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THE
INDEPENDENTmonthly
MONTHLYfor
FORIrish
IRISHPharmacists
PHARMACISTS
The
independent
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
www.yourmedicines.ie
Interview
Terry Maguire
Community
pharmacy
under attack
editorial
contents
4-12 NEWS
15-16 INTERVIEW
THE WINNER IS
20
TERRY MAGUIRE
22
DAVID JORDAN
23
LAW
24
JULIAN JUDGE
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
26
FINANCE
28
E-PHARMACY
Introducing www.yourmedicines.ie
31
SPECIAL FEATURE
32
Q&A
34
PICTURE GALLERY
44
OUTSIDE EDGE
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.
news
news
news
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.
Hospital Pharmacist
scoops Pharmacist of
the Year Award
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
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
news
news
news
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.
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.
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
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
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
2009/ADV/LAC/050
news
news
news
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
10
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
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
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
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.
Heart Foundation on 01
668 5001 or see www.
happyheartweekend.ie
www.wartner.ie
Further information available on request.
Chefaro Ireland Limited, Farnham Drive, Finglas, Dublin 11, Ireland.
Tel: 01 879 0647 E-mail: info@omega-pharma.ie
Source:
Source: IMS
IMS MAT
MAT 12/08
12/08
interview
Four decades,
three careers
in an award winning
pharmacy life
D r D es Co rrigan
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.
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.
16
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INTERVIEW
PHARMACY
AWARDS
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
Patient-Nominated Award
Excellence in Hospital Pharmacy
sponsored by Teva Pharmaceuticals sponsored by Sanofi Aventis
Claire Keane, St
Vincents Hospital,
Dublin Eva Dockery,
Sligo General Hospital
were finalists in this
category.
Dr Des Corrigan
19
opinion
opinion
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
terry m agu i re
AD Butterfly001.03.09
T 021 4619040
F 021 4619049
@ contact@actavis.ie
opinion
david jo rdan
the coalface
Mind your
language
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
LAW
Financial
Emergency Measures in the
Public Interest Bill 2009
what does it really mean for
pharmacy?
Co r m ac ON ei l l
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
j u l ian j u dg e
new
20g t
rave
avail l pack
able
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
nts
Cal
e
n
e
des
e
v
e
pr
24
2009/ADV/CAL/090
finance
k i er an m o o r e
Levy
2 per cent
4 per cent
6 per cent
26
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
www.yourmedicines.ie
June Shannon reports on a new Irish OTC website which promotes self-care and
encourages the public to attend their pharmacist.
28
of the
g term
itionally
1. Armstrong B. Epidemiology of malignant melanoma: intermittent or total accumulated exposure to the sun? J Dermatol
Surg Oncol. 14: 835-849 (1988)
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
5/2/08
15:04
Page 1
15:04
Page 1
www.thorntonross.com
www.thorntonross.com
ew
5/2/08
AFTERBURN - A REVOL
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
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)
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 major breakthrough
for minor burns
For further information, contact Thornton & Ross Ltd.
Telephone
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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
SPECIAL FEATURE
31
QA
D r J o h n Hi llery
&
32
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.
At Pinewood Healthcare,
we stand for
choice.
P I N E W O O D
HEALTHCARE
A Better choice for your patients health
picture gallery
IPU AGM
2009
Ms Liz Hoctor
Mr Bernard Duggan,
Chairman of the IPU
Emloyee Committee
GSK
alli
(orlistat 60mg)
34
clinical review
Important
decisions
in the management of
epilepsy
By Dawn O S h e a
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
500
500mg
mg
POM
POM
500mgeasier*
prolonged-release
Helps make treating Epilepsy in children
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
Prolonged Release1
500mg
prolongedSodium
Valproate
and Valp
Sodium Valproate a
PA 540/150/7
PA 540/150/7
30 sachets
For
oral use.
Sodium
Keep 500mg
out of the
reachValp
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children.
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read the patient i
leaflet carefully before use.
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Use asPlease
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directed
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Do notThe
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above 25C.
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30 sachets
IE.EPI.09.03.03.
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.
38
Managing movement
and more
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
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
40
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26.06
43.95
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Quality of sleep1,2
Morning alertness1
Quality of life and daytime well-being1
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
therapy). Caution is advised with concomitant use of alcohol, benzodiazepine and non-benzodiazepine hypnotics (e.g. zalepon,
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
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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
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PSI Benevolent Fund Golf
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The annual Golf Classic in aid
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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
medicines.ie
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43
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outside edge
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healthy life...
...with
44
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