supplements. For pregnancy symptoms, identify any self-care measures or OTC products tried.

Medication? Check for medicines that could affect conception or pregnancy safety. Flag retinoids, ACE inhibitors, certain antiepileptics, NSAIDs, herbal remedies, and weight-loss products.

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SENSITIVE SKIN Sensitive skin is a common concern among customers and is one of the most frequent skincare enquiries in community pharmacies.

Although not a medical diagnosis on its own, “sensitive skin” is a descriptive term used when the skin reacts easily to products, environmental triggers, or topical ingredients.

These reactions can include stinging, burning, redness, dryness, or itching. Sensitive skin can affect people of any age, but it is particularly common in individuals with a history of eczema, dermatitis, allergies, or dry skin conditions.

Pharmacy assistants often act as the first point of contact for customers experiencing discomfort, irritation, or persistent facial and body reactions. Understanding the causes, common triggers, and suitable product recommendations enables the pharmacy team to support customers effectively and safely, while also recognising when referral to the pharmacist or GP is required.

People with sensitive skin have a weakened or compromised skin barrier. The skin barrier (also known as the stratum corneum) functions to retain moisture and protect against irritants, microbes, and allergens.

When this barrier becomes impaired, the skin becomes more prone to dryness, inflammation, and reactions to otherwise harmless substances.

Sensitive skin often overlaps with other skin conditions such as:  Atopic dermatitis (eczema)  Contact dermatitis  Rosacea  Psoriasis  Seborrhoeic dermatitis These conditions can worsen sensitivity and increase vulnerability to external triggers.

COMMON SYMPTOMS OF SENSITIVE SKIN Customers may present with:  Redness or blotchiness  Tightness or dryness  Stinging or burning sensations after applying skincare or cosmetics  Itching  Flaking or rough patches  Visible blood vessels (especially in rosacea)  Breakouts triggered by skincare products

COMMON CAUSES AND TRIGGERS Many reactions arise from:  Fragrance or perfumed products  Alcohol-based toners  Strong exfoliants  Retinoids or high-strength acids

SENSITIVE SKIN

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 Hot showers  UV exposure  Pollution These can strip the skin of its natural oils, intensifying sensitivity.

MEDICAL OR INTERNAL FACTORS  Stress and lack of sleep  Hormonal changes (e.g., pregnancy, menopause)  Allergies  Dehydration  Underlying skin conditions Medications such as topical retinoids, benzoyl peroxide, isotretinoin, and certain diuretics may increase skin dryness and irritation.

SUPPORTING CUSTOMERS IN THE PHARMACY Pharmacy assistants should take a gentle, reassuring approach. Customers may feel frustrated or embarrassed by their skin issues, and many will have already tried multiple products without success.

KEY PRINCIPLES FOR RECOMMENDING SKINCARE 1. Simplify the routine Pharmacy teams can recommend gentle, dermatologically tested cleansers and moisturisers such as Cetaphil, which are suitable for use alongside prescription treatments for eczema, acne, or rosacea.

These formulations help maintain hydration and reduce irritation that may be caused by medical creams or topical medicines.

Advise a minimal skincare routine consisting of:  A mild, fragrance-free cleanser  A barrier-restoring moisturiser  Daily SPF (sensitive skin formulation) 2. Avoid harsh ingredients Recommend avoiding fragrances, essential oils, strong exfoliants, foaming cleansers, and alcohol-based products.

3. Focus on barrier repair Ingredients known to support the skin barrier include:  Ceramides  Hyaluronic acid  Niacinamide (in low concentrations)

 Glycerin  Squalane 4. Patch-test new products Customers with highly reactive skin should test new products on a small area behind the ear or forearm for 24–48 hours.

5. Support for itchy or inflamed skin In cases of mild irritation, pharmacy products such as:  Emollients  Cooling gels  Oat-based creams can provide relief.

6. Discuss lifestyle factors  Reduce very hot showers  Use gentle laundry detergents  Protect skin against cold and wind  Manage stress where possible

WHEN TO REFER TO THE PHARMACIST OR GP Referral is essential when:  Symptoms are persistent, worsening, or unexplained  The customer has severe redness, swelling, crusting, or signs of infection  There is suspicion of eczema, psoriasis, or rosacea  The customer has reacted to a prescribed medication  There is broken skin or weeping lesions Symptoms do not improve after trying sensitive-skin routines.

WWHAM Who? Any age group, but often adults with a history of eczema, allergies, or previous skin irritation.

What are the symptoms? Redness, burning, stinging, itching, dryness, flaking, or irritation after using skincare or being exposed to environmental triggers.

 Preservatives and colourants

How long have they had the symptoms? Is this a new issue following a change in skincare, or a long-term sensitivity? Persistent symptoms may require referral.

Customers often seek advice after switching products or following a trend they saw online.

Action already taken? Customer may have switched products, used moisturisers, or avoided makeup. Ask what has helped or worsened symptoms.

ENVIRONMENTAL FACTORS

Medication? Check for new prescription or OTC products, including retinoids, acne treatment, steroid creams, or isotretinoin. These may contribute to sensitivity.

 Harsh cleansers

 Cold or windy weather  Central heating or air conditioning

SHAVING CARE

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SHAVING CARE Shaving is an everyday grooming routine for many people, but when not done correctly, it can lead to discomfort, irritation, or infection.

Common shaving concerns include razor burn, nicks and cuts, ingrown hairs, and shaving rash (pseudofolliculitis barbae).

Pharmacy assistants play an important role in helping customers choose suitable products, prevent irritation, and manage shaving-related skin problems. Understanding the different shaving methods, skin types, and appropriate aftercare enables the pharmacy team to offer tailored, effective advice.

Shaving removes both hair and part of the skin’s surface layer, which can leave the skin sensitive and vulnerable to irritation. The act of dragging a razor across the skin causes mild abrasion and can disrupt the protective moisture barrier, especially if the blade is dull or used incorrectly.

Razor burn refers to the redness, stinging, or soreness that develops after shaving. Ingrown hairs occur when freshly cut hairs curl back into the skin, causing bumps or inflammation.

These issues are most common in individuals with curly or coarse hair and in areas where shaving is frequent — such as the face, legs, or underarms.

COMMON CONTRIBUTING FACTORS Several factors can contribute to shaving irritation or poor results:

 Always use a sharp, clean razor blade — ideally replaced every 5–10 shaves or sooner if it tugs or feels rough.

 Avoiding fragranced lotions or alcoholbased splashes, which can sting and dry the skin.

 Shave in the direction of hair growth to minimise irritation. Those seeking a closer shave can carefully go across or against the grain afterward, but only with proper lubrication.

 Applying a light antiseptic or antibacterial gel if small nicks occur.

 Use gentle, short strokes rather than long, forceful movements.

Consistent aftercare helps maintain healthy skin and prevent long-term irritation.

 Rinse the razor frequently during use to prevent clogging.

WHEN TO REFER

 Using sunscreen on freshly shaved areas exposed to the sun, as skin is more sensitive to UV damage post-shave.

Referral to the pharmacist or GP may be needed if:

 Dry shaving without adequate lubrication

 Avoid repeatedly going over the same area.

 Using a blunt or dirty razor blade

 The skin is severely inflamed, blistered, or infected

 Shaving too quickly or against the direction of hair growth

For customers with frequent razor burn or ingrown hairs, consider recommending electric shavers or beard trimmers, which can be gentler on the skin.

 Not preparing the skin properly before shaving

AFTERCARE

 Excessive pressure on the razor

After shaving, the skin needs soothing and protection. Pharmacy assistants can recommend:

 The patient has widespread razor rash unresponsive to self-care

 Underlying skin conditions like eczema or acne Encouraging proper preparation and aftercare can prevent most of these problems.

PRE-SHAVE PREPARATION Good preparation is the key to a comfortable shave. Advise customers to:  Soften the hair with warm water — ideally after a shower or by applying a warm, damp towel to the area for a few minutes.  Use a quality shaving gel, cream, or foam to lubricate and protect the skin. These products help the razor glide smoothly, reducing friction and irritation.  Avoid soap as a substitute — it can dry out the skin and increase razor drag.  Exfoliate gently once or twice a week (especially before shaving) to remove dead skin cells and help prevent ingrown hairs.

For sensitive or acne-prone skin, fragrancefree or hypoallergenic formulations are best.

SHAVING TECHNIQUE Advise customers on the following techniques to reduce irritation and improve comfort:

 There are painful or persistent ingrown hairs that appear infected

 The patient shows signs of folliculitis (pustules or clusters of spots)

 Cool water rinses to remove any remaining product and close pores.

 The irritation coincides with new shaving products or medications (e.g., retinoids, isotretinoin)

 Alcohol-free aftershave balms or moisturisers containing aloe vera, chamomile, or vitamin E to calm the skin.

Prompt referral ensures proper diagnosis and treatment if a skin condition or infection is present.

WWHAM Who? Anyone experiencing irritation, redness, or discomfort after shaving.

Pay attention to customers with sensitive skin, acne, eczema, or coarse curly hair, as they are more prone to shaving problems.

What are the symptoms? Ask about redness, bumps, itching, burning, or spots.

Determine whether there are any cuts, ingrown hairs, or signs of infection.

How long have they had the symptoms? Occasional mild irritation after shaving is common. Persistent or worsening symptoms lasting more than a week, or repeated ingrown hairs, may need pharmacist review.

Action already taken? Find out if they have changed razors, shaving products, or routines, and whether they’ve tried moisturisers, aftershaves, or antiseptic creams.

Medication? Check for skin treatments (e.g., acne medications, retinoids, steroids) or medical conditions that make skin more sensitive.

SLEEP DISORDERS

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SLEEP DISORDERS Sleep is a universal human need and a cornerstone of physical and mental wellbeing.

Yet, around one in three adults in Ireland reports poor sleep, and nearly half of all people globally will experience a sleep disorder at some point in their lives. The consequences can be significant — persistent fatigue, poor concentration, reduced work performance, increased risk of accidents, and long-term links with chronic illness and mental health conditions such as anxiety and depression.

As one of the most accessible healthcare professionals, the pharmacy team is well placed to offer early support, practical advice, and appropriate referral for people struggling with sleep problems.

CONTRIBUTING FACTORS Poor sleep can arise from a combination of lifestyle, medical, medication-related, and demographic factors. Understanding these helps tailor advice to each individual.  Lifestyle factors include excessive caffeine, alcohol, or nicotine intake, irregular sleep schedules, and excessive screen time before bed.  Medical factors such as pain, depression, anxiety, respiratory conditions, or cardiovascular disease can interfere with sleep quality.  Medication-related factors include stimulants, corticosteroids, SSRIs, decongestants, and beta-blockers, all of which can contribute to insomnia.  Demographic factors such as older age, shift work, pregnancy, or menopause also play a role.

Encourage pharmacy staff to explore these possible contributors when a patient requests a sleep aid, to ensure advice is both appropriate and safe.

NON-PHARMACOLOGICAL MANAGEMENT Behavioural strategies remain the first-line approach to managing sleep disorders.

Reinforcing good sleep hygiene during every consultation is one of the most effective interventions.

Patients should be advised to maintain regular bedtimes and wake times, even on weekends, to help regulate their internal body clock. Caffeine, alcohol, and nicotine should be avoided in the hours leading up to bedtime, as all can delay sleep onset or cause restless sleep. Reducing screen time before bed is essential — the blue light emitted from phones, tablets, and televisions suppresses melatonin, a hormone critical for sleep.

A comfortable, quiet, and dark bedroom is key to good sleep. Encourage patients to reserve their beds for sleep and intimacy only, avoiding late-night work or television in bed.

Regular physical activity can help improve sleep quality, but it should be scheduled earlier in the day rather than close to bedtime.

Cognitive Behavioural Therapy for Insomnia (CBT-I) is the gold standard treatment for chronic insomnia. It helps patients change

unhelpful thoughts and behaviours that perpetuate poor sleep, using techniques such as sleep restriction, stimulus control, and cognitive restructuring. With the growth of digital CBT-I programmes and mobile apps, pharmacists can now signpost patients toward reputable, evidence-based tools that are more accessible than ever.

PHARMACOLOGICAL OPTIONS Medication may be appropriate for short-term or specific sleep disorders, but it should always be used cautiously and under supervision.

Short courses of benzodiazepines such as temazepam or the related Z-drugs (zopiclone, zolpidem) may be prescribed for acute insomnia. Melatonin may benefit patients with circadian rhythm disorders, but initiation and dose adjustment should be GP-led.

For Restless Legs Syndrome (RLS), dopamine agonists (e.g., ropinirole, pramipexole) or gabapentinoids (gabapentin, pregabalin) may be used, while iron supplementation is indicated when ferritin levels fall below 75 µg/L. Patients with obstructive sleep apnoea (OSA) should remain under specialist care, often involving continuous positive airway pressure (CPAP) therapy or wake-promoting agents.

Pharmacy teams should always counsel on correct use, treatment duration, and safety — especially around the risks of alcohol consumption, next-day drowsiness, and driving impairment.

PHARMACIST-LED ACTIONS Pharmacists play a pivotal role in identifying and managing sleep issues within the community. Structured screening tools such as the Epworth Sleepiness Scale (for OSA) or the Insomnia Severity Index can help guide assessment and referral.

During medication reviews, pharmacists should be alert to medicines that may disrupt sleep and suggest alternatives or dose adjustments where appropriate. When dispensing hypnotics, staff should reinforce short-term use, monitor for side effects, and counsel on dependence risks.

Referral is essential for patients with persistent insomnia, suspected OSA, or underlying mental health concerns. GPs can arrange further evaluation, while specialist sleep clinics — such as those in Beaumont, Tallaght, Cork, or Galway — offer comprehensive diagnostic support.

WWHAM Who? Anyone struggling with difficulty falling or staying asleep, frequent waking, or excessive daytime tiredness. Pay close attention to older adults, shift workers, pregnant or menopausal women, and patients with chronic conditions such as depression or pain disorders.

What are the symptoms? Ask if they have trouble falling asleep, waking too early, or feeling unrefreshed in the morning. Explore whether snoring, restless legs, or breathing pauses occur — possible signs of sleep apnoea.

How long have they had the symptoms? Transient sleep issues lasting a few nights may relate to stress or temporary lifestyle factors.

Action already taken? Check if they have tried over-the-counter sleep aids, herbal remedies, or lifestyle adjustments.

Medication? Review current medicines that may contribute to poor sleep — such as stimulants, corticosteroids, SSRIs, or decongestants. Patients on sedatives or sleep medication should be counselled on short-term use and the risk of dependency.

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SMOKING CESSATION

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SMOKING CESSATION Smoking remains the leading cause of preventable illness and death in Ireland, with more than 100 people dying each week from smoking-related conditions. On average, people who smoke lose at least 10 quality years of life, and many live with long-term respiratory, cardiovascular, and metabolic complications. Because community pharmacies are often the first point of contact for health advice, pharmacy staff play a crucial role in helping people to quit.

Research consistently shows that combining behavioural support with nicotine replacement therapy (NRT) can significantly improve a smoker’s chances of long-term success.

With the right guidance, encouragement, and follow-up, pharmacy teams can help customers understand their motivations for smoking, identify barriers to quitting, and choose the most appropriate products or services to support their quit attempt.

THE ROLE OF THE PHARMACY TEAM Pharmacy staff are uniquely positioned to support smoking cessation because they engage regularly with customers seeking advice for respiratory symptoms, cardiovascular concerns, stress-related conditions, and long-standing health issues.

A simple, supportive conversation can be enough to trigger a quit attempt.

Pharmacies may also offer more structured services, including:

low mood. It allows the customer to break the behavioural habit of smoking while gradually reducing nicotine dependence.

Nicotine Patches  Provide a steady dose of nicotine throughout the day  Available as 16-hour and 24-hour patches (equally effective)  Useful for moderately dependent smokers  Customers should apply patches to a different area daily to avoid skin irritation  If a customer experiences persistent redness or sensitivity, advise them to consider another form of NRT Nicotine Gum  Helps manage cravings and occupies the mouth, replacing the “hand-to-mouth” smoking habit  Available in different strengths depending on nicotine dependence  Works best when chewed slowly using the “chew and park” technique Nicotine Inhaler  Delivers nicotine vapour absorbed through the lining of the mouth and throat  Addresses both physical cravings and the behavioural routine of smoking

 brief interventions and motivational advice

 Beneficial for people who miss the act of holding a cigarette

 guidance on choosing and using NRT

Nicotine Lozenges

 carbon monoxide (CO) monitoring

 Available in strengths for light or heavy smokers

 weekly check-ins for customers attempting to quit  signposting to HSE QUIT Services, which offer free counselling, phone support, and group programmes These services help customers understand that quitting reduces the risk of heart attack, stroke, chronic lung disease, diabetes complications, and cancers — and improves energy levels, sleep, healing, fertility, and overall quality of life.

BRIEF SMOKING CESSATION ADVICE: THE THREE A’S (ASK, ADVISE, ASSIST) A short conversation at the counter can make a significant difference: 1. Ask the customer whether they smoke.

2. Advise them clearly and non-judgmentally to consider quitting.

3. Assist by offering NRT options or referring them to the HSE QUIT Service if they wish further support.

Even if the person is not ready to quit, this simple interaction can begin the process of change.

Nicotine Replacement Therapy (NRT) NRT helps reduce withdrawal symptoms such as cravings, irritability, poor concentration, and

 Useful for customers who prefer discreet, easy-to-use options  May cause temporary mouth or stomach irritation if swallowed too quickly Pharmacy Awareness: Medicines Interactions Smoking affects the metabolism of several medicines through pharmacokinetic and pharmacodynamic mechanisms. When someone quits, blood levels of certain

medicines may change. Pharmacy teams should be alert to possible interactions with:  hormonal contraceptives  beta-blockers  theophylline  clozapine  some benzodiazepines A customer planning to quit may need a medication review, especially if they take longterm medicines.

PHARMACY CONSIDERATIONS  Do staff routinely ask about smoking status during consultations?  Are team members confident assessing a customer’s readiness to quit?  Is up-to-date training available on NRT products stocked in the pharmacy?  Do you have contact details for local HSE QUIT advisors or printed leaflets?  Can your pharmacy provide CO monitoring or structured follow-up?  Are staff comfortable discussing health risks without judgement and offering supportive advice?

WWHAM Who? Generally adults who smoke; note pregnancy, chronic illness or young adults.

What? Not symptoms — but smoking habits, dependence level, and motivation to quit.

How long have they smoked? Duration and daily consumption help determine the most suitable NRT form and strength.

Action already taken? Cutting down, switching brands, attempting coldturkey, or prior NRT use.

Medication? Check for interacting medicines; advise limits such as: • maximum 15 high-strength lozenges daily • caution using inhalators in customers with COPD or chronic throat conditions

SORE THROAT

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SORE THROAT Sore throat is one of the most common reasons people visit a pharmacy. It is usually mild and self-limiting, but it can cause significant discomfort and affect daily life. Most sore throats are caused by viral infections such as the common cold or flu, while a smaller number are due to bacterial infections like Streptococcus pyogenes (strep throat).

Pharmacy assistants play an important role in assessing symptoms, offering appropriate advice or over-the-counter (OTC) treatments, and recognising when referral to a pharmacist or GP is necessary.

CAUSES AND CONTRIBUTING FACTORS The majority of sore throats are viral and resolve without antibiotics within seven to ten days. Common viral causes include rhinoviruses, influenza, and adenoviruses.

Bacterial infections account for roughly 10–15% of adult cases but are more common in children and teenagers. Other causes include allergies, dry air, smoking, voice strain, or mouth breathing.

Environmental factors, such as exposure to dry or heated air during winter, can worsen symptoms. Acid reflux (GERD) can also lead to throat irritation in some patients. Pharmacy teams should consider these background factors during patient consultations.

COMMON SYMPTOMS Patients with sore throat often describe:  Pain or scratchiness in the throat  Difficulty swallowing or talking  Redness and inflammation in the throat or tonsils  Swollen glands in the neck  A mild fever, headache, or general fatigue

These non-pharmacological measures are suitable for most mild cases and should always be recommended alongside any medication.

PHARMACOLOGICAL OPTIONS There are a wide range of OTC treatments available for symptom relief. Pharmacy assistants should be familiar with the main product categories and when to refer to the pharmacist for advice.  Analgesics: Paracetamol or ibuprofen are effective for pain and fever. They can be safely recommended for most adults unless contraindicated.  Lozenges and Sprays: Many contain soothing agents such as menthol, honey, or glycerine. Some also include antiseptics (e.g., cetylpyridinium chloride) or mild local anaesthetics (e.g., benzocaine, lidocaine) for short-term pain relief.  Mouthwashes and Gargles: Saltwater rinses or antiseptic mouthwashes may help reduce throat irritation and bacterial load.

If symptoms are severe or accompanied by persistent high fever, rash, or difficulty breathing, referral for medical review is essential.

 Throat Sprays with Anti-inflammatory Agents: Some contain flurbiprofen, which can reduce inflammation and pain. These should be used as directed and not for prolonged periods.

SELF-CARE AND NONPHARMACOLOGICAL MANAGEMENT

WWHAM

Reassure patients that most sore throats improve on their own within a few days. Simple self-care measures can make a big difference:  Hydration: Encourage plenty of fluids to soothe the throat and prevent dehydration.  Rest: Adequate rest supports the immune system and speeds recovery.  Soothing relief: Warm drinks with honey and lemon, or cold treats like ice lollies, can help reduce discomfort.  Avoid irritants: Patients should avoid smoking, alcohol, and very spicy or acidic foods.  Humidify the air: Using a humidifier or inhaling steam can help ease dryness and irritation.

Patients should be reminded that antibiotics are not usually necessary for sore throats caused by viruses. The pharmacist or GP will only prescribe them when there are clear signs of bacterial infection.

WHEN TO REFER Certain symptoms suggest the need for medical assessment rather than self-care.

Always refer to the pharmacist or GP if the patient reports:  A sore throat lasting longer than one week  Severe pain, or difficulty swallowing or breathing  High fever, rash, or swollen glands that do not improve  Recurring sore throats or tonsillitis  A compromised immune system (e.g., due to chemotherapy, diabetes, or HIV)  Children under 12 months or frail older adults Prompt referral ensures early identification of serious conditions such as strep throat, quinsy (peritonsillar abscess), or glandular fever.

Who? Anyone complaining of throat pain, difficulty swallowing, or hoarseness.

Pay close attention to children, older adults, and those with chronic illnesses or weakened immunity, as they may need medical referral.

What are the symptoms? Ask about pain level, duration, presence of fever, swollen glands, or difficulty swallowing. Check for warning signs such as rash, drooling, or breathing difficulty.

How long have they had the symptoms? Most viral sore throats clear within 7–10 days.

Action already taken? Ask what the patient has tried — such as lozenges, sprays, paracetamol, or home remedies — and whether these have helped.

Medication? Check for current medicines and conditions that could influence product choice (e.g., asthma, ulcers, allergies to anaesthetics, or NSAID sensitivity). If they are on multiple medications or have long-term conditions, refer to the pharmacist for product selection and dosage guidance.

Always read the label.

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STRESS

STRESS

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Stress is a natural human response to challenging or demanding situations. In small amounts, it can be helpful — motivating us to act or perform. However, when stress becomes chronic or overwhelming, it can have serious effects on both physical and mental health.

In Ireland, increasing numbers of people report feeling under constant pressure due to work, financial strain, family responsibilities, or health concerns. Long-term stress contributes to conditions such as insomnia, high blood pressure, headaches, digestive issues, anxiety, and depression.

Pharmacy teams are often a first point of contact for patients seeking support.

Understanding how to recognise stress, offer practical advice, and know when to refer can make a meaningful difference to patients’ wellbeing.

Stress occurs when a person perceives that the demands placed on them exceed their ability to cope. The body’s “fight or flight” response releases hormones such as adrenaline and cortisol, preparing us to respond to threats. In the short term, this is adaptive — but over time, persistently raised stress hormones can cause both mental and physical exhaustion.

Common causes of stress include work pressures, financial concerns, family or relationship difficulties, ill health, bereavement, and major life changes. Even positive events such as moving house or starting a new job can act as triggers.

RECOGNISING THE SIGNS Stress affects everyone differently, but typical symptoms can be grouped into physical, emotional, and behavioural categories:  Physical: headaches, muscle tension, palpitations, digestive problems, fatigue, or disturbed sleep.  Emotional: irritability, anxiety, low mood, or feeling overwhelmed.  Behavioural: changes in appetite, increased smoking or drinking, social withdrawal, or poor concentration.

Pharmacy assistants should look out for customers mentioning symptoms such as tiredness, sleep problems, or persistent tension, which may signal stress rather than an isolated illness.

SELF-CARE AND NONPHARMACOLOGICAL MANAGEMENT Encouraging healthy coping strategies is the cornerstone of managing stress. Simple, sustainable lifestyle adjustments can make a significant difference.  Regular physical activity such as walking, cycling, or swimming helps reduce stress hormones and release endorphins that improve mood.  Balanced diet: skipping meals or relying on caffeine, alcohol, or sugary snacks can worsen irritability and fatigue.

 Sleep hygiene: maintaining a consistent bedtime routine and avoiding screens late at night promotes better rest and resilience.

 B vitamins play a role in nervous system function and energy metabolism and can be useful in stress-related tiredness.

 Relaxation techniques: deep breathing, meditation, mindfulness, and yoga can help calm the mind and body.

 Sleep aids (e.g., short courses of sedating antihistamines or herbal combinations) may be appropriate for temporary insomnia linked to stress, under pharmacist guidance.

 Social support: talking to trusted friends, family, or colleagues can relieve emotional pressure.

Pharmacy staff can gently promote these strategies during everyday consultations, reminding patients that self-care is not selfish — it’s essential.

PHARMACOLOGICAL OPTIONS While stress itself is not treated with medication, pharmacists can recommend short-term support to help patients manage related symptoms such as anxiety, tension, or sleep disturbance.  Herbal remedies such as valerian, passionflower, or ashwagandha are available over the counter and may support relaxation. Patients should be advised that results can vary and interactions with prescribed medicines should be checked by the pharmacist.  Magnesium supplements may benefit individuals experiencing muscle tension, fatigue, or mild anxiety, especially if their diet is lacking.

Always remind patients that supplements and OTC remedies are adjuncts, not cures, and should be used alongside lifestyle measures.

WHEN TO REFER Not all stress can be managed through selfcare or OTC remedies. Pharmacy staff should refer to the pharmacist or GP if:  The patient’s stress is severe, persistent, or worsening.  They report symptoms of anxiety, depression, or panic attacks.  There are signs of self-harm, hopelessness, or suicidal thoughts.  Physical symptoms (such as palpitations, chest pain, or weight loss) are significant or unexplained.  The patient is pregnant, breastfeeding, elderly, or taking multiple prescribed medicines.

Early intervention and referral to counselling, psychological therapy, or GP review can prevent long-term complications.

WWHAM Who? Anyone feeling overwhelmed, anxious, tense, or struggling to cope with everyday pressures. Pay particular attention to students, parents, shift workers, carers, and older adults, who may be under sustained stress.

What are the symptoms? Ask about sleep patterns, energy levels, mood changes, headaches, or irritability. Identify whether stress is causing physical symptoms like palpitations or stomach upset.

How long have they had the symptoms? Mild stress lasting a few days may respond to lifestyle changes and relaxation techniques. Persistent stress lasting weeks or months, or symptoms interfering with daily life, should be referred for further support.

Action already taken? Find out what coping strategies or products the person has tried — e.g., exercise, supplements, herbal remedies, or sleep aids — and whether these helped.

Medication? Check for prescribed medicines that may interact with herbal or nutritional supplements. Patients on antidepressants, sedatives, or anxiety medication should be referred to the pharmacist before using any OTC product.

STRETCH MARKS

STRETCH MARKS  Stretch marks become pale, silvery, or white  Texture becomes more flat or slightly depressed Later Stage – Striae Albae:

In a culture increasingly shaped by bodypositivity and self-acceptance, many individuals still feel pressure to achieve “flawless” skin due to beauty standards perpetuated by celebrity culture and social media. As a result, customers continue to seek advice on managing common skin concerns such as stretch marks. Although stretch marks are medically harmless and extremely common, they can cause distress or impact self-esteem. Pharmacy assistants therefore play a key role in offering empathetic support, clear information, and appropriate product guidance.

 Fully matured stretch marks

UNDERSTANDING STRETCH MARKS

General Principles:

Stretch marks (striae) are discoloured, indented streaks that form when the skin rapidly stretches or shrinks. This sudden change causes collagen and elastin—two key proteins responsible for skin strength and flexibility—to tear. As the skin heals, visible marks develop. Stretch marks are not painful, dangerous, or harmful to health. They often fade over time, with or without treatment, but rarely disappear completely.

Stretch marks frequently appear on the abdomen, thighs, hips, breasts, upper arms, lower back, and buttocks.

 Hypopigmented, thin, and wrinkled  Indicate long-term collagen and elastin loss Early intervention offers the best cosmetic outcomes.

TREATMENT OPTIONS Stretch marks require no medical treatment; however, many customers wish to improve their appearance. Your role is to provide realistic expectations, empathetic reassurance, and guidance on available options. v Stretch marks are normal and extremely common.  Treatments may help fade appearance but cannot completely “erase” stretch marks.

TOPICAL TREATMENTS

 Eating a balanced, nutrient-rich diet (vitamins A and C, zinc, protein)

Retinol (Vitamin A derivatives):

Pregnancy: Rapid stretching of the abdomen and hormonal changes contribute significantly.

Not suitable during pregnancy or breastfeeding.

Puberty: Growth spurts during adolescence frequently cause striae.

Bio-Oil:

Underlying conditions: Rarely, conditions such as Cushing’s syndrome cause excessive cortisol levels, weakening skin integrity.

PROGRESSION OF STRETCH MARKS Stretch marks evolve over time.

Understanding these stages supports appropriate counselling: Early Stage – Striae Rubrae:  Pink, red, or purple lines  Slightly raised and may be itchy  Represents active inflammation and connective-tissue damage Intermediate Stage:  Redness fades

PREVENTION STRATEGIES

 Maintaining a stable weight and avoiding rapid fluctuations

Side effects: dryness, irritation, photosensitivity.

Bodybuilding: Rapid muscle growth can overstretch skin.

There is limited clinical evidence that topical products completely prevent or cure stretch marks. However, many customers experience emotional or cosmetic benefit from regular application, and the act of massaging can itself promote wellbeing.

 Without treatment, stretch marks typically fade within 6–12 months.

Several factors contribute to the development of stretch marks, including:

Genetics: A family history of stretch marks increases likelihood.

General Note:

While not always possible, customers can lower their risk by:

CAUSES OF STRETCH MARKS

Long-term steroid use: Prolonged use of corticosteroid tablets or creams can reduce collagen levels.

for prevention is limited, the moisturising action and massaging effect can support skin comfort and elasticity.

 Newer stretch marks respond better than older ones.

Improves skin texture and increases collagen production. Requires several months of consistent use.

Rapid weight gain or weight loss: Quick skin expansion or shrinkage stresses the dermal structure.

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 Drinking adequate water daily  Engaging in regular exercise to support collagen production

WHEN TO REFER Referral to the pharmacist is recommended if:  Stretch marks appear suddenly with no clear cause

A blend of oils, vitamins, and plant extracts marketed to improve uneven skin tone, scars, and stretch marks. Studies show improvement in appearance with continued use, particularly in skin elasticity.

 Stretch marks cover large areas and distress is significant

Palmer’s Cocoa Butter Range:

 The customer experiences low mood or body-image concerns affecting daily life

Products formulated with cocoa butter, Vitamin E, collagen, and elastin. Widely used during and after pregnancy. While evidence

 Customer wishes to explore prescription options

 There are signs of skin irritation or adverse reaction to products

WWHAM Who? Anyone experiencing stretch marks due to pregnancy, puberty, rapid weight changes, bodybuilding, steroid use, or genetic factors. Can affect both men and women.

What are the symptoms? Pink, red, purple, or silver lines on the skin; sometimes itchy or raised in early stages; later becoming pale, thin, or indented.

How long have they had the symptoms? Newer stretch marks respond better to treatment. Long-standing striae may be more difficult to improve.

Action already taken? Customer may have used oils, moisturisers, retinol products, or massaged the area.

Medication? Check for long-term corticosteroid use, which can contribute to stretch marks. Retinol-containing products require caution in pregnancy and breastfeeding.

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THRUSH

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THRUSH Thrush, also known as candidiasis, is a common fungal infection caused by an overgrowth of Candida species, most often Candida albicans. It can affect various parts of the body, but in pharmacy practice, the most frequent presentations are vaginal thrush and oral thrush.

Although usually mild and easily treatable, thrush can be uncomfortable, distressing, and recurrent for some patients. Pharmacy assistants play a key role in identifying symptoms, offering appropriate over-the-counter (OTC) treatments, and knowing when to refer to the pharmacist or GP for further assessment.

Thrush develops when the normal balance of microorganisms in the body is disrupted, allowing Candida to multiply. This imbalance can be triggered by:  Antibiotic use, which reduces protective bacteria  Hormonal changes, such as during pregnancy or menstruation  Diabetes, especially if poorly controlled  Weakened immunity, for example due to illness or medication  Irritants such as perfumed soaps, bubble baths, or tight synthetic clothing It is important to distinguish thrush from other conditions such as bacterial vaginosis, urinary tract infections (UTIs), or sexually transmitted infections (STIs), as these require different treatment and medical review.

SYMPTOMS Vaginal Thrush  Itching, soreness, or irritation around the vagina and vulva  Thick, white, “cottage cheese-like” discharge with little or no odour  Pain or discomfort during sex or urination  Redness and swelling around the affected area Oral Thrush  White patches or coating on the tongue, inner cheeks, or gums  Soreness or burning sensation in the mouth  Cracked corners of the mouth  Loss of taste or an unpleasant taste Symptoms are often mild but can become more pronounced in recurrent or untreated cases.

SELF-CARE AND LIFESTYLE ADVICE Good hygiene and prevention strategies can reduce the likelihood of recurrence. Patients should be advised to:  Wear loose-fitting, breathable cotton underwear and avoid tight clothing.  Avoid scented soaps, bubble baths, or vaginal deodorants, which can disrupt the natural pH.

 Dry the genital area thoroughly after bathing and avoid using harsh towels.  Manage contributing factors such as diabetes by keeping blood sugar levels under control.  If using antibiotics, consider probiotic yoghurt or live cultures to help restore healthy flora (though evidence is mixed).

For oral thrush, treatments such as miconazole oral gel or nystatin suspension may be recommended under pharmacist supervision.

Patients should be advised to complete the full course as directed and avoid sexual intercourse during treatment to prevent discomfort and reinfection.

 For oral thrush, rinse the mouth after using inhaled corticosteroids and clean dentures regularly.

WHEN TO REFER

Encouraging these habits supports effective treatment and helps prevent recurrence.

 This is the first episode and diagnosis has not been confirmed previously

PHARMACOLOGICAL OPTIONS

 The patient is under 16 or over 60 years old

OTC treatments are available for uncomplicated thrush in healthy adults who have had it before and recognise the symptoms.

 Symptoms are recurrent (≥4 times in 12 months)

 Antifungal creams (e.g., clotrimazole 2% or miconazole) provide local relief for external itching and irritation.  Vaginal pessaries or tablets (e.g., clotrimazole 500 mg or 200 mg) treat the infection internally and are inserted at night.  Oral capsules (e.g., fluconazole 150 mg single dose) provide a convenient systemic option.  Combination packs are available for patients with both internal and external symptoms.

Always refer to the pharmacist or GP if:

 There is abnormal vaginal bleeding, offensive discharge, or severe pain  The patient is pregnant, breastfeeding, or has diabetes or immune compromise  The infection may involve the penis (balanitis) or another body area  Symptoms do not improve after treatment or return within two months Early referral ensures accurate diagnosis and safe management.

WWHAM Who? Adults with vaginal, penile, or oral irritation, discharge, or soreness.

Pay special attention to pregnant women, people with diabetes, recurrent symptoms, or immunocompromised patients, who should be referred.

What are the symptoms? Ask about itching, soreness, unusual discharge, or oral discomfort. For vaginal thrush, check if the discharge is thick and white with no odour.

How long have they had the symptoms? Symptoms that persist longer than one week, worsen, or recur frequently require pharmacist or GP review.

Action already taken? Ask whether they have used antifungal creams, pessaries, or oral capsules before and if symptoms resolved.

Medication? Check for current medicines or medical conditions that may predispose to thrush (e.g., antibiotics, corticosteroids, oral contraceptives, or diabetes). Ensure no interactions with antifungals.

TOPICAL ANALGESICS

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TOPICAL ANALGESICS Muscle and joint pain is one of the most common reasons customers seek advice in the pharmacy. These symptoms affect individuals of all ages and can significantly impact comfort, mobility, and quality of life.

While oral analgesics remain familiar options, topical analgesics—available as rubs, creams, gels, sprays, and patches—offer targeted relief and are widely used for a range of musculoskeletal conditions. Pharmacy assistants play an important role in helping customers choose the most appropriate product and ensuring safe and effective use.

UNDERSTANDING TOPICAL ANALGESICS Topical analgesics are applied directly to the skin over painful muscles or joints.

They provide relief through localised action, minimising systemic side effects. These products may offer:  Local analgesic effects  Local anaesthetic effects

of action. Some formulations offer warming effects, while others provide cooling relief. e. Heat Therapy Patches - These patches provide continuous heat (typically 8–12 hours) and are useful for muscle stiffness, tension, and chronic low-grade pain.

Topical analgesics are available as gels, lotions, ointments, sprays, patches, and rollons. Customer preference for texture, scent, and ease of application should be considered.

PATIENT SELECTION AND APPROPRIATE USE

 Customers should be advised to wash hands thoroughly after applying creams or gels.

Customers may be confused by the large variety of topical analgesics and uncertain about which option suits their symptoms.

Pharmacy assistants can guide them by clarifying:

 Topical analgesics should never be applied near the eyes, on mucous membranes, or on broken skin.

 Location and type of pain  Whether the pain is acute (e.g., sprain, strain) or chronic

Referral to the pharmacist is warranted when:  Pain is severe, persistent, or unexplained  There is suspicion of infection, swelling, or deformity

 Antipruritic effects

 Whether the customer is using oral analgesics concurrently

 Counterirritant effects

 Any history of sensitivities or allergies

They can be used alone or alongside oral analgesics when appropriate. In many cases, customers prefer topical options for minor sprains, strains, overuse injuries, exerciserelated discomfort, or localised joint pain.

Topical analgesics should be applied only to intact, unbroken skin. Areas treated with counterirritants should not be covered with tight bandaging or occlusive dressings, as this can increase absorption and risk irritation.

Common active ingredients include:

Many OTC topical analgesics are intended for short-term use, generally no longer than seven days unless otherwise advised by a healthcare professional.

SUPPORTING CUSTOMERS

SAFETY CONSIDERATIONS AND WHEN TO REFER

 Explain the differences between warming, cooling, and salicylate-based products

v Methyl salicylate  Menthol  Camphor  Methyl nicotinate  Capsaicin  Trolamine salicylate Each ingredient works differently, and understanding the distinctions helps ensure the right recommendation is made.

TYPES OF TOPICAL ANALGESICS a. Counterirritants - These ingredients (menthol, camphor, methyl salicylate, capsicum) stimulate sensory receptors to create sensations such as cooling or warming, which distract from deeper pain. They are helpful for minor muscle aches, joint pain, or acute musculoskeletal injuries. b. Salicylate-Based Products - These contain ingredients related to aspirin and may reduce pain in joints close to the skin surface, such as hands, elbows, and knees. They are useful for localised arthritic discomfort. c. Capsaicin Products - Derived from chilli peppers, capsaicin produces a warming or tingling sensation. It works by reducing substance P, a neurotransmitter involved in pain transmission. Capsaicin often requires several days to weeks of consistent use before full effect is achieved. d. General Analgesic Rubs and Creams - These may include combinations of ingredients to provide multiple mechanisms

Pharmacy assistants must ensure safe product selection:  Patients taking anticoagulants should avoid salicylate-containing topicals, as they may prolong prothrombin time.

 Pain does not improve after several days of treatment  The patient has significant medical conditions or is on complex medication regimens  The customer requests stronger analgesia beyond OTC scope

When recommending topical analgesics, it is helpful to:

 Advise on consistent application for best results  Discuss the expected onset of relief  Highlight appropriate use alongside oral analgesics, when suitable

 Customers with sensitive skin or eczema may react to counterirritant ingredients.

 Reinforce follow-up advice if symptoms persist

 Capsaicin may cause significant warmth or burning, which is normal but may be intolerable for some users.

Clear, confident guidance improves customer outcomes and helps ensure that products are used safely and effectively.

WWHAM Who? Anyone experiencing musculoskeletal pain, localised joint pain, sprains, strains, or exercise-related discomfort.

What are the symptoms? Pain, stiffness, swelling, or localised tenderness.

Clarify location, severity, and whether the pain is acute or chronic.

How long have they had the symptoms? Short-term injuries may respond well to topical treatments. Persistent or worsening symptoms require pharmacist involvement.

Action already taken? Customers may already have tried oral analgesics, rest, ice/heat, or previous topical products.

Medication? Ensure topical products are applied only to intact skin. Advise patients on anticoagulation therapy to avoid salicylate-containing topicals.

Check for allergies or concurrent treatments.

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VAGINAL DRYNESS

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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  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)

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 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 Sufferers of vaginal dryness can be advised that it’s worth trying self-help options first. It can help to:  try using a lubricant or vaginal moisturiser – these can be bought without a prescription  give yourself enough time to become aroused before having sex – read more about female arousal and get good sex tips

TREATMENTS The most common treatment for vaginal dryness due to low estrogen levels is topical estrogen therapy. These replace some of the hormones 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.

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.

WWHAM 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 advice 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.

10%

of Ireland’s population is estimated to have a wart or verruca in their lifetime**

EFFECTIVE IN 1 TREATMENT

***

SUITABLE TO USE FOR

AGES 4+

FREEZE AWAY MAX™ VERRUCA & WART REMOVER Utilises the same cryotherapy technique as used by healthcare professionals Removes common verrucas & warts Precision freeze spray Easy to use at home Treatment as fast as 10 seconds

Available from your Uniphar Scholl rep *Nielsen GTC Harmonized Data, 52 weeks unit sales December 2024 **www2.hse.ie. accessed Nov2025 ***The majority of users experience cure or improvement within one treatment.

Visit uniphar.ie or email linkup@uniphar.ie

WARTS

WARTS Warts are common, harmless skin growths caused by human papillomavirus (HPV).

Their appearance varies depending on the HPV strain, the thickness of the skin, and the customer’s immune response. Although they are medically benign, warts can cause embarrassment, cosmetic concern, and discomfort—especially when located on the hands or around the nails. Community pharmacy teams are well placed to support customers with advice, product selection, and reassurance.

TYPES OF WARTS Many strains of HPV can cause warts, but the most frequently seen non-plantar types include:

 Skin trauma (knocking, rubbing, biting nails)  Immune system strength— immunocompromised individuals are more prone  Moisture and maceration (e.g., thumbsucking in children) Warts spread through direct contact or indirectly via contaminated surfaces.

Customers should be reassured that warts are extremely common and often self-limiting.

TREATMENT GOALS

B. Cryotherapy Products (Home-use)

Wart management aims to:

Home freezing kits are available for common warts on hands and other non-sensitive areas.

 Remove the wart safely  Avoid causing scarring  Reduce risk of spreading to other areas or people

Common Warts

 Prevent recurrence

Firm, rough, raised growths typically appearing on the hands, fingers, and knees.

Children, individuals with reduced immunity, and those taking immunosuppressive medication should always be referred to the pharmacist before initiating treatment.

Plane (Flat) Warts Small, smooth, flat-topped lesions, often skincoloured. Common on the face, neck, shins, and backs of hands. Often appear in clusters.

Filiform Warts Long, narrow, finger-like projections commonly found on the face, particularly around the mouth, nose, or eyes.

Periungual Warts Warts that form around or under the fingernails or toenails. These can distort nail growth and may be more difficult to treat.

Mosaic Warts

Customers should be advised to seek further care if:

 Warts develop close to the eyes or on the face in a concerning manner

TREATMENT OPTIONS A. Salicylic Acid Products Widely recommended first-line for many common wart types.

DIFFERENTIATING WARTS FROM OTHER SKIN CONDITIONS

 Apply once daily or as directed.

 Medicated pads or plasters

 Collodion-type solutions Counselling points:

 Protect surrounding healthy skin with petroleum jelly or a plaster.  Filing or soaking the wart beforehand may improve efficacy.

Warts: Rough, cauliflower-like texture; may have pinpoint black dots; interrupt normal skin lines.

 Not suitable for certain patient groups (e.g., neuropathy, poor circulation).

Corns/Calluses: Thickened, hard skin with smooth edges; related to friction or pressure; no black dots.

WWHAM

Several factors influence how warts look and spread:  Body location (skin thickness varies)  HPV strain

 Maximum of three applications per wart.  Not for very young children or use on the face near the eyes.

C. Other Treatments Formaldehyde preparations

Glutaraldehyde solutions

 Liquid or gel applicators

FACTORS AFFECTING APPEARANCE AND DEVELOPMENT

 A treated wart usually falls off in 10–14 days.

 The area becomes painful, swollen, or shows signs of infection

Warts typically appear asymmetrically.

Scratching or picking can spread them in linear patterns, and customers may notice new lesions developing nearby.

Using a consultation room for assessment can provide privacy and comfort when examination is necessary.

 Customers must follow instructions carefully to prevent skin damage.

Used for resistant warts. May irritate the skin; avoid use on sensitive areas.

Available forms include:

Skin Tags: Soft, flesh-coloured, pedunculated growths that do not resemble warts.

Counselling points:

 Warts persist after 12 weeks of treatment

Clusters of small, superficial warts that form a “mosaic-like” pattern on the skin (non-plantar locations only for this guide).

Customers often confuse warts with corns, calluses, or skin tags. Key distinctions for pharmacy staff include:

95

Applied once or twice daily. May stain skin brown temporarily.

Note: These products should not be used on anogenital warts.

SELF-CARE AND PREVENTION ADVICE Pharmacy assistants should reinforce good hygiene and habits to reduce recurrence:  Avoid picking or scratching warts  Keep hands clean and dry  Do not share towels, nail clippers, or personal items  Cover warts with a plaster if they catch on clothing or cause embarrassment  Encourage children to avoid biting nails or sucking fingers  Wash hands after touching warts Prevention helps limit spread to other people and to other areas of the same body.

Who? Any individual with a skin growth suspected to be a wart. Pay special attention to children and customers with diabetes or weakened immunity.

What are the symptoms? Raised, rough, skin-coloured or darker bumps; flat smooth lesions; growths around nails; clusters of multiple warts. Ask if they are painful, spreading, or catching on clothing.

How long have they had the symptoms? Warts may persist for months or years. Recently developed warts or long-standing lesions may influence the choice of treatment.

Action already taken? Determine whether customers have tried salicylic acid, cryotherapy, filing, or home remedies.

Medication? Check for factors affecting suitability (e.g., diabetes, peripheral vascular disease, immunosuppressive medicines).

December 2025 Week 52

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October 2026 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

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December 2026 M 7 14 21 28 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

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January 2027 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

Dec ‘26/ January 2027 Week 1

Monday 28

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Friday 1

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150

COMPANY LISTINGS

BUYING GROUPS AND FRANCHISING

• Pharmacy valuations

Uniphar

• Taxation

• Pharmacy sale brokerage • Due Diligence and fundraising

Bayer Ltd, Consumer Health

• Audit • Pharmacy specific online management accounts Sector: Pharmaceutical Retail & Wholesale

• Year-end statutory account production

Uniphar is the market leader in Ireland with c.50% of the wholesale market. We use cuttingedge distribution facilities and digital innovation to ensure timely, secure delivery to Irish pharmacies. We also have a significant retail footprint through our retail pharmacy brands Allcare, Hickey’s, McCauley and Life Pharmacy.

• Payroll

If you would like to talk to us about joining Allcare Pharmacy or Life Pharmacy, please contact Robert or Laura.

• Bookkeeping • Company Secretarial Services Key Representative: Johnny O’Sullivan Tel: +353 (0)51 870152 Email: josullivan@fitzgeraldpower.ie Website: www.fitzgeraldpower.ie

Key Representatives:

Email: info@fitzgeraldpower.ie

Allcare: Trish Biggane - tbiggane@uniphar.ie

Tel: +353 (0)51 870152

Moblie: +353 86 048 7987

Company Address: Greyfriars, Waterford City, Waterford, X91K2WV

Life: Laura Garrett - Igarrett@uniphar.ie Mobile: +353 87 1194374

Email: info@uniphar.ie

PHARMACEUTICAL COMPANIES

Tel: +353 1 428 7777

Arok Healthcare

Website: www.uniphar.ie

Bayer is a global enterprise with core competencies in the life science fields of health care and nutrition. In line with its mission, “Health for all, hunger for none,” the company’s products are designed to help people thrive, by supporting efforts to master the challenges presented by a growing and aging global population.

Bayer Consumer Health aims to provide consumers around the world with a range of non-prescription healthcare products to improve their health and well-being. Informing and educating consumers about our products through innovative advertising and marketing programs has been a key element of our success to date. In Ireland, our brands’ distribution through pharmacy is supported by our field sales team with category detailing and point of sale.

For more information, go to www.bayer.ie Product Portfolio: Alka-Seltzer

Company Address: 4045 Kingswood Rd, Citywest Business Park, Co. Dublin D24 V06K

Bepanthen

FINANCE & BANKING

Berocca

Fitzgerald Power

Sector: Accountancy/Finance Fitzgerald Power is the leading financial advisor to the Irish community pharmacy sector and a recognised leader in pharmacy sales brokerage in Ireland. With offices in Dublin and Waterford, we understand the unique opportunities and challenges faced by Irish pharmacists.

We know it is essential for pharmacy operators to have access to sector-specific, up-to-date financial information. Drawing on our deep experience and knowledge of the pharmacy market, we provide clients with the insights they need to grow their businesses.

From analysing the impact of HSE announcements on profit margins to preparing comparative studies and benchmarking reports, we believe in equipping our clients with timely, relevant information and working closely with them to shape a clear strategic direction for their community pharmacy businesses.

Our community pharmacy team offers the following services: • Financial health checks which includes a comparison of current performance against sector averages

Bepantiseptic

Sector: Personal Wellness

Canespro

At the heart of Arok Healthcare is a commitment to women’s health and wellbeing. Our products support women to treat their intimate health concerns with confidence. We are passionate about fostering a customer base and community where women feel informed, supported, and empowered to take control of their intimate health, enabling them to thrive.

Canesten

Our commitment to wellness and improved quality of life is also reflected in our Family Health products. We seek to provide a range of selfcare products that fit seamlessly into the entire family’s routine. Our award-winning products in this range have a long history in Family Health.

Arok Healthcare is a personal wellness brand with a special focus on Women’s Health and Family Health. We specialise in high-quality and innovative brands focused within the over-the-counter (OTC) self-care category.

Regelle: Long Lasting Vaginal Moisturiser.

Relactagel: Lactic Acd Gel, Treatment for BV. FamilyD: Vitamin D Supplements for the entire family.

Website: www.arokhealthcare.com Email: info@arokhealthcare.com Tel: 01 8900406 Company Address: Swords Business Campus, Swords, Co. Dublin K67V1W8

CanesMeno Clarityn Cystopurin Losec Control Rennie Key Representatives: Alan McCormick, Sales Manager North Leinster, 087 4737712 Alan Cawley, Territory Manager South Leinster, 087 0686751 Fiona Taylor, Territory Manager South, 087 8538380 Neville Moore, Territory Manager West, 087 4866114 Website: www.bayer.com Email: info.ireland@bayer.com Tel: 353 1216 3300 Company Address: 1st Floor, The Grange Offices, The Grange, Brewery Road, Stillorgan, Co Dublin, A94 H2K7

COMPANY LISTINGS

Bluefish Pharmaceuticals

Website: www.brmarketing.ie Email: partner@brmarketing.ie Tel: +353 01 885 0800 Company Address: 9 Abbey House, Clonee, Co. Meath, D15 FXC3

Brandshapers Ltd Sector: Pharmaceutical marketing of ethical medicines and OTC products Bluefish is committed to delivering effective and affordable medicines.

Our vision is to make high-quality medicines widely available across the EU, empowering individuals and healthcare providers with reliable solutions. Through strategic partnerships and sustainable practices, we aim to shape the future of healthcare by delivering value and innovation to our customers and communities.

Ethical Products: Alendronate, Amlodipine, Amorolfine, Anastrozole, Atorvastatin, Clopidogrel, Coamoxiclav, Donepezil, Doxycycline, Eplerenone, Escitalopram, Letrozole, Melatonin (Meladura), Metformin, Mirtazapine, Modafinil, Montelukast, Omeprazole, Pantoprazole, Risedronate, Sertraline, Simvastatin, Valaciclovir, Venlafaxine.

OTC confined products: Paracetamol Bluefish, Ibuprofen (Mybufen), Cetirizine( Zitrease).

OTC confined products: Paracetamol Bluefish, Ibuprofen (Mybufen), Cetirizine(Zitrease).

Website: www.bluefishpharma.com Email: info-ir@bluefishpharma.com Tel: +353 1468 7672 Company Address: Bluefish Pharma, 4045 Kingswood Road, Citywest Business Park, Co Dublin

BR Healthcare

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Jenny Vernal (South Dublin, Carlow, Kildare, Kilkenny, Laois, Wicklow & Wexford) Phone: 087 7770882 Email: jenny@eurosalesinternational.ie Suzanne Cooney (Waterford, Cork, Kerry & Tipperary) Phone: 087 210 5126 Email: suzanne@eurosalesinternational.ie Adrian O’Driscoll (Limerick, Clare, Galway, Mayo, Roscommon, Leitrim, Longford, Offaly, Sligo) Phone: 087 763 6914 Email: adrian@eurosalesinternational.ie Clodagh Birney (Donegal and Northern Ireland) Phone: 0044 7748 113044 Email: clodagh@eurosalesinternational.ie Telesales:

Sector: Sales, Marketing, Wholesale and Distribution

Sandra Cheung / Catherine Delappe orders@eurosalesinternational.ie

Brands

Sandra: Phone: 01 4050900 Email: sandra@eurosalesinternational.ie

Baby: Kendamil, Kandoo, InfaCare.

Beauty: Sculpted by Aimee, Skingredients, Real Techniques, EcoTools, Tanologist, CurlyCo, Profusion.

Personal Care: Bulldog, Blistex, Breathe Right, Just For Men, Vagisil, Banana Boat, Hawaiian Tropic, Enliven, Odor Eaters.

Catherine: Phone: 01 405 0900 Email: catherined@eurosalesinternational.ie Online: https://b2b.eurosalesinternational.ie/customer/ account/login/

Fragrance: Beverly Hills Polo Club.

Or Register Here: https://www. eurosalesinternational.ie/register/

VMS: Chewy Vites, MyVitamins.

Website: www.eurosalesinternational.ie

Healthcare & OTC: CB12, Difflam.

Email: info@eurosalesinternational.ie orders@eurosalesinternational.ie

Supplements: MyProtein.

Functional Drinks: LoBros.

Key Representatives: Sharon Cahill Key Account Manager (Pharmacy) Sharon.Cahill@brandshapers.ie Mob: +353 87 4055364 Simon Byrne Field Sales Manager (Pharmacy) Simon.Byrne@brandshapers.ie Mob: +353 87 663 9570

Tel: 00 353 1 450 7771 Telesales Order Line: 00 353 405 0900 Company Address: Unit 3/4, Ballymount Business Park, Ballymount Drive, Ballymount Industrial Estate, Walkinstown, Dublin 12, D12 F884

Fresenius Kabi Ireland

Website: www.brandshapers.ie Sector: Multi-channel importers and distributors of food and healthcare brands BR Marketing represents a portfolio of leading brands across various categories and channels.

Since 1983, we have been a trusted partner of brand owners and trade customers, strategically nurturing brands from market entry through to category leadership. Passionate, dynamic and results-driven, we have a proven track record as a value-adding distributor in the Irish market.

A full-service provider, we are experts in importation, distribution, account management and brand marketing. Our market knowledge, coupled with our team’s capabilities and experience, gives us The Competitive Edge on which brands realise their ambitions.

Brands: Alcosense, Bare Addiction, Derbac M, Haliborange, Jakemans, Kalms, Klearvol, Nannycare, Olbas, ProPlus, Proven, Somega, Sorted Skin, SULA.

Email: Info@brandshapers.ie

Sector: Global Healthcare Company

Tel: (053) 917 9007

At Fresenius Kabi, we are committed to life. We are dedicated to putting essential medicines and technologies in the hands of people who help patients and finding the best answers to the challenges they face. Our product portfolio includes a comprehensive range of clinical nutrition products. In fact, we are the only company in Ireland offering parenteral and enteral nutrition as well as pumps and medical devices. All helping to serve our patients who are at the heart of everything we do.

Company Address: Ballytramon Business Park, Ardcavan, Castlebridge, Co. Wexford Y35 Y19A

Eurosales International Ltd

Sector: Marketing, Sales & Distribution of Cosmetics, Toiletries & OTC Products Key Representatives: Tracy Byrne (Monaghan, Cavan, Westmeath, Meath, Louth & North Dublin) Phone: 086 2344408 Email: tracyb@eurosalesinternational.ie

Fresenius Kabi provides a broad range of enteral nutrition solutions, including oral nutritional supplements and tube feeds, designed to support patients with diverse clinical needs and improve outcomes.

Products: Fresubin® Pro Compact, Fresubin® 3.2kcal, Fresubin® 5kcal shot, Fresubin® 2kcal Mini Drink, Fresubin® Thickened Level 2, Fresubin® Thickened Level 3, Fresubin® 2kcal Crème, Calshake Powder, Diben Drink,

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COMPANY LISTINGS

Fresubin® 2kcal Drink, Fresubin® 2kcal Fibre Drink, Fresubin® 2kcal Fibre Mini Drink, Fresubin® Protein Energy Drink, Fresubin® Energy Drink, Fresubin® Energy Fibre Drink, Fresubin® Jucy Drink, Fresubin® Original Drink, , Fresubin® YOCrème, Supportan® Drink, Thick & Easy Original, Thick & Easy® Clear.

Marketing Contact: fk-enquiries.ireland@fresenius-kabi.com Website: www.fresenius-kabi.com www.fresubinsamples.ie Email: fk-enquiries.ireland@fresenius-kabi.com Company Address: Fresenius Kabi, Unit 3B, Fingal Bay Business Park, Harry Reynolds Road, Balbriggan, Co Dublin K32YK12

Galderma

Cetaphil Moisturising Cream 50g, 450g Cetaphil Pro Redness Prone Skin Cleansing Facial Wash 236ml Cetaphil Pro Redness Prone Skin Tinted Moisturising Day Cream SPF30 50ml Cetaphil Pro Redness Prone Skin Moisturising Night Cream 50ml Cetaphil Itch Prone Moisturising Body Wash 295ml Cetaphil Itch Prone Moisturising Body Lotion 295ml Marketing Contacts: Acnecide + Purifide: Leon Davidson Cetaphil: Madeline Grinham Website: www.galderma.com Company Address: Evergreen House North, Grafton Place, London, NW1 2DX

Haleon

Sector: Healthcare and Pharmaceuticals Acnecide + Purifide provides a range of skincare products for acne, spot or blemish-prone skin, inspired by the latest dermatology science and expert approaches in acne treatments and clearer skin skincare.

Acnecide targets the 3 main causes of acne: clogged pores, excess oil and bacteria, with 5% Benzoyl Peroxide in a leave-on or wash-off format.

Sector: Consumer Health Haleon is a leading consumer company that specialises in everyday health. We work to put better everyday health in more hands through our superior brands, including Sensodyne, Advil and Centrum. Our brands are trusted and use by more than one billion consumers and are recommended by health professionals all around the world.

Purifide offers daily care for blemish-prone skin with a range of cleansers, moisturisers, and targeted solutions to help keep skin clear.

Brands:

Acnecide 5% w/w Gel 40g

Oral Health: Sensodyne, Sensodyne Pronamel, Corsodyl, Aquafresh, Poligrip.

Acnecide Face Wash 5% w/w Gel 50g Purifide Daily Cleanser 235ml Purifide Daily Moisturiser SPF30 50ml Purifide Blackhead Control Deep Exfoliating Cleanser 120ml Purifide Post Breakout Serum 30ml Purifide Power Patch Fast Fix 36 patches Purifide Power Patch Skin Restore 23 patches Cetaphil is an expert sensitive skincare brand with face & body products that are recommended & trusted by dermatologists for sensitive skin.

Cetaphil Gentle Skin Cleanser (118ml, 236ml, 473ml, 1ltr)

Sector: Supplements ITL Health, the makers of MAG365 and PrizMAG, is a family-owned business committed to delivering tangible health results. “In the Light” is more than just our name-it’s our guiding principle. We operate with purity, transparency, and education at the forefront, ensuring every product meets the highest standards.

Our award-winning magnesium-based supplements are crafted in small batches using premium ingredients, without fillers or manufacturing chemicals. Each product is vegan, free from common allergens, and designed for optimal absorption to maximize health benefits.

Experience the many health-boosting benefits of magnesium with ITL Health’s pure and effective supplements.

Website: www.itlhealth.eu Email: info@itlhealth.com Tel: +353-404-78208 Company Address: 22 Northumberland Road, Ballsbridge, Dublin 4, D04 ED73

Kenvue Ireland

Pain Relief: Panadol, Voltarol, Excedrin, Anadin, Advil, Para.

Vitamins, Minerals & Supplements: Centrum, Emergen-C, Caltrate.

Respiratory: Otrivine, Nurses, Piriton, Flixonase.

Skin: Imedeen, Zovirax.

Digestive Health: Nexium Key Representatives: First Contacts: Matthew Beattie, Pharmacy Controller Marie Bruckert, Country Manager (Ireland) Marketing Contact: Sophie McKenna, Customer Marketing Manager Website: www.haleon.com

Cetaphil Oily Skin Cleanser (236ml, 473ml, 1ltr)

Email: Help Line: mystory.ie@haleon.com

Cetaphil Hydrating Foaming Cream Cleanser (236ml, 473ml, 1ltr)

Tel: 01 495 5000

Cetaphil Gentle Exfoliating SA Cleanser (236ml, 473ml)

ITL Health

Company Address: Haleon, 12 Riverwalk, Citywest, Dublin 24, Ireland

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

Products: Nicorette®, Calpol®, Benylin®, Imodium®, Motilium®, Regaine®, Sudafed®, Sinutab®, Actifed®, Johnson’s®, Aveeno®, Neutrogena®, OGX®, Listerine®, Zarbee’s® Website: www.kenvue.com Tel: 012664749 / 1800 22 00 44 (helpline) Company Address: Office 5,6 & 7, Block 5, High Street, Tallaght, Dublin 24, D24 YK8N

KRKA Pharma Dublin, Ltd

Cetaphil Gentle Exfoliating SA Lotion (236ml, 473ml) Cetaphil Daily Hydrating Moisturiser 88ml Cetaphil Daily Defence Cream SPF50 50g Cetaphil Daily Defence Moisturiser SPF30 50g Cetaphil Rich Night Cream 50g Cetaphil Hydrating Night Cream 50g Cetaphil Hydrating Eye Gel 14ml Cetaphil Moisturising Lotion (236ml, 473ml, 1ltr)

Sector: Pharmaceutical Supplier of Generic Ethical Medication Krka first joined the Irish market with prescription medicines in 2011. Our current portfolio consists of 235 formulations covering a large number of therapeutic areas including cardiovascular, central nervous system, and gastrointestinal.

COMPANY LISTINGS

The Company’s goal is to strengthen its position by adjusting the portfolio in a way that meets the market’s demands. In order to do that we focus on producing high-quality, safe and effective pharmaceutical products.

Over the years we’ve established business relationships with numerous accounts throughout Ireland. Having open and transparent communication with our accounts is one of our top priorities. This enables us to position ourselves as a reliable and trustworthy supplier and business partner.

Quality, safety and efficacy are major priorities at Krka. A vertically integrated quality assurance and production model ensure control of the whole process from the development of the raw materials to the manufacture of finished products. This model ensures that we can continue to deliver consistency in quality, value and supply to our customers.

Website: www.krka.ie Email: orders.IE@krka.biz Tel: 01 413 3710

PrecisionBiotics / Novozymes

Sector: Food Supplements Over 20 years ago, our scientists began researching thousands of bacterial cultures, together with experts from one of the world’s leading centers of microbiome research, the APC Microbiome Institute in UCC, Ireland.

Since then, they’ve discovered hundreds of different bacterial cultures and they’ve put each one through rigorous scientific tests. Amongst these hundreds are a handful of special bacteria that stand out because of the precise and significant impact they make to human gut health. When these unique cultures pass all our tests, which include clinical trials in the UK and Europe, the Precision Biotics team are proud to produce them in a high quality and convenient form for consumers and clinicians.

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Procter & Gamble Ireland offers a wide range of products across various categories. In Beauty Care, they provide Aussie hair care, Head & Shoulders anti-dandruff shampoo, Herbal Essences hair care, Olay face and skin care, SKII luxury skincare, and Pantene hair care. In Baby Care, Pampers offers nappies, pants, and wipes for baby and toddler needs. Feminine Care includes Always feminine care pads, and Always Discreet for light bladder protection.

For Personal Health Care, Clearblue offers pregnancy and ovulation tests, Fixodent denture adhesives, Oral-B toothbrushes and dental floss, Seven Seas supplements, and Vicks cough, cold, and flu relief. In Grooming, Braun offers personal grooming products, Gillette razors and skin care, and Venus razors and shaving gels.

Website: www.pg.co.uk Tel: +353 1 429 9100 Company Address: c/o The Graan House - Unit E1 + E14, Calmount Park, Ballymount, Dublin 12

Perrigo

Our leading product Alflorex, containing the bacterial culture 35624, which has won numerous awards including Best Digestive Product at the IPN Awards in 2025 for the 9th time. Our innovative team has developed 1714° in partnership with leading clinicians which is the culture in Zenflore aimed at reducing fatigue.

Sector: Pharmaceuticals

We also launched Alflorex Immune in 2019.

In 2024 Precision Biotics launched four new products Alflorex Children; Zenflore Calm; Women’s Flora and Good Bacteria.

Since 1887, Perrigo has been providing highquality products that support personal health and wellness through effective solutions that meet the needs of consumers.

Sector: Sales, Marketing & Distribution of OTC & Healthcare products direct and via wholesale

For information on any of our products contact our sales partner Pamex Limited, Moneen Business Park, Castlebar, Co. Mayo (info@pamex.ie - 094 902400)

Our mission is to make lives better by bringing quality, affordable self-care products that consumers trust everywhere they are sold.

Full Product Portfolio:

Website: www.precisionbiotics.ie

Aloclair Plus, Bio-Oil®, Bioxcin, Bisodol, CCS, Colief®, Cymex, E45®, Foster Grant®, Kwells, Lamisil, Multi-Gyn, Multi-Mam, Nailner, Nicotinell, Perspirex, P20, PoxClin, Proceive®, Tasectan AF, TePe®, Wartie.

Email: Ask@precisionbiotics.com

OTC Confined: Abidec Multivitamin Drops, Beconase Hayfever Spray, Lyclear Crème Rinse, EllaOne, NorLevo, Nytol, Perrigo Paracetamol 500mg Tablets, Perrigo Ibuprofen 200mg Tablets, Perrigo Ibuprofen Max 400mg Tablets, Solpa-Extra, Solpa Cold & Flu Multi-Relief Capsules, Solpa Cold & Flu Multi-Relief Max Sachets, Solpadeine Capsules, Solpadeine Soluble, Solpadeine Tablets.

Help Line: 01 413 3710 Order Line: 01 413 3710 Company Address: Unit H, 1st Floor, Citywest Shopping Centre, Saggart, Co. Dublin, D24 TYT9

Ocean Healthcare

CELEBRATING 20 ye ars

Key Representatives Territory Managers: Mark Keane, Territory Manager – North Leinster.

Email: keanem@oceanhealthcare.ie

Tel: (021) 206 6012 Company Address: Office 1, Building A3, Fota Business Park, Carrigtwohill, Co Cork T45T924

Procter & Gamble Ireland

Trevor Fletcher, Territory Manager – South Leinster.

Email: fletchert@oceanhealthcare.ie Martine Byrne, Territory Manager Connaught, West of Ireland Email: byrnem@oceanhealthcare.ie John Paul Healy, Territory Manager – Munster, South of Ireland Email: healyjp@oceanhealthcare.ie Website: www.oceanhealthcare.ie Email: info@oceanhealthcare.ie Tel: +353 (1) 296 8080 Company Address: Ocean Healthcare LTD, Unit 13, Block A, The Courtyard, Carmanhall Rd, Sandyford Business Park, Dublin 18, D18 Y397

Procter & Gamble Limited is a leading provider of health and beauty care products based in Dublin, Ireland. The company has been an integral part of the Irish market for over 50 years, delivering high-quality consumer goods and well-known brands such as Braun and Oral-B. As part of the global Procter & Gamble family, Procter & Gamble Ireland operates with a strong commitment to quality and innovation, catering to the diverse needs of Irish consumers.

The company supports a wide range of health and beauty products and continually strives to improve and expand its product offerings.

Products:

Non-Confined: Abidec Advanced Multivitamin Syrup, Becodefence Adult, Bronchostop Cough Syrup, Bronchostop Cough Pastilles, Broncho 5in1 Syrup, Broncho Junior Cough Syrup, Compeed Blister, Compeed Corn, Compeed Callous, Compeed Bunion, Compeed Cold Sore, Jungle Formula Insect Repellent, Lyclear Express Shampoo, Lyclear Express Spray, Lyclear Shampoo, Milk of Magnesia, NiQuitin Patches, NiQuitin Mini Mint Lozenges, NiQuitin Mini Citrus Lozenges, Tiger Balm Red, Tiger Balm White.

Management: Mr Niall Faul: Ireland Market Lead Ms Anne-Marie O’Neill: Pharmacy Sales Manager Ms Kira Mulhere: National Account Manager Ms Niamh Farrell: National Account Manager Pharmacy Team: Alan Harnett: 086 818 9846 North Leinster

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COMPANY LISTINGS

Jennifer Valentine: 086 467 9113 Greater Dublin Brendan O’Keeffe: 086 818 9843 South of Ireland Paul Flynn: 086 142 7717 South East Ireland Ollie Higgins: 087 953 3161 West of Ireland Distribution: Via Wholesalers.

Website: www.perrigo.com Tel: +353 01 709 4000 Company Address: The Sharp Building, Hogan Place, Dublin 2, D02 TY74

Pharma Nord Ireland

Sector: Nutraceutical Pharma Nord is one of Europe’s largest manufacturers of products with essential nutrients. We use science-based methods to create high-quality dietary supplements, herbal remedies and medical drugs. Our products are safe, effective and well-documented.

The products are tested in scientific research and to date, more than 300 scientific studies involving Pharma Nord’s products have been published, including the sensational Q-Symbio and KiSel-10 studies.

Pharma Nord has a global presence with its production facilities and headquarters in Denmark, and its products distributed in Europe, the Middle East, Asia and the US. We offer pharmacies personalised 1-to-1 and group product training, online or in-person.

Marketing support is also available. Please send your enquiries to ireland@pharmanord.com.

Website: www.pharmanord.ie Email: ireland@pharmanord.com Tel: 01 899 1650 Company Address: Unit 289 Blanchardstown Corporate Park 2, Ballycoolin, Dublin 15

Pharma Plus

Sector: Supplements Pharma Plus is an Irish-made supplement brand designed by pharmacists to help you feel your best every day. Backed by science and trusted by health professionals, each formula combines high-quality, effective ingredients that support real results - from energy and immunity to gut, skin, and heart health. Formulated by pharmacists, trusted by you.

Product Portfolio: Active Immune Berry 30 Sachets, Active Immune Peach & Mango 30 Sachets, Active Immune Teen 28 Sachets, MenoPlus 60 Caps, Omega 3 1000 60 Caps, Pharma Biotic 28 Sachets, Pharma Biotic 7 Sachets (After Antiobiotics), Pharma Glow 28 Sachets, Vitamin D3 1000iu 60 Caps, Pharma Boost 20 Eff Tabs, Magnesium+ 90 Caps Website: www.pharmaplus.ie Company Address: 77 Lower Camden St, Dublin, D02XE80

Pure Encapsulations

THE PURE DIFFERENCE IN FOOD SUPPLEMENTS For more than 30 years, Pure Encapsulations has produced hypoallergenic, researchbased food supplements. Our products are meticulously formulated using pure ingredients and designed to deliver predictable results, even for the most sensitive people.

Pure Encapsulations offers you a wide selection of products that can be personalised to address a range of health functions and help you reach your wellness goals.

Vision Support Formula, B12 Methylcobalamin, Nutrient 950 E, Nutrient 950 E without Cu + Fe + Iodine, Metabolic Xtra, NAC 600 mg, NAC + Glycine Powder, Niacitol 500 mg, Iron-C, ONE Omega, Pyridoxal-5-Phosphate 50, Pyridoxal-5-Phosphate 50, Potassium Citrate, PureDefense, ProFlora 123, ProFloraGG 25B, ProFlora GI, Pure Genomics Ultra Multivitamin, Phosphatidylcholine, Phyto-ADR, Potassium Magnesium Citrate, Poly-ProFlora Powder, Pancreatic, VegEnzymes, Pycnogenol 100 mg, Quercetin, Resveratrol, Resveratrol Extra, Reduced Glutathione, Rhodiola Rosea, Saccharomyces Boulardii, Selenium 200 µg, Vitamin K with D3, Thyroid Support Complex, ONE Multivitamin, ONE Multivitamin with Iron, PreNatal Nutrients, Ubiquinol-QH 100 mg, Vitamin A 10000 IU, Vitamin C Chewables, Vitamin D3 1000 IU, Vitamin D3 Vegan 2000 IU, Vitamin D3 Liquid, Zinc 15, Zinc Complex, Zinc Chewables. https://pure-encapsulations.co.uk/ support@pure-encapsulations.uk

Pure Encapsulations products are formulated by nutritionists and leading medical experts to provide strengths and dosing consistent with clinical experience and published research.

Key Representative

We take high standard seriously, which is why we’re the most recommended professional supplement brand, ranked highest in quality and trust.1 And the most dispended professional supplement brand by functional Medicine practitioners.2

Website: https://pure-encapsulations.co.uk/

According to health care professionals in the U.S., among brands surveyed, Nutritional Business Journal® 2016, 2020; 2023 Kaiser Associates 2014

Sara Gibson Email: Sara.Gibson@ie.nestle.com

Email: support@pure-encapsulations.uk Company Address: Pure Encapsulations, 3009 Lake Drive, CityWest Business Campus, Dublin 24, D24 H6RR

1

In the U.S., among practitioners and brands surveyed, The Institute for Functional Medicine® 2017 2

Product Portfolio: Ascorbic Acid, Buffered Asorbic Acid, Buffered Ascorbic Acid Powder, B12 Adenosyl Hydroxy, Alpha Lipoic Acid 600 mg, Acetyl-L-Carnitine 500 mg, Ashwagandha, B12 Liquid, B12 Folate, B-Complex Plus, Biotin 8 mg, Black Currant Seed Oil, Borage Oil, Betaine HCl Pepsin, Bromelain 2400 500 mg, Boswellia, Boswellia AKBA,Calcium Citrate, Cranberry D-Mannose Powder, Cogni Active, Calcium MCHA, Phytosterol Complex, Calcium Magnesium Citrate, Calcium Magnesium Citrate + , Malate, CoQ10 120 mg, CoQ10 120 mg, CoQ10 60 mg, CoQ10-SR with PQQ, Cranberry + D-Mannose, Chromium Picolinate 200 µg, Curcumin 500 mg with Bioperine, Copper Citrate, Copper Glycinate, Curcumin, Vitamin E, Digestive Enzymes Ultra, Digestive Enzymes with Betaine HCl, DGL Plus, Daily Support Formula, Ester-C® & Flavonoids,EPA + DHA Essentials, Epi-Integrity Powder, Evening Primrose Oil, Ashwagandha Xtra, Folic Acid, Folate 400, Gluten Dairy Enzymes, Glucosamine + MSM with Ginger & Turmeric, Grapefruit Seed Extract, Griffonia, Homocysteine Factors, Hair + Skin + Nails Ultra, Hyaluronic Acid, Inositol Powder, Iodine Potassium Iodide, Iodine + Tyrosine, L-Arginine, L-Carnitine, Liposomal Vitamin C Liquid, L-Glutamine 500 mg, L-Glutamine 850 mg, L-Glutamine Powder, L-Lysine, L-Lysine, Liposomal Glutathione, L-Tyrosine, L-Theanine, Maca-3, Magnesium Citrate, Magnesium Citrate + Malate, CurcumaSorb, Mineral 650A, Magnesium Glycinate, Magnesium Powder, MicroDefense with Oregano, Manganese, MotilPro, MenoVive,

Rowex Ltd trading as Sandoz

The Rowex you trust, now powered by Sandoz – opening a world of new possibilities for you and your patients.

The relationships you trust: You’ll still work with the same local team. Our Bantry roots and our commitment to the community are stronger than ever.

The reliability you need: Our new global network delivers a higher level of supply chain reliability.

Expect greater stock transparency and clearer communication from a partner better equipped to support your Pharmacy.

The possibilities you deserve: Direct access to the Sandoz pipeline opens up a world of new treatment options – from life-saving medicines in complex areas to a continuous flow of new generics and biosimilars.

Here for you always: Maintaining personal relationships with our customers is important to us. That’s why, whether it’s in person or over the phone, you always have a dedicated representative who truly knows your business.

Key Representative: Joe Keane – Head of Country Tel: 1800 83 20 83 Company Address: Newtown, Bantry, Co. Cork, P75 V009

COMPANY LISTINGS Scope Ophthalmics Ltd

Solvotrin Therapeutics Active Iron

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At Théa, we believe that true eye care goes beyond treatment — it’s about improving lives through vision. That’s why we remain 100% preservative-free, unwavering in our mission to protect the eyes and the people who trust us every day.

Sector: Healthcare and Pharmaceuticals

Key Representatives:

Established in 2009, Scope is an Irish familyrun business with a strong heritage of bringing premium, evidence-based products to Healthcare Professionals and consumers alike.

The company focuses on two healthcare categories – Ophthalmology and Food Supplements. Scope operates in Ireland, UK and USA and prides itself on product offerings that are well-established with a track record of successfully supporting patient outcomes worldwide.

Thomas Clarke Tel: 087 190 7929: Donegal • Sligo • Leitrim • Mayo • Roscommon • Galway • Clare • Westmeath • Longford

Bio-Kult® Products: Bio-Kult® Everyday, Bio-Kult® Boosted, Bio-Kult® Candea, Bio-Kult® Migrea, Bio-Kult® Pro-Cryan, Bio-Kultv Infantis.

VIVIO® Products: VIVIO® Junior Cough Syrup, VIVIO® Junior Multivitamin Tonic, VIVIO® Junior Tummies Bifibaby Drops, VIVIO® Junior Gummies.

Ophthalmics: OPTASE® Products: OPTASE® Moist Heat Mask, OPTASE® Tea Tree Oil Eyelid Wipes, OPTASE® TTO Eyelid Cleansing Gel, OPTASE® Cleanse & Protect, OPTASE® Allergy Eye Drops, OPTASE® Comfort Drops, OPTASE® Comfort Dry Eye Spray, OPTASE® Cooling Mask.

OPTASE® LIFE: OPTASE® LIFE Sensitive Eye Makeup Remover, OPTASE® LIFE Sensitive Eye Daily Renewal Cream, OPTASE® LIFE Bright Eyes.

Eyetamins® by OPTASE® (Formally Actase®) Launching February 2026: Eyetamins® Vision Support, Eyetamins® Omegaeye Advanced, Eyetamins® Dry Eye Comfort (launching August 2026).

Sector: Iron Supplements Active Iron is clinically proven to increase iron and energy levels, helping to fight tiredness & fatigue.* Active Iron is specially formulated to avoid constipation, making it kind on the stomach while being strong enough to increase iron levels.

How does it work? Active Iron’s groundbreaking whey protein formula targets the body’s natural site of absorption, the DMT-1. This helps reduce oxidation and protects the gut from inflammation. As a result Active Iron delivers 2X better absorption of iron sulphate.2 ‘Wang et al. 2017, Acta Haematologica, 138: 223-232.2Ledwidge et al. 2021, Data on file. doi: https://doi. org/10.1101/2021.09.01.21262983 Website: www.activeiron.com Email: info@solvotrin.com

Théa Pharma Ltd.

Sector: Eye Health

Chief Executive Officer: Tom Freyne

Théa Pharma Ireland is the Irish subsidiary of Laboratoires Théa, Europe’s leading and most innovative eye health group, founded in 1994

by Henri Chibret. The Chibret family has been devoted to ophthalmology for over 150 years, driven by one simple purpose — to help people see life better.

Area: North Leinster Tel: 0877 752 164 Jan Dillion Area: Munster Tel: 0870 925 411 Gavin O’Leary Area: Connaught Tel: 0876 248 719 Victoria Kehoe Area: Ulster Tel: +447736 879 987 Jacqueline Strong Area: South Leinster Tel: 0873570199 Company Address: 5 Westland House, Westland Park, Willow Road, Dublin 12, D12 Y012

Marketing Contact: Yanni Kokosioulis Yanni.kokosioulis@theapharma.com Website: www.theapharma.ie Tel: +353 94 925 0290 Company Address: Golden Mile Industrial Park, Breaffy Rd. Castlebar, Co. Mayo, Ireland, F23 D299

United Drug

Company Address: Exham House, The Fingerpost, Douglas, Cork, T12 PDD2

Key Representatives:

Shane Halpin

Ciara Cotter Tel: 087 271 8631 Tipperary • Waterford • Limerick • Cork • Kerry

customerservice@pharmed.ie

HYLO® Products: HYLO Fresh®, HYLO Tear®, HYLO Forte®, HYLO Dual Intense®, HYLO Dual®, HYLO Care®, HYLO Night®, EvoTears®.

Head of Sales Ireland: Steve Betts

Ewa Wolanin Tel: 087 239 5028: Dublin • Meath • Offaly • Cavan • • Monaghan • Louth • Wicklow • Wexford • Kilkenny • Carlow • Laois • Kildare

Théa was the pioneer and remains the world leader in preservative-free eye care, a breakthrough that transformed the future of ophthalmology. By removing preservatives, Théa opened the door to safer, gentler treatments that truly respect and protect every patient’s vision.

Since its introduction to Ireland in 2018, Théa Pharma has earned the trust of ophthalmologists, pharmacists, and consumers nationwide. In just a few short years, it has become one of the most respected and trusted names in Irish eye care.

Our strength lies in our people — a passionate, dedicated team united by care, integrity, and innovation. We are proud to offer a wide range of clinically proven solutions for Dry Eyes, Blepharitis, Lid Hygiene, Allergy, and Eye Nutrition, empowering patients to look after their eyes with confidence and comfort.

Sector: Pharmaceutical distributions of products & services United Drug is Ireland’s leading pharmaceutical wholesaler and distributor, serving more than 1,900 pharmacies, hospitals and primary care centres nationwide. A trusted partner to the healthcare sector, United Drug provides a comprehensive range of ethical and over-thecounter medicines, ostomy and unlicensed medicines, as well as front-of-shop products.

United Drug Distributors Main Agencies: A Menarini, Abbott Laboratories, Accumed, Aguettant, ALK-Abello, Alliance, Amgen, Ambu, Amicus, Astellas, AstraZeneca, Atnahs Pharma, Aymes, Azure Pharmaceuticals, AZIENDE CHIMICHE RIUNITE, B Braun, Besins Healthcare (UK) Ltd, Bial, Biogen, BioProject Ireland, Bristol-Myers Squibb, Bicon, Bayer, Camurus, CD Pharma AB, Celgene Limited (Ireland), Celltrion, Cheplapharm, Citrine, Clonmel, Coloplast, Consilient Health Ltd, Convatec, Daiichi-Sankyo, Dr. Falk, Eisai, Ennogen Healthcare, Eli Lilly, Eurocept, Ferring, Flen Healthcare, Flynn Pharma, Galapogos , Galderma, Galen, Glenwood, Glucorx, GSK, GWP Pharma, Ipsen, Immedica Pharma, Indivior, Johnson & Johnson, Jed Pharma, Juvela, Karo Pharma, Kora, Krka Pharm, Kyowa Kirin, Juvise, Leo Laboratories, Meda Ireland, Mediteq, Merck Sharpe & Dohme, Mundipharma, Mylan, Norgine, Nutricia, Octapharma, Omega Pharma, Organon, Pfizer Ireland, Pharmacosmos, Phrassa Pharma ,Pinewood, Proveca, Reckitt Benckiser, Rowa / Rowex, Regeneron,

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COMPANY LISTINGS

RPH Pharmaceuticals, Santen UK Limited, Satipharm LTD, Scope Ophthalmics, Seacross Pharma, Servier Laboratories, Stanningley, SevenSeas, Substipharm, Swedish Orphan, T.G. Eakin Ltd, Takeda, Teva Pharmaceuticals, Tillotts, UCB, Unomedical Lt, Viatris, ZR Pharma

Valeo Healthcare

Andrea Fleming Head of Healthcare Marie Amond Customer Business Manager

United Drug Consumer 4711, After Bite, Aloe Dent, Aloe Pura, Anusol, Arm & Hammer, Australian Tea Tree, B.Fresh, B.Tan, Babyliss, Batiste, Baylis & Harding, Bell’s, Blank Canvas, Bondi Sands, CeraVe, Childs Farm, Cutex, Dirty Works, Dispensary, Dr Organic, Dr Paw Paw, Dr Salts +, ECI Natural Health, Epaderm, Euthymol, Faith In Nature, FamilyD, Femfresh, First Aid, Fish SoHo, Flawless, Free Breath, Fruit of the Earth, Halls, Hero, He-Shi, Homedics, Il Salone by Alfaparf, Intempo, John Frieda, Lansinoh, Mavala, Mefix, Mepore, Mitchum, Nair, Nitty Gritty, NUK, O’Keeffes Working Hands, Ovelle, Pearl Drops, Pharmacy Essentials, Profoot, Reach, Regelle, Relactagel, Remington, Replens, Revlon Haircare, Salter, Sanctuary Spa, Seavite, Snowfire, So…?, St Tropez, Sterimar, Super Facialist, Swedish Collagen, Swedish Nutra, Tabac, The Breath Co., The Solution, Trojan, Tubigrip, Vagisan, Vital Baby, Viviscal.

Marketing Contact: Karen Gibney Tel: 086 1362277 Email: Karen.gibney@united-drug.com Website: www.united-drug.com Email: Wholesale@united-drug.com Tel: +353 1 463 2300 Company Address: United Drug House, Magna Drive, Magna Business Park, Citywest Road, Dublin D24 XKE5

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Management: Denis Lynch Chief Commercial Director

Distribution: Via Wholesalers, and direct to Retail and Hospital Pharmacies.

Main Agencies:

Key Representatives

Sector: Healthcare Distributor of Vitamins, Minerals and Herbal Supplements, Aromatherapy Oils, Skincare and Dietary Foods. Comprehensive range of literature (posters, window kits, samples) provided to health professionals and educational booklets available for customers. Nutritional Information.

Database covering: supplements, nutritional concerns, herbal remedies, drug-nutrient interactions, provides literature searches for awide variety of nutritional topics. Media plans, POS and information available on request.

Extensive range of VMS, Herbal Products, Skincare, Medical Devices and Medicated Confectionary, including: Vitabiotics (Pregnacare, Jointace, Wellwoman, Wellman, WellKid, Perfectil); Vit D3 (BabyVitD3 & Adult D3); Emerald Farm (Cold Press CBD Oils); Matchstick Monkey (Teething Toys); King Hair & Beauty (Hair Care); Sonisk (Sonic Toothbrush & Oral Care Range); Ortis (Fruit & Fibre Cubes); FSC/Bee Health (Waterfall & Propolis); Kelkin (Vitamins, Aromatherapy Oils and Skincare); Fisherman’s Friend; Dextro; Kobayashi Healthcare (Cura Heat, Kool N Soothe & Hot Hands; Passion For Life Healthcare (Actifresh, Audiclean & Snoreeze range) & Vamousse (Head Lice Range).

Stephen Moloney Customer Business & Sales Manager Ashleigh Mulhall Brand Manager Ayanda Modipane Brand Manager Territory Managers Lisa Kelly Tel: 0862061449 Lisa.kelly@valeofoods.ie Territory Manager: Dublin / Northwest Chris Ferncombe Tel: 086 033 8162 Territory: South East & Midlands Mike Peters Tel: 086 856 2077 Territory: South Gary Considine Tel: 087 933 4227 Territory: West Website: www.valeofoods.ie Email: valeohealthcare@valeofoods.ie Tel: +353 01 405 1500 Company Address: Merywell Industrial Estate, Ballymount, Dublin 12

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