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8 news issue 10 volume 12 • novemBeR 2010 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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