inTervieW - Green Cross Publishing

issue 10 volume 12 novemBeR • 2010 www.greencrosspublishing.ie 

neWs 

CPD model to be 

“supportive, enabling 

and transformative” p4 

Disciplinary implications 

of failure to collect 

50 cent charge p4 

Pharmacy education 

reforms “very 

challenging” p4 

Statutory responsibilities 

of superintendent 

pharmacists p4 

Inaugural conference of 

Irish Medication Safety 

Network p6 

New award to recognise 

outstanding healthcare 

professionals p12 

EU ditches direct to 

consumer advertising 

plan p14 

MEPs plan ‘black label’ 

for high risk products p14 

The THE independenT INDEPENDENT monThly MONTHLY foR FOR iRish IRISH phaRmacisTs 

PHARMACISTS 

inTervieW 

Masters of Pharmacy 

series – ingrid Hook 

Terry Maguire 

The joy of 

respectful 

listening 

Des Corrigan 

The medicinal 

merits of 

allspice 

DaviD JorDan 

Producing 

pharmacists for 

the 'mail boat" 

FinanCe 

How safe 

are your 

investments? 

FinTan Moore 

O’Sean’s Eleven 

LeTTers Page 

Prof Weedle’s 

comments on codeine 

Made to leap from 

your shelves 

Benylin Mucus Relief. PA Number: 823/35/1. PA Holder: McNeil Healthcare(Ireland) Ltd., Airton Road, Tallaght, Dublin 24, Ireland. 

Full prescribing information available upon request. Product not subject to medical prescription. BEN/039/00

INDICATED FOR MILD TO MODERATE PAIN RELIEF 

Effective Pain Relief including: 

Headache Migraine Headache Dental Pain Period Pain Fever 

ABBREVIATED PRESCRIBING INFORMATION. Please refer to the Summary of Product Characteristics before dispensing: Buplex 200 mg Film-coated Tablets. 

Indications: Mild to moderate pain, such as headache including migraine headache, dental pain. Primary dysmenorrhoea. Fever. Dosage: Short-term use only, not 

longer than 7 days. Dose depends on the patient’s age and body weight. Tablet should be swallowed with a glass of water during or after a meal. Mild to moderate pain 

and fever: Adults and adolescents older than 12 years (≥40 kg): 200-400 mg as a single dose or 3-4 times a day every 4 to 6 hours. In migraine, 400 mg as a single dose, if 

necessary 400 mg every 4-6 hours. Maximum daily dose: 1200 mg. Children 6-9 years (20-29 kg): 200 mg 1-3 times a day every 4 to 6 hours as required. Maximum daily 

dose: 600 mg. Children 10-12 years (30-40 kg): 200 mg 1-4 times a day every 4 to 6 hours as required. Maximum daily dose: 800 mg. Primary dysmenorrhoea: Adults and 

adolescents over 12 years of age: 200-400 mg 1-3 times a day, every 4-6 hours, as required. Maximum daily dose: 1200 mg. Contraindications: Hypersensitivity, Last 

trimester of pregnancy, History of gastrointestinal bleeding or perforation related to previous NSAID therapy, Active or recurrent peptic ulcer/haemorrhage, Severe 

hepatic or renal insu� ciency, Severe heart failure or coronary heart disease, Signi� cant dehydration, Cerebrovascular or other active bleeding, Dishaematopoiesis of 

unknown origin, Children younger than 6 years of age. Warnings and Precautions: Use the lowest e� ective dose for the shortest duration necessary. Symptoms of 

an infection may be masked. Avoid concomitant use with other NSAIDs, including COX-2 inhibitors. GI bleeding, ulceration and perforation may occur with or without 

warning symptoms or previous history of GI events. Consider combination therapy with protective agents (e.g. misoprostol or proton pump inhibitors) for at risk 

patients. NSAIDS should be used with caution in patients with a history of peptic ulcer, GI bleeding, intestinal in� ammation, hepatic, renal or cardiac insu� ciency, 

hypertension, congestive heart failure, disturbed haematopoiesis, blood coagulation defects, respiratory disorders and immediately after surgical intervention. All 

patients, particularly the elderly and patients with impaired hepatic and renal function, on long term NSAID treatment should be kept under regular surveillance with 

monitoring of renal, cardiac and hepatic function and of haematological parameters. High dose and long term use may be associated with a small increased risk of 

arterial thrombotic events. Careful consideration before long term use in patients with cardiovascular disease or risk factors. Discontinue at � rst sign of skin rash, 

mucosal lesion or other sign of hypersensitivity. May impair female fertility. Strict consideration should be given to the bene� t-risk ratio in the following conditions: SLE 

or other autoimmune diseases, Congenital disturbance of porphyrin metabolism, First and second trimesters of pregnancy and Lactation. Interactions: Other NSAIDs; 

Anticoagulants; Ticlopidine; Methotrexate; Moclobemide; Phenytoin; Lithium; Cardiac glycosides; Diuretics and antihypertensives; Captopril; Aminoglycosides; SSRIs; 

Ciclosporin; Cholestyramine; Tacrolimus; Zidovudine; Ritonavir; Mifepristone; Probenecid; Sul� npyrazone; Quinolone antibiotics; Sulphonylureas; Corticosteroids; 

Anti-platelet aggregation agents; Alcohol; Bisphosphonates; Oxpentifylline; Baclofen. Side E� ects: Headache, somnolence, vertigo, fatigue, agitation, dizziness, 

insomnia, irritability, heartburn, nausea, vomiting, diarrhoea, � atulence, constipation, dyspepsia, abdominal pain, gastrointestinal ulcers, sometimes with bleeding 

and perforation, occult blood loss which may lead to anaemia, melaena, heamatemesis, ulcerative stomatitis, colitis, exacerbation of in� ammatory bowel disease and 

Crohn’s disease, complications of colonic diverticula. Shelf Life: 2 years. Pack Sizes: Blister: 12, 24 & 50 � lm-coated tablets. Marketing Authorisation Holder: Actavis 

Group PTC ehf, Reykjavikurvegi 76-78, 220 Hafnar� ordur, Iceland. Marketing Authorisation Number: PA 1380/87/1. Legal Category: Product not subject to medical 

prescription. Retail sale through pharmacies only. Further 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 Generation of API: January 2010. 

Date of Preparation: August 2010. FADHCP-02710. 

NEW

The independenT monThly foR iRish phaRmacisTs 

issue 10 volume 12 • novemBeR 2010 

4 neWs 

10 LeTTers 

Reaction to Prof Weedle’s comments on 

codeine 

14 eu neWs 

16 HerbaL MeDiCine 

The merits of Christmas cooking 

Des Corrigan 

18 inTervieW 

Masters of Pharmacy 

ingrid Hook – teaching legend 

20 THe CoaLFaCe 

Are we producing pharmacists for export? 

David Jordan 

Irish Pharmacist is published by 

GreenCross Publishing, 

7 Adelaide Court, Adelaide Road, Dublin 2. 

Tel: 01 418 9799. Fax: 01 478 9449. 

maura@greencrosspublishing.ie 

www.greencrosspublishing.ie 

Irish Pharmacist endeavours to ensure 

accuracy of information given and of 

claims made in articles and advertisements. 

Nevertheless, no responsibility is accepted 

in respect of such information or claims. 

Any opinions expressed by contributors are 

entirely their own and do not purport to be 

the views of Irish Pharmacist. 

© Copyright GreenCross 

Publishing 2010 

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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 

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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 30 years experience working in 

healthcare publishing. Their stated aim is to publish 

titles which are incisive, vibrant and pertinent to their 

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EDITOR: Maura Henderson 

DESIGn: Barbara Vasic 

REPORTER: June Shannon 

SUB-EDITOR: Tim Ilsley 

PUBlISHER: Graham Cooke 

PUBlISHER: Maura Henderson 

COnTRIBUTORS: Iain Cahill, Dr Des Corrigan, 

Garry Finnegan, David Jordan, Julian Judge, 

Fintan Moore, Terry McGuire, Cormac O’neill 

PHOTOGRAPHy: Audrey Hanley 

PRInTERS: newman Thomson ltd 

lETTERS TO THE EDITOR: 


Advertising: 

graham@greencrosspublishing.ie 

or 0872222221 

22 vieW FroM above 

listening to your ‘difficult’ clients can be 

most rewarding 

Terry Maguire 

24 LaW 

Treating children – the legal implications 

for pharmacists 

Cormac o'neill 

26 FinanCe 

How safe are your investments? 

iain Cahill 

28 CreaTive WriTing 

lefty 

Julian Judge 

Exputex 145x210 16/10/2008 10:51 Page 1 

conTenTs 

Good News 

for chesty coughs 

Exputex 

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COMPLETE WITH 

CHILD RESISTANT 

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SUGAR FREE 

✓ Non drowsy 

✓ Mentholated 

✓ 300ml - the lowest cost 

sugar free carbocisteine 

mucolytic syrup (on a ml 

per ml basis 250mg/5ml) 1 

Prescribing Information 

(Please refer to full Summary of Product Characteristics [SmPC]) 

Exputex 250mg/5ml Oral Solution 

Presentation: Carbocisteine provided as 250mg/5ml oral solution. Uses: As 

a mucolytic adjunct for respiratory tract disorders characterised by excessive 

or viscous mucous. Dosage and administration: Oral. Adults/Elderly: 

Three 5ml spoonfuls three times daily initially. Reduce to two 5ml spoonfuls 

three times daily when a satisfactory response has been obtained. Children: 

6-12 years: 5ml spoonful (250mg) two to three times daily. 2-5 years: Half a 

5ml spoonful (125mg) two to three times daily. Under 2 years: Not recommended. 

Contraindications: Hypersensitivity, patients with known active 

peptic ulceration. Special Warnings and Precautions: Patients with a history 

of peptic ulceration, avoid in patients with active ulceration, patients on a 

controlled sodium diet. Contains parahydroxybenzoates (E215, E217 and 

E219), sunset yellow FCF (E110) and ethanol. Interactions: None listed. 

Pregnancy and Lactation: Not recommended. Undesirable Effects: 

Nausea, headache, gastrointestinal upset and skin rash. Overdose: No 

experience. Serious effects not expected. Legal category: S1B(E) Product 

Authorisation number: PA 488/14/1. Product Authorisation holder: 

30 e-PHarMaCy 

Depression – new campaign – something 

to sing about 

June shannon 

32 Case sTuDy 

Cluster headache in a 24 year old woman 

Dr edward M o'sullivan 

34 ProDuCTs 

38 CrossWorD 

38 CLassiFieDs anD 

reCruTiMenT 

40 ouTsiDe eDge 

O’Sean’s Eleven 

Fintan Moore 

Monmouth Pharmaceuticals Limited, Hampshire International Business Park, 

Chineham, Basingstoke, Hampshire, RG24 8EP, UK. Distributed by: Cahill 

May Roberts, Pharmapark, Chapelizod, Dublin 20. Further information is 

available from: Shire Pharmaceuticals Limited, Hampshire International 

Business Park, Chineham, Basingstoke, Hampshire, RG24 8EP, UK. Tel: +44 

1256 894000. Date of revision: June 2008. Exputex is a registered trademark 

of Shire US Inc. in Ireland. 

Adverse events should be reported to the Pharmacovigilance Unit 

at the Irish Medicines Board (IMB) (imbpharmacovigilance@imb.ie). 

Information about adverse event reporting can be found on the IMB 

website (www.imb.ie). Adverse events may also be reported to 

Shire Pharmaceuticals Ltd on +44 1256 894000. 

MONMOUTH 

P H A R M A C E U T I C A L S 

Monmouth Pharmaceuticals Ltd, 

Hampshire International Business 

Park, Chineham, Basingstoke, Hants 

RG24 8EP 

1 MIMS May 2008 Date of preparation: October 2008 IRE/EXP/08/0001

4 

news 

The PSI and the Irish Centre 

for Continuing Pharmacuetical 

Education (ICCPE) are to 

hold a number of information 

meetings for superintendent 

pharmacists to advise them on 

their statutory responsibilities 

under the 2007 Pharmacy Act. 

The meetings, which will 

take place at a number of 

locations around the country 

later this month and in early 

December, are also intended 

to facilitate a dialogue with 

superintendent pharmacists 

and to clarify any issues or 

concerns they may have. 

Attendants will also hear 

about the development of 

new resource material for the 

training and development of 

superintendent pharmacists, 

who have a key professional, 

clinical and strategic role in 

the management and operation 

of pharmacies. 

The ICCPE has also recently 

launched its autumn 2010 

educational programme that 

includes a number of important 

lectures specifically 

designed for pharmacists. 

Theses include: Men’s health, 

Schizophrenia, Challenging 

Behaviour, Making Medicines 

Management Safer, High 

Tech Medicines, and needle 

Exchange. 

For more information please 

see: www.iccpe.ie 


irish CPD model: "supportive, enabling, and transformative" 

THE PSI is planning to host a 

number of Continuing Professional 

Development (CPD) information 

meetings for pharmacists 

around the country in the new 

year Irish Pharmacist reports. 

The meetings, which are 

planned for late January/early 

February 2011, aim to inform and 

advise pharmacists about the 

PSI’s new CPD model for Irish 

pharmacists which was launched 

by the Minister for Health last 

month. 

Under the 2007 Pharmacy 

Act all pharmacists on the PSI 

register must be compliant with 

the new CPD system of lifelong 

learning by 2014. 

The Review of International CPD 

Models was one of two reports 

commissioned by the PSI and 

launched by the Minister on the 

15th October last, which form 

part of a new framework of 

education and training for Irish 

pharmacists. 

The report’s vision of a CPD 

system for pharmacists in Ireland 

is one, which is focused on patient 

safety, assures competency 

across the profession to meet 

patient needs and demonstrates 

this competency to others. 

According to the report the 

new CPD model will provide for 

a mechanism to allow for innovation 

and development in the role 

of the pharmacist. The system 

will also be supportive, enabling 

and transformative and one that 

meets personal and professional 

needs. It will also be flexible, 

user-friendly, contemporaneous 

and recognised by pharmacists 

Ms Deanna Williams, registrar of the ontario College of 

Pharmacists, spoke about the merits of the ontario CPD 

model. 

as helping to support the way 

in which they practise. The new 

report envisions a system that 

rewards learning by professionals 

and provides internationally 

recognised accreditation as well 

as encouraging and supporting 

engagement with other healthcare 

professionals. 

Speaking at the launch Professor 

Paul Gallagher, Chair of the 

Professional Development and 

learning Committee of the PSI, 

said that the new CPD framework 

should become an integral 

part of a healthcare professional’s 

practice experience. 

“The new system has been 

determined by the Council of 

the PSI, on the basis of best 

international practice and experience 

and following a thorough 

consultation with pharmacists 

and other key stakeholders. 

There is no doubt that there is 

solid support for this new CPD 

system. Pharmacists are anxious 

to expand on the services they 

provide and to provide the best 

possible care to their patients 

and to the public.” 

Ms Deanna Williams, Registrar 

of the Ontario College of Pharmacists, 

was also present at the 

announcement and outlined the 

merits of the new CPD model, 

which is based on a template 

that has existed in Ontario since 

1997. Ms Williams said that the 

effectiveness of the Ontario 

CPD model for pharmacists was 

reflected in its roll out across 

other healthcare professions in 

the region. 

At the launch the PSI also 

unveiled its new Tutor Training 

and Accreditation Programme 

(TTAP), an innovative programme 

that has been developed 

by the RCSI on behalf of 

the PSI to train and accredit tutor 

pharmacists who oversee the 

workplace training of pharmacy 

interns. 

Pharmacy education reforms will be “very challenging” to implement 

The recently announced pharmacy 

education reforms which 

will see the current 4+1 model 

of pharmacy education replaced 

by an integrated five-year programme 

will be “very challenging 

to implement” in the current 

economic climate the Head of 

the School of Pharmacy at TCD 

has said. 

Commenting on the reforms, 

which were announced by the 

Minister for Heath last month 

Professor Marek Radomski said 

that while the proposals were 

“groundbreaking” they would 

be “very challenging to implement.” 

According to Prof Radomski 

the current economic climate 

across Ireland has not escaped 

higher education and Irish 

pharmacy programmes have 

become “chronically underfunded.” 

“The budget for the School 

of Pharmacy and Pharmaceutical 

Sciences has been reduced 

over the past two years. We’ve 

managed to weather the storm 

by the hard work and dedication 

of our staff but resources 

are now stretched to breaking 

point. While we are enthusiastic 

about the delivery of a new programme 

we are acutely aware 

of the necessity for adequate resourcing 

of undergraduate cur- 

Psi/iCCPe meetings on role of 

superintendent pharmacists 

ricula. As a result, I believe that 

these new reforms in pharmacy 

education will be difficult to 

implement without concomitant 

changes in the funding of Irish 

higher education. The School 

of Pharmacy and Pharmaceutical 

Science looks forward to 

working together with government, 

PSI and other educational 

institutions to ensure the future 

success of our students and 

schools”. 

According to the TCD School 

of Pharmacy the new curriculum 

“will better integrate academic 

studies with pharmaceutical 

practice and experience from 

the beginning, allowing stu- 

dents to get the hands-on experience 

they’re currently lacking.” 

The national Pharmacy Forum 

will oversee the implementation 

of this new programme across 

the three schools of pharmacy in 

TCD, UCC and RCSI. 

The TCD School said that 

it “embraces these proposed 

changes” championed by the 

PSI. “Trinity recognises that these 

plans are founded on the most 

progressive trends in undergraduate 

pharmacy education worldwide. 

This new programme will 

enable students to be on top 

of the latest pharmaceutical 

studies and research while at the 

same time getting the hands on 

patient care experience that is 

crucial for practising pharmacists.” 

Pharmacists legally obliged to collect 50 cent prescription charge 

Pharmacists who fail to collect 

the controversial 50 cent 

prescription charge as mandated 

by the Minister for Health may be 

subject to disciplinary proceedings 

the PSI has warned. 

According to a letter sent by 

the PSI to all pharmacists, the 

Society notes that it has “received 

a large number of queries in 

relation to the requirement on 

the part of community pharmacy 

contractors to collect the 

prescription levy introduced by 

the Health (Amendment) (no. 2) 

Act 2010.” 

In the letter the PSI explains 

that as of 1st October 2010 “it is a 

legal requirement for a community 

pharmacy contractor to 

collect the levy of €0.50 per item 

dispensed under the Medical 

Card Scheme.” 

Prof Marek radomski 

“A failure to collect the prescription 

levy is a breach of this 

legislation and it should be noted 

that all pharmacists are obliged 

to “comply with all relevant laws, 

regulations, rules, professional 

standards” (Principle 3 of the 

Code of Conduct for Pharmacists) 

and also to “practise within relevant 

legislative and professional 

regulatory guidance” (Principle 

4 of the Code of Conduct for 

Pharmacists). Any pharmacist 

who fails to collect this levy in accordance 

with this legislation may 

be subject to disciplinary process 

under Part 6 of the Pharmacy Act 

2007,” the PSI stated. 

The disciplinary process under 

part 6 of the Pharmacy Act forms 

part of the complaints, inquiries 

and discipline process. Where a 

formal complaint is made about a 

pharmacist this would be initially 

considered by the PSI’s Preliminary 

Proceedings Committee 

and then progressed through the 

process in accordance with the 

legislation. 

Meanwhile the President of 

the IPU Mr Darragh O’loughlin 

last month criticized the HSE for 

its failure to communicate to the 

public about the introduction of 

the new levy 

In terms of the implementation 

of the levy he said: “Pharmacists 

are opposed to the levy; 

however, we are legally obliged 

to collect it on behalf of the HSE. 

We would encourage patients to 

continue taking their medicines 

as prescribed. If people have any 

questions on their medication, 

they should drop in to their local 

pharmacist for advice.”

NEW 

Won’t irritate your stomach like ibuprofen might 

Soluble is the fastest growing segment in adult analgesics** 

*When compared to standard Paracetamol, Panadol Extra Soluble can give 30% more pain relieving power. 

CONTAINS PARACETAMOL. ALWAYS READ THE LABEL/LEAFLET. **Source IMS OTCIRL MAT AUG 2010. 

Abbreviated prescribing information: Please consult the summary of product characteristics for full prescribing information. Product 

information for Panadol Extra 500mg/65mg Soluble Effervescent Tablets. Composition Each tablet contains Paracetamol 500mg and 

Caffeine 65mg. Therapeutic Indications The tablets are recommended for use as an analgesic in the relief of mild to moderate pain such as 

is associated with rheumatism, neuralgia, musculoskeletal disorders, and headache and of discomfort associated with influenza, feverishness 

and feverish colds, toothache and dysmenorrhoea. Posology and Method of Administration For oral administration Panadol Extra Soluble 

should be dissolved in at least half a tumbler full of water. Children Not recommended for children under 12 years of age. Minimum dosing 

interval: 4 hours. Should not be used with other paracetamol-containing products. Contraindications Known hypersensitivity to paracetamol, 

caffeine or any of the other ingredients. Special Warnings or Precautions for Use Paracetamol should only be used with caution in patients 

with liver or kidney impairment. Prolonged use except under medical supervision may be harmful. Do not exceed the stated dose. Take 

only when necessary. If symptoms persist, consult your doctor. Each tablet contains sodium (427mg). Persons on a low sodium diet should 

not take this product unless advised by a doctor. Keep out of reach and sight of children. Interactions with other Medicaments and 

other forms of Interactions Paracetamol may increase the elimination half-life of chloramphenicol. The absorption of paracetamol may be 

increased by metaclopramide and decreased by cholestyramine. Oral contraceptives may increase the rate of clearance of paracetamol. 

The anticoagulant effect of Warfarin and other Coumarins may be enhanced by prolonged regular daily use of paracetamol with increased 

risk of bleeding; occasional doses have no significant effect. Pregnancy and Lactation Epidemiological studies in human pregnancy have 

* 

shown no ill effects due to caffeine or paracetamol used in the recommended dosage, but patients should follow the advice of their doctor 

regarding its use. Paracetamol is excreted in breast milk but not in a clinically significant amount. Undesirable Effects Adverse effects 

of paracetamol are rare but hypersensitivity including skin rashes may occur. The most common adverse effects associated with caffeine 

are nausea due to gastrointestinal irritation, insomnia and restlessness as a result of stimulation of the central nervous system. Overdose 

Immediate medical attention (in-hospital, if possible) is required in the event of overdose, even if there are no significant early symptoms. 

Marketing Authorisation Holder GlaxoSmithKline Consumer Healthcare (Ireland) Limited, Stonemasons Way, Rathfarnham, Dublin 16 

Marketing Authorisation Number PA 678/39/10. Date of (Partial) Revision of the Text October 2008 Legal Category: Pharmacy Only. 

Further information available on request from GlaxoSmithKline, Stonemasons Way, Rathfarnham, Dublin 16, Ireland. 

GSKCH 2010/0344

6 

news 

The key role of the hospital 

pharmacist in medication safety 

was highlighted at the inaugural 

conference of the Irish Medication 

Safety network (IMSn) which took 

place in Farmleigh House in Dublin 

last month. 

Entitled ‘networking for Safety’, 

the conference, which sought to 

improve standards in medication 

safety, was officially opened by 

the Minister for Health Ms Mary 

Harney and was attended by a 

number of pharmacists and other 

healthcare professionals. Speakers 

included Dr Deirdre Madden, author 

of the Patient Safety Commission’s 

2008 publication ‘Building a 

Culture of Patient Safety’; Ms Marita 

Kinsella, Chief Pharmacist at the 

Department of Health; and senior 

Hospital pharmacist and 

winner of the 2009 Helix 

Health Pharmacist of the year 

Award, Mr Tim Delaney has 

been seconded to the HSE 

from Tallaght Hospital as 

national Programme lead of 

the Executive’s new national 

Medication Safety Programme. 

The HSE’s new medication 

safety programme was 

established by the Executive 

within its Quality, Safety and 

Risk Framework and forms 

part of the HSE’s Quality and 

Clinical Care Directorate under 

Dr Barry White. 

Initial projects currently 

being developed by the 

new programme include: a 

standard drug prescription 

and administration record 

The Irish Medicines Board 

(IMB) has recently signed 

three separate co-operation 

arrangements with its 

counterpart regulatory bodies 

in Canada, new Zealand and 

Singapore. The arrangements, 

which will facilitate enhanced 

regulatory performance 

and public safety, are 

designed to broaden existing 

contacts and to establish 

a co-operative framework 

of mutual support and 

information exchange. 

The three new 

arrangements were signed 

by Mr Pat O’Mahony, Chief 

Executive of the IMB, at the 

hospital pharmacists with a special 

interest in medication safety. 

The IMSn’s principal aim is to 

improve patient safety with regard 

to the use of medicines through 

improved sharing of information 

throughout the acute healthcare 

sector and the adoption of national 

and global initiatives to help 

minimise risks to patients. A key 

aim of the IMSn is to have medication 

safety included in HIQA’s new 

hospital licensing regime which 

is currently going through the 

consultation process. 

Speaking at the conference, 

Minister for Health Ms Mary 

Harney said : “I am pleased to 

see the Irish Medication Safety 

network working hard to raise the 

standards of medication safety in 

for acute hospitals; a national 

medication management 

standard for acute hospitals 

and self – assessment system; 

and the implementation 

of the Irish Medication 

Safety network’s guidance 

5th international Summit 

of Heads of Medicines 

Regulatory Agencies, which 

took place last month in 

the UK. According to Mr 

O’Mahony, “Increased 

communication and cooperation 

between the 

IMB and our counterparts 

in Canada, new Zealand 

and Singapore will assist 

each organisation to better 

achieve our common goal of 

protecting and enhancing 

the health and safety of our 

respective populations.” 

Co-operation arrangements 

were signed by the IMB with: 

Health Canada represented 

our hospitals, and I thank them for 

their commitment and dedication 

in this area. I’d like to acknowledge 

their work in highlighting 

the importance of implementing 

best practice in medication safety 

standards throughout our acute 

healthcare system.” 

Established in 2007, the IMSn is 

a voluntary network of independent 

pharmacists and other 

specialists working in the acute 

healthcare sector with a special 

interest in medication safety. The 

network has representation from 

all major hospitals in the country, 

both public and private, reaching 

over 50 acute healthcare facilities 

in Ireland. 

For more information please see 

www.imsn.ie 

documents on specific highrisk 

medications and the 

monitoring of compliance by 

individual hospitals. 

As national lead with the 

medication safety programme 

Mr Delaney will also be the 

HSE representative on the 

Medication Safety Forum, 

which was set up by the 

Department of Health in 

response to the report of 

the Commission on Patient 

Safety and Quality Assurance. 

Chaired by the Chief 

Pharmacist at the Department 

of Health Ms Marita Kinsella, 

the Forum is monitoring 

29 separate improvement 

projects designed to achieve 

safer, more effective use of 

medicines. 

by Ms Meena Ballantyne, 

Assistant Deputy Minister, 

Health Products and Food 

Branch; new Zealand 

Medicines and Medical Device 

Safety Authority (Medsafe) 

represented by Dr Stewart 

Jessamine, Group Manager; 

and the Health Sciences 

Authority of Singapore 

represented by Dr John lim, 

Chief Executive Officer. 

Similar arrangements are 

already in place between 

the IMB and its American 

counterpart, the US FDA, the 

UK regulator, the MHRA, and 

Australia’s Therapeutic Goods 

Administration (TGA). 

The majority of medication errors 

in Irish residential care facilities 

are “entirely preventable” a 

new study has revealed. 

According to the research which 

involved a three year prospective 

study of medication errors in 

residential settings as reported 

to the national Poisons Information 

Centre (nPIC) of Ireland, almost 

half of all errors or 43.1 per 

cent involved the administration 

of the wrong medication while 

45.1 per cent related to patients 

being given the wrong dose. 

The study, which was carried 

out by researchers from the nPIC 

and the Department of Geriatric 

Medicine at Beaumont Hospital 

in Dublin, reviewed a total of 

102 cases where residential care 

patients experienced a medication 

error between January 2007 

and December 2009. Medication 

errors were categorised as: administration 

errors, prescribing/ 

physician errors or dispensing/ 

pharmacy errors. 

While the study found that errors 

involving the administration 

of the wrong medication and 

the wrong dose predominated, 

there were two pharmacy errors 

involving the dispensing of the 

wrong medication. 

According to the research the 

principle medicines implicated 

in medication errors in patients 

over the age of 65 were cardiac 

drugs at 15.2 per cent and gastrointestinal 

preparations at 13.6 

per cent, while anti-epileptics 

accounted for 11.9 per cent of 

errors. 

Anti-epileptic medication was 

implicated in the vast majority of 

medication errors in the under 


Hospital pharmacists have key role in medication safety 

Tim Delaney seconded to the Hse’s 

medication safety programme 

Mr Tim Delany 

IMB signs co-operation arrangements with 

counterparts in Canada, new Zealand and Singapore 

Minister for Health, Mary Harney and geraldine Creaton, 

irish Medication safety network (iMsn) at the inaugural 

iMsn conference in Dublin. 

Majority of medication errors 

in irish residential care facilities 

“entirely preventable” 

65s at 36.1 per cent, followed by 

anti-psychotics at 13.3 per cent 

and antidepressants at 12. 4 per 

cent. 

According to the study 12 

patients were symptomatic at 

the time of the nPIC enquiry. 

A total of 11 patients were 

referred to a hospital emergency 

department, 18 were referred to 

a GP, while supportive management 

was recommended for 38 

patients. 

“Cardiac and anti-epileptic 

medications predominated in 

patients aged over 65 and under 

65 respectively. The majority of 

errors involved the administration 

of the wrong medication 

and the wrong dose. These 

errors are entirely preventable,” 

the study concluded. 

Meanwhile another new study 

by the same research team entitled 

‘Medication errors in older 

adults: The Experience of the 

nPIC Ireland’ has revealed that 

the vast majority of medication 

errors among the elderly were 

the result of individuals inadvertently 

taking an additional dose 

of their medication(s). While the 

study found that most incidents 

took place at home and did not 

result in any harm, the researchers 

concluded “healthcare professionals 

should always discuss 

correct dosing procedures with 

older adults.” 

These research studies were 

presented by researchers from 

the nPIC, Ireland at the 6th 

Congress of the European Union 

Geriatric Medicine Society, 

which took place in Dublin from 

the 29th of September to the 1 st 

of October last.

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Name of the Medicinal Product: Nicorette Icy White 2mg and 4mg Medicated Chewing Gum. Qualitative and Quantitative Composition: Each medicated chewing gum contains 2 mg or 4mg nicotine as a resin complex. Pharmaceutical Form: 2mg Gum: Medicated Chewing Gum. A square, coated, white coloured chewing gum. 4mg Gum: Medicated Chewing Gum. A 

square, coated, cream coloured chewing gum. Therapeutic Indications: For the treatment of tobacco dependence by relieving nicotine craving and withdrawal symptoms: thereby facilitating smoking cessation in smokers motivated to quit. - helping smokers temporarily abstain from smoking. Posology and Method of Administration: Nicorette Icy White Gum should be 

chewed slowly. Smoking cessation Adults The strength of gum to be used will depend on the smoking habit of the individual. In general, if the patient smokes fewer than 20 cigarettes a day, Nicorette Icy White 2mg Gum is indicated. If more than 20 cigarettes per day are smoked Nicorette Icy White 4mg Gum will be needed to meet the withdrawal of the high serum nicotine 

levels from heavy smoking. The patient should be urged to stop smoking completely when initiating therapy with Nicorette Icy White Gum. The chewing gum should be used whenever there is an urge to smoke according to the “chew and rest” technique described on the pack. After about 30 minutes of such use, the gum will be exhausted. Not more that 15 pieces of the 

chewing gum may be used each day. Absorption of nicotine is through the buccal mucosa, any nicotine which is swallowed being destroyed by the liver. Nicorette Icy White Gum may be used for up to 3 months during which time the habits associated with smoking will be lost. For those using the 4mg Gum, the 2mg will be helpful during withdrawal. If not successful after 12 

weeks the patient should be encouraged to make a fresh attempt to stop smoking. This may necessitate full or partial re-treatment with an NRT programme. Temporary Abstinence During periods of temporary abstinence, the patient should use Nicorette Icy White Gum when required to relieve nicotine cravings and withdrawal symptoms. The strength of gum to be used will 

depend on the smoking habits of the individual. In general, if the patient smokes fewer than 20 cigarettes a day, Nicorette Icy White 2mg Gum is indicated. If more that 20 per day are smoked Nicorette Icy White 4mg Gum is indicated. Not more than 15 pieces of the gum should be used per day. A minor reduction in total clearance of nicotine has been demonstrated in healthy 

elderly patients, however, not justifying adjustment of dosage. Contraindications: Use in non-smokers and use in persons hypersensitive to nicotine or any ingredient in Nicorette Icy White Gum. Special Warnings and Precautions for use: Nicotine in any dose form is capable of inducing a dependence syndrome after chronic use and is highly toxic after acute use. However, 

dependence with Nicorette Icy White Gum is a rare side-effect and is both less harmful and easier to break than smoking dependence. Nicorette should be used with caution in patients with cardiovascular disease, severe/moderate hepatic impairment, severe renal impairment, active and duodenal ulcers. Nicotine, both from NRT and smoking, causes the release of catecholamines 

from the adrenal medulla. Therefore, Nicorette should be used with caution in patients with hyperthyroidism or pheochromocytoma. Patients with diabetes mellitus may require lower doses of insulin as a result of smoking cessation. Smokers who wear dentures may experience difficulties in chewing Nicorette Icy White Gum. Interactions with other medicinal products 

and other forms of interaction: Smoking (but not nicotine) is associated with an increase in CYP1A2 activity. After cessation of smoking, reduced clearance of substrates for this enzyme may occur. This may lead to an increase in plasma levels for some medicinal products of potential clinical importance and for products with a narrow therapeutic window, e.g. theophylline, 

tacrine and clozapine. The plasma concentration of other drugs metabolised in part by CYP1A2 e.g. imipramine, olanzapin, clonipramine and fluvoxamine may also increase on cessation of smoking, although data to support this are lacking and the possible clinical significance of this effect is unknown. Limited data indicate the metabolism of flecainide and pentazocine 

may also be induced by smoking. Undesirable Effects: Nicorette Icy White Gum may cause adverse reactions similar to those associated with nicotine administered by other means and are dose dependent. Common (>1/100) CNS: Headache Gastrointestinal: Nausea, GI discomfort, vomiting, hiccups. Local:Irritation of the mouth or throat, jaw muscle ache. Less common 

(1/100-1/1000) Circulation: Palpitations. Skin: Erythema, urticaria. Rare (

8 

news 


sanctions against pharmacists who fail to pass 

on benefit of lower prices discussed in the Dáil 

In a recent Dáil debate 

lucinda Creighton questioned 

Mary Harney about any 

action the Minister intends 

to take to ensure pharmacies 

are passing on the benefits 

of savings of the price of 

commonly used drugs to non 

medical card holders. 

The minister gave the 

following reply: "I have 

introduced a number of 

measures in the past year 

to reduce the costs of drugs 

and medicines for both the 

State and consumers. These 

measures have included a 

reduction in the wholesale 

and retail mark-ups under 

the Financial Emergency 

Measures in the Public Interest 

Act 2009 and new price 

agreements with IPHA (Irish 

Pharmaceutical Healthcare 

Association) and APMI 

(Association of Pharmaceutical 

Manufacturers in Ireland) 

which have reduced the 

price of hundreds of the 

most commonly prescribed 

off-patent medicines by 40%. 

Cumulatively these measures 

are expected to deliver 

savings to the State of over 

€200m in 2010. 

"I was most concerned to 

learn that some pharmacists 

were not passing on the 

benefits of these price and 

margin reductions to those 

patients whose expenditure 

on drug purchases are not 

met by the Health Service 

Executive e.g. persons whose 

monthly expenditure is below 

the €120 per month threshold 

under the Drugs Payment 

Scheme. 

"I have raised this matter 

with the Irish Pharmacy Union. 

It is disappointing that some 

pharmacists are withholding 

the benefit of the lower prices 

from some of their customers. 

The public deserve better 

in these difficult economic 

times. 

"The Code of Conduct for 

CIALIS* (TADALAFIL) REPUBLIC OF IRELAND ABBREVIATED PRESCRIBING 

INFORMATION. Presentation Tablets 2.5mg, 5mg, 10mg, or 20mg of tadalafil. Also contains 

lactose. Uses Treatment of erectile dysfunction in adult males. Dosage and Administration 

Adult men: The recommended dose is 10mg orally, taken at least 30 minutes prior to sexual 

activity. In those patients in whom tadalafil 10mg does not produce an adequate effect, 20mg 

might be tried. Maximum dosing frequency, once per day. 10mg or 20mg tadalafil is not 

recommended for continuous daily use. In responder patients to an on-demand regimen, who 

anticipate a frequent use of Cialis (ie, at least twice weekly), a once daily regimen with the lowest 

doses of Cialis might be considered. The recommended dose is 5mg taken once a day at 

approximately the same time of day. The dose may be decreased to 2.5mg once a day based on 

individual tolerability. The appropriateness of continued use of the daily regimen should be 

reassessed periodically. Elderly: Dosage adjustment not required. Impaired renal or hepatic 

function: In patients with severe renal impairment the maximum recommended dose is 10mg. 

Once a day dosing of Cialis is not recommended in patients with severe renal impairment. In men 

with hepatic impairment the recommended dose is 10mg. There are no available data about the 

administration of doses higher than 10mg of tadalafil to patients with hepatic impairment. There 

is limited clinical data on the safety of Cialis in patients with severe hepatic impairment; if 

prescribed, a careful individual benefit/risk evaluation should be undertaken by the prescribing 

physician. Once a day dosing has not been evaluated in patients with hepatic impairment; 

therefore, if prescribed, a careful individual benefit/risk evaluation should be undertaken by the 

prescribing physician. Diabetes: Dosage adjustment not required. Use in children and 

adolescents: Cialis should not be used in individuals below 18 years of age. Not indicated for use 

by women. In clinical trials, Cialis demonstrated improvement in patients’ erectile function and 

the ability to have successful sexual intercourse up to 36 hours following dosing. Contraindications 

Known hypersensitivity to any ingredient. Patients using any form of organic 

nitrates. In men with cardiac disease for whom sexual activity is inadvisable. Physicians should 

consider the potential cardiac risk of sexual activity in patients with pre-existing cardiovascular 

disease. Patients with myocardial infarction within the last 90 days, patients with unstable angina 

or angina occurring during sexual intercourse, patients with New York Heart Association class 2 

or greater heart failure in the last 6 months, patients with uncontrolled arrhythmias, hypotension 

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10 

Dear Madam, 

news 

reaction to Professor Weedle’s comments 

on the new codeine regulations 

The interview with Prof. Peter 

Weedle in the last edition 

of the Irish Pharmacist was 

an interesting insight into a 

man who has garnered great 

respect within his profession. 

It is for that reason that I 

write to you. While Peter may 

be right in stating that the 

codeine regulations have 

made a positive impression on 

people of influence, it is a sad 

reflection on those self same 

individuals, if something as 

half baked and ill conceived 

actually impresses them. It 

may go some way to explain 

why there is a lack of appreciation 

in the same quarters for 

the substance and potential 

of community pharmacy. Signicant 

progress for pharmacy 

took place in the mid 90s with 

the advent of clause 9 in our 

contract. However, a new government 

- with an unfettered 

free market approach - viewed 

pharmacy simply as another 

retail opportunity. Changing 

the view of these people is 

akin to trying the impossible, 

however given the economic 

destruction thy have overseen, 

their days are hopefully numbered. 

My comments do not 

detract from the achievement 

of bringing in new pharmacy 

legislation. Politicians however 

will always be open to 

legislation that gives cover in 

crisis, it is a different process to 

make them more amenable to 

responsible innovation. This is 

true particularily where there 

are strong contrary lobbies. 

These regulations have 

copper-fastened in the minds 

of many, the view that pharmacists 

are mere conduits for 

the dispersal of medicines. 

People, respectable citizens, 

have been given the third 

degree by some of our more 

zealous colleagues, their only 

Pharmacists – to provide Drug 

Treatment Pharmacist Services 

The Irish Prison Service (IPS) invites tenders for the provision of Drug 

Treatment Pharmacist Services. 

Pharmacists are now being sought to provide Drug Treatment 

Services (i.e. to include methadone dispensing and administration and 

all associated professional services), as part of a multidisciplinary team, 

in Wheatfield Prison. This presents an opportunity for pharmacists 

to become involved in the area of drug treatment services in prisons. 

The contract will be managed by the Chief Pharmacist, Healthcare 

Directorate, IPS. 

Lot 1: Wheatfield Prison 

Cloverhill road, Clondalkin, Dublin 22 

For full tender information please visit the public sector procurement 

opportunities website at www.etenders.gov.ie 

Tender documents are available on www.etenders.gov.ie; or by 

email from cputenders@irishprisons.ie. 

Completed tender documents must be returned, in hard copy, 

by 4:00pm on 1st December 2010 to Irish Prison Service, Central 

Procurement Unit, IDA Business Park, Ballinalee Road, longford. Ph 043 

333 5187. 

For further information, please contact the Healthcare Directorate, 

IPS on 043 333 5119. 

sin, requesting a packet of 

soluble solpadeine to alleviate 

the effects of excess. For 

this grave sin, they have been 

condemned to wander for an 

eternity from one pharmacy 

to another seeking remedy for 

their discomfort. 

More seriously, for pharmacy 

it has created a mindset 

in the public at large that 

pharmacists cannot be trusted 

in their professional judgement, 

and lack the ability to 

judge circumstances as they 

present themselves. Given the 

fact that within three weeks of 

Aug 1, there was an epidemic 

of period pain, chronic back 

pain, hard to shift headaches, 

none of which responded to 

paracetamol or ibuprofen and 

even a segment on a radio programme 

telling people what 

to say to ensure a purchase, all 

this has left the pharmacist in 

an invidious position. 

The reality is that that these 

Letters to the editor: 

email: maura@ 

greencrosspublishing.ie 

Post: 

The Editor 

Irish Pharmacist 

7 Adelaide Court 

Adelaide Road 

Dublin 2 

Fax: 

01 4789449 

regulations were conceived 

to impress others. This is to 

misread the direction the 

supply of medicines is taking 

and merely reflects our age old 

ability to underrate ourselves. 

More open supply channels for 

medicines are the future if only 

for economic reasons. Boots 

are being proactive in this area 

already. Pharmacy services 

are available, accessable 

with qualified and motivated 

people ideally positioned to 

drive this more open access 

with a solid professional 

approach. Unfortunately the 

codeine regs have undermined 


us in the eyes of the public. 

They have reflected a very 

shallow approach to the 

problem of addiction, creating 

an impression that does not 

enhance our case for a wider 

professional role. The PSI 

would be better advised in 

future to involve themselves 

in real dialogue as distinct 

from the HSE patented variety; 

there is no substitute for open 

and frank exchange of views, 

everyone learns. 

yours sincerely 

richard Collis 

PHARMACY SUPPLY & SERVICES 

The Irish Prison Service (IPS) invites tenders for the provision of 

pharmacy supplies and services to the prison below. 

This service will, in addition to the provision of dispensing services, 

include the planning and delivery of pharmaceutical care to all 

prisoners. This contract will be managed by the Chief Pharmacist, 

Healthcare Directorate, IPS. 

Lot 1: Castlerea Prison 

Harristown, Castlerea, Co. roscommon 

Tender documents are available on www.etenders.gov.ie or by 

email from cputenders@irishprisons.ie. Completed tender documents 

must be returned in hard copy, by 4:00pm on 20th December 2010 

to the Irish Prison Service, Central Procurement Unit, IDA Industrial 

Estate, Ballinalee Road, longford, Ph. 043 333 5187. 

For further information, please contact Healthcare Directorate, IPS, 

on 043 333 5119.

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12 

news 

n500,000 worth counterfeit 

drugs seized in ireland 

The Irish Medicines Board 

(IMB), Revenue Commissioners, 

Customs Service and An Garda 

were among authorities from 

more than 45 countries who 

participated in an InTERPOl-coordinated 

international internet 

week of action recently targeting 

the online sale of counterfeit 

and illegal medicines, to raise 

awareness of the associated 

health risk. The action resulted 

in arrests across the globe and 

the seizure of thousands of 

potentially harmful medicines. 

In Ireland, a joint operation by 

the IMB, Customs and Garda led 

to the seizure of 262,000 tablets 

and capsules worth an estimated 

€500,000. The substances seized 

included products for weight 

loss and erectile dysfunction as 

well as mood stabilisers. 

Focusing on websites supplying 

illegal and dangerous 

If the menopause was discussed 

more openly, fewer Irish women 

would feel isolated, uncertain and 

frustrated by menopausal symptoms. 

That’s according to the Dublin 

Well Woman Centres, which 

recently launched a new online 

forum where women can discuss 

the menopause with medical 

experts as well as their peers. 

The online forum, called On the 

Vine, is being launched to mark 

World Menopause Day today. Also 

to mark the Day, Well Woman has 

initiated a series of fact-sheets on 

the menopause, which will see 

factsheets on various topics being 

published approximately every 

two months. The first factsheet 

deals with the topic of ‘hot flushes. 

Both the online forum and the 

factsheets are being hosted on 

www.wellwomancentre.ie. 

medicines, Operation PAnGEA 

III involved national medicines 

agencies, police and customs 

with support from Internet 

Service Providers (ISPs), payment 

systems providers and 

delivery services. Together 

they targeted the three main 

components abused by people 

seeking to make a profit in this 

illegal website trade, the Internet 

Service Provider (ISP), electronic 

payment system and the delivery 

service. 

On an international scale 

267,855 packages were inspected 

globally by regulators 

and customs throughout the 

week-long operation resulting in 

the seizure of 10,916 packages. 

1,014,043 tablets were seized in 

total largely relating to erectile 

dysfunction pills, weight loss 

tablets, antibiotics, hormones 

and steroid products, anti- 

Speaking on World Menopause 

Day, Well Woman’s Chief 

Executive, Alison Begas, said: “In 

spite of our more open society, 

menopause is still one of those 

topics that gets very little public 

airing. In fact, more often than 

not when it is mentioned, it is the 

butt of jokes, which does nothing 

to encourage open discussion of 

the issue. 

“Our new online forum, On the 

Vine, is an attempt to get women 

talking about menopause. We 

want them to share experiences 

and discuss their approaches to 

dealing with symptoms,” said Ms 

Begas. “We know from research 

– and indeed from feedback 

from women at our clinics – that 

most women are not informed 

about the menopause. According 

to research conducted by the 

depressants, pain killers, cardiac 

medication, anti-cholesterol, 

stimulants/amphetamines, 

cancer medication and insulin. 

328 portal hubs were inspected 

for illegal activity resulting in the 

removal of 290 websites. 

Operation PAnGEA has grown 

extensively since it first took 

place in 2008 involving eight 

countries including Ireland. It is 

the largest internet-based action 

of its kind co-ordinated by the 

Permanent Forum of International 

Pharmaceutical Crime (PFIPC), 

the Heads of Medicines Agencies 

Working Group on Enforcement 

Officers (HMA WGEO), InTERPOl 

and World Customs Organisation 

(WCO) with the assistance of the 

pharmaceutical industry and the 

electronics payment industry 

in support of the International 

Medical Products Anti-Counterfeiting 

Taskforce (IMPACT). 

Menopause still not discussed openly 

Women’s Health Council in 2008, 

almost 60 per cent of women 

aged 35 to 50 wanted more information 

about the menopause. 

By getting women talking about 

menopause, we hope to achieve 

a better understanding about this 

change in life.” 

In addition to the on-line forum 

and fact-sheets, Well Woman also 

publishes a leaflet on the menopause, 

which is available online 

or in hard copy from its clinics at 

Pembroke Road, liffey Street and 

Coolock in Dublin. For further 

information, see: www.wellwomancentre.ie 

To access the factsheet, see: 

www.wellwomancentre.ie/content/downloads/menopausefactsheet1.pdf 

The web-forum : www.wellwomancentre.ie/forum/forum 

A new booklet has been 

launched by the Irish 

Osteoporosis Society to mark 

World Osteoporosis Day 2010 

which took place on October 

20th. Osteoporosis Guidelines 

is aimed at healthcare 

professionals to aid diagnosis 

and recognise symptoms of an 

otherwise silent disease. 

Currently, 300,000 people 

in Ireland over the age of 

50 are estimated to have 

osteoporosis and one in two 

Irish women and 1 in five 

men over the age of 50 will 

have an osteoporosis-related 

fracture in their lifetime. 

This is predicted to become 

a major healthcare burden 

over the next 25 years as the 

population ages. 

President of the Irish 

Osteoporosis Society, 

Professor Moira O’Brien 

warned that osteoporosis is set 

to become a ‘new epidemic’. 

“Osteoporosis suffers from 

severe under recognition 

and often goes unnoticed 

until a fracture occurs. 

Unfortunately, only 15% of 

people who have osteoporosis 

are actually diagnosed. Even 

after a fracture, the majority 

of these women will not 


new award to recognise 

outstanding healthcare 

professionals 

Healthcare professionals who strive to deliver outstanding service to 

their patients are to be recognised. Astellas recently announced the 

launch of a new initiative, the Astellas Changing tomorrow Awards 

2010, which aims to recognise the outstanding achievements of 

healthcare professionals who are striving to change the course of 

tomorrow for patients in Ireland. Astellas has launched this new 

initiative in Ireland to identify those in healthcare who endeavour to 

deliver an outstanding service for their patients, as often these vital 

efforts can go unnoticed. To enter your nomination and for more information 

visit www.changingtomorrowawards.ie The closing date 

for entries is 5pm, Thursday, 18th of november, 2010. Professionals 

working in health who are interested in entering can also request 

more details from their local Astellas representative. 

The closing date for entries is 5pm, Thursday, 18th of november, 

2010, soon after which a shortlist of entries will be chosen and announced 

in early January. The winner of each category will then be 

chosen and announced at the Astellas Changing tomorrow Awards 

2010 ceremony on Monday, 31st of January, 2011. 

osteoporosis guidelines for healthcare professionals 

receive treatment for their 

osteoporosis. 

“We have drafted these 

guidelines to help healthcare 

professionals look out for 

signs of osteoporosis. While 

there have been many 

advances in the management 

of the disease, there are still 

important care gaps and we 

must do all we can to promote 

the detection of osteoporosis 

before the first fracture 

occurs.” 

To order copies of the 

Osteoporosis Guidelines contact 

the Irish Osteoporosis Society on 

1890 252 751.

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WRINKLES

14 

eu news 

Gary Finnegan, 

European Correspondent and Irish 

winner of 2009 and 2010 EU Health 

Prize for Journalists 


eu ditches drug ‘advertising’ plan 

A 

key European Parliament 

committee 

has scrapped proposals 

that would 

have allowed infor- 

and critics claimed any change 

to the legislation would put 

the EU on a slippery slope to 

the kind of all-pervasive drug 

commercials seen on US televi- 

steering the directive through 

the parliament, has changed 

the emphasis of the Commission’s 

proposal to focus on 

patients’ rights to information. 

tal impact of their products, 

provided regulators give 

permission. 

Fjellner said MEPs on the 

public health committee want 

mation on medicines to be 

sion. 

The onus will now be on companies to engage more 

published in print and online 

The original directive had national authorities and the with patients but will have to 

consumer media. 

been put forward by the industry to provide citizens operate under strict supervi- 

The move was greeted with 

European Commission’s with objective and unbiased sion, adding that the rewritten 

relief by patient and con- 

industry department which information on medicines, directive focuses on transparsumer 

organisations who have 

insisted that a clear distinc- while maintaining protections ency and consumer rights. 

mounted fierce resistance to 

tion would be drawn between for the public against “unso- The directive will now be 

the Information to Patients Di- 

promotional material – which licited communication” from debated by health ministers, 

rective, fearing it would open 

would still be prohibited – and manufacturers. 

in consultation with MEPs and 

the door to drug advertising. 

factual information designed Companies will be allowed the European Commission, 

Advertising prescription 

medicines to the general 

public is banned in Europe 

swedish MeP Christofer 

Fjellner 

to empower the consumer. 

Swedish MEP Christofer Fjellner, 

who was responsible for 

to provide the public with 

non-promotional material on, 

for example, the environmen- 

before finally coming before 

a full sitting of the European 

Parliament next year. 

MePs strengthen drug monitoring system 

The EU has overhauled its 

medicines surveillance rules 

and looks set to force high-risk 

product to carry a black symbol 

on their packaging. 

Two years after the changes 

were first proposed, the European 

Parliament has finally 

voted in favour of sweeping 

reforms which will require national 

governments to set up 

designated pharmacovigilance 

websites. 

The new rules mean phar- 

Ineffective counterfeit 

medicines, forged pharmacy 

receipts and dodgy sick 

certs are costing Europe an 

estimated €56 billion a year, 

according to a new report 

on corruption in the health 

sector. 

The European Healthcare 

Fraud and Corruption 

network (EHFCn) said 

funding that should be used 

for patient care is being 

maceutical companies will 

have to do more to inform patients 

on how to use medicines 

and report adverse reactions. 

Authorities across Europe 

will also be expected to pool 

information on dangerous 

side effects of medicines in an 

effort to pick up rare problems 

which can be missed in clinical 

trials. 

The ‘Eudravigilance’ database 

will become the single 

point of contact for informa- 

billions squandered on healthcare fraud 

swallowed up by fraudsters – 

something governments have 

begun to take seriously in a 

time of dwindling budgets. 

Poor quality treatment, 

sometimes from unqualified 

practitioners, continues to be 

a problem, according to the 

EHFCn, along with perverse 

incentives that encourage 

overuse of medicines. 

In a study of fraud in seven 

European countries, it was 

tion on adverse events associated 

with medicines. MEPs 

backed the new rules after 

intense negotiations with EU 

member states, some of whom 

have been reluctant to cede 

control to Brussels and share 

data with European counterparts. 

The European Commission, 

European Medicines Agency 

(EMA) and national regulators 

will have full access to the 

database, while companies, 

concluded that the “pay 

for service” system in The 

netherlands and Belgium 

incentivises doctors to 

provide as much treatment 

as possible and ultimately 

squeezes more money from 

the public coffers than 

necessary. 

EHFCn President Paul 

Vincke said cross-border 

“healthcare shopping” 

is also a major source of 

healthcare professionals and 

the public will be given “appropriate” 

access, according to 

a compromise text hammered 

out in late September. 

The deal, which was broadly 

welcomed by health professionals, 

industry and consumer 

groups, became the first element 

of the three-part pharmaceutical 

package to clear all 

stages of European Parliament 

approval. The legislation 

comes into force in mid-2012. 

fraud, with patients in the 

Republic of Ireland accessing 

free healthcare services in 

northern Ireland by using 

false addresses. 

Closer cooperation 

between authorities and 

the use of sophisticated 

computer systems to track 

patients and medicines 

will help curb corruption in 

the health sector, experts 

concluded. 

EMA beefs 

up conflict of 

interest rules 

The European Medicines Agency 

(EMA) has unveiled a more robust 

process for ensuring members of 

its scientific committees have no 

commercial interests that would 

affect their impartiality. 

The move came after transparency 

groups criticised the 

authorities for taking advice from 

experts who had worked with the 

pharmaceutical industry during 

the H1n1 flu pandemic. The World 

Health Organisation (WHO) has 

also pledged to review its approach 

to avoiding conflicts of interest 

in the wake of the furore over the 

pandemic. 

Meanwhile, the regulator has 

also promised to take a more open 

approach to requests for access to 

documents related to medicines. 

The EMA came under fire from the 

European Ombudsman on two 

separate occasions this year for its 

reluctance to hand over documents 

requested by citizens. 

The Agency says it wants to become 

more transparent but will still 

have to edit some documents prior 

to disclosure in order to protect 

commercially sensitive information 

and to safeguard personal data.

16 

heRBal medicine 

Adding spice to the 

Christmas baking 

What we eat at Christmas is not necessarily all bad 

– Des Corrigan takes a closer look at the benefits of 

yuletide spices 

as soon as I opened the front door 

I realised that it was THAT time of 

the year. Given the foul weather 

outside it was comforting to come 

home to the fabulous smell of 

the Christmas baking wafting out 

from the kitchen. The welcoming aroma of the 

mixed spices which the Higher Management was 

using as part of her tried and trusted cake and 

pudding recipes reminded me that the festive 

season was just around the corner. 

At first glance it is difficult to see anything 

healthy in the way we celebrate Christmas in 

Ireland with over-eating and drinking the norm. 

However, the familiar scents of cinnamon, cloves, 

nutmeg, ginger and allspice which make up what 

is called mixed spice, got me thinking about 

these and the other herbs and spices which form 

part of our Christmas traditions. Given that these 

herbs and spices all contain pharmacologically 

active chemicals I wonder if in fact we might 

be doing our bodies some good by ingesting 

them alongside all the calories, saturated fat and 

alcohol we consume over the Christmas holidays. 

“ 

Sometimes a little 

common-sense 

is needed...no one has 

suggested that pregnant 

women avoid ginger 

biscuits or Thai food. 

CLove oiL – Pain kiLLer 

Allspice is a peppercorn-like spice from a 

Caribbean plant called Pimenta. While it is central 

to Caribbean cooking its main medical effect 

is on flatulence and given the impact of rich 

Christmas food on the human digestive system, 

maybe that is no bad thing to have in the diet. 

The main chemical in allspice is eugenol which 

is also the major component of the essential oil 

of cloves. As is well known, that oil is used as a 

dental pain reliever which may be as effective 

as a benzocaine gel. There is good scientific 

evidence for this and for the effectiveness of a 

combination of clove oil with zinc oxide paste 

in cases of dry socket inflammation after tooth 

extraction. It is active against many bacteria 

especially those associated with dental caries and 

periodontal disease. 

nuTMeg – naTuraL HigH? 

nutmeg is a traditional component of eggnog 

but does anyone actually drink eggnog at 

Christmas nowadays? It is also a component 

of mixed spice. The main chemical in Myristica 

fragrans as it is known botanically is called 

(with great originality) myristicin. This molecule 

has a similar structure to MDMA (Ecstasy), the 

main difference being that it has no nitrogen 

atom. nutmeg has long had a reputation as a 

hallucinogenic drug in US prisons where inmates 

reportedly consumed several dessert spoons 

of the powdered seed in order to get high. 

Intoxication is likely to occur after ingestion of 5g 

or more of nutmeg which is equivalent to about 

1 to 2 mg of myristicin per kilo of body weight. 

It has been suggested by way of explanation of 

the psychotropic effects that myristicin might 

be metabolised in the body to an amphetamine 

derivative but extensive studies in humans have 

shown no evidence of such metabolites. 

ginger – anTi-eMeTiC 

The remaining two ingredients in the mix are 

the real ‘biggies’ in terms of their health impact. 

Ginger has been used for centuries in cooking 

and as a medicine because of its characteristic 

smell and pungent (heat inducing) taste. In 

recent times attention has focussed on its 

anti-emetic effects and on its role in alleviating 

arthritic complaints. 

While the evidence for the latter shows 

considerable promise it is not yet comparable 

to that for the effect on nausea and vomiting. 

Studies in animals show evidence of the ability 

of ginger products to counteract vomiting. A 

large number of RCTs confirm this in cases of 

travel sickness with the added advantage that 

ginger does not cause the drowsiness associated 

with other travel sickness products which is 

important if one has to drive on continental roads 

after leaving the ferry. There is also high level 

clinical evidence supporting the use of ginger in 

morning sickness and in post-operative nausea 

and vomiting. 

Use in morning sickness raises the question 

of the safety of the spice during pregnancy, 


Dr Des Corrigan is the former Director 

of the School of Pharmacy at TCD, and 

won the lifetime Achievement Award 

at the 2009 Pharmacist Awards. 

He is the Irish representative on the 

Scientific Committee of the European 

Monitoring Centre for Drugs and Drug 

Addiction. He also currently chairs 

the national Advisory Committee 

on Drugs as well as the chair of the 

Traditional Herbal Medicinal Products 

Subcommittee of the Advisory 

Committee on Human Medicines at 

the Irish Medicines Board. 

dr des CorrIGAN 

with a number of commentators pointing out 

that no formal safety studies during pregnancy 

have been carried out and that effects on the 

foetus cannot therefore be ruled out. There have 

been follow-up evaluations during the morning 

sickness trials which did not show any evidence 

of abnormalities or increased risk of stillbirth or 

miscarriages. Sometimes a little common-sense is 

needed in these situations because most of the 1 

million tons of ginger produced worldwide ends 

up in confectionery, soft drinks and ethnic dishes. 

And no one has suggested that pregnant women 

avoid ginger biscuits or Thai food. 

CinnaMon – For DiabeTes 

It is the aroma of cinnamon bark and its more 

widely available Chinese variety which evokes 

Christmas for me. Medically the focus in recent 

years has been on the anti-diabetic effects of 

the oligomeric procyanidins in cinnamon rather 

than the fragrant oil. Animal studies show that 

these effects could lead to a reduction in diabetic 

complications. 

Human studies have given mixed results with 

some RCTs showing reductions in fasting blood 

glucose in type 2 diabetics of between 8 and 

29 per cent. Other RCTs have not shown such 

effects. It is likely that dosage is an issue as the 

range has been from 1 to 10g of bark daily. This 

is an awful lot of spice and certainly your average 

cake would not get anywhere near that amount. 

A 2007 review in the journal Pharmacotherapy 

concluded that there was a modest effect on 

glucose levels but that cinnamon should not 

be recommended as a replacement for proven 

lifestyle modifications, oral antidiabetics and 

insulin but it did not say that supplementation 

with a high quality product might not be a 

worthwhile idea. 

sPiCe Wars 

Christmas is traditionally a time of peace and 

goodwill so it is easy to forget that all of the 

aforementioned spices are sourced from exotic 

locations such as Grenada, Sri lanka, and 

Zanzibar and that over the centuries the spice 

trade was the cause of many wars costing many 

lives with empires, colonies and huge fortunes 

won and lost. Such concerns are however far 

from most peoples minds as they tuck in to their 

Christmas pudding and cake.

HERE’S 

For the treatment 

and management 

of atherothrombosis. 

Prescribing Information for Grepid 75 mg film-coated tablets. Qualitative and Quantitative Composition: Each film-coated tablet contains 75 mg of clopidogrel (as besilate). Pharmaceutical Form: Pink, round, biconvex, film-coated tablets. Therapeutic Indications: For the prevention of atherothrombotic events in 

patients suffering from myocardial infarction (from a few days until less than 35 days), ischaemic stroke (from 7 days until less than 6 months) or established peripheral arterial disease. Dosage and Method of Administration: Oral use. Adults and elderly: Administered as a single daily dose of 75 mg with or without food. Paediatric 

Patients: Not recommended. Contraindications: Pregnancy & Breast-feeding: It is preferable not to use clopidogrel during pregnancy as a precautionary measure. Breast-feeding should not be continued during treatment with Grepid. Not to be administered in patients with severe liver impairment and those experiencing active 

pathological bleeding. Hypersensitivity to clopidogrel or to any of the excipients. Special warnings and precautions for use: Therapeutic experience is limited in patients with renal and moderate hepatic impairment. Grepid should be used with caution in patients at increased risk of bleeding. Discontinue use with this medication 

7 days prior to surgery. Alert physician upon any unusual bleeding. Clopidogrel may lead to a rare event of Thrombotic Thrombocytopenia Purpura (TTP). Delay treatment with Grepid in patients that have experienced an acute ischaemic stroke in the past 7 days. Contains Lactose. For further information, please refer to the SPC. Drug 

Interactions: Concomitant use of clopidogrel and oral anticoagulants is not recommended due to increased intensity of bleeding. To be used with caution with the concomitant use of glycoprotein IIb/IIa inhibitors, aspirin, heparin, thrombolytics, NSAID’s & CYP2C19 inhibitors. Undesirable effects: Common: Bleeding, haematoma, 

epistaxis, gastrointestinal haemorrhage, diarrhoea, abdominal pain, dyspepsia, bruising, bleeding at puncture site. For further information, please refer to the SPC. Shelf Life: 2 years. Marketing Authorisation Holder: Pharmathen S.A., 6 Dervenakion, 15351-Pallini, Attiki, Greece. Licence number: EMEA/H/C/001059//0000. Grepid 

75 mg film-coated tablets is a prescription only product. Further prescribing information is available upon request from Pinewood Laboratories Ltd. Date of revision of text: August 2010. 

Ireland’s No. 1 Generic Healthcare Specialists

18 

inTeRview 

In part two of our series on the 

Masters of Irish Pharmacy June 

Shannon talked to the teaching 

legend – Ingrid Hook 

if you are an Irish pharmacist working in 

Ireland today chances are that you have 

been taught by Ms Ingrid Hook, who for 

the past 40 years has dedicated her career 

to the teaching of Pharmacognosy and the 

development of the School of Pharmacy 

at TCD. 

Ms Hook was born in what was then 

Czechoslovakia and grew up in Innsbruck, 

Austria. An only child, she followed her widowed 

mother to England at the age of eight. Despite 

a hugely difficult start to her new life in the UK 

– which included travelling alone to a strange 

country at the tender age of eight without a 

word of English – Ingrid went on to become a 

gifted and successful scholar. A love of science, 

especially botany, proved to be the stimulus for 

a hugely successful career in the subject area 

of pharmacognosy, the historic ‘roots’ of the 

pharmacy profession. 

Medicine’s loss… 

According to Ms Hook she originally wanted to 

study medicine but was put off by the length 

of time it took to qualify. Thankfully for the 

hundreds of Irish pharmacy students she went on 

to teach, Ms Hook instead opted for pharmacy, 

a choice that she said she never once lived to 

regret. 

Ms Hook qualified with a BSc (Pharm) at the 

UK Manchester University in 1965, where she 

specialised in Pharmacognosy. She did her preregistration 

year in the hospital pharmacy at 

Withington Hospital in Manchester. That had a 

“wonderful pharmacy. It was…a manufacturing 

pharmacy as well so I got exposure to the 

whole aseptic scene. We made ampoules… 

large volume parenterals, we also made a lot of 

ointments because there was a big skin clinic 

there…at that stage we had already started 

ward rounds so it was a big pharmacy and it 

really proved to me that hospital pharmacy was 


Ms INGrId Hook 

First woman Head of School of 

Pharmacy and teaching supremo 

my number one choice of direction,” Ms Hook 

explained. 

The 60s 

In 1966 she moved to Blackpool to try her hand 

at community pharmacy, or, in her own words: 

“I decided to check that I didn’t like community 

pharmacy”. After two years and satisfied that 

community pharmacy was not for her, Ingrid was 

appointed as a hospital pharmacist at Fulwood 

Hospital in Preston, lancashire. 

In 1969 Ingrid married the now well-known 

rugby pundit and broadcaster George Hook 

whom she had met in the UK. They both decided 

to return to live in Ireland but unfortunately at 

that time in Ireland there was no reciprocity 

for Ingrid’s UK Pharmacy degree and when she 

went to make enquires about practising here she 

learned that she would have had to repeat the 

entire three years. 

Almost by default therefore Ms Hook sought


out an alternative career path and in 1970 was 

lucky enough to be appointed lecturer in 

Pharmacognosy at what was then known as 

the College of the Pharmaceutical Society of 

Ireland based in the headquarters of the PSI in 

Shrewsbury Road and administered by UCD. 

In 1977 administration of the Pharmacy 

College was transferred to TCD, although it was 

to be another 20 years before the School was 

transferred physically to a purpose built building 

on the main TCD campus at College Green in 

October 1997. In 1993 Ingrid was appointed 

Senior lecturer in Pharmacognosy at TCD and six 

years later became Head of the Department. 

FirsT woMan 

In 2003 Ms Hook became the first female head 

of the School of Pharmacy at TCD, a position to 

which she was elected by her peers, and she 

went on to successfully steer the School through 

what she described as a particularly difficult and 

challenging time. 

Ms Hook faced a myriad of difficulties on 

her appointment in 2003, chief of which was a 

significant staff shortage, especially in the areas 

of Pharmacy Practice and Pharmacology due to 

the very sudden and untimely death of Professor 

Graham Shaw, TCD’S highly respected Professor 

of Pharmacology and the early retirement of Mr 

Gordon Davis, Senior lecturer in Pharmacology. 

This took place against a backdrop of 

organisational, financial and administrative 

changes at TCD in July 2003, which resulted in the 

once separate departments of Pharmacognosy, 

Pharmaceutical Chemistry, Pharmaceutics, 

Pharmacology and the Centre for the Practice of 

Pharmacy, being amalgamated into one School 

of Pharmacy, within the Faculty of Science. 

Bologna declaraTion 

Staff retirements, accreditation issues and the 

imminent impact of the European Bologna 

Declaration – which called for the modularisation 

of higher education – made for a very busy and 

challenging time for the new Head of Pharmacy. 

The 1999 Bologna Declaration called for 

massive reforms to be introduced across all 

European higher education institutions so that 

all courses were compatible and comparable. 

This pan European ideal aimed to facilitate the 

integration of universities within Europe so that 

theoretically students would be able to move 

seamlessly between universities or different 

subject areas. Ms Hook was instrumental in the 

modularisation of the BSc Pharm degree in TCD, 

which was introduced in October 2007. 

“ 

“What saddens 

me is that 

the people who are 

actually losing out 

are what you now are 

calling the ‘end users’ 

i.e. the students.” 

During her five years as Head of School from 

2003-2008, Ms Hook, together with all the 

School’s staff worked hard to successfully guide 

the pharmacy course through four accreditation 

visits by the PSI. Staff numbers were brought 

back to full complement and in July 2005 she 

was involved in the transfer of the School of 

Pharmacy from the Faculty of Science to what 

was seen as its more natural home in the Faculty 

of Health Sciences. 

TrouBle coMes in Threes! 

During Ms Hook’s tenure the School was also 

visited by three major disasters, which included, 

two major fires one in May 2004 and another in 

July 2006 and a major flood in January 2006. 

Reflecting on her time as Head of School Ms 

Hook stated that the biggest challenge was the 

staffing issues “because everything else worked 

from that point on.” 

If you had the staff you could have the course 

running but if you didn’t have the staff then 

obviously the staff in-house wouldn’t have 

been able to cope. Once we had the staff in 

place it meant then that we could continue 

with accreditation and allow the graduation of 

pharmacy students, she explained. 

In September 2009 Ms Hook retired following 

more than four decades in academic pharmacy in 

Ireland. However, like most highly committed and 

dedicated professionals she is still an amazingly 

busy woman for someone who is supposed to be 

retired. 

She continues to come to College three days 

a week as a visiting academic, still gives some 

lectures in Pharmacognosy to undergraduate and 

postgraduate students. She is also still involved 

in research and is a member of a number of high 

profile boards and institutions including the 

Irish Medicines Board (IMB), the Science Subcommittee 

of the Royal Dublin Society (RDS), 

and the Scientific Committee of the European 

Scientific Co operative on Phytotherapy. 

Ms Hook also serves as an expert member on 

the Herbal Medicines Sub-Committee of the 

IMB and a Pan European Working Party in Good 

Practice in Traditional Chinese Medicine Research 

in the Post-genomic era (GP-TCM) – a European 

Coordination Action project to inform best 

practice and harmonise research of the safety 

and efficacy of traditional Chinese medicine in EU 

member states. 

work/liFe Balance 

As a mother of three and grandmother of four Ms 

Hook told Irish Pharmacist that although she may 

have come to a career in academic pharmacy 

by default she never saw herself as a “true blue 

academic” and as a busy working mother she was 

“grateful” to academia for allowing her to strike a 

happy work/ life balance. 

According to Ms Hook, striking a good work/ 

life balance today is not so easy to achieve due to 

what she sees as a shift in emphasis in academia 

over the past decade from one which was very 

much teaching-oriented to today where the 

focus seems to be more on research, publications 

and research funding. 

“About ten years ago the whole emphasis in 

academia changed and it became very researchoriented 

where your whole career was based 

on the number of publications that you had, the 

type of publications, the amount of money that 

you brought in. Whereas when I was in academia 

inTeRview 

“ 

“About ten 

years ago the 

whole emphasis in 

academia changed … 

your whole career was 

[now] based on the 

number of publications 

that you had, the type 

of publications, the 

amount of money you 

brought in.” 

at the beginning…the emphasis was more on 

teaching, the students and student welfare and 

student ability…and your subject…we loved our 

subjects, we carried on with our research…the 

research that we were allowed to do was what we 

felt was relevant research. now I don’t think you 

have the same kind of choice.” 

sTudenTs losing ouT 

“What saddens me is that the people who are 

actually losing out are what you now are calling 

the ‘end users’ i.e. the students.” 

Ms Hook said that it was possible to learn to be 

a good teacher and that it was important to gain 

students’ respect and to be respectful of them. 

“you need to be available to them, you need 

to be able to answer their questions whenever 

they arise, you need to be able to give them the 

information in a format that they can understand 

at a level that they can understand with the 

background information that you can hand out 

to them. “ 

The Trinity academic added that teaching itself 

has changed very much over the past decade 

with technological advances and the advent of 

e-learning. 

“I don’t know whether it is going to make 

better pharmacists or better graduates,” she 

added. 

Asked what one piece of advice she would give 

to someone thinking of studying pharmacy she 

said that what she has always said to prospective 

students over the years was that pharmacy was a 

good comprehensive science-based education, 

that allows graduates to work in a wide range of 

areas from community to hospital to industry and 

journalism to name but a few. 

“I would always recommend it to somebody 

good at science because it gives you a very large 

number of opportunities.” 

Reflecting on a career spanning four decades 

during which hugely committed teachers like 

herself and Dr Des Corrigan dedicated their time 

to teaching and mentoring future generations 

of Irish pharmacists Ms Hook said “I hope we 

taught them well, that they had a good Trinity 

experience…and that we showed them that 

natural products still have a place in modern 

pharmacy.” 

19

20 

opinion 

tHe CoAlfACe 

brain drain or over- 

supply – you decide 

David Jordan has dug up some interesting figures 

relating to the future supply of pharmacists. 

so we have reached October and for 

the interns and tutors it is a case 

of another year over. And from all 

our points of view the last year has 

certainly been a memorable one. 

The old Chinese curse ‘May you live 

in interesting times’ springs to mind. I had a chat 

with my departing intern about her job prospects 

and the outlook is indeed gloomy. Once again 

the talk is of emigration. Mostly Australia and 

Canada, the UK does not get much of a look in 

with today’s graduates. Even though emigration 

is not the big deal that it was when I qualified 

this still saddens me. After five years of hard slog 

at the expense of the taxpayer they, through no 

fault of their own, will now be lost to Ireland. 

now those of you accustomed to my 

scribblings will know that this is the kind of thing 

which gets me thinking. Just how many positions 

are available to the 170 graduates who will be 

sitting their final exams this november? not 

enough it seems. The current freeze on hospital 

appointments is not helping. Maybe in a few 

years this might change but for now it just adds 

to the woe. But just how many new pharmacists 

does Ireland need every year? 

“ 

I would readily 

have more 

pharmacists practising 

in my pharmacy if I 

could get away with 

paying them the 

minimum wage. 

Foraging For Figures 

So I set off to find out. My first port of call, as with 

any pharmaceutical matter, was the PSI. no don’t 

worry, this is not going to be another PSI rant. I’ll 

have plenty more of them in articles to come. I 

emailed them asking if they were aware of any 

manpower studies in relation to pharmacists. 

I also emailed the Department of Education as 

they pay for all the pharmacy courses. By return 

the Department replied that they did not have 

any studies but referred me to the HEA. They in 

turn referred me to Fórfas on whose website I 

found surveys for 2005, 2006 and 2007. At the 

time of writing the PSI hasn’t even replied to my 

original email. OK so I’m allowed a little rant! I 

also culled some figures from the PSI’s Corporate 

Strategy. So they weren’t totally useless. 

WoManPoWer 

I started by calling these ‘Manpower’ surveys. 

However Womanpower may be more accurate. In 

2005 the fairer sex accounted for 50 per cent of 

the pharmacist workforce, by 2007 this figure had 

risen to 70 per cent. 

Aside from this, the number of pharmacists 

on the PSI register increased from 2,500 in 2005 

to 4,500 in 2010. (lets not forget the 500 or so 

Qualified Assistants who are still on the register 

as well.) Assuming that approximately 10 per cent 

of the register is not in active practice this gives 

a workforce of 4,000 to 4,100. This is a massive 

increase in any workforce in such a short period. 

When you look at the age profile the numbers 

over 55 years of age in 2005 was 10 per cent. 

This rises to 18 per cent in 2007. So in the next 7 

years (i.e. up to 2017) we can expect about 500 

pharmacists to retire from active practice. So how 

are they being replaced? The surveys reported 

a growth rate on 10-12 per cent p.a. in pharmacy 

with a replacement rate of 2.8 per cent required. 

The PSI’s Corporate Strategy estimates that they 

will register 150 from Irish universities, 90 EU 

nationals and 10 from outside the EU every year. 

I suspect that many of the EU nationals will be 

Irish students currently studying pharmacy in 

the UK. That is 250 new pharmacists every year. 

A replacement rate of 5.5 per cent. Twice the rate 

that Fórfas recommends. So the 500 retirements 

from 2007 to 2017 have already been replaced 

by 2009. By 2017 500 retirements will have been 

replaced by 2,500 new pharmacists. Even with 

my B in leaving Cert maths these numbers 

don’t add up. So why all the pharmacy places 

in universities? 

over-suPPLy 

All of the studies mentioned above noted the 

pharmacist shortages which certainly existed 

at stages in the past. But it seems that when 

planning for university places – if any such 

planning occurred – no account was taken of 

EU pharmacists who now have free movement 

and mutual recognition of qualifications. Also no 

allowance was made for all the Irish students who 

might travel to the UK to study there. So now it 

would seem that we are heading for massive over 

supply. 

The PSI has stated in their strategy that 

they would like to see more pharmacists per 

pharmacy. They have also said that they would 

like to see a return to a version of geographic 

distribution via some form of licensing. While 

these are laudable desires there is no mention 

dAvId jordAN 


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 

of how this is to be paid for. I would readily have 

more pharmacists practising in my pharmacy if I 

could get away with paying them the minimum 

wage. If the current over-supply continues this 

may yet be a practicable proposition. 

The same market forces may deal with this 

matter at least on a short term basis. numbers 

aren’t available yet but I suspect that the 

numbers of Irish students travelling to the UK 

to study pharmacy is on the wane. Those who 

started in the last few years will most likely finish 

their course but I doubt if many have started 

in 2010. Also the current recession/depression/ 

double dip/'we’re all screwed anyway', will 

discourage pharmacists from the eastern states 

of the EU from travelling here. 

But for now unless the PSI, Department of 

Education and the HEA sit down together and 

discuss this it looks like we will be pumping our 

taxes into training our best and brightest for 

export. 

Just to finish on a side note. When UCC 

announced the start of their pharmacy course I 

asked a southern colleague why did Cork need a 

School of Pharmacy. His reply was “Sure Dublin has 

two, boy.” Hate mail 

can be sent 

to me via the 

editor!

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22 

PINIoN 

opinion vIew froM Above 

Pharmacy 

listening service 

There was a time when Terry Maguire pitied those 

who studied the social sciences but all that has 

changed now that he has become a de facto social 

worker. 

as a career I never considered 

social work, as a student I pitied 

as misguided those studying the 

social sciences and as a graduate 

I worried for those condemned to 

a life in the social services since 

in later life they were most likely to contemplate 

suicide on a weekly if not daily basis. So it has 

come as somewhat of a surprise that I now find 

I have by default ended up performing a job 

that is more social work than anything else. I 

am a case worker for the manic, the confused 

and downright bewildered and the surprising 

thing is I rather like being the listening ear, the 

unpaid community counsellor. It’s all part of a 

pharmacist’s job it seems and there are rewards; 

my customers can prove the most colourful 

threads in the rich weave that forms the beautiful 

fabric of life. let’s meet a few of them; those 

whom I see more regularly than most since their 

GP considers them possessing more than one 

day’s supply of medicines a major clinical risk. 

“ 

leticia... 

removed the 

toilet-roll from its 

holder and shoved 

it over the smoke 

detector, something 

she tells me she had 

seen in a movie. 

angela’s aspiraTions 

Angela is convinced her daughter will become 

a famous paediatrician and I am supporting her 

in this belief since belief is the best she can have 

now that the child has been removed from her 

by the real social services. In mid-August she let 

me know, to my delight I must say, that her little 

darling had obtained 9 A* in her GCSEs. She has 

recently revised this story to an aspiration for 

these heady grades when the exams are taken 

in two years time. This may prove difficult since 

Angela’s daughter is only taking six subjects 

at GCSE and is seldom found in her academic 

establishment. The little angel is difficult, wilful 

and as vicious as a burning wasps’ nest and I feel 

genuine remorse for the foster family who have 

got her; nothing could pay this family. 

And then there’s leticia. leticia’s moods swing 

more than a pendulum clock. Her mental health 

is indeed poor but when she’s manic – and if you 

don’t have to live with her – she can be great fun. 

She changes GP more than I change the tyres 

on my car. Her current GP is keeping a sensible 

distance but she claims to be deeply in love with 

him and she believes he secretly reciprocates her 

feelings. 

leticia has just been in court charged with 

smoking on a flight. She could not last without a 

cigarette during the three hour flight time from 

Benidorm, indeed she had great trouble getting 

through the first hour so she got into the aircraft 

toilet and before she lit up she removed the 

toilet-roll from its holder and shoved it over the 

smoke detector, something she tells me she had 

seen in a movie. This cunning plan failed and the 

stewards were quickly battling against the door. 

She refused to come out claiming to be unwell. 

On arriving at Belfast International Airport, the 

captain, using some of the extensive library of 

emergency anti-terrorist legislation available to 

him, had her arrested and charged. 

The judge was particularly unhappy with her 

behaviour and handed down a £300 fine but she 

rages against this perceived injustice to anyone 

who will listen and most mornings lately that is 

me. 

respecTFul lisTening 

Sean has been smoking for 20 years and has been 

trying to stop for 19 years. He finds stopping 

smoking easy he has, like Mark Twain, found 

it so easy to stop he has done it 50 times. It’s 

staying stopped that seems to be his problem. 

He has obtained so much nRT from his GP in the 

last 6 months that he is now trying to talk me 

into buying his unused 

nRT stock back at a 

discount. 

And then 

there’s Steven 

who, to 

his credit, 

overcame a 

significant 

alcohol 

problem about 

10 years ago. 

When his elderly 

terry M AGuIre 


Terry Maguire owns two 

pharmacies in Belfast. 

He is an honorary 

senior lecturer at the 

School of Pharmacy, 

the Queen’s University 

of Belfast. His research 

interests include 

the contribution of 

community pharmacy 

to improving public 

health. 

aunt, with whom he lived and cared for, was in 

the final stages of Alzheimer’s, he was refused 

respite care. So he simply walked out leaving 

the front door open and from a phone box in the 

centre of Belfast rang the police telling them he 

was a concerned neighbour and was reporting 

himself (Steven) missing and telling the police 

that something needed to be done for the old 

dear who would soon be wandering the streets. 

He turned up two weeks later with a tan and 

reclaimed his aunt from the geriatric ward of 

the local hospital. Since her death he has tried 

several times to get, as he keeps telling me, “his 

career going”. Firstly, he decided to become 

a sculptor and bought a second hand furnace 

that he set up in his small living room. He made 

twisted iron designs until the furnace burned a 

hole through the floor into which it collapsed 

and where it remains in situ to this day. He also 

had a go at sculpturing tree stumps but now-adays 

he is trying to become a writer and insists 

I read the copious rubbish he produces. These 

are ostensibly short-stories about old Belfast and 

its great characters but, from what I have read, it 

seems he merely plagiarises story-lines from the 

nightly TV soaps. 

But to them all, and may more, I will continue 

to respectfully listen, as all pharmacists do. I have 

become convinced that listening is the glue that 

retains a semblance of civilisation within our 

fragile communities. As the credit crunch bites 

deeper north and South there will 

be an even greater need 

for more respectful 

listening.

Communication is important 1-3 

If only I could 

fi nd the 

words 

Abbreviated Prescribing Information: 

For full prescribing information refer to the Summary of Product Characteristics. Name: Ebixa Active Substance: Memantine Hydrochloride. 

Indication: Treatment of patients with moderate to severe Alzheimer’s disease. Dosage & Administration: Treatment 

should be initiated and supervised by a physician experienced in the diagnosis and treatment of Alzheimer’s dementia. Therapy 

should only be started if a caregiver is available who will regularly monitor the intake of the medicinal product by the patient. Treatment 

is orally either as tablets (10 mg) or solution (10 mg/g) taken with or without food at the same time every day. The solution 

should only be dosed onto a spoon or into a glass of water using the pump. Maintenance dose is 20mg/day, (two tablets or 2ml 

solution [4 downward strokes] once daily). Treatment starts with 5mg/day (half a tablet or 0.5 ml solution [1 downward stroke] 

once daily) for the fi rst week; the 2nd week 10mg/day (one tablet or 1 ml solution [2 downward strokes] once daily); the 3rd week 

15mg/day (one and a half tablets or 1.5ml solution [3 downward strokes] once daily) and the 4th week 20mg/day (two tablets or 

2ml solution [4 downward strokes] once daily). Moderate renal impairment 10mg/day (one tablet or 1 ml solution [2 downward 

strokes] once daily), if well tolerated after 7 days the dose can be titrated up to 20mg/day (two tablets or 2 ml solution [4 downward 

strokes] once daily). Severe renal impairment- dose is 10 mg/day (one tablet or 1 ml solution [2 downward strokes] once daily). 

Mild-moderate hepatic impairment- no dose adjustment. Severe hepatic impairment- no data available. Children & Adolescents: 

Not recommended. Contraindications: Hypersensitivity to the active substance or any of the excipients. Pregnancy and Lactation: 

Pregnancy: Memantine should not be used in pregnant women unless clearly necessary. Lactation: Memantine should not 

be used in women who are breastfeeding. Special Warnings and Precautions for use: Caution is recommended in patients with 

epilepsy. Caution is advised in patients with raised urine pH as this may elevate plasma levels. Clinical trial data are limited on patients 

with recent myocardial infarction, uncompensated congestive heart failure and uncontrolled hypertension and patients with 

these conditions should be closely supervised. Avoid concomitant use of NMDA antagonists (see also interactions). Patients with 

sugar intolerance should not take Ebixa. Patients should be warned to take special care if driving and using machines as Ebixa has 

minor to moderate infl uence on these tasks. Interactions: Effects of L-Dopa, dopaminergic agonists and anticholinergics may be 

enhanced. Effects of barbiturates and neuroleptics may be reduced. Concomitant administration of Ebixa with antispasmodic agents 

Ebixa 

Approved from the moderate stage 

of Alzheimer’s Disease onwards 5 

e.g. dantrolene and baclofen can modify their effects, dose adjustments may be necessary. Plasma levels of cimetidine, ranitidine, 

procainamide, quinidine, quinine and nicotine may be increased. Co-administration with hydrochlorothiazide (HCT) may lead to a 

reduced serum level of HCT. Concomitant use of NMDA antagonist- amantadine, ketamine, dextromethorphan or phenytoin should 

be avoided. Close monitoring of prothrombin time or INR is advisable for patients treated concomitantly with oral anticoagulants. 

Adverse reactions: Common (≥1/100 to

24 

law 

lAw 

Treating children 

– the legal implications 

The law Reform Commission’s consultation paper 

on Children and the law: Medical Treatment has 

implications for the practice of pharmacy. 

The law considers children to be persons 

under the age of 18. The law Reform 

Commission makes over 20 provisional 

recommendations for reform. This is a 

first step in the long journey to becoming 

law. The paper notes the fact that there 

is no explicit statutory definition of what constitutes 

‘medical treatment’ or ‘healthcare’ and recommends 

that, in the context of determining the scope of consent 

to medical care and treatment, a broad definition of 

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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 

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these terms should be used to encompass diagnosis 

and treatment (of course this includes pharmacological 

treatments) and invites submissions on the form of 

these definitions. 

Pharmacists are welcome to forward their opinions 

on the matters arising in this area of the Commissions 

work to the law Reform Commission and they will be 

received graciously and with great interest. 

The law Reform Commission provisionally recommends 

that: 

...with 

Rubex is used for the prophylaxis and 

treatment of ascorbic acid defi ciency. 

CorM AC o’NeIll 


Cormac O’neill 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. 

1. 16 and 17 year olds should be presumed to have 

full capacity (based on a functional test of understanding) 

to consent to, and refuse, medical treatment. This 

should apply to surgery and access to contraception. 

The latter being of direct interest to Irish pharmacists as 

they are charged with dispensing contraception. 

2. It should be provided in legislation that a person 

who is 16 years of age is presumed to have capacity to 

consent to and refuse healthcare and medical treatment. 

In the context of refusal of life sustaining treatment, 

it provisionally recommends that a 16 year old 

may make a High Court application to have his or her 

purported refusal appraised. It also provisionally recommends 

that children aged over 12 years of age but less 

than 14 years of age may not be regarded as being 

capable of refusing medical treatment and therefore 

any person of this age who refuses necessary treatment 

will be treated none the less. 

3. A 14 or 15 year old person could be regarded as 

capable of giving consent to healthcare and medical 

treatment, provided he or she has the capacity 

to understand the nature and consequences of the 

treatment being provided, and subject to the following 

conditions: 

a. In the opinion of the medical practitioner, the 

patient understands the nature and consequences of 

the proposed treatment; 

b. The medical practitioner must encourage the 

patient to inform his parents or guardians; 

c. The medical practitioner must consider the best 

interests of the patient; and 

d. The medical practitioner must have due regard to 

any public health concerns. 

There is obviously plenty of scope for conflict to arise 

with regard to the above guidelines. not only is the 

decision a pharmacist faces in this area an ethical one it 

may also be a legal one. 

4. It would be lawful for a healthcare professional 

such as a pharmacist to provide healthcare and medical 

treatment to 12 and 13 year olds provided that: 

a. The medical practitioner must notify the parents or 

guardians of the child and take account of their views; 

b. The medical practitioner must take account of the 

views of the child in question; 

c. The medical practitioner must consider the best 

interests of the patient, the pharmacist should bear in 

mind that some patients need to be protected from 

themselves; and 

d. The medical practitioner shall have due regard to 

any public health concerns. Therefore, if the disease will 

infect others if it is untreated the public health concerns 

must be addressed and accounted for in the pharmacist’s 

decision. 

5. It should be provided in legislation that a person 

who is 16 years of age is presumed to have capacity to 

make an Advance Care Directive. 

6. The Mental Health Act 2001 be amended to make 

separate provision for people under 18; that all persons 

under 18 who are admitted and treated under the Mental 

Health Act 2001 should have access to an independent 

advocate; and that a Mental Heath Tribunal (with 

an age appropriate focus) should hear from such an 

advocate at the earliest possible opportunity.

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26 

finance 

How safe are your 

investments? 

Across Europe insurers have been busy preparing for 

Solvency II legislation and how does this affect little 

old me you ask... 

With all the noise about 

pensions and tax 

season, I wanted this 

month to call attention 

to two things. Both of 

which are very much in 

the space I find myself in 

at the moment. 

Firstly its about looking at how I can work 

with clients to protect what they have. As many 

of you may recall, last year we launched our 

book Surviving to Win, which was our attempt 

to bring solutions in a world where everyone is 

quick to define the problems but slow to bring 

forward solutions. The release of the book has 

lead us to renegotiating over €150m of debt 

on behalf of investors who have been seeking 

how to deal with banks around their own issues. 

Unfortunately while we thought that this would 

be a process that would be both logical and 

sensible, neither has prevailed, as the banks 

have been slow to be able to deal with their own 

problems let alone that of the debt holder. 

“ 

It is becoming 

clearer to people 

that: 'how safe are the 

holders of my assets' is 

as important a question 

as 'how safe are my 

investments'? 

how To deal wiTh The Banks 

Frankly, from an investor perspective it has been 

both frustrating and difficult to handle even 

when all of the potential solutions are presented 

to them. While we have been getting the results 

that work for all parties, it has been slower than 

it needed to be. As a bye the bye, we are running 

information evenings and a two day course on 

dealing with the banks which has come about as 

a result of people requesting us to do so. If you 

want details, go to survivingtowin.com or drop 

me an email. 

Having got the infomercial out of the way, 

I want to address the issues around dealing 

with people with debt. That is ensuring that 

we cover all of the ways that a client protects 

themselves and their family. With this in mind 

and considering the time of year, the question 

of pensions comes to the fore. For many the 

notion is that all pensions are equal subject 

to management fees and fund manager. But 

as the recent Brendan Murtagh case outlined, 

the ability to put a trust structure in place is 

an important measure in protecting assets for 

potential creditors into the future. While I am not 

suggesting that this is the case for many people, 

it is becoming clearer to people that how safe 

are the holders of my assets is as important a 

question as how safe are my investments. When 

you couple this thinking with the advent of a 

new directive called Solvency II being introduced 

within the EU on the 1st January 2013, it really is 

time to take stock of your own position. 

solvency ii? 

Solvency II will govern capital adequacy 

standards in the European insurance and life 

insurance industry. It represents a complete 

overhaul of the existing rules (Solvency I), which 

date back to the 1970s. One of the pillars of the 

new directive is the introduction of a risk-based 

approach to reserving. In future, European 

insurers will have to be able to pass a 1-in-200 

years’ event stress test, which has been designed 

to give the industry enough cushion to withstand 

even the most severe of bear markets without 

being forced to sell out in the darkest hour. Risky 

asset classes such as equities, commodities and 

other alternative investments will be assigned 

much higher reserve requirements than less risky 

asset classes such as bonds. 

While that is the more academic version of 

the story, in layman’s terms (or in my simple 

thinking), it means that insurance companies 

(and pension funds) need to hold a far greater 

portion of their assets in bonds than they needed 

to do so before. While it can be argued that 

the regulation is not specific to pension funds, 

the fact that it impacts insurance companies 

does affect those people who do not operate 

their own self administered pensions and rely 

on insured arrangements. It has been a while 

since I had a bit of a rant about the need for 

taking charge of all that we do. Whether it is 

understanding how to handle our new world of 

high net debt and low net assets or deciphering 

how we can mind our own investments, it has 

IAIN CAHIll 


iain Cahill aCCa Mba QFa 

Director 

art of Wealth Ltd. 

Dunlair House 

old athlumney 

navan 

Co. Meath 

Mob: 087 2411371 

Tel: 046 9072824 

never been a more important time to look at 

the small print in how we manage our wealth. 

If you use insurance companies as a means 

of managing your pension funds, below is an 

interesting break down of where pension funds 

are currently invested after the recent melt down. 

Across Europe insurers have been busy 

preparing for when the new rules to come into 

effect. As you can see from chart 1 below, the 

average exposure to equities is already very low 

– around 7 per cent according to Deutsche Bank. 

As Solvency II (unlike Solvency I) penalises the 

insurer if there is a duration mis-match between 

assets and liabilities, forced buying of bonds 

from the insurance sector may have been a major 

feature in the bond market rally of the past six 

months. 

Is it any wonder that the insurance companies 

are moving away from the with profits 

guarantees and in particular have you noticed 

that any projections that you may be receiving 

on your pension statements now talk about a 

projected growth of 4.8 per cent as opposed to 

the heady days of 8 per cent. I don’t know about 

you, but even at my age it would take too long 

to make any headway on my retirement needs if 

that is the best Gross return on offer. 

Please please please heed the need to be 

thinking protection of assets and the need 

for more informed control of the investment 

strategy. Secondly, if your own debt is a challenge 

and you need to understand more about what 

to do about it, come online or drop me an email 

and learn to be in charge. Finally, is now a good 

time to invest in Irish property? I am beginning to 

think so if you get the location right. Remember 

you heard it here first…Happy and safe investing. 

Chart 1: european insurance industry asset allocations 

Source: Deutsche Bank

28 

cReaTive wRiTing 

Lefty 

Donnie looked up at the lunar-like 

ceiling of spacelights that added 

to that morning’s world of white. 

The trolley hit a bump and he 

increased his grip on lefty. It was 

like the bump was a reminder of 

the fate that lay in store for lefty in about half 

an hour’s time. After 43 years of living together, 

sharing each milestone in his life, Donnie 

and lefty were parting company forever that 

morning. Donnie was scared. 

It had all began just over a fortnight ago 

with that most invasive of four letter words, ‘a 

lump’. The English language is full of four letter 

words but that word ‘lump’ has transcended 

literal meaning. There’d been no symptoms, no 

warnings, nothing, none of that, just a lump on 

lefty that couldn’t be wished away or justified by 

any sort of activity. It was there in the morning, 

and like the princess that no matter which way 

she turned or lay could always feel the pea in her 

bed, Donnie could always feel the lump. 

Donnie thought of that as the trolley waited for 

the lift to open. The nurse wanted to check his 

wristband, make sure she had the right patient, 

that sort of thing. Donnie had his right hand 

cradling lefty which entailed the nurse having 

to go and get it but she’d seen it many a time 

before. 

It’s alright … you’re not the first.’ And checked 

the band. 

‘When’d you discover it?’ 

‘late last week.’ 

‘That’s good … time’s everything with these. 

you’d be surprised at how many just ignore it… 

leave ‘til it’s too late…hope that it will go away… 

that sort of thing…especially men.’ 

“ 

How lefty was 

the one that 

‘hung low’ and how as 

many years ago he’d 

considered lefty as his 

barometer for a girl. 

Satisfied with what she’d checked she returned 

his hand to lefty. They’d laughed at that. His 

other hand was free, lying loose over his chest. 

She’d moved that to lefty also and they’d 

laughed more. Then she’d gone back to checking 

charts and he returned to his thoughts of lefty. 

Initially, he’d assumed that they’d just cut 

it, the lump, out and then when he learnt that 

everything on the left had to go, he’d accepted it 

pretty quickly because he’d just wanted that out, 

out, out of him, out of that inside of him forever. 

And everyone reassured him that because he’d 

got attention that he’d be fine, so much that he 

had himself convinced also and that’s when he 

became sorry for lefty. like he was abandoning 

a friend of old, someone who’d been there 

always, that half of a team that gave the complete 

backup. 

Donnie thought back to when he’d last held 

lefty with this sort of protection. It was a soccer 

match and the opposition had a free kick. He and 

lefty were the wall. The kicker didn’t like him. 

They’d had history throughout the match and 

he’d come across to say. 

‘Hey Donnie, I don’t care about the goal but his 

ball’s taking your head off.’ 

Initially he’d held his arms over his face but at 

the penultimate moment just as the boot was 

coming into the leather he’d thought ‘What 

about Righty and lefty!! Forget the head… 

protect them nOW!’ and he had and they’d been 

very grateful. 

And then there was the time, Donnie’d been 

about 13 or so when lefty had disappeared after 

a cold swim and he’d told his Mother and his 

sisters had laughed and how he’d thought he was 

gone forever but like the faithful friend he was 

lefty had come back and now here was Donnie 

having him cut out. 

The lift opened and a team of white crowded 

over, questions, questions…name, date of birth, 

mother’s maiden name and all the faces were 

unfamiliar and he knew they were just checking 

to make sure they’d the right patient but Donnie 

just gripped lefty even more. 

And then the surgeon, Donnie knew 

him, ‘thank God’ … someone he knew…his 

jack-hammered heart relaxed, and then the 

anaesthetist. She was attractive, foreign looking, 

her hand on his chest, soothing: 

julIAN judGe 


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 

‘Breathe slowly and deeply.’ Said with a deep 

eastern-like accent as a mask descended over his 

mouth. 

‘Think of something pleasant, far away and 

count to ten…you won’t beyond five.’ Said the 

exotic eastern throat and Donnie relaxed into a 

far away pleasant place and thought of lefty and 

43 years of being together. 

How lefty was the one that ‘hung low’ and 

how as many years ago he’d considered lefty as 

his barometer for a girl. If lefty didn’t respond 

she could forget about it and he’d go find 

another for him, how crossing his legs, although 

easier would never be the same again, nothing 

to adjust. 

Donnie got to three and had an immediate 

thought of ‘this was it, time to say goodbye to 

lefty.’ Initially he was panicked: just how was he 

to say goodbye to a testicle? He heard: 

‘Slow and deeply…that’s it.’ Again and the 

answer came to him. 

So, somewhere between four and five in his 

count Donnie relaxed his grip and gave lefty one 

last scratch. 

Author’s note. 

A friend of mine, 43 years old, otherwise completely 

healthy, recently discovered a lump on his left 

testicle. He had it removed last week and is now 

waiting on biopsy results. 

The main symptom of testicular cancer is a 

swelling or lump on one of your testicles. The lump 

is usually completely painless, no matter how 

small. Other symptoms are a swelling in either ball, 

discomfort or heaviness or a dull ache in the groin. 

For further information visit www.cancer.ie or 

phone National Cancer Helpline at 1800-200-700.

When it comes to 

Pharmacies, we do 

things by the book, 

because we’re 

re-writing it.. 

Join us today on www.intervene.ie 

or call us on 021 4368810 

www.intervene.ie

30 

e-phaRmacy 


juNe sHANNoN 

Depression – new campaign 

– something to sing about 

Mr Johnny Logan and Ms niamh kavanagh; pictured at the launch of a new campaign called Lean on Me. 

Despite the high 

prevalence of 

depression worldwide 

and the fact that an 

estimated 400,000 

people in Ireland 

today experience depression at any 

one time, the issue is still surrounded 

by a wall of silence and stigma. 

According to the WHO globally, 

mental health conditions account 

for 13 per cent of the total burden 

of disease, and 31 per cent of all 

years lived with disability. “By 2030, 

depression alone is likely to be the 

single highest contributor to burden 

of disease in the world – more so 

than heart disease, stroke, road 

traffic accidents, and HIV/AIDS.” 

“ 

“There 

is strong 

evidence that 

depression can be 

a hidden disorder 

and can manifest 

itself in many 

different ways.” 

epidemic 

A major new international survey 

on the prevalence of depression 

in Europe has revealed that almost 

half or 48 per cent of people have 

experienced depression at some 

stage in their lives and a massive 80 

per cent know someone affected by 

the condition. 

However despite the huge 

prevalence of depression the new 

online survey by market research 

agency Ipsos MORI, carried out 

among 7,122 people in seven 

European counties including Ireland, 

also found that over half or 55 per 

cent of those who had experienced 

depression, did not tell their family 

and friends. In fact the survey found 

that two thirds of those surveyed 

or 75 per cent reported that they 

actually withdrew from family and 

friends when they were depressed. 

The reasons those surveyed gave 

for withdrawing from social and 

family supports when depressed 

included: 28 per cent saying they 

were “too scared, ashamed or 

overwhelmed”; 18 per cent thought 

that family and friends would not 

understand and would turn away 

from them; 57 per cent stated that 

they “didn’t want to burden them” 

with their problems and 29 per cent 

said that they didn’t know how to tell 

them. 

There is an estimated 400,000 

people in Ireland experiencing 

depression at any one time yet 

despite the huge prevalence of the 

disease it is clear from this Ipsos 

MORI survey that a significant 

amount of stigma still surrounds the 

issue. 

lean on Me 

In an effort to break down the walls 

of stigma and silence that continue 

to surround mental health issues 

such as depression lundbeck, 

in association with AWARE, has 

launched a new mental health 

awareness campaign and website 

entitled ‘lean on Me’ which aims 

to encourage friends and family 

to support those affected by 

depression. 

The results of the IPOS Mori survey 

were published last month to mark 

the launch of the ‘lean on Me’ 

campaign. 

The ‘lean on Me’ campaign has 

been developed to dispel the myths 

surrounding depression. Its aim is 

to encourage better understanding 

of the condition, and, above all, 

empower people by providing 

support to those affected and 

encouraging them to seek treatment 

if necessary. 

The campaign includes an 

interactive website – www. 

June Shannon 

reports on a new 

mental health 

awareness 

campaign and 

website www. 

leanonme.net which 

hopes to break 

down barriers by 

encouraging friends 

and family members 

to support those 

suffering with the 

condition. 

leanonme.net – which provides 

detailed information on the causes, 

symptoms and impact of depression. 

eurovision legends 

Johnny logan and niamh Kavanagh 

were on hand to launch the 

campaign last month. The singers 

teamed up with Bray Gospel Choir to 

deliver a surprise performance of Bill 

Withers’ classic song ‘lean on Me’ to 

passers by and lunchtime shoppers 

in the centre of Dublin. 

Speaking at the launch two-time 

Eurovision winner Johnny logan 

explained why he got involved with 

lean on Me: “lean on Me has an 

important message – be a friend 

to lean on. I know that I wouldn’t 

be where I am today without the 

support and love of my friends and 

family.“ 

niamh Kavanagh commented 

“Just by being a friend to someone 

affected by depression you could 

help them on the road to recovery. 

The campaign challenged my 

perception of depression. It uses a 

different approach to encourage 

better understanding, empower you


to provide support to those affected 

and, encourage them to seek 

treatment.” 

The campaign was formally 

launched at an event at the RCPI on 

Kildare Street in Dublin at which Mr 

David Carton, Chairman of Aware, 

spoke about depression in Ireland. 

“Aware greatly welcomes the launch 

of lean on Me, focusing as it does 

on the importance of support for 

anyone experiencing depression. 

We urge anyone who is concerned 

about a friend or family member to 

encourage them to see their GP or 

mental health professional to ensure 

that they receive the appropriate 

care.” 

Kerry based GP Dr Eamonn 

Shanahan emphasised the crucial 

role played by family and friends 

in supporting a loved one with 

depression. “Studies have shown 

that the support of friends and 

family can help improve the recovery 

outcomes for those with depression,” 

he said. “Indeed, the World Health 

Organisation says that ‘psychological 

support from family, friends or health 

providers is powerfully protective 

hidden disorder 

Dr Conor Farren, Consultant 

Psychiatrist at St Patrick’s Hospital, 

Dublin, said, “There is strong 

evidence that depression can be a 

hidden disorder and can manifest 

itself in many different ways. It is vital 

to appreciate that even the most 

complicated cases of depression 

can be effectively treated, and 

the start of that treatment for the 

sufferer is through recognition of Mr David Carton, aware; Ms eithne boyan, Lundbeck; Dr Conor 

Metatone Irish their problem, Pharmacist and then Ad sharing 11/09/2009 the 03:23 Farren, pm st Patrick’s Page 1university 

Hospital; and Dr eamon shanahan, 

burden, with family, friends, support pictured at the launch of a new campaign. 

groups or professionals.” 

e-phaRmacy 

in depression. I encourage anyone 

who is concerned about a friend or 

family member to visit the lean on 

Me website to learn more about the 

ways in which they can provide this 

valuable support.” 

website 

Ms Eithne Boyan, Managing 

Director, lundbeck (Ireland) ltd, 

said, “lundbeck is committed to 

promoting awareness of depression 

Further information available on request. 

Chefaro Ireland Limited, Farnham Drive, Finglas, Dublin 11, Ireland. 

Tel: 01 879 0647 E-mail: info@omega-pharma.ie 

and in recent years has worked 

on a number of public awareness 

campaigns aimed at reducing the 

stigma associated with depression. 

We are delighted to support this 

innovative and uplifting new 

initiative.” 

As well as information on 

depression, www.leanonme. 

net features a downloadable 

leaflet, “How to Say lean on Me”, 

which provides information on 

how to begin a conversation 

about depression, and advice on 

supporting a friend who is affected 

by depression. The site also features 

a Friend Clip feature, which gives 

visitors the opportunity to star in 

their own ‘lean on Me’ video and 

share it with a friend. 

lean on Me is being supported 

with a comprehensive nationwide 

advertising campaign, including 

radio, outdoor, postcard and GP 

posters. 

Further information can be found on 

www.leanonme.net. 

Aware, the depression support 

organisation, is supporting the 

campaign and is urging anyone who 

needs help to call their helpline – 1890 

302 302. 

when recovering from the flu you 

may not be getting all the vitamins and 

minerals you need to aid a speedy recovery 

metatone for use after illness, colds or flu, when 

feeling tired or run down and after loss of appetite 

metatone - just the tonic 

Licensed Medicine. Always read the leaflet. 

31

32 

case sTudy 

Cluster headache in a 24 

year old woman 

a 

24-year-old female patient 

presented with a four year history 

of daily headaches. She reported 

8-10 attacks per day and the 

duration of attacks lasted from 30- 

90 minutes. Most of these attacks 

would occur spontaneously but she always got 

an attack awakening her from sleep at around 

2am. When she awoke with this attack it would 

make her restless and agitated, forcing her to 

pace the bedroom floor until it subsided after 

approximately 30 minutes. The typical clinical 

characteristics of her headaches and associated 

symptoms were: 

• Abrupt in onset and occurred without warning 

• Always unilateral in location in the left 

periorbital/frontal region and extending to 

the temple 

• Duration 30-90 minutes 

• Sharp, piercing and burning in character 

• Very severe 

• Forehead sweating 

• Associated with restlessness, agitation and a 

feeling like ‘banging’ her head off a wall 

• Ipsilateral conjunctival tearing 

• Ipsilateral conjunctival reddening 

• Ipsilateral nasal congestion. 

• Ipsilateral nasal rhinorrhoea. 

• Ipsilateral ptosis of left upper eye lid. 

• Ipsilateral miosis of left pupil. 

Other symptoms associated with some 

attacks included intermittant photophobia, 

Prevalence Common: 10-12 per cent 

population 

phonophobia, nausea and occasional vomiting. 

The rest of the physical and neurological 

examination was normal. 

These headaches were having a major impact 

on her life. She was unable to get any relief from 

the attacks and as an acute therapy she was 

consuming up to 10 paracetamol daily without 

benefit. She was also on amitriptylline 25mg 

nocte as a preventive therapy, with no resultant 

change in the frequency of attacks. Over the 

years she had tried many other analgesics and 

preventive therapies without benefit. In addition 

she had been prescribed courses of antibiotics 

for a presumptive diagnosis of chronic sinusitis. 

Her life was being controlled by the headaches 

and she was unable to pursue a career or get a 

job. She previously had been working as a clerical 

officer but was forced to give up her job. Her 

social life had become non-existent. During this 

four-year period she had attended emergency 

departments and GP out-of-hours services on 

many occasions, all of whom either diagnosed 

‘severe migraine’ or ‘sinusitis’ and for immediate 

pain relief she was treated acutely with either 

parenteral courses of nSAIDs or narcotic agents, 

all of which were ineffective. 

Investigations carried out over the four-year 

period included a CTScan brain, CTScan sinuses, 

MRI scan brain and many blood tests, all of which 

were entirely normal. 

This patient has a diagnosis of chronic cluster 

headaches, a benign primary headache disorder. 

Migraine Cluster headache 

Femalea:Male 3:1 1:5 

Rare:0.5 per cent Population 

Frequency of attacks 2 attacks per month 2-8 attack per day 

Duration 4-72 hours 15 minutes –180 minutes 

Headache Unilateral (70 per cent) or bilateral 

(30 per cent) 

Always unilateral 

Character of headache Throbbing and Pounding Sharp/piercing or ‘boring’ 

Location Vary from frontal to temporal, 

parietal and occipital locations. 

Periobital, orbital and 

temporal in location 

severity Severe Excruciatingly painful 

autonomic symptoms Seldom Frequent 

nausea / vomiting Common Rare 

Photophobia and 

Phonophobia 

Common Rare 

impact Patient needs to lie down in a 

quiet dark room 

Patient becomes restless, 

agitated and paces the floor 


dr edwArd M. o’sullIvAN 

ClINICAl dIreCtor HeAdACHe/MIGr AINe 

dePArtMeNt of NeuroloGy 

Cork uNIversIt y HosPItAl 

ANd GP Cork CIt y. 

At her initial consultation, the following 

management plan was put in place: 

• Keep a headache diary 

• Discontinue paracetamol and amitriptylline 

• As an acute therapy, the patient was 

commenced on 100 per cent oxygen through 

a non re-breathing mask at a high flow rate of 

7-10 litres per minute for 15 minutes for each 

attack. 

• As a preventive therapy, she was prescribed 

verapramil 240mg daily. 

• Patient was advised to stop smoking. 

Ten days after presentation the patient was 

followed-up with a telephone consultation. She 

was much improved. Her cluster attack rate was 

now two per day and the attacks were relieved 

by the oxygen therapy within 10 minutes. The 

attacks were also less severe. 

At a subsequent telephone consultation 

another week later the patient was experiencing 

her first headache-free days in four years. The 

frequency of attacks was 1-2 per day and with 

the oxygen therapy, the attack was aborted in 10 

minutes. 

discussion 

Cluster headache is a rare primary benign 

headache disorder which exists in acute and 

chronic forms. It is characterised by a headache 

described as being excruciatingly painful and 

known as one of the ‘worst pains known to man’. 

Women have described it as being more painful 

then childbirth. Many patients have been driven 

to suicide because of their severity. 

The headache is always a unilateral headache 

typically located in the periorbital/orbital and 

temporal regions with ipsilateral autonomic 

symptoms: conjunctival tearing, reddening, nasal 

congestion, rhinnorhoea, ptosis and miosis. The 

case study outlined is a text book description 

of the disorder, nevertheless the patient went 

for many years without a correct diagnosis 

and as a consequence the most appropriate 

treatment choices to optimise her care were 

never prescribed. The delay in diagnosis I would 

attribute to the rarity at which cluster headache 

is encountered in clinical practice. Many doctors 

will only see a few cases during the course of 

their career. It is most often wrongly diagnosed 

as migraine which, by comparison, is the most 

frequent headache disorder for which a patient 

attends their doctor. The clinical symptoms 

which differentiate between migraine and cluster 

headache are tabulated below. 

neurophysiology 

The understanding of the neuro/ 

pathophysiology mechanisms of cluster 

headaches is hypothesised on the activation 

and integration of the trigeminovascular 

and cranial parasympathetic systems. The 

ophthalmic division of the trigeminal nerve is 

the pain sensitive pathway of the intracranial 

structures: cerebral arteries, meninges. The 

driving mechanism for trigeminovascular 

activation is hypothalamic dysfunction. On 

activation, neurotransmitters (CGRP, neurokinin 

and substance P) are released via a retrograde 

transmission from the peripheral end of the 

trigeminal nerve which innervate the proximal

Date of preparation: April 2010 

Tevirl PO4/04/10 

•Effective at reducing headache recurrence 1 

PHARMACEUTICALS 

IRELAND 

Naramerg 

Naratriptan 2.5mg 

•Well tolerated with a lower incidence of adverse events 

than sumatriptan 2 and zolmitriptan 3 

For further information, please contact: Teva Pharmaceuticals Ireland, Unit 1, The Business Centre, Blackthorn Business Park, Coe’s Road, Dundalk, Co Louth Tel 042 939 5892 Fax 042 939 5898 www.teva.ie Freephone 1800 201700 

Abbreviated Prescribing Information 

Naramerg 2.5 mg Film-Coated Tablets 

Refer to Summary of Product Characteristics before prescribing. 

Presentation: Each tablet contains 2.5 mg naratriptan (as naratriptan hydrochloride). Indications: Acute treatment of 

the headache phase of migraine attacks with or without aura. 

Dosage and Administration: Naramerg should be taken as early as possible after the onset of a migraine headache, 

but is effective if taken at a later stage. Do not use prophylactically. Swallow whole with water. Adults (18-65 years of 

age): Single dose of 2.5 mg. A second dose as required, with minimum interval of 4 hours between doses. Do not 

exceed two 2.5 mg tablets in any 24 hour period. Children and adolescents 65 years: Not recommended. Renal impairment: Mild or moderate renal impairment - maximum total daily dose of 

2.5 mg. Severe renal impairment - Do not use. Hepatic impairment: Mild or moderate impairment - maximum total 

daily dose of single 2.5 mg tablet. Severe impairment - Do not use. Contraindications: Hypersensitivity to any of 

the ingredients, heart disease, myocardial infarction, vascular disease, cerebrovascular accident, transient ischaemic 

attack, hypertension, severely impaired renal/hepatic function, concomitant administration of ergotamine, derivatives of 

ergotamine (including methysergide) and any triptan/5-hydroxytryptamine 1 (5-HT 1 ) receptor agonist with naratriptan. 

Special Warnings and Precautions for Use: Only use where there is a clear diagnosis of migraine. Not indicated 

for use in the management of hemiplegic, basilar or ophthalmoplegic migraine. Not be used in patients with risk factors 

for ischaemic heart disease. Following administration, naratriptan can be associated with transient symptoms including 

chest pain and tightness. There is a theoretical risk of a hypersensitivity reaction in patients with known hypersensitivity 

to sulphonamides. Should not be used with products containing St John’s Wort. There is a risk of medication-overuse 

headache with prolonged use. Contains Lactose. Drug Interactions: Theoretical possibility of increased risk of 

coronary vasospasm with co-administrations of ergotamine, ergotamine-containing preparations, dihydroergotamine, 

sumatriptan and 5-HT 1 receptor agonists, risk of serotonin syndrome following the use of selective serotonin reuptake 

inhibitors or serotonin noradrenaline reuptake inhibitors and triptans. Pregnancy and Lactation: Safety in pregnancy 

has not been established. Balance risks against benefits. Avoid breast-feeding for 24 hours after treatment. Effects on 

Ability to Drive and Operate Machines: Drowsiness and other symptoms of migraine may reduce ability to perform 

skilled tasks. Adverse Reactions: Some of the symptoms reported as adverse events may be part of the migraine 

attack. Common (≥1/100,

34 

portions of the cerebral arteries and dura. This 

mediates a local inflammatory reaction (plasma 

extravasation) which in turn stimulates painful 

sensory receptors located on the cerebral 

arteries. The sensory afferent painful information 

is relayed along the ophthalmic division of the 

trigeminal nerve and synapses in the trigeminal 

nucleus caudalis in the brainstem (pons). Second 

order neurones further relay this information 

to the thalamus and third neurones relay the 

information to the higher cortical functions in the 

brain where pain is perceived. 

In addition, at the trigeminal nucleus caudalis 

(TnC) in the pons, there is an inter-neuronal 

connection between the TnC and superior 

salivatory nucleus and this results in activation of 

the cranial parasympathetic system which travels 

via the greater petrosal, a branch of the 7th 

cranial nerve, thus explaining the secreto-motor 

symptoms seen in cluster headache (trigeminalautonomic 

reflex). The partial Horner’s syndrome 

which completes the symptoms and signs is 

postulated to be due to sympathetic dysfunction 

caused by internal carotid dilatation as it 

traverses the cavernous sinus.1 

It is prudent that all patients who present with 

cluster headaches should be investigated and 

have MRI neuroimaging for potential secondary 

causes such as an internal carotid artery 

aneurysm or lateral protrusion of a pituitary 

macroadenoma into the cavernous sinus, both of 

which can mimic this disorder. 

case sTudy 

pRoducT news 

new Toleriane Teint Mineral Compact 

– for intolerant normal/combination 

sensitive skin 

nearly 60 per cent of women encounter skin discomfort and claim to 

have sensitive skin and of those, 30 per cent of women have skin which is 

sensitive to make-up. Skincare expert la Roche-Posay recenty launched new 

Toleriane Teint Mineral Compact for sensitive skin available in pharmacies 

nationwide from October. la Roche-Posay has created a new generation of 

foundation for women with sensitive, normal/combination or oily skin who 

find covering skin’s irregularities difficult. 

Sensitive skin with imperfections requires a foundation which provides 

good coverage whilst looking natural and respecting the skin’s fragility. 

la Roche-Posay’s expertise in foundations coupled with their skincare 

knowledge guarantee maximum tolerance along 

with unique make-up know-how. 

Women with these skin types (norm/comb 

or oily) often find that foundation is shiny and 

does not stay on throughout the day. They also 

notice that foundations can suffocate skin 

or aggravate imperfections. nEW Toleriane 

Teint Mineral offers the high coverage of 

a corrective foundation with the purifying 

properties of a mineral powder in a compact. 

It covers imperfections and mattifies the skin 

without blocking the pores whilst improving 

skin health. It has a buildable coverage for a 

perfectly corrected complexion with a natural 

long-lasting finish. Following one month of use, results 

showed a reduction in imperfections and improved complexion. 

TreaTMenT 

For over a generation, neurologists have been 

using oxygen therapy in the management of the 

acute attack. Oxygen therapy has established 

itself as a first-line agent and treatment of choice. 

The mode of delivery and action is unique to 

cluster headache and should be administered as 

100 per cent oxygen through a non re-breathing 

mask at a high flow rate of 7-10 litres per minute 

for 15 minutes. 

The efficacy of this treatment has, up to 

recently, been anecdotal with up to 70 per cent 

of cluster patients getting relief of their headache 

and associated symptoms within 10-15 minutes. 

A pivotal study by Goadsby et al was published 

in JAMA in December 2009 confirming and 

validating the use of oxygen therapy.2 

The mode of action of oxygen therapy is now 

better understood and it is postulated that it 

inhibits trigeminovascular and parasympathetic 

activation. This inhibition is concentrated at 

the superior salivatory nucleus where there is 

suppression of parasympathetic nerve fibre 

transmission in those fibres travelling via the 

greater petrosal nerve. 

The only pharmaceutical agent which 

has proven efficacy for the acute attack is 

subcutaneous sumatriptan 6mg, the triptan 

therapy (5-HT-1B/1D receptor agonist). This 

parenteral medication is not licensed in Ireland 

and is only available on a named patient basis. Its 

efficacy is similar to oxygen. nasal sumatriptan 


has also demonstrated a benefit but has a slower 

onset of action. 3 

All narcotic agents and other analgesics have 

no role in the management of the acute attack. 

They have no proven efficacy and this case study 

bears testament to this. In addition their habitual 

use predisposes the patient to developing 

chronic daily headache and medication overuse 

headache. 

The calcium antagonist, verapramil, is the 

treatment of choice as a preventive therapy. 

There are many randomised and nonrandomised 

clinical trials proving its efficacy. It 

can be commenced at a dose of 80mg tds and 

titrated upwards if required. Some patients need 

to go up to a dose of 480mg. Patients should 

be monitored at the higher doses as verapramil 

can prolong the PR interval and patients should 

have an ECG prior to commencement. Verapramil 

blocks the entry of calcium into smooth muscle, 

reducing blood vessel dilatation which is 

responsible for the severe pain. Patients achieve 

a reduction in cluster headache days and the 

number of attacks per day.4 

references 

1. Journal of Headache and Facial Pain. Sept 2009 

1131-43. 

2. Journal of the American Medical Association. 

December 2009. 

3. Journal of neurology 2003. 630-33. 

4. Headache 2009. 117-25. 

Panadol Extra Soluble 24s – 30 per cent 

more powerful* 

Ireland’s no.1 brand of pain reliever** has introduced Panadol Extra Soluble 

Tablets this month. Pharmacy only Panadol Extra Soluble provides your 

customers with a non-codeine solution for pain relief. Panadol Extra Soluble 

Tablets 24s contains 500mg paracetamol plus 65mg caffeine in a soluble 

format – the fastest growing format***. The product is available as from 

October 14 th and will be supported by a heavy weight TV campaign and 

in-store POS. 

*when compared to standard paracetamol, Panadol Extra Soluble can give 

30 per cent more pain relieving power 

**Source: IMS & nielsen June 2010 

***IMS OTCIRl MAT Aug 2010 

www.yourmedicines.ie

36 

pRoducT news 

‘Change one thing’ information pack 

launched for patients with high blood 

pressure 

Sanofi-aventis has launched a new patient advice tool for doctors and nurses 

treating patients with high blood pressure under the Triapin brand. The 

Change One Thing pack provides physicians with ready-made patient advice 

literature for those patients who may need to adapt their lifestyle to help 

lower their blood pressure. 

Change One Thing provides advice across five lifestyle areas in the 

management of blood pressure – salt intake; smoking; stress reduction, 

being more active, and; complying with medications. Patients are often 

presented with a range of lifestyles habits to adapt in one go. It can be hard 

to maintain these changes. Change One Thing pack helps to achieve this. 

The doctor or nurse enters an agreement with the patient on changing one 

lifestyle habit over an agreed period of time by giving only one item from 

the pack. When this becomes a new habit a new item can be added and so 

on. 

Dr Garrett Hayes lent his support to the launch of the news tool and 

he said: “The EUROASPIRE study has demonstrated a high prevalence of 

modifiable risk factors in coronary heart disease patients. We have seen the 

positive impact made on the treatment of coronary heart disease through 

statins and other medications, but there has not been a corresponding 

improvement in patient lifestyle management.” 

Dr Velichka Valcheva, Medical Director of sanofi-aventis said: “Our goal 

is to assist doctors in delivering meaningful, lasting lifestyle advice to their 

patients” 

If you would like a Change One Thing pack sent to you, please contact 

Celine Reilly at 01 403 5600 or email celine.reilly@sanofi-aventis.com. 

Caption 

Dr Garrett Hayes, with Elaine Ryan, sanofi-aventis and Dr Elen Shiryayeva 

also of sanofi-aventis. 

Centrum – supplies restored 

Pfizer Consumer Healthcare has announced that supplies of Centrum are 

being restored. 

Initially, Centrum Advance and Centrum Select 50+ will be available from 

the beginning of november from your usual wholesaler. Supplies of Centrum 

Junior and Centrum Cardio will follow shortly thereafter. 

Following resumption of shipping, batch numbering will be as follows: 

• for Centrum Advance, the last three digits will read 103 and above. 

• for Centrum Select 50+, the last three digits will read 090 and above. 

Only product with lot numbers corresponding to the above numbering 

system should be sold to consumers. 

The full Centrum range will now comprise the following four products 

(pictured); Centrum Advance (30s and 60s packs); Centrum Select 50+ 

(30s and 60s packs); Centrum Junior (30s pack) and Centrum Cardio (60s 

pack). Full product details are available from Pfizer Consumer Healthcare 

representatives and from the IPU data base. 

Customers can be assured that Pfizer is committed to driving Centrum 

sales growth and will be supporting the brand with a high level of marketing 

support over the coming months. 


Roger & Gallet – Christmas Coffret 

Roger & Gallet Christmas Coffrets are available in three different Roger 

& Gallet fragrances – their signature scent, Jean Marie Farina which is 

refreshing, their fragrance for invigoration – Bois D’Orange and Rose with 

relaxing properties. Each Coffret contains 30ml Eau de Cologne, 100ml 

perfumed soap and 75ml perfumed luxurious bath & shower gel. 

Rose Christmas Coffret 

Jean Marie Farina Christmas Coffret 

Bois D’Orange Christmas Coffret 

Roger & Gallet, whose perfumes promote well-being through the powers 

of Aromachology, recently launched in pharmacies in Ireland. Concentrated 

in rare natural essences and essential oils, these fragrant ranges offer a 

complete sensory experience: perfumed waters, as well as round and liquid 

soaps, shower gels and body milks. 

Each Coffret contains 30ml Eau de Cologne, 100ml perfumed soap, and a 

75ml perfumed luxurious shower & bath gel. 

– Eau de Cologne 30ml – Roger & Gallet’s fragranced waters with 

recognized properties of Aromachology channel the 

art of well-being through fragrance. 

– Perfumed soaps – delicately wrapped in pleated silk paper and 

manufactured using the traditional “cauldron method” 

and fragranced using a process that seals natural essential oils into the 

heart of the soap, so as to keep the fragrance 

intact and maintain its authenticity throughout its use. The soap’s highly 

extended life-span results from a 

manufacturing technique kept secret by the brand for over a century. The 

100 per cent vegetal-based formula enriched 

with essential oils does not dry out the epidermis, it leaves skin feeling 

sublimely soft. 

– Perfumed bath and shower gels – Roger & Gallet bath and shower gels 

gently cleanse the skin. For optimum comfort, 

a calcium ion complexing agent is incorporated into the formula to help 

prevent skin from drying out. Their texture 

lends itself to being massaged over skin under the shower, procuring an 

invigorating sensation of well-being. 

www.medical


Prolia: unique new treatment for 

post-menopausal osteoporosis now 

reimbursed in Ireland 

Amgen Ireland and GlaxoSmithKline (Ireland) ltd (GSK) recently announced 

that denosumab has become available in Ireland to treat osteoporosis in postmenopausal 

women at increased risk of fracture and will be reimbursed under the 

General Medical Services and Drugs Payment Schemes. 

In Ireland, more than 300,000 people have osteoporosis. Despite the availability 

of treatment options, many of these women experience fractures due to poor 

compliance with therapy. With proven efficacy and a six-monthly injection, denosumab 

offers women with osteoporosis a new alternative to current treatments. 

Denosumab works in a different way from other osteoporosis treatments. It 

is the first and only approved therapy that specifically targets RAnK ligand, an 

essential regulator of osteoclasts (the cells that break down bone). Denosumab 

helps stop the process that causes bone loss throughout the skeleton, resulting in 

greater bone density, stronger bones, and reduced risk for fractures at the spine, 

hip and other non-vertebral sites. 

The reimbursement for denosumab follows a review of the therapy’s cost-effectiveness 

by the national Centre for Pharmacoeconomics (nCPE) for the prevention 

of osteoporotic fractures in postmenopausal women and will be available on both 

the GMS and DPS schemes as of October 1st. 

Discussing denosumab, specialist in bone health at St James’s Hospital, Professor 

Bernard Walsh said: “It is good to have another proven therapeutic arm available 

to us in the treatment of osteoporosis. The clinical study results are impressive and 

confirm the efficacy of the use of a monoclonal antibody treatment in this disease.” 

Dr Gillian Darling, GP Specialist in Women’s Health in leopardstown and the 

Dublin Well Woman Centres commented: “As most osteoporosis patients are treated 

in primary care it is an advantage to have a treatment that can be administered in the 

GP surgery as well as the hospital clinic setting. 

“Recent studies would seem to point to a strong efficacy and good tolerability profile 

of denosumab in the treatment of osteoporosis in post-menopausal women.” 

Denosumab, which is being co-marketed in Ireland by Amgen and GSK, marks 

an innovative approach to the treatment of post menopausal osteoporosis. Statistics 

show that 90 per cent of hip fractures in senior citizens are due to osteoporosis 

and that one in five patients suffering hip fracture die within four months and 30 

per cent within a year. 

For more information on denosumab’s reimbursement, please visit www.ncpe.ie 

ClonMedica now distributing Hedrin 

and Virasoothe 

Thornton & Ross ltd (T&R) are pleased to announce the appointment 

of ClonMedica, the OTC Division of Clonmel Healthcare Company ltd 

as its distributor in the Republic of Ireland for the Hedrin range of head 

lice treatments and Care Virasoothe Chicken Pox Relief Cooling Gel. The 

change is effective from 1st november after which all orders should be 

sent to Clonmel Healthcare. T&R would like to thank Allphar Services ltd 

for establishing these products in Ireland. Allphar will remain as T&R’s 

distributor for the rest of its pharmacy range including the market leading 

Galfer and Cerumol brands. 

Commenting on the change Rob Purkis, European Market Development 

Manager for T&R, says that the move reflects the synergy of Hedrin and 

Virasoothe with ClonMedica’s successful children’s product range and 

the Company’s contacts with a range of healthcare professionals. A 

similar approach in the UK has made Hedrin the market leading head lice 

treatment1 and is establishing the more recently launched Virasoothe which 

is clinically proven to relieve the symptoms of chicken pox. T&R is keen to 

communicate the clinically proven benefits of these products to a wider 

group of healthcare professionals than has been possible before and this has 

been a key factor in the appointment of ClonMedica. 

Martin Gallagher, Marketing and Sales Director of Clonmel Healthcare 

ltd, commenting on the appointment, expressed his enthusiasm for this 

new venture and is confident that this addition to the Company’s range of 

children’s product will result in greater understanding of the benefits of 

Hedrin and Virasoothe amongst healthcare professionals. 

pRoducT news 

Multaq – first-line option 

in new 2010 ESC Guidelines for the 

Management of Atrial Fibrillation 

Sanofi aventis announced recently that the European Society of Cardiology 

(ESC) 2010 new Guidelines for the Management of Atrial Fibrillation (AF) 

have been released and recommend that Multaq (dronedarone) should be 

used for maintenance of sinus rhythm as a first-line treatment option in all 

patients with paroxysmal and persistent AF (class of recommendation I, level 

of evidence A) other than those with CHF nyHA class III/IV or unstable CHF 

nyHA class II (class of recommendation III, level of evidence B). 

Multaq was granted a Class I recommendation, a designation assigned 

in the guidelines when “there is evidence and/or general agreement that a 

given procedure/therapy is beneficial, useful, and effective.” The Task Force 

for the Management of Atrial Fibrillation of the ESC recognised the extensive 

clinical development of Multaq, giving it their highest ranking A for level of 

evidence. Moreover, the guidelines recommend that Multaq may also be 

used to achieve rate control in non-permanent AF except for patients with 

nyHA class III – IV or unstable heart failure (class of recommendation IIa, 

level of evidence B). 

Importantly the new guidelines include, for the first time, a statement 

on the importance of reducing hospitalisation as a key therapeutic goal in 

the management of AF. They also state that Multaq should be considered 

in order to reduce cardiovascular hospitalisation in patients with nonpermanent 

AF and cardiovascular risk factors (Class of recommendation IIa, 

level of evidence B) as well as in patients with AF and stable heart failure 

(nyHA Class I, II) (Class of recommendation IIa, level of evidence C). 1 

The guidelines do not recommend use of Multaq in patients with nyHA 

class III and IV or with recently unstable (decompensation within the prior 

month) nyHA class II heart failure. 

“Sanofi-aventis is pleased with this first-line recommendation for Multaq 

in the AF guidelines which recognises the extensive clinical development for 

the product as well as the innovative outcome of reducing cardiovascular 

hospitalisation as demonstrated in the ATHEnA trial,” said Marc Cluzel, 

Executive Vice President, Research and Development, sanofi-aventis. 

Xamiol 60g Gel discontinued 

lEO Pharma has announced that Xamiol Gel 60g will be discontinued 

from november 2010. Please note that Dovobet Gel 60g will continue 

to be available. Dovobet Gel 60g contains the identical product form, 

active ingredients and strength as Xamiol (calcipotriol/bethamethasone 

dipropionate). Dovobet Gel is indicated for both scalp and mild to moderate 

body plaque psoriasis. The price is also identical. 

This discontinuation is not due to any safety or quality issues with Xamiol 

Gel, therefore pharmacists and patients may continue to dispense or use 

Xamiol Gel that they currently have. 

If you require any further information, please contact the Marketing 

Department at 01 4908924 or email paul.kirwan@lEO-Pharma.com 

independent.ie 

37

38 

classifieds/cRosswoRd 

DaTes For your Diary 

noveMber 

Tuesday 16 Nov 2010 

spectrum alliance 

Conference, red Cow Hotel, 

naas road, Dublin 22 

The Spectrum Alliance is 

hosting a major conference at 

the Red Cow Hotel, naas Road, 

Dublin, on ‘Common Themes: 

Strategies for Managing 

Co-occurring Conditions.’ The 

conference will address 

connections linking: ADD/ 

ADHD, Asperger’s syndrome, 

and dyslexia and dyspraxia. 


see www.spectrumalliance.ie 

or Tel 083 322 6523. 

Organiser Spectrum Alliance 

Website www. 

spectrumalliance.ie 

Monday 15 Nov 2010 to 

Tuesday 16 Nov 2010 

science Foundation ireland’s 

(sFi) science summit 2010, 

Hodson bay Hotel, athlone 

Science Foundation Ireland’s 

(SFI) Science Summit 2010 will 

take place over two days in the 

Hodson Bay Hotel, Athlone. 


see: www.sfisummit.com 

Please note that this website 

name: 

Address: 

E-mail: 

ip Crossword no.180 

1 2 3 4 5 6 

7 

8 

10 11 12 13 

9 

14 

15 16 17 18 

20 

will be going live over the 

coming weeks with additional 

information and updates. 

Website www.sfisummit.com 

Wednesday 24 Nov 2010 

Csi Mini-Med open Lecture 

series: ‘Life after stroke’, 

Dublin 

RCSI Mini-Med Open lecture 

series: “life after Stroke” by Dr 

Frances Horgan, School of 

Physiotherapy, RCSI. 

The RCSI Mini-Med Open 

lecture Series is free of charge; 

however registration is 

essential in order to guarantee 

a place. 

Previous lecture series have 

attracted widespread public 

interest with demand for 

places far outstripping 

availability. 

Register online at: www.rcsi.ie/ 

minimed 

Organiser RCSI 

Website www.rcsi.ie/minimed 

Wednesday 26 Jan 201 

rCsi Mini-Med open Lecture 

series: ‘advanced Diagnostics 

in Cardiovascular Disease’, 

Dublin 

RCSI Mini-Med Open lecture 

series: ‘Advanced Diagnostics 

in Cardiovascular Disease’ by 

19 

21 

Professor Dermot Kenny, 

Clinical Research Centre, 

Beaumont Hospital, RCSI. 

The RCSI MiniMed Open 

lecture Series is free of charge; 

however registration is 

essential in order to guarantee 

a place. 

Register online at www.rcsi.ie/ 

minimed 

Organiser RCSI 

Website www.rcsi.ie/minimed 

CLassiFieDs 

supervising Pharmacist – 

Munster area 

Supervising Pharmacist 

required in Co Waterford for 

Cover from end of October 

onwards for approx. 10 

months. There is a 2 week 

rota in operation Mon - Sat 

with an average of 35 hours 

per week. no late nights 

or Sunday Openings. Busy 

dispensary with full back up 

and support provided, no 

managing of staff required. 

Candidates should be PSI 

registered with at least 3 

years experience in Ireland, 

and be extremely customer 

focused. 

Please orward CVs to 

audreyhallahan@gmail.com 

Diary/CLassiFieDs serviCe 

aT irisH PHarMaCisT 

Please email your ad to 


across 

1 Acetylsalicylic acid aspiring to lose its tail! (7) 

4 Strip, relief or book. That’s funny! (5) 

7 A divan identical to another? (4,3) 

8 learn treatment of kidney condition (5) 

9 Would such limbs enable a sailor to walk on water? 

(3,4) 

10 nelson’s went with a bang in O’Connell Street (6) 

12 What sounds like Becker & yeltsin may be found in 

Ossory (6) 

15 A vein in the throat sounds like a circus performer (7) 

17 Joint discovered in enamel bowl! (5) 

19 Confidential low ranking soldier? (7) 

20 Condensation found in momma’s tea mug (5) 

21 Try Hugo churning a dairy product (7) 

Down 

1 Subsequent to a broken fret (5) 

2 Measly complaint of German origin? (7) 

3 nakedness of dim sun exploding (6) 

4 Country porcelain? (5) 

5 Sam sure changes as he rubs away aches and pains (7) 

6 His sacs burst under the car (7) 

10 Does the cat wear them to bed? (7) 

11 Cases to lug a scrambled egg! (7) 

13 Aperture to go in pen disorder (7) 

14 Drop “C” we hear, for oedema (6) 

16 Colum comes around for a replacement (5) 

18 Ate W.H. ground for flour ingredient (5) 


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AnSWERS TO lAST MOnTH’S 

CROSSWORD 

Congratulations to the winner of last month’s crossword: 

Marie Mclaughlin, Pharmacy Department, University Hospital Galway, 

newcastle Rd, Galway. 

For a chance to win €70, please send completed entries to: 

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1 

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I T A M 

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B I 

I A E O I N 

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R A D I C A L U G F 

U A S N C I 

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L D M A I D 

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O R S A L 

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N C T R 

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O P E N A 

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I R D 

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R T L U E A 

I O L A 

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I R S I C K 

N N O N L E 

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G R E A T 

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T H Y R O I D

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40 

opinion 

O’Sean’S eleven 

We’ve all seen the George 

Clooney movie Ocean’s Eleven, 

in which he plays the part 

of Danny Ocean, a very cool 

and sophisticated crook who 

assembles a gang of ten fellow 

criminals to carry out a complex multi-million dollar 

raid on three casinos. His celluloid achievements pale 

in comparison to the real life raid carried out in Ireland 

during the last decade. The title character, Dinny 

O’Sean, is unlikely to be as handsome as George 

Clooney – let’s face facts, the Americans can find 

prettier people for any role. They have Obama, we 

have Cowen. They had Monica lewinsky, we had Terry 

Keane. Enough said. 

The movie opens in the year 2000, in the small 

hours of the morning in the snug of an otherwise 

empty Dublin bar. O’Sean has brought together a 

renegade band of crooks, swindlers and chancers 

to unveil his master plan. They are the lowest of the 

outsIde edGe 


low – nigerian customs officials in lagos airport have 

the mugshots of these guys pasted on the wall of the 

arrivals hall so that they can be stopped from entering 

the country and corrupting it. They are however, 

pillars of the establishment in Ireland. 

O’Sean calls a hush, and the gang listen wide-eyed 

as he begins to speak. ‘Right, lads, we are going to fINtAN Moore 

carry out the biggest heist in world history – we are 

going to rob 35 billion euro from the Irish people.’ After a sharp intake of breath followed by a gabble 

of excited voices, one crook pipes up – ‘But the 

country doesn’t have 35 billion euro.’ 

O’Sean smiles benevolently upon him, and says ‘I 

know. And here’s the gas bit – we steal the money 

before they even have it, then they have to try and 

replace what we stole. And the really funny thing is that 

even when they find out, we’ll never see a day in jail. 

‘Here’s the plan. Paddy One – you set up a bank 

and you lend money to every gombeen in sight 

to buy land to develop. Ability to repay doesn’t 

matter. Paddy Two – you’re going to be one of those 

gombeens (laughter); you buy any land, anywhere, at 

any price as long as you can build on it. Paddy Three 

– you’re going to be a builder – you build houses, 

apartments, offices, shops and you’re to import tens 

of thousands of foreign workers to live in them as they 

build them. That’ll inflate the value. Paddy Four – you 

infiltrate the Department of Finance, and instil the 

mantra ‘light Touch Regulation’ into the thick skull of 

every fecker you meet. Paddy Five – you do the same 

in the Financial Regulator’s office. Paddy Six – you 

become an economist (more laughter), no not an 

ecologist, you gobshite, an economist, it’s okay – you 

don’t have to know anything, just keep repeating 

the phrase ‘continued growth’ until 2008, then ‘soft 

landing’ until we get the loot out of the country. 

Paddy Seven – you’ve got to spread the love – dirty 

job, but you gotta schmooze up the politicians, show 

them a good time and throw them lots of money. 

Make sure they know that it’s the Capital Gains Tax 

that’s keeping the show on the road. Paddy Eight – we 

need you to work on the trade unions – make sure 

the workers get payrises paid for by the Capital Gains 

Tax, then their extra money will inflate the price of 

property which makes more Tax for more payrises – 

sure it’ll end in tears, just not ours. Paddy nine – you 

become an estate agent, and advertise everywhere, 

big expensive glossy photos – all very pretty, stops 

anyone asking too many questions in case they lose 

their piece of the action. Paddy Ten – you become a 

property fund manager. It doesn’t matter what idiot 

scheme you put the investors’ money into as long as 

it’s made of brick, and make sure they pay too much 

for it – and don’t forget your commission. 

‘Remember, lads – we sell the bullshit to everyone, 

but don’t believe it yourselves – we keep sucking the 

money out and away to where they’ll never find it, 

and then we get out ourselves.’ 

Then the old, the sick and the handicapped get to 

pay for the party. 

HObbS CHOiCe 

It was kind of funny to see Eddie Hobbs back on 

television with his ‘hard-hitting’ consumer show 

about the ‘extra markup’ we charge to private patients 

compared to what we charge the HSE. The last I 

saw of him was back in 2006 when he was pushing 

property on Cape Verde. Anybody who took that 

advice doesn’t read Eddie’s column in the Star – they 

wear it as a blanket as they sleep in a doorway. Given 

that jewellers have a 300 per cent markup, coffee 

shops 100 per cent, groceries 50 to 100 per cent and 

shoe shops 100 per cent then anybody thinking that 

50 per cent is high is deluded. It shows that the 20 per 

cent rate for the HSE is exceptionally low. I don’t like 

to engage in ‘whataboutery’ in any discussion, but 

given that newsagents have a markup of over 70 per 

cent, what should a fair price be for the RTE guide? 

Somehow, I doubt if Eddie’s going to tell us.

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