THE INDEPENDENT VOICE OF PHARMACY

August 2013 Volume 5 Issue 8

In this issue:

NEWS:The value of pharmacy down by 5% Page 4

PROFILE: Boots Ireland new Commercial and Operations Director Page 9

DEBATE: Time for a change say pharmacy technicians Page 14

AWARDS: Further profiles of the Irish Pharmacy Awards 2013 winners Page 16

FEATURE:Brush up on Oral Health - value in the oral healthcare market Page 34

TOP 100:IPN’s annual look at the OTC market in Ireland and the Top 100 products Page 44

Shortlisted BUSINESS TO BUSINESS MAGAZINE OF THE YEAR

for GenericsFirst

As the Leading Generic supplier in Ireland, we are proud to offer the medical community throughout the country the choice to prescribe and dispense quality generic treatments. In doing so, we are working with you to help your patients benefit from quality and cost-effective medications.

With over 30 years manufacturing healthcare products in Ireland, Pinewood Healthcare is one of the largest generic suppliers with a workforce of over 340 people. We are always committed to providing the Irish market with quality brands at inexpensive prices.

Quality Choice Value Service

Irish Pharmacy News is circulated to all independent, multiple and hospital pharmacist, government offi cials and departments, pharmacy managers, manufactures and wholesalers. Buyers of pharmacy groups and healthcare outlets. Circulation is free to all pharmacists subscription rate for Irish Pharmacy News ¤60 plus vat per year.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. Pharmacy Communications Ireland 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.

IRISH PHARMACY NEWS

ForewordContentsPage 6Pharmacists voice caution overonline prescription service

Page 12Ireland plays its part in global counterfeit drug crackdown

Page 16Profi le of Bradley’s Pharmacy Group Innovation and Service Development win

Page 32New legislation due on the use of e-cigs

Page 44The top 100 products by volume and value in pharmacy

Page 63Finding new cheese in pharmacy - special report

Bureaucracy generally satisfi es the egos and keeps those who are caught within its tentacles in long-term employment. Bureaucracy gives its administrators power over individuals who, in many instances know far more about the subject in question than those in charge of creating the new rules and regulations for it. In addition, those on the receiving end are often looked down upon by these so-called bureaucratic ‘superiors’. Both regard each other as the enemy.

To the administrators, it is only their job and they may even leave half-way through a project. Their research and thought processes will be continually interrupted and the project will become seemingly endless. Similar delays will be encountered when their fi nal proposals are sent along a long chain of command for approval.

When it comes to a question of safety standards, this requires much more thought and concentration. This type of responsibility often frightens people and encourages them to drag their feet even more, as has happened in the case of the pharmacy technicians, who have waited ten long years for a decision to be made on whether or not they can become ‘offi cially recognised’.

Most administrators and organisations seem to come up with the same old excuses; they require more information; they ask for more time, they will pass the buck and, on many occasions, to put it politely, their pretentious waffl e and gibberish baffl es others’ brains. Oh, and then there are the endless meetings and reports on reports.

However, it is an illogical and slightly absurd situation that the pharmacy technicians fi nd themselves in. By offi cially asking to become offi cially recognised and for this to happen, the bureaucrats have to agree that this would be advantageous for all concerned. If they do conclude that this would be ‘a good thing’ for ‘the good of the general public’, courses and examinations would have to be standardised. More excuses for talk, talk, talk and not much action.

Would this standardisation take another ten years to consider?

The result of the blame culture is that shunning responsibilities is preferable to being blamed. But as one pharmacist said in IPN only last month, ‘taking a decision is better than taking no decision at all, even when it is the wrong decision’.

Perhaps the procrastination is because someone has recognised that there really will not be a role for pharmacy technicians in the future so they don’t want to waste anyone’s time? If so, why not say so?

It has been suggested, in the debate on page 14 of this issue that soon, young, newly qualifi ed pharmacists will be employed in pharmacies as Number Twos; to work in the dispensary alongside the principle pharmacist so they will be able not only to offer legal and authorised cover in the dispensary but also help with the additional services the pharmacy offers to the public, such as patient advice, testing, the day-after pill and fl u jabs.

This happens already in some of the chains and larger independent pharmacies but if this fashion takes off, then there would be no case to be answered. There would be little point in the technicians acquiring their own, offi cial qualifi cations and rule book.

But, how about those rural pharmacies, where they are the only source of primary health care for miles around? Quite probably, they could not afford to pay the salary of a second pharmacist but there would be an argument for employing a qualifi ed technician.

The PSI states that it is going to explore the possible recognition and registration of technicians, either ‘on a voluntary or a future legislative basis’, as has been set out in their Service Plan for 2013. NB There is only a quarter of the year remaining.

It is rare for a section of a profession to wish for more legislation and bureaucracy but it does seem that this is what pharmacy technicians would like.

Why have they had to wait so long to hear the bureaucrats’ decision?

You have heard it here.

Editor - Bridget Casey

Regulars

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63

CPD: Smoking cessation 39

Feature: Pharmacy role insports injuries 66

Out and About 72

Clinical Profi les 76

Product Profi les 77

Appointments 78

PUBLISHERIPN Communications Ireland Ltd. Clifton House, Lower Fitzwilliam StreetDublin 2 00353 (01) 6690562

MANAGING DIRECTORNatalie Maginnis n-maginnis@btconnect.com

9

GROUP SALES MANAGERDebbie Graham debbie.hpn@btconnect.com0044 7450274112

EDITOR - Bridget Casey bcasey.ipn@btconnect.com

SUB EDITOR - Kelly Jo Eastwoodkjeastwood@hotmail.com

SENIOR JOURNALISTCiara Jordan

EDITORIAL DEPARTMENTeditorial@ipnirishpharmacynews.ie

ACCOUNTS - Julie Daly cs.ipn@btconnect.com

ADVERTISING MANAGERNicola McGarveynicola@ipnirishpharmacynews.ie

CONTRIBUTORS - Rebecca KilfeatherJohn Hogan, Conall Lavery

ART DIRECTOR - Smart Page Design

12

for GenericsFirst

As the Leading Generic supplier in Ireland, we are proud to offer the medical community throughout the country the choice to prescribe and dispense quality generic treatments. In doing so, we are working with you to help your patients benefit from quality and cost-effective medications.

With over 30 years manufacturing healthcare products in Ireland, Pinewood Healthcare is one of the largest generic suppliers with a workforce of over 340 people. We are always committed to providing the Irish market with quality brands at inexpensive prices.

Quality Choice Value Service

4

NewsGP fees to be brought into pharmacy line

MISSED DIAGNOSIS IDENTIFIED AS PRIORITY AREAMissed diagnosis and medication error have been highlighted as areas to be prioritised when developing educational strategies and risk management systems for healthcare practitioners, including pharmacists, in Primary Care. The fi ndings are the result of systematic review of international malpractice claims in primary care carried out at the HRB Centre for Primary Care Research based at the Royal College of Surgeons in Ireland (RCSI).

Missed diagnosis was the most common source of malpractice claims, accounting for one in four (26%) to two in three (63%) of the total. Among adults, cancer and heart attacks were the most commonly missed diagnosis. Among children, malpractice claims related to meningitis and cancer according to the claims. The second most common reason for claims came from errors in prescribing medication.

Commenting on the review lead author Dr Emma Wallace, a GP and HRB Research Fellow at the Centre, said, “We recognise that malpractice claims are not a perfect substitute for adverse events. However, notwithstanding this, malpractice claims do have potential to offer insights into the types and causes of adverse events in clinical practice.”

Key fi ndings from the review include:

Failure to or delay in diagnosis was the commonest medical misadventure cited in primary care malpractice claims.

The diagnoses most frequently cited in claims were cancer and myocardial infarction for adults and meningitis for children. The second commonest reason for claims was medication error.

In the USA, the annual prevalence of malpractice claims against family practitioners appears to have remained relatively stable over the past two decades.

In the UK and Australia, malpractice claims against GP's appear to be rising.

Family practice is consistently ranked in the top fi ve most sued specialities on US medical indemnity databases.

The majority of claims are successfully defended. (Two-thirds of US claims and up to half of UK claims)

news brief

This will result in further savings expected to be in the region of ¤5m in a full year, he added. The Minister was responding to recent questions asked in the Dail regarding the savings realised from the administration of vaccine by pharmacists as opposed to general practitioners.

He added that there are ‘no plans to transfer responsibility for administration of seasonal fl u vaccine to community pharmacists.’ “Seasonal Flu vaccination forms part of the Adult Immunisation Programme operated by the HSE. Seasonal Flu

Legislation is currently being prepared by Health Minister James Reilly, under the Financial Emergency Measures in the Public Interest Act 2009, to bring the fees for GP administration of seasonal influenza in line with those set for pharmacists.

vaccination is available every year as the vaccine changes every year to suit the strain of the circulating virus. The vaccine is free to those in at risk groups,” he said.

Deputy Caoimghlin O Carolain also asked if ‘other potential opportunities for transfer of duties have been explored; the potential savings identifi ed.’

“Regulations were introduced in October 2011 to provide a legal basis for community pharmacists to supply and administer seasonal infl uenza vaccine,” replied the Minister.

“The fee for pharmacists of ¤15 was set in accordance with the provisions of the Community Pharmacy Contractor (CPC) Agreement. This provides a choice for those to whom this vaccination is recommended either to have the vaccine administered by their GP or by a participating pharmacist. Based on HSE vaccine delivery statistics, thus far, the majority of those vaccinated have opted to have their seasonal infl uenza vaccination administered by their GP.”

Value of pharmacy down 5%Recent CSO Retail Sales figures have shown that the value of pharmacy sales (Pharmaceuticals, Medical and Cosmetic Articles) is down 5% annually, with volumes down by 6.3% - the steepest falls of any retail business sector.

continue to fall, with little sign of the situation abating. Pharmacies are facing a significant reduction in consumer demand, with the worst ever recorded drop in consumer spending in the first quarter of the year, and reductions in payments for medical card and other State schemes. This, combined with increasing Government influenced costs, is undermining pharmacy businesses the length and breadth of the country. Given the current lack of consumer confidence, many

The Irish Pharmacy Union has called on the Government to address the costs under its control to assist the retail sector to offset dropping sales. The IPU stated that urgent action is required to address the sharp reduction in consumer confidence, which is having a negative impact on pharmacies and other businesses throughout the country.

According to IPU President Rory O' Donnell, "Pharmacy sales

pharmacy owners and their staff are now facing a difficult number of months ahead.

"Urgent action is required from Government to address business costs under their control, especially the cost of regulation, but also rates, rents, energy prices and other local charges, which continue to put pressure on many retailers, threatening both businesses and jobs."

Deputy Caoimghlin O Carolain Health Minister James Reilly

5

News

Minister misses a trick

news brief

President of the Irish Pharmacy Union, Rory O’Donnell said, “The announcement is yet another blow to the pharmacy profession, which is already reeling from loss of business due to the poor economic climate. Pharmacists are angry and disillusioned that a real opportunity to engage in true reform in the delivery of healthcare services that will deliver savings and meet patients' needs has been ignored, in favour of a self-defeating 'slash and burn' policy that continues to undermine the pharmacy sector, and the delivery of services to patients."

The cuts will see the end to the retail mark up for drugs dispensed under the Drug Payments Scheme and the Long Term Illness Scheme.

The fees paid by the State to pharmacists for services, such as administering the flu vaccine are to be reduced by around 7.5%

Department ‘must intervene’ in drug shortage crisisThe Irish Pharmacy Union (IPU) have asked the Department of Health to intervene with medicine shortages in Ireland.

According to a survey carried out by the IPU pharmacists are spending up to eight hours per month trying to resolve medicine shortages.

Commenting on the survey findings, President of the IPU, Rory O' Donnell, said, "The survey results clearly highlight that there is a significant level of medicine shortages, with no sign of an improvement, at least in the short-term. More and more time is being spent by pharmacists in addressing medicine shortages issues, time that would be better spent tending to the needs of patients. The longer the situation is allowed to continue, the greater the impact on patients' health".

The lack of alternative drugs has been reported as the main reason for the shortages and the problem is widespread across the country.

The IPU has also warned that the introduction of reference pricing will only exacerbate the situation,

The Minister for Health James Reilly has introduced further cuts to pharmacist remuneration under the Emergency Measures in the Public Interest (FEMPI) Act that the Irish Pharmacy Union has said will result in a further 34% reduction in income for pharmacists.

particularly if the reference price is set too low.

O’ Donnell added, “Ultimately, it is up to the Department of Health to ensure that patients have continuity of supply of medicines and we would ask that steps be taken as a matter of urgency to solve the existing problems of medicine shortages and to ensure that further shortages do not occur"

The IPHA said of the medicine shortages, “It is committed to ensuring that patients have access to the full range of modern medicines in a timely manner.The Supply Agreement between IPHA and the State which was renewed last October defines the mechanisms for the supply of medicines to Irish patients.

They continued, “Key provisions in the Agreement are designed to ensure as far as is possible, continuity of supply, but from time to time disruptions to supply

in the market place can emerge with individual products. These arise as a result of manufacturing processes, but in more recent times, shortages have emerged due to the trading of products across European markets which occurs when the price in one country has been pushed well below that in other countries. IPHA member companies work tirelessly to secure the availability of medicines for Irish patients, however, these cross border trading issues are beyond their control.”

A recent European survey by the European Association of Hospital Pharmacists (EAHP) revealed that 93% of hospital pharmacists had experienced drug shortages in the past year. The survey listed causes of the shortages to be decreasing manufacturing sites in Europe, extended supply lines due to outsourcing and low levels of contingency stocks because of financial pressures stemming from low generic-drug prices.

BE PART OF THE GATHERINGThe Royal College of Surgeons in Ireland (RCSI) is hosting the ‘RCSI Gathering’ from 12th to 14th September. The three day event will be an opportunity to reconnect with old friends and colleagues and to celebrate RCSI’s unique heritage and global connections. The weekend festivities include a rich and varied social and educational programme.

Key events include:

12th September: RCSI Gathering 2013 Celebration with celebrity guest at the Convention Centre, Dublin

13th September: Education Forum: ‘International Higher Education: New Horizons for Ireland’ at RCSI

14th September: Black Tie Gala Dinner at the Burlington Hotel

To view the full programme or to register visit www.rcsi.ie/gathering2013 or phone 01 402 2235

DIANETTE SAFETY INFOImportant safety information from Bayer Ltd, as approved by the Irish Medicines Board (IMB) is available to view on the IMB website.

The safety information follows a review of the known risk of thromboembolic events and benefits of medicines containing cyproterone acetate 2 mg and ethinylestradiol 35 micrograms (Dianette). The evaluation has been performed by the European Medicines Agency’s Pharmacovigilance Risk Assessment Committee (PRAC) following concerns about the risk of venous and arterial thromboembolism (VTE and ATE) associated with those products.

Pharmacists and other healthcare professionals are encouraged to report any adverse reaction, including possible thromboembolic or cardiac events, which may be associated with the use of Dianette to the IMB or to Bayer at adr-ireland@bayerhealthcare.comFor further information, please contact Bayer at info.ireland@bayerhealthcare.com or by telephone at 01-2999313.

resulting in ¤32m savings for the government. However, the cut to doctors' remuneration will be even greater for providing a flu vaccine service.

Minister Reilly has said that confirmed cuts made in previous years will be maintained, which have provided savings of ¤570m to the exchequer since 2009.

O’ Donnell added, "Community pharmacists can deliver many more services to patients. By engaging constructively with pharmacists to deliver these services, significant health and financial benefits would

accrue to both patients and the State. In focussing on cuts and ignoring the capacity for pharmacists to deliver convenient, accessible and cost-effective healthcare, the Minister has missed a real opportunity to completely reform the healthcare system."

6

NewsIreland takes part in international drug crackdown

ES ¤9M TO DEVELOP NEW CLASS OF DRUGS The Trinity College spinout company, Trinity Therapeutics which is developing a new class of drugs to tackle inflammatory diseases has raised over ¤9 million to fund clinical trials.

The drug discovery and early drug development company focused on anti-inflammatory therapeutics, recently announced the funding from new investors, Fountain Healthcare Partners and founding investor, the Wellcome Trust. Other investors in Trino include Enterprise Ireland and Growcorp.

The company is developing PH46A, the lead candidate from a novel, proprietary, class of drugs which was inspired by the indane scaffold molecule derived from a Taiwanese fern. PH46A is a potential first-in-class oral small molecule drug for the treatment of inflammatory bowel disease (IBD), which could be used in both ulcerative colitis (UC) and Crohn’s disease (CD).

Other molecules in Trino’s drug class show promise with broad anti-inflammatory activity that could be suitable for applications in dermatology, pulmonary and auto-immune disease and the company will work to develop these compounds internally and in partnership with major international research centres.

The additional funding from the Wellcome Trust is in the form of a prestigious, international and highly competitive Strategic Translation Award.

Head of Business Development at the Wellcome Trust, Dr Richard Seabrook commented, “Current treatments for inflammatory bowel diseases often have significant side effects and patients are faced with tough decisions in how to manage their condition. We are pleased to extend our successful partnership with Trino to support the development of PH46A as a potential new therapy for these debilitating disorders.”

The company founded by Trinity pharmacologist Professor Neil Frankish and medicinal chemist Professor Helen Sheridan centres on their highly innovative work on pharmaceutical grade drugs based on the indane skeleton as derived from a Taiwanese fern, used historically in plant-based medicine.

news brief

They were among authorities from 100 countries which participated in this INTERPOL co-ordinated initiative which took place from 18 to 25 June. The operation has resulted in 58 people being arrested worldwide and some 9,610 illegal online pharmacy websites being shut down through domain name or payment facility removal.

In Ireland, the joint operation by the IMB, Customs and Gardaí led to the detention of 192,061 tablets/capsules (121,026 tablets 2012) with an estimated value in excess of ¤612,535. The number of packages detained during the operation in Ireland by Customs was 270. The substances detained included mood stabilising medicines, weight loss products as well as medicines indicated for erectile dysfunction and fertility treatment. Other medicines detained included antibiotics, anabolic steroids, corticosteroid and dietary supplements which contained prescription only ingredients.

Pat O’Mahony, Chief Executive, Irish Medicines Board, outlined that; “In the first six months of this year, we have detained over 671,230 illegal and counterfeit medicines, valued at ¤2,013,708, including over 192,061 medicines alone in this week-long Operation. This is only one element of our year long concerted strategy

The Irish Medicines Board (IMB), Revenue’s Customs Service and An Garda Síochána have announced details of their role in Operation Pangea VI which is an international week of action targeting the online sale of counterfeit and illegal medicines.

with partner agencies – An Garda Síochána and Revenue’s Customs Service, to stem the flow of counterfeit and illegal medicines coming into Ireland.”

This is the sixth Operation PANGEA, to-date, focusing on illegal websites that supply illegal and dangerous medicines. The initiative, which aims to protect public health by highlighting the dangers of counterfeit and illegal medicines, is the largest internet–based action of its kind. Under this Operation, 200 national medicines agencies, police and customs with support from Internet Service Providers (ISPs), the electronic

payment industry, technology companies and delivery services worked together to target the three main components abused in the illegal website trade: the ISPs, e-payment systems and the delivery network.

During the Operation, six advertisements were removed from websites in Ireland to bring them into compliance including those advertising Botox and Weight Loss medicines. Separately, two websites in Ireland were notified to the Irish Domain Name Registrar with a view to withdrawal of their registrations.

John Keane and fellow pharmacist Robert Keane has recently organised a charity cycle to raise much needed funds for cancer prevention and research. John, of Market Point Pharmacy, Mullingar told Irish Pharmacy News, "This event was organised to promote awareness of the fourth biggest cancer affecting Irish women among fellow pharmacists and the general public. We also used it as an opportunity to raise funds for the Irish Cancer Society to date we have raised well over ¤10,000." Pictured are John and Robert with some of the main group of cyclists.

Pat O’Mahony, Chief Executive, Irish Medicines Board,

Cycling for cancer

Standardised Mini-Mental State Examination (SMMSE)

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For more than 10 years, Ebixa® has helped patients with Alzheimer’s disease

overcome everyday challenges.1

It’s one of the Originals from Lundbeck, a company recognised

worldwide for its pioneering work within the field of CNS disorders.

Abbreviated Prescribing Information: For full prescribing information refer to the Summary of Product Characteristics. Name: Ebixa Active Substance: Memantine Hydrochloride. Indication: Treatment of patients with moderate to severe Alzheimer’s disease. Dosage & Administration: Treatment should be initiated and supervised by a physician experienced in the diagnosis and treatment of Alzheimer’s dementia. Therapy should only be started if a caregiver is available who will regularly monitor the intake of the medicinal product by the patient. Regular review to assess clinical benefit: The tolerance and dosing of memantine should be assessed regularly, with the first assessment within three months of the start of treatment and thereafter regularly according to current clinical guidelines. Maintenance treatment can be continued for as long as a therapeutic benefit/tolerability continues for the patient. Discontinuation should be considered when therapeutic benefit/tolerability for the patient is no longer present. Treatment is orally either as tablets (10 mg) or solution (5 mg/pump actuation) taken with or without food once a day at the same time every day. The solution should only be dosed onto a spoon or into a glass of water using the pump. Maintenance dose is 20 mg/day (two tablets or 2 ml solution equivalent to 4 pump actuations). Treatment starts with 5 mg/day (half a tablet or 0.5 ml solution equivalent to 1 pump actuation) for the first week; the 2nd week 10 mg/day (one tablet or 1 ml solution equivalent to 2 pump actuations); the 3rd week 15 mg/day (one and a half tablets or 1.5 ml solution equivalent to 3 pump actuations) and the 4th week 20 mg/day (two tablets or 2 ml solution equivalent to 4 pump actuations). Moderate renal impairment 10 mg/day (one tablet or 1 ml solution equivalent to 2 pump actuations) if well tolerated after 7 days the dose could be titrated up to 20 mg/day (two tablets or 2 ml solution equivalent to 4 pump actuations). Severe renal impairment- dose is 10 mg/day (one tablet or 1 ml solution equivalent to 2 pump actuations). Mild-moderate hepatic impairment- no dose adjustment. Severe hepatic impairment- no data available, not recommended. Children & Adolescents: Not recommended. Contraindications: Hypersensitivity to the active substance or any of the excipients. Pregnancy and Lactation: Pregnancy: Ebixa should not be used in pregnant women unless clearly necessary. Lactation: Women taking Ebixa should not breast-feed. Special Warnings and Precautions for use: Caution is recommended in patients with epilepsy. Caution is advised in patients with raised urine pH as this may elevate plasma levels. Clinical trial data are limited on patients with recent myocardial infarction, uncompensated congestive heart failure and uncontrolled hypertension and patients with these conditions should be closely supervised. Avoid concomitant use of NMDA antagonists (see also interactions). Patients should be warned to take special care if driving and using machines as Ebixa has minor to moderate influence on these tasks. Oral solution only: Patients with rare hereditary problems of fructose intolerance should not take Ebixa 5 mg/pump actuation oral solution as it contains sorbitol. Interactions: Effects of L-Dopa, dopaminergic agonists and anticholinergics may be enhanced. Effects of barbiturates and neuroleptics may be reduced. Concomitant administration of Ebixa with antispasmodic agents e.g. dantrolene and baclofen can modify their effects, dose adjustments may be necessary. Increased plasma levels could occur with concomitant use of cimetidine, ranitidine, procainamide, quinidine, quinine and nicotine. Co-administration with hydrochlorothiazide (HCT) may lead to a reduced serum level of HCT. Concomitant use of NMDA antagonists (amantadine, ketamine and dextromethorphan) or phenytoin should be avoided. Close monitoring of prothrombin time or INR is advisable for patients treated concomitantly with oral anticoagulants. Adverse reactions: Common (≥1/100 to <1/10) headache, somnolence, hypertension, constipation, dizziness, dyspnoea, drug hypersensitivity, balance disorders and elevated liver function test. Uncommon reactions (≥1/1,000 to <1/100): cardiac failure, fatigue, fungal infections, confusion, hallucinations (mainly in patients with severe Alzheimer’s disease), venous thrombosis/thromboembolism, vomiting, gait abnormal. Very rare (<1/10,000): seizures. Not known: Hepatitis. Isolated cases of pancreatitis and psychotic reactions have been reported post-marketing. Alzheimer’s disease has been associated with depression, suicidal ideation and suicide. In post-marketing experience these events have been reported in patients treated with Ebixa. Overdose: Symptomatic treatment. Elimination: Mainly in unchanged form via the kidneys. Legal Category: POM. Marketing Authorisation Holder: H.Lundbeck A/S, Ottiliavej 9, DK-2500 Valby, Denmark. Marketing Authorisation Numbers: EU/1/02/219/005 Ebixa 5 mg/pump actuation oral solution-50 ml bottle. EU/1/02/219/006 Ebixa 5 mg/pump actuation oral solution-100 ml bottle. EU/1/02/219/007 Ebixa 10 mg film-coated tablets, 28 pack size. EU/1/02/219/008 Ebixa 10 mg film-coated tablets, 56 pack size. Further information may be obtained from: Lundbeck (Ireland) Ltd., 7 Riverwalk, Citywest Business Campus, Dublin 24.Date of Preparation: May 2012

Reference: 1. Rive et al. Int J Geriatr Psychiatry 2004; 19: 458-464.

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ebixa_advert_A4_may13_04.indd 1 10/07/2013 15:57

Your advice on using REGAINE® Foam twice daily can stay with them, even if you can’t.

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Regaine® Foam.1 And it’s not only effective but also quick and easy to apply, slotting readily into

their daily grooming routine. Further information available

from www.regaine.ie

Regaine for Men Extra Strength Scalp Foam 5 % w/w Cutaneous Foam. Compostion: Minoxidil 5% w/w. Indications: Treatment of androgenetic alopecia in men. Dosage: Regaine is for external use only. Do not apply to areas of the body other than the scalp. Hair and scalp should be thoroughly dry prior to topical application of the foam. A dose of 1 g (equivalent to the volume of half a capful) of Regaine should be applied to the total affected areas of the scalp twice daily. The total dosage should not exceed 2 g. It may take twice-daily applications for 8 to 16 weeks before evidence of hair growth can be expected. Users should discontinue use if there is no improvement seen after 16 weeks. If hair regrowth occurs, twice daily applications of Regaine are necessary for continued hair growth. Special populations: There are no specific recommendations for use in elderly patients or in patients with renal or hepatic impairment. Pediatric population: Regaine is not recommended for use in children below the age of 18 years due to lack of data on safety and efficacy. Method of administration: Hold can upside down and press the nozzle to dispense foam onto the hand. Spread with fingertips over entire bald area. Hands should be washed thoroughly after application. Contraindications: Hypersensitivity to minoxidil or to any of the excipients. Special warnings and precautions for use: Regaine should be used when the scalp is normal and healthy. i.e it is not red or inflamed or not infected or irritated or painful. Minoxidil is not indicated when there is no family history of hair loss, hair loss is sudden and/or patchy, hair loss is due to childbirth, or the reason for

hair loss is unknown. Patients with known cardiovascular disease or cardiac arrhythmia should contact a physician before using Regaine. The patient should stop using Regaine and see a doctor if hypotension is detected or if the patient is experiencing chest pain, rapid heartbeat, faintness or dizziness, sudden unexplained weight gain, swollen hands or feet or persistent redness or irritation of the scalp. Regaine contains ethanol (alcohol), which will cause burning and irritation of the eye. In the event of accidental contact with sensitive surfaces (eye, abraded skin and mucous membranes) the area should be bathed with large amounts of cool tap water. Regaine also contains butylated hydroxytoluene, which may cause local skin reactions (e.g. contact dermatitis), or irritation to the eyes or mucous membranes, and cetyl and stearyl alcohol, which may cause local skin reactions (e.g. contact dermatitis). Some patients have experienced changes in hair colour and/or texture with Regaine use. Increased hair shedding can occur due to minoxidil’s action of shifting hairs in the resting telogen phase to the growing anagen phase (old hairs fall out as new hairs grow in their place). This temporary increase in shedding generally occurs two to six weeks after beginning treatment and subsides within a couple of weeks (first sign of action of minoxidil). If shedding persists users should stop using Regaine and consult their doctor. Users should be aware that, whilst extensive use of Regaine has not revealed evidence that sufficient minoxidil is absorbed to have systemic effects, greater absorption because of misuse, individual variability, unusual sensitivity or decreased integrity of the epidermal

barrier caused by inflammation or disease processes in the skin (e.g. excoriations of the scalp, or scalp psoriasis) could lead, at least theoretically, to systemic effects. Accidental ingestion may cause serious cardiac adverse events. Therefore this product has to be kept out of the reach of children. Undesirable effects: Nervous system disorders; Common: Headache. Vascular disorders; Uncommon: Hypotension Rare: Palpitations, Heart rate increase, Chest pain. Respiratory, thoracic and mediastinal disorders; Uncommon: Dyspnoea. Skin and subcutaneous tissue disorders; Uncommon: Hypertrichosis (unwanted non-scalp hair including facial hair growth in women), pruritus (including rash pruritic and application site, generalized and eye pruritus, temporary hair loss (see section 4.4), changes in hair texture and hair colour, skin exfoliation (including application site), rash (including application site, pustular, papular, generalized and macular rash), acne, dermatitis (including contact, application site, allergic, atopic and seborrhoeic dermatitis) and dry skin (including application site dryness). General disorders and administration site conditions; Uncommon: Oedema peripheral, Application site irritation (including skin irritation), application site erythema (including erythema and rash erythematous). PA No.: PA 823/48/3. Date of revision of text: August 2012. PA Holder: 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.Reference: 1. Olsen EA et al. J Am Acad Dermatol 2007; 57: 767-74.

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Creating change and new positivityRichard Bradley, Boots Ireland’s new Commercial and Operations Director

“My approach to change is how you lead and create it, rather than sitting back and allowing it to happen to you. I would put energy into creating a positive new future for the profession, such as creating new income streams that will make up for the diminishing income from dispensing,” Bradley told Irish Pharmacy News.

Bradley feels that pharmacists should have much more of an input into the primary and secondary health care sectors.

“There’s a lot more the profession can offer, such as regular testing for long term conditions, such as heart disease and diabetes. It is far more convenient for a patient to visit their (own) pharmacy to have their blood pressure checked every six months rather than go to a doctor. I would like to see medication management with the pharmacist but a lot has to change for that to happen,” Bradley said.

Boots Ireland has been the first to introduce many pioneering services for their pharmacies, for example, Boots Ireland was the first to introduce the availability of the emergency contraceptive pill without a prescription and the first to offer flu vaccinations to patients in their pharmacies.

“I am proud to say that these initiatives are Boots led and have benefited the profession as well as our patients,” continued Bradley. “Boots in Ireland has committed to investment in pharmacy to lead the way and change the industry. Each accomplishment and new

innovation inspires us to keep moving forward and to find other ways to improve and transform the profession.”

Bradley first started as a pharmacist with Boots in Birmingham, UK and has continued to work with Boots under various roles both in the UK and, more recently Ireland.

Bradley said, “The advantage of working in the same company throughout your career is you have the opportunity of experiencing different roles and aspects of an industry whilst staying in the same company with the same missions and ethos.”

Along with his Tipperary born wife and family, Richard moved to Ireland with Boots in 2007. He has most recently led the introduction of the new transactional website ‘boots.ie’, which is dedicated and tailored to Boots’ customers in Ireland.

“A key part of the Boots strategy is being available for our customers whenever and wherever is convenient to them. For us, it is all about accessibility, which is why we have opened more shops all over Ireland in recent years. The website is an extension of that. It is there to complement what the store can offer. Our aim is to offer customers a great shopping experience however they choose to shop - on-line or in-store - and to provide advice and information on our ranges to our customers from the convenience of their own home.”

Profile

The recent Financial Emergency Measures in the Public Interest (FEMPI) cuts to pharmacists’ fees by the government sees a significant loss to Irish pharmacists’ income. Richard Bradley, the new Commercial and Operations Director of Boots Ireland says pharmacists should look to extend the primary care services available to customers.

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Regaine for Men Extra Strength Scalp Foam 5 % w/w Cutaneous Foam. Compostion: Minoxidil 5% w/w. Indications: Treatment of androgenetic alopecia in men. Dosage: Regaine is for external use only. Do not apply to areas of the body other than the scalp. Hair and scalp should be thoroughly dry prior to topical application of the foam. A dose of 1 g (equivalent to the volume of half a capful) of Regaine should be applied to the total affected areas of the scalp twice daily. The total dosage should not exceed 2 g. It may take twice-daily applications for 8 to 16 weeks before evidence of hair growth can be expected. Users should discontinue use if there is no improvement seen after 16 weeks. If hair regrowth occurs, twice daily applications of Regaine are necessary for continued hair growth. Special populations: There are no specific recommendations for use in elderly patients or in patients with renal or hepatic impairment. Pediatric population: Regaine is not recommended for use in children below the age of 18 years due to lack of data on safety and efficacy. Method of administration: Hold can upside down and press the nozzle to dispense foam onto the hand. Spread with fingertips over entire bald area. Hands should be washed thoroughly after application. Contraindications: Hypersensitivity to minoxidil or to any of the excipients. Special warnings and precautions for use: Regaine should be used when the scalp is normal and healthy. i.e it is not red or inflamed or not infected or irritated or painful. Minoxidil is not indicated when there is no family history of hair loss, hair loss is sudden and/or patchy, hair loss is due to childbirth, or the reason for

hair loss is unknown. Patients with known cardiovascular disease or cardiac arrhythmia should contact a physician before using Regaine. The patient should stop using Regaine and see a doctor if hypotension is detected or if the patient is experiencing chest pain, rapid heartbeat, faintness or dizziness, sudden unexplained weight gain, swollen hands or feet or persistent redness or irritation of the scalp. Regaine contains ethanol (alcohol), which will cause burning and irritation of the eye. In the event of accidental contact with sensitive surfaces (eye, abraded skin and mucous membranes) the area should be bathed with large amounts of cool tap water. Regaine also contains butylated hydroxytoluene, which may cause local skin reactions (e.g. contact dermatitis), or irritation to the eyes or mucous membranes, and cetyl and stearyl alcohol, which may cause local skin reactions (e.g. contact dermatitis). Some patients have experienced changes in hair colour and/or texture with Regaine use. Increased hair shedding can occur due to minoxidil’s action of shifting hairs in the resting telogen phase to the growing anagen phase (old hairs fall out as new hairs grow in their place). This temporary increase in shedding generally occurs two to six weeks after beginning treatment and subsides within a couple of weeks (first sign of action of minoxidil). If shedding persists users should stop using Regaine and consult their doctor. Users should be aware that, whilst extensive use of Regaine has not revealed evidence that sufficient minoxidil is absorbed to have systemic effects, greater absorption because of misuse, individual variability, unusual sensitivity or decreased integrity of the epidermal

barrier caused by inflammation or disease processes in the skin (e.g. excoriations of the scalp, or scalp psoriasis) could lead, at least theoretically, to systemic effects. Accidental ingestion may cause serious cardiac adverse events. Therefore this product has to be kept out of the reach of children. Undesirable effects: Nervous system disorders; Common: Headache. Vascular disorders; Uncommon: Hypotension Rare: Palpitations, Heart rate increase, Chest pain. Respiratory, thoracic and mediastinal disorders; Uncommon: Dyspnoea. Skin and subcutaneous tissue disorders; Uncommon: Hypertrichosis (unwanted non-scalp hair including facial hair growth in women), pruritus (including rash pruritic and application site, generalized and eye pruritus, temporary hair loss (see section 4.4), changes in hair texture and hair colour, skin exfoliation (including application site), rash (including application site, pustular, papular, generalized and macular rash), acne, dermatitis (including contact, application site, allergic, atopic and seborrhoeic dermatitis) and dry skin (including application site dryness). General disorders and administration site conditions; Uncommon: Oedema peripheral, Application site irritation (including skin irritation), application site erythema (including erythema and rash erythematous). PA No.: PA 823/48/3. Date of revision of text: August 2012. PA Holder: 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.Reference: 1. Olsen EA et al. J Am Acad Dermatol 2007; 57: 767-74.

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Richard Bradley, Boots Ireland

10

The website offers customers 26,000 health and beauty products available to order online . Customers can either collect through their local Boots’ store or the goods can be delivered straight to their home. The Irish website is similar to the UK site in its look and feel but is tailored to suit the needs of Irish customers. For example, more emphasis has been put on baby products, due to the fact that, currently Ireland has one of the highest birth rates in Europe and almost two-thirds (61%) of Irish women who shop on-line are mothers.

Bradley has always had an interest in business and a key part of this is to understand what customers want and to develop strategies to deliver it to them. He also says that it is important to enthuse and guide his teams.

“Our core purpose in Boots is ‘everyone’s right to feel good’. Whether it is in beauty or pharmacy healthcare, the work we do is more than just a job, it’s purpose beyond profit. A big benefit of working in Pharmacy and a pharmacy-led retailer is, ultimately what we do to change people’s lives. Boots makes a difference in the communities by working, for example with our

charity partner, the Irish Cancer Society. Boots Ireland raised over ¤184,00 during our first year of supporting the Irish Cancer Society. This money will go toward supporting the Irish Cancer Society Night Nurse Service,” Bradley said.

Boots carries out extensive research into customers’ needs by appointing research panels, organising customer care surveys and offering them a Boots Advantage Card.

“The Boots Advantage Card gives us a great insight into what customers want so that we can continue to offer more personalised offers tailored specifically to them,” he explained

“Our customers know that our products are well tested, our staff are well trained and that we have a brand they can trust,” he added. “Accessibility is what is important to us and we have invested heavily in our Irish brand. We now have 74 stores throughout Ireland in the right locations for our customers.”

Although Boots has only been in Ireland since 1996, the company has a long heritage dating back to Nottingham in the mid-19th century.

Bradley said, “We are very proud of our heritage and our history of helping people with their healthcare needs in an affordable way. We translate our brand to the country that we are in and offer our customers the products that they want whether that’s in-store or now on-line from boots.ie. ”

Bradley also plans to reward Boots’ loyal customers, who are predominantly women aged 20-55 with extended offers on the Boots Advantage Card and he also plans to bring new beauty content, brands and products to Boots in the coming year.

He said, “The Boots Advantage Card scheme is one of the most loved loyalty programmes in Ireland. We have increased the number of members this year by 9% to almost 1 million Irish users (approximately 22.2% of the population) and what we would like to concentrate on is developing the services and personalised offers through the card.”

Since Bradley moved to Ireland from the UK, he has been able to compare the Irish and UK pharmacy sectors and the many differences between the two.

He said, “The Irish, in certain respects are ahead of the UK, especially in terms of how the pharmacist is viewed by the community. They are the first port of call because of the cost involved in seeing a doctor. They can also interact and spend more time with their patients compared to the UK as they do not have the same volumes to dispense.”

Bradley added, “However, there are a lot of initiatives happening in pharmacy across the globe that Ireland has yet to catch up on.”

Bradley concluded by explaining how he sees the future of pharmacy in Ireland.

“In the next 15-20 years, I think we’ll see a move towards a more personalised multichannel healthcare offering. Advances in technology, such as electronic prescriptions, robotic dispensing and robotic accuracy checks will allow the pharmacist to come out from behind the dispensary,” he said.

“The big difference the pharmacist will be able to make in the future is interaction with the patient. This is already happening in a number of pharmacies, which have an automated dispensing process already or have fantastic dispensers that are well trained and can do the job as well as the pharmacist. Having these amenities allows the pharmacist to have contact with their patients, work on consultations, on vaccinations or on medicine reviews.

“I think the future of pharmacy is a more holistic approach to health care, which is pharmacy led.”

“I think we'll

see a move

towards a more

personalised

multichannel

healthcare

offering”

12

NewsPharmacists wary of new online prescription service

PEOPLE IN CONNAUGHT HAVE THE WORST ATTITUDE TO AGEING

In a survey commissioned by Boots Ireland 46% of people in Connaught said they did not feel positive about how they are ageing however nine out of ten felt that their generation was proactively managing their health.

Daragh Matthews, Age Action Ireland said, “I am pleased to see that research by Boots Ireland shows that nine in ten over 60s feel their age group are active in managing their health and well-being. Age Action welcomes the efforts of Boots Ireland to celebrate the fact that people are living longer lives and want to stay fi t and healthy.”

People living in Munster felt the most positive with 66% with 63% in Ulster and 61% in Leinster feeling positive about their physical and mental health, their fi tness, appearance and their outlook for the future.

The Boots research also examined how older people in Ireland viewed themselves and others. 85% of people over 60 said that they still considered themselves to be young and over half did not consider another person to be ‘old’ until they were aged 80 years or older. Over a quarter of respondents said they ‘never’ considered other people to be ‘old.’

The research, commissioned by Boots Ireland, comes as the retailer today launches its new enhanced offer for customers over the age of 60.

Speaking at the launch of Boots More Treats for Over 60s, Celia Holman Lee said, “I have always encouraged people to embrace ageing. Getting older shouldn’t stop you from feeling good both mentally and physically. It is great to see from the research that over 60s already have a positive attitude towards ageing.”

news brief

Patients may request a six-month supply of the contraception pill by contacting Lloyds Online Doctor and completing a confi dential, online questionnaire. Within one working day, a registered doctor will assess the request and, assuming the necessary criteria are met will post a prescription directly to the patient’s home, which can be dispensed at any pharmacy within the Republic of Ireland. Irish law currently does not permit electronic prescriptions; therefore the website has to issue a hand-signed paper prescription, which is sent to the patient in the post.

Generally, the cost of renewing the contraceptive pill in this manner is ¤25, compared the ¤40-¤70 that it costs for a GP visit.

“Women in Ireland spend up to ¤250 a year on oral contraception, almost half of which is spent on doctors’ fees to renew their prescription," said Dr Christina Hennessey, Service Development Clinician with Lloyds Online Doctor. "The Online Doctor service offers women a reliable, cost effective solution to their contraceptive needs and its convenience is complementary to demanding schedules."

While the service is convenient and cost effective, some Irish pharmacists are concerned about the risks associated with ordering a prescription online.

A new online service is offering online repeat prescriptions for patients on oral contraceptives.

if a patient is lying, though if a patient visits a new GP for the fi rst time there is nothing to say that patient won’t lie to them also. This service has been in the UK since 2002 and has 600,000 patients with no major catastrophic events occurring from people lying so far. Every application for a prescription is reviewed by a doctor and many prescriptions are rejected. The website is quite explicit that the service is for women who are currently taking the pill and need a repeat prescription. We rely on people to tell the truth and we do require people using our services to tick a declaration that they are doing so.”

Brett added, “The service is designed to increase accessibility. There are many illegal sites that sell prescription drugs. The online service which Lloyds offers is a reputable, regulated and a safe online alternative to these dangerous sites.”

The service is also available for erectile dysfunction and hair loss.

Evolving technician roles on FIP agenda

The programme will focus on the role of pharmacy technicians in managing complex patients including evolving and increasing roles, impact of regulation, education and logistics. It will also have complex patient case studies - a selection of case studies exemplifying different aspects of complexity.

Clare Ward President of the Irish Association of Community Pharmacy Technicians (IACPT) told Irish Pharmacy News, “The IACPT are very excited to have been asked to be part of the registration

process for the FIP Congress. Specifi cally, looking after the special Ireland and UK rate for the pharmacy technician’s symposium. The IACPT have chosen four of the IACPT Committee members to attend the technician’s symposium. We would also like to thank Actavis for their support with this.”

The FIP congress will be in Ireland this year as part of The Gathering from 31st August to 5th September and will be hosted by the Pharmaceutical Society of Ireland (PSI). The congress has not been in Ireland since 1975.

Founded in 1912, the FIP is the global federation of national associations of pharmacists and pharmaceutical scientists. It sets global pharmacy standards through professional and scientifi c guidelines, policy statements and declarations, and works in collaboration with international organisations such as the World Health Organization (WHO) and other United Nations agencies. Through its 127 Member Organisations FIP advocates for and serves more than three million practitioners and scientists around the world.

The International Pharmaceutical Federation (FIP) world congress will be holding the second annual symposium for pharmacy technicians and pharmacy support workforce.

Kevin Rabbitt, pharmacist in Care Pharmacy Galway, said, “Although I have no doubt pharmacists will accept the prescriptions as valid, I have huge concerns with the risk of patients lying in order to get a cheap prescription. I would also be concerned with young girls getting the contraceptive pill online for the fi rst time without seeing a doctor directly. This service makes it easy for these girls because it is easy to lie to a computer.”

Christine O’ Connor, pharmacist in CH Chemists, said, “Personally I feel the risks of this service are too high, especially with the contraceptive pill. The observation of blood pressure with the pill is very important and patients could give misleading information about their health in order to make sure they are approved.”

Dr Tom Brett from Lloyds told Irish Pharmacy News, “The service is designed to be safe and a comprehensive questionnaire asks a series of 20-30 questions. There are measures in place to check

Dr Thom Brett

EsomeprazoleGASTRO-RESISTANT

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Nepramel is indicated in combination with appropriate antibacterial therapeutic regimens for the

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Nepramel is also indicated for patients requiring continued NSAID therapy1

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ABBREVIATED PRESCRIBING INFORMATION Nepramel 20 and 40 mg gastro-resistant capsules, hard Nepramel 20 mg Capsules: Each capsule contains 20 mg of esomeprazole (as magnesium dihydrate). Nepramel 40 mg Capsules: Each capsule contains 40 mg of esomeprazole (as magnesium dihydrate). Presentation: Nepramel 20 mg Capsules: Capsule with an opaque yellow cap and an opaque white body imprinted in black with “20 mg”. Nepramel 40 mg Capsules: Capsule with an opaque yellow cap and an opaque yellow body imprinted in black with “40 mg”. Indications: Gastro-oesophageal Reflux Disease (GORD): treatment of erosive reflux oesophagitis, long-term management of patients with healed oesophagitis to prevent relapse, symptomatic treatment of GORD. In combination with appropriate antibacterial therapeutic regimens for the eradication of Helicobacter pylori, healing of H. pylori associated duodenal ulcer and prevention of relapse of peptic ulcers in patients with H. pylori associated ulcers. Patients requiring continued NSAID therapy: healing of gastric ulcers associated with NSAID therapy, prevention of gastric and duodenal ulcers associated with NSAID therapy, in patients at risk. Prolonged treatment after i.v. induced prevention of rebleeding of peptic ulcers. Treatment of Zollinger Ellison Syndrome. Dosage: The capsules should be swallowed whole with liquid. The capsules should not be chewed or crushed. Adults and adolescents from the age of 12 years: Gastro-oesophageal Reflux Disease (GORD): Treatment of erosive reflux oesophagitis: 40 mg once daily for 4 weeks. An additional 4 weeks treatment is recommended for patients in whom oesophagitis has not healed or who have persistent symptoms. Long-term management of patients with healed oesophagitis to prevent relapse: 20 mg once daily. Symptomatic treatment of gastro-oesophageal reflux disease (GORD): 20 mg once daily in patients without oesophagitis. If symptom control has not been achieved after 4 weeks, the patient should be further investigated. Once symptoms have resolved, subsequent symptom control can be achieved using 20 mg once daily. Please refer to Summary of Product Characteristics. Children below the age of 12 years: Not recommended. Impaired renal function: Dose adjustment is not required in patients with impaired renal function. Treat patients with severe renal insufficiency with caution. Impaired hepatic function: Dose adjustment is not required in patients with mild to moderate liver impairment. For patients with severe liver impairment, a maximum dose of 20 mg should not be exceeded. Elderly: Dose adjustment is not required. Contraindications: Known hypersensitivity to esomeprazole, substituted benzimidazoles or any other constituents of the formulation. Esomeprazole should not be used concomitantly with nelfinavir. Warnings and precautions: In the presence of any alarm symptom (e.g. significant unintentional weight loss, recurrent vomiting, dysphagia, haematemesis or melaena) and when gastric ulcer is suspected or present, malignancy should be excluded. Patients on long-term treatment should be kept under regular surveillance. Patients on on-demand treatment should be instructed to contact their physician if their symptoms change in character. When prescribing esomeprazole for eradication of Helicobacter pylori possible drug interactions for all components in the triple therapy should be considered. Contains sucrose. Patients with rare hereditary problems of fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency should not take this medicine. Contains parahydroxybenzoates, which may cause allergic reactions (possibly delayed). Treatment with proton pump inhibitors may lead to slightly increased risk of gastrointestinal infections. Esomeprazole is a CYPRC19 inhibitor; the potential for interactions with drugs metabolised through CYP2C19 should be considered concomitant use of esomeprazole and clopidogrel should be discouraged. Esomeprazole should be stopped for at least 5 days before CgA measurements. Esomeprazole may reduce absorption of vitamin B12. Interactions: Esomeprazole is metabolised by CYP2C19 and CYP3A4 and inhibits CYP2C19. Ketoconazole, itraconazole, atazanavir, nelfinavir, saquinavir, diazepam, citalopram, imipramine, clomipramine, phenytoin, voriconazole, cisapride, warfarin, clarithromycin, St. John’s Wort, rifampicin. Pregnancy and lactation: For esomeprazole clinical data on exposed pregnancies are insufficient. Caution should be exercised when prescribing to pregnant women. Nepramel should not be used during breast-feeding. Undesirable effects: Headache, abdominal pain, constipation, diarrhoea, flatulence, nausea/vomiting, peripheral oedema, insomnia, dizziness, paraesthesia, somnolence, vertigo, dry mouth, increased liver enzymes, dermatitis, pruritis, rash, urticaria. Refer to Summary of Product Characteristics for other adverse effects. Pack size: 28 capsules. Marketing authorisation holder: Clonmel Healthcare Ltd., Clonmel, Co. Tipperary. Marketing authorisation number: PA 126/208/1-2. Full prescribing information is available on request, or go to www.clonmel-health.ie. Medicinal product subject to medical prescription. Date last revised: March 2012. Ref 1: Nepramel Summary of Product Characteristics2012/ADV/ESO/077

14

Clare Ward

Debate

Time for a change - say pharmacy techniciansThe campaign for recognition and regulation of Pharmacy Technicians has been a long and contentious one.

The Irish Association of Community Pharmacy Technicians (IACPT) has been lobbying for recognition and regulation for the last three years and the National Association of Hospital Pharmacy Technicians (NAHPT) for the last ten. And, although there has been more activity in the last couple of years, technicians continue to go unrecognised and unregulated.

Clare Ward, President of the IACPT said, “Pharmacy Technicians are support staff and an integral part of the pharmacy team. It is important for them to be competent and highly trained so that their employers can trust them. In order for this to happen, pharmacy technicians need to be accountable for their actions and this cannot happen unless they are regulated.”

Examining key roles

Currently, the key role of a community pharmacy technician is to prepare and dispense medicinal products under the supervision of a pharmacist. If an error is made by a technician, the pharmacist is at fault. No

accountability lies with the technician whatsoever.

The IACPT and NAHPT have recently discussed, with the Pharmaceutical Society of Ireland (PSI) the possibility of regulation, under the Pharmacy Act 2007.

Ward said, “We have come to a point where we can choose between the Health Care Act 2005 and the Pharmacy Act 2007 because it would be possible for pharmacy technicians to be regulated by both. We are currently focusing our attention on the Pharmacy Act 2007 because we believe the PSI will have a better understanding of a technician’s role and the continuous professional development that should be involved.”

The PSI told Irish Pharmacy News, “The PSI is cognisant of the important role played by all members of the pharmacy team, who operate under the supervision and direction of a pharmacist in the delivery of safe, integrated and patient-centred healthcare. It also acknowledges the contribution of non-registered team members, such as pharmacy technicians. Mindful of its primary function to regulate the profession of pharmacy in the Republic and having regard to the need to protect, maintain and promote the health and safety of the public and having due regard to the international trend towards the regulation of pharmacy technicians, the PSI has committed, in its (recently published 2013-2017) Corporate Strategy to explore the possible recognition and registration of these practitioners, either on a voluntary or a future legislative basis. In the first instance, this will involve an evaluation of pharmacy technician education and training programmes

available in Ireland and work, in this regard is scheduled to take place over the course of 2013, as set out in the PSI’s Service Plan for this year.”

In order for pharmacy technicians to be regulated on a legislative basis, the Department of Health must give its permission for this.

The Department of Health said, “The Department expects that the evaluation of pharmacy technicians' education will take place during 2013, as set out in the PSI’s Service Plan. When the PSI has completed its review, it will submit it to the Department for its consideration. At that stage, the Department will

Yvonne Sheehan

15

examine the necessity, if any for legislation in the area.

“In considering the PSI review, the Department will have regard to international trends, including developments in some countries to regulate pharmacy technicians.”

Regulation and patient safety

The PSI will examine the courses, which are available to pharmacy technicians, in order to ensure that they are of similar standards and, as a result some technicians may be required to undertake extra education and work experience. Therefore, there is a distinct possibility that some of today's technicians may be required to carry out extra education and/or work experience.

Ward said, “Some technicians may be unhappy with this but regulation is about patient safety and, if technicians have a standard higher level of training then customers and patients will have more trust in them.”

Ireland is following in the footsteps of Canada and the UK. In both countries, pharmacy technicians are regulated by having an umbrella qualification.

Alison Casey, a pharmacy technician in David Murphy Pharmacy, Naas, Co Dublin said,

“I would like the job satisfaction of knowing that my job is seen as a profession. If it means that I have to do extra training or career development, I feel that it would be worth it.”

Yvonne Sheehan, President of the NACPT said, “There is no protection of the title 'Pharmacy Technician' or set standards for the education and training of pharmacy technicians. In theory, anyone could set up a pharmacy technician training course and anyone who holds a pharmacy technician qualification or equivalent from any jurisdiction may apply for a pharmacy technician post in Ireland. We need to set (the) standards for education providers, for course content and learning outcomes so that we can produce competent pharmacy technicians. Statutory regulation and registration will support this by ensuring competency and clear standards.”

Sheehan added, “There may be a fear that pharmacy technicians are trying to take (on) the pharmacist's job. That is why, with all the campaigns we carry out, we are (seen to be) as

transparent as possible. We want to dispel any fears, by installing a proper framework and outline so there can be no loopholes or confusion as to what the technician’s role is."

Standard rates of pay

Margaret O’ Doherty, owner/pharmacist of the Raphoe Pharmacy, Co Donegal said, “I can’t see any pharmacist feeling insecure because of technicians. If anything, I see it as the other way around. Many newly qualified pharmacists are taking on the role of technician because it makes more sense financially (for pharmacy owners) to take on a pharmacist rather than a technician. If technicians were regulated this may change”

One of the added bonuses of regulation for technicians would be a standard rate of pay. Currently, pharmacy technicians are paid at the discretion of the pharmacist, which means some may be on the minimum wage.

Oonagh O’ Hagan, Managing Director of Meagher’s Pharmacy group said, “I feel a register of qualified technicians would be very useful in recruitment. Placement on the register would be recognition in itself and lead to better terms and conditions (including salary) for registered technicians.”

If Pharmacy Technicians become qualified, both Sheehan of the NAHPT and Ward of the IACPT agree that they will need to be represented by a union.

Sheehan said, “Our association recommends that our members join a union as they may be able to provide guidance and indemnity insurance to regulated professionals. Pharmacists and pharmacy technicians in the public sector are represented by the Impact union. We would welcome a similar service by the Irish Pharmacy Union (IPU) for community pharmacy technicians in the future."

Ward added, “When regulation comes in for Community Pharmacist Technicians, they will need to be represented. I would appreciate the IPU putting on record some kind of (official) support for technicians because, to date we have not had any.”

No comment says IPU

Irish Pharmacy News asked the IPU for a statement on their stance on pharmacy technicians' regulations. They said, “We do not have a specific stance on this issue and, therefore we have no comment to make.”

Ward estimates that pharmacy technicians will be regulated and recognised in the next five years.

To find out more about the regulation of pharmacy technicians or to join the Association, see the IACPT website for community pharmacy technicians, www.iacpt.ie or, for hospital technicians, see the NAHPT website, www.pharmtech.ie.

" .......regulation is about patient safety and, if technicians have a standard higher level of training then customers and patients will have more trust in them.”

“There may be a fear that pharmacy technicians are trying to take (on) the pharmacist's job. That is why, with all the campaigns we carry out, we are (seen to be) as transparent as possible."

Oonagh O'Hagan

16

Winners

Pharmacy Representative

of the Year Finalist

Irish Pharmacy Awards 2013EXCELLENCE IN PHARMACY

The level of competition and new imaginative projects in this year’s category of Innovation and Service Development Award (Chain) sponsored by Clonmel Healthcare, demonstrates the lengths the pharmacy industry is willing to go to, to improve the service they provide to their customers in a tough time for the sector. Technology is at the forefront of this change and the Bradley’s Pharmacy App, which was awarded the winning trophy, shows that innovation can enhance the patient’s pharmacy experience by making life more convenient while also improving the relationship between the pharmacist and patient.

Brian Pagni, Managing Director of Bradley’s Pharmacy said, “To win the Innovation and Service Development Award (Chain) is important but what makes us at Bradley’s feel privileged to win is the fact that the award is judged by our peers. The judging panel is made up of successful business people and people who know the sector. They know what innovation should be introduced to the sector. This endorsement, mixed with the high level of competition at the awards, makes winning the award extra special.”

The Bradley’s Pharmacy App is completely branded with their own name, logo & information. This new and free pharmacy

Martin Gallagher, Clonmel Healthcare (Sponsor), Brian Pagni, Bradley's Pharmacy and Kevin McCabe.

Innovation and Service Development Award (Chain)Sponsored by Clonmel Healthcare

17

app allows customers to communicate directly with any of Bradley’s 18 pharmacies to avail of their many services, which include; Order Repeat Prescription – customers can order their prescription through the app, if the pharmacy has a valid repeat prescription, the pharmacy will have this ready for collection. Pill Reminder – this allows the user to set a timer on their phone that reminds them to take medication at a particular time. The app also has access to the services the pharmacy offers and links to the website to avail of special offers.

“Innovation is very important in pharmacy because if you stand still in this industry you may as well be going backwards. For us it is about trying to find something that has actual patient benefit and a modern patient will get full use and value from the app.” Pagni told Irish Pharmacy News.

Bradley’s invested heavily in information technology & business systems because they had to find out how to work smarter, not harder, whilst managing their workflow. This allowed the pharmacies in the group to deal with any obstacles that arise in the current climate.

Bradley’s choose the Pharmacy App because they felt that extending the health services available in the pharmacy was not a viable option.

Pagni said, “A lot of pharmacists are going down the route of offering extra services like cholesterol checking etc. That was not for us. I don’t think a pharmacy can be the best at offering these services because patients want conclusive outcomes and very often a pharmacist has to refer the patient to the doctor after these services. I don’t want Bradley’s to be second or third best at offering a service and so we decided to go down another route.”

Ista Chief Executive and Pharmacist, Ciaran O’Connor, said, “We are delighted at Ista Technologies that Bradley’s Pharmacy Group is one of the first pharmacies in the country to adopt the pharmacy app for their store. It shows how forward thinking they are as a business and their deep commitment as a pharmacy to their customers, that they now offer this service for free.”

With too much technology however, there is always a risk of alienating some of the pharmacies loyal customers.

Pagni said, “There is always a risk of pushing patients away with this kind of technology, especially as much of our patient base is elderly. We made sure the app was as simple as possible to download and use and there are minimum settings on the mobile phone. I have found that many elderly patients are embracing the app and find it very user friendly.”

The pharmacy app has exceeded Bradley’s expectations and met their customer targets. They are now in the process of perfecting and refining it.

“Getting active participation is where we are with the app now. We are making sure that the customers who will benefit from the app the most are aware of it and are actually using it. Our pharmacy app is a service that we know will only progress in the future. We are currently in the process of creating the option of photo development. We also invite our customers to let us know what services they would like to see on the app in the future,” Pagni said.

Bradley’s was established by Pagni in 2000 and started with one pharmacy, in Carlingford Co Louth. Bradley’s now has 18 stores throughout Ireland.

Pagni said, “I intended from the beginning of Bradley’s that it would become a chain. I had previously worked in Independents as a pharmacist and always felt like I needed and wanted to do more.”

Between the years 2000 and 2008, Bradley’s grew from one to 14 pharmacies but the effects of the down turn affected the rate of growth. Pagni has seen the effect of the recession and government cuts in his 13 years as Managing Director of Bradley’s.

Pagni concluded, “Bradley’s stands out in pharmacy as we strive to provide excellent customer service, we are always looking at ways to improve and help us ‘stand out’ from other pharmacies. We make sure every customer gets the complete customer care, especially with advice. We aim to get our

pharmacists to interface with their patients on a one to one basis.”

A pharmacy manager must be aware of every aspect of their business and understand it. The good side of the recession is many pharmacies realise that we have to change and innovate in order to keep up. The days of relying on a prescription are going. Technology is going to be a big part of how we dispense in the future. It is best to be at the forefront of change and to lead it rather than be dragging behind. That is what Bradley’s tries to do.”

Brian Pagni, MD, Bradley's Pharmacy

“Innovation is very important in pharmacy because if you still stand in this industry you may as well be going backwards”

18

Winners

Pharmacy Representative

of the Year Finalist

Irish Pharmacy Awards 2013EXCELLENCE IN PHARMACY

The overhaul of a business can be a daunting task, there is always a risk of the project not going according to plan. Burren Pharmacy in Lissdoonvarna decided to make the jump to rebrand their pharmacy in 2012 and have reaped the rewards ever since. In spite of the incessant tales of economic gloom in recent times, the pharmacy has consistently expanded and grown over the last year under the direction of Michelle Quinn, Pharmacy Manager and owner of Burren Pharmacy, and this year’s winners of Actavis Business Development of the Year Award (Independent).

Having correctly anticipating more government cuts and strains on dispensing margins, Burren Pharmacy decided to change their business model from a model heavily based on dispensing fee incomes, a model that is adopted by many small to medium sized independent pharmacies throughout Ireland, to focus more on the front of shop sales and patient-pharmacist interactions.

Quinn said, “We made the major strategic decision to concentrate on the front of shop after a lot of research and the inevitable changes in Irish Pharmacy. It has turned out to be the right decision and what could have been a very tough year has turned into a very positive year for us.”

Having outgrown their former

Michelle Quinn, Burren Pharmacy with Award sponsor Barry Doyle of Actavis

Actavis Business Development of the Year Award (Independent)Sponsored by Actavis

19

premises, which Quinn purchased in 2007, relocation was a priority. A redevelopment project was undertaken to transform a 19th century derelict building on the town square, the original town pharmacy, into a state-of-the-art retail pharmacy premises, the new home of the new Burren Pharmacy and completing the main market square in Lisdoonvarna.

The transformation of Burren Pharmacy concentrated on bringing the pharmacist from behind the dispensary to the front of shop where they can interact with the patients.

A key aspect of the new pharmacy layout was to promote interaction between patient and pharmacist, removing barriers and taking the pharmacist outside the dispensary. Burren Pharmacy make a point of listening and responding to specific patient concerns, Quinn herself has experienced illness in her family and through this experience, understands firsthand the importance of a pharmacist understanding the small issues as well as the big issues of an illness.

“I like to take the time to listen and address all the concerns of my patients. My brother suffered from an illness and I saw how it can feel like a barrier if a pharmacy doesn’t understand the small issues in an illness, such as carrying certain products like certain dressings etc. Little touches like these can improve a patient’s quality of life and I try to do this with Burren Pharmacy,” Quinn said.

Quinn wanted to make Burren Pharmacy unique and to stand out from any other pharmacy. Critical to any retail business is branding. Previously, it was felt by Quinn that the unique name of the pharmacy, trying in with the locality, was not sufficiently capitalised upon. As part of the new shop design, efforts were made to incorporate limestone features in keeping with the Burren, while maintaining a professional and modern look. New carrier bags, consistent signage and staff uniforms were put in place, to differentiate the pharmacy and its offering from competitors. The customer shopping experience has been transformed, with a bright, modern store that is exclusive to Burren Pharmacy.

Quinn said, “What sets our branding apart from other pharmacies is that nothing is generic. Burren Pharmacy team researched everything and

came up with the branding ourselves. It took a lot of work but I am so pleased and proud of the result.”

In retail, it's important to be the expert on the products you sell and offer quality. One innovative step which has been taken within the pharmacy is to introduce Burren Pharmacy recommended products, explaining what they are for and why they are worth buying. This has been particularly successful in encouraging patients to ask about, and switch to pharmacy only products. From Quinn’s experience in working in Pharmacy in Lisdoonvarna for several years, she was able to identify what products her customers would require and what stock would be requested. She ensures that the pharmacy carries products that are exclusive to Burren Pharmacy and they now carry a vastly improved range of products.

“I have been here a long time and I know what my customers want, I try to make sure we carry products that are a little bit different that sets us (Burren Pharmacy) apart,” Quinn said.

All staff received training in areas such as skincare and merchandising. Each team member was encouraged to identify and take specific responsibility for at least one aspect of the business development, leading to a sense of ownership and pride in achievements and therefore a team that works well together.

Lisdoonvarna is a small town that relies heavily on tourism and Burren Pharmacy saw this as an opportunity. Multilingual

documentation was developed and circulated to all local hotels and guesthouses, outlining the services and choice available from the Pharmacy. In addition, as part of the development work, a substantial gift centre was incorporated in the shop with premium gifts such as quality Irish Jewellery available to purchase.

Burren Pharmacy understands that independent pharmacists are a key part of their community.

Quinn said, “2012 was a year of outreach and engagement with our local community. I have visited several schools performing science experiments, we have run art competitions and sponsored the local GAA team, amongst many other activities. Our innovative digital community display is updated regularly and is a focal point for community news, attracting attention to the shop. We have

engaged with the old and young, for instance delivering congratulations and welcome packs to parents of newborn babies free of charge.”

Quinn concluded, “It’s a tough time for Pharmacy at the moment and sometimes we have to change in order to be successful. I think the pharmacy model and the business model can complement each other as long as it is done well and if it is, it can be very effective.”

She added, “We have had an incredible year, we have watched the business grow and then winning the Business Development of the Year Award was an added bonus. It’s such a confidence boost to have all our hard work recognised. Coming home as winners to Lisdoonvarna has given the community a sense of pride and made everything worthwhile.”

Michelle Quinn, Burren Pharmacy

20

Winners

Pharmacy Representative

of the Year Finalist

Irish Pharmacy Awards 2013EXCELLENCE IN PHARMACY

The response for the Counter Assistant of the Year Award this year, for the Irish Pharmacy Awards was overwhelming. The high standard of nominations meant that the category had the highest amount of finalists than ever before, which made the choice of selecting winners extremely difficult.

A good counter assistant is a pivotal aspect of any successful pharmacy. This award recognises those who go above and beyond their job description and make a real difference to the pharmacy and their local community. The 2013 winner, who beat the stiff competition in the category, is Mairead Tobin, who has a real passion for her job as a counter assistant and has made an impact in not only the pharmacy in which she works but also in her local community of New Ross, Co. Wexford.

Marie Foley, the pharmacy manager at Hanly’s Pharmacy nominated Tobin. Foley said, “Mariead is a vital part of our team at Hanly’s pharmacy and to the 3 pharmacies in the local pharmacy group. She has been with us for 12 years and in this time she has helped to make the pharmacy more innovative and has become involved with the local community. She is so committed to her job and is always positive in everything she does. She is the staff member who, if anything needs to be done, you know you can ask her to do it and have the confidence that she will do it well.”

Ingrid Walsh, Sanofi (Sponsor) with Mairead Tobin, Hanley's Pharmacy

Counter Assistant of the Year AwardSponsored by Sanofi

21

Tobin regularly gives up her day off to visit the local hospital or nursing home and help the staff with caring for their patients. She helps with the lunches and dinnerssand often sits with patients to keep them company.

Foley added, “Mairead has a great relationship with our customers. If she is on a day off, we regularly have customers who choose to come back when she is available as they only want to deal with her in the pharmacy. She has many loyal customers and regularly goes beyond what is required of her for the sake of the patients and the pharmacy.”

Tobin has suggested a number of initiatives for the pharmacy, which have been taken up, such as delivering medication to patients' homes when they are unable to get to the pharmacy. She also picks up prescriptions for patients if they are unable to do so themselves and she often does this in her own time.

Foley said, “This delivery initiative has resulted in a number of our patient’s lives being less burdened and stressful and they appreciate Mairead’s efforts, making them very loyal patients.”

Another new concept which Tobin thought of for the pharmacy was to bring a local nurse into the pharmacy to conduct iron tests. This has been well received by the public and Hanly’s hope to make this a regular occurrence in the pharmacy.

Tobin has worked in Hanly’s for 12 years.

Her first role was as a counter assistant at the age of 16. The previous-owner of Hanly’s Pharmacy before it was bought by David Wilson, Pat Hanly encouraged Tobin to apply for the job because she saw huge potential in her.

Tobin said,” Mrs Hanly has been a huge influence on how I deal with patients and customers. She taught me that you always do everything you can for a customer even if it means that you have to go out of your way to do so. This has always been the standard way for me to do my job and I don’t think anything of it. I have always had a great relationship with Mrs Hanly from the day I started and she is like a

family member to me now.”

Going out of her way for patients is something that Tobin does on a daily basis. For example, one of her patients recently sustained a serious leg injury that limited his mobility so Tobin decided to go to the local hospital to arrange a wheelchair for him. As the patient did not ask Tobin to do this, he was completely overwhelmed by her kindness.

Once a second pharmacy opened, Tobin was asked to relocate and assist with the launch.

“It was only me and a pharmacist in the new pharmacy and I had to help in the dispensary out of necessity. I really enjoyed it and learned so much from the experience,” Tobin said. "Previously, I had only worked in the front of the pharmacy."

It was not long until Tobin was relocated back to the New Ross pharmacy where she completed a Pharmacy Technicians' course.

“I enjoy working as a pharmacy technician but I do wish we could be recognised for what we do. We offer a service to patients and give advice when the pharmacist is busy. Our role is developing all the time to include new services. I would like to see the role developing even more. I would like to see technicians extending their services to include the administration of the emergency contraceptive and blood pressure testing. If all we have to do is some extra training, I can’t see why it could not be done by a technician in the coming years.”

Tobin has done extensive training in her 12 years at Hanly’s. After completing a course in first aid and bandage training, she is the first port of call in Hanly's for all first aid related queries.

She has also completed seminars in most of the front of shop products, including skin care and make-up.

David Wilson, owner of Hanly’s Pharmacy said of Tobin, “Mairead puts her heart and soul into her job. She is a very worthy winner and a great employee.”

Speaking about the award Tobin is still in shock that she won the award.

“I felt so privileged to be nominated. I never expected to win. The whole experience was amazing and I felt so appreciated

and special from the beginning. I never knew that I did anything unusual with how I did my job until the awards. My customers have been so kind and are still congratulating me. It has all been such a positive experience.”

Ingrid Walsh of Sanofi comments: "As a global, integrated healthcare leader Sanofi is totally focused on patients' needs so it is a real honour for us to be associated with this particular award. Counter Assistants are the face of community pharmacy and are the first point for customers in need of advice or assistance. Every one of the finalists stood out, each for different reasons, with but all with one thing in common, their absolute focus on patient needs."

Mairead Tobin, Counter Assistant of the Year winner

22

Winners

Pharmacy Representative

of the Year Finalist

Irish Pharmacy Awards 2013EXCELLENCE IN PHARMACY

The Pharmacy Representative of the Year is a new award, which has been included in the Irish Pharmacy Awards. The qualities, which the independent panel of judges were looking for were creativity, an inspiring work ethic and a candidate who is an integral part of a team. The winner, Helen Taylor has all these qualities - and more. She has an exceptional work ethic that goes beyond what is required for an employee and describes her team at McLernon Computers as her 'family'.

Nicola McGarvey, Irish Pharmacy News with winner of the Pharmacy Representative of the Year Award, Helen Taylor, McLernon Computers

“I love my job. I am more than just an employee, my job is my life. A big part of that is the McLernon’s team. It’s like working for a big family. Everyone supports and looks after each another. I couldn’t imagine working anywhere else as I don’t think I would find another team like the one I am in,” Taylor said.

Taylor started her career in

Pharmacy Representative of the Year AwardSponsored by Irish Pharmacy News

THE INDEPENDENT VOICE OF PHARMACY

23

pharmacy at the age of 16, working as a counter assistant in a pharmacy in Richhill, Co. Armagh. It was in this pharmacy that she learned ‘the ropes’ of pharmacy and how to run a business.

Taylor said, “Marion Hammel, the pharmacist in Richhill Pharmacy and she taught me everything there was to know about pharmacy. She assigned me to the job of placing orders so I would become familiar with drug names and she

taught me how to treat the customers. She made me love pharmacy and everything that was involved in it. I loved working in that role because I felt that I was helping people and getting to know the community.”

Taylor stayed in the independent pharmacy sector for ten years and eventually moved on to Boots in Banbridge, Co. Down. While she was at Boots, she trained to be a Pharmacy Technician and was fully involved in the many transitions and new initiatives which were then taking place both within Boots and in community pharmacy in Northern Ireland.

Taylor stayed with Boots for eight years

and worked her way up through the career opportunities which were presented to her and her role included more responsibility, she was in charge of stock control and developing and delivering dispensing protocols in the other Boots stores. A colleague, Harry Harron, told her about the Trainer position in McLernon Computers and advised her to go for the job.

“I felt I had reached my peak at Boots and there was nothing left for me to do in my current role," she said. "I went to the interview with McLernon’s thinking I would never get the job. However, I was very keen to succeed as I was attracted to how diverse the role was and being able to arrange my own schedules."

When Taylor started her new position as a trainer at McLernon Computers, there were only two trainers covering the whole of Ireland and there was only 10 MPS (McLernon Pharmacy Systems) installed. There are now over 1000 MPS systems installed in Ireland and she is supported by six other trainers all regionally based.

Taylor was nominated for Pharmacy Representative of the Year award by the Managing Director of McLernon Computers, Keith McLernon.

In the nomination McLernon said, “Helen is a great example of someone who goes above and beyond what might be expected of her, in order to ensure that McLernon customers obtain the best training in their pharmacy dispensing and EPOS software to ensure that they run their business and care for their patients to the highest possible level. She is the best advertisement for our business, our customers feel secure in the knowledge that because Helen is there they will receive the best possible training and support. She believes that her job is not over until her customers are using their MPS dispensing and EPOS systems in such a way as to maximise profitability, improve efficiency and deliver real returns.”

Commenting on her MD's remarks, Taylor said, “I feel as if it is a part of my job to go beyond what is required of me. Good customer service is what McLernon’s is known for. I like to make every customer feel important simply because they are. We build up relationships with everyone in a pharmacy and encourage them to ask questions. Keith is an excellent boss as he empowers us all to take the initiative and do what we think is best.”

The reaction to Taylor’s award has been remarkable. Her customers have sent her flowers, gifts and cards of congratulations and it was these kind words from her customers which made Taylor stand out.

McLernon said in Taylor’s nomination, “Customers tell me that they have switched to

McLernons systems after hearing about the positive experiences had by their peers of Helen’s professionalism, her talents as a trainer, her dedication to her job and her commitment to stay with them until they are happy and are fully conversant with their new software.”

Speaking of the award, Taylor said, “It is so wonderful to win. It gives you such a boost that you are doing something right.”

Another McLernon’s customer, Tony McEntee, CEO of Uniphar Retail Services said, “Helen managed a major restructuring programme in 2012 for Uniphar Retails Services from start to finish and always delivered on time. Throughout the process, we always felt that our best interests were the key drivers and difficulties were overcome without any fuss. Helen interacted with all areas of our business and she understood our business requirements in minute detail. It is difficult to envisage a more deserving recipient of the 'Company Representative of the Year award' simply because Helen tells you the solutions before you know there is a problem. She has perfected the art of customer service.”

In her 26 years' experience of working in the pharmacy sector, Taylor has evolved from Counter Assistant to Pharmacy Technician to Senior Trainer and now has many roles including managing the customer services' department

in Mclernon’s and representative, project planning for new initiatives

With so much experience in pharmacy, she has seen the landscape change drastically.

“When I started in pharmacy, pharmacists were still compounding and making up cough mixtures," she said. "Pharmacy has come a long way since then. With all the recent cuts, I feel that pharmacy is moving towards providing more services, such as blood pressure and diabetes checks. I think the dispensary will become more technical. With all the changes, however I do hope that some of the special relationships will be retained between patients and pharmacists because that is what makes the sector so unique.”

Taylor added, “I’d like to thank all those customers who have been in touch to congratulate me on my award – I know from experience how busy a pharmacy is, and I really appreciate everyone who took the time to lift the phone or send a card. And I’d also like to thank my colleagues and the Directors at McLernons for giving me such wonderful support and sharing in the same ethos that our customer is at the heart of everything we do.”

24

Winners

Pharmacy Representative

of the Year Finalist

Irish Pharmacy Awards 2013EXCELLENCE IN PHARMACY

Healthwise Pharmacies is an Irish owned group of pharmacies dedicated to providing quality healthcare in the heart of local communities. Their concept was developed in order to combine the benefits of group purchasing with the integrity and service levels of the locally run community pharmacy. “Our goal is to refine our business model to ensure we grow sales and retain margin in the face of continued pharmacy cuts and reduced consumer spending. This will allow us to continue to provide a high level of service to our patients, and allow us to grow and develop our pharmacy group, and to maintain our position as one of the most progressive pharmacy groups in Ireland,” says Director James Cassidy.

The model has evolved where the shared ownership allows stakeholders have a share in a business which avails of the product range, prices and support services of the Healthwise model, while ensuring the pharmacy remains under the management of a dedicated local pharmacist.

Healthwise Pharmacies hope to preserve the ethos of the locally run community pharmacy, while offering a wide range of products and services at the keenest prices. They have introduced a range of Healthwise value lines offering popular products at massively discounted prices and offer a wide range of community healthcare initiatives .The key to the Healthwise model remains the offering of quality and personalised healthcare to local communities ,by a dedicated and committed team led by a

Paul Neill, Krka (Sponsor) with James Cassidy

Business Development of the Year Award (Chain)Sponsored by KRKA

Generic medicines of European quality Krka is one of the world’s top ten generic companies*, with almost 60 years of experience in the production of high quality generic drugs.

*Gen

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www.krka.ie

25

pharmacist familiar with the local patient base.

Patients can call in to their local Healthwise pharmacy for a full medicine review or for a free health check (no appointment necessary). “Our model ensures this is available within the local community, and the convenience and accessability improves uptake of services for the community and also improves footfall for our business.

“Services available include free blood glucose test (diabetes), free weight and body mass, index measurement, free blood pressure measurement, free upgrade of blood glucose meters for any diabetic patient. We also offer weight management clinics, asthma management ,smoking cessation, skincare and allergy services, and are happy to provide a free personalised consultation in private on any aspect of patient health or concern,” says James.

“Healthwise Pharmacies are keen to encourage patients to maintain a healthy lifestyle as best they are able. The team in each of the local branches is best placed to help their local patients according to their specific individual needs. We bring a personalised approach to a full review of all aspects of patient health, and talk individual patients through any issues of concern surrounding healthcare or medication.

“Most pharmacies promise this service, but focused delivery on the ground is the key to success and is not often achieved. This focus on improving general health and best managing any existing medical condition is rewarded by great customer loyalty. This in turn leads to increased footfall and spend, which has allowed us to maintain our business in the face of the current recession and government cuts.”

Healthwise Pharmacies have developed a strong brand image with a distinctive logo and a common shop layout applied to all of their shops. This combined with a major focus on sourcing quality pharmacy related products at very competitive prices, ensures that Healhwise are seen as offering real value. The perception of quality, value and an attractive range of products seems to be resonating with members of the public who tend to seek their shops out when travelling to other Healthwise catchment areas.

“We track existing customers through loyalty cards and prescription records and it is gratifying to see our efforts to

develop loyalty bearing fruit. This is further enhanced by our online presence through our website www healthwisepharmacies.ie and on various social media sites (we regularly run promotions and competitions on Facebook and Twitter and get excellent local responses to competitions and promotions run on these platforms.) We are confident that we have created a distinctive brand with good local awareness in our target communities.

“Our service levels are enhanced by our ability to access prescription records for all patients across the group using our customised head office PMR software. This enables patients who may have forgotten their medicine or may have specific requirements, to call into a sister Healthwise store where we can access their history and ensure they receive appropriate help. We have been thanked many times for our ability to provide such assistance to visiting patients.

In addition to the value provided by Healthwise central purchasing and fully licensed wholesale company, he attributes his

success to being co-founded on their ability to retain the strong local ethos in their pharmacies. “We work extremely hard on ensuring a consistent figure leads the Healthwise pharmacy in each community. This belief was the reason for offering equity stakes in some individual stores to stakeholder pharmacists.

“Pharmacies managed by employee pharmacists are also given a clear strategy and targets for their store. We have a significant bonus structure in place for managing pharmacists in all Healthwise Pharmacies. This has helped ensure a very low turnover of staff and allowed us to deliver on the concept of ensuring the Healthwise pharmacist is well known locally and provides a consistent and convenient port of call for quality Healthcare in the heart of local communities.

“We believe this business model has been very successful so far and will ensure Healthwise Pharmacies will continue to grow our business and remain profitable as the sector develops.

“We have class leading IT systems allowing detailed interrogation of all of our sales and business activities, and closely monitor performance of all shops. This information is used to actively manage and support the operation of all branches. .”

Backed by a strong team, Healthwise have developed a strong brand identity, excellent customer loyalty, and have continued to grow the business in the face of the current challenging environment.

“We receive regular feedback from our website and online customer feedback forms, and also have a strong presence on social media. We have seen increased participation in competitions and promotions run purely through social media, and importantly gain excellent local traction from these activities. We are constantly expanding and developing this offering and will continue to work hard with our team to meet the challenges ahead.”

James Cassidy, Managing Director,

Healthwise Pharmacies

Paul Neill from KRKA comments, “When presented with the opportunity to become one of the sponsors of the IPN Awards we jumped at the chance. We see this as an excellent opportunity to not only promote and recognise excellence within pharmacy in Ireland but also a high profile chance to promote the KRKA brand.

“The IPN Awards provide pharmacies with an annual opportunity to review and improve their business model and their service offering to patients. The nature of this competition and the recognition from among peers that the recipients of these awards receives has obvious benefits in terms of improvement across the sector.”

26

Pharmacy Team of the Year AwardSponsored by McNeil Healthcare

Winners

Pharmacy Representative

of the Year Finalist

Irish Pharmacy Awards 2013EXCELLENCE IN PHARMACY

As Henry Ford once said, “Coming together is a beginning. Keeping together is progress. Working together is success.” This is certainly a true adage for their team working together within Brennans Pharmacy Group, who scooped the prestigious Community Pharmacy Team of the Year Award. For Managing Director Fergus Brennan, their excellent collaboration has produced results exceeding their individual capabilities; allowing patients and customers to engage with confidence and thus generating a synergy that has enabled the team and business to grow immensely.

Michael Black, Feilim Henry, Fergal McDermot, Orla O’Donnell, Geraldine Freeman, McNeil Healthcare (Sponsor), Fergus Brennan, Danielle McNenamin, Elizabeth Doran, Michael Mullen, Aaron Carlyle, Brennans Pharmacy Donegal

“Our team foundation beliefs lie in sourcing staff whom will fit into our mission and ethos,” explains Fergus. “We have strong core values that translate to endeavouring to serve our community and customers in a caring and supportive manner and it is this that drives us to work together as efficiently as possible.”

Brennans pharmacy have three

27

stores located in Clonmany, Carndonagh and Buncrana. For Fergus the journey was a long one as he set out on a road with one destination; to find individuals matching the Brennans desire of providing excellence in customer service every day.

“Our patients and our customers are the reason we open our doors every day,” he says. We have three simple routines that ensure we keep moving forward:

Appreciate each others skills;

Have trust and honesty

Celebrate our successes

“Each member of the team is a ‘champion’ of their own skill-set. We work in an intense environment and I feel it’s important that each member of staff is aware of what they bring to the table to assist with the effective working of their colleagues.

“We have clear goals, roles and responsibilities and I feel investing in these relationships with each other has the knock-on effect. We all need to focus on providing an uplifiting customer service experience and therefore if we are happy working together as a team, our customers will feel that energy in a positive way also.”

Evidence of their innovation is apparent throughout. Team leader within the

Brennans Clonmany branch, Feilim Henry constistently uses every opportunity to train staff colleagues and pass on new ideas about giving the patients exceptional pharmacy service. Feargal, group support pharmacist is the training co-ordinator for OTC medicines and minor ailments. He gives focused and structured OTC training, which has greatly

improved the teams product knowledge.

Using these stratgeies has meant the team can offer patients the best advice and respond effectively to enquiries they make about products and services advertised.

The team also support many local causes and charities, emphasising their desire to lend a hand to their local community.

“We strive to make links with our local community. Our contribution is very important to us and we have sponsored many community events and competitions including the local primary schools, the Carndonagh Community Hospital, the Funny Feet Fund and the Croc Crusade. We have held our own in-store events, including those to support hospice care and Daoffodi Day for the Irish Cancer Society. All of our team members received training on various cancer issues from our relief pharmacist.

Fergus continues: “Toegther we always have an eye on what we can improve within the pharmacy and the team to improve our service. We have recently received the boost of additional manpower which has allowed us to move forward with our health promotion activity. We are never standing still.”

In late 2012 Brennans began offering a new mobile messaging service for patients called ‘Text & Collect’. All team members have promoted this service and they are now providing it to over 150 patients.

“We had a series of meetings to find the best way to deliver this service and it has helped us to organise our workload on

a daily basis, improving patient compliance so as the patient doesn’t run our of their medicines and also frees us up to spend more time to consult with our patients.

“As a team we worked together on this project to fully identify the best way of utilising our skills so as to deliver the service as efficiently as possible.”

Using the brennanspharmacy.com email system, staff can be kept informed refularly of onging developments and this is used as a unique communication tool within the branches.

“A huge achievement for us as a team was to reach the Top 100 Stores in the Retail Excellence Ireland Awards last year. The awards programme involves the rigorous assessment of retail practice and the selection of best in class retail operators. Working in an independent pharmacy makes it difficult to benchmark ourselves against the rest of the pharmacy industry. Achieving our place in the Top 100 stores with tough multinational competition and wining such high recognition indicates we are delivering excellent customer service through a driven, dedicated and patient focused team. Our team was commended for being attentive, friendly and knowledgeable with a vast product range and a fantastic store. We strive to create a comfortable, friendly and warm atmosphere, which was evident in the report. We support and encourage each other to maintain our high standards of customer service. We are all extremely passionate about our customers and our team. We are very proud of our success and recognition as one of the Top 100 retail stores in Ireland.”

For winning the prestigious ‘Community Pharmacy Team of the Year Award’ Fergus comments, “It is important to acknowledge the other nominees within our catgeory. Stacks pharmacy, McCabes pharmacy, Boots pharmacy, DocMorris pharmacy, Marketpoint pharmacy, Murrays pharmacy

“The standard of service being provided throughout pharmacy in Ireland across the board is exceptional and it has been inspirational to have been shortlisted amongst the calibre of those names above; and a true honour to have been selected as the winner. This has given us a further drive to keep moving forward with our goals and vision, there is a bright future on the horizon for Brennans with many challenges. But challenges bring opportunity.

“Pharmacy is undergoing critical change at the moment, but we firmly believe that if we adapt to this change as quickly and efficiently as possible, the future is not only bright, it’s inspiring.”

“Under the caring and inspirational leadership oF Feilim Henry, we genuinely work as one happy Family in our team at Brennans Clonmany . We enjoy each others company and have built real trust, co- operation and Friendship in our group. We Feel privileged to serve our local community every day. We look Forward to Further growth and exciting changes in the years ahead so that we can continue to deliver an outstanding community pharmacy service to our patients,” adds Fergus.

Feilim Henry, Sarah McCarron, Michael Black, Fergus Brennan, Bridgeen McConologue

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■ Tostran® is the only 2% testosterone gel: - Accurate 10 mg dosing5 - Simple dose titration5 - Easy to apply, with minimal waste5

A simple solution to a serious problem

Tostran® Abbreviated Prescribing Information Please refer to Summary of Product Characteristics before prescribing. Presentation: Tostran 2% gel, contains testosterone, 20mg/g. Indications: Replacement therapy with testosterone for male hypogonadism when testosterone deficiency has been confirmed by classical clinical symptoms and laboratory analyses. Posology: The recommended starting dose is 3g gel (60mg testosterone) applied once daily at approximately the same time each morning to clean, dry, intact skin, alternately on the abdomen or to both inner thighs. Application elsewhere should be avoided. The dose should be adjusted to the clinical or laboratory response. The daily dose should not exceed 4g of gel (80mg testosterone). The gel must not be applied to the genitals. Not for use in women, or children under the age of 18 years. Contraindications: Androgens are contraindicated in known or suspected carcinoma of the breast or the prostate, known hypersensitivity to testosterone or any of the excipients, and in women. Warnings and Precautions: Tostran should not be used to treat non-specific symptoms suggestive of hypogonadism if testosterone deficiency has not been demonstrated and if other aetiologies responsible for the symptoms have not been excluded. Tostran is not indicated for treatment of male sterility

or sexual impotence. Prior to initiation of therapy, all patients must be examined to exclude a risk of pre-existing prostatic cancer. Careful and regular monitoring of breast and prostate must be performed. Testosterone may accelerate the development of subclinical prostatic carcinoma and benign prostatic hypertrophy. Oedema with or without congestive heart failure may be a serious complication in patients with pre-existing cardiac, renal or hepatic disease. The treatment must be discontinued immediately if such complications occur. Testosterone may cause a rise in blood pressure and Tostran should be used with caution in men with hypertension. Tostran should be used with caution in patients with ischaemic heart disease, epilepsy, migraine and sleep apnoea as these conditions may be aggravated. Care should be taken in patients with skeletal metastases due to risk of hypercalcaemia/hypercalcuria. In diabetic patients, the metabolic effects of androgens may decrease blood glucose and therefore insulin requirements. Patients who wash in the morning should apply Tostran after washing, bathing or showering. Avoid the potential for transfer of testosterone from the patient to another person by careful hand washing and the wearing of loose clothing after the gel has been applied and has thoroughly dried. Bathe or shower before any

close contact with another person. Particular care must be taken to prevent transfer of testosterone to pregnant women or children via skin contact. Interactions: When androgens are given simultaneously with anticoagulants, the anticoagulant effect can increase and patients receiving anticoagulants require close monitoring of their INR. Concurrent administration of testosterone with ACTH or corticosteroids may increase the likelihood of oedema and caution should be exercised. Undesirable effects: Very common (>1/10): application site reactions (including paraesthesia, xerosis, pruritis, rash or erythema); common (>1/100, <1/10): peripheral oedema, hypertension, polycythemia, increased prostate specific antigen, hirsutism, gynaecomastia. Certain excipients may cause irritation and dry skin. Pack Size: 60g metered-dose canister. Legal Category: Prescription Only Medicine. Further information is available from the Marketing Authorisation Holder: ProStrakan Limited, Galabank Business Park, Galashields, TD1 1QH, United Kingdom. Distributor: Clonmel Healthcare Ltd, Waterford Road, Clonmel, Co. Tipperary. Tel: 052 77777. Marketing Authorisation Number: PA1049/005/001. ® Registered Trade Mark. For further prescribing information go to www.clonmel-health.ieDate of last revision: April 2009. 2009/ADV/TES/094

Adverse events should be reported. Reporting forms and information can be found at www.yellowcard.gov.uk.

Adverse events should also be reported to ProStrakan Limited on 00 44 1896 664000

References:

1. Kapoor D. et al. Diabetes Care 2007; 30: 911-917.

2. Roumeguere T. European Urology 2006; 50: 898-900.

3. Greenstein A. et al. The Journal of Urology 2005; 173: 530-532.

4. Dumas C. Poster presented at the 25th Scandinavian Meeting of Urology, Göteborg, June 2005.

5. Tostran® Summary of Product Characteristics.

TOSTRAN IS THE CLONMEL BRAND OF TESTOSTERONE.

29

ReportPharmacy set to deliver more services

PSI published new Corporate StrategyPharmacists delivering more services like vaccinations, screening and disease monitoring to facilitate faster and more efficient care for patients will be key strategic objectives for the Pharmaceutical Society of Ireland (PSI), the Pharmacy Regulator, over the next five years, according to its new president, Eoghan Hanly.

Speaking at the launch of the regulator’s new Corporate Strategy 2013-2017 by the Minister for Health, James Reilly TD, Hanly said the previous PSI strategy, based on the implementation of the Pharmacy Act 2007, had put pharmacy services and the regulation of those services in Ireland on a solid foundation.

“The three-year period covered by the previous PSI strategy has been marked by significant achievements in relation to the overall drive to improve patient safety and outcomes. The establishment of the new Irish Institute of Pharmacy, the creation of the National Forum for Pharmacy Education and Accreditation, and an effective Fitness to Practise framework have all brought significant benefits to both patients and the practising profession,” Hanly said.

“But now we must ensure that we complete the important work we have started to support the Pharmacy Ireland 2020 vision, and that the full benefits of this work are brought to bear for patients, for the public, and for those working in the healthcare system, including pharmacists and pharmacy owners. The significant economic turmoil, the demographic pressures of an ageing population, and the increasing prevalence of non-communicable diseases mean pharmacists in Ireland and internationally have a key role to play in becoming more centrally involved in the delivery of safe, high-quality, evidence-based healthcare services. The pharmacy profession in Ireland is now much better positioned to meet the challenges of providing effective, safe and high-quality services to patients and the public over the next five years. And the PSI will continue to support the pharmacy profession in this context.”

Mr Hanly said that continuing to work closely with Government was a fundamental pillar of its Corporate Strategy and in particular the implementation of the aspects of the 2012 policy document “Future Health” which relate to extending the scope of pharmacy practice to support public health. In line with international evidence on

best patient outcomes, the PSI corporate strategy committed to a multi-disciplinary approach including working with the HSE and other key healthcare providers and stakeholders to improve patient outcomes.

The key objectives outlined in the Corporate Strategy 2013-2017 include: promoting lifelong learning, continuing to assure high standards of patient care and good pharmacy practice; facilitating the development of pharmacy as a profession in Ireland; ensuring fair registration procedures and delivering an effective compliance system.

Irish Institute of Pharmacy

The Corporate Strategy also looks at the Institute of Pharmacy and outlines its keys objectives for its term.

‘The implementation of the CPD model, the establishment of the Irish Institute of Pharmacy, and the commencement of its operations, are the other key educational

development activities arising from the recommendations of the Review of International CPD Models that the PSI will oversee over the period of this Strategy,’ states the Strategy.

The Institute – being set up with the assistance of the Royal College of Surgeons in Ireland

(RCSI), which has been contracted by the PSI to manage its activities – will be the mechanism to provide pharmacists with a structured approach to engage with CPD, and will facilitate the quality assurance and the effectiveness of the system. The PSI will engage with the profession to facilitate the transition to this new approach.

Work to be undertaken by the Institute within the next 2-3 years includes:

• Establishment of a CPD portfolio system and a dedicated information and learning portal to allow pharmacists to identify, record and reflect on learning obtained and required;

• Development and piloting in 2014 of a competency-based Quality Assurance process. This

QA process, incorporating a review of learning portfolios and a practice review process, will be peer-led, -designed and -assessed, the purpose of which is to validate and support each pharmacist’s engagement with CPD on a regular basis through the feedback mechanism, and to generate an evidence base of the profession’s competency development. Full roll-out of the system is anticipated by the end of 2015.

The significance of these reforms is that they will enhance and provide an evidence base of the competencies of Irish pharmacists and will bring Irish pharmacy into line with internationally benchmarked standards. This will further facilitate the expansion of pharmacy services and will add value by improving integrated care services for patients.

Pictured launching the new strategy with the Minister for Health, Dr James Reilly TD, are

immediate past PSI President Paul Fahey (left), new PSI President Eoghan Hanly (right) and

Acting PSI Registrar Ciara McGoldrick.

Low testosterone

■ 17% prevalence in men with Type 2 Diabetes1 and 10-20% prevalence with Erectile Dysfunction2

■ In hypogonadal men, testosterone treatment alone may restore erectile function and significantly increase sexual desire3

■ Tostran® - returns hypogonadal men’s testosterone levels to the normal range and keeps them there4

■ Tostran® is the only 2% testosterone gel: - Accurate 10 mg dosing5 - Simple dose titration5 - Easy to apply, with minimal waste5

A simple solution to a serious problem

Tostran® Abbreviated Prescribing Information Please refer to Summary of Product Characteristics before prescribing. Presentation: Tostran 2% gel, contains testosterone, 20mg/g. Indications: Replacement therapy with testosterone for male hypogonadism when testosterone deficiency has been confirmed by classical clinical symptoms and laboratory analyses. Posology: The recommended starting dose is 3g gel (60mg testosterone) applied once daily at approximately the same time each morning to clean, dry, intact skin, alternately on the abdomen or to both inner thighs. Application elsewhere should be avoided. The dose should be adjusted to the clinical or laboratory response. The daily dose should not exceed 4g of gel (80mg testosterone). The gel must not be applied to the genitals. Not for use in women, or children under the age of 18 years. Contraindications: Androgens are contraindicated in known or suspected carcinoma of the breast or the prostate, known hypersensitivity to testosterone or any of the excipients, and in women. Warnings and Precautions: Tostran should not be used to treat non-specific symptoms suggestive of hypogonadism if testosterone deficiency has not been demonstrated and if other aetiologies responsible for the symptoms have not been excluded. Tostran is not indicated for treatment of male sterility

or sexual impotence. Prior to initiation of therapy, all patients must be examined to exclude a risk of pre-existing prostatic cancer. Careful and regular monitoring of breast and prostate must be performed. Testosterone may accelerate the development of subclinical prostatic carcinoma and benign prostatic hypertrophy. Oedema with or without congestive heart failure may be a serious complication in patients with pre-existing cardiac, renal or hepatic disease. The treatment must be discontinued immediately if such complications occur. Testosterone may cause a rise in blood pressure and Tostran should be used with caution in men with hypertension. Tostran should be used with caution in patients with ischaemic heart disease, epilepsy, migraine and sleep apnoea as these conditions may be aggravated. Care should be taken in patients with skeletal metastases due to risk of hypercalcaemia/hypercalcuria. In diabetic patients, the metabolic effects of androgens may decrease blood glucose and therefore insulin requirements. Patients who wash in the morning should apply Tostran after washing, bathing or showering. Avoid the potential for transfer of testosterone from the patient to another person by careful hand washing and the wearing of loose clothing after the gel has been applied and has thoroughly dried. Bathe or shower before any

close contact with another person. Particular care must be taken to prevent transfer of testosterone to pregnant women or children via skin contact. Interactions: When androgens are given simultaneously with anticoagulants, the anticoagulant effect can increase and patients receiving anticoagulants require close monitoring of their INR. Concurrent administration of testosterone with ACTH or corticosteroids may increase the likelihood of oedema and caution should be exercised. Undesirable effects: Very common (>1/10): application site reactions (including paraesthesia, xerosis, pruritis, rash or erythema); common (>1/100, <1/10): peripheral oedema, hypertension, polycythemia, increased prostate specific antigen, hirsutism, gynaecomastia. Certain excipients may cause irritation and dry skin. Pack Size: 60g metered-dose canister. Legal Category: Prescription Only Medicine. Further information is available from the Marketing Authorisation Holder: ProStrakan Limited, Galabank Business Park, Galashields, TD1 1QH, United Kingdom. Distributor: Clonmel Healthcare Ltd, Waterford Road, Clonmel, Co. Tipperary. Tel: 052 77777. Marketing Authorisation Number: PA1049/005/001. ® Registered Trade Mark. For further prescribing information go to www.clonmel-health.ieDate of last revision: April 2009. 2009/ADV/TES/094

Adverse events should be reported. Reporting forms and information can be found at www.yellowcard.gov.uk.

Adverse events should also be reported to ProStrakan Limited on 00 44 1896 664000

References:

1. Kapoor D. et al. Diabetes Care 2007; 30: 911-917.

2. Roumeguere T. European Urology 2006; 50: 898-900.

3. Greenstein A. et al. The Journal of Urology 2005; 173: 530-532.

4. Dumas C. Poster presented at the 25th Scandinavian Meeting of Urology, Göteborg, June 2005.

5. Tostran® Summary of Product Characteristics.

TOSTRAN IS THE CLONMEL BRAND OF TESTOSTERONE.

30

News

Risk assessments for diabetes

news brief

Patients have to answer a series of questions relating to age, gender, waist circumference, BMI, ethnic background, family history and a blood pressure reading is taken. A points' system is then used to identity the possibility of a person developing Diabetes. Based on their score, appropriate advice is offered by the pharmacist to the patient, in the form of suggested lifestyle changes and, if necessary, a GP referral.

Anna Clarke, Health Promotion and Research Manager for Diabetes Ireland, told Irish Pharmacy News, “Diabetes Ireland is always delighted whenever an initiative is developed, which raises awareness of Type 2 diabetes. The pharmacist is in an ideal position

€40m pharmaceutical investmentA €40 million investment is expected to position Ireland as a global centre for pharmaceutical innovation and advanced manufacturing.

The Synthesis & Solid State Pharmaceutical Centre (SSPC) will be based in the University of Limerick (UL) and will be a collaboration between 17 companies and eight academic institutions concentrating on environmentally friendly research and process efficiencies.

Professor Edmund Magner, Professor of Chemistry in the University of Limerick told Irish Pharmacy News, “It’s very prestigious for UL to have this kind of international recognition. It is a unique situation to have this level of interaction between so many companies and institutions but it is a strong indication that there has always been a need for it. The SSPC will make pharmaceutical research more efficient, cost effective and greener.”

The government is funding ¤30 million of the project through the Department of Jobs, Enterprise and Innovation. A further ¤10 million investment will come from key industry partners.

Speaking at the launch of the research centre the Minister for Finance, Michael Noonan said, “The pharmaceutical sector is one of the largest and most successful industries in Ireland and is responsible for over ¤50 billion in exports annually.”

A new Diabetes Risk Assessment has been developed by Boots to assess a person’s risk of developing Type 2 Diabetes.

He continued, “Funding science at this level positions Ireland at the forefront of research and development at an international level but also brings benefits back to the local economy. The SSPC will strengthen the position of the University of Limerick as a leader in the area of pharmaceutical manufacturing and will attract the world’s best and brightest research talent to this great city and county.”

The SSPC has already started recruiting postgraduate and PHD researchers and hopes to encourage further foreign investment and consequentially create more jobs in the sector.

The pharmaceutical sector currently employs over 60,000 people.

Some of the companies involved in the collaboration are already significant employers in Ireland such as; Pfizer, Glaxo Smith Kline, Eli Lilly, Merck, Janssen Pharmaceuticals, Roche, Bristol Meyers Squibb, Clarochem Ireland, UCB Pharma, Alkermes, Abbvie, Eirgen Pharma, APC Ltd, Scale-up Systems, Innopharma Labs, Glantreo, and Amebis Ltd.

It will also see UL working with institutions such as Athlone IT, Waterford IT, Trinity College Dublin, University College Cork and University College Dublin.

CONTROLLED DRUG DELIVERYThe Royal College of Surgeons Ireland (RCSI) Pharmacy School is working closely with the Tissue Engineering Research Group to develop a new technology for controlled drug delivery.

TheraColl is a new, porous collagen-based scaffold that has the texture of polystyrene and foam, which can be implanted into the body to promote bone tissue regeneration and faster bone healing.

Working closely with pharmacy final year students and Pharmacy school professors, including Dr Sally Ann Cryan, who is Associate Professor in Pharmaceutics, Professor Fergal O'Brien and the RCSI spin-off company, SurgaColl are evolving the TheraColl to allow controlled drug delivery

O’Brien told Irish Pharmacy News, “I think Pharmacy is very important in regenerative medicine. We are incorporating traditional pharmacy methods into the scaffolds in order to enhance the molecules.”

He continued, “At present two bone morphogenetic proteins (BMP) products, which use collagen as a carrier are approved for use in clinical bone repair. Both of them have been the subject of much controversy because of safety concerns, due to the associated severe side effects of their non-controlled delivery, which include a risk of cancer. TheraColl would overcome these drawbacks by releasing protein in a controlled way.”

O’Brien and the RCSI Pharmacy School are currently working on furthering the technology for tissue regeneration in areas including respiratory, cardiac and cornea repair.

O’Brien said, “The death of tissue because of the lack of a blood supply is one of the most common causes of failure of biomaterials for tissue regeneration. Along with the expertise from pharmacists, TheraColl proposes to overcome this problem by slowly releasing vascular endothelial growth factor (VEGF), a protein which is widely known to increase blood vessel formation.”

The cost of developing TheraColl has been ¤400,000 to date and the project has been supported by Enterprise Ireland.

in the community to asses and screen for diabetes.”

“The development of Type 2 diabetes can be prevented, especially amongst those who are at 'high risk', such as those carrying excess weight or who are not very active.”

The service offered in Boots stores will aim to help those Irish people at risk of developing the condition to understand if they are likely to develop Type 2 diabetes and to take positive steps to lower their chances of developing it in the future.

It is estimated that there will be almost 280,000 people in Ireland who will suffer from diabetes by the year 2030, which is about

7.5% of the population.

Mary Rose Burke, Director of Pharmacy, Boots Ireland, said, Working with Diabetes Ireland, we want to ensure that Irish people are informed and confident about reducing their diabetes risk. The Diabetes Risk Assessment is simple and free and is one of the easiest things you can do today to take ownership of your health.”

Diabetes Ireland offers all pharmacists in the Republic Diabetes Awareness Days for their patients. They are held within the pharmacy and will help to detect anyone susceptible to the onset of Diabetes 2.

Further information can be found on the website: diabetes.ie

Dr Mary Shire, Vice President Research, UL, Michael Noonan, Minister for Finance, Professor Don Barry, UL President, Minister

of State, Department of Environment, Community and Local Government with special responsibility for Housing and Planning

1a/1b Meridian Estate, Carnbane Business Park, Newry, Co Down, BT35 6QH Telephone: 028 3083 5500 Fax: 028 3083 5544 Vat Reg No: 893 8572 61 Corporation No: NI 058603

To receive a Glucomen LX or for further information contact Medicon at info@mediconire.com or

telephone (1) 6305149

32

News

PharmaConex on the move

news brief

PharmaConex Ireland’s premium locum and recruitment agency for Pharmacy are delighted to announce that they are moving to new offi ces in Dublin City Centre from 1st of August.

The new offi ces are located in the landmark Capel Building on the Luas line between the Jervis Centre and the Four Courts. PharmaConex are really looking forward to the move to the prestigious new location which boasts a host of amenities both internally and nearby – we hope that both candidates and clients will feel free to drop in for a coffee and a chat anytime they are in the area.

PharmaConex have grown over the past 3 years from 1 full time employee to 5 offi ce staff across two locations and 10 full time Relief Pharmacists. As well as providing full time and locum

New CPD Framework launched by PSNI

The new CPD framework outlines the requirements that must be met by pharmacists in order to meet the CPD standards. This includes information about:

• The amount and type of information to be recorded as CPD

• How a CPD portfolio record will be called for assessment

• The records kept by the Pharmaceutical Society of registrants’ CPD

• The criteria that we use to evaluate whether or not the CPD requirements have been met

• The application process for extenuating circumstances

• The CPD requirements for registrants returning to practice

• The CPD requirements for visiting pharmacists

• What constitutes CPD non- compliance

The most signifi cant changes that will apply to the CPD process from 1 June 2013, as a result of the new CPD framework are:

• From 1 June 2013, CPD will become a statutory legal

requirement for all registrants of the Pharmaceutical Society NI. All registrants must submit their portfolios in June 2014; of which a minimum of 10% of portfolio records will be selected for formal assessment.

• Registrants will be given the option to record how they have applied their learning in practice or describe how they will apply their learning in future

Garry McKenna, vice president and lay member of the council, stated, “As a lay member of Council I have been greatly impressed with the

professionalism and commitment of Pharmacists. I understand that, over the past seven years, pharmacists have evidenced their professional development through the current CPD process and I believe this new Framework can only enhance the confi dence, we the public have in pharmacy and pharmacists.

“The 100% submission of all portfolios provides confi dence and assurance to us as patients and service users but it also underlines how we as a regulator take our role seriously in terms of providing public protection.”

REVIEW OF E-CIGS FOR PHARMACY SUPPLYTHE Department of Health is carrying out a review to see if e-cigarettes should be licensed and only sold in pharmacies under proposals to tighten up the regulation of nicotine products. The review has been ordered by Health Minister James Reilly who said he wants to get more information before deciding if they should be licensed.

Dr Reilly has already said he has not decided if he will follow the UK and make them licensed here. He said the Department of Health is carrying out a review fi rst.

The Irish Medicines Board (IMB) would then decide, on the recommendation of Dr Reilly, whether the e-cigarettes would be licensed.

A spokeswoman for the IMB said it is waiting for a recommendation from the department. It comes as the European Parliament voted to classify e-cigarettes as a medicinal product, meaning they can be prescribed by doctors to help smokers cut down or quit.

AMENDMENTS SOUGHT TO PHARMACY ACTHealth Minister James Reilly was asked in a Dail debate on July 11 this year if he would consider removing the part of the Pharmacy Act that prohibits a bankrupt person from registering as a pharmacist.

The Minister stated: “Section 14(1) (f) of the Pharmacy Act 2007 provides that one of the requirements for registration as a pharmacist is that the person is not an undischarged bankrupt.

“Some technical amendments have been sought to the Pharmacy Act 2007 including an amendment to section 14(1) (f) to remove the restriction on a person who is an undischarged bankrupt from being registered in the Register of Pharmacists. These amendments are currently being examined and will be considered for inclusion as part of any future amendments to the Act.”

Pharmacists they now also provide Technicians both full time and locum and deal with most major Groups in Ireland as well as

independents across the country. Pictured below are the Dublin team from PharmaConex in the reception area of their new offi ces.

From 1 June 2013, all pharmacists will have a legal obligation to undertake and record Continuing Professional Development activity (CPD) in order to maintain registration as a pharmacy professional in Northern Ireland.

All pharmacists have a new legal obligation with regards to CPD

Garry O’Riordan, Barbara Kelly, Stuart Brown, Paolo Iacovelli

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Oral Health Care

Brush up on Oral Health

The oral health care market in Ireland has increased by 15.6% from 2007 to 2012 according to Euromonitor International. Up to one million Irish people are postponing dental check ups due to Government cuts to dental patients covered by the two state run dental schemes and 75% of people who are entitled to a free dental examination do not avail of the service.

The Irish Dental Association (IDA) said cutbacks to the two main dental health schemes and ongoing confusion over people’s

entitlements have led to an alarming deterioration in the dental health of the population.

The high cost of attending a dentist is encouraging customers to invest in cheaper dentistry substitutes. While this is bad news for Irish dentists this means an increasing amount of people will turn to their pharmacist for advice with their oral health care and hygiene needs. According to the most recent research by Euromonitor, the oral health care market in Ireland had an over-all annual growth rate of 2% in 2011.

The research also reports the high cost of dentistry services in Ireland, alongside better education and availability of information has served to continue to raise awareness of the importance of personal oral care among the Irish population. While discretionary spending has been reduced, interest in personal appearance has not waned, resulting in the growth of interest in more

affordable dental treatments, especially those that can carried out at home, thereby avoiding additional consultation and treatment fees.

Furthermore, this shift has increased the number of products available in the Irish market, especially in terms of tooth whitening products, which recorded current value growth of 9% in 2011. While concerns have been raised in relation to the levels of bleaching chemicals contained in some of these products, this has not deterred many Irish consumers from attempting to attain the perfect white smile, as portrayed

to them in the mass media, at a fraction of the cost of professional treatments.

Oral care is expected to see a constant value CAGR of 2% over the forecast period. Reduced access to free or subsidised dental services following changes to national insurance schemes will discourage consumers from expensive dentistry services and cause them to continue to rely more heavily on affordable mass products.

In order to offer your patients advice on what products are available over the counter for oral health care issues it is important to be aware of common oral ailments and complaints and when to advise a patient to visit a dentist.

Gingivitis

Gingivitis is a form of periodontal disease. Periodontal disease is inflammation and infection that destroys the tissues that support the teeth, including the gums, ligaments and the tooth sockets ( bone that supports the teeth.). This is caused by a buildup of plaque for long periods of time. It can be related to poor dental hygiene, undiagnosed diabetes, poor diet or on occasion pregnancy.

The disease can often be silent for many years and only present itself with bleeding and swollen gums. Gum disease can result in teeth loss. Patients who smoke or suffer from diabetes are at a higher risk of developing the disease.

If a patient is presenting with symptoms of gingivitis they should have their teeth professionally

34

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TePe are manufactured in Sweden to the highest quality standard ensuring consistency and safety. TePe comply with the new ISO certifi cation. The comprehensive range includes nine colour-coded sizes ensuring there is one to suit virtually every interdental space.

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TePe’s range of interdental brushes are the easy-to-use

alternative to dental fl oss.

Available in several colour coded sizes, all TePe Interdental Brushes have

plastic-coated wires for comfort and protection. Developed in collaboration

with dental expertise, TePe Interdental Brushes are thoroughly tested in terms

of quality and durability.

For more information please call +44 (0) 1934 710022, email infoUK@tepe.com, or visit www.tepe.com

Interdental brushes to suit every need

To receive your free sample:

• Visit: tepe.com/uk/samplerequest and use code IPN08a

• Or, use the QR code below.

FREETePe Angle™ SampleVisit:tepe.com/uk/samplerequest and use code IPN08a

Why do consumers choose TePe Interdental Brushes?

Dental professionals now recommend interdental brushing more often than fl ossing. The TePe brand is not only recommended more often than any other but is also personally used by a majority of dental professionals.

So, why do consumers choose TePe Interdental Brushes over other brands?

TePe are manufactured in Sweden to the highest quality standard ensuring consistency and safety. TePe comply with the new ISO certifi cation. The comprehensive range includes nine colour-coded sizes ensuring there is one to suit virtually every interdental space.

Why should pharmacy stock TePe?

In stocking TePe Interdental Brushes you can expect signifi cant profi tability and turnover from a relatively small shelf space. Retail sales of TePe are regularly within the top three fastest oral care lines.

TePe is continually promoted to dental professionals who, in turn, are responsible for driving your sales. The TePe brand is supported with signifi cant consumer advertising and promotional activity.

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36

by any number of factors such as eating, drinking, oral hygiene, sleeping and the effect these activities have on saliva flow. Mouthwash can reduce halitosis due the anti-microbial influence of the product. Brushing the tongue or using a specially designed tongue scraper can remove the putrifying plaque deposits that release the volatile sulphur compounds that cause the odour. However, in the case of persistent bad breath Patients should be advised to seek professional advice to determine the cause asyit can sometimes be caused by underlying systemic disease.

Dry Mouth

Xerostomia or dry mouth occurs due to reduced or absent saliva flow. Xerostomia is not a disease, but it may be a symptom of various medical conditions such as a side effect of radiation to the head and neck, or a side effect of a wide variety of medications. It is also common in older adults.

Some common complications associated with xerostomia include a constant sore throat, a burning sensation in the mouth, difficulty speaking and swallowing, hoarseness and dry nasal passages. The loss of the protective function of the saliva can also predispose the patient to tooth decay.

Patients who present with the symptoms of xerostomia should be encouraged to preform regular self-examinations of their mouth for ulcers or sores and possible signs of tooth decay.

Soft bristled toothbrushes and mildly flavoured , sodium laurel sulphate free, low-abrasive fluoride toothpastes are recommended to minimise.discomfort and irritation to the soft tissues in the mouth and to help protect the teeth from decay.

Saliva substitutes and stimulants such as lozenges, sprays and gels are available over the counter and provide relief for these patients and minimise dental damage, however they are not a cure for the condition. If the patient is presenting with persistent symptoms of xerostomia they should be advised to visit their doctor or dentist for a prescribed solution.

Mouth Cancer

There are more than 300 cases of cancer of the mouth (oral cavity and pharynx) reported in Ireland every year. The cancer is more common in older men than women. Most recent data from the national cancer registry shows that in 2010 394 people were diagnosed with cancers in Ireland of the oral cavity and pharynx, 153 (women) and 241 (men). Early detection of mouth cancer greatly improves the chances of survival.

Kevin O’Hagan, Health Promotion Manager, Irish Cancer Society said, “Mouth, head and neck cancers are increasing and awareness is still relatively low. The good news is that if caught early, treatment can be very successful. We encourage anyone concerned about a change in their mouth area or with any of the following

symptoms; a sore or ulcer in your mouth that does not heal, white or red patches inside the mouth, a lump in the mouth or neck a persistent sore throat and hoarseness, to go to their dentist for a mouth examination.”

Teeth Whitening

Regulations regarding tooth whitening came into force in Ireland last year, which strictly regulates the use and sale of hydrogen peroxide – the chemical used in tooth whitening.

Under the European Council Directive tooth whitening can only be carried out by a dentist and tooth whitening products containing over 6% of hydrogen peroxide are now illegal and their sale is prohibited.

Over the counter tooth whitening products that use other chemicals and ingredients are still an available alternative. The cost of tooth whitening in Ireland is high and cosmetic dentistry is not covered by the state run dental schemes.

More affordable teeth whitening has increased because of this, even before the legislation was introduced. According to Euromonitor tooth whitening products had a growth rate of 9% in 2011.

Attracta Burke, BSc(Pharm)M.P.S.I and Managing Director of Premium Distribution told Irish Pharmacy News, “ Teeth Whitening continues to be popular with consumers. The publicity around the change in legislation has increased consumer awareness regarding adverse effects of hydrogen peroxide and also made people aware that there were indeed safe and effective alternatives. With the continuing recession consumers are searching for cost-effective home treatments that work.”

She added, “Pharmacists should keep abreast of available products & ingredients in oral health. By transferring this knowledge to key staff in the pharmacy this will benefit their customers and their business.”

cleaned however they should also be advised to practice good oral hygiene after they have seen the dentist. In order to prevent plaque buildup, patients should be encouraged to brush for two minutes, twice daily with either a manual or powered toothbrush and to use interdental brushes, dental floss, interdental sticks, or water irrigation devices. The most common dental diseases start between the teeth. By daily interdental cleaning , both gum disease and dental decay can be prevented. A toothbrush cannot clean the surfaces in between the teeth and so interdental cleaning is an essential part of oral home care, along with the use of anti-bacterial mouthwash and antiplaque or anti-tartar toothpastes.

According to Euromonitor Irish customers prefer toothpastes that promise to cater for multiple dental issues including breath, plaque control and whitening. Colgate-Palmolive led the oral care market in 2011 with 30% value market share.

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.

Halitosis

Halitosis or bad breath can be caused by excessive amounts of volatile sulphur compounds (VSCs) being produced by bacteria in the mouth. This can be influenced

"Mouth, head and neck cancers are increasing and awareness is still relatively low"

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Module 1 June 2012

Chronic Pain – assessment and management in primary care

For use by Healthcare Professionals in the Republic of Ireland only© Copyright 2012 Pfizer Healthcare IrelandDate of Preparation: Module 1 June 2012 EPBU/2012/XXX

Established Products

Educational distance learning content for healthcare professionals in Ireland

Introduction

Pain is one of the commonest reasons for patients to seek medical attention.1 A recent survey has shown that as many as 8.3 visits per year to primary care physicians in Ireland were due to symptoms of pain.2 A large scale survey carried out in 15 European countries and Israel in 2006, screening 46,394 respondents reported that the prevalence of chronic pain of moderate to severe intensity in adult Europeans was 19%.3

More recent survey data from another study, carried out in 2,019 people with chronic pain and 1,472 primary care physicians across 15 European countries, have demonstrated that chronic pain affects 12-54% of adult Europeans, and its prevalence in Ireland is up to 13%.2 The PRIME (Prevalence, Impact and Cost of Chronic Pain) study, on the other hand, determined the prevalence of chronic pain to be as high as 35.5% in Ireland.4 The PRIME study was designed to investigate the prevalence of chronic pain in Ireland; compare the psychological and physical health profiles of those with and without chronic pain; and explore pain-related disability.4 Responses to survey questions were obtained from 1,204 people.

Despite the magnitude of the problem, chronic pain is both under-recognised and undertreated in primary care.2,5 Indeed, up to 38% of patients reported being inadequately managed in primary care for their pain symptoms.2 In addition, people with chronic pain reported waiting up to 2.2 years between seeking help and diagnosis, and 1.9 years before their pain was adequately managed.2

Sheehan et al reported in 1996 that the estimated cost of pain for 95 patients to the Irish Health Services when added to the amount of Social Welfare payments received and the lost earnings of each patient amounted to 1.9 million pounds at the time of referral.6 The recent data from PRIME survey show that the mean cost per chronic pain patient is estimated at €5,665 per year across all grades of pain, which was extrapolated to €5.34 billion or 2.86% of Irish GDP per year.7 This demonstrates an urgent need for cost effective strategies to manage chronic pain effectively.

Understanding chronic pain

Chronic pain is defined as pain that outlasts normal healing time (usually three to six months), and is most frequently associated with musculoskeletal disorders such as low back pain and arthritis. However, it can also be associated with other disorders such as depression or metabolic disorders or neurologic conditions such as multiple sclerosis.

Pain (acute or chronic) can be categorised as nociceptive or neuropathic. Nociceptive pain is caused by an active illness, injury and/or inflammatory process associated with actual or potential tissue damage i.e. Nociceptive pain results from activity in neural pathways secondary to actual or potential tissue damage. Nociceptive pain is mediated by pain receptors located in skin, musculoskeletal system, bone, and joints.8 Neuropathic pain, on the other hand, results from direct injury to a peripheral or central sensory nerve; the affected nerves do not produce transduction at nociceptors.8 Pain characteristics and associated conditions for both types of pain are shown in Table 1.

CPD 32: SMOKING CESSATION

Smoking Cessation

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60SecondSummary

In summary, smokers typically go through six stages of the process of quitting smoking and each of these stages involve new issues and challenges. These stages are pre-contemplation, contemplation, preparation, action, maintenance and relapse.

It is important that the person is supported and encouraged along the way so as to achieve the target of smoking cessation. Therefore, it is important that there are services in place. It can be clearly identifi ed that from pharmacy-based smoking cessation services in the UK the support of the pharmacist in combination with nicotine replacement therapy achieves a higher rate of success than with NRT alone.

Since smoking has detrimental effects to society, both socially and economically by creating more services for patients to quit smoking this may help decrease the burden of smoking on society.

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A survey carried out by SLAN, 2007 reported that 29% of adults are current smokers (31% men and 27% women). It also found that smoking was more prevalent in younger people, with 35% aged between 18-29 as compared to 25% aged 45-64. Also, smoking is seen to be more common among the lower social class. However, it can be recognised that smoking rates have decreased since 1998, when there was an estimated 33% of smokers in the population compared to 29% in 2007. Another report on the Health Behaviour in School-aged Children in 2006 reported that 15% of children aged 10-17 were current smokers and smoking among girls was higher than that amongst boys.1, 2, 7

Smoking places a huge burden on individuals, health services and society. Many acute and chronic illnesses are caused and exacerbated by smoking. The

HSE provides services to help improve and promote public health and awareness about the harmful effects of smoking on the population.7

Smoking cessation can significantly reduce the risk of smoking-related diseases. Tobacco dependence is a chronic condition that requires repeated interventions, effective treatment and helpful resources.4

SMOKING RELATED HARM

Smoking is a contributory factor in poverty and health inequalities. Money spent on tobacco and smoking in low income families means money not spent on basic necessities including health care.2, 7

It has been shown that, due to the severe health effects of tobacco use this contributes

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?

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

Published by IPN and supported with an unrestricted educational grant from Pfizer Healthcare Ireland. Copies can be downloaded from www.irishpharmacytraining.ie

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.

Tobacco use is one of the significant causes of mortality and ill health in the Irish population. Half of all smokers die prematurely as a result of their smoking and, on average smokers lose 10 years off their life. According to the Health Service Executive (HSE) in Ireland, up to 6,500 people die annually due to smoking and this puts a strain on public health and inequalities.1, 7

Biography - Rebecca Kate Kilfeather graduated with a BSc Hons Biological Science and a Master of Pharmacy from The Robert Gordon University, Aberdeen in 2011. She completed her pre-registration year in The Royal Infi rmary, Edinburgh in 2012, taking in rotations in the Sick Kids Hospital Edinburgh and the Chalmers Sexual Health and HIV clinic in Edinburgh. Upon moving back to Ireland, Rebecca worked with Pharmaconex locuming in Dublin. Currently she is working in the Perrystown Pharmacy. She was recently nominated for Young Pharmacist of the Year 2013.

Module 1 June 2012

Chronic Pain – assessment and management in primary care

For use by Healthcare Professionals in the Republic of Ireland only© Copyright 2012 Pfizer Healthcare IrelandDate of Preparation: Module 1 June 2012 EPBU/2012/XXX

Established Products

Educational distance learning content for healthcare professionals in Ireland

Introduction

Pain is one of the commonest reasons for patients to seek medical attention.1 A recent survey has shown that as many as 8.3 visits per year to primary care physicians in Ireland were due to symptoms of pain.2 A large scale survey carried out in 15 European countries and Israel in 2006, screening 46,394 respondents reported that the prevalence of chronic pain of moderate to severe intensity in adult Europeans was 19%.3

More recent survey data from another study, carried out in 2,019 people with chronic pain and 1,472 primary care physicians across 15 European countries, have demonstrated that chronic pain affects 12-54% of adult Europeans, and its prevalence in Ireland is up to 13%.2 The PRIME (Prevalence, Impact and Cost of Chronic Pain) study, on the other hand, determined the prevalence of chronic pain to be as high as 35.5% in Ireland.4 The PRIME study was designed to investigate the prevalence of chronic pain in Ireland; compare the psychological and physical health profiles of those with and without chronic pain; and explore pain-related disability.4 Responses to survey questions were obtained from 1,204 people.

Despite the magnitude of the problem, chronic pain is both under-recognised and undertreated in primary care.2,5 Indeed, up to 38% of patients reported being inadequately managed in primary care for their pain symptoms.2 In addition, people with chronic pain reported waiting up to 2.2 years between seeking help and diagnosis, and 1.9 years before their pain was adequately managed.2

Sheehan et al reported in 1996 that the estimated cost of pain for 95 patients to the Irish Health Services when added to the amount of Social Welfare payments received and the lost earnings of each patient amounted to 1.9 million pounds at the time of referral.6 The recent data from PRIME survey show that the mean cost per chronic pain patient is estimated at €5,665 per year across all grades of pain, which was extrapolated to €5.34 billion or 2.86% of Irish GDP per year.7 This demonstrates an urgent need for cost effective strategies to manage chronic pain effectively.

Understanding chronic pain

Chronic pain is defined as pain that outlasts normal healing time (usually three to six months), and is most frequently associated with musculoskeletal disorders such as low back pain and arthritis. However, it can also be associated with other disorders such as depression or metabolic disorders or neurologic conditions such as multiple sclerosis.

Pain (acute or chronic) can be categorised as nociceptive or neuropathic. Nociceptive pain is caused by an active illness, injury and/or inflammatory process associated with actual or potential tissue damage i.e. Nociceptive pain results from activity in neural pathways secondary to actual or potential tissue damage. Nociceptive pain is mediated by pain receptors located in skin, musculoskeletal system, bone, and joints.8 Neuropathic pain, on the other hand, results from direct injury to a peripheral or central sensory nerve; the affected nerves do not produce transduction at nociceptors.8 Pain characteristics and associated conditions for both types of pain are shown in Table 1.

CPD 32: SMOKING CESSATION

to socio-economic difference in health. Thus, smokers in lower socio-economic groups have poorer health outcomes.1, 7

The economic and social cost of smoking imposes a huge burden on society, due to time lost at work from smoking related disease and illness. In Ireland smoking related health care costs accounts for 6-15% of all annual healthcare costs.1, 2

Therefore, by promoting and addressing tobacco use and consumption this may benefit health protection but could also help save the economy and health services money, which may be better spent.

Tobacco smoke contains a deadly mix of up to 7,000 chemicals, most which are toxic and can cause cancer. It can cause serious health problems, diseases and death. People who quit smoking can reduce their risk of diseases and premature death.4

There is overwhelming evidence for the health benefits, effectiveness and cost effectiveness of quitting smoking and treating tobacco dependence. However, despite availability of cost effective treatment for tobacco dependence, the public health sector in many countries is not investing in smoking cessation services, nor developing

an infrastructure to motivate and support smokers to quit.7

PUBLIC INFORMATION

Currently, clear health warnings on the effect of tobacco products on people’s health is advertised extensively and sometimes aggressively. This informs the public of the detrimental effects of smoking, for example the pictorial warnings on tobacco products.

Currently Ireland has one of the highest rates of taxation on tobacco products. In the UK currently all tobacco advertising is banned and the display of tobacco products is also banned in large supermarkets. Also, in certain parts of the UK there has also been a ban imposed on the sale of tobacco products from vending machines. Smoking bans came into place across Ireland.1, 2

SERVICES

Support is a key element in helping people to stop smoking. In the UK smoking cessation services based in the pharmacy demonstrated that they offered successful support in helping smokers to quit. A study showed that 14.3% of smokers who used the pharmacy service were still not smoking at 52 weeks due to the combination of pharmacist support and NRT. It also found that 2.7% were still not smoking using only NRT. This highlights the benefit of behavioural support in stopping smoking.5, 6

PHARMACIST ROLE

Promoting healthy lifestyles is a component of the services a community pharmacy provides. It could take only a comment from the pharmacist when dispensing prescriptions to members of the public but it could have a profound effect and lead to someone quitting smoking. Simple link sales, for example someone buying a cough medicine could be asked about smoking.

By proactively raising the subject at an opportunistic moment and offering brief advice may help engage someone in a discussion about changing to a healthier lifestyle.

ACCESS

Access to services to promote smoking cessation should be readily available to patients. If a patient indicates a desire to quit, the information provided is key to the patient quitting smoking. Furthermore this could help the patient to voice concerns or barriers that may be limiting them from stopping smoking. By having access to these services this may help to provide a starting point in the promotion of a healthier lifestyle.

BENEFITS

The benefits to health, both short term and long term should be highlighted when a person decides to quit smoking.

Learning, Evaluation, Accredited, Readers, Network | www.learninpharmacy.ieSupported by

Module 1 June 2012

Chronic Pain – assessment and management in primary care

For use by Healthcare Professionals in the Republic of Ireland only© Copyright 2012 Pfizer Healthcare IrelandDate of Preparation: Module 1 June 2012 EPBU/2012/XXX

Established Products

Educational distance learning content for healthcare professionals in Ireland

Introduction

Pain is one of the commonest reasons for patients to seek medical attention.1 A recent survey has shown that as many as 8.3 visits per year to primary care physicians in Ireland were due to symptoms of pain.2 A large scale survey carried out in 15 European countries and Israel in 2006, screening 46,394 respondents reported that the prevalence of chronic pain of moderate to severe intensity in adult Europeans was 19%.3

More recent survey data from another study, carried out in 2,019 people with chronic pain and 1,472 primary care physicians across 15 European countries, have demonstrated that chronic pain affects 12-54% of adult Europeans, and its prevalence in Ireland is up to 13%.2 The PRIME (Prevalence, Impact and Cost of Chronic Pain) study, on the other hand, determined the prevalence of chronic pain to be as high as 35.5% in Ireland.4 The PRIME study was designed to investigate the prevalence of chronic pain in Ireland; compare the psychological and physical health profiles of those with and without chronic pain; and explore pain-related disability.4 Responses to survey questions were obtained from 1,204 people.

Despite the magnitude of the problem, chronic pain is both under-recognised and undertreated in primary care.2,5 Indeed, up to 38% of patients reported being inadequately managed in primary care for their pain symptoms.2 In addition, people with chronic pain reported waiting up to 2.2 years between seeking help and diagnosis, and 1.9 years before their pain was adequately managed.2

Sheehan et al reported in 1996 that the estimated cost of pain for 95 patients to the Irish Health Services when added to the amount of Social Welfare payments received and the lost earnings of each patient amounted to 1.9 million pounds at the time of referral.6 The recent data from PRIME survey show that the mean cost per chronic pain patient is estimated at €5,665 per year across all grades of pain, which was extrapolated to €5.34 billion or 2.86% of Irish GDP per year.7 This demonstrates an urgent need for cost effective strategies to manage chronic pain effectively.

Understanding chronic pain

Chronic pain is defined as pain that outlasts normal healing time (usually three to six months), and is most frequently associated with musculoskeletal disorders such as low back pain and arthritis. However, it can also be associated with other disorders such as depression or metabolic disorders or neurologic conditions such as multiple sclerosis.

Pain (acute or chronic) can be categorised as nociceptive or neuropathic. Nociceptive pain is caused by an active illness, injury and/or inflammatory process associated with actual or potential tissue damage i.e. Nociceptive pain results from activity in neural pathways secondary to actual or potential tissue damage. Nociceptive pain is mediated by pain receptors located in skin, musculoskeletal system, bone, and joints.8 Neuropathic pain, on the other hand, results from direct injury to a peripheral or central sensory nerve; the affected nerves do not produce transduction at nociceptors.8 Pain characteristics and associated conditions for both types of pain are shown in Table 1.

Learning, Evaluation, Accredited, Readers, Network | www.learninpharmacy.ie

CPD 32: SMOKING CESSATION

Furthermore, the withdrawal symptoms experienced should be explained. Such effects of nicotine withdrawal include malaise, headaches, dizziness, sleep disturbances, coughing, irritability, increased appetite, weight gain, anxiety and impaired concentration. On average these effects generally last between 2-4 weeks and become less evident as time increases without smoking.

A set date should be established as a quit date, this will help the patient identify a target to achieve. Visual reminders, for example cigarettes, lighters and ashtrays should be removed as the presence of them may cause the patient to rebound back to old habits. Family and friends should be made aware of the quit date as their support may be required throughout the process.

PHARMACOTHERAPY

Smoking cessation interventions are cost effective ways of reducing health problems and promoting life. Advice should be provided to smokers to help them quit and follow-up health provided, where appropriate. Therapy is chosen according to the smoker’s habits, likely adherence, previous experience of smoking aids, contraindications and adverse effects.8

Tobacco smoking increases the metabolism of some medicines by stimulating CYP1A2 hepatic enzyme. Therefore, when stopping smoking certain drugs can be affected, such as theophylline, cinacalet, ropinirole, some antipsychotics (clozapine), olanzapine, chlorpromazine and haloperidol. Thus these drugs require regular monitoring for adverse effects.8

NICOTINE REPLACEMENT THERAPY (NRT)

NRT can be used after abrupt cessation or in conjunction to a reduction of smoking cigarettes in an advance of quitting. It can be used to treat cravings and enforce abstinence. There are various choices of NRT, such as nicotine patches, which are a prolonged release formulation that can be applied for 24 or 16 hours. For patients who experience cravings on waking, a 24 hour patch is more suitable. Immediate release formulations available include gum, lozenges, sublingual tablets, inhalers and sprays – these are used when the urge to smoke occurs or to prevent cravings.8

The choice of therapy depends on patient preference, previous treatment should also be taken into account. Combination therapy may benefit some people who have a high level of nicotine dependence or who have tried previously to quit and failed. For

example, a patch and an immediate release formulation. All preparations are licensed for adults and children over 12 years old, with the exception of nicotinell lozenges, which are licensed for under 18 years only when recommended by a doctor. Cautions should also be taken when NRT is used in haemodynamically unstable patients. Oral Preparations should be used in caution with oesophagitis, gastritis or peptic ulcers as

the swallowed nicotine can aggregate these conditions.

Acidic beverages (coffee or fruit juice) may decrease the absorption of nicotine via the buccal mucosa and should be avoided for 15 minutes before using oral nicotine. Patches may cause abnormal dreams and so removal of the patch overnight may help. While breast feeding nicotine can be present in

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Learning, Evaluation, Accredited, Readers, Network | www.learninpharmacy.ie

CPD 32: SMOKING CESSATION

Pfi zer Healthcare Ireland are committed to supporting the continuous professional development of pharmacists in Ireland. We are delighted to be supporting Irish Pharmacy News in order to succeed with this.

Pfi zer’s support of this programme is the latest element in a range of activities designed to benefi t retail pharmacy. Other initiatives include the Multilingual Pharmacy Tool, Pharmacy Dietitian programme, host your own website with www.mylocalpharmacy.ie and the support of Pfi zer for a year, pharmacy Consultation Room brochures and posters as well as a host of other patient-assist programmes including the Quit with Help programme and www.mysterypain.ie.

If you would like additional information on any of these pharmacy programmes, please contact Pfi zer Healthcare Ireland on 01-4676500 and ask for the Established Products Business Unit.

Supported by Pfi zer through an unrestricted educational grant. The opinions expressed are the authors and not the sponsors.

the milk and the amount to which the infant is exposed is small, however intermittent therapy is preferred.8

GUM

Patients who smoke less than 20 cigarettes per day should use one piece of the 2mg strength gum when they get the urge to smoke. The gum should be chewed until the taste becomes strong and then placed between the cheek and gum, one piece generally lasts about 30 minutes. People smoking more than 20 cigarettes per day or for those who require more than 15 pieces of the 2mg gum, they should use the 4mg strength. Not more than 15 pieces of 4mg gum should be used per day. The treatment choice should be continued for 3 months before reducing dose.8

INHALATION CARTRIDGES

These can be used when the urge to smoke occurs and are generally ideal for patients who feel that they would miss the hand to mouth action of smoking. No more than 12 of the 10mg or 6 of the 15mg inhalators should be used per day. An inhalation cartridge last 40 minutes of intense use. However, these should be used in caution with patients with COPD or chronic throat disease.8

LOZENGES

A lower strength lozenge should be used in patients who smoke less than 20 cigarettes per day, and the higher strength lozenge should be used in those who smoke more than 20 cigarettes per day. One lozenge can be used every 1 to 2 hours when the urge occurs. No more than 15 of the higher strength lozenges should be used per day. The chosen strength should be continued for 6-12 weeks before reducing dose.8

SUBLINGUAL TABLETS

For the person who smokes less than 20 cigerattes per day, one tablet can be used each hour and increased to two tablets if necessary. For those who smoke more than 20 per day, 2 tablets can be used each hour, with not more than 40 tablets per day. Treatment should continue for 3 months before reducing the dose.8

ORAL SPRAY

The oral spray can be used in patients who prefer this device, with one or two sprays used when craving occurs and up to four sprays can be used per hour with not more than 64 sprays used per day.8

TRANSDERMAL PATCHES

For those who smoke more than 10

cigarettes per day a high strength patch can be advised, which should be applied each day for 6 to 8 weeks, followed by a medium strength patch for two weeks and then a low strength patch for 2 weeks. Those who smoke less than 10 cigarettes per day can start on a medium strength patch for 6 to 8 weeks and then a low strength patch for 2 to 4 weeks. If a patient is not ready to reduce a slower titration schedule can be advised. Patches should not be placed on broken skin and should be used with caution in patients with skin disorders. As patches can also cause sleep disturbance, the 16 hour patch can be advised as this is removed over night.8

COMBINATION THERAPY

Combination therapy can be used as this may benefit the patient. In this instance a patch could be advised and some oral therapy such as gum, lozenge or an inhalator to help combat when cravings hit. The patient should be advised to decide on a preparation that best suits them and their habits. Furthermore the patients’ lifestyle should also be taken into account. For example, gum may not suit a patient who cannot chew gum during their daily activities by actively including the patient in the decision- making process because this will help reinforce their target of quitting smoking.

BUPROPION

Bupropion is a prescription only medicine and is used to treat and control nicotine cravings in an aid to smoking cessation. It is a selective inhibitor of the reuptake of noradrenaline and dopamine. However, the exact mechanism of action in smoking cessation is unknown. One of the main side effects associated with bupropion is seizures, and therefore is contra-indicated in patients with epilepsy and other CNS conditions. It cannot be used in pregnant or breast feeding women or anyone under 18 years of age. Treatment should be started one or two weeks before the target quit date, 150mg should be taken daily for the first 6 days and then twice daily. Treatment should be discontinued if cessation has not been achieved by week seven.8

VARENICINE

Varenicine is a selective nicotine receptor partial agonist, which is used as an aid in smoking cessation. It is started one to two weeks before the established quit date; it is a 12 week course that can be repeated in individuals who have quit to help reduce the risk of relapse.8

REFERENCES

1. HSE, National Standard for Tobacco Cessation Support Programme. March 2013. (www.hse.ie/cessation)

2. HSE, The Health Service Executive Tobacco Control Framework. Feburary 2010.

3. National Institute Health and Clinical Excellence. Quick Reference Guide: Smoking Cessation Services. February 2008.

4. Centres for Disease Control and Prevention: Smoking Cessation. (www.cdc.gov/ tobacco/data_statistics/fact_sheets/ cessation/quitting/)

5. WHO: Policy recommendations for smoking cessation and treatment of tobaccodependence. (www.who.int/ tobacco/resources/publications/tobacco_ dependance/en/)

6. Currie, I et al. An evaluation of the range and availability of intensive smoking- cessation service in Ireland. May 2008. Royal Academy of Medicine in Ireland, 2009.

7. WHO, Policy recommendations for smoking cessation and treatment of dependence. WHO, 2004.

8. British National Formulary. March 2013.

Module 1 June 2012

Chronic Pain – assessment and management in primary care

For use by Healthcare Professionals in the Republic of Ireland only© Copyright 2012 Pfizer Healthcare IrelandDate of Preparation: Module 1 June 2012 EPBU/2012/XXX

Established Products

Educational distance learning content for healthcare professionals in Ireland

Introduction

Pain is one of the commonest reasons for patients to seek medical attention.1 A recent survey has shown that as many as 8.3 visits per year to primary care physicians in Ireland were due to symptoms of pain.2 A large scale survey carried out in 15 European countries and Israel in 2006, screening 46,394 respondents reported that the prevalence of chronic pain of moderate to severe intensity in adult Europeans was 19%.3

More recent survey data from another study, carried out in 2,019 people with chronic pain and 1,472 primary care physicians across 15 European countries, have demonstrated that chronic pain affects 12-54% of adult Europeans, and its prevalence in Ireland is up to 13%.2 The PRIME (Prevalence, Impact and Cost of Chronic Pain) study, on the other hand, determined the prevalence of chronic pain to be as high as 35.5% in Ireland.4 The PRIME study was designed to investigate the prevalence of chronic pain in Ireland; compare the psychological and physical health profiles of those with and without chronic pain; and explore pain-related disability.4 Responses to survey questions were obtained from 1,204 people.

Despite the magnitude of the problem, chronic pain is both under-recognised and undertreated in primary care.2,5 Indeed, up to 38% of patients reported being inadequately managed in primary care for their pain symptoms.2 In addition, people with chronic pain reported waiting up to 2.2 years between seeking help and diagnosis, and 1.9 years before their pain was adequately managed.2

Sheehan et al reported in 1996 that the estimated cost of pain for 95 patients to the Irish Health Services when added to the amount of Social Welfare payments received and the lost earnings of each patient amounted to 1.9 million pounds at the time of referral.6 The recent data from PRIME survey show that the mean cost per chronic pain patient is estimated at €5,665 per year across all grades of pain, which was extrapolated to €5.34 billion or 2.86% of Irish GDP per year.7 This demonstrates an urgent need for cost effective strategies to manage chronic pain effectively.

Understanding chronic pain

Chronic pain is defined as pain that outlasts normal healing time (usually three to six months), and is most frequently associated with musculoskeletal disorders such as low back pain and arthritis. However, it can also be associated with other disorders such as depression or metabolic disorders or neurologic conditions such as multiple sclerosis.

Pain (acute or chronic) can be categorised as nociceptive or neuropathic. Nociceptive pain is caused by an active illness, injury and/or inflammatory process associated with actual or potential tissue damage i.e. Nociceptive pain results from activity in neural pathways secondary to actual or potential tissue damage. Nociceptive pain is mediated by pain receptors located in skin, musculoskeletal system, bone, and joints.8 Neuropathic pain, on the other hand, results from direct injury to a peripheral or central sensory nerve; the affected nerves do not produce transduction at nociceptors.8 Pain characteristics and associated conditions for both types of pain are shown in Table 1.

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Cholestagel:an engineered BAS in a tablet formulation

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Information about adverse event reporting can be found atwww.imb.ie. Adverse events should be reported to theSanofi Drug Safety Department at the above address.

formulationformulation

Sanofi 18 Riverwalk, Citywest Business Campus, Dublin 24Sanofi 18 Riverwalk, Citywest Business Campus, Dublin 24Sanofi 18 Riverwalk, Citywest Business Campus, Dublin 24

Please refer to the Summary of Product Characteristics which Please refer to the Summary of Product Characteristics which Please refer to the Summary of Product Characteristics which Please refer to the Summary of Product Characteristics which Please refer to the Summary of Product Characteristics which Please refer to the Summary of Product Characteristics which can be found at http://www.medicines.ie/ before prescribing.can be found at http://www.medicines.ie/ before prescribing.can be found at http://www.medicines.ie/ before prescribing.can be found at http://www.medicines.ie/ before prescribing.

101767_Cholestagel_Irish_Reminder_Portrait ad_v06.indd 1 24/07/2013 17:08

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The above product list is based on wholesaler data currently available to IMS Health. This list has been limited to OTC classes 1-18 & 97 in accordance with standard reporting practices.

100TOP BRANDS

SOLPEDEINE TOTAL

EXPUTEX

NUROFEN PLUS

NUROFEN CHILD

NUROFEN

CALPOL

GAVISCON

PARALIEF

NICORETTE

PANADOL EXTRA

NUROFEN EXPRESS

GALFER

LEMSIP

MOTILIUM

CALCICHEW D3 FORTE

PANADOL

CANESTEN

STREPSILS

NUROFEN COLD & FLU

SUDAFED

SENOKOT

DULCO LAX

NIQUITIN CQ

BEROCCA

CALPOL SIX PLUS

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DUPHALAC

ZIRTEK

MAXILIEF

DIORALYTE

SAVLON

OTRIVINE

DAKTARIN

FYBOGEL

DIFFLAM

SINUTAB

E 45

PIRITON

VOLTAROL P

PARATABS

BUPLEX

ACTIFED

CORSODYL

EASOFEN

IDEOS

PHARMATON

IMODIUM

BONJELA

SILCOCKS BASE

SEVEN SEAS C L O

CALDESENE

AQUEOUS

PANADOL ACTIFAST

RENNIE

SUDOCREM

VERMOX

ARRET

DEEP HEAT

BENYLIN DAY NIGHT

CETRINE ALLERGY

UNIFLU GREGOVITE C

CORTOPIN

BENYLIN DRY N/D

BENYLIN 4 FLU

ZOVIRAX GLX

IMODIUM PLUS

SUDAFED NASAL

CLONFOLIC

CODINEX

PHARMATON KIDDI

NICOTINELL

TYROZETS

EMULSIFYING

BROLENE

ANUSOL

OPTREX

HYDROCORTISYL

PANADOL NIGHT

CYSTOPURIN

ACIC

CERUMOL

BENYLIN CHILDREN

PARALINK

TEARS NATURALE

BEPANTHEN

LACRI LUBE

VICKS

SOLPA SINUS

BENYLIN PHLEGM

EURAX

BENYLIN CHESTY N/D

ANADIN PARACETAMOL

OILATUM

DICLAC

STREPSILS PLUS

BENYLIN DRY COUGH

SEVEN SEAS ACTV 55

CELLUVISC

DISPRIN

MURINE

COLPERMIN

26272829303132333435363738394041424344454647484950

51525354555657585960616263646566676869707172737475

767778798081828384858687888990919293949596979899100

TOP 100 PRODUCTS BY VOLUME

Pharmacy channel continues to ridehigh on OTC tidal wave

Irish Pharmacy News’ annual Top 100 section reveals the over-the-counter products being sold in Ireland by both value and volume.

Despite the global financial crisis, sales of OTC medicines have continued to rise, spurred by a swathe of recent innovation, greater promotion of self-medication and increased access through expanding channels of distribution. Consistently outperforming the pharmaceutical sector, the OTC market is now a key source of business expansion and competitive edge.

Why is this information important to you? Put simply, knowing your

market ensures you provide for your customers. This Top 100 will provide a sharper understanding of consumer decisions, leading to better opportunities for assisting in their choices.

The OTC landscape is changing and with thus bringing new challenges. As highlighted in the most recent research, pharmacies continue to perform well in this sector due to the high level of knowledge amongst pharmacy staff in relation to general medical

conditions and the suitability of products. It is not unusual for consumers to build up a long term relationship with their local pharmacy, further contributing to the popularity of this channel.

Knowing your market

Whilst consumer health in Ireland recorded growth in 2012, this was at lower levels than that seen over the review period.

Sales through pharmacy continue to lead in the Irish market,

despite increasing availability of products through other channels – supermarkets in particular. The strong position of pharmacies was supported by the large number of products which may only be sold through this channel, as well as the high level of knowledge amongst pharmacy staff in relation to general medical conditions and the suitability of products.

Growth for consumer health in Ireland is expected to remain positive, due in large part to the

IPN presents the TOP 100

PRESCRIBING INFORMATION(Please consult the Summary of Product Character-istics (SmPC) before prescribing.)Zirtek Allergy & Zirtek Allergy Relief10 mg film-coated tablets (UK)Zirtek 10 mg film-coated Tablets (ROI)Zirtek Allergy Solution 1 mg/ml & Zirtek AllergyRelief for Children 1 mg/ml oral solution (UK) Zirtek Oral Solution (ROI) cetirizine dihydrochlo-ride Active Ingredient: Tablets 10 mg cetirizine dihy-drochloride (also contains lactose). Solution: 1mg/ml cetirizine dihydrochloride (also containssorbitol, methylparahydroxybenzoate, propylpara-hydroxybenzoate). Indication(s): For the relief ofnasal and ocular-symptoms of seasonal and peren-nial rhinitis. For the relief of symptoms of chronicidiopathic urticaria. Dosage and Administration:Tablets: Children aged from 6 to 12 years: 5 mgtwice daily (a half tablet twice daily). Adults andadolescents over 12 years of age: 10 mg oncedaily (1 tablet). Solution: Children aged from 2 to6 years: 2.5 mg oral solution twice daily, 2.5 mlsoral solution twice daily (a half spoon twice daily).Children aged from 6 to 12 years: 5 mg oral solu-tion twice daily, 5mls oral solution twice daily (afull spoon twice daily). Adults and adolescents over12 years of age: 10 mg oral solution once daily,10mls oral solution (two full spoons). Patients withrenal impairment: Patients with renal impairment:dose adjustment is recommended (consult SPC).Contraindications, Warnings, etc: Contraindica-tions: Hypersensitivity to the active substance, toany of the excipients, to hydroxyzine or to anypiperazine derivatives. Patients with severe renalimpairment at less than 10 ml/min creatinine clear-ance. Solution:Patients with rare hereditary prob-lems of fructose intolerance should not takecetirizine 1 mg/ml oral solution Tablets: Patientswith rare hereditary problems of galactose intoler-ance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take cetirizine10 mg film-coated tablets. Precautions: Caution isrecommended if alcohol is taken concomitantly andin epileptic patients or patients at risk of convul-sions. Allergy skin tests are inhibited by antihista-mines and a wash-out period (of 3 days) isrequired before performing them. Methylparahy-droxybenzoate and propylparahydroxybenzoatemay cause allergic reactions (possibly delayed). In-teractions: none known. Pregnancy and lactation:Caution should be exercised when prescribing topregnant or lactating women as cetirizine passesinto breast milk. Driving etc: Do not exceed the rec-ommended dose and responses should be takeninto account before driving or operating hazardousmachinery. Adverse Effects: Common: fatigue,dizziness, headache, abdominal pain, dry mouth,nausea, somnolence, pharingitis. Common ad-verse effects reported in children: diarrhoea,somnolence, rhinitis, fatigue. Consult SPC for otherside-effects. Pharmaceutical Precautions: No spe-cial precautions for storage.

Marketing Authorisation Number(s): UK Tablets7 pack (GSL) PL 00039/0561 Tablets 21 & 30pack (P) PL 00039/0542 Solution 70 ml (GSL)PL00039 0541 Solution 150 ml & 200 ml (P) PL00039/0540 ROI Tablets 7 pack (PharmacyOnly) PA 891/8/2 Tablet 30 pack (POM) PA891/8/2 Solution 100ml (Pharmacy Only)PA/891/8/3

Further information is available from Marketing Authorisation Holder:UCB Pharma Ltd, 208 Bath Road, Slough,Berkshire, SL1 3WE. Tel: +44 (0)1753 534 655;Fax: +44 (0)1753 536 632 Email: medicalinformationuk@ucb.comUCB (Pharma) Ireland Ltd ,United Drug House,Magna Drive, Magna Business Park, City West Road, Dublin 24, Ireland. Tel: +353 (0)146 37395;Fax: +353 (0)146 37396 Date of Revision: March 2012 (UK/12ZI0001)Zirtek is a registered trademark

References: 1 SmPC 2 J Day Ann Allergy AsthmaImm 1997;79:163-72 3 IMS Data MAT Feb 2012Date of Preparation April 2012. Full prescribing In-formation available on request. UK/12ZI0005

Ireland’s best sellingantihistamine3

• Indicated in the treatment ofseasonal and perennial allergicrhinitis and chronic idiopathicurticaria1

• Non sedating1

• Once daily tablet dosing1

• Fast onset of action2

• No known drug interactions1

Get in touch withyour allergy. Fast2

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NICORETTE

SOLPEDEINE TOTAL

NUROFEN PLUS

NUROFEN CHILD

CALCICHEW D3 FORTE

EXPUTEX

NIQUITIN CQ

GAVISCON

NUROFEN EXPRESS

CALPOL

PHARMATON

NUROFEN

BEROCCA

MOTILIUM

PANADOL EXTRA

CANESTEN

NUROFEN COLD & FLU

LEMSIP

IDEOS

SUDAFED

SENOKOT

ZIRTEK

DIORALYTE

DIFFLAM

CALPOL SIX PLUS

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MAXILIEF

NICOTINELL

PARALIEF

DULCO LAX

VOLTAROL P

E 45

STREPSILS

IMODIUM

SINUTAB

OTRIVINE

PANADOL

CELLUVISC

GALFER

ZOVIRAX GLX

CALDESENE

ACTIFED

DAKTARIN

UNIFLU GREGOVITE C

MACUSHIELD

CORSODYL

BENYLIN DAY NIGHT

IMODIUM PLUS

COLPERMIN

BENYLIN 4 FLU

PIRITON

DEEP HEAT

BONJELA

CLONFOLIC

ARRET

SAVLON

BUPLEX

FYBOGEL

SEVEN SEAS C L O

CODINEX

SEVEN SEAS ACTV 55

MOREPA

BROLENE

EASOFEN

PHARMATON KIDDI

THERMACARE

CETRINE ALLERGY

OPTREX

ANUSOL

AQUEOUS

BENYLIN DRY N/D

PANADOL ACTIFAST

CYSTOPURIN

ELAVE

PANTOLOC CONTROL

FLIXONASE ALLERGY

PARALINK

PANADOL NIGHT

CALTRATE

CORTOPIN

SILCOCKS BASE

SINUS RINSE

ACIC

LUTEIN OMEGA 3

OILATUM

SUDOCREM

DUPHALAC

DICLAC

ZANTAC 75

OCUVITE LUTEIN

SOLPA SINUS

EURAX

EMULSIFYING

ANUSOL HC

SUDAFED NASAL

CENTRUM ADVANCE

RENNIE

LYCLEAR WEL

CYMEX

OSTEOFOS D3

BEPANTHEN

26272829303132333435363738394041424344454647484950

51525354555657585960616263646566676869707172737475

767778798081828384858687888990919293949596979899100

The above product list is based on wholesaler data currently available to IMS Health. This list has been limited to OTC classes 1-18 & 97 in accordance with standard reporting practices.

100TOP BRANDS

essential nature of many products. However, this will be limited somewhat by the mature stage of consumer health, alongside the expectation that consumer spending will remain subdued for some time to come. Initial indications of recovery, whilst welcome, are currently viewed with some scepticism, especially in light of continued budgetary cuts imposed by the government, and the impact this will have on consumers’ spending capacity.

Therefore the information over the forthcoming pages is more critical than ever – to ensure you, the pharmacy team, ensure customers are focusing resources to get the best in value in return.

There is a ripple of movement evident in this year’s figures compared to those of 2012. Solpaedine manages to retain the top spot whilst Gaviscon and Calpol have reversed form with the former now placed at number 7 and Capol over-taking at a position of number 6 this year.

Moving higher up the ranking are Lemsip, up to the number 12 spot from 14 in 2012 and Pandol has also made its way up the list. Dropping off the Top 100 altogether this year is Callvisc, making way for Anadin Paracetamol which is a newcomer at position 90.

Robin Hanna, McLernon Computers told IPN: “McLernon Computers recognise that their customers need information and not just data from their pharmacy management dispensing and EPoS systems.

“That is why our MPS suite of programmes provide the information that they need, in a format that best suits them. Recognising that some of our customers require different types of information, we have forged an alliance with Real World Retail, which provides customised business reports for our pharmacists for both the dispensing and the retail aspects of their pharmacy.

“Irish Pharmacy News provides a valuable service to Irish Pharmacy with the publication of the IMS Top 100 OTC products, ensuring that they stock the right products to meet their customers’ needs. “Using this, in association with our own MPS Retail EPOS programme will ensure that McLernons customers have all the right information, in the right format, in order to enable them to make better business decisions.”

The Real World Retail report on page 66 discusses the importance of identifying trending items in order to grow sales, margins and reducing stock levels. According to the report pharmacists can and should reduce their stock levels in OTC to an estimated 9 weeks cover in order to make significant savings. In order to make this transition it is essential to know what stock to curtail.

The information in the coming pages gives you this information and allows you to focus your stock levels appropriately. An informed, customer-focus led stock can

lead to a less cluttered pharmacy and less wastage in out-of-date products and markdowns and hence higher profit margins.

The pharmacy landscape has changed significantly in the recent years and the front of shop is an area that can be improved and become more efficient in profit terms, especially as patients are struggling to afford GP visits and look to OTC products as an alternative.

The Top 100 gives you the opportunity to identify what your key products are and therefore who are your key customers. Using this information for category management can assist you to achieve maximum benefit from your front of shop and not waste space on unpopular products.

The data provided by Irish Pharmacy News and IMS combined with your own EPOS system can be utilised by all community pharmacists to improve their retail business.

TOP 100 PRODUCTS BY VALUE

When pain and fever leaves mum feeling a little anxious.

Product Name: Calpol 120mg/5ml Infant Oral Suspension. Composition: Calpol Infant Oral Suspension contains 120mg Paracetamol in each 5 ml. Indications: Calpol Infant Oral Suspension is indicated for the treatment of pain (including teething pain), and as an antipyretic. Dosage: Infants aged 2-3 months: Post-vaccination fever and Other causes of Pain and Fever - if your baby weighs over 4 kg and was born after 37 weeks: One 2.5 ml (small end of spoon). If necessary, after 4-6 hours, give a second 2.5 ml dose. Do not give to babies less than 2 months of age. Do not give more than 2 doses. Leave at least 4 hours between doses. If further doses are needed, talk to your doctor or pharmacist. It is important to shake the bottle for at least 10 seconds before use. Children aged 3 months – 6 years: 3 – 6 months: One 2.5 ml spoonful (small end) 4 times. 6 – 24 months: One 5 ml spoonful (large end) 4 times. 2 – 4 years: One 5 ml spoonful (large end) and one 2.5 ml spoonful (small end), 4 times. 4 – 6 years: Two 5 ml spoonfuls (large end), 4 times. Contra-indications: Calpol Infant Oral Suspension is contra-indicated in patients with known hypersensitivity to paracetamol, or any of the other components. Special warnings and special precautions: Calpol Infant Suspension should be used with caution in moderate to severe renal impairment or severe hepatic impairment. The label contains the following statements: Store below 25°C. Protect from light. Contains paracetamol. Do not exceed the stated dose. Keep out of reach of children. Do not take more than

4 doses in 24 hours. Dose 4 times a day. Do not repeat doses more frequently than 4 hourly. Do not give for more than 3 days without consulting a doctor.If symptoms persist consult your doctor. If you child is taking any other medicine, consult your doctor or pharmacist before taking this product. Immediate medical advice should be sought in the event of an overdose, even if you feel well. (label).Immediate medical advice should be sought in the event of an overdose, even if you feel well, because of the risk of irreversible liver damage. (leaflet).Do not take with any other paracetamol containing products. The following precautions should be followed when taking this medicine:Do not take with any other paracetamol-containing products.Never give more medicine than shown in the table.Do not overfill the spoon.Always use the spoon supplied with the pack.Do not give to babies less than 2 months of age.For infants 2-3 months no more than 2 doses should be given.Do not give more than 4 doses in any 24 hour period.Leave at least 4 hours between doses.Do not give this medicine to your child for more than 3 days without speaking to your doctor or pharmacist.As with all medicines, if your child is currently taking any medicine consult your doctor or pharmacist before taking this product.Keep out of reach and sight of children. Undesirable effects: Paracetamol has been widely used and, when taken at the usual recommended dosage, side effects are mild and infrequent and reports of adverse reactions are rare. Chronic hepatic necrosis has been reported in a patient who took daily therapeutic doses of

paracetamol for about a year and liver damage has been reported after daily ingestion of excessive amounts for shorter periods. A review of a group of patients with chronic active hepatitis failed to reveal differences in the abnormalities of liver function in those who were long-term users of paracetamol nor was the control of the disease improved after paracetamol withdrawal.Nephrotoxic effects following therapeutic doses of paracetamol are uncommon. Papillary necrosis has been reported after prolonged administration.Adverse effects of paracetamol are rare but hypersensitivity, including anaphylaxis and skin rash may occur. Blood and the lymphatic system disorders: Thrombocytopenic purpura, haemolytic anaemia, agranulocytosis. Hepato-biliary disorders: Anaphylaxis, Chronic hepatic necrosis, liver damage, Nephrotoxic effects. Immune system disorders: Papillary necrosis. Skin and subcutaneous: Skin rashes (with or without itching). Social circumstances: Overdosage. Name address of the holder of the marketing authorisation: McNeil Healthcare (Ireland) Ltd, Airton Road, Tallaght, Dublin 24, Ireland. Marketing authorisation number: PA 823/10/2. Date of revision of text : November 2012. Classification: General sale in child resistant packs containing not more than 60ml of the 120mg/5ml dose form. Retail sale through pharmacy in child resistant packs containing not more than 140ml of the 120mg/5ml dose form. Further information available upon request from Johnson & Johnson (Ireland) Ltd.

Calpol® Infant Suspension (paracetamol) • Fast on fever• Tough on pain• Gentle on tummies

Your trusted advice with our trusted name

Calpol_IRE_MotherAndDaughter_210x297.indd 1 16/07/2013 13:52

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100TOP CATEGORIES

This category is unsurprisingly, the highest seller in Irish Pharmacies with a market value of ¤73.3 million. Pharmacists are often the first port of call for advice on Coughs, Colds and Allergies, especially because of the cost of attending a GP.

Having a large selection of ailments for each illness in the category will encourage customers to return to the pharmacy.

Cough’s and cold can be difficult to control and medication can depend on the type of cough the patient may have. Pharmacies should be ready for allergy season. Over 470,000 adults and children suffer from asthma and 60% will suffer from allergic rhinitis.

Irritable Bowel Syndrome (IBS) affects an estimate 20% of the adult female Irish population. However many sufferers are not aware they have the condition. Many sufferers will try to use digestive remedies such as anti-acid medication or OTC constipation remedies. There are other conditions that cause a patient to seek digestive remedies such as heart burn.

Digestive Remedies are worth ¤37.2million in the Irish Pharmacy market so being aware of the different variations of digestive remedies can be profitable to the pharmacy business.

Rennie® has a heavyweight media campaign running throughout the year including TV and new Radio advertising, along with a range of POS materials to support the sales channel, all of which will ensure its top of mind for consumers at key times.

1 3

4

5

Cough, Cold and Allergy

Both Topical and Oral analgesics have a market share of ¤68.5million in Ireland. Oral analgesics treat such a wide range of complaints and most of the general public are uncertain what analgesics are suitable for what ailments. Having a counter assistant who understands what medication should be used as appropriate treatment can dispel this confusion. Topical Analgesics are increasing in popularity as many patients have started to self care for sporting and other injuries

2 Analgesics

Digestive Remedies

Skin care has evolved in pharmacy to a point where many have skin care specialists and most counter assistants have training in the area.

Many pharmacies have invested in skin care technology that can diagnose a skin care routine specific to a patient. Skin care and dermatological’s advice is an area that can be exclusive to pharmacy and most customers will not find an alternative supplier.

Having exclusive brands to a pharmacy will encourage customers to only shop in your pharmacy. This category is worth ¤28.5million in Ireland.

Dermatological

Many skincare products contain harsh chemicals linked to sensitive skin conditions and eczema prone skin.That’s why elave contains only the safest non-reactive ingredients. Developed by experts in dermatology elave skincare cleanses, softens and protects skin everyday. Designed to be used together the elave dermatological range allows you to discover a daily routine free from worrying chemicals that will enhance all skin types even the most sensitive.

The Government and Health Minister James Reilly have aggressively campaigned to reduce smoking in Ireland. There have been initiatives such as health professional training to encourage patients to stop smoking. Pharmacists have always been the health professional that patients will turn to first for advice and aids for smoking cessation.

Offering private consolations that can monitor patient’s progress in smoking cessations will encourage patients to choose one pharmacy over another.

There are several Nicotine Replacement Therapy aids available on the market from lozenges to inhalers to sprays. This category is worth ¤22.6 million.

NRT Smoking Cessation Aids

Solpadeine is Irelands number one pharmacy only pain relief brand and includes a range of pain solutions to address different customer needs. Pain management is one of the most vital services provided by pharmacies today. Solpadeine is an effective short–term solution for acute pain and contains a triple acting set of ingredients, including codeine to block pain messages, paracetamol to relieve pain symptoms and caffeine to help speed up absorption of the paracetamol. Available from Omega Pharma/Chefaro Ireland.

49

6

7

8

9

10

Eye care is worth ¤6.6million and this category can vary from eye drops for sensitive eyes to eye ointments to contact lens products.

Conjunctivitis is redness and inflammation of the tissue that covers the front of the eye. It is very common and there are several OTC products that can deal with the condition depending on the cause such as chloramphenicol eye drops.

More people wear contact lens now than ever before as they are now more convenient, accessible and affordable. The cost of a consolation will deter customers from seeking advice on caring for their lens with an Optician and instead will go to an informed pharmacist. The pharmacist should let customers know that they have the appropriate training to give advice and provide solutions to minor eye problems.

Eye Care

A survey by EU research agency Eurofound reported that 46% of Irish people are stressed and have problems sleeping and focusing on daily tasks. The recession has taken its toll on many Irish people and many are seeking solitude with their pharmacist.

Calming and Sleeping aids are worth ¤4.5million in the pharmacy market. Sleeping aids available OTC are effective but customers should be advised that sleeping pills are not a long term solution for insomnia but they can assist with particularly stressful times.

Calming and Sleeping

Wound care is a large part of the pharmacies front of shop. It is currently valued at ¤4.3 million in Ireland. Pharmacy counter assistants and pharmacists are now trained in first aid and

are familiar with the appropriate equipment and advice for certain

ailments. This can encourage loyal and repeat customers.

Skin Wounds are a common health concern, which can vary from abrasions, lacerations, rupture injuries, punctures, to penetrating wounds. Advising on treatment for pressure sores in bedridden or elderly patients is a large part of wound care in the pharmacy.

Having the equipment and know-how to address wounds appropriately and timely with dressings and wound closures will minimise cosmetic scaring and infection while making the patient more comfortable.

Wound Care

A survey by the Irish Dental Association reported that Irish people are not attending the dentist regularly. This means that customers have to maintain good oral health with OTC products.

There are many toothpastes and mouth washes that cater to customers busy lives and offer a multitude of solutions to many mouth care problems such as sensitivity, bad breath and plaque.

New legislation also means that in order to have teeth whitening using hydrogen peroxide customers can only attend a dentist. This has led to an increase in at home teeth whitening kits that do not include the chemical. This market is worth ¤4.1 million.

Adult Mouth Care

This category is worth ¤0.6 million. There have been advancements is Ear care equipment in recent years with ear wax cleaning systems that include syringes and irrigation kits that the customer can use at home.

Customers should be advised to take care when cleaning their ears as it can be easily damaged. Children should be deterred from using Q tips or cotton buds as it can lead to serious damage.

Ear Care

Cerumol Ear Drops Solution has long been Ireland’s leading brand and its growth continues. The tried and trusted formulation accounts for more than half of all sales in its category according to IMS data1 and sells more than two and half times more units than its nearest competitor1

Cerumol Olive Oil Ear Drops provide medicinal grade olive oil in a convenient patient-ready format. The product offers a natural way to gently soften and remove ear wax and has no known side effects.

1. IMS unit data MAT Sept 2012

50

100TOP BRANDS

1st SOLPEDEINESolpadeine is Irelands number one pharmacy only pain relief brand and includes a range of pain solutions to address different customer needs. Pain management is one of the most vital services provided by pharmacies today. Solpadeine is an effective short–term solution for acute pain and contains a triple acting set of ingredients, including codeine to block pain messages, paracetamol to relieve pain symptoms and caffeine to help speed up absorption of the paracetamol. Available from Omega Pharma/Chefaro Ireland.

2nd EXPUTEXThe number 1 selling mucolytic in Ireland

3rd NUROFEN PLUS The dual action formula of Nurofen Plus provides relief from strong pain. Not to be recommended without patient consultation and for no longer than 3 days. Available from Reckitt Benckiser

4th NUROFEN FOR CHILDREN Nurofen for Children starts to work in just 15 minutes to relieve fever and lasts for up to 8 hours – that’s up to 2 hours longer than paracetemol based products. It also treats pain from those little tumbles, earache and relieves the fever associated with teething. Plus it comes with a unique easy dosing device, which helps make giving the correct dose to your child simple. Now available: Nurofen for Children Six Plus 200mg/5ml Oral Suspension for children aged 6-12 years. Available from Reckitt Benckiser

6th CALPOLCalpol is specifi cally formulated for babies and infants from as young as 2 months. It has a pleasant strawberry fl avor and will relieve pain (including teething pain) and feverishness, without irritating the stomach. Contains Paracetamol. ALWAYS READ THE LABEL. Available from McNeil Healthcare.

The number 1 selling mucolytic in Ireland IRE/BU/EXP/12/0001

No.62 Exputex

No.62 Ireland Volume • No.62 Ireland Value

Exputex Advert D2_Layout 1 02/08/2012 15:37 Page 1NO.1 IRELAND VOLUME NO.2 IRELAND VALUE

NO.2 IRELAND VOLUME NO.6 IRELAND VALUE

NO.3 IRELAND VOLUME NO.3 IRELAND VALUE

NO.4 IRELAND VOLUME NO.4 IRELAND VALUE

NO.6 IRELAND VOLUME NO.10 IRELAND VALUE

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100TOP BRANDS

7th GAVISCONGaviscon has been tried and trusted by millions since the launch of its fi rst products nearly 40 years ago. There are a number of products in the range - each tailored to suit the varying symptoms of heartburn and indigestion. Gaviscon Extra, which it’s unique two way action helps patients fi ght both heartburn and indigestion. Available from Reckitt Benckiser. Gaviscon, what a feeling!

8th PARALIEFParacetamol 500mg tablets 24 pack. For the relief of headaches, musculoskeletal disorders, period pain, toothache, colds and fl u and the pain of osteoarthritis. Available from ClonMedica.

9th NICORETTENICORETTE® understands that all smokers are different. We offer the widest range of NRT products to help your customers quit smoking. NICORETTE® QuickMist provides smokers with an NRT format to help them quit smoking for good. NICORETTE® QuickMist has been clinically proven to relieve nicotine withdrawal symptoms and cravings.

Product name and PA number: Nicorette QuickMist 1mg/spray Oromucosal Spray. PA 823/49/29. PA Holder: McNeil Healthcare (Ireland) Limited, Airton Road, Tallaght, Dublin 24, Ireland. Classification: Products are not subject to medical prescription. Further information is available upon request. IRE/NI/13-0422

11th NUROFEN EXPRESS Nurofen Express tablets get to Work twice as fast as standard Ibuprofen * They tablets come in 200mg sizes or single dose 400mg Maximum strength single dose tablet . * refers to absorption . Compared to 200mg ibuprofen tablets.

12th GALFERGalfer from Thornton and Ross are 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 foods or supplements containing vitamin C (ascorbic acid)

Galfer is distributed by Allphar OTC.

NO.7 IRELAND VOLUME NO.8 IRELAND VALUE

NO.8 IRELAND VOLUME NO.28 IRELAND VALUE

NO.9 IRELAND VOLUME NO.1 IRELAND VALUE

NO.1 IRELAND VOLUME NO.1 IRELAND VALUE

NO.12 IRELAND VOLUME NO.38 IRELAND VALUE

55

100TOP BRANDS

13th LEMSIPLemsip. New to the Lemsip range is Lemsip Decongestant & Flu Capsules with Caffeine Paracetamol 500mg, Phenylephrine Hydrochloride 6.1mg, Caffeine 25mg. It contains Phenylephrine as a decongestant to relive sinus and nasal congestion. Lemsip Decongestant & Flu Capsules with Caffeine is exclusive to pharmacy. Available from Reckitt Benckiser.

21st SENOKOTSenokot is a gentle constipation remedy that can help to restore a patient’s digestion system to its normal self. Senokot contains senna, a natural plant extract which works by stimulating the muscles in the bowel. Available from Reckitt Benckiser.

24th BEROCCABerocca is the No. 1 brand for an effervescent multivitamin. This September Berocca Boost is celebrating its 5th successful year in Pharmacy. To support this, Berocca will implement a strong strategic mix of TV, Radio, Sampling events, Press, PR PLUS eye catching window display kits, fl oor display units & sampling kits. What key ingredients does Berocca Boost contain?Vitamins B2, B3, B6 & B12 - contributes to sustained energy release and supports the nervous system.Vitamin C and Zinc - promotes a healthy immune system. Guarana – a fast-acting, natural energiser, clinically proven to decrease tiredness and increase accuracy. A little KICK when you need it!Approval Code L.IE.CC.07.2013.0120

27th ZIRTEK Zirtek not only offers your patients the opportunity to control hayfever but also provides symptom relief for skin, dust or pet allergies. Zirtek has a leading market position and is available as tablets, solution and with decongestant.

28th MAXILIEFMaxilief effervescent tablets contain Paracetamol 500mg, Codeine 8mg & caffeine 30mg. Available in 24 & 60 packs. 60 pack is GMS reimbursable. Available from ClonMedica.

NO.13 IRELAND VOLUME NO.18 IRELAND VALUE

NO.21 IRELAND VOLUME NO.21 IRELAND VALUE

NO.24 IRELAND VOLUME NO.13 IRELAND VALUE

NO.27 IRELAND VOLUME NO.22 IRELAND VALUE

NO.28 IRELAND VOLUME NO.26 IRELAND VALUE

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100TOP BRANDS

36th E45E45 is the No.1 selling brand for dry skin. E45 have over 50years experience of dealing with dry and problem skin (like eczema & sensitive skin). E45 have a range for effective moisturising, for every body, every day, even for eczema. Available from Reckitt Benckiser.

40th BUPLEXBuplex is available in packs of 200 mg x 12, 24 & 50 Film coated Tablets & 400 mg x 12 & 24 Film coated Tablets. Buplex contains Ibuprofen and delivers effective pain relief from a wide range of pain. Available from Actavis Ireland Ltd.

NO.36 IRELAND VOLUME NO.31 IRELAND VALUE

NO.40 IRELAND VOLUME NO.56 IRELAND VALUE

43rd EASOFEN ClonMedica is delighted to announce the launch of Easofen 400mg MAX STRENGTH fi lm-coated Tablets. The new 400mg strength joins the current offering of Easofen 200mg in 3 pack sizes - 12, 24 and 48.Easofen 400mg is available in retail pharmacies only.Please contact Clonmel Healthcare on 01-6204000 if you require any additional information onEasofen 400mg.

46th IMODIUM Imodium(R) is an effective treatment for diarrhoea. There are three variants, each providing relief for unique treatment requirements. Imodium(R) Instants provide fast relief while on the go, Imodium(R) Plus provides multi symptom relief from diarrhoea, cramps and bloating and Imodium(R) LiquiRelief provides gentle, soothing relief.PA name/number: Imodium Instants PA 823/56/2, Imodium Plus PA 823/60/2, Imodium LiquiRelief PA 823/56/5. PA Holder: McNeil Healthcare (Ireland) Limited, Tallaght, Dublin 24. Classifi cation: Not subject to medical prescription. Further information available upon request. IRE/IM/13-0420

48th SILCOCKS BASE Silcock’s Base can be used as a skin moisturiser and or as a soap substitute. Silcock’s Base is manufactured by Rowa Pharmaceuticals Ltd in Bantry, Co. Cork. Available in 100g Tube and 500g tubs.

NO.43 IRELAND VOLUME NO.63 IRELAND VALUE

NO.46 IRELAND VOLUME NO.33 IRELAND VALUE

NO.48 IRELAND VOLUME NO.80 IRELAND VALUE

Recommend Symprove post antibiotic treatment

Simple to use –

‘thing’ in the

morning

To stock Symprove email pharmacyorders@allegro.ieor phone 01-8580801To find out more about our research programme visit:

Proven as a breakthrough treatment for IBSin an independent NHS trial at King’s CollegeHospital1, results showed Symprove waseffective at combating symptoms includingconstipation, cramping pain and diarrhoea,achieving a statistically significantsymptom severity score.

Finally! A Multi-SymptomTreatment for IBS

Patients taking part in the trial were diagnosed according to Rome lllcriteria with either moderate to severe symptoms, randomised, andgiven a daily dose of 1ml per kilo of bodyweight of Symproveor placebo over 3 months.

Very few probiotics are backed up by investigator-led clinical trialevidence supporting a recommended course of treatment and dosage.

Taking a Course of SymproveFor first-time users, it’s recommended that people take a Course of Symprove to fully restore balance in the gut. Many people take a maintenance dose after course completion.

58

100TOP BRANDS

50th E45Caldesene 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 also available from ClonMedica.

53rd RENNIERennie® is a fast-acting, effective remedy for heartburn, indigestion and trapped wind. Because they're easy to carry around you can always have a Rennie® remedy to hand whenever heartburn, indigestion or trapped wind strikes. You can take a Rennie® discreetly wherever you are.Rennie® comes in a wide range of great tasting fl avours & pack sizes so your customers can choose the remedy that suits them best. Rennie® is a tried and trusted remedy that has provided relief from heartburn and acid indigestion for over 70 years.

NO.36 IRELAND VOLUME NO.31 IRELAND VALUE

NO.53 IRELAND VOLUME NO.96 IRELAND VALUE

54th SUDOCREM Sudocrem is a market leading product for treating nappy rash. Clinically proven, it helps to soothe, heal and protect your baby’s delicate skin from further irritation. Sudocrem has a water-repellent base which forms a protective barrier, therefore helping to stop any irritants coming into contact with the skin. In addition, the emollient effect of Sudocrem can help to soothe sore infl amed skin whilst leaving the skin feeling soft.

57th DEEP HEAT Pain is an unpleasant sensation that can be a result of injury, disease or even emotional upset. The management of pain therefore needs to tackle both the physical and psychological aspects of the experience.Mentholatum DEEP HEAT can play an important role in pain management, assisting with the prevention and relief of pain, as well as helping people maintain an active lifestyle. The Deep Heat range temporarily relieves minor aches and pains of muscles and joints due to: arthritis, strains, simple backache or sprains. Staying active is key to physical and emotional well being.

59th CETRINE Cetrine Allergy 10mg 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, Bantry, Co. Cork. Always read the leafl et.

NO.54 IRELAND VOLUME NO.85 IRELAND VALUE

NO.57 IRELAND VOLUME NO.51 IRELAND VALUE

NO.59 IRELAND VOLUME NO.66 IRELAND VALUE

Rennie Peppermint 680mg/80mg Chewable Tablets - Rennie Spearmint 680mg/80mg Chewable Tablets - Rennie Sugar Free 680mg/80mg Chewable TabletsFor full details refer to the Summary of Product Characteristics (SmPC) Qualitative and quantitative composition: Each chewable tablet contains: Calcium Carbonate 680.0mg & Heavy Magnesium Carbonate 80.0mg. Indication: For relief of stomach upsets due to hyperacidity and heartburn. Dosage/Use: Tablets to be taken orally, sucked or chewed. Adults over 18 years old: One or two tablets as required, to a maximum of eleven tablets a day. Elderly: No dose adjustment required. Take care to observe the contraindications and warnings. Contraindications: Hypersensitivity to any of the ingredients, hypercalcaemia, hypercalciuria and/or conditions resulting in hypercalcaemia e.g sarcoidosis, nephrolithiasis due to calculi containing calcium deposits, severe renal insufficiency and hypophosphatemia. Warnings and Precautions: Caution in cases of impaired renal function, monitor plasma calcium, phosphate and magnesium regularly in these patients. Prolonged use should be avoided. As with other antacids, Rennie tablets may mask a malignancy in the stomach. The stated dose should not be exceeded and if symptoms persist after 7 days further medical advice should be sought. Long term uses at high doses can result in undesirable effects such as hypercalcaemia, hypermagnesaemia and milk-alkali syndrome, especially in patients with renal insufficiency. Not to be taken with large amounts of milk or dairy products. Prolonged use possibly enhances the risk for the development of kidney stones. Patients with rare hereditary problems of fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency should not take this medicine. Magnesium salts may cause central nervous system depression in the presence of renal insufficiency. Interactions: It is preferable to administer Rennie separately from other drugs, allowing a 1-2 hour interval. Changes in gastric acidity during treatment with antacids may impair absorption of other drugs, if taken concomitantly. Antacids containing calcium and magnesium may form complexes with certain substances, e.g. antibiotics (tetracyclines, quinolines), cardiac glycosides (digoxin), levothyroxine and eltrombopag resulting in decreased absorption. This should be borne in mind when concomitant administration is considered. Due to an increased risk of hypercalcemia, serum calcium should be regularly monitored during concomitant use of thiazide diuretics. Calcium and magnesium salts can impede the absorption of phosphates, fluorides, and iron containing products. Pregnancy and lactation: Rennie can be used during pregnancy and lactation if taken as instructed and the prolonged use of high doses is avoided. Pregnant women should strictly limit their use to the maximum recommended daily dose and avoid concomitant, excessive intake of milk and dairy products in order to prevent calcium overload which might result in milk alkali syndrome. No increased risk of congenital defects observed to date. In case of high or prolonged doses or renal insufficiency, the risk for hypercalcaemia and/or hypermagnaesia can not be excluded. Undesirable effects: Hypersensitivity reactions (e.g. rash, urticaria, angioedema and anaphylaxis) very rarely reported. Prolonged use of high doses, especially in patients with impaired renal function can result in hypermagnesemia or hypercalcaemia and alkalosis which may give rise to gastric symptoms and muscular weakness. Nausea, vomiting, stomach discomfort and diarrhoea may occur. Muscular weakness may occur. Only occurring in the context of milk-alkali syndrome: ageusia, calcinosis, asthenia, headache and azotemia. General sale. Marketing Authorisation Holder: Bayer Ltd, The Atrium, Blackthorn Road, Dublin 18. MA Number (s): Rennie Peppermint PA1410/53/1, Rennie Spearmint PA1410/53/2, Rennie Sugar Free PA1410/53/3. Additional information is available from: Bayer Ltd., The Atrium, Blackthorn Road, Dublin 18. Tel: +353 1 2999313. Date of preparation: January 2013.

SIMPLY RELIEVED WITH RENNIE www.rennie.ie

Simple To TakeRennie comes in handy tablet formso relief is just a quick chew away

Simple to RecommendRennie tablets provide fast effective relief and are available in a wide range of pleasant tasting flavours

FOR INDIGESTION AND HEARTBURN RECOMMENDING

RENNIE IS AS SIMPLE AS 1, 2, 3!

3

2

1

relief and are available in a wide range

www.rennie.ie

L.IE

.CC

.04.

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.009

2

Simple To CarryRennie tablets can be popped in the handbag or pocket for on the go relief

75104260 Rennie_IPN_297x210mm.indd 1 24/04/2013 11:49

60

100TOP BRANDS

67th CLONFOLICClonfolic - folic acid 400mcg – can help reduce the risk of having a baby with Spina Bifi da by up to 70%. Women should start taking folic acid fourteen weeks prior to becoming pregnant to ensure that there is suffi cient folic acid built up in the body. It is also important to continue taking folic acid for the fi rst 12 weeks of pregnancy. Available from ClonMedica.

79th ACIC Acic Cold Sore 5% w/w Cream (Aciclovir) – for the Treatment of Cold Sores. Marketed by Rowex Ltd, Bantry, Co. Cork.

NO.67 IRELAND VOLUME NO.53 IRELAND VALUE

NO.70 IRELAND VOLUME NO.82 IRELAND VALUE

80th CERUMOL Cerumol Ear Drops Solution has long been Ireland’s leading brand and its growth continues. The tried and trusted formulation accounts for more than half of all sales in its category according to IMS data1 and sells more than two and half times more units than its nearest competitor1

Cerumol Olive Oil Ear Drops provide medicinal grade olive oil in a convenient patient-ready format. The product offers a natural way to gently soften and remove ear wax and has no known side effects.1. IMS unit data MAT Sept 2012

93rd DICLAC Diclac Relief 1% w/w Gel (Diclofenac Sodium) is indicated for Post-traumatic infl ammation of the tendons, ligaments, muscles, and joints, e.g. due to sprains, strains and bruises. Localised forms of soft-tissue rheumatismMarketed by Rowex Ltd Bantry, Co Cork.Always read the leafl et.

98th DISPRIN The Disprin range includes Disprin Extra Strength 500mg Effervescent Tablets, Disprin Direct 300mg Chewable Tablets (which should be allowed to dissolve on the tongue), Disprin Original 300mg Dispersible Tablets and Paracetamol Tablets from the makers of Disprin. Disprin acts as a key brand beacon for the analgesic category.

NO.80 IRELAND VOLUME NO.N/A IRELAND VALUE

NO.93 IRELAND VOLUME NO.87 IRELAND VALUE

NO.98 IRELAND VOLUME NO. N/A IRELAND VALUE

61

NewsNew Governance arrangements for HSE

Amongst the changes to governance announced is the disestablishment of the existing Board of the HSE and the formal establishment of the Health Service Directorate. In effect, the Directorate will replace the Board of the HSE.

Director General Designate of the HSE since July 2012, Tony O’Brien, has also been formally appointed by Minister Reilly as Director General of the HSE and Chairman of the Directorate.

A number of National Directors have also be appointed to the Directorate by Minister Reilly. These include Laverne McGuinness, Chief Operating Officer and Deputy Director General; Tom Byrne, Chief Financial Officer; John Hennessy,

As part of Future Health, the Government’s reform programme for the Irish health service, the Minister for Health, James Reilly T.D., signed into effect a number of changes to the governance arrangements of the Health Service Executive (HSE). These changes take effect from, Thursday 25 July 2013.

Director Primary Care, Ian Carter, Director Acute Hospitals; Pat Healy, Director Social Care; Stephen Mulvany, Director Mental Health; and Stephanie O’Keeffe, Director Health and Wellbeing.

The Integrated Services Directorate (ISD) of the HSE, which currently has responsibility for the delivery of all health and personal social services across the country including hospital, primary, community and continuing care services, will cease to exist. Responsibility for service areas currently within ISD transfers to the newly established Service Divisions. This process will allow the HSE to move towards a commissioning environment within a Healthcare Agency. The newly established role of Chief

Operations Officer will have primary responsibility for overall performance management across the entire service, for service planning, and for ensuring that services are delivered in an integrated and co-ordinated way across all areas.

In parallel with these changes, four Regional Directors for Performance and Integration (RDPIs) have been appointed. These are David Walsh, HSE Dublin Mid Leinster; Angela Fitzgerald, HSE Dublin North East; Gerry O’Dwyer, HSE South; and Gerry O’Neill, HSE West.

The RDPIs will play a key role in the performance and integration of services at regional level, and ultimately will act as commissioning/contract managers within the Healthcare Agency.

They will also, on an interim basis, take on the full range of delegated operational responsibilities currently held by the Regional Directors for Operations (RDOs), reporting directly to the relevant National Director for individual service areas.

Mr. Tony O’Brien, Director General of the HSE said: “The governance changes announced today are a further important step in the reform programme for the Irish health services which sees a more accountable architecture being put in place for the many important services that we deliver to so many people throughout the country. These changes follow other recent significant developments in health including the announcement of the six hospital groups.”

• Fast relief of allergies• One tablet per day• 24 hour control

Cetirizine Dihydrochloride

Product Name: Cetrine Allergy 10mg Film-coated Tablets.Composition: Each tablet contains 10mg Cetirizine Dihydrochloride.Description: White, oblong film-coated tablets, scored on one side. Can be divided into equal halves. Indication(s): Relief of nasal and ocular symptoms of seasonal and perennial allergic rhinitis (hay fever), chronic idiopathic urticaria.Dosage: Adults, elderly and children aged 12 years and over: 10mg once daily. Children from 6 years to 12 years: 5mg (half a tablet) twice daily. Moderaterenal insufficiency (creatinine clearance CrCl 30-49ml/min): 5mg once daily. Severe renal insufficiency (creatinine clearance <10ml/min): 5mg once every 2days. Children under 6 years: Not recommended. Contraindications: History of hypersensitivity to any constituent in the tablet, piperazine derivatives or hydroxyzine. Severe renal impairment < 10ml/min creatinine clearance. Warnings and Precautions for Use: Reduce dosage in patients with significant renalimpairment. Caution in epileptic patients and patients at risk of convulsions. Contains lactose. Discontinue use of cetirizine dihydrochloride three days before allergy testing. Interactions: Caution is advised when taking concomitantly with alcohol or other CNS depressants. Pregnancy and Lactation: Caution duringpregnancy and breast-feeding. Ability to Drive and Use Machinery: Usually non-sedative, patients should take their response to the product into account. Undesirable Effects: Cetirizine at the recommended dosage has minor adverse effects on the CNS, including somnolence, fatigue, dizziness and headache. In some cases, paradoxical CNS stimulation has been reported. Instances of abnormal hepatic function with elevated hepatic enzymes accompanied by elevatedbilirubin have been reported which resolves on discontinuation of the drug. Uncommon: Agitation, diarrhoea, pruritus, rash, asthenia, malaise.Marketing Authorisation Holder: Rowex Ltd, Bantry, Co. Cork. Marketing Authorisation Number: PA 711/75/2. Further information and SPC are availablefrom: Rowex Ltd, Bantry, Co. Cork. Freephone: 1800 304 400 Fax: 027 50417 E-mail: rowex@rowa-pharma.ieLegal Category: Not subject to medical prescription.Date of Preparation: March 2012

ABBREVIATED PRESCRIBING INFORMATION

07-13

Cetrine Allergy Advert 07-13_Layout 1 23/07/2013 16:53 Page 1

63

100TOP REPORT

Finding new cheese in Pharmacy John Hogan - John Hogan spent 25 years working in commercial roles in the retail industry both in the UK and Ireland. In the UK, he worked with French Connection (£70m sales), a major fashion retailer, and then with Martin McColl (£400m sales) a chain of 750 convenience stores. In 1996 he joined Heatons Department Stores, Dublin, as Financial Controller, then IT manager/Business Analyst, then CFO. Whilst there, the business grew 10-fold (to ¤250m sales), he was second in charge for most of this time. This hands-on experience included growing the Sports business from start-up to 3rd largest in Ireland, implementing EPOS and ERP systems, setting up a Merchandise Planning department. In Nov 2010, he set up as a retail Advisor (Rhodium Retail), doing work with clients in Agri, Fashion, Department Stores and Pharmacy.

Conall Lavery - Conall Lavery is an entrepreneur, Entropy one of the companies he founded was the leading company in Ireland in IT security. Conall has worked in the Communications and IT industry in Ireland since 1986; previously he worked for Motorola, Philips and Marconi. In 2000 Conall was a fi nalist for Ernst & Young’s Entrepreneur of the Year (EoY). He was voted HBAN Angel investor of the year in 2011. Types of early stage businesses he has helped are from the ICT, accounting services, SaaS, travel, and renewable sectors. Conall is a graduate of the Marketing Institute of Ireland. In September 2008 Conall completed the Diploma in Corporate Governance (UCD).

You might recall the business book Who Moved My Cheese? It is about the journey of change management to fi nd new pieces of cheese after the original cheese has been eaten. The original cheese is certainly disappearing in pharmacy. The government has commenced the reduction of drug support schemes, most recently highlighted by the abolition of the 20% margin on DPS and LTI. Retail demand has been eating away at sales and margins in the front of the shop for a few years now. Analysis of the HSE published dispensing statistics of 2010 and 2011 (see Figure 1) shows that the overall dispensing grew 1.4%, but the community pharmacies only grew their business 0.4% while the groups grew by 5.9%. The groups are eating the Community’s lunch!

The Cheese in the Dispensary

In Real World Retail, we have built a system to help pharmacists fi nd other cheese. Many pharmacists we talk to initially believe the cheese is in the front of the shop. In fact, the larger cheese is still in the dispensary; we would usually start there and then move on to the front of the shop. So where is it in the dispensary? The fi rst place to look is in dispensary stock. Many pharmacies are over-stocked; it is understandable because the pharmacist wants to give an excellent patient service. We believe a pharmacy can run with 3 weeks of stock and better availability if they have the tools in place to prevent stock outs. We have seen 5+ weeks of stock in pharmacies and for every week you can reduce the stock you put Figure 1 (Note only groups with the same name were identified in this analysis)

¤10k in your bank for a typical sized pharmacy.

The next easiest cheese is in dispensing generics. All pharmacies are working on this but a sensible target would be 85% generics for the full range of branded medicines that are off patent, of which about a third come into this category. Just a 10% improvement will increase profi tability by ¤7,000, again in the typical pharmacy.

The next area is in leakage from the dispensary. There is leakage from claims, loans and stock loss that happen because they just take so much time to get right. We would fi nd another ¤6,000 margin here in the average pharmacy.

There is a lot of margin too to be extracted from a pharmacy’s supply chain. These need to be negotiated over and over again - what you don’t ask for you don’t get. In such a fast changing

environment, it is easy to do a great deal one day for it to be a poorer deal a number of months later if it is still in place. We arm you with the reports to negotiate hard with the suppliers.

More diffi cult, but by far and away the most valuable area to fi nd cheese in the dispensary is to recruit more patients and keep those that you have. Though some will shy away from recruiting new patients, the reality is that your competition is going to do it. Your patient database is a rich source of leads to attract more patients in an ethical way. Are you also in contact with those patients who have missed their visit cycles with you (see Figure 2 over leaf)? Given how much patients are still worth fi nancially and their loyalty to their pharmacist, patient recruitment and retention is the area that produces the most cheese of all.

The annual payback of the

above examples should at least compensate you for the amount you are going to lose in the elimination of the margin for DPS and LTI. Make no mistake, some pharmacies are doing this and over time they will become stronger than those who don’t.

If you have a group of pharmacies, you probably believe you are doing most of the above already, however these tools give much greater transparency to these areas and are generated automatically so it is possible to go to another level altogether.

The Cheese in the Front of Shop

The cheese at the front of shop takes longer to extract, especially if retailing is not your forte. Any professional retailer will tell you that buying is the most important aspect to retailing. Buy too much and you tie up cash in stock and end up paying for it in markdowns or sell by dates. Though the

64

Figure 4

amount of stock that you should be carrying varies entirely according to your department profi le, your cover should be no more than, say 7-9 weeks of short lead time stock, such as OTC and no more than 20-25 weeks of the likes of fragrance and skincare. Many pharmacies have substantial savings to be made in stock levels, which will also reduce clutter. An integral part of achieving these stock savings is category planning and space productivity, which have been covered really well in this magazine in the last few issues. Those with the right information at their fi ngertips will grow sales, grow margins and reduce stock levels.

Sales can be further increased by improving linked sales through cashier training, and cashier hours need to be appropriate to how busy the pharmacy is at each time of the day or month (see Figure 3). We are constantly surprised at the differences between the good stores and the not so good ones when we do our comparisons. Understanding your cashier productivity and aligning staffi ng to your demand will save money and improve customer service. Signifi cant shrinkage in retail is at the till. With the right system you will be able to identify fraud and complacency.

Another substantial piece of cheese in the front of shop is in a One to One Loyalty system. We have all become jaded by run of the mill loyalty systems where we are constantly spammed by the supplier who just updates us on our points tally or offers us non relevant promotions. What if you had one that was tuned to your customers’ wants and needs? For instance, if a mother of a baby received promotions (that your supplier probably pays for) that are either of benefi t to her or her baby?

Or if you could see which of your customers is not a patient with you? Connect a third party loyalty card system to Real World Retail and you can expect to see an uplift in sales and customers in the front of shop, who stay with you longer.

One opportunity often missed in all types of retailers with multiples stores is not spotting trending items soon enough. A typical EPOS system will give you reports of Top Sellers but it is diffi cult to pick out the items that are trending in just a few stores. Real World

Retail’s system generates the report (Figure 4) so you can quickly replicate success in a few stores across all stores

At Real World Retail we acknowledge we have learned so much from our current customers

but we we have a lot more to learn. We will never know as much as you do but, when you combine your knowledge with our science in Real World Retail you put yourself on another level from your competitors in your geographic area.

Figure 2

Figure 3

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safe and rational use of nutrition and supplements that can naturally optimise performance.

“The Pharmacist has a very important role to play in providing accessible and

Sports

Exercise your sports injury knowledge

There is a new emerging role for the pharmacist in the area of sports medicine. Pharmacists need to be aware of drugs in sport for both performance modification and prevention or treatment of disease and injuries. Pharmacists can offer free informed advice to athletes on

For more information on Kelkin Revive Gel, contact your Kelkin Representative or Kelkin Offices on: 01 4600400. Alternatively visit our website: www.kelkin.ie

For more information on Kelkin Revive Gel, contact your Kelkin Representative or Kelkin Offices on: 01 4600400. Alternatively visit our website: www.kelkin.ie

Beat The Training Fatigue…Kelkin are delighted to announce the launch of the new Kelkin Revive Gel sachets, which have been specially formulated to provide energy in a quick and easy formula.

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The World Anti-Doping Code, published by the World Anti-Doping Agency (WADA), standardises anti-doping regulations across all sports and countries in Ireland. This Code includes a list of substances and methods which are prohibited in sport. Some of these substances are contained in medicinal products marketed in Ireland.

Selection of substances Prohibited in and out-of-Competition

• Non-approved substances- any pharmacological substance that is not currently approved by the government regulatory or any health authority.

• Anabolic Agents such ad danazol, testosterone, stanozolol

• Peptide Hormones, Growth Factors and Related Substances such as erythropoiesis-Stimulating Agents. Chorionic Gonadotrophin and Luteinizing Hormone are prohibited in men-only.

• Hormones and Metabolic Modulators

• Diuretics and other Masking Agents

• All Beta-2 Agonists are prohibited except inhaled formoterol, up to a maximum of 54micrograms over 24 hours, inhaled salbutaol, yp to a maximum of 1600 micrograms in 24 hours and inhaled salmeterol.

For the most recent list of prohibited substances see the Irish Sports Council or Eirpharm website.

Irish Sports Council Therapeutic Use Exemption (TUE) Policy

If a medication is prohibited and requires a TUE, athletes should first seek to use an alternative permitted medication. If there is no permitted alternative athletes should adhere to the Irish Sports Council TUE Policy which states that athletes on the Irish Sports Council Registered Testing Pool must apply for a TUE before using the substance (a Pre-Test TUE); athletes not on the Registered Testing Pool may take the substance, and if required, apply for a

Post-Test TUE, but should ensure that a medical file for use of the medication is in place. Athletes who compete at an International Level or who are on their International Federation Registered Testing Pool should check and comply with the TUE requirements of their International Federation.

In the current hot and humid conditions pharmacist should be aware that rehydration (the prevention of dehydration) and the replacement of the essential electrolytes of Sodium Potassium and Magnesium are very important to athletes and all active people, and in addition to the prevention of dehydration, which can be a very serious situation in extreme heat and humidity, will also help prevent muscle tissue damage. Isotonic Sports Drinks were invented for this purpose and are available in powder form. They have the added advantage that they can be used for the treatment of Diarrhoea and vomiting especially in sick children.

accurate advice to Athletes and coaches in terms of Medicines and Nutrition,” according to Clare based Community Pharmacist Brendan Rochford who has over 12 years’ experience as a consultant in Drugs in Sport with the Irish Sports Council.

Rochford continued, “"It can be difficult for Athletes who are subject to Drug Testing to know what medicines and supplements they safely can take without risking inadvertently testing positive. Most participants of high level sports including Track and Field Athletes, Rugby Players and Inter County GAA players are subject to drug testing."

"One simple measure is that the pharmacist should check if the athlete is subject to Drug Testing before supplying an OTC or prescription medicine. If they are a Drug Tested Athlete, then the information on the status of their medicine is readily available online at eirpharm.com and on the Eirpharm App developed for the Irish Sports Council. It’s also worth noting that for any Athlete who has a medical condition that justifies the use of a specific medicine that would otherwise be banned there is a Therapeutic Use Exemption for which they can apply."

68

Ireland’s No. 1 Generic Healthcare Specialists

20 mg & 40 mg gastro-resistant capsules, hard

Esomeprazole

Nexazole

Nexazole: for the treatment of erosive reflux oesophagitisPrescribing Information for Nexazole 20 mg & 40 mg gastro – resistant capsules, hard. Qualitative and Quantitative Composition: Each capsule contains 20 mg or 40 mg of esomeprazole (as esomeprazole magnesium dihydrate). Pharmaceutical Form: Hard, gastro-resistant capsule: Slightly pink body and cap, containing white to almost white pellets. Therapeutic Indications: Treatment of erosive reflux oesophagitis. Prevention of relapse of healed oesophagitis in long-term management of patients. Symptomatic treatment of gastroesophageal reflux disease (GERD). Eradication of H. pylori concurrently given with appropriate antibiotic therapy for treatment of H.pylori-associated ulcers. Treatment of NSAID-associated gastric and duodenal ulcers in patients requiring continued NSAID-treatment. Prophylaxis of NSAID-associated gastric ulcers and duodenal ulcers in patients at risk requiring continued therapy. Prolonged treatment after i.v. induced prevention of rebleeding of peptic ulcers. Treatment of Zollinger Ellison Syndrome. Dosage and Method of Administration: Capsules should be swallowed whole with liquid. The capsules can be opened and the pellets mixed in half a glass of non-carbonated water or if desired this solution administered through a gastric – tube in patients with swallowing difficulties. The capsules and / or contents should not be chewed or crushed. Treatment of erosive reflux oesophagitis: 40 mg once daily for 4 weeks. Long-term management of patients with healed oesophagitis to prevent relapse: 20 mg once daily. Symptomatic treatment of gastroesophageal reflux disease: 20 mg once daily. Eradication of H. pylori for treatment of H.pylori-associated ulcers: 20 mg with 1 g amoxicillin + 500 mg clarithromycin, all twice daily for 7 days. NSAID associated gastric & duodenal ulcers: 20 mg once daily for 4 – 8 weeks. Prophylaxis treatment: 20 mg once daily. Prolonged treatment after i.v induced prevention of rebleeding of peptic ulcers: 40 mg once daily for 4 weeks. Zollinger Ellison Syndrome: Initial dose is 40 mg once daily. Dosage should be individually adjusted. Daily doses up to 160 mg have been used. If the required daily dose exceeds 80 mg, it should be divided and given twice daily. Severe liver impairment: Patients should not exceed a max. dose of 20 mg. Contraindications: Hypersensitivity to esomeprazole or to any of the excipients. Esomeprazole should not be administered with atazanavir. Pregnancy and breast-feeding due to insufficient data. Children under 12 years. Special warnings and precautions for use: The possibility of a malignant gastric tumour should be excluded as Nexazole may alleviate symptoms and delay diagnosis. Regularly monitor patients on long-term treatment. Patients on on-demand treatment should contact their physician if symptoms change in character. If esomeprazole is used in combination with antibiotics, then the instructions for the use of these antibiotics should also be followed. Treatment with esomeprazole may lead to slightly increased risk of gastrointestinal infections such as Salmonella and Campylobacter. Contains sucrose – Patients with rare hereditary problems of fructose intolerance, glucose – galactose malabsorption or sucrase-isomaltase insufficiency should not take this medicine. Drug Interactions: Esomeprazole can affect the absorption of ketoconazole and itracanazole. Dose reduction may be required when administered with drugs metabolised by CYP2C19 as esomeprazole may increase their plasma concentration. Monitor patients when given in combination with warfarin or other coumarine derivatives. Undesirable effects: Common: Headache, abdominal pain, constipation, diarrhoea, flatulence, nausea/vomiting. Shelf Life: 2 years. Marketing Authorisation Holder: Pinewood Laboratories Ltd., Ballymacarbry, Clonmel, Co. Tipperary. Marketing Authorisation Holder Number(s): PA 281/146/1-2. This medicine is a prescription only product. Further prescribing information is available on request. Date of revision of text: July 2010.

Nexazole_IPN_A4.indd 1 27/07/2010 11:40:05

70

News

New president for PGEU

news brief

Slovakia, which became a full member of PGEU in 2004, will take over the PGEU Presidency for the first time since its creation. Member of the Executive Committee of the Slovak Chamber of Pharmacists since 1997, President of the Slovak Chamber of Pharmacists in 2000-2001, Mr Krchňák has been the Chamber representative for European Affairs in PGEU since 1998.

Mr Krchňák graduated from the Faculty of Pharmacy of Comenius University in Bratislava in 1984.

€1.75 million to establish the first Irish Prostate Cancer Outcomes ResearchProfessor John Fitzpatrick, Head of Research at the Irish Cancer Society last month announced that the Society, in collaboration with Movember, will dedicate €1.75 million in funding to establish the first Irish Prostate Cancer Outcomes Research (IPCOR) in Ireland that will monitor, benchmark and publicly report annually on outcomes of prostate cancer treatment and care. This equates to €350,000 in funding being allocated per year, for up to five years.

The aim of IPCOR is to effectively record and report on outcomes of prostate cancer treatment and care with a view to improving the lives of those living with and beyond prostate cancer. It aims to build on the National Cancer Registry data, by collecting data for all newly diagnosed prostate cancer cases in Ireland with the involvement of clinicians who treat men with prostate cancer.

The Society is calling for applications from suitably qualified organisations to submit a proposal by 3pm on Friday, 6th September 2013 to establish IPCOR, and successfully manage this grant. More information is available onhttp://www.cancer.ie/research/apply-for-funding

“The Irish Cancer Society’s mission critical, as the National Cancer Charity, is to eliminate cancer. To achieve this, one of our primary goals is to lead

At its annual General Assembly held this year in Rome, the Pharmaceutical Group of the European Union has elected Mr Štefan Krchnák from the Slovak Chamber of Pharmacists as PGEU President for 2014.

excellent, collaborative research in Ireland that will improve the care and survival of patients. IPCOR represents the first significant step towards achieving this goal for men living with prostate cancer,” said Prof Fitzpatrick.

“IPCOR will be the first Irish, quality clinical registry, funded by the Irish Cancer Society and Movember that will contain population-based, clinical and patient-reported data of men diagnosed with prostate cancer. This is significant because it will not only provide evidence-based data to clinicians, hospitals and decision makers on prostate cancer clinical practice, but it will also foster and evaluate improved quality of treatment and care for men newly diagnosed with prostate cancer.”

The main objectives of the Irish Prostate Cancer Outcomes Research (IPCOR) are:

XTANDI™ AUTHORISED IN THE EUROPEAN UNION (EU) Astellas Pharma Europe Ltd., Medivation, Inc.; the European Commission (EC) has now granted the marketing authorisation for XTANDI (enzalutamide) capsules for the treatment of adult men with metastatic castration-resistant prostate cancer whose disease has progressed on or after docetaxel therapy. Xtandi had previously received a positive opinion by the European Medicines Agency (EMA) and a positive Committee for Medicinal Products for Human Use (CHMP) opinion on 25th April 2013.

Enzalutamide is a novel, once-daily, oral androgen receptor signalling inhibitor.It inhibits multiple steps in the androgen receptor (AR) signalling pathway, which has been shown to decrease cancer cell growth and induce cancer cell death (apoptosis). The EU authorisation is based on results from the phase III AFFIRM study. The phase III AFFIRM trial was a randomised, double-blind, placebo-controlled, multinational trial evaluating enzalutamide (160 mg/day) versus placebo in 1,199 men with progressive metastatic castration-resistant prostate cancer who were previously treated with docetaxel-based chemotherapy.

AFFIRM confirmed that enzalutamide demonstrated a statistically significant improvement (p<0.0001) in overall survival compared to placebo, with a median survival of 18.4 months in the enzalutamide group versus 13.6 months in the placebo group, an advantage of 4.8 months [hazard ratio (HR) = 0.631]. The study also concluded that enzalutamide was generally well tolerated by patients and met all secondary endpoints.

He opened his own pharmacy in �urany, where he still works, in 1995. He was the author of the first computer software for pharmacy in Slovakia (1988) and is still involved in pharmacy eHealth solutions, being a member of Committee for eHealth implementation of the Slovak Ministry of Health since 2006.

Mr Krchňák will continue the work of the current Italian President, Mr Maximin Liebl, who will stand down from his role in December.

Mr Krchňák said: “I am immensely proud to be the first PGEU President from the Member States who joined the EU in 2004. I am looking forward to leading PGEU in a year which will see significant challenges, with a number of important developments affecting pharmacy at European level, and to continuing the work of advancing our profession in these times of both economic pressure and huge professional opportunity.”

Professor John Fitzpatrick

• Monitor, benchmark and publicly report annually on the outcomes of prostate cancer treatment and care.

• Provide risk adjusted, evidence based data to clinicians, hospitals and decision makers on prostate cancer clinical practice that fosters and evaluates improved quality of treatment and care for men diagnosed with prostate cancer.

• Foster research leading to improvement in care and survival; ideally enabling comparisons across countries.

Diary dateMore than 6,500 of pharmacy professionals are due to descend in Birmingham for an action-packed two days at The Pharmacy Show, Sunday 29th & Monday 30th September 2013 at the NEC.

New for 2013 will include; Medicines Optimisation Theatre; Clinical Theatre in association with The Clinical Pharmacy Congress; Keynote sessions including Pharmacy Entrepreneurs, CCGs and Wholesalers Panels; Special sessions covering Specials, Price Fixing, PI Supply.

Further information and details of how to attend can be found by visiting www.thepharmacyshow.co.uk.

Nitty Gritty can be ordered from Pemberton on 01-4632424

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The Irish Pharmacy Awards 2013 Red CarpetPictured below are some of those who attended the hugely successful Irish Pharmacy Awards 2013. The Awards, now in their second year, have been hailed as the biggest night in the pharmacy calendar.

Details of the Irish Pharmacy Awards 2014 with all of the categories and how you can enter will be announced shortly so make sure you watch this space!

1 2

3 4 5

Out & About

72

6 7

1. Orla O'Donnell, Raymond O'Donnell, Elizabeth Doran, Danielle McMenamin, Michael Mullen, Anna Lisa Mullen, Fergus Brennan and Mairead Brennan, Brennans Pharmacy

2. Helen Byrne, Emma Clarke, Roisin Flanagan, Lisa Copas, Padraigin McCaughey, Mary Clarke Marie Patton and Michael McCarthy, McCabes Pharmacy

3. Gichka Hristova and Mary Boylan, Walshes, Tesco

4. Roisin and Tom Murray, Murrays Pharmacy

5. Lisa Connolly and Marnie Harrington, Harringtons Pharmacy

6. Conor Corcoran and Mairead Reen, Reens Pharmacy

7. Nicola McNamee and Sarah Campbell, Bradleys Pharmacy

Greater BP reduction vs. other ARBs*1-7

Effective BP control maintained over 24 hours1,8

Proven achievement of recognised BP targets9,10

* vs. losartan, valsartan and candesartan

ABBREVIATED PRESCRIBING INFORMATION. Benetor 10, 20, 40mg film-coated tablets (olmesartan medoxomil). Refer to Summary of Product Characteristics (SPC) before prescribing. Presentation: Film-coated tablets containing 10mg, 20mg, 40mg olmesartan medoxomil. Contains lactose. Uses: Treatment of essential hypertension. Dosage: Adults: Recommended starting dose 10mg daily. If required the dose may be increased to 20mg daily. Maximum dose 40mg daily. Elderly: No dose adjustment generally required. Patients with moderate renal or hepatic impairment: Maximum daily dose is 20mg. Children, adolescents (below 18 years) and patients with severe hepatic impairment or severe renal impairment: Not recommended. Contra-indications: Hypersensitivity to any component. Second and third trimesters of pregnancy. Patients with biliary obstruction. Warnings and Precautions: Correct intravascular volume depletion before administering. In patients with other conditions associated with stimulation of renin-angiotensin-aldosterone system, possible side effects include acute hypotension, azotaemia, oliguria or, rarely, acute renal failure. Increased risk of severe hypotension and renal insufficiency in patients with bilateral renal artery stenosis or stenosis of the artery to a single functioning kidney. Periodic monitoring of serum potassium and creatinine levels is recommended in patients with impaired renal function. No experience in kidney transplantation or end-stage renal impairment. Hyperkalaemia (which may be fatal), risk factors include diabetes, renal impairment, age (> 70 years), combination with medicines which increase potassium levels, potassium supplements, intercurrent events. Close monitoring of serum potassium in at risk patients is recommended. Not recommended for combination use with lithium. Special caution is recommended in patients suffering from aortic or mitral valve stenosis, or obstructive hypertrophic cardiomyopathy. Not recommended in patients with primary aldosteronism. The blood lowering effect of olmesartan medoxomil is somewhat less in black patients than non-black patients. Do not initiate during pregnancy. Excessive blood pressure decrease in patients with ischaemic heart disease or ischaemic cerebrovascular disease could result in a myocardial infarction or stroke. Interactions: Concomitant use with potassium supplements, potassium sparing diuretics and drugs that increase serum potassium levels (e.g. heparin) is not recommended. The blood pressure lowering effect of olmesartan medoxomil can be increased by concomitant use with other antihypertensive medications. Risk of acute renal failure with concomitant use of NSAIDs and angiotensin II antagonists. Monitoring of renal function and regular hydration of the patient is recommended. Use with NSAIDs can reduce the effect of olmesartan maedoxomil. Coadministration of warfarin and digoxin had no significant effect on the pharmacokinetics of olmesartan, warfarin or digoxin. Use in combination with lithium not recommended. If necessary, careful monitoring of serum lithium levels recommended. No clinically relevant interactions between olmesartan and drugs metabolised by cytochrome P450 enzymes 1A1/2, 2A6, 2C8/9, 2C19, 2D6, 2E1 and 3A4 are expected. Pregnancy and Lactation: Contraindicated in second and third trimesters of pregnancy. Not recommended in first trimester and during breast feeding. Discontinue as soon as possible if pregnancy occurs during therapy. Undesirable Effects: Market experience: The following have been reported very rarely (<1/10,000): Thrombocytopenia, hyperkalaemia, dizziness, headache, cough, abdominal pain, nausea, vomiting, pruritus, rash, allergic conditions such as angioneurotic oedema, dermatitis allergic, facial oedema, urticaria, muscle cramp, myalgia, acute renal failure, renal insufficiency, asthenia, fatigue, malaise, lethargy, abnormal renal function tests, increased hepatic enzymes. Clinical Trials: Common side effects include dizziness, bronchitis, cough, pharyngitis, rhinitis, abdominal pain, diarrhoea, dyspepsia, gastroenteritis, nausea, arthritis, back pain, skeletal pain, haematuria, urinary tract infection, chest pain, fatigue, influenza-like symptoms, peripheral oedema, pain, increased creatinine phosphokinase, hypertriglyceridaemia, hyperuricaemia, and liver enzyme elevations. Less common side effects include vertigo, hypotension, angina pectoris, rash, hyperkalaemia. Overdosage: Most likely effect is hypotension. In the event of overdosage, monitor the patient carefully and give symptomatic and supportive treatment. Pack Sizes: Blister containing 28 film-coated tablets. Legal Category: POM. Product Authorisation Numbers: PA 1595/1/1-3. Product Authorisation Holder: Daiichi Sankyo Ireland Ltd., Riverside One, Sir John Rogerson’s Quay, Dublin 2. Additional information is available on request from: Daiichi Sankyo Ireland Ltd., Telephone: (01) 489 3000, Fax: (01) 489 3033, E-mail: medinfo@daiichi-sankyo.ie Date of Preparation: November 2009.

References: 1. Smith D et al. Am J Cardiovasc Drugs 2005; 5(1):41-50. 2. Oparil S et al. J Clin Hypertens 2001;3;283−291,318. 3. Brunner HR et al. Clin Drug Invest 2003;23(7):419−430. 4. Brunner H and Arakawa K. Clin Drug Invest 2006;26(4):185−193. 5. Ball KJ et al. J Hypertens 2001;19(Suppl 1):S49−S56. 6. Stumpe KO and Ludwig M. J Hum Hypertens 2002;16(Suppl 2):S24−S28. 7. Giles TD et al. J Clin Hypertens 2007;9:187−195. 8. Fabia M J et al. J Hypertension 2007, 25:1327-1336. 9. Püchler J et al. J Hypertension 2001, 19(Suppl 1):S41-48. 10. Barrios V et al. Vascular Health and Risk Management 2009:5 723-729.

Date of item: July 2013 DSIE/BEN54

ABBREVIATED PRESCRIBING INFORMATION. Benetor 10, 20, 40mg film-coated tablets (olmesartan medoxomil). Refer to Summary of Product Characteristics (SPC) before prescribing.olmesartan medoxomil. Contains lactose. Uses: Treatment of essential hypertension. Dosage: Adults: Recommended starting dose 10mg daily. If required the dose may be increased to 20mg daily. Maximum dose 40mg daily. Elderly: No dose adjustment generally required. Patients with moderate renal or hepatic impairment: Maximum daily dose is 20mg. Children, adolescents (below 18 years) and patients with severe hepatic impairment or severe renal impairment: Not recommended. Hypersensitivity to any component. Second and third trimesters of pregnancy. Patients with biliary obstruction. of renin-angiotensin-aldosterone system, possible side effects include acute hypotension, azotaemia, oliguria or, rarely, acute renal failure. Increased risk of severe hypotension and renal insufficiency in patients with bilateral renal artery stenosis or stenosis of the artery to a single functioning kidney. Periodic monitoring of serum potassium and creatinine levels is recommended in patients with impaired renal function. No experience in kidney transplantation or end-stage renal impairment. Hyperkalaemia (which may be fatal), risk factors include diabetes, renal impairment, age (> 70 years), combination with medicines which increase potassi

Benefit from Benetor®

For the Effective Management of Essential Hypertension

Benetor®

Olmesartan medoxomil

ABBREVIATED PRESCRIBING INFORMATION. Benetor 10, 20, 40mg film-coated tablets (olmesartan medoxomil). Refer to Summary of Product Characteristics (SPC) before prescribing. Presentation: Film-coated tablets containing 10mg, 20mg, 40mg Adults: Recommended starting dose 10mg daily. If required the dose may be increased to 20mg daily. Maximum dose 40mg daily. Elderly: No dose adjustment

generally required. Patients with moderate renal or hepatic impairment: Maximum daily dose is 20mg. Children, adolescents (below 18 years) and patients with severe hepatic impairment or severe renal impairment: Not recommended. Warnings and Precautions: Correct intravascular volume depletion before administering. In patients with other conditions associated with stimulation

of renin-angiotensin-aldosterone system, possible side effects include acute hypotension, azotaemia, oliguria or, rarely, acute renal failure. Increased risk of severe hypotension and renal insufficiency in patients with bilateral renal artery stenosis or stenosis of the artery to a single functioning kidney. Periodic monitoring of serum potassium and creatinine levels is recommended in patients with impaired renal function. No experience in kidney transplantation or end-stage renal impairment. Hyperkalaemia (which may be fatal), risk factors include diabetes, renal impairment, age (> 70 years), combination with medicines which increase potassium levels, potassium supplements, intercurrent events. Close monitoring of serum potassium in at risk patients is recommended. Not recommended for combination use with lithium. Special caution is recommended in patients suffering from aortic or mitral valve stenosis, or obstructive hypertrophic cardiomyopathy. Not recommended in patients with primary aldosteronism. The blood lowering effect of olmesartan medoxomil is somewhat less in black patients than non-black patients. Do not initiate during pregnancy. Excessive blood pressure decrease in patients with ischaemic heart disease or ischaemic cerebrovascular disease could

Concomitant use with potassium supplements, potassium sparing diuretics and drugs that increase serum potassium levels (e.g. heparin) is not recommended. The blood pressure lowering effect of olmesartan medoxomil can be increased by concomitant use with other antihypertensive medications. Risk of acute renal failure with concomitant use of NSAIDs and angiotensin II antagonists. Monitoring of renal function and regular hydration of the patient is recommended. Use with NSAIDs can reduce the effect of olmesartan maedoxomil. Coadministration of warfarin and digoxin had no significant effect on the pharmacokinetics of olmesartan, warfarin or digoxin. Use in combination with lithium not recommended. If necessary, careful monitoring of serum lithium levels recommended. No clinically relevant interactions between olmesartan and drugs metabolised by cytochrome P450 enzymes 1A1/2, 2A6, 2C8/9, 2C19, 2D6, 2E1 and 3A4 are

Contraindicated in second and third trimesters of pregnancy. Not recommended in first trimester and during breast feeding. Discontinue as soon as possible if pregnancy occurs during therapy. (<1/10,000): Thrombocytopenia, hyperkalaemia, dizziness, headache, cough, abdominal pain, nausea, vomiting, pruritus, rash, allergic conditions such as angioneurotic oedema, dermatitis allergic,

facial oedema, urticaria, muscle cramp, myalgia, acute renal failure, renal insufficiency, asthenia, fatigue, malaise, lethargy, abnormal renal function tests, increased hepatic enzymes. Clinical Trials: Common side effects include dizziness, bronchitis, cough, pharyngitis, rhinitis, abdominal pain, diarrhoea, dyspepsia, gastroenteritis, nausea, arthritis, back pain, skeletal pain, haematuria, urinary tract infection, chest pain, fatigue, influenza-like symptoms, peripheral oedema, pain, increased creatinine phosphokinase, hypertriglyceridaemia, hyperuricaemia, and liver enzyme elevations. Less common side effects include vertigo, hypotension, angina pectoris, rash, hyperkalaemia. Overdosage: Most likely effect is hypotension. In the event of overdosage, monitor the patient

Legal Category: POM. Product Authorisation Numbers: PA 1595/1/1-3. Product Authorisation Holder: Daiichi Sankyo Ireland Ltd., Riverside One, Sir John Rogerson’s Quay, Dublin 2. Additional information is available on request from: Daiichi Sankyo Ireland Ltd., Telephone: (01) 489 3000, Fax: (01) 489 3033, E-mail: medinfo@daiichi-sankyo.ie Date of Preparation: November 2009.

Oparil S et al. J Clin Hypertens 2001;3;283−291,318. 3. Brunner HR et al. Clin Drug Invest 2003;23(7):419−430. 4. Brunner H and Arakawa K. Clin Drug Invest 2006;26(4):185−193. Stumpe KO and Ludwig M. J Hum Hypertens 2002;16(Suppl 2):S24−S28. 7. Giles TD et al. J Clin Hypertens 2007;9:187−195. 8. Fabia M J et al. J Hypertension 2007, 25:1327-1336.

Vascular Health and Risk Management 2009:5 723-729.

Benetor A4 IPN Advert.indd 1 22/07/2013 09:11

United Drug Blue Sapphire ShowThe United Drug Pharmacy Show was the biggest to date of the seven years that the show has been in existence.

It was extra special this year because United Drug was celebrating its 65th Anniversary (Blue Sapphire) in the pharmacy sector and had, as its theme: The best is yet to come.

The event was held in the Aviva Stadium and was spread over a three-day period. There were over 65 products, services and promotions on show, which allowed the many pharmacists who attended to meet the suppliers and companies there to discuss their new products, existing ranges and advances in technology – all in an informal and professional manner!

Out & About

74

Matthew Beattie, Siobhan Connolly, Niamh Coffey, Claudia Long, Paul Hatton, Eoghan Webb from GSK

Tom O’Brien, Danny Lynskey, Jeffrey Walsh, Gerard Flynn, Padraic O’Brien and Peadar Flynn from Pinewood

Gavin Rooney, Boots, Gerry McCauley, CPL, Jeffrey Walsh-Pinewood and Clare Fitzell, Boots

Anne Barrett, Hickeys Rush, Siobhan Connolly, Doherty's Pharmacy, Ruth Hooijenga, UD and Margaret Mullane, Petra

Jean Tomkins and Leo Price United Drug James Falvey, Aoife Pearson and Michael Cullen from Fannins

Paul Nash and Daniel Byers KRKA

75

Ger Kenny, Brendan McLoughlin, Geraldine Freeman, Enda O'Conlon, Alan Burke, Barry Allan and Daragh Predergast,

McNeil Healthcare

Marie Richardson and Adrienne Stack from Stacks Pharmacy with Sinead McMahon and Joan Millar from Ovelle Ltd.

Tom McDonald, Ronan Walsh and Ingrid Walsh Sanofi

Barry Fitzpatrick and John Arnold

Keith Doyle, Neilmed, Agnese Sauka, Chamber Pharmacy, Emma Rooney, Chambers Pharmacy, Bharat Mehata, Neilmed

Neil Weir, Weirs Pharmacy, Mullingar and Laura O'Toole, Sona Nutrition

Jacqueline O'Donnell, O'Donnells Pharnacy and Daragh Prendergast, McNeil Healthcare

76

Clinical Profiles

Rowex Ltd is pleased to announce the launch of Sidena (Sildenafil) 25mg, 50mg & 100mg Tablets x 4’s.

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

In order for Sildenafil to be effective, sexual stimulation is required.

The Details are as follows: Sidena 25mg Tablets x 4’s – ¤12.31Sidena 50mg Tablets x 4’s – ¤14.35Sidena 100mg Tablets x 4’s – ¤17.44The presentations are fully reimbursable under the GMS.

For further information contact Rowex Ltd., Bantry, Co. Cork. Freephone 1800 304 400, email rowex@rowa-pharma.ie

Actavis Ireland is pleased to announce two ‘first to market’ launches for June with the release of Nemdatine (Memantine) 10 mg film-coated tablets and Lycimor (Lymecycline) 300 mg x 28 hard capsules.

Indicated for the treatment of patients with moderate to severe Alzheimer’s disease, Nemdatine is available in 10 mg packs of 28 and 56 film-coated tablets.

Subject to medical prescription, Nemdatine 10 mg x 28 & 56 film-coated tablets are GMS reimbursable and are available from all wholesalers since June 4th.

Nemdatine 10 mg x 28 tablets is available at a trade price of ¤23.36 and the 10 mg x 56 tablets at ¤46.72Indicated for the treatment of moderate to severe acne, Lycimor 300 mg is available in packs of 28 hard capsules and is available from all wholesalers from June 20th.

Subject to medical prescription, Lycimor 300 mg x 28 hard capsules is available at a trade price of ¤4.64.

Delivering key products continues to be an important focus for Actavis Ireland and these latest launches continue to underline Actavis’ position as the fastest growing pharmaceutical company on the Irish market1.

For further information on the Actavis portfolio please contact Actavis on 1890 33 32 31 or email on contact@actavis.ie1 IMS Health April 2012

TWO MORE ‘FIRST TO MARKET’ LAUNCHES FOR ACTAVIS: NEMDATINE (MEMANTINE) AND LYCIMOR (LYMECYCLINE)

KRKA are delighted to announce the launch of 5 additional products available with GMS reimbursement from 1st July 2013.Diacronal MR (gliclazide) 30mg and 60mg, Icorvida SR (indapamide) 1.5mg, Kamiren (doxazosin) 4mg, Venlafex XL (venlafaxine) 37.5mg, 75mg and 150mg, Vizarsin FCT and ODT (Sildenafil) 25mg, 50mg and 100mg. Diacronal MR (gliclazide) prolonged release tablets are indicated for treatment of patients with non insulin dependent diabetes.Trade Price:Diacronal MR 30mg prolonged release tablets x 60 ¤3.98Diacronal MR 60mg prolonged release tablets x 30 ¤3.98 (the only generic version of the 60mg currently available in Ireland)Icorvida SR (indapamide) prolonged release tablets are indicated for the treatment of patients with hypertension.Trade Price:Icorvida SR 1.5mg prolonged release tablets x 30 ¤2.95 (the only generic version currently available in Ireland)Kamiren (doxazosin) prolonged release tablets are indicated for the treatment of patients with hypertension.Trade Price:Kamiren (doxazosin) 4mg prolonged release tablets x 28 ¤8.48Venlafex XL (venlafaxine) prolonged release tablets are indicated for the treatment and prevention of major depressive episodes.Trade Price:Venlafex XL 37.5mg prolonged release tablets x 28 ¤8.06Venlafex XL 75mg prolonged release tablets x 28 ¤11.56Venlafex XL 150mg prolonged release tablets x 28 ¤19.48Vizarsin (sildenafil) film coated and orodispersible tablets are indicated for the treatment of men with erectile dysfunction. Trade priceVizarsin 25mg film coated tablet x 4 ¤12.31Vizarsin 50mg film coated tablet x 4 ¤14.35Vizarsin 100mg film coated tablet x 4 ¤17.44Vizarsin 25mg orodispersible tablet x 4 ¤12.31 (the only orodispersible sildenafil currently available in Ireland)Vizarsin 50mg orodispersible tablet x 4 ¤14.35 (the only orodispersible sildenafil currently available in Ireland)Vizarsin 25mg orodispersible tablet x 4 ¤17.44 (the only orodispersible sildenafil currently available in Ireland)For further information on these products or the rest of KRKA’s portfolio please contact our Dublin office on 01 293 9180 or email info.ie@krka.biz

KRKA ANNOUNCE 5 ADDITIONAL MOLECULES TO THEIR RANGE

Rowex Ltd is pleased to announce the launch of Memantine LEK 10mg film-coated tablets x 28’s & 56’s (Memantine Hydrochloride)

Memantine LEK 10mg Film-coated tablets are indicated for the treatment of patients with moderate to severe Alzheimer’s disease.

The Details are as follows:Memantine LEK 10mg Film-Coated Tablets x 28’s - ¤23.36

Memantine LEK 10mg Film-Coated Tablets x 56’s - ¤46.72

The presentations are fully reimbursable under the GMS.

For further information contact Rowex Ltd., Bantry, Co. Cork. Freephone 1800 304 400, email rowex@rowa-pharma.ie

MEMANTINE LEK LAUNCH

Actavis Ireland is pleased to announce a ‘day one’ launch - June 21st - of Sildenafil Actavis. Launching in three skus: 25 mg, 50 mg and 100 mg x 4 film-coated tablets, the launch is significant for Actavis, coming on the first day after patent expiry on June 20th and adding to a substantial list of launches already in 2013.

With the market growing in Ireland by 5%1, Sildenafil is indicated for the treatment of men with erectile dysfunction. Sildenafil Actavis is available from all wholesalers from June 21st.

Delivering key products continues to be an important focus for Actavis Ireland and this latest ‘day one’ launch continues to underline Actavis’ position as the fastest growing pharmaceutical company on the Irish market1.

Subject to medical prescription, Sildenafil is available at the following trade prices:

• 25 mg x 4 film-coated tablets ¤12.31• 50 mg x 4 film-coated tablets ¤14.35

• 25 mg x 4 film-coated tablets ¤17.44For further information on the Actavis portfolio please contact Actavis on 1890 33 32 31 or email on contact@actavis.ie

ACTAVIS ‘DAY ONE’ LAUNCH FOR SILDENAFIL

ROWEX LTD LAUNCH SIDENA (SILDENAFIL) 25MG, 50MG & 100MG TABLETS X 4’S

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Product Profiles

Bayer - Bepantiseptic

Bayer Bepanthen™ has launched an exciting campaign aimed at giving a modern make over to one of Ireland’s most reliable first aid creams, Germolene. Now known as Bepantisepic™, this reliable, much loved product features all of the great benefits of Germolene. The brand overhaul and renaming has been created to mirror the ever evolving consumer.

Bepantiseptic™ is an antiseptic and analgesic ointment for the effective treatment of minor cuts and grazes, stings and insect bites, minor burns, scalds and blisters, spots and chapped and rough skin. The wide variety of uses makes BepantisepticTM a must have in any first aid kit.

Kelkin Re-launch Sulá Sugar-Free Confectionary Range:

The Irish market for sugar-free confectionery is growing steadily driven by consumers’ demand for calorie controlled convenient, healthier products. Retailers only have to look at other key European markets to fully understand the enormous potential. Sulá’s flip top box range contains mouth-watering traditional flavours, produced and packaged to meet consumers’ demands; presented in convenient, trendy, 42g pocket-sized boxes featuring clean and simple packaging designs. The hard boiled candies are free from artificial flavours, preservatives, hydrogenated fat and Aspartame and are a natural choice for a healthier lifestyle. The sugar-free sweets are perfect for people wishing to reduce their calorie intake without sacrificing confectionery treats, as each Sulá sweet contains only 7-9 calories!

If shelf space is an issue Sulá offer a FREE counter top merchandising solution or custom made clip strips. Contact Kelkin Ltd. to place your order now - 01 4600400.

WE NEED TO TALK ABOUT...BALDNESS New research reveals men too embarrassed to talk

Hair loss is a major concern for Irish men yet most are reluctant to talk about it even with those closest to them according to the results of a new study which was commissioned by REGAINE® for Men Foam. Nearly four out of ten men (38%) admitted to being concerned about losing their hair. Yet 71% per cent of those surveyed admitted that they have never discussed their hair loss with a partner while just 17 per cent have sought advice from a healthcare professional such as a doctor or pharmacist.

Commenting on the research, Dr Maurice Collins FRCSI, specialist in hair restoration medicine said “The results indicate that hair loss is a sensitive issue that can effect men deeply. The effective medical treatments now available will help to encourage a more open discussion on the subject of hair loss in men and its treatment.”

Another Day One Launch from Actavis!

Actavis Ireland is delighted to announce the launch of Zoledronic Acid 4mg/5ml x 1 Vial on Day One following patent expiry.

Zoledronic Acid is indicated for the prevention of skeletal related events (pathological fractures, spinal compression, radiation or bone surgery) in adult patients with advanced bone malignancies. It is also indicated for the treatment of adult patients with tumour-induced hypercalcaemia (TIH).

Commenting on this important Day One launch, Actavis Ireland Hospital Business Manager, Caroline Fitzgerald said “Actavis is committed to bringing value and choice to the Irish Market. Actavis offers fast access to a wide choice of Hospital Pharmaceuticals across all therapeutic areas. We operate contemporary GMP approved manufacturing facilities in Europe, with meticulous in house quality standards and rigorous regulatory environments ensuring the highest quality at all times. We will continue to expand our product portfolio throughout 2013 in order to provide the highest quality pharmaceuticals possible.”

Zoledronic Acid 4mg/5ml is available to order from the Allphar/Uniphar network.

For further information on the Actavis portfolio please contact us in Cork today on 1890 33 32 31 or email on contact@actavis.ie

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Send your appointments announcements to Irish Pharmacy NewsOur appointments page offers you a chance to offi cially welcome your new colleague to your pharmacy and to let your peers know about positive happenings within your business. Simply send in 100-200 words providing some background career details on the person and a separatehigh-resolution headshot (preferably a JPEG) to accompany the piece.

Send your details and photograph to editorial@ipnirishpharmacynews.ie or call (01) 602 4715 for more details.

Appointments

The HSE announced that, Mr Ian Carter National Director Designate of Acute Hospitals in the HSE and former CEO of St James’s Hospital has taken over responsibility for the Special Delivery Unit (SDU). The SDU was established by Minister for Health, Dr James Reilly to reduce the numbers of patients on hospital trolleys and on waiting lists.

Dr Stephen Byrne was recently appointed Chair in Clinical Pharmacy Practice along with the post of Head of the School of Pharmacy at UCC. He will take up his post in October of this year. Current Head Professor Caitriona O’Driscoll congratulated Dr Byrne not only for his work to date but his engagement with the profession and his colleagues in both hospital and community pharmacy practice.

Eoghan Hanly has been elected as President of the Pharmaceutical Society of Ireland. Hanly was previous Vice-President. Noel Stenson has been elected the new Vice-President. Hanly succeeds Paul Fahey who served as President for two years. Eoghan Hanly graduated from Robert Gordon University Aberdeen in 1995 with a degree in Pharmacy. Since 1996 he has practised as a pharmacist in his family’s pharmacy in Loughrea, Co Galway, which was established by his grandfather, P.J. Killian in 1940.

The PSI has announced changes to its Council. The following pharmacists have been appointed (or reappointed) following the election process earlier this year: Nicola Cantwell, Richard Collis, Georgina Ann Frankish, Eoghan Hanly and Conor Phelan. Rita Purcell has been reappointed to the Council as the nominee of the Irish Medicines Board. Dr Chantelle McNamara, GP, is a new appointment. In addition, Pat O’Dowd has been appointed to the Council as the nominee of the HSE. A further four Council members are expected to be appointed by the Minister for Health shortly.

Paul Reid has been appointed as the new Managing Director of Pfizer Healthcare Ireland. Paul will be responsible for the performance of Pfizer’s commercial subsidiary in Ireland and is also head of Pfizer’s Specialty Care Business Unit which is responsible for many of Pfizer’s leading medicines in inflammation, vaccines, haemophilia and infective diseases. Paul has over 18 years of pharmaceutical experience, 12 of these at Pfizer where he has held a number of different roles in sales and marketing, including Sales Director/Head of Learning & Development and Marketing Director. Prior to joining Pfizer, he worked with Aventis Pharma, Nutricia Ireland and Rowa Pharmaceuticals.

Cllr. Tim Lombard has been elected as the new Chairperson of the Regional Health Forum for the HSE South at its annual general meeting in Cork.The functional area of the Regional Health Forum in the HSE South covers the city councils of Cork and Waterford and the county councils of Carlow, Cork, Kerry, Kilkenny, South Tipperary, Waterford and Wexford.

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AV1328 - Confidante - Irish Pharmacy News - Pharmacy JUL13.indd 1 26/07/2013 14:25