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August 2017 Volume 9  Issue 8


Pre-order now for September delivery!


From low you, to go go go you

Winners Issue

In this issue: NEWS: IPHA crunch meeting with HSE fails to deliver Page 4

REPORT: Workplace health focus of Index Page 14

TOP 100: Top 100 OTC products Annual Feature Page 18

FEATURE: Something to Smile about in Oral Health Page 44

Kick start your day with Nature’s Bounty®

CPD: Crohn’s Disease Page 57

AWARDS: Profiles of the 2017 Winning Entries Page 63 Food supplements should not be used instead of a varied balanced diet and a healthy lifestyle. Nature’s Bounty® is a registered trademark.

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Date of Preparation: July 2017 PP-GEP-IRL-0471 NOTE: This application is for general guidance only and is not intended as a substitute for the use of a professional trained interpreter which is the recommended best practice for addressing language barrier in a medical context or setting. While every effort has been made to ensure that translations are accurate, this application is not intended as a substitute for professional translation service.



This year’s August issue is the biggest in the history of Irish Pharmacy News, boasting the most up to date information on OTC market trends, as well as profiles from the winners of The Irish Pharmacy Awards.

Page 5: Pharmacy welcomes announcement of Drug Strategy

Page 6: Our special report looks at what Brexit may mean for the Irish pharmaceutical industry

The Top 100 OTC Products, now in its 6th year remains one of IPN’s most anticipated features in the pharmacy calendar. This compendium is brought to you exclusively from IPN, with data and analytics Provided by Quintiles IMS. Utilising this section will open you up to the best opportunities in retail pharmacy and ensure you are abreast of the latest trends and market movement. From page 18 onwards you can read the Top 100 OTC products for 2016/17; who takes the premium position this year, the movers, new entrants and the companies dominating the market.


Page 14: Health and its role in the workplace are the focus of Pfizer Index

Tom Murray, owner of Murray’s Pharmacy outlets in Donegal, is quoted on page 4 as stating that Pharmacy competitiveness and job security for staff working in Border pharmacies could be under threat if a “hard Brexit” occurs.

Page 18: Top 100 OTC Products for 2016/17 Page 52: Recognition for research champions Page 63: Irish Pharmacy Awards 2017 winner profiles

Mr Murray, who is also Donegal spokesman for the community group 'Border Communities Against Brexit' which recently won an EU Citizens Award for its work campaigning against Brexit, believes the impact of Brexit will be felt by border pharmacies in many ways.


“There are some border pharmacies on both sides of the border where the staff work and live on opposite sides of the border. Therefore under the potential for a hard Brexit there may be difficulties for those staff in crossing the border to get to work,” he says.


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

The decision by the UK to leave the EU brings with it much uncertainty for the Irish economy and for the Irish pharmaceutical market.


In lead news this month, the newly established body ‘Medicines for Ireland’ published its policy Manifesto. The policy document calls for a number of proposals, including the provision of a longterm roadmap for how Ireland procures, supplies and affords medicines for Irish patients.

EDITOR - Kelly Jo Eastwood ACCOUNTS Jon Dickinson COMMERCIAL MANAGER Barry Maguire ADVERTISING MANAGER Nicola McGarvey CONTRIBUTORS Conor Hogan Paul Mulholland Niamh Cahill Olivia McGill Aisling Kennedy Eamonn Brady

Against a backdrop of growing difficulties experienced by Irish patients in affording and accessing life-savings medicines, the group has come together to propose and push for a radical reform of the current system of medicine supply. Turn to page 12 for the full story. Lastly, the hugely successful Irish Pharmacy Awards were held in May past, with 16 winners announced on the night. In order to promote best practices and shared learning from the Awards, this issue features in-depth profiles of all those who gained an accolade on the night - Coverage starts on page 63.

All rights reserved by Irish Pharmacy News. All material published in Irish Pharmacy News is copyright and no part of this magazine may be reproduced, stored in a retrieval system of transmitted in any form without written permission. IPN Communications Ltd. have taken every care in compiling the magazine to ensure that it is correct at the time of going to press, however the publishers assume no responsibility for any effects from omissions or errors.

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Feature: Irritable Bowel Syndrome


CPD: Crohn’s Disease 57 Feature: Back to School 118

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Product Profiles Clinical Profiles

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News Crunch meeting fails to clear new news brief medicines logjam UPDATE ON THE EPORTFOLIO REVIEW PROCESS

Thousands of patients in Ireland with serious conditions ranging from heart disease, cancer and skin conditions are being denied access to nine new medicines that are routinely available across Europe.

The Pharmaceutical Society of Ireland (Continuing Professional Development) Rules 2015 (SI No 553 of 2015) came into effect on 1 January 2016. These rules set out the legal framework to give effect to the PSI’s CPD model including a system of quality assurance of pharmacists’ CPD.

This is despite the medicines having been through all HSE assessment processes and ¤140m in savings having been provided by member companies of the Irish Pharmaceutical Healthcare Association (IPHA) under its agreement with Government.

The system of quality assurance is known as the ePortfolio Review process and will be carried out by the Irish Institute of Pharmacy (IIOP).

At a crunch meeting between IPHA and Government representatives last week, no assurances were given by the official side that the medicines currently stuck will be cleared.

The system will operate with the PSI randomly selecting the names of a group of pharmacists from the Register of Pharmacists each year to submit an extract from their ePortfolio to the IIOP for review. For more information on this year’s process please see below.

Oliver O’Connor, CEO of IPHA said, “For the nine medicines it has been 2 years on average from the time of the first application for reimbursements. It is 520 days since the outcome of the full Health Technology Assessment. This delay is inexcusable and is letting down patients.”

Once notified, selected pharmacists can then expect to subsequently receive communication directly from the IIOP advising of the deadline and details relating to the submission of individual ePortfolio extracts. The IIOP will also advise of any supports and tools that are available to pharmacists to assist in their submission. Further information and supports about CPD and the ePortfolio system are available from the IIOP website. ePortfolio Review Process 2017 - The ePortfolio Review process for 2017 commenced at the end of July. Pharmacists who are randomly selected for eportfolio review will be notified by the PSI via email. Supporting materials and the e-portfolio review standards are available from the IIOP. Extenuating Circumstances Process - Pharmacists, who have been selected for ePortfolio review and feel that they have reason to be exempted due to circumstances beyond their control should review the extenuating circumstances policy. Applications will be managed on a case by case basis in the strictest confidence and should be submitted in writing either by post or by email to


When the Government and IPHA concluded a new agreement one year ago, the Minister for Health welcomed a new Agreement and indicated that “the Government wants to ensure that Irish patients continue to have access to new and innovative medicines and that Ireland remains at the forefront of its European peers in terms of early access.” Recently the Government launched a new Cancer Strategy which has the objective of putting Ireland in the top quartile in Europe for cancer outcomes.

The Government is clearly failing on its own policy, says IPHA as:

indication that anything would change in future.

• No progress has been made on access to new and innovative medicines - instead they are routinely delayed and sent for political decision to the Minister for Health

“At that meeting IPHA pressed our analysis that the HSE had enough money in its 2017 budget to fund new medicines, given the ¤140m savings IPHA members have provided. We pointed out that Health was reported as underspent by ¤21m in the June Exchequer returns. No evidence was offered showing an inability to fund new medicines this year. Yet the delays continue.

• Ireland is certainly not at the forefront of European peers – instead we are lagging and getting worse • Ireland is 16th out of 26 countries in use of newly authorised medicines • Other European countries make new medicines available to patients within 6-12 months of authorisation Mr O’Connor continued, “Last week, IPHA pointed out this failure of policy to the State’s Agreement negotiating team but no resolution was offered. There was no

“You certainly can’t bring the best treatments to cancer patients and others if you provide for no growth at all in the medicines budget. “The issue is not about pricing. Other countries in Europe have similar pricing and budget controls and yet they provide medicines much faster. “Ireland can do better: patients can and should have faster access to new medicines.”

Pharmacists welcome Emergency Contraception go ahead The Irish Pharmacy Union (IPU) has welcomed the announcement by Minister for Health Simon Harris that, as of 1 July, emergency hormonal contraception (EHC) will be available to women with medical cards directly from their community pharmacy. The announcement was confirmed as the Minister signed the statutory instrument changing access to emergency hormonal contraception (EHC) for medical card holders. In response to the announcement, IPU President, Daragh Connolly said, “We are delighted that at last after many years of lobbying on this key concern, women on medical cards who, up to now, had to go to their GP to get a prescription if they wished to get emergency hormonal contraception (EHC) on the medical card, will be able to access it directly from their community pharmacy free of charge.

”Emergency contraception is time sensitive. Its effectiveness diminishes between the time of unprotected sex and the time of taking it, emphasising both the importance of all women being able to readily access it, and thus the value of the convenience and accessibility offered by community pharmacies. The necessity to attend a GP for a prescription has always been an unnecessary barrier and has also meant that the poorest and most

vulnerable women in Irish society have not been treated equitably with private patients in terms of access to EHC.” Pharmacists are looking forward to quickly implementing this move, as they have been safely dispensing emergency contraception without prescription to private patients since 2011.

News Work finally starts on 2011 Pharmacy news brief Review Report Work on implementing the Pharmacy Review Report from 2011 has finally commenced with the establishment of a HSE and IMPACT Implementation of Pharmacy Review Steering Group, Irish Pharmacy News (IPN) has learned. Since publication of the report, which highlighted the need for career struture changes for pharmacists, no recommendations have been implemented and the lack of action has been a subject of criticism by pharmacists for some time.

Pharmacy Review Steering Group in January 2017.

In May a HSE National Human Resources Report noted that the Review Report was under discussion and that a National Steering Group had been formed.

“Arising from a recommendation of the Implementation of Pharmacy Review Steering Group a working group was established in February 2017 to review current HSE Hospital Pharmacy Structures in the context of the 2011 Report on the Review of Hospital Pharmacy. This group are currently finalising a report on this review process. The group also identified a number of issues requiring further review which HSE and IMPACT are currently examining the detail of same.”

“A sub-group is meeting with union representatives to carry out a table top exercise to map the recommendations contained in the report onto the current service configuration. The sub group will report back to the national group shortly,” the Report stated. In a statement issued to IPN the HSE said that initial engagement occurred in 2016 with the establishment of the HSE and IMPACT Implementation of

The HSE said, “The first meeting of the HSE/IMPACT Implementation of Pharmacy Review Steering Group occurred in February 2017 and the HSE are satisfied with the progress of this group to date.”

The HSE declined to comment on when it hoped to complete implementation of the Review Report but said that the

Steering Group would “prioritise the recommendations in relation to the phased implementation of the review”. The Review Report was signed off by the HSE and the Hospital Pharmacists Association of Ireland (HPAI) in 2011 but was never implemented. The Review Report made eight recommendations, including the proposal that each HSE Integrated Service Area (ISA) hospital group have a Director of Hospital Pharmacy and a Director of Medicines Management. The Review Report states: “It is recommended that the structural changes proposed in this report would be implemented on a phased basis over a one year period commencing with the appointment of Directors of Hospital Pharmacy and Directors of Medicines Management and Regional Pharmacy Leads.”

Pharmacy welcomes National Drugs Strategy The Irish Pharmacy Union (IPU) has welcomed the publication of a National Drugs Strategy. Noting the proposal to establish a working group to explore the response taken in other jurisdictions to the possession for small quantities of drugs for personal use, Daragh Connolly, community pharmacist and IPU President, said, “Pharmacists have argued that the possession of small amounts of illegal drugs for personal use should be treated as a health problem rather than a criminal issue and that people with drug problems should be given the same level of care as people with other health issues.” Mr Connolly said that addressing the drug problem in Ireland is a balancing act between preventing illicit use of drugs and associated health problems, and ensuring access to treatment for those addicted to drugs. “The World Health Organisation has acknowledged that people with drug disorders deserve the same level of care as patients with any other health condition. Health services need to be able to identify drug use and drug use disorders at an early stage and provide prevention, treatment and harm reduction interventions,” added Mr Connolly.

FIRST NATIONAL ACTION PLAN Minister for Health, Simon Harris TD, and Minister for Agriculture, Food and the Marine, Michael Creed TD, have secured Government approval for Ireland’s first National Action Plan on Antimicrobial Resistance 2017-2020. The overall goal of Ireland’s National Action Plan on AMR is to ensure, for as long as possible, the availability of effective antibiotic treatment options for both humans and animals, with safe medicines that are quality-assured, used in a responsible way, and accessible to all who need them. Minister for Health, Simon Harris TD said, “The rise in antimicrobial resistance is one of the greatest potential global threats to human health. The truth is that If AMR continues to rise it will become increasingly difficult and expensive to control and treat infections in medical care. As a country we need to act now to respond to this reality. “This National Action Plan represents Ireland’s commitment to the development and implementation of a cross-sectoral ‘One Health’ approach to the problem of antimicrobial resistance. The Plan has been jointly developed by both Departments with the oversight and guidance of the Interdepartmental AMR Consultative Committee which was established by the Chief Medical Officer and Chief Veterinary Officer of our two respective Departments.”

Daragh Connolly, IPU President Mr Connolly said that, for people who are not yet dependent on drugs, efforts should focus on preventing dependence and reducing the harm associated with drug use. “Pharmacists are the appropriate profession to lead this changing approach. We already provide

opiate substitution using methadone; we provide needle exchange services in areas of need and we provide a crucial point of contact with healthcare for those whose problems have made them outsiders in our society. We want to do more and we are ready to do more,” he concluded.

The Action Plan will be published in September and the implementation and evaluation processes will be designed encompassing ‘One Health’ and sector specific timeframes and responsible bodies for each activity over the lifetime of the Plan.


News news brief

Impact of Brexit on border Pharmacy Dozens of pharmacies situated along the Border with Northern Ireland could see the cost of goods rise dramatically when Brexit comes into force, a Donegal pharmacist has warned.


border then that competitiveness and price point for us obviously changes so we become less competitive, which will have the potential to affect the front of shop quite dramatically and also has the potential to dramatically affect the cost of living for the communities we live in.

The health services on both sides of the border are set to benefit from a welcome investment from the EU’s INTERREG VA programme secured by Co-operation and Working Together (CAWT), the cross border health and social care partnership. The Special EU Programmes Body has awarded a total of ¤26.5 million euros to the CAWT Partnership, which will directly benefit people living in Northern Ireland and the border counties of the Republic of Ireland. This EU funding will be used to support four large-scale cross border health and social care projects up to 2021. The projects are in the areas of acute hospital services, mental health, children’s services and community health and wellbeing. A fifth project is being led by NHS Scotland and is in the area of primary care and older people’s services. The CAWT Partnership is an active participant in this Scottish led Project which has a budget of ¤8.7million Coupled with the recent major developments in all-Island and cross border health services including the investment of £65 million in the North West Cancer Centre at Altnagelvin Area Hospital, the Emergency Cardiology Service for Donegal being provided via Altnagelvin Area Hospital and the development of Paediatric Congenital Cardiac Services in Dublin to cater for the all-Island population, we expect this EU INTERREG investment to lead to further consolidation of North/South Co-operation in the vital health and social care sector. The CAWT partnership members who jointly secured this EU funding are the Health Service Executive (HSE) in the Republic of Ireland and the Southern Health and Social Care Trust, the Western Health and Social Care Trust, the Public Health Agency and the Health and Social Care Board in Northern Ireland.


“The cost of living for the customer, the cost of competitiveness of the shop and potentially job security for the staff could all be threatened depending on how severe and how hard the border will be depending on what level of import duty is applied.” Tom Murray, Director of Murray Pharmacy Group in Donegal

Tom Murray, owner of Murray’s Pharmacy outlets in Donegal, said pharmacy competitiveness and job security for staff working in Border pharmacies could be under threat if a “hard Brexit” occurs. Mr Murray, who is also Donegal spokesman for the community group Border Communities Against Brexit, which recently won an EU Citizens Award for its work campaigning against Brexit, believes the impact of Brexit will be felt by border pharmacies in many ways. “There are some border pharmacies on both sides of the border where the staff work and live on opposite sides of the border. Therefore under the potential for a hard Brexit there

may be difficulties for those staff in crossing the border to get to work,” Mr Murray said. In terms of non-medicinal supplies a lot of border pharmacies and particularly pharmacies in the Republic of Ireland would source much of their front of shop retail from Belfast or other wholesalers in the North. “That’s what makes us so much cheaper than most of our competitive pharmacies down the country and certainly cheaper than all the supermarkets and major retailers in border areas who source their products in Ireland,” Mr Murray explained. “If there is an import duty of up to 23% placed on that by the EU

Mr Murray also made the point that time is money for hauliers transporting supplies and if they are going to experience delays at border crossings this will inevitably impact costs. The only possible benefit of Brexit could be that border pharmacies won’t see as many patients travelling North for their prescriptions. “There is also the fact that if Britain steps outside of the EU completely pharmacists in the North won’t be able to recognise a prescription written in the Republic of Ireland and therefore patients in the Republic won’t be leaking into the North for perceived better prices,” Mr Murray remarked. Mr Murray added that most Border pharmacists are adopting a “wait and see approach” to Brexit as they are too busy fighting fires on a daily basis.

Local Pharmacist Paul O’Hea to speak at Retail Excellence annual eCommerce Conference Retail Excellence’s annual ecommerce conference is set to take place on the 27th of September in the Crowne Plaza Hotel, Blanchardstown. With a conference programme filled with speakers from both local and global markets the conference is designed to give Irish retailers an insight into how to navigate the world of ecommerce and make full use of the ever changing digital landscape. Listed as one of the key speakers, Director of Inish Pharmacy, Paul O’Hea said, “events like these are important for us as a forward thinking pharmacy. The networking

opportunity alone and learning gained is invaluable” With 3 pharmacies across the Donegal region and a website portal that allows patients and consumers to purchase direct from the pharmacy. Inish’s use of ecommerce is something Mr O’Hea would like to see more of in the industry. He commented, “In a pharmacy setting it can be hard to see how something like ecommerce can be beneficial

without having an understanding of what can seem like complex, unchartered territory, events like these shed light on the subject and give real insight” Commencing at 08.15, the conference is expected to have a high turnout with industry experts providing a look into the digital trends happening across Europe and the future of ecommerce.

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Pharmacists, on your bikes! Community Pharmacists organised The Careplus Frontline Cycle over the weekend Over the weekend pharmacists across Ireland cycled over 230km to raise funds in aid of FAMILY CARERS IRELAND, LARCC (CANCER SUPPPORT) and THE PHARMACY BENEVOLENT FUND. THE CAREPLUS FRONTLINE CYCLE saw over 40 pharmacists and their friends and families from across Ireland get on their bikes to cycle from Dublin to Galway (via Mullingar). The event began in Dublin on Friday 21st July, stopping in Mullingar for some much-needed rest and then finished up in Galway on Saturday, July 22nd. Commenting on the event coorganiser Robert Keane says "This year the CarePlus Frontline Cycle has chosen the Family Carers, LARCC and The Pharmacy Benevolent Fund as our charities for this year’s cycle. It’s always a great weekend and this was the largest to date”. Organising the event was Mullingar-based pharmacists John Keane and Robert Keane, owners of CarePlus Pharmacies and Eamonn Brady, owner of Whelehans Pharmacies in Mullingar.

Since its first cycle in 2011, the event has raised close to ¤40,000 for a range of charities including Irish Cancer Society’s Action Prostate Charity, Ovarian Cancer, First Fortnight and Good to Talk Mullingar and the organisers hope to exceed the ¤15,000 raised at its last cycle event. All funds donated this year will be donated to Family Carers Ireland, LARCC and The Pharmacy Benevolent Fund. Speaking to the cyclists at their stop in Aughrim (outside Ballinasloe), Bernie McHugh, manager of Cancer Support Sanctuary LARCC explained that “The LARCC Centre based in Multifarnham offers emotional and psychological support to people and their families who are living with cancer. The Centre provides a homely supportive environment where patients and family members can participate in its courses, obtain information and parttake in the full range

of support services on offer which include:- counselling, complementary therapies, nurse support, telephone helpline, breast care service, manual lymphatic drainage therapy, bereavement support and pamper days. Bernie explains that “LARCC cares for over 800 people per annum through counselling, complementary therapies, nurse support and a range of specialist services We welcome people from all over Ireland. It costs hundreds of thousands per annum to run the service with 80% needing to be raised through fundraising and donations and so the money raised by the CarePlus Frontline Cycle is greatly valued and goes a long way in continuing services at LARCC”.

Support from Pharmacy Business Community John Keane and Robert Keane would like to “thank all the sponsors from the pharmacy community who supported the cycle including CarePlus Pharmacy, System plus, United Drug, Clanwilliam Health, JPA Brenson Lawlor, McLernons MPS, ABC Stocktaking, iMED Healthcare, ORS Hydration and JM Stenson Construction,”. Eamonn Brady explained that “without the support of the pharmacy businesses community the cycle would not have been such a success”. Many people turned out on Saturday morning to see cyclists off on the second leg to Galway and many joined on the cycle including local TD Robert Troy.





1. L to R: Robert Keane (Keanes Careplus, Organiser), Simon Gillivan (Pharmed Mullingar, Sponsor), Aine Gavigan (Uisneach Catering, Sponsor), John Keane (Keanes Careplus, Organiser), Bernie McHugh (LARCC), Conor McCormack (Roscommon), Fergal McCormack (Tipperary), Martin Hanrahan (Tipperary) 2. L to R BACK Robert Keane (Keanes Careplus, Organiser), John Keane (Keanes Careplus, Organiser), Robert Troy (Longford/Westmeath TD), Eamonn Brady (Whelehans Pharmacy, Organiser) Front on bike: Bernie McHugh (LARCC) 3. All the Saturday cyclists before leaving for Galway 4. Eamonn Brady (Whelehans)


News New Pharmacy Appointments The Council of the Pharmaceutical Society of Ireland (PSI), the pharmacy regulator, has elected a new President, Mr Rory O’Donnell, and a new Vice-President, Ms. Nicola Cantwell. The Council also welcomed new members following their appointment by the Minister for Health. Rory O’Donnell is a community pharmacist with a pharmacy in Gweedore, Co. Donegal. He qualified in pharmacy from Robert Gordon University, Aberdeen and holds a Science degree from Trinity College Dublin, as well as a diploma in Diabetes Management. He has undertaken professional development with the Irish Management Institute and the Institute of Directors in Ireland. He served as President of the Irish Pharmacy Union from 2012-2014 and recently completed a term as President of the Pharmacy Benevolent Fund. He is currently Chairman of hmR Ireland. Rory was appointed to

the PSI Council in 2015 and is the outgoing Vice-President. Nicola Cantwell lectures on the Pharmacy Technician Course in IT Carlow and coordinates the work placement modules. Minister Simon Harris has appointed seven new members to the Council of the PSI this week. The new appointments include pharmacists Michael Lyons, Marie Louisa Power, Sean Reilly and Veronica Treacy and public interest nominee Dr Ailis Quinlan. Hugo Bonar, a nominee of the Health Products Regulatory Authority, and pharmacist Nicola Cantwell have been re-appointed to serve a second consecutive term each.

Rory O'Donnell

Nicola Cantwell

Hickey’s Pharmacy ‘build for the future’ Hickey’s Pharmacy held their second annual Pharmacist Conference entitled “Building for the Future” in the Crowne Plaza Hotel Dublin on the 29th May 2017.

Those who attended the Hickey's Pharmacy Pharmacist Conference The conference attracted an excellent line-up of speakers from a variety of backgrounds. The event was aimed at Hickey’s Pharmacy, non-supervising group of pharmacists, many of whom are still relatively new to their own Pharmacy careers. There was an emphasis on ‘the


future’ and ‘the team’, and how the pharmacist group can contribute to the direction of the teams they work in, through effective communication and leadership. The day witnessed several contributors, some of whom brought educational pieces relevant to everyday practice but

also an emphasis was placed on soft-skills development, enabling newer team members to effectively navigate their environment, work well with others, and achieve their goals whilst complementing their core/technical skills. Managing Director Paddy Hickey welcomed delegates to the

event. Next month’s issue of Irish Pharmacy News will look in greater detail at how Hickey’s Pharmacy are being innovative in the training and development of Pharmacy staff.



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News Medicines for Ireland manifesto calls for radical overhaul of medicines policy in Ireland A National Medicines Strategy for Ireland which provides a long-term roadmap for how Ireland procures, supplies and affords medicines for Irish patients, is one of the key proposals contained in Medicines for Ireland’s policy manifesto published last month (July). Medicines for Ireland is a newly launched grouping of key medicine suppliers, including some of the largest suppliers of medicines to the HSE.

medicine policy is set in Ireland, which they believe is outdated, lags far behind European best practice and is undermining patient access and affordability.

Against a backdrop of growing difficulties experienced by Irish patients in affording and accessing life-savings medicines, the group has come together to propose and push for a radical reform of the current system of medicine supply.

The group cite the experience in New Zealand which has had a national medicines strategy for over a decade and approach the issue of medicine supply in a more planned and structured way than is the case in Ireland.

Medicines for Ireland’s manifesto has six core proposals which are critical to ensuring a properly functioning market and to safeguarding patients. These are:

Issues which must be addressed urgently in Ireland include:

 A National Medicine Strategy which sets out a long-term plan for medicine usage and supply in Ireland;  Establishment of new National Medicines Office to implement this strategy and oversee the ¤2 billion annual medicine spend;  A new Medicine Pricing Agreement, which sets medicine prices, between the Department of Health and pharmaceutical industry - ending the existing situation where only part of the industry participates in these negotiations;  A Biosimilar Strategy, driven by the HSE, to kick-start switching to more affordable but equally effective biosimilar medicines. This has the potential to unlock hundreds of millions in savings in the years ahead;  Driving real competition in the medicines market through dynamic pricing schemes, particularly for high-volume medicines; and  Measures to tackle the growing problem of medicine shortages (currently over 140 medicines out of stock). The group’s policy proposals aim to radically overhaul the way

 The lack of a long-term plan for medicine supply in Ireland to ensure Ireland can continue to afford new, but more expensive, innovative medicines and the need for a cohesive body to implement it;  The ad hoc approach to medicine procurement and how to afford it into the future, especially hospital and high-tech medicines, which has seen the latter’s cost to the State more than double from ¤315 million to over ¤662 million in less than 10 years;  An archaic National Medicine Pricing Agreement which is negotiated without the largest suppliers of medicines to the HSE being party to the negotiations and the agreement;  The growing problem of medicines shortages, with the number and range of out of stock medicines increasing yearon-year; and  The failure of the HSE to make significant savings by switching to more affordable (up to 30% cheaper) biosimilar medicines. Of the biosimilars available in Ireland currently, they are less than 1% of the market with more expensive biologics making up the remaining 99%. Jeffrey Walsh, Joint Chairperson

8th HIGHEST Ireland ranks as the 8th highest health spend per capita amongst 35 OECD countries.

DOUBLED COST The State’s spend on high-tech medicines has doubled in cost in seven years from €315 million in 2009 to €662 million in 2016.


€62 billion worth of biologic medicines are expected to go off patent by 2020, but only 11 of the 23 biosimilars authorised by the European Medicines Agency are currently reimbursed by the HSE

14,157 vs 36

There is a lack of genuine competition between biologics and biosimilars in Ireland. In just one case Enbrel (biologic) sold 14,157 packs during May 2017, with its biosimilar equivalent Benepali selling just 36



In 2017, Ireland will spend €14.6 billion on health, an increase of almost one billion since 2016.

Total spend on medicine in 2015 by the HSE was €2 billion – the largest single item in the healthcare budget.

18.4% OVER 60

18.4% of the population is now over 60, with this figure expected to reach 1.15 million by 2026.

140 MEDICINES OUT OF STOCK Medicines shortages are increasing, with over 140 medicines currently out of stock in Ireland.

of Medicines for Ireland and Commercial Manager, Pinewood Healthcare, added, “The slow pace of change is frustrating for patients and those who want to see the current shortcomings addressed. As medicine suppliers, we feel the same frustration and that’s why we have developed our manifesto with real, fundamental, and actionable reform in mind. “Much has been said about the problems in the supply of

medicines – lack of affordability, delayed or denied access, growing shortages. It all points to the unsustainability of continuing our current approach. Medicines for Ireland have designed our policy proposals to empower the Department of Health to reform now, rather than when the existing problems are even more acute. We can develop a better way but urgent reform must now be a priority for all stakeholders”, concluded Walsh.

New Pharmacy division launch BR Foods Limited, with over 34 years’ experience servicing the retail food trade in Ireland, is delighted to launch a new Pharmacy division called BR HEALTHCARE to supply the Irish Pharmacy market with a range of health & beauty products. Their emphasis is to source innovative, trending, key areas in Pharmacy. Initial brands include: NUTRIPODZZ New Superfood range of seeds & berries, Ready Spex – high optical quality, modern design, reading glasses. Watsons Manuka Honey – high quality New Zealand Manuka Honey, MGO standard. Le Petit Oliver – natural skin-care range. Klear-vol – Essential oil capsules for inhalation. Love Boo – natural skincare range for mothers, mothers to be and babies. Annabel Karmel – organic baby puree range. The new company is being spearheaded by Liam Kellegher, formerly Sales Manager with United Drug Consumer, who takes over as Business Development Manager in this new exciting venture for BR.


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Pfizer Index Report Research shows Irish people remain concerned about health funding “Against a backdrop of economic renewal, it is also noteworthy, that again in 2017, the survey shows that people view health as the greatest priority area for Government spending." These were the words of Managing Director of Pfizer Ireland, Mr Paul Reid as he launched the latest Pfizer Health Index. In terms of workplace health, the Pfizer Health Index found that: - 80% of Irish workers feel they have a good work/life balance and 88% of people find the content their job interesting; - The vast majority of people say they have a good relationship with colleagues with 92% of those surveyed giving their work relationships a ranking of between 3 and 5; - The average number of sick days per year is 3.56;

Paul Reid, Managing Director, Pfizer Ireland The 12th Pfizer Health Index, an annual survey which charts the health perceptions, attitudes and behaviours of Irish adults, was launched at the Royal College of Physicians in Dublin. Focusing this year on the theme of workplace health, the findings of the Index were discussed by guest speakers, Professor Anne Drummond, Director of the UCD Centre for Workplace Safety and Health, Kate O’Flaherty, Director of the Health and Wellbeing Programme at the Department of Health and Health Index Ambassador, former Rose of Tralee and Startup Founder Maria Walsh. Mr Reid presented the findings to an audience of healthcare and employment-related associations and stakeholder groups. The Pfizer Health Index is a national study of health and wellness, and focuses on topics such as attitudes and perception of health, disease incidence, illness experience and impact, health funding, interaction with medical services and levels of health insurance. This year’s findings demonstrated that: • The majority of people surveyed (63%) rate their health as 8 out of 10 or higher with 14% giving their health a score of 10 out of 10;


• Key personal priorities for Irish people continue to be family health and wellbeing, personal health and financial health; • The volume of people holding a medical card dropped just one point from 2016 to 42%. Numbers of medical card holders in Ireland first began to increase in 2010 and remain at recessionary levels. • In terms of medical insurance levels, 26% of people of those surveyed have neither private medical insurance or a medical card; • Engagement with medical professions is relatively high with 30% of those surveyed having visited their GP in the last month, and 41% having attended a screening in the last year;

- In relation to disease incidence, 27% of those working have a health condition - high cholesterol, high/low blood pressure, asthma, chronic pain and arthritis are the most common conditions; - Workplace stress is an issue in Ireland with 62% reporting moderately to very stressful work environments; - The majority of people (75%) have never discussed a health issue with their employer, citing a lack of understanding/ability to support as the main concern in doing so. For those who did speak to an employer about their health, the vast majority (80%) found their response to be good or excellent; - 17% of those surveyed have their private health insurance paid for in full by their employer;

- 51% have flexible working options – they can start early, finish early, make the most of flexi-time and job-sharing options. Unveiling the Pfizer Health Index findings, Paul Reid, Managing Director of Pfizer Ireland said, "Each year, the Pfizer Health Index shines a light on a new aspect of health policy. This year, as the economy recovers and employment levels continue to rise, it is timely to be focusing on workplace health and to ask questions of employers and employees - as one of Ireland's largest private sector employers, at Pfizer we are pleased to participate in the conversation. Against a backdrop of economic renewal, it is also noteworthy, that again in 2017, the survey shows that people view health as the greatest priority area for Government spending." Kate O’Flaherty, Director of the Health and Wellbeing Programme at the Department of Health, added, “We know work is good for our health and the workplace is recognised internationally as a priority setting for promoting and improving health and wellbeing. Healthy Ireland is currently developing a national Healthy Workplace Framework, which aims to maximize the opportunity this presents to improve the health of a large part of our population. Building a workplace culture which values health and wellbeing will be of benefit to all sectors.”

• Irish people view the greatest priorities for Government spending as – 1. health (75%), 2. education (50%) and 3. job creation (30%). Each year, the Pfizer Health Index focuses on a particular topic and this year, the topic of health in the workplace was chosen. The survey asked questions such as how workers feel about health and wellbeing, how stressful their jobs are and how and whether employers in Ireland prioritise workplace health.

Grainne O’Leary, Arthritis Ireland, Karen O’Keefe, Pfizer and Kate O’Flaherty, Director of the Health and Wellbeing Programme at the Department of Health and Health Index Ambassador

Abbreviated Prescribing Information Abbreviated Prescribing Information Nurofen Express 200mg Tablets Nurofen Express 200mg Tablets Nurofen Express Maximum Strength 400mgTablets Tablets Nurofen Express Maximum Strength 400mg Refer Summary Product Characteristicsfor forfull fullinformation information Refer toto Summary ofof Product Characteristics Active ingredient: Ibuprofen sodiumdihydrate). dihydrate).Pharmaceutical PharmaceuticalForm: Form:Coated Coatedtablet tablet - whiteto tooff-white, off-white,bioconvex, bioconvex, round, round, sugar sugar coated tablet with an identifying logo black and red (for Active ingredient: Ibuprofen (as(as sodium identifying logo in in400mg black(for (for200mg 200mgtablet) tablet) redface. (for400mg 400mgtablet) tablet)on onone oneface. face. hite to off-white, bioconvex, round, sugar coated tablet with an- white identifying logo in black (for 200mg tablet) and red (for tablet) on and one Indications: anti-inflammatory, analgesicand andantipyretic antipyreticfor forshort-term short-termmanagement managementofofmild mildto tomoderate moderatepain painsuch suchas as isis associated associated with headache, dental pain, period pain, muscular strain, and for the of the of head colds and influenza. Dosage & Indications: anti-inflammatory, analgesic pain, fever, fever,and period pain, muscular strain,backache, backache, forsymptoms themanagement management thesymptoms symptoms head colds and influenza. Dosage d to moderate pain such as is associated with headache, dental pain, fever, period pain, muscular strain, backache, for the management ofand the ofofhead colds of and influenza. Dosage && Administration: oral administration.Short Shortterm termuse use only.Adults Adultsand andchildren childrenover over12 12years: years: Nurofen NurofenExpress Express200mg 200mgTablets: Tablets: 1-2 1-2 tablets every four hours with aa maximum in maximum dose 1200mg a a2424hour Nurofen Express Maximum Strength ForFor oral administration. withmaximum maximumof of6dose 6tablets tabletsof ina1200mg a24 24hours, hours,i.e. i.e. doseofof 1200mginin hourperiod. period. Nurofen Express Maximum Strength ars:Administration: Nurofen Express 200mg Tablets: 1-2only. tablets every four hours with a maximum of 6 tablets in a 24 hours, i.e. inmaximum a 24 hour period. Nurofen Express Maximum Strength 400mg Tablets; ONLY 1 TABLET PER DOSE.1 1tablet tabletevery everyfour fourhours hourswith withaamaximum maximumofof33tablets tabletsininaa24 24hours, hours,i.e. i.e.maximum maximum dose dose of 1200mg in a 24 hour period. Max duration of treatment 33days. IfIfthe symptoms worsen you should consult a adoctor. If Ifinin adolescents this medicinal product 400mg Tablets; ONLY 1 TABLET PER DOSE. period. Max duration of treatment days. the symptoms worsen you should consult doctor. adolescents this medicinal product blets in a 24 hours, i.e. maximum dose of 1200mg in a 24 hour period. Max duration of treatment 3 days. If the symptoms worsen you should consult a doctor. If in adolescents this medicinal product is required for more than 3 days symptomsworsen worsen adoctor doctorshould shouldbe beconsulted. consulted.Not Notsuitable suitablefor forchildren childrenunder under 12 12 years years of of age age without medical advice. Use NSAIDs with in elderly and the dose period due totohigher ofof adverse drug reactions (ADRs). is required more than 3 days oror if ifsymptoms NSAIDs withcaution caution inthe the andatatperiod thelowest lowestdue doseof ofshortest shortest period higherrisk risk adverse drug reactions (ADRs). uitable for for children under 12 years of agea without medical advice. Use NSAIDs with caution in the elderly and Use at the lowest dose of elderly shortest to higher riskdue of adverse drug reactions (ADRs). Discontinue if no benefit is seen intoleranceoccurs. occurs. Contraindications:History Historyofofgastrointestinal gastrointestinalbleeding bleedingor or perforation related related to to previous previous NSAIDs NSAIDs therapy. Active peptic ulcer/haemorrhage (two distinct episodes ofofproven ulceration oror bleeding) or Discontinue if no benefit seen oror intolerance Active or or history historyof ofrecurrent recurrent peptic ulcer/haemorrhage (twoorormore more episodes proven ulceration bleeding) ntestinal bleeding oris perforation relatedContraindications: to previous NSAIDs therapy. Active or perforation history of recurrent peptic therapy. ulcer/haemorrhage (two or more distinct episodes of distinct proven ulceration or bleeding) or or other gastrointestinal disorder. Patientswith witha aknown knownhistory historyofofhypersensitivity hypersensitivityreactions reactions(e.g. (e.g.asthma, asthma,bronchospasm, bronchospasm, rhinitis, rhinitis, angioedema angioedema or or urticaria) urticaria) in response to ibuprofen (the active substance) or any ofofthe excipients, acetylsalicylic acid (aspirin) oror other non-steroidal other gastrointestinal disorder. Patients in response to ibuprofen (the active substance) or any the excipients, acetylsalicylic acid (aspirin) other non-steroidal e.g. asthma, bronchospasm, rhinitis, angioedema or urticaria) in response to ibuprofen (the active substance) or any of the excipients, acetylsalicylic acid (aspirin) or other non-steroidal anti-inflammatory drugs (NSAIDs). Useininchildren childrenunder under1212years yearsofofage. age.Patients Patientswith withsevere severehepatic hepaticfailure, failure, severerenal renal failure failure or or severe severe heart heart failure. failure. Patients with problems glucose-galactose malabsorption insufficiency should anti-inflammatory drugs (NSAIDs). Use Patientsintolerance, with rare rare hereditary hereditary problemsof offructose fructoseintolerance, intolerance, glucose-galactose malabsorptionororsucrase-isomaltase sucrase-isomaltase insufficiency should re hepatic failure, severe renal failure or severe heart failure. Patients with raresevere hereditary problems of fructose glucose-galactose malabsorption or sucrase-isomaltase insufficiency should take this medicine. During the lasttrimester trimesterofofpregnancy. pregnancy. Warningsand andPrecautions: Precautions:Undesirable Undesirableeffects effectsmay maybe be minimised minimised by using using the the minimum minimum effective dose for duration totocontrol symptoms. The ananincreased frequency ofof adverse reactions to notnot take this medicine. During the last effective for the theshortest shortest durationnecessary necessary control symptoms. Theelderly elderlyhave have increased reactions ndesirable effects may be minimised by usingWarnings the minimum effective dose for the shortestbyduration necessary todose control symptoms. The elderly have an increased frequency offrequency adverse adverse reactions toto NSAIDs especially gastrointestinal bleedingand andperforation perforationwhich whichmay maybe be fatal.Prolonged Prolongeduse useof ofNSAIDs NSAIDsin inthe theelderly elderly isis not not recommended. recommended. Use Use with NSAIDs, including selective inhibitors, should Increased risk ofof aseptic meningitis with especially gastrointestinal bleeding with concomitant concomitant NSAIDs,inhibitors, includingcyclooxygenase-2 cyclooxygenase-2 inhibitors, shouldbe beavoided. avoided. aseptic meningitis useNSAIDs of NSAIDs in the elderly is not recommended. Usefatal. with concomitant NSAIDs, including cyclooxygenase-2 selective should beselective avoided. Increased risk of Increased asepticrisk meningitis with with Systemic lupus erythematosus and mixedconnective connectivetissue tissuedisease. disease.NSAIDs NSAIDsshould shouldbe begiven givenwith withcare careto topatients patientswith with aa history history of of gastrointestinal gastrointestinal disease (ulcerative Crohn’s disease) may GIGIbleeding, ulceration perforation, which can bebe fatal, hashas Systemic lupus and mixed disease (ulcerative colitis, colitis, disease)as astheir theircondition condition maybe beexacerbated. exacerbated. bleeding, ulcerationoror perforation, which can fatal, n with care toerythematosus patients with a history of gastrointestinal disease (ulcerative colitis, Crohn’s disease) as their condition mayCrohn’s be exacerbated. GI bleeding, ulceration or perforation, which can be fatal, has been reported with NSAIDs anytime timeduring duringtreatment, treatment,with withororwithout withoutany anywarning warningsymptoms symptomsor oraaprevious previoushistory history of of serious GI GI events. events. The The risk ulceration isishigher increasing doses, ininpatients with a ahistory ofof ulcer, particularly if complicated been reported allall NSAIDs atat any risk of of GI GI bleeding, bleeding, ulcerationor orperforation perforation higherwith with increasingNSAID NSAID patients history ulcer, particularly if complicated ymptoms or awith previous history of serious GI events. The risk of GI bleeding, ulceration orserious perforation is higher with increasing NSAID doses, in patients withdoses, a history of with ulcer, particularly if complicated with haemorrhage perforation, andininthe theelderly. elderly.These Thesepatients patientsshould shouldcommence commencetreatment treatmenton onthe thelowest lowestdose dose available. available. Combination Combination therapy with agents (e.g. or pump should be for and also forfor patients requiring with haemorrhage oror perforation, with protective protective (e.g.misoprostol misoprostol orproton proton pumpinhibitors) inhibitors) should beconsidered considered forthese thesepatients, patients, and also patients requiring tment on the lowest dose and available. Combination therapy with protective agents (e.g. misoprostol therapy or proton pumpagents inhibitors) should be considered for these patients, and also for patients requiring concomitant low dose aspirin, otherdrugs drugslikely likelytotoincrease increase gastrointestinalrisk. risk.Patients Patientswith withaahistory historyof ofGI GItoxicity, toxicity, particularly particularly when elderly, elderly, should report abdominal (especially GIGIbleeding) particularly ininthe initial When GIGI bleeding or concomitant low dose aspirin, oror other should report any any unusual unusual abdominalsymptoms symptoms (especially bleeding) initialstages stagesofoftreatment. treatment. bleeding with a history of GI toxicity, particularly whengastrointestinal elderly, should report any unusual abdominalwhen symptoms (especially GI bleeding) particularly in the initialparticularly stages ofthe treatment. When GI When bleeding or or ulceration occurs patients receivingNurofen NurofenExpress ExpressTablets, Tablets,the thetreatment treatmentshould shouldbe bewithdrawn. withdrawn.Caution Cautionshould shouldbe be advised advised in patients patients receiving receiving concomitant medications which increase ofofulceration or bleeding, anticoagulants such asas ulceration occurs in in patients receiving concomitant whichcould could increasethe therisk risk ulceration bleeding,such suchasasoral oralcorticosteroids, corticosteroids, anticoagulants such hdrawn. Caution should be advised in patients receiving concomitant medications whichincould increase the risk medications of ulceration or bleeding, such as oralorcorticosteroids, anticoagulants such as warfarin, selective serotonin reuptake inhibitors or anti-platelet agents such as aspirin. Caution (discussion with doctor or pharmacist) is required prior to treatment in patients with a history of controlled or uncontrolled hypertension, congestive heart failure, cardiac oedema, established selective serotonin reuptakeor inhibitors or anti-platelet agents suchprior as aspirin. (discussion with doctor or pharmacist) is required prior to treatment patients with a history of controlled or uncontrolled hypertension, congestive heart failure, cardiac oedema, established ionwarfarin, (discussion with doctor pharmacist) is required to Caution treatment in patients with a history of controlled or in uncontrolled hypertension, congestive heart failure, cardiac oedema, established ischaemic heart disease, peripheral arterialdisease disease and/orcerebrovascular cerebrovasculardisease. disease.Similar Similarconsideration considerationshould shouldbe bemade made before before initiating longer-term longer-term treatment with factors for events hyperlipidaemia, diabetes mellitus and smoking). ischaemic heart disease, peripheral arterial treatment of of patients patients withrisk risk factors forcardiovascular cardiovascularhyperlipidaemia, events(e.g. (e.g.hypertension, hypertension, hyperlipidaemia, diabetes mellitus and smoking). consideration should be made before and/or initiating longer-term treatment of patients with riskinitiating factors for cardiovascular events (e.g. hypertension, diabetes mellitus and smoking). Prolonged use any type painkillerforforheadaches headachescan canmake makethem themworse. worse.IfIfthis thissituation situationisisexperienced experiencedor orsuspected, suspected, medical medical advice should should be be obtained and treatment be The ofof'Medication Overuse should suspected inin patients who have use ofof any ofof painkiller obtained treatment should should bediscontinued. discontinued. Thediagnosis diagnosis 'Medication OveruseHeadache Headache shouldbebe suspected patients have n is Prolonged experienced ortype suspected, medical advice should be obtained and treatment should be advice discontinued. The and diagnosis of 'Medication Overuse Headache should be suspected in patients who who have frequent or daily headaches despite (or because of ) the regular use of headache medications. Clinical trial and epidemiological data suggest that use of ibuprofen, particularly at high doses (2400mg daily) and in long term treatment may be associated with a small increased risk of of arterial frequent ortrial daily headaches despite (or because of ) the regular use ofthat headache Clinical particularly trial and epidemiological data suggest(2400mg that use of ibuprofen, particularly at high dosestreatment (2400mg daily)may and in be longassociated term treatment with may beaassociated with a small increased arterial ns. Clinical and epidemiological data suggest usemedications. of ibuprofen, at high doses daily) and in long term small increased risk ofrisk arterial thrombotic events (for example myocardialinfarction infarctionororstroke). stroke).Overall, Overall,epidemiological epidemiologicalstudies studiesdo donot notsuggest suggestthat that low low dose dose ibuprofen ibuprofen (e.g. (e.g. < < 1200mg 1200mg daily) is associated with an increased risk of myocardial infarction. Serious skin reactions, some ofofthem fatal, including Exfoliative thrombotic events (for example myocardial daily) is associated with an increased risk of myocardial infarction. Serious skin reactions, some them fatal, including Exfoliative tudies do not suggest that low dose ibuprofen (e.g. < 1200mg daily) is associated with an increased risk of myocardial infarction. Serious skin reactions, some of them fatal, including Exfoliative Dermatitis, Stevens-Johnson syndromeand andToxic ToxicEpidermal EpidermalNecrolysis, Necrolysis,have havebeen beenreported reported veryrarely rarelyin inassociation association with the the use of of NSAIDs. NSAIDs. Patients Patients appear to be at risk these reactions early ofoftherapy, the ofofthe occurring inin the majority of of cases Dermatitis, syndrome at highest highest riskof of reactionsthe earlyin inthe thecourse course therapy, theonset onset thereaction reaction occurring the majority cases very rarelyStevens-Johnson in association with the use of NSAIDs. Patients appearvery to be at highest with risk ofuse these reactions appear earlytoinbethe course ofthese therapy, onset of the reaction occurring in the majority of cases within the first month of treatment. Nurofen Express Tablets should be discontinued at the first appearance of skin rash, mucosal lesions, or any other sign of hypersensitivity. Renal impairment as renal function may deteriorate. Hepatic dysfunction. Patients with bronchospasm or SLE within the first monthof ofskin treatment. Nurofen Expresslesions, Tablets should be discontinued at the appearance of skin rash, mucosal lesions, or any other sign of hypersensitivity. Renal impairment as renal functiondysfunction. may deteriorate. Hepatic dysfunction. Patients with bronchospasm or SLE first appearance rash, mucosal or any other sign offirst hypersensitivity. Renal impairment as renal function may deteriorate. Hepatic Patients with bronchospasm or SLE should consult their doctor before taking this medicine. Bronchospasm may be precipitated in patients suffering from or with a previous history of bronchial asthma or allergic disease. There is some evidence that drugs which inhibit cyclo-oxygenase/prostaglandin synthesis may cause consultsuffering their doctor before this medicine. Bronchospasm may precipitated in patients suffering from ordisease. with a previous history bronchial asthma or allergic disease. There is some evidence that drugs which inhibit cyclo-oxygenase/prostaglandin may cause d inshould patients fromtaking or with a previous history ofbebronchial asthma or allergic There is of some evidence that drugs which inhibit cyclo-oxygenase/prostaglandin synthesissynthesis may cause impairment of female fertility by an effect on ovulation. This is reversible on withdrawal of treatment. As NSAIDs can interfere with platelet function, they should be used with caution in patients with intracranial haemorrhage and bleeding diathesis. If you are pregnant, elderly or have impairmentAs of female fertility by an effect on ovulation. This is reversible on withdrawal of treatment. NSAIDswith can interfere with in platelet function,with they should be used with caution in patientsand with intracranial haemorrhage andIfbleeding diathesis. If you areelderly pregnant, or elderly or have reatment. NSAIDs can interfere with platelet function, they should beAsused caution patients intracranial haemorrhage bleeding diathesis. you are pregnant, have asthma or are receiving regular medical treatment please consult your doctor before taking this medication. Each tablet contains an average of 24.6mg (200mg) or 49.2mg (400mg) of sodium. This should be considered in patients whose overall intake of sodium must be markedly restricted. asthma or are receiving regular medicalcontains treatment please consult your doctor before (200mg) taking this medication. Each (400mg) tablet contains average of This 24.6mgshould (200mg) or 49.2mg (400mg) of sodium. This should be considered in patients overall intake of sodium must be markedly restricted. this medication. Each tablet an average of 24.6mg or 49.2mg ofansodium. be considered in patients whose overall intakewhose of sodium must be markedly restricted. There is a risk of renal impairment in dehydrated adolescents. Interaction with other medicinal products and other forms of interaction: known to interact with the following (please see SPC for full details): Corticosteroids, Anti-coagulants, Anti-platelet agents and SSRIs , Anti-hypertensive is a risk ofand renalother impairment in dehydrated adolescents.known Interactionto with other medicinal and other forms of interaction: known interact with theCorticosteroids, following (please see SPC for full details): Corticosteroids, Anti-coagulants, Anti-platelet agents, and SSRIs , Anti-hypertensive nalThere products forms of interaction: interact withproducts the following (please see SPC fortofull details): Anti-coagulants, Anti-platelet agents and SSRIs Anti-hypertensive (ACE inhibitors and Angiotensin II Antagonists) , Diuretics, Cardiac glycosides, Lithium, Methotrexate, Ciclosporin, Other NSAIDs including cyclooxygenase-2 selective inhibitors, Aminoglycosides, Probenecid, Oral hypoglycaemic agents, Zidovudine, Mifepristone, Tacrolimus, Quinolone hotrexate, Ciclosporin, Other NSAIDs including cyclooxygenase-2 selective inhibitors, Aminoglycosides, Probenecid, Oral hypoglycaemic agents,Oral Zidovudine, Quinolone (ACE inhibitors and Angiotensin II Antagonists) , Diuretics, Cardiac glycosides, Lithium, Methotrexate, Ciclosporin, Other NSAIDs including cyclooxygenase-2 selective inhibitors, Aminoglycosides, Probenecid, hypoglycaemicMifepristone, agents, Zidovudine,Tacrolimus, Mifepristone, Tacrolimus, Quinolone antibiotics and low dose aspirin. Fertility, Pregnancy and Lactation: Ibuprofen is not recommended during the first six months of pregnancy and is contraindicated in the last trimester of pregnancy. Ibuprofen and its metabolites can pass in very small concentrations into the breast milk. No mended during months of pregnancy and is contraindicated in the last of pregnancy. Ibuprofen its metabolites pass initsvery small concentrations into the breast milk. No antibiotics and lowthe dose first aspirin.six Fertility, Pregnancy and Lactation: Ibuprofen is not recommended during the first sixtrimester months of pregnancy and is contraindicated in theand last trimester of pregnancy. can Ibuprofen and metabolites can pass in very small concentrations into the breast milk. No harmful effects to infants are known, so it is not necessary to interrupt breast-feeding for short-term treatment with the recommended dose for mild to moderate pain and fever. Side Effects: Haematopoietic disorders (anaemia, leucopenia, thrombocytopenia, pancytopenia, ort-term treatment the so recommended for mild to moderate and fever. Side Effects: Haematopoietic (anaemia, leucopenia, thrombocytopenia, pancytopenia, harmful effects to infantswith are known, it is not necessary to dose interrupt breast-feeding for short-term pain treatment with the recommended dose for mild to moderate paindisorders and fever. Side Effects: Haematopoietic disorders (anaemia, leucopenia, thrombocytopenia, pancytopenia, agranulocytosis) are very rare - first signs are fever, sore throat, superficial mouth ulcers, flu-like symptoms, severe exhaustion, nose and skin bleeding, and bruising. Hypersensitivity reactions consisting of urticaria and pruritus (uncommon), severe hypersensitivity reactions including likeagranulocytosis) symptoms,are severe nose bleeding, andflu-like bruising. Hypersensitivity reactions consisting of urticaria and reactions pruritus (uncommon), severe reactions reactions including very rareexhaustion, - first signs are fever, soreand throat,skin superficial mouth ulcers, symptoms, severe exhaustion, nose and skin bleeding, and bruising. Hypersensitivity consisting of urticaria and pruritus hypersensitivity (uncommon), severe hypersensitivity including tongue and laryngeal swelling, dyspnoea, tachycardia, hypotension (anaphylaxis, angioedema or severe shock) are very rare. Aggravated asthma, bronchospasm. Respiratory tract reactivity comprising asthma or dyspnoea. Headache, dizziness. Aseptic meningitis (very rare). Impaired matongue or severe shock) are very rare. Aggravated asthma, bronchospasm. Respiratory tract reactivity comprising asthma or dyspnoea. Headache, dizziness. Aseptic (very rare). Impaired and laryngeal swelling, dyspnoea, tachycardia, hypotension (anaphylaxis, angioedema or severe shock) are very rare. Aggravated asthma, bronchospasm. Respiratory tract reactivity comprising asthma or dyspnoea. Headache,meningitis dizziness. Aseptic meningitis (very rare). Impaired hearing (uncommon). Cardiac failure, oedema, hypertension (very rare). Abdominal pain, nausea and dyspepsia (uncommon) Diarrhoea, flatulence, constipation and vomiting (rare). Peptic ulcers, perforation or gastrointestinal haemorrhage, malaena, haematemesis, sometimes fatal, ausea and dyspepsia (uncommon) flatulence, constipation and vomiting (rare). Pepticflatulence, ulcers,constipation perforation or gastrointestinal malaena, haematemesis, sometimes fatal,fatal, hearing (uncommon). Cardiac failure, oedema,Diarrhoea, hypertension (very rare). Abdominal pain, nausea and dyspepsia (uncommon) Diarrhoea, and vomiting (rare). Peptic ulcers,haemorrhage, perforation or gastrointestinal haemorrhage, malaena, haematemesis, sometimes particularly in the elderly, ulcerative stomatitis, gastritis, exacerbation of colitis and Crohn’s disease (very rare). Liver disorders, especially in long-term treatment (very rare). Severe forms of skin reactions such as bullous reactions including Stevens-Johnson Syndrome, erythema multiforme disease (very rare). Liver disorders, especially in long-term treatment (very rare). Severe forms ofinskin reactions such as bullous reactions including Stevens-Johnson Syndrome, erythema multiforme particularly in the elderly, ulcerative stomatitis, gastritis, exacerbation of colitis and Crohn’s disease (very rare). Liver disorders, especially long-term treatment (very rare). Severe forms of skin reactions such as bullous reactions including Stevens-Johnson Syndrome, erythema multiforme and toxic epidermal necrolysis can occur (very rare). Acute renal failure, papillary necrosis, especially in long-term use associated with increased serum urea and oedema (very rare), decreased haemoglobin levels and decreased urea clearance (very rare). Name and Address of Marketing specially long-term use associated with increased serum urea especially and oedema (very rare), decreased levels and urea clearance (very rare). Name and Address Marketing and toxicin epidermal necrolysis occur (very rare). renal failure,campus, papillary necrosis, long-term associated increasedhaemoglobin serum urea and oedema (very rare),decreased decreased haemoglobin levels and decreased urea clearance (very rare). Name andof Address of Marketing Authorisation Holder: Reckittcan Benckiser Ireland Ltd,Acute Citywest Business Dublin 24, Ireland. PAinNumber: PA use 979/32/10 and with PA 979/32/11 eland. PA Number: PA 979/32/10 and PA 979/32/11 Authorisation Holder: Reckitt Benckiser Ireland Ltd, Citywest Business campus, Dublin 24, Ireland. PA Number: PA 979/32/10 and PA 979/32/11 For full prescribing information, please consult the SPC which is available on For product queries, please call (01) 630 5429 or contact the MAH above. For productinformation, queries,please please call (01) 630 is 5429 or on contact the MAH above. ForLegal full prescribing consult the SPCDate which available For product queries, please call (01) 630 5429 or contact the MAH above. Category: Retail Sales through Pharmacy only. of preparation: May 2016. Legal Category: Retail Sales through Pharmacy only. Date of preparation: May 2016.

1.Steiner TJ, et al. J Headache Pain. 2007;8: S3-47 1.Steiner TJ, et al. J Headache Pain. 2007;8: S3-47 2.Cathcart S, et al. Cephalagia. 2010; 30(10): 1250-1267 2.Cathcart S, et al. Cephalagia. 2010; 30(10): 1250-1267 3.RB market research, survey, 2013, Headache Awareness Week, 1-33, 1010 participants. 3.RB market research, survey, 2013, Headache Awareness Week, 1-33, 1010 participants. 4.Moore A, et al. Pain. 2014. 155(1):14–21 4.Moore A, et al. Pain. 2014. 155(1):14–21 5.Nurofen Express 400mg Maximum Strength Tablet SPC. Accessed 22/02/2017 SPC/Nurofen+Express+Maximum+Strength+400mg+Tablets/ 5.Nurofen Express 400mg Maximum Strength Tablet SPC. Accessed 22/02/2017

ALWAYS READ THE LABEL. Date of preparation: Mar 2017 IRL/N/0317/0017 ALWAYS READ THE LABEL. Date of preparation: Mar 2017 IRL/N/0317/0017

News New treatment options for common debilitating skin disease Researchers focusing on the common debilitating skin disease Hidradenitis suppurativa (HS), which causes deep, painful lesions and leads to a poor quality of life have isolated new treatment options after performing a comparative analysis that showed which cells were active – and responsive to medication -- in those living with HS. Additionally, the researchers showed that the biological brakes that exist in a healthy immune system appear unable to control this inflammatory response in HS patients, indicating an underlying imbalance within their immune systems. Crucially, this research brings to light the potential of targeting the Th17 pathway to treat HS, with the researchers believing that existing medication used to treat other skin conditions may prove effective.

Professor Brian Kirby, Consultant Dermatologist, St Vincent's University Hospital

pathway are already on the market, but have not yet been tested in clinical trials as agents for tackling HS. We hope our work opens the door to better outcomes for clinicians and HS patients alike.” This research was recently published in the top-ranked international dermatology journal, the Journal of Investigative Dermatology (DOI: 10.1016/j. jid.2017.05.033). In addition, the study was selected as the Editor’s Choice by the highly prestigious Science Translational Medicine journal, which recognised the potential clinical impact of this work on patients’ lives.

Professor Fletcher says, “Similar treatments have been extremely successful in treating psoriasis, HS is thought to be both underresearcher Barry Moran, both which is another inflammatory reported and under-diagnosed, at Trinity College Dublin, and The work relied on the high-end, skin disease. In the samples we but researchers estimate that dermatologists Professor Brian SFI-funded Flow Cytometry Facility screened we saw that HS patients 1-4% of people have the Kirby at St. Vincent’s University at the Trinity Biomedical Sciences who had been successfully treated disease. HS sufferers experience Hospital, and Dr Anne-Marie Tobin Institute. It was a collaborative by a therapy known as ‘TNF extreme pain and must manage at Tallaght Hospital, studied the effort between translational blockers’ had far fewer Th17 cells the psychological distress that cells that were most active in the scientists in the Schools of than previously, which suggests accompanies the disease. Current blood and skin of HS patients Biochemistry and Immunology that medications which target this treatments are often ineffective, so Practice Review will be introduced this year for all pharmacists practising in patient-facing roles with compared with healthy volunteers. and the School of Medicine in pathway may hold the key. there is a pressing need for more Trinity, and collaborators from This approach led them to identify effective new therapies. the first pharmacists due particular to be randomly selected by the PSI in the autumn. Tallaght Hospital and St. Vincent’s inflammatory cells in “Our work provides a target University Hospital, UCD. the skin of HS patients, known as molecule for drug developers A research team led by Ussher Th17 cells, as key mediators of aiming to tackle HS. A number of Assistant Professor in Translational To support the professiontheduring the roll out of this products new CPD process the IIOP has announced details that focus on the Th17 Immunology Jean Fletcher, disease.

Join the IIOP for the launch of Practice Review this Autumn

of a nationwide roadshow to launch Practice Review. These events are now available for booking on the IIOP website (

This roadshow will provide with anof opportunity to learn about what this Practice Review Join the IIOP for pharmacists the launch Practice Review Autumn involves, to ask questions about the process and to hear from other pharmacists that have

Practice Review will be introduced this year for all pharmacists practising in patient-facing roles with the first experienced Reviewselected first-hand inPSI theinpilot. pharmacists duePractice to be randomly by the the autumn. booking on the IIOP website To support the profession during Attendees have the opportunity to shape the ( the roll out of this will new CPD process the IIOP has announced Thisfor roadshow will provide questions when registering the event. details of a nationwide roadshow pharmacists with an opportunity to to launch Practice Review. These learn about what Practice Review involves, to ask questions about events are now available for

the process and to hear from

the roadshows by submitting

experienced Practice Review first-hand in the pilot.

the event.

discussion at the by submitting questions when registering for other pharmacists thatroadshows have Attendees will have the opportunity to shape the discussion at

The Roadshow will take place in the following locations: Date Tuesday, 05 September Wednesday, 06 September Tuesday, 19 September Wednesday, 27 September Tuesday, 03 October Tuesday, 24 October


Rochestown Park Hotel, Rochestown Road, Douglas, Cork

O'Callaghan Davenport Hotel, 8-10 Merrion Street Lower, Dublin 2 Hotel Kilkenny, College Rd, Sugarloaf Hill, Kilkenny Maldron Hotel, Sandy Road, Galway Radisson Blu Hotel & Spa Limerick, Ennis Road, Limerick Clayton Hotel Leopardstown, Central Park, Leopardstown, Dublin

Book your place, and submit your questions on the IIOP website. 16

The Roadshow will take place in the following locations:


This is not a Lubricant; it is a stimulation Gel!



80% of women who used Durex Intense Gel in a test achieved orgasm! IRL/DUX/0117/0003 Date of Preparation: Jan 2017

The Top 100 OTC Products

The Rise to the Top The 2016/17 Top 100 OTC Products Irish Pharmacy News presents this year’s Top 100 OTC Products, in association with QuintilesIMS. With a global team of 50,000 including over 370 employees in Ireland, QuintilesIMS harness market insights, commercial and scientific depth and executional expertise to empower clients to achieve some of their most important goals: Internationally they support and advise over 30,000 pharmacies across Europe and are bringing an understanding and knowledge to Irish pharmacies to help them thrive in this ever-competitive environment. The report The following 24 pages offers a unique insight into the performance of the key brands, stemming over six years, in the Irish OTC market. The report offers exclusive access to this crucial information. It is the only place you will find year-on-year comparisons for this period, presented in an easy to navigate chart and via an in-depth focus on each of the brands that have been supportive in making this Top 100 report possible. The companies who feature in this year’s Top 100 are those who have invested in continued product development, training, marketing initiatives and promotional campaigns, both in consumer marketing and in trade activity. This has set them apart from their competitors. Ongoing support from suppliers demonstrates the level to which they value community Pharmacy and ensures that Pharmacy teams have the means to make sure the front of shop reaches its maximum potential. The list, which includes household name brands to diagnostic products, reflects a rolling year of distribution data based on volume sales for the period June 2016 to May 2017 [inclusive]. It is designed to give the most up to date information available. The unique way in which it is presented allows an opportunity to reference the performance of the most successful and popular products in the Irish market over a six-year period. OTC Shoppers The promotion of self-care means consumers are making more informed choices in relation to their health. Understanding purchasing decisions and patterns within your front of shop will naturally help to maximise revenue. More importantly though, the trusted advice of a Pharmacist further facilitates the notion of selfcare. Fundamentally, the pharmacy is a unique environment where the consumer can make their own choices, but also receive guidance to make more informed decisions regarding the products they purchase. The almost limitless resources we all have access to online, very often leads to confusion with consumers being

targeted by several brands for most ailments. How are they deciding which to try, and subsequently to repeat purchase? The changes and pressures in the prescription market in Ireland also emphasise the growing commercial relevance for Pharmacies in the OTC space. The Top 100 report represents the essential products that every Pharmacy should be aware of, but an understanding of the relevance of these products to your own customer base is also vital. The requirements of your own Pharmacy’s demographic need to be met when you are making purchasing decisions. Pharmacists should know their best sellers and ensure a consistent supply of stock. Out of stock products result in lost sales, and can, in turn, lead to loss of customers. In terms of maximising revenue in OTC, there are several questions to ask: Do you know how much OTC sales revenue contributes to the business overall? How does this compare to your competitors? Are there products or categories that need addressing? What are the top OTC products? Why are people purchasing them? There are several fundamentals to achieving success in OTC to boost business in terms of both footfall and OTC sales. o Ensuring signpost brands are visible in all categories - visibility is important even to those customers who aren’t brand-focused. o As well as stocking leading brands, attention should be given to new products. Your customers may have already been targeted with consumer advertising. o Don’t try to stock everything - check your EPoS or sales data regularly to work out what sells and what doesn’t and don’t feel obliged to purchase the entire offering when trying a new range. o Pricing isn’t your USP - The two biggest launches for pharmacy in recent years, were Bronchostop and Nexium Control, both of which have a higher RRP than competitors. The customer wants them and will spend accordingly.

Please note that the four- year comparison listed opposite, along with other comparisons with previous years, may include brands and categories whose classification may have changed over the four year period. The IPN top 100 OTC products and the method of its collation evolves with the pharmacy sector and in this context, comparisons with previous years are for indicative purposes only, using the data as printed in the IPN Top 100 in the year in question. As such, all comparative data publishes in this issue is designed to offer readers a broad reference tool rather than a like for like comparison.


o Advice is what the public expects of community pharmacies – Take the time to ask questions when selling medicines. Your staff are your biggest asset, so keeping them informed is crucial.

at 3.3% (including an extra day due to leap year) and March at 2.8%. Category wise the overall growth was driven by a small increase in prescription volume and strong OTC healthcare sales due to a late cough and cold season.

• Paralief has made its debut in the top 10, moving up 6 places this year. Clonmel have made a strong push this year with growth across a number of brands, including Caldesense and Maxlief.

o Ensuring the appropriate balance between prescription, OTC and Health and Beauty for each individual store, dependant on the patient and customer profile.

Maximising the data from outside sources and EPoS systems, can all help to identify what is needed and when. This will help you to secure the best possible deal from your supplier. Together with link selling, clever category management and keeping abreast of changes in the market, your OTC section can really become the heart of your business.

• Significant movers this year include Nexium Control, gaining 10 places. Bronchostop, a debutant to the market in 2015/2016 has continued to grow upon its impressive first year, climbing further to 26 this year. The growth underlines the place of natural remedies within the OTC market

The picture so far in 2017 The retail pharmacy market is undergoing considerable change. It is more important than ever for Pharmacies to build an effective shopper experience, coupled with key engagement strategies.

This year’s report – They key facts

According to Retail Ireland Monitor’s Q1 report, there was continued growth in pharmacies as consumers spend on beauty and fragrances. The sector grew by 4.4% in value terms in the quarter and 6.3% in volume – reflecting both the price competitiveness of the sector and reductions in the reimbursement costs of medicines. A very strong January sales period (growth of 5.9%) made this the fastest growing month compared to a more modest February

20 17

20 16

20 15

• New additions to the Top 100 this year include Optrex, Brupro, Lyclear and Paratabs.

• Perrigo’s Solpadine is now the top selling OTC product and leading analgesic for the sixth year running.

• Johnson & Johnson continue their assertiveness within the OTC market, featuring no less than 19 brands which treat many different ailments. This is underlined with particularly big movement from Benylin Night and Day (up 8 places), and the continued strength of Calpol, Nicorette and Aveeno within the top 20.

• Hylo Forte move up 21 places, which is indicative of a stronger focus in the last 12 months on eye care in pharmacy.

• RB have the second highest number of product in this year’s top 100, with 14 products.

• Panadol Extra Overtakes Nurofen for Children to become the leading non-codeine based NSAID/Oral Analgesic

20 14

20 13

20 12

20 17

20 16

20 15

20 14

20 13

20 12

1 1 1 1 1 1

14 14 14 14 13 14

2 2 2 2 3 3

15 15 17 21 0 59

3 3 3 3 2 2

16 19 20 26 29 50

4 5 5 9 10 11

17 17 16 25 59 0

5 4 4 4 4 4

18 18 21 18 19 21

6 6 6 7 6 7

19 16 15 16 17 17

7 7 7 8 11 10

20 20 19 20 20 19

8 13 11 10 8 8

21 28 18 22 26 40

9 8 9 11 9 9

22 23 22 17 16 15

10 9 8 6 7 6

23 22 28 15 14 13

11 11 13 13 15 16

24 24 25 19 18 18

12 12 12 12 12 12

25 25 26 23 21 22

13 10 10 5 5 5



amol Brand in Pharmacy*



s ab at




va Ad ol

Pa n


Pa r



IMS MAT Mar 2012

nmel, Co. Tipperary. t. ys read the label.



TOP 100 OTC PRODUCTS 20 20 20 20 20 20 17 16 15 14 13 12 BUTTERCUP BRONCHO


52 60 60 0 0 0

CALPOL SIX PLUS 27 26 27 31 25 25


53 51 48 0 0 0


28 32 36 37 38 47



29 33 29 33 28 44


30 27 23 24 22 24

26 35 0 0 0 0


32 37 32 34 37 34


33 30 34 29 31 29


34 34 37 36 32 31


35 43 50 68 58 64


36 39 59 86 68 81


37 52 49 55 61 63


38 44 57 65 71 96


39 36 33 27 24 20


40 38 38 38 34 36


41 49 31 28 27 27


42 40 54 0 0 0


43 47 43 58 86 86

CONTOUR NEXT 44 50 65 97 0 0 SINUTAB


20 20 20 20 20 20 17 16 15 14 13 12

45 42 39 42 35 30

20 20 20 20 20 20 17 16 15 14 13 12 NIQUITIN

77 0 0 35 23 23


78 90 85 85 84 72

54 55 44 48 41 39


79 67 71 76 69 94


55 21 24 30 40 51


80 76 67 60 44 41


56 45 53 0 0 0


81 81 79 0 0 0


57 70 - - - -


58 58 52 50 47 48



59 57 62 49 46 67

PHARMATON WNS 84 68 68 70 45 33


60 29 30 40 0 0


61 59 55 56 55 56

BEPANTISEPTIC 82 71 91 0 0 0

83 95 - - - -


85 91 80 79 79 93


86 87 94 0 0 0

SUDAFED NASAL 62 62 64 69 66 76


87 82 86 0 0 0


63 65 66 67 57 55


88 80 89 0 0 0

E 45

64 56 46 43 36 35


89 83 92 0 0 0


65 86 0 0 0 0


90 - - - - -


66 85 56 32 30 26


91 96 84 0 0 0


67 63 61 57 53 53


92 77 76 77 63 70


68 69 69 64 73 65


93 - - - - -


69 66 58 59 56 49


94 - - - - -


70 64 63 63 52 46


95 - - - - -


71 73 70 100 78 79


96 89 82 71 48 38


72 72 75 88 65 69


97 - - - - -

73 78 73 61 49 42


98 61 47 52 54 54


99 92 88 82 74 73


100 99 95 0 0 0


46 31 35 41 43 58


47 - - - - -


48 53 45 45 42 52



49 46 40 39 33 28

BENYLIN DRY N/D 74 74 72 74 62 66


50 54 41 46 50 45


75 84 96 0 0 0


51 48 42 75 70 71


76 79 90 66 0 0

** O N 1





T O WO R K *








d on absorption da


**IMS MAT Volume Sales June 2017. Solpadeine Soluble Tablets contain paracetamol, codeine phosphate hemihydrate and caffeine. For the treatment of acute moderate pain which is not relieved by paracetamol or ibuprofen alone, including migraine, headache, backache, menstrual pain, musculoskeletal pain, toothache, common cold, influenza. Adults and children 12 years and over: 2 tablets dissolved in water 3 – 4 times a day. Max 8 tablets in 24 hours. Do not give to children under 12 years. Do not take for more than 3 days without consulting a doctor. Do not take any other paracetamol or codeine containing products concurrently. Can cause addiction. Use for 3 days only. In case of overdose, seek immediate medical advice, even if the patient feels well. Contraindications: Acute asthma, known hypersensitivity to ingredients, lactation, known CYP2D6 ultra-rapid metabolisers, patients 0-18 years who undergo tonsillectomy and/or adenoidectomy for obstructive sleep apnoea syndrome. Precautions: Renal or hepatic impairment, non-cirrhotic alcoholic liver disease, obstructive bowel disorders, previous cholecystectomy, acute abdominal conditions, pregnancy, prostate hypertrophy, the elderly. Pregnancy and lactation: Not recommended during pregnancy and breastfeeding. Side effects: Thrombocytopenia, anaphylaxis, cutaneous hypersensitivity reactions, hepatic dysfunction, GI disturbance, dependency or worsening of headache following prolonged use. PA 1186/11/1. P. MAH: Chefaro Ireland Limited, 1st Floor, Block A, The Crescent Building, Northwood Office Park, Dublin 9. RRP (ex. VAT): 12€€5.40, 24 €8.50. Date of preparation: April 2014.

The Top 100 OTC Products 1

Solpadeine – Perrigo

Solpadeine is Ireland’s number 1* pharmacy only pain relief brand and offers a range of different pain solutions to address different customer needs. Pain management is one of the most vital services provided by pharmacists today. Solpadeine is an effective short-term solution for acute pain when Paracetamol and Ibuprofen are not enough. With a triple active formulation of paracetamol, caffeine and codeine; Solpadeine provides fast and effective relief from headache, backache and other acute pain. Product name: Solpadeine Soluble Tablets (P), Solpadeine Tablets (P) and Solpadeine Capsules (P). MA Holder: Chefaro Ireland Ltd., First Floor, Block A, The Crescent Building, Northwood Office Park, Dublin 9, Ireland. Further information is available upon request. *Source: IMS MAT May 2017 Value Sales


Nurofen Plus – RB Ireland

Nurofen Plus is the No. 1 selling product from Nurofen*. The dual action formula provides fast effective relief from strong pain. The combined targeted action of Nurofen plus and the powerful action of codeine, helps eliminate messages of pain, providing fast powerful relief from migraine, period pain, dental pain, sciatica, lumbago and rheumatic pain. Pharmacy only product.


Exputex – Phoenix Labs

The leading brand of expectorant Cough Syrup in Ireland maintains its position at number three in the Top 100, for the third year in a row.

*IMS OTC Value Sales MAT June 2016


Panadol Extra – GlaxoSmithKline Consumer Health

Panadol Extra Soluble tablets contains a second active ingredient, caffeine, that amplifies the analgesic effect of Paracetamol, giving up to 30% more pain relieving power when compared to standard paracetamol tablets. So, when you have a headache Panadol Extra Soluble can deliver powerful, effective relief. And it’s gentle on your stomach, too. Panadol Extra Soluble is also effective in treating backache, rheumatic pains and muscle pains, period pains and toothache.



Nurofen for Children – RB Ireland

Nurofen for Children have been supporting parents for 18 years by providing effective relief for children suffering from pain, fever and cold and influenza. Our ibuprofen based liquid medicine provides relief for children. It starts to work in just 15 minutes and lasts for up to 8 hours for fever. Being there for parents when their children are unwell is at the heart of everything we do, which is why we developed a non-drip syringe which was specifically designed so parents can give medicine to their little one without having to worry about accuracy of dosing or spilling. Nurofen for Children Orange or Strawberry 100mg/5ml contains ibuprofen. Suitable from 3 months and weighing over 5kg. Always read the label.


Calpol – Johnson & Johnson

CALPOL® has over 45 years’ experience in Ireland, helping parents to care for their little ones when they’re feeling unwell. CALPOL® Infant Suspension is specifically formulated for babies and infants from as young as 2 months. It has a pleasant strawberry flavor and starts to work on fever in just 15 minutes but is still gentle on delicate tummies. It is an effect pain reliever for teething pain, colds, earache, sore throat and immunisation fever. CALPOL® Infant Suspension won Best Children’s Product at this year’s IPN OTC & Retail product awards. Calpol will be supported this season with TV, Digital, Radio and Pharmacy Point of Sale. Contact Your OTC Territory Manager for more information. MAH: McNeil Healthcare (Ireland) Ltd. Airton Road, Tallaght, Dublin 24, Ireland. Product not subject to medical prescription. Further information available upon request from Johnson & Johnson (Ireland) Ltd.



Nurofen Express – RB Ireland

Nurofen Express contains a unique formula of sodium ibuprofen that gets to work twice as fast as standard ibuprofen, providing fast, effective relief from everyday pains such as headache, dental pain, period pain, backache, muscular pain, fever and cold & flu symptoms. The 400 mg single dose tablets are driving overall value sales* for the segment. Nurofen Express is supported throughout the year with strong TV and in store campaigns. Pharmacy only product. *IMS OTC Value sales MAT Dec ‘16 Nurofen Express Tablets contain either 200mg or 400mg ibuprofen (as sodium dihydrate). Always read the label. Date of preparation: Jan 2017 RL/NfC/0117/0002

ParaliefClonmel Healthcare

Paracetamol 500mg tablets 24 pack. For the relief of headaches, musculoskeletal disorders, period pain, toothache, colds and flu and the pain of osteoarthritis. Now also available in the range is Paralief 500mg Effervescent Tablets in 12 and 24 pack sizes.


Nicorette Johnson & Johnson

NICORETTE®-is Ireland’s No.1 NRT* and total OTC** brand! At NICORETTE® we understand that every smoker is different and that each person wants to cut down or quit in a way that is right for them. For years, we have been supporting smokers who want to quit or cut down the number of cigarettes they smoke, and we have developed a range of products to help different smokers to reach their personal stop-smoking goals. NICORETTE® offers a unique format, QuickMist, for smokers who need fast-acting relief from cravings. NICORETTE® is supported throughout the year with In-store POS, TV, Digital, Press, Radio and Out of Home Advertising. MAH: McNeil Healthcare (Ireland) Ltd. Airton Rd., Tallaght, Dublin 24, Ireland. Full prescribing information available upon request. Products not subject to medical prescription. *IMS Data May 2017, Value Sales and Value Share **IMS Data June 2017/MAT 2017/YTD 2017, Value Sales


Gaviscon – RB Ireland

Gaviscon Extra is specially formulated and contains sodium alginate and double the concentration of calcium carbonate compared with Gaviscon Original for acid neutralising effect. It not only helps neutralise acid but it also creates a physical barrier to soothe heartburn and indigestion fast. Gaviscon Extra gets to work instantly; and can be used during the day and at bedtime making it a very convenient option for heartburn and indigestion sufferers. Gaviscon Extra comes in both tablet and liquid formats. Full product details available on Zinc number IRL/GOTC/0717/0017, Date of prep July 2017


The Top 100 OTC Products 11

Calcichew D3 Forte – Takeda

Climbing again this year, Calcichew is up 9 places in total over the six year period covered.


Galfer – Thornton and Ross

Galfer is available in capsules and syrup. Both contain the active ingredient ferrous fumarate. Used to treat iron deficiency anaemia, the increased iron intake allows the body to increase its production of red blood cells. The absorption of iron from the gut is decreased if it is taken at the same time as coffee, tea, eggs or milk. Its absorption is enhanced if it is taken at the same time as Vitamin C (Ascorbic Acid). Galfer is now distributed by Clonmel Healthcare.


Nurofen – RB Ireland

No.1 range for mild pain relief.* Nurofen tablets work where they are needed – at the site of pain. They quickly relieve pain, reduce inflammation and lower temperature. Fast, effective relief from everyday pains such as headache, dental pain, period pain, backache, muscular pain, cold & flu symptoms and fever. Pharmacy only product *IMS OTC Value Sales MAT June 2016


Lemsip – RB Ireland

No movement from last year for the popular cold relief drink.


Aveeno – Johnson and Johnson

AVEENO® Daily Moisturising Lotion: AVEENO® products are formulated with naturally active ingredients to provide real skincare benefits. Our Daily Moisturising Lotion, formulated with naturally active colloidal oatmeal is fast absorbing, clinically proven to significantly improve the condition of dry skin in just 2 weeks and moisturises skin for 24 hours. Look out for our new Daily Moisturising Yogurt Range! Formulated with colloidal oatmeal and nutrient rich yogurt concentrate, the AVEENO® Daily Moisturising Apricot & Honey and the AVEENO® Daily Moisturising Vanilla & Oat scented body yogurt will provide an enriching experience that is as good for your skin as it is for your senses.


Dioralyte – Sanofi

Dioralyte continues to rise up the top 20 by three places from number 19 last year. The brand has show sustained growth through the last 5 years.


Cetrine Allergy – Rowex

Cetrine Allergy 10 Tablets (Cetirizine) Cetirizine is indicated for the relief of nasal and ocular symptoms of seasonal and perennial allergic rhinitis. For the relief of symptoms of chronic idiopathic urticaria. Available in packs of 7's and 30's. Marketed by Rowex Ltd, Co. Cork. Always read the leaflet.


Nurofen Cold and Flu – RB Ireland

The highest value selling pharmacy Cold & Flu brand*. The dual action formula of Nurofen Cold & Flu provides nondrowsy relief from the symptoms of cold & flu. Combining the action of Nurofen with the decongestant pseudoephedrine, each tablet provides effective relief from aches and pains, headache, fever, blocked noses and sinuses and eases the pain of sore throats. Supported on TV, on-line and in-store throughout the cold and flu season. Pharmacy only product. *IMS OTC Value sales MAT Dec ‘16 Nurofen Cold & Flu Film Coated Tablets contain 200mg ibuprofen and 30mg pseudoephrine. Always read the label.


Canesten – Bayer

Canesten is the No 1 women’s health brand worth ¤2.6m and is growing at+ 9%*. The wide range of Canesten formats gives women the opportunity to choose the right treatment format for their needs. Canesten Combi is the key product recommended as it treats thrush both the internal infection and the external itch. Canestest is the first OTC self-test available to women and Canesbalance is an OTC treatment for BV without the need to go to the GP *IMS L.IE.COM.07.2017.1388


Sudafed – Johnson and Johnson

SUDAFED® is the number one selling decongestant brand in Ireland *. Over the past 30 years SUDAFED® has pioneered clinically proven, over-thecounter treatments for congestion and associated symptoms. This enables people to treat a vast array of congestion symptoms without the need to acquire a prescription. Symptoms which Sudafed helps offer relief from include: Nasal Congestion, Sinus Pressure and Catarrh. Contact Your OTC Territory Manager for more information. *IMS/ MAT April 2017, MAH: McNeil Healthcare (Ireland) Ltd., Airton Road, Tallght, Dublin 24. Product not subject to medical prescription. Full Prescribing Information available from Johnson & Johnson (Ireland) Ltd.


Y For Co ug h AN AT HOME syrup

ON THE GO pastilles

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











*4 m

g lo z e n g e v s. pla c e


g lo z e n g e v s. pla c e b o

Mini Lozenges: Starts to relieve sudden cravings fast*

Patch: Smart control technology for 24 hour craving control

*4mg only Product Information: NiQuitin Mini 4 mg Mint Lozenges (nicotine) and NiQuitin Clear 21mg/24hrs transdermal patches (nicotine). Indications: Treatment of tobacco dependence by relief of nicotine withdrawal symptoms and cravings. Use with behavioural support. Legal category: GSL. PA 1186/18/12 and PA 1186/18/3. Licence Holder: Chefaro Ireland Ltd. First Floor, Block A, The Crescent Building, Northwood Office Park, Dublin 9, Ireland. Information about this product, including adverse reactions, precautions, contra-indications and method of use can be found at: enges/ and Date of revision: July 2107.

The Top 100 OTC Products 21

Duphalac – Mylan

This medication is a laxative used to treat constipation. It may help to increase the number of bowel movements per day and the number of days you have a bowel movement. Lactulose is a colonic acidifier that works by increasing stool water content and softening the stool.


Panadol – GlaxoSmithKline

Panadol this year sees a rise of two places, which is in line with the growth of the Panadol Extra range.


Motilium – Johnson and Johnson


Calpol six plus – Johnson and Johnson

CALPOL® has over 45 years’ experience in Ireland, helping parents to treat their child’s pain and fever at all ages and stages. As children get older their needs can change in all sorts of ways. That’s why we have created CALPOL® SIXPLUS™ Suspension. It’s specially formulated to provide effective, soothing relief from pain and fever in children aged 6 and over and starts to work on fever in just 15 minutes without being harsh on the tummy. Calpol will be supported this Back to School season with TV, Digital, Radio and Pharmacy Point of Sale. Contact Your OTC Territory Manager for more information. MAH: McNeil Healthcare (Ireland) Ltd. Airton Road, Tallaght, Dublin 24, Ireland. Product not subject to medical prescription. Further information available upon request from Johnson & Johnson (Ireland) Ltd.

Motilium has dropped just one place this year maintaining decent market share from it's massive 6 place jump in 2016


Strepsils – RB Ireland

Strepsils Intensive 8.75mg/dose Oromucosal spray is an effective Sore Throat treatment that gets to the site of pain and inflammation straight away, directly in the throat for fast and long-lasting relief. 1 dose (3 sprays) helps provide relief from throat pain, difficulty swallowing and swelling in the throat for up to 6 hours. The spray contains a single active ingredient – Flurbiprofen, an effective NonSteroidal Anti Inflammatory Drug. Full product details available on Zinc number: IRL/SP/0717/0009, date of prep July 2017


Senokot – RB Ireland

Senokot is a gentle effective constipation relief product. Senokot contains senna, a natural plant extract. The brand maintains its position at number 25.


Buttercup Bronchostop – Perrigo

Buttercup Bronchostop Cough Syrup, Buttercup Bronchostop Berry Flavour Cough Pastilles, treatment to relieve any type of cough. Bronchostop is a traditional herbal medicinal products used for the relief of coughs, such as chesty, dry, tickly, irritating coughs and catarrh, exclusively based upon long-standing use. Bronchostop is available in both a syrup and pastille format, for use at home and on the go. Buttercup Bronchostop Cough Syrup (TR 2006/1/1) GSL, Buttercup Bronchostop Berry Flavour Cough Pastilles (TR 2006/1/2) GSL, TR Holder: Kwizda Pharma Gmbh, Effingergasse 21, 1160 Vienna, Austria. Further information is available upon request.


Voltarol P – GlaxoSmithKline Consumer Healthcare

Voltarol Emulgel is a topical gel that provides relief for pain and inflammation of muscles and joints. Voltarol gel creates a reservoir of diclofenac when applied regularly according to instructions, which gives the skin a source of the active ingredient throughout the day for lasting relief of pain and inflammation. Unlike products that work by just heating or cooling the skin, Voltarol Emulgel contains an anti-inflammatory medicine (NSAID) called diclofenac.


Maxilief – Clonmel Healthcare

Maxilief effervescent tablets contain Paracetamol 500mg, Codeine 8mg & caffeine 30mg. Available in 24 & 60 packs. 60 pack is GMS reimbursable. Available from Clonmel Healthcare.


Dulcolax – Boehringer Ingelheim

Dulcolax is the world’s No1 selling laxative range*, and offers a choice of treatments to suit patients’ individual constipation needs at their own pace. Dulcolax Tablets offer predictable overnight relief from constipation and have a comfort coating so they are gentle on the stomach and Dulcolax Suppositories can provide relief in as little as 10 minutes. New DulcoSoft offers gentle relief from constipation by softening hard dry stools making it easier and more comfortable to go. *Based on sales data 2016 DulcoSoft contains Macrogol 4000


Product Information: Please consult the summary of product characteristics for full product information. Flixonase Allergy Relief 50 micrograms per dose Nasal Spray (fluticasone propionate 50 micrograms per spray). Uses: Prevention and treatment of allergic rhinitis. Dosage and method of use: Adults: Two sprays into each nostril once or twice a day if required. Maintenance: one spray per nostril once a day if possible. Use lowest possible maintenance dose. Max 4 sprays a day in each nostril. Children under 18 years: Not to be used. Contraindications: Hypersensitivity to ingredients. Precautions: Seek medical advice if inadequate relief after 7 days, or require more than 6 months continuous use. Seek medical advice before use with: concomitant corticosteroid use, fever, nasal/sinus infection, recent nasal injury/surgery, nasal ulceration, pregnancy, breast feeding. Caution commencing in those withdrawing from systemic steroids, particularly if impairment of adrenal function suspected. Systemic effects of nasal corticosteroids may occur, particularly at high doses prescribed for prolonged periods. Side effects: Dryness and irritation of the nose and throat, unpleasant taste and smell, headache and epistaxis. Hypersensitivity reactions including skin rash and oedema of the face or tongue. Rarely anaphylaxis/anaphylactic reactions and bronchospasm. See SPC for full details. Legal category: Pharmacy Only. Product Authorisation Holder: PA 0678/095/001. Product Authorisation holder: GlaxoSmithKline Consumer Healthcare (Ireland) Limited, 12 Riverwalk, Citywest Business Campus, Dublin 24, Ireland. Date of last revision: 28 April 2017. Further information available on request.


The Top 100 OTC Products 31

Nexium Control – Pfizer Consumer Healthcare

Nexium Control® has been one of the most successful OTC launches ever. Since its launch, the product has taken the top spot in the OTC PPI market and is now second in the overall category with a 28% value market share for the year to May 2017. A high level of continued marketing support has driven the success of the brand together with an extensive training programme which is available on request from Pfizer Consumer Healthcare representatives. Full product details available on For pharmacy only. 1. IMS Monthly Report Data May 2017


Benylin Day and Night – Johnson and Johnson

Voted Best Cough, Cold and Flu Product at this year’s IPN OTC & Retail Product Awards, BENYLIN® Day and Night tablets are the only day & night tablets for 24 hour cold and flu relief. During the day the white tablet relieves fever and decongests the nose. During the night the blue tablet helps relieve cold symptoms for a better night sleep. The coming winter season will again see heavy investment behind BENYLIN® Day and Night with TV and digital support as well as eye catching in store POS. Contact your Johnson & Johnson OTC territory manager for more information. MAH: McNeil Healthcare (Ireland) Ltd. Airton Road, Tallaght, Dublin 24, Ireland. Full prescribing information available upon request. Product not subject to medical prescription.


Piriton – GlaxoSmithKline

Piriton tablets are used in the treatment of acute allergic reactions. It contains the active ingredient clorphenamine maleat.


Codinex – Pinewood Healthcare

Another strong year for the codeine based medication, climbing 3 places to follow on from last year's 20 place spike.


Cortopin – Pinewood Healthcare

Pinewood's hydrocortisone cream has made significant gain this year. The brand has never appeared within the top 40 before- up 15 places


Otrivine – GlaxoSmithKline Consumer Health

Otrivine® Adult Nasal Spray is a nasal decongestant spray that helps to unblock nose in 2 minutes and last for up to 10 hours. It contains the active ingredient xylometazoline hydrochloride that helps to open up and clear nasal passages.


Tyrozets – Johnson and Johnson

Continues to show marked growth year on year up the list, as J&Js throat lozenges move from 44 to 38 on the list.


Berocca – Bayer

Has showed a sustained period of sales over the last three years with similar positioning.


Daktarin – Johnson & Johnson

Johnson and Johnson’s Daktarin remains a popular choice for Athlete’s Foot treatment.


Difflam – Meda

Difflam Oral Rinse is a locally acting analgesic and antiinflammatory treatment for the relief of painful inflammatory conditions of the mouth and throat, which has sustained strong sales over the last four years, with very little change in position.


The Top 100 OTC Products 41

Zirtek – United Drug

After a strong year of both trade and consumer advertising the strength of the Zirtek brand has been highlighted by the significant growth on the listy this year from 49 to 41. Despite stronger market regulations, the brand shows excellent improvement.


Artelac – Bausch and Lomb

Just a small drop of two places for the eye drops brand, which endured a brilliant jump of 14 places a year ago.


Vicks – TEVA Pharmaceuticals Ireland

The VICKS® range of products treat the symptoms of coughs and colds, providing effective relief for cough, nasal congestion, sore throat, runny nose, fever & related symptoms in children and adults. Products include: Vicks® Vaporub , Vicks® Inhaler Nasal Stick , Vicks® Sinex Micromist and Vicks® First Defence.


Easofen – Clonmel Healthcare

The full Easofen range now comprises of Easofen 200mg film-coated tablets 12, 24 and 48 packs, Easofen Max strength 400mg film-coated tablets 24 pack and Easofen for Children Strawberry 100mg/5ml and 200mg/5ml Oral Suspension in 100ml and 200ml pack sizes.


Buplex TEVA Pharmaceuticals Ireland

Buplex 200 & 400 mg film-coated tablets offer relief from mild to moderate pain, such as headache, including migraine headache, dental pain, period pain and fever. The active ingredient is Ibuprofen. Product features include: • Tablet can be divided into equal halves • Can use from age 6 upwards (200mg only) • Film-coated tablet • Lactose free• Available through pharmacy only • Pack size 12, 24 (200 & 400mg) & 50 (200mg only) Further information is available on request from: TEVA PHARMACEUTICALS IRELAND, Freephone: 1800 201 700 E: Always read the label carefully. Date of Preparation: July 2017. IE/OTC/17/0038


Corsodyl GlaxoSmithKline Consumer Health

The GSK brand has maintained a healthy level of consumer activity in the market and has justified it, with significant growth of 5 places this year. It has now edged ahead of listerine in the oral care section of the pharmacy.

Further information is available on request from: TEVA PHARMACEUTICALS IRELAND, Freephone: 1800 201 700 E: Always read the label carefully. Date of Preparation: July 2017. IE/OTC/17/0038


Contour Next – Bayer Diabetes

Diabetes Moniters have been included in the Quintiles IMS Figures since 2014, and the Ascencia brand continues to grow through this period- up 6 places.


Sinutab – Johnson and Johnson

A drop of three places for the popular decongestant containing paracetamol and pseudoephedrine from Johnson and Johnson.



Fybogel – RB Ireland

A minimal drop in places this year for RB's constipation relief brand


Caldesene – Clonmel Healthcare Caldesene Medicated Powder (Calcium undecylenate 10% w/w) protects your baby by attacking harmful bacteria and soothing irritation. Its special formulation forms a barrier against wetness and eliminates the need to rub the affected area and irritate further. Caldease Medicated Ointment (Zinc Oxide 15% w/w) and CaldeSpray for Nappy Rash (Zinc Oxide milk spray) are additional products in the Caldesene range.

a Panadol Extr ts le b ta l o m ta er. ard parace relieving pow ared to stand p in a m p o c re n o e h m *W ive up to 30% Soluble can g

Product Information: Please consult the summary of product characteristics for full product information. Panadol Extra 500mg/65mg Soluble Effervescent Tablets, paracetamol, caffeine. Indications: Relief of mild to moderate pain such as that associated with rheumatism, neuralgia, headache, musculoskeletal disorders, menstrual pain, toothache, fever, symptoms of colds and flu. Dosage: Adults and children 12 years and over: 2 tablets up to 4 times a day. Max 8 tablets in 24 hours. Do not give to children under 12 years. Minimum dosing interval: 4 hours. Contraindications: Hypersensitivity to paracetamol, caffeine or any of the other ingredients. Precautions: Diagnosed liver or kidney impairment, hereditary sugar intolerance, pregnancy, concurrent use of other paracetamol-containing products, excessive caffeine intake, low sodium diet. Do not exceed the stated dose. Prolonged use except under medical supervision may be harmful. Side effects: All very rare: Hypersensitivity reactions including anaphylaxis and skin rash, thrombocytopenia, angiodema, Stevens-Johnson syndrome, bronchospasm, hepatic dysfunction. Frequency unknown: Nervousness, dizziness. Overdose: Immediate medical advice should be sought in the event of an overdose, even if symptoms of overdose are not present. Combined with dietary intake, higher doses of caffeine can cause: insomnia, restlessness, anxiety, irritability, headaches, GI disturbances and palpitations. Legal Category: Pharmacy Only. MA Number: PA 678/39/10. MA Holder: GlaxoSmithKline Consumer Healthcare (Ireland) Limited, Riverwalk, CityWest Business Campus, Dublin 24. Text prepared: July 2016. Further information available on request. Panadol is a registered trade mark of the GSK group of companies. Contains Paracetamol. Always read the label/leaflet.


The Top 100 OTC Products 51

Nicotinell – GlaxoSmithKline Consumer Health

Nicotinell® is used for the treatment of tobacco dependence by providing relief of nicotine withdrawal symptoms including cravings, thereby facilitating smoking cessation or temporary smoking reduction in smokers motivated to quit smoking. Contains nicotine.


Viscolex – Pinewood Healthcare

A drop of 11 places this year for Pinewood's cough syrup, having made a significant jump of 8 just a year previously.


One Touch Verio – Lifescan

A significant jump for the One Touch Verio this year, having debuted last year at 70 it has grown Again significantly in market share moving up from 70 to 57.


Paracetamol Pfizer – Pfizer Consumer Healthcare

A strong year for pfizer's paracetemol brand. A coupled TV campaign with Nexium has proved effective, moving the brand up 8 places in a great year for the consumer brands.


Listerine – Johnson and Johnson


Bonjela – RB Ireland

Bonjela is the No.1 mouth pain brand in pharmacy*. There is now a range of products to suits your customers’ needs- Bonjela gel for the relief of pain, discomfort and inflammation caused by mouth ulcers, dentures and sore spots, Bonjela Baby teething gel for relief of pain and inflammation caused by teething and Bonjela Complete Plus which soothes pain and aids the healing of mouth ulcers and small wounds in the mouth cavity. Bonjela Complete Plus comes with a unique precision applicator, and each bottle contains 100 applications. *IMS OTC Value sales MAT June 2017

Despite a small drop of two places the well-known consumer brand continues to make a strong showing within pharmacy.


Imodium – Johnson and Johnson

IMODIUM® is an effective treatment for diarrhoea. With a range of products available, IMODIUM® has a treatment to suit your customer’s needs. IMODIUM® Instants dissolve instantly on the tongue with no need for water, for on the go relief. IMODIUM® LiquiRelief can stop diarrhoea in 1 hour, providing effective relief in a soothing liquid capsule.


Actifed – Johnson and Johnson

MAH: McNeil Healthcare (Ire). Ltd. Airton Road, Tallaght, Dublin 24. Product not subject to medical prescription. Full Prescribing information available upon request from Johnson & Johnson (Ireland) Ltd.

Johnson and Johnson’s antihistamine bounces back to gain one places after a drop of 11 last year


Buplex Actavis

This entry represents the sales of the brand whilst owned by actavis. See Number 47.



Paracetamol Actavis – Actavis

A significant drop of over 30 places for the paracetamol brand which, at one time, featured in the top 30

Irelandâ&#x20AC;&#x2122;s No.1 choice of multivitamins & minerals


* of multivitamins and minerals in Pharmacy based on total Pharmaton unit sales. Pharmaton Capsules is a pharmacy status medicine. Further information is available in the SmPC. MA holder: Sanofi, One Onslow street, Guildford. Surrey GU1 4YS UK

TV and Radio campaign starting this August STOCK UP NOW

The Top 100 OTC Products 61

Vermox – Johnson and Johnson

Vermox moves down two places with the J&J brand falling twice in the last two year's


Sudafed Nasal – Johnson and Johnson

SUDAFED® is the number one selling decongestant brand in Ireland *. Over the past 30 years SUDAFED® has pioneered clinically proven, over-the-counter treatments for congestion and associated symptoms. By targeting nasal mucus directly, SUDAFED® Nasal Spray Solution is clinically proven to start relieving congestion within minutes. One application of the nasal spray can help you breathe easy for up to 10 hours. *IMS/ MAT April 2017, MAH: McNeil Healthcare (Ireland) Ltd., Airton Road, Tallaght, Dublin 24. Product not subject to medical prescription. Full Prescribing Information available from Johnson & Johnson (Ireland) Ltd.


Deep Heat – Mentholatum

Up 2 places: Deep Heat – Relief from Muscular Aches, Pains and Stiffness: Topical pain relieving products are becoming increasingly popular as customers become more concerned about using oral painkillers, especially for long-term conditions such as arthritis. Topical painkillers are available over the counter in formats including creams, gels, sprays and patches and they can be effective and convenient way to help patients manage and treat pain. Deep heat can be used for nagging back pain, painful, stiff or aching muscles. It should be used before exercise for the relief of muscular aches and pains. How does heat treatment work? When heat is applied to the body, it activates receptors in the skin which then sends signals to the brain which dilute the pain. Heat increases blood flow to the affected area providing oxygen and nutrients to aid the healing process and help restore movement.


Hylo Forte – Scope Opthalmics

Hylo-Forte is a preservative-free eye drop which provides a longer lasting, intensive, soothing relief for more severe cases of dry eye. Delivered via the unique, patented, COMOD system, HYLO-Forte will release one drop for every click in a pump action technique. HYLO-Forte is preservative and phosphate free and will remain sterile for six months from the time of opening, making it very economical. Hylo-Forte eye drops are suitable for adults and children of all age groups and can also be used during pregnancy and breast-feeding. It is safe to use with contact lenses and so you do not need to remove your lenses before applying the drops. The recommended dosage is one drop in each eye, three times daily, however the drops can be used more frequently if required. RRP: EUR 13.51 See for more information


Savlon – Novartis Consumer Health

Savlon has made a massive jump up the list this year, from number 85 in 2016. having been a top 30 products in 2013, this marks a return in sales form for a household name.


Rennie – Bayer Consumer Healthcare

Rennie has provided relief from heartburn for in excess of 70 years and remains a household name. It has dropped off this year slightly down 4 places from 63.


Brolene – Sanofi

With the active ingredient of propamidine isethionate, Brolene has sustained small growth, moving up 1 place.


Arret – Johnson and Johnson

J&J's diarrhoea management brand slips another 4 places down the list, following a drop of 8 last year.


E45 – RB Ireland

RB Ireland’s E45 cream, which is available in a range of sizes, remains a popular treatment for a range of dry skin conditions including Eczema and dermatitis. It has lost some ground over the years and drops 10 places since last year.



Panadol Actifast – GlaxoSmithKline Consumer Health

Panadol's extensive range provides many options in OTC pain therapy, their Actifast brand drops 6 places though the range continues to have 4 brands within the top 100.

has Back to School c ove r e d !

Get ready for Back to School with CalpolÂŽ - the pain and fever reliever for children.

Lets Kids be Kids MAH: McNeil Healthcare (Ireland) Ltd. Airton Road, Tallaght, Dublin 24. Products not subject to prescription. Full prescribing information available upon request from Johnson & Johnson (Ireland) Ltd. IRE/CA/17-2708

Voltarol® Emulgel® 2% w/w Gel


Voltarol® Emulgel® Extra Strength 2% w/w Gel for the relief of pain and inflammation. Contains diclofenac diethylammonium. Always read the label / leaflet. Diclofenac Diethylammonium Product Information: Please consult the Summary of Product Characteristics for full product information. Voltarol Emulgel Extra Strength 2% w/w Gel (diclofenac). Indications: For the local symptomatic relief of pain and inflammation in trauma of tendons, ligaments, muscles and joints, localised forms of soft tissue rheumatism. Dosage: Adults and adolescents 14 years and over: 2g to 4g of gel, applied topically 2 times daily – morning and evening. It is recommended that treatment to be limited to 7 days. Patients should consult their doctor if the condition does not improve. Contraindications: Patients with or without chronic asthma in whom attacks of asthma, urticaria or acute rhinitis are precipitated by aspirin or other non-steroidal anti-inflammatory agents. Hypersensitivity to diclofenac, acetylsalicylic acid or other non-steroidal anti-inflammatory drugs. Hypersensitivity to any other ingredient of the gel. Use in third trimester of pregnancy, in children and adolescents aged less than 14 years is contraindicated. Warnings and Precautions: Caution with oral NSAIDs as may result in unwanted side effects. Avoid use with other products containing diclofenac. Apply only to intact, non-diseased skin and not to skin wounds or open injuries. It should not be used with occlusion. It should not be allowed to come into contact with the eyes or mucous membranes, and should never be taken by mouth. Application over extensive areas for prolonged periods or application in excess of recommended dosage may give rise to systemic effects. These include gastrointestinal disturbances and bleeding, irritability, fluid retention, rash, hepatitis, renal dysfunction, anaphylaxis and rarely blood dyscrasias, bronchospasm and erythema multiforme.

Discontinue if rash develops. Use with caution in patients with a history of peptic ulcers, gastrointestinal bleeding, hepatic or renal insufficiency, or bleeding diathesis, or intestinal inflammation. Pregnancy and Lactation: The systemic concentration of diclofenac is lower after topical administration, compared to oral formulations. During the first and second trimester of pregnancy, diclofenac should not be given unless clearly necessary. Only use during lactation on the advice of a health professional. Diclofenac is contraindicated during the third trimester of pregnancy. Should not be applied on the breasts of nursing mothers, nor elsewhere on large areas of skin or for a prolonged period of time. Side effects: Very rare: rash pustular, hypersensitivity (including urticaria), angioedema, asthma, photosensitivity reaction. Rare: Dermatitis bullous. Common: Dermatitis (including contact dermatitis), rash, erythema, eczema, pruritus. Overdose: The low systemic absorption of topical diclofenac renders overdosage extremely unlikely. MA Holder: GlaxoSmithKline Consumer Healthcare (Ireland) Limited, 12 Riverwalk, CityWest Business Campus, Dublin 24, Ireland. MA Number: PA 678/140/3. Legal Category: Pharmacy only. Text revised: October 2016. Further information available on request.

Trade marks are owned by or licensed to the GSK group of companies. CHGBI/CHVOLT/0245/16

The Top 100 OTC Products 71

Cystopurin Bayer Consumer Healthcare

The brand has made a small gain of two places on last year which continues its trend since entering for the first time in 2014.


Imodium Plus – Johnson and Johnson

IMODIUM® Plus offers the most complete relief from diarrhoea, wind, bloating and cramps. Treating diarrhoea reduces the loss of salts and fluids and so helps people to feel better faster. For more information on Imodium® please contact your Johnson & Johnson Territory Manager. MAH: McNeil Healthcare (Ire). Ltd. Airton Road, Tallaght, Dublin 24. Product not subject to medical prescription. Full Prescribing information available upon request from Johnson & Johnson (Ireland) Ltd.


Seven Seas Cod Liver Oil – Merck

Seven Seas, a traditionally recognised brand has seen marked growth- up 5 places


Benylin Dry Night and Day – Johnson and Johnson

BENYLIN® offers a range of products that provide relief from specific types of cough. Our Benylin Dry Cough product provides fast relief from as little as 15 minutes. Dry coughs are caused by an inflammation of the upper airways caused by dust, foreign bodies or a throat infection. There is no mucus or phlegm produced. BENYLIN® Non-Drowsy Dry Cough works by suppressing the coughing mechanism that causes a dry cough. Its non-drowsy formula helps you to get on with your day.


Thermacare – Pfizer Consumer Healthcare

Thermacare continues to grow year on year, up 9 places this year, growing on it's 12 place jump last year. The brand continues to show tremendous promise.


CB12 – Meda

CB 12 has shown some decent growth this year in sales, the brand up 3 places which includes the full range of oral health products; mouth wash, spray, toothpaste, and gum. A strong showing for one of the newer oral health brands on the market.



NiQuitin offers a range of products specifically designed to help customers beat both the underlying physical addiction and sudden cravings. NiQuitin Patches, with unique Smart Control TM Technology, provide a 24-hour craving control. Oral formats of NRT help relieve cue-provoked breakthrough cravings – the cravings which are brought on at specific times or situations when someone would usually smoke. NiQuitin Clear 21mg, 14mg, 7mg /24 hrs transdermal patches (nicotine). For the relief of nicotine withdrawal symptoms including cravings as an aid to smoking cessation. NiQuitin patches should be applied once a day, at the same time each day and preferably soon after waking and worn continuously for 24 hours.


Bepanthen – Bayer Consumer Health

Bepanthen is the No 1 nappy care brand in pharmacy with 48% market share and its growing at a rate of 20%*. Bepanthen is promoted as the ideal brand for everyday protection with major investments behind the brand – Pregnancy TV, EU Mom, digital advertising, baby fairs and sampling. Bepanthen has won the National Parenting Product award and Maternity & Infant award in 2016, as voted by Mums. Bepanthen can be used everyday for gentle and effective protection and Is free from antiseptics, fragrances and preservatives. Available in both 100g and 30g sizes. *IMS Mat April 2017 L.IE.COM.07.2017.1388


Pharmaton Kiddi – Boehringer Ingelheim

Pharmaton Kiddi is the No. 1 choice of children multivitamins in Pharmacies with a unit share of 61.1%. Hence, more than 1 in every 2 children multivitamins sold in pharmacies is Pharmaton Kiddi. To continue driving support for Pharmaton Kiddi and help grow your business, Pharmaton will be investing in a strong back to school campaign involving a strong communication mix of radio and PR, We will also be providing eye-catching POS material with a strong emotional message to parents. So stock up now and contact your Pharmaton sales rep for any more details.


Ideos – Fannin

Drops 4 places from 76


The Top 100 OTC Products 81

Cerumol – Thornton and Ross

Cerumol Original Ear Drops is a tried and trusted ear wax treatment which has successfully treated millions of ears over the years - and continues to do so today with its gentle but effective formulation.


Silcocks Base Generic

Ovelle Silcocks Base prevents itching or flaking skin due to dryness. Can also be used as a substitute to soap for eczema sufferers.


Zovirax – GlaxoSmithKline Consumer Healthcare

The evergreen cold sore brand continues to be popular amongst consumers.


Bepantiseptic – Bayer Consumer Healthcare

The brand struggles to continue its massive growth from last year, when it moved up 20 places. It has dropped down just 11 places this year, showing moderate growth over the two years.


Gaviscon Extra Strength – RB Ireland

Climbing over ten places is Gaviscon's extra strength formulation. The brand was a new entry last year and has made significant growth on the back of this.


Pharmaton – Boehringer Ingelheim

Pharmaton is the No. 1 brand for multivitamins and minerals in Pharmacy based on IMS value sales. It is a Pharmacy only focused brand hence helping to grow and support your business. To continue driving support for the brand and helping grow your business, Pharmaton will be investing in implementing a strong communications mix of TV, Press, PR including eye catching POS materials over the rest of the year. So stock up now and contact your Pharmaton sales rep for any more details.


Acic – Rowex

Acic Cold Sore 5% w/w Cream is indicated for the treatment of Herpes simplex virus infections of the skin, lips and face (recurrent herpes labialis) Marketed by Rowex Ltd, Co. Cork. Always read the leaflet.



Cetriz – Actavis

Allergy relief tablet, down 7 places


Elave – Ovelle Pharmaceuticals

Specialist Irish skincare brand Elave maintains a position within the top 100.



Lyclear is Ireland’s number 1* selling head lice brand. There are a wide range of Lyclear products available to choose from, either with or without insecticides. The Lyclear range also includes a repellent as well as treatments. Lyclear’s treatment Shampoo, Sensitive & Spray products do not use a chemical action but work by suffocating and dehydrating the lice and eggs, therefore head lice are unlikely to become resistant to any ingredients. Lyclear Sensitive, Shampoo & Spray are medical devices. Lyclear Crème Rinse (P). MA Holder: Chefaro Ireland DAC, Treasury Building, Lower Grand Canal Street, Dublin 2, Ireland. Further information available upon request. *Source: IMS MAT Volume Sales June 2017

Naturally Beautiful Results



Nourish your skin with simple, wholesome care. Inspired by Greek yogurt, NEW AVEENO® Daily Moisturising Body Yogurts and Washes blend naturally active oatmeal and nutrient rich yogurt concentrate. With rich textures and delightful scents, our Body Yogurts intensely nourish skin for up to 48hrs* and reveal healthier looking skin.

*Hydration test, product application on towel dried skin. IRE/AV/17-2730

The Top 100 OTC Products 91

Compeed – Johnson and Johnson

With a new entry in 2014 the brand has maintained a healthy level on the list, up 5 places from last year.




A debut to the top 100 for the eye care brand.

Benylin 4 Flu – Johnson and Johnson

A significant drop this year for the "4 Flu" brand, which may be losing out to it's in house rival "Day and Night"


Sudocrem – Actavis

Sudocrem Antiseptic Healing Cream is an iconic Irish brand manufactured in Baldoyle, Dublin.



A new entrant for the generic's manufacturer with their Ibuprofen medication seeking to compete with a traditional brands

It is indicated in the management of various dermatoses including local skin reactions associated with incontinence (nappy rash, cuts & grazes, eczema, sunburn, minor burns, surface wounds, acne and bed sores). Sudocrem Antiseptic Healing Cream is a licenced medicine and has been used by generations of Irish for its soothing, protecting and healing properties. Further information is available on request from: TEVA PHARMACEUTICALS IRELAND, Freephone: 1800 201 700 E: Always read the label carefully. Date of Preparation: July 2017. IE/ OTC/17/0038


Lyclear Dermal Cream GlaxoSmithKline Consumer Healthcare

Lyclear Dermal Cream is used to treat infestations of scabies and crab lice on the body. It contains the ingredient permethrin which belongs to a group of medicines called pyrethroids which kill mites such as scabies and crab lice.

99 95


Anusol – Johnson and Johnson

A drops of 7 places from 92 last year.

A new entry into the top 100 for Pinewood’s paracetamol product


Silcocks Base – Pinewood Healthcare

Pinewood’s Silcocks Base drops 7 places this year. It had previously been in the Top 40 of the Top 100 in 2012.



Uniflu – Phoenix Labs

A unique combination product for the symptomatic treatment of colds and flu. Uniflu is the only product on the market which has 5 active ingredients to treat the symptoms of pain, headache, congestion, runny nose and fever. Uniflu also contains Vitamin C.

A GREAT SELLING PRODUCT, right under your nose A popular, trusted brand, offering around the clock relief from hayfever and other allergy symptoms Max strength treatment Zirtek D includes an active decongestant to help to clear blocked noses Available in extra value packs of 30 Awareness and sales driven by high-profile marketing activity, including online advertising and social media Point-of-sale material available for your use

Contact your regional representative today to order Zirtek, your point-of-sale support, or to discuss your requirements.


Zirtek IE

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

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

Product licence holder:

UCB Pharma Limited Legal Category: OTC


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

Adverse events should be reported to the Health Products Authority at or via email to Adverse events should also be reported to UCB Pharma Ireland Ltd via email

February 2017 UK/16ZI0052

Advertorial totalhealth celebrates over 100,000 customers in its VIP Loyalty Card scheme In June, totalhealth rewarded customer Catriona Roughneen with ¤1,000 worth of shopping to thank her for being the Pharmacy Group’s 100,000th VIP Loyalty Card member. O’Donnell’s totalhealth Pharmacy in Swinford, Co Mayo had the happy news last month that they were the lucky pharmacy to sign up the Pharmacy Group’s 100,000th VIP Loyalty Card customer.

John Arnold,Commercial Director at totalhealth pharmacy group, Customer Catriona Roughneen, Ian Johnson, MD at O’Donnell’s totalhealth pharmacy, Swinford, Mayo Customer Catriona Roughneen was announced as totalhealth’s 100,000th VIP Loyalty Card customer as part of the extremely successful totalhealth VIP Loyalty Card scheme. The VIP Loyalty Card scheme offers totalhealth customers fantastic value and special offers for being part of the loyalty card program which is operated across the totalhealth Pharmacy Group. The race to sign up the 100,000th VIP Loyalty Card member caused great excitement throughout the


group across Ireland, with each pharmacy hoping to be the one to sign up the lucky person! Ian Johnson, Managing Director at O’Donnell’s totalhealth Pharmacy in Swinford, who registered the 100,000th totalhealth customer, said: “Our customers love being rewarded with loyalty points in our pharmacy and they also love the fact that they can collect or use points on their loyalty card if they are visiting a different totalhealth pharmacy in another town.” Mr. Johnson explained that he

was delighted to register one of his customers as the 100,000th member of the totalhealth VIP Loyalty Card scheme. “It was a pleasure to tell Caitriona that she was the 100,000th customer to sign up to our VIP Loyalty Card scheme and she is thrilled that she can now enjoy her win locally in Swinford or in any other participating pharmacy in the group. “As Catriona is now the 100,000th member of the totalhealth scheme, she has been awarded

with ¤1,000 worth of shopping in any participating totalhealth Pharmacy.” Speaking about the success of the totalhealth VIP Loyalty Card scheme, John Arnold, Commercial Director at totalhealth Pharmacy Group, said: “The scheme is a massive success with over 100,000 customers now signed up to our VIP Loyalty Card and we have new members joining every day. The exceptional growth of the totalhealth Pharmacy Group is proof that we are the pharmacy brand that our customers know and trust.”

Two pharmacies celebrate rebranding to the totalhealth Pharmacy Group Lynch’s totalhealth Pharmacy in Kells and RX+ totalhealth Pharmacy in Shannon have undergone impressive rebrands within the very successful totalhealth Pharmacy Group. There was great excitement within the totalhealth Pharmacy Group recently with the opening of a brand new premises at Lynch’s totalhealth Pharmacy in Kells, Co. Meath and a complete refit and rebranding at RX+ totalhealth Pharmacy at the Skycourt Shopping Centre in Shannon, Co. Clare.

Lynch's totalhealth Pharmacy rebrand, Kells, Co Meath

Lynch's totalhealth Pharmacy team, Kells, Co Meath Neil Sokay, owner and pharmacist at Lynch’s totalhealth Pharmacy, Kells, is a member of the totalhealth Pharmacy Group as he feels that being part of the innovative group allows his pharmacy to be part of something much bigger whilst still retaining his independence as a local community pharmacy in Kells.

and with the fantastic help and support we receive from the totalhealth Group.”

He said: “The move from our old premises across the road into our wonderful new premises has invigorated our pharmacy and our team. Our patients and customers love the new space and design and are always keen to tell us so. We are thrilled with the outcome

He said: “There is no doubt that being part of the totalhealth Pharmacy Group has helped my business grow. Customers are eager to find out what we can offer them in various areas within the new refitted and rebranded pharmacy.”

Likewise, Seadn Hillery, owner and pharmacist at RX+ totalhealth Pharmacy in Shannon, said his recent refit and rebranding within totalhealth Pharmacy Group has rejuvenated his business.

John Arnold, Commercial Director at totalhealth Pharmacy Group, explained that they are delighted with the result of the rebranding in Kells and Shannon. He said: “totalhealth, as a group, is continuing to grow (presently at 68 pharmacies) as pharmacists around the country see and learn that we are a Pharmacy Group who can improve their business. “From the early days, it was clear that purchasing and obtaining the very best value for each pharmacy in our group was core to our members. This led us to develop the totalhealth Electronic Ordering System (EOS) which is a system that works alongside the pharmacists’ current dispensary software. Since its inception, it has proved invaluable to the pharmacists in our group.” The totalhealth Pharmacy Group is also keenly aware that independent pharmacists who join the group still want to retain control and

Internal layout of RX + totalhealth Pharmacy, Shannon

maintain their own unique stamp on their business. “For us, this meant that each totalhealth Pharmacy up and down the country should not be generic or carbon copies of others within the group. “The outcome is that we have pharmacies that are tailored to the owner and location, a combined journey that sees all totalhealth Pharmacies appear in similar branding, but with each store retaining its own individual personality.” Mr. Arnold added that the totalhealth Pharmacy Group pride themselves on being much more than a buying group as the group is 100% owned by the members themselves equally. For more information on becoming a member of the totalhealth Pharmacy Group contact John Arnold on 0872391108 or email

RX+ totalhealth Pharmacy, Shannon


Feature Give Irish consumers something to smile about The Irish Dental Association has (last month) said it is shocked by new figures from the Central Statistics Office which show there has been a 57% fall in household spending on dental care over the last five years. contributors and medical card patients) has seen over half a billion euro taken away from patients towards meeting the costs of their dental care since 2010. The role of Pharmacy in Oral Health In today’s information-driven society, pharmacists are constantly bombarded with new information on thousands of prescription medications, non-prescription medications, and dietary supplements, and it is challenging to keep updated. The role of the pharmacist in oral healthcare has gained importance in view of delivering primary dental care services from the professionals to the public. Pharmacists are in a unique position to disseminate information on oral health, since they are in the frontline primary source of information to many patients.

According to the CSO’s Household Budget survey, households are now spending just ¤84.53 on their dental care, scarcely above the ¤74 families were spending back in 2000. The findings were discussed at a meeting of the IDA GP committee. Following that meeting the Chief Executive of the IDA Fintan Hourihan said it was impossible for a family to maintain good dental health at this level of expenditure. He has called on the Taoiseach to set up a cross-departmental group to devise a response plan. “We are seriously concerned about the impact of cuts in household spending on citizen’s dental health,” he said. “While this may be caused by the economic collapse and cuts of ¤500m in state supports for dental treatments, these figures indicate Irish people are not prioritising their dental care and that needs to change. This is not an optional expense. Prevention is cheaper than cure and if we don’t address the issue now we are simply storing up problems for the future.” Meanwhile, back in May of this year, President of the Irish Dental Association, Dr Robin Foyle called on the Minister for Health, Simon












TABLE – CSO HOUSEHOLD BUDGET SURVEYS – REPORTED SPENDING ON DENTAL CARE Harris, to end decades of neglect of oral health which he says has been overseen by successive Governments. His comments follow a litany of missed deadlines, raids on funding supports for patients and delays in appointing a full-time Chief Dental Officer to help frame a new oral health policy. Dr Foyle, who’s a Wexford based dentist, says that it was over 23 years since the last oral health policy was published. He said this lack of leadership was symptomatic of an appalling disregard for oral health by the Minister and his predecessors. “Oral health is undoubtedly

suffering, particularly for those who can least afford dental care. The evidence around us is mounting on a daily basis: children faced with large numbers of extractions due to lack of early visits and prevention, increases in the numbers of children requiring treatment under general anaesthesia, increases in the number of patients requiring hospital admissions for dental treatments, noticeable increases in the levels of decay, longer orthodontic waiting lists and falls in the number of regular dental visits.” The IDA estimates that cuts in funding for the two state funded dental schemes (for eligible PRSI

There are a variety of ways by which a community pharmacist can play an active role in oral disease prevention, identification, assessment, and referral. Even though they cannot take over the role of dental professional, they can endorse the advice given by them. Pharmacists can emphasise the nature of dental disease, its prevention, and importance of regular dental check-ups and medications. Chestnut et al. in his study on dental care advice, products, and information provided by community pharmacists found that they could perform a better role in oral health care through support and education from the dental practitioners. Oral health care continues to be an important routine for Irish consumers who tend to only go to the dentist out of necessity and instead look after their own oral health. This has had a positive impact on sales within adult mouth care as consumers tend to be willing to spend money on products to improve their oral health. Demographic changes are having an impact on all aspects of healthcare, and dental care is no exception. With an ageing population, people are living longer and retaining their teeth longer. This means that there

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Feature is greater potential for dental problems, meaning that education on the importance of oral disease prevention and a stronger focus on general oral care will be even more important in the future.

• Oral cancer

Consumer education is going to be core to ensuring the preventative message gets across. Compliance with a tailored oral care routine is key to getting consumers to change their behaviour. Just using toothpaste and a toothbrush is now no longer enough.

• Dry mouth

According to Euromonitor, The oral care market in Ireland grew by 3% in current value terms in 2016 to reach ¤124 million. Oral care is a category that was never impacted upon by the economic downturn as it is seen as an essential daily activity for consumers. Demand for perfect teeth remained important for both male and female consumers and while many try to avoid visiting the dentist, they still like to maintain their own oral hygiene to the best that they can. Oral care is expected to see a value CAGR of 2% at constant 2016 prices over the forecast period to reach ¤138 million in 2021. Growth is anticipated to be slightly slower compared to the review period, with the category continuing to mature with a slowdown in innovation expected. Growth will nevertheless likely remain relatively robust, particularly within tooth whiteners and dental floss. Common Oral Health Problems The two main diseases which affect oral health are:  Dental caries (tooth decay), wherein bacterial processes that demineralise tooth surfaces result in cavities or holes in the teeth;  Periodontal (gum) disease, wherein inflammatory responses to bacterial biofilm along the gum line result in damage to the tissues and bones that surround and anchor teeth. There is now clear evidence that both of these diseases can be prevented or at least considerably reduced. Indeed, since the introduction of water fluoridation in the 1960s, there has been a substantial reduction in the prevalence of dental caries in Ireland. Despite this improvement, large numbers of people continue to suffer high levels of tooth decay. In addition to dental caries and periodontal disease, there are a number of other important oral conditions which impact on oral health and well-being including:


• Dental trauma (fracture of teeth due to injury) • Tooth wear (dental erosion, attrition and abrasion)

• Mouth ulcers • Cold sores • Tooth sensitivity • Halitosis (bad breath) Dental caries (tooth decay) is a major oral health problem in most industrialised countries, affecting 60–90% of schoolchildren and the vast majority of adults. The early manifestation of the caries process is a small patch of demineralised (softened) enamel at the tooth surface, often hidden from sight in the fissures (grooves) of teeth or in between the teeth. The destruction spreads into the softer, sensitive part of the tooth beneath the enamel (dentine). The weakened enamel then collapses to form a cavity and the tooth is progressively destroyed. Caries can also attack the roots of teeth should they become exposed by gum recession. This is more common in older adults. Periodontal Gum Disease Periodontal or gum disease is a pathological inflammatory condition of the gum and supporting tissues (periodontal tissues) surrounding the teeth. Most Irish adults suffer from some form of periodontal disease: based on the most recent national oral health survey, only 18% of 16–24 year olds, 8% of 35–44 year olds and 7% of older people aged 65 years and over have healthy gums. Gingivitis Most children have signs of some inflammation of the gingival tissue at the necks of the teeth; among adults, the initial stage of gum disease is prevalent. This condition is termed gingivitis and is characterised by redness of the gum margins, swelling and bleeding on brushing. Fluoride is a substance that naturally occurs in some water sources. It is derived from fluorine, the thirteenth most common element on earth, and is known to help prevent dental caries. Fluoride toothpastes are an important source of additional fluoride and should be used twice a day to help maintain a constant level of fluoride in the mouth. Daily fluoride mouth rinses are particularly useful for people who are prone to high levels of decay and also for people wearing orthodontic braces; fortnightly fluoride mouth rinse programmes

are used in a number of schools in non-fluoridated areas. It is advisable that fluoride mouth rinsing be carried out at a different time from fluoride tooth brushing to maximise the added benefits from these topical fluorides. Fluoride varnishes and gels are alternative forms of topical fluorides that require application by a dentist or dental hygienist. Despite the widespread availability of fluoride toothpastes, the most recent national oral health surveys show that only 58% of Irish children brush their teeth at least twice a day as recommended and that older people (aged 65+) in particular have poor oral hygiene habits. Only 52% of older people who have natural teeth (i.e., are not toothless) brush their teeth at least twice a day and 4.5% never brush. Reducing Sugar There is overwhelming evidence that frequent consumption of sugars is associated with caries. Dietary advice should be aimed at limiting the frequency of sugar intake. Studies have shown that sugar consumption remains a moderate risk factor for caries even when populations have adequate exposure to fluoride, and that exposure to fluoride coupled with a reduction of sugar intake has an additive effect on caries reduction. In a comparison of food habits in children and adolescents in 35 countries and regions covering Europe, Israel and North America, Ireland ranked as having the highest average weekly frequency of sweets consumption. Foods and drinks containing “free sugars” (i.e., sugars which have been added to food plus sugars naturally present in honey, fruit juices and syrup) should be recognised and the frequency of their intake – especially between meals – reduced. Tooth brushing The most important plaque control method is tooth brushing, which should be established as a daily routine from early childhood. Parents/carers should commence brushing their child’s teeth (without toothpaste until age 2 years) as soon as the first tooth appears in the mouth. From age 2 years, a pea-sized amount of toothpaste containing 1,000–1,500 ppm fluoride is recommended. Parents should continue to brush their child’s teeth until the child develops sufficient manual dexterity to effectively brush his/ her own teeth (approximately age 7 years). Parents should ensure that the first permanent molar teeth, which appear at the back of

the mouth at about this time, are included in the brushing routine as soon as they appear. Tooth brushing skills should be taught to people of all ages. The precise technique is less important than the result, which is that plaque is removed effectively every day without causing damage to the teeth or gums. Recommended Tooth brushing Technique A gentle scrub technique with very short horizontal movements to dislodge plaque at the gum margins is effective for most people and is easy to teach and readily accepted. Thus, careful use of a gentle scrub method using a toothbrush with densely packed, round-ended synthetic filaments of soft to medium texture should be encouraged for effective plaque removal. A toothbrush with a small brush head may also be recommended, as a small brush head enables better access to the back of the mouth and to tooth surfaces than a large brush head. While a variety of powered toothbrushes have become increasingly available, only powered toothbrushes with a rotation oscillation action (i.e., brush head moves in one direction and then the other) have been found to be better than manual toothbrushes at removing plaque and reducing gum inflammation, and are no more likely to cause injuries to gums. Faulty tooth brushing techniques involving excessive pressure may considerably increase gingival recession (i.e., the gum line recedes leading to exposure of the roots of the teeth), and loss of tooth substance by mechanical abrasion, and must therefore be corrected. Holding the toothbrush in a pen grip using just the thumb and forefinger, as opposed to resting the toothbrush in the palm of the hand and gripping with four fingers, results in less pressure being applied when tooth brushing and is recommended. Recommended Flossing Technique Starting with clean hands, break off about 45 cm (18 inches) of dental floss from its dispenser. Wind one end of the floss around a middle finger of one hand. Wrap the other end and most of the floss on the same finger of the other hand, leaving a small length (7 to 10 cm / 3 to 4 inches) stretching between the hands. With the floss held tightly between thumb and forefinger or using your interdental flosser, use a gentle sawing motion to guide the floss between adjacent teeth. Take care not to snap the floss against the gums when doing this to avoid injury.



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Imodium Instants 2 mg Orodispersible Tablets. Composition: Loperamide hydrochloride 2 mg per tablet. Pharmaceutiocal form: Orodispersible tablet. Indications: As an adjunct in the management of diarrhoea together with fluid and electrolyte replacement. Dosage: The orodispersible tablet should be placed on the tongue. The tablet will dissolve and is to be swallowed with saliva. No liquid intake is needed for the orodispersible tablet.Adults and children over 12 years only: The usual dose is 2 tablets initially, followed by 1 tablet after each further episode of diarrhoea up to a maximum of 5 in 24 hours. Elderly: No dose adjustment is required for the elderly.Renal impairment: No dose adjustment is required for patients with renal impairment. Hepatic impairment: Although no pharmacokinetic data are available in patients with hepatic impairment, Imodium Instants should be used with caution in such patients because of reduced first pass metabolism (see 4.4 Special warnings and precautions for use). Contraindications: In patients under 12 years of age. In patients with a known hypersensitivity to loperamide hydrochloride or to any of the excipients. Imodium should not be used as the primary therapy: - In patients with acute dysentery, which is characterised by blood in the stools and high fever, - In patients with acute ulcerative colitis, - In patients with bacterial enterocolitis caused by invasive organisms including Salmonella, Shigella, and Campylobacter, - In patients with pseudomembranous colitis associated with the use of broad spectrum antibiotics.Imodium should not be used when the inhibition of peristalsis is to be avoided due to the possible risk of significant sequelae including ileus, megacolon and toxic megacolon. Imodium must be discontinued promptly when constipation, abdominal distension or ileus develop. Special warnings and precautions for use: Treatment of diarrhoea with loperamide HCl is only symptomatic. Whenever an underlying etiology can be determined, specific treatment should be given when appropriate. Imodium is not a substitute for rehydration therapy. In addition to taking Imodium, the patient should be advised to drink plenty of fluids such as water, clear soup and squash. Patients should be advised to consult their doctor if diarrhoea persists for more than 24 hours. Loperamide should be used with caution when hepatic function, necessary for the drug’s metabolism, is defective as this may result in relative overdose leading to CNS toxicity. Patients with AIDS treated with Imodium Instants for diarrhoea should have therapy stopped at the earliest signs of abdominal distension. There have been isolated reports of toxic megacolon in AIDS patients with infectious colitis from both viral and bacterial pathogens treated with loperamide hydrochloride. Antimotility agents such as loperamide may precipitate ileus and toxic megacolon in patients with ulcerative colitis, and should be avoided in severe acute attacks. It may be used cautiously in mild or less severe attacks as an adjunct to other measures, but should be discontinued promptly should abdominal distension or other untoward symptoms occur. The stated dose should not be exceeded. Cardiac events including QT prolongation and torsades de pointes have been reported in association with overdose. Some cases had a fatal outcome. Patients should not exceed the recommended dose and/or the recommended duration of treatment. Undesirable effects: The frequency categories use the following convention: very common (≥1/10); common (≥1/100 to <1/10); uncommon (≥1/1,000 to <1/100); rare (≥1/10,000 to <1/1,000); and very rare (<1/10,000). Immune System Disorders: Rare - Hypersensitivity reaction, Anaphylactic reaction (including Anaphylactic shock), Anaphylactoid reaction. Nervous System Disorders: Common – Headache. Uncommon- Dizziness, Somnolence, Rare - Loss of consciousness, Stupor, Depressed level of consciousness, Hypertonia, Coordination abnormality. Eye Disorders: Rrare – Miosis. Gastrointestinal Disorders: Common – Constipation, Nausea, Flatulence. Uncommon - Abdominal pain, Abdominal discomfort, Dry mouth, Abdominal pain upper, Vomiting, Dyspepsia. Rare – Ileus (including paralytic ileus). Megacolon (including toxic megacolon). Abdominal distension, Glossodynia Skin and Subcutaneous Tissue Disorders: Uncommon – Rash. Rare - Bullous eruption (including Stevens Johnson syndrome, Toxic epidermal necrolysis and Erythema multiforme), Urticaria, Pruritus Angioedema. Renal and Urinary Disorders: Rare - Urinary retention. General Disorders and Administration Site Conditions: Rare - Fatigue. MA Holder: McNeil Healthcare (Ireland) Limited, Airton Road, Tallaght, Dublin 24 Ireland. MA Number: PA 823/56/2. Revision of text: May 2017. Legal Category: Not subject to medical prescription. Further information available upon request from Johnson & Johnson (Ireland) Ltd.

COLPERMIN® Gastro-Resistant Capsules. Composition: Each capsule contains 0.2ml (187mg) of Peppermint oil. Excipients: Each capsule contains 136mg Arachis oil, refined. Pharmaceutical Form: Gastro-resistant Capsules, hard. Size 1, enteric coated hard gelatin capsule coloured light blue/dark blue, with a blue band between cap and body, containing an oily mixture with an odour of peppermint. Indications: For the treatment of symptoms of discomfort and of abdominal colic and distension experienced by patients with irritable bowel syndrome. Dosage: One capsule three times a day, taken 30-60 minutes before food with a small quantity of water. The capsules should not be taken immediately after food. The dose may be increased to two capsules, three times a day when discomfort is more severe. Children under 15 years: There is no experience of COLPERMIN® Capsules in children under the age of 15 years. The capsules should be taken until symptoms resolve, usually within one or two weeks. At times when symptoms are more persistent, the capsules can be continued for longer periods of not longer than 2 to 3 months per course. Contraindications: This product should not be used in patients who are hypersensitive to any of its ingredients, including menthol and arachis oil (peanut oil). Special Warnings and Precautions for use: Patients who already suffer from heartburn, sometimes experience an exacerbation of these symptoms when taking the capsule. Treatment should be discontinued in these patients. The capsules should not be broken or chewed because this would release the peppermint oil prematurely, possible causing local irritation of the mouth and oesophagus. This product should not be taken by patients known to be allergic to peanut and / or soya. Interactions with other Medications and other forms of Interaction: Antacids should not be administered at the same time as COLPERMIN®. Undesirable Effects: Post marketing data: Adverse drug reactions (ADRs) identified during post-marketing experience with Peppermint Oil are included in the table below. The frequencies are provided according to the following convention: Very common ≥1/10 , Common ≥1/100 and <1/10 , Uncommon ≥1/1,000 and <1/100, Rare ≥1/10,000, and <1/1,000, Very rare <1/10,000, Not known (cannot be estimated from the available data) Adverse Drug Reactions Identified During Post-Marketing Experience with Peppermint Oil Frequency Category Estimated from adequately designed clinical trials or epidemiology studies: Immune System Disorders: Not known - Hypersensitivity** Nervous System Disorders: Not known - Burning sensation mucosal Gastrointestinal System Disorders: Not known - Anorectal discomfort, Dyspepsia Gastrooesophageal reflux, Nausea, Vomiting. (** Individual intolerance as well as allergic reactions may occur. These may include erythematous skin rash, headache, bradycardia, muscle tremor, ataxia, arthralgia and dry mouth. This may occur in conjunction with alcohol.) MAH: McNeil Healthcare (Ireland) Ltd. Airton Road Tallaght Dublin 24 Ireland. MA number: PA 823/45/1. Date of revision: June 2015. Product not subject to prescription. Full prescribing information available upon request from Johnson & Johnson (Ireland) Ltd. * This refers to OTC medicines


Imodium Plus 2mg/125mg Tablets. Composition: Each tablet contains loperamide hydrochloride 2 mg and simeticone equivalent to 125 mg dimeticone. Pharmaceutical Form: White, capsule-shaped tablets. Indications: Imodium Plus 2mg/125mg Tablets are indicated for the symptomatic treatment of acute diarrhoea in adults and adolescents over 12 years when acute diarrhoea is associated with gas-related abdominal discomfort including bloating, cramping or flatulence. Dosage: Adults over 18 years: Take two tablets initially, followed by one tablet after every loose stool. Not more than 4 tablets should be taken in a day, limited to no more than 2 days. Adolescents between 12 and 18 years: Take one tablet initially, followed by one tablet after every loose stool. Not more than 4 tablets should be taken in a day, limited to no more than 2 days. Paediatric population: Imodium Plus is contraindicated in children under 12 years. Use in the elderly: No dosage adjustments are required for the elderly. Use in renal impairment: No dosage adjustment is necessary in patients with renal impairment. Use in hepatic impairment: Although no pharmacokinetic data are available in patients with hepatic insufficiency, Imodium Plus should be used with caution in such patients because of reduced first pass metabolism. Contraindications: Children less than 12 years of age. Hypersensitivity to the active substances or to any of the excipients. Patients with acute dysentery, which is characterised by blood in stool and high fever. Patients with acute ulcerative colitis. Patients with pseudomembranous colitis associated with broad spectrum antibiotics. Patients with bacterial enterocolitis caused by invasive organisms including Salmonella, Shigella and Campylobacter. Imodium Plus must not be used when inhibition of peristalsis is to be avoided due to the possible risk of significant sequelae including ileus, megacolon and toxic megacolon. It must be discontinued promptly if constipation, ileus or abdominal distension develop. Special warnings and precautions for use: Treatment of diarrhoea with loperamide-simeticone is only symptomatic. Whenever an underlying etiology can be determined, specific treatment should be given when appropriate. In patients with (severe) diarrhoea, fluid and electrolyte depletion may occur. It is important that attention is paid to appropriate fluid and electrolyte replacement. If clinical improvement is not observed within 48 hours, the administration of Imodium Plus must be discontinued. Patients should be advised to consult their physician. Patients with AIDS treated with Imodium Plus for diarrhoea should have therapy stopped at the earliest signs of abdominal distension. There have been isolated reports of obstipation with an increased risk of toxic megacolon in AIDS patients with infectious colitis from both viral and bacterial pathogens treated with loperamide hydrochloride. Although no pharmacokinetic data are available in patients with hepatic impairment, Imodium Plus should be used with caution in such patients because of reduced first pass metabolism. This medicine must be used with caution in patients with hepatic impairment as it may result in a relative overdose leading to central nervous system (CNS) toxicity. Imodium Plus should be used under medical supervision in patients with severe hepatic dysfunction. Cardiac events including QT prolongation and torsades de pointes have been reported in association with overdose. Some cases had a fatal outcome Patients should not exceed the recommended dose and/or the recommended duration of treatment.. Interaction with other medicinal products and other forms of interaction. Non-clinical data have shown that loperamide is a P-glycoprotein substrate. Concomitant administration of loperamide (16 mg single dose) with quinidine, or ritonavir, which are both P-glycoprotein inhibitors, resulted in a 2 to 3-fold increase in loperamide plasma concentrations. The clinical relevance of this pharmacokinetic interaction with P-glycoprotein inhibitors, when loperamide is given at recommended dosages is unknown.The concomitant administration of loperamide (4 mg single dose) and itraconazole, an inhibitor of CYP3A4 and P-glycoprotein, resulted in a 3 to 4-fold increase in loperamide plasma levels. In the same study a CYP2C8 inhibitor, gemfibrozil, increased loperamide by approximately 2-fold. The combination of itraconazole and gemfibrozil resulted in a 4-fold increase in peak plasma levels of loperamide and a 13-fold increase in total plasma exposure. As these increases were not associated with measured central nervous system central nervous system(CNS) effects, as measured by psychomotor tests (ie.subjective drowsiness and the Digit Symbol Substitutions Test). The concomitant administration of loperamide (16 mg single dose) and ketoconazole, an inhibitor of CYP3A4 and P-glycoprotein, resulted in a 5 fold increase in loperamide plasma concentrations. This increase was not associated with increased pharmacodynamic effects as measured by pupillometry. Concomitant treatment with oral desmopressin resulted in a 3 fold increase of desmopressin plasma concentrations, presumably due to slower gastrointestinal motility. It is expected that drugs with similar pharmacological properties may potentiate loperamide’s effect and that drugs that accelerate gastrointestinal transit may decrease its effect. Since simeticone is not absorbed from the gastrointestinal tract, no relevant interactions between simeticone and other drugs are expected. Paediatric population: Interaction studies have only been performed in adults. Undesirable effects: Immune system disorders Rare Hypersensitivity reaction, Anaphylactic reaction (including Anaphylactic shock), Anaphylactoid reaction Nervous system disorders Common Headache, Dysgeusia Somnolence, Dizziness Rare Loss of consciousness, Depressed level of consciousness, Stupor, Hypertonia, Coordination abnormality Eye disorders Rare Miosis Gastrointestinal disorders Uncommon Abdominal pain, Abdominal discomfort, Abdominal pain upper, Vomiting, Constipation, Abdominal distension, Dyspepsia, Flatulence, Dry mouth Rare Ileus (including paralytic ileus), Megacolon (including toxic megacolon) Common Nausea Skin and subcutaneous tissue disorders Uncommon Rash Rare Bullous eruption (including Stevens Johnson syndrome, Toxic epidermal necrolysis and Erythema multiforme), Angioedema, Urticaria, Pruritus Renal and urinary disorders Rare Urinary retention General disorders and administration site conditions Uncommon Asthenia Rare Fatigue. MAH: McNeil Healthcare (Ireland) Limited, Airton Road, Tallaght, Dublin 24, Ireland. MA Number: PA 823/60/2 Date of revision of text: June 2017. Product not subject to medical prescription. Full prescribing information available upon request


Treating Irritable Bowel Syndrome Irritable bowel syndrome (IBS) is an extremely common gastrointestinal disorder, effecting as many as 20 per cent of the population, according to IBS Ireland. Though there is no single cause, it usually occurs when the contractions of a person's large intestine muscles deviate, and the bowel becomes increasingly sensitive to the presence of gas and other movements. It ordinarily first manifests in people between the ages of 20 and 30, and has more than double the prevalence among women than men. There is no cure for IBS, the sufferer can usually manage their symptoms, which vary from person to person tend to include abdominal pain and discomfort, bloating, wind and flatulence, distension, diarrhoea and constipation. Known triggers include certain foods, lack of exercise and stress. Only about a quarter of IBS sufferers seek medical attention for their condition. “Due to the sensitive nature of the symptoms of IBS,” as Phil Winston of Meagher's Pharmacy notes, “many people with the condition may feel embarrassed and don’t seek advice”.

• Are they passing faeces less often than before? Less than three times daily?

A pharmacy could encourage more people to come forward through the distribution of literature and the conduction of awareness campaigns emphasising the manageability of the condition, and through reassuring potential customers that their symptoms are not associated with more serious medical conditions like cancer.

“Reducing your stress levels,” Ultan Molloy of HealthWest Community Pharmacy notes, “exercising regularly, maintaining a good work-life balance, and psychological strategies such as cognitive behavioural therapy have all been shown to be beneficial.” If lifestyle alterations are less than effective, there are medications that could be recommended.

Diagnosis Correctly identifying a customer's condition as IBS is crucial, and there are several questions a pharmacist can ask to help make their determination: • Do they suffer from abdominal pain or discomfort for three days or more per month? • Have they been experiencing this pain or discomfort for three months or more? • Are they experiencing bloating? • Is the problem worse in the morning than at night? • Is there an increase in urgency? Do they have to rush to the toilet? • Are they passing faeces more often than before? More than three times daily?

• Do they experience less discomfort after they have passed faeces? • Have their stool changed in appearance? Is it watery or lumpy? A plan should be put in place to help sufferers treat their symptoms which can include identifying and excluding foods from their diet, as well as increasing exercise and taking steps to better manage their stress levels.

Low FODMAP Diet Derived as an acronym for 'Fermentable, Oligo-, Di-, Mono-saccharides And Polyols', FODMAPs are carbohydrates containing fermentable sugars (convertible to gas and acids) that the small bowel is ineffective at absorbing. These are foods that feed bad bacteria to the intestine, causing stomach pain, bloating and diarrhoea through the release of gas. Developed within the last decade in Melbourne's Monash University, the Low FODMAP Diet has proven beneficial to people with IBS, by helping them avoid those foods, including garlic, onions, cauliflower, apples and cabbage. There are many websites devoted to the Low FODMAP Diet, and literature could be easily composed to help the customer commence and

maintain it. There are also a variety of Low FODMAP smartphone applications, that provide accurate real-time information about foods that trigger IBS reactions, available for download including one developed by Monash University itself. The customer should be encouraged to keep a food diary and to consider gradually reintroducing some of the foods they have excluded from their diet individually, so as to confirm or eliminate certain foods as suspects for their IBS. This will in time allow them to have a more manageable and less restrictive diet. Changes in how they eat may also help relieve symptoms. For instance, if a person was to chew their food more, that the gut would processes their food faster, reducing the chances that the food will ferment. Exercise Promotion Exercise is not just beneficial for IBS sufferers, but for virtually

all people. For adults, WHO recommends a minimum of 150 minutes of moderate physical activity per week (for children it is 60 minutes a day – a target 4/5 of children in Ireland do not meet). Pharmacists should stress this recommendation and promote increased exercise generally. The important role exercise plays in preventing and tackling IBS, however, should be especially emphasised, as it has been shown to relieve the symptoms of most people who suffer from the condition. If the customer is suitable for physical exertion, their aim should be to practice exercise robustly for at least half an hour a day, five times a week. The workout should require enough effort so as to increase both breathing and heart rate. Examples include hillwalking and brisk walking in general. Stress Reduction/Cognitive Behaviour Therapy Practices that may be recommended to reduce stress include physical activities


Feature these medications encourage your bowels to push the stools out, by working to increase the bulk of your stool by helping them retain fluid. The customer should start on a low dose and, only if necessary, increase their dose every few days until one or two soft stools are produced. They should also drink plenty of fluids during treatment. Diarrhoea

such as yoga and Tai Chi, and relaxation techniques including meditation and breathing exercises. If these prove ineffectual in the case of chronic stress, however, counselling and Cognitive Behaviour Therapy (CBT) could be routes that may contemplate. The focus of CBT is on developing individualised coping strategies, which help people regulate their emotions, and aid in altering unhelpful and destructive behaviours patterns. CBT has many advantages over other kinds of talk therapies, as it can be completed in a comparatively short period of time and, thanks to its highly structured nature, it can be provided in different formats including groups therapy, computer programmes and selfhelp books. Medication Antispasmodic medications are the most commonly recommended treatments for IBS symptoms such as bloating, spasm or colic, and abdominal pain, and by reducing the motility of the intestines. They work by relaxing the muscles in the digestive system. Examples of antispasmodic medicines include hyoscine butylbromide, theraputic perppermint oil and mebeverine. These medications are not recommanded for women who are pregnant.


If antispasmodic medications prove inefficacious, the customer may consider speaking to their GP about tricyclic antidepressants (TCAs), as they are known to have anti-pain and gut-slowing qualities. TCAs have been shown to have positive effects on the digestive system, which simultaneously causing a reduction in anxiety and pain sensations. There is no evidence, meanwhile, that complimentary treatments such as aloe vera, acupuncture or reflexology have any effect in treating IBS. Be careful when using medication for other conditions also. Painkillers containing codeine, for instance, are cause constipation in people with IBS, while Ibuprofen is a known stomach irritant. When treating pain, paracetamol should be recommended over other painkillers as it has no negative effect in the gut. Blood pressure tablets and iron supplements can trigger symptoms, and antibiotics can have adverse effects on gut bacteria. Constipation For people experiencing IBS-related constipation, it is recommeded that they take a bulk-forming laxative such as isaghula husk or methylcellulose. In the same way as dietary fibre,

IBS-related diarrhoea is usually treated with antimotility medications, with loperamide the most frequently recommended. It works by decelerating the passage of food through the digestive system by slowing the contractions in the intestine muscles, allowing more time for stools to solidify. It is not advisable for pregnant women to take loperamide, and it has been known to have side effects such as skin rashes, drowsiness, abdominal cramps and bloating. Bile acid binders, including Prevalite, Colestid and Welchol, are medications that disrupt the circulation of bile acids and prevent their reabsorption from the gut, and are known to benefit some people with IBS-related diarrhoea. Their most common side effect is bloating. Indigestion Nearly three quarters of people who suffer from IBS also experience indigestion, and it has been suggested that the two conditions represent the same disease entity. There are several behavioural tips a pharmacist should give to a person with indigestion. You should suggest that they chew slowly with their mouth closed, which will help them not to swallow too much air, which can be an aggravation. They should avoid late night meals, cigarettes and alcohol, and should drink fluids after rather than during meals. Nitrates, medications that widen blood vessels, are normally recommended as a treatment for indigestion. They relax the ring of muscle between the gut and the oesophagus and stomach. This, allowing acid to leak back up. People with indigestion should avoid non-steroidal anti-inflammatory drugs (NSAIDs).

Participants sought for Irritable Bowel Syndrome Study Researchers at the School of Psychology at NUI Galway are seeking 1,000 female participants who suffer from the symptoms of irritable bowel syndrome and other inflammatory bowel conditions to take part in an online study. Dr Jonathan Egan, Deputy Director of the Doctorate in Clinical Psychology at NUI Galway and board member of the MSc in Health Psychology, and a Chartered Health and Clinical Psychologist of the Psychological Society of Ireland is leading the study with Isha Doyle, a student in the MSc in Health Psychology at the University. Dr Egan said, “Stress is known to affect the severity and possibly the direction of these diseases and things related to stress are an important focus of research attempting to improve future treatments for these conditions. We are only starting to understand how the brain-gut axis operates, and it seems that it is important for people to ‘connect with their gut reaction’ in order to be able to understand their emotions. Our research will ask people who are experiencing these symptoms or those who have Crohn’s disease or Colitis to see what psychological factors improve or worsen their experience of these conditions. “Already an initial analysis of the first hundred or so participants has indicated a high level of people feeling misunderstood by others. The symptoms can also affect a person’s sexual expression. Many have ongoing worry about planning their day so that they can access adequate toilet facilities. High levels of fatigue, poor ability to concentrate as well as high levels of stress, anxiety and mood being affected appear to be common.” To participate in the study, visit: https://www. IBSandIBDnuigalwaystudy.

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On going TV advertising Point of Sale material Extensive training resources Informative website Name of product: Nexium Control 20 mg gastroresistant tablets. Active ingredient: Esomeprazole. Product licence numbers: EU/1/13/860/001 and EU/1/13/860/002. Name and address of the company responsible for placing on the market and where additional information available: Pfizer Healthcare Ireland, Citywest, Dublin 24. Supply classification: Pharmacy Only. Indications: The short-term treatment of reflux symptoms (e.g. heartburn and acid regurgitation) in adults. Side Effects: Common: headache, abdominal pain, constipation, diarrhoea, flatulence, nausea/ vomiting. Uncommon: peripheral oedema, insomnia, dizziness, paraesthesia, somnolence, vertigo, dry mouth, increased liver enzymes, dermatitis, pruritus, rash urticaria. Rare: leukopenia, thrombocytopenia, hypersensitivity reactions e.g. fever, angioedema and anaphylactic reaction/shock, hyponatraemia, agitation, confusion, depression, taste disturbance, blurred vision, bronchospasm, stomatitis, gastrointestinal candidiasis, hepatitis with or without jaundice, alopecia, photosensitivity, arthralgia, myalgia, malaise, increased sweating. Very rare: agranulocytosis, pancytopenia, aggression, hallucinations, hepatic failure, hepatic encephalopathy in patients with pre-existing liver disease, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis (TEN), muscular weakness, interstitial nephritis, gynaecomastia. Not known: hypomagnesaemia; severe hypomagnesaemia can correlate with hypocalcaemia; hypomagnesaemia may also result in hypokalaemia, microscopic colitis, subacute cutaneous lupus erythematosus (SCLE). Precautions: Patients should be instructed to consult a doctor if: They have significant unintentional weight loss, recurrent vomiting, dysphagia, haematemesis or melaena and when gastric ulcer is suspected or present, malignancy should be excluded as treatment with esomeprazole may alleviate symptoms and delay diagnosis. They have had previous gastric ulcer or gastrointestinal surgery. They have been on continuous symptomatic treatment of indigestion or heartburn for 4 or more weeks. They have jaundice or severe liver disease. They are aged over 55 years with new or recently changed symptoms. Patients with long-term recurrent symptoms of indigestion or heartburn should see their doctor at regular intervals. Especially, patients over 55 years taking any non-prescription indigestion or heartburn remedy on a daily basis should inform their pharmacist or doctor. Patients should not take Nexium Control as a long term preventive medicinal product. Treatment with proton pump inhibitors (PPIs) may lead to a slightly increased risk of gastrointestinal infections such as Salmonella and Campylobacter and in hospitalised patients, also possibly Clostridium difficile. Patients should consult their doctor before taking this medicinal product if they are due to have an endoscopy or urea breath test. Co-administration of esomeprazole with atazanavir is not recommended (see section 4.5). If the combination of atazanavir with a PPI is judged unavoidable, close clinical monitoring is recommended in combination with an increase in the dose of atazanavir to 400 mg with 100 mg of ritonavir. Esomeprazole 20 mg should not be exceeded. Esomeprazole is a CYP2C19 inhibitor. When starting or ending treatment with esomeprazole, the potential for interactions with medicinal products metabolised through CYP2C19 should be considered. An interaction is observed between clopidogrel and esomeprazole. The clinical relevance of this interaction is uncertain. The use of esomeprazole with clopidogrel should be discouraged. Patients should not take another PPI or H2 antagonist concomitantly.This medicinal product contains sugar spheres (sucrose). Patients with rare hereditary problems of fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency should not take this medicine. Increased Chromogranin A (CgA) level may interfere with investigations for neuroendocrine tumours. To avoid this interference, Nexium Control treatment should be stopped for at least 5 days before CgA measurements. If CgA and gastrin levels have not returned to reference range after initial measurement, measurements should be repeated 14 days after cessation of PPI treatment. Proton pump inhibitors are associated with very infrequent cases of SCLE. If lesions occur, especially in sun-exposed areas of the skin, and if accompanied by arthralgia, the patient should seek medical help promptly and the health care professional should consider stopping Nexium Control. SCLE after previous treatment with a proton pump inhibitor may increase the risk of SCLE with other proton pump inhibitors. Contra-indications: Hypersensitivity to esomeprazole, substituted benzimidazoles or to any of the excipients. Esomeprazole must not be used concomitantly with nelfinavir. Dosage and Method of use: The recommended dose is 20 mg esomeprazole (one tablet) per day. It might be necessary to take the tablets for 2-3 consecutive days to achieve improvement of symptoms. The duration of treatment is up to 2 weeks. Once complete relief of symptoms has occurred, treatment should be discontinued. If no symptom relief is obtained within 2 weeks of continuous treatment, the patient should be instructed to consult a doctor. Dose adjustment is not required in patients with impaired renal function. Due to limited experience in patients with severe renal insufficiency, such patients should be treated with caution. Dose adjustment is not required in patients with mild to moderate liver impairment. However, patients with severe liver impairment should be advised by a doctor before taking Nexium Control. Dose adjustment is not required in elderly patients. There is no relevant use of NEXIUM Control in the paediatric population below 18 years of age in the indication: “short-term treatment of reflux symptoms (e.g., heartburn and acid regurgitation)”. The tablets should be swallowed whole with half a glass of water. The tablets must not be chewed or crushed. Alternatively, the tablet can be dispersed in half a glass of non-carbonated water. No other liquids should be used as the enteric coating may be dissolved. The water should be stirred until the tablet disintegrates. The liquid with the pellets should be drunk immediately or within 30 minutes. The glass should be rinsed with half a glass of water and the water drunk. The pellets should not be chewed or crushed. Date: October 2016. For full product information please refer to 1. IMS Date May 2017

Pfizer Consumer Healthcare, Citywest, Dublin 24. PP-NEX-IRL-0049. July 2017

News More effective treatment for cystic news brief fibrosis patients on its way LOCAL ‘RESEARCH CHAMPIONS’ RECOGNISED John Halligan T.D., Minister of State for Training, Skills, Innovation, Research and Development with Julie Sinnamon, CEO of Enterprise Ireland has presented two outstanding achievement awards to NUI Galway for reaching the pinnacle of European research. The ‘Ireland’s Champions of EU Research’ event took place in the Royal Hospital Kilmainham in Dublin recently. In the category ‘Recognising the career development of our next generation researchers’, NUI Galway’s Dr Conor O’ Byrne, received an award for his leadership of the project *PATHSENSE (Understanding and Exploiting Mechanisms of Sensory Perception in Bacteria). This ¤3.4 million project will recruit 13 PhD fellows in a collaboration involving eight universities and four companies, located in seven different countries around Europe. The overall goal of the project is to identify vulnerabilities in pathogenic bacteria that can be targeted with next generation antimicrobial treatments. In the category ‘Collaborative Research’, Dr Michael Madden at NUI Galway, received an award for his leadership of the *ROCSAFE project, a ¤4.7 million 13 partner project with Irish partners Reamda Limited, Scorpion Networks Ltd, UCC, Department of Defence and the Health Service Executive. The overall goal of ROCSAFE is to fundamentally change how CBRNe events are assessed, in order to ensure the safety of crime scene investigators by reducing the need for them to enter high-risk scenes. For this, ROCSAFE will make use of costeffective remotely-controlled robotic air and ground vehicles. Sixteen individuals received Horizon 2020 achievement awards for their projects which exhibited outstanding leadership in their respective programme areas, ten of whom were from higher education institutes. The aim of the event is to recognise the immense contribution of the award winners and all project leaders from Ireland in the ¤75 billion Horizon 2020 EU Framework Programme for research and innovation.


We are a step closer to a better treatment for patients with cystic fibrosis. New research presented today at the International Pharmaceutical Federation’s Pharmaceutical Sciences World Congress describes how scientists have developed a formulation that increases the delivery of a novel “antivirulence” agent to the lungs. About 80% of cystic fibrosis patients suffer from chronic lung infections caused by Pseudomonas aeruginosa. Persistent lung infections such as pneumonia and bronchitis are central in the development of chronic lung disease in these patients and significantly increase morbidity. P. aeruginosa infection is associated with rapid decline in lung function and increased mortality. This is commonly treated with antibiotics such as tobramycin, with variable success rates. P. aeruginosa usually grows in biofilms, where the cells stick together in a self-produced matrix that makes them resistant to antibiotics. An international consortium of scientists has been working on a new type of compound called quorum sensing inhibitors (QSIs), which can interrupt communication pathways between bacterial cells, resulting in reduced virulence and decreased tolerance to antibiotics.

“We are now at a stage where we have a handful of promising candidate compounds in this class, from which we could identify a lead compound. But, in the interest of efficiency, we have simultaneously been working on how the eventual lead compound could best be delivered locally to the lung. One of the problems is that our prototype QSI compound was poorly soluble in water, yet we wanted to be able to deliver it to the lungs in a solution in combination with tobramycin,” says Dr Tomás Sou, a researcher at the Department of Pharmacy, Uppsala University, Sweden. The research presented today shows that using certain solubilising excipients allows the production of a multidrug formulation that can deliver the desired amount of the QSI and tobramycin to the lungs of rats with P. aeruginosa infection. This formulation was effective in sensitising the bacteria to the antibiotic and showed a

reduction in colony forming units of the bacteria when these two compounds were administered together. “More than 70,000 people suffer from cystic fibrosis worldwide. This research could ultimately improve the quality of life for these patients and, potentially, others,” Dr Sou says. “P. aeruginosa infections are also a concern in hospitals, particularly for patients who have been in hospital for more than a week. These infections can be life-threatening. Our work could eventually also have relevance for these people.” The consortium, SENBIOTAR, has brought together experts in different fields of science from Sweden, the UK, Canada and Denmark. “It is through this multidisciplinary team effort that we have been able to make such good progress within a short timeframe in this field,” Dr Sou says.

Dispensing Zantac Syrup The Pharmaceutical Society of Ireland (PSI) is reminding all pharmacists to be extra vigilant in paediatric dispensing of Zantac Syrup 75mg/5ml. In particular, pharmacists are reminded of the risk of giving over-doses of Zantac Syrup 75mg/5ml to young babies suffering from reflux. Pharmacists are urged to review a previously published learning that followed an inquiry concerning the dispensing of Zantac Syrup 75mg/5ml to an infant, and take all precautions necessary to ensure a similar incident does not happen in their Pharmacy. In addition, there are risk reduction tips to help pharmacists review and improve their own practice. The pharmacist has a legal responsibility to review each

prescription prior to dispensing and supply of the medicine to ensure that the medicine is safe and appropriate for the patient. Ranitidine is often prescribed for infants ‘off label’ and therefore the relevant dosing information may not appear in the product’s Package Leaflet or Summary of Product Characteristics (SmPC). Therefore the dose should be checked using a reliable resource, for example, the BNF for Children. The infant’s weight will be needed

New distribution for Ocean Healthcare Ocean Healthcare has been appointed distributor of the Colief Range in Ireland. Colief Infant Drops for colic is the no 1 lactase enzyme supported by clinical trials and has been on the market for 15 years. The range also includes Colief Baby Scalp Oil, Colief Vitamin D Drops, Colief Mum to Be Moisturising Cream and NEW Colief Breathe Easy Patch which is a soothing solution for easy breathing. For more information contact your Ocean Healthcare Representative or call Ocean Healthcare on 01 2968080.

to calculate the dose. In the absence of this information, a reliable average weight for age table (for example as given in the BNF for Children) can be used to calculate the dose. However, it is important to either see the infant or check with the parent or carer to ensure the value chosen is a good approximate. The infant’s actual weight should be obtained as soon as possible and the dose re-calculated to ensure it is appropriate.


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*Removes more plaque than a regular toothpaste after a professional clean and twice daily brushing. Reference: 1. Data on file, GSK, RH02434, January 2015. Trade marks are owned by or licensed to the GSK group of companies. CHGBI/CHCSYL/0134/16

News LloydsPharmacy discuss success with Quinton As we continue Cellnutrition’s first birthday celebrations, next in our series of real stories from real pharmacies is Grainne from Lloyds Blanchardstown – one of the top performing stores for Cellnutrition Quinton products. Talking about why they decided to stock the products, we hear the who, why and how about the mineral revolution from LloydsPharmacy. Grainne is the Manager of LloydsPharmacy in Blanchardstown and has been working for Lloyds for 15 years. They have a strong team that work extremely well together to bring the best products to the Irish market. The customers of LloydsPharmacy trust and believe in Grainne and her team and the products that they recommend. They pride themselves on the excellent advice, service and product range they offer.

What benefits have they noticed? We have a particular lady who has been plagued with joint pain for many years. Since she started taking Quinton Hypertonic, she has had no pain in her joints, which is a remarkable effect. Why do you think Lloyds have been so successful selling Quinton?

They decided to stock Cellnutrition products after Sarah Ashe, buyer for OTC in Lloyds had a meeting with the founder John Kelleher. Grainne and her team really got behind Quinton after an extremely informative training session on the product where it was explained in detail. With the belief that natural is nicer, they feel it is different from the other products they stock and everyone should be using it! Read on to find out more about the successes Lloyds have had with Cellnutrition Quinton.

I believe we have been successful in selling Cellnutrition Quinton because we believe in the product so much ourselves. This gives us the ability to make informed recommendations to customers because we know, on a personal level, that it works. We also attribute the success of the product to our customers. They often describe how they initially bought it for themselves, have seen such amazing results and just HAVE to recommend to their friends and family who then come in to try it for themselves.

What results have your customers experienced since using Quinton?

How important is the supplement market to Lloyds and its customers?

The results experienced by our customers range from a reduction in aches and pains, improved sleeping patterns and appetite changes to regulating weight. They have also noticed how effective it is at enhancing other non-mineral-based supplements they are taking.

The supplement market is very important to us and our customers. Our customers’ habits and lifestyles are changing toward a want for much more natural remedies and we pride ourselves on providing them with a product that gives them just that and genuinely works.

Sarah Ashe, Buyer, LloydsPharmacy What is your favourite element with regards to selling Quinton?

plenty of energy and lost weight using Hypertonic after four months taking one ampoule a day."

Our favourite element of Quinton, plain and simple, is that it works. We have huge belief in the product and have seen how it has impacted so many of our customers lives for the better. The fact that everyone can take Quinton is also a huge plus.

"I have reduced my paracetamol intake on Hypertonic and feel great. I don't feel like I need my paracetamol anymore."

Grainne was excited to share some amazing stories from some her customers with us too: "Best thing I've ever taken. I have

"I've had problems with my knee. I couldn't get up and down. I started on one Hypertonic a day and haven't looked back." "I'm a nurse and I use the Isotonic. I will be recommending it to all of my nursing colleagues."

Cellnutrition partner with Irish health and fitness blogger Galway-based mineral supplement specialists, Cellnutrition, has partnered with leading health and fitness blogger, Maeve Madden in their quest to rid the world of mineral depletion. Cellnutrition CEO, Nicola Abbott said about the partnership, “We are delighted to have partnered with Maeve Madden and to have her as a Brand Ambassador for our Quinton product.” Quinton is a 100% natural mineral supplement containing 78 minerals and trace elements and comes in two main forms, Hypertonic and Isotonic. Quinton Hypertonic begins your day with a boost. Designed for days when an extra spurt of energy is needed, our


natural Hypertonic formula is perfect for fortifying and energising your cells. Quinton Isotonic gently replenishes the minerals and trace elements missing from your system. Perfect for winding down at the end of the day, it aids a good night’s sleep. Quinton is the world’s only 100% natural and bioavailable nutritional supplement to nourish your cells with 78 minerals and trace elements in the precise proportions they require to be strong and healthy.

Maeve Madden is a Fitness/ Commercial Model, Actress, Lifestyle Blogger, Personal Trainer and former professional dancer, born and raised in Ireland. From a young age Maeve always had a passion for fitness, health and beauty. Maeve’s drive to share her secrets for becoming the best version of you has earned her a loyal social media following of over 115,000. With her honest lifestyle struggles especially with bloating, Maeve is very well respected in the

fitness, lifestyle & beauty sector. Ms Abbott continued, “This is a very natural fit for us as Maeve has been a great advocate of our products in the past and continues to use them after seeing the many benefits they offer. We take an alternative approach when it comes to selecting our brand ambassadors as we want them to love the product just as much as we do and have the same values.”

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CPD 81: CROHN’S DISEASE Biography - Eamonn Brady MPSI is the owner of Whelehans Pharmacy in Mullingar. He graduated from the Robert Gordon University in Aberdeen in 2000 with a First Class Honours MPharm degree in pharmacy. He worked for Boots in the UK before moving back to Ireland in 2002. He bought Whelehans Pharmacy in Mullingar in 2005. He undertakes clinical training for nurses and other healthcare professional in the midlands and undertakes talks on health and pharmacy related subjects. Contact Eamonn at 04493 34591 if you wish him to undertake training or a health talk.

1. REFLECT - Before reading this module, consider the following: Will this clinical area be relevant to my practice. 2. IDENTIFY - If the answer is no, I may still be interested in the area but the article may not contribute towards my continuing professional development (CPD). If the answer is yes, I should identify any knowledge gaps in the clinical area. 3. PLAN - If I have identified a knowledge gap

- will this article satisfy those needs - or will more reading be required? 4. EVALUATE - Did this article meet my learning needs - and how has my practise changed as a result? Have I identified further learning needs?

• an unknown trigger or perhaps set of triggers that may include viruses, other bacteria, diet, stress, or other environmental factors.

Crohn’s is a chronic condition with many experiencing it as an ongoing and life-long condition often with periods of remission as well as relapses or flare-ups. There is currently no cure for Crohn’s but medication and sometimes surgery can give long periods of relief.

CAUSES The exact cause is not known but researchers and experts think Crohn’s is caused by a combination of factors, including: • Genetic factors • an abnormal reaction of the digestive system to bacteria in the intestine

60 Second Summary Crohn’s disease is one of the two main forms of inflammatory bowel disease (IBD). The second main form of inflammatory bowel disease is ulcerative colitis. Crohn’s disease causes inflammation of the digestive system. Crohn’s is a chronic condition. Many experience it as an ongoing and life-long condition often with periods of remission with relapses or flare-ups. The most common symptoms during a flare ups are; Abdominal pain and diarrhoea; Tiredness and fatigue; Feeling generally unwell. Anti-inflammatory drugs used for Crohn’s include: • Aminosalicylates such as mesalazine and sulphasalazine.

DIFFERENCE BETWEEN ULCERATIVE COLITIS AND CROHN’S DISEASE Ulcerative colitis only affects the inner lining of the colon, also known as the large intestine. In Crohn's disease, inflammation can appear anywhere in the digestive tract, from the mouth to the anus. Crohn’s generally affects all the layers of the bowel walls, not just the inner lining so tends to have more serious symptoms.

Disclaimer: All material published in CPD and the Pharmacy is copyright and no part of this can be used within any other publication without the permission of the publishers and author.

5. WHAT NEXT - At this time you may like to record your learning for future use or assessment. Follow the 4 previous steps, log and record your findings.

Crohn’s Disease Crohn’s disease is one of the two main forms of inflammatory bowel disease (IBD). The second main form of inflammatory bowel disease is ulcerative colitis. Crohn’s disease causes inflammation of the digestive system. Inflammation is the body’s reaction to injury or irritation, and can cause redness, swelling and pain. In the case of Crohn’s, while it is due to an immune response, it does not appear to be an autoimmune disease meaning that it is not caused by the immune system being triggered by the body itself. Crohn’s disease got its name from an American doctor Burrill Crohn who first reported cases in 1932 in Mount Sinai hospital in New York.

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• Corticosteroids such as prednisolone, hydrocortisone and budesonide. • Immuno-suppressants such as azathioprine, methotrexate and tacrolimus • Biological or ‘anti-TNF’ drugs such Symptomatic drugs used include:

HOW DOES CROHN’S DISEASE AFFECT THE INTESTINAL TRACT? Any part of the intestinal tract can be affected in Crohn’s disease. The most common area is the last part of the small intestine (terminal ileum) and the first part of the large intestine (colon), near the appendix. For some only the colon is affected, in a pattern like ulcerative colitis. In others, multiple parts of the

• Anti-diarrhoeal such as loperamide and cholestyramine • Bulking agents such as ispaghula husk. • Painkillers such as paracetamol and aspirin. Advances such as the development of biological drugs have produced better results meaning less surgery. There are changes in the way surgery for Crohn’s is now managed.


intestinal tract are affected. Rarely, the mouth, throat, oesophagus or stomach may be affected. A patch of inflammation may be as small as a few centimetres or extend most of distance along the intestinal tract. As well as affecting the lining of the bowel, Crohn’s may also go deeper into the bowel wall. In some cases, the inflammation in the intestinal tract triggers inflammation outside the intestine leading to other inflammatory complaints affecting the joints, eye, skin and endocrine system to name the most common. SYMPTOMS Crohn’s disease is a very individual condition ranging from very few symptoms to others with frequent flare-ups or constant disease. The part of the intestinal tract most affected with Crohn’s influences the symptoms. In general, the most common symptoms during a flare-up are: • Abdominal pain and diarrhoea. Sometimes mucus, pus or blood is mixed with the diarrhoea. • Tiredness and fatigue. This can be due to the illness itself, from the weight loss associated with flare-ups or surgery, anaemia from blood loss or simply due to a lack of sleep due to pain, diarrhoea and other symptoms which inevitably affect sleep. • Feeling generally unwell. Some people may have a raised temperature and feel feverish. • Mouth ulcers • Loss of appetite and weight loss. • Anaemia (a reduced level of red blood cells). Crohn’s makes anaemia more likely due to blood loss, not eating enough because of symptoms like pain and diarrhoea and because the body is not fully absorbing the nutrients from the food. Anaemia is a major factor in tiredness. PREVALENCE It’s estimated that Crohn’s disease affects one in every 650 people in the UK. The figures in Ireland are not thought to be significantly different. Crohn’s appears to be slightly more common in women than in men. The Irish Society for Colitis and Crohn’s disease indicated there were 5.9 new cases of Crohn’s disease in Ireland per 100,000 population in 2011 and compared to 14.9 new cases of ulcerative colitis per 100,000 the same year. The incidence of Crohn's disease is higher than ulcerative colitis in children. The peak age of incidence of Crohn’s is between the ages of 15 and 35, with a second (smaller) peak from the 50s to 70s. IBD diagnosed in children can behave differently and can be treated differently to that diagnosed in adults It’s more common in urban rather than rural

areas and in northern developed countries, although the numbers are beginning to increase in developing nations. It is also more common in smokers. MAIN TYPES OF CROHN’S DISEASE Crohn’s is often categorised to which part or parts of the intestinal tract are most affected. The main types are: TERMINAL ILEAL AND ILEOCAECAL Crohn’s in the ileum (the last part of the small intestine) is known as ileal or sometimes ‘terminal ileal’ Crohn’s because it affects the terminus or end of the ileum. If it affects the beginning of the large bowel it is known as ileocaecal Crohn’s. In this type of Crohn’s, pain is often experienced in the lower right side of the abdomen, especially after eating. There is often weight loss, and diarrhoea may occur. Because Crohn’s in the ileum can make it difficult for the body to absorb bile salts, bile salts can build up leading to irritation the bowel lining; Diarrhoea often occurs and is most likely to be watery. The diarrhoea is unlikely to be bloody, as any blood lost will be digested by the time it reaches the rectum. About four in 10 people with Crohn’s have ileal or ileocaecal disease. SMALL BOWEL Abdominal pain and diarrhoea are also common symptoms if Crohn’s occurs further up the small bowel. Again, the diarrhoea is unlikely to be blood stained, but weight loss and anaemia may be experienced. Nearly a third of people with Crohn’s have it in the small bowel. COLONIC Crohn’s disease in the colon (large intestine or large bowel) is known as ‘Crohn’s colitis’. This is a common form of Crohn’s disease. The main symptom tends to be blood stained diarrhoea. Because of the inflammation, the colon cannot hold as much waste as normal so very frequent bowel movements occur (six or more a day), especially if the rectum is inflamed. GASTRODUODENAL Crohn’s in the upper intestinal tract (the oesophagus, stomach or duodenum) is much less common. Symptoms that indicate Crohn’s in the upper intestinal tract include indigestion-like pain, nausea, loss of appetite, and weight loss. PERIANAL Crohn’s in the area around the anus can occur on its own or at the same time as inflammation in other parts of the body. It can cause symptoms such as: • Fissures: tears in the lining of the anal canal which can cause pain and bleeding, especially during bowel movements. • Skin tags: small fleshy growths around the anus.

• Haemorrhoids: swollen areas in the anal canal. • Abscesses: collections of pus that can become swollen and painful. Most often found in the area around the anus and can cause a fever or lead to a fistula. • Fistulas: narrow tunnels or passageways between the intestinal tract and the skin or another organ. In perianal Crohn’s, fistulas often run from the anal canal to the skin around the anus. They appear as tiny openings in the skin that leak pus or sometimes faecal matter. They can irritate the skin and are painful, but can usually be treated with medication and/or surgery. ORAL CROHN’S Crohn’s can occasionally affect the mouth. True oral Crohn’s which typically causes swollen lips and mouth fissures, is rare. However, about one in five people with Crohn’s tend to develop mouth ulcers. COMPLICATIONS Complications of Crohn’s can also be troublesome. Complications may occur in the intestinal tract or other areas of the body. Complications in the intestinal tract may include strictures, perforations and fistulas. Complications of Crohn’s disease affecting the intestinal tract STRICTURES Ongoing inflammation and then healing in the bowel may cause scar tissue to form. This can create a narrow section of the bowel, known as a stricture. A stricture can make it difficult for food to pass leading to a blockage. Symptoms include severe cramping abdominal pain, nausea, vomiting and constipation. The abdomen may become bloated and distended and the intestinal tract may make loud noises. Strictures are usually treated surgically mainly with operation known as a stricturoplasty. PERFORATIONS Very occasionally, a severe blockage caused by a stricture may lead to a perforation or rupture of the bowel, making a hole. The contents of the bowel can leak through the hole and form an abscess. This causes pain and a fever. An abscess may also develop into a fistula. FISTULAS (FISTULAE) A fistula can form when inflammation in Crohn’s spreads through the whole thickness of the bowel wall and continues to tunnel through the layers of other tissues. These tunnels or passageways can connect the bowel to other loops of bowel, to the surrounding organs, such as the bladder and vagina, or to the outside skin, including the skin around the anus (discussed earlier). Fistulas may be treated medically or with surgery.




on the cause of anaemia, iron, B12 or folic acid supplements are the most common treatments.

Crohn’s disease can also cause problems outside the intestinal tract. Some people with Crohn’s develop conditions affecting the joints, eyes or skin. These often occur during active disease, but they can develop before any signs of bowel disease or during times of remission.

Crohn’s increases risk of bone thinning; this is mainly due to poor absorption of calcium needed for bone formation. Sometimes low calcium levels is because the diet does not contain enough dairy foods or the use of steroid medication. Calcium supplementation and for some drug treatment with the likes of alendronates is needed.




Inflammation of the joints affects up to one in three people with IBD. In people with Crohn’s, arthritis is more commonly associated with Crohn’s colitis (Crohn’s disease in the colon). The inflammation usually affects the large joints of the arms and legs, including the elbows, wrists, knees and ankles. Fluid collects in the joint space causing painful swelling, although there can be pain without obvious swelling. Symptoms generally improve with treatment for intestinal symptoms and there is mainly no lasting joint damage. A small percentage develop swelling and pain in the smaller joints of the hands or feet. This may be longer lasting and persist while the inflammatory bowel disease is in remission. More rarely, ankylosing spondylitis can develop in which the joints in the spine and pelvis become inflamed. This can flare up independently of the Crohn’s. Medication and physiotherapy can be helpful in treating arthritic symptoms.

About one in four people with Crohn’s develops gallstones. These are small ‘stones’ made of cholesterol which can get trapped in the gallbladder (just under the liver) and can be very painful. Several factors linked with Crohn’s can make gallstones more likely including poor absorption of bile salts often caused by inflammation. Bile salts help to digest fats during digestion. Some of the drugs used to treat Crohn’s such as azathioprine and methotrexate may increase liver problems.

Diarrhoea, abdominal pain, and weight loss lasting for several weeks or longer indicate Crohn’s is a possibility particularly if a family history of inflammatory bowel disease. Tests and physical examinations can confirm a diagnosis. These include:



Crohn’s can cause skin problems. The most common skin problem is erythema nodosum, which affects about one in seven people with Crohn’s. Painful red swellings appear, usually on the legs, and then fade leaving a bruise-like mark. This condition tends to occur during flare-ups and generally improves with treatment for the Crohn’s. More rarely, a skin condition called pyoderma gangrenosum affects people with Crohn’s disease. This starts as small tender blisters, which become painful, deep ulcers. These can occur anywhere on the skin, but most commonly appear on the shins or near stomas. It is usually treated with steroids or immune-suppressants but may need biological therapy.

Crohn’s disease doubles the risk of blood clots in the veins, including DVT (deep vein thrombosis) in the legs. Risk is highest during a flare-up or if confined to bed (e.g.) during a hospital visit. Warning symptoms patients need to be aware of include pain, swelling and tenderness in the leg, or chest pains and shortness of breath.

EYES Eye problems affect approximately one in 20 people with Crohn’s. The most common condition is episcleritis, which affects the layer of tissue covering the sclera (the white outer coating of the eye) making it red, sore and inflamed. Two other eye conditions associated with Crohn’s are scleritis (inflammation of the sclera itself) and uveitis (inflammation of the iris). These conditions can usually be treated with local steroid drops, although uveitis and scleritis may need treatment with immunesuppressants or biologic drugs. Patients with Crohn’s should be aware to mention any eye condition promptly to their doctor.

A rare condition called Primary Sclerosing Cholangitis (PSC) affects up to one in 25 people with Crohn’s, usually those with the disease in the colon. PSC causes inflammation of the bile ducts and can eventually damage the liver. Symptoms include fatigue, pain, itching, jaundice, and weight loss. Treatment is usually with ursodeoxycholic acid.

ANAEMIA Anaemia means fewer red blood cells than normal and/or lower levels of haemoglobin in the blood. Haemoglobin is a protein found in red blood cells to help carry oxygen around the body. There are several different types of anaemia. People with inflammatory bowel disease are most likely to develop iron deficiency anaemia. This is caused by a lack of iron in the diet or poor absorption of iron from food and can be made worse by ongoing intestinal blood loss due to inflammation. Another type of anaemia is vitamin deficiency anaemia, caused by a low intake or poor absorption of certain vitamins, such as vitamin B12 or folic acid. This particularly affects people with Crohn’s who have had sections of the small intestine removed. Some of the drugs used for Crohn’s such as sulphasalazine and azathioprine can also cause anaemia. Symptoms of anaemia include tiredness and fatigue and if not treated can lead to shortness of breath, headaches and general weakness. Depending

CROHN’S DISEASE LINK TO CANCER Severe or extensive Crohn’s disease affecting all or most of the colon for many years can mean a slightly increased risk than normal of developing colon cancer

BLOOD TESTS AND STOOL TESTS Simple blood tests can show inflammation and anaemia; both of which are indicators of Crohn’s. Stools can also be tested for signs of bleeding or inflammation, and to check whether diarrhoea is caused by an infection. ENDOSCOPY There are several types of endoscopy which have different names based on the type of scope used and part of the intestinal tract being examined. For example: • An upper GI endoscopy: a thin flexible tube with a camera in its tip is inserted through the mouth to examine the oesophagus, stomach and duodenum. • A sigmoidoscopy or colonoscopy: for symptoms in ileum or colon a sigmoidoscope (a short endoscope) or a colonoscope (a longer and more flexible endoscope) will be inserted through the anus to examine the rectum and colon. Endoscopies should not be painful but may be uncomfortable so the patient may be given a sedative to help relax. Biopsies (small samples of tissue) are often taken during the endoscopy. These can then be examined under a microscope to confirm the diagnosis. BARIUM X-RAY TESTS Barium sulphate is a harmless white chalky substance that coats the lining of the intestinal tract and so give a clearer outline in an x-ray. It can be given as a drink to help show up problems in the stomach or small intestine, or in an enema to show up inflammation in the colon. MRI AND CT SCANS MRI (Magnetic Resonance Imaging) and CT (Computerised Tomography) scans can determine the extent of the inflammation. MRI scans use magnets and radio waves, and CT scans use a special kind of x-ray to build up a ‘3D’ image of the body. Ultrasound is sometimes also used to aid diagnosis.



• Bulking agents such as ispaghula husk (Fybogel®)

People with Crohn’s can get bowel symptoms when the disease is not active. This might be due to Irritable Bowel Syndrome (IBS), which tends to be more common in people with Crohn’s than in the general population. There is no blood loss in IBS, but it can cause abdominal pain, bloating and a varying bowel habit with diarrhoea and/or constipation. If you are having symptoms like these, and tests do not show active inflammation or an infection, then it may be IBS. Treatment varies from changing diet to over the counter products like peppermint oil and mebeverine.

• Painkillers such as paracetamol and aspirin.

TREATMENT Treatment for Crohn’s may be medical, surgical or a combination of both. For mild Crohn’s, no drug treatment may be needed. Dietary therapy may be another option for some. Treatment will depend on the type of Crohn’s. MEDICATION USED TREAT CROHN’S DISEASE Drug treatment for Crohn’s aims to reduce symptoms and control flare-ups, and then to prevent a relapse once the disease is under control. This can mean taking medication on an on-going basis, sometimes for many years. ANTI-INFLAMMATORY DRUGS Help to reduce inflammation and include: • 5 ASAs or aminosalicylates such as mesalazine (brand names include Asacol®, Pentasa® and Salafalk®) and sulphasalazine (Salazopyrin®) • Corticosteroids, often just called steroids, such as prednisolone, hydrocortisone and budesonide (Entocort®) • Immuno-suppressants such as azathioprine (Imuran®), methotrexate and tacrolimus • Biological or ‘anti-TNF’ drugs such as infliximab (Remicade®) and adalimumab (Humira®). Biological therapies are generally reserved for people in poor general health with severe symptoms of Crohn's disease, especially if corticosteroids and immuno-suppressants are unsuitable or ineffective. Biological treatment usually lasts at least 12 months, unless these drugs stop being effective sooner or the patient cannot tolerate. After this time, condition will be assessed to determine if further treatment is necessary. SYMPTOMATIC DRUGS Help control and reduce common symptoms such as pain, diarrhoea and constipation. They include • Anti-diarrhoeal such as loperamide (Imodium®) and cholestyramine (Questran®)

SURGICAL TREATMENT FOR CROHN’S Over the last 20 years, advances such as the development of biological drugs have produced better results for Crohn’s disease meaning surgery is less often needed. There have also been changes in the way surgery for Crohn’s is now managed. For example, extensive re-sections (removal of diseased sections of the intestine) are now less common. However, surgery remains an important treatment option, often in combination with medical therapies. It is estimated that about seven out of 10 people with Crohn’s will still need surgery at some point in their lives. Surgery may sometimes be the only option when other treatments cannot sufficiently control their symptoms. Occasionally, an urgent operation is required, for example a severe blockage in the intestines or a hole or tear in the bowel. DIETARY TREATMENT FOR CROHN’S DISEASE Enteral nutrition (also known as dietary treatment or nutritional therapy) involves a liquid diet replacement usually for a few weeks. These feeds contain all the essential nutrients in a simple form that the body can absorb with little or no digestion. They come in a range of flavours. An alternative may be to take the feed overnight through a nasogastric tube (a fine tube passed through the nose down into the stomach). Enteral nutrition is widely used for children with Crohn’s disease, because it helps their growth and avoids the use of steroids. There is less evidence for the effectiveness of enteral nutrition in adults, particularly for active Crohn’s disease. Research has shown it to be less effective than steroids. However, enteral nutrition may be recommended for adults who prefer not to use drug therapy, and it can be useful as a supplement for people who need extra nutrition. DOES A CHANGE IN DIET HELP? No clear evidence indicates that any food or food additive directly causes or improves Crohn’s. Generally, the most important thing is to try to eat a nutritious and balanced diet to help maintain weight and strength, and to drink sufficient fluids to prevent dehydration. Some people with Crohn’s find that certain foods trigger symptoms or make them worse and that reducing or adjusting the amount of fibre they eat or cutting out wheat or dairy products may help. To ensure the diet remains healthy and well balanced, it is important the patient gets advice from a doctor or from a qualified dietitian before making significant changes. If the patient has a stricture, avoiding ‘hard to digest’ or ‘lumpy’ foods that might cause a blockage is advised. Such

foods might include nuts and seeds, fruit and vegetable skins, and tough meat or gristle. It may also help to have small, frequent meals or snacks, and to chew food thoroughly. If the bowel is not absorbing nutrients properly, perhaps because of extensive inflammation or a shortened bowel after surgery, some people find a low-fat diet reduces diarrhoea. Avoiding carbonated drinks or other foods containing benzoates or cinnamon can help prevent symptoms. Many with Crohn’s lack certain vitamins and minerals, such as iron, calcium, vitamin D or vitamin B12, especially if they have a poor appetite or active diarrhoea or blood loss. Some of the drugs used for Crohn’s can also lead to deficiencies, for example sulphasalazine can affect the body’s ability to absorb folates, and steroids can cause calcium loss. In these cases, a supplement may be useful, but should be discussed with the doctor, pharmacist or dietitian. If tests show a serious deficiency, a course of supplements or enteral nutrition may be advised. Vitamin B12 supplements are sometimes given by injection and iron supplements intravenously (by injection using a ‘drip’) as this can make them easier to absorb. ARE COMPLEMENTARY AND ALTERNATIVE APPROACHES HELPFUL? Some people with Crohn’s disease have found complementary and alternative medicines helpful for controlling symptoms such as such as abdominal pain and bloating. However, there are few reliable scientific studies to show the effectiveness of such therapies and it is possible that their symptoms may have gone into remission coincidentally, given the unpredictable course of Crohn’s or there may be a placebo effect. One area where there has been some scientific research is the use of omega 3 fish oils. However, a recent review concluded that fish oils were probably not effective at keeping people with Crohn’s in remission, as although some studies found symptoms improved, two larger studies showed no benefit. A small study on acupuncture for active Crohn’s also showed very slight improvement, but not enough to be significant. Other research has suggested that the herbal medicine wormwood may help with steroid reduction, but more research is needed in this area. There is ongoing research into the use of probiotics for inflammatory bowel disease, but so far they have not been found helpful for Crohn’s. REFERENCES • • • • •

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Irish Pharmacy Awards Winner of the Idis Community Pharmacist of the Year 2017

Idis Community Pharmacist of the Year 2017

Nial Tully MPSI, John Tully MPSI and Maura Tully HEI pictured with the team from Tully's totalhealth Castlerea

Nial takes top Pharmacist honours

“I felt it was a great honour to even be nominated as a finalist at the Irish Pharmacist Awards never mind the actual winner.” The Staff at Tully’s remark on how his mentoring skills, his infectious enthusiasm for his work and his ability to roll up his sleeves creates a high morale and sense of camaraderie to make this such a vibrant Pharmacy. Winning Family

Newly crowned Idis Community Pharmacist of the Year 2017 Nial Tully from Tully’s totalhealth Pharmacy in Castlerea comments on his recent win, “I was obviously very honoured, humbled and shocked by it.


Indeed, winning is something of a habit for the Tully family it seems. In 2007 Nial’s father, John Tully, who is also a pharmacist at Tully’s, won the Pharmacist Contribution to the Community award at the Helix Health Pharmacists Awards. Furthermore, in 2015 the pharmacy won Most Improved Pharmacy of the Year at the Total Health Awards.

Family Business Tully’s Pharmacy was established in 1940 by Nial’s grandfather, Vincent Tully, in the same premises on the Main Street that the pharmacy is run from today. Tully’s totalhealth Pharmacy is a family run community pharmacy with three pharmacists, John, Nial and Catherine Hanley, and in total a staff of 15 are employed. Mr Tully, who is also currently studying Cardiology in Clinical Pharmacy at Trinity College Dublin, has officially worked as a pharmacist at Tully’s since 2007 but his work in the pharmacy informally began at a much younger age when he “used to come in and do the bottles.” “You got 10p as your wage and you went out and got a lucky bag and it was mighty,” he recalled. On a more serious note, he remembers that being at the pharmacy from a young age helped to instil in him the ethos of service and customer care. But as fortunate as the town of Castlerea is to have a pharmacist like Mr Tully, there was a time when things could have turned out differently.

“I pretty much always wanted to be a pharmacist. I think there was a short period of time when I was a young fella that I wanted to be a fireman but it was always my dream to be a pharmacist,” Mr Tully said. “I was never forced down that road. I just saw what being a pharmacist meant to Dad and saw what being a great pharmacist meant to Dad’s customers and the respect and the benefit that he gave to his customers. That’s something that I would like to be able to grow on, that level of service and benefit to the town.” Quality Service Like most pharmacies, Tully’s prides itself on providing a comprehensive, high quality service to customers. Some of the many services provided include blood pressure monitoring, cholesterol and diabetes screening and aftercare, emergency contraception, flu vaccination, medicine use review, skin analysis, smoking cessation, needle exchange and methadone, weight/BMI checks, healthy heart and hearing aid testing. “To be a really great community pharmacist you must always go that extra mile for your customers”, Mr Tully believes. In fact, he says much of what it means to be a great pharmacist you won’t find in books.

“It is very important that you are a caring individual. I’d imagine you wouldn’t get into the trade unless you are a caring individual. A lot of it you won’t learn in books. A lot of it is empathy. Some people come in and they just want to talk. And that is a service that is needed to be provided because it’s a level of building up of trust,” Mr Tully remarked. “It involves a good reading of people, selfbelief and self-awareness and the ability to follow through on any decision or action taken to ensure a patient’s safety regardless of how it affects anything. It’s the patient who matters. “As pharmacists we’re on the frontline of healthcare. Most people would turn to a pharmacist before any other person in the healthcare industry. Possibly because it’s free but our goal would be strive to deliver a world-class service. I’m hoping winning the Idis Community Pharmacist of the Year Award will show we’re gaining ground on this. It is all about customer service in all parts of any business and if you can deliver on that, then you’re winning.”

IDIS Community Pharmacist of the Year 2017 Winner Niall Tully, Tully’s totalhealth Pharmacy, Castlerea, recieves his award from Anna Ryan, Key Accountg Manager, IDIS Global Access


Irish Pharmacy Awards Winner of the Idis Community Pharmacist of the Year 2017

Nial Tully and his team take part in many charity and sponsorship initiatives putting support back to the community

Education is another important part of being a pharmacist, Mr Tully believes. Educating the customer regarding their prescription and medication is a huge part of a pharmacists’ work. “When a patient has a consultation and they get bad news all they hear is bad news. They don’t hear what to do or how to deal with it… when the diagnosis settles it is important to have that follow up and chat with somebody and the pharmacists are in a prime position to do that,” Mr Tully explained. He went on to contend that greater links between doctors and pharmacists in scenarios such as these should be fostered in order to increase education and awareness among patients about their health. Education around medication and health literacy is another challenge pharmacists are faced with overcoming on a daily basis. “You would be surprised at how reiterating the simple things helps and it’s the little tips that people take home with them,” Mr Tully noted. He added that it is surprising how little or how much people know and understand when it comes to their medication and that being able to read people and provide education at their level of understanding is vital. Engaging The Community The pharmacy is very active in engaging the community in health education events and recently featured a Breast Check information stand with an artificial female torso to help women know what they’re looking for when examining their breasts for suspicious lumps. The information stand, run by a breast cancer survivor has been to the pharmacy twice and will return in the future. A free paediatric first aid course with the Irish


Taking part in the Darkness into Light initiative

Red Cross was also hosted by the pharmacy recently and was extremely well attended. So much so, that the venue for the event was forced to move from the pharmacy to a bigger location. More than 60 locals attended the information session. In the future more charity days are planned along with further health awareness events, such as a healthy heart day. The pharmacy always promotes ‘Movember’ during the month of November and men’s health awareness events are planned this year also. Pharmacy Challenges Mr Tully is acutely aware of the challenges facing pharmacies in maintaining their competitiveness and understands that expanding healthcare services provided to the public in pharmacies is of “utmost importance” if pharmacies are to survive into the future. “The price of what you offer will become less and less important because the price of drugs will all co-align with reference pricing. So it’s not going to be about the price of the drug. It will be about the services you offer,” Mr Tully maintained.

“The biggest challenge at the moment is always going to be the global players… The day of the single independent pharmacy will soon be gone. If you look at most of the markets in the world you will have four or five big players that would own 60 to 80% of pharmacies in the country. You would only have single figure percentages of independents whereas it’s the other way around here and I think that will only change. “The only way to survive as an independent will be through a symbol group like totalhealth that are still fully independent but have the power to compete with global players. It’s only going to be a matter of time that it happens and totalhealth can provide the strength you need to compete. They have already freed up my time to be able to focus on my customers and I ended up winning this award.” Sponsor of the award, Idis are a leader in providing ethical compliant access to unlicensed medicines for healthcare professionals, work directly with pharmacists globally, to help them obtain access to unlicensed medicines that have received initial approval, but may not be commercially available in the country.

Irish Pharmacy Awards Winner of the GSK Self-Care Award 2017

GSK Self-Care Award 2017 Sponsored by GSK who’s philosophy is helping customers to help themselves, Award Winner Amy Kieran displayed exactly that ethos having built a strong and friendly relationship with customers, offering a caring ear, whilst providing professional medical advice to those who need it, making her a worthy winner of this years award. Customer Engagement Described as an Aladdin’s Cave by many customers who will find everything from medicines, health supplements, wellbeing ranges to gifts, Kieran’s Avenue Pharmacy has built up a unique community in Dundalk since it opened in 2014. “We are very interactive with all our customers,” said Amy. “We get to know them and find out what their health needs are. When giving out prescriptions I make sure I counsel patients on what ailment they’ve got and whether they have had it before. “When customers gain your trust, they tell you things. If they have issues, we can advise them and point them in the right direction or recommend something to help them.” Strategies and Initiatives Kieran's Avenue Pharmacy regularly runs promotions to proactively encourage better physical and mental health, as well as help treat existing health conditions.

Proud Pharmacist Amy Kieran, Kieran's Avenue Pharmacy holding her award


Research shows that men are more likely to lead less healthy lifestyles than women. But when it comes to prevention and early detection, men's health often takes a back seat. Men are also more likely to put off routine check-ups and delay seeing a healthcare provider for symptoms of a health problem.

Proactive on health: Kieran's Avenue Pharmacy drives wellbeing in Dundalk

In order to counteract this trend, Amy regularly runs men’s health promotions to encourage them to understand the risk factors and take better care of their health.

Amy Kieran, Pharmacist and Owner of Kieran's Avenue Pharmacy, Winner of the GSK Self Care Award at the Irish Pharmacy Awards, speaks about innovation in business and working in the local community.

Cholesterol Testing

“We publicised our most recent promotion by giving out postcards in advance as well as inviting people directly to the event. We set up a stall with information leaflets and a book called the Man Manual. It covers the things that affect men most, like giving up smoking, dealing with depression, seeing your doctor, diet and exercise.”

Last year the pharmacy ran a men’s health week for local businesses in the town, with Amy writing a lot of information in the packs herself. They tested customer’s blood pressure, blood sugar, cholesterol and even promoted the benefits of the flu vaccine.

“High cholesterol by itself usually has no signs or symptoms so it’s important to test regularly to reduce the risk of developing heart disease,” advised Amy. “Our cholesterol testing day is always booked out. If customers’ results are high, we recommend changes in diet and lifestyle, as well as suggesting they try natural supplements, rather than going on statins.” As well as men’s health, Amy focuses a lot of promotions on children and young people, as well as those who are suffering with diseases like cancer and Alzheimer’s. “We get different companies to run promotions on different products,” said Amy. “We run a dental promotion annually, where a dental nurse comes in to give children advise on dental health and to advise cancer patients on any oral issue they might have and recommend specific products that will help. It’s good for the staff as we get trained too and we can pass on the advice to customers in the future.” Customer Service One of the reasons customers love Kieran's Avenue Pharmacy is because Amy always makes herself available to tend to every customer’s need and to have a chat. “I’m here all the time, customers are meeting me,” said Amy. “We have excellent customer service. All our staff are very well trained. One of them won the KRKA Counter Assistant Of the Year at the IPN awards in 2016, which recognises excellence in knowledge and service to customers. It was a big deal as we were only open a short time.” Community Spirit As well as running educational events aimed at preventing disease and promoting health, the pharmacy has an extremely personal touch, like delivering medications to customers who aren’t mobile enough to come to the pharmacy and even helping people who are lonely in the area to find friendship. “We identified a lot of women of retirement age and older who were lonely,” explained Amy. “We invited the different women we had met for a coffee morning once a month and hooked them up. The feedback was very positive.”

prevent different diseases,” said Amy. “For example, I have recommended vitamin D to customers for years. Now, our local GP regularly tests patient’s vitamin D levels and has found that 95% of them are deficient in this important vitamin. Vitamin D can prevent a lot of neurological conditions like MS and even depression, so it’s an important one for customers to know about. “We recommend diet and exercise to help prevent a number of conditions,” continued Amy. “We have supplements that help lower cholesterol, which in turn can help prevent heart disease.” Customer Impact The level of individual care and attention that Amy and the staff at Kieran's Avenue Pharmacy provide is so high that they were recently thanked in the obituary and funeral mass of one of their former customers. “We had a big impact on the life of one of our customers who sadly recently passed away,” explained Amy. “A lady who had Alzheimer’s and then cancer. Her husband was extremely grateful for our friendly service. As well as helping with practical things like switching from tablets to liquid medication and researching different things to make his wife’s life easier, we would make him a coffee when he came in and let him unburden his worries. We weren’t doing anything more than we do for any other patient but he really appreciated it.” Through this experience in particular, Amy and the staff got heavily involved with Alzheimer’s in the community, running a Tea Day for Alzheimer’s for the last three years, as well as supporting the local day care centre for Alzheimer’s patients. Opportunities and Challenges Pharmacists play a vital role in the health care system through the medicine and information they provide. Pharmacist responsibilities include a range of care for patients, from dispensing medications to monitoring patient health and progress to optimise their response to medication therapies.

However, many pharmacists want to have a broader range of medicines at their disposal and be able to prescribe as well as dispense medicine. “I feel we are really restricted not being able to prescribe medicine and the remunerators for the services provided by pharmacists is ridiculous,” said Amy. Many pharmacists are worried about the increases in business costs, such as local charges, energy costs and rents, as well as cuts to pharmacy incomes from government payment schemes “I don’t think we are being paid enough for what we can do,” said Amy. “The government needs to think about the extra costs that go with having your own pharmacy. For a new pharmacy, it’s very difficult to run a dispensary.” Winning the Award Winning the IPN award has given everyone at Kieran's Avenue Pharmacy huge reason to celebrate. “It’s recognition of everything we are doing,” said Amy. “It’s great for team morale and the community. It’s a chance to celebrate and promote what we do.” On the night, Amy also pointed towards the sponsor’s GSK influence in the award “GSK have had a real emphasis on self-care of late, and their continual training, and support around this has enabled our pharmacy to trickle down this ethos to our customers, to a point where they are taking healthcare into their own hands. Strong brands like Voltarol enable people to get back to their best a lot more quickly, and it is all under their own control” The GSK Self Care Award recognises community pharmacy’s commitment to tackling health inequalities and serves to reward achievement in the development and implementation of health promotion and community wellbeing strategies and initiatives.

The feedback from Kieran's Avenue Pharmacy customers is that the staff has built a community within a community. They love the warm, friendly feeling when they go in and that there is always something different, in terms of displays and promotions. They even appreciate that it always smells lovely! Winning Ways For Amy, keeping up to date on products and medical advancements helps keep the pharmacy ahead of the competition. “We make ourselves different,” said Amy. “We set goals and work hard to achieve them. When we get something new in, all the staff are trained on why we have it and how it will benefit the customer. I always make time for a representative to come in and tell me about something new to the market.” Disease Prevention Amy’s extensive knowledge of vitamins and supplements makes her expert on ways customers can be proactive on disease prevention. “I know about a lot of things you can use to

Linda Nevin receiving the GSK Self Care Award 2017 Award on behalf of winner Amy Kieran – Kieran’s Avenue Pharmacy, Dundalk receiving her award from Matthew Beattie, Customer Business Manager – GSK


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Irish Pharmacy Awards Winner of the United Drug Business Development (Independent) Award 2017

United Drug Business Development (Independent) Award 2017

United Drug Business Development (Independent) Award Winner, Eamonn Brady – Whelehan’s Pharmacy Mullingar receiving his Award form Stephen O’Donohue, Procurement Director – UD

Eamonn talks evolving business Pharmacist Eamonn Brady of Whelehans Pharmacy, Mullingar, winner of the United Drug Business Development Award for an Independent Pharmacy at the Irish Pharmacy Awards, speaks to IPN about the pharmacy’s excellent work in successfully developing its business. 72

120 Years in Business Established over a century ago in 1898, Whelehans is an independent traditional dispensing pharmacy. Since acquiring the pharmacy in 2005, Pharmacist Eamonn Brady has continued to grow the business, building a trusted reputation and brand. It is this commitment to building a successful business that ultimately led to the pharmacy winning the United Drug Business Development Award for an Independent Pharmacy at the Irish Pharmacy Awards. Speaking to IPN following the win, Mr Brady said the team was surprised, humbled and delighted to win the Award. “It is great to get recognition from our peers” Mr Brady remarked.

This category is supported by United Drug, who work shoulder-to-shoulder with independent pharmacies, to provide patients with better healthcare solutions. Despite the success of the business to date, with a static economic outlook and numerous attritional changes to traditional pharmacy revenues and fees, it became apparent to him that to realise his vision and continue to grow the business, he would need to do something different and offer true value to customers. According to Mr Brady, there was a need to continue to grow a forward looking, progressive independent pharmacy and a requirement to do this effectively and more importantly, sustainably. The “More Than Just a Pharmacy” project, initiated at Whelehans, is a shining example of what can be achieved when you have vision and the belief in yourself and your team to deliver what is of most benefit to your community. That said, the ultimate barometer of success is whether the community support your initiative, as Mr Brady knows only too well. Community support Given the public response and the uptake of the extensive range of services now available at Whelehans, there can be no doubt that the community support the ‘all under one roof” concept. The Whelehans tag line, published on all materials and proudly on display on the wall adjacent to the main dispensary counter is: “It’s all about YOU - reminds the public that they are at the core of everything that Whelehans does”. The goal of the initiative was to better serve and provide facilities and amenities to Mullingar and surrounding communities and at the same time grow and develop a different pharmacy business success model and secure a sustainable future for the team. To that end, this has been achieved.

second pharmacy opened in Clonmore Mullingar in May 2017,” The large team work across a range of services in health, beauty, residential care delivery and therapy. Whelehans has a suite of treatment and therapy rooms that allows staff and therapists operate in private, away from the hustle and bustle of the town streets. Whelehans Chiropodist Clinic takes place every Tuesday and Thursday. The appointment slots are mostly fully booked in advance, so much so that adding another clinic day is now being considered. “Our Chiropodist has been of great value for Whelehans in supporting condition related charities related to diabetes and arthritis,” Mr Brady said. Whelehans Nutrition clinic runs twice a week and offers a variety of different services including a 6-12 week weight loss and dietary management programme including ad-hoc nutrition advice. Whelehans Chartered Physiotherapy Clinic also operates twice a week and has proved extremely popular. Like the other services, physiotherpay has been a great asset to Whelehans in reaching out to Arthritis and Fibromyalgia groups with advice and information. Building on the success to date, a range of new classes in Pilates and stretching and exercise have been launched. “The beauty business has gone from strength to strength with our Beautician Tamara Keena and her team winning the Best Salon/Spa category in the prestigious 2016 Westmeath style awards,” Mr Brady added. Service Development Many other services have been developed including 24 Hour Blood Pressure Monitoring, Compression Hosiery Measurement and Supply, Acupuncture Clinic, Personal Coaching Clinic and Holistic Therapies including massage, reflexology and most recently, Cranial Sacral Therapy.

The pharmacy aimed to provide more services under one roof than many traditional pharmacies as well as more initiatives to bring service and information out to the community.

Despite the lengthy list of services, Mr Brady noted that the pharmacy has some exciting services commencing later this year.

“The Mullingar community and surrounding area now has in Whelehans two top class health facilities giving access to a wide and diverse range of services, all in one place,” Mr Brady remarked.

Whelehans delivery service has grown from strength to strength and Whelehans now has a fleet of four vans delivering medication to patient homes as well as nursing homes, schools, businesses and other organisations in Westmeath and beyond.

With the increase in footfall and visitors to the store this brings, along with instore promotions and retention strategies, business has increased. The success of these initiatives, along with other strategic growth initiatives has been borne out by the continued double-digit revenue growth over the last few years with staff numbers increasing by 50 per cent. Since acquiring the business, Mr Brady has expanded health and beauty services and his team of health and beauty professionals run clinics and services offering people more services under one roof. “We now have over 30 staff in two pharmacies in Mullingar. The

“Our free prescription and medicine delivery service has been a great success but it is more than just a delivery service. We provide health advice, training and more as part of this service,” Mr Brady said. He and the team visits schools, residential care settings, businesses and community groups giving talks and demonstrations on everything from adrenaline pen administration and healthy eating advice to health checks. “Most of these services are free and the benefit to us is that the community gets to know our team and services with many coming in to our pharmacy afterwards to use our services.”

Having been at Whelehans for many years, first as a Pharmacist and then as owner, Mr Brady is extremely well known throughout the local community. At the core of Mr Brady’s vision as a community Pharmacist is his belief that prevention is better than cure. He strives to help people to help themselves through education and information initiatives delivered in a variety of ways. These range from his weekly Ask the Pharmacist columns and condition specific articles in local and national press, to the wide variety of subjects covered in public health talks hosted by Whelehans, which now attract leading experts and speakers as well as sizable audiences. Mr Brady also features regularly on local radio health related discussions. Most recently he spoke about Alzheimers, Autism and Medicinal Cannabis use. Furthermore, he has taken his education led initiatives into local schools, both primary and second level, to help educate and inform the communities of the future. This activity is underpinned by a strong web/ multimedia presence which is designed primarily as an education/information resource that the public can access easily and quickly when they need it. Pride in his Profession Mr Brady is proud of his profession and takes every opportunity to promote the benefits and awareness of what the local pharmacist can offer people to support them with their health and wellbeing. He also believes it is vital that pharmacies expand and develop their services in order to survive. Pharmacies are facing numerous challenges, among them the fact that Ireland has more pharmacies per head of population than most other Western countries and increasing bureaucracy and administration from organisations such as the HSE, Mr Brady said. This is why it is crucial pharmacies continue to adapt and change to survive more challenging economic conditions. “Without expanding healthcare services a pharmacy’s customers will go elsewhere where they get more services under one roof and with the continued cuts in traditional dispensing business payments, such as HSE fee reductions, reductions in price of drugs and increasing competition between pharmacy on drug prices, without innovating and starting new income streams it will be harder for pharmacies that don’t diversify to survive,” Mr Brady advised.


Irish Pharmacy Awards Winner of The Peoples Pharmacist 2017 in association with A.Menarini Consumer Health


Consumer Health The People's Pharmacist 2017 in association with A.Menarini Consumer Health

The Peoples Pharmacist 2017 in association with A.Menarini Consumer Health winner Kilian McGreal - McGreals Pharmacy, Blessington (right) receiving his award from sponsor Johnny Murphy Head of Consumer Heath A.Menarini Consumer Health

Championing the people puts McGreal’s pharmacy ahead of the pack Killian McGreal of McGreal's Pharmacy, Blessington, Winner of the People's Pharmacist Award at the Irish Pharmacy Awards, about the importance of integrated patient care and engaging with the community. 74

“The best pharmacy in the world, with the best staff in the world”, is just one of the comments left by customers on McGreal’s Pharmacy Facebook page, so it is no wonder it won the People’s Pharmacist Award, the only award within the Irish Pharmacy Awards that is solely nominated by and voted for by the general public. Through social media, as well as local and national press, The People’s Pharmacist campaign reached in excess of half a million people nationwide. The voting campaign, lasted a full month, with campaigns and organic good-news pieces picked up by the major news outlets across the country. Assistance from sponsor A. Menarini who McGreal also credited on the night, extended the

scope of the award “A.Menarini’s support of the award allowed the campaign to reach further into communities- beyond pharmacy circles”. Generations of Service Killian’s grandfather first opened the pharmacy in 1961 in Blessington, County Wicklow. His father took it over in the early to mid-seventies, when he finished college and Killian himself joined in 2003, after he finished his education.

Not only are the staff there to respond to every patient need, but on any day they are needed too. “In terms of service, we open every day of the week,” said Killian. “I work St Stephen’s Day, Christmas Day and New Year’s Day myself as I wouldn’t want to ask anyone else to work on those days.” Integrated Patient Care

Exceeding Expectations

At McGreal’s Pharmacy, staff are trained in integrated patient care and have gone beyond the call of duty on many occasions. One such occasion was when one of its opticians, while carrying out an eye test, came across a patient with a potentially life threatening condition. Another was when one of its technician, trained in First Aid, was able to administer a lifesaving EpiPen to a customer in the shop.

Killian and his team have gone above and beyond the normal level of care for their patients, something which was key in earning him the award. “There are very few professions where engagement in the local community is as high as with pharmacy,” said Killian. “I love the patient engagement and the opportunity to innovate and develop something in the healthcare realm.”

“While doing an eye test on a customer, one of our opticians noticed there was thickening of the artery at the back of the retina, which is a sign of high blood pressure and potentially high cholesterol,” explained Killian. “He referred the customer into the pharmacy where we checked the blood pressure and found it a bit high and within an hour they were in with the doctor.

Pharmacists are increasingly the first point of call for the public on health issues and are often consulted before GPs or hospitals. Many pharmacists now offer more services such as delivery services, blood pressure and cholesterol testing and trusted medical advice free of charge, but at McGreal’s Pharmacy they go beyond this. One example of the exceptional care they provide, is that every member of Kilian’s team is authorised to give out his private phone number to patients, should they need it.

“What would have been undiagnosed high blood pressure and high cholesterol was immediately treated. They could have gone another five years undiagnosed if it wasn’t for that integrated patient care. It wasn’t that our pharmacists or technicians were trying to diagnose anything, they

Killian has pioneered healthcare innovation and community engagement in the development of McGreal’s Pharmacy since then and has grown the business from one thriving pharmacy in the heart of Blessington to eight new McGreal’s Pharmacy opening across Leinster.

were making the connection. We want to be the linchpin between the various other services that already exist.” Linchpin Wanting to be this linchpin motivated Killian to build a Primary Care Centre in Blessington, with the aim of providing the HSC with a space for services such as occupational therapy, physiotherapy, dentistry, and psychiatric clinics and linking up services for patients. “The centre allows us to be more engaged with primary care provision, and all the services on the other end, in a primary care setting,” said Killian. “Most pharmacists think their only job is to dispense but for us it doesn’t stop there. It’s about thinking outside the box.” McGreal’s Pharmacy technicians and pharmacists receive integrated patient care training, so they have a basic understanding of all the services that are provided, not only in pharmacies but across the board, so they can identify what patients’ needs are and advise on how to access services needed. Pharmacy’s Role McGreal’s Pharmacy takes a holistic approach to patient care, offering an array of other services like opticians, audiologists, home care, nutrition and

“We pride ourselves on going the extra mile,” said Kilian. “It can be anything from a palliative care or chemotherapy patient needing my mobile number to ensuring the right patient medication reviews or over the counter engagement is being carried out. It’s knowing peoples’ names, their families and their situation.” Customer engagement leading up to the award was excellent, with a quarter of a million views, across the shops, of the award piece on Facebook. “Our customers are delighted,” said Killian. “Winning the award has created a great sense of positivity. People voted because of our brilliant team and the customer service ethos we have. Our staff understand they need to exceed each patient’s expectations, all of the time,” continued Killian, “and that patients should be happier walking out of the shop than they were walking in.”

Kilian McGreal, McGreal's Pharmacy, Blessington


Irish Pharmacy Awards Winner of The Peoples Pharmacist 2017 in association with A.Menarini Consumer Health living aid. Killian believes it’s the role of pharmacies to complement the conventional pharmacy, GP, primary care offering in this way. “You have the state using the concept of GP led integrated patient care but they don’t have the time or the level of patient engagement it requires to provide this service,” said Killian. “I think pharmacy is much better placed to provide this service. “Most people are unaware of the services available within their community and how to access them,” he continued. “There is no official integrated patient care qualification, so we are developing our own training modules. Our staff can’t be

things, outside of being a pharmacist, that makes you a good pharmacist. Challenges and Opportunities Constantly changing and innovating are what’s needed to stay at the forefront of healthcare provision, says Killian. And while he regards it as a challenge, it’s an exciting one that he embraces. “As well as constant innovation, pharmacies must also develop customer service and healthcare offerings,” said Killian. “Through working with a brilliant team, who all know what their role is, as well as putting targets in place and constantly reassessing those targets,

pharmacists will overcome any challenge to what they want to achieve.” Killian wants McGreal’s to be the leading customer focused healthcare retailer in the country and is very committed to achieving that. Winning the Award “That’s what we aspire to be and that’s what we hope we are,” said Killian in true entrepreneurial spirit. “This award is a great reflection on the team and it has reinforced the quality of service they provide and the incredible support our communities show us. It’s great for all round positivity in the shops, which is amazing.”

Kilian is pictured with Health Minister Simon Harris who cut the ribbon at the new Blessington Primary Care Centre

experts in psychiatry or wound dressing or occupational therapy but they can identify if a patient needs those services, where they are available and how they can be accessed. Community Involvement Pharmacists are highly qualified healthcare professionals in the heart of the community , but for Killian, a pharmacist’s role is about much more than dispensing medicine and giving advice. “It’s about being involved in the community and giving back to the community in whatever way you can,” said Killian. “I am on the community forum, I have chaired the economic think tank with the county council, I’m director of the Blessington Greenway, I’ve been grand marshal and a leprechaun at the St Patrick’s Day parade. I’m involved in the theatre group, Tidy Towns as well as school issues. I feel there are a lot of


Kilian McGreal, Pharmacist, Mark Daly, Catriona Cullen, Mary Murphy, Luz Santos, Duarte Nunes de Silva, Susan Dowling and Nicola Farrington

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Irish Pharmacy Awards Winner of the McLernon Computers Innovation & Service Development (Independent) Award 2017

McLernon Computers Innovation & Service Development (Independent) Award 2017

Bernadette Lyons dispenser, Olivia Mcnamara counter assistant, Claire O'Connell pharmacist, Brian Clancy pharmacist, Marcella Fitzgerald dispensing technician, Annemarie Moroney counter assistant

Leading Independent Pharmacy in Innovation Superintendent Pharmacist Michelle Quinn of the Burren Pharmacy, Lisdoonvarna, Co. Clare, winner of the Innovation & Service Development for an Independent Pharmacy award, speaks to IPN about the pharmacy’s work in implementing innovative diagnostic screening services for customers. 78

Hard work pays off Spirits are high at Lisdoonvarna’s Burren Pharmacy in Co. Clare following the team’s recent success at the Irish Pharmacy Awards. The accolade sponsored by McLernon Computers Innovation & Service Development for an Independent Pharmacy is the second national award it has received in recent years. The team picked its first trophy for Business Development at the 2013 Irish Pharmacy Awards, Michelle Quinn, Superintendent Pharmacist at the Burren Pharmacy, told IPN. Commenting on the recent win, Ms Quinn said she and all the team are absolutely thrilled to have won the award.

“We put a lot of hard work in this year and while we were quietly confident it was a huge surprise and very exciting to hear our name called out on the night. We have a fantastic team here and it’s wonderful to see that being recognised…the staff and everyone really has gotten a great boost from it,” Ms Quinn remarked. Having worked at the busy pharmacy almost 10 years now, Ms Quinn oversaw the relocation in 2012 to the square of the town at the site of the original town pharmacy many years ago. The rural based, community and independent pharmacy has grown from a staff of three Counter Assistants and one Pharmacist to two Counter Assistants, two Dispensers and three Pharmacists today. “The team has progressed through the demands of the business. It’s a good team. Everyone works very well together and it’s a team that work very hard and have great ideas and are very enthusiastic. I suppose given the [staff] numbers we have we can do events and innovations and progress as a result,” Ms Quinn said. Patient-Led Care Commenting on the pharmacy’s ethos, Ms Quinn stressed that the team are “all about patient-led care. We endeavour every day to improve patients’ health and resolve any personal issues they may have.” It was via in depth consultations with customers that a number of concerns and health issues were highlighted to the team, which led to innovations and extra services being provided by the pharmacy in direct response to the needs of the community. Several innovative services and technologies have been introduced at the pharmacy in recent years, including the introduction of Spirometry Testing and Atrial Fibrillation diagnostics.

“We are not diagnosing COPD here in the pharmacy - we are using spirometry, which is a measure of the airflow through the lungs and airflow obstruction, that is used to give patients a measurable parameter of their lung health. That is done in the consultation room and it is a useful tool to highlight the importance of smoking cessation and because the parameter is measurable people can really see the need stop smoking and improve their lung health. “As it’s done in a private room it allows the Pharmacist to counsel for the risk factors, which is usually most commonly smoking, and you can have a more worthwhile conversation on smoking cessation.” The service was introduced in 2016 and since this time has resulted in a number of positive outcomes for customers, with many quitting smoking following testing. Furthermore, as Spirometry Testing is not widely available in general practice, with some GPs providing the service and others not, the test provides individuals with access to a valuable test that they may otherwise be unable to access due to the patchy nature of Spirometry Testing in the community nationwide. “I’ve met people who have been waiting a long time to get Spirometry Testing in hospital and they really appreciate the screening service. While they know it’s not a replacement for a full doctor consultation it does give patients a quick and measurable indication of their lung health and they feel that’s worthwhile and they can use that to improve their lifestyle and see the Doctor sooner if necessary,” Ms Quinn added. “If someone has symptoms and risk factors we would use it as a referral to the

local doctor to follow up if they needed medication or anything like that. “What we’re trying to achieve is early intervention to improve patient health and patient outcomes in the future and avoid a progression onto mild, moderate or severe COPD.” Championing Stroke Prevention The Atrial Fibrillation service was also introduced free of charge to customers in 2016. It involves a private consultation with customers lasting about 15-20 minutes and is non-invasive. Atrial Fibrillation is an abnormal heart rhythm and is associated with an increased risk of heart failure, dementia and stroke. According to the Health Information and Quality Authority (HIQA), it is the most common arrhythmia seen in general practice and the burden of Atrial Fibrillation is increasing as the population ages. The condition is common in about 5 to 10 per cent of people aged over 65 years and increases with age. It is often asymptomatic and is usually picked up as an incidental finding, Ms Quinn stated. “It’s a potent risk factor for stroke. It actually increases the risk of stroke fivefold and is associated with a more severe stroke,” she added.

Focus on Lung Health “The goal of our spirometry screening is to detect early Chronic Obstructive Pulmonary Disease [COPD],” Ms Quinn noted. “COPD is a disease that is characterised by persistent respiratory symptoms and airflow limitation and that’s due to airway abnormalities. The causes are usually significant exposure to noxious gases. That would be most commonly tobacco smoking or maybe occupational exposure to fumes and dust.” The test is non-invasive, easy test to perform and is readily available free of charge in the pharmacy. It is most commonly offered to people over 40 who have a risk factor, such as smoking, and is used as an effective tool for smoking cessation. “Because COPD usually remains undiagnosed in primary care I felt early diagnosis was worthwhile,” Ms Quinn explained.

McLernon Computers Innovation & Service Development (Independent) Award Winner 2017, Michelle Quinn - The Burren Pharmacy, Lisdoonvarna receiving his Award from Robin Hanna – McLernon Computers


Irish Pharmacy Awards Winner of the McLernon Computers Innovation & Service Development (Independent) Award 2017

Michelle Quinn Pharmacist performing blood pressure testing and Atrial Fibrillation Screening

Marcella Fitzgerald, Dispensing Technician serving customer Pharmacist Brian Clancy

“Atrial Fibrillation has different classifications. It may be mild, it may be transient, it may be persistent, we wouldn’t know but we would highlight that to the patient and refer them straight to the GP for a full ECG assessment and hopefully by screening we prevent stroke in a certain number of patients. “We’re trying to prevent stroke. In this area, we’re rural. It’s convenient. It’s easy. It’s just a screening and is non-invasive so people can avail of our services free of charge with the aim to prevent stroke.” Feedback following introduction of the service has been hugely positive to date and the service is greatly appreciated by locals. Other services provided at the pharmacy include blister packing, a medication delivery service, stocking measuring and fitting, and the flu vaccination.


training programme. In-house training on new legislation and medication is also conducted regularly to ensure staff are up to date on new developments. “We pride ourselves on having well trained and well-informed staff. One of our counter assistants has a special interest in asthma care so she completed asthma training and is up to date on all the treatments there. Also, an Asthma Nurse comes to the pharmacy once a year to assess patients. We have a staff member with a special interest in sports nutrition,” Ms Quinn remarked. Healthcare promotion days are run on a regular basis, such as an asthma day, skincare health day and a baby bump and toddler day.

Award winning Team

On these special event days, the pharmacy fundraises for local causes and aims to keep the community at the centre of everything it does.

The staff are highly trained, with every staff member trained in the counter assistants

“The community” is a strong word in pharmacy. We are an independent

community pharmacy and take part in as many community events as we can,” Ms Quinn said “The staff are so enthusiastic and every initiative mentioned has been wholeheartedly supported and implemented by every single member of the team. It’s every member here that takes part and the initiatives are hugely supported. I can’t explain to you how fantastic it is to have that here in the shop. It really does add to the community pharmacy. There’s a lot of personality here and a lot of enjoyment taken from the days and the patients enjoy that too. It’s very interactive and a very involved team here.” This award, supported by McLernon Computers, is a deserved win for the team, who include: Pharmacist Claire O’Connell, Pharmacist Brian Clancy, Dispensing Technician Marcella Fitzgerald, Dispensing Technician Bernadette Lyons, Counter Assistant Annemarie Moroney and Counter Assistant Olivia McNamara.

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Irish Pharmacy Awards Winner of the Uniphar LinkUp Young Community Pharmacist of the Year 2017

Uniphar LinkUp Young Community Pharmacist of the Year 2017

Pharmacist Sarah Chamber, Pharmacist, Hickey's Pharmacy Grafton Street, Dublin

A Driving Force in Hickey’s Dublin Pharmacist Sarah Chambers of Hickey’s Pharmacy, Grafton Street in Dublin, winner of the Uniphar Young Community Pharmacist of the Year, speaks to Kelly Jo Eastwood about the drive behind her growth in the Pharmacy profession.

Sarah took away the award this year for her outstanding work in community Pharmacy, executing a number of initiatives based on the needs of her customer base, including staff training, in-store planning and promotion of clinical screening, advanced vaccination, sexual health and emergency medicines. In her relatively short career to date, Sarah has demonstrated innovation and initiative in her role as a Pharmacist, establishing herself as an integral part of many of her patient’s healthcare provision. Sarah began her career with Hickeys Pharmacies in 2012 as a Pharmacy intern in the busy Tallaght Fortunestown store. Once qualified, she broadened her experience by taking a relief pharmacist role


with the company. This experience allowed Sarah to see the varying demographics that make up the communities served by Hickey’s stores. An opportunity arose for her to take a full time support role in Grafton Street and she embraced the opportunity to work in a diverse and dynamic environment and began building relationships with her customers. She has described the relationship between pharmacist and customer as “truly unique” and one that is built on trust; trust which can only come by building personal relationships with the people involved. Sarah was the obvious choice to take over as supervising pharmacist from her long standing colleague Richard once her necessary three-year qualification period was satisfied. Sarah thrives on continuous education and learning and has special interests in the area of advanced vaccination services, provision of emergency medicines and sexual health. Sarah says that she strives to provide the best Pharmacy experience for the diverse community she meets every day working as a Pharmacist on one Dublin’s busiest retail streets. “When I started, I was delighted to meet such a large number of regular customers,” she said, discussing working in such an unusual location to Irish Pharmacy News.

“They travel in from Rathgar, Rathmines, some as far as Naas, and Wicklow. Staff members Yvonne and Richard have built up such great relationships with them, and they like to come back. “A lot of people who work in the city would use us as their regular Pharmacy, but a lot of walk-ins too, and a lot of tourists, people who’ve just got off a plane and perhaps forgotten their medication” she adds. A Driving Force Her nominee says of Sarah, “Sarah is a vibrant, diligent and passionate pharmacist who strives for excellence in her practice. This excellence is coupled with a natural disposition to benevolence, empathy and warmth toward the community that she serves in Grafton Street and wider area. The city centre environment from which she operates enjoys a blend of regular repeat community business mixed with the varied and often complex demands of the many single occasion visitors to the popular Dublin shopping area. “Sarah, alongside her support pharmacist Richard, and store manager Yvonne, heads up the busy team in Grafton St. providing services such Express Prescription Service, Medication Management, Emergency Contraception, STI screening, Cholesterol

Testing, Seasonal Flu and Advanced Vaccination Services, BP screening and 24 hour BP monitoring.” Sarah has been a driving force in terms of the advancement of clinical services in Grafton St. Services such as the ‘Let’s get Checked’ STI screen, ambulatory BP monitoring, cholesterol and diabetes screening and advanced vaccination services are available not only to the general public but also to corporate clients. Throughout the course of her, Sarah conducts regular training in store with all staff members on dealing with emergency medical situations. She has also developed innovative ‘emergency boxes’ for adults and children which contain lifesaving adrenaline, CPR mask, timer etc. These emergency boxes have been an important tool in recent months when Sarah has had to deal with a number of emergency situations in the Grafton Street store. “I have embraced the recent changes in the world of Pharmacy, including the augmented vaccination services and the provision of emergency medicines,” she adds.

Mr Dermot Ryan, Managing Director, Uniphar Retail Services presents the Uniphar Link Young Pharmacist Award 2017 to Sarah Chamber, Hickey’s Pharmacy Dublin


Irish Pharmacy Awards Winner of the Uniphar LinkUp Young Community Pharmacist of the Year 2017

Sarah Chambers pictured with Deirdre O'Kane, compere of the 2017 Irish Pharmacy Awards

“The profession is well placed to grow the provision of such services due to the accessibility, competence and training of pharmacists. I am committed to continuous self-development and recognise the importance of training and lifelong learning to build on and expand the services provided by pharmacists. I am excited about what the future holds for the profession.” Her organisation, training, and her innovative emergency boxes have meant that these emergencies were dealt with effectively, safely and calmly, ending in optimum patient outcomes. Sarah has organised many clinics for services making them easily available to people working in the city centre Monday to Friday who may not otherwise be able to avail of them. Probably one of the most important examples is seasonal flu vaccination. The Grafton Street branch has seen year on year growth in the uptake of this service because of the links that Sarah has made with the client base in the surrounding areas. Pharmacist of Tomorrow Sarah has a number of interest areas that cross paths with other healthcare professionals. One such example is that


of her interest in sexual health. She is a member of the National HIV testing and STI testing management clinical working group, under the HSE Sexual Health and Crisis Pregnancy Programme. Sarah works closely also with a number of GPs and health clinics in the city centre on a regular basis. In recent months her response to a number of emergency services has meant that Sarah has had to work with paramedics for handover of care, something which she has done with effortless professionalism. Her city centre location means that she is close to the Schools of Pharmacy in Trinity and RCSI, and she has taken time out of her busy schedule to speak to pharmacy students on her experiences to date. She has also facilitated a number of student placements on the old and new degree courses and engaged with organisations such as APPEL on these placements. Sarah is the pharmacist of tomorrow. She has identified the needs of her customer base in the Grafton Street area and responded appropriately. She has identified her specific training needs and that of her team and has provided for this in her practice. The recent legislation that allows for the provision of medicines to save life or

avoid serious distress to health has been welcomed by Sarah and she has saved the life of three patients who have presented in the Grafton Street store with anaphylaxis. For many, such events would seem exceptional. For Sarah, she remained calm at all times, dealt professionally with each situation. She provided a genuine warmth and reassurance to the patients involved (the first of which was a 17-year-old girl). Sarah remained with each patient until the emergency services arrived and provided professional hand over of care. She also made contact with relatives where appropriate, again giving information and reassurance. Sarah attracted much media attention for these events; again, she remained an upstanding example to the profession of Pharmacy in her dealings with the media. Winning the award Speaking at the Irish Pharmacy Awards, Sarah remarked “It is an honour to be given such a prestigious award and I hope this marks the beginning of a long career in Pharmacy. It is brilliant that Uniphar support us younger pharmacists, and recognise our development so early in our careers.”



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Irish Pharmacy Awards Winner of the KRKA Counter Assistant of the Year 2017

KRKA Counter Assistant of the Year 2017

Rhonda Finnegan, McCartan's Pharmacy with Daniel Byers, General Manager, KRKA Ireland

The frontline of pharmacy: compassion is key to being a good counter assistant Rhonda Finnegan, winner of the KRKA Counter Assistant of the Year Award at the Irish Pharmacy Awards, speaks to IPN about the importance of good communication with customers and being on the frontline of healthcare.

Pharmacy Counter Assistants are usually the first people customers interact with in a pharmacy. It is their job to advise patients correctly about their health needs and to act as brand ambassadors for the business. Ms Finnegan has worked as a pharmacy Counter Assistant for 17 years, 15 of those have been with McCartans Pharmacy. She began her career with McCartans Pharmacy at their Bayside branch, where she enjoyed the community vibe and the intimate environment of the pharmacy, before moving to the Sutton branch, where she currently works. It was clear to the judging panel that Ms Finnegan’s knowledge and expertise as a counter assistant come from enjoying her role and a quest to always do her best for her customers. “I love my job because I’m given a lot of free reign to make decisions in the shop,” said Ms Finnegan. “I train new staff and give them lots


of one to one. I went through a lot of training and learning at the beginning, which I really enjoyed and I want to replicate that for new staff. A lot of the assistants go from the counter to a technician role but I’ve always liked being behind the counter.

“We do in-house training for anything new that comes on the market,” said Rhonda. “We make sure the staff are as knowledgeable and compassionate as can be. The pharmacist has a lot of responsibility but counter assistants are the first people customers see and speak to.

Decision Maker

“I make sure training manuals are in place, staff are up to date on products and customers are looked after to the best of our ability.”

One of the things Ms Finnegan really enjoys about the role is deciding what products to buy in. “I love making decisions about products. Seeing products I’ve ordered take off is very satisfying, “she said. “I enjoy matching up products with customers who might need them. The public will let you know whether you’re doing a good job. I get a lot of positive feedback, which is really rewarding.” As McCartans Pharmacy expanded, Rhonda moved to the bigger shop in Sutton. While, she says the increase in size was challenging, her natural warmth and ability to be flexible and to adapt saw her through the change. “It was a bit challenging because the front of shop was twice the size of what I was used to. My role has evolved so many times as McCartans got bigger and bought more branches. The cosmetic end of the pharmacy wouldn’t have been my forte. I like dealing with over the counter medicines, meeting with drug representatives and finding out about new products our customers would benefit from.” In the new pharmacy, Ms Finnegan made sure everything was merchandised, decided on the type of space necessary to carry more products for customers, as well as looking after new staff. But when McCartans changed five of their ten branches to Allcare franchises, the ordering process changed, bringing her back behind the counter. “There’s a little bit less for me to do now in terms of ordering,” said Ms Finnegan. “This brings me back to the counter, which is what I enjoy most. “When a customer comes in, we’re dealing with them at their most vulnerable. It could be that they are not well, a loved one isn’t well or they could be at the end of their tether dealing with a sick child. I take pleasure trying to improve their situation. I want them to go out feeling better than when they came in.” Listening to people’s problems comes naturally to Ms Finnegan, making her a hit with customers and staff alike. “When customers come back and tell you that you’ve helped them, you feel good about yourself on top of them feeling better. It’s not the easiest task being able to communicate well with the public but I like doing it. There isn’t a day that goes by that a situation doesn’t crop up where you want to help someone, to put their mind at ease. Sometimes customers come back and tell you that whatever you advised or suggested didn’t work and that’s a learning process in itself.”

The wellbeing scene has exploded since Ms Finnegan started as a Counter Assistant, an area she has thoroughly enjoyed becoming knowledgeable in. “It’s been challenging to keep up with everything that’s on the market in order to recommend them to people to complement their lifestyle but that’s where training comes in. We know about a product that might go hand in hand with a customer’s medication. It’s important to know what might lessen side effects of certain medications, for example.” “A lot of customers want lifestyle changes, to improve their diet for example, we have products in the pharmacy to complement that. Eye sight has been a huge thing in last few years, customers taking supplements for this and for arthritis. There are always new clinical trials on different things. We try to have the latest but also the best treatment for people.” On the frontline Counter Assistants need the knowledge and confidence to talk to customers. It is their job to promote the pharmacy as a hub for healthy living, advice and care. If they don’t, the customer may not get what they need and also might not return. “Usually the first person a patient or customer interacts with is the counter assistant,” said Ms Finnegan. “It’s crucial that that staff member is knowledgeable and compassionate and listens to people. The counter assistant role isn’t about recommending a product or service for the sake of it. We think everything through and we do a lot of follow ups. If a customer comes in and they don’t know what they might need, we advise them. We get their number and get back in touch with them or source something that’s beneficial to them if we don’t have it. We make sure the customer is looked after to the best of our ability.” For Ms Finnegan, she feels that sometimes really good OTC staff don’t get credit for providing consultations with customers that, a lot of times determine whether they go back to the shop.

“We are the frontline of healthcare in many ways,” she said. “Sometimes the Pharmacist doesn’t get fully involved in a customer consultation. Sometimes it’s an informal chat, where you are able to talk them around to doing something about their situation. Talking to us can be time out for them, a way for them to stand outside their situation. We can be more diplomatic than perhaps their family can. When I’m having a bad day, this keeps me going. It’s the reason I’m here so long.” Teamwork There is no ‘I’ in teamwork and for Ms Finnegan, being recognised for her work with this award would not have happened if it wasn’t for the rest of the team. “They are all amazing, we make a great team. I wouldn’t be able to work here as long as I have without the support of the team. When I won the award, I wasn’t expecting the number of customers to come in and congratulate me. I was felt humbled, it was lovely. It was a big stand out moment for me.” KRKA’s support of this award category is so important, as it means that talented Counter Assistants like Ms Finnegan, and the teams they are part of, are recognised for their customer service, professionalism and dedication. Being part of the changes to the role of the Counter Assistant over the years, has been an exciting part of the job for Ms Finnegan. “Our role has changed for the better,” she said “The staff are better trained now than they ever were. There is so much opportunity for people on the floor to improve their knowledge on pharmacy.” “It can be a rollercoaster ride, that’s what has attracted me to stay for such a long time. From learning about vitamins and homeopathic remedies and supplements to doing blood pressure monitoring, BMI checks, providing dietary advice and managing medication. There isn’t a counter assistant who doesn’t learn something new every day and have new opportunities. These allow staff to introduce new ideas, feel part of a great team and hopefully make people’s lives a little bit better.”

Lifelong Learning One of the main things Ms Finnegan loves about the job is that she is always learning and finding out about new things. “I like pushing things to make my customers happy. With the internet, people have heard about different products. They come in asking about them, there is always something to learn in this job” She is passionate about compassion, and regards it as the most essential characteristic a Counter Assistant can have.

Rhonda Finnegan, pictured right, with Pharmacist Brian McCartan, McCartan's Pharmacy and Sheila Thompson


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As an adjunct to diet and exercise for appropriate patients with type 2 diabetes








NOW EVEN MORE REASONS TO CHOOSE JANUVIA® FIRST AS A PARTNER TO METFORMIN1 Januvia or Janumet. For Januvia only– Renal Impairment: Lower dosages are recommended in patients with moderate and severe renal impairment, as well as in ESRD patients requiring haemodialysis or peritoneal dialysis- see Dosage. For Janumet only - Lactic acidosis and renal function: a very rare, but serious, metabolic complication can occur due to metformin accumulation. Cases in patients on metformin have occurred primarily in diabetic patients with significant renal failure. Reduce incidence by assessing other associated risk factors. If suspected, discontinue treatment and hospitalise patient immediately. Determine serum creatinine concentrations regularly, i.e. at least once a year in patients with normal renal function and at least two to four times a year in patients with serum creatinine levels at or above the upper limit of normal and in elderly patients. Decreased renal function in elderly patients is frequent and asymptomatic. Exercise special caution where renal function may become impaired, e.g. when initiating antihypertensive or diuretic therapy or when starting treatment with a non-steroidal anti-inflammatory drug (NSAID). Surgery: due to metformin hydrochloride content of Janumet, discontinue treatment 48 hours before elective surgery with general, spinal or epidural anaesthesia. Do not resume earlier than 48 hours afterwards and only after renal function is normal. INTERACTIONS For Janumet only - Alcohol: avoid alcohol and medicinal products containing alcohol due to risk of lactic acidosis. Cationic agents that are eliminated by renal tubular secretion (e.g., cimetidine): these may interact with metformin by competing for common renal tubular transport systems. Consider close monitoring of glycaemic control, dose adjustment within the recommended posology and changes in diabetic treatment when these agents are co-administered. Iodinated contrast agents in radiological studies: intravascular administration of these agents may lead to renal failure, resulting in metformin accumulation and a risk of lactic acidosis. Discontinue Janumet prior to, or at the time of the test and do not reinstitute until 48 hours afterwards, and only after renal function is found to be normal. Combination requiring precautions for use: glucocorticoids (given by systemic and local routes) beta-2-agonists, and diuretics have intrinsic hyperglycaemic activity. Inform the patient and perform more frequent blood glucose monitoring, especially at the beginning of treatment. If necessary, adjust dose of the anti-hyperglycaemic medicine during therapy with, or on discontinuation of the other medicine. ACE-inhibitors: as these may decrease the blood glucose levels, if necessary, adjust dose of the antihyperglycaemic during therapy with, or on discontinuation of the other medicine. PREGNANCY AND LACTATION: Do not use during pregnancy or breast-feeding. Animal data do not suggest an effect of treatment with sitagliptin on male and female fertility. Human data are lacking. SIDE EFFECTS Refer to SmPC for complete information on side effects There have been no therapeutic clinical trials conducted with Janumet tablets however Janumet is bioequivalent to co-administered sitagliptin and metformin. Sitagliptin: Serious adverse reactions including pancreatitis and hypersensitivity reactions have been reported. Hypoglycaemia has been reported in combination with sulphonylurea and insulin. The following adverse reactions were reported from both clinical trials and post-marketing experience: Sitagliptin only: Common: hypoglycaemia, headache, Uncommon: dizziness, constipation and pruritus. Sitagliptin with metformin: Common: hypoglycaemia, nausea, flatulence and vomiting; Uncommon: somnolence; upper abdominal pain, diarrhoea, constipation and pruritus. For Januvia and Janumet: Post-marketing experience additional side effects have been reported (frequency not known): hypersensitivity reactions, including anaphylaxis, angioedema, rash, urticaria, cutaneous vasculitis, exfoliative skin conditions including Stevens-Johnson syndrome (see precautions), and bullous pemphigoid; acute pancreatitis, including fatal and non-fatal haemorrhagic and necrotising pancreatitis (see precautions); impaired renal function, including acute renal failure (sometimes requiring dialysis); vomiting; pain in extremity, arthralgia, myalgia, back pain and arthropathy; interstitial lung disease. Januvia: Description of selected adverse reactions Adverse experiences reported regardless of causal relationship to medication and occurring more commonly in patients treated with sitagliptin included upper respiratory tract infection, nasopharyngitis, osteoarthritis and pain in extremity. In the Trial Evaluating Cardiovascular Outcomes with sitagliptin (TECOS), after a median follow up of 3 years, sitagliptin, when added to usual care, did not increase the risk of major adverse cardiovascular events, or the risk of hospitalisation for heart failure compared to usual care without sitagliptin in patients with type 2 diabetes and established cardiovascular disease. PACKAGE QUANTITIES Januvia 25 mg, 50 mg and 100 mg film-coated tablets 28 tablets Janumet 50mg/850mg and 50mg/1000mg film-coated tablets 56 tablets Legal Category: POM. Marketing Authorisation Numbers Januvia 25 mg: EU/1/07/383/002 Janumet 50 mg/850 mg: EU/1/08/455/003 Januvia 50 mg: EU/1/07/383/008 Janumet 50 mg/1000 mg: EU/1/08/455/010 Januvia 100mg: EU/1/07/383/014 Marketing Authorisation Holder Merck Sharp & Dohme Limited, Hertford Road, Hoddesdon, Hertfordshire EN11 9BU, UK Date of revision: January 2016 © Merck Sharp & Dohme Ireland (Human Health) Limited, 2016. All rights reserved. Further information is available on request from: MSD, Red Oak North, South County Business Park, Leopardstown, Dublin 18 or from Date of preparation: October 2016. Adverse events should be reported. Reporting forms and information can be found at Adverse events should also be reported to MSD (Tel: 01-299 8700)

Reference: 1. Green JB, Bethel MA, Armstrong PW, et al. Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2015;373(3):232–242.

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JANUVIA® (Sitagliptin) JANUMET® (Sitagliptin/metformin hydrochloride) ABRIDGED PRESCRIBING INFORMATION Refer to Summary of Product Characteristics (SmPC) before prescribing. PRESENTATION Januvia® 25 mg, 50 mg and 100 mg film-coated tablet each containing 25 mg, 50 mg or 100 mg of sitagliptin respectively. Janumet® 50 mg/850 mg and 50 mg/1000 mg tablets each containing 50 mg sitagliptin and 850 mg or 1000 mg metformin hydrochloride. INDICATIONS For adult patients with type 2 diabetes mellitus Januvia is indicated to improve glycaemic control: as monotherapy • in patients inadequately controlled by diet and exercise alone and for whom metformin is inappropriate due to contraindications or intolerance as dual oral therapy in combination with • metformin when diet and exercise plus metformin alone do not provide adequate glycaemic control • a sulphonylurea when diet and exercise plus maximal tolerated dose of a sulphonylurea alone do not provide adequate glycaemic control and when metformin is inappropriate due to contra-indications or intolerance • a PPARγ agonist (i.e. a thiazolidinedione) when use of a PPARγ agonist is appropriate and when diet and exercise plus the PPARγ agonist alone do not provide adequate glycaemic control as triple oral therapy in combination with • a sulphonylurea and metformin when diet and exercise plus dual therapy with these medicinal products do not provide adequate glycaemic control. • a PPARγ agonist and metformin when use of a PPARγ agonist is appropriate and when diet and exercise plus dual therapy with these medicinal products do not provide adequate glycaemic control. Januvia is also indicated as add on to insulin (with or without metformin) when diet and exercise plus stable dosage of insulin do not provide adequate glycaemic control. Janumet: as an adjunct to diet and exercise to improve glycaemic control in patients inadequately controlled on their maximal tolerated dose of metformin alone or those already being treated with the combination of sitagliptin and metformin. • in combination with a sulphonylurea (i.e., triple combination therapy) as an adjunct to diet and exercise in patients inadequately controlled on their maximal tolerated dose of metformin and a sulphonylurea. • as triple combination therapy with a PPARγ agonist (i.e., a thiazolidinedione) as an adjunct to diet and exercise in patients inadequately controlled on their maximal tolerated dose of metformin and a PPARγ agonist. • as add on to insulin (i.e., triple combination therapy) as an adjunct to diet and exercise to improve glycaemic control in patients when stable dosage of insulin and metformin alone do not provide adequate glycaemic control. DOSAGE AND ADMINISTRATION Januvia - One 100 mg sitagliptin tablet once daily, with or without food. Janumet - The dose of antihyperglycaemic therapy with Janumet should be individualised on the basis of the patient’s current regimen, effectiveness, and tolerability while not exceeding the maximum recommended daily dose of 100 mg sitagliptin. For patients not adequately controlled on metformin alone, the usual starting dose should provide sitagliptin dosed as 50 mg twice daily (100 mg total daily dose) plus the dose of metformin already being taken. For patients switching from co-administration of sitagliptin and metformin, Janumet should be initiated at the dose of sitagliptin and metformin already being taken. For patients inadequately controlled on dual combination therapy with the maximal tolerated dose of metformin and a sulphonylurea or with maximal tolerated dose of metformin and a PPARγ agonist or with maximal tolerated dose of metformin and insulin, the dose should provide sitagliptin dosed as 50 mg twice daily (100 mg total daily dose) and a dose of metformin similar to the dose already being taken. All patients should continue their recommended diet with an adequate distribution of carbohydrate intake during the day. Januvia and Janumet - In combination with a sulphonylurea or with insulin, consider a lower dose of sulphonylurea or insulin, to reduce risk of hypoglycaemia. Renal impairment: For Januvia only: When considering sitagliptin with another anti-diabetic product, its use in patients with renal impairment should be checked. Moderate impairment (CrCl ≥30 to <50 mL/min), the dose is 50 mg once daily. Severe impairment (CrCl <30 mL/min) or with end-stage renal disease (ESRD), the dose is 25 mg once daily. Mild impairment, no dose adjustment. Assessment of renal function is recommended prior to initiation of Januvia and periodically thereafter. For Janumet only: Should not be used in patients with moderate or severe renal impairment (creatinine clearance < 60 ml/min). Hepatic impairment: For Januvia only - no dosage adjustment necessary for patients with mild to moderate hepatic impairment. Januvia has not been studied in patients with severe hepatic impairment and care should be exercised. However, because sitagliptin is primarily renally eliminated, severe hepatic impairment is not expected to affect the dose of sitagliptin. For Janumet only – do not use. Elderly < 75 years: For Januvia only - no dosage adjustment necessary. For Janumet only - use with caution as age increases. Monitoring of renal function is necessary to aid prevention of metformin-associated lactic acidosis. Children: no data available. CONTRAINDICATIONS For Januvia - Hypersensitivity to active substance or excipients. For Janumet - Hypersensitivity. Diabetic ketoacidosis and diabetic pre-coma. Moderate and severe renal impairment (creatinine clearance < 60 ml/min). Acute conditions with the potential to alter renal function such as dehydration, severe infection, shock. Intravascular administration of iodinated contrast agents. Acute or chronic disease which may cause tissue hypoxia such as cardiac or respiratory failure, recent myocardial infarction, shock. Hepatic impairment. Acute alcohol intoxication, alcoholism. Lactation. PRECAUTIONS AND WARNINGS For Januvia and Janumet - General: do not use in patients with type 1 diabetes or for diabetic ketoacidosis. Acute pancreatitis: Use of DPP 4 inhibitors has been associated with a risk of developing acute pancreatitis Inform patients of the symptom of acute pancreatitis: persistent, severe abdominal pain. Resolution of pancreatitis has been observed after discontinuation of sitagliptin, but very rare cases of necrotising or haemorrhagic pancreatitis and/or death have been reported. If pancreatitis is suspected, Januvia or Janumet and other potentially suspect medicinal products should be discontinued; if acute pancreatitis is confirmed, Januvia or Janumet should not be restarted. Caution should be exercised in patients with a history of pancreatitis. Hypoglycaemia when used with other anti-hyperglycaemic medicinal products: Rates of hypoglycaemia reported with sitagliptin were generally similar to rates in patients taking placebo. Hypoglcaemia has been observed when sitagliptin was used in combination with insulin or a sulphonylurea (see side effects). Therefore consider a lower dose of sulphonylurea or insulin to reduce the risk of hypoglycaemia when administering Janumet or Januvia. Hypersensitivity reactions: Serious hypersensitivity reactions have been reported, including anaphylaxis, angioedema, and exfoliative skin conditions including Stevens-Johnson syndrome. Onset occurred within the first 3 months after initiation of treatment with some reports occurring after the first dose. If suspected, discontinue


John Meaney OBrien, Sharon Meaney OBrien, Padraig Stokes and Barbara Stokes


Lisa Malone and Anthony Malone - Castletown Pharmacy


Aga Mazur, Aisling Cahill and Gaba Carslake - Clearwater Allcare Pharmacy


Adrian Dunne Front right with his Pharmacy - Team Finalists


Terry Clarke, Dr Anna Clarke, Joan Moloney and Chris Jolliffe


Dr Paul Ryan and Niamh Ryan


Ciara Hegarty, Jolanta Puckovaite, Tracy Turner, Fernanda Weiss, Gretta OHare, Yvonne Somers - Bradleys Pharmacy


Sian Feeney, Nathalie Kalo and Aine Tierney - Boots Ireland


Maple Pharmacy Team Dublin

Irish Pharmacy Awards Winner of the Johnson & Johnson Community Pharmacy Team of the Year 2017

Johnson & Johnson Community Pharmacy Team of the Year 2017

Pharmacy Channel Manager, Brendan McLoughlin from Johnson and Johnson presents Kate Clarke Managing Supervising Pharmacist Meaghers and the Pharmacy Team with their Award for Community Pharmacy Team of the Year 2017 Winner, Meaghers Pharmacy, Barrow Street Dublin

Team working in building the Meaghers Group The team in Meaghers pharmacy Barrow Street are a close-knit family unit who work together to deliver absolute excellence to customers.


The Johnson and Johnson Team of the Year Award applauds an exceptional team, who work collaboratively to anticipate the needs of their customers. The Meaghers team also shone for the way in which they support one another - It is evident that their core value of family is a concept they live by. The team consists of the Manager Kate Clarke, Support Pharmacist Lisa Coffey, Pharmacy technicians Trisha Cahill and Leanne Fallon, Cosmetic advisor Nicole Fallon and Health and Wellbeing advisor Elaine Southern. The team exhibit all the qualities of a tight knit unit who use their individual talents and strengths to deliver for their customers. Communication is Key In terms of working together it is their ability to communicate with each other that ensures that each team member have the correct information as and when they need it. They can be open

and honest with each other and effectively communicate with one another and the wider Meaghers community to ensure they have all the tools they need to deliver to the customer. It is their communication skills that make the team able to effectively make decisions. To be effective they must be able to sort through the viable options, consider the implications of each, and ultimately select an option that best serves the interests of the team and the customer. Not only is it important to make the right decision, pharmacy teams are often under a tight time-frame. Making a decision quickly is often critical. The team is trusted to solve problems for the customer they are empowered to do this as they are trusted both by the customer and by their manager. The individuals The true mark of an effective team is what it does when a problem arises. The Barrow Street team quickly recognises a problem, digs deep to understand the causes, develops creative approaches to dealing with it, and ultimately put their ideas into play. Each team member brings something different to the table including their own experience working in pharmacy and their individual passions and interests. Nicole is a gifted beauty expert who has a key interest in skincare and making their customers feel better about themselves, Elaine has a passion for holistic healthcare, she believes preventative healthcare and offering products and services to their customer to enable them to proactively improve their health and wellbeing. Lisa is passionate about enhancing the role of the Pharmacist in the community and is a firm believer that as the gateway to the healthcare system, pharmacists are uniquely placed to be on hand to their patients to enhance their healthcare experience. Leanne and Trisha are talented and dedicated Pharmacy Technicians who take great care to support the pharmacists to deliver excellence in prescription services. As the main point of contact for their doctors and healthcare partners in nursing homes they are a key touchpoint to ensure the dispensary is run smoothly and at maximum efficiency for their customers. Their manager Kate brings a passion for pharmacy and healthcare, leading her team in delivering excellence for customers she is adept at harnessing the team members individual strengths and binding them together to work together seamlessly for the good of the store and the team. When confronted with a difficult task or problem the Barrow Street team work together to overcome any situation. They thrive on challenges and delight in overcoming obstacles to offer top class patient care. From day to day operations, adapting to the continuously changing customer profile and delivering to their core customer the team brainstorm, divide the task into manageable parts and work together supporting each other along the way to constantly smash targets, improve sales and expand the services they offer to their customers.

pharmacy group has adapted its product offering, pharmacy services and how they communicate with their customers. Partnering with Influencer and Media experts such as Image Magazine and Beauty bloggers. Meaghers have used Instagram, Snapchat and Facebook live to engage the customer in Barrow Street. The team have stepped outside their comfort zone and have embraced the opportunity to communicate with their customers through these avenues. The group believes there is an opportunity to display the products and services they provide in a way that their customers can relate to. Triumph after Tragedy Ms Joanne O’Hagan, Area Manager, Meaghers Pharmacy Group, tells IPN. “The team were nominated for this award to honour the memory of a very special lady, their teammate and member of the Meaghers family Donna Fox, who they tragically lost in 2016. Donna worked as a Health and Nutrition expert delivering a special kind of patient care with her gentle, warm and caring nature. Her customers will remember her tender manner, unassuming nature, extreme professionalism and her incredible knowledge in the area of health and wellbeing. When we lost Donna the entire Meaghers family were shook to their core. Her sudden passing reminded the team in Barrow Street just how important their work relationships truly are. More than colleagues but friends, the team in Barrow pulled together and helped each other through the tough days and continue to celebrate Donna’s life, although missing her every day we remember her with love and thanks for knowing such a special girl. This award is for Donna, always remembered here in Meaghers.” Ms O’Hagan told the Irish Pharmacy News that the management and wider team of Meaghers pharmacy could not be prouder of the Barrow street team on winning this award given the difficult times they have endured. Go Team Meaghers! “Their Barrow Street team came together through the toughest of times and helped and supported each other like the family that they are,” she said. “Each team member has their own individual strengths and passions but together they work incredibly hard to deliver excellence to the customers of Barrow Street every single day. The team deliver the Meaghers vision and represent their brand proudly. The special

brand of customer service provided by their team in Barrow Street is constantly recognised and applauded by their customers, it is a very special place to visit and the team is a very special team indeed. The core values of Meaghers are lived and breathed in Barrow Street where the customer comes first and the team work positively and proudly to give back to the community like the family they are. We are proud to have their team in Barrow street honoured with this award and we are delighted that they have been chosen as the leading pharmacy team in the market, go team Meaghers!!” These sentiments were echoed by Ms Oonagh O’Hagan, Managing Director of Meaghers Pharmacy Group. “The team in Barrow Street had an incredibly tough time last year with the really sad and tragic passing of Donna” she told IPN. “I have never seen a team pull together in such a time of despair so much. It has been really inspiring to watch them. Sometimes you get a really strong person on a team who leads it, and Kate is a really strong manager. But what has happened on that team is that you can really see how that team is made up by the sum of their parts. On some days, who you might think is the strongest person might be having a really, really tough day and the others get them through it and then on another day, it would be another person.” Ms O’Hagan continued: “I think over the last year, what they have achieved in terms of being able to tackle all the customer queries about everything has been amazing. There are still plenty of suppliers coming in asking for Donna, as well as many customers asking for her. They have been able to handle all of that in a professional manner, while being heartbroken, which has been incredible to watch. I am so proud of them. The results that they get in terms of retail sales, prescription numbers, everything is so impressive. They over-exceed in every single KPI we ever give them. I am really proud also of Kate, who is not so much a manager as a real leader. When the chips are down people shine and they have certainly shone.”

A Winning Team The team have gone from strength to strength and worked together throughout tough times to constantly improve and adapt to the changing landscape of community pharmacy. Some innovative strategies the team have employed include using social media to engage with the profile of their customer. The store is located in the Dublin Docklands and shares a building with the Google European headquarters. The

Leanne Fallon, Trainee Technician & Skincare Advisor, Trish Cahill, Trainee Technician & Healthcare Advisor, Kate Clarke, Supervising Managing Pharmacist, Lisa Coffey, Support Pharmacist and Elaine Southern, Health and Wellbeing Advisor


Irish Pharmacy Awards Winner of the QuintilesIMS Superintendent Pharmacist of the Year 2017

QuintilesIMS Superintendent Pharmacist of the Year 2017

Fergal O’Shea – Key Account Manger QuintilesIMS presents Award winner Eugene Renehan Meaghers Pharmacy Group with the QuintilesIMS Superintendent Pharmacist of the Year 2017 Award

Eugene Renehan on Leading from the Front Eugene Renehan graduated from Trinity College Dublin in 2005, completed his pre-registration year in Bhagwans Pharmacy in Ballinteer and registered as MPSI in 2006. Eugene joined the Meaghers family as a Support Pharmacist in May 2007. 96

The Meaghers family In the 10 years since that point he has become a vital part of the management team of a company which has more than doubled in size and developed a significant online presence. Mr Renehan has held key positions in the company such as, Managing Supervising Pharmacist, Group Dispensary Purchasing and Compliance Manager, Group Dispensary Business Manager and now Superintendent Pharmacist. Mr Renehan told the Irish Pharmacy News that he is delighted to have won the QuintilesIMS Superintendent Pharmacist of the Year Award for 2017. “I was very proud to have been selected for this Award,” Eugene said.

“It is a great honour. It is always nice to be recognised for the work you do. These Pharmacy Awards are very significant in terms of community Pharmacy” Mr Renehan has a passion for teaching and coaching other Pharmacists and has a keen interest in giving back to the profession, enhancing the role of the Pharmacist in the community and passing on the vital experience that he has acquired. Eugene has been a tutor Pharmacist since 2008 and helped design and implement the Meaghers Intern programme. He has mentored and trained a number of pharmacy graduate students for a 12-month period preparing them for their final registration exam. Since 2011 Mr Renehan has acted as Professional Registration Exam (PRE) Assessor in RCSI. His passion for working with the newest group of pharmacists led to his appointment to the RCSI National Pharmacy Internship Programme (NPIP) Advisory Group (2014/2015). He currently represents community pharmacists on the Steering Group of the Irish Institute of Pharmacy (IIOP) and is a Strategic Advisory Board member for the School of Pharmacy and Pharmaceutical Sciences in Trinity College Dublin. Team Work Mr Renehan oversees 14 other pharmacists in the group and encourages them to continually develop themselves. In his role of Superintendent Pharmacist, he is there to guide and educate the interns and Pharmacists. He acts as a central point for advice and to ensure the policies and procedures are being maintained and implemented. He represents the team to management and advocates on the part of the Pharmacist along with representing the company externally. “I have a team of 14, who I am privileged to lead,” Mr Renehan said. “I am there to provide them with support, but they also make my life easier with their hard work and dedication. It is impossible to make progress in a team environment if everyone isn’t working from the same page.” Mr Renehan understands patients’ needs when delivering healthcare in the community through: • Being a key driver in the overall business strategy in particular the healthcare strategy on an annual basis. Delivering the four key initiatives in 2016/17 targeting Obesity, Diabetes, Flu Vaccination and Mental Health, which are key areas of concern in the Irish population • Understanding the communities served by the pharmacies through regular surveys and workshops relating to healthcare and obtaining feedback through our shop and social media channels such as Snapchat. • Running the Pharmacist at the Counter initiative to ensure more patients are directly exposed to a Pharmacist consultation. Over 9,000 extra Pharmacist led consultations were carried out in Meaghers Pharmacies in 2016 as a result. As Superintendent, Mr Renehan has overall responsibility for the provision of pharmacy services in Meaghers. He is a key driver of the business and ensures that the correct framework is in place to providing excellent patient care.

Standard Operating Procedures (SOPs) are updated annually and contain best practice in delivering dispensing and consultation services. Mr Renehan has worked with local nursing homes to ensure Medication Usage Reviews are carried out on a regular basis for the patients in the homes. The MUR which they have designed took into account best practice in this area and was implemented in Mount Tabor nursing home. During recent HIQA inspections Meaghers were commended on this service and this has led the nursing home to become the HIQA reference nursing home for best practice in this area. Meaghers continue to update and improve this service in line with HIQA guidelines. Core values - Family, Community and Positivity Mr Renehan said “It is so important for the pharmacy to be there for their patients to treat them with the respect you would a family member to and to support them when they are going through a difficult period.” “In terms of the challenges that face community pharmacy over the coming years – further cuts by the HSE resulting in reduced income makes it harder to offer the services that patients need,” Mr Renehan said, “There is an increased challenge of keeping younger Pharmacists interested in the profession. Career prospects are being eroded by the significant cuts to pharmacy and younger Pharmacists are somewhat disillusioned by the profession they are practicing compared to the one they chose on their CAO forms. Pharmacies around the country are experiencing difficulties recruiting and retaining staff and in some areas relief cover is next to impossible to find. There is a further challenge of encouraging students to do pharmacy in the first place. Changes to the degree structure imposed upon the colleges now have the requirement to pay fees for their final year. A significant piece of work remains with regard to organising training places for students for their last two years of placement – failure to do this properly could lead to a disruption to the future supply of pharmacists or a reduction in the quality of student produced. Eugene said there are, however, a number of exciting opportunities on the horizon for pharmacy. “Pharmacy is beginning to get the recognition it has long deserved for its ability to help primary care,” he said. “Expansion of the vaccination services along with the expected approval of the nationwide minor ailments scheme will allow us to engage with the customer better and show the value of the community pharmacy. Pharmacy has a wealth of hardworking professionals eager to expand our paid services on behalf of the HSE. The introduction of a New Medicines or Medicine Use Review service have been shown to be effective in the UK and would bring about significant improvements in patient outcomes in Ireland. It remains to be seen if the government will have the appetite for these

developments. But we don’t have to wait for the HSE funding though to have an impact on our communities. Meaghers regularly seek out opportunities to give back to the community.” In Ireland and in particularly Dublin the plight of homelessness has reached chronic levels. Meaghers recently set up a collaboration with the Peter McVerry Trust. Eugene was integrally involved in the setting up of our winter campaign #Wrap4Homeless. In total, an amazing ¤25,600 was raised for the trust which will help give 5,688 people who have fallen into homelessness a bed for the night. “Recognition for the work Pharmacists do is important and these awards give a few of these hardworking Pharmacists a moment in the sun,” according to Area Manager for Meagher’s Group, Ms Joanne O’Hagan. “Eugene is a natural leader and influencer. Pharmacy has experienced a number of tough years and having Eugene in charge of the dispensary department has ensured that the HSE, FEMPI and other cuts have been negated as much as possible through expansion of services, increased compliance and increased visibility online. Our business development and innovation has been recognised nationally through us winning the Deloitte Best Managed Company on multiple occasions from 2015-2017. Internationally Meaghers have been recognised as an Irish Champion at the European Business Awards. Meaghers are delighted that Eugene has been named as QuintilesIMS Superintendent of the year, the award has recognised what we here in Meaghers already knew, the future of the pharmacy profession lies with pharmacists like Eugene, the entire Meaghers family are incredibly proud of Eugene and all he has achieved thus far in his career. Eugene is a man with incredible commercial acumen, the skills to drive the business forward in an innovative and strategic fashion while always staying true to the core values that are so important in a community Pharmacist.”

Kate Clarke, Managing Supervising Pharmacist in Meaghers Barrow Street with Eugene Renehan, QuintilesIMS Superintendent Pharmacist of the Year


Irish Pharmacy Awards Winner of the Unilever OTC Retailer of the Year Award 2017

Unilever OTC Retailer of the Year Award 2017

Unilever OTC Retailer of the Year 2017 Award Winners - Boots Ireland, receive their Award from Colm Dowling Pharmacy Customer Accounts Manager, Unilever. Caoimh McAuley & Bernadette Lavery - Ann Marie Brett & Kerry Murray - Boots Ireland

Boots secure OTC Retailer title Boots Ireland took home the prestigious and hotly contested Unilever OTC Retailer of the Year Award at the 2017 Irish Pharmacy Awards, after impressing the judges with their innovation in customer care and health promotion. Anne Marie Brett from Boots talks about what it is to win the award. 98

With Unileverâ&#x20AC;&#x2122;s ever expanding range of front of shop pharmacy products, this made them the ideal partner to campaign along-side IPN, helping us to find the best OTC retailer of the year. Customer purchases of OTC products have consistently risen, for many reasons. The convenience of treating a condition with an OTC product is appealing to the typically busy person, who seeks to avoid a lengthy and expensive GP visit in favour of meeting the demands of home and work. In addition, patients in the information age have an increased level of awareness about health. The over-the-counter market continues to thrive as manufacturers continue to think of new promotional and packaging ideas as the general public take a great interest in their own health and wellbeing. Pharmacies are increasingly witnessing heightened footfall as GP visits decrease.

Holistic Approach Customers always score Boots well for value and this is key for the team, as a brand. They regularly track performance on this metric. Boots healthcare score for value improved by over 6% in the last year alone. This reflects their efforts to ensure that they offer value to customers through promotional activity, pricing and through the advice colleagues give in store. Customers return to Boots in order take advantage of the value that their great promotion plan gives. In conjunction with their suppliers, Boots focus on taking a holistic approach to key events in customers lives throughout the year in an effort to ensure they have the right product offering at the right time.

Susan O'Dwyer, Superintendent Pharmacist, Boots Ireland Competition “Competition has become more intense as the OTC market in Ireland is evolves at fast pace. Pharmacies are working hard to improve the performance of their front of shop and OTC business as funding pressures are experienced by the prescription side of the business,” says Anne Marie Brett, former Senior Buying Manager - ROI Healthcare at Boots. “Pharmacies across the country have improved their customer facing offer by investing in the training of their key people along with seeking out retail expertise to help give a better customer experience. Store layouts, merchandising principles, promotional activity and breadth of offer have all become more sophisticated as pharmacies try to attract more customers. Grocers and discounters are also realising the opportunities available in categories such as footcare and GSL medicines. They are becoming increasingly competitive particularly in relation to factors such as pricing and convenience which are key to customers.” Research Over the last nine months, to acquire a better understanding of their customers, Boots have undertaken team key pieces of customer research, with customers telling staff that would like to see information regarding the best direction for them to take their healthcare.

For example, they have focused on “New Year New You” incorporating Weight Management and NRT as their customers look to the teams within Boots to support them as they embark on that journey to make a key change in their lives. Within that campaign their NRT proposition was market leading and was supported by the Stop for Good Pharmacy service which supports customers over that difficult first 12 weeks. Many Boots Healthcare Advisors are trained in this programme and have supported many of customers as they embark on this difficult journey. There are examples of this type of approach right across the year all of which have grown customer loyalty and therefore revenue and profit growth. Healthcare Advisors The Healthcare Advisors in store are key to success at Boots – everyday they have great conversations with customers supporting them through illness, finding solutions for everyday problems and giving great advice to help everybody feel good. Twice a year they support colleagues via a Healthcare Advisors Conference with comprehensive training on selected topics which is supported and delivered by suppliers. As part of their Healthcare customer strategy, Boots has focused on innovation and ensuring that they are leading on best in class launches across a broad range of NPD. This has been made possible by the support obtained from suppliers. Some of the successes have been:

In addition to this, Boots supports its colleagues via a Healthcare Advisors Conference with comprehensive training on selected topics, is supported and delivered by their suppliers.

Urostemol from Perrigo which was launched mid 2016 – the aim for Boots was to be number 1 in the market and they achieved this by utilising all of the channels at their disposal; clear display on incontinence builds, training from Perrigo at the Healthcare Advisors conference on incontinence as a condition, tagging in TV advertising and social media activity. The combination of the above activity has made a success of this launch and feedback from Perrigo indicates that Boots have claimed significant market share and are the number 1 retailer in the market.

“At Boots one of our core principles is customer first and colleagues at the heart of what we do”. By keeping this principle at front of mind and focusing on care when thinking about about our customers and colleagues we have had a great year in terms of our retail healthcare business,” adds Anne Marie.

Blue Iron from Blackrock Pharmacy which has grown Boots liquid iron supplements category. Blackrock have been supportive from a training and customers engagement point of view making Boots their number 1 retailer since launch in the ROI market and are 6 months ahead of initial forecasts.

This empowered pharmacists, OTC staff, as well as, most importantly, the customers themselves. The results were also immediate in terms of sales uplift as customers could better navigate the fixture from in front of the counter.

Get Well, Stay Well Boots Brand Products allow the team create that point of difference for their customers. They have launched innovative products such as Dual Defence, Beauty Beneath and the A-fib Monitor which have proved really popular with customers. “Our aim is to ensure our customers know how to get well and stay well. The advice and information we provide at the OTC counter is key to improving the health and wellbeing of our customers,” adds Anne Marie. “From an OTC perspective we are always striving to ensure customers are aware of all the solutions options they have to choose from – some of these solutions will be in the form of product intervention but some solutions will be hints and tips around lifestyle changes. Through our marketing campaigns we aim to ensure that this information is available to as wide an audience as possible. “In Boots our CSR policy is very important to us. We have provided over ¤1,000,000 to the Irish Cancer Society for Night Nurse care over the last 3 years. Our colleagues in stores are the back bone of how this money is raised through in store fund raising activity; Cake Sales, Fashion Shows etc. This partnership ensures that our colleagues are aware and mindful of customers and patients going through the cancer journey. We have additional services in store such as the Irish Cancer Society Pharmacist and Boots Cancer Beauty Advisor providing additional services to patients helping through the different stages of their illness. Boots teams actively participate in activities in the community with support cancer care in the community. “Our teams both in stores and the support office but customers first every day. All the decisions we make, the conversations we have, the links with our suppliers are driven by a desire to ensure that we provide the best care for our customers. It is this focus that has made us the most successful healthcare retailer on the Irish market. Customers choose us for the quality of conversation, the care they receive and the solutions we can provide. The customer comments we receive on a daily and weekly basis bear this out – it’s this feedback that provides us with the encouragement to keep doing what we do.” Winning the award Speaking to Irish Pharmacy News on their win she added, “It’s been great to win the Unilever OTC Retailer of the Year award. As a team in Boots we’re always focused on the customer – we use a lot of insight to understand what our customers are looking for. And we use that every day to try and come up with the right plans, to engage customers and colleagues in stores. We’ve also worked really hard on the training side of things, ensuring that our colleagues are set up to have great conversations with customers, no matter what conditions they present with.”


Irish Pharmacy Awards Winner of the MSD Innovation & Service Development (Chain) Award 2017

MSD Innovation & Service Development (Chain) Award 2017

Mick Phelan, Business Unit Director, MSD on stage presenting Louise Doherty, Systems Innovation Manager and Finn McCann, Head of IT, CarePlus Pharmacy Group the winning award MSD Innovation & Service Development (Chain) Award 2017

CarePlus Pharmacy get Smart in Innovation The winner of this yearâ&#x20AC;&#x2122;s MSD Innovation & Service Development (Chain) Award was the Careplus Pharmacy Group. speaks to IPN about their latest innovation driving the business forward. 100

Careplus firmly believe digital technology will undoubtedly reshape how customers interact with both their pharmacy and pharmacist. Focused on leading the way and driving significant changes in an area that sees a rapid rate of change and development, Careplus have been digitally proactive in their approach and come up with an 1st of its kind in Ireland, smart phone app. Offering a convenient prescription ordering service to customers, the app allows prescriptions to be photographed and additional notes to be made before it is sent to the customers local Careplus pharmacy. Once the order is received, an alert is sent to the customer when their prescription is ready for collection. Other features of the app include an information station, where customers can look up advice on a range of

health topics; a pharmacy locator, as well as other special offer information. These features will only continue to evolve and Careplus will look to add additional services in the coming months. Vision for the Future The last two years have seen CarePlus grow significantly, with the rollout of a franchisebased retail pharmacy promoting communitybased independence with a system and structure normally associated with larger multinational retail chains. The company operates 35 pharmacies and plans to open a further 30 this year. CarePlus CEO John Carroll comments that “Ireland’s Pharmacy sector has become a competitive one. As a group,” our focus is to empower our pharmacists and their employees to become best in class within their locality” At the heart of the CarePlus business philosophy is the brand embracing a hands on approach when it comes to digital strategy. A sentiment, newly appointed Commercial Director Niamh Lynch is keen to echo “Careplus Pharmacy has a clear strategic vision and its accelerated growth plans will deliver over 100 digitally focused Careplus Pharmacies by 2019 – With this focus and ambition, I am confident Careplus will become an iconic retailer in this space over the next couple of years”. “Since its inception, we strive to allow the community pharmacists we work with and technological advancements to not only enhance, but add value to their Pharmacy operations. It also enriches the relationships they foster with their patients and customers.” Finn McCann, Head of IT with CarePlus comments. In addition to the CarePlus TouchPlus ordering system a next generation business intelligence tool has been successfully launched – It has a unique interface, allowing the Pharmacist to visualise and analyse valuable data from their dispensary system and allow Pharmacy owners to pinpoint and address issues that impact on profit on a day to day basis.

what is a lengthy and tedious process of manually changing paper shelf edge labels and replacing it with customer service and sales driving activities. Both projects reflect how innovation in technology can enable the development of pharmacies and how they operate within their communities. Using such technologies allow Pharmacies to drive in the procurement of ethical, over the counter and front of shop product. “As we build the CarePlus brand, we are attentive to the needs of those whose pharmacy of choice within their community is CarePlus. Vital to a customer is of course the relationship they have with the pharmacist and front of store team, but also offering convenient solutions that make their daily lives all the easier is something we pride ourselves on. The order feature gives customers the freedom to send the prescription from their phone and the face to face interaction between them and the CarePlus pharmacy team is maintained and improved upon, whilst waiting periods diminish and the customer experience is vastly improved – which is what the CarePlus brand is all about” Louise Doherty, Systems Innovation Manager adds, “With Ireland having the highest penetration of smartphone users in Europe; customers and patients are becoming more dependent on their devices every day. We acknowledge the importance of the smartphone world to our business; not just as it stands now, but in preparing us for the future. “Pharmacies need to look at better ways of communicating with our customers and being

digitally proactive attracts new customer’s opportunities, providing convenience for the customer are key components to the success of the App with our CarePlus members” “With a rising volume of price changes, pharmacy retailers need to have a ticketing strategy to keep up with the pace and become sophisticated in the way they manage product and price changes” “Electronic shelf edge labelling and the app assist with operational efficiencies, waste reduction, and customer engagement. Winning the Award After accepting the award on the night, Finn McCann said, “We’re delighted to have won the Award, we think it’s a terrific endorsement of the work that we’ve been doing over the years, in innovation and in helping our Careplus pharmacies become more proactive in the area of technology, and the digital space in general. The app reduces waiting times, and also allows pharmacists to prepare their prescriptions during off-peak periods.” Sponsor MSD has also long been a Community Pharmacy supporter and their partnership with this award demonstrates their dedication to the transformation of the way healthcare is delivered and support of innovation and advancements in the delivery of better patient outcomes.

Enhancing Customer Service Delivering an excellent customer service is another key part of Careplus’ differentiation strategy and enabling their stores to be as productive with their time as possible, allowing them direct their attention to customers and patient care. An extra innovative tool has been developed to demonstrate this focus. Teaming up with Market Hub Technologies to become the first retail chain in Ireland to introduce digital shelf labelling, the new resource helps Careplus Community Pharmacists have the ability to manage their products and pricing digitally with on-shelf pricing linked directly to their POS system. The electronic shelf edge labels aim to significantly improve the store environment while ensuring price accuracy for customers. In addition, they drive increased efficiency and profitability by removing time spent in

Mick Phelan, Business Unit Director, MSD with Louise Doherty, Systems Innovation Manager and Finn McCann, Head of IT, CarePlus Pharmacy Group


Irish Pharmacy Awards Winner of the Cell Nutrition Business Development (Chain) Award 2017

Cell Nutrition Business Development (Chain) Award 2017

Sarah Leadbetter, Aisling Cahill and Sarah Sambrookes, Allcare Pharmacy Group receive the Cell Nutrition Business Development (Chain) Award 2017 from Nicola Abbot, CEO, Cellnutrition

Wellness campaign does the trick for Allcare The winner of the Cellnutrition Business Development Chain Award was Allcare Pharmacies. The chain took away the Award after its wellness campaign demonstrated innovation and results within an increasingly competitive landscape. 102

The Cellnutrition Business Development (Chain) Award serves to recognise those who have displayed success in terms of sales, training, recruitment, customer service, product development or other areas of business development. In September 2016, ‘wellness at Allcare’ was launched in three Allcare stores. The locations that were chosen for the trial were unique in the fact that each had a totally different demographic, age profile, level of disposable income and level of education. The objectives were to increase sales/margin, identifying new products, as well as training their pharmacy teams to deliver the above. Challenges Sarah Sambrookes explains, “A key challenge for Allcare Pharmacy Group was to take a stagnant declining vitamins and minerals category and put a plan in place for 2016/2017

to grow this category in terms of sales and margin. “Our challenges included re-engaging with our staff, retraining on existing product ranges and introducing new ranges to the category. We had to bring our staff on the Wellness journey and explain our new way of viewing this category and the growth opportunity. “On a customer level, we wanted to enhance the shopping experience and make it easier for the customer to self-select a wellness product according to their needs whilst expert advice was on hand. Our existing customer base were primarily prescription customers but we wanted to encourage a new set of customers to shop within our pharmacies. The new customers we wanted to attract were the health conscious ‘living well’ that may have a health services or prescription need or may well have family members at a different life stage. “Within the pharmacy industry, our aim was to ensure that Allcare Pharmacy Group had a unique selling point in a category that had huge growth potential.” New Initiative The main objective of the initiative was to roll-out the new wellness category into selected pharmacies. The objectives were clear, increasing sales/margin, identifying new products ranging and training/supporting our pharmacy teams to deliver the above. The project plan was an extremely important tool in the planning. Keeping tight deadlines ensured that each stakeholder delivered on time and the project roll-out was smooth. The team were also using the trial as a learning curve for improvements for the 2nd phase in 2017. Between the roll-out in September 2016 and the roll-out 2017, there are 160 new products on the wellness planograms. Training has been rolled out in March 2016 to support these new ranges with an emphasis on the margin opportunity. The trial was a success, and over a four-month pilot from September to December 2016, sales in Wellness/VMS grew by 34.1% on average in three trial stores while the group grew by 6.3% “In September 2016, ‘wellness at Allcare’ was launched in our three pilot stores,” continues Sam. “The locations that were chosen for the trial were unique in the fact that each had a totally different demographic, age profile, level of disposable income and level of education. The success of the trial in these pharmacies would determine the final outcome of the business case for the roll-out in early 2017 in other company owned pharmacies. The trial was a success and a further investment by Allcare has seen the initiative completed in 9 more pharmacies by mid-March 2017.

three trial stores in September 2016. Managing pharmacists and front of counter Managers attended. We have planned a second session for 9 stores that rolled out Wellness on the 10th April 2017. “During March/April 2017, our staff are attending bespoke training sessions on four new brands that we implemented onto our planograms recently including Quest, Proven probiotics, kinetica and Nature’s Aid. We are also working closely with suppliers to follow up with short informative session’s in-store to support staff that may not have been able to attend. “We have also engaged and encouraged our pharmacists to leverage ‘Wellness’ products through the dispensary trade. We have a dedicated section which allows our pharmacists to link and upsell from prescriptions. “All of the above is in tandem with our health promotion calendar which centres around healthy weight loss, smoking cessation, cholesterol screening, and full health checks. During the pilot in our three Allcare stores, we asked an independent research company to talk to Allcare customers and ask them about their attitudes to Wellness. Confidence in Pharmacy In the last five years, the interest in healthy lifestyle/ wellness and all the products and services that go with it has grown exponentially, as a visit to your local supermarket will tell you. Now estimated to be worth more than $3 trillion worldwide, in 2002, pharmacy owned just over 16% of that market. Today, it is estimated that less than 5% of wellness spend resides with pharmacies (Euromonitor, December 2015) We focused on Vitamin, Mineral and Health Supplement (VMHS) products and the following were some of the highlights of the research: • 69% of customers claimed to have taken VMHS products in the last 12 months. This rose to 78% in the 18-34 age group • 65% said they bought their VMHS products in a pharmacy, with 16% using health shops and 18% supermarkets to source their product • When asked what factor was of most help in buying VMHS products, by far the most important to customers was well trained staff at 52%, followed by sections in store clearly laid out by brand at 19% and sections in store clearly laid out by condition (e.g. heart health, arthritis etc.) at 13%

• 74% claim that they trust the VMHS products recommended by pharmacy staff and 3 in 5 claim they prefer purchasing in pharmacy because they will get the right advice. • Interestingly, Wellness purchases do not appear to be overly price sensitive with 47% of respondents claiming they were willing to spend more on VMHS purchased from a pharmacy and 33% were neutral on the matter. The research was carried out on a base of 487 Allcare customers responding. Allcare franchisees and managing pharmacists had access to deeper and broader range of information on Wellness and other relevant topics from the customer research. Winning the Award Sam, who accepted the Award, said, speaking to Irish Pharmacy News, “We’re very proud to have won this Award, and to have developed this project last year in and around wellness, and to have implemented it in 12 stores. We’re going have further roll out across the Allcare Pharmacy Group around Ireland.” Ms Sambrooks also took the opportunity to acknowledge sponsor Cellnutrition and the value of having a big industry retail name attached to the award. “Strong retail brands, especially newer ranges like Cellnutrition, help keep our customers coming back. Brands like this with strong clinical efficiency allow customers to get something they cannot get outside pharmacies” Crediting the hard work done by the team at Allcare, and noting the success of the initiative, for both customers and Allcare, Sambrooks comments “The initiative was to implement a new strategy around the decline in VMS catagrory in our pharmacies, and to provide a new shopping experience for our customers, to find exciting new ranges, and also for us as a pharmacy group to make a margin out of it.” “I’d like to acknowledge the members of our team, who helped to engage customers in the experience of our new wellness strategy in our pharmacies.”

“We held focus groups for our pharmacists at the start of the project to capture their thoughts on wellness and how we could focus on the category that would add value to their customers. Wellness Training “Each of our stores received a comprehensive “Wellness” training folder for all staff members. This was provided to enable our pharmacists and pharmacy team for product training. It a reference tool for all ‘Wellness’ products. We launched this at a session we held for our

Marie McCarthy, Business Manager, Allcare Pharmacy Group


Irish Pharmacy Awards Winner of the RB Nurofen for Children Baby Health Pharmacy of the Year 2017

RB Nurofen for Children Baby Health Pharmacy of the Year 2017

Pharmcist Sheena Mitchell, Milltown totalhealth Pharmacy

Wonderous Sheena makes it ‘Two in a Row’ Sheena Mitchell, Pharmacist at Milltown totalhealth Pharmacy scooped the RB Nurofen for Children Baby Health Pharmacy of the Year Award for second consecutive year at the 2017 Irish Pharmacy Awards. 104

The Pharmacy Expanding on their success from last year, the Pharmacy’s WonderBaba blog has continued to have a huge impact on their presence within the local and national baby market. Their online shop www.milltownpharmacy. ie has continued to grow, and approximately 95% of their orders are related to the baby and child market. The blog also receives 10,000 hits per month, and engages with a community of 11,000 Facebook followers, who have accredited the page with a 5 star rating. Milltown totalhealth Pharmacy is an independently owned Pharmacy leading community health within the Dublin 6 area for 23 years. Since Ms Mitchell acquired the Pharmacy business in 2008 it has developed in many specific areas including within the

store itself, serving the healthcare needs of the local community and also online to the Mother & Baby community predominantly via Sheena’s award winning WonderBaba Blog. The Blog WonderBaba provides easily understood professional health advice to parents from a mother and Pharmacist. The success of the WonderBaba blog initially led to the development of an Ecommerce website for the Pharmacy highlighting reviewed products from the blog. In recent months development has started on transforming the blog into a complete accessible and convenient healthcare destination for parents and babies where they can seek advice, shop and enjoy the many resources and tools on offer. “Originally, I started the blog right after I had my own children,” Ms Mitchell explains.” The reason it came to fruition was because I identified a lot of dangerous information on the internet between mums trying to advise each other, and I didn’t really feel that it was an appropriate place for mums to seek such advice online in Ireland. “I set up the blog to provide a safe environment for parents to seek advice when they’re most vulnerable, which generally tends to be when you have a young baby, and when you’re sitting at home and you have no access to healthcare.” The service provides a 24 hour a day service to prevent parents from feeling isolated and

unsupported in modern times. WonderBaba is achieving its goal of delivering one to one confidential advice and providing a platform for parents to order products and have them delivered to their door. It is a complete service which maintains the personal feel of a bricks and mortar Pharmacy. Ms Mitchell continues, “As Pharmacists we’re masters of being a jack-of-all trades. You have to be so adaptable, because you never know in community Pharmacy what’s going to come through the door. I think that really the backbone of community Pharmacy would be; being able to manage diverse and unique situations. However, I think that everyone – not just in Pharmacy – has a lot of personal interests, and with that, you can be passionate about it and you can work harder to provide a more excellent level of service, because you’re personally invested. “WonderBaba has continued to have a huge impact on Milltown totalhealth Pharmacy’s presence within the local and national baby market which is pretty remarkable for a small community Pharmacy. Their online shop has continued to grow where approximately 95% of all orders are related to the baby and child market. This achievement is the driving force of development of the improved WonderBaba site. Expert advice There is no doubt that parents online are now better informed in relation to their children’s

Nurofen for Children Baby Health Pharmacy of the Year 2017 winner Sheena Mitchell - Milltown totalhealth Pharmacy, Milltown receiving her award from Adrian McCourt – Senior National Account Manager RB

health. The power of trusted advice is always easily identifiable though the response to the blogs and product reviews. Ms Mitchell has answered 1000’s and 1000’s of one to one queries which takes dedication and commitment of an extraordinary level. She also sits on the “mummypages” panel as their expert Pharmacist and has recorded several baby information videos with them for “mummypages” TV. She has also been asked, to speak professionally on several occasions highlighting the fact that herself, WonderBaba and Milltown totalhealth Pharmacy have together carved an expertise that will only continue to get stronger as time passes by. The success of the Wonderbaba blog, the website and Facebook forums that have built up in response to providing professional health advice to parents online, at work or in their homes has been a huge team effort. The WonderBaba brand is a team of hard working, diligent and professional individuals who deliver the service on many different levels from Ms Mitchell as the online Pharmacist to the team in the Pharmacy managing all in-store operations. This is never more evident that at the WonderBaba – Milltown totalhealth


Irish Pharmacy Awards Winner of the RB Nurofen for Children Baby Health Pharmacy of the Year 2017 Pharmacy stand at Irelands Pregnancy and Baby Fair where all team members adapted to providing a unique new service in a very new environment! The Nurofen for Children Baby Health Pharmacy of the Year Award recognises Ms Mitchell’s exceptional commitment to helping new parents and young families. On winning the Award for a second consecutive year she says, “We’re really delighted. In the last year, we have achieved a lot and the blog has continued to expand and grow.” “Behind the scenes there’s an awful lot more development going on. We’re about to launch – it’s still in the developing stage at the moment – a new WonderBaba website, which doesn’t just encompass a blog as such. It has the blog, obviously, which is the main feature, but it’s going to be a more one-stop shop for advice and service, with resources and links to other healthcare professionals, and guidance.” The Ethos of WonderBaba “Trust is absolutely critical,” Ms Mitchell says. “That is the difference between blogging as a parent and blogging as a healthcare professional, because obviously I’m indemnity insured as a pharmacist to give advice online, and with my PSI code of conduct I always have to act in a professional manner, and I find that integrity critical to the blog. “So, while I will talk on a personal level, there’s always quite a bit of distance, for example I’ll talk about in the blog I might give an example of myself using a product, in the context of a conversation similar to one that you’d have in the pharmacy. I imagine the kind of conversations that I would have with parents in the pharmacy, and use that register and conversational tone in the blog. And that’s the key: that’s where the trust is coming from. I have found that a lot of the demographic that ask me questions would be to a demographic that are new to parenting, and new to healthcare in general, so they’re coming from zero knowledge. And obviously it’s hard to tell online, but a lot of them are lacking in education about healthcare, and many of the questions you get are quite basic. So, it’s good that they have somewhere to ask them. “I think social media has become a much bigger part of our method of communication than I certainly ever thought, and while in a way I’d almost be quick to dismiss it, in terms of delivering a public health message, it’s invaluable. Because that’s the way that the parents of today, or the patients of today are communicating. That’s what they’re reading, that’s where they’re accessing their information. So, if we don’t modernise and get on board with that, and manage to do that in a professional manner, we won’t reach them. You can use it to relate to people in a very positive way, and promote a very strong public health message.” Healthcare with Heart Ms Mitchell tells us, “Milltown totalhealth Pharmacy are honoured previous winners


WonderBaba on display

of this award and the team have worked tirelessly to continue to develop and deliver the innovative service. With thousands of queries being answered every year at no cost to parents, at a time when the health of their families is of utmost importance, it is essential that this service be provided. Milltown totalhealth Pharmacy is constantly evolving and adapting the service in response to the needs of their patients and customers. The new development of the WonderBaba website will transform it from a home-made blog site into a one-stop caring Pharmacy service is something that will lead the way in Pharmacy and ensure the Pharmacists remain at the helm of community health.

“We care for our online customers with the same sensitive nature professional attitude that they find in store. Indeed many of our ‘online’ customers come to thank us in store and when we exhibited at Irelands Pregnancy and Baby fair, as they are so excited to put a face behind the persona.”

“WonderBaba strives to provide ‘healthcare with heart’ which is something that only a community pharmacy can achieve. The vision of being able to deliver this passionately to the modern online communities of our society is what makes us unique. We use our platform for the good of the profession but also for the good of the many charitable organisations that we have grown relationships with on the way.

“There is no other team who are more committed to providing parents a convenient and accessible healthcare service which they can access from their phones, tablets, laptops or PC’s. Our customers know we care and that is why they return for continued personal parenting support and advice.”

“The Milltown totalhealth Pharmacy team are a team of people of wonderful people who support the WonderBaba brand and share Ms Mitchell’s passion for delivering a professional healthcare service in a new and exciting way. The team embrace the changing environment they work in from in store, to online to now exhibiting at baby fairs and shows in front of 15000 parents each time!


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Irish Pharmacy Awards Winner of the Excellence in Diabetes Management Award 2017 HOSPITAL PROFESSIONAL NEWS IRELAND

Excellence in Diabetes Management Award 2017

Pharmacist Paul Cunningham, Cunningham's Pharmacy

Paul delivers success in Diabetes care As Ireland faces an increasing diabetes burden, the role of the community pharmacist is crucial in helping to tackle the issue. Here, Paul Cunningham, Cunningham’s Pharmacy Athlone and winner of the HPN Excellence in Diabetes Management Award 2017 discusses why he focuses on this aspect of health promotion. 108

First and foremost, Paul Cunningham, Pharmacist and owner of Cunningham’s Pharmacy in Athlone, is someone who has lived with Type 1 Diabetes for over 20 years - having been diagnosed with diabetes a couple of weeks before he began studying diabetes as part of his Pharmacy course in College. Paul has two pharmacies in Athlone, with the one he actively works in of average size in a suburban Retail Centre opposite Athlone IT. “Like every Pharmacy we have all ages and backgrounds visiting our store together with a transient student population,” he explains. Paul qualified as a pharmacist from Trinity College in 1997.While in college, he took part-time jobs in Donnybrook Pharmacy and spent a summer working for Matt O’Flaherty’s Pharmacy , Shop Street Galway. His first job post-graduation was working for Aileen Goods Pharmacy, before moving to

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Irish Pharmacy Awards Winner of the Excellence in Diabetes Management Award 2017 Athlone in 1999 where he managed McSharry’s Pharmacy, Golden Island. He continues, “In 2002, with my brother Enda, we opened a Pharmacy on the Dublin Road, Athlone which I have managed and developed ever since. In 2007 I set up a second store in Monksland on the Roscommon side of Athlone and subsequently have taken over the running of both stores as Enda set up his own Pharmacy in Galway. “I am a Community Pharmacist to my core. I have never worked anywhere else and love “the cut and thrust” of retail life married to the very real difference you can make to people’s lives in the community.” Describing some of the innovations available with the Pharmacy he says, “Many years ago I installed ipads at our tills to avail of the many health related apps available on them. I did not want to be a pharmacy that spoofed customers. The information we give our customers is accurate and we use these ipads to reaffirm that with the patient often printing off useful articles or emailing them relevant links on whatever their health query is.

Pharmacist Paul Cunningham, Cunningham's Pharmacy

“We have a Text and Collect system in operation which is a win for us as it allows us to organize our dispensary’s prescription workload and more importantly for our patient as their medication is ready for them when they arrive.

“We stock as many replacement glucometers as we can get our hands on and equally aim to always keep diabetes diaries in stock. Thankfully the need for recording results in diaries is diminished with the advent of so many good Diabetes apps. I keep as much diabetes literature in store as I can and wherever I can refer someone with diabetes, to assist their care, I do so.”

Diabetes Community Care

Diabetes Diagnosis

“Last year our shop sponsored the Midland Diabetes Ireland’s branch Diabetes talk in Athlone .In previous years I have given talks to the Athlone Diabetes branch on my own experiences with diabetes and new treatments. In 2011 I ran the Dublin City Marathon, the Athlone 3/4 marathon and two half marathons to prove to myself that it could be done and raised over ¤1000 for Diabetes Ireland in the process.

Being diagnosed with Diabetes can be a very daunting and scary place, Paul reflects. “I remember well over 20 years ago facing a list of intimidating complications and fearing what the future held for me. Three weeks after being diagnosed with diabetes I studied the condition as part of my college course. So from day one I was hooked on this condition that can threaten so many organs in your body.

“When I was newly diagnosed with diabetes and a Pharmacy student I was amazed by how confusing many pharmacies seemed to find the Blood Glucose testing world. It was common place for the pharmacist not to be sure which lancet went with each lancing device and so on. My number one priority in my Pharmacy was ensuring all staff were familiar with all diabetes testing equipment and medication. On a basic supply level when the diabetes customer comes in we aim to have what they are looking for and know what it is. That is a given. I wouldn’t fancy being without my insulin and I don’t expect our customers to be either. “When somebody comes to our store newly diagnosed I will endeavour to engage with them for as long as time permits. I will listen to their fears, help them with any queries they may have. I often find with Type 1 diabetes telling them I have the condition over 20 years and have no complications is a big help. I will set them up on a LTI card and, once done promptly, we can loan them their medications until the card comes through. Often they may not have questions they will think of there and then so I will give them my mobile to contact me at any time if they so need. Any device or gadget that may be useful to the diabetic customer I aim to stock it. I myself am a recent convert to the Freestyle Libre sensor and went to great lengths to find something that would protect it while I played soccer. An Italian company and a device called the POD solved this.


“My aim as a pharmacist and Type 1 diabetic is to help ease the transition from not having to worry about blood sugars to the daily toll of doing so for people. I am a firm believer that diabetes, in a funny kind of way, can be a force for positivity in people lives as it makes us have a look at our lifestyle choices when otherwise we possibly would not. I like to consider my store as a Resource Centre for people with diabetes. I try to keep many books on the condition in store which I lend out to people as well as keeping up to date with any innovative products on the market from the Exactech glucometer pen, back in the day, to the Freestyle Libre Sensor of today. I am in a position where I try most things that come out (within reason!) and can report back on their effectiveness to customers coming in. To be honest my position is not one of what can I sell to this person but one of what positive contribution can I make to their Diabetes Care. Over the last year my interest in diabetes has been re-awoken due to the many innovative diabetes products coming onto the market. People with diabetes have never had it so good. From apps that will calculate bolus doses and motivate you - to glucometers that will sync with apps. “Not to mention a whole new sway of Insulins and new medications recently out on the market. Since my own diagnosis I have often been frustrated by the focus on medication and testing devices in Diabetes Research. While these obviously have their place I would be of

the opinion that it is one thing to know what to do whereas it is a different thing entirely to actually do it. I would like to see more investment in the motivation and Mental Health of people with Diabetes. You have two choices with diabetes. You can embrace it or stick your head in the sand. Inevitably the guy with his head in the sand is going to cost the state much more in the long run. At the recent Diabetes Conference in Croke Park, Professor Jim Lucey Medical Director at St. Patrick’s Mental Health Services made this point very well. “In his opinion there is no ”Health without Mental Health”. GP’s and Diabetes Clinics have continual struggles getting people with Diabetes to make appointments. No health professional has the access Pharmacists have to people with diabetes. We observe eager, scared newly diagnosed Type 1 and Type 2 Diabetics become nonchalant and “head in the sand” patients on a continual basis. This is something I would like to explore going forward. “Having the conversation, keeping it positive and keeping them motivated in the pharmacy setting or directing them to existing services that could help them. Over the years I have had Diabetes Ireland in store with me as well as various Glucometer testing days. I have always done diabetes screening in store. “Typically when someone comes into the Pharmacy just after being diagnosed with diabetes feeling their lives have shuddered to a stop I delight in telling them that diabetes has had a positive affect on my life. That I have ran a marathon with the condition and how it has never held me back. When more established diabetics are struggling with their control I understand that too because I have been that soldier. No two people are the same and this rings true for diabetes more than for any other condition. “Pharmacy is a completely underutilised tool in the war on diabetes. GP’s struggle to get their diabetic patients meet their twice a year appointments and yet we have highly qualified health professionals who meet diabetics once a month, and often more, whose contributions are not, in my opinion, properly considered. Pharmacy could definitely have a Diabetes Educator and motivational role to play going forward and I look forward to seeing this develop in time.”

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Irish Pharmacy Awards Winner of the iMed Community Pharmacy Technicianof the Year 2017

iMed Community Pharmacy Technician of the Year 2017

iMed Community Pharmacy Technician of the Year 2017 Winner, Aisling Devane - Ballisodare Pharmacy, Sligo with Patrick Roche - iMed Country Director

Raising the Profile of Technicians The winner of this yearâ&#x20AC;&#x2122;s iMED Community Pharmacy Technician of the year was Aisling Devane. Devaneâ&#x20AC;&#x2122;s dedication and diligence to enhancing the role of community pharmacy technicians is what caught the eye of the judges. 112

By ensuring Ballisodare Pharmacy runs seamlessly from day to day, allowing Pharmacists to be left with time to perform other duties such as flu vaccinations, weight management clinics, smoking cessation clinics, cholesterol testing, BP testing, Midazolam training for Care assistants, diabetes managements, skin assessments, urine analysis etc. Devane illustrates the importance of the Pharmacy Technician role. Ensuring the most vulnerable in society receives the best form of healthcare possible, is paramount to practices at Ballisodare Pharmacy. In order to do this a seamless structure is in place and Aisling is imperative to the upkeep of this structure. Having worked in the Pharmacy for the past 8 years Aisling has continued to improve

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Irish Pharmacy Awards Winner of the iMed Community Pharmacy Technicianof the Year 2017

get access to all the patient information in timely fashion. Her involvment in the procurement of medicines within the dispensary, always ensures High Tec medicines as well as unlicenced medicines are ordered in a timely fashion and the patient is contacted once medicines are received by the Pharmacy. Back Row: Enda Lannon (Pharmacist/Owner) Michelle Dempsey (Pharmacist) Colin Lannon (Pharmacist. Front Row: Grainne Regan - works in SGH now, Aisling Devane (Pharmacy Technician), Ann Flatley (Shop Assistant)

procedures and protocols time and time again to ensure the fluent functioning of the Pharmacy. Ballisodare Pharmacy is an extremely busy Pharmacy. As well as caring for the community, Owner Enda Lannnon and the team also care for seven HSE care homes for adults living with disabilities; one of which accommodates 150 patients. Speaking about Devane, Owner Enda comments “Aisling conducts herself in a very professional manner, always being very conscience about patient privacy. She is a very approachable individual and her efficiency and attention to detail is what makes Ballisodare Pharmacy an outstanding Pharmacy,” Lead Pharmacy Technician at Ballisodare Pharmacy, Devane has worked as a technician for the past seven years although only finished her technician's course in 2015. Her potential was quickly recognized by the superintendent pharmacy and she was quickly promoted from OTC to dispensary staff. “Aisling is a very bright lady and learned tasks quickly to be completed within the dispensary”. Devane has always endeavoured to care for people. Starting off studying nursing, then training to be a dental technician, finally she became a Pharmacy Technician. Excelling while undertaking the pharmacy technician course, she continually maintained high grades throughout the two year course. She also regularly attends accredited IPU, CPD'S for Pharmacy Technicians and well as reads pharmacy material such as the IPN, Irish Pharmacist and The IPU Review.


Customers often attend our pharmacy before going to their GP if they have a wound that needs attention. Following examination from the Pharmacist, Devane would regularly dress patient wounds and her training as a nurse in invaluable to fulfill this service. Compression hosiery is often required by customers and a made to measure service is offered when required; measuring the patient according to sizes and ordering the stockings in turn. Improving Procedures Devane also displays leadership qualities and is dedicated to the training and development of junior staff members to ensure customers receive the best possible care “Aisling is a very organized individual and carries out work to a superior standard. She has implemented templates in relation to Care homes. Dates on these templates indicate as to when requisitions form care homes are due, when orders should be processed and when orders would be deliver thus providing a seamless working structure in our Pharmacy. She also oversees all dosset pack patients and provides the same seamless approach via these templates and is conscientious about explaining medication to patients and ensuring they are fully aware of what their medication is to be used for and directions for use” Recently Devane changed the way in which file patient’s records were filed providing each individual with a clear sleeve thus making it much easier for the pharmacist to

She has also introduced templates for requisitions to Care homes and Dosset Pack patients which in turn has relieved the pressure on Pharmacists who may have overlooked unforeseen work that has to be carried out. The pharmacy is very busy serving the community on a day to day basis and the structure implemented in relation to care homes and dosset pack patient has been invaluable to the advance fulfilment of work. Winning the Award On winning the Award Devane said, “I am definitely in shock, definitely didn’t expect to get it! It means a lot! It’s really nice to be recognised” she said, speaking to Irish Pharmacy News upon receiving the Award.” She also acknowledged the hard work done in Ballisodare Pharmacy, and noted the importance that community pharmacy has to patients’ lives. “We have a great team at Ballisodare Pharmacy. We deal with customers on a day-to-day basis with various medical problems, and we try to get our customers to leave with satisfaction, and also to make a little bit of a difference in a person’s life.” Owner of Ballisodare Pharmacy Enda concludes, “Aisling thoroughly deserves the title of iMed Community Pharmacy Technician of the Year as her work ethic is nothing short of extraordinary. Aisling is integral to the seamless running of our Pharmacy and is one of the reasons why our Pharmacy has been so popular with the community of Sligo. Aisling is extremely efficient and is always looking for new ways to improve the functioning of the Pharmacy. Customers are extremely grateful for the dedication and care given to them as seen in enclosed testimonials. We acknowledge how lucky we are to have Aisling as our technician and hope we will have more years of improved excellence in patient care.”

News Accord Healthcare Launch Hi Tech Resource for Pharmacists Accord Healthcare has launched a new Hi Tech Resource to pharmacies across the country from August. “We have developed a handy reference folder for pharmacists, which explains more about the Hi Tech scheme and each of our products. The folder which we believe will sit on pharmacist’s desks will prove to be quite a helpful reference for them. Providing this guide for customers is another way we in Accord hope to build on our commitment to be the Preferred Partner of pharmacists across the country,” Mr O’Brien added.

As the generic Hi Tech product is priced 60% below the branded product, when pharmacists dispense items from the Accord Hi Tech portfolio, they are not only helping to provide a quality treatment for patients, but they are also helping the state to make considerable savings, which in turn allows access to new medicines, allowing patients access to treatments they so vitally require.

Accord representatives will be sharing copies of the Accord Hi Tech Resource from August. If you would like to receive a copy you can request it from your Accord Representative or call the office in Cork on 021-461 90 40. For further information contact: Marguerite Tierney, Accord Healthcare: Marguerite_Tierney@ or call 021 4619040.

Accord Healthcare recognises the increased demand for prescription drugs and new treatments, which means there is an ongoing need to deliver meaningful value for money to the state. With this in mind, Accord have developed a wide ranging portfolio of generic Hi Tech medicines, covering several therapeutic areas, such as Oncology, Neutropenia and Immunosuppression to name but a few, which the company will continue to add to in the coming months and years.

Padraic O Brien, Accord Healthcare, Head of Commercial Speaking from the company’s headquarters in Cork, Padraic O’Brien, Accord Head of Commercial said, “With our combined Accord and Actavis portfolio we now boast one of the widest Hi Tech portfolios of any generic supplier on the Irish market, which we are extremely proud of.




















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Back-to-School Every September, teens and children, naturally more susceptible to germs than adults thanks to their less mature immune systems, are suddenly thrown into close contact situations with dozens of other young people with equally immature immune systems, many actively encouraging the spread of germs through the practice of imperfect hygiene habits. This is why any parent with a child over five knows that a return to school is more often than not accompanied by a return to illness. In fact, over two thirds of parents report their children sick within the first month of the new school year. Most of the ailments are unavoidable but insignificant, and can be treated easily by consulting with a pharmacist and through OTC medication. As Dublin community pharmacist Bernard Duggan points out: "There are always minor ailments that you don't need to bring your child to the GP for. You're not going to be able to completely stop these from occurring, but there are small steps you can take." Colds and Flu The average child suffers eight to ten colds a year, which makes it by far the most frequently back-to-school illness. It's symptoms, however, can often be alleviated without medication, by simple recommendations like consuming hot drinks and other fluids, and getting plenty of rest in a warm comfortable bed. Exercise caution when recommending medication to alleviate cold and flu symptoms and pay particular attention to the child's weight and age when calculating the dosage of, for instance, children's ibuprofen or aspirin. Stress the importance of not going beyond the recommended dosage to the parents, and under no circumstances allow them to give adult medication to their child. Aspirin is particularly inadvisable for under 16s, as it has links to Reye's Syndrome. The same caution should also be observed when selling liquid medicine, for instance cough bottle, ensuring a correct dosage based on the age and weight of the child. It might be worth recommending a medication syringe over a household spoon to ensure that the child will get the exact amount prescribed,


rather than too much or too little. (While not too many babies will be attending school, it is worth noting that pharmacists should discourage parents from putting liquid medication into a baby's bottle, as it often leads to them not finishing their dosage). Preventative measures can also be suggested to hopefully preclude a child's chances of developing a cold or flu. Getting the flu vaccination, for instance, is vitally important. If a child is a very frequent sufferer of colds, you might suggest that their parents multi-vitamins or a herbal supplement to boost their immune system. Zinc, meanwhile, has been shown to shorten the length of the common cold, and Ginseng is useful in the aftermath of a cold, in that it has been shown to relieve this fatigue and help to speed up someone's recovery Prescriptions for Children It goes without saying that a pharmacist must, to ensure the safety and appropriateness of a patient's medication, exercise their independent judgement

when dispensing a prescription. In the case of children's prescriptions, this judgement is particularly vital, as children are especially susceptible to dosing errors and are much more likely to suffer an ADR (adverse drug reaction). Common prescription paediatric drugs, meanwhile, can often be found wanting when it comes to details on their labelling. First and foremost, it should be established that the child's details on the prescription are correct. The pharmacist should then make efforts determine that the medication prescribed is correct. For instance, is the dosage too high based on the age and weight of the sufferer? Have antibiotics been prescribed for a condition where they will have virtually no positive effect? If the prescriber has not already written the age of the child on the prescription, the exact date of birth must be obtained from the prescriber and written on the prescription before the transaction can go ahead. The pharmacist should also dialogue with the GP or practitioner to

establish if indeed an error has been made on the prescription. If not already known from the patient's medical records, it should be endeavoured to establish if the patient has any known allergies or has experienced any adverse drug reactions in the past. Head Lice At any given time, according to the Irish Pharmacy Union, one tenth of Irish children are suffering from head lice. These parasitic insects are most commonly found in children between the ages of four and eleven, and the only preventative measure is to avoid head-tohead contact with infected people. While not especially harmful, the rate of contagion is such that early detection is essential to prevent outbreaks. “While lice aren’t dangerous,” Eamonn Brady from Whelehans Pharmacy, Mullingar notes, “they are extremely contagious and their bites may cause the scalp to become itchy and inflamed.” Itching is the most common symptom of head lice, brought

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Feature signs of acne, a condition that massively damages self-confidence in teenagers. Acne Linked to the an increase in testosterone during puberty, acne occurs when the skinâ&#x20AC;&#x2122;s sebaceous glands produce inordinate quantities of oil, leading to the formation of whiteheads and blackheads, as hair follicles are obstructed by dead skin. In some cases this can lead to a build-up of pusfilled spots on the skin.

about as an allergic reaction to saliva from the louse's bites. It often takes months for a child to exhibit this symptom after their first infection, however, some never experience any kind of allergic reaction. As such, if the parent has any suspicions that one of their children has lice, it should be recommend that they examine their child's scalp using a fine-tooth plastic detection comb. If lice are detected, there are several medications available including dimeticone 4% lotion, isopropyl myristate and cyclomethicone solution. Even after the successful elimination of the lice, however, parents should be encouraged to continue detection combing. Teenagers According to a CMO 2013 report in the UK, have experienced the least improvement in health status of any age group in the over the last 50 years. They

also have the worst medical adherence record of any group, eat on average only three fruits and vegetables a day, and tend to deficiencies in iron, selenium and magnesium. As the first port of call in the health system, pharmacies have a massive role to play in improving outcomes for teenagers by administering health and lifestyle advise (including sexual health), helping them with their drug adherence and providing the ear of a considerate professional for them to share their problems. Someone who won't trivialise them. They can encourage teenagers to come to their pharmacy by making sure relevant products are stocked and by offering suitable advice. Skincare products or deodorants specifically aimed at teens should be immediately visible and attractively displayed, especially popular cosmetics and concealers that help hide

While management options vary depending on the severity of the case, products containing ingredients such as benzoyl peroxide can be used to treat mild acne. As you don't want the sufferer to lose hope or discontinue their treatment, it is important that you warn the sufferer beforehand that it commonly takes several months for any improvement to occur. If OTC products continue to be ineffective over an especially long period of time, or if the acne is severe, the patient should be directed to see their GP who typically prescribe topical or oral antibiotics. Athletes Foot Athletes Foot is much more commonly found in teens, especially males, than it is in children. It is highly contagious, and can be easily spread through contact with the infected area or with skin particles left on shoes, towels or floors. It proliferates quickly in the warm and humid environments common in schools, such as changing rooms, showers and swimming pools. It also sometimes occurs as a consequence of wearing

tight-fitting closed-toe shoes or having a less than regular footwear changing regime, often the case among school children. Usually characterised by flaking, itching and inflammation of the skin, the space between the fourth and fifth toe is the most commonly affected area. Other symptoms include dry skin, blisters and thick or discoloured toenails. If untreated, complications can occur including ulceration. It is generally treated by OTC topical antifungal medication containing terbinafine, clotrimazole, econazole, ketoconazole, miconazole and sulconazole, are available over the counter, which come in the form of sprays, creams and powders. Conclusion An unintended consequence of going back-to-school is that it leads children open to contracting various illnesses. While this creates more business for pharmacies, it also leaves them open to hazards that they need to navigate with a great deal of care and responsibility. As children are much more susceptible to dosing errors and adverse drug reactions, pharmacist must be painstaking in their approach to make sure that the medication selected is correct. They should also be ready to spot errors in GP prescriptions. As well as children, pharmacists shouldn't forget teenagers, whose health outcomes have been dis-improving in recent year. Pharmacies can make simple steps to encourage more of them to frequent.

8th All Ireland Pharmacy Conference Registration is now open for the 8th All Ireland Pharmacy Conference, which will take place in the Ballymascanlon House Hotel, Dundalk on 17 October 2017. This conference is jointly co-ordinated by the Northern Ireland Centre for Pharmacy Learning and Development and the Irish Institute of Pharmacy. This cross-border conference aims to bring together people with an interest in pharmacy practice from all of Ireland to allow networking and the exchange of ideas. The conference aim is to share good practice across the primary and secondary care sectors. The conference focuses on providing a forum for sharing insights from pharmacy practice research across the island of Ireland - it is open to pharmacists, technicians and pharmaceutical assistants, and will be of particular interest to individuals with an interest in pharmacy practice. On the evening of Monday 16th October 2017 the conference dinner will take place at 8.00pm and provides an opportunity to network with colleagues. The main conference proceedings will start at 9.30am on Tuesday 17th October 2017 with a keynote address by Professor Rose-Marie Parr (Chief Pharmaceutical Officer, Scotland) entitled Building Capacity in Healthcare. The remainder of the conference will involve parallel oral sessions and poster presentations. Individuals interested in attending the conference can register by visiting A delegate fee of ¤45, which can be paid online, also includes attendance at a conference dinner on Monday 16 October 2017.


News Food and nutritional research improves cancer survival rates

news brief

Up to 80% of cancer patients unintentionally lose weight which can have a devastating impact on their quality of life according to Dr Aoife Ryan, dietitian and lecturer in Nutritional Sciences at UCC.


The weight loss reduces their ability to tolerate chemotherapy and leading to poor survival rates.

An Taoiseach, Leo Varadkar has joined Minister for Health Simon Harris and Minister of State Catherine Byrne to launch “Reducing Harm, Supporting Recovery – a health led response to drug and alcohol use in Ireland 2017-2025.”

The seriousness of this issue is illustrated by the fact that one in five cancer deaths are caused from wasting, not from cancer. The wastage affects not just the muscles involved in movement but also the muscles involved in breathing and in the heart. Dr Ryan says, unfortunately, there is no safe drug to prevent or reverse this or to safely stimulate appetite. "It seems it is almost the norm to lose weight once you develop cancer. Ten years ago it was thought patients were losing fat. Now we can use their CT scans to measure exactly what patients are losing and we are gaining a huge understanding that that weight loss is actually muscle. It is the rapid loss of muscle.” A great example of how the roles of nutritionists and food scientists can help cancer patients can be seen from current research at UCC into the development of innovative protein gels, dietary drinks and appetite-increasing supplements to assist cancer patients who are experiencing involuntary and at times life-threatening weight loss. Dr Ryan’s team of nutritional scientists at UCC have performed a detailed study of the nutritional status and quality of life in ambulatory Irish cancer patients attending for chemotherapy at Cork University Hospital and the Mercy University Hospital. In a

Reducing Harm, Supporting Recovery lays out the direction of government policy on drug and alcohol use until 2025. The new strategy aims to provide an integrated public health approach to drug and alcohol use, focused on promoting healthier lifestyles within society. Dr Aoife Ryan, dietitian and lecturer in Nutritional Sciences at UCC study which has been on-going since 2011, 1,020 patients have been recruited to date. "We have looked at over a thousand patients having chemotherapy here in Cork and only 4% of them look underweight. We rarely see obviously wasted cancer patients anymore, nowadays they look normal or overweight but, underneath that fat, there is very little muscle. Over 40% have sarcopenia and these patients live about half as long as people who maintain their muscle." It is known that protein intake is of fundamental importance in this regard, and so she is looking at ways to increase this intake and also to address why patients are losing weight in the first place.

"They are losing weight because cancer causes huge amounts of inflammation in their bodies. So can we dampen down inflammation which would cause them to stop losing weight? If they are weight stable they will live longer." As part of this work, Dr Ryan develops products in conjunction with colleagues including Dr Shane Crowley and Professor Alan Kelly of the School of Food and Nutritional Sciences at UCC. Professor Kelly says this work is a perfect example of where a complementary relationship between Nutrition and Food Science can deliver hugely important outcomes.

Advisory Team of the Year accolade Fitzgerald Power were honoured to receive the Advisory Team of the Year Award for their work in the Irish Community Pharmacy sector at this year’s Irish Accountancy Awards. The award was announced at the annual black tie gala awards ceremony on Thursday, May 18th, at The Ballsbridge Hotel, Dublin, with more than 300 industry figures in attendance.

Key actions of Reducing Harm, Supporting Recovery include: • Introduction of a pilot supervised injecting facility in Dublin’s city centre; • Establishment of a Working Group to examine alternative approaches to the possession for personal use of small quantities of illegal drugs; • Funding for a programme to promote community awareness of alcoholrelated harm; • A new targeted youth services scheme for young people at risk of substance misuse in socially and economically disadvantaged communities; • Expansion of drug and alcohol addiction services, including residential services; • Recruitment of 4 Clinical Nurse Specialists and 2 Young Persons Counsellors to complement HSE multi-disciplinary teams for under 18s;

The Irish Accountancy Awards recognise and celebrate excellence in the accountancy profession in Ireland over the past year.

• Recruitment of 7 additional drug-liaison midwives to support pregnant women with alcohol dependency;

Over the last 35 years Fitzgerald Power’s Pharmacy Advisory Team has established itself as the sector’s leading provider of professional services to the Irish community Pharmacy sector by delivering accountancy and commercial advice of the highest quality to pharmacists throughout Ireland. Their expertise is recognised by Revenue, the pillar banks and representative bodies such as the Irish Pharmacy Union.

The strategy contains an ambitious 50 point Action Plan from 2017 to 2020, and provides the scope to develop further actions between 2021 and 2025 to ensure the continued relevance of the strategy to emerging needs into the future.

• The early Work Programme of the Standing SubCommittee will focus on Drug-related Intimidation Maurice Fitzgerald accepting the Advisory Team of the Year Award on behalf of Fitzgerald Power


News Vision assistance apps launched Novartis, in partnership with the NCBI, is delighted to announce the launch of a suite of vision assistance apps. The award-winning ViaOpta Navigator and ViaOpta Daily apps were developed to better assist those living with visual impairment. ViaOpta Navigator app enables blind or vision impaired people to move independently by providing essential information to support orientation when walking. Similarly, ViaOpta Daily uses vocal guidance and audible tutorials to help with everyday activities. The cutting-edge technology used aims to make a difference in the lives of those who live with visual impairment and who seek discreet assistance. Loretto Callaghan, CPO Head for Novartis Ireland, said, “Novartis is proud to continually support those living with visual impairment. We work tirelessly with organisations such as the NCBI to create patientfocused innovative solutions to enhance the lives of many here in Ireland. We are delighted that patients will now have the opportunity to benefit from the use of the ViaOpta apps to improve their independence and quality of life.”

Sandra Foy, and Doreen Curran of Novartis are pictured with Chris White, CEO, NCBI and Amie Hynes Fitzpatrick, NCBI employee The real-world benefits of these apps can be seen in their extensive functionality. ViaOpta Navigator and ViaOpta Daily have been created to assist the visually impaired better experience the

Joint Committee on the future of Mental Health This month, the Dáil agreed to establish a new Joint Committee on the Future of Mental Health Care. The intention is that the Joint Committee will aim to achieve cross-party agreement on the implementation of a single, long-term vision for mental health care and the direction of mental health policy in Ireland. In announcing the establishment of the new Committee, the Minister for Mental Health and Older People, Mr Jim Daly TD, said, “This is good news for all those with an interest in how we further develop and implement our mental health services. At this time with our ten year policy ‘A Vision for Change’ being reviewed, it is very timely that our parliamentarians will have the opportunity to play their part in feeding into the future policy direction in this area.” While the Committee when up and running will decide its own business, it is expected that members will examine issues such as the current integration of delivery of mental health services in Ireland, the availability, accessibility and alignment of such services and supports as well as


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the need to further develop prevention and early intervention services, particularly for young people. The Minister added, “I am keen that the Committee should also have a say on the significant challenges we face in the recruitment and retention of skilled mental health professionals. This is a problem to which there is no off the shelf solution so the Committee’s views on this will be very welcome. I look forward to regularly engaging with the Committee in the coming months. I also wish to acknowledge the role of Deputy James Browne in helping to progress the issue.” The Joint Committee will make its final report to both Houses of the Oireachtas by 31st October 2018.

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MyPro is a brand new range of 2nd generation probiotics designed for specific concerns. The first in the MyPro range to be launched is Iro-Sorb, a clinically proven formulation that helps solve iron deficiency in a completely new increasing the uptake, not only the intake! Containing the hero strain of LP299V, MyPro Iro-Sorb also contains a folic acid booster and added Vitamin C to help increase the iron absorption. Gentle to the gastrointestinal system. Patent protected. Suitable for women of child bearing age and also people with active lifestyles. RRP €19.95

Much loved staple of Irish families, Sudocrem, expands its product range with new nappy rash barrier ointment, Care and Protect - Sudocrem Care and Protect specially designed to protect against the causes of nappy rash - Care and Protect voted Nappy Cream Product of the Year, following UK launch With an 86-year history, Sudocrem has long been a tried and trusted staple in the treatment of nappy rash for generations of Irish families. Sudocrem Care and Protect has been developed specifically for babies, with all the ingredients designed to protect against nappy rash. Sudocrem’s Care and Protect nationwide distribution will see the new product available in pharmacies across Ireland from 1 August. The product’s roll-out will be supported by a comprehensive marketing campaign extending across autumn/winter 2017. As Sudocrem now expands its’ range, through Care and Protect, its pivotal presence in the Irish market looks set to grow even further.

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Suitable for term infants and young children from birth to 18 months with medically identified increased energy and nutrient requirements A protein: energy ratio of 10.5% in line with WHO/FAO guidelines1 The only High Energy formula in UK & Ireland to contain 100% whey, partially hydrolysed protein2-4 Clinically proven to be well tolerated5 Calcium and vitamin d for normal growth and development of bone Important Notice: Breast milk is best for babies and breastfeeding should continue for as long as possible. This product must be used under medical supervision. SMA® PRO High Energy is a milk based formula for the dietary management of babies and young children with medically determined high energy requirements as identified by a Healthcare Professional. It is suitable as the sole source of nutrition up to 6 months of age, and in conjunction with solid food up to 18 months of age. SMA® PRO High Energy is not intended for use with preterm babies, for whom fortified breast milk or a low birth weight formula such as SMA® PRO Gold Prem 1 is more appropriate. 1. WHO/FAO/UNU Report of a Joint Expert Consultation. Protein and Amino Acid Requirements in Human Nutrition. Technical Report Series No. 935. World Health Organisation 2007; 185-93 2. SMA® PRO High Energy datacard. Available at https://www.smahcp, accessed June 2017 3. Nutricia. lnfatrini data card. Available at, accessed June 2017 4. Abbott. Similac High Energy datacard. Available at accessed June 2017 5. Lama More RA et al. Poster presentation at LASPGHAN 26-29 March 2014

Bioxsine for Hair Loss is back on TV this August! Bioxsine is back on national TV on RTE, TV3 and TG4. Bioxsine is scientifically proven to reduce hair loss and increase hair growth. Bioxsine contains Herbal BIOCOMPLEX B11 with unique minerals and vitamins ingredients. The range is formulated to suit the needs of both men and women and also has a stronger Forte range for those experiencing greater hair loss. Greater efficacy against hair loss is when the shampoos are used with the serums. • Bioxsine Femina Shampoo 300ml and Conditioner 300ml for Women • Bioxsine Hair Loss Shampoo 300ml and Serum • Bioxsine Forte Shampoo 300ml and Serum Spray Available from Ocean Healthcare (01 296 8080) and Wholesalers.

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Bepantiseptic 55g Bayer have just launched into pharmacy our new Bepantiseptic 55g, the First Aid Antiseptic cream with local anaesthetic. The wound market in Ireland has grown by 6% in 2017*. Over the last 3 years Bepantiseptic is achieving positive growth of 72%**. Bepantiseptic has 34% market share with Bepantiseptic 30g pack the top selling line in Pharmacy channel*. Our new larger 55g pack offers better value for consumers and it will be available from August. Peaks within the category are more pronounced during the summer months but the usage is high over the whole year. New Bepantiseptic 55g pack will be supported by radio advertising and in-store POS materials (shelf trays) highlighting its unique benefits. To address the heaviest users of the first aid cream Bepantiseptic target mums with kids. Bepantiseptic First Aid Cream has an antiseptic action to help prevent infections, plus a soothing local anaesthetic to numb the pain. Bepantispetic’s dual action is an effective treatment for minor cuts and grazes, minor burns, scalds & blisters, sting and insect bites, spots, chapped or rough skin. Contains both Phenol (Antiseptic and Local Anaesthetic) and Chlorhexidine Digluconate (Antiseptic). Always read the label. *Creams and Ointment only, IMS MAT March 2017 **IMS – over 3 years L.IE.COM.07.2017.1388


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The V-Comb eliminates the need to use harsh chemicals to kill lice, which makes it safe and ideal to use on children.

Detects & prevents infestations Used regularly, the V-Comb will help detect head lice activity early so treatment can begin immediately to prevent a full-blown infestation.


Immediate visible results The transparent LED lit Filter Compartment lets the user see lice and eggs that have been removed from the hair while they are using the V-Comb.

Please contact your Brandshapers Sales Representative today to order VComb t: 053-9179007 e:

Hygienic & mess free

Incorporating combing and vacuuming, the V-Comb extracts head lice and eggs from the hair into disposable Capture Filters to be removed and sealed for disposal after treatment .

Clinical Profiles NEW INDICATION FOR CLONMEL HEALTHCARE Clonmel Healthcare are delighted to announce an additional indication for Pregabalin Clonmel 25mg, 50mg, 75mg, 100mg, 150mg, 200mg and 300mg Capsules, Hard Pregabalin Clonmel Capsules, Hard are currently indicated for: 1 • Epilepsy - Pregabalin Clonmel is indicated as adjunctive therapy in adults with partial seizures with or without secondary generalisation. • Generalised Anxiety Disorder - Pregabalin Clonmel is indicated for the treatment of Generalised Anxiety Disorder (GAD) in adults. • For the treatment of peripheral and central neuropathic pain in adults Pregabalin Clonmel Capsules, Hard are available in a 56 and/or 84 pack size and are GMS reimbursable Full prescribing information is available on request or alternatively please go to www.clonmel-health. ie. Medicinal product subject to medical prescription. Please contact Clonmel Healthcare on 01-6204000 if you require any additional information on Pregabalin Capsules, Hard. Ref 1. Pregabalin Clonmel Capsules, Hard Summary of Product Characteristics PA 126/278/1-6, 8 PA Holder: Clonmel Healthcare Ltd, Waterford Road, Clonmel, Co. Tipperary Legal Category: Prescription Only Medicine. Date Prepared: July 2017. 2017/ADV/ PRE/026

NEW HOPE IN TRIPLE NEGATIVE BREAST CANCER Research led by Irish scientists has found a potential new approach to treating one of the most difficult-totreat forms of breast cancer, which currently has limited treatment options. Scientists from BREASTPREDICT, an Irish Cancer Society Collaborative Cancer Research Centre, in collaboration with an EUfunded research consortium called RATHER, have shown that a new drug, called THZ-1, can prevent the growth of triple negative breast cancer. Triple negative breast cancer affects approximately one in five women diagnosed with breast cancer, and is more often diagnosed in younger women. This aggressive subtype lacks three important proteins or biomarkers in the tumour cells, namely estrogen receptor, progesterone receptor and HER2. This means that patients with this type of breast cancer cannot receive ‘targeted therapies’ such as hormone therapy (e.g. Tamoxifen)


or Herceptin. Instead, the only effective treatment for these patients is chemotherapy, making this type of cancer one of the most difficult to treat. This most recent study focused on a protein called CDK7, which the researchers found to be present at high levels in triple negative breast cancers. Interestingly, patients with high levels of CDK7 present in their tumour were more likely to experience a disease relapse following standard chemotherapy treatment. This means that high CDK7 levels could be used as a ‘biomarker’ to identify patients unlikely to respond well to chemotherapy. This type of test could be very useful to their doctors, as they could then prioritise these patients for a more aggressive treatment regime. The researchers also tested a drug that acts on CDK7, called THZ-1, to investigate if this could be a novel treatment for triple negative breast cancer. Remarkably, treating triple negative breast cancer cells grown in the laboratory with THZ-1 halted their growth, both on its own and in combination with other treatments. The researchers proposed THZ-1 as a novel treatment option for this aggressive cancer type, particularly in combination with existing treatments, to improve their success rate.

SANOFI GENZYME AND ALNYLAM REPORT POSITIVE RESULTS Sanofi Genzyme, the specialty care global business unit of Sanofi, and Alnylam Pharmaceuticals, Inc, the leading RNAi therapeutics company, have announced new positive results from the ongoing phase 2 open-label extension (OLE) study with fitusiran in patients with hemophilia A and B, with or without inhibitors (N=33). These results were presented in an oral presentation at the International Society on Thrombosis and Haemostasis (ISTH) 2017 Congress, held from July 8 - 13, 2017 in Berlin, Germany. Fitusiran is an investigational RNAi therapeutic targeting antithrombin (AT) for the treatment of patients with hemophilia A and B, that is designed to lower levels of AT with the goal of promoting sufficient thrombin generation upon activation of the clotting cascade to restore hemostasis and prevent bleeding. The updated clinical results in the fitusiran phase 2 OLE study showed that the safety and tolerability profile of fitusiran remains encouraging, with no thromboembolic events, including during co-administration of replacement factor or bypassing agents. The majority of adverse

events (AEs) were mild or moderate in severity, with the most common AEs consisting of transient, mild injection site reactions (ISRs). In addition, once-monthly subcutaneous (SC) administration of fitusiran achieved lowering of AT, increases in thrombin generation, and, in a post-hoc exploratory analysis, reductions in the median estimated annualized bleeding rate (ABR) in patients with and without inhibitors. Based on these results, the companies announced last week the initiation of the ATLAS phase 3 program for fitusiran in patients with hemophilia A and B with or without inhibitors. The ongoing fitusiran phase 2 OLE study includes patients (N=33) with hemophilia A (N=27) and hemophilia B (N=6). The study includes 14 patients with inhibitors, including one with hemophilia B. Fitusiran was administered as a low volume (less than 1 mL), monthly, subcutaneous, fixed dose of 50 mg (N=13) or 80 mg (N=20). All results are as of a June 15, 2017 data transfer date. Patients were treated for up to 20 months in the phase 2 OLE, with a median of 11 months on study. The majority of AEs were mild or moderate in severity, with the most common non-laboratory AEs consisting of transient, mild ISRs (18 percent of patients). There was one discontinuation due to an AE, an asymptomatic alanine aminotransferase (ALT) elevation in a patient with chronic hepatitis C virus (HCV) infection. Serious adverse events (SAEs) considered possibly related to drug were reported in two patients: asymptomatic ALT elevation in one patient with chronic HCV infection, as noted above, and seizure with confusion in one patient with a prior history of seizure disorder. Asymptomatic ALT increases greater than 3x the upper limit of normal (ULN), without concurrent elevations in bilirubin greater than 2x ULN, were observed in 11 patients, all of whom were hepatitis C antibody positive; at current follow-up, all ALT elevations are resolved (N=10) or resolving (N=1). No thromboembolic events, laboratory evidence for pathological clot formation, or instances of anti-drug antibody (ADA) formation were reported.

NEW RESEARCH POINTS TO TREATMENT BREAKTHROUGH FOR GLOBALLY DEVASTATING VIRUSES An international collaboration, including scientists from Trinity College Dublin has potentially unlocked the door to better treatment of viral diseases, including the flu and the common cold.

The researchers discovered that an ancient, 1.5 billion year old cell biological process found in plants, fungi and mammals enhances viral disease in mice and the researchers believe it is highly likely it has the same effect on viruses in humans. They identified a protein, called Nox2 oxidase that was activated following infection with viruses, including influenza, rhinovirus (i.e. common cold), dengue and HIV, irrespective of the strain of the virus. Once activated the Nox2 oxidase suppressed the body’s key antiviral reaction and its ability to fight and clear the viral infection which in turn resulted in a stronger or more virulent disease in mice. The study also investigated a new prototype drug to treat these debilitating viral diseases. They found that the Nox2 oxidase protein activated by the viruses is located in a cell compartment called endosomes. They carefully modified a chemical that inhibited or restrained the activity of the Nox2 oxidase, to enable it to reach this endosome compartment. Their customised drug was found to be very effective at suppressing disease caused by influenza infection. In the 2015/16 flu season in Ireland 1856 people were hospitalised as a result of flu, there were 84 deaths from flu and at peak flu season, 80 in every 100,000 of the population had the flu, according to the HSE influenza surveillance reports. The global burden is also staggering with more than 5million cases of infection annually with up to 10% resulting in death. The collaboration was led by RMIT University scientists in Melbourne and includes researchers and clinicians from eight universities across Australia, the United States and Trinity College Dublin in Ireland. Dr Selemidis, head of the Oxidant and Inflammation Biology Group at RMIT University said, “Current treatment strategies are limited as they specifically target circulating viruses and have either unknown or very little effect against new viruses that enter the human population." “The study identifies a protein of the immune system that contributes to the disease caused by flu viruses irrespective of their strain. It also developed a novel drug delivery system to target this protein, which drastically alleviated the burden of viral disease. This work identifies a treatment strategy that has the potential to alleviate the symptoms caused by some of the most devastating viruses worldwide, including the flu,” Dr Eunice To said.



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