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issue 5 volume 11 may 2009

www.greencrosspublishing.ie

THE
INDEPENDENTmonthly
MONTHLYfor
FORIrish
IRISHPharmacists
PHARMACISTS
The
independent

NEWS PHARMACIST AWARDS


Just 2 per cent
of non-branded
generics prescribed
in 2008 p4

Self-care website
The winners and losers! p18 launched
Luigi Barlassina

The Schindler
of pharmacy

Pharmacies raided
in the Mid West p4

Dawn O'Shea

Management
of epilepsy

PSI estimates
income of 6.5
million in 2009 p4

Q&A

Inappropriate
prescribing cost
almost 40 million
in 2007 p6

Dr John Hillery
Recent appointee to
the PSI Council
Fintan Moore

Complaints to PSI
increased in 2008

Thelma and
Louise,
Bertie and Brian

p6

More than a third


of pharmacists
voted in recent PSI
elections p8
IPU AGM news
roundup p10

www.yourmedicines.ie

Interview

Dr Des Corrigan, recipient of the


Lifetime Achievement Award at
the 2009 Pharmacist Awards

Terry Maguire

Community
pharmacy
under attack

The clever way to fight stomach discomfort.

Now your customers can fight fullness, bloating


and nausea wherever and whenever it strikes with convenient
and discreet Motilium Fastmelts.
PA Holder: McNeil Healthcare (Ireland) Ltd., Airton Rd, Tallaght, Dublin 24. PA Number: 823/51/1. Product not subject to a medical prescription. Full prescribing information available on request. MOA/019/00

Feel full with less food

Reductil (sibutramine) (Ireland), 10 & 15 mg Reductil 10 mg and 15 mg (sibutramine)


Prescribing Information (refer to Summary of Product Characteristics for full information).
Presentation: Capsules containing 10 mg or 15 mg of sibutramine hydrochloride monohydrate (equivalent to 8.37 mg or 12.55 mg of sibutramine). Indications: Adjunctive therapy, within a weight
management programme, for patients with nutritional obesity and a BMI of 30 kg/m2 and patients with nutritional excess weight and a BMI of 27 kg/m2, if other obesity-related risk factors are present.
Reductil may only be prescribed to patients who have not adequately responded to an appropriate weight-reducing regimen alone. Dosage and administration: Initial dose: 10 mg once daily with liquid.
In patients with an inadequate response after 4 weeks, the dose may be increased to 15 mg once daily provided that 10mg is well tolerated. Treatment must be discontinued in patients who do not respond
adequately to Reductil (refer to SmPC for details), as non-responders are at higher risk of undesirable effects. Reductil should only be given for periods up to one year. Contra-indications: Hypersensitivity to
product constituents, galactose intolerance, Lapp lactose deficiency or glucose-galactose malabsorption; organic causes of obesity; history of major eating disorders; psychiatric illness; Gilles de la Tourettes
syndrome; concomitant use, or use during the past two weeks, of MAOIs, other centrally-acting drugs or tryptophan; history of coronary artery disease, congestive heart failure, tachycardia, peripheral arterial
occlusive disease, arrhythmia or cerebrovascular disease; inadequately controlled hypertension (>145/90 mmHg); hyperthyroidism; severe hepatic or renal impairment, and in patients with end stage renal
disease on dialysis; benign prostatic hyperplasia with urinary retention; phaeochromocytoma; narrow angle glaucoma; history of drug, medication or alcohol abuse; pregnancy and lactation; children and
young adults up to the age of 18 years and patients over 65 years of age. Precautions and warnings: Blood pressure and pulse rate should be monitored in all patients. These parameters should be checked
every 2 weeks for the first 3 months of treatment (refer to SmPC for further details). Particular care should be taken in monitoring blood pressure in patients with sleep apnoea syndrome. Use with caution in the
following groups of patients:- those with mild to moderate hepatic or renal impairment, patients with a family history of motor or verbal tics, patients with epilepsy, patients with open angle glaucoma, patients
who are at risk of raised intraocular pressure and those that have a history of depression. As serotonin re-uptake inhibition can result in an increased risk of bleeding, (including gynaecological, gastrointestinal
and other cutaneous or mucous bleeding) Reductil should be prescribed with caution in patients receiving medications that are known to affect haemostasis or platelet function or those who are predisposed
to bleeding. Adequate contraceptive measures should be taken in women of childbearing potential. Side effects: Prescribers should consult Summary of Product Characteistics for full information. Most
side effects occur during the first 4 weeks of treatment, with severity and frequency diminishing over time. Very common (>1/10): constipation, dry mouth, insomnia. Common (<1/10 and >1/100): tachycardia,
palpitations, raised blood pressure, vasodilation, nausea, haemorrhoid aggravation, light-headedness, paraesthesia, headache, anxiety, sweating, taste perversion. Clinically significant adverse events:
thrombocytopenia, Henoch-Schnlein purpura, atrial fibrillation, paroxysmal supraventricular tachycardia, allergic hypersensitivity reactions, agitation, depression, seizures, serotonin syndrome, transient
short-term memory disturbance, blurred vision, diarrhoea, vomiting, gastrointestinal haemorrhage, alopecia, rash, urticaria, cutaneous bleeding reactions (ecchymosis, petechiae), acute interstitial nephritis,
mesangiocapillary glomerulonephritis, urinary retention, abnormal ejaculation/orgasm, impotence, menstrual cycle disorders, metrorrhagia and reversible increases in liver enzymes. A mean increase in resting
blood pressure of 2-3 mmHg, and a mean increase in heart rate of 3-7 beats per minute have been observed. Clinically significant increases in blood pressure tend to occur early in treatment and therapy
should be discontinued in such cases. Withdrawal symptoms have rarely been observed. Patients should be cautioned that their ability to drive or operate hazardous machinery might be impaired when taking
Reductil Drug interactions: Caution with drugs which affect CYP3A4 enzyme activity, including ketoconazole, itraconazole, erythromycin, clarithromycin, troleandomycin, cyclosporin, rifampicin, phenytoin,
carbamazepine, phenobarbital and dexamethasone. Sibutramine inhibits serotonin reuptake and should not be used concomitantly with other drugs which also raise serotonin levels in the brain, i.e. SSRIs,
sumatriptan, dihydroergotamine, pentazocine, pethidine, fentanyl, dextromethorphan. Caution should be used when prescribing Reductil to patients taking medicines which may raise blood pressure or heart
rate (eg sympathomimetics) such as certain cough/cold and allergy medications (e.g. ephedrine, pseudoephedrine), and certain decongestants (e.g. xylometazoline). 2 weeks should elapse between use of
sibutramine and MAOIs. Use in Pregnancy and Lactation: Reductil is contra-indicated in these cases. Overdosage: The most frequently noted adverse events associated with overdose are tachycardia,
hypertension, headache and dizziness. Treatment should consist of general measures employed in the management of overdosage (e.g. keep airways unobstructed as needed, monitor cardiovascular
function, general symptomatic and supportive measures). Gastric lavage may be beneficial. Cautious use of beta blockers may be indicated in patients with elevated blood pressure or tachycardia. The results
from a study in patients with end-stage renal disease on dialysis showed that sibutramine metabolites were not eliminated to a significant degree with hemodialysis. Legal Category: POM. Marketing
Authorisation Numbers: PA 38/75/1 (10 mg), PA 38/75/2 (15 mg). PA holder and further information is available from: Abbott Laboratories Ireland Ltd., Dublin 24, Ireland. PI/103/007Ire. Date of
revision of PI: November 2005. PPD/RED/2006/112. Date of preparation: August 2006.
Reference: 1. Reductil SmPC.

The independent monthly for Irish Pharmacists

editorial

issue 5 volume 11 MAY 2009

contents
4-12 NEWS
15-16 INTERVIEW

Dr Des Corrigan, recipient of the Lifetime


Achievement Award at the 2009 Pharmacist Awards.

18-19 PHARMACIST AWARDS 2009 AND

THE WINNER IS

We reveal the winners of the 2009 Helix Health


Pharmacist Awards 2009 in association with the PSI
Benevolent Fund.

20

TERRY MAGUIRE

View from Above

22

DAVID JORDAN

Mind your language David Jordan goes on an


international crusade to ensure that pharmacists
can speak the language of the country in which they
practise.

23

LAW

The Financial Emergency Measures in the Public


Interest Bill 2009 what does it really mean for
pharmacy?

24

JULIAN JUDGE

On the global success of a 48-year-old single woman


who lives alone with her cat and has never been
kissed.

Where
complacency
has no place
At the time of writing, swine
flu is a real and worrying
threat to populations around
the globe, not least in those
countries where tragically
deaths have already occurred.
Although, to date, there
has been just one confirmed
case in Ireland of the A/H1N1
influenza and the patient
in question has thankfully
recovered, the question must
be how prepared are we if
the WHO decides to raise the
level once more to grade 6
and what part are pharmacists
expected to play in all of this?
According to Dr Tony
Holohan, the Chief Medical
Officer at the Department
of Health, we have enough
antiviral stockpiles for 47
per cent of the population.
Mr Darragh OLoughlin, Vice
President of the IPU, told the

Irish Times recently that most


pharmacists did not have any
Tamiflu in stock as the HSE
was ensuring stocks were kept
in quarantine until absolutely
needed.
In fairness to the
Department, it has been
holding daily press
conferences with members
of the media since details of
initial cases of the virus first
emerged in Mexico towards
the end of April.
However, like most things
in life, we will not know just
how well we are prepared for
the reality of a pandemic until
it hits.
It can be a delicate balance
between not fanning the
flames of unnecessary panic
and hype and remaining
vigilant; however, one thing
is for certain when dealing

26

FINANCE

What does the April budget mean for you?

28

E-PHARMACY

Introducing www.yourmedicines.ie

31

SPECIAL FEATURE

History of Pharmacy - A Schindler Pharmacist

ensure accuracy of information given and of claims made in

32

Q&A

accepted in respect of such information or claims. Any opinions

Dr John Hillery, Consultant Psychiatrist and recent


appointee to the PSI Council

34

PICTURE GALLERY

35-36 CLINICAL REVIEW



Important decisions in the management of epilepsy


By Dawn O Shea

38-42 PRODUCT NEWS


43

CROSSWORD AND CLASSIFIEDS

44

OUTSIDE EDGE

Fintan Moore draws some interesting comparisons


between Thelma and Louise and Bertie and Brian

Irish Pharmacist
endeavours to
articles and advertisements. Nevertheless, no responsibility is
expressed by contributors are entirely their own and do not
purport to be the views of Irish Pharmacist.
Copyright GreenCross Publishing
2009
No part of this publication may be
reproduced, stored in a retrieval system,
or transmitted in any form by any means electronic, mechanical
or photocopy recording or otherwise whole or in part, in any
form whatsoever for advertising or promotional purposes without
the prior written permission of the publishers.
GreenCross Publishing is a recently established publishing house
which is jointly owned by Graham Cooke and Maura Henderson.
Between them Graham and Maura have over 25 years experience
working in healthcare publishing. Their stated aim is to publish
titles which are incisive, vibrant and pertinent to their readership.

with a virus we have never


encountered before, there can
be no room for complacency.
On a brighter matter, you
may have noticed that this
issue of Irish Pharmacist has
arrived a little later than
usual. Apologies but we
deliberately held off so as to
bring you coverage of the Irish
Pharmacy Awards, which were
held on 9 May at a glittering
event in the Mansion House
in Dublin. Read all about the
pharmacy event of the year
on pages 18 and 19 and also
see pages 15 and 16 for the
first media interview with this
years lifetime achievement
award winner Dr Des Corrigan
a very worthy and popular
recipient.
June Shannon
june@greencrosspublishing.ie

Editor: June Shannon


Design: Barbara Vasic
SUB-EDITOR: Tim Ilsley
Publisher: Graham Cooke
Publisher: Maura Henderson
Contributors: David Jordan, Julian
Judge, Fintan Moore, Cormac ONeill, Terry
McGuire, Iain Cahill, Garry Finnegan
Cartoonist/Illustrator:
John Corrigan
Photography: Audrey Hanley
Printers: Graham & Heslip Ltd.Letters to
the Editor:
june@greencrosspublishing.ie
Advertising: graham@
greencrosspublishing.ie
or 0872222221

Irish Pharmacist is published by GreenCross


Publishing, Lr Ground Floor, 5 Harrington
Street, Dublin 8.
Tel: 01 478 9770. Fax: 01 478 9764.
www.greencrosspublishing.ie

Irelands No.1* Insect Repellent


Product
Destination specic formulations
Online advertising campaign for
Summer 2009

Tel: 01 879 0660 Email: info@omega-pharma.ie


*IMS MAT 12/08

news
news
news

issue 5 volume 11 MAY 2009

Just 2 per cent of non-branded generics prescribed in 2008


The rate of pure or non-branded generic prescribing on the
GMS scheme in Ireland last year
was astonishingly low at just 2.4
per cent, Irish Pharmacist reports.
According to a new report
from the National Pharmacoeconomics Centre at St Jamess
Hospital in Dublin, 18 per cent
of prescription items were dispensed generically last year on
the GMS scheme - 15.9 per cent
of these were branded generics
while just 2.4 per cent were nonbranded.
This compares to generic
prescribing rates of approximately 63 per cent in the US and
50 per cent in some European
countries.
The report, Generic Drug
Utilisation in Ireland in 2008,

Pharmacies
raided in the
Mid West
Three men have been arrested
following a series of raids on
pharmacies in the Mid West of the
country last month.
According to the gardai, a
total of three pharmacies were
raided in Co Limerick two in
the town of Hospital (OBriens
and Gannons pharmacies) and a
third in Castleconnell (Newtown
Pharmacy) in the early hours of
Wednesday, 29 April last.
The men were taken for
questioning to garda stations in
Limerick city; one at Roxoboro
Road garda station and the other
two at Henry Street station.
Speaking to Irish Pharmacist,
Ms Kay Murphy, pharmacist with
OBriens Pharmacy, Hospital, Co.
Limerick, said that the alarm went
off at approximately 1.15am.
The men broke the front window of the pharmacy and took
the float from the till but thankfully nobody was hurt which was
the main thing, Ms Murphy said.
The gardai told Irish Pharmacist
that the gang did not seem to
be targeting pharmacies in any
co-ordinated manner but that it
seemed to be more of an opportunistic strike.

which looked at the percentage


of prescription items dispensed
generically across the GMS and
DP/LTI schemes, also revealed
that 11 per cent of prescription
items on the DP/LTI schemes
were dispensed generically, 7
per cent less than those on the
GMS scheme.
It further revealed that 25
per cent of prescription items
on the GMS and 27 per cent of
those on the DP/LTI schemes
were dispensed as proprietary
preparations, despite the fact
that a generic equivalent was
available.
In relation to cost, the study
found that approximately 8 per
cent or 67.12 million of the
total ingredient cost of drugs
dispensed on the GMS scheme

in 2008 was spent on generic


drugs while approximately 4.1
per cent (15.32 million) of the
total ingredient cost dispensed
on the DP/LTI schemes was
spent on generics.
Furthermore a massive
163.36 million or 19 per cent
of the total ingredient cost of
medicines in the GMS scheme
was spent on proprietary drugs
where there was an equivalent
generic available and 64.4
million or 17 per cent was spent
on proprietary drugs in the DP/
LTI schemes despite generic
equivalents being available.
The study also revealed that
the rate of generic prescribing
has not changed very much
over the past five years with a
similar proportion of expendi-

Hospital Pharmacist
scoops Pharmacist of
the Year Award

Mr. Howard Beggs, Chief Executive of Helix Health, Ms. Cicely


Roche of the Awards Organising Committee, Award Winner
Mr. Tim Delaney of Tallaght Hospital and Mr. Ken Murnaghan
of Ulster Bank.
Dublin based hospital pharmacist Tim Delaney, Head
of Pharmacy at Tallaght Hospital in Dublin was named
Pharmacist of the Year at the 2009 Helix Health Pharmacist
Awards, which took place in Dublin on the 09 May. A very
popular overall winner, Tim also received the Professional
Excellence Award-sponsored by Ulster Bank at the event.
Tim was nominated on the basis of his outstanding
contribution not only to pharmacy but also to healthcare in
Ireland in general. He is very well respected both at home
and abroad. Held in aid of the PSI Benevolent Trust Fund the
award ceremony raised a massive 40,000 for the charity.
(For more details and photos from the event please see
pages 18 and 19)

ture in generics on the GMS in


2008 (7.7 per cent) compared to
2003 (7.1 per cent).
However, the expenditure on
proprietary drugs, which had a
generic equivalent on the GMS
scheme, increased from 15.1 per

cent in 2003 to 18.7 per cent in


2008.
This demonstrates the potential for increased savings to
be made over time as product
patent expires, the report
stated.

Competition Authoritys
report on community
pharmacy sector
imminent
The Competition Authority
(CA) is expected to recommend
the implementation of a
messenger model to facilitate
consultations between
pharmacist representatives
and the HSE as a way forward
for negotiations between the
two bodies, Irish Pharmacist has
learned.
This recommendation is
expected to be contained in
the CAs report on its consultation process with community
pharmacy, which is expected to
be published shortly.
The messenger model would
involve an independent third
party acting as a messenger
between the HSE and pharmacists. For example, the third
party could obtain information
from pharmacists regarding the
level of fees they would accept
from the HSE for their services.
They then provide this information to the HSE which then
decides how much to offer.
The Authority initiated a
consultation process with the
community pharmacy sector
last October with a view to exploring ways in which pharmacists could engage collectively
in discussions with the State
without falling foul of competition law.
Speaking to Irish Pharmacist,
Mr Bill Prasifka, Chair of the
CA, said that the Authority was
hoping to publish its document
within the first half of this year.
In calling for submissions,
the CA published a 25-page enforcement decision, in which it

explained that the HSE was not


an undertaking with respect to
its activities under the Competition Act because it is not
engaged in these activities for
gain. It added that the Executive was also not an undertaking
with respect to its activities in
issue under EC competition laws
because it is engaging in these
activities in the public interest,
both as part of the essential
functions of the State and also
on the basis of the principle of
social solidarity.
Since the Authority gave
notice of the pharmacy consultation process, the Government has enacted the Financial
Emergency Measures in the
Public Interest Bill 2009, which,
according to Mr Prasifka, clarifies
what the position will be going
forward.
It has always been our
position that the HSE the
Government is free basically to
negotiate, to impose terms to
do really whatever it wants in
the healthcare sector for the reasons of European and domestic
law that were set out in that
guidance note. The issue then
becomes what can people do
on the other side.
Mr Prasifka explained that
private operators, e.g. community pharmacists, could consult
with the Government but the
one line they cannot cross is
the whole issue of collective
conduct and particularly the
issue of collective conduct in
terms of collectively withdrawing services.

PSI estimates income of 6.5 million in 2009

The PSI will earn d3.75 million


- or more than half of its entire
projected income for 2009 of
d6.5 million - in registration
renewal fees from pharmacy
businesses alone, according to
the Societys proposed Service
Plan for 2009 which is currently
under revision.
In its proposed Service Plan for
2009, a copy of which has been
seen by Irish Pharmacist, the PSI

is also expecting to earn d1.8


million this year from registration
renewal fees paid by pharmacists and a further d225,000
from education fees paid by prereg students. The PSI will also
take in d85,500 in registration
fees from Irish pharmacists and a
further d96,900 from those from
the EU/EEA.
Of the PSIs entire income in
2009 of d6.5 million, the Society

has put a reserve fund of 7.5 per


cent or d500,000 to cover potential and probable legal costs
in relation to Fitness to Practise
cases.
In total, the proposed plan
has calculated that the PSI will
spend d6,317,368 in 2009 and
earn d6,534,096. The projected
surplus of d216,728 is to be
transferred to a contingency
fund for unexpected expenses

and costs.
A sum of d150,00 has been
proposed to cover allowances
for private sector PSI Council
Members with a further d58,000
to cover Council and Committee
meeting expenses in 2009.
According to the PSIs
proposed Plan: This expenditure is essential to support the
extensive number of Council and
Committee meetings that take

place in order that Council and


Committees effectively perform
their statutory functions.
It is important to note that the
PSI has advised Irish Pharmacist
that the contents of the Societys
Proposed Service Plan for 2009
was subject to review in light of
the economic environment and
Government decisions in relation
to savings in the public sector
and recruitment embargo.

Why should your


customers put up with diarrhoea?
When theres a solution as simple as this.
Diarrhoea has many causes and can strike at any time. Many people are reluctant to treat it because
they believe its a natural defence mechanism to flush out toxins or that treatments cause constipation.
Diarrhoea is actually a symptom that the digestive system is working too fast. Imodium works with the
body to slow the digestive rhythm to a natural pace, which prevents further fluid loss and stops diarrhoea.
So theres no need for anyone to suffer in silence.

ReStoReS youR boDyS natuRal RhythM.


Tradename: Imodium Plus 2mg/125mg Tablets and Imodium Plus Chewable Tablets and Imodium Instants 2mg Tablets. Qualitative and Quantitative Composition: Imodium Plus: Each tablet contains loperamide hydrochloride 2 mg and simeticone.
Imodium Instants: Loperamide hydrochloride 2 mg per tablet. Pharmaceutical form: Imodium Plus Tablet: Tablet, White, capsule-shaped tablet and Imodium Plus Chewable: White, round, flat-faced tablet with a vanilla-mint odour. Imodium Instants: Orodispersible
tablet White to off-white, circular, freeze-dried tablets. Therapeutic indications: Imodium is indicated for the symptomatic treatment of acute diarrhoea in adults and adolescents over 12 years Posology and method of administration: Adults over 18 years: Imodium
Plus: Take/Chew two tablets initially, followed by one tablet after every loose stool. Not more than 4 tablets should be taken in a day, limited to no more than 2 days. Adolescents between 12 and 18 years: Take/Chew one tablet initially, followed by one tablet after
every loose stool. Not more than 4 tablets should be taken in a day, limited to no more than 2 days. Use in children: Should not be used in children under 12 years. Use in the elderly: No dosage adjustments. Use in renal impairment: No dosage adjustment. Hepatic
impairment: Imodium Plus should be used with caution in such patients because of reduced first pass metabolism. Imodium Instants: Adults and children over 12 years only:The usual dose is 2 tablets initially, followed by 1 tablet after each further episode of diarrhoea
up to a maximum of 5 in 24 hours. Elderly:No dose adjustment. Method of administration:Oral.Contraindications: Imodium should not be used in: Children less than 12 years of age. Patients with a known hypersensitivity (allergy) to any component of the product.
Acute dysentery, which is characterised by blood in stool and high fever. Acute ulcerative colitis. Pseudomembranous colitis associated with broad spectrum antibiotics.Patients with bacterial enterocolitis caused by invasive organisms including Salmonella, Shigella
and Campylobacter.In general, Imodium should not be used when inhibition of peristalsis is to be avoided due to the possible risk of significant sequelae including ileus, megacolon and toxic megacolon. It must be discontinued promptly if constipation, subileus and/
or abdominal distension develop. The stated dose should not be exceeded. In addition to taking Imodium, patients should be advised to drink plenty of fluids such as water, clear soup and squash. Patients should be advised to consult their doctor if diarrhea persists
for more than 24 hours. In addition Imodium Plus Chewable should also not be used in: Patients with rare hereditary problems of fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency, because the product contains sorbitol and
sucrose. Special warnings and precautions for use: In patients with (severe) diarrhoea, fluid and electrolyte depletion may occur. It is important that attention is paid to appropriate fluid and electrolyte replacement. If clinical improvement is not observed within 48
hours, the administration of Imodium must be discontinued. Patients should be advised to consult their physician.Patients with AIDS treated with Imodium Plus for diarrhoea should have therapy stopped at the earliest signs of abdominal distension. There have been
very rare reports of toxic megacolon in AIDS patients with infectious colitis from both viral and bacterial pathogens treated with loperamide hydrochloride. Although no pharmacokinetic data are available in patients with hepatic insufficiency, Imodium should be used
with caution in such patients because of reduced first pass metabolism. Patients with hepatic dysfunction should be monitored closely for signs of CNS toxicity. Imodium Plus should be used under medical supervision in patients with severe hepatic dysfunction.
Since treatment of diarrhoea with loperamide and simeticone is symptomatic, diarrhoea should be treated causally whenever such treatment is available. Interaction with other medicinal products and other forms of interaction. Non-clinical data have shown
that loperamide is a P-glycoprotein substrate. Concomitant administration of loperamide (16 mg single dose) with quinidine, or ritonavir, which are both P-glycoprotein inhibitors, resulted in a 2 to 3-fold increase in loperamide plasma levels. The clinical relevance of
this pharmacokinetic interaction with P-glycoprotein inhibitors, when loperamide is given at recommended dosages (2 mg, up to 8 mg maximum daily dose), is unknown. Adverse Effects Imodium Plus: Clinical trial data (common events only, reported for loperamide
with simethicone).Gastrointestinal system disorders: Nausea. Special senses: Taste perversion.Post-marketing experience (reported with loperamide with simethicone, or loperamide alone). Skin and appendages: Very rare: skin rashes, pruritus and urticaria. Very
rare (for loperamide): angioedema. Body as a whole, general: Very rare (for loperamide): allergic reactions and in some cases severe hypersensitivity reactions including anaphylactic shock and anaphylactoid reactions. Gastrointestinal system disorders: Very rare:
abdominal pain, nausea, constipation, flatulence, vomiting, and dyspepsia. Very rare (for loperamide): abdominal distension, ileus and megacolon including toxic megacolon (See warnings and special precautions for use).Genitourinary: Very rare (for loperamide):
urinary retention. Central and Peripheral Nervous System: Very rare (for loperamide): dizziness. Special senses: Very rare: taste perversion. Psychiatric: Very rare: drowsiness. Imodium Instants: In clinical trials, constipation and dizziness have been reported
with greater frequency in loperamide hydrochloride treated patients than placebo treated patients. The following adverse events have also been reported with use of loperamide hydrochloride: Skin and Appendages Very rare: rash, urticaria and pruritus. Isolated
occurrences of angioedema, and bullous eruptions including Stevens-Johnson Syndrome, erythema multiforme, and toxic epidermal necrolysis.Body as a whole, general Very rare: isolated occurrences of allergic reactions and in some cases severe hypersensitivity
reactions including anaphylactic shock and anaphylactoid reactions. Gastrointestinal System Disorders Very rare: abdominal pain, ileus, abdominal distension, nausea, constipation, vomiting, megacolon including toxic megacolon, flatulence, and dyspepsia. Skin
and Appendages Very rare: rash, urticaria and pruritus. Isolated occurrences of drowsiness Central and Peripheral Nervous System Very rare: dizziness A number of the adverse events reported during the clinical investigations and post-marketing experience with
loperamide are frequent symptoms of the underlying diarrhoeal syndrome (abdominal pain/discomfort, nausea, vomiting, dry mouth, tiredness, drowsiness, dizziness, constipation, and flatulence). These symptoms are often difficult to distinguish from undesirable
drug effects. MA Holder: Imodium Plus: McNeil Ltd, Saunderton, High Wycombe,Buckinghamshire,HP14 4HJ. Imodium Instants: MA Holder Janssen-Cilag Limited, Saunderton, High Wycombe,Buckinghamshire,HP14 4HJ UK. MA Number: Imodium Tablets:
PA755/3/2. Imodium Plus Chewable Tablets: PA755/3/1. Imodium Instants: PA 755/43/3. Not subject to medical prescription. Further information available upon request from Johnson & Johnson (Ireland) Ltd. Tel: 01-4665200.
IMD/009/00

news
news
news

issue 5 volume 11 MAY 2009

40 million cost of
inappropriate prescribing
in 2007
A recent study on the
prevalence of potentially
inappropriate prescribing
in the elderly in 2007 has
revealed that more than one
in four or 27 per cent of older
people were prescribed one
potentially inappropriate
medication (PIM), a further
10 per cent were prescribed
two PIMs and 4 per cent were
prescribed three or more. The
practice also cost a massive
39 million.
The findings of the study by
a team of researchers from the
School of Pharmacy, UCC, the
Department of Pharmacology
and Therapeutics, TCD, and
the Department of General
Practice, RCSI, were presented
at the RCSIs annual research
day recently.

Researchers carried out a


retrospective, populationbased study using the Primary
Care Reimbursement Services
(PCRS) pharmacy database.
Thirty prescribing quality
indicators were applied to
334,452 prescription claims
for those aged 70 and over in
2007.
The main findings of
the research revealed that
20 per cent of the elderly
were prescribed proton
pump inhibitors (PPIs) at full
therapeutic dose for two
consecutive months and
this was more likely in those
aged 75 years or over; 8 per
cent of those surveyed were
prescribed non-steroidal antiinflammatory drugs (NSAIDs)
for three consecutive months,

Pharmacists still in dark


in relation to cut in
professional fees

more likely in female patients;


and 7 per cent were prescribed
digoxin >125ug/day, which
was more likely in those aged
75 years or over.
Also the study found that
the total ingredient cost of
the PIMs was 39,204,062,
the highest being PPIs at
24,510,624, neuroleptics
at 5,815,282 and duplicate
classes of medicines on the
same prescription claim cost
4,544,244.
According to the researchers,
the findings identified a high
prevalence of potentially
inappropriate prescribing with
significant cost consequences.
Reasons behind these
prescribing patterns need to
be understood to improve
future prescribing.

Hospital Pharmacists Annual Conference

Mary Harney, Minister for Health


At the time of going to press,
the Minister for Health had
yet to announce details of
the expected reduction
in fees to pharmacists
under the provisions of
the Financial Emergency
Measures in the Public
Interest Act, 2009.
However, details were
released in relation
to all other health
professionals covered by
the Act which include GPs,
dentists, optometrists,
ophthalmologists and
dispensing opticians who
hold contracts with the
HSE, doctors and others
who take smears under the
National Cervical Screening
Programme and psychiatrists
who participate in the
Mental Health Tribunal
process.
It is expected that the
reduction in the level of
fees for pharmacists will be

approximately 8 per cent,


in line with fee reductions
for GPs announced by the
Minister on 30 April last. In a
statement issued at the time
of the announcement, the
Department of Health stated
that the Minister has not yet
completed her deliberations
in relation to pharmacists
because of the range and
complexity of the various
dispensing fees, markups and reimbursements
which fall to be examined.
However, it is expected that
decisions with regard to
pharmacists will be made
within the next two weeks.
The Government
announced on 3 February
last that it intended to seek
savings of 80 million on
a full-year basis through a
general reduction of the
order of 8 per cent in all
professional fees, including
those of health professionals.

2008
ANNUAL REPORT

Pictured at the Annual Educational Conference of the Hospital Pharmacists Association of Ireland
(HPAI) which took place in Dublin on Saturday 18 April and Sunday 19 April were: Ms Liz Hoctor,
President of the IPU; and Ms Elaine Conyard, President of the HPAI.

Complaints to PSI increased in


The PSI received and investigated a total of 49 complaints
last year compared to 35 in
2007, according to the Societys Annual Report for 2008.
Thirteen of the complaints
related to alleged dispensing
errors, six were received in relation to refusal to supply and
a further six related to allegations of breaches of pharmacy
or medicines law. A further
four complaints related to
brand substitution, while the

PSI received three complaints


in each of the categories relating to out-of-date medications,
allegations of poor professional performance/poor service
levels, unprofessional attitude
and poor clinical practice.
Two complaints were
received in relation to competency, while two further
complaints were received
in relation to information or
advice and one complaint
referred to inadequate packag-

ing or presentation.
According to the report, this
upward trend in complaints
is likely to continue as public
awareness of the PSI and its
functions increases.
Writing in the PSI Annual
Report, the Societys Registrar,
Dr Ambrose McLoughlin,
said that 2008 had been a
significant and challenging
year for the PSI and warned
that the economic downturn
would have an impact on the

THE PHARMACEUTICAL
SO
ANNUAL REPORT
2008
OF2008
IRELAND
pharmacy sector.
We have come under
intense public scrutiny in
2008 and that will continue in
the years ahead. It is critically
important that we monitor
the environment in which we
operate and that we maintain
our efforts to influence and
impact on key decision makers.
The years ahead will be equally
challenging. The new PSI has
come a long way since 22 May
2007, Dr McLoughlin stated.

2008
ANNUAL REPORT

2008
ANNUAL REPORT

THE PHARMACEUTICAL SOCIETY


OF IRELAND
THE PHARMACEUTICAL SOCIETY
OF IRELAND

THE PHARMACEUTICAL SOCIET

AD Tree001.03.09

MAKE LIGHT
WORK OF ACID

ABBREVIATED PRESCRIBING INFORMATION: Please refer to the Summary of Product Characteristics before prescribing: Pantoflux 20 mg & 40 mg gastro-resistant tablets.
Qualitative and Quantitative Composition: Each gastro-resistant tablet contains 20 mg or 40 mg pantoprazole (as 22.58 mg or 45.16 mg pantoprazole sodium sesquihydrate). Pharmaceutical form: Elliptical gastro-resistant tablets. The
20 mg tablet is light yellow in colour while the 40 mg is a dark yellow coloured tablet. Therapeutic indications: 20 mg: For the treatment of mild reflux disease and associated symptoms and the prevention of the reoccurring symptoms. For
long-term management and prevention of relapse in reflux oesophagitis. Prevention of gastro-duodenal ulcers induced by NSAIDs in patients at risk with a need for continuous NSAID treatment. 40 mg: For symptomatic improvement and healing of gastrointestinal diseases which require a reduction in acid secretion: Duodenal ulcer, Gastric ulcer, moderate and severe reflux oesophagitis; Zollinger-Ellison-Syndrome and other pathological hypersecretory conditions; Eradication of
Helicobacter pylori, in combination with antibiotics in patients with duodenal ulcer or gastric ulcer. Posology and Method of Administration: Pantoflux should not be chewed or crushed, and should be swallowed whole with water one hour
before a meal. Recommended dosage: 20 mg: Adults and adolescents >12 years: Treatment of mild reflux disease and associated symptoms: One Pantoflux 20 mg gastro-resistant tablet per day. Symptom relief is generally accomplished
within 2-4 weeks, and a 4-week treatment period is usually required for healing of associated oesophagitis. A further 4 weeks may also be required for healing. When symptom relief has been achieved, re-occurring symptoms can be controlled
using an on-demand regimen of 20 mg once daily, when required. A switch to continuous therapy may be considered in case satisfactory symptom control cannot be maintained with on-demand treatment. Adults: Long-term treatment and prevention of relapse in reflux oesophagitis: For long-term treatment, a maintenance dose of one Pantoflux 20 mg gastro-resistant tablet per day is recommended, increasing to 40 mg per day if a relapse occurs. After healing of the relapse the dosage
can be reduced again to 20 mg. Prevention of gastro duodenal ulcers induced by NSAIDs in patients at risk with a need for continuous NSAID treatment: One Pantoflux 20 mg gastro-resistant tablet per day.
40 mg: Adults: Treatment of duodenal ulcers: One tablet of Pantoflux 40 mg per day for 2-4 week depending on the clinical need. Treatment of moderate and severe reflux oesophagitis and gastric ulcers: One tablet of Pantoflux 40 mg per day
for a 4-week period, may be extended a further 4 weeks if clinically necessary. Long-term treatment of Zollinger-Ellison-Syndrome and other pathological hypersecretory conditions: Initially 80 mg per day (2 tablets of Pantoflux 40 mg). Thereafter, the dosage can be titrated up or down as needed using measures of gastric acid secretion to guide. With doses above 80 mg daily, the dose should be divided and given twice daily. A temporary increase of the dosage above 160 mg
pantoprazole is possible but should not be applied longer than required for adequate acid control. Treatment duration in Zollinger-Ellison Syndrome and other pathological hypersecretory conditions is not limited and should be adapted according
to clinical needs. Eradication of Helicobacter pylori (H.pylori): The recommended dose is 40 mg Pantoflux twice daily in combination with one of the three following combinations: (a) amoxicillin 1 g twice daily + clarithromycin 500 mg twice
daily; (b) clarithromycin 500 mg twice daily + metronidazole 500 mg twice daily, (c) amoxicillin 1 g twice daily + metronidazole 500 mg twice daily. The second Pantoflux 40 mg tablet should be taken before the evening meal. Combination
therapy should be implemented for 7 days. At the end of the 7 days combination period, pantoprazole may be continued to ensure the healing of the ulcer. For duodenal ulcers, this may require an additional 1 to 3 weeks. For gastric ulcers, this
may require an additional 3 to 7 weeks. Elderly: The daily dose of 40 mg pantoprazole should not be exceeded. An exception is combination therapy for eradication of H. pylori, where elderly patients should receive the usual pantoprazole dose (2
x 40 mg/day) during 1 week treatment. Patients with impaired renal function: The daily dose of 40 mg pantoprazole should not be exceeded. For this reason, H. pylori triple therapy is not appropriate in these patients. Patients with hepatic cirrhosis: Pantoflux 40 mg should only be given every other day. In these patients, hepatic enzyme levels should be monitored during the treatment. If hepatic enzyme levels become elevated, treatment with pantoprazole should be discontinued.
For this reason, H. pylori triple therapy is not appropriate in these patients. Children: Not recommended. Contraindications: Hypersensitivity to the active substance or to any of the excipients. The preparation should not be used in combination
therapy for the eradication of Helicobacter pylori in patients with moderate or severe hepatic or renal impairment. Pantoflux 20 mg and 40 mg gastro-resistant tablets should only be used during pregnancy and lactation under the careful supervision of a doctor and when the benefit to the mother is considered greater than the potential risk to the foetus/baby. Special Warnings and Precautions for Use: In patients with severe liver impairment the liver enzymes should be monitored
regularly during treatment with pantoprazole, particularly on long-term use. In the case of a rise of the liver enzymes Pantoprazole should be discontinued. Decreased gastric acidity due to any means including proton pump inhibitors increases gastric counts of bacteria normally present in the gastrointestinal tract. Treatment with acid-reducing drugs may lead to a slightly increased risk of gastrointestinal infections, such as Salmonella and Campylobacter. In patients with
Zollinger-Ellison-Syndrome and other pathological hypersecretory conditions requiring long-term treatment, pantoprazole, as all acid-blocking medicines, may reduce the absorption of vitamin B12 (cyanocobalamin) due to hypo- or achlorhydria.
This should be considered if respective clinical symptoms are observed. Prior to treatment of gastric ulcer, the possibility of malignancy should be excluded as treatment with Pantoprazole may alleviate the symptoms of malignant ulcers and can
thus delay diagnosis. In long term treatment, especially when exceeding a treatment period of 1 year, patients should be kept under regular surveillance. Interaction with other Medicinal Products and Other Forms of Interaction: Use of
PPIs is contraindicated during atazanavir treatment. Pantoprazole may reduce or increase the absorption of drugs whose bioavailability is pH-dependent (e.g. ketoconazole, itraconazole, atazanavir). Interaction of pantoprazole with other drugs
metabolised via the cytochrome P450 enzyme should also be considered. Patients treated with coumarin anticoagulants, monitoring of prothrombin time/INR is recommended after initiation, termination or during irregular use of pantoprazole.
There were also no interactions with concomitantly administered antacids. Undesirable Effects: The most frequently reported undesirable effects include gastro-intestinal disorders and headache, otherwise the product is well tolerated. Shelf
Life: 2 years. Pack Sizes: Blister: 28 gastro-resistant tablets. Marketing Authorisation Holder: Actavis Group PTC ehf, Reykjavikurvegi 76-78, 220 Hafnarfjordur, Iceland. Marketing Authorisation Numbers PA1380/002/1-2 Legal
Category: POM. Full Prescribing Information including the SPC is available on request from Actavis Ireland Limited, Euro House, Little Island, Co. Cork or email: contact@actavis.ie. Information about adverse event reporting can be found on
the IMB website (www.imb.ie) or by contacting Actavis Ireland Limited. Date of Preparation or Last Review: April 2009. ADPAN001.04.09

news
news
news

issue 5 volume 11 MAY 2009

More than a third of pharmacists


voted in recent PSI elections

John Collins, one of the


elected

More than a third of all pharmacists


registered in the State voted in the
recent 2009 PSI elections, which saw
a turn out of 1,767 of a total electoral
register of 4,301 pharmacists.
The five pharmacists who were
elected to the Council of the
PSI after the counting of votes,
which took place on Thursday 16
April in Dublin were: Paul Fahey,
Faheys Pharmacy, Tullamore, Co
Offaly, Margaret Doherty, Raphoe
Pharmacy, Co Donegal, John Collins,
Kinsale Pharmacy, Kinsale, Co Cork,
Eoghan Hanly, Killians Pharmacy
Ltd., Loughrea, Co Galway, and Ann

Frankish, Pharmacy Department,


Rotunda Hospital, Dublin.
The PSI also announced that the
following pharmacists are to be
included in a panel for the filling of
certain vacancies on the Council:
Leonie Clarke, Metis Consulting Ltd.,
Blackrock, Co Dublin, Adrian Dunne,
Adrian Dunne Pharmacy, Dublin,
Margaret Grennan, Grennans
Pharmacy, Dundalk, Co Louth,
William Boles, AC Boles Ltd., Dublin,
Mary Rose Burke, Boots Ireland,
Peter Weedle, Weedles Pharmacy,
Mallow, Co Cork, and Orlaith
Brennan, United Drug, Dublin.

Infant Colic - Management


options using
Lactase Enzyme
Following research0 1 at Guys
Hospital,
which
identified
transient lactase deficiency
as one possible causative
factor in Colic, Colief Infant
Drops
are
increasingly
being recommended as a
management option.
The research shows that
transient lactase deficiency in
the upper digestive tract may
be corrected by adding lactase
enzyme to the infants feed
before the baby is fed.
Treatment protocols based on
managing lactose in the babys
feed are now recognised as a primary
treatment option for Infant Colic2 3.

Pharmacists called on
to donate goods
The childrens charity Barnardos is calling on all
pharmacies to donate goods to it Brand New
Appeal.
The Brand New Appeal is unique to Barnardos
shops, through which the charity offers brand new
goods (donated from a wide range of retailers,
wholesalers and manufacturers) which are sold at a
fraction of the cost in its charity stores.
The Brand New Programme has grown dramatically
since its inception in 2002. The products are sold at
very competitive prices. All profits raised through the
shops go directly towards funding Barnardos work
with children and families in Ireland.
Barnardos shop in Dublins Liffey Street is
completely dedicated to brand new goods and there
are also Brand New items for sale across the charitys
chain of stores.
Barnardos contacted Irish Pharmacist about the
appeal and said it would be delighted to accept
toiletries, make-up, gift sets, hair accessories, hair
brushes, mirrors, baby products such as soothers,
bottles etc. as well as photo frames, costume
jewellery etc. However, for obvious reasons it
cannot accept hair dyes, medication of any kind or
perishables. In some cases the charity can arrange
to collect goods from pharmacists depending on
location, if not, they can discuss the collection with
individual pharmacists, as there are a selection
of Barnardos shops around the country and a
warehouse in Dublin. Barnardos would be delighted
if pharmacists could also let their suppliers know
about the Brand New Programme as the charity may
also be able to work with them.
According to the charity Barnardos would be
delighted to work with pharmacists across Ireland
as the products they donate would make a real
difference to the performance of our shops and in
turn provide much needed funds for the work of
Barnardos.
Barnardos supports children whose well-being is
under threat, by working with them, their families
and communities and by campaigning for the rights
of children. Barnardos was established in 1962 and
is Irelands leading independent childrens charity. If
you are interested in learning more about the Brand
New appeal or if you would like to donate to this
service, you can contact: Brand New, 733 Northwest
Enterprise Centre, Ballycoolin, Dublin 15, Tel: 01 861
2070, Email: gift.nkind@barnardos.ie. If you would
like to know more about the work of Barnardos,
please visit www.barnardos.ie

alli launch

This management strategy can be applied


equally to breast-fed and formula-fed infants: in
formula-fed babies by pre-incubating the formula with
Colief (lactase enzyme), and with breast-fed babies
by adding lactase to a little expressed breast milk
(10 15ml) and feeding this to the baby immediately
before breast-feeding.
0 Kanabar et al, Journ Hum Nutr Dietet 2001.
1 Review at www.jr2.ox.ac.uk/bandolier/booth/family/colicup.html
2 NHS-Prodigy Clinical Guidance www.cks.library.nhs.uk/colic_infantile
3 Marks et al, Guidelines Working Party Report www.eguidelines.co.uk/links
/guidelines/summaries/gastrointestinal/wp_infant_colic.php

For further information please look up: www.colief.com


If you have any questions regarding Colief please phone this free phone number: 1-800 522 8243

Distributed by Clonmedica, the OTC Division of Clonmel Healthcare.


Available from your local pharmacy

2009/ADV/LAC/050

Pictured at the launch of alli (orlistat 60mg) by


GSK recently were Dr Martin Henman, Senior
Lecturer in Pharmacy Practice, School of Pharmacy
and Pharmaceutical Sciences, TCD; Ms Elizabeth
Reynolds, General Manager, GSK, and Prof Patrick
Wall, Associate Professor of UCD School of Public
Health and Population Science.

news
news
news

issue 5 volume 11 MAY 2009

IPU AGM NEWS

More than one in ten cannot


afford vital medication

Liz Hoctor addressing the AGM

Governments health policies


have manifestly failed - IPU
The IPU passed a motion
of No Confidence in the
Governments health
policies at its recent AGM in
Waterford. A similar motion
was passed by the Irish
Medical Organisations AGM
in Kerry which also took place
last month.
Speaking at the IPU AGM,
which took place on Saturday,
25 April, the President of the
IPU, Ms Liz Hoctor, said that
the Governments health policies had manifestly failed
and she urged a fundamental
review of health strategy. Ms
Hoctor said that pharmacists
were now fearing a wave of
cuts being imposed on the
sector by Government that
could lead to up to 5,000 job
losses across the country
and increased problems for
patients trying to get access
to medicines.
Ms Hoctor continued: The
Irish Pharmacy Union is and
always has been willing to
work in partnership with Government to achieve savings
on the medicines bill, despite

the fact that the HSE has


abandoned a partnership approach in recent years. Even
when the courts ruled that
the HSE had acted unlawfully
in reducing pharmacists payments, we continued to seek
opportunities to work with
Government and demonstrated that pharmacists can be
part of the solution to rising
healthcare costs and not part
of the problem.
We made submissions to
the Department of Health
and Children outlining how
savings could be achieved
through the greater use
of generics and reducing
the enormous waste of
medicines. So far our
proposals have fallen on deaf
ears.
The AGM also passed a motion calling on all members
of the Oireachtas to repeal
Section 9 of the Financial
Emergency Measures in the
Public Interest Act 2009
to protect patient care, to
preserve frontline pharmacy
services and maintain jobs.

The IPU has called on the


Government to immediately
remove restrictions preventing
pharmacists from offering
cheaper generic drugs to
patients in the wake of a new
survey which revealed that
more than one in ten people
without a medical card cannot
afford vital medication.
According to the results of
a new survey by Behaviour
and Attitudes, 11 per cent
of people are cutting back
on their use of medication
as a result of the recession,
even where they have been
prescribed for them. The same
survey found that 14 per cent
of people were unable to
afford a visit to the doctor or
a medical service for the same
reason.
The figures were revealed
as pharmacists gathered for
their AGM in Waterford late
last month. Responding to
the survey, IPU President Ms
Liz Hoctor warned that if

patients were not taking their


medication as required or
prescribed, they were more
likely to require hospital care.
The IPU called on the
Government to immediately
remove restrictions which
prevent pharmacists from
offering patients the choice of
a cheaper generic medicine,
when it is appropriate to do
so. According to the Union,
pharmacists in many other
European countries are able
to offer generic medicines
to reduce costs for both the
patient and the Exchequer.
Were noticing that patients
are opting to reduce the
frequency with which they
take prescribed medicines,
even though the effectiveness
of prescription medicines can
be reduced by such changes.
For example, a patient
may have been prescribed
medicines to take on a daily
basis and they may start taking
them every second day, to

try to make the medicine last


longer. However, a patients
health is likely to suffer in
the long term by doing
this. It would be helpful to
patients if I could offer my
patients a cheaper generic
alterative, where it is safe and
appropriate to do so, Ms
Hoctor said.
At the AGM, the IPU also
called on the Government
to introduce Medicines Use
Reviews for patients with their
pharmacists, which would
identify problems that many
elderly patients have when
taking their medicines. This
would also cut down on the
huge amount of medicines
wasted every year, which
would save the Government
millions.
This recommendation was
included in a recent report
by Dr Michael Barry on
savings on drug costs, which
was commissioned by the
Government.

Tonnes of out-of-date medicines


dumped across country
Hundreds of tonnes of outof-date or unused medicines
are being dumped across the
country at huge cost to the
taxpayer, delegates attending
the IPU AGM in Waterford on
25 April were told.
The AGM heard that a
recent campaign organised
by pharmacies and the
HSE in the Cork and Kerry
region collected a massive
3.5 tonnes of medicines,
which could otherwise have
ended up in bins across the
counties. Pharmacists are
now calling on the HSE to
organise a nationwide drug
dump at pharmacies to collect

unwanted medicines.
Mr Keith OHourihane of
Pharmacy First Plus, Cork, said:
The campaign to encourage
people to return unused
and out-of-date medicines
to their local pharmacy has
been hugely successful. It
is not advisable to allow
medicines to build up in your
home, especially if there are
young children in the house,
due to the risk of accidental
poisoning. Also, out-of-date
medicines are less effective
and some even become
harmful to take.
The fact that tonnes of
unused medicines are being

returned highlights the


fact that many patients are
not taking their medicines
as prescribed. This is very
concerning and I believe many
patients end up in hospital
due to the fact that they are
not taking their medicines
correctly. The introduction of
a system whereby pharmacists
could carry out a one-on-one
consultation with patients,
who are taking a large amount
of medicines, would highlight
any problems that patient may
have in taking their medicines.
This would also reduce the
wastage of medicines and save
millions for the Exchequer.

Pharmacists call for free diabetes screening

10

The IPU has called for a free


public diabetes screening
service to be made available
in pharmacies across the
country to counter the growing incidence of the disease.
The call was made at
the recent IPU AGM where
the Union expressed deep
frustration at the lack of
political will to expand the
role of the pharmacist to
allow them to play a greater

role in the management of


chronic diseases, such as
diabetes.
Speaking at the AGM,
Donegal pharmacist, Mr
Rory ODonnell, said: The
introduction of screening for
diabetes and, indeed, other
chronic diseases, through
pharmacies will make significant savings for the Exchequer by reducing the demand
for services in other parts of

the healthcare system, including the already overburdened A&E departments.


If the Government fails to
act, it is a missed opportunity, especially for patients.
The time has come for the
powers that be to think outside the box and recognise
this is an obvious solution for
improved healthcare which is
practical, cost-effective and
with long-term benefits to

communities.
The community pharmacy network in Ireland is an
underutilised resource in the
delivery of primary healthcare. If enabled, it will make
access to healthcare more
inclusive, improve patient
care and implement preventative healthcare interventions which will transform the
management and treatment
of chronic diseases in this

country.
According to the IPU, as
many as 200,000 people
in Ireland now suffer from
type 2 diabetes with tens
of thousands of people not
even aware that they have
the disease. The treatment
of type 2 diabetes costs the
Irish health service 580 million every year and many are
now describing it as a silent
epidemic.

ADDED POWER

TO REACH BP GOAL

71.4% of patients previously uncontrolled


on 2-3 antihypertensives reached DBP
goal on MicardisPlus 80/251

MICARDIS and MICARDIS PLUS DOSE OPTIONS TO REACH GOAL BP

40mg
MICARDIS

80mg
MICARDIS

80mg/12.5mg
MICARDIS PLUS

80mg/25mg
MICARDIS PLUS

MicardisPlus prescribing information (ROI) Tablets containing 40 mg telmisartan (a specific angiotensin II receptor subtype 1 antagonist) and 12.5 mg hydrochlorothiazide (HCTZ; thiazide diuretic), 80 mg telmisartan and 12.5 mg HCTZ or 80 mg telmisartan and
25 mg HCTZ. Indication: essential hypertension in patients whose blood pressure is not adequately controlled on telmisartan alone or in the case of 80/25mg, in patients whose blood pressure is not adequately controlled on 80/12.5mg or who have been stabilised
on telmisartan and HCTZ given separately. Dose: adults only: once daily 40/12.5 mg or 80/12.5 mg respectively if blood pressure not controlled by 40 mg or 80 mg telmisartan alone. 80 /25 mg once daily in patients whose blood pressure is not adequately controlled
by 80 mg/12.5 mg or who have been stabilised on telmisartan and HCTZ given separately. Maximum antihypertensive effect takes 4-8 weeks to develop. Maximum dose in mild to moderate hepatic impairment 40/12.5 mg. Contra-indications: hypersensitivity to
any of the ingredients; pregnancy and lactation; hypersensitivity to other sulphonamide-derived substances; cholestasis; biliary obstructive disorders; severe hepatic or renal impairment; refractory hypokalaemia, hypercalcaemia. Precautions: hepatic impairment;
renovascular hypertension; renal impairment; kidney transplantation; intravascular hypovolaemia; other conditions with stimulation of the renin-angiotensin-aldosterone system; primary aldosteronism; aortic or mitral valve stenosis; obstructive hypertrophic
cardiomyopathy; diabetes mellitus; hyperuricaemia; frank gout; electrolyte imbalance including hypokalaemia, hyponatraemia and hypochloraemic alkalosis; hyperkalaemia; hypercalcaemia; hypomagnesaemia; fructose or galactose intolerance; the lapp lactase
deficiency; glucose-galactose malabsorption; ischaemic cardiopathy or ischaemic cardiovascular disease; history of allergy or bronchial asthma; systemic lupus erythematosus; photosensitivity. Telmisartan is apparently less effective in lowering blood pressure in
black patients than in non-blacks. Interactions: lithium; medicinal products associated with potassium loss and hypokalaemia, or that may increase potassium levels or induce hyperkalaemia, or are affected by serum potassium disturbances; NSAIDs; pressor amines;
metformin; anionic exchange resins; nondepolarising skeletal muscle relaxants; treatments for gout. The hypotensive effects of telmisartan and other antihypertensive agents may be potentiated by baclofen, amifostine. Furthermore alcohol, barbiturates, narcotics
or antidepressants may aggravate hypostatic hypotension; other antihypertensive agents; thiazide diuretics may interact with digitalis glycosides, antidiabetic medicinal products, calcium salts, beta-blockers, diazoxide, anticholinergic agents, amantadine, cytotoxic
agents. Side-effects: Adverse reactions reported with the fixed dose combination include: Common (1/100 to < 1/10): dizziness. Uncommon (1/1,000 to < 1/100): hypokalaemia; anxiety; syncope; paraesthesia; vertigo; tachycardia, arrhythmias; hypotension,
orthostatic hypertension; dyspnoea; diarrhoea, dry mouth, flatulence; back pain, muscle spasms, myalgia; erectile dysfunction; chest pain; blood uric acid increased. Adverse reactions reported with telmisartan alone include: Unknown frequency: upper respiratory
tract infection, urinary tract infection, including cystitis; eosinophilia, anaemia, thrombocytopenia; hypersensitivity, anaphylactic reactions; hyperkalaemia; bradycardia; stomach discomfort; eczema, drug eruption, toxic skin eruption; arthrosis, tendon pain; renal
dysfunction, renal impairment (including acute renal failure); asthenia, drug ineffective; haemoglobin decreased. Adverse reactions reported with HCTZ alone include: Unknown frequency: gastrointestinal disorders; hepatobiliary disorders; xanthopsia; blood and
lymphatic system disorders; metabolism and nutrition disorders; skin and subcutaneous tissue disorders; immune system disorders; endocrine disorders; renal and urinary disorders; pyrexia; sialoadenitis; restlessness; light-headedness; vasculitis necrotizing;
weakness; triglycerides increased. Prescribers should consult the Summary of Product Characteristics in relation to other side effects. Presentations: blister packs of 28 tablets, 40/12.5 mg EU/1/02/213/002, 80/12.5 mg EU/1/02/213/007, 80/25 mg EU/1/02/213/018.
Prescription only. Marketing authorisation holder: Boehringer Ingelheim International GmbH, D-55216 Ingelheim am Rhein, Germany. Prepared March 2009. For full prescribing information please see Summary of Product Characteristics. For further information
please contact Boehringer Ingelheim Ireland Ltd, Corrig Court, Corrig Road, Sandyford Business Estate, Dublin 18. Micardis prescribing information (ROI) Tablets containing 20, 40 or 80 mg telmisartan, a specific angiotensin II receptor (type AT1) antagonist.
Indication: essential hypertension in adults Dose: usually 40mg once daily, range 20-80 mg. Can be used together with thiazide-type diuretics such as hydrochlorothiazide. Maximum antihypertensive effect takes 4-8 weeks to develop. May be taken with or without
food. Maximum dose in mild to moderate hepatic impairment 40mg. No dose adjustment needed for patients with mild to moderate renal impairment or the elderly. Limited experience available in severe renal impairment or haemodialysis, a lower starting dose of
20 mg is recommended in these patients. Not recommended in patients <18 years. Contra-indications: hypersensitivity to any of the ingredients; pregnancy and lactation; biliary obstructive disorders; severe hepatic impairment. Precautions: mild to moderate
hepatic impairment, renovascular hypertension; renal impairment; kidney transplantation; intravascular hypovolaemia; dual blockade of the renin-angiotensin-aldosterone system; renin-angiotensin-aldosterone system stimulation; primary aldosteronism; aortic or
mitral valve stenosis; obstructive hypertrophic cardiomyopathy; hyperkalaemia (main risk factors for hyperkalaemia are: diabetes, renal impairment, age > 70 years, concomitant use of other drugs that may provoke hyperkalaemia and intercurrent events, in particular
dehydration, cardiac decompensation, metabolic acidosis, worsening of renal function, cellular lysis (e.g. acute limb ischemia, rhabdomyolosis, extended trauma.); fructose intolerance; ischaemic cardiopathy or ischaemic cardiovascular disease. Thought to be less
effective in black patients than in non-blacks. Interactions: concomitant treatment with medicinal products that may provoke hyperkalaemia (salt substitutes, potassium sparing diuretics, ACE inhibitors, angiotensin II receptor antagonists, NSAIDs (including some
COX-2 inhibitors), heparin, immunosuppressives (cyclosporine or tacrolimus), trimethoprim); lithium, ramipril, thiazide or loop diuretics, other antihypertensive agents, baclofen, amifostine, alcohol, barbiturates, narcotics, antidepressants, systemic corticosteroids.
Side-effects: Uncommon (1/1,000, <1/100): hyperkalaemia, syncope, insomnia, vertigo, hypotension, dyspnoea, abdominal pain, diarrhoea, dry mouth, dyspepsia, flatulence, hyperhidrosis, pruritus, renal impairment including acute renal failure, myalgia, chest
pain. Rare (1/10,000, <1/1,000): upper respiratory tract infections including pharyngitis and sinusitis, anaemia, thrombocytopenia, anxiety, depression, abnormal vision, tachycardia, orthostatic hypotension, stomach upset, vomiting, abnormal hepatic function/
liver disorder, erythema, angioedema, urticaria, arthralgia, back pain, muscle cramps, pain in limb, weakness, influenza-like illness, blood uric acid increase, blood creatinine increased, hepatic enzyme increased, blood creatine phosphokinase increased. Incidence
not known: urinary tract infection including cystitis, eosinophilia, hypersensitivity, anaphylactic reaction, bradycardia, drug eruption, toxic skin eruption, rash, eczema, tendonitis, drug ineffective, haemoglobin decreased Presentations: blister packs of 28 tablets,
20mg EU/1/98/090/010; 40mg EU/1/98/090/002; 80mg EU/1/98/090/006 Prescription only. Marketing authorisation holder: Boehringer Ingelheim International GmbH, D-55216 Ingelheim am Rhein, Germany. Prepared
January 2009. For full prescribing information please see Summary of Product Characteristics. For further information please contact Boehringer Ingelheim Ireland Ltd, Corrig Court, Corrig Road, Sandyford Business Estate, Dublin
18. Micardis is a registered trademark. Reference: 1. Neldam, S and Edwards, C. Expert Opinion in Pharmacother 2009; 10 (3), 345-352. 2009-MIC-005.

news
news
news
Topical oral
salicylate gels
safe for use
in children
IMB
The Irish Medicines Board
(IMB) has stated that, following a review of salicylatecontaining products such as
Bonjela for use in children
under the age of 16 years, it is
satisfied that the risk-benefit
for such products in children is
positive when used according
to their approved conditions
of use. The Board added that
it would continue to monitor
these products closely on the
Irish market.
The notice, which was issued last month by the IMB,
came following a decision by
the Medicines and Healthcare
Products Regulatory Agency
(MHRA) in the UK to restrict
the use of salicylate-containing products for oral use in
children aged under 16 years.
The new MHRA advice in
the UK recommends these
products are not used in those
aged under 16 years. This is
due to salicylate salts having
the same effect on the body
as aspirin, which is already
contraindicated in children
and young people aged under
16 years.
The UK agency stated that
this was a precautionary
measure only and there were
no new safety concerns. The
advice was introduced due to
a theoretical risk that these
products could increase the
possibility of a child developing Reyes syndrome a rare
but serious condition.
This MHRAs decision was
taken following a risk/benefit
review which was conducted
following publication of a case
report in June 2008 of a suspected but unconfirmed case
of Reyes syndrome associated
with the use of an oral gel containing choline salicylate in a
20 month old child. The review
concluded that the symptoms
reported in the case report
were not consistent with
Reyes syndrome and were
more likely to reflect salicylate
toxicity due to incorrect use of
the gel.
The IMBs advice to parents and carers is that oral
gels containing choline
salicylate should be applied
very sparingly and only at the
frequency indicated in the
product information. These

12

issue 5 volume 11 MAY 2009

Pharmacies must
display certificates
of registration

Dr Ambrose McLoughlin,
Registrar and CEO of the PSI
All pharmacies registered
in Ireland must now display
certificates of registration
on their premises, the PSI
has stated. The certificate of
registration of the pharmacy
itself and that of the supervising pharmacist must both be
clearly displayed.
In a statement issued late
last month, the PSI said that
it had issued new certificates
of registration to pharmacies which must be clearly
displayed on the premises
so that the public can ensure
that the pharmacy they use is

products should only be used


when clearly necessary and
are intended for short-term
use only.
The IMB stated that, at
present, there are two relevant
products containing this
active ingredient licensed
in Ireland: Bonjela Oromucosal Gel and Teejel Gel. These
products have been licensed
for use in children since 1983
for the treatment of infant
teething. The IMB stated that
the risk associated with their
short-term use is extremely
low and, to date, has received
no reports of adverse reactions in children with these
products. The risk of toxicity is
associated with incorrect use
or overdosing.
The IMB emphasised that
before any medicine is administered to a child, parents are
advised to read the product
information carefully and
consult with their doctor or
pharmacist as appropriate.

properly registered with the


regulator.
Dr Ambrose McLoughlin,
Registrar and CEO of the PSI,
described the development as
more progress in the drive for
accountability and transparency in the sector.
As well as the pharmacys
certificate being displayed,
the certificate of registration
of the supervising pharmacist
must also be conspicuously
displayed in the pharmacy
from now on. This, in addition
to the new online registers of
pharmacies and pharmacists
which is available on the PSI
website, will help the public to
check the registration status
and credentials of a pharmacy
or pharmacist.
A register of retail pharmacy
businesses (pharmacies) was
introduced this year for the
first time and, from 1 January
2009, all pharmacies operating in the State must be registered with the PSI in order to
legally open and operate.
The new regulations
governing the operation of
pharmacies, which require all
pharmacies to operate to the

same high standards, include


a new professional management structure in every pharmacy of superintendent and
supervising pharmacists.
The management of the
sale and supply of medicines
in a pharmacy is now under
the strategic control of a
superintendent pharmacist.
Each pharmacy must also
have a supervising pharmacist
responsible for managing the
pharmacy on a day-to-day
basis.
New annual certificates of
registration have also been
issued to all pharmacists and
pharmaceutical assistants,
and all registered pharmacists
have also been issued with a
European Health Professional
wallet card.
Under the new pharmacy
regulations, the sale and supply of all medicines in pharmacies must be by or under
the personal supervision of a
pharmacist, and the pharmacist must ensure that patients
have sufficient information
and advice to use and store
their medicines correctly and
safely.

in brief
Cancer conference to
host public information
symposium
The annual International
Cancer Conference will host
a public symposium on
cancer issues at the Institute
of Molecular Medicine, St
Jamess Hospital, Dublin, on
Wednesday, 13 May at 5pm.
This is the first time that a
public symposium of this kind
has been held.
The symposium is entitled
The fight against cancer
Where do we stand? and will
be chaired by broadcaster and
author, Dr John Bowman, and
Dr Muiris Houston of the Irish
Times.
According to Professor Mark
Lawler, conference organiser:
We have decided to extend
our conference programme to
include direct interaction with
the general public and this is
what this symposium is about.
Our panel of experts will
take questions and deal with
cancer-related issues, which
are of concern to so many
people.
We will provide the latest
information on cancer, to
include risk, treatment, the
future and new therapies.
Those attending will find
this symposium helpful and
informative.
For further information on
the Public Symposium, visit
www.cancerconference.ie or
phone the Irish Cancer Society
Helpline (1800 200 700).
Attendance at the
symposium is free of charge.

Happy Heart Weekend 14-16 May 2009


Celebrity magician Keith
Barry, TV presenter Caroline
Morahan and model Sara
Kavanagh launched the Irish
Heart Foundations Happy
Heart Weekend appeal for
volunteers to raise funds for
their new CPR campaign.
With nearly 5,000 lives lost
to sudden cardiac arrest
annually in Ireland, the
national heart health charity
wants to save more lives by
distributing self-training CPR
kits to 27,500 Transition Year
students around the country.
By training the students
and their families, and with
the support of the Vodafone
Ireland Foundation, the
charity hopes to reach a
target of 80,000 people
the capacity of Croke
Park by the end of 2009.
To volunteer for Happy

Heart Weekend which


takes place from the 14 to
the 16 May call the Irish

Heart Foundation on 01
668 5001 or see www.
happyheartweekend.ie

See the Difference


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3. Silk DB et al. Clin Nutr 2001; 20(1): 4958. 4. Elia M et al. Alimentary Pharmacology & Therapeutics. 2008; 27:120-145.

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MAT 12/08
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issue 5 volume 11 MAY 2009

interview
Four decades,
three careers
in an award winning
pharmacy life

D r D es Co rrigan

Dr Des Corrigan, former Director of the School of


Pharmacy at TCD was a worthy recipient of the Lifetime
Achievement Award at the 2009 Pharmacist Awards
which took place in Dublin this month. June Shannon
spoke to the amiable TCD academic on a hugely
successful and fascinating career spanning four decades
in academia, herbal medicines and drugs policy.

I am absolutely thrilled because something that comes from


your professional colleagues and peers means far more than
anything else, Dr Corrigan said recently on receiving the news
that he was to be awarded the 2009 award.
I see it as recognition for those of us in the profession who seem to be
outside the mainstream of community and hospital pharmacy. Those of us in
academic pharmacy, in regulatory affairs wherever pharmacists are working
we all consider ourselves pharmacists. It is a recognition of the fact that
pharmacy is a broad church and that people contribute to the profession
in many different ways. It [the award] is not just for me, it is a recognition
of all of the things that all of my other colleagues do, Dr Corrigan told Irish
Pharmacist.
Medical history
Dr Des Corrigan qualified from the old College of the Pharmaceutical Society
of Ireland at Shrewsbury Road in 1965 and, apart from a 12-month stint in
industry immediately after graduating, he has dedicated the last 42 years of
his career to the School of Pharmacy at TCD.
In fact, it was a love of research that lead Dr Corrigan to a career in
academia as, in 1966, it was the only pathway open to pharmacy graduates
interested in research.
He was appointed junior lecturer in the Department of Pharmacognosy in
October 1966. However, by his own admission, Murphys Law kicked in and
a heavy workload of teaching five and a half days a week meant that it took
him longer than I would have liked to complete his PhD in Phytochemistry
and Chemistry. In 1975, he was appointed Head of the Department of
Pharmacognosy on the death of his predecessor, Mr Christy OConnor.
It was his keen interest in phytochemistry and pharmacognosy that
were to shape the young lecturers career and lead him to become one of
Irelands, and indeed Europes, leading experts in the areas of drugs, drug
addiction and herbal medicines.
Drugs Squad
Dr Corrigan has been involved in the drugs area since 1968 when he and the
late Christy OConnor were called upon by the newly-formed Garda Drugs
Squad to analyse all drugs seized by the Gardai. For 13 years, they provided
a forensic analytical service to the squad. From 1968 to 1981, all of the drugs
that were seized by the Drugs Squad were brought to Shrewsbury Road for
analysis. Dr Corrigan and his colleagues were also regularly called upon to
give expert evidence in court in relation to numerous drug cases.
Drug addiction and prevention
In the early 1980s, he became involved in prevention activities through

the Health Education Bureau working with pharmacists, teachers, parent


groups and healthcare professionals, training them on drug addiction and
prevention. Since 1995, he has been the Irish representative on and acted
as Chairperson (1997-2000) of the Scientific Committee of the European
Monitoring Centre for Drugs and Drug Addiction (EMCDDA) which is based
in Lisbon.
He also chaired the EU Risk Assessment Committee for New Synthetic
Drugs which was charged with looking at the risks associated with new
synthetic drugs that were appearing in Europe at the time, such as ecstasy
and its various chemical modifications, e.g. MBDB and 4MTA. In fact, it was
the work done by Dr Corrigan and his colleagues on the Risk Assessment
Committee and during the Irish EU Presidency in 2004 that lead to the recent
legislation banning the sale of so-called party pills or benzylpiperazine
(BZP) drugs in head shops in Ireland.
Party pills
Asked how drugs such as these were allowed into the retail businesses in
the first place, Dr Corrigan explained that, because they werent classified as
medicines or food supplements, there was no legal mechanism to control
them. They therefore came into a grey area from a legal perspective.
Interestingly, BZP drugs were originally developed as an antidepressant
in the 1960s but clinical trials were dropped because of unacceptable side
effects, which were similar to amphetamine or speed, Dr Corrigan explained.
These party pills were then developed as a quasi-legal alternative to
ecstasy and incorporated another related drug called TFMPP to mimic the
effects of ecstasy. According to the drugs expert, some of these party pills
also contain the plant extract, LSA, a natural form of LSD and others contain
a plant called Sida-, which contains ephedrine, which Dr Corrigan said, was a
concern.
One of the concerns I have about this is some people might use this not
realising that it doesnt say ephedrine on the label. If they are involved in
sport and tested through the GAA testing scheme, they are likely to test
positive for a banned doping substance which ephedrine is. The more I
find out about what is being sold, the more concerned I get, he told Irish
Pharmacist.
Busy and exciting times
2004 was a particularly busy and exciting year for Dr Corrigan when he was
asked to chair the European Horizontal Working Party on Drugs one level
below the Council of Ministers during Irelands Presidency of the EU. The
work done by this group lead to the development of new legislation, which
allows for an early warning system for new synthetic drugs across the EU and
also provides a risk assessment for new substances.

15

interview
Dr Corrigan also chaired the Dun Laoghaire/Rathdown Local Drugs Task
Force from 1997 to 2000 an experience that he described as fascinating.
He said he was particularly blown away by the energy and commitment of
the various community and voluntary groups involved.

National Advisory Committee on Drugs


In 2000, he was appointed Chair of the National
Advisory Committee on Drugs (NACD), which advises
the Government on problem drug use in Ireland in
relation to prevalence, prevention consequences and
treatment based on analysis and interpretation of
research findings.
The NACD carries out population surveys every
four years and also commissioned the landmark
ROSIE study a national longitudinal study designed
to evaluate the effectiveness of treatment and other
intervention strategies used in Ireland for Opiate
Dependence Syndrome with adult opiate users.
That has been a major study showing just how
well drug treatment works for everyone involved the individual drug user, their family and the rest of
the community. Everybody gains when people are in
treatment for their drug addiction, Dr Corrigan said.
The most recent population study carried out by the NACD in March
entitled Drug Use in Ireland and Northern Ireland 2006/2007 Drug
Prevalence Survey: Sedatives or Tranquillisers, and Anti-depressants
revealed that 11 per cent of the population in Ireland have taken sedatives
and tranquillisers at some stage in their lives, while nine per cent reported
taking antidepressants.

issue 5 volume 11 MAY 2009

phytomedicines and to assist with the harmonisation of their regulatory status


at European level. Dr Corrigan also chairs the Traditional Herbal Medicinal
Products Subcommittee at the IMB and is the Irish expert on one of the
subcommittees that look at the quality of herbal medicines for the European
Pharmacopeia.
Three-year delay
According to Dr Corrigan, the new EU Directive on
Traditional Herbal Medicinal Products (2004/24/
EC), which came into force on 30 April 2004 and
was transposed into Irish law in July 2007, was a
hugely important development for pharmacists.
They will have a range of registered products
that have been stringently tested that they can
include as another option in their OTC prescribing
for patients in the pharmacy. Some pharmacists
may have been reluctant to get involved because
they werent licensed products but the new
Directive changes all of that.
However the three-year delay between the
introduction of the Directive and its transposition
into Irish law means that patients are missing out,
Dr Corrigan said.
Under the Directive, all of the products will have to be registered by April
2011 the IMB estimated there were about 5,000 products on the market
in Ireland that is a huge amount of work. There has been a very slow rate
of applications, other EU Member States are way ahead of us and I think
patients are missing out There is a huge level of evidence on the value of
these medicines. There is this idea that these are scientifically untested and
unevaluated but these are heavily tested materials that, once registered,
pharmacists can feel confident in recommending them to patients, he
added.

Another highlight
for me would be
the quality of students
entering pharmacy over
the last 20 years. That is a
tremendous intellectual
resource within the
profession.

Need for vigilance


The findings also indicated that, while 89 per cent of current users got their
sedatives or tranquillisers on prescription from the chemist, 11 per cent of
those using prescription medicines obtained them without a prescription.
The study further revealed that, of those respondents who used sedatives
or tranquillisers, 7 per cent got them from someone they knew and 2 per
cent bought them without a prescription at a chemist.
Dr Corrigan told Irish Pharmacist that it was a worry that two per cent of
the population reported buying sedatives or tranquillisers from a chemist
without a prescription and called for more vigilance in this area.
After more than four decades in the area, Dr Corrigan said that he has now
reached a stage where he is no longer surprised by the Irish drugs scene
and its emerging trends.
It is constantly changing in ways that are often totally unpredictable.
Going way back to late 1970s and early 1980s, the emergence of heroin was a
surprise. We didnt have much experience of heroin, it was mostly cannabis,
LSD, amphetamines and barbiturates cocaine was coming for a long time
the two surprising ones would have been ecstasy at the end of the 1980s
and the beginning of the 1990s and, more recently, the party pills and head
shops.
Future of drug abuse in Ireland
On the future of drug abuse in Ireland, he said that, while he had got out
of the practice of predicting anything about the drug scene here, a recent
survey by the European School Survey Project on Alcohol and other Drugs
(ESPAD) revealed some glimmers of hope in the fact that there has been a
drop in the experimentation rate with cannabis among 15 and 16 year olds.
All of the indications are that the heroin situation is somewhat stable,
although the level of heroin use has increased outside of Dublin, which is a
worry. What may happen with cocaine and the recession nobody knows? It
is a reasonable hypothesis that with the old clich cocaine was Gods way
of telling you you had too much money the recession might have an impact
on the levels of cocaine use. But we wont know that with any degree of
certainty until we do the next population survey in late 2010/2011.
Herbal medicine the day job
Coupled with his work in the drugs arena, Dr Corrigan is also very well
known at home and abroad for his work in herbal medicines, which, for him,
was simply the day job.
A lot of people would associate me with drug misuse but that was very
much secondary to my involvement with medicinal plants, particularly
herbal medicines, he explained.
The TCD academic was involved at EU level from 1992 to 2003 with
the European Scientific Cooperative on Phytotherapy (ESCOP) an
umbrella organisation representing national phytotherapy associations
across Europe in their discussions with European medicines regulators.
The main aims of the EU body are to advance the scientific status of

16

School of Pharmacy, TCD


While Dr Corrigan was heavily involved, both at national and European
levels, in drug policy and herbal medicines, he was also the Director of the
School of Pharmacy at TCD from 1997 to 2003.
Asked to reflect on particular highlights from his long and very successful
career, Dr Corrigan mentioned the opening of the new purpose-built
pharmacy building on Trinitys main campus in October 1997, which also
coincided with his appointment as Director of the School. The development
of the new building he credited entirely to the hard work and dedication
of his predecessor, Mr Val Harte. Also he recalled the official opening of the
new School by the then Minister for Education, Michel Martin, the following
summer as a particular highlight.
Baptism of fire
The move to the main TCD campus, however, was also (or at least threatened
to be) a genuine baptism of fire for Dr Corrigan. He recalled that he started
as Director of the new School on Monday at 9am and at 9.30am welcomed
the first group of first-year pharmacy students into a purpose-built school of
pharmacy for the very first time.
However, on the Friday he received a visit from the College Safety Officer
and the Head of HR who advised the fledging Director that he either closed
the new School for a week or faced a strike because the builders insisted on
smoking in the new laboratories which contained several hundred litres of
flammable solvent and this obviously posed a serious safety risk. So it was a
great start, he smiled. The School was closed for a week.
Personal highlights
Recalling his personal highlights, Des said that these included the work he
did during the Irish Presidency of the EU in 2004, both chairing the HDG
and leading the EU delegation to the UN in Vienna for the Commission for
Narcotic Drugs. Another personal highlight was chairing the EULAC EU Latin
American and Caribbean Dialogue on drugs in Dublin as part of the EU
Presidency.
A dedicated teacher and consummate professional, it is telling of the
man that he also recalled the many students he has guided through the
profession over the past four decades as a major highlight in his career.
Another highlight for me would be the quality of students entering
pharmacy over the last 20 years. That is a tremendous intellectual resource
within the profession we have been attracting the top five per cent of the
leaving cert cohort consistently over the last 20 years. Some people look and
see that as a misallocation of talent in that they should be doing things other
than pharmacy. But I see this as being a tremendous resource for pharmacy
and I look forward to those individuals changing pharmacy in ways that
none of us can even imagine at this stage.

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INTERVIEW
PHARMACY
AWARDS

issue 5 volume 11 MAY 2009

And the winner is

Pharmacist Awards 2009

Recognising Excellence in Pharmacy


As the official Media Partner for the Helix Health Pharmacist Awards 2009
in association with the Benevolent Trust Fund of the PSI, Irish Pharmacist
is delighted to introduce the winners of the 2009 Pharmacist awards. The
winners were announced at a glittering event in the Mansion House in
Dublin on Saturday, 09 May and Irish Pharmacist would like to congratulate
all the winners and finalists. Congratulations also to Helix Health particularly
Deirdre O Sheehan and Jennifer Hughes, whose sterling hard work in
organising the event made for a wonderful evening.
Professional Excellence Award
sponsored by Ulster Bank

Pharmacist Contribution to the


Community sponsored by Hilary
Haydon and Company

Excellence in Community Practice


sponsored by Helix Health

Mr. Howard Beggs, Chief Executive of Helix


Health, Ms. Cicely Roche of the Awards Organising
Committee, Award Winner Mr. Tim Delaney of
Tallaght Hospital and Mr. Ken Murnaghan of Ulster
Bank.

Mr. Howard Beggs, Chief Executive of Helix


Health, Ms. Cicely Roche of the Awards Organising
Committee, Award Winner Ms. Mary-Jo Duffy
of Duffys Pharmacy, Co. Clare and Ms. Yvonne
McCormack of Hilary Haydon & Company.

Mr. Howard Beggs, Chief Executive of Helix Health,


Award Winner Mr. Noel Stenson of Achill Pharmacy,
Co. Mayo and Ms. Cicely Roche of the Awards
Organising Committee.

Winner: Tim Delaney, Head of Pharmacy, Tallaght


Hospital, Dublin.

Winner: Mary-Jo Duffy, Duffys Pharmacy, Ennis,


Co Clare.

Winner: Noel Stenson, Achill Pharmacy, Achill


Sound, Achill, Co Mayo.

Tim was nominated on the basis of his outstanding


contribution not only to pharmacy but also to
healthcare in Ireland in general. He is very well
respected both at home and abroad.

Over the past 23 years, Mary-Jo has built up a


reputation as a loyal, dedicated and extremely
hard-working pharmacist. Well liked by her staff
and patients alike, Mary-Jos commitment to her
local community extends well beyond the confines
of her Ennis pharmacy.

In addition to running a busy rural pharmacy on


Achill Island, Noel is a prolific contributor to the Irish
Centre for Continuing Pharmacy Education. Hugely
dedicated to the profession, the Mayo pharmacist is
currently studying for an MSc at the RCSI despite his
many other commitments.

Dermot Smyth, Breens Pharmacy,


Main Street, Slane, Co Westmeath;
and Marie OBrien, OBriens
Pharmacy, Oliver Plunkett Street,
Mullingar, Co Westmeath were
finalists in this category.

Sheila ODriscoll, ODonovan Pharmacy, Bishopstown


and Teacher Practitioner, School of Pharmacy,
UCC, Cork; and Brian OReilly, OReillys Pharmacy,
Fairgreen, Naas, Co
Kildare were finalists in
this category.

Mary Rose Burke, Boots Ireland, Boots the Chemist,


Liffey Valley Shopping Centre, Dublin; and Sheila
Ryder, School of Pharmacy, TCD, Dublin were finalists
in this category.

Helix Health would like to thank the following companies for their contribution
to the evening: IMS, First Databank Europe, Central Databank, PC Cubed, Unicare
Pharmacy, Mc Cabes Pharmacy, Willach and Heisse, IMI Irish Medical Information,
Servier, Merck Sharp & Dohme, William Fry, KPMG and FAI Vantage Club.
18

PHARMACY AWARDS

issue 5 volume 11 MAY 2009

Patient-Nominated Award
Excellence in Hospital Pharmacy
sponsored by Teva Pharmaceuticals sponsored by Sanofi Aventis

Practice-Based Research Award


sponsored by Helix Health

Mr. Howard Beggs, Chief Executive of Helix


Health, Ms. Cicely Roche of the Awards Organising
Committee, Award Winner Mr. Donagh Corby of
Firgrove Pharmacy, Cork and Ms. Aideen Kenny of
Teva.

Ms. Cicely Roche of the Awards Organising


Committee, Ms. Carole Cafferky of Sanofi Aventis,
Award Winner Ms. Geraldine Colohan of Portiuncula
Hospital, Co. Galway and Mr. Howard Beggs, Chief
Executive of Helix Health.

Mr. Howard Beggs, Chief Executive of Helix Health,


Award Winner Mr. Bernard Duggan of Dargans
Pharmacy, Dublin 7 and Ms. Cicely Roche of the
Awards Organising Committee.

Winner: Donagh Corby, Firgrove Pharmacy,


Bishopstown Shopping Centre, Bishopstown,
Cork.

Winner: Geraldine Colohon, Portiuncula Hospital,


Co Galway

Winner: Bernard Duggan, Dargans Pharmacy,


Burkley Road, Dublin.

Geraldine had the unique distinction of receiving


a joint nomination from three people involved in
the healthcare sector from nursing, primary care
and HSE management. The Chief Pharmacist at
Portiuncula Hospital was nominated for her work
ethic and professionalism, qualities described
as commendable and inspirational by all who
encounter her.

Bernard is both a practicing pharmacist and active


researcher dedicated to improving the practice of
pharmacy through research. He is widely published
with a special interest in facilitating seamless care
between the primary and secondary care sectors.

Donagh has been described by his patients as


always willing to offer advice on any health
concern and a kind, patient, obliging and
empathetic pharmacist.
Richard Woods, Woods Pharmacy, Dominick Street,
Mullingar, Co Westmeath; and Donough Connolly,
Connollys Pharmacy, Avenue Road, Dundalk were
finalists in this category.

Tamasine Grimes, Tallaght Hospital, Dublin; and


Cristin Ryan, School of Pharmacy, UCC were finalists in
this category.

Claire Keane, St
Vincents Hospital,
Dublin Eva Dockery,
Sligo General Hospital
were finalists in this
category.

Young Pharmacist of the Year


Award sponsored by Clonmel
Healthcare

The Liz Herbert Lifetime


Achievement Award sponsored
by Moroney Barron Solicitors

Overall Pharmacist of the Year


sponsored by GlaxoSmithKline

Mr. Howard Beggs, Chief Executive of Helix


Health, Ms. Cicely Roche of the Awards Organising
Committee, Award Winner Ms. Claire Murphy
of Unicare Pharmacy, Blackrock and Mr. Martin
Gallagher of Clonmel Healthcare.

Mr. Howard Beggs, Chief Executive of Helix


Health, Ms. Cicely Roche of the Awards Organising
Committee, Ms. Fiona Barron of Moroney Barron
Solicitors, Award Winner Dr. Des Corrigan of
Blackrock and Mr. Declan Herbert.

Mr. Howard Beggs, Chief Executive of Helix


Health, Ms. Cicely Roche of the Awards Organising
Committee, Award Winner Mr. Tim Delaney
of Tallaght Hospital and Mr. Dave Barrett of
GlaxoSmithKline.

Winner: Claire Murphy, Unicare Pharmacy,


Blackrock, Co Dublin

Dr Des Corrigan

Winner Tim Delaney, Head of Pharmacy, Tallaght


Hospital, Dublin

A graduate of Queens University Belfast, Claire has


worked in the Unicare Pharmacy Group for the past
number of years and currently works in Blackrock.
Her citation stated that she performs her day-today duties to the highest standard and runs a highly
professional, ethical and efficient dispensary.
John Green, Unicare
Pharmacy, Newbridge,
Co Kildare Miriam Kerins,
Lohans Pharmacy, Weir
Road, Kilcolgan, Co Galway
were finalists in this category.

This award is given to a pharmacist whose efforts


on behalf of the profession in Ireland over a
sustained number of years are deemed to have
been the most remarkable.
This testament is highly appropriate for the
winner of this award Dr Des Corrigan.
(Please see pages 15 and
16 for a full interview with
Dr Corrigan)

Tim was nominated on the basis of his outstanding


contribution not only to pharmacy but also to
healthcare in Ireland in general.

19

opinion
opinion

view from above

issue 5 volume 11 MAY 2009

Not having a say is


the problem

With the passing of new regulations that permit Northern Irish


pharmacists to be absent from the pharmacy for a period of
two hours from October 2009, Terry Maguire is angry that the
professions wishes have been ignored and he sees this as a first
step towards the demise of community pharmacy.

feel denied, I feel


ignored, I feel
aggrieved and I
feel downright
angry because
I have just been
disenfranchised. I am
being treated like a child,
I am being patronised by
a government which tells
me, on the one hand,
that my views count, yet,
on the other hand, totally
ignores me. My views
I now know count for
nothing.

Catch 22
There is a surreal
scene in the movie
Catch 22 where the
main protagonist (Art
Garfunkel actually) is
walking up a one-way
street while a coachman
is flogging his dead
horse in a vain attempt
to travel down the street
the wrong way. I only wish 30 years ago someone
had told me that I was that coachman. The
Medicines (Pharmacies) (Responsible Pharmacist)
Regulations 2008 have become law in Northern
Ireland and will come into force in October 2009.
The perfect murder?
The thin edge of a very painful stake has just
been inserted into the professions breastbone
with a view of eventually piercing its heart and
killing it. This is murder, be in no doubt, but it will
not be a quick murder, rather it will be committed
over a generation with the hope no one will really
notice. Indeed if pharmacists are kept fighting
about prescription payments or are busy parallel
exporting medicines to the Irish Republic, the
Government thinks, community pharmacists will
not really notice.
Why am I getting so annoyed since the PSNI
is holding a consultation so I can have my say in
that? Now those who give the PSNI consultation
papers only a cursory glance might think that
we, as pharmacists, are being consulted on
something meaty. Sorry, we are being asked how
we will implement a Total Quality Management
(TQM) system that is being imposed on us by
these new regulations. Its as if your mother has
decided that she is going to punish you and the

20

only say you have is which form of punishment


you would prefer - a cane, a slipper or a long wait
until your father comes home.
Imposed system
I am very happy that the profession, the PSNI that
is, mandates a TQM system on each community
pharmacy. Indeed both my pharmacies have
had such a system in place for some time and
both the professional and the commercial
aspects of my business have benefited greatly.
I am unhappy that this is being mandated by
legislation so its the Government dictating that I
do this; its the principle.
That said, I can live with an imposed TQM
system but then I find that this is only being
done to allow pharmacists to leave the premises
during opening hours. I have always believed
and still believe that a pharmacy is a pharmacy
only when it has a pharmacist in it. I have
never been convinced that, as a practising
pharmacist, I will need to be off the premises for
professional reasons. I need to be doing what I do
professionally in the pharmacy.
More that just a pharmacy
If my health board wants someone to talk to
schoolchildren about sexual health, then tell
them to get a social worker to do it. I would argue
that I am far from a Luddite and would suggest
that my pharmacies are as progressive as any in
the UK. We provide smoking cessation services
with over 150 enrolled since January, we are
implementing an obesity management service
this May and we are taking part in three Building
the Community Pharmacy Partnership Projects
and, of course, we do Managing your Medicines
and Minor Ailments.
We intend to take on more public healthfocused services when we finally agree a new
contract with the Department of Health, Social
Services and Public Safety (DHSSPS). I can do all
this and still not have the pharmacist absent from
the premises.
Source of my anger
Last year, the DoH (London) arrived in Belfast
and pharmacists were invited to hear about the
proposals. To a pharmacist, we said; no way, get
lost, but they returned to London and got on
with a UK change to the regulations.
Our Assembly agreed these new regulations
without any reference to the profession, yet I
have to say they mildly apologised for failing
to consult when it was pointed out to them.
So now we are in this place and this is the

terry m agu i re

source of my anger. Absence from the premises


for pharmacists is a given, with only a PSNI
consultation on how to do some of the less clear
bits of the regulations.
Okay, its only a two hour absence in a 24 hour
day and what we get to do in the consultation
is to say if these absences can be only for
professional service delivery; advice to an OAP
home on proper storage of medicines etc or if it
can be for other things such as lunch breaks, a
visit to the golf clinic or to pursue a juicy affair.
Coffee break
And I am asking myself why there is such an
obsession with the new designation of the
Responsible Pharmacist. Im beginning to
wonder if we have spent the last 150 years
acting very irresponsibly indeed. The regulations
insist that the public must be aware who the
responsible pharmacist is at any given time and if
indeed he or she is on the premises at all.
Sadie, did you get your medicines?
No, Agnes, but I do know that Mr Maguire is
the responsible pharmacist today and hes just
popped out for a coffee with that busty rep!
Yes, this really makes the dispensing process
much safer and more effective.
Welcome to Big Brother
Pharmacy
Wake up I have told my colleagues, this is a
campaign by vested interests, particularly the
Company Chemists Association (CCA), to ensure
that in 10 to 20 years from now CCA members
will be able to man their multiple pharmacies
with NVQ level 3 technicians whose job it will be
to shovel original packs of medicines in a hungry
dispensing robot while one pharmacist at head
office sits in front of a bank of video monitors
keeping an eye and acting responsibly for
perhaps 100 pharmacies.
With these new regulations, community
pharmacy is in a very dangerous place, yet we
can do nothing about it and, if we try, we will be
ignored. I give up. Im going to stop flogging this
dead horse and have decided to wait until my
father gets home and just hope that hes in a very
good mood.
Terry Maguire owns two pharmacies in
Belfast. He is an honorary senior lecturer
at the School of Pharmacy, the Queens
University of Belfast. His research interests
include the contribution of community
pharmacy to improving public health.

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opinion

david jo rdan

the coalface

Mind your
language

Irish Pharmacists David Jordan goes on an


international crusade to ensure that pharmacists can
speak the language of the country in which they
practise.

hose of you who follow my various


rantings will know that one of my
pet peeves is foreign pharmacists
ability to speak English, properly.
This is not to say that all foreign
pharmacists practising here cannot
speak English properly. But there is a sizeable
number who cannot and it does not seem that
anybody is doing anything about it.
Not wanting to be the hurler on the ditch, I
tried to get to the bottom of what was going on.
And, to be fair, to the PSI, I could not place all the
blame with them.

Whose responsibility is it anyway?


Across Europe regulatory authorities cited the
EU Free Movement Directive as the reason
for automatic recognition of each others
qualifications without any language requirement.
Most of them pass the buck and say that it is the
responsibility of the employer.
So I downloaded a copy of this Directive and
then I made my first mistake (in this matter
at least), I tried to read it. This directive could
replace all the Dalmane and Rohypnol in my
pharmacy. I did, however, discover the high
esteem with which pharmacists are held in the
EU. Pharmacists, doctors and other medical
professionals were included in the same
paragraph as leather workers, upholsterers and
saddle makers. High praise indeed.

At least the EU
recognises that a
medical professional
should at least be able
to speak the same
language as their
patients.
On the hunt
My next move was outlined in an earlier article.
I emailed the Offices of the Commissioner for
Health, Consumer Affairs and Languages. I
asked for their opinion of a EU Directive being
used as the reason for automatic recognition of
qualifications without any language requirement.
After some reminders the press office of the

22

Commissioner for Consumer Affairs replied that it


was not an issue for their office.
I responded that it is a consumer issue that
a healthcare professional may not be able to
communicate properly with them because
of a lack of local language skills. Patients as
consumers pay for their healthcare either directly
to the healthcare professional or indirectly via
taxes or insurance. All I got was that they could
not contribute any information on the matter.
At least the Commissioner for Consumer Affairs
replied. The Commissioner for Health and for
Languages has not, as yet, replied. Obviously
healthcare professionals and public safety are
held in high regard by the EU.

You dont mess with the Germans


All the above took place about eight months
ago. Last week, I decided to see if matters
had progressed. I had already asked a MEP to
follow up my emails to the Commission to see
if there were any replies. So far nothing. I also
emailed the pharmacy regulators all over the
EEA asking about language requirements for an
Irish pharmacist who wished to register in their
country. Hats off to the Nordic countries and
Switzerland they all replied within 24 hours to
my inquiry. The general gist of the replies was the
same:
There are no language skills necessary for
registration to practice. However, the employer
might demand language skills.
Still the same passing of the buck. The
Germans came up trumps with a declaration that:
One of the requirements for the Approbation
is that the person has knowledge of the German
language.
No messing around, you want to practice
in Germany, then you must be able to speak
German.

issue 5 volume 11 MAY 2009

The reply from Hungary also gave me some


hope:
According to Article 53 of Directive 2005/36/EC
(which has been transposed to our national law by
Act C of 2001 on the recognition of foreign diplomas
and qualifications), persons benefiting from the
recognition of professional qualifications shall
have a knowledge of languages (in this case the
Hungarian language) necessary for practising the
profession in the host Member State.
Downloading directives
It was at this point that I realised that there had
been an amendment to the Free Movement
Directive. So I set off to download 2005/35/
EC. In EU terms, this was a lightweight at only
121 pages. It also sought to limit itself to the
professions of nurse responsible for general care,
dental practitioner, veterinary surgeon, midwife,
architect, pharmacist and doctor. Article 53
was almost exactly as quoted by the Hungarian
regulator:
Knowledge of languages
Persons benefiting from the recognition of
professional qualifications shall have a knowledge
of languages necessary for practising the profession
in the host Member State.
The Hungarian Government has transposed
this into law so it begs the question why dont all
the other EU governments do likewise. I read the
Directive a bit further and came upon Article 63.
Transposition
Member States shall bring into force the laws,
regulations and administrative provisions necessary
to comply with this Directive by 20 October 2007
at the latest. They shall forthwith inform the
Commission thereof.
In search of common sense
So at least the EU recognises that a medical
professional should at least be able to speak the
same language as their patients. At last, some
common sense. So I tried to find out if the Irish
Government had transposed this into Irish law.
But, as I write, everybody seems to be on an
Easter break and I cant get any replies.
Mind you none of this deals with a working
knowledge of Irish pharmacy law or a basic
understanding of the myriad schemes that now
make up Irish pharmacy services. I suppose that if
they can speak the native language then at least
somebody can explain it to them.
To this end, I, for one, was insulted by the latest
circular from the PSI. I, like many others who sat
the rigorous forensic exam, do not need to be
reminded of the emergency supply regulations
and how to apply them. If the PSI thinks that it is
important, then maybe they should have ensured
that pharmacists know them before they register
them and allow them to practice. But hey, lets be
fair to them, they are probably too busy thinking
of emails on dubious subjects or making up nice
copybooks to send out. They have a lot of our
money still to spend. But that will be another
article for another day.
David Jordan has worked in community
pharmacy since 1979, qualifying as a
pharmacist in 1983. He was chairperson of
the Community Employee Committee of the
IPU from 1990 to 1998 and treasurer from
1994 to 1996. His main stress relief is riding
his motorbike with his friends from www.
irishbikerforum.com

LAW

issue 5 volume 11 MAY 2009

Financial
Emergency Measures in the
Public Interest Bill 2009
what does it really mean for
pharmacy?

Co r m ac ON ei l l

Irish Pharmacists resident law expert, Cormac


ONeill, explains the possible implications for
pharmacists of the Financial Emergency Measures in
the Public Interest Bill 2009 which gives the Minister
for Health the power to fix the rate of payment
to pharmacists and other health professionals for
services to the State.

ection 9 (1) of the Financial


Emergency Measures in the Public
Interest Act 2009 outlines specifically
and in detail what the Government
hopes to do with regard to the
proposed reduction of payments to
health professionals. Pharmacists are specifically
listed as being included for payment reductions
at Section 17 (c) of the Bill.
It is important, however, for readers to be
aware that these proposals are currently a Bill and
are not yet a statute. The Bill is making its way
through the Oireachtas at the moment and the
final Act, which eventually emerges, may contain
very different terms.
Superior in
law
This new Emergency
legislation is intended
to be separate
from any contract
which is currently
in place. No doubt
the Government
intends that this
new legislation will
be interpreted by
the courts and the
legal profession as
being superior to any
terms and conditions
contained in any
contracts currently in
place. Any new Act
should not be viewed
as a renegotiation of
the current pharmacy
contract because,
technically, it would
be a new and separate
device, in the light of
which the contract
must be read.
Even if a pharmacist
has a contract which

has been in place for sometime, this new


Act, when passed into Law, is intended to
be superior in law and therefore all of the
terms of such pre-existing contracts are
superseded by it.

the opportunity, which exists at the moment, to


implement new ways of doing things. Activitybased managements, zero-based budgeting
and value chain analysis are all management
techniques which are relevant and useful to
the problems faced by pharmacy and the
Government, but have never been attempted in
Ireland as alternatives to the incremental slashing
of payments to pharmacists. There is no doubt
that new effective and less costly ways must
be found to provide health services in Ireland;
however, there are more sophisticated ways of
doing it than currently being attempted by the
Government.

Financial hardship for


pharmacists
Many pharmacists who have been in business
for sometime and will have made large capital
investments may now be alarmed at the
forthcoming payment reductions being imposed
upon them by the current Government. The Bill at
Section 9 (4) states that the Minister will engage
in consultation as is considered appropriate.
I suggest that any delegations or lobbyists
working on behalf of the pharmacy profession
should demonstrate the financial hardship
upon pharmacists of this proposed measure.
Every effort should be made to point out that
pharmacists would find it very difficult to obtain
matching reductions in expenditure to those
being introduced on their incomes.
For example, landlords will not agree to reduce
rents in line with the reductions in income, which
pharmacists are facing. Employees also are not
likely to accept corresponding reductions in
their salaries and, of course, the cost of drugs
and medicines is not linked to the income or
payments level which the pharmacist receives in
such a way that it can be adjusted to pass on the
reduction to pharmacists.
Boom and bust
Section 5 (e) of the Bill mentions the impact on
the States ability to continue to provide health
services, at existing levels, if reductions are not
made. This is, of course, the pertinent point to
the entire bill. There is no doubt that efficiencies
must be achieved. This is always the case when
managing any organisation and it applies just
as much during times of boom as it does during
times of bust.
There are many ways of achieving this but
they all boil down to good management. Simply
imposing incremental pay reductions will forego

The pharmacy
profession looks like it is
entering a new and very
different age marked
by an ongoing dialogue
with politicians.

Benchmarking costs
The Bill proposes to implement into practice
an annual review of the stats payment to
all health professionals. This exercise is to
be undertaken having regard to the overall
success of the proposals and national economic
competitiveness. It is likely that this will involve
benchmarking the costs which the State pays
for health professionals against other European
Union members.
For example, there are considerable differences
between the amounts of money paid by the
Spanish Government to health professionals and
similar costs incurred by the Irish Government.
Section 13 (a) of the Bill proposes that this
ongoing review is conducted on an annual basis
and a report is to be put before the House of the
Oireachtas.
The pharmacy profession looks like it is
entering a new and very different age marked
by an ongoing dialogue with politicians who
themselves are likely to have less and less money
to spend if our economists are correct with
regard to their forecasts on taxation receipts.
Cormac ONeill is a barrister practising on
the Dublin and South Western circuits. He is
also a chartered management accountant
with considerable experience in industry
and banking. In addition, Cormac lectures
on Business and Law in the Institute of
Technology in Tralee and can be contacted on
087 657 1124.

23

a point of view

issue 5 volume 11 MAY 2009

j u l ian j u dg e

Dreaming the dream


Julian Judge puts the
global success of a
48-year-old single woman
who lives alone with her
cat and has never been
kissed down to simple
CaldeseneIPA5New3_'09 1/4/09 9:36 Page
dignity.

n 11 April, Susan Boyle from


Blackburn in Scotland conquered
the world in a little under four
minutes. In the intervening
period, she has had over 100
million You Tube hits, been
interviewed by Larry King, ITV
and Fox News. What did she
do that was so special? Did she save the world?
Cure cancer? No more hunger, war, strife, religion
whatever?
No, she did none of those. She sang a song on
1
a Saturday evening television programme called
Britains Got Talent. She sang a song, thats all she

new

20g t
rave
avail l pack
able

did. Sure, she has a voice to die for, one in a million


and Im sure shell win the competition and make
loads of records and money and hopefully have fun
doing all that. But is that why we, as a planet, have
fallen in love with her? Is it just that?

A matter of dignity
Its not what she did, its how she did it that has
swelled our eyes and made us examine our hearts.
Above all, she has dignity and thats what wiped
Simons smirk from his face. In those four minutes,
she created and sold something that you cant buy.
You see, you dont get dignity, you earn it. Heres
two definitions of it. Susan has both of them in
spades.
Dignity is the quality of being worthy of esteem
or respect. It gives rise to a persons standing
amongst others. (Oxford Dictionary.)
Human dignity is gleamed only now and then
and here and there in lonely splendour, throughout
the ages, a hope of the better man, never an
achievement of the majority. (James Thurber.)

A Misrables background?
Lets look at her background. Maybe the answer
lies in that backdrop. Shes from Blackburn, West
Lothian, in Scotland. Originally it was a cottonmanufacturing town and then moved to coal
mining. Its got a high unemployment rate. Susan
is the youngest of nine children. She took singing
lessons from an early age and wanted to be a
professional singer but stayed at home to care for
her parents.
Her mother died two years ago aged 97. Susan is
48. Do the maths and theres the time spent caring.
She sang I Dreamed a Dream from Les Misrables
as a tribute to her mother. Theres where part of
her dignitys backdrop came from. She earned that
courage.

nap

py r

ash

48-year-old Cinderella

&t

rea

ts

Susan Boyle and the HSE


Heres the point as regards the HSE. No matter how
much our anger builds and no matter how much
we gain satisfaction over a High Court victory, the
reality is that its so much more rewarding to be
reminded that everyone has dignity.
If only the HSE and, in particular, Mary Harney,
had an ounce of this we wouldnt be where we are
today and therein lies our frustration. Its such a
shame.

nts

Cal

e
n
e
des

e
v
e
pr

Medicinal product not subject to prescription.


Full prescribing information is available on request or go to www.clonmel-health.ie
PA 126/152/1 PA Holder: Clonmel Healthcare, Waterford Road, Clonmel, Co. Tipperary
Contains Calcium Undecylenate 10% w/w, 55g pack size.

24

Susan is what she is; someone on a street carrying


heavy shopping bags, perhaps having to stop every
now and then to adjust the weight depending on
which shoulder is aching that day. Her charm has
been earned. Susan has lived a dream until now.
Shes enacting a story we want to be true. Its in
our unconscious since we were infants. Go back to
Cinderella.
Shes not young. When youre an outsider at 48
its easy to think that all is gone. We want to be
wanted, appreciated, perhaps even feel relief for
helping create an environment of care. Heres a
question to illustrate the point. How do you feel
when that person to whom you gave medicines
at cost or went the extra yard to help arrives
unprompted at your counter with the box of
biscuits or bottle of wine?

2009/ADV/CAL/090

Julian Judge qualified as a pharmacist in 1990.


He has recently completed a Masters in Creative
Writing at the Department of English at UCD.
Contact Julian at email: julianjudge@hotmail.
com

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finance

k i er an m o o r e

issue 5 volume 11 MAY 2009

Budget 2009 Brace yourself


for round two

Irish Pharmacists financial expert, Kieran Moore,


looks at the implications of last months emergency
budget and asks what can we as taxpayers do
to alleviate the pain before the next budget in
December?

he tax changes that were made are


bad, but it could have been worse.
Lets start by looking at some of the
changes:
Income levy the levy introduced
last year has been doubled with the
entry levels to each band being reduced.
With effect from 1 May, they will be:
Income
15,028 - 75,036
75,036 - 174,980
Over 174,980

Levy
2 per cent
4 per cent
6 per cent

PRSI the employee PRSI ceiling has


increased from 50,700 to 75,036 with effect
from 1 May. There has been no change to
employer PRSI.
Health levy the health levy rates will
double to 4 and 5 per cent with effect from 1
May. The entry point to the higher rate will be
75,036.

The potential exists for


the next Budget to erode
many of the reliefs that are
currently available for gift
and inheritance tax and
also Capital Gains Tax.
Mortgage interest relief this will be
discontinued for any mortgage over seven
years from 1 May.
Interest relief for residential rental
properties the level at which interest
re-payments can be claimed against tax for
residential rental properties has been reduced
from the current 100 per cent to 75 per cent.
This does not apply to commercial properties.
Deposit Interest Retention Tax the
Minister announced an increase in the rate
of DIRT from 23 per cent to 25 per cent on
regular deposits and to 28 per cent on certain
other savings products.
Capital Gains Tax the rate of CGT has been
increased from 22 per cent to 25 per cent for
disposals made after midnight on 7 April.

26

Capital Acquisitions Tax similarly, the CAT


rate has been increased from 22 to 25 per cent
for gifts or inheritances made after midnight
on 7 April 2009, and the current thresholds
have been reduced by 20 per cent to the
following:
Group A parent to child 434,000
Group B related persons 43,400
Group C unrelated persons 21,700
Insurance policies a new levy on life
assurance is being introduced at the rate of 1
per cent on premiums and the current non-life
insurance levy of 2 per cent is being increased
by 1 per cent. The changes will take effect on
all premiums received by the insurer on or
after 1 June.
Capital allowances there will be a new
tax relief on capital expenditure incurred
in the acquisition of intellectual property.
Capital allowances for both private hospitals
and nursing homes are to be abolished, with
transitional arrangements being put in place
for projects that are at an advanced stage of
development.
Window of opportunity
Having seen the details and assessed their impact
on us, the next question is: is there anything we
can do to alleviate the pain before the next round
of changes come in?
The starting point must be to consider what
else the Minister said. In his opening address,
he outlined that, in the next Budget, due in
December 2009, he will look to a broad range
of measures to counter the deficit in the public
finances, including the introduction of a carbon
tax, a form of property tax and significant further
base broadening through the elimination of
unnecessary reliefs and a review of all areas of
tax-exempt incomes.
The Minister will also have available to him the
report of the Commission on Taxation, which
is due in the autumn. In the absence of that
report, he could not make structural changes to
the system, hence the 'fiddling' with the rates.
However, we are unlikely to be so fortunate, if
one can say that, next time around. There are
two areas that should form part of everyones
thinking over the next eight months: pensions
and Capital Tax planning.

Pensions
There have been no direct changes to the
pensions regime, so no further attack on salary
limits or a tax on pension tax-free lump sums.
If anything, the other changes made recently
encourage further pension funding, such as:
The income levy hits personal pension
contributions because such contributions are not
deductible from the levy. However, this is not the
case with company contributions, on which the
levy has no impact.
The increases in CGT and DIRT mean that the
tax-free growth of pension funds compares even
more favourably to non-pension investment.
Capital Tax planning
Beyond pension funding, future planning should
be to the fore of everyones mind before the next
Budget in December. The changes made this
time around to existing thresholds and rates of
tax would seem to be just the start of what we
can expect in this area. The potential exists for
the next Budget to erode many of the reliefs that
are currently available for gift and inheritance
tax and also CGT; this could affect areas such as
transferring businesses and passing assets on to
the next generation.
If this is something that you are considering,
then you must start putting a plan together now
so that you can take advantage of the current
(rather than future) tax treatments on these
transactions.
Seek out quality advice
Now is clearly the time to have an independent
expert review your situation to see what actions
you can take to maximise the opportunities to
further changes that these nine months presents.
Make sure that when you do this the advice you
seek is from advisors with the technical ability to
advise you in all the relevant tax and legal issues
you may face.
The importance of reviewing your
circumstances at this juncture cannot be stressed
enough it may be the case that a more taxefficient method of restructuring your business
and passing assets to the next generation will not
exist for many years.
Kieran Moore QFA
Director
Financial Engineering
Financial Engineering is regulated by the
Financial Regulator.
Financial Engineering Network Limited,
Harmony Court,
Harmony Row,
Dublin 2.
Tel. (01) 614 8000
www.fen.ie

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e-pharmacy

issue 5 volume 11 MAY 2009

www.yourmedicines.ie

promotes self care

June Shannon reports on a new Irish OTC website which promotes self-care and
encourages the public to attend their pharmacist.

recent online survey


by AC Nielsen found
that more than
one in three Irish
consumers agreed
that more medicines
should be made available without
a prescription, suggesting that Irish
consumers wish to take a more active
role in the management of their own
health.
Launched recently, the site (www.
yourmedicines.ie) is a welcome
development for both patients and
healthcare professionals.
The new site is the only Irish-based
website devoted solely to providing
information and advice for patients
and healthcare professionals on OTC
medicines.
www.yourmedicines.ie is the
brainchild of Graham Cooke and
Maura Henderson, co-founders of
GreenCross Publishing. Commenting
on the need for the site, Maura
said: The internet is awash with
information on medicines much of
it of dubious provenance and nearly
all of it trying to sell you something.
The idea behind yourmedicines.
ie is to provide the public and
pharmacists with an ethical site
which provides information only.
The site is the only such Irish
site which is devoted to providing
information on non-prescription
medicines and the treatment of
minor illnesses. Its focus is very much
about self-care and it encourages
people to attend their pharmacist
when they have minor illnesses
and only attend their GP when it is
something more serious.
Graham commented on the
simplicity of use and accuracy of

Maura Henderson and Graham


Cooke, www.yourmedicines.ie
the site: Unlike other healthcare
sites, this site is simple and easy to
navigate and doesnt bombard you
with loads of unnecessary options.
Graham also assures users about
the accuracy of the information
on the site: The accuracy of the
content is guaranteed because the
product information and patient
information leaflets have been
supplied by the pharmaceutical
companies. As for the healthcare
information also available on the site,
we are delighted to have someone
of the calibre of Dr Martin Henman
of TCD providing information about
the products uses, interactions and
contraindications.
Combatting the OTC maze
Commenting on the site Dr
Martin Henman, Medical Editor of
yourmedicines.ie and Head of the
Practice of Pharmacy at the School
of Pharmacy and Pharmaceutical

Sciences, TCD, said: Over the


counter (OTC) medicines are a
valuable way to treat simple illnesses.
The variety of OTC medicines on
sale today can be confusing, even
for health service professionals.
This site has been compiled to offer
guidance and advice, which will
help you to find a way through the
OTC maze. Its unique feature is that
it provides detailed information on
many of the medicines available
in pharmacies and other shops,
including a description of their active
ingredients and their instructions for
use.
www.yourmedicines.ie is
specifically designed to aid and
encourage the general public
when it comes to self-care. The site,
which provides a guide to all the
leading OTC products, also acts as a
reference guide for pharmacists and
healthcare professionals.
The benefits of appropriate selfcare have long been recognised;
patients benefit from being more
informed and empowered to take
responsibility for their own health.
A more proactive and preventive
approach to minor illnesses through
the use of first-line OTC treatments
may also result in reducing the
frequency of GP and A&E visits.
Growing benefits
According to the Interim report,
Pharmacy Ireland 2020, by the
Pharmaceutical Society of Ireland
(PSI), the frontline role of the
community pharmacist in the
management and treatment of
minor ailments and in the provision
of professional advice on selfcare is an important part of the
primary healthcare process. The
implementation of a National Minor
Ailments Scheme would benefit the
patient by providing greater access
to healthcare advice, would benefit
the health service by targeting
resources and making savings which
can be redistributed, and would
benefit the GP by freeing up their
time to treat more patients with a
serious or chronic illness, the report
stated.
True cost of minor
ailments
Furthermore, a recently published
UK report which analysed data from

28

210 general practices covering over


four million patient records and 190
million prescriptions, found that, in
2006, 7.5 million patients consulted
their GP about a minor ailment.
This suggests that 51.4 million GP
consultations a year were for minor
ailments only. The authors estimated
that this represented 18 per cent of
a GPs workload, or the equivalent of
at least an hour a day.
The report estimated that the
total cost to the NHS of these
consultations was 1.8 billion (2.5
billion) with 80 per cent of this (1.5
billion, 2.15 billion) due to the cost
of the GPs time.
Ten minor ailments (back pain,
indigestion, dermatitis, nasal
congestion, constipation, migraine,
acne, cough, sprains and strains, and
headache) were responsible for 75
per cent of the cost of minor ailment
consultations and 85 per cent of
the cost of prescriptions for minor
ailments.
A recent Irish Pharmaceutical
Healthcare Association (IPHA)
Switch on to Self-Care meeting,
heard that savings in the region of
75 million could be achieved if the
benefits of self-care and responsible
self-medication, a hidden asset in the
Irish healthcare system, were fully
realised.
Making an informed
choice
Easy to navigate, yourmedicines.
ie is intended to help users make
an informed choice when is comes
to using OTC medication. Users
can search the site by symptoms,
therapeutic area, ingredients or
product name. As well as listing
products, their indications and
ingredients, the site also contains
a wealth of information on minor
illnesses and how best to treat them.
Also the site acts as a news source
about new OTC products and news
issues relating to non-prescription
drugs.
For more information please visit:
www.yourmedicines.ie

Indeed, sun-induced melanoma has a current risk


factor in the UK and Germany of 1 in 200 of the
1,2,3 in the aftersun market
Unique
population.

of the

g term

Clinical pedigree confirms effectiveness

Greater awareness of the


short term discomfort and the long term
Cools and hydrates skin with no preservatives or allergens
health risks have resulted in greater use of high-SPF
Promotes natural healing
protectors and more care about exposure to the sun
Can be applied to face or body
though recent in-depth qualitative research4 has
Suitable for adults and children
shown that UK customers are less wary of British
as a medical device
issue 5 volume 11 MAY
2009 Classified
sunshine,
which could
lead to
accidental sunburns.
References

itionally

Aftersun rescue treatments have been traditionally


limited to cosmetic creams and moisturisers.

1. Armstrong B. Epidemiology of malignant melanoma: intermittent or total accumulated exposure to the sun? J Dermatol
Surg Oncol. 14: 835-849 (1988)

Unique in the aftersun market

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sunburnproduct
treatmentsnews
in the shade
Clinical pedigree confirms effectiveness

Cools and hydrates skin with no preservatives or allergens


Promotes natural healing

Can be applied to face or body


Suitable for adults and children
Classified as a medical device

References

1. Armstrong B. Epidemiology of malignant melanoma: intermittent or total accumulated exposure to the sun? J Dermatol
Surg Oncol. 14: 835-849 (1988)

SAVE YOUR
SKIN WITH AFTERBURN A NEW CHAPTER IN SUNCARE
Until now.
2. Khlat M, Vail A, Parkin M and Green A. Mortality from melanoma in migrants to Australia: variation by age at arrival and
duration of stay. Am J Epidemiol 135: 1103-1113 (1992)

3. Osterlind A, Tucker MA, Stone BJ and Jensen OM. The Danish case control study of cutaneous melanoma. II Importance
of UV- light exposure. Int J Cancer 42: 319- 324 (1988)

4. Data on file

4. Data on file

5. Data on file

5. Data on file

A F T E R B U R N - A R E V O L U T I O N A R Y S U N B U R N T R E AT M E N T F R O M T H E C A R E R A N G E

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Telephone +44 (0)1484 842217


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afterburn detail aid

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is a threat to everyone who goes outside


Set to be the latestSunburn
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cabinet and holiday essential, AfterBURN
especially if they fail to apply protection.
Sunburn Rescue Gel is a revolutionary new product specifically developed
Indeed,
sun-induced
has a skin,
current
risk
and clinically proven
to treat
and repairmelanoma
sun damaged
unlike
factor in the UK and Germany of 1 in 200 of the
traditional aftersun
products
that
simply
moisturise.
population.
AfterBURN Sunburn Rescue Gel is a unique dermatological gel with an
Greater awareness of the short term discomfort and the long term
osmotic action that draws water from deep in the skin (the dermis) to the
health risks have resulted in greater use of high-SPF
surface
(the epidermis)
helping
toexposure
rehydrate
treat sun damaged skin.
protectors
and more care
about
to and
the sun
The product
has undergone
clinical trials
highlighting
its efficacy which
has
though recent
in-depth qualitative
research
haveshown
shown
it helps
to:
that
UK customers
are less wary of British
could
lead toto reduce the chances of
Aid the skinsunshine,
healing which
process,
helping
premature accidental
skin aging sunburns.
Aftersun
rescue
Reduce redness
of the
skin treatments have been traditionally
limited
cosmetic
creams and moisturisers.
Cool irritation
andtoease
discomfort
9 out of 10 people
have
been
caught
out and experienced painful
Until now.
sunburn by overexposure to UV rays not surprising when 40% of us STILL
1,2,3

ew

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AFTERBURN - A REVOL

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2. Khlat M, Vail A, Parkin M and Green A. Mortality from melanoma in migrants to Australia: variation by age at arrival and
duration of stay. Am J Epidemiol 135: 1103-1113 (1992)

3. Osterlind A, Tucker MA, Stone BJ and Jensen OM. The Danish case control study of cutaneous melanoma. II Importance
of UV- light exposure. Int J Cancer 42: 319- 324 (1988)

Puts all
sunburn
in the sh

Sunburn is a threat to everyone who goes outside


use
below the recommended
minimum sun
protection factor and 43%
Afterburn
Sunburn
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Gel...
Afterbu
especially if they fail to apply protection.
only use sun protection cream when on holiday overseas. Sunburn can
a new
fromandnew
technology
a new o
Indeed,
melanoma
hassymptoms
a current risk
lead
to skinopportunity
becoming
red,sun-induced
tender
painful,
with
being at
factor in the UK and Germany of 1 in 200 of the
their worst between
6 and
48 hours after exposure to the sun.
Unique
in the aftersun market
population.
Dr John Ashworth,
Consultant
Dermatologist
Clinical
pedigree confirms
effectiveness says: Sunburn is
Greater awareness of the short term discomfort and the long term
effectively
a radiation
Prolonged
exposure
causes skin to
Coolsburn.
and hydrates
skin with nosun
preservatives
or allergens
health risks have resulted in greater use of high-SPF
Promotes
natural
healing
overheat
and
become
red
and
painful.
If
skin
is
burnt
then
people should
protectors and more care about exposure to the sun
Can be
applied
to face
or body
be sun
safe by
staying
out
of
the
sun
and usinghas
a hydrating treatment like
though
recent
in-depth
qualitative
research
Suitable
adults
and
children
AfterBURN
to soothe
theforarea
helpofrepair
shown that
UK customers
areand
lessto
wary
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Classified as
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which
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aftersun may not sunshine,
be effective
and
isdevice
simply
sunburns.
do not need to beaccidental
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References
References
Aftersun
rescue
never ignore serious sunburn. treatments have been traditionally
limitedRescue
to cosmetic
and moisturisers.
AfterBURN Sunburn
Gel iscreams
an odourless,
non sticky and nonstaining dermatological
gel
that
is
rapidly
absorbed
and acts quickly on
Until now.
the skin.
AFTERBURN - A REVOL
TM

1,2,3

Puts all
sunburn
in the sh

1. Armstrong B. Epidemiology of malignant melanoma: intermittent or total accumulated exposure to the sun? J Dermatol
Surg Oncol. 14: 835-849 (1988)

1. Armstrong B. Epidemiology of
Surg Oncol. 14: 835-849 (198

2. Khlat M, Vail A, Parkin M and Green A. Mortality from melanoma in migrants to Australia: variation by age at arrival and
duration of stay. Am J Epidemiol 135: 1103-1113 (1992)

2. Khlat M, Vail A, Parkin M and


duration of stay. Am J Epidem

3. Osterlind A, Tucker MA, Stone BJ and Jensen OM. The Danish case control study of cutaneous melanoma. II Importance
of UV- light exposure. Int J Cancer 42: 319- 324 (1988)

3. Osterlind A, Tucker MA, Stone


of UV- light exposure. Int J Ca

4. Data on file

4. Data on file

5. Data on file

5. Data on file

a major breakthrough
for minor burns
For further information, contact Thornton & Ross Ltd.

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29

First Irish online reference site devoted to promoting self care

www.yourmedicines.ie
NewsitelistsallleadingIrishnon-prescriptionmedicines

Site also contains information about illnesses and the proper use of OTC
medicines available for their treatment.
Edited by Dr Martin Henman, the new site not only acts as a reference guide for
pharmacists and other healthcare professionals, it also aims to encourage the
public in the correct approach to self-medication.
www.yourmedicines.ie will be supported by an online advertising campaign
along with promotion in mainstream media.

history of pharmacy

issue 5 volume 11 MAY 2009

SPECIAL FEATURE

The Schindler of pharmacy


Luigi Barlassina recounts the fascinating tale of Tadeusz Pankiewicz, a heroic
pharmacist who rescued countless Jews from the horror of Nazi death camps
during WWII.

is story isnt as well


known as that of
Oscar Schindler, but,
like him, Tadeusz
Pankiewicz is a hero
- a pharmacist hero.
When, under the German occupation
of Poland in World War II, the Nazis
established the Krakow ghetto,
Pankiewiczs pharmacy was the
only such establishment within its
boundaries. The Nazis tried to get rid
of its owner, offering him one of the
Jewish pharmacies in Krakow.
Pankiewicz refused, postponed his
decision and was finally permitted
to continue to run his pharmacy and
take up permanent residence in the
ghetto, becoming the only nonJewish Pole living within its walls. His
staff (Irena Drozdzikowska, Helena
Krywaniuk and Aurelia Danek) were
also given passage permits to enter
and exit the ghetto for work.
Hive of resistance
Due to his open-mindedness,
righteousness and high personal
culture, he won acceptance and
respect among the inhabitants of
the ghetto. Open 24 hours a day,
the Eagles Pharmacy (Apteka Pod
Orlem) soon became a hive of
resistance to Nazi policy, not only
providing medical help, but also
becoming a trusted location to host
meetings, exchange information and
to hide.
The often-scarce medications and
pharmaceutical products supplied to

Tadeusz and his staff


the ghettos residents, regularly free
of charge, substantially improved
their quality of life. But, in effect,
also contributed to survival itself.
As Pankiewicz mentioned in his
memories, he and his staff came up
with some tricks that helped a lot
of people avoid deportation. They
provided tranquilisers for children
who were being hidden from the
German soldiers during SS raids, and

Pharmacy under the Eagle outside and inside

hair dye for the older people of the


ghetto. This more youthful look of
the elderly enabled them to avoid
deportation to the death camps.
Clandestine living
In the last tragic days of the ghetto,
Pankiewicz and his staff were on
hand to distribute medicines and
dressings. Everyone who turned for
help received it.
Pankiewicz and his staff risked
their lives on a daily basis to
undertake numerous clandestine
operations: smuggling food and
information, and offering shelter
on the premises to Jews facing
deportation to the camps.
When the war finally ended,
Pankiewicz continued to work in
the pharmacy until 1953. He died
on 5 November 1993, after being
honoured (as had Schindler) by the
Israeli Holocaust Memorial authority
Yad Vashem, as Righteous Among
the Nations.
From pharmacy to
museum
Today, save for one stretch of
wooden stalls (see Figure), the

atmosphere of the pharmacy


has been lost. It was closed in
1967 and the interior damaged
when the building was converted
into a restaurant. Thankfully, in
1983 the pharmacy became a
branch of the Krakow Historical
Museum. It holds a permanent
exhibition dedicated to showing
the annihilation of Krakows Jews
by the Germans and the role that
Pankiewiczs pharmacy had in the
ghetto.
References
Museum of National
Remembrance at Under the Eagle
Pharmacy.
The Cracow Ghetto Pharmacy
(translation by Henry Tilles of
Apteka W Getcie Krakowskim, T
Pankiewicz). New York: Holocaust
Library, 1987.
Gilbert, M. The Holocaust, A
history of the Jews of Europe.
(1987 Macmillan.)
Crowe DM. The Holocaust Roots,
History and Aftermath. Published
by Westview Press.
Crowe D. Oscar Schindler.
Published by Basic Books.

31

Questions & Answers

issue 5 volume 11 MAY 2009

QA
D r J o h n Hi llery

Dr John Hillery is a Consultant Psychiatrist at Stewarts Hospital,


St John of God Hospitaler Order Kildare Services, Dublin West
Psychiatric Services. He is also an Honorary Lecturer and member
of ARiD Research Group at the UCD Centre for Disability Studies. Dr
Hillery is also Chairman of the International Association of Medical
Regulatory Authorities, and member of the Governing Authority
of the University of Limerick. He was recently appointed to the
Council of the PSI by the Minister for Health as a public interest
nominee. Originally from Clare, Dr Hillery is the son of the former
President of Ireland Dr Patrick Hillery,

&

Dr Hillery was happiest on September 03 1995 around 5pm


when Clare supporters streamed onto the pitch at Croke Park
and Anthony Daly received the Liam McCarthy Cup, salving the
longings of generations of Clare people.

Q. What other career might you have chosen?


A. Politics would seem the obvious one. I wonder
about the idea of the lifetime career politician
though.

Q. Which figures in Irish life (living or dead) do


you admire and why?
A. In public life, my father, for his achievements of
course but mostly for his ability to make myself
and my sister feel that we came first no matter
how busy he was.
Q. What is the one thing you would suggest to
improve the Irish health service?
A. Proper corporate and clinical governance.

Q. What is your earliest memory?


A. Waiting for my mother in her car while she did
a house call in west Clare when she worked with
my father in his practice.
Q. What is your greatest fear?
A. That my generation may leave a lesser nation
for our children.

Q. When and where were you happiest?


A. September 03 1995 around 5pm when Clare
supporters streamed onto the pitch at Croke Park
and Anthony Daly received the Liam McCarthy
Cup, salving the longings of generations of Clare
people.
Q. What would your superpower be?
A. The ability to slow time.

32

Q. What is the worst job you have ever done?


A. As the intern on call in the Richmond Hospital,
I had to tell a patient that her son, who had
visited her an hour earlier, had died on his way
home.
Q. What is your best trait?
A. Only others can answer this.

Q. What is your most unappealing habit?


A. Getting overtired, in which state I become
irrationally argumentative with those who care
for me.
Q. What trait do you most dislike in others?
A. The need to dominate others.
Q. Do you use alternative medicines?
A. No.

Q. Cat or dog?
A. Dog but have had bad luck in this recently with
two road fatalities in four years. Our cat, at 18
years, seems to be thriving. I wonder if there is a
connection?
Q. What keeps you awake at night?
A. My childrens social lives.

Q. Who or what makes you laugh?


A. My children, American sitcoms, people who
take themselves too seriously and cartoons
by Martin Turner, Tom Matthews and various
cartoonists for the New Yorker.

Q. Who or what is the greatest love of your life?


A. Luckily for me, my wife, Carolyn.

Q. How do you relax?


A. I dont know if I do but walking on the beach at
home at Spanish Point in Clare brings me close.
Q. What word or phrase do you overuse?
A. There are three possible answers to this
and embarrassingly forgetting the third.

Q. Favourite TV/radio programme?


A. I miss Vincent Browne from the radio. John
Bowman on the weekends is under threat.
Sunday Miscellany on RTE. On TV, I am catching
up on The Wire which, once you get used to the
language and the characters, is addictive.
Q. Favourite film and book?
A. Currently Gran Torino and Il Divo. For repeat
viewing, Shane, High Noon and The Third Man.
For repeat reading, Staying Alive, a collection
of poetry by diverse poets on diverse themes.
It seems always to have an answer to lifes
questions.
Q. What is your motto?
A. Dont criticise yourself, you may make it
unanimous!

Q. How would you like to be remembered?


A. That I kept trying.

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picture gallery

issue 5 volume 11 MAY 2009

IPU AGM

2009
Ms Liz Hoctor
Mr Bernard Duggan,
Chairman of the IPU
Emloyee Committee

Secretary General and


Standing Committee of the IPU

GSK

alli

(orlistat 60mg)

Launch in the Royal


College of Physicians

Pictured at the launch of alli (orlistat 60mg) by GlaxoSmithKline Consumer


Healthcare (Ireland) Ltd., in the Royal College of Physicians, the only medicine
to be granted a non-prescription licence for weight loss treatment in Ireland,
are (l-r): Ms. Marie Upton and Ms. Janice Morrissey, the Irish Heart Foundation
and Ms. Maeve Jordan, Naas General Hospital.

Pictured at the launch of alli (orlistat 60mg) by GlaxoSmithKline


Consumer Healthcare (Ireland) Ltd., in the Royal College of Physicians, the
only medicine to be granted a non-prescription licence for weight loss
treatment in Ireland, are (l-r): Ms. Liz Hoctor and Ms. Kate Healy, the Irish
Pharmacy Union, with Mr. David Barrett, Pharmacy Business Manager,
GlaxoSmithKline.

34

Pictured at the launch of alli (orlistat 60mg) by GlaxoSmithKline Consumer


Healthcare (Ireland) Ltd., in the Royal College of Physicians, the only
medicine to be granted a non-prescription licence for weight loss treatment
in Ireland, are (l-r): Ms. Mary Colclough, Irish Society for Quality and Safety in
Healthcare with Ms. Laura Swift and Ms. Denise McCarthy, Boots Chemists.

issue 5 volume 11 MAY 2009

clinical review

Important
decisions

in the management of

epilepsy
By Dawn O S h e a

In our worsening financial climate,


pharmacists are coming under
increasing pressure to substitute
cheaper generic preparations where
possible when filling prescriptions.
However, one condition which
stands out in this regard is
epilepsy. Several studies have now
documented unfavourable results
when patients are switched to
generic antiepileptic drugs

Facts and figures


It is estimated that 1 in every 20 people will
suffer a seizure at some point in their lives.
However, not all seizures are indicative of
epilepsy. Epilepsy is the most common
serious neurological condition, with an estimated prevalence of 5-10 per 1,000 people in
developed countries.6 In the region of 3 per
cent of the population will be diagnosed with
epilepsy at some point in life.7 In Ireland, it
is estimated that there are 30,000 to 40,000
people with epilepsy.8
For most patients, epilepsy is relatively
short-lived. More than two-thirds will enter
long-term remission and once remission has
occurred, subsequent relapses are uncommon. However, the longer the condition
remains active, the poorer the prognosis, so it
is important to achieve seizure control as early
as possible.9 However, up to 30 per cent of
patients will develop chronic epilepsy which
must be managed with ongoing treatment.

eneric substitution has been associated with


decreased symptom control and increased
frequency of breakthrough seizures.1,2 The
data show that, in patients who suffer breakthrough seizures on generic antiepileptics,
serum drug levels were significantly reduced
at the time of breakthrough seizure. Other studies have
shown increased drug levels on generic substitution and
this has been associated with cases of status epilepticus and
serious injury.3
Generic switching is also associated with increased
healthcare utilisation with significantly higher numbers of
out-patient visits and longer hospital stays.4 The result is that
switchback rates for generic to brand antiepileptics is 5 to 10
times higher than for any other class of medication.4,5
The issues surrounding generic antiepileptic substitution
are such that several professional organisations, including
the American Academy of Neurology and the American Epilepsy Society, have issued position statements recommending that formulation switching should not be permitted
without prior approval from the patient and treating physician. Several US states have even gone so far as to introduce
legislation which requires pharmacists to get explicit permission from the patient and doctor before making a generic
substitution in epilepsy medications.
Irish pharmacists are facing the dilemma of meeting the
financial needs of the State while ensuring effective seizure
control for the patient.

Cause and classification


A diagnosis of epilepsy is made if an individual has had two or more unprovoked seizures.
The condition can be classified according to
seizure type or cause. Partial or focal seizures
are categorised as simple partial, complex
partial or secondary generalised tonic-clonic
seizures. Temporal lobe epilepsy is a form of
partial or focal epilepsy. Generalised seizures
are categorised as generalised tonic-clonic,
absence, myoclonic, tonic or atonic.
There are numerous potential causes of
epilepsy including birth injuries, congenital
disorders, head injuries, tumours, infections,
genetic defects, degenerative diseases of the
brain or demyelinating diseases. Symptomatic
epilepsy is that which results from a known
cerebral abnormality, e.g. a tumour. Idiopathic generalised epilepsy, such as juvenile
myoclonic epilepsy and childhood absence
epilepsy, are largely genetic. However, in the
vast majority of epilepsy cases, no clear cause
is found. These cases are generally termed
cryptogenic epilepsies.
It is not uncommon for a patient to experience more than one type of seizure and it is
important that each type is properly identi-

fied in order to effectively manage the condition. Several behaviours or environmental factors can trigger seizures in epileptic patients.
Common triggers include sleep deprivation,
alcohol and stress.
Treatment
In the past, the goal of epilepsy treatment was
considered to be complete control of seizures.
However, the emphasis now is to enable patients with epilepsy to lead lifestyles consistent with their capabilities. The development
of new medications and surgical procedures
for epilepsy along with increased awareness
of quality of life issues and medication side
effects have ushered in a new era for the management of this condition.
A successful treatment plan is dependent
on an accurate diagnosis of the seizure
type involved and measurement of seizure
frequency and severity. Not all individuals
who suffer a seizure require antiepileptic
drugs. Up to 10 per cent of the general
population will experience a single seizure
at some point but the proportion that
suffers recurrent seizures is much smaller.
The decision to initiate antiepileptic
medication is based on the likelihood of
recurrent seizures and the main factor in this
prediction is the type of seizure involved.
Complete seizure control with minimal
side effects can be achieved with a single
antiepileptic agent in up to 80 per cent of
cases. Using the most suitable drug at an
appropriate dose increases the likelihood of
success in this regard.
If one drug is ineffective or produces
intolerable side effects, a second drug may
be tried. However, the second drug should be
titrated to an effective dose before the first
drug is withdrawn.
Different antiepileptic drugs are recommended for different seizure type. For
primary generalised tonic-clonic seizures,
carbamazepine, phenytoin and valproate are
the drugs of choice but phenobarbital and
primidone are recommended for second-line
or adjunctive therapy.
For partial seizures with or without secondary generalisation, recommended first-line

35

clinical review
agents are carbamazepine, phenytoin and
valproate. Second-line therapies include gabapentin, lamotrigine, phenobarbital, primidone or
felbamate, if its benefits outweigh the risk of aplastic anaemia, liver failure or both. Levetiracetam
is also indicated as monotherapy in partial onset
seizures with or without secondary generalisation
in patients with newly diagnosed epilepsy. Levetiracetam can also be used as adjuvant therapy of
partial onset seizures with or without secondary
generalisation in epilepsy patients over four years
of age, and of myoclonic seizures in patients over
12 years of age with juvenile myoclonic epilepsy
as well as for primary generalised tonic-clonic
seizures in patients from 12 years of age with idiopathic generalised epilepsy.
Ethosuximide and valproate are recommended
for absence seizures. Valproate is the recommended first-line treatment for myoclonic seizures but
clonazepam can be used as a second-line agent.
For mixed myoclonic and tonic-clonic seizures,
valproate and felbamate are the agents of choice.
Again the latter is only recommended for patients
whose condition is so severe that the benefits of
felbamate outweigh the risk.
Side effects are a major cause of treatment
non-compliance in epilepsy. The vast majority
of antiepileptic drugs have both systemic and
neurotoxic side effects. The barbiturates, such as
primidone and phenobarbital are associated with
nausea and rash but can also cause altered sleep
cycles, lethargy, behavioural changes and ataxia.
Tolerance and dependence are also important
considerations with these agents.
The systemic side effects of carbamazepine also
include nausea and rash but, in addition, it can
cause diarrhoea, hyponatraemia and fluid retention. Neurotoxic side effects of carbamazepine
include drowsiness, dizziness, blurred vision and
headache. Rare idiosyncratic reactions that can
occur with this agent include agranulocytosis,
Stevens-Johnson syndrome, aplastic anaemia,
hepatic failure, serum sickness and pancreatitis.
The most common side effects seen with

A successful treatment
plan is dependent on
an accurate diagnosis of the
seizure type involved and
measurement of seizure
frequency and severity.
ethosuximide include nausea and vomiting, sleep
disturbance, drowsiness and hyperactivity.
The use of felbamate can be associated with
nausea and vomiting, anorexia and weight loss as
well as insomnia, dizziness, headache and ataxia.
However, the most important side effects that can
occur with this agent are the rare idiosyncratic
reactions of aplastic anaemia and liver failure.
As is common with antiepileptic drugs, nausea
and rash can occur with lamotrigine. Neurotoxic
side effects seen with this agent include dizziness
and somnolence. Rare adverse reactions include
Stevens-Johnson syndrome and hypersensitivity
syndrome.
The systemic side effects of phenytoin include
gingival hypertrophy, hirsutism, rash and lymphadenopathy. With long-term use, osteomalacia
is a risk. Neurotoxic effects include confusion,
slurred speech, blurred vision and ataxia. Neuropathy may occur with long-term use. Rare adverse
reactions seen with phenytoin include rash and

36

lymphadenopathy.
Valproate is associated with nausea and vomiting, weight gain and hair loss. Bone loss, menstrual
irregularity and polycystic ovary syndrome can
occur with long-term use. Neurotoxic side effects include tremor and tiredness. Pancreatitis,
thrombocytopenia and impaired platelet function
can occur on rare occasions. Liver failure is a rare
but important consideration, especially in children
under two years of age.
Gabapentin has no known systemic side effects.
However, neurotoxic reactions can occur and
these include somnolence, dizziness and ataxia.
Although monotherapy is the preferred option,
a combination of antiepileptic drugs can achieve
seizure control with limited tolerability issues in
up to 15 per cent of patients. However, certain
combinations should be avoided, particularly
any combination of the central nervous system
(CNS) depressants phenobarbital, primidone and
diazepam.
As side effects are an issue with antiepileptic
medications, the pharmacist should discuss the
expectations of the treatment plan and the importance of compliance.
Other therapeutic approaches
The ketogenic diet is a special high-fat, low-carbohydrate diet that helps to control seizures. It is
similar to the modified Atkins diet but stricter. The
diet is usually prescribed for children rather than
adults. It has been shown to be particularly beneficial in certain forms of epilepsy including infantile
spasms, Rett syndrome and GLUT-1 deficiency.
Pharmacological therapy continues in conjunction
with the diet and the combination may allow a
reduction in dose or number of drugs. Vitamin and
mineral supplementation is important, particularly
calcium, vitamin D, iron and folic acid.
Surgery is a recognised treatment option for
epilepsy. At least 70 per cent of patients who
undergo temporal lobectomies have a marked
reduction in seizures or seizure freedom. Among
patients with well-localised, discrete epileptogenic
areas of the anterior temporal lobe, seizure activity
can be totally arrested in a very high percentage
of cases. If surgery is performed on patients with
more widespread epileptogenic brain areas, a
smaller percentage will become seizure-free.
Frontal lobectomies produce a total arrest of seizures in 30-40 per cent of patients. These numbers
are less statistically significant than the numbers
for temporal lobectomies because frontal lobe
epilepsy tends to involve more widespread brain
regions than other types of epilepsy, so successful surgical resection is much more difficult to
achieve.
Data suggest that gamma knife radiosurgery
can be used with acceptable safety and efficacy in
patients with medial temporal lobe epilepsy and
offers a potentially valuable modality to provide
long-term seizure control in patients with a single
temporal lobe seizure focus.10 This procedure may
offer a way to treat patients who have a single,
well-defined seizure focus while simultaneously
avoiding the risks associated with a craniotomy.
Neurostimulation therapy for epilepsy involves
appropriate targeting of applied electrical activation at selected nervous system sites, resulting in
anti-seizure effects without the common sedative
side effects of antiepileptic medications.
Deep brain stimulation (DBS) has also been
used in the treatment of epilepsy with stimulation
applied to several regions of the brain, including
the cerebellum, caudate nucleus, centromedian
thalamus, anterior thalamus, subthalamus, hippocampus and neocortical seizure foci. Short-term
DBS has been shown to be efficacious in refractory

issue 5 volume 11 MAY 2009

temporal lobe epilepsy.


Vagus nerve stimulation (VNS) is designed to
prevent seizures by sending regular, mild pulses of
electrical energy to the brain via the vagus nerve.
The VNS device, sometimes referred to as a pacemaker for the brain is placed under the skin on
the chest wall and a wire runs from it to the vagus
nerve in the neck. The device is programmed
to send electrical pulses at intervals tailored to
the individual patients needs. However, holding a special magnet near the implanted device
causes the device to become active outside of the
programmed interval. For people with warnings
(auras) before their seizures, activating the stimulator with the magnet when the warning occurs
may help to stop the seizure.
Conclusion
Up to 40,000 people in Ireland suffer with epilepsy.
In the last two decades, the approach to seizure
control has evolved such that the aim now is to
achieve maximum control with minimal side effects. Several pharmacological therapies are now
available for the management of epilepsy and, in
the majority of cases, patients become seizurefree with appropriate medication.
The UK National Institute for Health and Clinical
Excellence is currently reviewing its 2004 guidelines on the diagnosis and management of the
epilepsies in adults and children in primary and
secondary care. The updated version is due to be
completed by November 2010 and should provide
up-to-date guidance on the use of branded and
generic antiepileptic drugs and the management
of associated side effects.
References
1. Burkhardt RT, Leppik IE, Blesi K et al. Lower
phenytoin serum levels in persons switched
from brand to generic phenytoin. Neurology
2004; 63: 1494-6.
2. Berg MJ, Gross RA, Tomaszewski KJ et al.
Generic substitution in the treatment of
epilepsy: case evidence of breakthrough
seizures. Neurology 2008; 13: 127-30.
3. Nielsen KA, Dahl M, Tommerup E at al.
Comparative daily profiles with different
preparations of lamotrigine: a pilot
investigation. Epilep Behav 2008; 13: 127-30.
4. Lelorier J, Duh MS, Paradis PE et al. Clinical
consequences of generic substitution of
lamotrigine for patients with epilepsy.
Neurology 2008; 70: 2179-86.
5. Anderman F, Duh MS, Gosselin A et al.
Compulsory generic switching of antiepileptic
drugs: high switchback rates to branded
compounds compared with other drugs.
Epilepsia 2007; 48: 464-9.
6. Hauser WA, Kurland LT. The epidemiology of
epilepsy in Rocherster, Minnesota 1935 through
to 1967. Epilepsia 1975; 16: 1-66.
7. Berg AT, Shinner S. The risk of seizure
recurrence following a first unprovoked seizure:
a quantitative review. Neurology 1991; 41:
965-72.
8. Figures from Brainwave (The Irish Epilepsy
Association). www.epilepsy.ie. Accessed April
2009.
9. Sander JW. The incidence and prevalence
of epilepsy. Epilepsy 2007: From Cell to
Community, A Practical Guide to Epilepsy. 11th
ed (2007). Published by International League
Against Epilepsy (UK Chapter) and the National
Soc for Epilepsy. www.epilepsysociety.org.uk.
Accessed April 2009.
10. Regis J, Bartolomei F et al. Gamma knife surgery
in mesial temporal lobe epilepsy: a prospective
muticenter study. Epilepsia 2004; 45: 514-5.

500
500mg
mg

POM

POM

500mgeasier*
prolonged-release
Helps make treating Epilepsy in children

500mg prolonged-release granules

500mg
prolonged-release
granules
Sodium
Valproate and Valproic
Acid
Sodium Valproate and Valproic Acid
sanofi-aventis Ireland Ltd.
Citywest Business Campus
sanofi-aventis Ireland Ltd.
Dublin 24

Citywest Business Campus


Dublin 24

Prolonged Release1

500mg
prolongedSodium
Valproate
and Valp

Sodium Valproate a

500mg prolonged-release granules


Sodium prolonged-release
Valproate and Valproic
Acid
500mg
granules

Sodium Valproate and Valproic Acid


For oral use.

PA 540/150/7

PA 540/150/7

30 sachets
For
oral use.

Each sachet contains the eq


500mgEach
Sodium
Valproate.
sachet
contain

Sodium
Keep 500mg
out of the
reachValp
an
children.

Keep out of the r

Pleasechildren.
read the patient i
leaflet carefully before use.
the p
Use asPlease
directedread
by a doctor.
leaflet carefully
The granules
should bef
be
Use
as
directed
by
whole. Do not crush or chea
Do notThe
storegranules
above 25C.
shou

whole. Do not crush


Do not store above

30 sachets

New controlled-release formulation1


*A pharmaceutical form particularly suitable for children and adults with swallowing difficulties1,2
Epilim Chronosphere
ABBREVIATED PRESCRIBING INFORMATION
PRESENTATION
Epilim Chronosphere Prolonged Release Granules: Sachets contain: 66.60mg sodium valproate and 29.03mg valproic acid
equivalent to 100mg sodium valproate; 166.76mg sodium valproate and 72.61mg valproic acid equivalent to 250mg sodium
valproate; 333.30mg sodium valproate and 145.14mg valproic acid equivalent to 500mg sodium valproate; 500.06mg sodium
valproate and 217.75mg valproic acid equivalent to 750mg sodium valproate; 666.60mg sodium valproate and 290.27mg valproic
acid equivalent to 1000mg sodium valproate.
INDICATIONS
Treatment of generalised, partial or other epilepsy. Treatment and prevention of mania associated with bipolar disorders.
DOSAGE AND ADMINISTRATION
Dosage in Epilepsy: Initially 10-15 mg/kg/day. Titrate to 30mg/kg/day (children) or 20-30mg/kg/day (adults).
Dosage in Bipolar Disorder: Initially 20 mg/kg/day. Adjust according to individual response. Recommended daily dose 1,000
2,000mg (max 3,000mg).
May be given once or twice daily. Adjust dose in renal impairment and in the elderly.
Administration: Granules should be sprinkled on a small amount of cold or room temperature soft food or liquid. If taken in liquid, the
glass should be rinsed afterwards with a small amount of water and this should be taken as well. Granules should not be crushed or
chewed. A mixture of granules with soft food or liquid should not be stored for future use. Granules should not be sprinkled on warm
or hot foods or liquids. Granules can be poured directly into the mouth and washed down with a cold liquid. Granules should not be
given in babies bottles as they can block the nipple. Valproic acid plasma levels should be considered when adequate seizure control
is not achieved, or when adverse effects are suspected, [reported therapeutic level is 40-100 mg/L (300-700 mol/L)].
CONTRAINDICATIONS
Active liver disease, family or personal history of severe hepatic dysfunction, especially drug related. Porphyria.
PRECAUTIONS
Hepatic dysfunction: liver function tests advised before therapy and during the first six months, especially in patients at risk or with a
history of liver disease. Blood cell count, bleeding time and coagulation tests advised before therapy to avoid bleeding complications.
Pancreatitis, especially in young children. Hyperammonaemia: metabolic tests advised before therapy in those at risk. Systemic
lupus erythematosus. Risk of weight gain. Discontinuation should be done under the supervision of a specialist. Monotherapy is
recommended in children under 3 years but risks should be considered. May cause false positives in urine testing for diabetes.
Women of childbearing potential. Suicidal ideation and behaviour have been reported in patients treated with antiepileptic agents
in several indications. Therefore patients should be monitored for signs of suicidal ideation and behaviours and advised to seek
medical advice should signs emerge.
INTERACTIONS
Epilim affects the following drugs: antipsychotics, MAOIs, antidepressants, benzodiazepines, phenobarbital, primidone, phenytoin,
carbamazepine, lamotrigine, zidovudine, vitamin K-dependent anticoagulants.
Drugs which affect Epilim: phenytoin, phenobarbital, carbamazepine, felbamate, mefloquine, chloroquine, highly protein bound
agents (e.g. aspirin), cimetidine, erythromycin, carbapenem antibiotics, colestyramine.
Other interactions: Caution advised when using Epilim with newer anti-epileptics.

USE IN PREGNANCY AND LACTATION


Women of childbearing potential: should receive specialist neurological advice of the risks and benefits of continuing anti-epileptic
medication throughout pregnancy. Anticonvulsant monotherapy is preferable in divided doses at lowest effective dose. Epilim should
not be discontinued during pregnancy without assessment of the benefits versus risks.
Risk in the neonate: Rare reports of haemorrhagic syndrome (related to hypofibrinaemia) in neonates whose mothers received
sodium valproate during their pregnancy. Afibrinaemia has also been reported and may be fatal. Neonatal platelet counts, fibrinogen
plasma levels and coagulation status should be fully investigated.
Lactation: Epilim is excreted in breast milk in concentrations between 1 to 10%.
SIDE EFFECTS:
Occassional: congenital and familial/genetic disorders, transient GI disorders, sedation, dose-related ataxia, fine postural
tremor, increased alertness, aggression, hyperactivity, hyperammonaemia, thrombocytopenia, transient hair loss, amenorrhoea,
dysmenorrhoea, vasculitis, allergic reactions, increased weight.
Rare: hepato-biliary disorders, lethargy, confusion, stupor, hallucinations, convulsions, anaemia, leucopenia, pancytopenia,
cutaneous reactions, hearing loss. Very rare: pancreatitis, encephalopathy, coma, reversible parkinsonism/dementia/cerebral
atrophy, hyponatraemia, reduction in fibrinogen, reversible increase in bleeding time, spontaneous bruising or bleeding, toxic
epidermal necrolysis, Stevens-Johnson syndrome, erythema multiforme, gynaecomastia, reversible Fanconis syndrome, enuresis,
non-severe peripheral oedema.
PHARMACEUTICAL PRECAUTIONS: Do not store above 25C.
PACK QUANTITY: 30 sachets
LEGAL CATEGORY: POM
MARKETING AUTHORISATION HOLDER: sanofi-aventis Ireland Ltd., Citywest Business Campus, Dublin 24.
MARKETING AUTHORISATION NUMBERS: PA 540/150/5 (100mg), PA 540/150/6 (250mg), PA 540/150/7 (500mg), PA 540/150/8
(750mg), PA 540/150/4 (1,000mg).
Further information is available from: sanofi-aventis Ireland Ltd., 18 Riverwalk, Citywest Business Campus, Dublin 24 or contact
IEmedinfo@sanofi-aventis.com, Tel.: (01) 4035600. Please refer to the Summary of Product Characteristics which can be found on
IPHA @ http://www.medicines.ie/ before prescribing. Information about adverse event reporting can be found at www.imb.ie.
Adverse events should be reported to the sanofi-aventis Drug Safety Department.
Date of preparation: January 2009.

New controlled-release formulation

IE.EPI.09.03.03.

Date of preparation: March 2009.

References
1. Epilim Chronosphere Summary of Product Characteristics December 2008
Available in Ireland in the strengths 100mg, 250mg, 500mg, 750mg & 1000mg
2. Motte J. et al. Arch Pediatr. 2005 Oct; 12(10):1533-9. Acceptability and
safety of sodium valproate, a new prolonged-release granule formulation,
in monotherapy for epileptic children from 3 years of age.

product news
Actavis launches Fostolin and Klaram
Actavis Ireland has added to its growing list of generic treatments available
on the Irish market. Fostolin, a treatment for post menopausal osteoporosis
and Klaram, an antibiotic indicated for several different types of infections
have been launched by Actavis. Both will be available for prescription on
1st May. The introduction of these drugs could provide a potential saving of
4.8 million to the Irish market.
Tony Hynds, CEO of Actavis Ireland said, The launch of Fostolin and
Klaram marks another milestone in the growth of generic treatments in
Ireland. The growth of generic medication means more choice and value for
prescribers and patients as well as the potential for considerable savings.
Actavis is dedicated to opening up the generics market in Ireland.
Fostolin is indicated in the treatment of post menopausal osteoporosis
and reduces the risk of vertebral and hip fractures. Fostolin is the least
expensive Alendronate available and is up to 50 per cent savings compared
to the innovator . Alendronate is the first choice treatment for osteoporosis.
The introduction of Fostolin could create savings of 3.9 million for the Irish
market.

Klaram is an antibiotic indicated for several symptoms including


respiratory tract infections, skin and soft tissue infections, disseminated or
localised mycobacterial infections. Klaram is up to 40 per cent less expensive
than the innovator. The introduction of Klaram could create a saving of
928,000 to the Irish market.
Actavis is a leading generic pharmaceutical company with operations in
over 40 countries. Globally the company has built a strong reputation for
the production and efficient delivery of first class generic pharmaceuticals
at affordable prices. There are currently over 830 Actavis products on the
market worldwide and there are over 350 products under development and
pending registration. These products are currently sold in markets all over
the globe including the EU, US and Japan. It has had significant growth since
it was established in 1999 when it employed just 146 people. Currently it
employs 10,500 globally. Actavis Ireland is based in Cork. So far Actavis has
launched the oncology treatment Gemcitabine, Percarnil for cardiovascular
treatment and Donecept for Alzheimers disease to further enhance the
existing range available to the Irish market.

38

issue 5 volume 11 MAY 2009

No increased risk of treatmentinduced augmentation in RLS


in study with Mirapexin/Sifrol
(pramipexole)
New data presented today at the 61st Annual Meeting of the American
Academy of Neurology (AAN), show that augmentation did not
significantly differ in RLS patients treated with Mirapexin/Sifrol
(pramipexole) versus the group receiving placebo. Augmentation, i.e.
the worsening of RLS symptoms due to pharmacological treatment,
has been frequently observed in patients treated with levodopa,
a dopaminergic agent sometimes used to treat RLS. Existing data
for pramipexole, a non-ergot dopamine agonist, suggested that
augmentation is less frequent and less severe than with levodopa,
however, until now there had been no well designed study to compare
the frequency of augmentation under pramipexole versus placebo.
Although the phenomenon of augmentation in RLS has been widely
recognised by RLS experts, there was a lack of placebo-controlled
studies to differentiate the potential impact of the active drug in
causing symptoms worsening. Because of its already established safety
and efficacy profile in the treatment of RLS, pramipexole was used as
study drug for this trial. The results showed that the risk of developing
augmentation for RLS patients using pramipexole was comparable to
that of those who received a placebo, said Birgit Hgl, MD, assistant
professor of neurology, head of the Sleep Disorders Clinic at the
Medical University of Innsbruck, Austria and lead author of the study.
Overall, the data presented at AAN reaffirm the favourable safety,
efficacy and tolerability profile of pramipexole over the long term for
the treatment of restless legs syndrome in patients with moderate to
severe symptoms.

New study results support


once daily, prolonged release
formulation of Mirapexin/Sifrol
(pramipexole) for Parkinsons
First data showing outcomes of two double-blind studies investigating
the efficacy, safety and tolerability of Mirapexin/Sifrol (pramipexole)
in a prolonged release, once daily formulation, for the trea tment of
Parkinsons disease (PD), were presented at the American Academy of
Neurology Annual Meeting (AAN) in Seattle.
The first study compared the efficacy, safety and tolerability of
pramipexole prolonged release versus pramipexole immediate release
and placebo, in patients with early PD treated for up to 33 weeks. A
confirmatory statistical analysis conducted at week 18 demonstrated
that the pramipexole prolonged release formulation was superior to
placebo and had a comparable efficacy to the pramipexole immediate
release formulation, at the same daily dosage. A descriptive statistical
analysis showed maintenance of efficacy after 33 weeks of treatment
compared to 18 weeks of treatment in both pramipexole groups, while
placebo patients worsened from week 18 to week 33.
The second study, also conducted in patients with early PD, assessed
the efficacy and safety of an overnight switch from pramipexole
immediate release to a pramipexole prolonged release formulation, at
the same daily dose. The study showed that 84.5 percent of patients
were switched successfully from pramipexole immediate release to
pramipexole prolonged release (a successful switch was defined as
no worsening by more than 15 percent from baseline in the Unified
Parkinsons Disease Rating Scale (UPDRS) II+III score and no drugrelated adverse events leading to discontinuation).

for the treatment of Parkinsons Disease

Managing movement
and more

Prescribing Information Irl (PD indication only)


Mirapexin (pramipexole) Presentation: Mirapexin 0.088mg, Mirapexin
0.18mg and Mirapexin 0.7mg tablets containing 0.125mg, 0.25mg and
1mg respectively of pramipexole salt [dihydrochloride monohydrate].
Indications: The treatment of the signs and symptoms of idiopathic
Parkinson's disease (PD), alone (without levodopa) or in combination
with levodopa. Also indicated for symptomatic treatment of moderate to
severe idiopathic Restless Legs Syndrome (RLS); for full information on
RLS please refer to the SPC. Dosage and Administration: Adults. PD:
Administration: Give tablets orally with water in equally divided doses
three times per day. Initial treatment: 3 x 0.088mg base (3 x 0.125mg
salt) per day for first 5-7 days. Then 3 x 0.18mg base (3 x 0.25mg salt) per
day for 5-7 days, and then 3 x 0.35mg base (3 x 0.5mg salt) per day for
5-7 days. Increase the daily dose by 0.54mg base (0.75mg salt) at weekly
intervals to a maximum dose of 3.3mg base per day (4.5mg salt per day)
if necessary. Incidence of somnolence is increased at doses higher than
1.05mg base per day (1.5mg salt per day). Maintenance treatment
should be in the range of 0.264mg base (0.375mg salt) to a maximum of
3.3mg base (4.5mg salt) per day. Adjust dose based on clinical response
and tolerability; reduce dose of levodopa used in titration and
maintenance phases if necessary. Treatment discontinuation: Abrupt
discontinuation of dopaminergic therapy can lead to the development of
neuroleptic malignant syndrome. Reduce dose by 0.54mg base (0.75mg
salt) per day to 0.54mg base per day (0.75mg salt per day). Thereafter
reduce dose by 0.264mg base (0.375mg salt) per day. Renal impairment:
See SPC for revised dosage schedules. Hepatic impairment: Dose
adjustment in hepatic failure is probably not necessary. Children and

adolescents up to 18 years: Safety and efficacy not established. Contraindications: Hypersensitivity to pramipexole or any other component of
the product. Warnings and Precautions: Reduce dose for PD in renal
impairment. Inform patients that hallucinations (mostly visual) can
occur. Somnolence and, uncommonly, sudden sleep onset have been
reported; patients who have experienced these must refrain from driving
or operating machines. (A reduction of dosage or termination of therapy
may be considered). If dyskinesias occur in combination with levodopa
during initial titration of pramipexole in advanced PD, the dose of
levodopa should be reduced. Patients and caregivers should be aware
that behavioural changes can occur (e.g. pathological gambling,
increased libido and hypersexuality). Impulse control disorders such as
binge eating and compulsive shopping may occur. Dose reduction or
discontinuation should be considered. Patients with psychotic disorders
should only be treated with dopamine agonists if the potential benefits
outweigh the risks. Ophthalmologic monitoring is recommended at
regular intervals or if vision abnormalities occur. In case of severe
cardiovascular disease, care should be taken. It is recommended to
monitor blood pressure, especially at the beginning of treatment, due to
the general risk of postural hypotension associated with dopaminergic
therapy. Drug Interactions: There is no pharmacokinetic interaction with
selegiline and levodopa. Inhibitors of the cationic secretory transport
system of the renal tubules such as cimetidine and amantadine may
interact with pramipexole resulting in reduced clearance of either or both
drugs. Consider reducing pramipexole dose when these drugs are
administered concomitantly. The dosage of levodopa should be reduced,
and other PD medication kept constant, while increasing the dosage of

pramipexole. Caution with other sedating medication or alcohol due to


possible additive effects. Coadministration of antipsychotic drugs with
pramipexole should be avoided. Pregnancy and Lactation: Effects of
pramipexole in human pregnancy or lactation have not been studied.
Pramipexole should not be used in pregnancy unless the benefit
outweighs the potential risk to the foetus. Pramipexole should not be
used during breast-feeding. Undesirable Effects: Frequency of events in
placebo controlled clinical trials in Parkinson's Disease includes: Very
common (1/10): nausea, dizziness, dyskinesia, hypotension and
somnolence. Common (1/100 to <1/10) amnesia, behavioural
symptoms of impulse control disorders and compulsions, restlessness,
visual disturbance including vision blurred and visual acuity reduced,
vomiting, weight decrease, constipation, fatigue, peripheral oedema,
headache, abnormal dreams, confusion, hallucinations, insomnia.
Especially at high doses seen in Parkinson's Disease, signs of
pathological gambling, increased libido and hypersexuality have been
reported, generally reversible upon reduction of dose or treatment
discontinuation. Hypotension may occur at beginning of treatment,
especially if Mirapexin is titrated too fast. See SPC for other undesirable
effects. Legal Category: POM. Marketing Authorisation Holder:
Boehringer Ingelheim International GmbH, D-55216 Ingelheim am Rhein,
Germany. Marketing Authorisation Number: Mirapexin 0.088mg x 30
tablets EU/1/97/051/001; Mirapexin 0.18mg x 100 tablets
EU/1/97/051/004; Mirapexin 0.7mg x 100 tablets EU/1/97/051/006.
Further information is available from Boehringer Ingelheim Ireland Ltd.,
Corrig Court, Corrig Road, Sandyford Business Estate, Dublin 18. Date of
preparation: February 2009.

2008-MPX-010

product news
Circadin: Irelands first melatonin
agent now available
In a recent survey, nearly 60 per cent of Irish GPs questioned, occasionally
have trouble sleeping. Of this number, 20 per cent experience trouble
sleeping at least once a week. This independent GP research was
commissioned by Lundbeck to mark todays official launch of Circadin,
the first in class melatonin based sleep agent for the treatment of primary
insomnia available in Ireland. Circadin is indicated as monotherapy for the
short-term treatment of primary insomnia characterised by poor quality
of sleep in patients who are aged 55 or over. Clinical evidence reveals that
patients prescribed Circadin do not experience withdrawal symptoms
or dependency as have been experienced by patients using older sleep
medications. Furthermore, to mark the launch, a new website www.sleepwell.ie dedicated to sleep awareness was also unveiled today.
Circadin is a prolonged-release melatonin formulation. It releases
melatonin gradually over 8-10 hours, mimicking the bodys natural release
of melatonin, which encourages natural, restorative sleep, having no effect
on next day functioning.
In the GP survey, when questioned about the reasons for sleep problems,
nearly 55 per cent of GPs reported that work stress was the primary factor
followed by family problems (27 per cent). Financial problems were cited
by only 4.5 per cent. Nearly 80 per cent of respondents reported that the
current economic climate has made no difference to their sleep patterns.
Of those GPs who suffer from sleep problems, just under 7 per cent
thought that there was nothing that could be done to improve sleep. Nearly
23 per cent reported they knew what to do. When it came to proposing
solutions to help regulate sleep, the largest per centage of GPs suggested
going to bed earlier (19 per cent). This was followed by more exercise,
establish regular times for bed and getting up. Five per cent of GPs
mentioned melatonin as a way to improve sleep with only over 1 per cent
highlighting sleeping tablets.
Patients experiencing insomnia can find further information on sleep
disorders and ways of managing their sleep better on www.sleep-well.ie.
A leaflet on Insomnia is available by calling Lundbeck (Ireland) Ltd on
(01) 4689800

Creon 40,000 Capsules


Solvay Healthcare has announced the launch of Creon 40,000 in Ireland.
Creon 40,000 is indicated
for pancreatic exocrine
insufficiency. Pancreatic
exocrine insufficiency is
common in Pancreatic
disorders. Creon 40,000
offers simplicity and
convenience for patients
requiring higher doses.
Creon 40,000 reduces
the number of capsules
required and enhances
patient compliance.
Creon 40,000 capsules
are available in a
100 pack and is GMS
reimbursable. Creon
10,000, Creon 25,000
and Creon for children
continue to be available.

40

issue 5 volume 11 MAY 2009

Aloclair an efficacious and safe


alternative to Bonjela and Teejel Gel for
children under 16 years of age
Aloclair offers soothing pain relief from mouth ulcers and minor oral
lesions for ALL ages and contains NO salicylate salts.
Given the recent warning from the MHRA* in the UK that products
containing salicylate salts should not b used in those under 16 because of
the risk of Reye-s syndrome, parents and healthcare professionals will now
be looking for an effective and safe alternative.
Aloclair has a unique non-stinging, soothing actions which relieves the
pain of mouth ulcers within minutes and lasts for up to 6 hours Is alcoholfree formula means it doesnt sting on application and it comes in a
convenient applicator, making it easier to give to young children.
Aloclair contains soothing natural aloe vera extract, which alleviates
the pain and stop irritation, and moisturising hyaluronic acid. It works by
forming an invisible barrier over the sore area and gently adheres to the
insides of the mouth, quickly soothing a range of conditions such as, mouth
ulcers, minor oral lesions and irritation caused by braces.
The Aloclair range includes a rinse and spray and is available from
pharmacies nationwide.
For more information, please visit www.aloclair.com
The recommended retail price of the Aloclair range:


Aloclair Rinse 60ml


Aloclair Rinse 120ml
Aloclair Spraiy 15ml

5.99
8.99
4.99

Pinewood Healthcare launches Efaxil


XL 75mg & 150mg
Pinewood Healthcares commitment to provide the Irish market with quality
brands continues with the launch of Venlafaxine marketed under the brand
Efaxil XL 75mg & 150mg Prolonged Release Capsules.
Efaxil XL is indicated for the treatment of depressive illness, including
depression accompanied by anxiety and following an initial response, for
the prevention of relapses of the initial episode of depression or for the
prevention of the recurrence of new episodes. Efaxil XL is GMS reimbursable
and is available in the following presentations:
Efaxil XL 75mg Prolonged Release x 28 Capsules
GMS Code: 22603
Efaxil XL 150mg Prolonged Release x 28 Capsules
GMS Code: 22618

26.06
43.95

Pinewood Healthcare is a wholly owned subsidiary of Wockhardt Limited


and is the leading branded generic pharmaceutical company in Ireland.
With a state of art manufacturing facility in Ballymacarbry, Clonmel,
Pinewood is the largest employer among the generic companies in
Ireland employing over 350 employees. Pinewood markets a wide range
of products in Ireland and continually strives to provide the Healthcare
Industry with new products.
For further information relating to Efaxil XL or any product from the
Pinewood Healthcare range please contact 1850 207 207 or email info@
pinewood.ie.

Cir
c
rei adin
mb is
urs no
ab t
le

New Circadin
Feel the difference of

Natural Sleep

Circadin improves

Quality of sleep1,2
Morning alertness1
Quality of life and daytime well-being1

NO WITHDRAWAL SYMPTOMS OR DEPENDENCY


Abbreviated Prescribing Information: For full prescribing information refer to the Summary of Product Characteristics. Name:

2,3,4

& Common ( 1/100 to <1/10): No reactions listed; Uncommon (1/1,000 to <1/100): Irritability, Nervousness, Restlessness,

Circadin 2 mg prolonged-release tablets. Active Substance: Melatonin. Indication: Monotherapy for the short-term treatment of

Insomnia,Abnormal Dreams, Migraine, Psychomotor hyperactivity, Dizziness, Somnolence,Abdominal pain, Constipation, Dry mouth,

primary insomnia characterised by poor quality of sleep in patients aged 55 or over. Dosage and Administration: 2 mg taken orally

hyperbilirubinaemia, hyperhidrosis, asthenia, weight increased; Rare (1/10,000 to <1/1000): herpes zoster, leukopenia,

once daily, 1-2 hours before bedtime and after food. This dosage should be continued for 3 weeks. Children and adolescents: Not

thrombocytopenia, hypertriglyceridaemia, mood altered, aggression, agitation, crying, early morning awakening, libido increased,

recommended. Reduced renal/hepatic function: Caution is advised when administered to patients with renal impairment. Not

memory impairment, disturbance in attention, poor quality sleep, visual acuity reduced, vision blurred, lacrimation increased,

recommended in patients with hepatic impairment. Contraindications: Hypersensitivity to the active or the excipients. Pregnancy

vertigo positional, hot flush, gastrointestinal disorder, gastrointestinal upset, vomiting, bowel sounds abnormal, flatulence, salivary

and Lactation: Not recommended. Precautions: Circadin may cause drowsiness, therefore it should be used with caution if the

hypersecretion, halitosis, hepatic enzyme increased, liver function test abnormal, laboratory test abnormal, eczema, erythema, rash

effects of drowsiness are likely to be associated with a risk to safety. Circadin has moderate influence on the ability to drive and

pruritic, pruritus, dry skin, nail disorder, night sweats, priapism, fatigue. Overdose: If overdose occurs, drowsiness is to be expected.

use machines. Not recommended for use in patients with autoimmune diseases, patients with rare hereditary problems of galactose

Clearance of the active substance is expected within 12 hours after ingestion. No special treatment required. Elimination: Primarily

intolerance, the LAPP lactase deficiency or glucose-galactose malabsorption. Interactions: Melatonin may induce CYP3A isoenymes,

by renal excretion of metabolites. Legal Category: POM. Marketing Authorisation Holder: RAD Neurim Pharmaceuticals EEC

thus may give rise to reduced plasma concentrations of concomitantly administered drugs metabolised by CYP3A. Melatonins

Limited, 6 Fortuna Court, Calleva Park, Aldermaston, Berkshire RG7 8UB, United Kingdom. Marketing Authorisation

metabolism is mainly mediated by CYP1A enzymes. Caution should thus be exercised with concomitant use of CYP1A inhibitors

Numbers: EU/1/07/392/001-002. Further information may be obtained from: Lundbeck (Ireland) Ltd., 7 Riverwalk, Citywest

(e.g. quinolones-CYP1A2 inhibitors), CYP1A inducers (e.g. carbamazepine and rifampicin- CYP1A2 inducers) and with cigarette

Business Campus, Citywest, Dublin 24. Tel (01) 4689800 References: 1.Wade et al (2007), Current Medical Research and Opinions,

smoking due to the potential for altered melatonin levels. Caution is also advised if melatonin is taken concomitantly with

23(10): 2597-2605 2. Lemoine et al (2007), J Sleep Res, 16:373-3802. 3. Wade et al (2008),Aging Health, 4(1):11-21

fluvoxamine, 5- or 8-methoxypsoralen, CYP2D inhibitors e.g. cimetidine, oestrogens (e.g. contraceptive or hormone replacement

4. www.emea.europa.eu/humandocs/PDFs/EPAR/circadin/H-695-en6.pdf 5. Circadin Summary of Product Characteristics.

therapy). Caution is advised with concomitant use of alcohol, benzodiazepine and non-benzodiazepine hypnotics (e.g. zalepon,

Date of Preparation: September 2008.

zolpidem and zopiclone).

No clinically significant pharmacokinetic interactions were found with coadministration of

thioridazine/imipramine. However, the combination with imipramine resulted in increased feelings of tranquility and difficulty in
performing tasks.With thioridazine increased feelings of muzzy headedness were experienced. Adverse reactions: The following
adverse reactions were reported in clinical trials and were defined as possibly, probably or definitely related to treatment. Only those
adverse events occurring in subjects at an equivalent or greater rate than placebo have been included below.Very common ( 1/10)

CA1/1/09

product news
Vichy CAPITAL SOLEIL 2009 healthy sun
glow suncare protection for all skin
types, Children and Adults
New launches 2009
Capital Soleil Adult
Multi-Positional Spray
SPF30 (RRP: 19.50)
A multi-positional spray
offering ultra-quick
application in a nongreasy, no white streaks
texture.
Capital Soleil Hydra
Milk Body SPF 50+ (RRP
19.50) & Capital Soleil
Hydra Cream Face SPF
50+ (RRP 18.00) for sun
intolerant skin
Both products are suitable for
intolerant skin, offering a PPD
of 30 and come in a light nonsticky, non- greasy texture.

La Roche-Posay New Anthelios XL


Spray 50+ 200ml 22.50
protects against UVA & UVB rays
prevents cellular damage deep within
the epidermis

Vichy Capital Soleil


Technology
Dual Technology of Mexoryl
XL and Antioxidant Minerals
from Vichy Thermal Spa
Water.
Mexoryl XL is a patented
filtering system offering ultrasafe protection from both
UVA/UVB rays. The Capital
Soleil range offers broad PPD
protection, the highest being
PPD 30 which is offered in
Hydra Milk Body SPF 50+
and Hydra Cream Face SPF
50+. This is one of the highest
PPD ratings currently on the
market protecting against;
UVB rays which can cause
sunburn, skin damage and
cancer
UVA rays which can cause
oxidation, cancer and premature ageing.
The Antioxidant Minerals from
Vichy Thermal Spa Water - a key
ingredient in Capital Soleil - help
to protect cells against the effects of
free radicals, preventing UV induced
oxidation, hyper-pigmentation and
premature skin-ageing.
Capital Soleil: New Formulation
Charter
Paraben-free
Fragrance-free
Hypoallergenic
Tested under dermatological control
Available in pharmacies
nationwide from March 2009

42

issue 5 volume 11 MAY 2009

Ireland has among the


highest skin cancer
rates in Europe with
over 5,000 new cases
of the disease every
year
In Ireland, 1 in every 8
men and 1 in every 10
women will develop
skin cancer by the age
of 74 years
66 per cent of Irish
people have a higher
risk of developing Skin
Cancer because of
their skin type
90 per cent of all skin cancers are preventable. Virtually all the risk
comes from the sun and sun beds/sun lamps

*www.cancer.ie/sunsmart

New Anthelios XL 50+ Spray 200ml has


been developed with an ultra fluid fresh
texture which makes it easy to apply and
results in quick absorption. It provides
a non-sticky, non-greasy finish for long
lasting hydration +35 per cent after 4
hours. It has been created with a high
tolerance formula rich in La Roche-Posay
Thermal Spa Water which is proven to
soothe and protect. It is Fragrance-free
and Paraben-free. This is the first family
format offering in the Anthelios range.
Available in: SPF 50+/PPD 22 with a UVA
ratio: 2.3. SPF 30/PPD 15 with a UVA ratio:
1.9. SPF 20/PPD 9 with a UVA ratio: 2
La Roche-Posays sun protection range,
Anthelios XL, provides unparalleled
effectiveness and dermatological
tolerance to protect against cellular
damage caused by UV rays offering
the most effective sun protection on
the market. La Roche-Posay, the brand
of choice of 25,000 dermatologists
worldwide, has demonstrated the clinical
efficacy of Anthelios via 21 clinical studies.
The combination of patented filters
Mexoryl SX and Mexoryl XL enables
the Anthelios filtering system to ensure
efficient protection against the entire
spectrum of UVB & UVA rays; whatever
their intensity. In 2009, Anthelios XL 50+
Spray now contains Senna Alata to protect
against cellular damage deep within the
epidermis.

www.your

classifieds/crossword

issue 5 volume 11 MAY 2009

RECRUITMENT
Experienced pharmacist seeks
full-time/part-time/locum
position in Kildare,West Dublin
or Meath. Please contact: Anne
Browne on tel: 086 6038537
Experienced pharmacist
available for part-time or locum
work in the greater Dublin area.
Available Mondays,Wednesdays
and Thursdays. Please contact
Lukasz Szczepaniec on tel: 085
1476102 for further information.

Dates for your diary


14th May
Free Public lecture on
Melanoma
La Roche-Posay, are holding a
free public awareness lecture
in Royal College of Surgeons as
part of 2009 May Melanoma Skin
Cancer Awareness Month on
Thursday 14th May 18.00-19.30 to
discuss the increasing problem of
Melanoma in Ireland, how to self
check and safety in the sun.

Venue: Royal College of


Surgeons, 123 St. Stephens
Green, D 2
Room: Houston Lecture
Theatre
Date:
14th May 2009
Time: 18.00 19.30
Register your free place on:
www.BeSunAware.ie or phone
01-491 4355 during office
hours

numerous groups of people


in Ireland and their extended
families. As a means of gratitude
the Irish Guide Dogs for the
Blind have agreed to allow
sponsors to name one of
the puppies and follow their
progress throughout training.
Tee-times are being allocated
on a first-come first-served
basis. For more information on
the event or to enter a team
please contact Michelle Kurtz,
Communications and Marketing
Executive, on 01 6630934 or
email michellekurtz@ipha.ie.

Thursday, 21 May
IPHA Charity Golf Event
The 11th IPHA Annual Charity
Golf Event will take place in
the Glen of the Downs Golf
Club Delgany, Co Wicklow on
Thursday 21 May 2009 from
10.00 am to 18.00 pm. The
proceeds of this years event
will go to the Irish Guide Dogs
for the Blind. IPHA hopes to
raise in the region of 25,000
to support the training of 100
guide dogs. These dogs are
essential to the independence
and improved quality of life for

Pharmacy Xcelerate Skillnet


TRAINING EVENT DAYS:
APRIL-JUNE 2009
Galway
20 May
Course: Category
Management.
Improving pharmacy retailing
through proven category
management techniques.
Trainer: Mary Greenan.

Cost: 195.
Athlone
11 June
Course: Customer Focus.
Building customer loyalty
and gaining competitive
advantage through customer
focus.
Trainer: Mary Butler.
Cost: 195.
Dundalk
24 June
Course: Stock Control.
Improving cash flow through
stock control and the
application of retail maths.
Trainer: Mary Butler.
Cost: 195.
For more information, please
visit: http://xcelerate.ipos.ie.
Alternatively contact Emily
Ahern on Tel. 086 041 2111,
email: eahern@ipos.ie or Mary
Butler on Tel. 086 853 7425,
email: mbutler@ipos.ie
(*Price is subject to terms
and conditions.)

11 June
PSI Benevolent Fund Golf
Classic 2009
The annual Golf Classic in aid
of the PSI Benevolent Fund will
take place on Thursday, 11 June
at Newlands Golf Club in Dublin.
The entry fee of 690 per team
of three players covers green
fees, lunch on arrival and a
four-course meal for each player,
together with the opportunity
to carry off one of the many
splendid prizes on offer or, for
the first-placed team, the ICGSinitiated Benevolent Cup.

Further details available from


Cicely Roche on Tel. 086 815
8121 or email: cicelyroche@
eircom.net or Peter Finnegan
on Tel. (01) 285 4560 or email:
Finney@indigo.ie
FREE DIARY/CLASSIFIEDS
SERVICE AT IRISH
PHARMACIST
Please email your ad to
june@greencrosspublishing.ie

ip Crossword No.164
3

Across
1. Ointment gambolling as lamb (6)
4. On the flip side of the coin its an instrument! (4)
8. Jim, we hear, for a keep-fit establishment (3)
9. No particular officer? (7)
10. Hard growth encountered in war-time (4)
11. In rhyme, he simply met a pie man (5)
14. Painful kind of media aunt? (5)
16. City in a bottleneck? (4)
18. Cruet is shattered causing jaundice (7)
20. Flying saucer, initially! (3)
21. Centres of wheels in thorny bush (4)
22. Regard tern as backward at sea (6)

10

11

12

13

14

15

16

17

18

21

Name:
Address:

19

20

22

Down
1. Insects causing computer problems! (4)
2. Lob a mug awkwardly to produce back pain (7)
3. Anything in old English confuses a thug! (5)
5. Ventillate an affected manner? (3)
6. Supporters of electricity? (6)
7. Burden placed upon ourselves? (4)
12. Queer Ma demolished large tent (7)
13. Like Hamlet or his pastry! (6)
15. Tale that is spun? (4)
16. Abnormal sacs discovered in aristocracys Tsar
heritage (5)
17. Satellite reputedly made of cheese! (4)
19. But coming back, its a bath! (3)

Across:
1. fibula 4. abut 8. owl 9. disease 10. oman 11. slane 14. heard 16. drip
18. nervosa 20. ear 21. left 22. castle
Down:
1. frog 2. bulimia 3. laden 5. bra 6. teepee 7. isis 12. aliment 13. phenol
15. doom 16. drama 17. erne 19. ref

LAST MONTHS CROSSWORD ANSWERS

Congratulations to the winner of last months crossword,


Ann Barry Murphy, Walsh's Pharmacy, Unit 617, Ballincollig,
Co. Cork. For a chance to win 70, please send completed
entries: the Editor, Irish Pharmacist, GreenCross Publishing,
Lr Ground Floor, 5 Harrington Street, Dublin 8 or fax to
(01) 4789764 by 29 May, 2009.

medicines.ie
E-mail:

43

opinion
Thelmabutand
Louise
not as we know them
outside edge

he Financial Emergency Measures


legislation has given an incredible
amount of power to Mary Harney.
By the time you read this she will
have gone through the submissions
received regarding reform of the
pharmacy sector, and made a decision on what
changes to order. Or more accurately, she will
have waited just enough time from the closing
date for submissions to pretend that she read
them, and she will now have done what she was
always going to do anyway. I sincerely hope
my prediction is wrong, and that the IPU and
the Department of Health have thrashed out a
deal that we can live with, but I reckon that, as
you read this, we will be again at war with the

Minister, the HSE and the Department of Health.


Good luck.
bertie and brian
I have, at times in the past, been critical of the
Government parties. My criticism has been validated
by the economic mess that the Fianna Fail/PD alliance
has created. What is undeniable is that Bertie Ahern
and Brian Cowen have remade the ugliest ever
version of Thelma and Louise, but instead of Bertie
driving over the cliff, he handed the wheel to Biffo
before jumping clear.
We, the people, have yet to find out the finer details
of how the National Asset Management Agency will
operate. More precisely it remains to be seen how the
Government will ensure that the developers, builders

Maintain a

healthy life...

...with

The only Effervescent drink with


the power of 20 sun ripened oranges
and Glucose in every tablet
Talk to your local Pharmacist today and ask
how RUBEX can help to defend your immune
system from colds and u

44

Rubex is used for the prophylaxis and


treatment of ascorbic acid deciency.

fintan mo o re

Irish Pharmacists Fintan


Moore reviews Bertie
and Brian in a Thelma
and Louise remake
and shysters who screwed the country will escape
with as much of their loot as possible in order that
they can recapitalise Fianna Fil in future elections.
A difficult phase
However, shining like a good deed in an evil
world, I was heartened by one Fianna Fil deputys
comments regarding the Competition Authority.
At a meeting of the Oireachtas Committee on
Enterprise, Trade and Employment, Chris Andrews
said that the authority was like a 1980s skinhead
organisation who go around intimidating people
and are oblivious to the economic and social
damage they are doing. He then went on to say: I
apologise to all skinheads I have done them an
injustice.
I was glad Chris Andrews made that apology at
the end a lot of skinheads are just going through
a phase and grow up to be decent people.
Counselling the Council
The results of the Pharmaceutical Society council
elections were determined recently. I must confess
to having mixed feelings about the outcome.
I am pleased that five capable and principled
pharmacists were elected, of whom four were
community pharmacists and one was hospitalbased. It is vital that community pharmacy has
a strong voice on the council as the Pharmacy
Regulator is evolving.
However, it seems a shame that among the
unsuccessful candidates were pharmacists who
could have brought another perspective to issues.
I would like to wish the best of luck to the new
council members.
Surprise in the mail
We have all heard stories by now of toll companies
erroneously charging motorists for trips through
various toll points such as the Westlink Bridge. The
errors vary from people getting charged for trips
for which they had paid at the time of travel, or
even for trips which they had never made at all.
Broadcaster Ray DArcy was a victim of the latter
scenario, getting a letter in the post to demand
payment for a trip he could not have made because
he was on air at the time. The interesting thing
about the demands for payment, and the solicitors
letters that follow, is that they seem to put the onus
on the accused motorists to prove that they didnt
make the non-existent trips. Surely it should be up
to the tolling company to provide photographic or
other evidence of the trip before threatening legal
action.
What would be fun (and admittedly completely
puerile) to do would be get the name and address
of the managing director of the offending
company, and start mailing him invoices for
fictitious purchases. We could give him seven days
to pay the three euro owed for a pack of condoms
or else face legal action. Let him explain that to the
wife when she opens the mail!

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