assistant
pharmacy
Issue 3 Volume 1
•
A U T UM N
2008
Pharmacy Assistant is part sponsored by an educational grant from
• Sensitive skin
Causes and treatment
• Disorders of the scalp
Best solutions
• Headlice
Tackling the perennial pest
• Cows’ milk allergy
Treating infants
• Q&A–
Susan Bell
• Crossword –
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The first gentle shampoo with La Roche-Posay
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A unique frequent use shampoo for normal to
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> La Roche-Posay Thermal Spa water rich in
selenium and silica softens, soothes and
prevents irritation.
With use, reduces scalp sensitivity
> Polysorbane 20, a patented softening agent
reduces scalp sensitivity and optimises
tolerance of cleansing agents.
Reduction of scalp sensitivity
Evaluation by dermatologists*
*Clinical trial conducted on 51 patients, results after 28 days
> 100% reduction in dryness
> 82% reduction in erythema
> 75% reduction in desquamation
La Roche-Posay. Committed to dermatology.
www.laroche-posay.ie
assistant
pharmacy
•
A U T UM N 2 0 0 8
2
contents
Issue 3 Volume 1
Pharmacy Assistant‘s third edition is chock-full of informative
articles, some of which are very timely.
It’s hard to believe that it is back-to-school time, especially
given the dismal summer we have had this year in Ireland. So
good riddance to a bad summer and hopefully we will enjoy a
golden autumn.
As the kids return to school, our heads (excuse the pun) turn
to the dreaded attacks of lice infestation, which occur with the
same regularity as the changing of the seasons.
Our article on the treatment of this perennial scourge
gets down to the nitty gritty of dealing with a persistent but
treatable problem.
Speaking of scalp health, it seems that more and more of us
are suffering from disorders of the skin, particularly the skin
on our heads. The causes of this increase are the usual culprits:
pollution, stress and using the wrong type of product. Both
dandruff and dry scalp are easy to treat.
Besides the scalp, the rest of our epidermis is under attack
from the same culprits. Before we recommend solutions to our
customers, we should take the time to familiarise ourselves
with the various types of problems to which the skin is prone.
Allergy in one form or another is often the source of many
of these everyday problems and quite a lot of allergies start
in childhood. Our article on cows’ milk allergy describes the
best way to deal with babies who are prone to this common
problem.
Besides our educational articles, we also have a news update
section, our Q&A of a pharmacy assistant, plus you have a
chance to win €50 and impress your colleagues by entering
our crossword.
We do hope you find the current issue informative and
helpful, and if you have any suggestions or letters please email
them to: [email protected]
Pharmacy Assistant is
produced by GreenCross
Publishing as a supplement
to Irish Pharmacist.
GreenCross Publishing is a recently established
publishing house which is jointly owned by Graham
Cooke and Maura Henderson.
Graham can be contacted at graham@
greencrosspublishing.ie
Maura at [email protected]
3
7
Hot health topics
Disorders of the scalp
Scalp conditions have quite a negative
impact on our quality of life.
Cows’ milk allergy in infants
Cows’ milk is the most common cause
of food allergy in infants and children,
affecting approximately 5-7% of
infants.
10
15
18
20
21
© Copyright GreenCross Publishing 2008
The contents of Pharmacy Assistant are protected
by copyright. No part of this publication may
be reproduced, stored in a retrieval system, or
transmitted in any form by any means – electronic,
mechanical or photocopy recording or otherwise
– whole or in part, in any form whatsoever for
advertising or promotional purposes without the
prior written permission of the editor or publishers.
News to you?
Sensitive skin
There are many causes of sensitive skin
but the cure is often straightforward.
Headlice
Getting to grips with these perennial
little pests is easier than ever.
Product news
Crossword
Win €50
Q&A - Susan Bell
Disclaimer
The views expressed in Pharmacy Assistant are
not necessarily those of the publishers, editor or
editorial advisory board. While the publishers,
editor and editorial advisory board have taken
every care with regard to accuracy of editorial and
advertisement contributions, they cannot be held
responsible for any errors or omissions contained.
p h a r m ac y a s s i s ta n t
1
n e w s t o yo u ?
Irish would have rotten
teeth if it weren’t for
fluoride in the water
“Fluoridation
is extremely
important in
this country in
preventing dental
decay as we
have quite poor
eating and dental
care habits. If
we did not have
fluoridated water,
we would be at
eastern European
levels of dental
decay,” according
to Professor Helen
Whelton.
Professor Whelton recently received the 2008 Zsolnay
prize at the annual congress of ORCA in the Netherlands.
Ireland is the only country in Europe with a national
water fluoridation programme.
Pharmacists told to come clean
about homeopathic remedies
The Royal Pharmaceutical Society in the UK has been called upon to
condemn pharmacists who sell homeopathic remedies.
Edzard Ernst, professor of complementary medicine at Exeter
University, has written to the RPS alleging that pharmacists are
failing to inform customers about the shortcomings of homeopathic
treatments.
Professor Ernst says homeopathic remedies contain no biologically
active agents and are no more effective than placebo.
In Professor Ernst’s letter, he said that ‘customers are frequently
misinformed ... by promotional material available in UK pharmacies
and verbal advice given by pharmacists. Thus pharmacists breach
their own mandatory ethical code on a daily basis.’
Botox jabs can be
used to put an end to
sweaty armpits
Botox, the toxin jab loved by ageing
celebrities, also works on sweat glands.
People suffering from excessive
sweating are now turning to a new
product to deal with this deeply upsetting
problem.
Known as Sweatox, the injection works
by temporarily paralysing muscles with
a mild dose of toxin. When injected into
hands, feet or armpits, it freezes glands to
stop them reacting to the heat. Treatment
lasts for about seven months.
Typical examples of
eczema in young children.
2
p h a r m ac y a s s i s ta n t
Chlamydia drug
to become OTC
Pharmacists in the UK will be
able to dispense an antibiotic for
chlamydia later this year.
For the first time an antibiotic
for the treatment of chlamydia
is to be made available from
UK pharmacists without a
prescription. Anyone over 16 who
tests positive for the infection, or
who has had sex with someone
who tests positive, will be able to
purchase the antibiotic Clamelle
(azithromycin).
Rates of chlamydia infection
have soared in recent years,
particularly among young people.
Infection can cause serious
problems, including infertility in
later life.
Threats to male
fertility are many
and varied
Sexual infections are not the only threat to
fertility; it has been known for some years
that men who work as painters or printers are
much more likely to have a low sperm count
compared to men who work in office jobs due
to their repeated exposure to organic solvents,
such as paint thinner and turpentine.
But recently scientists revealed that eating
soya products can have a significant impact on
sperm count. Men who ate an average of half a
serving of soya food such as bean curd or soya
meat substitutes had lower concentrations of
sperm than their carnivorous brothers.
Cigarette smoking, drinking alcohol in
excess, drug use and stress can all contribute
to a low sperm count, while exercise and a
healthy diet can have beneficial effects. Seems
men should get back to a bit of ‘huntin’ and
shootin’’ if they are not to die out altogether.
dermatology
common
disorders
of the scalp
Negative impact
Disorders of the scalp can have a negative impact on
quality of life. It is important to be aware of some of the
common scalp disorders so as to meet your customers’
needs for unparalleled effectiveness and dermatological
tolerance of the treatments offered. Disorders of the
scalp can be mild to severe but, no matter what the
severity, there is often a negative impact on body image
and self-esteem.
Thankfully treatments have evolved that are more
effective and well tolerated by consumers which aids
compliance and thus efficacy.
Dandruff
Dandruff, otherwise known as Pityriasis simplex, is
the mildest of all scalp disorders; however, it can be
distressing if it persists. Internal factors such as stress,
family history, hormonal fluctuations, immunodeficiency
as well as external factors such as humidity, skin traumas,
aggressive shampooing, blow-drying, hair colouring,
perms, hard water, and a poor diet all play a part in
triggering dandruff.
Dandruff is characterised by small grey/yellowish
particles that are spread on the hair and scalp. These
are the skin cells of the scalp that are being shed at an
excessive rate. In the normal scalp, the natural process of
continuous skin cell renewal is very orderly and invisible
to the naked eye. In the scalp with dandruff, this process
becomes disordered, with excessive shedding of both
dead and living skin cells.
Dandruff is also associated with a tiny fungus called
Pityrosporum ovale. This fungus lives naturally on our
skin, normally without causing a problem. Unfortunately,
for some people, it can proliferate, both on the scalp and
deep down in the hair follicle, thus leading to dandruff.
Treatments
Many treatment shampoos are very harsh and can cause
dry skin which will make the flaking worse. They do
not reach and treat the hair root and so the problem
re-occurs.
However, newer shampoos have been developed
with root technologies that target dandruff without
damaging the hair, even coloured hair. Treatment
shampoos, such as La Roche-Posay’s Kerium range, have
been developed to treat different types of dandruff and
scalp disorders, from sensitive scalps to seborrhoeic
dermatitis. Adapted active ingredients combined with
high cosmesticity and tolerance ensures scalp disorders
are treated effectively without damaging hair.
p h a r m ac y a s s i s ta n t
3
Scalp disorder
Signs and symptoms
‘‘
’’
Kerium Intensive Micro-Exfoliating
Anti-Dandruff Shampoo Treatment for persistent dandruff containing:
• LHA™ keratolytic micro-exfoliant which quickly eliminates dandruff and controls desquamation of the scalp. Piroctone olamine, glycacil, lipacide anti-fungal purifies the scalp and prevents the creation of dandruff. Vitamin PP anti-
inflammatory neutralises itching.
• Kerium Micro-Exfoliating Anti-Dandruff Shampoo Cream Dry Scalp containing:
• LHA™ keratolytic micro-exfoliant which quickly eliminates dandruff and controls desquamation of the scalp. Containing: piroctone olamine, glycacil, lipacide anti-fungal purifies scalp and prevents the creation of dandruff. Glycerine moisturises and fights against dryness in order to restore physiological balance.
Seborrhoeic
dermatitis
of the scalp
• Patchy, scaling or thick
crust on the scalp that may
attach to the hair shaft.
• Yellow or white scales
• Red, greasy skin covered
with flaky white or
yellow scales.
• Small, reddish-brown
bumps.
• Itching or soreness.
• Skin flakes or dandruff.
Over-the-counter medicated shampoos,
such as those containing ketoconazole, tar,
pyrithione zinc and selenium sulphide.
Kerium Micro-Exfoliating Anti-Dandruff
Shampoo Gel Oily Scalp containing:
• LHA™ keratolytic micro-exfoliant which
quickly eliminates dandruff and controls
desquamation of the scalp.
• Piroctone olamine, glycacil, lipacide antifungal purifies the scalp and prevents the
creation of dandruff.
• Zinc Sebo-regulator salicylic acid.
• Topical solutions or creams, such as
hydrocortisone cream.
Sensitive scalp
• Stinging/sensitive scalp
Kerium Doux Sensitive Scalp containing La
Roche-Posay’s Thermal Spa Water, selenium
and silicium to soften hair and prevent
irritation and polysorbate 20 which is a
patented softening agent which reduces
scalp sensitivity and optimises the tolerance
of cleansing agents. Can be used alongside
scalp treatments. Frequent use for normal to
very sensitive scalps.
p h a r m ac y a s s i s ta n t
it is considered to be a hereditary disease.
Although psoriasis can start at any age, most
adults with psoriasis are aged 20-30 years or
50-60 years.
Seborrhoeic dermatitis
Seborrhoeic dermatitis is an inflammatory
skin disorder that causes excessive secretion
of the sebaceous glands (sebum). Red spots
or oily patches break out and are covered
in yellowish flakes which sometimes cause
intense itching. On the hair and scalp, the
disorder results in an oily, dandruff state.
Seborrhoeic dermatitis or scalp psoriasis?
Scalp psoriasis and seborrhoeic dermatitis
Scalp
psoriasis
and
seborrhoeic
dermatitis
of the scalp
can be
difficult to
differentiate.
of the scalp can be difficult to
differentiate. Both are common
conditions that affect the scalp.
In addition, they share similar
symptoms, such as itchy, red, scaly
skin.
Most often, the scales of
psoriasis are thicker and somewhat
drier in appearance than are the
scales of seborrhoeic dermatitis.
Also psoriasis usually affects more
than one area of the body. So
if you have scalp psoriasis, you
may also have mild psoriasis on
your elbows, knees, buttocks or
fingers. The general rule of thumb
is that scalp psoriasis appears as
a dry flaking of the scalp while
seborrhoeic dermatitis flaking has
a marked, oily aspect.
Sensitive scalp
Sensitive scalp occurs frequently
and triggering factors are
numerous. The main triggering
factors are considered to be
pollution, heat, stress, hair dyes,
harsh shampoos, certain drugs and
as a consequence of hard water.
Whatever the disorder of the
scalp, people will often seek a
solution at their local pharmacy.
It is therefore important to know
the main signs and symptoms of
these common scalp disorders
and to be able to differentiate and
advise on the most appropriate
treatment shampoo to alleviate
these distressing disorders.
**Use tests carried out on 480 women and men with dandruff. Preference vs. usual shampoo.
Dandruff
• Dry, flaking scalp
(Pityriasis)
Scalp psoriasis
Chronic dermatitis is characterised by
round plaques or patches? Scalp psoriasis
is a subtype of psoriasis manifesting on
the hair-covered area of the head. It may
be severe or mild and can affect the entire
scalp or just certain areas. The symptoms
are visible, thick, silvery layers of dead skin
cells together with soreness of the scalp,
sometimes accompanied by bleeding and
a lot of itching, and a feeling of tightness of
the scalp if large areas are covered.
Stress is a contributing factor to this
disease and, like all other types of psoriasis,
it is not contagious. Approximately 3% of the
population is diagnosed with psoriasis and
4
Treatment
Anti-dandruff innovation.
6 weeks anti-recurrence effect.
KERIUM DS
Treatment-shampoo Intensive
Anti-dandruff Micro-exfoliating
Dislodge persistent dandruff through root-targeting
micro-exfoliation.
> LHA™. An active ingredient with 7 times the
keratolytic activity of salicylic acid.
> Root-targeting technology, to treat dandruff
at its origin.
* 2 blind clinical studies carried out on 90 subjects with persistent, itchy dandruff.
Of these, 60 were treated with KERIUM Intensive and 30 with KERIUM Frequent Use. Shampoos were used twice weekly.
**Use tests carried out on 480 women and men with dandruff. Preference vs. usual shampoo.
Rapid results that last 6 weeks after treatment*.
> Regulates scalp desquamation.
> Neutralises itching.
Excellent tolerance and cosmetic qualities.
> 7 out of 10** users prefer KERIUM DS.
> Formula leave hair supple and shiny.
La Roche-Posay. Committed to dermatology.
www.laroche-posay.ie
GASTROINTESTINAL
H[Æknš:_Whh^e[WšLec_j_d]š9edij_fWj_edš=EH:
DERMATOLOGICAL
;Yp[cWšHWi^šKhj_YWh_W
RESPIRATORY
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symptoms can be so diverse?
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Relieves symptoms in 3-14 days1-4
Hypoallergenic amino-acid
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Proven to promote catch-up
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References on request.
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Nutricia, Block 1, Deansgrange Business Park, Deansgrange, Co Dublin.
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ti
nu
tr
i
2:04:41
cows’ milk allergy
in infants
c
ows’ milk is the most common cause of food
allergy in infants and children, affecting
approximately 5-7% of infants. The major
symptoms of cows’ milk allergy (CMA)
include skin rash, wheezing, vomiting,
diarrhoea, constipation, failure to thrive (put
on weight) and distress.
CMA has considerable negative effects
on the family unit, as exposed by findings
from an international survey of 1,000
parents. In addition to coping with the
disturbing physical effects of CMA on the
child (including vomiting, diarrhoea, failure
to thrive and eczema), 70% of parents said
that it makes them feel guilty and distressed
and 82% said that it has caused them to lose
sleep.1
About the parent survey
The telephone survey, commissioned by
Act Against Allergy, was conducted by an
independent market research company
among 1,000 parents of children aged 0-3
years from the UK, France, Germany, Italy
and Spain, 219 of whom were identified as
having children with known CMA.
• Just under half (49%) of parents said they
have had to miss work because of their
child’s allergy.
• Just under half (49%) said their child failed
to thrive as a result of CMA.
• 39% said the lives of other children in the
family have also been disrupted.
Stressful time
Dr Martin Brueton, a paediatric
gastroenterologist at Chelsea and
Westminster Hospital, London, commented:
“Having a child with cows’ milk allergy can
be very stressful for parents. The average
child with cows’ milk allergy suffers an array
of symptoms, from skin rashes to gastric
problems, cries a lot and is incapable of
properly putting on weight.
“Parents feel helpless as the instinct to
feed their infant even more milk - usually
the infant’s sole food source - compounds
p h a r m ac y a s s i s ta n t
7
n
ti
o
‘‘
’’
nu
tr
i
rather than solves the problem. Until the child
is properly diagnosed and put onto a suitable
milk substitute, the impact on the parents
and the family as a whole is considerable.”
Professor Jonathan O’B Hourihane,
paediatric allergist and head of paediatrics
and child health at Cork University Hospital
stated that “Children who are suspected of
having cows’ milk allergy should be referred
to a paediatrician. International best practice
is to use extensively hydrolysed or amino acid
formulae. There is no place for soya milk or
goats’ milk, which both appear to be used
very commonly in Ireland, for reasons that are
not easy to define.”
The big eight
Cows’ milk is one of the European Union’s
‘big eight’ allergy-inducing foods alongside
gluten, eggs, fish, peanuts, soya, treenuts
and shellfish.2 More serious than lactose
intolerance, a true milk allergy presents in
one or more of three organ systems:
• Gastrointestinal (vomiting, diarrhoea,
abdominal cramps, bloating) – affecting
50-60% of those with CMA.
• Skin (rashes, including eczema and atopic
dermatitis) – 50-70%.
• Respiratory (wheeze, cough, runny nose)
– 20-30%.3
Treatment for CMA
CMA is caused by proteins in a cow’s milk. The
treatment for this condition is to remove the
cow’s milk protein from the baby’s diet (see
Figure 1).
Figure 1. Protein chains in regular
infant formula
Formulae/milks unsuitable for
management
Soy milk and goats’ milk have been used as
substitutes but are unsuitable nutritionally.
In addition, there is a high chance that babies
allergic to cow’s milk will also be allergic to
these. Adverse reactions to soy have been
reported in up to 35% of babies with CMA.
The Food Safety Authority of Ireland (FSAI)
has stated that soy is unsuitable for infants
under six months due to its phyto-oestrogen
content.
Fifty per cent of children grow out of CMA
by their first birthday and 80% by school age.
Parents feel
helpless as
the instinct to
feed their infant
even more milk
- usually the
infant’s sole
food source
- compounds
rather than
solves the
problem.
Helpful website
A website – www.actagainstallergy.ie has
been designed to assist both healthcare
professionals and parents. It features a wealth
of information on CMA, including interactive
tools for parents such as an online clinical
diary to track their child’s progress, a forum
to share experiences with other CMA parents
and an ‘Ask the Expert’ section enabling
direct interaction with some of the top
paediatric allergists in Europe. Monthly
Figure 2. Amino acid formula
Amino acid formula
Amino acid formula is considered to be
the gold standard treatment for CMA. In
an amino acid formula, there are no whole
proteins present – just single, free amino
acids (see Figure 2). Neocate is an amino
acid formula. Neocate is manufactured in an
environment that is guaranteed to be free of
cow’s milk. It is nutritionally complete with
all the carbohydrates, fats and vitamins and
minerals required for infants aged from birth
to one year.
8
Extensively hydrolysed formula
In these formulae, the protein chains are
hydrolysed to make them shorter than
the proteins found in cows’ milk (see
Figure 3). There are a couple of brands of
hydrolysed formula on the market – Cow &
Gate’s Nutrilon Pepti and Nutramigen. For
approximately 10% of infants, hydrolysed
formula fails due to the high sensitivity of
these infants to residual allergens.
Figure 3. Hydrolysed and
extensively hydrolysed formula
updates with all the latest information on
the condition can be sent to visitors to the
website. Just register online for this service.
For further information on CMA visit:
www.actagainstallergy.ie or Freephone
1800 341 111.
References are available on request.
p h a r m ac y a s s i s ta n t
CPH
’
.
.
e
.
s
u
a
c
e
h
t
r
e
W h a t ev
POSSETTING / REFLUX
Possetting, reflux
LACTOSE INTOLERANCE
Mild colic, wind,
diarrhoea, gastroenteritis
ENFAMIL O-LAC
with LIPIL*
No improvement
ENFAMIL AR
with LIPIL*
COW’S MILK PROTEIN
ALLERGY / INTOLERANCE
Severe colic, atopic eczema,
constipation, vomiting,
diarrhoea, failure to thrive
NUTRAMIGEN 1&2
No improvement
We have a solution to help
you manage the symptoms
Mead Johnson Careline: 00800 8834 2568
www.meadjohnson.co.uk
Important Notice: Breastfeeding is best for babies. The decision to discontinue breastfeeding may be difficult to reverse and the
introduction of partial bottle-feeding may reduce breast milk supply. The financial benefits of breastfeeding should be considered
before bottle feeding is initiated. Failure to follow preparation instructions carefully may be harmful to a baby’s health. Parents should
always be advised by an independent healthcare professional regarding infant feeding. Nutramigen must be used under medical
supervision. Information for healthcare professionals only.
*Trademark of Mead Johnson & Co. 2008
CPHVA_IrishPharmacy_297x210.indd 1
13.08.2008 12:33:42 Uhr
dermatology
Sensitive skin care
Skin sensitivity
Skin sensitivity is defined as a hyper-reactivity and lowered
tolerance threshold of the skin to factors that are normally well
tolerated. The skin is therefore more vulnerable to stress factors
which may be of internal or external origin.
The skin can, in response to various factors, become dry, red
or inflamed. Skin is considered sensitive when it over-reacts to
various stimulants that do not affect tolerant skins.
These factors may be physical (UV radiation, thermal
variations, heat wind), chemical (soap, hard water, cosmetics,
pollution), hormonal (menstrual cycles) or even emotional
(psychological stress). Sensitive skin is over-susceptible to
environmental factors and those suffering from sensitive skin
may describe a sensation of pins and needles, tingling, itchiness,
heat and tightness or drying of the skin.
Interestingly, 70% of women who buy their skin care products
in pharmacies claim to have sensitive skin. As such, it is very
important for the pharmacy assistant to be aware of the causes
of skin sensitivity and to be able to advise on daily skin care for
even the most sensitive skins.
Causes of skin sensitivity
The causes of skin sensitivity are numerous and sensitivity
may be of pathological origin, for example in people with
eczema and dermatitis. Or it may be a personal perception
10
p h a r m ac y a s s i s ta n t
with customers describing stinging, burning sensations or an
acquired sensitivity (for example, as a side effect of certain
medications). There are also skin sensitivities that are triggered
by the sun, known as heat rash or polymorphous light eruption
(PLE).
Other environmental factors, such as wind, cold and central
heating, can also cause over-dry and sensitive skin. Hormonal
factors are very much related to sensitive skin. Pregnant or postmenopausal women will often describe symptoms of sensitive
skin which may be observed as clinical signs, such as:
• erythema: localised or extensive redness;
• skin dryness: a lot of flaking or peeling skin on certain parts of
the face;
• telangiectasia: little dilated blood vessels on the surface of
the skin; and
• patches of eczema.
Sometimes sensitive skin is subjective in that no visible
signs of irritation are observed, but a customer will describe
symptoms of discomfort or tightness.
Diet can also be a trigger factor in sensitive skin especially for
people with rosacea in whom spicy foods can cause flushing
of the skin. Surprisingly only 2% of people with eczema are
sensitive to certain food types.
For a lot of people, skin sensitivity is subjective, but it is
estimated that 50-60% of women
and men consider that their skin is
uncomfortable and intolerant, so it is
important at the pharmacy to be aware of
these different types.
Four types of sensitive skin
Generally speaking there are four types of
sensitive skin. These are:
• Pathological: allergic, atopic.
• Vascular: very fine, delicate, sensitive
skin which is prone to flushing.
• Contact: skin that is aggressed by
external allergenic factors.
• Environmental: sun, wind, cold, air
conditioning.
Allergy versus sensitivity
An allergy is an exaggerated
response of the immune system.
Usually it is experienced by only a
small number of people exposed
to a substance.
One in six of the population
will develop an allergy at some
stage in their lives.
It can be diagnosed by a
skin prick test, patch test or IgE
blood tests. However, continual
exposure to the allergen can
have serious consequences.
‘Sensitivity’ refers to a
temporary, non-fatal reaction to
internal (emotions/hormonal) or external
factors (harsh weather/cosmetics).
Care of sensitive skin
At the pharmacy, it is important to
encourage your customers to record
sensitive episodes, as sensitivity may be
related to the internal or external trigger
factors. It is important to discuss these
with your customer, i.e. which type of
sensitivity they suffer from (pathological,
vascular, contact or environmental). La
Roche-Posay has developed Sensitest
which is a helpful tool in determining
your customers’ sensitive skin types. It is
available online at: www.laroche-posay.ie.
For people with very intolerant skin,
Sensitive skin
Allergic skin
Redness
Stinging
Feeling of tightness
Broken veins
Tingling sensation
Itchy, irritated skin
Severe erythema
Swelling, inflammation
Pruritus (itching)
Weeping
Possible cause: dry
skin, eczema irritant
creams and ointments,
environmental, hormonal
factors
Possible cause: latex,
nickel, wasp sting,
certain drugs; less likely
to be topical creams
La Roche-Posay’s Toleraine
range is specifically designed
for the most intolerant skin
and has the safety of a 0%
allergenic formula.
0% fragrance
0% preservative
0% alcohol
0% lanolin
0% surfactants
100% thermal spring water
patch testing new cosmetic products
behind the ear for a minimum of 24 hours
is a very safe practice. For babies, apply
a small quantity on the forearm for
three consecutive days prior to use.
TOLERIANE
With La Roche-Posay Thermal Spa Water
High tolerance formulation to restore skin comfort.
Ultra-pure formula
> With a selection of 16 ingredients to limit the risk of allergy
Ultra-soothing cocooning cream
> With 100% soothing La Roche-Posay Thermal Spa Water and
10% moisturising glycerine
Tolerance tested on more than 500 patients
0% Fragrance
0% Preservative
0% Alcohol
0% Lanolin
0% Surfactants
100% Thermal Spa Water
La Roche-Posay. Committed to dermatology.
www.laroche-posay.ie
Daily skin care
For very sensitive and intolerant
skin, there is a need for a specific
skin care routine that will cleanse,
moisturise and correct. Choose
make-up, moisturisers and
sunscreens that are hypo-allergenic
and fragrance-free. When choosing
make-up, especially foundation,
non-comedogenic (non-pore
clogging) is the best option. Also
use a daily photo protection that has
a high UVA/UVB protection.
Irish Heart Week
September 22nd - 28th 2008
Know your blood pressure and keep it down
The Irish Heart Foundation’s Irish Heart Week will focus on blood pressure and keeping
it at a healthy level. The campaign will emphasise how important it is to know your blood
pressure level and to keep it at a normal level to reduce the overall risk of heart disease and
stroke. If blood pressure is over the recommended levels for health then you need to manage
it with your doctor. The good news is that this can be done very well through lifestyle
changes, such as stopping smoking, cutting down on salt, getting more active, losing weight
and medication.
High blood pressure is very common in people aged over 45. A recent Irish survey showed that 34%
of men and women had high blood pressure but were not on medication to control it. Another 18%
were on medication but their blood pressure was still high. Only 40% of Irish men and women over
the age of 45 had normal blood pressure levels.
Promoting Irish Heart Week in your pharmacy
The Irish Heart Foundation is asking you to support the campaign by promoting blood pressure
awareness in your pharmacy during Irish Heart Week. You can:
• Display Irish Heart Week promotional materials.
• Circulate flyers and information on the week and your plans for promotion.
• Promote lifestyle changes which can reduce high blood pressure, such as salt awareness
or physical activity.
Free Irish Heart Week promotional materials
If you would like to order our free Irish Heart Week materials please call or email Catherine
Laffan on (01) 668 5001 or [email protected]
Materials available include:
• Magazine attractive, full-colour 24 page consumer magazine with feature articles
on blood pressure using case studies and interviews with doctors and patients, tips
on healthy eating and getting active.
• Posters promoting blood pressure awareness (A3 size).
• Leaflet all about Blood Pressure (DL size – 4 page).
• Personal Record Card for clients to record their blood pressure measurement
(pocket-size).
• Salt leaflet and other Heart Health information leaflets.
12
p h a r m ac y a s s i s ta n t
DRY MOUTH
a question of Awareness!
D
ry Mouth (Xerostomia) is
caused by a decrease in saliva
production. It is a common
condition affecting over
10% of the population. The
prevalence rises as the number
of prescribed medications taken increases.
Indeed, studies show that as many as 25% of
people over 65 suffer from Dry Mouth, rising to
almost 50% among nursing home occupants.
The most common cause of Dry Mouth
are medications. Dry Mouth is a know side effect of
over 400 commonly prescribed medications. The most
commonly implicated include tricyclic antidepressants,
antipsychotics, atropines, antihistamines, beta blockers,
bronchodilators and diuretics.
Dry Mouth is a big issue for people undergoing cancer
treatments - radiotherapy and chemotherapy. Dry
Mouth is also associated with many medical conditions
like Diabetes, Renal Dialysis, Cystic Fibrosis, Sjogren’s
Syndrome (Auto immune condition) and Rheumatoid Arthritis
etc. Other common causes include Mouth Breathing (especially
during sleep), Anxiety, Smoking, Alcohol and the Ageing Process.
There is a serious lack of awareness of Dry Mouth as a condition
among sufferers and health professionals alike. Despite the high
number of sufferers, and its adverse effects, Dry Mouth is seldom
talked about, or properly explained. If not recognised and treated
Dry Mouth can lead to oral complications like gum
disease, bad breadth, mouth ulcers and tooth caries.
Dry Mouth can also cause speaking and swallowing
difficulties.
People with Dry Mouth tend to drink a lot of fluids,
suck on sweets or chew gum for relief, but that will
not protect against the side-effects. Essentially,
Dry Mouth adversely affects one’s quality of life!
Biotene oral care range is the original and world
leader in Dry Mouth care, providing both relief and
protection. All Biotene products are sodium laurly
sulphate (SLSs) and alcohol free – these components increase
tissue dryness and are common in many oral care products.
Biotene uses the same natural bio-active enzyme systems
as healthy saliva, thereby helping to restore and boost saliva’s
natural antibacterial defences when maintaining a healthy
mouth.
For Dry Mouth sufferers the best products are Biotene Oral
Balance Gel (especially good when used last thing at night)
and the gentle Biotene Mouthwash. The range also includes
toothpaste (Original, Gel and Sensitive), chewing gum and Oral
Balance Moisturising Liquid (a new liquid version of the Oral
Balance Gel).
Biotene products are made in Ireland and available through
United Drug, Uniphar and Pharmed. For further information and
free samples contact Europharma Concepts Ltd, Clara, Co Offaly,
tel: 057 9364950, e-mail: [email protected] or log onto www.epc.ie.
p h a r m ac y a s s i s ta n t
13
NOW THERE’S
NEW HEDRIN
SPRAY
The easy new way to
eradicate head lice
r Research confirms it – mums love the idea of
the new Hedrin point-and-shoot trigger spray.
r The same highly effective formula – no
pesticides, no resistance problems, no odours,
no laborious combing, all the unrivalled efficacy
of Hedrin 4% lotion to eradicate head lice.
r Even easier to apply - particularly on long
hair and for self-application.
r Powerful support - new TV advertising
campaign this year.
POWERFUL NEW EVIDENCE
FROM CLINICAL TRIALS
Hedrin kills lice in the lab – 100% Success
r In-vitro studies have shown that lice coated
with Hedrin under laboratory conditions are
all killed.1
Hedrin kills lice in humans – 97% Success
r A new Clinical Trial conducted in Manisa
province, Turkey in April and May 20082 has
demonstrated that Hedrin has 97% efficacy
in-vivo.
New Study on How Hedrin Works
r New Mode of Action Study (copies available
from Thornton & Ross) has been undertaken
which uses evidence-based data to describe
how Hedrin 4% dimeticone lotion kills
head lice.
1,2
Data on file
MAKE HEDRIN YOUR
No.1 RECOMMENDATION
Product Information: Hedrin 4% Lotion Spray. Presentation: cutaneous solution containing 4% dimeticone w/w. Indications: for the eradication of head lice
infestations. Dosage and administration: Adults and children over 6 months: Apply sufficient lotion to cover dry hair from the base to the tip to ensure that no
part of the scalp is left uncovered. Work into the hair spreading the liquid evenly from roots to tips. Allow hair to dry naturally. Hedrin should be left on hair for
a minimum of 8 hours or overnight. Wash out with normal shampoo, rinsing thoroughly with water. Repeat the treatment after seven days. Contraindications:
Hypersensitivity to any of the ingredients. Precautions and Warnings: Discontinue at the first appearance of a skin rash or any other signs of local or general
hypersensitivity. For external use only. If accidentally introduced into the eyes, flush with water. Side Effects: Minor adverse events include an itchy or flaky scalp
and dripping/irritation around the eyes. Manufacturer: Thornton & Ross Ireland Ltd, Belgard Road, Dublin 24. For information call Allphar Services Ltd (01) 404 1605.
Date of preparation: June 2008
of
ay.
s,
acy
n
e
N
HOT
TOPIC
headlice
What are headlice?
Headlice are tiny insects that live on human scalps. They are very
common and the majority of children will get them at least once
or twice. Indeed the number of cases of headlice has increased
worldwide since the mid-1960s, reaching hundreds of millions
annually.
Lice feed by biting the scalp and sucking blood. They have
a specially designed mouth that pierces the skin and injects
saliva to stop the blood from clotting, and then they suck up the
blood/saliva mixture. This saliva can be a cause of the itching.
Head lice also have claws on the end of each of their six legs that
enable them to cling to the hair and move about. They cannot
jump, however, and do not have wings so they cannot fly.
Headlice
have a
specially
designed
mouth that
pierces the
skin and
injects saliva
to stop the
blood from
clotting, and
then they
suck up the
blood/saliva
mixture.
They breathe through holes in the sides of their bodies called
spiracles and cannot survive for long away from a human head, since
they quickly dehydrate and die without their blood meals.
Some facts
A recent survey found that two-thirds of Irish parents fear that the
headlice situation is getting worse, yet nearly half do not check
for headlice often enough. The survey of over 2,000 Irish parents
revealed that the most common reason given for the increasing
difficulty in controlling headlice was failure of parents to take action.
Experts recommend that parents check their child’s hair and scalp
for head lice at least once each week.
However, the survey revealed that 43% of parents
do not do a weekly check. In fact 10% only check
once a term during the school holidays or never at all.
How lice spread
The female headlouse lays eggs by night and glues
them to the base of the hair, close to their food source
(blood). These eggs are called nits and look like small
shiny, white bumps on the hair. The lice hatch in
approximately 10 days, but the egg case is left behind
to grow out with the hair. One symptom associated
with headlice is scratching which, in turn, can lead to
disturbed sleep.
Headlice are spread by head-to-head contact. As
they do not jump or fly, they creep from one head
to the next and need to be near the skin to survive.
Contrary to popular belief, infestation with headlice
does not indicate a lack of hygiene - lice have no
specific preference for clean or dirty hair. Lice cannot
be spread by towels, bedding, clothes, furniture, pets
or brushes.
p h a r m ac y a s s i s ta n t
15
Prevention
Wet detection combing once a week is thought to be the best
preventive method against headlice. The hair should be washed
using ordinary shampoo and towel dried until it is damp, leaving it
clean, wet and tangle-free.
A plastic fine tooth/detection comb should be used for the
detection – the teeth should touch the skin of the scalp at the top
of the head and then be combed through to the edge of the hair.
After each stroke, the teeth of the comb should be closely checked
for lice. This should be repeated all the way around the head.
of all ages. Regular detection combing can detect lice early on
in an infection. This should not only be carried out on a routine,
regular basis but also in response to any ‘contact tracing’ that
identifies a risk of infection. Normal shampooing will have no
effect on head lice and if a person has asthma, eczema or sensitive
skin, it’s important to note that there are a number of suitable
products available too.
Meanwhile, successfully treating a dose of headlice does not
mean another one will not follow suit immediately, which is why
contact tracing is so important to follow to reduce the chances of
re-infection.
‘‘ ’’
Treatment
Headlice can be treated with pesticide lotions and liquids,
non-pesticide lotions, wet combing with conditioner or with
alternative treatments, such as herbal remedies. Conventional
pesticide-based treatments are available in pharmacies. They
need to be applied at least twice, a week apart, to kill the lice.
Non-pesticide lotions coat the outside of the lice so they suffocate
and die, meaning there’s no chance for the lice to build up a
resistance to the treatment.
Combs can remove lice and nits but do take time and patience
to ensure a thorough job is done. It’s quite easy to miss a few and
needs to be done twice a week for at least two weeks. Pharmacies
are advised to have plenty of information on hand to dispense to
enquiring customers.
A recent survey
found that two-thirds of Irish
parents fear that the headlice
situation is getting worse, yet
nearly half do not check for
headlice often enough.
Things to remember
It’s not just children who catch headlice – they can affect people
Pharmacists expect dramatic increase in
headlice as children go back to school
W
ith the back-to-school season upon us,
parents are being urged to conduct
routine screenings for lice to help stem
lice outbreaks.
Pharmacists are encouraging parents
to screen children routinely for headlice
every week when children return to school at the end of
the month. Early detection can reduce the spread of the
infection within schools and help stem lice outbreaks before
they grow into big problems. Parents who perform regular
checks will find that the problem “is manageable and will
save time and worry and distress to children in the long run”,
according to pharmacist Aisling Reast of Kinirons Pharmacy,
Lucan, Co Dublin. Pharmacists are warning that there may be a dramatic
increase in headlice cases as children return to school. There
What to do:
1. Check children’s hair for lice regularly. Wet comb the hair
every week and tie up long hair in a pony tail to avoid hair
coming into contact with other hair that might be infested.
2. Treat the hair only if live lice or unhatched eggs are present.
Treat the child as soon as possible. Always seek advice from
your pharmacist on the most appropriate product to use.
16
p h a r m ac y a s s i s ta n t
is no way of preventing headlice but the earlier the infection
is detected, the easier it is to get rid of the lice. It is estimated
that one in ten children suffer from head lice at any one
time with 80% of headlice infestations occurring in children
between the ages of 4 and 16.
”We are urging parents and carers to check their children’s
heads for headlice and nits routinely every week,” said Ms
Reast. “The first sign that infestation is present is usually
an itchy head. However, older children and adults may not
experience any itching. Children of all ages are vulnerable
to pesticides, especially those who suffer from asthma and
allergies. It is always best to seek advice from a pharmacist
or other healthcare professional, who can advise on all cases
as well as specific problems which might arise, where, for
example, children have asthma, a pre-existing skin condition
or where treatment has failed previously” she said.
3. Inform the school, contacts and friends when your child has
nits. The school can then inform other parents that there is an
outbreak, so everyone can check and treat their own children.
4. Always follow the instructions on the treatment pack and any
advice given by your pharmacist. Treatment should be repeated
after seven days to kill any eggs that may have hatched in the
meantime. Products used to treat headlice do not prevent
the infection from occurring and should never be used as a
preventative measure.
Fact: New clinical
proof that
a 10 minute
head lice
treatment time*
is effective
1
• Clinically proven to kill head lice
• 10 minute treatment time*
• Easy to apply to scalp and hair
• No traditional pesticides
means no resistance
• Value for money –
comb included in pack
STOCK UP NOW
headlice.ie
1. Burgess IF, Brown CM, Lee PN, Randomised, controlled, single, parallel group clinical
trials to demonstrate the efficacy of isopropyl myristate/cyclomethicone solution
(Full Marks Solution) against head lice. Pharm Jnl 2008; 280; 371-375.
*10 minute treatment time refers to two applications, seven days apart.
SSL Healthcare Ireland Ltd, Monarch Industrial Estate, Belgard Road, Dublin 24.
Full Marks is a trade mark of the SSL group.
productnews
Taking care of those precious First Teeth!
First Teeth is the Only Safe-to-Swallow!
Fluoride Free Toothpaste gel for babies
(aged three months to three years) that
really helps reduce the bacteria that
cause baby bottle tooth decay. First
Teeth is unique because it contains
the same protective enzymes found in
natural breast milk, which
help create a healthy balance
of oral flora.
First Teeth is a nonfoaming gel so therefore it
is easy to use and it also
contains calcium. It is
made with real applebanana flavour with
no artificial colours,
additives, sweeteners,
harmful preservatives or
flavourings.
The First Teeth
combo pack version
also comes with an
Infa-Dent finger
brush and gum
massager. Infa-Dent
was developed by
dentists to safely
clean (use with First
Versatile display unit for
Colief Infant Drops from
Clonmedica
New boost for
Berocca
A new Colief display unit is available through Clonmedica’s
(the OTC division of Clonmel Healthcare) sales
representatives and available for pharmacy only.
The unit holds eight packs of Colief and has a free
helpful leaflet for new parents called ‘Tips for calming a
Crying Baby and dealing with Colic’. The leaflet will fit in
any purse or wallet comfortably.
Colic can be very distressing for both babies and parents. Although colic is not fully understood,
it is thought to be associated with temporary lactose deficiency in some babies and, rather than
attempting to treat the symptoms of colic, Colief allows babies with transient lactase deficiency to
enjoy their normal feed while greatly reducing the digestive discomfort associated with colic.
The active ingredient in Colief is lactase, an enzyme which occurs naturally within the body.
Colief Infant Drops added to the baby’s usual milk greatly reduces the level of lactose by breaking
this down into glucose and galactose, before the baby is fed.
Studies have shown that the hours of crying may be greatly reduced when a baby’s usual milk is
treated with Colief.
Nicopass – the unique lozenge
Nicopass is the new unique lozenge from
Clonmedica which helps set smokers free
- free to give up smoking forever, free to
feel comfortable when out for a meal, at
a meeting, at the cinema or on a plane or
train journey.
Nicopass is the fastest growing NRT
product in France and it is now available
in a 1.5mg dosage in two great flavours
– freshmint and liquorice mint.
With roughly 31% of the population
smoking daily – that is one in three (Irish
Cancer Society statistics) Nicopass couldn’t
be entering the market at a better time. The
lozenge market is the fastest growing value
sector of the NRT market (up 14% year on
year IMS April 08). Consumers are looking
for a product which will help set them free.
18
p h a r m ac y a s s i s ta n t
Teeth baby toothpaste)
your baby’s or toddler’s
tiny teeth and sore teething
gums. It slips on parent’s
finger and grips, making it
easy to gently manoeuvre
around a baby’s mouth.
First Teeth is made in
Ireland by Europharma
Concepts, Clara, Co Offaly
For FREE samples and
information e-mail info@
epc.ie , tel: 057 9364950 or
log on to www.epc.ie.
First Teeth and Infa-Dent
are available from Pharmed,
United Drug and Uniphar.
Nicopass 1.5mg has a nicotine-masking
flavour which helps aid consumer
compliance and acts as well as a 2mg gum.
It is sugar free and is available in two great
flavours – freshmint and liquorice mint and
in two sizes – 12s and 36s.
Advertising on radio and on buses, DART
and pub ashtray sites will help launch
Nicopass to consumers. Colourful and
effective point of sale material is also
available.
Your Clonmedica representative has
information on all this advertising activity
as well as the launch bonus deal for
Nicopass.
Distributed by Clonmedica, a division of
Clonmel Healthcare Ltd, Waterford Road,
Clonmel, Co Tipperary.
Bayer has launched a new
addition, Berocca Boost,
to its successful Berocca
brand. Ireland is the first
market globally to launch
this innovative Berocca Boost
product, which has resulted in
significant worldwide interest
in the launch here.
Designed as a healthy
alternative to other stimulants
such as coffee or energy drinks
and containing vitamins,
minerals and guarana, Berocca
Boost has been clinically
proven to give an instant boost
of energy, increasing speed
and accuracy while decreasing
tiredness.
This latest addition to the
highly popular brand is aimed
at consumers who need a
pick-me-up to re-energise and
get them over a slump in their
day. One glass of refreshing
Berocca Boost provides 100%
of the recommended daily
allowance of vitamins B and C.
The launch of Berocca
Boost will be supported with
a new Irish TV commercial
reaching over three million
people several times, an
impactful outdoor advertising
campaign and PR announcing
the launch. A dedicated
website - www.beroccaboost.
ie - is also being launched
with a nationwide consumer
sampling programme planned
for September.
New Mobilise Plus – unique soft chew formulation
and only available from pharmacy
Mobilise Plus is a food supplement which, when taken
daily, can help maintain healthy joints by nourishing the
cartilage, synovial fluid and other connective tissues.
Mobilise Plus contains glucosamine hydrochloride
750mg and chondroitin sulphate 200mg. These combined
actives help to promote healthy joints. It is available in a
lemon and lime flavour and is unique as it is in a ‘soft chew’
formulation making it very easy and pleasant to take.
Mobilise Plus is only available from pharmacy.
To launch this new product, Clonmedica has a fantastic
consumer giveaway - a free shopping handle with every
purchase of Mobilise Plus* - which can be claimed by
clicking on the Clonmedica website–www.clonmedica.ie.
Please ask your Clonmedica representative about the
exciting pharmacy bonus deal for Mobilise Plus.
*While stocks last.
Study shows Pharmaton nearly twice as
effective as multivitamins
Pharmaton Capsules can be more
effective than multivitamins alone
in improving the quality of life in a
population subjected to the stress of
high physical and
mental activity.
The research is
published for the
first time in
Ireland in the
inaugural issue
of Pharmaton
News, a
newsletter produced for
pharmacies by Boehringer
Ingelheim.
The study involved 625
patients (16-73 years) of both
sexes, divided into two groups
taking one capsule per day for 12
weeks. A total of 382 people took
Pharmaton Capsules and 243 took
a multivitamin product without
ginseng.
By the end of the trial, both
treatment groups showed an
increase in the quality of life
index, the biggest change being
11.9 points for Pharmaton
Capsules (group A), compared to only
6.4 point average change with the
multivitamin preparation (group B).
The resulting quality of life was
assessed by a standardised 11-item
questionnaire. Group A (Pharmaton)
showed significant improvement in
every one of the 11 questionnaire items,
whereas group B (multivitamin) did not
show significant improvement in any of
these items.
According to the authors, the increase
in quality of life observed in the
Pharmaton Capsules group was highly
significant (p<0.0001) and significantly
superior to that seen in the multivitamin
group.
p h a r m ac y a s s i s ta n t
19
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Set yourself
FREE
new
from smoking
Please read the package leaflet carefully before use.
Set yourself free with Nicopass® 1.5 mg Lozenge Nicotine
(as resinate) from ClonMedica.
Nicopass® 1.5 mg Lozenge Nicotine (as resinate) is the new sugar-free
nicotine replacement lozenge that will set you free from smoking.
Long lasting Fresh Mint and Liquorice Mint flavours.
INSTRUCTIONS FOR USE: This medicinal product is for the relief of nicotine withdrawal symptoms, in nicotine dependency as an aid to smoking cessation.
For oromucosal use. Keep all medicines out of the reach and sight of children. Please read the package leaflet carefully before use.
 SUGAR FREE
artificially sweetened with aspartame and acesulfame potassium
 LOZENGE TO MELT IN MOUTH
gradual release of nicotine (about 30 minutes)
Exclusive flavours
Permaseal:
nicotine masking agent
Peppermint:
sfor an immediate fresh effect
slong lasting fresh mint or
original liquorice mint
flavours
Hypromellose
for hardness:
dissolves over approximately
30 minutes.
basic pH
Buffer system
(sodium bicarbonate
+ anhydrous sodium
carbonate):
for a total bioavailability
of nicotine1
ISOMALT
Flavour enhancer
1. Study on file, PIERRE FABRE MEDICAMENT, 92100 BOULOGNE – France.
PA 329/10/1-2
ABBREVIATED PRESCRIBING INFORMATION
Nicopass 1.5 mg Fresh Mint and Liquorice Mint Lozenges
Presentation: The fresh mint lozenge is beige, opaque, square. The
liquorice mint lozenge is brown, opaque, square. Each lozenge
contains 1.5 mg nicotine corresponding to 8.33 mg nicotine resinate.
Indication: Relief of nicotine withdrawal symptoms in nicotine
dependency as an aid to smoking cessation. Dosage: Lozenges
containing 1.5 mg of nicotine are not suitable for smokers who are
heavily or very heavily dependent on nicotine (score of 7 to 10 in the
Fagerström test). Treatment usually proceeds in 2 phases. In the first
phase, a lozenge should be sucked whenever there is an urge to smoke.
The number of lozenges is generally 8 to 12 daily and must not exceed
20 lozenges daily. The duration of this phase is about 3 months, but
may vary according to the individual response. In the second phase
when the urge to smoke is completely suppressed, gradually reduce
the number of lozenges daily. Treatment should be stopped when the
dose is reduced to 1 to 2 lozenges daily. It is recommended not to use
lozenges for more than 6 months. Children and adolescents under 18
years: Nicopass should not be used by people under 18 years without
recommendation from a doctor. Method of administration: The lozenge
is placed in the mouth and regularly moved from one side of the mouth
to the other. It should be sucked slowly until it is completely dissolved.
The lozenge must not be chewed or swallowed. Refrain from drinking
or eating when the lozenge is in the mouth. Acidic beverages (coffee
or soda) should be avoided for 15 minutes prior to Nicopass. Contra
indications: Non-smoker or occasional smoker, hypersensitivity to
any of the excipients. Fresh mint only: hypersensitivity to peanut or
soya because of the content in soya oil. Warnings and precautions:
The use of Nicopass must be associated with total cessation of
tobacco consumption. Dependent smokers with a recent myocardial
infarction, unstable or worsening angina including Prinzmetal’s angina,
severe cardiac arrhythmias, uncontrolled hypertension or recent
cerebrovascular accident should be encouraged to stop smoking with
non-pharmacological interventions (such as counselling). If this fails,
Nicopass may be considered but as data on safety in these patients
PA Holder: PIERRE FABRE MEDICAMENT 45, place Abel Gance - 92100 BOULOGNE - France
are limited, initiation should only be under close medical supervision.
A doctor should be consulted if the patient has stable cardiovascular
disease, diabetes mellitus, hyperthyroidism, phaeochromocytoma,
severe hepatic and/or renal impairment. Swallowed nicotine may
exacerbate symptoms in people suffering from active oesophagitis,
oral or pharyngeal inflammation, gastritis or peptic ulcer. Contains
aspartame, a source of phenylalanine that may be harmful for people
with phenylketonuria. Contains isomalt, therefore patients with rare
hereditary problems of fructose intolerance should not take Nicopass.
Nicotine is a toxic substance. Keep lozenges out of the reach and
sight of children. The therapeutic dose intended for adults might
cause severe, even fatal intoxication in children. Interactions: At
cessation of smoking cytochrome CYP1A2 activity decreases which
can lead to increased blood concentrations of medicinal products
metabolised via CYP1A2, such as caffeine, theophylline, flecainide,
clozapine, olanzapine, ropinirole, pentazocine. The dose may need
to be adjusted, and for medicines with a narrow therapeutic margin,
such as theophylline, smoking cessation should be accompanied
by close clinical monitoring and the patient should be informed
about the risk of overdose. Nicotine can interact with cortisol and
catecholamine, nifedipine, beta-blockers, insulin, diuretics, H2antihistamines, oestrogen-progestogen combinations. Pregnancy
and lactation: In pregnancy complete cessation of tobacco smoking
should always be recommended without nicotine replacement therapy.
Nicotine is excreted in breast milk in quantities that may affect the
child even in therapeutic doses. Refer to the Summary of Product
Characteristics. Undesirable effects: Most common: Dizziness,
headache, pharyngolaryngeal pain, hiccup, sore throat, mouth
irritation, dry mouth, nausea, vomiting, abdominal discomfort. For
other undesirable effects see Summary of Product Characteristics.
Pack sizes: 12 and 36 lozenges. Marketing authorisation holder:
Pierre Fabre Medicament, 45 place Abel Gance, 92100 Boulogne,
France. Distributed by: Clonmel Healthcare Ltd, Clonmel, Ireland. PA
329/10/1-2. Full prescribing information is available on request. Date
last revised: February 2008.
www.nicopass.ie